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0110 PHINNEY'S LANE
�,�p r ,. a '-k ;�:� .P x •�r''+0.�t'i ti'.^,` k � � � ,kart f✓ dY ! _ � � - v. �!'''�``'�..� �d yak - - � � it � '+l �'� nisl ..r:, P ��' ,. .;�� �' � v,' � .. ,. c r c n :; .. - '� y...:.�. �a..bN.`'. .... r �.� �,:,N � x e �: � tr, °v '�.. ,;pr ;�' SatCr 'a?.+' t �..u.:_ �?.� ,_'�:. ..' ,�' �' iryry �. . � � r � v �� c � �P ,. t� �.6 ,, ._ r .. �f � � i �a e', y U y"-y ,{� a - .� �,� �- � �. .. v. - [... ._. - � .. C_ .. ..�.. ,� p � _ ., .; _ ., 1I r - o e. �. I � ,. .. y �..�� n p ..r� a �i �.. F � .. � .. �� � � V ,. `... ,'I C � �n .. _ _ _ x - _, ., � � � - � .' ., � � � i. e� .. ' . - o � .. T o .. ., .. Y .. o � .. v' o - . p ,. _ - a 0 a . . a . a ,. h TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION .. TOWN OF BARN TT.L.ul. Map ° 2 Parcel_ Application Health Division 1�1 A bate►s 2 ued I S` I Y Conservation Division Application Fee D Planning Dept. -- ------per mrrit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner_ G ze Address Telephone Permit Request 7' 5�n`ge& Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,/l1' Construction Type � lob/ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ...V Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes YNo On Old King's Highway: ❑Yes s'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 ❑ now size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ���1 �.�lJv� J��� Telephone Number Address ,/ � ,vD "le License # _ A0Z9 q �� � grty Home Improvement Contractor# Email Worker's Compensation #41a", z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Id SIGNATURE DATE / �`� ;a FOR OFFICIAL USE ONLY APPLICATION# i1 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME INSULATION 4 FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FjNAL BUILDING 4 t. D'A -CLOSED OUT A$SOTION PLAN NO. it } I OWNER AUTHORIZATION FORM: Ye,s87P14 A . M'A'AxDR..G (Owner's Name) i . owner of the property located at (Property Add ss) (Property)A dress) hereby_authorize [_.:& i C (Sub ontractor) an authorized subcontractor for.RISE Engineering;,to act on my behalf to obtaln a building permit,and to perform,work on my property;, QwnerVign.ature - Dat® ' �-- i , t is i r M.assachusefts -DepaP'tn4nt of 1pblic Safety { Board of Buildi6g Regulations ed Standards. . 1 Construction Supervisor. License: CS-100988 .„ 1 1 S HENRY E CASSID'Y T $SHED ROW k WEST YARMOUr10EI Expiration Commissioner 11/11/20115 F Office of Consumer Affairs and Business Regulation" 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 } _ Home Improvement'Co4tr4rtor.Registration d l Registration: 153567 Type: Private Corporation Expiration: 12/15/2014 Tr# 233831 CAPE COD INSULATION INC HENRY CASSIDY , m ti 18 REARDON CIRCLE 1 r -- ----- --- SO. YARMOUTH,,MA 02664 5 i Update Address and return card.Mark reason for change. Address Renewal Employment r �, Lost Card SCA t'Co 20M-05/11 1.411 ((oft/Kwl{cjw6leal'x'1o1&CJJCGC1ueje1M ' � Office of Consumer Affairs& Business Regulation License or registration valid for indlvidul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 8istration" " :153567 Type: Office of Consumer Affairs and Business Regulation xpiration: 12/1-5/20.1:4 Private Corporation 10 Park Plaza-Suite 5170 t : Boston,NIA 02116 CAPE COD INSULATION,,,,I�JC ki s � HENRY CASSIDY 18 REARDON CIRCLE SOINARMOUTH, MA 02664 f- Undersecretary Atvwitho t Wnatree j . , L , i , The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations W R d I Congress Street, Suite 100 o� 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): Address: City/State/Zip: _56 UA GlV WLou r n Phone#: Are you an employer? Check the a ppropriate box: Type of project(required): 1.❑ I am a employer with 2r-2 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 many capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.x d.uire re - 5. ❑ We are a corporation and its 10:0 Electrical repairs or additions required.] officers have exercised their. . 11. Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work ❑ g P myself: [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c, 152, §1(4),and we have no employees. [No workers' 13. Other I(i171 comp. insurance required.] *Any applicant that checks box#I must also fill out the section below-showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. . I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �Wy� G�/U�'�UT kPolicy#or Self-ins. Lic. #: �C ��2 r'I 0 Expiration Date`. t Job Site Address: City/State/Zip: G Attach a copy of the Workers" �', _compensation policy declaration page(showing the policy number and expiration date). Failure tosecure 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 forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ify the pains and penalties of perjury that the information provided above is true and correct. a nature: Date: " ' i I , . l f Phone#: r Official use only. Do not write in this area,to be completed by city or town official.' City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4:Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 5¢y CAPECOD-27 CVANGELDER I A�OO��w DATE(MM/DDIYYYY) y; CERTIFICATE OF LIABILITY INSURANCE 41112014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS yt CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Cape Cod Commercial ROgers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 IAJC.No.Ext: /uc Nod ($77)816-2156 South