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0040 CRAWFORD ROAD
�r ,,, . , I is � e �. I. r:3• Y .�r,U �:., it _ `r . ,. .. �. r. �� ., � .� ��ti' r .. •4,. t• �� f rr��:l ,�rY t i; •71+r tk+ ,�" I,ral a �rr�41r ;, � 9Y .�'�"r�{t ti}�il, "il ! �' fl ., r1, ,�' 't' �G rP r r u + o ! ,eU� t •�:r + R at!(f.. a�. L i t. {. r +! ,.,dr *�r, n .. 1 Y('�+' . t�-r .+ � ti -,�,• � n a � ! r: .rt E _ �� "er r} !�•�k'{.. .. ',�' q RY. 1It f,�� ���r �:.• I�IY �a ` t t +,ri t !� ,� rv,� � ! y �� � +� ,,.6, ++� , r i, ,+ Y �. �., } �,�•.�, �r •Y� .���t �+ �� `tYltt�� � '� 'II �,, rat �.�- !.' a �,,'u, � °'ry, ,�k +i� �,i rr�.!ry. r�,. r.. k r`ao il' �, r r +� 'ir �' f! ri,.t x� ❑, fr, I u .'.t I ., r. � � ,. �� � � e .. ' it .. a' �. ,� �• R• .. 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Town of Barnstable D Building Post�This Ca d So That�t'is Uis�ble from the Street:.-A roved Plans,Must,be,Retamed onJob and this,Gard Mustbe Kept i6 Posted Until`Final Inspection lias Been Made x s .. Permit ° :Where atGert�ficate ofdOc a anc, -is Re a red such`BuildmshallNotabe Occu_,red until a Finai Ins eetiort hasbeengmade4 Permit No. B-19-1507 Applicant Name: Brian Olsen _ Approvals Date Issued: OS/03/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 11/03/2019 Foundation: Location: 40 CRAWFORD ROAD,{OTUIT Map/Lots 005 043 Zoning District: RF Sheathing: Owner on Record MCLELLAN,DAUID G&AMY B � > Contractor Namety, MAN K OLSEN Framing: 1 Address: PO BOX 1490 � Contractor License CS,066339 2 COTUIT, MA 02635 Est Protect Cost: $4,495.00 Chimney: Description: 10 Hours of Air Sealing,400sgft of cellulose, 20sgft of R38 in attic Permit Fee: $85.00 Insulation: Project Review Req: } Free Paid $85.00 Date 5/3/2019 Final: �. v, 3 31 Plumbing/Gas t �� � � y � � Rough Plumbing: :i FgBuilding Official . Final Plumbing: This permit shall be deemed abandoned and invalid unless the work a'horned by this permit is commenced within siz,mo the after issuance. All work authorized by this permit shall conform to the approved application-and thei,approved construction documents-for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structuret'sfiS111155e in compliance with the local zoning- laws an codes. This permit shall be displayed in a location clearly visible from access street o.road and shall be maintained open for pub'k spection for the entire duration of the Final Gas: work until the completion of the same. �a Electrical The Certificate of Occupancy will not be issued until all applicable sign turns by,the Building and ire Off'iaals are�provided on this;,permit. Minimum of Five Call Inspections Required for All Construction Work Service: 1.Foundation or Footing � - Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining`is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: f Official Website of The Town of Barnstable - Property Lookup Page 1 of 4 I Select Language I v k Assessing Division Property Lookup Results - 2017 367 Main Street,Hyannis,MA.02601 <<BACK TO SEARCH<< Print Friendly Owner Information-Map/Block/Lot:020/0921-Use Code: 1300 Owner Name as of LEBLANC,MICHAEL L&MARY C Map/Block/Lot G/S MAPS 1/1116 LUDLOW 020/092/ 40 CRAWFORD ROAD Property Address , 205 SCHOOL STREET COTUIT,MA.02635 �•" Co-Owner Name Village:Cotuit Town Sewer At Address: No Cfl . f GIS Zoning Value:RIF j ►__ -____ ___ __.__._..._.___ _A; Assessed Values 2017-Map/Block/Lot:020 1092/ Use Code 1300 2017 Appraised Value �2017 Assessed ValuePast Comparisons Building $0 $0 Year Assessed Value U� Value: IExtra $0 $0 2016-$259,400 1 f1 vA\ a Features: V 2015-$308,100 2014-$308,200 V �� v � ' 2013-$308,200 s Outbuildings:$0 $0 12012-$301,800„ , 2011 -$300,400 Land Value: $227.200 $227,200 2010-$312,400 � 2009-$303,300 i 1 t 2017 Totals $227,200 $227,200 2008-$342,400 �J 2007-$342,000 1 i Tax Information 2017-Map/Block/Lot:020 1 092/-Use Code: 1300 I Taxes Cotuit FD Tax(Residential) $513.47 Community Preservation Act Tax '$65.02. Fiscal Year 2017 TAX RATES HERE Town Tax(Residential) $2,167.49 $2,745.98 4A, Sales History-Map/Block/Lot:020 1 092/-Use Code: 1300 U History; `1J� Owner:' Sale Date Book/Page: Sale Price: LEBLANC,MICHAEL L&MARY C LUDLOW2016-10-21 30026/89 $1.. http://www.townofbarnstable.us/Assessing/propertydisplayscreen17.asp?a... 11/20/2017 Official Website of The Town of Barnstable - Property Lookup Page 2 of 4 Syr , KINGSLAND BAY REALTY LLC 2014-04-02 28066/217 $259900 j HAMBLIN,MERRI G 2014-04-02 28066/214 $0 HAMBLIN,STEPHEN C&MERRI G 1973-07-13 1896/236 $0 Photos 020!092/-Use Code: 1300 Sketches-Map/Block/Lot:020/092/-Use Code: 1300 1 A sketch is not available for this parcel. AS Built C.ardS:Click card#to view:Card#1 Card#2 i Constructions Details-Map/Block/Lot:020/092/-Use Code: 1300 Land USE CODE 1300 Lot Size(Acres) 0.81 Appraised Value $227,200 Assessed Value $227,200 Construction details are not available for this parcel. Outbuildings&Extra Features-Map/Block/Lot:020/0921-Use Code: 13000 There are not any extra building features on record at this time. t-_. �- __.._ -_._._.-,-._.-.-.__..-._.._,_._._a___ ._..,__.- Sketch Legend' `Property Sketch Legend 821N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area. FTS Third Story Living Area(Finished) SOL Solarium BMT- Basement Area(Unfinished)FUS Second Story Living Area SPE Pool Enclosure (Finished)' ' BRN, Barn GAR Garage TQS Three Quarters Story(Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine,Unfinished UUA Unfinished Utility Attic i FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in Porch PRT Portico WDK Wood Deck PTO Patio i (?Print Friendly http://www.townofba-rnstable.us/Assessing/propertydisplayscreen17.asp?a... 11/20/2017 Assessor's office Ost floor): ill� e /� . Assessor's map and lot number ............... ....... .......: v.•... .. ..oFT t>o� M Board of Health (3rd floor): J� Sewage Permit number .aZ �. .... : >;. BaaesTsntt S Engineering Department (3rd floor) rA°d !Ag ��0, 6.39:. House number ........: ..... .... ....... o yAr'\ ' Definitive Plan Approved by Plan mg Board ___ ________ I--_1"61_REAULATIONr _ :. • APPLICATIONS PROCESSED 8:30' 9:30 A.M. and 1:00.2:00 P.M. only TOWN - 'OF . BARYNSTAB`LE B U I'Ll1*G I S-P•ECTO R Q APPLICATION FOR*PERMIT TO ... y .. ......................G .... ....... .. ... .............. TYPE OF CONSTRUCTION .. } ..........19. TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby appli.es7or a permit according to the following'information: ..................................... Location .......... .. .... Proposed Use ..... .........(. ...r�'.`?-�A.....:.......a. ". ......C " --.. G�` ""1 .. �.` z S ... . Zoning District ........:.. ..... 7••..i.......... ......... _ ........Fire~District Name of,Owner .... 7/.. .��:�a.#-i7/Address .... ......... ........................... Name of Builder ..........Address `-_ Nome of Architect Address Number of Rooms ....................: .::..........Foundation Exterior ............ G(lK ....� / .......................Roofing ......... ... ........ ... . Floors .Interior. ...... Heating Plumbing, ... Fireplace .................... .........:.....,..........:........................................Rpproximate Cost ..... ......... 1.000......... .................. .. Area . f �' . ........ Diagram of Lot and Building with Dimensions - ` FeeAk C� t.: . lqo OCCUPANCY-PERMITS REQUIRED FOR NEW DWELLINGS ' I hereby.agree to'conform to all the Rules and Regulations of,the Town-of Barnstable,-re rding the above construction. oo Na Construction r'isor:s License .................................... LeBLANC, MICHAEL #' No :.32354: ,Permit for .Build. Shed...,,.. ; .........Access Qxy....to...D.We.1l ixi. ' Location ...Lat.A.42..........40..CrAwford...Road ' .....C.a > a. ................................:::.........: , Owner .....Mchae.1.:L�LI. TIc..:................... .' Type of'-Construction` :...Fr3Tri�...:.................... Plot ....a..........,. » .. Lot* k ' Permit Granted ....October =1.�..........1.9 88 s Date of Irispection ...... ....:.........19 _ Date: Com letedi........ .S"r...........19 7 z r 0 Ar it �.� ~�.� � _ � • 1 � - � < r). :-. --' 4r • ,.: „ ..,t.i.,�.. ,."'f..,.. «.. ,.;..:�.�}. .*-.E-.<�.t's.. .;trzek:: 'v;.. �i; wd, r:_r3 t:,.-_,, ..�' - ..r,+*.. c�,,;�, Assessor's office (1st floor): /,f 'J (/ Assessor's map and lot number .......................................... . . THE o Board of Health (3rd floor): Sewa a Permit number j T' 9 Z B9H39TSDLL, i Engineering Department (3rd floor): � rasa House number ....................... oo 1639• .................. . 5 . �o�ar'� Definitive Plan Approved by Planning Board ________________________________19_____-__ . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only ` TOWN. OF BARNSTABLE BUILDING "I NSPECTO,R APPLICATION 'FOR PERMIT TO ...................:/.���1....................... ........,....:..:...................................................... TYPE OF CONSTRUCTION ........v�. .................................................................................................:.. (IT�t ..� ............19:, TO THE INSPECTOR OF BUILDINGS" The undersigned /hereby applies for �a permit/according to the following information: Location f'C?. '•.. `J.l......`..�'�l/1/G� �7` 1../T_- .:.............................' ............................ . I .............. Proposed Use -<.�"?- 1 ...: / .�`---e:...CJ r�-- r....�..1`" d;2s ? ,.................. ................ .... ........... ............ "?. .. ZoningDistrict .............. ... ..........................................Fire District .......................................................... ..................... Name of Owner /3.4��' —/`'/�� /Address j................A-le............................ Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ......................................... ...................Address ... --.-.-:....>....... _......:..............:.:..............:......::................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior .............Roofing ` t.................... .... .......................................... ...................... Floors ......................................................................................Interior ...................:................................................................. Heating ` .....Plumbing /Vc��f Fireplace .......................:............................................................Approximate Cost .................I DOD Area ..............�......`...k k'....... Diagram;of Lot and Building with Dimensions. Fee` ... �rr.{ t...... . Ci u t -,r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name • _ � .. . ................. - � ... Construction Supervisor's License .................................... LeBLANC, MICHAEL A=005-043 065 ^ �' V3 No 32354.... permit for ...Build Shed ....................... Accessory to Dwelling Location ..Lot...#4 2.,......4 Q. Crawford Road Cotuit Owner ....... ichael...LeBlanc.................... t { Type of Construction ......Frame ......................:.......... i Plot ............................ Lot ................................ t Permit Granted .... ctober 17, 19 88 i Date of Inspection ....................................19 Date Completed � Y i \S )b�` r / s • t (70 8 Assessor's office(1st Floor): THE �� Assessor's map and lot number / �o� Toy . r ♦� Board of Health(3rd floor): a _ ,gyp 4/07" tSewage Permit number A BMHd9'tADLL i Engineering Department(3rd floor): �o rasa House number o i639• ®� Definitive Plan Approved by Planning Board 19 NO d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only 7- TOWN OF BARNSTABLE BUILDING INSPECTOR ` APPLICATION FOR PERMIT TO �i?SO�rzvc { TYPE OF CONSTRUCTION ,, c7 19 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 40 <f)24 r_0 P- 0 12,q, 610-711'LI 7— Proposed Use f Zoning District Fire District Name of Owner /�"�G�'�t ( f e_ 1�r� C- Address Y•'�O ��W�� �� �Iui 7_ Name of Builder 2e F241C- `fS �C Address ?D_ ,3 D X y/y 6049010/ 5-3 Name of Architect Sttir r' ` ���PS Address Number of Rooms � Foundation Exterior r'�� Roofing U Floors � � Interior Heating �`%� Plumbing Fireplace f-�/J«"� Approximate Cost Area Diagram of Lot and Building with-Dimensions Fee �. Lf I, 1$ 7 (l z2 � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name / Construction Supervisor's License 0 2-74,4 LeBLAC, MICHAEL A=005-043 No 33235 Permit For Build Addition Single Family dwelling Location 40 Crawford Road Cotuit Owner Michael LeBlac Type of Construction Frame Plot Lot Permit Granted S =f-PmhPr 9 9 19 89 Date of Inspection 19 Date Completed 19 t 7S re PERMIT COMPLETED 1J1/3-L ` ` � sk'PT1C SYSTEM)MIDST BE ssor's Asse off V� /ice(1st Floor): d D 7 (3 INSTAUM IN COMM `TME j Assessor's map and lot number __ �.tl�� Board of Health(3rd floor): _ 51 .7OS A �r EMROM�CODE Sewage Permit number 7 TOWNTO WVLA•nON 9TsnLL Engineering Department(3rd floor): . •`••a�\iY � rnda House number i639• Definitive Plan Approved by Planning Board 19 . a YAI a APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO rI S9��vGV' l�l^Ge ` x 2 oC J%B1C T TYPE OF CONSTRUCTION �O �'�'►STILyGI\�') V d 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use Fes 7 Zoning District , Fire District Name of Owner ,.�� ` 4,e Address 4�® tli Name of Builder Le&4111C— C Address Name of Architect � f+PS lvo'�t Address Number of Rooms Foundation •Exteriors Roofing Floors Interior Heating 1491 Plumbing Fireplace Approximate Cost l Area L4 2- Sf t Diagram-of Lot and Building with Dimensions Fee . Igo 1� t1 /V c/v 110�5 T 7 rP OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License 2���� L B AC, MICHAEL - No- 33235 Permit For Build Addition P c Single Family Dwelling ` _ 1 Location 40 Crawford Road s' Cotuit ?' owner Michael- T, B1 ac Type of Construction Frame >r- Plot Lot y' Permit Granted September 22, 19 89 Date of Inspection 19 Date Completed r 19 m 4w L� 4 !u y k) Kam! n;_ G8 -5 37°'27 ' 50 „ w �Es � � 0 \ L oT 4Z 4, Z :5, / 00 .5 ►1J 47.4 i Q 30.S- o T 4 EeiST/UG, . N o G194JV 04 T/D ill N r° Zo,c c p N 48.o o lS i4o, oo' A& 777 A d / ouV4Jo471o,Ll L EZrl 4c47740AJ - LDT. 42 C2A k/,co,PO ,eD_.- DATE xg/7wL ScA o k 6 0/ /v o, FA 4,100I 1, MA6. On the basis of my knowledge, information and• belief, I certify to 7WETmwa/oX,0Rey1TgBLE that as a result of a survey made on the ground on , I find that: The—structure(s) are located on the site as shown. 