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HomeMy WebLinkAbout0056 PHEASANT WAY �� � � �� � . = - . c ��� - '. .. _ �i E ',Y;'. ;p .{� .. �, .- . �. � . � _ �`i w n� - w .b �r a i o .. a '.� .. .. t Q V � � Y n n a . ._. _. � ., :., � � - - d -. , .. .. � � � -' � r - .. ., ,, - - ,, � >, - - - "; .. :_. _ .. �.. - .0 .. � - .: - P .. �. , �. ,. _ 1 ,r 2 .. - e .. � _ � 4 .. .. � ., rF � . � , .. w ,. .�. L 4 =,. y ;, E -.� _ . � � .,. � :. u,. v .. a r`. < ._ ,,, . :� . � � Y �: Y �1 -. , H � � � _ ,; 4 y ." 7 c ' e - a � ,. ,.�y� � ,�� •_ r, ,� ..�� ti � ti ,�y e ... .., .� .. ,. .: .. e ' .�, . .. .- � _., � � � .. :- - y .r �. yr �_ _ h „ .... � fir, .- .-� _ S * y ,. � ,. .. .�. .. a: I y ,' �. �._-. , r i �4 P Town of Barnstable TPermi Expires 6 mont onr issue date 4 Q Regulatory Sakes Fee Bnxrtssasre, Richard V.Scali,Interim Director BuRding Division s Tom Perry,CBO,Building Commissioner �, 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:508-790-6230 - EXPRESS PEST APPLICATION - RE81DENTUL ONLY Map/parcel Number. 2 0-7 Noi Valid witllorct Red X--Press Imprint Property`Address -5 elyl (Residential Value of Work S 18 $ 6 44.— Minimum fee of S35.00 for work under$6000.00 , Owner's Name&Address M-,*Jyin (foken�nr.,��Q S 'fit-. sfo the •, r-fA4, ,vd(e D (o 5 2- Contractor's Named ®7 Telephone Number � Home Improvement Contractor License_(if applicable)j9 6 - Email: Construction Supervisor's License=(if applicable) /Q 9z 0 S orkmart's Compensation Insurance Check one: ❑ I am a sole proprietor APR 2 J Zo�� ❑ I am the Homeowner I have Worker's Compensation Insurance _ TOWN r BARNSLLr ABLE Insurance Company Name dt/��� �. �� /U Workman's Comp.Policy tt U) q 5-,/Q Copy of Insurance Compliance Certificate must accompany each permit. y Permit Requ t(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ ReplacementWindows/doors/sliders.U Value (maximum 37 9 of windows T of doors: - ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Wheri:required: Issuance of this permit does not exempt compliance NAth other toxm department regulations,i.e.Historic,Conservation,etc. 'Note: Pope caner must sign Property Owner Letter of Permission. o y f the Home Improvement Contractors License&Construction Supervisors-License is it SIGNATURE: Q:1�VPFILESIFORMSIbuiidingp fo 1EXPRESS.doc _ l Revised 061313 1 I1 Home Depot Contractor License Numbers:. MA: 107774, 112785 Salesperson Name and Registration Number: ROBERT D DELISLE Home Improvement Agreement Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: Melvin Cohen New England South 10638601 First Name Last Name Branch Name Lead# 56 Pheasant Way FEN !RVILLE MA 02632 Customer Address City State Zip (508) 790-7557 (508) 274-8255 Home Phone# Work Phone# Cell Phone# macohen@massmed.org Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL. Acknowledged by: X 03/28/2018 Customer's Signature, Date 1 Office Of Consumer Affairs&Basiaess ReRalatioa �-==�7HOME IMPROVEMENT CONTRA[?OR �- '1 Type: �kr 4 Regietratiorr. 154788 ' Expiration, 5129r2o18 individual UBALDO MILLER UBALDO DULLER 28 LESLIE LANE OAK BLUFFS, MA 02557 Undersecretary _ iviassachL'setis Department a"r PubiiC Safeiv BGard Of Building PEg,;i;�� o:�s anti Siandar14 ►� �••. LiCense: CS_109205 .. UBALDO C MILLER f: P.0- BOX 3238 28 LESLIE LANE rY OAK BLUFFS MA 02667 9 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 1 Congress Street, Suite 100 V 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): U U A L6 D MILLER Address: L Qr1e-- Z557 . City/State/Zip: Oa K 3 I u. p s I MA Phone#: 6d g-6 qZ 6 9VZ Are you an employer?Check the appropriate box: Type of project(required): LEI❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' insurance.* 9. ❑Building addition [No workers coo comp.insurance p• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing'all work officers have exercised A-beir IL F]Plumbing repairs or additions myself. [No workers'comp. right of exemption' per MGL 12.❑Roof repairs insurance required.]t c, 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#]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 showine the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration datej. Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby tce�,t y u er the pains and penalties of perjury that the information provided above is true and correct. Signature: V. u Date: Phone#: Official use only.Do not write in this area,to be completed by city or town official. M 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#: f Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card HOME DEPOT USA INC Registration: 112785 2455 PACES FERRY RD C-11 HSC Expiration: 04122,12019 ATLANTA,GA 30339 Update Address and return card. Mark reason for change. ❑ Address ❑ Renewal ❑ Employment.❑ Lost Card Office of Consumer Affairs 5 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SUDDle, Card before the expiration date. If found return to: _ Registration Expiration , Office of Consumer Affairs and Business Regulation —_ +12765 04,2212019 10 Park Plaza Suite 5170 46ME DEPOT USA INC Boston;MA 02116 ANDREW SWEET � �a-- 2455 PACES FERRY RD C-11 HSC o ATLANTA,GA 30339 UndersecretaN d IthoU signature 4, r The Commonwealth of?Massachusetts Department of Industrial.4ccidents Office of Investigations Is 1 Congress Street,Suite 100 Boston,ALA 02114-201.7 www massgov/dia Workers'Compensation.Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Indiridual): O Qi Pep Q Address:. �6 e s�ivRN�r City/State/Zip: 11 • diSY.T- Phone#: 71IY "I,5__ Are you an employer?Check the 4propriate box: '! Type of project(required): 1.• I am a employer with 4. I am a general contractor and I j employees(full and/or p -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 emplo ees These sub-contractors have j 3. ❑Demolition working for mein any acity. empioyees and have workers' .[\io workers' comp.in ance comp.msurance,: p• Bolding addition required.] 5..Q We are a corporation and its 10.