Dennis,MA 02660 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE _ NAIC it _ INSURER A:Peerless Insurance Company INSURED INSURER B:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER C:Evanston Insurance Company 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,'MA 02664 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. INSRDDL SUBR - POLICY EFF POLICY EXP - - LTR TYPE OF INSURANCE POLICY NUMBER IMM/DD1YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -'AGE TO R CLAIMS-MADE OCCUR CBP8263063 04/01/2014 04/01/2015 pi E ES E ENTEDa occurrence $ 100,00 MED EXP(Any one person) $ _ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY PRO- C] JECT: LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER! $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ _ Ea accident IS ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2016 BODILY INJURY(Per person) $ ALL OWNED rx), SCHEDULED AUTOS AUTOSBODILY INJURY(Per accident) $ 1,000,000 X HIRED AUTOS NON-OWNED' PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB • X- OCCUR - EACH OCCURRENCE $. 1,000100 C EXCESS LIAR CLAIMS-MADE RIO XON.1453512 04/01/2014 04/01/2015 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate $ 1,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY - STATUTE ER D, ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCA00525904 06/30/2013 06130/2014 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED9 ® N/A — (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yyes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,.may be attached If more space is rerjulred) Workers Compensation 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 EVIDENCE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE. DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Town,of Barnstable *Permit t� Expires 6 moon t rom&we ate : Regulatory Services Fee *' seansresrXMASS t 1639. Richard V.,Scali,Interim Director - Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 026.01..... www.town'.barnstable:ma.us ice: 508-862-4038 . _ Fax:;508-790-6230 - JAN AD SS PERMIT APPLICATION — RESIDENTIAL .ONLY Not Valid without Red X-Press Imprint Nit � /t Property Address /' �.D �� t'�,lNe s G eAt Jer-il-i ll- i¢ ©.7-(3.2- VResidential Value of Work$ /AA i J,S'S Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address f4S�DIrA/?�art� /I D 1?411ilUey'3 AN Badervilla lq,4 0,74j? Contractor's Name CAPE CoD� AlAkA1 Telephone Number SOS-398-6o3 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) IT EilWorkman's Compensation Insurance , Check one: ❑ I am a sole proprietor 0 p ❑ I am the Homeowner D I have Worker's Compensation Insurance Insurance Company Name �C1i�'1- -✓!�/ Workman's Comp.Policy# 4)(-C: 5 000 Y3- 1L Copy of Insurance Compliance Certificate in accompany each permit. Permit Request(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 ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors:. [Smoke/Carbon Monoxide detectors 4 floor:plans marked with red S and inspections required. Separate Electrical&Fire Permits-required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner.Letter of Permission. A copy of the Home Improvement Contractors License&Construction.Supervisors License is re ed. SIGNATURE: T:\KEVIN D\Building han,!.,xPRESS PERMIT�EXPRESS.doc Revised 061313 9 ,m vr SMO KE DETECTOE�IE ►ED I DING DEPT. DA ----,_ _:'_ FIRED _..... -- _ ,_..._ _ _. - EPARTMENT- ROT.H SIGNATURES ARE RED IREU FOR PERMITTING -- - - _. _.. -- _ . --- - S y ATTENTION: ----- -- ---MA ACHUSELTS_LA REDUIRES —� CARBON MONOXIDE DETECTOR --- -- -- ALL RESIDENTIAL DWELLINGS. -- -- --- IN ADDITION TO THE FIRE ALARM 1 - --- - - -iN&PEGTION,-THE_INSTALLATION_OF L.__. -- -_ _._ Q . CO DETECTORS, IN"ACCORDANCE r _WITH 527 CMR 31.00 WILL BE. §�/ . Combo VERIFIED hRIOR 10 S-*Ntta-THE-- -- ;roy -- - _ BUILDING PERMIT ---- - ------------------ - • { � I .L OFTNE Tp� • MRNSUBLE, "�: ,�� Town of Barnstable 'Oren Mai" Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property hereby authorize HOC 60 Gf /1,41f El to act on mp behalf, in all matters relative to work authorized by this building permit application for: (Address of jot) igna re of Owner Date L Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QVIPFILES\FORMS\building permit forms\EXPRESS.doe Revised 061313 Town of Barnstable Regulatory Services '70 THE Tp Richard V. Scali,Director .Building Division BARNSTABLE, ' Tom Perry,Building Commissioner MASS. . Q� �e39. 200 Main Street, Hyannis,MA 02601 pTfD MA't A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMP ION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/tow state zip code The current exemption for"homeowners" as extended to include ner-occupied.dwellings of six units or less and to allow homeowners to engage an individual for hir who does not possess license,provided that the owner acts as supervisor. DEFINITION O HOMEOWNER Person(s)who owns a parcel of land on which e/she resides or' ends to reside,on which there is,or is intended to be,a one or two- family dwelling, attached or detached structure 'accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be consider a homeowner Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she sh 11 be res onsible for all such work performed under the building permit. (Section 109.1.1) /I The undersigned"homeowner" assumes responsiblh for cornpiiance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she un 'rst ds the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will compl w" said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing ,000 cubic fe t or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeow er performing work\for which a building permit is required shall be exempt from the provisions of this section (Section 09.