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HomeMy WebLinkAbout0010 PEN LANE p 'fie n v m o � e e a > Town of Barnstable it PostThis Card So That tt;ts Visible From<the Sireetj:q�fprovedPlans Must,be Retained onobandthrs Card Must be:Ke t 1A1LABLB, a v ° o.ste 16sirtWher=a CeFs . �ar Permit t ... Permit NO. B-18-1376 Applicant Name: R.J. HAMEL CO. Approvals Date Issued: OS/30/2018 Current Use: Structure Permit Type: Building=Siding/Windows/Roof/Doors Expiration Date: 11/30/2018 Foundation: Location: 10 PEN LANE,CENTERVILLE Map/Lot 193-207 Zoning District: RC Sheathing: Owner on Record: MCLEAN, DAVID&REED,GEORGANNA Contractor Name: .R.J. HAMEL CO. Framing:, 1 Address: 10 PEN LANE ( Contractor License 115971 2 CENTERVILLE, MA 02632 _ a, Est Pro ect Cost: $4,900.00 4 x o7 {V Chimney: t Description: siding&roof Peit Fee: $35.00 rm k.; F Insulation: Project Review Req: Fee Paid $35.00 Date � 5/30/2018 Final: vlp�i ,�,nyw--.- Plumbing/Gas y _ '✓ Rye V!/ Rough Plumbing: 71 j Building Official Final Plumbing: ', Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six month after issuance. g permit has been granted. All work authorized by this permit shall conform to the approved application and the approved construction documents for whictkthi`s r ��� Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoningjby��laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public mspect16 for the entire duration of the Electrical work until the completion of the same. y The Certificate of Occupancy will not be issued until all applicable signatures by the wldg n and'F e Off cials are'pI V1 6d onthis permit. Service: B Minimum of Five Call Inspections Required for All Construction Work:! 1.Foundation or Footing _ Rou h: xx u. . g 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7:Final Inspection before Occupancy 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 i w 14, ' Application number......:S.-..1... -......L. ., , � Date Issued................... Building Inspectors Initials....... ............... A MAY 4 2018 Map/Parcel...............(. ......0..tom.. .. ............... TOWN O� BARNSTABLE TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHEMZATION PROPERTY INFORMATION Address of Project: Q �`�K 2vt-e ER STREET VILLAGE Owner's Name: �1i1 C��-�tAl Phone Number 50 Jr Email Address: Cell Phone Number Project cost $ (4, ajVO ' Check one Residential t/ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK t YJ Siding 0 Windows (no header change)# 0 Insulation/Weatherization ED Doors (no header change) # Commercial Doors require an inspector's review E!TRoof(not applying more than 1 layer of shingles) Construction Debris will be going to I�tL•SS y — �z( wlw ► CONTRACTOR'S INFORMATION Contractor's name —TZ {, l/�e L Home Improvement Contractors Registration(if applicable) # 5 —Zj / (attach copy) Construction Supervisor's License# (attach copy) ZpL. eelt.-I Email of Contractor7TO�.., - S 573 Phone number 5-)D� ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER .................................................;...,...... *For Tents Only* Date Tent(s)'will be erected Removed on. .- ,number of tents total , Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions,of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES * . Manufacturer# Model/I.D. Fuel TYP e Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CAM and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature-- Z Date All permit applications are s ject to a building official's approval prior to issuance. ,. 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 App1icant Information F Please Print Legibly Name(Business/Orgmization/Individual): g4 to L Address: City/State/Zip: tj✓wl P/ Phone#: 6 2 Are.yoy an employer?Check the appropriate boa: Type of project(required): l. I am a employer with �j 4. n I am a general contractor and I employees(fall and/or part-time).* have hired the sub-contractors 6. ❑New constriction 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. EJ Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers'comp.insurance comp.insurance t required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.0-1b of repairs insurance required.]t a 152,§1(4),and we have no employees.[No workers' 13.