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Home My WebLink About0128 CURLEW WAY �r _ . _ � - - -- - - } f ,� �; k r C 4 :, � -- .� 1� Ir• , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_' CS Z S Parcel o Application # Health Division Date Issued ZA �s Conservation Division Application F -J �� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 12 4 C.tA R t-0-v A 7 Village C aTH i-T- Owner Ih,-A,� J /VL_ ac LLOSA 9 Address i ZS eu C2 c cw ct A!j Telephone _Ck5s?- 5Z>�i • 27 s3- Permit Request 'CL1v►.4,rL j_AZt ice„ 21Atyt&zd -, 1 �k- _�5 o� bo2 �W3 rvS aZ-4-770N.-f 2MCCMUZOAt c ,�I/�C� ��IoK� 6-(Lt.n� �T ,_,,i mac. L c A'� �sCS`�✓L-t��+T' Square feet: 1 st floor: existing 9�proposed O 2nd floor: existing C/ proposed 45 Total new Zoning District Flood Plain Groundwater Overlay Project Valuation :Z2 o cn Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a Two Family ❑ Multi-Family(# units) � Age of Existing Structure Historic House: ❑Yes �Nlo On Old Kings:Highway L1 Yesw o Basement Type: eylfull ❑ Crawl ❑Walkout ❑ Other C g Basement Finished Area (sq.ft.) X Basement Unfinished Area (sq.ft) p 9 y sow Number of Baths: Full: existing I new x Half: existing 1 nevy�iC Number of Bedrooms: 3 existing a new Total Room Count (not including baths): existing new First Floor Room Count 3 Heat Type and Fuel: 2(Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes >Mo Fireplaces: Existing o New o Existing wood/coal stove: ❑Yes r2KNo 114 Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ ^Q 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 Telephone Number 7��45 3• ��2 Address To 802 License # (fS- oZSo 7 7 f K Home Improvement Contractor# Email Worker's Compensation # A% Y95i;f Y77-1 V ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: , FOUNDATION 1 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ti PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ven� DATE CLOSED OUT ASSOCIATION PLAN NO. P 77se Commonttretrlth ofMassachusefts Department of Ir fz al Accidrents t3, ce of nvestigaiions 600 Washington&Y-eet Boston,,MA 02111 n mv.Ynas&go 1dla 4, Workers' Compensation Insurance Affidavit:Builders/ContractorsMectricians/Rumbers Applicant Information Please Print I egibig Name O u ice Orpuization/Individual)_ S,4 ev 2ts6 Address: B2 o7r V 2 __-- -- City/State/Zip:_S Phone Are ou an employer?Check the appropriate box: Type of project(required): -- 4. I am a contractor and I �.1 J I. I am a employer with 6_ ❑New oanstruc-tioa employees(fall and/or part-time).* have hired the sub-contractors. 2.❑ I am a sole proprietor or partner listed on the attached sheet 7. XItemodeling ship and hate no employees These sub-oontractors have S. ❑Demolition, working for me in any capacity employees and have workers' 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 of ]save exercised their I ILT-1 Plumbing repairs or&dditiov-& myself [No worbE!rs'comp. right.ofexemption.per bfGL 12-.[]Roof repairs insurance z ed,]$ c.152,§1(4),and we ha-.m no employees_[No work' 131:1 Other --- comp-insurance required-] *Any applicml that checks box-91 wnst also fill out the section below sbawing tbeit workere compensation poRLT information- -- T aumeowners who submit this aidavit iadicatiag they ace doing as tragic and then hug outside contractors mast subuik anew affidavit indir song such.. ICamtmctors that check this boot mint attached an additiooal sheet showing the nanme of the sins-coomacoon znd statE whether or not those aWries have emplayem If the solo--coutiactors bare empIoyees,they must pmvide their workers'comp.po&cp number. lam an employer ihati-s prm iditag workers'compertsa ion immrau-ce for my employees Below is the policy andjob site infornta&IL lusumee Company Name: Policy 9 or Self-ins-Lic-4.. (it� y�IeSIo �V 77 Expiration Date:_ 11- 2-c>- l s _ Job Site Address: 1 Z e G+12Ljff)%/ CitWState/Zip:�f'Y Q" Aftach a coP7 of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure too secure co mrsge 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-yearimpnso t,as wen 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 Imrestigations of the DIA for insarrance,coverage vrerffication" I do hereby c¢rhfy under thajmis,andpena peaury thatthe informiation prm*idfed above is bus and correct Sirmature: Date: Phone#: 2 p/•. SS3— 91/ 001ciai use only. Ela not ipsite in this area,for be completed by city ar town official. City or Town:. Permit/License# Lcs-uing Authority(circle oae).: 1.Board of Health 2.Building Department 3.CitytPown Clerk 4.Electriical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: -- j 6 Town'of Barnstable { r �. °•. Regulatory Services X&M �, Richard V.Scali,Director ; Building Division Tom Perry,Building Commissioner 200 Maia Stnee�Hyannis,MA 02601 www.townbarnstable.ma.ns Officer 508-862-4038 Fax: 508-790-6230. Property Owner Must Complete and Sign This Section If Using A Builder I, /of,V-1 1.00L asOwnerofthesubject `�ro� J P PAY herebpaut:horize ....,,z s� Q�s-r ,a- to act on mybehA in all matters relative to work authorized bytbis budding permit application for. J z lc' (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 Signature of Owner ig�of Applicant kc Print Name Print Name _ Date . t. QTORMS-OWNII MMISSMNFOOTS ° l own oritsarnsmine Regulatory Services ofy Richard V.Scali,Director o" Baffli g bivwon r ' # B�a"r'•-"� ``a� Tom Perry,Building Commissioner �.