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0137 DEBBIES LANE
217S�1S whT '— DP�t`'►A�£ Tb,¢ouae�vwa- }�ow� L�ER� LEvEI. 1 t i 1 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) M AC DATA TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ') � .C.V Map " Parcel I vj� pp A lication # . Health Division Date Issued Z.G Conservation Division Application Fee BUILDING DEPT. �� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board APR 0 5 2016 Historic - OKH _ Preservation/ Hyannisn BARNSTABLEMgiL 3 Project Street Address 3 1)>° l C. Village Co��T Owner �S f��r% n SeIJ�C✓ Address C04 e4 GXj 114* o)ijsa Telephone .SD i���— S_)S' I �,,A4h ANJ DAt 1, CC,S Permit Request RV�tl �e GtT7C�" !�S/'G'eY7�l� �a/�► �y e p%4 u � r /in N &- J. 'C n+u �c I a)t/;1 enjF m6 eS rce quare feet: 1st floor: existing proposed nd Aor: existing prop sed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes . ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ® No On Old King's Highway: ❑Yes )d No Basement Type: X Full ❑ Crawl X!Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new d Number of Bedrooms: q existing.4new Total Room Count (not including baths): existing, new First Floor Room Count _ Heat Type and Fuel: ❑ Gas qQ Oil ❑ Electric ❑ Other Central Air: ❑Yes W No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ;d No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: �D existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# 1 i Current Use g,es)cC?\kkk Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name i /Ml /e5 .,NkrLY (OPS - Telephone Number Address al Aerh_" License # me� PC14 I&V 0 0 1 Home Improvement Contractor# b )I e`1 S�G. �L e—L CB r`` Worker's Compensation # VSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE ' OWNER ° DATE OF INSPECTION: 1 FOUNDATION • A r FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL .� PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ... o DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts PrintFo mx Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation'Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Hurley-Testa Construction Co.,Inc. Address:PO Box 615 City/State/Zip:Medfield, MA 02052 Phone#:508-359-8720 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑ I am a employer with 2 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.T 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.[1 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other 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 thepolicy and information. Insurance Company Name:Central Insurance Policy#or Self-ins.Lic.#:845-0918 ExpiratioQDate:�04/06/Aj =,:,::,,,, Job Site Address: City/State/ p: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the aims and enahies o er'u in that the ormation provided above is true and correct. Si tore: - - _ -- - _ Date 771 Phone#:508-359-8720 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i SHE r Town of Barnstable Regulatory Services anxxsresi.E. y MASS. Richard V.Scali,Director i639' �0 iOrFDr�wt" 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 Sections If Using A Builder as Owner of the te subject U � . J hereby authorize - �% D S7_& : � L.�) to act on my behalf, (� -7 in all matters relative to work authorized by this building permit application for. (Address of Job 1 "Pool fences and alanrns are-the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final f inspections are performed and accepted. hu IS' ___7z�� Sifnature of Owner' Signatur o Appli nt &Z0r'J I V4 -FES,)-7Y Print Name Print Nam IA YI t5 Date Q:FORMS:O WNERPERMIS SIONPOOLS Town of Barnstable Regulatory Services , P�QE rotyy Richard V.ScaIi,Director ' Building Division HARNSTABLF. ' Tom Perry,Building Commissioner iFrnsa 200 Main Street; Hyannis,MA 02601 prEO �a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ROMEOWNER LICENSE EXEMPTION Please Print RATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone,"r CURRENT MAILING ADDRES S: ci\which /she state zip code The current exemption for"homeown 'wasxtended to include owner-occ ied dwellings of six units or less and to allow homeowners to engage an individual o does not possess a license, rovided that the owner acts as supervisor. DEFINITION OF HOME R Person(s)who owns a parcel of land /she resides or intends to side,on which there is,or is intended to be,a one or two- family dwelling, attached or detachedcessory to such use an or farm structures. A person who constructs more than one home in a two-year period shall not bd a