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HomeMy WebLinkAbout0026 PEARL ROAD N TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Ap cation # o Health Division Date Issued if Conservation Division Application F ' Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street AddressCD Village Owner(r-kc°-r cv�(NwSKq Address y A hcuco Telephone G V 3 zc_X3 �1 1 Permit RequestMc, �. _205rqi"1r-t-1—j r 4 iC $ 5••`�cTl�� � c-PsL"Ft � Square feet: 1 st floor: existing%proposed 2nd floor: existing propose dotal f%w Zoning District Flood Plain Groundwater Overlay 10 a� Project Valuatio C 6C)� Construction Type ~ ra Lot Size Grandfathered: ❑Yes ❑ No If yes, attach lupportirrLg donentation. cr M Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes FerNo On Old King's Highway: .❑Yes WINo Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 100 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing %new Total Room Count (not in ding baths): existing new First Floor Room Count Heat Type and F el: LI Gas ❑ Oil ❑ Electric ❑ Other yp ;(Yes c e Central Air: ❑ 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 ❑ No If yes, site plan review # Current Use Proposed Use _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) -- Name. Telephone Number �� Address CQ5_-1 my License# 111(9 Home Improvement Contractor# aI o Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO S SIGNATURE DATE ' 1 J `t FOR OFFICIAL USE ONLY k, APPLICATION# } DATE ISSUED MAP/PARCEL NO. - inn 'x ADDRESS VILLAGE OWNER k DATE OF INSPECTION: L"�FOUNDATIOND ti!."t)"i�if,71 -'F�" 1LIP^x. - FRAME; ) _. �i a .a,INSULATION ` FIREPLACE �r {: ELECTRICAL: ROUGH FINAL .. PLUMBING: ROUGH FINAL _GAS: ._ ,_ ROUGH FINAL FINAL BUILDING lW `? ®i� s15 1 DATE CLOSED OUT ASSOCIATION PLAN NO. - t T ke o snrompwM of Massachusefis Depart rt afhuhuf id Accidents - (), a of Inmmtigadons ` 600'TIashington Street , Boston,MA 02111 y' runny.massgoiMia Workers' CompensatianInsurance Affidavit:Builders/Coniracto cians/Mumbers AplAkant Infarmation ' Please Print Legibly Naznt;(BttsinesslO aniz�ionl3ndividnal7 S CC i—�'ss"�L:��'S1��3 t _.—St' Address: City/Stau!]Zip_ Phone 4- Are u an employer?Check the appropriate box: Type of project r 3'i� I?�'o3 t"�1��= 1_ I am a employer with 4. ❑ I ern dal contractor and I ! 6_ ❑ gonsfrrrc#ion employees{full ancVbrpart—ime.).* haves the sub-contractors 2_❑ I am a sole proprietor or partner- listed on the attached sheet * Remodeling sub-contractors have, slug and hate no employees 8- ❑I7lemolitiou employees and have.workers' � worjcing forme in any capacity_ � 9_ ❑Building addition [No workers' comp.insurance Comp'insura�l f` 5. ❑ Vile are a corporation�tnd its 10.0 Electrical repairs or additions 3_❑ I am a homt�wner doing all work =s have exerci t required] offi hsed the I1_❑ ir . Plumbin�repairs or additions . myself.[No workers'comp_ right of exmmption per MGL 12...0 Roof repairs insurance required_]F c_152,§I(4),and we havena employees-[Np# 13_.❑Other comp_in=ance required-I *Any appH,otat that checks boa#1 toast also fill out the:section below showing ihea vrortets'compeer do9 polir_T infflrto 6072- T Homeowners w-ho sabmit this affidavit intlicsung d3ey am doing all trod[sad tfien hire outside contactors must subunit SLUM affidavit ind"trsiing MdL -•rCoammuors that check this box mint attached an additional sheet dowiag the Time of die sub-cogs and state arhether or not those Mdties have employees. If the saB-contmctors hwe employees,they must provide their workers'tamp.policy number .Tam an empinper that is prm idng tvorkers'co►trperuyL on ansrrrartcs for my ampLoyeccs. Belotr is Ste po c}curd job site information. r Insurance Company Name: t• � Policy#or Self-ins-Ltc.4 t FxpuationDate: i Job Site Address: Crty/StatelZtg: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secarecoverage as requiredunder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 31,50G.0G andlor one-yearimprisonment 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 ereby certify re ke pruns rtdpenatffes�qfpedg�ry Mat the inn prmation prat�idad abase is true and correct P' _ . 