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HomeMy WebLinkAbout0016 WASHINGTON BURSLEY WAY �Co t,�,�as i�.� fir, T'ursl � . r Y _ �- � .. .., _ - .. e ,. .. - _ ,. - L �. .a ... . ,. u y a a. ..�.- 0 Town of Barnstable Permit# j6, - 331T .l, Expires 6 monies rom issue date Regulatory Services Fee • ,nxivsrnste. 0 a $' Richard V.Scati,Interim Director Building Division Tom Perry,CBO,Building Commissioner •�" 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us NOV 09 2016 Office: 508-862-4038 _ - ro VVN C Fax: 508-790-6230 N�LyN 'VsTA - EXPRESS PERMIT APPLICATION - RESIDENTIAL O �E Not Valid without Red X-Press Imprint Map/parcel Number -'Z 10 / Property`P.ddress �� � hu r� rcl a y — [`Residential Value of Work$ (2 I R Z — Minimum fee of$35.00 for work under$6000.00 , Owner's Name&Address Fre,�,eo,c f�`�'n S,-A he_ e)I Contractor's Name rV a wS l3RiR,(J!50/� Telephone Number�dl Home Improvement Contractor License#(if applicable) / 7,32 Email: Construction Supervisor's License#(if applicable) 0 TS70 7 AWorkian's Compensation Insurance Check one: "❑-I"am`a"sole proprietor \ I am the Homeowner , .I have Worker's Compensation Insurance Insurance Company Name�,4c0_,0l)fll�l Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles).All construction debris will be taken to • t ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side [ErReplacement Windows/doors/sliders.U-Value O (maximum.35)#of windows s #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 required. SIGNATURE: Q:IWPFILESWORMS\building permit forms\EXPRESS.doc Revised 061313 1 � ri rnon an P mint Terms, WA Meirsen dim RLUWW H!64y?ndmen,of&ud.cm Krw&glwd'. tPnrG&rdi:ardi€hddinw Hae`, t ewillpPam?5-D b dw, n Nees umW6JV4VIYAS tLC. _ - 16Washingtnn uvslev my FU 1360,79i MA 917324S.. MOMS,S, L64d F[rm#1237 onwile-,w onn` l sv �. eaenr A0.b 4M1 LrnWrt €i12865 . . �'�5C3Xt64�11'28' V<I'� a�'a' -,r5f:�-22351 Fxq:401•E33.46 F i�sa ren +.qiSne t ` 'i 9t raeor r'' :i la9�r r ai ru` �', y. 9e1 h r'i u y. . 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Bu,iuw h w'w d zF�i�r tk 1.}his rust of& f " cur,ufnd�r�l nds oi+ q s ofrls + gr � �aa; a�_6 iu j n coor1 A act;d r d ivp, s rm-mr�induft ohe ovam ateartied Noiiccs ofi 4 mAsWoa,"46 dapAmt Wmill'01 z iiidZL ors" Ely ilei tra,di: f B IV. Im,g;lirlg-1 di is; ���arrsree _ .z OWPl.��. 8�ia�.ea[5i�i 6,ra96f9mke nlhim& 1i'6u vcL.-itieutlel YOU,'ME DT_T-E—Rs 'MAYCANUT T'B_I k T����1'f[]iN�k`Or - Y"!�'rM—E_NOT'.L—AXE,T��i�+T I�f�ll G OF 1�' 2416 Oft 1 HIRD BUS1�DMY AM ER T�l�.lD:�'l E OF I l am`-'AJC�'�i N, paeelo� cy :: r _itc�9Eifyhfbst7u'1:i Her • H"oiert it ar75c tsL�.il!u l' isu�ir, . E°im.1'�`bi3ee; : H!i�iii NAudt� Aft ii ••, .q 4 1 }1 ... '--7.� ReGistration: 173245 Type: Supplement Card Expiration: 90 91'2013 SGJ i !ER 1 =�i`/ �Nu AND �r�/� +`�G`��/S-I L SRIAN DENNISON 2a AILglON RD i INCOI N, R 020085 IJndate Address and re-Wn card.Mark reason for c!ian,e. _ Address I — Ejuployment Last Card 8-ration valid:or individual use oWy oe�ore the f air 3usiuess -Orrice o e ularaa eYp on date. Id found re-.era to: IOtUI� IIVI?RO`JE:WEti i DC�sTR ::'OR pface of Consumer,fairs and Business RZ ation 70 plaza-S uslw 5' :2 iS -i �OS�oii._ 11®e . 1' �� _ n ti cl..n., `C iRIAN DENNISON :6 ALBION RD '- Not valid witnoii±sip2ture INCOLN, RI 02865 :—!;�dersecreiary artm•_nt of Publi., safety D �rlassa`-h ,sett, p - r „t'u�•� Soad of Building Regulations and Standards i iCense: CS-095707 -,: MAN D DENNISON 7 LAMBS POND C1RcLE CHARLTON MA 01 07 F . CA, Expiration: Commissliner The zrorrrrrronivealth of Allassaclutsetts Department of Iirdtrstr•ial Accidettts 1 Corrgl ess Street, Srtite 100 e Boston, MA 02114-2017 >. wwmimiss.;ov/dig Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FiLED A-ITH THE PERt1•IITTING AUTHORITY. Applicant Information Please Print Legibly Nam,e (Busincssr'Organizati(in"Individual): 6er CL La3� City/State/Zip: ,[ �itd'v� ' Phone 14: Are you an emplover'!Check the appropriate box: Type of project(required): [.,I I atn a etnDlover with 2r_)-templovees(full andiorpart-tune)_ 7. ❑New construction _.