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such k,that such Homeowner shall act as supervisor." Many homeowners w o use this exemption are unaware that the are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervi rs,Section.2.15) .This lack of awareness often results in serious problems, particularly when the homeowner hires unlicens persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. he homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,, any communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 CAPECOD-54 DEATON ACORO" DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 11/21/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain.policies may require an endorsement. A statement on this certificate does.not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Ann Pell,CIC,CISR Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134IA/C.No Ext: A!c No):(877)816-2156 South Dennis,MA 02660 E-MAIL ro ell ADDRESS:a P @ 9ersgray.com INSURERS)AFFORDING COVERAGE NAIC# INSURERA:SCOttsdale Insurance Company INSURED INSURERB:Arbella Indemnity Insurance Cape Cod Alarm Co Inc. INSURER C:Associated Employers Insurance Co. 11104 204 Old Townhouse Road INSURER D: West Yarmouth,MA 02673 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. ILTR TYPE OF INSURANCE DD B POLICY NUMBER MM/DDY� MMlDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE a OCCUR - CPS2021103 09/01/2014 09/01/2015 PREMISES KLNI hU occurrence) $ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ]JECT ❑LOC -PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ s Ea accident B ANY AUTO 1020005044 09/01/2014 09/01/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ 1,000,000 X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS $ Per accident $ UMBRELLA LIAB X OCCUR A X EXCESS LIAB CLAIMS-MADE XLS0094406 09/01/2014 09/01/2015 EACH OCCURRENCE $ 3,000,00 AGGREGATE $ 3,000,000 DED X RETENTION$ 0 $ WORKERS COMPENSATION - _ AND EMPLOYERS'LIABILITY - X STATUTE -ERH C ANY PROPRIETORIPARTNERlEXECUTIVE YIN WCC6006433012014A 09/01/2014 09/01/2015 OFFICER/MEMBER EXCLUDED? N I A E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Installation and monitoring of security systems Certificate holder is provided additional insured status with respect to general.liability when required in a written contract or agreement CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Wiring Inspector ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main St Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD u y, 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/Electric ans/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): CAPE COD ALARM CO., INC. Address: 204 OLD TOWNHOUSE ROAD City/State/Zip:WEST YARMOUTH, MA 02673 Phone#: (508) 398-6316 Are you an employer?Check the appropriate box: Type of prof ct(required): 1. ✓❑ I am a employer with 30 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 shipand have no employees These sub-contractors have 8. ❑ Demol'tion working for me in any capacity. employees and have workers' comp. insurance.# 9. ❑Build' g addition [No.workers' P•orkers' comp. insurance required.] 5. ❑ We are a corporation and its 10.❑ Electrical al repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11. Plumbing ❑ I g repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof r atrs insurance required.]t c. 152, §1(4),and we have no ��y , , employees. [No workers' 13.[rOther�J aj�,s �L1.5 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 anew a�tithose davit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or n 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.Associated Employers Ins., Co. Policy#or Self-ins.Lic.#: WCC5006433012014A Expiration Date: Sep ember 1, 2015 Job Site Address: /l 0 ,P4,,VN e y f IN City/State/Zip: jC ett rV1P A 0263d2— Attach a copy of the workers' compensation policy declaration page(showing the policy number ind.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 RK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of p rjury that the information provided above is trh a and correct. Signature:, Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector.5.Plu inbing Inspector 6.Other Contact Person: Phone#: • , • • �a ����'�,��mod, �., Fold,Then Detach Along All Perforations I � ONdMON1N'EA1LT�1`OF IV9 a d-e� I ® ® IVVQ/iE4 LTFi�{0 �i1A a IMI� ® e '11, ELECTR I C I•ANS j.W.BOA OrZ i SSUES l Hlr FOI.LOWI NG L 1 CEi�ISE I,EC`CKI C1 ANS 1. I5SUS' TH FOL S A I#EU i 5TT itEb SYSTrrM CON,tRAG70 Is ,,A"" {LO,WI NG 1,i CN5 A Ft1K1 l S TEiEb SY5t�M TECFIN 1 G I,AN CRP1 COD ALARM CO I NC 1 �4 u1 GI`NE A C:QRMtR., GI'NC A CORMI ER + z. 204 OLU OWNH0 SE. (�I1 1I cW .Pj i dJ 1 j � V'... .:. .... 9�MARGATE ��� t + 1 5 YARMOUTH �A 0267� 153fi; , 159�y C 0oUTH' �lNI$ /3�/16 5� DE 54 MA �z66o 66fi �•� 1507 51�IU1 Pf"13 i uvCommonwealth of Massachusetts Department of Public Safety keurih'ticvlrms-ti-l.imnsc License: SSCO-000248 GENE CORMIER 204 OLD TOWNHOUSE RD W YARMOUTH MR, e Commissioner Expiration: 11/07/2016 *'AMA11119gy, SERv1dxq And IVIOiVII' owivg-of SC-CURhY, RUE, ANd-CCTV.SysTEus- ('08) W8,6316 * (800) 16&000 FAX: OMCE 004398.5666 * FA7C: CENTRAL.STATION 008)760-20]Z MA UcENsE No. V92C TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r Map Parcel ' ••., .:Applicatio:n Health Division Date Issued Z' Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan.Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address ® M C I ' Village(,l 1t e('✓1) e, Owner r -6 rc, Address I& e Telephone 3- 0. — W Permit Request _PevaNlr zt, e Aazem _rAdzAks �N Ae �l eI'GtTi iDr�,S ,�er' Vt. =41 e.-, LiGS. 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 Arealk r. _ P"W� Number of Baths: Full: existing new Half: existing ' _ -new Number of Bedrooms: existing _new a .w r'? Total Room Count (not including baths): existing new First Floor Room Coin r Heat Type and Fuel: ❑ Gas XOil ❑ Electric ❑ Other Central Air: ❑Yes )(No Fireplaces: Existing New Existing Wool/Coal stzw des ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name -,�. �6C1'She�S � Telephone Number (5V 6�vU Address AOAv License # 11�1 e Home Improvement Contractor# Worker's Compensation # (1 (/&t f 73� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO AI&44 das&,_ tvn+u I n E!I' SIGNATURE DATE 11h I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER w DATE OF INSPECTION: - FOUNDATION ` FRAME 512�jv " INSULATION 0IP- FIREPLACE ELECTRICAL: ROUGH - FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL •- - FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. *� The Commonwealth ofMassachusetts Department of Industrial Accidents l Office of Investigations 1 600 Washington Street f Boston MA 02111 www.nlass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber Applicant Information Please Print Legibl Name (Business/organization/Ind ividual): ��A ;(($11�� Address: GcrS p City/State/Zip.n rV► A f �� Phone #: .��g_ Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with_y 4 ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7: Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working forme in any capacity. employees and have workers' 9 ❑ Building addition. [No workers' comp. insurance comp. insurance.$. 5. required.]. [] We are a corporation and its 10.❑ Electrical repairs or addil 3..❑ officers have exercised their 11.❑ Plumbing repairs.or addil I am a homeowner doing all work. myself. [No workers' comp. right of exemption per MGL l2.❑ Roof repairs insurance required]f c. 152,§1(4);and we have no q ] employees. [No workers' 13.❑❑ Other comp. insurance required,] *tiny applicant that checks box 41 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. iContractors 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job sik information. Insurance Company Name: 1r6l H c ns, Lic.#:_ Expiration Date: Policy or Self-i #, Job Site Address: e L4► e- City/State/Zip:(fin 11 Attach a copy of the workers' compe sation policy declaration page.(showving the policy number and expiration dat Failure to secure coverage as required under Section 25A of MGL c.' 152 can lead to the imposition of criminal penalties o: 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 of up,to $250,00 a day against the violator. 'Bc 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 certi and r thepains andpernaldes ofperjury that the informationprovided above is true and correct c Signature: A. Date: Phone.#: Official use only. Do not write in this area, to be completed by city or town offcidl City or Town: PermiULicense # Issuing Authority(circle one): 1, Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S.'Plumbing Inspector 6. Other y . Information and Instructio-ns Massachusetts General Laws chapter 152 requires all employers to rovide workers' compensation for their employees. Pursuant to this-statute, an employee is defined as "...every perso in the service of another under any contract of hire, express or implied, oral or written." An emp�er is defined as``an individual, partnership, associ ion, corporation or other legal entity, or any two or more of the for\ omg engaged in a joint enterprise, and including e legal representatives of a deceased employer, or the receiver orr trustee of an individual,partnership, associatio or other.legal entity, employing employees. However the owner of a �welling house having not more than three ap tments and who resides therein, or the occupant of the dwelling ho se of another who employs persons to do m intenance, constriction or repair work on such dwelling house or on the gro ds or building appurtenant thereto shall of because of such employment be deemed,to be an employer." MGL chapter 1 2, §25C(6) also states that"every st to or local licensing.agency shall withhold the issuance or renewal of a lie nse or permit to operate a busin ss or to construct buildings in the commonwealth for any applicant who h s not produced acceptable evi nce of compliance with the insurance coverage required." Additionally, MG chapter 152, §25C(7) states " either the commonwealth nor any of its political subdivisions shall enter into any contr ct for the performance of p tic work until acceptable evidence of compliance with the insurance requirements of this hapter have been present to the contracting authority." Applicants Please fill out the worke ' compensation idavit'completely, by checking the boxes that apply to your situation and, if necessary, supply sub`-con actors)name ), address(es) and phone numbers) along with their certificate(s) of insurance. Limited Liabili Companies LC)or Limited Liability Partnerships (LLP) with no employees other than the members or,partners, are no required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is requir . Be ad ised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of suran coverage, Also be sure to sign and date the affidavit.. The affidavit should be returned to the city or town at th application for the permit or license is being requested,not the Department of Industrial Accidents. 