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HomeMy WebLinkAbout0011 PEEP TOAD ROAD �i P��� �� � 'J - -� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION T OWN OF BARNSTABLE Map Parcel Application 4 � Health Division Date Issued t7 lF?IYI Conservation Division Application Fee Planning Dept. '°� °°�° �° °�°° Permit Fee 'T�'�l"! Date Definitive Plan Approved by Planning Board e:Am - Historic - OKH — Preservation/ Hyannis Project Street Address ` ee P Cep Village tt�� �n Owner pk- L 1-�fi� Address Ace, P 1 bo" P=n Telephone -7 �} `� _ 4 `f v-1 Permit Request 6D �^ Z (4` If t'o ,o QoA-r6 ConnN --., Square feed st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio d� 3 �c> Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Z 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 ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name P-e{-dt Telephone Number Address 1f' r)r�n u l TS— License # 06� I Home Improvement Contractor# 0 I Email cl e orker's Compensation # ALL C NSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /%-)c ` z�� �� ��- ,ate- lU. ,�� �✓�o� r SIGNATURE v-��A DATE d / 2,ZI l FOR OFFICIAL USE-.ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ' ADDRESS VILLAGE OWNER s , DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL s _ . GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT: ASSOCIATION PLAN NO. Town of Barnstable Building . : : Post -hisfCard' o That rt�s;Vrs�ble`from:the Street'- � rovedPlans Mu t be`Retainedd on"Job and this�Card Must�be Ke 't Posted Until Inal Inspection HasBeen Made 4019.. e : Permit iJU here a;Certificat of Occrr an asRe aired sucfr Burlclin shall Not,be Occu ied until a,Ftn I�Ins` rorr has,been made .erg � �.p.�- �upeCt Permit NO. B-17-2916 Applicant Name: JOSEPH J REILLY Approvals Date Issued: 09/14/2017 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 03/14/2018 Foundation: Location: 11 PEEP TOAD ROAD,CENTERVILLE Map/Lot: 173 057 Zoning District: RC Sheathing: Owner on Record: BOLIO,MARIA y ontracxor Name: JOSEPH J R£ILLY Framing: --1 . Address: 11 PEEP TOAD ROAD r Contractor License CSSL-102771 2 CENTERVILLE,MA 02632 Est Project Cost: $2,314.00 Chimney: Description: weatherization Permit Fee: $85.00 Insulation:. Project Review Req: weatherization fee Paid $85.00 Date 9/14/2017 Final: KjA i ' 7 4 E , .-.. �.. Plumbing/Gas Rough Plumbing :Building Official Final.Plumbing: This permit shall be deemed abandoned and invalid unless the work authors A%,,this permit is commenced within six4months after issuance. , w Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shah be in compliance with the local zoning by laws:and codes. Final Gas: r fQ � � This permit shall be displayed ina location clearly visible from access sheet or road and shall be maintained open for public inspEdion for the entire duration of the work until the completion of the same. b Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and,,Fire Officials are,yprovided on thispermit. Service: Minimum of Five Call Inspections Required for All Construction Work.=` 1.Foundation or Footing x Rough: 2.Sheathing Inspection N 3.All fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT + Town of Barnstable 5 � Regulatory Services �1AIidS L , Richard V. Scali,Director Al' S; g Buildin Division - Tom Perry,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 I, Maria Breton , as Owner of the subject property hereby authorize Retrofit Insulation to act on my behalf, in all matters relative to work authorized by this building permit application for: 11 Peep Toad Road Centerville, MA 02632 ' (Address of Job) ** Pool