omeowner. Such" omeowner"shall submit to the Building Official on a form acceptable to the Building Official,thhall b res onsible for I such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for c pli ce with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understan th Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply wi said p cedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings cont ' 35,000 cubic feet or larger will be equired to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any ho owner performing work for which a buiIdin ermit is required shall be exempt from the provisions of this section((Section 109.1.1-Licensing of construction Supervis.0 ; provided that if the homeowner engages a person(s)for hire to do suc work,that such Homeowner shall act as supervisor. Many homeowners who us this exemption are unaware that they are assuming the res onsibilities of a supervisor (see Appendix Q,Rules &Regula ions for Licensing Construction Supervisors,Section 2.15) Thi ack of awareness often results in serious problems, pa 'cularly when the homeowner hires unlicensed persons. In this case, ur Board cannot proceed against the unlicensed erson as it would with a licensed Supervisor. The homeowner acting a Supervisor is ultimately responsible. To ensure that the h meowner is fully aware of his/her responsibilities,many communities requir as part of the permit application,that the. omeowner certify that he/she understands the responsibilities of a Supervisor. n the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certifica ion for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 4/5/2016 4:06 PM FROM: Fax Gallant Insurance Agency TO: 915087906230, PAGE: .002 OF 002 i DATE (MM/DD/YYYY) ACORDy CERTIFICATE OF LIABILITY INSURANCE 04/05/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone: (978)263-3500 Fax: (978)263-1438 - CONTACT Jeanne Mayer ' GALLANT INSURANCE AGENCY,INC. PHONE FAX 199 GREAT ROAD/P O BOX 975 W . No EM: (978)263-3500 (978)263-1438 ac No ACTON MA 01720 E-MAIL DRESS: jmayer@gailantins.com @/� ailantins.com ADt%g INSURER(S) AFFORDING COVERAGE NAIC i INSURER A : Central Mutual Ins.Co. INSURED HURLEY-TESTA CONSTRUCTION CO INC. INSURER B : Central Mutual Ins.Co: P O BOX 615 INSURER C MEDFIELD MA 02052-0615 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 49183 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MINI.."",EXP LIMITS LTR INSD V✓VD MM/DD/YYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY CLP8450917 04/06/16 04/06/17 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR DAMAGE TO RENTED ISES $ 300,000 PREM Ea occurence MED.EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑J PECTRO- LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ' (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED - - BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS + (per accident UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ LIED I RETENTION$ $ B WORKERS COMPENSATION WC8450918-19 04/06/16 04/06/17 X STATUTE ERH AND EMPLOYERS' LIABILITY - ANY PROPRIETOR/PARTNER/EXECUnVE Y/N E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I 1 N/A E.L.DISEASE-EA EMPLOYEE $ 1000000 (Mandatory In NH) r r 0 yes,describe under - E.L.DISEASE-POLICY LIMIT $ 1000000 DESCRIPTION OF OPERATIONS below r r DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Re:Debbles Lane CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATNE Attention: c_`J ' G Theresa M. Farrah ACORD 25(2014/01) 01988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD f ,sue �e �pomvr�zarcurecz�o�C? ac�ucaelt �----- -.. �\ Office of Consumer Affairs&Business Regulation License or registration valid for individul"use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: e istration: Office of Consumer Affairs and Business i 9 146172 Type: ess Regulation � Expiration:.. -.-3[30120:1;7:. Private Corporatir 10 Park Plaza-Suite 5170 == Boston,MA 02116 HURLEY-TESTA CON STCOIVIPANY,INC. GREGORY TESTA 7 STAGECOACH RD MEDFIELD,MA 02052 Undersecretary N li tho signature i f -- . 3 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-089604 Construction Supervisor GREGORY A TESTA 7 STAGE COACH RD MEDFIELD MA 02052 -. Expiration: Commissioner 02/27/2018 Construction coon Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massach State Building Code is cause for revocation of this licentts se. DPS Licensing information visit: Vyyyyy.MASS.GOV/IMPS r ' AT •g,.. 