�� 200 Main Street, Hyan is,MA 02601 www bo4vL.barnstable ma-us Office: 508-862-4038 Fax: 508-790-6230 HOAMOWNER IJCK SE IIEIION --- -- �pleasePtint DATE: JOB LOCAI M- nnmber shot vHInge name home phone I wok phone CURRENT MAILING ADDRFSS: citYAM rip code The current exemption for"homeowners"was extended to include owner-og npied dwellings of six units or less and to allow homeowners to engage an individual for hire who does notpossess a license,provided that the owner acts as supervisor. DORMION OF HQMEOWNER Person(s)who owns a parcel of]and on which he/she resides or intends to'Ycside;`ori which there is,or is intended to be,a one or two- family dwelling ached 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 foam acceptable to the Building Official,that he/she shall be responsible for all such work performed under the bodinz permit. (Section 109.1.1) The tmdersigped".homeowner"assumes responsibility for compliance with the Siam Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned`homeowner"'certifies that he/she understands the Town ofBarstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requitemeats. Signature ofHomeowner Appiorval ofBuilding Official .Note: Three-family dwellings containing 35,000 cubic feet or larger wM be required to comply with the State Building Code Section 127.0 Constiuction Control :- ' HOMIIOWt�'S E�11�TION ' 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 assumMK the responsr'hiIities of asupervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section I S) 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 forni'`currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. dmgpermith=IEXFFM&doc Revised 061313 Rightfax C2-1 2/19/2015 6:46: 37 AM PAGE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) T IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S)OR-PRODUCER.AND TNE-CERTIFICATE HOLDER, ,AUTHORIZED REPRESENTATIVE IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy((es)must be endorsed. If SUBROGATION IS WAIVED,subject to the arms and conditions of the poilcy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER CONTACT NAME: THE INS AGCY OF CAPE COD PHONE FAX P 0 BOX 960 (A/C,No,EXt): (A/C,No): EAST SANDWICH,MA 02537 E-MAIL ADDRESS: 77GBG INSURER(S)AFFORDING COVERAGE NAIC if INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY SUNRISE RESTORATION COMPANY INC INSURER B: INSURER C: P O BOX 802 INSURER D: EAST SANDWICH,MA 02537 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TH 5 TO CERTIFY A HE S OF INSURANCE LISTED BE=VE I O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE WAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDWYYYY) (MMOO1YYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑OCCUR. AMAGE TO RENTED $ REMISES(Ea occurrence) ED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL 8 ADV INJURY $ POLICY PROJECT LOC ENERAL AGGREGATE $ 1RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY YM US-496SP477-14 11/29/2014 11/2W2015 X LIMITS ANY PROPERITORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Q N/A E.L.EACH ACCIDENT (Mandatory In NH) $ 100 000(Mandatory E.L.DISEASE EA EMPLOYEE $ 100,000 u yes,oeaalbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERAMONS/LOCATONS/VEHICLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CER771CA77E ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE-BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 20D MAIN STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS,MA 02601 AUTHORIZED REP7 �l A ,�, ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD t988-2010 ACORD CORPORATION, All righrtf s reserved. massacnusetts -Uepartment of auoiic,stimyt Board of Building Regulations and Standards C ontitrurti,an Supen is-or License: CS-025077 _5 1 ti tx PETER C MEOMA , 29 BOARDLEY� Sandwich MA 02�63 Expirchimn Covivnisstoner 04112/201B' .•< � 't''./fix T�rxJ9r iltr�!'4[I.rrfJ��JL r;�*„+lIYJ�',T+J�..�f.nFtli`,�, - . Rice of Consumer Affairs&Business"Regulation ME IMPROVEMENT CONTRACTOR egistration- .18bO'37,,- Typs: Expiration: 6/1912016 SuppleMr ' } SUNRISE RESTORATIOONkOCC'MPANY b t # PETER MEOMARTINO` 0.0,BOX 802 4E'.SANDWICH,MA 02537 i;n'd rsecretary l � - SMOKE DETECTORS REVIEWED LE IL IN-DEPT. DATE FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING Main Level n c� 17'4 --1 51 c, >r 6'�T�y w 7 6' 3' r 0' 1n00a8®m �7'6' L en - i - 1r to. 1 4'r r4• ur r4• n uleti t � B-�Min Uvr BLAIR_WELLBELOVED 10/12/2015 Page:20 2nd level 71r 2 6- ({ 8 9' b �71• I i 71 ./ 1 � r'- r1'i T {— T ^1 M andLW 1.6' 17 r 71' 1'10' S'7 l ➢moama � b yam;;� �,'� -u t-A 4. �7'7--I�.., T q —'7 riO, to 4r iv 1 w r r--i �r 2nd Yre1 BLA1R WELLBELOVED 10/12/2015 Page:21 A VM \`1 Basement 36 61 0B 10' G w ELF T6 Gv�� ' r y� i Z Gn LIU rn Mac k t�M BLAIR_WELLBELOVED 10/12/2015 Page:19 SMOKE DETECTORS REVIEWED h�� B E BUILDING DEPT, DATE FIRE 6EPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING Main Level 7T e 161C 77 t • 16'6' & o ' _ Lellnlun �7'6' an u t N - 1 24, y o' BLAIR_W LLBELOVED 10/12/2015 Page:20 t 2nd level ar rr �—zs• �-a..� �trs•— tl 9' IWi011 7 tl. Wk— �'r T — r I---r r t sv- r u• r la' r, ts'7• ,�, e. s ��o b t—r r � i7r rrJ trm' sr )'T JY CIO -s: T r--3 r I rr-i riW i err-�1 Tnd IY..I BLAIR_WELLBELOVED 10/12/2015 Page:21 1 .e lr1 . s Basement / 7S 10' tr ' rj G D Un . � 1 C" PA JJ Baaam�nt BLAIR_WELLBELOVED a 10/12/2015 Page:19 FI ®HTECTARS REVIF 0 A BUILD G DEPT. ..! //5 DATE FIRE DEPARTMENT BOTH SIGNATURES ARE REQUIRED IFOR PERD HITpAtG Main Level - 178 IY to, 1T t I 16'6• L� N 16' J .. 16666Esn 2'6• m an h A*> info Cv rre h h � a 6',U•� ,,,b try i .. 66rr,►uw b �7 N 1WYl 71 J' +66LLIif69 k h 374 ,. Wnl�vw BLAIR W LLBELOVED 10/12/2015 Page:20 4 1 , 2nd level xr —2 ITT 24 eI S i 9 111 b T m�nm I r 5�1 T - err i sr 2'n• ' T - I z' 2Gmtll� 15'2. .. l s� kc) p _ b Wlaax6r ��,:r 7e. ca �� tliuj W a�000ma -s=_ 4 2- b �TKa ti . r 5'—i —A'r 1 I" -rr T .r-------I 1 2nd Yvel BLAIR_WELLBELOVED 10/12/2015 Page:21 f t t�1 I Basement u s� 3s[o- Rye \ N ri-j r„k9 h " ti Basemen[ BLAIIt_WELLBELOVED 10/12/2015 Page:19 . . DEC 3 02015 TOWN OF ff ,4R f1 t1ERMIT APPLICATION Map Parcel VIV :> Application OV& Health Division Date Issued Conservation Division Application F / Planning Dept. Permit Fee' l.C� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village moo-7 u tiT , Owner �A_/e] ..L-3€La VE-V Address i 2 y c yR 4ggoy u 4 Telephone Permit Request AmP A w C�sr''Nr �. Gt o�dC Tm M�rs.�s ti_ ��b 2-oast Z;1.d Square feet: 1 st floor: existing J9proposed 2nd floor: existing 76 proposed Total new O Zoning District Flood Plain Groundwater Overlay *—Project Valuation �� truction Type w'P fR.Aw1E Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 3/ Historic House: ❑Yes WNo On Old King's Highway: ❑Yes �IfNo I Basement Type: ;Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 7 sc Basement Unfinished Area (sq.ft) 20 S Number of Baths: Full: existing L 4f new { Half: existing new o Number of Bedrooms: .3 existing _new Total Room Count (not including baths): existing 4� new First Floor Room Count Heat Type and Fuel: 9/Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes $9 No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing U 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 SW A,-,& ,C RZ&n2, -tea Telephone Number 7 9/2 Address VD 6e,x &O Z License # C. S—G 2 15;70? 