fences and alarms are the responsibility of the applicant. Pools are not to e filled or utilized before fence is installed and all final Signature o Owner Signatur Appli ant f 4P L� Print ame Print Na Date Q:FORM&O WNERPERMI S SIONPOOLS wommwa� {Off ce-of Consumer Affairs and Biziucss Regulation 10'P&.k Plaza:Suite 5170 onto '1 �� ets 02116 Home Improvement _ Re ' aon Type: Private Corporation 6cplration: 71281Y016 Tr# 288184 N, INC. �, '` RETROFfT INSULATION, i '= ` ' JOSEPH REILLY '=�4 '='�� P.O. BOX 105 '�;"��. '�� ,-i✓ SEEKONK, MA 02771 - ` F �'/'� 1 Updrte Address ad MUM card.Muk rwon for eb lut®e. �_,Y" Addrm Rmew I Mftpbywat ❑Loat Csrd -- 4 '1a owrsxoru o�p Iecso%+asslld Lioomo or re&kmtion valid for kwhidaal use oNly Ooa o[Comma AMU to 346m RV01002 blare the e> atlon date. If found return to: MOME IMPRO)POE fT CONTRACTOR p�a of Can 0 AIlil s and Bardeen 8esulffba k t4epb�tlon•`.L 160481 10 Park Pbm-Suite 57,70 aw 8 Private Carporsrlcn Fo ft4 MA 02116 RETROFIT �^ N �a Z- JOSEPH , FALLRNER MA 02T2t `_ u ash Nat valid without stodutare t ttt f Commonwealth of Mas- sachusetts a Division of Professional Licensure I Board of Building Regulations and Standards Constructio0�8 eMsor Specialty CSSL-102771 - ., ; E it l pires:06/05/2019 . �: JOSEPH J REILLY PO BOX 10's SEEKONK MA 0277;1 � Commissioner CL I The Commonwealth of Massachusetts Department of Industrial Accidents s I Congress Street,Suite 100 a Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):RetroFlt Insulation Address:PO Box 105 City/State/Zip:Seekonk, MA 02771 Phone#:508-989-6436 Are you an employer?Check the appropriate box: Type of project(required): 1.n✓ I am a employer with 10 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 0 4.D 10 Building addition I am a homeowner 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 11.Q Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.�Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E]Other Weatherization 152,§1(4),and we have no employees.[No workers'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. TContractors 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:STAR Ins. Co. Policy#or Self-ins.Lic.#:V9WC802160 n Expiration Date:8-2-18 Job Site Address: J/"�� / U (`� — City/State/Zip: 0e"/)&-V /1 e-- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirationopate). Failure to secure coverage as required under MGL c. 152,525A is a criminal violation 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 a day against the violator.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 pains an enalties o perjury that the information provided above is true and correct. Signature: Date: j 2,2, / Phone#:5087989-6436 Official rise only. Do'not write ea,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#: RETRINS-01 DCARVAL 0 '4`4C ,OR1:X CERTIFICATE OF LIABILITY INSURANCE DATE 07/2 712 0 1 YY) 07/27/2017 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 have ADDITIONAL INSURED provisions or 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 License#1780862 CONTACT Diane Carvalh0 HUB International New England PHONE FAX 222 Milliken Boulevard A/c,No,Ext: A/C,No): Fall River,MA 02721 EnDOREss:diane.carvalho@hubinternational.