'Should yo ha e any questions regarding the law or if you are required to obtain a workers' compensation policy, please call t Department at the number listed below. Self-insured companies should enter their self-insurance license number on appropriate line. City or Town Officials Please be sure that the affidavit co Mete and printed legibly. The Department has.provided a space at the bottom of the affidavit for you to fill o in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pe it/ticen e number which will be used as a reference number. In addition,an applicant that must submit multiple pe it/license pplications in any given year, need only submit one affidavit indicating current policy information(if necessa ) and und, r"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has be n officially stamped or marked by the city or town may be provided to the applicant as proof that a vali affidavit is o file for future permits or licenses. A new-affidavit must be filled out each year. Where a home owner o citizen is obta' ing a license or permit not related to any business or commercial venture (i.e.. a dog license or permit t burn leaves et .) said person is NOT required to complete this affidavit. The Office of Investigations ould like to tha you in advance for your cooperation and should you have any questions, please do not hesitate to_give us a call. The Department's address, to ephone and fax nu m er: The Com nwealth of Massachusetts Depa.rtme t of Industrial Accidents 0ffic of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617,-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24707 www.mass.gov/dia ENERGY CON SERVA'x'ZON APPLICATION FOR FOR ENERGY UVICUCIENCY FOR O AM TWO AM MY DEV CHEb RESZ7.7E1`tTZAS� CONSTR(JCTYOI� (780 CIYCR 61.00) � � Site Address; Applicant Name_ "Ile print Town: I Applicant Phone. 36 Applicant Signature: Date of Application: NEW CONSTRUCTION: choose ONE of the-following two'o tioas 780 CN R TABLE 6107.1 PRES CRZPTXVE ENVELOPE COMT ONENT CRITERIA FOR NEW ONE- AND,TWO-FAIY.CCL•Y BUILDINGS MAXIMUM Maov1UM Ceiling or . Slab Option l: Basement Fenestration eXposed Wall Floor Wall 1'erirneter AF.U-g FTSPF U-factor floors R-value R-Value R Value R-Value and De th R=Value National Appliance-S R-10, Consc yaUon Act(N/ 35 R 3 8 R 19 R-19 R-10 ft • 1997 as amended,mh calcr as a licablc Note: This form is not required ifyou choose either of the two versions of REScheck as fisted bc1oW. Optibn 2: REScheck Version 4.1.2 or latex variant software analysis must be completed 780 CMR 6107.3.2 REScheck--Web which caa be accessed at htt6://www.cnnrgycodt-,S.goy/reschre6 �;D�ZZ OlVS OR AT,T RATXOI`�S.TO E�[STING BU 11DZNG3,,.O SCR 5 FEARS OLD *buildings under 5 years old must use option 91 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wa11 & Ceiling Area equals Formula: (100 x b = a) SF 100 x _ % of glazing (b).Glazing area equals . SF If&zing j.s< 0%.ire the chart below, If lazing is } 40 % rgce; •d to "SUJI ROOM' section 780 CAM TABLE 6101.3 PRESCRIPTIVE ENVELOPE COW ONENT CRTTERIAADDITIONS TO EXISTING. LOW-RISE RESDOEJ�TIAL PU DINGS M.A X24UM Ceiling and Slab Per Fenestration •Wall Floor ;!R- ent Mall R-Va Exposed floors R-Value R-value Value U-factor R-Value and D ,39 R-37 a R-13 • R-19 10 R-10, EL R-30 ceiling insulation may be used in place of R-37 if th•e insulation achievn the full R-value over the entire ceiling area i.e.noncom ressrd over exterior Walls, and including any access o rains • ' SUINROOM—An addition or alteration to an existing building/dwelling unit wherathe to glazing area of said addition exceeds 40%'of the combined gross wall and ceiling axea of addition.. Note: Owner to, 511 out CorisumerIn ormalion Form found in A endix 120,P ��la ons an Standards Xaro Building R Place Ce _ Room 1301 One Ashburton Boston. Massachusetts 02108 . Home Improvement Contractor Registration Reqistration: 141078 Type: Private Corporation 261850 Expiration: 1162010 E.A. BARSNESS E CO.' INC. ERIC BARSNESS 54 ANGUS WAY CENTERVILLE, MA 02632 Marl` eut for change Update Address and return card. Address _ Renewal = Employment _ Lost Card b pPS-GA1 0 5W-07107-PC8as0 � Board of Building Regulations and Standards License or registration valid for indieul use only t r HOME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: Board of Building Regulations and Standards Registration: 141078 One Ashburton Place Rm 1301 ExPlraEi ; 1/6/2010 Tr# 261850 Boston,Ma.02108 19 ?Type: Private Corporation E.A. BARSNESS&CO.,INC. ERIC BARSNESS — 54 ANGUS WAY *iot valid without signature CENTERVILLE,MA 02632 Administrator! =3/2/109:41 HIC Registration,Complaints The Official Website of the Office of Consumer Affairs& Business Regulation (OCABR) Mass.Gov Consumer Affairs and Business Regulation Home > Consumer > Housing Information > Home Improvement Contractor Program > ......................