14 oeeorWane& 1-o -1he 7ow/V 4m41149 3y- The title lines , and lines of occupation of the ��E���H °i M46 site are aj shown hereon. The site ij situated in Flood 'Gone n- s WIMAM C,N Community Panel No.gsroee/ / A Date: rwio i9iiK Date. 2 �o '�2 ��STE� p� O SURVEY l;'illiam I.. Warwick.,it,LS Town of Barnstable *Perm /6 A'1Z q, Expires 6 nw nussue Regulatory Services Fee • snEtxsTnBi.E. • 039. Richard V.Scali,Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number 00. %®q 3 Not Valid without Red X-Press Imprint Property Address q 0 C R 4 w r 0 f p 0 C 4 ru i_' Residential Value of Work$ i G 00 •°a Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address A4 i G ti e L ° Q n# 14 AR Y T L e b ?o 13ox 1 `l ;Z21 C0rut'4-, M4 6Fa4,3S- Contractor's Nam t°G h 4 e- 1 k L-C 1>1 Q 17 C Telephone Number i0d�`/71 3 dW Home Improvement Contractor License#(if applicable) l 0 3 y Email: Construction Supervisor's License#(if applicable) � f>! " O !r733 7 if [/Workman's Compensation Insurance k one: AU am a sole proprietor TOWN �j' �7 �20 ❑ I am the Homeowner t ❑ I have Worker's Compensation Insurance /f pry Insurance Company Name :�S So f t�i#%e d— 6m l e yj SJf/ .4m(e `/9. t l� Workman's Comp.Policy# W cc rd 0 re01 ht 24 I S�A 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 ❑Re-roof(hurricane nailed)(not stripping Going over existing layers of roof) ❑ Re-side [Replacement Windows/doors/sliders.U-Value 0,3 0 (maximum.32)#of windows . 6 H #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: Prope Owner must sign Property Owner Letter of Permission. A py o e Home Improvement Contractors License&Construction Supervisors License is e ired. SIGNATURE: C:\Users\DecollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 r 77ae Coutmonivealth-of Massachusetts De t nent ofIndustaial Acciden& Office of Investigations .. ....... . 600 Washiaagion Smwt Boston,MA 02111 rams aniasmgvv1di a Workers' Compensation Insurance Affidavit: Builders/Contracturs/Electricianst lumubers Applicant Information Please Plant Lei bly Name(Brasmess/Organizationftdividual),: Address: R o LI©X 3 41 i l City/Stat'e z1P_. C u of �� Phone Are you an employer?Check the appropriate boa.: Type of project(regidred): 1-❑ I am a employer unth 4. ❑ I am a general contractor and I 6. ❑Neur constriction employees(full andlor part-time).* have hired the snob-contractors 2-Er I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have wodcus' 9. ❑Building addition [No workers'comp.insurance. comp.insuraII e. required-] 5- ❑ We are a corporation and its 10-❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers.have exercised their 11-❑Plumbing repairs or additions myself[No workers'camp- right of exemption per MGL 12-❑Roof repairs insurance required-]o c..152,§1(4),and we have no employees.[No workers' 1.3..[]�Other & 2d f 00001Y comp.insurance required_] *Any appki a=that checks box$1 also fill ow the section below showiagtheir woxkets'comp msation policy irfona3tim. T Homeowners who submit this affidava indicating they are doimg all work and then hue outside contactors otmst snhffiit a neg afudasi t indxcatimg such =Contactors that check this buz must attKbed am additional sheet shore the name of the sub-ccaarectoxs and sM wbff&u or on those entities bsve employees. If the sub-connectors have employees,they most provide tkeir workers'camp.policy number. l an"an eanjplaAvr that ss prmMinag worlrers'congwasadon hisnamuce for nay euuTlopw% Below is the,policy an d jo,b infbrmataon. Insurance.Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: ° C A W o City/State/Zip: Attach a copy of the workers',compensation,policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 2.5A of MGL c, 152 can lead to the imposition of cruninal 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 GILDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DU for insurance coverage verification. 1 do hereby certify rar h ins and;penalties of petyau.ry that the information provided' above is burin and correct Si tore: Dare: Phone 9: Official use only. Do not write in this area,to be completed.by cily or town official City or Town: Permit/License 0 Issuing Authority(circle one): 1.Board-of Health ?.Building:Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: Phone#: oF� BARNSTABM • 9� MAM Town of Barnstable RFD MA'I A 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, Yki tA/cQ &m -eeAe6 , as Owner of the subject property hereby authorize Wii/11 C/ l e&kli` to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) e of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\)ecollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\E)PRESS.doc Revised 040215 Details Page 1 of 1 t1 The Official Website of the Executive Office of Public Safety and Security(EOPSS) Mass.Gov Home State Agencies F etails empgraohmc Information : A L LEBLANC me: form -at-ion : COTUIT MA 02635 Unjtedktates License Intormaxion Icense o: CSFA-057337 License Type: Construction Supervisor 1 &2 Family rofession: Building Licenses Date of Last Renewal: -6/13/2015 Issue Date: Expiration Date: 7/3/2017-- icense Status: Active Today's Date: 8/27/2015 Secondary License: Doing/Business As: atus Chan e: Lic ns enewal o Prerequisite Information Limcloline No Discipline Information ocumen um Close Window ©2011 Commonwealth of Massachusetts Site Policies Contact Us y http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=246388& 8/27/2015` �eover�caiuueallf a�G���lrcvrcc�urell3 �\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: istration: 104364 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 eg Wxpiration: :71131`01:6, Private Corporation Boston,MA 02116 LEBLANC BUILDERS GO;*INC: Michael LeBlanc f 40 Crawford Rd. Waquoit,MA 02536 Undersecretary Not valid without signature Itet fi�assa vitcting Reg �Fami1`• - t hoard o`8 er 457337 Con'truction S"r se CSFA 40 CRA 0710312015 01L1)3 � ?013 ® , 93q Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services. Fee s 6n • BARN r�►sts, � Thomas F.Geller,Director i639. " Building DivisionPRESS PERMIT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 O C T I T 2013 www.town.barmtable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDE BARNSTABLE Not Valid without Red X-Press Imprint Map/parcel Number Property Address 4y�/G�fl'v�� &kesidential Value of Work$ y' g Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address vt 607I/l"-4-- Contractor's Namer/`fie Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner n—rl�ve Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# (GCJ,C C 5-ov 7rr 8'0 Z.0 1-5 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 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ' ©'Replacement Windows/doors/sliders.U-Value ©'Z (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 t sign Pr arty Owner Letter of Permission. ' A copy of the ome Improv ent Contractors License&Construction Supervisors License is requir SIGNATURE: QAWPFILESIFORMS\building permit forms\EXFRFSS.doc Revised 060513 The Commoinvealth of Massaehrfseffs I)"eparftnent of liuhuhial 4ccidents Office of lma iigations 600 Washiriglon Street Boston,MA 02111 Y nw.mass;.gmAdia Workers' Compensationlnsurance Affiidavit: Builders/ContractorsMectricians/Plumbers Appliatut Information Please print h . Name{Susme�sl0rganizatio�Itndividua!): �UGl L Address: E-40 awstat'i 4- UD/_ /�' Phone 47 Fire yo employer?Check the appropriate box: Type o#;project(required): 4. I am s contractor and I . Yl}e P� 3 l.. I am a emp loyer with�— ❑ 6. New consfrucfiion employees{full and/or part-time).