7 Home Improvement Contractor# 1600 17 Email ?21m en O Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO QLIL.%_I PS Mt SIGNATURE DATE :1 FOR OFFICIAL USE ONLY E APPLICATION# r DATE ISSUED, Y MAC/PARCEL NO. - r t i. ADDRESS VILLAGE . OWNER -,DATE OF INSPECTION: FOUNDATION FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH , FINAL . RLUMBING: ROUGH FINAL GAS: ROUGH h FINAL r' PINAL BUILDING /•tl �� o (� �� - DA-F&CLOSED OUT ,r AS .,. TION PLAN NO. { Rze Cri'wn omwalth of�1assachuseff-s Deparftntnt ref 1 idusbid Accidents ± 0ce ofrtv�tigvtierrs Boston,MA 02UI wn7v.a la-1mgovIdira Workers' Campensafion Insurance Affidavit:Buflders(C;`opt#ract�orsrTlectricians/ umbers Applicant Information Please Print,TegibTy Name(Busire orpanim ionitudividmo: Sit ry (Z i-r6 Address: To Z. City/Stat&Zip Phone Are on an employer?Check the appropriate box: Tweofproiect(required)- 1. I am a e n PtoYer with. 4. I am a dal contractor and I _�— 6_ New oansErxrafio3a employees(full andlorpart-time).* hiaveluredthe sub-contractors. 2.❑ I am a sole proprietor or partner- listed on the attached sheen 7- NRemodeling slip and haze no employees These sub-contractors have 3-. Demolition working for mein any capa.citT employees and have workers', 9. . Building addition [No workers'Coup.insurance. Comp-msurance_I- required I 5. We area corporation and its 10.❑Electrical repairs ar a ddiii oo s 3.❑ 1 am a homeowner doing all work officers harm exercised their I Lo Plumbing repairs or additicu myself [No workers'comp. ri&.ofe=mptioaper MGL 12-Q Roof repairs insurance requuiree&]I c-152,§1(4} and we have,no employees-(No wokem, 13-E]Other --- comp-insurance required- *Any spyUctut that checks boat-#1 tzmst also fill out the section below shovring their workers'eo-mpensstion pointy mfatnnrtiumL T Snmeowners orW submit ties sffdavil indkwdeg they are doing all wo*and d=hue outside contrsaom anw submit anew affidavit maacsting such tContrsctors that check this boot mast attached an additional sheet sbo -the name of the mb-ooaftnctors and state whether ornnt thnsa®mties bave employees. Ifthe stilrcontmctors hate emplafees,they must pMMde their workers'comp.policy aumber_ I am an employer ihatis ptmfidrng tt�orkam'compensation insurane#for nzy entpFoyees Beloit is the poSey rued job site informa&& Insurance Compat.yName: �Z-..1ll.r�i1 —/1-y►�4 _ Paling#or Self-ins-Lim.:9-- Gt y pl vSlo Y 77— / F--Tumtion Date: Job Site Address: 1 Z'0 GKILLAffk/ 'City/State/Zip: T Q' At#ach a copy of the workers'compensation policy declaration page.(showing the policy number and expiration date). Failure to secure•coverage as required under Sectiog 25A o€MGL c, 152 can lead to the imposition of c im Mial penalties of a fine up to$1,500.00 and/or one-yearimprisonmen,as well as civil penalties in the form of a STOP WORK BORDER and a fine of up to$250-00 a day against the violator. Be advised that a cop of this statement may be forwarded to the Office of Iurestigatiorts of the DIA for insgnartm coverage 4wification. I do hereby ccrhfy tinder the ' s and pens pe*t xry fhat$re iriforxtaiion prm�idRd above is irus and correct SiEmature: / r Bate: Phone#: ' -2 F/ZA— Q, Edal use anly. Eta not write in fhfs area,tabs campieted by city or town of ciaL City or Town:. PermitUcense# Issuing Authority(circle one): . 1.Board of IleaIth- 2.$adding Department 3.CitylTown Clerk 4.EIectrical Inspector S.Plumbing Inspector 6.Other Convict Person: Fhone�: Town of Barnstable Regulatory Services ` ' ` Richard V.Scab,Director BQflding Division Tom Perryi Building Commissioner 200 Main Sb=4 Hyannis,MA 02601 wwwA wn.barmstable na.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section if Using A Builder O as wner of the s ro aject P PAY . hemby authorize �,....r2 s ��- - to act on my behalf, in all matters relative to work authorized bythis bolding permit application for. I z QP 4::µ C "—...f •- (Address of job) Pool fences and aa= are the responsibi7 7of the applicant. Pools are not to be filled or utized before fence is installed and all final inspections are performed and accepted Signature of Owner Tta=iE of Applicant Print Name Pant Na= /l `d.� Date - QTORM&OWMERMLSSMIe0oIs M-Ineffice of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration 160030's. Type:,- Eipiration 6/,19/2016.4 Supplet7c:rt *a= SUNRISE RESTORATION COMPANY ,F t e- PETER MEOMARTINO a P.O.BOX 802 ° 7 =— �E.SANDWICH,MA 02537 Undersecretary 'r Massachusetts -Department of Public Safety ° Board of Building Regulations and Standards Construction Supervisor � License: CS-025077 AMis I IS I� PETER C MEOMATINNO" 29 BOARDLEY RO1 Sandwich MA 02363 f Expiration } 04/12l2016 Commissioner Aso& CERTIFICATE OF LIABILITY INSURANCE DATE`°'MCIY""' 12/28/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE'ISSUING INSURER($), 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 endorsoment(s). 1' - PRODUCER NAME: 61 is MDreis " THE INSURANCE AGENCY OF CAPE CODE INC. PHONE 888-2766 p N.), E MAIL SS: ell ,ia In ran cod,COM P.O.BOX 960 INSURER S AFFORDING COVERAGE �40142 C# EAST SANDWICH MA 02637 INSU�8: URICH INSURANCE COMPANY INSURED INSU SUNRISE RESTORATION COMPANY INC INSURERC: INSURER D P O BOX 802 INSURER E; EAST SANDWICH MA 02537 weuRER�; COVERAGES CERTIFICATE NUMBER: 20428 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THIS TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN'kAAY HAVE BEEN REDUCED BY PAID CLAIMS, INSLT R TYPE OF INSURANCE IMMPOLICYRUMBER MM/LID POLICY EX LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE ❑OCCUR 1 11 ES r6a ooau-rranrvi) F MED EXP Anj wm per9on $ N/A PERSONAL&ADV INJURY $ O(1J1,AGGREGATE LIMBAPPUF,g PERT GENERAL AGGREGATE 1—R OTHUFL, POLICY ElJECT 0 LOC PRODUCTS-COMPIOPAOG AUTOMOBILE LIABILITY COMMINqQSINGLE LI $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per paraem) 1i AUTOS AU105 NIA BODILY INJURY(Per orald(int) > HIRED AUTOS AUTO$ PROPERTY D E �u (Per eedao t UMBRELLALUA9 OCCUR EACMOCCURitENCE ea ��LIAB CLAIM&MADE N/A AGGREGATE $ M DED RETENTION S �/ WORKERS COMPENSATION X STn ERA $ AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNERMXECUTINQ E.L,EACH ACCIDENT A OFFICERIMEMBEREXCLUDED7 wA wA wA 6ZZUB2EO6443715 11/29/2015 11/2912018 9 100,000 IM+mddtoy k1 NH If yes,deepibo , E.L,DISEASE-EA EMKOYE $ 100,000 undw DMORIPT10N QF TIONS WI&x E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCAT1om/vEHICLEs(ACORD 101,AOdMolml Rcrrmrko khodWo,rimy So nRnehed If mom npaeo to raqulrod) Workers'Compensation benefits will be paid to Massachusette employees only,Pursuant to Endorsement WC 20 03 06 8,no authorization Is given to pay claims for benefits to employees In states other than Massachusetts if the Insured hires,or has hired those employees outside of Massachusetts, This Certificate of Insurance shows the policy in force on the date that this certlflcate was issued(unless the expiration date on the above policy precedes the Issue date of this eartlicate of Insurance). The status of this coverage can be monitored daily by acoming the Proof of Coverage-Coverage Verification Search tool at WWW.mass.govAwd/Workers-CompensatlomAnvestlgadonel, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS, 200 Main Street AUTNORMED REPRESENTATIVE Hyannis MA 02601 Daniel M.Crowey,CPCU,Vice President—Residual Market—WCRIBMA 01988-2014 ACORD CORPORATION. All rights roserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. Parcel v vL App lication o l,%iLbq Health Division Date Issued C 2�1 Conservation Division Application Fee ?�V Planning Dept. Permit Fees ' Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address -VIZ$ ti.9_m / 1A� Village C a�►�.�, T Owner A 2 4A& 4E c._o vE�C Address Telephone Sow . So9 .. 2 9.S75' Permit Request Cb 1 rjwlL t;d**k of w � = to Square feet: 1 st floor: existing proposed 2nd floor: existing 9.S'�proposed Total"newer Zoning District Flood Plain Groundwater Overlay Project Valuation J;00 Construction Type Lot Size Grandfathered: f-Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Sc> Historic House: ❑Yes 2KNo On Old King's Highway: ❑Yes a%No_ Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) i4 Basement Unfinished Area (sq.ft) Number of Baths: Full: existing I new Half: existing t new Number of Bedrooms: ,3 existing _new Total Room Count (not including baths): existing 61 new First Floor Room Count Heat Type and Fuel: VGas ❑ Oil ❑ Electric ❑ Other Central Air: #❑Yes )KIN�o Fireplaces: Existing a New 4 Existing wood/coal stove: ❑Yes A No Detached garage: ❑ existing ❑ new size_Pool: 0 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 ON If yes, site plan review# Current Use 9-les, Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name SKw A%sc IZ 3xa�'1wv Telephone Number 78l-4S3-8J2S Address SO 16ax 1902 License # C.8-� 0Z.So77 . _s/1�► Home Improvement Contractor# /64k0 3•'7 Email Worker's Compensation # tati y9s'6?4172.1Y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �krtiift i*t" .y SIGNATURE r DATE /ZP i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r MAP/PARCEL NO. F, ` x [' ADDRESS VILLAGE _ r OWNER r DATE OF INSPECTION: FOUNDATION - FRAME- INSULATION FIREPLACE ` ELECTRICAL: ROUGH ` FINAL ' r t - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL R RNAL BUILDING 6r P DATCLOSED OUT j ASS'CTION PLAN NO. r 1 Sunrise Restoration Company 480 Rte 6A, PO Box 802, East Sandwich, MA 02537r— Home Improvement Contractor#: 160037 AUTHORIZATION TO PERFORM SERVICES AND .4DIRECTION TO PAY 0 L, '� 1n referred to as "Customer," authorizes Sunrise Restoration Company, herein referred to as Sunrise, to perform all necessary board-up, cleaning, and ,C�� demolition services. on Customer's property at: / Tel: Customer authorizes Insurance Company, herein "Insurance Company," to directly and solely pay Sunrise for work it performs. Should for any reason the check(s) from the insurance company arrive at and or be made payable to the Customer, Customer then agrees to pay Sunrise immediately upon receipt of said check(s). In order to expedite payment to Sunrise, .Anthor' ' U) dm Customer agrees to pay to Sunrise Customer's insurance claim �'• Deductible,the amount of which is stated in Customer's insurance policy. } Insurance Company: Policy Number: The "Customer" agrees that Sunrise is working for the Customer and not the Insurance Company or its agent or adjuster. Additional remarks: Customer will not be responsible for any payments other than those made by their insurance company. They have no personal financial responsibility. I have read this document and-co• letely accept the terms contained within. Customer Signature Date a Print Customer Ivame -.0— SunMeAWtion Company S gnature Date r Print Page Page 1 of 4 Print this page • Owner Information-Map/Block/Lot: 025/063/-Use Code: 1010 Owner Map/Block/Lot GIS MAPS WELLBELOVED,BLAIR D & 025 /063/ Owner Name as NICOLE R Property Address of 1/1/15 128 CURLEW WAY 128 CURLEW WAY COTUIT, MA. 02635 Co-Owner Name Village: Cotuit Town Sewer At Address:No GIS Zoning Value: RF • Assessed Values 2015- Map/Block/Lot: 025/063/-Use Code: 1010 2015.Appraised Value 2015 Assessed Value Past Comparisons Building $158,600 $ 158,600 Year Total Assessed Value: Value Extra $27,600 $ 2700 2014- $ 323,900 Features: 2013- $ 323,900 $ 5,300 $ 5,300 2012 - $ 355,800 Outbuildings: 2011 $ 357,200 Land Value: $ 132,400 $ 132,400 2010 - $ 359,600 2009 - $ 373,800 2008 - $ 389,300 2015 Totals $323,900 $323,900 2007 - $402,100 Residential Exemption Received=$87,192 • Tax Information 2015-Map/Block/Lot: 025/063/-Use Code: 1010 Taxes Cotuit FD Tax $ 719.06 (Residential) Community Preservation $ 66.04 Act Tax Town Tax(Residential) 2,201.38 Fiscal Year 2015 TAX RATES HERE 2,986.48 http://www.townofbamsta-ble.us/Assessing/printl 5.asp?ap=0&searchparce1=025063 10/8/2015 Print Page Page 3 of 4 Replacement Cost $172,426 Bathrooms 1 Full+ lH Lot Size 1.34 (Acres) Model Residential Total Rooms 6 Rooms Appraised $ 132,400 Value Style Cape Cod Heat Fuel Gas Assessed Value 32,400 Grade Average Heat Type Hot Air Year Built 1996 AC Type None Effective 8 Interior HardwoodCarpet depreciation Floors Stories 2 Stories Interior ,wall Walls Living Area sq/ft 1,904 Exterior Clapboard Walls Gross Area sq/ft 3,180 Roof Gambrel Structure Roof Cover Asph/F GIs/Cmp • Outbuildings & Extra Features-Map/Block/Lot: 025/063/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value , WDCK Wood Decking 120 $ 3,000 $ 3,000 w/railings SHED Shed 160 $2,300 $ 2,300 BMT Basement- 952 $20,900 $20,900 Unfinished FOP Open Porch-roo ceiling f- 204 $ 6,700 $ 6,700 • Sketch Legend Property Sketch Legend B214 Bam-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor,Living Area FTS Third Story Living Area SOL Solarium (Finished) BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure (Unfinished) (Finished) . BRN Bam 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 http://www.townofbamstable.us/Assessing/print l 5.asp?apt&searchparcel=025063 10/8/2015 Print Page Page 4 of 4 FHS Half Story(Finished) PIRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in PRT Portico WDK Wood Deck Porch PTO Patio i http://www.townofbamstable.us/Assessing/printl 5.asp?ap=0&searchparcel=025063 10/8/2015 a .. � t, r !, � � � ., r t �I d �� S C�� . � � M � . _ C•v La�`Or 1 l �� U�' � IN✓�e.