�i am a sdle proprietor or parcrership and have no employees working-for mein 8. ❑Remodeling any capacity.IVo workers-camp.insurance required-1 9. ❑Demolition _ 3.❑I am a homeowner doing all:cork my.,-el`lino:cork8f;`comp.in>*urancc required-] ` 10❑Building addition =L. 1 am a homeowner and will be hiring contractor to conduct all:cork on my pron_rry. I will e air or additions 1 1. Electrical r s � ensure that all contractors either have workers'compensation insurance ar arc sale ❑ p proorictors with no•_tnployees- 12.17 Plumbing repairs or additions 5.0 1 am a genera's cons actorand l have hired the sub-contractors listed on the attached sheet. 13_i❑Roof repairs fiese sub-contractors have empioyees and have workers comp.insurance _ / 6.❑ilia:are a corporation and its officers have--xereiscd their right of exemption per:v tGL c. l�.LiXOther Gt11 n���-�tptrf 1521,§1(4),and the have no employees.iNto workers'comp.insurance required.], re 1xc- ,No,,t `Any applicant that checks box-1 must also Fill out tha section bclov-showing their workers compensation policy information. Hnmeuwners who submit this affidavit indicating the,:are doing all work and then hue outside contractors must submit a new affidavit indicating such. <Contractors!hat check this box must attached an additional slx•ta showing the name of-the sub-contractors and crate whether nr not those critics have atnployces If the sub-contractors have employe-s they must provide their worker comp.policy number. i lain art ettiployei-that ispr•ovidirrg rvorkers'conrpeirsation insurancefor,ratty employee& Belo;%,is the policy andjoh siteZ- infor•mation. 1 Insurance Company dame: Policy 1 or Self-ins.Lic.Y: 3 13 D Expiration Date:_ I / Job Site Address: / G✓ �r n d✓1 t' l e l�J�: City/State/Zip: v4,n7tion eAttach a cop;of the`corkers' compensation policy declaration age(showing the policy number and e date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a tine up to 51,500-00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copv of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby cei b •under thep'bzs and penalties ofpeijwy that the information provided above zs true and correct Signature: Date: Phone7: Official use only. Do not write in this area,to be completed by city or•town official. Citv or Town: Permit/License T Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: - Phone ir: SOUTNEW-01 UOLLINGER =6129121016 OIYYYY) CERTIFICATE.OF LIABILITY INSURANCE 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 IREPRESENTATIVE OR PRODUCER;AND THE.CERTIFICATE HOLDER: IMPORTANT: If the. certifigte holder is an ADDITIONAL.INSURED,.the policy(ios).must be endorsed: If SUBROGATION.IS WAIVED,subject to the terms and conditions of tfie 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): t ACT. PRODUCER ` CoBiz Insurance,Inc--CO EE(3 )988-0446a (303)988-0804 No E 821 17th St CoBizjnsuran cobainsurance.com Denver,CO 80202 ��'. INSU AFFORDING COVERAGE NAIC# INSURERA:ContinentitWestecn Insurance Company 110804 INSURED INSURERS: Southern New England Windows LLC wsURER C: i DIBIA Renewal by Andersen INSURER D: 26 Albion Road Lincoln,RI 02865 wsuRER.E INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW-HAVE BEEN ISSUED TO THE INSURED NAMED.ABOVEFOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING:ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER:D000MENT WITH RESPECTTO 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 BEENREDUGED BY'PAID CLAIMS. INSR POLICY EFF .POLICYEXP..j LIMITS LTR TYPE OF INSURANCE. I INSD I WVD POLICY NUMBER MMMD MMID 1,000,00 A i X ,COMMERCIAL GENERAL LIABILITY I I I I j EACH OCCURRENCE � I I CPA3136080 07/01/2016 07101/201 T PREMISES(Ea ocaarence 1$ 1'.00,0 J CLAIMS=MADE OCCUR j I I 1.0,00 I MED EXP(Arty one person) 5 j I i i 1,000,000 1 PERSONAL&ADV INJURY j S 1 I GENERAL AGGREGATE j S 