* have hired the sub-contsactars 2_❑ I am a sole proprietor or partner- listed on the attached sheet; 7- ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity employees and have woticers' 9. Building addition [No workers' comp.insurance camp-insurance., required-] 5..❑ We area corporation and its 10.❑Electrical repairs or additions 3-❑ I am a homeowner doing all work officers have exercised their l l_0 Plumbing repairs or additions myself. [No workers'comp right of ememption per MGL 12..[__1 Roof repairs insurance required,]3 c_152,§1(4),and we have no m � employees [No workers' _. comp_insurance required-] Amy applicwt that checks boa#1 most also fill out the section below showing thew wolken'compensation policy information_ T Homeowners who submit this affidavit indicating they are doing all wmk and then hire outside contiactors mass#submit anew affidasit indicating such- 10=tcacmrs tbst check this box most attached an additional sheet showing the name of the sots-cowls and state whether or mot those eatifies have employees. If the sub-contractors have employees,they must piuvide their workers'comp.policy number: .Taman employer that is proiitffug workers'compensation insurance for my employees Below is Ste poM7 and job site inforRtatIVIL Insurance CompaayName T Policy#or Self-ins Lim; . lit�� SRO 79 $"O l���3 ' Expiration Date: Job Site Adders: t1y "cityrstaterzip/7�— Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section.25A of MGL c. 152 can bead to the imposition of criminal penalties of a fine up to$1,500.OU and/or one-year itnprisontnemt as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insuran ge verification_ I do hmby certify tinder the ass enatl es ofpet7ury that the information provided ubiwe%s bue and correct Si tore: Date.: Phone V 7-7 ©Juzai use only. Do not write in this area,to be completed by city or town offrciaL City or Town: PermitUcense At Issuing Authority(circle one): 1.Board of Health 2.Budding Departmeat 3.City/Fown Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or,implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for auy applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant_ Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an.applicant that must submit multiple permit/license applications in any�given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the.applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Ile to thank 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,telephone and fax number: n e A The Commonwealth of Massachusei t Department of Industrial Accidents , Office of kvestigatians 600 Washington Street Boston,MA G21 I I Tel.9 617-727-4900 W 406 or I-& MASSAFE Revised 4-24-07 Fax#617-727-7749 w .mass.govldia r' oFTME r Town of Barnstable } °t Regulatory Services 9BAIPWNSTAXLKg Thomas F. Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �7 , as Owner of the subject property hereby authorize �U/ to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed-and all final inspections are performed and accepted. tote o caner &S(gaaAe'-of Applicant zQ /tee Print Name Print Name Date Q:FOR.M&OWNERPERMISSIONPOOLS 62012 FIKE Town of Barnstable Regulatory Services 9 "srE�; Thomas F.Geiler,Director 16 ji• Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS:- city/town state i zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet 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 homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many 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. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOudook\QRE6ZUBN\EXFRESS.doc Revised 053012 Bifsiness egu at," Y' 0 frce�f C f�o umer WAS I I 4 HOME IMPROVEMENT CONTRACTOR Type: 4 Registration:"04P4364 Private CorporaUoi Expiration: 7La014 L NC BUILDS( ti�7t Michael LeBlanc 40 Crawford Rd 4 02536 Waunit, r Undersecretary , MA k Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor I &2 Family4 License:CSFA457337 iclL L>LEs�-:Arr 40 CRAWFORD)Etn 22s COTUIT MA 02 5 J.�+•� " 'Y` � Expiration Commissioner 07/03/2015 r A� WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Employers Insurance Company 54 Third Avenue,Burlington,Massachusetts 01803 (800)876-2765 NCCI NO 40959 POLICY NO. WCC 5007818012013 PRIOR NO. WCC 5007818012012 ITEM I The insured Leblanc Builders Co Inc' Mail Address: PO Box 3414 Waquoit MA 02536 Stnset No. Town or My County State ZIP Code FEIN xxx*0044 ❑Individual [Partnership ®Corporation ❑Joint Venture 0Association ❑Other Other workplaces not shown above: 2. The policy period Is from 01/01/2013 to 01/01/2014 12:01 a.m.standard time at the Insured's mafiing address. 3. A: Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Low of the states listed here: AAA B. Employers Liability Insurance:Part Two of the polity applies to work In-each state listed In item 3A The limits of our liability under Part Two are:.. Bodily Injury by Accident$ 600,000 each accident Bodily Injury by Disease $ 500.000 colicy limit Bodily Injury by Disease $ 600.000 each employee -C. Other States Insurenoe.Coverage Replaced By Endorsement WC 20 03 06A D. This policy Includes,these endorsements and schedules:SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating plans.. All information required below is subject to verification and change by audit Classdcations Premium Basis Rates Cade Estimated Par$100 Es*nsbd No. ram Annum or A nxw Rerraarsr�iae Rarnunu k*n Prmum INTRA 037139 , SEE E CrENSION`OF INFOFWA*nC N PAGE Minim i urn premium$ 500.00 Total Estimated Annual Premium $ 5,557.00 As indicated Interim adjustments of premium shall be made: Deposit Premium $ 1,443.00 ❑ Annually ❑ Semi Annually Quarterly ❑ Monthly MA Assessment Chg. $5,123.35 x 4.2000% $215.00 This policy,including all endorsements,Is hereby countersigned by R 11AW012 Aug mind f wh" pate GOV GOV KIND PLACING CLAIM NAME SAFETY 'William F Borhek Ins Agency STATE CLASS AUDIT OFFICE OFFICE CHECK GROUP Inc MA 5606 14 504 311"Pymouth Street Halifax,MA,02336 WC 00 W 01 A(7-11) ftkdW wUh 0 Vftd..W& or fhe Netbml Cour ca on C,ompwtsow Inwrwm, FW Town of Barnstable *Permit# ee 6moathsfrom issue date Regulatory Services Thomas F. Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERWT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number O v 5-0`{mil Property Address Residential Value of Work00. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name�e �f lVl+�� &/s Telephone Number 5 "42-2)- 2- 1 61( Home Improvement Contractor License#(if applicable) y- Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance P Check one: ❑ I am a sole proprietor ❑ I am the Homeowner �E F I have Worker's Compensation Insurance gAR�ST�BL 7O Insurance Company Name- i°7ex �f�o Workman's Comp. Policy# L✓G'C 0 -2gr �Z4j Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑. Re-roof(stripping old shingles) 'All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value #of doors (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property O gn Property Owner Letter of Permission.' A copy he Ho provement Contractors License& Construction Supervisors License is requir d. SIGNATURE: Q:IWPFILESTORMS\building permit forms\EXPRESS.doc Revised 070110 r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Organization/Individual): T/(k}'✓c 6e) Address: �X14 City/State/Zip: (/tql � oz Phone #: �� 3 Are you an employer? Check the appropriate box: 1.E�.I am a employer with �! 