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of South Carolina 19259 INSURED INSURER B:National LiabilitV&Fire Insurance Company 20052 RetroFit Insulation,Inc. INSURER C: PO Box 105 INSURER D: Seekonk,MA 02771 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD I WVD POLICY NUMBER fMMIDDNYYYI (MMIDDrrrYYILIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR S 2187653 08/15/2017 08/15/2018 DAMAGE TO RENTED PRE ED $ 100,000 MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY jECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 fE,accident) ANY AUTO A 9100182 08/11/2017 08111/2018 BODILY INJURY Perperson) $ OWNED ONLY X AUTOS BODILY BODILY INJURY Per accident $ X AUTOS ONLY X NON-OWNED ONLYY PROPERTY accident) $ A X UMBRELLA LIAR M OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE S 2187653 08/15/2017 08/15/2018 AGGREGATE 1,000,000 DED I I RETENTION$ $ B WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITYaTATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N V9WC802160 08/02/2017 08/02/2018 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE National Grid THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 40 Sylvan Road ACCORDANCE WITH THE POLICY PROVISIONS. 02451 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Parcel Detail Page 1 of 3 h tl�`I.�i�✓t�(I�. 4�.-: � �EA�; I •:'. � e Logged In As: Parcel Detail Tuesday,August 29 2017 Debi Barrows Parcel LQokUD Parcel Info-- Parcel ID 173-057 ( Developer Lot LOT 1 � Location 11tlxPEEP TOAD ROAD Pri Frontage 129 ' Sec Road OAK STREET(CENT./V sec Frontage 130 Village Centerville Fire District Town sewer exists at this address�NO Road Index 1230 Asbuilt Septic Scan: `x` 173057_1 Interactive Map Owner Info Owner B�OLIO,1MARIA ' j owner streetl 11 PEEP TOAD ROAD I street2 I city JCENTERVILLE state MA � (zip 102632 Country I ��. Land Info ........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................ : Acres 0.35 � �use SFmML-01 Zoning Nghbd 0105 Topography Level Road Paved utilities Public Water,Gas,Septic Locatlon � I Construction Info Building i of 1 Year � �� 1977 Roof Gable/Hi� Ext ..... Wood Shin le Built � I Struct p Wall g ' uArea 1709-m,,,,,,,._� .a, Caves Asph/F GIs/Cmp Type None p Style Cape Cod wall Drywall Rooms Bed Bedrooms dena _ Bath Resi CaretFl p Rooms Heat Total Grade Verage Type Rooms Water Rooms 6 Rooms . Heat Found- w stories 1 3/4 Stories Fuel Gas aclon Poured Conc. Gross 820f Area4 777771 • Permit History Issue Date Purpose Permit# Amount Insp Date Comments 6/30/2013 INSULATE- 4/1/2013 Insulation 201301869 $2,300 12:00:00 AM WEATHERIZE-AIR SEAL 18/1/1986 Addition B29810 $10,000 CE GARAGE http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12069 8/29/2017 �F rt�r ro Town of Barnstable Regulatory Services Richard V.Scali,Director MASS ca.: ° ls . ��� Buildi g Division '°'Fay& Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office:508-862-4038 Fag: 508-790-6230 Property Owner-Must- ---- ---� - Complete and Sign This Section I, Maria Breton 6 G 6 0 , as Owner of the subject property hereby authorize Retrofit Insulation to act on my behalf, in all matters relative to work authorized by this building permit application for: 11 Peep Toad Road Centerville, MA 02632 (Address of Job) ** Pool fences-and alarms are the responsibility of the applicant. Pools are not to be filled-or-utilized before fence is installed and all final Signature o Owner Signature of Appl cant Print ame Print Name o Date QTORMS:OWNERPERMISSIONPOOLS ' ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Cle Map pp Parcel ` A licatio 4�� N1�O Health Division Date Issued 7 /C /� Conservation Division Application Fee Planning Dept. Permit Fee �J i Date Definitive Plan Approved by Planning Board GSC I II'S Historic - OKH _ Preservation / Hyannis Project Street Ad(/Irress' Village CAN 4��wV� Owner NVL�A, Wo I 10 Address Telephone 4' Permit Request 114 Qi �/ r 4 Max �_4vv- � b4 !ate k� w 01 r6 alti ott cart ,�,,y,0 p l (, oev, 110 " GIB 466 