114 Si tore: Date: Qjicial use only. Do not trrite in fads area,to bs campleted by city ar town of j�i'c&L f City or Town: PermitUceuse# 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#: 6 Information and Instructions Massacbksetts General Laws chapter 152 requires all employers to pr vide workers'compensation for their employees. Zeruesms tthisstatute,anemployee is defined as"...every person' the service of another under any contract of hire, or' lied, oral or written." An employer is ed as"an individual,partnership,associatio corporation or other legal entity,or any two or more of the foregoing en aged in a joint enterprise,and including the egal representatives of a deceased employer;or the receiver or trustee o individual,partnership,association or er legal entity,employing employees. However the owner of a dwelling h e having not more than three apartz is and who resides therein,or the occupant of the dwelling house of anofh r who employs persons to do mamte ante,construction or repair work on such dwelling house or on the grounds or boil ' g appurtenant thereto shall not b ause of such employment be deemed to be an employer." r MGL chapter 152, §25C(6) o states that"every state or cal licensing agency shall withhold the issuance or renewal of a license or permi to operate a business or to construct buildings in the commonwealth for any applicant who has not produce acceptable evidence o compliance with the insurance.coverage required." Additionally,MGL chapter 152, § C(7)states"Neither i e commonwealth nor any of its political subdivisions shall enter into any contract for the perfo ante of public wor until acceptable evidence of compliance with the insurance requirements of this chapter have be resented to the retracting authority." _ Applicants Please fill out the workers'compensation davit co Ietely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)aame(s), dress(e and phone number(s)along with their ceri7.IIcaic(s)of insurance. Limited Liability Companies(LLC) L ted Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry wo e compensation insurance. If an LLC or LLY does have ` employees,a policy is required. Be advised that th davit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. o be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application fo permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions e ding the law or if you are required to obtain a workers' compensation policy,please call the Department at n er listed below. Self-insured companies should enter their self-insurance license number on the appropriate lin City or Town Officials Please be sure that the affidavit is complete and p ` ed legibly\nb Department has provided a space at th e bottom of the affidavit for you to fill out in the event the O cc of Invas has to contact you regarding the applicant Please be sure to fill in the permit/license number 'ch will ba reference number. In addition,an applicant that must submit multiple permit/license applicatio in any gir, ed only submit one affidavit indicating current policy information(if necessary)and under"Job Si Address" plic t should write"all locations in (city or town)."A copy of the affidavit that has been offici y stampedrked b the city or town may be-provided to the applicant as proof that a valid affidavit is on file for Lure permlicenses. new affidavit must be fulled out each year.Where a home owner or citizen is obtaining a `cense or pot relate o any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)sat erson is Nquired to co lete this affidavit. The Office of Investigations would like to thank yo in advancur cooperation d should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax numb The Co wealth of Massachusetts Depaztin t of Industrial Accidents Q .ee of javestigatims Q waswngton Street oston:I 02111 Tel.