4• ❑ I am a general contractor and I Type of project(required): employees (full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner-, listed on the attached sheet. 7. 0 Remodeling. ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity; employees and have Norkers' [No workers' comp, insurance comp,insurance.$ 9• ❑Building addition required.] 5. ❑ We are a corporation and its 10.t]Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp., right of exemption per MGL insurance required.] t a 152;§1(4), and we have no 12•E]Roof repairs employees. [No workers' 114i�"Other W t yLaw S comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit.indicating such. $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: /pt��l'/2Fiµ1v.7�P�C syJ1dbLJj,Y�C Policy#or Self-ins.Lic. #: lo4c SVo-2 rI k'a 1,2-6 1( Expiration Date: Job Site Address: I V 4~&OeW 44P7VtV-/ I/3 City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins ce co erage verification. I do hereby certify under th ains enalties of perjury that the information provided above is true and correct Signafore: Date: Phone#: J� — �7 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 oae): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector, 6. Other Contact Person: Phone#: �TME ,,, Town of Barnstable Regulatory Services VANS LE, MAE& g, Thomas F. Geiler,Director 1639. �m ` a • Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject ptoperty -hereby authorize- %/ G �7�5 C-^ 2�1 C_ to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature-of Applicant Print Name Print Name Date Q:FORM&O WNERPERMISSIONPOOLS THE r Town of Barnstable Regulatory Services BARNSTABLE, * Thomas F. Geiler,Director 9 MASS. 039. A��`� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state t . ,�, zip code. The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who'does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides.or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official 6n�a`t6tm acceptable to'the-Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. •HOMEOWNER'S EXEMPTION IL - The Code states that: "Any homeowner;performing:work for'which':a building.permit is required shall be exempt from the provisions of this section(Section 109.1.1.-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack ofawareness often results in serious problems,particularly. when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed. Supervisor. The homeowner acting as Supervisor is ultimately responsible. ' To ensure that the homeowner is fully aware of his/her responsibilities,many 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:forms:homeexempt WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY. INFORMATION PAGE Associated Employers Insurance Company Burlington, Massachusetts NCCI NO 40959 (800)876-2765 POLICY NO. I WCC 500781 801 201 1 PRIOR NO. IWCC5007818012010 ITEM 1. The Insured Leblanc Builders Co Inc Mailing Address: P O Box 3414 Waquoit MA 02536 (No. Street Town or City County State Zip Code ❑ Individual ❑ Partnership ® Corporation ❑ Other FEIN 04-2742044 Other workplaces not shown above: ' 2. The policy period is fron-P /01/2011 t001/01/2012 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ 5 0 0,0 0 0 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06 A D. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Estimated Per$100 Estimated Code Total Annual of Annual No. Remuneration Remuneration Premium INIRA 037139 SEE EXTENSION OF INFOR ATION PAGE Minimum premium$ 500.00 Total Estimated Annual Premium $ 14,924.00 As indicated,interim adjustments of premium shall be made`. Deposit Premium $ 3,928.00 ❑ Annually ❑ Semi Annually ❑ Quarterly ® Monthly MA Assessment Chg. $11,563.20 x 6.8000% $786.00 This policy,including all endorsements,is hereby countersigned by C��UGC Do 11/16/2010 p Y Authorized Signature Date GOV GOV I KIND JPLACINGJ CLAIM NAME SAFETY STATE CLASS I AUDIT I OFFICE OFFICE CHECK GROUP The Fairway Agency Inc MA 15474 . 8 1504 1 1 305 Forest Street WC 00 00 01 A(11 88) Bridgewater,MA 02324 Includes copyrighted material of the National Council on Compensation Insurance, used with its permission. ;/he TOo�n�noozu�eaLf/z ✓//Ccraaczcfzu6P,Lr�:;4a�T' Office of Consumer Affairs&Business Regulatiou �, License or registration valid for individul use only 1' HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 1.,043(i4 Type, Office of Consumer Affairs and Business Regulation Expiration 7/13/2012 Private Corporahc. 10 Park Plaza-Suite 5170 Boston,MA 02116 LEBLANC BUILDERS C�O�'ING , t Michael LeBlanc 1 f 'y' C40 Crawford Rd. a g- -> - — -- Waquoit MA O2536 y Undersecretary ? Not valid without signature Massachusetts Departinent of Puhfic Safety Board of 1311ildinl- Reloulatipns at►d Standards Construction Supervisor License One- and Two- Family Dwellings License: CS 57337 MICHAEL L LEBLANC . �. r 40 CRAWFORD RD/PO BOX 14 ' COTUIT, MA 02635 c-- J'"G" Expiration: 7/3/2013 -z., ('ummiss"Mer Tr#: 20442 't TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map d.0 Parcel 0 `1� / Permit# /jO l Health Division J Date Issued �- Q Conservation Division Fee_ > [9 i Tax Collector �C /�J�� Treasurer _§ Planning Dept. - Date Definitive Plan Approved by Planning Board " Historic-OKH Preservation/Hyannis Project Street Address Village 9 � ''U Owner !-�`� / _ Address R;d Telephone Permit Request Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Estimated Project Cost Zoning District Flood Plain -62 Groundwater Overlay Construction Type- Lot Size d _ Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. .Dwelling Type: Single Familp�_ Two Family ❑ Multi-Family(#units) Age of Existing Structure 1'z- Historic House: ❑Yes o On Old King's Highway: ❑Yes Basement Type: Lull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) slyer Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing 7i new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel:Xas ❑Oil ❑Electric 0 Other Central Air: ❑Yes 0 No Fireplaces: Existing Z New Existing wood/coal stove: ❑Yes ❑No Setaotred garagtMisting ❑new size P existing new size Ramf9tiffg-0Tew size ❑new size Shed:-9-existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes If yes,site plan review# (Nurrnnf I len e�,, Drnnnenrl 1 Inn L� �� { TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION PMapp d U 5 Parcel 0 ` Permit# r 2—�- r 2 Q Health Division ' Date Issued Conservation Division Fee & (2 Tax Collector - Treasurer 1 Planning'Dept. , Date Definitive Plan Approved by Planning Board ' Historic-OKH Preservation/Hyannis t Project Street Address ` Village 6-�770 Owner / — Address Telephone Permit Request Square feet: 1st floor:existing 1�0-'� proposed• 2nd floor:existing `� proposed Total.new Estimated Project Cost 61 Zoning District Flood Plain Groundwater Overlay Construction Type- Lot Size _ Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single FamilP6,- Two Family ❑ Multi-Family(#'units) Age of Existing Structure /;2- Historic House: ❑Yes On Old King's Highway: ❑Yes 4 Basement Type:- Q�Full . ❑Crawl ❑Walkout ❑Other �Basement Finished Area(sq.ft.) lyy .,Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing Ali new Number of Bedrooms: existing_ new ' Total Room Count(not including baths):existing new First Floor Room Count He6t Type'and Fuel:,�/Gas Q Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No• . Fireplaces: Existing Z: New Existing woodkoal stove: ❑Yes ❑No 9e isting ❑new size P existing new size i w- size ❑new size Shed:-❑-existing O new .size " ' Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ f Commercial ❑Yes If yes,site plan review# Current Use Proposed Use . ^ k BUILDER INFORMATION C r Name ���! �- 1�-S �`�� L Telephone Numbers Address X 7 l License# Home Improvement Contractor#' y 3 6 S� Worker's Compensation# W C 3 '�-5 7 7 bD At- ALL CONSTRUCTION DEBRIS RESULTING FRO THIS PROJI T WILL BE TAKEN TO SIGNATURE DATE i < FOR OFFICIAL USE ONLY PERMIT NO. - be+ 21, DATE ISSUED MAP 7 PARCEL NO. ADDRESS f ` VILLAGE OWNER ' s. _ r - 3 r - s• ^ r f .