°...................................................,................................,........................................,..............°...............................,......................................................... :...,....................,......,.. HIC Registration Complaints Registration# 141078 Registrant E.A.BARSNESS&CO.,INC. Name ERIC BARSNESS Address 54 ANGUS WAY City,State,Zip CENTERVILLE,MA,02632 Expiration Date 1/6/2012 Status n No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search ©2010 Commonwealth of Massachusetts http://db.state.ma.us/homeimprovement/licdetails.asp?txtSearchLN=41722 Page 1 of 1 r EIG Fax Server 11/16/2009 9: 19 : 12 AM PAGE 2/003 Fax Server ACORQM CERTIFICATE OF LIABILITY INSURANCE 09/06/2009 08/06/2009 PRODUCER (80.0)333-7234 FAX THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Z33 West Central Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick, MA 01760 Regina Fernald INSURERS AFFORDING COVERAGE NAIL# INSURED Ea Barsness & Co Inc - INSURER A' Berkley Excess 54 Angus Way INSURERS: American International Group Centerville, MA 02632 INSURERC: INSURER D: INSURER 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MMIDDIYY AT MMIDD LIMITS GENERAL LIABILITY NC861738 02/07/2009 02/07/2010 EACH OCCURRENCE $ 100000 TCO, MERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 10000 - CLAIMS MADE OCCUR MED EXP(Any one person) $` S00 A PERSONAL&ADV INJURY $ 100000 GENERAL AGGREGATE $ 200000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 200000 Fxl POL ICY n PRCT O- LOC JE AUTOMOBILE LIABILITY - - COMBINED SINGLELuIT $ ANY AUTO (Ea accident)ALL OWNED AUTOS - - BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) . GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO - OTHER THAN EA AGG $ AUTO ONLY: AGG $ _ EXCESSIUMBRELLA LIABILITY - EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE - RETENTION $ _ - $ WORKERS COMPENSATION AND WC6387325 08/02/2009 08/02/2010. X TORYSTATU LIM. OE H EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ - 10000 OFFICER/MEMBER EXCLUDED? _ E.L.DISEASE-EA EMPLOYEE $ 10000 If yes,describe under - SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 50000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS.ADDED BY ENDORSEMENT SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE,ISSUING INSURER WILL ENDEAVOR TO MAIL O3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, TOWN OF BARNSTABLE BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 MAIN ST OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ' HYANNIS, MA 02061 AUTHORIZED REPRESENTATIVE Ronald itl eaves/REF1 ACORD 25.(2001/08) FAX: (508)790-6230 _ ©ACORD CORPORATION 1988 !Massachusetts - Department of Public Safeth Restricted to: 00 . Board of Building Re�ulatiom and Standards 00- Unrestricted Construction Su 1G-1 2 Family Homes pervisor License License: CS 79883 Restricted to. tm _a ERIC A BARSNESS Failure to possess a current edition of the r' Massachusetts State Building Code ANGUS WAY is cause for revocation of this license. CENTERVILLE, NIA p2632 . Y Refer to: W W W.Mass:Gov/DPS �. Jam- �s Expiration: 8272011 (ummissi++ner Tr#: 20501 4 iT x �: •M• : . ... es¢s` .. :: Town of 8arstab � RC i>i�arO ',�t�l V1CS g �'3' Ttiomas E t3edcr'Duectoe u>fld�ug Ihvis>ton : .: Thomms>PeeYy,..;. , . {.. BuildWs Com mfissioner_. .. 20t}Main Street; Hyann�,MA 02601 .. ': .. www.townbarastebte ma.us - ... . . OV6 5U8=862AO38 Fux .50$7't0-6230 ..... �. , PtrO (' C Omer Mus# : PY Complete°and Sin Thrs Se�iiox. f tTs A,Bu>'1de�r . .. _ _ . .. _ . . . - ;T, �� Gr . c 1 1 ,as Owner Uf the su ,,- ptopczty .. ..._ herel p authanrc :� E3ficl�hC 3 t3[ ` ISnCSS�6 to act nn rn�behalf, : . in Il:matters;relacnTe ru aatk au, ''onzcd.b�thrs buildictg perrmt 3pphcation fox:: /! � '� n tAaa> f O : _. . .... . .. _ .:: . S' iaturc ref O�neic llate vie . . Print I*1 .; .. If Property Owner is applycng far perm►t:please complete hpe meotvners Ltcease Exemp ton p'onn... the reverse side.:::: .. _ .. .. .. . ., C ltfscratdcsnll 11Appt)atatGocallblicrAsuftl�Vm E6wsiTriupurary tnl�mct FilcslCdnte�u I I..r r otcl. r 1�C }1t. ,&.&.CS5 dflc Revised 04t) 09 .. .. _. . ... _ .. . . _ . _ .. 10 a 4V C' i eC( r G O2efu"'CS Srl 8'2' I t V` tv F---J d---1 - ee I 3 ,I a�annerrr r —_ —rr to ---- SMOKE DETECTORS REVIEWED z 6 2 ' A BUILDING EPT. DATE FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING 26 6- Basement 10010050 1/29/2010 Page: 6 flo �'h �� neYs M.iin Level lnGW�� G su���oor- � P5 Ond . - ,,-A ems) c ,]2'---.'--' f --is 51-- 1 007 i q V Ac e t/ / o L � I ✓ ; o Doors d2'2'--1 KrTCHEN 2 2'--1 L Y. ,a'9 T �� rh ��bI too '' 1-7.2.. 7.,. 21- T 4 7 io- 2.,..-4 - CLUSH(11�° . 9. 1 - - ' f{foNT BORM. 6ALKHQB[3 - F-- 10010050 1/29/2010 Page: 7 2-,-id,Floor 1! � I 2 10- ;6,2" -ail 1' Y ra�e a�f Suvl-�oor - �!►�� b �, 1. �x�� IM �-� 5TeR RORM _ AIIlCl111 f�Awels) Floo r j� S ter' G 5 (Wherc- re mo'��� 1 _ /� S tat T 'e" �D eX 05e oar► a.°.._ 2•�•� ; 1/�/0 �'- �•I[/��� ..(,/. Ili 6'.. °.