❑Other S 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. lContractors 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: L A-5 I-`P,[.- IJ Policy#or Self-ins.Lic.#: �Q�t,�' 4�0 l� Z Z ?n Expiration Date: Job Site Address:T_71% l r rl f City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct, Signature: Date: Phone#: J � Official use only. Do not write in this area,to be conTleted by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Bufiding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions -�• Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this stAute,an employee is defined as"...every person iri the service of another under any contract of hire, express or implied,oral or written." An employer is defin "an individual,partnership,association,corporation or o er legal entity,or any two or more of the foregoing engan a joint enterprise,and including the legal representativ of a deceased employer,or the receiver or trustee ofant' dividual,partnership,association or other legal entity, loying employees. However the owner of a dwelling house�having not more than three apartments and who resid therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construc;tio or repair work on such dwelling house ent be dee med to be an employer." of such to or on the grounds or burl ' appurtenant thereto shall not because yin c MGL chapter 152, §25C(�ale states that"every state or local licensing ency.shall withhold the issuance or renewal of a license or permit o operate a business or to construct b ' rugs in the cominonwealth for any applicant who has not produce acceptable evidence of compliance the insurance coverage'required." Additionally,MGL chapter 152, § C(7)states."Neither the commonwe th nor any of its political subdivisions shall enter into any contract for the perfo ante of public work until accep a evidence of compliance with the insurance requirements of this chapter have be presented to the contracting ority:' Applicants Please fill out the workers' compensatio affidavit completely,by Necking the boxes that apply to your situation and,if es and ho number(s)s along with their certificate(s)of . necessary,supply sub contractors)ram address(es) p r( ) g insurance. Limited Liability Companies(L C)or Limited Liab' Partnerships(LLP)with no employees other than the members or partners,are not required to can)y workers'comp e anon insurance. If an LLC or LLP does have employees,a policy is required. Be advised at=iobes davit ay be submitted to the Department of Industrial Accidents for confirmationof;nsTMancecov e to sign and date the affidavit. The affidavit should be returned to the city or town that the applicati n for the p or license is being requested,not the Department of Industrial Accidents. Should you have any que "ons regar ' g the law or if you are required to obtain a workers' compensation policy,please call the Department then er listed below. Self-insured companies should enter their self-insurance license number on the appropriate e. City or Town Officials Please be sure that the affidavit is complete and printe egrbly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Offic of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number w ' h be used as a reference number.. In addition,an applicant that must submit multiple permit/license applicatio in given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job S' Ad ss"the applicant should writs"all locations in,, (city or town)."A copy of the affidavit that has been offi ' y stain ed or marked by the city or town may be provided to the applicant as proof that a valid affidavit is one r future p its or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is ob ' ' a license or ermit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.) aid person is T required to complete this affidavit. The Office of Investigations would like to th you in advance r your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and number: TYt Commonwealth of achusetts " Department of Industrial A 'dents office of I,nvestigat! 600 Wasbangton Sreet Boston,MA 42111 Tel.