0 111 O-�� vZz Ava OV• Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new -Zoning District Flood Plain Groundwater Overlay Project Valuation ,�-�I 2� y 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 bath;): existing new First Floor Room Count Heat Tye b and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other :7 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood%coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: O!existing 0 new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Ahorization ❑ Appeal # Recorded ❑ Commercial ❑Yes �'No If �es site plan review# Y Current Use Proposed Use APPLICANT INFORMATION HOMEOWNER) Name Telephone Number Address � �� �-- �� License# !I d�9, �/ 7 0nA• ,�J' Y ry v�6 Home Improvement Contractor# Jr' 5-6 Worker's Compensation # Wt1Got*�Ze) j ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Jdr SIGNATURE DATE L-2,6 // -a i z FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS = VILLAGE k OWNER • . a DATE OF INSPECTION: J 4 -FOUNDATION FRAME INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1 -. Nlassitchusetts - Department of Public Safl•t\ Board of Buihlin!- Re-tilations and Standards. Construiction Supervisor License Licenw"-CS� 100988 �M 9 HENRY CASSIDY 8 SHED ROW ` WEST `¢ARMOUTH, MA 02673 Expiration: 11/11/2013 Tr#: 7620 C!X/Xie Office of Con§u'mer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 021.16 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/22t)14 Tr# 233831 CAPE COD INSULATION, INC,, HENRY CASSIDY 18 REARDON CIRCLE ---- - ---__ SO. YARMOUTH, MA 02664 Update Address and return card. Marls reason for change. (� Address Ll Renewal Lrnployrnent Lost Card ";;��r �(`(`onrrrrr,rztclerr.r!/�o�G�lla��ar�ctic�Ct .. 5 Office of Consumer Affairs& Business Regulation License or registration valid for indiviilul use only p OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: � egistration: 153567 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-,Suite 5170 xpiration: 12/15/2014 Private Corporation s Boston,MA 02116 CAPE COD INSULATION,,'INC: .. HENRY CASSIDY 18 REARDON CIRCLE +sc , SO.YARMOUTH, MA 02664 Undersecretary of val' witho t nat re °\ The Commonwealth of'Massachusetts Print Form Department oflndustrial Accitlents Office of Investigations I Congress Street, Suite 100 Boston, lV1A 021I4-2017 www.rnass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber-s .Ap )licant Information Please Print Le gibl Naine (B(isiness/Organization/Individual): ybu 4h Q&L r`yddress:-__� _k�vdo�. �lf�U�j (`tly% , ip:------ `- *Cia Phone #k: � �2 youanemployer? Checkppropriate box: Type of project (required) I. I tun a employer with 210______ `. ❑ 1 am a general contractor and 1 cuiplovccs (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling �Ilip and have no employees 'These sub-contractors have g, ❑ Demolition working for a-,e in any capacity. employees and have workers' 9. Building addition No workers' comp. insurance comp. insurance.$ g required. 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a horneowner doing all work officers have exercised their l LE] Plumbing repairs or additions mysel1'. (No workers' comp. right of exemption per MGL 12.❑ Roof re ars insurance recluirccl.] -t c. 152, §1(4), and we have no �j h�� employees. [No workers' 13.E Other comp. insurance required.] // auY applic int dun checks box tll roust also till out the section below showing their workers'compensation policy information. 