+ . 1 DATE OF INSPECTION') FOUNDATION FRAME s , INSULATION x 1"i ti FIREPLACE ; ;, f , 4R 4 ELECTRICAL: ROUGH FINAL` ` ' IN- PLUMBING: ROUGH FINAL' GAS: ROUGH FINAL ► _ FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massacftuseirs . ....... - Department of Indttstrrial Accidents Office offlyesdoodoos -_ -: 600 Washington Street `- },' Boston,Mass. 02111 Workers' Compensation Laurance Affidavit name: location hone tl city ❑ I am a homeowner Performing all work myself. ❑ I am a sole rietor and have n.o one worlQn in anv amty / din ricers' co ensation for mv....... .employees s�°0.::::. :::.:. n this job.:;:.;::.::::.::>::>::;:::;:>:<:>:::<:::.»>:« Iam P. ..::::::.:.::.::::: :.::...:.:,. .:.::::::. ,:::::.:::::.. : TPA% anv na ... ..... . re add ...::..:..:....:::::::.::.:::....: ;:;;:::;::::.:::�;:;:::::�>' ..... .. .... . ... . . ...... . . Qiiaine.#. insurance co. ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have ; ' compensation olices: ::.::..::.,.:::.:.:.:::.;:.;:.;:;.>;.:;:.::;;<:.>;::::;;::::<::>::«>:«;;;;:>::<::<::::>:<:.;::: ;::><;:« following workers comp polices: ..,. :<.;.;;:.:::::::::::::::.;:.;:.;;<.:::::::::.:::.;:::.:;.;:.:.::::.:::::::::. ...:::::..:::::.:::::::::::::._::.:::::::::::::::: ::::::::.:. the foll g conivani main ::::.:::::.::::..:.,......... dress::. . .:.� ...:. .. cittir ............ .......................................................... .'<::»:::..::::�::::.>.....::':::... -..hii:4};:{•.v::v:.v.v:.::4:Ji'::v::::v.............:..................}.v::n........ ON ............................. anv :.:....:...::....:..................:........... cdrIIQ :.......... ;.t ats:rMxz: . dress: e .:. ........ .. .:. ..... cl >`:iCP i ...........::::................::. ......::........ ..........:.:..:.:..':..:::: ; .....:..... n...IIrance Failure to secure coverage as required under section 25A of MGL 152 can had to the imposition of crhnbW penalties of a Sae up to si,5o&o0 and/or on!yam,imprisonment as well as civil,penaitien in the form of a STOP WORK ORDER and a fine of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the Oince of Investigations of the DIA for coverage verdU ation. I do hereby certify raider the pauu of eflur3'that the informadon provided alcove is true and correct Date Z- — Sigoature Print name /f'�11�l 1 L� l/` Phone 0 g -7 -) - '� 1111 IN oincial use only do not write in this area to he completed by city or town oiHdai perm"cense# ❑Building Department city or town• (]Licensing Board - ❑Selectmen's Office check if immediate response is required ❑Health Department contact person: phone#; ❑Other. (renwa 9/95 PIA) Information and Instructions - Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law",an employee is defined as every person in the service of another under any co=-- of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more c the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the recen,e. trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work an such dwelling house or on the grounds building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or reneF of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who h! not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall eater into any contract for the performance of public work until acceptable evidence of compliance with the insu *+ce requirements of this chapter have been presented to the cantra =- authority. • - j FAIMi Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if yc are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of tl affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit cease member which will be used as a refc=ce number. The affidavits may be returned io the Department by main or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. i The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents 0mce of Ipye:doadons 600 Washington Street • Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 Ok The Town of Barnstable ram. Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date___—.. AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at lease:one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ��o — IV Estimated Cost Type of Work: ' Address of Work: Owner's Name:___�/�,� Date of Application: . I I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 [3Bu ilding not owner-occupied [30wner pulling own permit Notice is hereby given that: OWNERS PULLING TE[EIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permits as the t of the caner. L/IJ Dat Contractor Name Registration o. OR Date Owner's Name q:fomu:Affidav fie TDarrvnzamcuea��i a�,/�aaaac/uiaetla BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 057337 Expires.07,ia3/2001 Tr.no: 11629 Restricted To: 1 G MICHAEL L LEBLANC 40 CRAWFORD RD.PO:BOX_1422 L4~-6�s COTUIT, MA 02635 Administrator J• .HOME IMPROVEMENT CONTRACTOR + Registr,ati;on .104364 kType - PRIVATE CORPORATION I � R, Expiration 07/13/00 'ram LEBLANC BUILDERS CO. INC. "Michael L. LeBlanc -7f 40-� Crawford Rd./ P.O. Box 414 ADMINISTRATOR 6da.gU01t MA 02536 9 4 •„e • TOWN OF BARNSTABLE Permit No. __-_2 64? ---- 1 Building Inspector Cash OCCUPANCY PERMIT Bond -----=---x_-_------ � Issued to Michael LeBlanc Address Lot 42, 40 Crawford Read, Cotuit Wiring Inspector 1 f� ✓ ,� Inspection date Plumbing Inspectorf' � �� �� Inspection date Gas Inspector V Inspection date XEngineering Department - Inspection date Board of Health a. Inspection date v Lr 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. Qlvv X I 19 _ /3✓1' /'� ............................._.. .... _ _.........v..............._..........g................._ ....__._._......_.._�_._ fBuildin Inspector /S. E�ssor's map and lot number 3, 3B.K..... �'� 0 ....... .. ..... Sewage Permit number A..' 5../ .U?/ A7a � �-, � ri Qyof rot~� r THE House number .......d d. °P LL HJHB9T4DLE .......... ...... MAM WIN TITLE 5 9°o,e� 'Fi 63pY9• 'OF av M bIRON � ABLETOWNVNIRMNSi {r•\0� + r : . BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...................... '. .............�....................................... TYPE OF CONSTRUCTION � s f ` + ........... .......... ............... .4....................................................................................... ..........A.........1.: ..............19..a.�i TO THE INSPECTOR OF BUILDINGS: . The undersigned her�eby applies for a permit according to the (following information: Location ....G..o ..../..2....5,-.. tN `r.....Gr�� �/I.P`G�IP. �.:.............G.G? e E" i$............................... Proposed Use ................. . �(.e�.?.