#617-727-49 00 W 406 or 1-877-LEAS E Revised 4-24-07 Fax#617-727-7749 www.mass;gov/dia 1 /8 /2014 11 : 48 : 49 AM 8620 ® 02/02 7 ® DATE(MM/DD/YYYY) ( CERTIFICATE OF LIABILITY INSURANCE 01/D812014 �y 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). PRODUCER 01720-001 CNAOMNTACT Kerry Insurance Agency Inc PAH/c°.NI&o.Ext: (508)255-8000 a/c.No.: (508)240-1860 PO BOX 1945 EMAIL N. Eastharn,MA 02651 ADDRESS: INSURER(S)AFFORDING COVERAGE AIC INSURERA: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B P L F Construction Inc INSURER C 251 Tonset Road INSURER D: Orleans,MA 02653 INSURER E INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED- NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILNR TYPE OF INSURANCE INSR SWBD POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY EC OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT r 3 $ Ea accide l ANY AUTO B0DILY15 4Y(Per person $ ALL OWNED SCHEDULED c �— AUTOS AUTOS BODILY�%LU, Y(Per accideiq; $ HIRED AUTOS NON-OWNED PROPER.•TY4 DAMAGE c._ $ AUTOS Per accidbrit. UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ;;3 EXCESS LIAB CLAIMS MADE AGGREGATI ^: $ DED RETENTION $ TH $ Oy, WORKERS COMPENSATION X TORY L'TITS OER AND EMPLOYERS'LIABILITY ANY PR E.L.E.L.EACHA CIDENT r $ i 100,000.00 A OFFICER/MEMBER EXCLUDED? FY N/A VWC-100-6011968-2013A 7/6/2013 7/6/2014 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 D�eSsCRPcNe under PERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE 200 MAIN STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HYANNIS,MA 02601 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 5260 l ��cao��ir�aoizcuea C/Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: A, 7770 Type: Office of Consumer Affairs and Business Regulation xpiration:,. 2k3l201,6- Corporation 10 Park Plaza-Suite 5170 PLF CONSTRUCTION INC Boston,MA 02116 t � r= t PAUL FRANCIS �! 251 TONSET RD �., ORLEANS, MA 02653 Undersecretary Not valid without sig iture . 1�7 � �- � <<� . -?--__-..--- _.._ ......_..............._._......... 02e '°O7��zoaxcoeall� Office of Consumer �aouiatio ae _..............._..._................._._.... Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR RACTOR before the expiration date. If found return to: 133330 Up,"Expiration:F'-6i9i2015 DBA Type Office of Consumer Affairs and Business Regulation FRANCIS CONSTRUCTION�t (" 10 Park Plaza-Suite 5170 Boston,MA 02116 ;, PAUL FRANCIS 1 ? 251 TONSET RD. `,J ORLEANS,MA 02653 4 i Undersecretary Not valid wi On signa ure Massachusetts -Department of Public Safety Board .of Building Regulations and Standards Construction Supervisor License: CS-077691 - PAUL L FRANCIS-` 251 TONSET RD ORLEANS MA 0265 I Expiration Commis sioner 12/21/2015 rr We have read the foregoing instrument and hereby agree to all the terms. conditions. and incorporated herein and made a part of hereof. By signing this Agreement,Owner acknowledges receipt of a complete and original signed copy of this entire Agreement and all documents referred to herein. Contractor may not start work until after this Aurecment has been signed. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. CONTRACTOR: PLF CONSTRUCTION,INC. P 1 L.Francis, President Address: 251 Tonset Road Orleans,NIA 02653 Telephone: 508-,53"r-3b \ OWNER: Bonnie Weston By Greg G yowsky .Address: 184�'V1cl-ellan Road Nepean,Ontario K2H-9A2 Canada TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ' Parcel:. vl tX'�/07 `-Application �I Health Division Date Issued 7 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street � Address * 29_earl Village Owner fJD17n/e �� ddress /�� �-Cl�e//ey Telephone Jag Permit Request lip__ �T . A.)6 A!i)t� Square feet: 1 st floor: existing aropose&' 2nd floor: existing proposed— Total new Zoning District Flood Plain Groundwater Overlay . Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup portingtdocum{ntation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) (7 x.M Age of Existing Structure �� Historic House: ❑Yes :No On Old King!sJHighway`''❑Y MONO Basement Type: Wull ❑ Crawl ❑Walkout UOther. m r �' Basement Finished Area (sq.ft.) 5 Basement Unfinished Area (sq. 1) q 0 n Number of Baths: Full: existing new Half: existing n�,w ` Number of Bedrooms: existing ne Total Room Count (not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑ Gas 4Oil ❑ Electric ❑ Otherf�.� Central Air: ❑Yes )I No Fireplaces: Existing t 'New Existing wood/coal stove: ❑Yes Sill No Detached garage: ❑ existirounew size Pool: ❑ existi new size _ Barn: 0 existin 'hew size_ Attached garage: ❑ existinnew size _Shed: ❑ existirnew size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # - Recorded ❑ Commercial ❑Yes )f'No If yes, site plan review # Current Use 1CC �t"(r Proposed Use 'Yl� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 2f elephoneNumber SC -77/ Address is—C_Q � :� License#� — �30?- Home improvement Contractor# / _ Y' �7C�TrTZJ31 ! orkers Compensation # �yLcAf �a- 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO wo- L_ SIGNATURE DATE 1� FOR OFFICIAL USE ONLY .i `APPLICATION# ' — DATE ISSUED MAP/PARCEL NO. - •,F ADDRESS VILLAGE �. OWNER ti DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL F { PLUMBING: ROUGH FINAL GAS: ' ' "' ROUGH `''` FINAL F s. E FINAL BUILDING $ z - DATE CLOSED OUT — ASSOCIATION PLAN NO. ` i rnr l2TCn r CHOICE; r — — 7.7, -- I Office Use Only Sr'ita3 1971 JOB NUMBER,cem,qhSid r , i Resto 001ft; ------------- If Z® 1� � s� Z�l I i k 217 Thondon Drive,Hyamzis,Mass.02601 508-771-3110 - 800-464-3318(MA.Only),774-470-2211 Fax MASS.HOME IMPROVEMENT CONTRACTOR REG.#100121 MASS.CONSTRUCTION SUPERVISOR REG.#000043 ASSIGNMENT AND AUTHORIZATION TO PAY. The undersigned, herein called claimant, has authorized and .ordered from Oceanside, Inc. , the materials and/or services requested. Undersigned hereby assigns to Oceanside, .Inc. any unpaid''proceeds due or to become due, under the claimant' s policy with the insurance company to pay direct to Oceanside, Inc. or to include its name on a check or draft, for all requested work. In the event that Oceanside ' s claim. herein is .not covered by, or paid by, an insurance company,t claimant agrees to pay Oceanside, . Inc. within. sixty (60) days after .work has` been completed. Claimant understands that Oceanside, .Inc. is working for them and not the insurance company or the adjuster. Payments remaining due and payable after the claimant has received payment from the insurance company shall bear interest at, one and one- half (1-1/2%) percent per month. In the event that there is a breach by the claimant of any .of the conditions of this agreement, Oceanside, Inc. shall be entitled to recover., as additional damages, attorneys ' 'fees, costs and any other collection expenses reasonable and attributable to said breach. If payment is not received within 60 days, collection action will commence without further notice to` the claimant '' DATE: June 28, 2013 PHONE: 613-302-8121 Gregory R. Gayowsky C ANT'S IfS IGNA E PRINT NAME 184 McClellan Road, Nepean Ontario, K2H-9A2 CANADA MAILING ADDRESS (BILLING) CITY STATE ZIP 26 Pearl Road, Centerville, MA 02632 LOSS ADDRESS Douglas A. Bentley/Friedline & Carter Adjustment, Inc. INSURANCE ADJUSTER' S NAME/CO. Massachusetts Property Insurance .Underwriting. Association INSURANCE -AGENCY NAME C:\HOME\Financial\Cape C0d\Insurance\2013 Claim Activity\ASSIGNMENT 201 Ldoc The.Commonwealth of Massachusetts ' Department of Industrial Accidents ' Office of Investigations [- 600 TVashington Street Boston,MA 02111 wwrw.nzass.gov/dia` Workers' Compensation Insurance Affidavit:)Builders/Contractors/Electricians/Pl.umbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ( e:earieiP , t fly; Address:' tR 1 -The rn-L n-7)r I U,e City/State/Zip: Phone# r,�). 77 Are you an employe Check the appropriate box: Type of project(required): 1.