2;000;00 GENT AGGREGATE LIMIT APPLIESPER:f i 2,000,000 �- PRODUCTS-COMPrOP AGG S POLICY I jEa LOC S 2,ODD,�OD i EMPLOYEE.BENEFi j OTHER_ I COMBINED SINGLE LIMB 7_1I S 1,ODO,ODQ 1 AUTOMOBILE LIABILITY , (Ea-acaderd) A I X I ANY nLrro I CPA3136080 10710112016;0T10112017!BODILY INJURY(Per person)-L s_ —? _SCHEDULED ` j i 1 BODILY INJURY(Per acatleM)1 ALL OWNED 1 PROPERTY DAMAGE g 1 IAUTOS I AUTOS I NON-OWNED I Per acdderd HIRED AUTOS I AUTOS j I 1 I 5,000,000 j }( t UMBRELLA LIAR h OCCUR EACH OCCURRENCE S A EXCESS LIAR CLAIMS-MADE] ICPA3136080 { 07101/2016'07/01/2017 AGGREGATE s Aggregate ;s 5,000,00 I DED I X I RETENTIONS 01 I I i STATUTE ER H WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN CA3136081 07104/2016 107f017209T E.L.EACH ACCIDENT S 1,000;000 A ANY PROPRgrowPARTNER/DCECUTNE NIA; 1,000;000 OFFICERIMEMBER EXCLUDED'? �_J I E.L DISEASE-EA EMPLOY S ((Mandatory in NH) I I 11,000,000 yy E.L DISEASE-POLICY LIMIT s IOESCRIPfION d—b0 der rPERATIONS below I I i DESCRIPTION OF OPERATIONS I LOCATIONS[VEHICLES(ACORD 101,Additlorml Remarks Schedule,may be atfacltert Ir moue space la required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE wrrm THE POLICY PROVISIONS. AUTHOR®REPRESENTATIVE ©J988-2014 ACORD CORPORATION. Ail rights reserved•' ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD TOWN Off`BARNSTABLE BUILDING PERMIT APPI:ICATION Map Parcel BUILDING DBPT. Application # — S Health Division Date Issued Conservation Division AUG 0 8 20% Application Fee Planning Dept. TOWN OF BARNSTABLE Permit Fee Date Definitive Plan Approved by Planning Board e � Historic - OKH _ Preservation/ Hyannis ' Project Street Address _V_1106 6Z d�d$e Village Z :2:� ,i,JI,o Owner Addressi� Telephone ,57 j! -- Permit Request 1W,i V!:��l,L�,�J1®�� /Z ,�3J ���/ 4r2f//ram/b,� i�z,4 r� �.� s� ��- eer-o V4 L1,W1;aY Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 UConstruction Type—AZ1 4 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 AfNo On Old King's Highway: ❑Yes 2'No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name e� c g ,44z,s,is ^,eo�4 Telephone Number v �'��/2 / Address /� ,`�, �d,���L/,�� License # cam/ ; f�3G js Home Improvement Contractor# 7 Email,&LIU�� C,�i°�Z2a 6 ,&zjG`7 2� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATEd7/� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE ^OWNER .l DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of lnrlustdalAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 3v�v}v,1=s,gov1dire ilh \Porkers' Compensation Insurance Affidavit; Builders/Contractors/Electricians/Plumbers, Aticant InformationTO BE FILED WITH THE PERMITTING AUTHORITY, Please Print Le ibI Name (Business/Organization/Individual): Address: Ci /State/Zi ty p Phone #: F2.[] e you nn employer? C eck the appropriate box; 1 � Type of project (required): am a employer with zi employees(full and/or par(•time).'I am a sole proprietor or partnership and have no employees working for me in 7 ❑ New construction any capacity. (No workers'comp. insurance required.) 8. [] Remodeling 3.[]I am a homeowner doing all work myself. [No workers'cornp. insurance required,)1 9. ❑ Demolition i 4.[]1 am a homeowner and will be hiring contractors to conduct all work on m property, i ensure chat all contractors either have workers'compensation insurance or are i will 10 Building addition I proprietors with no employees. I I, Electrical repairs or additions S.Q I ama general contractor and I have hired the subcontractors listed on the attached$heel, 12'❑Plumbing repairs or additions These subcontractors have employees and have workers'comp, insurance)' 13.QRoof repairs 6.