❑.Electrical repairs or additions 3.C I am a homeowner doing all work ofticers have exercised their I 11:❑Pl bing repairs or additions I myself. Tlo workers' comp. right of exemption per MGL 17 repairs iesurance required-]t c. 152,§1(4),and we have no i I employee. [No workers' � 13.[]Other i comp.msurance required] 'Any applicant that checks box#!must.also fill out the section below showing.their workers'compensation policy'information. t Homeowners who submitthis 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+be sub-contractors and state whether or act 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 the policy and job site infonnation. /1 Insurance Companv Name: �Jtj/'/t�t� �IL�J Cttic� t//M!on/ ,Lh( /�_ . l�9 Policy b or Self-ins.Lic.#: 1 9 Expiration Date: Job Site Address: 5 t'o kect s" W)4 y City/State/Zip: m A 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 TTAGL c. 152 can lead to the imposition of criminal penalties of a due 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 fie 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. 'urance coverage verification. I do hereby certify under i ains and p 9 all' of er"u that the information provided above is true and correct Date: L4 —L 5 —P Phone'': Official use only. Do not write in this area,to be completed by city or town ofj'iciaL City or Town: PermitUcense#f Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 5.Other Contact Person: Phone'": f '`4�R& CERTIFICATE OF LIABILITY INSURANCE [:DATE(MMIODNYYY) 222/2018 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 CONTACT. MARSH USA,INC. NAME- TWO ALLIANCE CENTER PHONE FAX 3560 LENOX ROAD.SUITE 2400 E-MAIL A!C No): ATLANTA.GA 30326 ADDRESS: CN 101642069-HameD-GAW-18-19 INSURERS AFFORDING COVERAGE NAIC p INSURED INSURER A:Old Re blic Insurance Co 24147 THE HOME DEPOT,INC. INSURER B:New Hampshire Ins Co 231141 HOME DEPOT U.S.A.,INC. IN,' c:HDmeRisk C rive Insurance Company 2455 PACES FERRY ROAD BUILDING C-20 INSURER D: ATLANTA.GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439=16 REVISION NUMBER: 3 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 SUER LTR- TYPEOFINSURANCE POLICY NUMBER FOUCYEFF POLICYEXP A X COMMERCIALGENFAALLIABII:ITY MMlDD MWDD LIMITS MWZY 312717 03/01/2018 03/01/2019 EACH OCCURRENCE S 9,000,000 CLAIMS-MADE OCCUR DAMAGETORENTED LIMITS OF POLICY XS PREMISES Ea occurrence S 1.000.000 OF SIR:S1M PER OCC MED EXP(Any one person) S EXCLUDED PERSONAL 8 ADV INJURY S 9.000,000 GEN'L AGGREGATE LIMB APPLIES PER: ( POLICY PRO- ❑ GENERAL AGGREGATE S 9,000,000 JECT LOG OTHER: PRODUCTS-COMPIOP AGG S 9,000,000 A AUTOMOBILE LIABILITY MWTB312718 03/01/2018 03/01/2019 COMBINED S,NGLE LIMB S X ANY AUTO Ea accident S 1000.000 OWNED SCHEDULED BODILY INJURY(Par person) S AUTOS ONLY AUTOS SELF INSURED AUTO PHY DMG HIRED NON-OWNED BODILY INJURY(Per accident) S AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE S Per accident S UMBRELLA LIAB OCCUR EXCESS LIAO EACHOCCURRENCE S CLAIMS-MADE AGGREGATE S DIED RETENTIONS B WORKERS COMPENSATION WC014122577(AK,NH,NJ,VT) 03/012018 037012D19 X 'PER OTH- S BAND EMPLOYERS'LIABILITY YIN STATUTE ER ANYPROPRIErORIPARTNEPJEXECUTIVE WC 014122578(WI) 03/0112018 031012019 OFFICERIMEMBEREXCLUDED9 a NIA E.L.EACH ACCIDENT S 5.000.GW (Mandatory in NH) if yes,describe under E.L.DISEASE-EA EMPLOYEE S 5.000,000 DESCRIPTION OF OPERATIONS below Continued on Additional Page E.L.DISEASE-POLICY LIMIT S 5,000,000 rC Excess Auto 297-1=10011-00-2018 03/012018 03/012019 Limit: 4,000,000' 0 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC 2455 PACES FERRY ROAD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING C-20 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ATLANTA,GA 30339 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Of Marsh USA Inc. I Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: CN 101642069 LOC#: Atlanta ACOREO ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY MARSH USA,INC. NAMED INSURED THE HOME DEPOT,INC. POLICY NUMBER HOME DEPOT U.S.A.,INC. 2455 PACES FERRY ROAD BUILDING G20 CARRIER NAIC CODE ATLANTA.GA 30339 ADDITIONAL REMARKS EfFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier:Indamnity,Insurance Company of North America Policy Number WLRC6478319f(AL,AR,FL,10.IA,KS,KY,tA,MS,MO.NE,Nti,NO,OK,SC,SD,TN,WV,WY) Effective Date:03M112018 Expiration Data:03012019 (EL)Limit:S1,000,000 Carrier.New Hampshre Insurance Company Policy Number WC 014122576(DC.DE,HI,IN,MD,MN.MT,NY,RI) Effective Dale:03101/2018 Expiration Dole:0310112019 (EL)Limit:S1,000,000 Cartier:ACE American Insurance Company Policy Number.WCU C64783221(OSI)(AZ CA,IL,NC.OR,VA,WA) Effective Date:03/DW018 Expiration Date:03/0112019 (EL)Limit:S1,000,000 SIR S1,000,000 SIR for the slates of AZ,CA.IL,NC,OR,VA,WA Carrier.National Union Fire Insurance Company Policy Number.XWC 4595580(QSI)(CO.CT,GA,ME,MI,NV,OH,PA,UT) Effective Date:OY012018 Expiration Dale:031012019 (EL)Urnit:S1,000,000 S1.000,000 SIR for the states of COME NV,MI,OH,PA,UT S750,000 SIR for lha state of GA S350,000 SIR for the stale of CT Carrier.National Union Fire Insurance Company Pdicy Number.XWC 4595581(QSI)(MA) Effective Date: :01012001 ExprationDate:03/012D19 MA (EL)Limit:$1.000,000 SIR:$500.000 TX Employers XS Indemnify Carrier9linios Union Insurance Company Policy Number.TNS C4916693A(TX) Effective Dale:03/012018 Expiration Date:03/0112019 (EL)Limit:SlQoo0:000 SIR:St,000,coo I I ACORD 101 (2008/01) The ACORD name and logo are registered marks off A 2008 CORD CORPORATION: All rights reserved. ACORD F1HE r Town of B � arnstable Permit# Regulatory Services ` 6 sfr°„�issrr��e saaivsrast�, Fee Thomas F.Geiler,Director m Building Division Tom Perry, CBO, Building Commissioner.,_; 200 Main Street, Hyannis,MA o2601 www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Yafid without Red X-Prgrs Imprint Map/parcel Number Z_ Property Address 4t216 4a,6-W� W Y v& (Residential Value of Work - !Z Minimum fee of$35.00 for work under$6000.o0 Owner's Name&Address ti inG� �f�3j ��: CJ6n WO , contractor's Name i G Telephone Number, Some Improvement Contractor License#(if applicable) 157629 ;onstruction Supervisor's License#(if applicable) 1W(277 pworkman's Compensation Insurance eck one: 0Y1 I am a sole proprietor ❑ lam the Homeowner MAR 2 7. 