8P INSTABLE B � - � N DA E III;:. g FIR EPARTMENT PERMITTING Remove existing r non-bearing wall GNATURES ARE RERUIRED FOR TH , a Existing Lji\vmg Room �01 •y CL IMPORTANT UPGirRAE)C, R , QUIRED �.. STATE BUILDING COD REQU RE5 TI E U GRADING: OF SMOKE DETECT RS F R THE ENTIRIJ D ELLING WHEN ° ONE OR MORE SL EPIN 'AREAS AREA DE OR CREATED, 12'-2" NOTE:. A SEPARkTE IERMIT IS RE UIR"D FOR THE Remove non- INSTALLATION OF SMO DETE TORS THE ELECTRICAL bearing existing PERMIT DOES NO SAT 3FY TH S REQYIREAIENT Wall O O Remodel existing O 0 bath o G Existing Kitchen Remove partition wall,non-bearing - Demo'/bath. See page 4 for ,lob Name Drawing No. added hall to 137 Debbies Lane Demolition Plan-proposed family room DATE DRAWN BY Hurley-Testa Construction Co.,Inc. Fp.BgASjs , 08/25/15 GREG TESTA M dWd.MA02062 uaacsano�i 'sue.xsaao e, FRI __ SCALE PAGE Rev V. �/a" _ 114. 1 OF6 A } Existing windows Qty 2 18'-7" t New walls to create closet, new doors 1' 10.. Existing Window V Bedroom o New door Existing LinenT' Closet Existing Bedroom xistsing Stairs New non bearing partition walls, °P o� 2x4 framing,12" blue board and � plaster Demo old Jacuzzi .: , ;. Eting Hall to instal shower k.. and tub Toilet to remain rF Bedroom a New shower 0 Reconfigure wall for larger closet and Extend existing 5'-0" Existing wall to make larger closet Vanity and sinks a= Walk—in double doors a0 New ub Closet to remain Existing 2x6 wall -opened up,new R-21 al fiberglass insulation Cc) i� o ✓I �t w/vapor barrier + w 1 '-91/2" 2 Existing windows to remain Exisitng slider • Job Name Drawing No. 137 Debbies Lane Second Floor-Proposed Hurley-Testa Construction Co ,Inc. DATE - DRAWN BY eo,eoxes 08/25/15 GREG TESTA M.dkld,MAW-052 seJss srzog{ sa-acsaao m. ... SCALE PAGE Rev %a" = V-0" 2 OF 6 A y E 2x4 existing wall framing,new R- 15 fiberglass insulation with vapor barrier. Existing Living Room 2x4 existing wall. , framing,new R- 15 fiberglass insulation with .vapor barrier. Existing bath to _ remain,but bex remodeled N completely. a �. 12'-2" tZ See pg 4 for details on new O f hall 2x4 existing wall - - framing,new R-. 15 fiberglass Existing Kitchen insulation with ?' vapor barrier.��21 _ — ——r a_ Job Name Drawing No. - 137 Debbies Lane First Floor-proposed Hurley-Testa Construction Co.,Inc. DATE DRAWN BY P,.0..8.¢x 616 08/25/15 GREG TESTA MedI.Id,MA M2 uuossanumi soe-awsoao m. FRI ._...... SCALE PAGE Rev 3 OF 6 A Existing House V Existing New 2x 4 wall j Garage with R-15 fiberglass ; insulation w/ Garage ceiling to be vapor barrier insulated with R-38 era.plywood base, �. 36 in zi 2x6 pt framing, fiberglass insulation foam insulation in w/vapor barrier a; joist bays New 2x 4 wall with R-15 fiberglass Up Existing wall insulation w/ vapor barrier N i - -- n i Existing Existing door `. Family room Job Name Drawing No. 137 Debbies Lane First Floor Hall to Family Room-proposed Huxley-Testa Construction Co.,Inc. DATE DRAWN BY P,dWkH MA 08/25/15 GREG TESTA ' Medfeld,MA2`0� enocsrzzogi wszcaeai ru M SCALE PAGE Rev %a" = 11-01. 4 OF 6 A 40'-0" Y Remove existing 2x4 walls,frame to code:2x4 pt sills,2x4 wall framing, 1" Remove existing 2x4 walls,frame to foam insulation secured to foundation, code:2x4 pt sills,2x4 wall framing, 1" R-15 fiberglass insulation with vapor foam insulation secured to foundation,R- barrier in wall bays. 15 fiberglass insulation with vapor barrier in wall bays. Existing non EXIStlrlg bearing wall to be boiler room removed N _ Existing Electrical Closet 12'-2" k Remove existing 2x4 walls,frame to code:2x4 pt sills,2x4 wall framing,1" Existing foam insulation secured to foundation, ' Laundry Room R-15 fiberglass insulation with vapor Lr x. barrier in wall bays. Pr Existing window Existing window to remain I to remain LI Job Name Drawing No. 137 Debbies Lane Basement Hurley-Testa Construction Co.,_Inc. DATE - DRAWN BY P,O.,B0015 08/25/15 GREG TESTA Medfeia MA M1os2 sus3csano Rl soe.msat,�m ® _ SCALE PAGE Rev YV 11-0.. 5 OF 6 A General Notes: 1. Major flood due to multiple frozen pipes caused significant damage to second floor, first floor. Walls and ceilings were removed that got wet. While remodeling customer wanted to reconfigure the part of the first and second floors. 2. First floor to be reconfigured on one side to make larger open area. 3. Hall created in garage comer to allow access from main house to existing family room behind garage. 4. Half bath on first floor to be removed, already have existing full bath on first floor. 