[]We area corporahion and its officers have exercised their right of exemption per MGL Q. CE 152,§1(4),and we have no employeps. (No workers'comp, insurance required.) i 4'[,Other Any applicant that checkA box NI must also till out the section below showing their workers'compensation policy information. r Homeowners who submihhis affidavit indicating they are doing all work and Then hie outside contractors mussy information a new affidavit indicating such. IContraciors Ihat check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp. policy number, I am«n enrployer that isprovirling workers' conrpensatc'on insurance foamy errrployees,, Below Is t/tepolicy and job site injorrrralz'otz ~ Insurance Company Name: Policy # or Self•ins. Lic. #: Expiration Date: .(% �. Job Site Address: j ''—`�� --� Attach a copy of the workers' conipon ition policy eclar tion page (Showing the policy Failure to secure coverage as required under MGL Q. 152, §25A is a criminal punishable,Gumber.an byUP to$tion 1,500.00 te) and/or one-year imprisonment, as well as civil violation unshable by a fin penalties in the form of a STOP WO RK day against the violator. A copy d'f.,this statement may be forwarded to the Office of Investigations tgations of the DI ER and a fine f up to$7.50.00 a coverage verification. A for insurance l rlo hereby certify unrler the pains atul penalties of perjury that the Information provided abov - St nature: i e is true and correct. Phone : Date; Official use only, Do.�liot write In this rrrea, to be completed by city or town ofJlclal City or Town Permit/License Issuing Authority (circle one); 1, Board of Health 2, Building Department 3, City/Town Clerk 4, Electrical Inspector S, Plumbing Ins ectot^ 6, Other p Contact Person: Phone g; i. f. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-100988 Construction Supervisor HENRY E CASSIDY. 8 SHED ROW WEST YARMOUTH ^^� Expiration: Commissioner 11/11/2017 1112 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 . Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY -- 18 REARDON CIRCLE - S0. YARMOUTH, MA 02664 Update,Address and return card. Mark reason for change. SCA i :'+ 2OM-0511I [] Address Renewal Employment Lost Card �ie aa�unao�uverr./C/o�C�/�/r!�warcc�ccaeCZi !\ -Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENt CONTRACTOR before the expiration date, If found return to: egistration: 153567 Type: Office of Consumer Affairs and Business Regulation V xpiratlon: ;:;121,1:5120:1.6 Private Corporation 10 Park Plaza-Suite 5170 y Boston,MA 02116 CAPE COD INSUtATIVN:ANC' .. — HENRY CASSIDY 18 REARDON CIRCLE` - \ SO. YARMOUTH, MA 02664 Undersecretary N valid wi ut sign e i CAPECOD-27 CLEDDLIKE AFRO` CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYYY) 7/1/2016 i 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: DeLawrence Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/c No Ext: A/c No): South Dennis,MA 02660 A DRESS:bdelawrence@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company INSURED INSURER B:Safety Insurance Company 39454 Cape Cod Insulation,Inc.: INSURER C;Endurance American Specialty Insurance Company 41718 18 Reardo•n 91.rcie INSURER D:Atlantic Charter Insurance Company 44326 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, T513 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.`LIMIT'S SHOWMMAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR TYPE OF INSURANCE D POLICY EFF POLICY E P LTR INSD WVD POLICY NUMBER MM/DDlYYYY MM/DDlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR CBP8263063 04/0112016 04/01/2017 PUAMAQE REMISES EaoT17517nce $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 LOC X POLICY PRO PRODUCTS•COMP/OP AGG $ 2,000,000 JEOT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO 6232707 COM 01 04/01/2016 04101/2017 BODILY INJURY(Per person) $ ALL OWNED AUTOS X SCHEDULED AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X AUTOS PROPERTY DAMAGE $ Per accident X UMBRELLA LIAB X OCCUR:r �.',EAQH:O.000RRENCE $ 2,000,000 C EXCESS LIAR CLAIMS=MADE EX610006635001 04/01/'2016 •04/011201T AccREcicTE $ DEO I X I RETENTION$ 10;000 Aggregate $ 2,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N E STATUTE' ER D ANY PROPRIETOR/PARTNER/EXECUTIVE WC-00431902 06130/2016 06/30I2017 L :;, 1,000,000 OFFICER/MEMBER