°. (ram-CO 6 g- AIN . �1 ATTIC'(I) - - AI]IL — SIDE eoxel - 1---- - —26.6, - - 10010050 1/29/2010 Page: 9 _ i r � t►,E7 Town of Barnstable P � *Permit# 5 s I .2 Expires 6 morom issue date = XAM Regulatory.Services Fee 9�b3.619. .0� Thomas F.Geiler,Director ''lFo rut� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 �� - • Ulm: 508-862-403 8 ax! 508-790-6230 JUL l 8 2405 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Yalld without Red X-Pressimprint TOWN OF BARNSTABLE parcel Number 12©q (!)5 , arty Address ------------ esidential Value of Work Minimum fee of•$25.00 for work under$6000.00 er's Name&Address `' p&04 1L � 11��1�f1�P�a� v,� P - "1 •- 1-1R►r -C2—Co3-Q- ractor'sName Telephone Number-Li Z�--l `1 -1 Le Improvement Contractor License#(if applicable)_ aruction Supervisor's License#(if applicable) Q 2(,v Torkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Q I have Worker's Compensation Insurance rance Company Name �� ) P�� 0 o—, -T tg S - ;kman's Comp.Policy# & Cog 5 y iy of Insurance Compliance Certificate must be on file. nit Request(check box) ZIp • �R Toof(stripping old shingles) All construction debris will be taken ❑Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows. U Value (maximum.44) 'What required: Issuance of this permit does not exempt compliance with other.town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. q d. nature 'n=*cxpmtrg 1sc063004 f The Commonwealth of Massachusetts Department of Industrial Accidents OfficeVIIHY 119-711817s 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit S e 'a -kname: *location: 1` \Y1 Y�•(� l S G'\ �_� city P i/NA--(-r phone# ❑ I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job �--- [ ( q x address � ''=fi�� ��:�1�"I:f�� .�\ �'' .�• s.. � �' .,.�'` 's a .r�y''� z� x�.r� city � r 1 d21P5`5 phone t4 insurance cos ohc,# .10 Q I am a sole proprietor,general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: company name. address. z city: hone# � , Y µx 4 o Y: insurance coi h ollc # ..° company name. ��. address. d; Al ', ♦ av a i city: a � � hone# insurance ctr olio ,# } Failure to secure coverage as required under Section 25A of MGL 152 can(cad to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations.of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature f ` Date Print name fk Phone# 7tyo ly do not write in this area to be completed by city or town official permit/license# FiBuilding Department ❑Licensing Board mmediate response is required (:]Sclechnen's Office contact person: phone Department #; FlOther Town of Barnstable P p Regul;atory Services • $ARN5TABLE Thomas F.Geiler,Director . MASS. 16319. n319.�a � Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barustable;maxs Office: 508-862-4038 Fax: 508-790-6230 - _ Property Owner Must_. Complete and Sign.This Section If Using A.Builder. h &aA& , as Owner of the subject property 'hereby authorize.'G'�Z E A U L T to act on my behalf, e relative to work authorized b this buildin ermit application for; mall matt rs y g P . 616 CI'Nr6R V/U 67 M/I (Address of Job) ignature of Owner Date ,T05EPH M/49rO96� j Print Name p:FORMS:OWNERPERMISSION ACORD- CERTIFICATE OF LIABILITY INSURANCE DATE(MMI°°""' ,/2004 PRODUCER ? THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McShea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Osterville, Ma. 02655 INSURERS AFFORDING COVERAGE INSURED Pahl J Cazeault & Sons INSURER A: Llovdls Roofing Inc. INSURER B: r s Insurance 1031 Main Street INSURERC: Osterville, Ma 02655 INSURER0: INSURER 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. INSR TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE MMIOD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1 ,000 ,000 COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE ®OCCUR MED EXP(Any one person) $ L;L034776 v4/30/04 04/30/05 PERSONAL&.ADVINJURY $1 ,000 ,000 GENERAL AGGREGATE $2,000 ,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG . POLICY PE� LOC $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY �I EACH OCCURRENCE $ lJ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND ORYSTATU L M TS ER EMPLOYERS'LIABILITY 7PJUB-0095664A04 08/13/04 08/10/05 E.L.EACH ACCIDENT_$B E.L.DISEASE-EA EMPLOYEE $1 OTHER E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURETO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED RE MA I ACORD 25.S(7/97) O ACORD CORPORATION 1988 a Client#: 19989 2CAZEAULTPA ACORDr. CERTIFICATE OF LIABILITY INSURANCE 0DA 51 105° '. PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling &O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St. PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Western World Paul J. Cazeault&Sons Roofing, Inc. INSURER B: 1031 Main Street INSURER C: Osterville, MA 02655 INSURER D: INSURER 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. POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM DD LIMITS A GENERAL.LIABILITY NPP925580 04/30/05 04/30/06 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED nce $50 OOO CLAIMS MADE 7 OCCUR MED EXP(Any one person) $2 500 X BI/PDDed:1,000 PERSONAL BADVINJURY $1000000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1 00O 000 17 POLICY PRO- JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATLIMU- OTH- EMPLOYERS'LIABILITY --' ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations-performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Paul J.Cazeault&Sons DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 n DAYS WRITTEN Roofing,lnc. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1031 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Osterville, MA 02655 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 #M38166 L31 0 ACORD CORPORATION 1988 glz'eB oar0d of Building Regulat'ons an tan �ars�� One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement iCion,tractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2006 PAUL J. CAZEAULT & SONS, INC J' Paul Cazeault 1031 MAIN ST ' OSTERVILLE, MA 02658 Update Address and rcturn.card.Mark reason for chang 11 Address 0Renewal Employment C1Lost Card DPS•CAl Co SOM•04/04•G101216 ✓/ eweal(/ Board of Building Regulations and Standards HOME IMPROVEMENT IMPROVEMENT CONTRACTOR License or registration valid for iudividal use uulN. ... Registration:. 