2012 ❑ I have Worker's Compensation Insurance isurarice Company Names�J arc•=� ®W�.C?F ggRNSTgB j LE orkman's Camp. Policy# �Ql / a - f3t'6 opy of Insurance Compliance Certificate must accompany each permit zmit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going-over existing layers of roof) Re-side #of doors Replacement Windows/doors/sliders. U-Value (maximum.44)#of windows *Whore required: Issuance of this permit does not exempt compliance with other town department re bitio• P gu ns,i.e.Historic,Conservation,etc. • ***'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. -NATUR,: PFI1.ES70RMS1bui1ding permit form 02RESS.doe The Commonwealth of Massachusetts a Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): Address: City/State/Zip: L43 lj�G vl(� ; M4— Q)7,? Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.� I am an employer with 9 —. 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 7.\remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. JJ`"' ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers'comp.insurance comp.insurance.I required] 5.0 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 perm MGL insurance required]t c. 152, § 1(4),and we have no 12. ❑Roof repairs employees.[no workers' 13. ❑ Other comp.insurance required.] 'Any applicant that checks box#1 most also rill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contactors that check this box must attach 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. lam an employer that 1s providing orkers'compensation insurance for my employees.Below is the policy and job site information. ���� � ] Insurance Company Name: �C l^K /Q 1�►'1 f `�C�i Policy#or Self-ins.Lic.#: �L ) 9 " l 356 Expiration ate: l z Job Site Address: G J1 4 Wa City/State/Zip: C tin le,ralk /1,4—. 0074yz-,�. 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 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify nder the pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: Print Name: 1VlC1)C-Je /c�IC�S/ 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 Heath 2. Building Department 3.City/Town Clerk . 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: ace►4hueEft�- 1►.,►-ta�r�f`if o►`.�� - ` I,r( of H ublr r B,rtlthriLl, cg( t,on� tc S ttctc" ConsQrucfion,Su ind St utl tr Incense: CS 100077 Pervisor License ;` Re, ricted to NkIaHAEL 'DIJpLEY 137 ch NTR m r AS AL S, IT 3 r� H�LAND';MA 01721'` �'^C_ — q t *` c orhrruti9----------- 'Expiration. 5/(i12012 { T -----___ Tr# ,10,,0077 T +4Ya} ° i ` .- a ,. •h. .. . AOORD CERTIFICATE-01" 'LIABIL1W INSURANCE OP ID HL DATEIMMtp0/YI UNITE51 08/15/11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFYY ORMATIO ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE East Douglas Insurance Agency -HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR PO Box 1370 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW{ Douglas MA 01516 i Phone: 508-476-2101 Fax:508-476-1296 INSURERS AFFORDING COVERAGE NAIC it INSURED It - •_ INSURER A. Nesters World insurance Co. - t INSURER8. -Commerce Insurance C any 34754 United Painting Company Inc INsuRERa Scottsdale insurance Company 200 Butterfield Drive, quite I INSURERD. Associated Ashland MA 01721 Employers Insurance WSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INbK RIJU Man _. ICY EXPIRATION _------ - LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE[MMIDDIM DATE M LIMITS GENERAL LIABILITY - EACH OCCURRENCE s 1,000,000 A X COMMERCIAL GENERAL LIABILITY NPP0 02 3 4 01 04/15/11 0 4/15/12 PREMISES(Ea omwence) $ 100,000 CLAIMS MADE a OCCUR MED EXP(Any one prison) $ 5,000 PERSONAL a ADV INJURY s 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG s 2,000,000 POLICY %9 El LOC - AUTOMOBILE LIABILITY COMBINIM B ANY AUTO " BDGTQN 04/15/11 04/15/12sINGLEImIrr s 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Peer pe—) s - X HIRED AUTOS , BODILY INJURY s X NON-OWNED AUTOS Per - PROPERTY DAMAGE : (Per ac6derwQ e GARAGE LIABILITY ' r AUTO ONLY-EA ACCIDENT s ANY AUTO 0714ER THAN I EA ACC S ' AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY r EACH OCCURRENCE s 4,000,000 C X I OCCUR E�cLAIMsMAm XLS0073744 .04/15/11 04/15/12 AGGREGATE s4,000,000 DEDUCTIBLE t 6 S FZrB4T1ON WORKERS COMiPENSATION AND TORY LIMBS X ER —-� EMPLOYERS LIABILITY D ANY p1ioPRIETowPARTNER/DcEctmv[ QQ 12 6 6 9-13 5 68 0 8/15/11 0 8/15/12 E.L EACH ACCIDENT S500,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 ;QM'.yyeess,'desciibevr1,dei. .,AL'F'ROVISIONS below E.L:DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS *Supplemental Name* Jnited Painting Company; Inc DBA United Home Experts t United Painting Company, LLC CERTIFICATE HOLDER CANCELLATION UNI TP02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL United Painting Company, Inc. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR t 200 Butterfield Drive; Unit I REPRESENTATIVES. Ashland MA 01721 AUTHORIZED REPRESENTATIVE. Marc Laroccrue i ACORD 25 (2001/08) ©ACORD CORPORATION ' ILI\ ' 1fcF ► • c,f( r-1n�u»�er Aftair� and '�,1���'.�u Bu��ne" Kegltialic►�� 1 H Park Plaza - Suite S 170 `t 13tlSic,n. MaSSadlLlsetis ()21 1 o Improvemew 'ontraciur Regisirat](Al Registration: 157108 Type Supplement Card UNITED HOME EXPERTS Expiration: 9/5/2013 MICHAEL DUDLE'r' -- - -- - - - -=- -- - - __- 200 BUTTERFIELD DR STE t -___-------.