EXCLUDED? F N/A :EACH ACCIDENT $ (Mandatory In NH) E.L.DISEASE EQ.EMPIQIE $ 11000,000 .. If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEA$@ POLICY LIMIT.;;$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES' (ACORD 101,Additional Remarks Schedule maybe attached if more space Is required) Workers Compensation includes Officers or Proprietors: Additional Insured status is provided under the General Liability and Auto Liablkl " hen required by written contract or agPedmeht'with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Vah&Hig W.Bujlders THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 94A Corp�IrYferce Park South ACCORDANCE WITH THE POLICY PROVISIONS, Sou�ttr'Chatham,MA 02659'--,... AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD � r Town of Barnstable Regulatory Services. qsA �• Richard'V.Scali,Director Building Division Tom Yerry,'Building Commissioner 200 Maiu Street,Hyanais.-AA,.02601 iyw-w.town.barnstable.ma.ns Office: 508-862-403$ Fax: 508-790-6230 Property Owner Must Complete and Sign This Section:' MJsin A Bui d( z- 7, ,as.Oumer of t]ie subject property hereby authonre C� � -u°�h,,�T,,,N. to act on rnybehalf, in all matters relative to work authorized by t his building permit application for (Address'of Job): Pool fences and alarms are the re-sponsibiliLyof the applicant.P061S are not to be filled or utilized before fence is installed and all final inspections are performed and accepted: 4 Si;nature o Owner SignatuzE of Applicant Z rmt Name Y Print Name - IL A Da s I Q:FOnIS:OU•';MRPERM]SS]ONPOULS i r Town of Barnstable *Permit ' Expires 6 monthsfro!n issue date Regulatory Services Fee 2 5 f Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building CommissionetV �aa 200 Main Street,Hyannis,MA 02601 A® offPERMIT �.,Office: 508-862-4038 www.town.barnstable.ma.us S E P 8 m FaZQ� �- x.9�8-790-6230 EXPRESS PERMIT APPLICATION - RESID %JPFD1**NSTAELE Not Valid without Red X-Press Imprint Map/parcel Number 2 Property Address p Ll s esidential Value of Work `t` C70 0 Minimum fee of$25.00 for.work under$6000.00 Owner's Name&Address WodL4A v✓ Uvj Cck6o lc Contractor's Name UU�/ �� � (� Telephone Numbe 3o fy - Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) '. ❑Workman's Co pensation Insurance r� Chec ne: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's C*ompensatiqn Insurance Insurance Company P Y Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Pemmi Request c box) Re-roof(stripping old shingles) All construction debris will betaken to Y/ t d uLd W`v ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pr erty Owner must sign roperty Owner Letter of Permission. Home p actors License is required. SIGNATURE: I Q:Forms:expmtrg Revise071405 h 5' CT a, z i P.O. Bo1311 508-367-1679 1 i Centerville, MA 02632 <m Fax: 508-790-1856 PROPOSAL UBMITTED TO:! PHONE: DATE- (A S7 STREET ! v �( JOB NAME: JOB#: \ n i.� /I o- CITY,STATE and IP CODE: a JOB LOCATION: �; v1 ARCHITECT: DATE OF PLANS: JOB PHONE: We hereby submit specifications and estimates for: 0\ oe0/0 DU Vsi 4_tl ) ! ` Ve Pupa hereby to furnish material and labor-complete in accordance with the above specifications, for the sum of: � Payment to be made as follows: dollars($ � All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices. Any alteration or deviation from above specifi- cations involving extra costs will be executed only upon written orders,and will become g .ure an extra charge over and above the estimate. All agreements contingent upon strikes, Note:This proposal may be ' accidents or delays beyond our control. Owner to carry fire,tornado and other necessary withdrawn by e: if not accepted within days. insurance. Our workers are fully covered by Workman's Compensation Insurance. affeptance of propool-The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature: to do the work as specified. Payment will be made as outlined above. . Date of Acceptance: Signature: Ok Board of Building Regulations and Standards i HOME IM �yEMENT CONT ;. Re.istraal RACTOR " __. 