[O I am a employer with j 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. []Remodeling ship and have no employees. These sub-contractors have 8. Eil6emolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance. #. .9. Building addition . required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13' Othe{� 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 the policy and job site information: Insurance Company Name:. /{�rt� 7" ���c -IC�►'lc�� 1-1 t �f!1�C�r,�r� Policy.#or Self-ins.Lit:#: �}- �J�.�� �3 Expiration Date: .. j c�(� Job Site Address: t //� r° UT City/State/Zip: Attach a copy of the Workers' compensation policy declaration page(showing the policy number and expiration date)Q�p3,2 Failure to secure coverage as required under Section 25A of MGL c. 152'can lead to theimposition of criminal penalties of a fine up to$1,500.00.and/or one-year irriprisonment;as well a�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 copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification: I do hereby alties of perjury that the information provided above is true:a .d correct. . Signature: Date. 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#: 1 Massachusetts - Department of Public Safety., Board of Building Regulations and.Standards Construction Supervisor _ License: CS=073097 PETER A LAROC E 18 C EDRIC ROAD '� •d CeetervWe MA 02632t. Expiration 11/0312014 Commissioner` ffice of;Con�nt ier Affairs&�osiness..Regulition IVI�IMPR+OV;1=11iiIVT�ONTi ►CTOR 'egistratw 'a��a Type`? Expira� 4�w Supplement OCEANSIDE,_INC TER LAROCFE 217 Thornton Di +: �" . s Hyannis; MA 0260 eXs eretary. l . Client#:23059 OCEAINCI ACORD- CERTIFICATE OF LIABILITY INSURANCE FaTE(MWDDIYYYY) 1/02/2013 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). PRODUCER CONTACT Rogers&Gray Ins. Kingston PHONE 434 Rte 134 A/c No Exl: a/c,Ne: 877 816 2156 E-MAIL mail@rogersgray.com South Dennis,MA 02660-3700 ADDRESS: 508 746-0055 .. - _ INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Co 17000 Oceanside Inc.INSUREDINSURER S:Everest National Ins.Co 217 Thornton Drive INSURER C Hyannis,MA 02601-8105 INSURERD: INSURER E: - INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. TN`SR ADDLSUBR " LTR TYPE OF INSURANCE "INSR WVD- POLICY NUMBER -MMIDD/YEYYY MMIDDIVYYY LIMITS A GENERAL LIABILITY 8500053796 1/01/2013 01/01/2014 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY - PRESESEa RENTED $100 000MI e CLAIMS-MADE FXIOCCUR - MED EXP(Any one person) $5,000 PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $2,000,000 POLICY JECOT- LOC - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED .- - AUTOS AUTOS BODILY INJURY(Per accident) $ _ HIRED AUTOS AUTOSWNED - PROPERTY DAMAGE $ Per accident $ UMBRELLA.LIAB OCCUR - EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE .* - AGGREGATE $ DED - RETENTION$ - - - $ B WORKERS COMPENSATION C04WC00045131 I/01/2013 01/01/201 X wcsTATu- OTH- AND EMPLOYERS'LIABILITY YIN lr ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? - E.L.EACH ACCIDENT $500 OOO ® NIA - (Mandatory In.NH) NO EXCLUSIONS. E.L.DISEASE-EA EMPLOYEE $500 OOO If yes,describe under. DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES'(Attach,ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE 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. _ AUTHORIZED REPRESENTATIVE - ©198 -2010 ACORD CORPORATION.All rights reserved: ACORD 25(2010/05) 1 Of'I The ACORD name and logo are registered marks of ACORD #S92190/M9218I3 CJF 1. TOWN OF BARNBTABLE Permit No. -------------------- Building Inspector ""'*"' Cash �o rar►� OCCUPANCY PERMIT Bond .... ___....... _�d glyy 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 ,-r-- Tf 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 a r _ 6 .� ° 1Z ' 3z- „E:: � 3 -5 r 100 Lo T 3 r. ti S! J N 4-0 �_ u F o� ry t O_ r r t N 4z _ b) f M , :, U �V M F I -- +��.-;',c'. -•ram-^","-� �'- ,.