�...... ....... ZonirigDistrict ........................:.................................:..............Fire District .............................................................................. Name of Owner .. ... .lr!!7 `131^14...............Address °�`'� ® �` Name of Builder' /.............................e�SAddress ........ ..... .. ................. .................... ....... ...Name of Architect .. r ! Address �� � � �� .... /�� Number of Rooms ...... Foundation .l a . o ........ ' .I ��' Exterior `S ......... ..�.�.4..�..................p.............. . ..............,..............Roofing ..............�:��/••�!°"�'1...�s-........................................ Floors ....... .......•.................................... ......Interior 5-4e.ey/24,,l. . ° .... .............................. ��� �. ......Plumbing .^.. .Heating .... ../�..... ..._..,...........:.....................:...........:........ .................................................................................. Fireplace .......;y............................... ...Approximate Cost �.0� QD®. �r �. /.... .......... Definitive Plan Approved by Planning Board _ _________ _______________19 Area {/. G?./.f................. Diagram of Lot and Building with Dimensions Fee ©"!L SUBJECT TO APPROVAL OF BOARD OF HEALTH ' 1 + . d27# 53 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS. L hereby agree to conform to all the Rules and Regulations of.the Town of Barnstable regarding the above construction. Name .. W...... ... .... ...... :............................. r • y LbBLANC, -MICHAEL 24647 One 1/2 Story : o ................. Permit for .................................... Single Family Dwelling ............................................................................... t Lot #42 , 40 Crawford Rd. rLocation ................................................... ......... '. Cotuit - - 'Michael LeBlanc Owner i • Frame s Type of Construction - ............:............................. r I V Plot ..... Lot ................................ December 16, 82 n Permit Granted ........... .........................19 Date of I ni G5tS o�� :. .................19 s i Date Completed .... ....... :......19 v t. t - - I 4.0 -S 3 7 ' ZJ So w Q s.' � L qT'. ¢z ' i• Z �, ioo s' ` 4 7.6 c o T 4:3 0 L o T 41 E e iST/uG ° ,� o �ou.Ua4 T/oA7 N o p - C� Z4,0 to V / 370 Z7 OkG Gou[JOAJ'/OCJ ��eTrc�c.AT'io,c./ LO 77 . .402 G;2A ",cO,E'D AE'O.' - $A Z,cJ 6 7T,A 6�E, /t�(,4 SS, ` Da-re /;Z/7/c3L 54ALE. / 30 �jO S 0/ .N A• GA LMOLJ rAl &f A'j$4 r i On the basis of my knowledge, information and• belief, I certify to 77ze ow oF/BRec/1TgBGE _ that as a result of a survey made on the ground o &Yff2,_, I find that: a l r e t i he struct zre s , a e located d on he site as . shown. M uccorWanee Ao ,die TcwA/ r®rni 1.4 j Laws The title -lines and lines of occupation of the �E���H OF Mgsr site are a..; shown hereon. W,«,AM 4�ti The site ij situated in Flood Zoned a M• N WARWICK' rn Community 2anel No.2s000/ 'I&A Date: 77;77A � � No..19771 y ' Date: 2 L sTEa``ypa ;µ SU RV 1 illiam X'o Warwick#1iI� Assessor's offioe Ost floor): OFTMEtO Assessor's map and lot number ......... "...!q?�-�.... Board of Health (3rd floor): fO�Q Sewage Permit number .................................................: ..1 2 BAHd9TADLE, J Engineering Department (3rd floor): y� n 'oo 0e 9- House number K .. 1?� d j '°rt 3 a`e............................... ............ .... ................ o war APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING, INSPECTOR APPLICATION FOR PERMIT TO .. )�. R'[�.a.... . .....ff t).O n�.... . I C�/ �00 w, .A. TYPE OF CONSTRUCTION ......O.C. ' .0 i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location T 7 {� t`C C. 1 C t .......................................................................... . Proposed Use . ..'.. .e� ..........J ....................................................................................... .......... .................................. C � �?�.. .............Fire District .........0 Zoning_District .......................................... Name of Owner r(lleh�ei � Yli r... � -......Address ...CY� �� G'til .................................. . ..... I f................................ Name of` Builder ............... -- .................................Address .........,_!>..��,- .................................................................... t EName of Architect 1.i.-l. .E.( ....�L)�a ...�C� :C' '1�?:.Address ..... 7i.tt, ,?1 ++................................................ Number of Rooms ...............�C...................................................Foundation ..... .!�.w. ....:+ !9 '' .......................... Exterior .... ,7 1CC�` ...7�..!....��!..................:...Roofing .......'..Le�� �-1,~?-. ..........................;........................... Floors .........w7�t.4�...............................................................Interior ...... ................................. ...............}........... ............. Heating w .*� .Plumbing y Z Fireplace :.........................................................................Approximate Cost ......�. .r ..................... ......................... C - / ------l 9-------- • Area .....�--.1..... •. ....`.::_..•....... Definitive Plan Approved by Planning Board __________________________ ,, �I . Diagram of Lot and Building with Dimensions Fee / / "� ......�...... ...... SUBJECT TO APPROVAL OF BOARD OF HEALTH au 7 OCCUPANCY-'PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. t Name 1. ... f .... t Construction Supervisor's License ......' LeBLAC, MICHAEL & MARY A=005-043 No 29618 Permit for ..Build Addition .... ......................... ......Si ngle. Family„Dwelling .... Location ......Lot #A2.......40,.Crawford Road ..... ................... Cotuit ............................................................................... Owner .::.Michael. & Mary LeBlac f" Type of Construction :;Fa rme........................ , ............................................................................... 'Prot ............................. Lot ................................ Permit Granted ...... July 9, 86 Date of Inspection ....................................19 Date Completed ......................................19 D e-C r vE►) ao r TO 6vl l- D f},Pu l Tl-iV S 7A7 Assessor's offioe. (1st floor): Assessor's ma and lot number V G�� u of THE To ,r--S�11C SYSTEM MU Board of Health (3rd floor): g2--7O-,S- �? ` INSTALLED IN COMP Sewage Permit number .............................................. WITH TITLE 5 �33AUSseTa LE, . Engineering Department (3rd floor): �• �// .nn ENVIRONMENTAL CO 1. ,�•� House number ..............................�f.....' ..... 1..�.....^ APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOMIN REGULATI TOWN OF BARNSTABLE BUILDING - INSPECTOR APPLICATION FOR PERMIT TO .}>UT..ON...Arf�3.... L'i'"!c — fA"(L q<00 � cc�� '� .................................y........................ TYPEOF CONSTRUCTION ......000. `.1.............................................................................................................. .............. .......:.4..................141. TO THE INSPECTOR' OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....... .. .