45356 2007 EMMANUEL - I COI HECTOR SANG 286 STRAWBERRY : CENTEERVILLE MA 02682. E Adininistr-ator i I UU Garr.nr _ /Ov.tsta _ 4 — L."� to �; .,3a G.p.U. SOX ! :, `� ����r`�r'� t'�IT - y��• locx� C�tLL � v�a�T � I V��o vc ToT•AL_ ToTtS t- "C>4-t L�-( h LiD�,n./ t „ LsJuot:z �UF1 S 0fZ �,`IA, .•k I � 1 I o WILLIAM . M C. 1 , o NYE � J ', f ,,/No. 1933 _ ;. V A 7/-1 0/y/�s / 0"k e v?SZ 1, 1�`�+A`/ =5U 77 —r.0 7JJ ���ii Z: >lTi�:TVTiI� i 77iT�--. ii o..° 4' 1-6 Iw. Ga.l.. IWV. i T-AwK --- (bvr) 9518 (�V Ss1VL H\Q. , GAL- LEAS" `c PIT D w n-u ° t) I —V/ASFIEA It `Sroli� �.S 1"tj A T I C) RI CEJQ i G'e\/1 LL E KA � t-tZ T t t~ r t-!A 7 T t t{=- c-tC,��.3 pt'r_�,t`! i�i__r=( r•Y E k�i c C. �-tC.t' �E� li �✓�f't_�(�i W tTI5. Tt-! j1L��= l.iS-1E=- �,.�� , ►= Tom : �- o-r• l U 1 t.IZ- PC.Pt1.,) UrJ1� '..�G PA66 Za- -t �t":+ t7i .P•.F-t I I-!C t i',!'.� (-\",i C i_} r�r..� U �L•L'-V1l_l_i Ci fVrtil, (SJ st'k':_�:.i�{_l.l (- ."�O(;�/'_�' � .�{li:_ I.�f'{-�•ir•l�� `.� tC,C.fi.:r� , t ��,. 1',(,: lJ',: i � tt-i 1�5=}`["=_i_/l•�( �lt_, t_1.� �'• !_, " ' _ -' �'_-,__- .__s._._._-_.__. + i Assessor's map and lot.'number ... :..11 1...�...�.:IG� , SEPTIC SSYStEM MUST 6E ?, iK� a t INSTALLED IN COMPLIANCE SewageA Permit number WITH ARTICLE a J.. �� �... 11 S TAT TOWN OF �BA,RITARY CODEB� �IE ` F THE T �v ''�. PLO . 0�♦O �4 ,a a tia . a STAB E mob Y ,•� Y BUILDING ' INSPECTOR Mp a all u APPLICATION FOft PERMIT TO . m ..................................................................... .... r. TYPE OF CONSTRUCTION `=:.. .......................................................... 7)1 2 i ...... .............19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a per it according to the follo g information: /o Location ..f .. . .... ........... ............... . .............................. . ProposedUse ...... .................... :....................................................... .................................................................... Zoning District ....... . .........................Fire District Name of Owner Gam..:... Address ......... ........... .... Name of Builder ......Address .............. Nameof Architect .................................:................................Address .............................................. .................................... QNumber of Roo .... ..: ......... ... ... ...Foundation .... .............. ................................... Exterior ..... .....................................Roofing ................... .........:....................................................... Floors ..............:.....Interior .......... .... ......... ..................:..................................... .. /.... Plumbing .............................................................. ................... �Z (I �' Fireplace .... ....... .. ...... ............. .... ........ ...... .......:..Approximate:Cost .......r..._....tt:...................................... ...... - G , Definitive Plan Approved by Planning •oard -----------_-_--_-._:__:_---19 --. Area .................. Diagram of Lot and Building with Dimensions Fee0 o7S SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and. Regulations of the Town of Barnstable r didthe above construction. Name .......................................... ................................. Small, Alan E. 9605 one story No ............. Pe"r; ............................... k ' single fdmil dwelling - �,Q rtWaslhiagton'BurnleyWay...... C Location;!. ... .......... �} f lie C enterville ........ w �* 44>2 R+ Ala mall �?` Owner ......... .................... ..... .. .......... r frame Type•of Construction .......................................... ; 0 C ,r- - lY ..A.. •t Ca / to. 7 . 4 �i • C' '� is ................. .......... ryE Y 101 "Plot ...............'-.: ...... Lot ....... .-................................. r_ < Sept ber16 77 Permit Granted' - ......,19 t ' 7 Date of Inspection .