�: / --sy� _>-_� a �:. r 0�L ILI 8SUP1�l219 a mo,642040 } I as to CERTIFIED PLOT. PLAN i �D 7 3 Pz-,4 C�wT��v/ LE NEW CONSTRUCTION ONLY : --- . TOP OF FOUNDATION IS FEE` � IN `; I ABOVE LOW POINT OF ADJACENT •ROAD.: SCALE: /" 40 DATE 3/2_1/ /7 L®��'DG� fff AC�i'RlNiG CQ. INV ;i�ATno5o I CERTIFY THAT THE yt!diPTio CLIENT SHOWN ON THIS PLAN IS LOCATED E STERED rREGISTERED CIVIL I LAND JOB NO: 7?c'/..'�_ ON THE GROUND AS INDICATED AND ... �.M. CONFORMS TO THE ZONING LAWS ENGINEERS, SURVEYOR DR- BY: T ° < .T� /3> OF AA BARNSBL , r- .3.3—N.0 _MAiN.__S,T__.� 7!2TMAIN T_ CH BY: SO. YARMOUTH, MASS. HYANNIS, MASS. SHEET OF f�— -- - REG."LAND SU;RVEYO§t . 4 A rssor s map and lot number . . .....,f�...... c�. . ... �Gf• /% "7'7Q CF TN E T0� e q )SEPTIC SYSTEM MUST BE Q`' Sewage Permit number .................. ......®...................:....... I d� °� INSTALLED IN COMPLIANCE,? WITH ARTICLE II 'STATE a = DAUSTSDLB. : House number ................. ... ................................. * a «. CSANITARY CODE AND `�OWPd °o rb 9 00 REGULATIONS. °yara- TOWN OF BARNSTABLE DUIfLDING INSPECTOR APPLICATION FOR PERMIT TO ........................... TYPE OF CONSTRUCTION e ...........� 190 TO THE INSPECTOR OF BUILDINGS: ;YV u s The undersigned hereby applies for a permit according to the following information: Location .. .%��,o.oM4....AV01... !/ r�...... . ...:: ........ . Proposed Use .. : .gS�l/./ �/ .. fa Q.v.S ............................................ ............................................ ..... .... Zoning District ..../C. .�:(.l. . .. ......... .. ...... . .....Fire District .::.. t,4 n .., ..5........................................... Nameof Owner .. / ..... ..... ............Address ....... ....................................................................... Nameof Builder .......................Address ................... .............................................:................. Name of Architect 0Q140,I ' 14?' / V41e1tl-5Address ....................... ot Number of Rooms ��..... .t� ............:.........,.Foundatiori .......... ............................................:................. Exterior ..............:::` ..............................................:......:J..........Roofing ...........................................:........................................ Floors ........Interior............... ....................................."'—, ........... e;. .... ................................ .... - Heating ..........!96 ................:..................'.. ...........:Plumbing ......:..................................... :...:............. .......... . Fireplace ........ ./...................................................................Approximate Cost ............ .t............................................ �v' � / �. Definitive Plan Approved by Planning Board ________________________________19________ . Area .................................... Diagram of Lot and Building with Dimensions Fee ....................:......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH A q37 f I hereby agree to conform to all the Rules and Regulations of the,Town of Barnstable regarding the above construction. Name :..... ..., 6 ��. ....................................... � [ Bepoao, Gil A=247~224 N- 21.118-- Permit . . --'' � - - --'- -���_ � � ----------- ' ^------------------~------. - . . ' Ovvner --..lil.. -----------.. ^ ' ' ^ Tvno of Construction -Wood-.���p��-----..-- ' ' ^ `r-----'--'-----------------. ~^ � . ~-P � c . �--------� �t.----��-----.. . . . ~ ' Permit Ono"tnd .---��r��.�22^---.lP ?0 *~- - ' Date of Inspection --------.--.'-lA '�. ' �8te Completed - -----.,.]9 ' .� . ' PERMIT REFUSED ' ' | | ' ^ / . "6- � . ~ ` � . ^ � ^,x.m�/�..-=...—''p..,`..f--��'=-' . .--..-.---.-.-..---...-~..~,—...- .�---.-^...---~-~----...--.--..-��. ' ^ . � ____-----------.. lg Approved ^ � - -------r-----'--~'~-----'-'-- . � . ' - '---'-------'---'---^-' ' . . . " t r_ roe s X►' "a w--h C t t oi �y } c� SM i t � Lit-►'�. G� �� �. � � tea, oTg L 2cacar� i r _ —