#6 7-727-4M ext 446 or 1-8 SAFB Fax#617 727-7744 Revised 4-24-07 w,mt .gQv1dia i TE CERTIFICATE OF LIABILITY INSURANCE DAaS/12/20� ) 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 endorsement(s). PRODUCER NAME-o Rosemarie Gillard EASTERN INSURANCE GROUP LLC PHONE (78i 261-2023 FAx 19�.Ns.J'zIA' AIC o E AIL r illard easterninsurance.com 233 WEST CENTRAL ST INSURERS AFFORDING COVERAGE NAIC# NATICK IMA 01760 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURERS: ROBERT HAMEL INSURERC: HAMEL ROOFING INSURERD:. P 0 BOX 543 74 DEPOT ROAD INSURER-E: - CATAUMET MA 02534 INSURER F: COVERAGES CERTIFICATE NUMBER: 154124 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 - A sQSYI POLICY EFF POLICY EXP TYPE OF INSURANCE LTR POLICY NUMBER fMMIDDfYYYYI (MMIDDIYYYYILIMITS _ _ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $• "6A1GfAGE"Tip CLAIMS-MADE U OCCUR PREMISES(Ea occurrenceI $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ ` GWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑[C LOG PRODUCTS-COMP/OPAGG $ R OTHE AUTOMOBILE LIABILITY - ,CO BINED:SINGI LIMIT $ lEe bf.G(donl) _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED-AUTOS AUTOS N/A BODILY INJURY(Per accident) $ _ NON-OWNED PROPERIY DAMA E $ HIRED AUTOS AUTOS Par accident UMBRELLA LIAR. _ OCCUR ' EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $, DIED RETENTION$ $ WORKERS COMPENSATION - - _ AND EMPLOYERS'LIABILITY YIN X PS UTE ERH ANYPROPRIETORIPARTNERIEXECUTIVE E-L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED7 NIA N/A NIA AWC40070259242017A 05/13/2017 05113/2018 (Mandatory In NH) t •• E.L,DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 500;000 N/A a DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Add(tlonaLRemarks Schedule,maybe attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees In states other than Massachusetts If the Insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the Issue date of this certificate of insurance). .The status of this coverage,can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govllwd/workers-compensationtinvesflgbtjbns,/.,. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable Bldg Dept ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE (. r' .. Hyannis MA 02061 " Da niel M.Crt> y,CPCU,Vice President-Residual Market-WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ROOFING PROPOSAL Hamel Roofing R.J. Hamel PO Box 543 Cataumet, MA 02534 (508) 563-6092 CS SL 98778 HNC 115971 Dave & Georgina McLean 508-280-4828 3/12/18 10 Penn Lane 508-364-3858 (Georgina) Centerville, MA We hereby submit specifications and estimates for: Strip approximately 400 square feet of siding and apply Typar Housewrap to bare sidewall. Remove approximately 200 square feet of roofing and step flashing. Apply ice &water barrier at roof/sidewall transition and along first three feet of bare roof deck. Apply roofing underlayment to rest of bare roof deck. Roof, using Certainteed Landmark Pro Series lifetime warranty, algae resistant roof shingles. Install new step flashing. Re-sidewall using Waska Extra white cedar shingles at 5" exposure to match existing. Re- teand replace one corner board using PVC trim. Remove all debris from 8b situ We Propose hereby to furnish material and labor—complete in accordance with above specifications,for the sum of: Four Thousand Nine Hundred Dollars ($4,900) Payment to be made as follows: $2,450 in advance, and$2,450 upon completion All material is guaranteed to be as specified.All work to be completed in a workmanlike manner according to standard practices.Any alteration or deviation from above specifications i involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate.All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry necessary Insurance.Our workers are fully covered by Workman's Compensation Insurance. Authorized Signature Acceptance of Proposal—The above prices,specifications and conditions are satisfactory and are hereby accepted.You are authorized to do the Note:This proposal may be withdrawn by us if not accepted within work as specified.Payment will be made as outlined above. Date of Acceptance: 90 days. t / Signature ' "r Signature Massachusetts Department of Public Safety Board of Building Regulations and Standards. License: CSSL-098778 Construction Supervisor Specialty ROBERT J HAMEL 74 DEPOT ROAD BOX 543 ,':%.F. CATAUMET MA 02534 1! � �� _ Expiration: Commissio er 06106/2019 Construction Supervisor Specialty Restricted to: CSSL-RF-Roofing CSSL-WS-Windows and Siding Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit:yWWy.MASS.GOV/DPS .._...,-_�... �e�cLyrarraoratuealC/a��2raa:tac`uwe :i Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration;-;..'1,15971 Type: Expiratio�>.;5�E201$ DBA R.J.HAMEL CO. IL i ROBERT HAMEL PO BOX 543/74 DEPOT - t_ 3 — F License or registration valid for individual use only CATAUMET,MA 02534 " -` Undersecretary before the expiration date. If found return touiation Office of Consumer Affairs and Business Reg ,1 T 5170 -- - 10 Park Plaza-Suite Boston,MA 02116 Not valid without signature ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r ()ZMap Parcel Application # / Health Division a Date Issued Conservation Division Application Fee G� Planning Dept. APR2 6 2011 Permit Fee v� • "� Date Definitive Plan Approved by Planning Board TOWN Historic - OKH _ Preservation/ Hyannis 4111 Project Stre Address / r Village t((& Owner t/&A ( "� Address Telephone 1)io - l✓ Permit Request CA wttog, �0 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 ❑Yeslo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - - - (BUILDER OR HOMEOWNER) �j Name Telephone Number Address I�W License# 1 V"V Home Improvement Contractor# Email � /� cG Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Uw*W Y SIGNATURE DATE �� r FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f, GAS: ROUGH FINAL " FINAL BUILDING DATE CLOSED OUT t ASSOCIATION PLAN NO. I The Commonwealth of Massachusetts Department of IndustrialAccidents z Office of Investigations b 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cape Cod Insulation Address: 18 Reardon Circle City/State/Zip:South Yarmouth, MA 02664 Phone#:508-775-1214 Are you an employer?Check the appropriate box: Type of protect(required): 1.0 I am a employer with 48 4. ❑ I am a general contractor and I 6 New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working forme 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.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4),and we have no 12.❑ Roof repairs ,. . employees. [No workers' 13.E Other Weetherization ' comp, insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy Information. f 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 riame 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 lbsurance jor my employees. Below Is Ilse policy and Job site information.,. Insurance Company Name:Atlantic Charter Policy#or Self-ins. Lie. #.WCE00431:902 Expiration Date:6/30/2017 Job Site Address: (a -V& L" / City/state/ZiPOA6U ke,t Vky Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 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 violgtor. 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 certo under the pains and penalties of perjury that the Information provided bove s true and correct. Henry . Cassidy . a Date: Phone#: 508-775-1214 Of lclal use only. Do not write In flits area,to be completed by city or town offlclal. City or Town: Permit/License # Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.PI(imbing Inspector 6.Other Contact Person: Phone#: CAPECOD-27 KDOYLE DATE(MM/DD/YYYY) �.►� CERTIFICATE OF LIABILITY INSURANCE 03/30/2017 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 la an ADDITIONAL INSURED,the policy(les)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 endorsements). PRODUCER RRAJACT A, Rogers&Gray insurance Agency,Inc. PHONE Ext; FAX,No: 877 816-2156 434 Rte 134 (AIC South Dennis,MA 02660 mall@rogersgray.com INSURERS AFFORDING COVERAGE NAIC p INSURER A:Peerless Insurance Company 24198 INSURED INSURER B:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Corrioany 44326 South Yarmouth,MA 02684 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF PLTROLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE I OCCUR R/0 CBP0263063 04/01/2017 04/01/2018 DAMAGE TO RENTED E.occurrence) $ 100,000 MED EXP(Any oneperson) 5,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE X LIMIT APaPLIES PER: GENERAL 2,000,000 POLICY 1.06, PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ a ANY AUTO gg 6232707 COM 01 04/01/2017 04/01/2018 BODILY INJURY Per person) OWNED AUTOS DONLY Ix AUTOSULED 1,000,000 pppN py�NEp BODILY INJURY Per accident X AH S ONLY AUTOS ONLY �2e08�RdT�t AMAGE $ C , X