103714 before the expiration dale. 11•Ibuud rrluru to: Expiration:,7192006 Board of Building Regulations and Sl:uidards Onc Ashhurtou Place Rin 1301 ,Type Private Corporation 13is1,,,, NLi.02108 PAUL J.CAZEAULT;&.SONS,INC' . Paul Cazeault 1031 MAIN S7 � OSTERVILLE,MA 02658 Administrator i ✓�++ �Oovi+oi�usuuer /�;flur�rwe(!d rl�! BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 026325 Birthdate: 10/20/1959 Expires: 10/20/2005 Tr.no: 8603.0 Restricted:. 00 PAUL J CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 Administrator Board of Buildin egulations .. ' One Ashburton Pace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LIPENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 10/20/200.5 Restricted To: 00 PAUL 1 CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 " Tr.no: 8603.0 Keep top for receipt and change of addrP-ec.nnf:fir #., _h � ; ` .7As`sessor's map and.lot number .. ...,0..�..-.... 2........... E'rH ,.p � of To ' Sewage 'Permit number .......9• -1..�....� ��..................... .............. ^.....y. 11 B>HHSTAII E. i House number ....................... //ll ...: r „ rhea ,t�S.l... Gp 039. e�0 TOWN �OF BARNSTABLE BUILDING INSPECTOR C o,ceurn APPLICATION FOR PERMIT TO ..........................................................::........ ....L�. ................................... TYPE OF CONSTRUCTION (1a0 F2-- ...4/ .....•.......................................... / . ....... 7. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for, a permit 'according to the following information: . Location ..........��.d..............�'1/ Gr'S'......".IV 4--1:.. �.� � .�::. ..: ................... r; Proposed Use .: 1 .... ...4 ........r L ,P.. ............................. ... . ................... Zoning District ........ ..+J......... ..... ........................Fire District ............... � ..... .................... ............. Name of Owner ................<<<. ..............k &. ••••••..Address ........4�.• ... ............................ "� , Name of Builder ....Address ........... lcl. :. Nameof'Architect --`...............................................................•••Address ....................................:.........................'....................... Number of Rooms Foundation .......4.. .....0q 1 ala,. ................. Exterior .......C,` ........ S.P!'�E;44. ...................... Floors �j�,n�� .... // ..............................:.............. .'�6.!.lrl. ..................................................dInterior Yrr Gl.... Fie ating .....k.a••c•...! J. - .... .................Plumbing ....... ...6-1.5................................... . . Fireplace ............� e ........................................................Approximate Cost ........ D ............................ . ..... Definitive Plan Approved by Planning Board ______________________________19-------- Area ...................... Diagram of Lot and Buildingwith Dimensions Fee ``�/.......................... SUBJECT TO. APPROVAL OF BOARD OF HEALTH oua 0 3 ss= lz 5 ,V4, 5� ,col r net OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town arnstable regarding the above construction. Name ........... ................. ................................................... Construction Supervisor's License L COIZITI, GUY No ..26447 .. Permit for :1 z.Story.. g t:Single Fa di y.Dwelling...................... - . _ Location ..110,•Phnney.'.,..Lane...................... = - S .......................... Owner Coletti ....................................... Type of- Construction' ......k'xam........................ l Y. 4 ............................................................-................... Plot . . ...................... Lot y.............................. Permit Granted .........X.......i..........:.........19 84 r.• f { ., f .� .. yr. '.•, !t � ; 4 f Date of Inspection ... 9 J ; Date Completed V... y. .. .. 19 ,? '� try - ,/} • \ - I - J p.•`.' . 44,Y_a✓ �•,� .� TOWN OF BARNSTABLE Permit No. --------_-------------------- _ Building Inspector tu,rr.n, Cash ------_------ _--- � wa OCCUPANCY PERMIT Bond ______-___ �__ ' Issued to Willy C, .•t'• Address F1T)L-V c T:-T1E', (.'.C?glf Wiring Inspector Inspection date Plumbing Inspector ! 1 Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .................................................. 19......_.._ c:............................... ... Building Inspector - FROM TOWN OF BARNSTABl E F r. Mr. Francis Lahtelne BUILDING DEPARTMENT Tbm Glcrk # � � � � � '� *967 MAN STREET HYANNIS, MA 02801 • Phone; 775-1#2a . SUBJECT:' r ` FOLD HERE.. .DATE ; _ .... - .. - OtJt�b ' 24,. 1984 MESSAGE Work hasunder�P6ndt #26447 tQw Cole•tt .?�: Please relea :-Bch ---�..» ., .. •, SIGNED .. DATE_ - REP(Y ' fj N87 RMI - - RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY'` PRINTED IN U.E.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. e 1 - 4 � M1 ll � 4 4 91.9 �, yam+ �9•� 2 Jr.7' d / 4 1 F i Lam: i •d = MAY rst �p�tN OF ,a �Fcst5T�2r=� �1D SLf�/f:`��S cr R16HARD �.� BAXTER y Q �` Poo i e s