�� i,J�t�� l o✓e.� _ //�1 vvt00%) ' p IN✓��e.s , i.J�l�b ��o�� koll l I 1 L .9 0V� « IV\SuIOL LIN -e �� w� p IN✓��.�, ��—ll b e..t o�� OA 04) 61 �5 � y r 4 v t L i s 6 .,»..��.w-•.ram-,�.�— } 0 4-or ( � CU\f-( e vo UJ wt. A -e c-Cl- A '5 y � � ,�' Ulzn�arrerx�sfrtue«l(f t'�'�r""lj��..�cc��.c(/s', • " y, L\ . _ ffice of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR _ egistration 1600,V— Type,,p Expiration 611.9/2016,'- Supple4ielnt�. ' SUNRISE RESTORATION.COMPANY ''` PETER MEOMARTINO- . P.O.BOX 802 E:SANDWICH,MA 02537 Undersecretary C Massachusetts -Department of Public Safety f t Board of Building Regulations and Standard's Construction Supen-kor f License: CS-025077 PETER C WO M tTINO' 29 WARDLEY RD Sandwich MA 02363, r Expiration ' 04/12/2016 Commissioner f�, w Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration - - -=-- Registration: 160037 Type: DBA : r Expiration: 6/19/2016 Tr# 254391 SUNRISE RESTORATION COMPANY :,. WILLAIM FEDER P.O. BOX 802 "? ----- --- - -- ------ -E. SANDWICH, MA 02537 -�- »- .; Update Address and return card.Mark reason for change. _ ,-- P g rt `�J Address ❑ Renewal ❑ Employment ❑ Lost Card SCA 1 0 20M-05/11 �c l�rrwnr�ruuccYlf�o`G"F`lCc3rCCC�CCJc/�J L\-. 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: gistration: 160037 Type: Office of Consumer Affairs and Business Regulation Wxe piration: 6/19/2016 DBA 10 Park Plaza-Suite 5170 0 '. Boston,MA 02116 SUNRISE RESTORATION COMPANY i. WILLAIM FEDER 480 RT.6A P.O.BOX 802 E.SANDWICH, MA 02537 Undersecretary Nit valid wAsij'natur CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) PTHCEkTIFICATE IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS TE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE C CT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the arms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER CONTACT P NAME: THE INS AGCY OF CAPE COD PHONE P O BOX 960 FAX (A/C,No,Ext): (A/C,No): EAST SANDWICH,MA 02537 E-MAIL 77GBG ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC I) INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY SUNRISE RESTORATION COMPANY INC INSURER B: INSURER C: P O BOX 802 INSURER 0: EAST SANDWICH,MA 02537 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CER Y THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. INSR ADD SUB LTR TYPE OF INSURANCE POLICY EFF DATE POLICY EXP DATE L R POLICY NUMBER (NUDMYYYY) (MN=\YYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE COMMERCIAL GENERAL LIABILITY $ CLAIMS MADE OCCUR. DAMAGE RENTED a $ REMISES(Ea occurrence) ED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: ERSONAL&ADV INJURY $ POLICY �PROJECT�LOG ENERAL AGGREGATE $ RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS LIMIT(Ea accident) BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ A WORKER'S COMPENSATION AND WC STAMORY DTHER EMPLOYER'S LIABILITY YIN UB-4956P477-14 11/29/2014 11/29/2015 X I LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? El WA (Mandatory In NH) E.L.EACH ACCIDENT $ 100,000 If yes,descrlbe under E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCA11ONS/VEHICLES/RESTRIC7IONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE'HOLDER CANCELLATION TOWN OFBARNSTABLE-BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 200 MAIN STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS,MA 02601 AUTHORIZED REPR A VE .` _ .. �:• ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. , N f _ „ - y �_t t I ,_G l� } _ r �► I I _ 1 ( E . 1 71 I '{ .. ."'r 1 "j { Y_''. �_k I ' ,.. -J f j"[- _1 f_� f w..^» { - - -{ 4 .- -•'} 1 .. - 1 Y , I r l l •�� I' 1 �1 ( 1' t j -r , � j I 12-L - i 1 I l y r - I t t I _._ jw_ , i I _ �'.�.'��_L.. I , ♦- r � + j { t I ..:t # , '., _IL_.i t �-trs- i -I--1 � {mil _.l -L—•-+- -r � � � !'11 -•--{ i i + M -j l , i-! Y I 'I 4. r a t l i i �.. _ l i -I_-I I � t l _I •- �.,....__ ' , ' Al AL I7-1 zt i�/OW faV' CLy1PL iEf!/�H I 1 SEAL. ' l.D t-r-TyA,/ �� .coc.4�-, -�,yir %ci T•s�E ',coaaP�.s! i - c _, -�- -- - - � Br4XT NYE•� leA- >y- l/.SEp "Expect the Best" CHAM PION Builders - Developers - Contractors B U I L D E R S , I N C. (617) 826-3800 FAX:(617) 829-0000 June 3, 1996 Mr. Ralph Crossen; Commissioner Barnstable Building Department 367 Main Street Hyannis , MA -02601 Re: Request; Building Permit Extension Lot 3 & Lot 5 Curlew Way, Cotuit, MA Dear Mr. Crossen: We respectfully request an extension on the building permits issued for#100 and #128 Curlew Way, Cotuit,MA. These permits were issued to Bayside Building Co. and identified as 94-213 and 94-215 respectively. Work on these lots, started under the original foundation permits, included: -Staking of lot boundaries, house, and septic locations. -Clearing of selected trees and shrubs. -General maintainence. (To promote interest from potential home buyers ) It has been several months, potential buyers are on board, and we now notice our permits have lapsed. We need to renew them promptly and ask for your assistance. Any questions please call me at 800 784 7400. Thanks for your cooperation on this matter. ,Sincerely, Jay W. Briggs Specializing in Affordable Single Family Custom Homes -.___.