UMBRELLA LAB X IOCCUR EACH OCCURRENCE 2,000,000 EXCESS LIAR CLAIMS-MADE R/O EXCl0006635001 04/01/2017 04/01/2018 AGGREGATE $ DED RETENTION$ Aggregate 21000FOOO D AND EMPLOYERS LIABILITY Y/N �( PER OTH- STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE WCE00431902 06/30/2016 OW30/2017 R1 pOp FIQER/M�M W,EXCLUDED? N/A E.L.EACH ACCIDENT , ,000 an story n ) 1,000,000 If yes,describe under E.L.DISEASE•EA EMPLOYEE DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT 11000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached It more space is required) Workers Cornpensetlon Includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Informational Purposes THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ��^ J ACORD 25(2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD f To n of Barnstable- regulatory S°e�riites �,} R&RNS'rABIi, , .. y MS& �, Richard-V.Scati,Director RWIding Division. VI 1.ofri Perry,Building Cormnissioner 200-Maio S&eet,-Iiyannis;MA 02601 a «��tie:tgtvn.bnrnctaEilcc'ria:os: ;�_:.a. Office: 508-862-4038 'Fax: 6081790-6230 Property Owner Must:, Complete 'and,$Jgn 'Phis-Scctioi.i r z �Usrna,. wilder .Fn gf 1, !</y(0 m c L.4_�Lv_ .� as_(?mmer;ofr tlie:subjcct= :y here b'Ypd,, ` to acL oii my +ehalf in all matters-relative to work authoiized by this building pemit'appliration for. l0 / Piv Ln.�e f 0 Z.G?Z � �r�.C�CIz'CSS O�•f 01)�,' �r� �r ter. s - "`-Poot.fe i<ces and Lanns are the respom-lb ty'� th ,applicant:P 15 y: are not.to be filled car utilized before,fend.'�.JS Italled and all final: '311spectiol s are performed,and accepted. Siattue of Owner ')Sipaiurez of1pplicstt rtyy • .A;i �1 tName ) l i t Nazz�c� z. uate ffry{ Q:FOTtMS;01v'\;FRP15Rl fJSSIONPWI.S . `s f.e Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-100988 Construction Supervisor HENRY E CASSIDY, 8 SHED ROW -3 WEST YARMOUJH 0 1. Expiration: Commissioner 11/1112017 1 �� (2S2 a r' Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Mai f* usetts 02116 Home Improvement LW tractor Registration 1 J -s�!: •�{ t ) Type: Corporation Registration: 153567 Cape Cod Insulation, Inc Expiration: 12/14/2018 18 Reardon CircleT{..)j1 So. Yarmouth, MA 02664 - � --1' Update Address and return card. Mark reason for change, SC41 ►.5 20M•05/11 nlc 7 4I'` .. ,�* � �pai�inno�ra�uem��o��tczaanc%twelt Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only r Type: Corporation before the expiration date. If foun urn to: 'Aegistratfon Expiration Off Ice of Consumer Affairs and sl ss Regulation ri 1667 12/14/2018 10 Park Plaza• e 5170 Boston,MA 11 Cape Cod InsulatlQ�,1(�d;�:.; =. Henry Cassidy 18 Reardon Clrc�� '`" So.Yarmouth,MAI\,, ` CJ Undersecretary t 4a0 Whout si atu 2 1 Town of Barnstable motHE ' . Regulatory Services Thomas F.Geiler,Director MASS.. g Building:Division s630.' 1°rEo A Tom Perry,Building Commissioner 200 Main Street, Hyannis;MA 02601 . www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 cam- -E� 1 a0 60:.1 PERMIT# FEE:,$ SHED REGISTRATION 200 square feet or less Location of shed(address) Village 1).VIAGlee.. ./ y J � .. 'T r/� ►� �i Jr Z 6 � cis 'Y y+ Property owner's name Telephone number % 43 Size of Shed Map/Parcel# :� Signature Date Hyannis Main Street Waterfront Historic District? Al 01d ring's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway. Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30 &3:307-4:30 PLEASE NOTE:'IF YOU ARE WITHIN THE JURISDICTION OF ANY:OF THE ABOVE COlYMSSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION'FEE.' PLEASE SEETHE APPROPRIATE COMMISSION FOR DETAILS. ' ------------- TmSz FORM MUST BE ACCOMPANIED BY A PLOT (PLAN � Q-forms-shedreg REV:05201 i , TOWN OF BARNSTABLE Permit No. ___20781 Building Inspector cash $428„001.19 i879 YYL OCCUPANCY PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." issued to Suffolk Realty Trust Address Box 308, Centerville, MA lot #22 10 Pen Lane, Centerville Wiring Inspector t.•"`E-� �^� Inspection date - a Plumbing inspector /� Inspection date Gas Inspector ( -� n Inspection date Engineering Departrrient___ Inspection date/,j 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. ......... 19 E '_. J.:.. .. .� y.. .. ... . , ........ .. ............. . ... .......»...... . ._� r Building Inspector a Assessor's map and lot number �d�i�l�I .