�...:..C..�2 M�4 f ��- ....�.!� ................. Proposed Use .. ........ Zoning District ........... .....:.....................�u. .T..............Fire District ......... .....� ........................................................ Name of Owner m�Lh�e� + L( Grc� � � CcfvU-� ........... ........:................Address .... ?................... ... .. .:........... .................................. Name of Builder .......... �.?! - 00T.................................Address ........6 ........................................................ .... .. Name of Architect' Dai°1 h.,. ... ...Address .....5..7?.[d.(,t(A.................................:............. Number ,of Rooms ......... ........................... Foundation CR'!'9.w� s ��-a-� ............ ......................................... Exterior ....a tap 1'JO��/...5�'1.).!��.��?.......................Roofing .....:�5��.��- ..................................................•... Floors . .......�.0.0.0............... �.Q�..... . .......................................,.........Interior .....,���, .......... ..... .... .. Heating hD ...:. .......Plumbing v •• Fireplace ..., .....................................................................Approximate Cost ..... ..s d.............................................. Definitive Plan Approved by Planning Board ________________________________19_______ . Area .. .r.. � Diagram of Lot and Building with Dimensions Fee /.1..'. . . . SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 h OCCUPANCY PERMITS REQUIRED FOR .NEW DWELLINGS' I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................... 444d�, Construction Supervisor's License .. .. ...... . ...... .... LeBLAC, MICHAEL & MARY 29618 Build Addition No ................. Permit for .................................... Single Family Dwelling ........................................................................... Lot #42, 40 Crawford Road Location ................................................................ Cotuit ................................................................................ Owner Michael 1*&**Mary***L*e I Bla*c Type of Construction ..........�rame......................... ........ ............................................................................... Plot ........................... Lot ................................ July 9, 86 Permit Gran*ed ........................................19 Date of Inspection ....................................19 z Date Completed ....... ...................19 g Assessor's map and lot number ... �,. K' i? E TOE` �s � , Q Gr Sewage Permit number ... ..... ` � Z B>BB9TJIHLE, i House number .�O r rasa ................ ............................................. O� 39T . \L �-M a' TOWN OF BARNSTABLE INSPECTOR BUILDING INSP z APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ............ ::........•.. ..........: ..��'� `................................................................... ...............................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following informattiio`n: Location ....lo i :.... � ^i.�.. t� ...� ; :I- -" ....:........ . ' " `..7. .. 4. ................................ ProposedUse ............... .....x......... .............................................................................................................................. ZoningDistrict .........................................................................Fire District .............................................................................. Name of Owner .. � .................Address .: `, r "{ ..... e ? .................... Nameof Builder' s .............................` Address .................... ....................................................... Nameof Architect ......... ... ...... ......... ................................Address ........ ....I... ................�;............................................ Numberof Rooms•...................................................................Foundation ..........................................................' ................ p Exienor Roofing f:` t .. ......... .................r. .............................................................. Floors ....... /�....��.fk...............................................................Interior ...................�. .��� ....a............................................. Heating !............1. . 4 ....... ...............:............... :.....::.:...:.....:....... . .Plumbing Fireplace ...... .......................................................................Approximate Cost ............... � .°6..,04,...� ....... Definitive Plan Approved by Planning Board ---------------_---------------19--------, Area ... ........!.:t. Diagram of Lot and,pBuilding with Dimensions Fee .........................:.................. SUBJECT TO APPROVAL OF BOARD OF HEALTH _ HW> ,eft v,� S3 f i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r b r` Name .. ...... .... ...... .............................................. LeBLANC, MICHAEL A=5-43 24647 One 1/2 Story No ................. Permit for .................................... Single Family Dwelling ............................................................................... Location Lot #42, 40 Crawford Rd. ................................................................ Cotuit ............................................................................... Michael LeBlac Owner .................................................................. Type of Construction ..Frame ........................................ ............................................................................... Plot ............................ Lot ................................ December 16 , 82 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 L-1_-z.1-�3 +— ----- fro IF}{ I r 1-2 uv v ti-- I L ( t T .....94- A. G ----- 1%z j �i G, 112T,kj r'�lp 2 t . I i -21 - - -- Vjl v I Lld7G+l - i IVVLJA i -T - - I l.- y 34 i! 7, � I VI► 't fi.'�c1 . (�i' h'�1� . I ;.1� � I p��—G �t� TN 1 G.\- " ` ,L �9/ - 1 - - --- -._--_--. - _. --- -L--- I i ' it 4�' i - �. �r J.;A vt- 7 1 ! A PPRO VED -_- - CHAN g kqedon Depermut T_T-- � �� (�vv►Jft�2bl _�. -r��`( ��'►�.) I I�l� reCaF"( >,crJ� PROJECT: rr4 I lzz�i� t MCI ALL Imo- i.� C-7 NEW ENGLAND DESIGN PO BOX 311 DATE: SCALE: �I I DWG. NO —3"� CHURCH ST. �, W.IBARNSTABLE , MA 02668 IF, /� ��� /� — DRAWN BY: APPROVED: ' `�� (508) 362-9724 1-800- 633-3317 REVISED: JOB NO.: 01 , 1 R a Nl N/i 1,GL.4ND i4E PRO&RAPHICS&S(1PPLY CO pq t r 7- .-7 � tkfj -7 -T Z- I C F- f -ni -4 1 T v L-rLAIF Tip, 16 '-Ji- 4 A� � --t 12- rie�q / t -Je Zf-i rpock-"T-� L- L/ 10 T- L"e Nil -ve 'Pi j4 tl L J --77 1 ry') 3E Lf'Ti ' � ' � � '� � ---�-_ --- - ,✓-- _ _------- _____ t f 2%Z.` l.J ,� -�ll•r +-few I ---—___- -_ __ -ry 7A t e T ot� N I i + � Inl l � �c �T� - it -a Ly ij' N 2+7'/7160 Imo0 C71 JK4 oft LIN vtj 2 (6- 1110 vie/ F- 012-4 PIA Njq- 'T it APPRo vED 7 NOTE C�,, HAN ES WN BARN STABLE Building Inspection Deparonent i:cao Kr\A I\jq C';'AvoL efP're T PROJECT: NEW ENGLAND DESIGN C - a PO BOX 311 DATE SCALE: DWG. NO.: 181 CHURCH ST. W. BARNSTABLE , MA 02668 DRAWN BY (508) 362-97 24 -'5' T APPROVED: 1-800- 633-3317 REVISED* JOB NO.: 10 NLVJF N61-ANO RFPHOGRAPHICS 30"PE y GO