__-_ ---_- - - -- ASHLAND, MA 01721 Update Address and return card. Mark reason for change. )PS-CAI Co 5OM•04104-(�GljOI216GG Address ❑ Renewal [_] Employment D Lost Card ✓llf V/07Itil/t4'nu�l�t 4�..'GGQ�QciuloC([d 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: Registration: Office of Consumer Affairs and Business Regulation 9 157108 Ty 10 Park Plaza•Suite 5170 Expiration: 9/5/2013 Supplement Card Boston,MA 02116 UNITED HOME EXPERTS MICHAEL DUDLEY 200 BUTTERFIELD DR STE 1 ASHLAND,MA 01721 Undersecretary Not valid without signature Arbitration: The contractor and the,homeowner hereby mutually agree.in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided'in MGL c 142A. Owner: --� 2 Contractor: a ' NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed , separately by the parties. t ' f NOTICE OF CANCELLATION'• 3/5/12............................... (Date)- You may cancel this transaction, without any penalty or obligation, within three business days from'the above date. If you cancel, anyproperty traded in; any payments made by you under the instrument executed by you will be returned within 10 business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled: If you cancel,;you must make available to the seller at your residence, in '. substantially as good condition as when,received; any property delivered to you ; under this contract or sale; or you inay,'if you wish, comply with the instructions of the seller regarding the return shipment of the property at the seller's expense and risk. If you do make the.property available to the seller, and if the seller does note. pick such property up within 20 business days of the date'the seller receives your notice of cancellation, you may retain or dispose-of the property without any further," obligation. If you fail to make the"property available to the seller, or if you agree to return the property to the.seller and fail to do so, then you remain liable for : performance of all obligations under the contract. , To cancel this transaction, mail or deliver'a signed and dated copy of this' cancellation notice or any other written notice, or send a telegram to: United. Painting Co. Inc. & United Home_Experts Inc. 200 Butterfield Dr. Suite I Ashland; MA 01721. .• k (Date) Not later than midnight of.. 3/8/12 ..: - _ I hereby cancel this transaction. ` ......... . (Date) - Y.....Buyer's signature .. We have received a copy of this notice: .... .....K.� ........ j! ....... f .. .... Buys(s 11) sig ature a Date ........... ....................... Buyer.(s) signature Date { { . . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 2— Permit# Is 5 + Health Division 2 O,S� S^'a/S Date Issued Conservation Division s a7A i OOSFee Tax Collector S — fag/ PMAJ R��, 7//9/o�l Application Fee Treasurer Planning Dept. Checko PW Date Definitive Plan Approved by Planning Board A� V : -.BOFB ROOMS Historic-OKH Preservation/Hyannis Project Street Address 4 Village cely Owner ��� S07 i a`Tv'1 Address Telephone SV 0 Permit Request Cv7- her Ck V...e k_ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed To I new, ` r-- Valuation Zoning District Flood Plain Grou dwater Overlay", Construction Type Al ®p Lot Size .S"I/ ± MiC Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family Cl Multi-Family(#units) Age of Existing Structure 1 es, Historic House: ❑Yes XNo On Old King's Highway: 0 Yes No Basement Type: Rlull Cl 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: Cl Yes KNo Detached garage:❑existing ❑new size Pool:❑existing 0 new size Barn:❑existing 0 new size Attached garage: existing ❑new size Shed: ❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 0 No If yes, site plan review# Current Use - = Proposed Use _ / BUILDER INFORMATION NameX f�e-1V 44 514-- Telephone Number Address 7-7 License# 1f6 97 2— Cr o �v< 1-6C9t p a 3S r Home Improvement Contractor# Worker's Compensation# i ALL CONSTRUCTION DEBRIS RESULTING FROM THISPROJECT WILL BE TAKEN TO �4" SIGNATURE DATE �7 ��! FOR OFFICIAL USE ONLY F PERMIT NO. - DATE ISSUED - MAP/PARCEL NO. ADDRESS r VILLAGE OWNER + f a f n DATE OF INSPECTION: r FOUNDATION -Y\ FRAME - 1 INSULATION FIREPLACE s: ELECTRICAL: ,ROUGH FINAL PLUMBING: ROUGH _ FINAL a p GAS: ROUGH N FINAL c� J FINAL BUILDING G h ✓ ! 2 '� --_ _ �,- 0 � G DATE CLOSED OUT qpD ASSOCIATION PLAN NO. M 4 c � , h I The Commonwealth of Massacnusens Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 M ..' www-mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BusinesslorpnizationAndividual): Address:_ >7 ���exll�� �Q�, City/Statelip:,. L���v� �`g ! Phone#: C' . s ©�-�� �/. �'7 e;; . Are you an employer? Check the-appropriate box:_ = Type.of project-(required): 1.❑ I am a employer with 4. I am a general contractor and I 6: New construction employees (full and/or part-time).* have hired the sub-contractors . 2 0I am a sole proprietor or partner- listed.on the attached sheet emodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. g• ❑ Building addition. workers' comp:insurance 5• ❑ We are a corporation and its [No officers have exercised their 10.❑ Electrical repairs or additions required.] 1LE] Plumbin repairs or additions 3.❑ I am a homeowner doing all work ' right of exemption per MGL g ep myself. [No workers' comp. - c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.❑ Other *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 their workers'comp—policy-information. - I am an employer that is providing workers'compensation insurance for my employees. Below 6-thee poticy and joli site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 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 may be 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: _—_ Si afore: Date: Phone# G 5`0 � 3'7 FOther only. Do not write in this area,to be completed by city or town official. n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: 1[nforrnation and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. "...every person in the s ce of another under any contract of hire, Pursuant to this statute, an employee is defined as express or implied, ral or written." An employer is define as"an individual,partnership, association,Corp ration or other legal entity,or any two or more a in aygint enterprise, and including the legal r resentatives of a deceased employer,or the of the foregoing g g to employees. However the receiver or trustee of an vidual,partnership, association or other le al entity, employing owner of a dwelling house aving not more than three apartments an who resides therein, or