�.. Sewage Peimit number. .:...................................................... . A-ITICLE ANY COD TAIIL i Housenumber ......... .......... ................................................ tw4krIONS,.. TOWN OF BARNSTABfLE BUILDING! IN , OR S P EC .r. APPLICATION FOR PERMIT TO ..............................Suffolk..Realty Trust ...................................... ................................................... TYPE OF CONSTRUCTION .....,single family residential ...... ..................... November 2 ...........................................19 $... TO THE INSPECTOR OF BUILDINGS:, The undersigned hereby applies for a permit according to the following information: Lot # 22 Pen Lane Centerville, MA 02632 Location ., ...................................................................................................................................................................... Proposed Use ...........single family...residential................... .............................................I......................... Zoning District ,single family residential Fire District .Centerville-Osterville Name of Owner Suffolk Realty Trust Address ..P.. O Box 308 Centerville Name of Builder Same ,,,,,,,,,,,,,•Address same ................................................ .................................... ............................... .Name of Architect ..................................................................Address .................................................................................... Number of Rooms seven .Foundation Poured concrete ............. ...................................................................... Exterior ,,.cedar shingles ,.,Roofing ,.....,,asphalt shingles„ ..... ...................... ....................... Floors carpeting over underlayment erior ..,.,kim coat plaster ............................... � � y... ..... Heatingforced hot water it ........................... ....................Plumbing ...... ....... Vc............................................................ bricl�-& block .............A Approximate C st ... 35:000. 00 Fireplace ..............� .......................... pp ................................�.... �� /�1/0 Definitive Plan Approved by Planning Board ______________________________19________. Area ........................ ...�...... Diagram of Lot and B1Lilding with Dimensions 0��. ®� Fee ........................ .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH �d s®D s M -I' F ' q.5 �O° I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .....!..�.G� Suffolk HYdXYX Realty Trust 20781 one story �No ........ Permit for .................................... single family dwelling ............................................................................... Location 10 Pen Lane ................................................................ Centerville . .......................................................................... .... Owner ..... Suffolk Realtv Trust ............................... Type of Constructioh frame - .......................................... j �...................................................................!............ Plot ............................ Lot ...... ................... "Permit Granted .......November..7............19 78 Date of Inspection .....4.... ............ ..........19 Date Completed ..... t1q.......1.119 PERMIT REFUSED ........................... ................... ...................... ............. ............. ................. ............................................................................... ........................................................................ Approved .........I........................................ 19 ................. ........ .................................................. 1 1 � �L� a�4a�++A*�w^.swn® F.:+ar+r.wlwfwewr� 1 fr ob cz- VI VII pt8, .tea�-- N 1 , �a� 0 77"E5'T H I r ; PER �-o WN,2 E eo eD5 6 f Q.TE.R i i5 A VA I L A 8 L E M/N/MU/ I SLJ/Lb/NG 6ET13/10K f2F:Qu/PE/`7F_Aj- FRONT `, 2Q ' S✓D _ /cJ '. REf:1R 1114 ' +�k/ vF►./r9V N0 -r- -rc)! BE �.GCf, 'e_� x'kOF'O FD � EU2OOM`S 3 ILC s ..�,/ Q�citE DES/C�✓ OW 33c� Gr-�1.,/�7Hy /5 use-7� PROPOSED. 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