1 Innicowncl_1 who submit this ai'tidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. �(.'nuractors that clicck this box nutst attached an additional sheet showing the nwue of the sub-contractors wd state whe(twr or not those entities have �ny�luycc,. rf the sub-contractors have employees,they must provide-their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for fny employees. Below is the policy and job site infurrrrufrolr. '��ii�q`` r' I,, 111Sl1ra11cC Company Name:_ (40 1U Policy U or Sell-ins. Lic. #: WGA o0 , 0 j z �� � Expiration Date: Job Site Address:__- T, -4dJ V d/ City/State/Zip OW-4/ Wt- tM tZ,6 Z_ Attltch a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). FW1(11V to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties ofa tin,' up to`f;1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of STOP WORK ORDER and a (-tile of up to$250.00 it day against the violator. Be advised that a copy of this statement may be forwarded to the Office of lnves(igations ofthe DIA for insurance coverage verification. 1(Iu hereby certify rtntler the wins curd enalties of )erjury t/tat tiie injorrnation provided above is true and correct. Date: Of jicial 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. tither Contact Person: Phone#: ACOR,C)_ GlIelltilt: 4591 GIC I N S U t- CERTIFICATE OF LAABILITY 1N,5URANCE ;w ' ' IIfiIS A- AN T ; R 0 7102010 12)IL MKIlt-N 11-YANO CONFERS NO RIGHTS U1.ON THC OF TIFIGAf �0 ILF `K-ATF 001 � N:'I -y014NE(A]lVL,LY Mit Ill),FXfENO 1 ttuyv OR ALTER CQVL-'UCLz AFFor� CLI.TIFWAI'C- OF INSURANCE DOES NOTCONS I Im It A GQN*I*"CTfiEIVVLLN _()Z - .D Uy ANG'I'liF,CFR*I II-ICATE I -IHF-1*�IUIN(� IN'�Wkl::N(�;J,AU I I IQKULL) It III, 11ul�lur 0--N--A L—IN,'i U N I I) the I L Yil;Y�IIIC 3, AC CIICI�IIYC(I.ItS-614,III , 'ATiON 1, VkjVr�Ii,i . ..... Lol colliq l nulls 11wqtloidof I I y WhIl' Mal[Lo I c l Y(' � Phdr+t —--------- ------- 1 7 6 U-16 0 2 1.k -N, �-MAII. 6 U I )0 o ............ ....... .............. "alIM011 WSLULIJIWO CC)IjjIjcjjjy [VIA 0,!km,I P.CQII1IIIeI'k:0 IIIGLIHIIACA; Collipjily ............................... uvYuner C ............... .................. ACA I NONWER: GIL k I 11, ovi ......... kv:'VISION IqUivil"JIL, ()F IN-stRnNCa Yt L.1sIrct IHE INSUZO OVI-, I I`KNI OH Yji�d K HOF ANY CONITNACT OR OTjIL'.R C)0(;Uhll--NI VVI-1-1-1 kl-,,� K--'R I'AiN. I H� 11\14URANCt: by rtjE p ljol, - Ili 0:11011'; AM) t-i�.)t'101VIONS t)[: 'il-ICH POLICIES. LIMITS SHUN 0 CS DESCRIDPD lo"RE-IN Is SU01IL.cr fl.) A(A. I I It- I I I iNI:j. I'C61`1 IRCOUCH) OY 14AICI CLAWS) .I-J-IwL I iA I" .................... J4/1.1112012 O41O*I12()1,'.j s'I 0010 0 1 Uktil-11Y ............ MIX L111IMPIE AMY 1'l,.0 Oo,000 ,till I'll ti,,k IA I I-, '1,2,J 0 0,U 0 0 It- A. zLI 2-11l1 It: I'r -. -.1- T, 'l2MMfjCKViw\ 0-1/011-2012 04/01/21U1, 110011-Y INJURY(11- X HMIruS INJURN'(P- AI . ....................- 14101f.IQ'N 04)0-1/20� Ii 1,000 Dot) ----—------------------- (I Q Q(I Xklll:wLl,-rIL1LLll-...... ------------- -—------------------ I QN bill c I')" 0YIN R P w I, --- I NWI 0I(AUS*1.11U.11LA IY VVGAM2`i�kj-, X WICSTAI'll 1 it ;1 id LII�Nitm cli�v,lv) C.L.LAIN I IOU N I A ACC-101"' Al .......- Nhj 0I ...... C.L.L)hX1"X P( IC I N,11 I [.1,1001)(I(JU ...........- 0111-1r,k I( )NN 1IL OCA I J(JN',' \A-:I ilCl.C�;(A11­6 ACOAL)to 1, It VpKqo 10"(11111YU) flifol i0SLII'Qd U01.1til 6widial LioUllity WI)Uli roquIrud [)y written .............. ........ ......------ CANCELLATION (,(-I" IkI6wlziho)I,Ific SHOUWANYOFTHEA00V6 QV.`iCIVWI�0 111i-QANiA4I,LI1)IJI-.I 014; 11-11' EXPIRATION DATE THEREOF, NCYIICL WILL K+ LJFLIVI:kt.0 IN ACCORDANCE WITH THE (OL-10Y MOVILIK"M3. I 121LId" c 'IUD -lO-IUACQNJO CONPONA110N,All iltPiki wawviitl. of'I I li�ACORL)Hama and 1000 ilfu fogl.iLarod m4rkii OACORD m F"Y MPAnNG mass save PARTICONTRACTOR itr;m6.:mo„on.