� I I"�--c`� Ste- S f��-� l �� "�1 a� �'� 2 � � � i � - t The Commonwealth ofIvassachaseins Department of Industrial Accidents oI/rceo//n�esbgahns 600 Washington Street ' �%. Boston,Mass. 02111 . Workers'Compensation Insurance Affidavit wcatinn city hr ❑ ►am a homeowner performina all work rilyself. ❑ I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. iJ G cit•: insurance co: u bum L uk-A�tL;� ❑ i am a sole proprietor,general contractor,or homeowner(cin:le one)and have hired the col,tractors listed below who have the following workers' compensation polices: h ne#s fpttt tan In.u9 r2n Failure to secure coverage as required voider Scctioo M of MG 1.152 can lead to the imposition of criminal penalties of a fine up to 51,.500.00 andlor aac years'imprisotitnent as well as civil penaltiq in the furm of a STOP WORK oRDER and a tore Of S100.00 a day against me. 1 understated Iliac a COPY Of ileis statement may be forwarded to the OMCC of Investigations Of the LI A for coverage verification. I do herehy certify under the pains mod penalties of perjyry that flee information provided above is true and corner. Signature (1 tvT atc (0 " 19to Print ncunc &Lea Phcnc# lot v�O bU 0 NMI" Cant, do not write in this area to to completed by city or town otficiitl periniOiccme# —Building ocpartnleat �I,ieensiog Hoard ediate response is required �$cleetmeo's OMCC �Hcsith Department phase#; � -Other J (reviccd.ir9i rJA! Information and Instructions Information and bstruc 'ons M .,. Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensationfor their � . employees. As quoted from the "law",an employee is defined as every person in the service of another under'any contract of hire, express or implie , oral r ritten. Massachusetts General Laws c tern 5sectlon 25 requires all employers to provide workers'wmpensation for their f another under any, AR� b6q@s•isgll9 ' �6id �'!"p1 ,$�'srtt0�� 'i i��f clla��n� y,gr any or more. of th �ng 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 }�ietwo or more of dlfi�gdg�aisuc$ctadritvktgit��n �i0$rc� >t9pirri � �oer the oiromeal�gunmrdsme t�ufilitirigdip'pdtl'sat ��ii�'�aal�� a�Pd+t�R�eYi�etm{�8�4 owner of a dwelling house having not more than three apartments and who resides therein, or the occupant o the N&elgtitajj8 ef�ia #noselmluap�gnstmtn> ttd#asogaatctsgt�ltistlDpgi�li 'QiiiE t313dr�eelling house rQ �lf6M titAlrAe employer. ifo�oo istbl�ia�sfea ' a�Oadhlid�staTtiaj'aataribtsr .4i��R•�� applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Al 'Z it 1�15�a�Etfb'A'� �� pait>dasfl l �tje a eyisk8WthhohlttjWbpoance or p�fll�ih&1�A��+�51Fkpftl�il� �t�"'�hsl�l�iao�st+rtbdlht+ai�saac�iteI I vf+tAM*tptept►1ye bpAE4Ilt8cn+#{r }]� OEiptable evidence of compliance with the insurance coverage required. m wealth nor an of its olitical subdivisions shall enter into any contract for the have A0F&�lented to the contracting authority. P ' �-tUFUIMI&t o s Tn � .�I O-cidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The of davi�t ss ould*T��e,,,.retu ed o the citty� o .tow t thhe a 1 r tJ a Wjf a6,dsituation and n "tJC a�m�YR o��dRtrMpej,8e to» t ��ito � F • � e tt�� f ,,,�I�,�, r andVle one n as` iT � Sil `t ' t84flpft8r& ta4�B*R&A9M#qO A,,1b non R icy, ase race coverPagaC c o ee�ur`e � �� to the affidavit. The Tndustnai Accidents far confrmatton o ed 8 e n to obtain a workers' compensation policy,please call the Department at the number listed below• Please b�sure that t4ie affidavit is corn le 1 bityootp?ibhitoghe pertnit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or F[�X unless other arrangements have been made. bottom Please be sure that the affidavit is cempiete and printed legibly. 'The Department has provided a space at the Pleas e T V�tl�e �f>itl�li9ltlike�vdtzt�tl�g�bldl"tced�ai� >�� iti�'3t1ERl�ld ��y pS�p tit�dilitiftASd9fl number which will be used as a reference number. The affidavits may be returned to 'i or F X unless other aizan emesits have been made. �aap>Ol wftyou in advance for you cooperatron an sou you ave any questions. . please do not hesitate to give us a 0lie Commonwealth Of Massachusetts The Department's address,telephone and f shingtou Street The Co OW"NOMsssachusetts p g f 9f iraGMal Accidents phone ijq&-exAO or 375 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749. phone#: (617) 727-4900 eat.406,409 or 375 n TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 025 063 GEOBASE ID 35242 ADDRESS 128 CURLEW WAY PHONE (508)888-664f Cotuit ZIP 02635- LOT 5' BLOCK LOT SIZE DBA ' DEVELOPMENT DISTRICT CT RET TYPE AGOOB �ff E#IPTION 8jy&I8ffjLOF PWR94PMT-0371) CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 OxtNE CONSTRUCTION. COSTS $.00 756 CERTIFICATE OF OCCUPANCY : BARNSTABLE, +' MA8& OWNER CHAMPION BUILDERS, ADDRESS 300 OAK STREET PEMBROKE, MA BUILD/IN I 0: BY DATE ISSUED 09/12/1996 EXPIRATION DATE j ,., '.cY" :.y,;.. .; :`^�+;, iY"•Ra )fYa° '"Ta. :. o ter s�t E, gi.Er<"5 ' r i _ t, wv ..� ~' TOWN OF BARNSTABLE, MASSACHUSETTS C U 1 L D IN ' A-025.063 DATE December2n• 19 94' : jPERMIT NO. "Q ��21 i APPLICANT Matthew Dace I ADDRESS r '� ' DVS' i�'rv, Buzzards Bay, MA IN01 (STREET) (CONTR'S LICENSE) BUILD DVIELLING 2 Single Family it Dwelling NUMBER OF PERMIT TO (_) STORY_. �i Y DWELLING UNIT (TYPE OF IMPROVEMENT) N0. _(PROPOSED USE) _ AT (LOCATION) 128 Curlew Road, Cotuit (Lot #5) ZONIRG DISTRICT (NO.) (STREET) BETWEEN (CROSS STREET) AND -. (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: Sewage #94-215 AREA OR 12S a 000.00 PERMIT VOLUME 2132 sq. ft. 191.88 ESTIMATED COST � FEE (CUBIC/SQUARE FEET) OWNER Champion Builders, Inc. ADDRESS State Rd., Unit 3A, Buzzards Bay, MA eu '/ THIS PERMIT CONVEYS NO RIGHT TO 'OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDI G INSPECTION ROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS &.-ZIT' .04 3 ' HEATIN SPECTION APPROVALS ENGINE G DEPARTM flA,1.41 0.4-y_760�&1* BOJAEA OF HEALTH OTHER SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK 15 NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION.. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. 1 r Assessor's office(1st Floor): •. > �� .•� -/ 3 Assessor's map and lot n ber �Cf/�� 5 / U� Conservation(4th Floor):' Jp t uSr�� Co Board of Health(3rd floor): o t' VIPTH TITL sanTLDLZ Sewage Permit number Engineering Department(3rd floor): House number 2,CJ Definitive Plan Approved,,by Planning Board .3 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M44y TOWN 0'F tY'BARNSTA�BLE 8 1LDI'NGk INSP�E�CT0R APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 L TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locations Proposed Use , �� _ tzz �� — Oa Zoning District Fire District Name of Owner ddress Name of Builder Address Name of Architect �-7 Address C Number of Rooms / Foundations P� Exterior Roofing Floors L � L/ Z76 Interior r Heating �_, ` , Z Plumbing Fireplace �� 4` ` Approximate Cost Area Diagram of Lot and Building with Dimensions Fee 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 Si ipervisor's License No Permit For i =� Location x-a Owner" 77'G �'� si✓ '1•Q-��/ Type of Construction _ Plot '% Lot jr Permit Granted r 19 Date of Inspection: ' Frame Insulation ,"' y`• 19 Fireplace 19 Date Completed �'�l'Q� 19 _ J i J a � 6 ! 