the occupant of the employs persons to do maintenance, nstruction or repair work on such dwelling house dwelling house of another or on the grounds or building a urtenant thereto shall not because f such employment be deemedto lse -employer"" MGL chapte(f:52, §25C(6),also s that"every state or local li ensing agency shall withhold the issuance or renewal of a license or permit too rate a business or to cons ct buildings in the commonwealth for any', applicant who has not produced.acce table evidence ance with the insurance coverage required. dence of comp Additionally,MGL chapter 152, §25C(7 tates"Neither the co onwealth nor any of its political subdivisions shall enter into any contract for the performance f public work until cceptable evidence of compliance with the insurance requirements of this chapter have been pres ted to the contrcc g authority. Applicants Please fill out the workers' compensation affida completel ,by checking the boxes that apply to your situation and,if necessary, supply 1 sub-contractor(s)name(s), addre (es)and hone number(s)along with their certificate(s) of insurance. Limited Liability.Companies(LLC)or L 'ted L' bility Partnerships(LLP)with no employees other than the to carry work co ensation insurance If an LLC or LLP does have members or partners; are not required - - employees,a policy is required. Be advised that.this a a may be submitted to the Department of Industrial Accidents for confirmation of insurance.coverage. Also a sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the"p 't or license is being requested,not the Department of Industrial Accidents. Should you have any questions regar g the law or if you are required to obtain a workers' n listed below. Self-insured companies should enter their compensation policy,please call the Department at the self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed 1 'bly. The artment has provided a space at the bottom of the affidavit for you to fill out in the event the Office f Investigation has to contact you regarding the applicant Please be sure to fill in the permit/license number which be used as a ference number. In addition, an applicant that must submit multiple permit/license applications in y given year,nee only submit one affidavit indicating current policy information(if necessary)and under"Job Site dress"the applicant s ould write"all locations in (city or town)."A copy of the affidavit that has been officially tamped or marked by th city or town may be provided to the applicant as proof that a valid affidavit is on file for fu a permits or licenses. A ew affidavit must be filled out each is obtaining a lic'nse or permit not related to y business or commercial venture year.Where a home owner or citizen (i.e. a dog license or permit to bum leaves etc.)said p T son is NOT required to comp ete this affidavit The Office of Investigations would like to thank you advance for your cooperation should you have any questions, � please do not hesitate to give us a call. The Department's address,telephone and fax number The Comoro wealth of Massachusetts Deparmen of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia °FZHE r° Town of Barnstable ~°^ i 'Regulatory Services 9BARNSTABM� Thomas F.Geiler,Director i679• prED wU►'t A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Pemut no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernizatioA,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: 0at.06Ze,, / Estimated Cost Address of Work: 7 Owner's Name: Date of Application: -7 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law []Job Under$1,000 ❑Building not owner-occupied El Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date . Contractor Name Registration No. OR Date Owner's Name Q16rimhomeaffidav i erase: C OF Nvb NSFR�� tNG ON U/'G0N t�r � O 046g72 ERVtSOR g�� S � q .�961 STFpN N Resr, 7 PD 'Mr 5 S DFNNIS 22 �h%`^`Cy~ >% lr no: / r n'Lq \i$� 7126.0 to Board of Building Regulations and Standards HOME(MOVEMENT CONTRACTOR 10650 2006 dual STEPHEN M W I MPHEN 77 EISENHOWER ( COTUIT,MA 02635 Administrator A 'HEh� lx4lr,: ' PAr 03 'j 'Town ®f Barnstable RegWatory-Services. eA XAM Thomas F'.Geller,i)lrec6i— ' 16591. Building Division Tom Perry, Building 6mmissioner 200 Main Street, Hyannis,NA 02601 Office: 508-862-4038 Fax: 508.790-6230 T't�p t-ry O evner Must Complete and Sign This Section if Using A. B..pi der 1 r --.-.-. --, as Own= of the subject proper#;, hereby authorize �� � /� , __ —to act on my behalf, in art matters relative to work authorized by his b' Adizg pen-nit application fm (address of job) - 4 5igtna e of Clu=ner Date Print Naule ` e- ��s IDtek .aS� �Aelo�►���/ is ' �° % : 156&o Tute. 4e �OwN pox, e pee --�-- 15E curbACK �Xi S� SeC�► ON T O �'L A N F— c vT 45ACK SGc�-:p�y Tel c'yr i -- 1 77 PH F A-S A /7 \A1A Y y.x 4 DesT� I ' I g0" "rvk5F � tgl� f I ►I-,-. F', p // - ? 7 1 sEA�HOLK/FR Dj3, !�1= VAT I O E�i�girreerpng Dept.(3rd floor) Map — - Parcel A .G 1FJJ,Permit# • House# Date Issued98 a•PM f Board of Health(3rd floor)(8:15 -9:30/1:00- -36j�" ` -E e 'j�� -,�O Conservation Office(4th floor)(8:30-9:30/1:00'2:00) ' ► - SEPTIC S 9 air 8 7 BE r cc3PJ�, Planning Dept.(1st floor/School Admin. Bldg.) n ALL PLIANCE Definitive P oved by Planning Board ' l 19 RJ.® ODE AND (ktTOWN OF BARNSTABLEAQkn� F ' Building Permit Application q Project Street Address / 1�13 e► -10}_4 Village. }� �� f oS► ^� 9 Owner r �� � �e ti �^°� � ' Address $� �1��e } wv4v (ew 4erV, d@, Telephone �50 7�0 Of U Permit Request btu �}((�(-,e ' i� 14 G2 J o a� r M ,t e o d'vi 1 i- , j z�S -First Floor square feet Second Floor square feet Construction Type Lv 000 Fn A►M e, Estimated Project Cost $ 4' 1 S o 0 V Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) r Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes s► Basement Type: [mull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing 3 New 3 _ 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Cl No If yes, site plan review# Current Use Proposed Use Builder Information Name PL 4l?f 14 PP I--f b ij Telephone Number '56� y�?7-7 G pb Address 3 7 3/1,J'o W A y License# 0 c�,s y I C ewi e r g%I I 4 :5 lo 32)_ Home Improvement'Contractor# 167, a/ 7 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE J L BUILDING PER DENIED FOR OLLOWI G REASON(S) FOR OFFICIAL USE ONLY ,43,1u PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS Y. VILLAGE? OWNER y ' e DATE OF.'INSPECTION: 3 FOUNDATION e , . M '� S f r`.. ' � r • y • • k . I 1 1 l r.. FRAME INSULATION FIREPLACE , ELECTRICAL:i ROUGH FINAL i PLUMBING: ROUGH ' FINAL �. GH FINAL' _ GAS: . I ROU FINAL BUILDING i r DATE'CLOSED OUT' - ASSOCIATION PLAN NO. , ' r - _ , }_ r i 1 ! 