(J�. ` / ...19 Date`Completed...[. ! l. i.: a .. -A 19 =PERMIT MEFUSED ......................................... ...... ... .. 19 v ................ ....... � ........... ..j s'-� � i_r �S, yew ..Fr R:. �`.�" s"` QS 4'Y � •t�•4• .^3 ................ ""'3E.................................. . .. y � •a ' �l • r- �f 7 ^t fi 1 Approved ..................................... ... 19 �, ... ...................................................... ........ .: . .................... ..................................... ....... .. Assessor's map and lot number Sewage:Permit number ..C...................s..................................... A FTNETO�♦ TOWN OF BARNSTABLE 9TABL a pYa�e� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... '.......:.:.. =` TYPE OF CONSTRUCTION ... . .... .. ............f. ..... .... ................. ..TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...'=.: .. ' ............................... ......................'4'!::......... � ..:11:............:..:`'...: ProposedUse ......................' .......:r: ............................................................................................................................ t r-• ZoningDistrict ............'...................... .. .....:.r ........................Fire District ...............`............................................................ Name of Owner . ......................- IV . ....Address ....��.: 'v� ...............:................................ — Nameof Builder .........{...............................:.:....................Address .........:.......................................................................... Nameof Architect ..................................................................Address ........../�..'....................................................................... Number of Rooms .`.:�.........................................................Foundation .... "�. t ... .................................. Exterior ......::.....r.r.*....._ ..............................................Roofing ........ � {�.:.`...t. �. .. ........................... .... ......... .. .. ,+ { ,r Floors ......:....�..::: Interior i. ... ' ..........!....... -.n... ........................................................ Heating ..................................`...............................................Plumbing ..............�.................. 1;.!...e� y........................... Fireplace ....................... ..:-...'.'......�:� ............................Approximate Cost .... � . .................................. ..... .... ....... Definitive Plan Approved by Planning Board -----------______-----------19 . Area ...:../.. '7�...:5: Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ti I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r Name... ................................................................................ i Smuall» Alan E. e=172_16= �9�Q� m � No -----.. �/ ---......--. ' dingle family, dwelling � --------.-----.----..--~---.—,. "~= �/ � ton Bunley Way ' � Location --................--.-............—.....---- � Centerville .---.----.----.--.—..—...------- Alan E. Small - Owner ---------------------- � f ranna . Type of Construction .......................................... � ---~—^—..—...--.—.—.--------.--- . � #10l ' Plot ............................ Lot ................................ ^ � ' ' September 16 77 � Permit Granted ........................................ ` � � . � Date of Inspection .......:..:.........................lQ � ~ Dote Completed ...................................... ~ ' � PERMIT RE FUSED � —.-------..—..—.-`.....�------.. lA ' - '--^~----^^----'------^-----'— . , '---~' — —'—^--^—' ........... .~�..�~.------.. , ex ~ . .----.----..�'��--.-----.—~--..--- . ................................................ lA ^ ^ ^---'---'—`^----'--'--'^------^'' � ----'------^^--^^^`----^'-'—~^^^^ | � ��