•na,uv unx::c+mv PERMIT AUTHORIZATION FORM �o�;� , owner of the property located at: (Owner's Name,printed) (Property Street Address) (CitylTown) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contract r li o steel below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner'9 Signature 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: Particip ting Contractor Date Rev. 12132011 (6 713 A 7 CAPECOD INSULATION PIKER OLASS SEAMLESS SPRAYFOAM SUSPENDED BATT5 GUTTERS INSYIATION CEILINGS 1-800-696-6611 Town of Barnstable ' Regulatory Services Z Building Division <Z) p 200 Main St -'w° Na Hyannis, MA 02601 r CZZ Date: 13113 r� Dear Building Inspector cis 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 Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) ( ) ( ) ( ) Floors Walls ( ) ( ) ( ) ( ) ( ) err fey 7 Sincerely �i hECJr, President on, Inc. Asse'ssor's offioe-(1st floor): Assessor's map~and lot number ......_ . .'�. .7 TNEt°�o 1 ` Board of Health (3rd floor): " (?i Seo s� fO� Sewage Permit number ..:4........:...........•............�..t. `` ' ���" 9T11DLE, Engineering Department (3rd floor):' IYSTALLE®ily�T�� ��� o' rasa House number '......................... 639. ....!`r•:.... ..... .... ... � '►Conn"� �,U elyVil WIT E YA r APPLICATIONS PROCESSED 8:3C 9:30''A.M, and' 1:00-2:00-P.M. only; iyr 0 ENTAL TOW TOWN ,OF .BARNSTA ' BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..f.:C ,ta�.�.:.A. .z ��'XZ `�.�� � :..! ! .!�...:Q: Z � ►.:. f 3" TYPE OF CONSTRUCTION 1.,,). 4�..' .L ......................................................................................... i pp 3. ....:....,. •....................19.E1j6 TO,THE INSPECTOR OF BUILDINGS:' . The undersigned hereby applies•'for a permit according to the following information: Location ....1.:.....4rAR £.'C'. .1. .t e...1...!..'..1.P..-.......� .................................. Proposed Use ..: ....4.14t ...lJ�' �' �a -...k"..� � ................................................................. Zoning District ......... .......F.ire ;District .........: ' •••... Name of Owner .. . . ��` .'! .Kl.l.4..-P.1:'. .�S.A..:.Address .!�.1:.......:E. ..................... Name of Builder ................ ............................. ................- .....Address .................................................................................... . . . . .............Addres Name of Architect :.CSI�!t'. r•... � ?��:` :` , s... -1. '...4. �........... _n A.......... • ? �_�` S Number of Rooms it �l Foundation �.�.. ....... ... ..�.�� �.1 � Exterior ..................:'........ ..........'.................._..................... :Roofing .. r� V ` '...... :1`M .. ! ��n .....`........... Floors .....................................:................................................Interior Heating ..................................................................................Plumbing .................................................. Fireplace ...................................................Approximate Cost '.. ..... ....................................:.... Definitive Plan Approved by Planr ing Board _______________________________19________ - - Area ........ Diagram of Lot and Building with Dimensions Fee ....� <. �. ........ .............'.. SUBJECT TO APPROVAL OF BOARD OF HEALTH , J ` 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 t construction. I n * Name f.✓0M-144. .:a.�,�............ .............. { Construction Supervisor's License . .. f , DiPESA, RALPIi & BONNIE € I Nq 29a!Q. Permit for guild Addition/Garage+ <„wf i -Q� �essory to Dwe.. ..... ....... ......Location l•1... eeptoad„Road r - ... r rz 2TlteYV1112 r. .......... y f Owner . ...:.RalP.h..&..Bonnie .DiPesa......_... ... .Type .of Construction .......... rame f( Plot'. .... �'.. 'Lof''......... ... .. '4 Permit Granted .......August..2.l.a. 19 86 yDate ofylnspection .. ' Date Completed ...... .. ............... .... ..19 ti .� Ye' + y } V Y 4 T�4V aY` � ^ • - � �,�1 i+ .: ,,e^�t.•{( by r '�.. ,Y 4 r � •� t , , _ . j„% i a; q _cam' ♦" „ C� � / ., _ , .', •�:. vAtsessor's map and lot number ............ SEPTIC SYSTEM MUST BE �-, Sewage-s'`'Permit number ...........................................:.............. INSTALLED IN COMPLIANCE ' WITH ARTICLE 11 STATE 7, AND oFTHETp 7^ TOWN OF BARNSV r Y OE TOWN r Q� ;f sa 9� '"6 9° 0�° �_ BUkIrLDI`HG INSPECTOR 11 MAXAPPLICATION.FOR PERMIT ,TO �.... ! . .,;.. :q,......................... `......................... TYPE OF CONSTRUCTION .....��.t �C. ...... . " . .. �2 .../ .........................197. .. r. .TO THE INSPECTOR OF BUILDINGS: (� The undersigned hereby applies for a permit according to the following information: Location ....G/ ...S IY.!.......k,.67.A 7T-).f J.l.. .. .1. ...../'1.. ............ Qe�... �...... �dc Proposed Use ......��1.'?r (e.....��'l�.l. ....../,l,G?����: ..................................... .................................................... /� l Zoning District ...... h...1; ....................................................Fire District 5, `i�,r.!! (C..... f�+ C c�// .............. Name of Owner t �� ... :.G4 4. ........................Address ..f.11 y. ....?.1..... . Aq. Name of Builder Z .Zlk ?....... �° 1. y ...............Address .��� � .�.�vl�l%1 F"�� �Z' �. .. �G: U Nameof Architect ...........l,7l�mZQ.........................................Address .....................:.-:.. ......................................... Number of Rooms 41 r ................................................Foundation .......� 5........................................................ Exterior .. .....J4.!!. ..4-5................................Roofing .........4i00 1......................... Floors ....y:2,.re�..........................................................Interior .......14L' .�/�,....................... Heating ..Cn1`.................................................................Plumbing � ��.... ../ Fireplace ....... ..e-1.................................................................Approximate Cost ........ .W. ,.. ................. Definitive Plan Approved by Planning Board _--- 9�_-----------19--.�_?. ( Are ...4 71 Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree: to conform to all the Rules and Regulations of the Tow of Bar stable rega ing the above construction. Name . ...1 .. .... ................................... Lebel, Douglas W. story 9467 o ... ...................................Permit for 4 ` Ingle family duelling........................: ' ... 4 Location...11Peep Toad Road (off Oak Street. Centerville v. Owner .......Douglas..W!...Lebel....................... y Type of Construction ........frame r ..... ........... i..i........ ...................................................... Plot .... ....................... Lot .......... 1.................. , { ' Permit Granted August 3 77 ......... ................................19 - r: Date--of Inspection ` 19 L> Datey Completedr 1 X ......... .19 PERMIT-'REFUSED ; ........ .�................... ~19 '- - ............................................................................... 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