1 , j t t l t i >. T-• -t-- - - --r - , - �- - }—i T` ! , ' --t--- T_ -' -r -`- -r i - - -� -I-- ' _' _ -1. _-T---r- 1..�. -T- t--- -T i - -t- r,..-. -r_ Y.. - �_ T -, - j---?- -t 4 --r- • f ._ r r i- --i_ 1 - _ S. _ rj ;- t - r r- _ -r- r- , - - T- 1 f - 73 -rt 1 - i _- 7 ...t - --r- -, 7. _ \ � r , -r-- f-- I - r- T r f -T. i_._-- . t r r' l- + r r � + I OANIEL E. !y ® - i ♦ O G ® !'-- i - r BRAMAN STRUCTURAL ✓., 1► - - .,._ �.t �.j `-'1_- k. - i r_r__,� - _ r-- ;- - - - y-- -f NO.36595 I ' dc+cxtIs I i , r i i i r � r � _ .J_ _ + , � � ( - -, - .r - 1 � - - 1-••_ _.._ (- - 1--- r - !_. _ t. r- .j. fiat. r UG i ' 1 , , f r �--_.._- _------------- --'�--- --------------- ���_----------- - ----- -- ---i ------- -- �- ---- ----- -- -- ..T___.__�__._ .. -� - - - -- ------- _ __._ _ ___.._. _ ..-. .._ _ __ _.1__.._ _ .. _�_ _�___ _ _. -____ __ _ _.___ _-_ _.___..__-�_-___.__..__.. i t C .....7__1 t ivc s T ty _ --f --- 4, 4 t _ moo. I_ - - _. I I 1 - . E i E — d r WT 9 - s4 6- - �J C3 PT The Town of Barnstable BARN STABLE. Department of Health Safety and Environmental Services Eo►rt16 Building Division 367 Main Street, Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice F Type of Inspection Location -r Permit Number Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: i 1 Please call: 508-790-6227 for re-inspection. Inspected by r Date The Town of Barnstable 1 )AlLf71)LL : Inspection Department 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner November 9, 1993 Ms. Helen Weinman 59 Pheasant Way Centerville, MA 02632 RE: A=207 161L 59-Pheasant Way, Centerville Dear Ms. Weinman: This letter will verify our telephone conversation of the above date re the operation of a business from your dwelling located at 59 Pheasant Way, Centerville. As per our conversation your dwelling is located in a Residence C zoning district and only single family dwellings are permitted. The operation of a business is in violation of the Town of Barnstable Zoning Ordinance and must cease immediately. Please be advised that you do have the right to petition the Zoning Board of Appeals for a Variance. Very truly yours, Gloria M. Urenas Zoning Enforcement Officer GMU/gr cc: Town Manager Zoning Board of Appeals Complainant TOWN OF BARNSTABLE ,• BUILDING DEPARTMENT' COMPLAINVINQU.IRY REPORT Date // S'% Rec'd Bv Assessor's No. � Last Name u C %�' First Name �r hi S ORIGINATOR Street Villacte � /2'�2 /GAL'` State) Zipc�2 6 � Telephone• Home 7 7/- C I�; Work Description: a I:iJMt'LL11iV1' //�/ 1 ��Y /Cat !Jl/p�/6�/l�/r1M ,✓f /�"GL A,-Aw I INQUIRY c e �i�.✓� r t#014 f4�'i r 4 Re uestor's Signature CCNiPLAINT Street Address ' TH /11;� 0 LOCATION A= OFFICE USE ONLY INSPECTOR'S Date � �j Ins ector �[ ACTION/ COMMENTS FOLLOW-UP ACTION ADDITIONAL INFO. ATTACHED�/ ,- COPY DISTRIBUTION: WHITE -DEPARTMENT FILE YELLOW - INSPECTOR PINK - INSPECTOR (RETURN TO OFFICE MGR.) MISC1 I ' "1--71 av �1 Nov. 8 , 1993 We the undersigned, residents of Pheasant Way Centerville, hereby request the appropriate enforcement agency of the Town of Barnstable to cause Ms . Helen Weinman 59 Pheasant Way Centerville to immediately stop the operation of a business known as Heartbeat Quilts . Pheasant Way is .r- ,3 residentially zoned; the business being operated by Ms . Weinman creates an undesirable amount of traffic on the street, much of which operates at unsafe speeds. �r G � - ,r,.,ry Lid,... �y.r i s} '��}k`G'!�`""a1,�+}i:�etYsNrRAy% #" �-8,•c � r y�rve...eatir � .�v. .. - _. ...Re �— ,r .�.' }a�r$:�1•=J b � 'r �t,,:.:f,'h Rn� }}P ` ,rRH ,� ,e RR�. �.R�. x 'ate, y9,{ij �.t•e�� a, ts -J 111tra aces -BRIC • FABU.", ra i Trr ,.L y Y � a '•, a Y-I PA �t% awTIE�MONTIH" CLUB What is a Fabulous Faba, Pack? A i 8-10 fat quarters(18'X2-2 the newest fabric offered by Hoffman,Hi-Fashion,RJR, Benartex,Kona Bay, etc. Fabric color and/orAdesign coordinates is wrapped up in a wide satin ribbon to complete the irresist- ible bundle. , Why subscribe? 41, F K to add dimension and vanety;to your fabric collection r* -availability of professionally`coordinated'pxces for small projects. , -to see and own the newest,most sensational fabric on the market. 1 -to receive suggestions and easy to.piece patterns using your fabric packs. 1Vlernbership fi Receive a stew fabulous fabric pack each in®nth-lataest fabric releases always included. ' m -101/6 discount coupon for additional yardage ordered from any pack(if available) i -members are eligible for additional futum special of6ei n'S. -Membership is FREE. MAIL.YOUR.AUTHORIZA TION CARD TODAY! ----------— - -----�.— =,_. -------- ------ FABULOUS FABRIC PAMOF-THE-MONTH CLUB AUTHORIZATION CARD ` • � _ •� ; ^TDB ' Yes,sign me up.for the.Pack-of-'The--Month Club, t �. I authorize Heartbeat Qtiilts to charge my credit card account monthly for each new fabric pack($11.95-14.95)each plus postage&handling).I'understand thdf if I am noi'compTetely satisfied I cart return the pack to Heartbeat.Quilts within 10 days from receipt of the pack.Lalso understand that I will be responsible for return postage on any pack I Jon't keep. I may cancel membership,in writing,'at any;trme.,— ',lame. ''hipping address: -ity: w State: �:'' a r. e{ .,'tZip: telephone Number: Day (.. ) Eves ( " ) Mastercard or Visa No# Bxpiration date: signature: Date' Ieturn to: Heartbeat Quilts, P.O. Box 2298,Centeiville,.MA 02634-2298. Any questions: call-(508)790-0645. '. .