1J�516�J -PA-FA -k6 �,Atzr3Ar GRrIJnErZ . _:'PAIL'-( FLOW - 3X)ly =330 67D n -5 0. USG 1000 61AL, i ` 51DEWdLL AAA =1 2 SF I / � BOTTOM Ala = k 2, SF 113 �F 1•o = 1131.PD, i� i a TDT-AL-t)a5i6N = A-43 6fi, ve;—� Zz 'TrAL VAILY Myj 6� Cve �. wA PE2GaLATI oN eATE = ( �� 2wiq o¢.Lev, t u48 \ H OF 9 of PETER oyG�ti a\o - % co SULLIVAN BAx01 -4 nER No. 29733 \ L T >T, lam- 3 1 4a..& TF -7 7 G'85 7z l ^Fl-=75•S P V iuv• a LA SvrrA I 2JT.iv✓ iar, GAL 748 U� (oo Al/ as9 ;� S�rlc TAQ4 W,it_ a { 34� 'Z I u� - f�: ALL- lm cruQc-s s�-r MM5 TUAKJ A.' -DEW + sTo�1E` Si4ALL BE �I-Z.D ; G�AVQ- 3 G 3 5ET Fir Bc�w bo5otrAPAZ `.DIL• Cez ll=I® Per FLAN Lac.&Ttot1 s�o La'f"D rr- !3 =<ol:. EGA 4._�-; n VV' DATE Ce�FY T+(At"' TKE F��4 PLAN �t"ERt�IC� 5gowq kzect4. (:�OMPuyS yvirtµ -ME St ELJi4 rP,urc. MO, OP ' 1�- TDWN OF�UL� P�►J hurl. C� E ►� I4vr (-o4�TV'D WITI I IJ E: toov �t-Ait.1, UT 6-t) e za/f,S� i NYE (W- • p�`flD�JdL�Aug 5u�.v�yorzS (IS FLAWED aN AN 1�15TC't1ktE I zw i t_ 0J6I N Lett.$ A14D rNE OW ets 4 400L D 0 ur -3E o 5TE2vIU-r-- MA44 , �5c-�� ro �TQ'P�c..ISr-�, , Pr�eTzty la etc-5 J , APPLICANT; 51M �tLZ�WG wG. I11/'o2;94 17:02 %Y6177277122 DEPT IND ACCID Z001 -- �; CatwWnwealtk o f MaJJaC1j.ttJetb �apartmertE o�J'•ndu�tria.L�cciden.� 600 Wwknyton Sh,t t James J.Campbell &ton, 02f f f Commissioner Workers' Compensation Insurance Affidavit ; with a principal place of business at: ?00 ()ALS- tT ff/S:S- (Grristaw4p) do hereby certify under the pains and penalties of perjury, that: Q l am an employer providmlg workers' compensation coverage for my employees working on this job. Insurance Company Policy Number O I am a sole proprietor and have no one working for me in any capacity. O 1 am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Humber Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number O I am a homeowner performing all the work myself. I understand_ that a copy of this s:.aternent will be forwarded to the Office of Investigations of the DiA for coverage verification and that failure to secure coverage as recFuiied under Section 25A of MGL 152 can lead to the Imposition of criminal penalties consisdn¢of a fine of up to S 1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. Signed,.this. '� 1 z 5 t day of �Q Lam--- 19� Licensee a Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOWN. OF BARNSTABLE BUILDING PERMIT # 3 �2, i .:.:Y;.:;.^.... � •::r:•(/ .......:..i.:.....:.>:......:; ;• .....Y..:...:Y:.?:nr../'/''� :: . .. ..........:: ... .......:....>.:... .: :o-..nr;kti:.::;i.:.'.;.r:Y.i:.;:r::::.Yr:::..;.rvY:.Y:?r>::.Y:r:r.:�:?Y•rYrv:::?'o?;?.r:?: ;?::?.:;.?•rI:?SJSUr/rEr:4Di:A{3TirErr:(•iMr:•:M??blDr}DY. ;Y:})c : Y r ; r:N .: :.::::::::::::::::::::.:::::::.::::.::.:...:::. ::. r?:::::::::::::::::::YY:::::. . . 0710111994 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND D.J.Rielly Insurance Agency,Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 243 Church Street DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Pembroke, MA 02359 POLICIES BELOW. (617)826 0123 COMPANIES AFFORDING COVERAGE ..................................................................................................... COMPANY A WCAR/Clgna Insurance Co. LETTER ..................................................................................................................................................................... ... ................ COMPANY B LETTER ...................................................................................................................................................................... COMPANY C Champion Builders,Inc. LETTER P.O.Box 1558 :..................................................................................................................................................................... Buzzards Bay,MA 02532 COMPANY D LETTER ................. COMPANY E LETTER >::::::::::;;....:::::::i::::»::>:<::;:::>::>:::st:::::»i::>::»<::>:::>::z:::><Y:>::::Y::»>:<:::::<:::<::z:»::»:::•:::�::.Y;:.;:.r;:.;:.:;:.r:.r:rY:•Y::.»:..:.:?«:::�:Yr::::.YrYY:.r>:.>;r:.Y::?.;:.;::::::::::::::::::::::::::::::::::::::: :COY GE. THIS ICI TO CERTIFY THAT THE POLICIES ES OF�INSURAIJCE •�•�•�LISTED BELOViI•HAVE•�BEEN•ISSUED TO•THE••INSURED NAMEDABOVE�••• ••FOI2�TFIE?FOLIC\'�PEIZIOD' INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ............................................................:....................................................................................................................................,....................................................................................... CO: TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE :POLICY EXPIRATION LIMITS LTR: DATE(MM/DD/YY) : DATE(MM/DD/YY) GENERAL LIABILITY :GENERAL AGGREGATE :S PRO .................................... COMMERCIAL GENERAL LIABILITY DUCTS-COMP/OP AGG. :$ ................ .................... vPER............................................... ................................. ................. :CLAIMS MADE: :OCCUR. : ::PERSONAL 8 ADV.INJURY :$ :OWNER'S&CONTRACTOR'S PROT. ;EACH OCCURRENCE :$ ....................... ............................... :FIRE DAMAGE(Anyone fire) S .................................. ...................... - :MED.EXPENSE(Anyone person)S :AUTOMOBILE LIABILITY ...... :COMBINED SINGLE ANY AUTO :LIMIT .S ................................................:............. :ALL OWNED AUTOS i : ............ :.BODILY INJURY :S ;SCHEDULED AUTOS ; ;(Per person) .HIRED AUTOS ........................... :BOD LY :NON-OWNEDAUTOS i(Pe01accidenf)INJURY S ............................................................................... :GARAGE LIABILITY ;PROPERTY DAMAGE S EXCESS LIABILITY :EACH OCCURRENCE :$ ;.........UMBRELLA FORM A.... _.:..__.._.._.._.........:.... GGREGATE E :OTHER THAN UMBRELLA FORM ..... - X i STATUTORY LIMITS WORKER'S COMPENSATION :•:::::.