�r�'.�*•-iY;rt_. .r,.. �;TA;£".•1aw� ifl�2`.�`+F 6�M ,tqn m �r„� a �... { , Pa, 10 DIRECTIONS TO 1REI.EN'S HOIdS ' k a a .•-'sue"'— . '",�` '`y ,.'}' * y� r ^ .. FROM SAGAMORE;BRIDGE: Route �6}4Q1id' Ca'p,e,• kighway) Exit 5 (Rte 149) to stop sign.' 'Go .straight through stop ,jsign (ride-'par-a11.el to highway on Service Rd) " to : f'irst:.righta=t'urn ;(OL1hfSTAGE°ROAD) . Go .to end (stop si n and -make ,feft; RACE 'L'ANE OLDS STA'GE'`ROAD g, ) ( ,,. , / � ) . Go, :3-1/2 miles to segond •traffic'''light" " Ice�lefti(SOUM.MAIIN STREET);,,;-qGo 1/2 mile to PHEASANT MAY: Make •right on, Phea'san,tdF;to end of street 'onto dirt road . .,'My house is #59 - second^'hou o' , .se • n''dirC road on the ,right in the woods . a. FROM''•PRO�VINCETOWN. Route �61 (Midi"Cap"e;`,11ighway)',, ExiYt ` 6 (Rte 132) make_-- left to fir.9t traffic •lighf :,(PHINNEYw'.:S-"'IANE) . Make :right onto Phinne ' s La'ne. Go, to}end . of`�road'f�{ �'u .will hit ,Route .Y 28. Make right .y g onto Route 28 to first, t'raff�ic li'gih� w(CCB . ' and CSobi1 Station on right) . bake '�left' at tra ffi•cr-fl'ighvIt'44go 'through ;one'-.;stop sign to first traffic light '(SOUTH 'MAIN.;STREET) . , Follow a}iove directions . ° _—_—__IC J r e A. �": t ��,. F F. .P Jt.a d�1 a .'y2 K ''� +++.�.,:.,.,� .•-dd.°'�•, .F}'kt! { r ft� ti° ♦+ /"': a},. f'R�j1ajll t� i"p .! ,'��"ifS'lye �frl},�'`''""T :r 3 �1 `a.rr'�. f� .:,�.K� J.r' t� a '•r `.�.... s( `k• `gt' '; 'r ��' {+' ��F daF{ lit,' t4� q 4 t - ' �• ,f 1 +f,r "� 3 a�j-�PA�iidr"1Ydi !"�� Si*.4"{ "y'ia°j f5Y1^ 1. = FFt �iA a , { l� ♦< j'nn49e " in rs s k t A `t' r}�+r �a 3 n }c>Fa .,,t�;: 'k „e � � f� it � e.^ - r,: - rsrA..•,�r,,. i •Lir 's a r �' S. M` t Y ,•'�M 1 ." -,y� jf('w,. " r+ . tx yi. +r L l "Jfl j,it ' bAffI<AIE" ��'��b� U.S'�FOSTAGE ,., PAID tilts q � t t, ' Centerville,MA e , v ,, �, Per it No.19 P.O. EtIA a.JZ9v a r. Yl".Centerville,MA A2634; y; .a ,. W�v ...♦ .^v �::'yG+3rY i'�;:{� * �z �t"` '� P 3 �, q.�•dt'�,le t ' >*, <�`g5, y `.�. � y�� � . 4y ! r�i2{ y S�t'�ti'c� `'ti y tttY ... 4 �-' � 'r'-^y`• . D �pp �$%q,\,.(�/• '. a� r f R {w • B(. ki""�+���� ,c v� r♦"z'b}t<a' }d e � F, - ♦ X '1.. jSq t t :tt 11i,. ...%.W'y:Jk.I�yl".1 ..4 f f� L,.; j3 t d�•.' .r•^ � g �r m*�.� t `�"aI�.H�+ i., M 1 �' n t e;, V-1..�1.4,�'�,e f-^ti''r,'��yer,� .err •,• o,, ' `•'3 r � w Hq ;��, �^Yf;s+v t ' '�`� rr �r� ., .. ,L t ' � •• ,- �� t{t=�{"a �: *t. 'd a f r�f� �'`M" L�'"�.,;�m s`""�.: .. ..<..,. �,a;,,,�H;,.,cr.�,•�a, '..J: ' f"41`y n,q y. iY _ i4..r 7g�:" {' g : •-A t 'A. �pfgai. ' ,� r. `}�, It V. , " .-n tif� F` :4'�"i:. ... ....- �PorF;•'F!k5?;•a';Y,trc*s+�l''"r}�v'.��.r'-u�34d4 eFrh, '°-eMl a..,, k .•:o`. �sr, C-TY 20 21,01.11., 5,00 Cl-1 1 A A E N T0 .!,V 59* Ffi-E.,43A'--NY RAY X p 21 0 2 2 93 5 AV T 21 1 110 R E U 4 AY 8 1TEV , I ""ONST o 0 15 4 1.061 0 T H E.R .............. IF 0 p 1 Ak 6(.'� ASO L tl V 69600 ASD NP .,.-4.ZoO ASJ,*-9 OTH Yf'll� C U R R N 7, E XJE lk2ip J..3 i.E T., is l pL L Ltwu A y f;x 7, El 2')3 7 0 0 2 3,70 0 -2'3 7 00 C-C)11111-9 f?C I A f., I NY D U S T R'`Aga E. 30 R 8 C i ll 3 3 ? AFD I I'';:..` .1 T 3 Telecopier/FAX 7 Telephone (508) 790-4833v r (508) 771-7533 COS a ®® (800) 344-2889 November 16, 1993 Town of Barnstable Town Hall Hyannis, MA 02601 Attn: Mrs. Urenas Dear Mrs. Urenas: This is to respond to your letter and confirm conversations in hopes of clarifying matters. My client, Helen Weinman, is a teacher and has a life long love of and interest in the art form of Quilting. She does not operate a business iri her home, but most ci her friends all share the common bond in the love and interest in quilting. Her teaching of classes in Quilting are conducted off the premises at such varied locations as libraries, museums, schools, Quilt Shops etc. Classes have been also conducted at the Cape Pointe Hotel in Yarmouth; Cape Plaza Hotel in Hyannis; Cliff House in Ogunquit, Maine; also at Tumbleweed Quilts, Hyannis; Lady Bug Quilts in Dennis; Rose Victoria in Dennis; Brooklyn Womens Exchange in N.Y.etc. Her Quilts are sold in/from all those locations. Most of her friends and visitors to her home share the love and interest in quilting, as does my own wife Carolyn, who also teaches with her. It is not unusual for friends who share this common interest to frequently drop over to show new creations, ask help on a problem corner or color coordination of fabrics etc. any more than it is to have Monday night football addicts drop over to watch a game or others sharing similar interests to open their homes to like minded persons on everything from lionel trains, model building, stamp collecting, gunsmithing. photography, basket making and other crafts. I see no need for my client to do anything but continue in the lawful use of her home, and I suspect any complaints received by you about her were actually made from ulterior motives . Based on discussions it is my understanding it is no longer your opinion that an illegal business takes place on the premises and that under your letter of 11/9/93 it would not be necessary for me to eal your decision to the zoning Board of Appeals. V ntruly r . n 'W e D .nsh c: client. POST OFFICE BOX 1136, 687 WEST MAIN STREET, HYANNIS, MA 02601 {; 'SA'1T.1.. `."�� 1F'• '!n of ,y 1.iR. +1. ^L-. '�, o'., M'"Y:3 _, r -.r, .. s ""Is1 1 ' .. �"�^'Y'.,,�."✓'nr""w✓`._"'." �a� 1�.�-. r 2�FF'4 o THE a TOWN OF BARNSTABLE Permit No. 29.182 BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash .�.39 ` / HYANNIS,MASS.02601 Bond .......X...� CERTIFICATE OF USE AND OCCUPANCY Issued to Roberts Realty Trust Address Lot #29, 59 Pheasant Way Centerville, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. January ..... I9.....88 ...... ..... ........ . - Building Inspector 9 TOWN OF BARNSTABLE BUILDING DEPARTMENT TOWN OFFICE BUILDING HYANNIS, MASS. 02601 �o r�r►• i .MEMO TO: Town Clerk FROM: Building Department DATE: An Occu anc Permit has been issued for the build ing authorized = P Y b gY BuildingPermit #..........2.....�� ...................................................................................................................._.................................... issued to ':. ?.. 7-�, ��' /. Z- Please release the performance bond. >5�`•"'.r.",.,r'.':i# m ...c :.: a. ,r....,. »ava�ep. i:.-a +<. ,,,,^k.< "'r` t's1..rs� '",:✓. 2111- ,.,-tom PINK DEPT FILE CDPY 'WHITE FIELD QPY/.YELLOW-APPLICANT COPY °: \ BUILDING TOWN OF BARNSTABLE, MASSACHUSETTS.. PERMIT V'A LID AT IbN Ar'207 162 m = DATE A r 1' 10 I p ' - 19 86 ,PERMIT NO, 9 APPLICANT "Oumer: I'� ADORE5S. 209 .. (NO.) (STREET). - (CONTR'S LICENSE) PERMIT TO Build`dW011jA 1 "NUMBER OF (�) STORY Single family dWel'l'in�'DWELLING UNITS 1 t" •� .;:(TYPE.OF:IMPROVEMENT):., NOr (PROPOSED USE) .. AT (LOCATION) :: lot-4�29 59 Pheasant Way, Centerville zoNlNc .....(N0.) DISTRICT RC. .....� '... .(STREET) . BETWEEN AND (CROSS STREET) . . (CROSS STREET) SUBDIVISION LOT' LOT BLOCK SIZE BUILDING IS'TO BE' FT. WIDE BY -FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM-IN CONSTRUCTION a TO TYPE:' USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS , Sewage i/85-215 t `• IiOIJU AREA OR­ 1 VOLUME t"' 1200 -ACL. Qt - PERMIT ESTIMATED COST $ Rfl 000 FEE 72:'00 CUBIC/SO UARE FEET) + . €' OWNER Roberts Realty Trust Dot N BUILDI G DE PT.,. I ADDRESS 27' P StrPar DLxb tr• B A —� It Y. MINIMUM REE-:.CALL .APPROVED PLANS MUST BE RETAINED ON JOB AN .w f.1NSPEC-TIONS k,EQUIRED FOR PZTCwlgzB- 'ALL!-CONSTRUCTION";WORK CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS'. ARE REQUIRED FOR FOUNOATION�S0R:F'OOTINGS. - - ELECTRICAL, PLUMBING AND MADE'. 'A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 1 PR.IOR:70'COVERING:STRUCTURAL QUIRED,SUCH,BUILDING SHALL NOT BE OCCUPIED UNTIL ME AL,IN (RE'ADY TO'LATH).- FINAL'INSPECTION HAS BEEN MAD'E;. FINAL-INSPECTION.:BEFOR,E'' OCCUPANCY: - � ` POST THIS CARD 'SO IT IS VISIBLE FROM . STREET ` BUILDING INSPECTION APPROVALS :' ' PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 yet 1 er A / Z Lq I ILA IINUIMSPLCI ION APPIIOVALS I:NGINI'L IN Cfl.l'AI LI I OTHER rBOARD OF.HEg TH¢ WORKSHALLNOTPROCEEDUNTILTHEINSPEC• PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION TOR HASAPPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE INSPECTIONS INDIBY TEE ON THIS G;)'tD Car:Fe CONSTRUCTION. ARRANGED FOR BY TELEPHt:)NF tHi vdRI1TFP:PERMIT IS ISSUED AS NOTED ABOVE. N()I'IFI(:AIIUN .. - Iv i LL' v i � I � i f • , Y }f. 7 L/ ri 441414,, KCH�ARD IJ r; .BAXTER _ a 24048 O CERTIFIED_ PLOT PLAN LOCATION C�,ti/-r"E��//1��. I CERTIFY THAT T H E oc c�/`�ITYcv./ SHOWN HEREON COMPLYS WITH SCALE / DATE _//_ ;THE SIDELINE AND SETBACK PLAN REFERENCE REQUIREMENTS OF THE TOWN OF AND l S _&/o;/ �rT Z9 LOCATED. WITHIN THE FLOODPLAIN. �� � �� ��' �" �' ��. 7 .- DATE : 1 BAXTER..t NYE, INC. THIS PLAN IS NOT_BASED -ON -AN'. . ' REGISTERED LAND SURVEYORS INSTRUMENT SURVEY- AND THE.-- OSTERVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT-LINES, APPLICANT/ nvaE / 4, . % - `74`ss0'r's map and lot number .....?.(2..7-1.6— : tHF T 0 SEPTIC SYSTEM MUST GE Sewage Permit number ..... r.....................`......: ;NSTALLED 1N CO' MP..IANC p WITH TITLE 0 t EAUSTADLE, House number #J�. / ... ............... ENVIRONMENTAL '° M6 IL 0� O 39- i. Err�YAY \ TOWN € F r s I I PT TOWN ;OF BARNST-C . BUILDING INS Z � APPLICATION FOR-PERMIT TO ............................. � � d4� ..... 1.......... ................................................. TYPEOF CONSTRUCTION ......... ................................... ................................................... • a .................�,�..:..... ..........19.t a ' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ermit acco�'tling to the following information: LocationWL /''^...Ile:. :f... .. ...... ......... ................:...... ........................... � .. ProposedUse .��.. I........................................................................................................................................... E P L)/ Zoning District ........... ............................................................Fire Distric .................`�?':�........`�4�. Name of Owner .1 ....Lr.► ,.....Address �i. � v .................... .... .. ..Name of Builder .. " ..........Address ......Z. -.... `K . ... �.�C-.. Nameof Architect ..................................................................Address .................................................................................... Number.of Rooms .................. ........................................Foundation ............ —:............. Exterior .................. .!. 1.....`- � !2..V ....:..Roofin (, .�'C 4. .?..��!�!�-.... !�l g - ...5.......... Floors PF .............Interior .................c�..l.!"t. . - �� Fiebting ....,/...e./..........................Plumbing ................ .. (... .... ./....::��_.L . :........... Fireplace ........ ...:.......... ...`'.5...:............................................Approximate Cost ....................... ................................... Definitive Plan A 1 pp'roved by Planning Board,_ �___a_________19?/__. Area /� ....� . Diagram of Lot and Building with Dimensions Fee "" SUBJECT TO APPROVAL OF BOARD OF HEALTH V, V i OCCUPANCY PERMITS REQUIRED FOR NEW W WELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............. .... T....... .....',�F�� .......................... � GC Construction Supervisor's License ..�1 .4.. 1.............. ROBERTS REALTY TR. A=207-162 ' I 29182 13� story single o ................. Permit for .................................... family dwelling ............... ........................................ Location Lot #29......59. ....Pheasant. . . . ...Way... . ....... .. . .. .... ..... .. Centerville Owner ...Roberts Realty Trust Type of Construction ......frame .................................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ..........Apri 1„10........1986 Date of Inspection ....................................19 Date Completed .........�. �o................19�� o^ r ire 0 s v