�:::::.::::::::::::.:.�:..:::::: :EACH ACCIDENT `$ ..... ...._ ........AND `100,000 DISEASE--POLICY LIMIT :f 600,000 EMPLOYERS'LU\BIUTY ............................:......... :DISEASE-EACH EMPLOYEE S 100,000 :OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS .: ...iiiii:'>a?::.::i.isi:::.........*.`i?;r:;:;`;:`;:''+':,C,i:i:ii:.`:.:..::;.'.;Ji i rr::;;. r: .. ::d5rrr.:. :.:o::r........::.::.: .:>:::::.:::::.rr::..;.:..:.. CERTIFICATt;:NQL.DER........................:.: . . .........:............................. N.C..EI..LA .ON................................... SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO TEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE MAIL 10 DAYS WRIT TOWI1 Of Sandwich LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 145 Main Street LIABILI OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. Sandwich, MA 02563 :::::'AUTHOR D PRESENTATIVE :::::: s; V ,,.;:::i;?;;•Y?;:c;i<::;::_;s:;:.x,;:;>:`:;:::;;::;:::::i:::�::irY:;:;:;:S::r::YY;:: ;, : Y:.;:?•r: YY :: ;;:::.Y:.r:.r>;:<:::::.: h..:..) ::::..:.:::::::::::::::::....:.....:.::::::::.:::::::::::::::.......:::::::.:::.:::::.::::::::........::..::::::.........:::::::::........:.:::::::::.:.:::.:: RQ:CORPORATI.OI�1;199:0. n POLICY NUMBER ❑ Ne NeU4 10 02 46 3 .INSURANCE COMPANY OF NORTH AMERICA ® Renewal; ❑ Rewrite of;w; NCCI CARRIER CODE: 14486 SVML PREVIOUS POLICY N0. IWOCI I C40046343 WORKERS COMPENSATION AND EMPLOYERS INFORMATION PAGE LIABILITY INSURANCE POLICY Item 1. FCHAMPION BUILDERS INC Inter/Intrastate Identification No.: The P 0 BOX 1558 Insured BUZZARDS BAY MA 02532 DIRECT BILLED Mailing ❑Individual ❑Partnership Address L ®Corporation ❑ Employer's Identification No.: FE I N # : 043145058 Other workplaces not shown above: STATE OF MASSACHUSETTS Item 2. Policy period from 06-27-94 to 06-27-95 12:01 A.M., standard time at the insured's mailing address. Item 3. A.Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MASSACHUSETTS 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 $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT WC 20 03 06 Item 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rate Code Estimated Total Per $100 of Estimated No. Annual Remuneration Remuneration Annual Premium CLERICAL OFFICE EMPLOYEES NOC 8810 45000. . 33 149. LOSS CONSTANT ( $10. :_IF APPLICABLE ) 10. ESTIMATED STANDARD POLICY PREMIUM 159. ( INCLUDED IN POLICY PREMIUM OF $32 ) MASSACHUSETTS D. I .A. ASSESSMENT 3.2° 5, EXPENSE CONSTANT 0900 160. Minimum Premium $ 102. Total Estimated Annual Premium $ 324. If Indicated here, interim adjust—, ( PAGE 1 LAST PAGE . ments of premium will be`made: ❑ Semi—Annually ❑ Quarterly ❑ Monthly Deposit Premium $ This policy includes these endorsements and schedules: WC 200306 000414 200301 200302 200303 . 200401 200601 AGENCY NO. 984020 04-2793460 BOS J R I E L L Y INS AGENCY Countersigned By R1 I I hl, A,vl 43 CHURCH STREET iAuthorized Agent) EMBROKE MA 02359 MARKETING OFFICE: NATIONAL WC9 RE POOL 94186 DOC 6176A WCY CKE-4266a Ptd. in U.S.A. Copyright 1987 National Council on Compensation Insurance INSURED'S COPY INC 00 00 01/ 105031 ��e -�amirreaiuuea,�b�o�✓�u'a°`rc�r.,eaelta `;"; DEPARTMENT OF PUBLIC SAFETY license CONSTRUCTION SUPERVISOR ' n { Pktes .Birl6date CS' 2017061i997 01/06/1962 DACEY 8UZZAROS BAY, NA 02532 ` commusstON6R l i z z _ .77 -�---- --r-- _ — - -Q 0711 Q Q Q _Q a Q - _Q QQ - Q a -a oa - ,- ............ i I , + I I I w BAY.8IDC 5UfLDING Cc INC- - .:CEWTEQVILLE _r I �---�-{-., __--�-.- ----__._..._._. --c,.n., T '!a•:t'-o" � �Lwaz Io N s — ..� �or6 -I .. - -"-- l If • 1 Y41 SOY�'1 � � � �I•. ._ �.. .. .. .... EE �•Yrl f - —I - , I , BAYSIDE BUILDIMCG Co1Nc. - ---._ --_.__-- —. I ', cENTeRVILLE /naSS." 40 cp ELMVWTioN�S 89-IS 6 I .. _...AN4...4AIV,._ + �OfM .mac . to LET �G..A.2AGM in _.DtN�N4 HOLM DOOR, Ir " nl r. mmwl _� n_ a-" A^corac c. ¢6cvy. h p ,°„ :?ua,.4" to Coon. • � b L•� u.r. wt=o EL V' in in , 34�.a + 14% y"--- -- -- BAY9IDE BUILDING Co Iwa. F7 -L`HNTERL/ILLY _—F_.►.cz�S.T......dt .G o R FLcob. ..pLat-i a; ea 4 oil r __ c3 { { Q I - Ul um r ry� ry� - .• r .. � � � � � Y7RG.LZ//�J r•IP �'�' �?, .�.P1e�D2a:0YA_..!� •� ... _ � �: .. .. do -. - • 4 _ - ---- B4K�lCG. BL11Lf)INfj. CO...• SENTERVICL6 �• P.La_ W iI%: _ i Fco a i• i �VITUgO\Vg 7 RIVCo WOOD 17N .::ANDM2.6GN "CLAM CASEYACAKIT-w . ¢IVGo alb.SSo 5-1 'bo v s'7 1 4 _ ... .. ... .; .:`.1 " --- 3641 4f^•__ Rlv�o Isa5 40 Ii' 41 t 1' -Cl Lce¢ -sec H ... ..�..:.:.._. :... . . . . •1 : 1•¢ � A 4�•C 0 a.•a 1� r _91 4 ... _ T. b. CA e x 4'•� colic.I.wu.s iI a a L J i ea.a..Dbo�ttr�tN-Wo 9qt'LALLY C�ol6 - J[�."M Au.AROVNq. ___ •�"yt.w' MI'L" ooTINVS I I ..� .. /��.. ... .. _� rs.J - ..�.— `•s�•co w w,sL.Lt b X I C_ HOOT I N J4, . r ---_ I me- —I C _ 1 lo" 1 !" •�I l�•.�.. CEN IL'4 !_/./�A9 N G, .reszv.. -BAstL//gym" -:POuWDATln11_ 88-IS Iop6 r i IISGC SHIQa"cs i . i . ""5F1�1L•.ZAS.;&-%p11AI-T.._SNINGt.t•S / 1Ko W OW .. .. I fib® � i �. � ,�� ,� .. .. - �. _ . . .• ., - i �� ". :ISO' Ird¢6Gtlat_`" OLyW000 CATWALIt'• •Lwa (g16•• � _ 7� -IX8 -SogFtY.\JIrN VGNTS . 7N000 PUI'L'QJ1 r+4 OICr .u_,.. - L1,l..G.I/ql N uJN Gt1TTCR.B. T'>ONN'SPaX)TS . — 1 RJ C.iQ'9�OAR0 'Tb TO OF NINgON.+C-ASIN44..: . -. �YG gTU1Sy tam" O•G• ... .. INlslu F� R d —i[a^.GOX '...gLiGATN1r•IG a., P su'fLoom C Slt>INC� +. cl..Apnoanos FrtouT', -. .JN 1NGI...C-4 "31/7 f:5 A R[.o IL. - � y'P�-OP br✓-_IN Foy cR::ouW �.. _, ! � .- � �I I t J VJ • � cad? ��P LN 1�1.1 Fl..00rt _- � J • � t?5"PAY .Suglrl.con �. ., *elf t0 mlb". 1 - !LMG.61Lt.ow SILL-KI{,L xld3`"' QOoIeLL�JeIfr..PstAl6Nrti« c M, .. J' S Y -.. S a 9pNA1-T-.�..Go TINE .Ps6tad..:. 2/ans• -- 13�0• v 131,a.. _ CoNun. St_AO - a++ j _ F3AY910IF BUILDING CoWe-, l;�ta'. ooTl 4 s C ILLG � A G OL T T -�-=T SE.CTIt'J1•� �J6" �.1'.O .:.� Be- to • 4ovG r � k—1 9 3,a„ LANDRY 2'4" 31'4" co ° ° in ° ° a 00 ° io ------------ - 0 b� 4'F-A 3 BASEMENT BUILD OUT w 128 CURLEW WAY COTUIT ;t HALL 2'10" F7 FXISTING BEDROOM NEW BA H iD fV [V OD 17'0" co NE CL 6'8" 'El 128 CURLEW WAY NEW BATH AND CLOSET COTUIT MA 2 J� t K41, 3 0 � f Go TT n LANDRY Ir 1 2'4" 31'4" co O 0 i N 00 Q a o o o � o 0 (D\ BASEMENT BUILD OUT 128 CURLEW WAY COTU IT' � low f HALL 2',0" O XISTING BEDROOM NEW BA H =p fV N Bo IT 0" co in NE�V CL 8'8, i 128 CURLEW WAY NEW BATH AND CLOSET COTUIT MA 2 jp E