5. Large master bedroom on second floor to be divided into two bedrooms with new closets. _ 6. Second floor bathroom — remove Jacuzzi, install new tile shower and new tub (no shower head). Toilet and sinks to remain in same location. New tile floor, shower/tub walls, new sinks and faucets (same vanity) 7. Finished basement had to be demo'd due to flood. Three walls had to be re-framed to code with PT toe plates and 2x4 framing. 8. All exposed bond joists to be insulated with 2" rigid foam insulation and spray foam around all edges. 9. All penetrations through top and bottom plates to be sealed with firestop caulk. 10. First floor full bath to be remodeled. Same plumbing fixture locations, new tub, same vanity and toilet, new plaster walls/ceiling, new the tub surround and floor, new exhaust fan. 11. Wiring in affected areas to be redone. 12. Existing plumbing in half bath to be removed and capped off. 13. Plumbing in second floor bath to be reconfigured for new shower-an tub. 14. Second floor old shower plumbing to be removed and capped off. - 15. Garage ceiling had to be removed along with insulation. New R-38 fiberglass insulation w/vapor barrier to be installed. Job Name Drawing No. 137 Debbies Lane Notes ` Hurley-Testa Construction Co.yInc. DATE DRAWN BY P OAO.61$ 08/25/15 GREG TESTA MedfeId.MA020M FRI _.' _ V evonsanu(Q1 ., „ SCALE PAGE Rev Lj- i I I -T-;_ ;- ��; --- �-- -r---, ;� -�-----FT �--� ---�-- -� --, -- ---,- '_! 1_�_ '-��_� ` �� 1 _ _� + it-► �._1 � _ - :E --j I-L J- -11- T. -L,--j-" -jj -417 _t- FA C4 7-7 2 i ' 1 ' ^I t 1 , , e _ i } i i } p ,..•—`ice'i.� }— -J- j��- R I i 1 •_ ; , , 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel icat� L#' I f Health Division Date Issued y 6/ s Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 4%e- S Village IV-- P 1„-,� !�A ! . Owner J7 Address GiO C ti Telephone Permit Request l��',[rj A���/�( ✓1 7'r/�//' l&\f l S n VC Square feet: 1st floor: existing pr o d 2nd floor: existing proposed Total new C �Zoning District Flood,Pl 'n Groundwater Overlay + ` Project Valuations ruction Tye Lot Size Grar1hered: Yes ❑ No If es, attach supporting documentation. Y pp 9 _9 Dwelling Type: Sin e Fa it � Two F& ily ❑ ulti-Family (# units) m F Age of Existing S ruct�u g g (`� Historic use: ❑Yes Q.No On Old King s;:Highway: U YeF ❑ No Basement Type: ❑ Full ❑ Crawl ko �/ ❑ Other �� `D Basement Finished Area (s .ft.) Basement Unfinished Area (sq.ft) F Number of Baths: Full: existing Vw Half: existing new R �7 Number of Bedrooms: isting new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas 26 Oil ❑ Electric ❑ Other Central Air: ❑Yes 29 No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name fe as Telephone Number Address ��(��^ n ��J` • License # L/ .S rJ l O Meod �Z e Home Improvement Contractor# Email%�LLP ,afG� c Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE y r s -✓" FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. � T y Town of Barnstable ° .Regulatory Services . RAINSUM � Y MACC �,, Richard V.Scab,Director 16►A. p Building Division Tom Perry,Building Commissioner 200 Main•Street Hyannis,MA 02601 www.town.barnstablema.us Office: 508-862-403 8 Fax: 508-790-6230 -Pro p* erty Owner Must Complete and Sign This Section If Using ABtulder as Owner of the subject property hereby authorize A6 !.r —� C.Sr�` ��s�f{�� to act on my behalf, in all matters relative to work authorized byrl i building permit application for. (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. S ature of Owner Signs oMPPKCaat Print Name 1-r�,,� Print Name I5 Date QFoxMs_owrtERPERMIssrorrnoors t , 17J6-28•--201' 3 7 cc Deed We, J.P.Anselme and, Marie Celine Anselme',husband and wife; as tenants by the entirety,' �( both.of'Newton, Middlesex County,Massachusetts ! for consideration paid of One,($1.00)'..Dollar ' grant to Veronika Testa; Trustee of The.Marie Celine Anselme 2012 Irrevocable Trust dated April 6,2012,; , with QUITCLAIM COVENANTS 00 - .. fo the land with the.buildings theieon iri Barnstable, Barnstable County, Massachusetts,bounded C11 and described as follows: S Lot No. 103 as shown on a plan of land entitled; "Wakeby Estates, Subdivision'Plan of Land in Barnstable, as surveyed for Green Pond Realty Trust"dated May 1, 1973, by Down Cape Engineering, Route 6A, East:Biewster, Massachusetts,recorded with the Barnstable County f o z Registry of Deeds in Plan Book 272, Page 92. n o Together with the right, pass and repass over,all the ways shown on said plan in common with others entitled thereto. Subject to and together with the benefit 6,Uall rights;right's of way,easements, restrictions, reservations, appurtenances and other matters of record, if any there be,insofar as the same Q W may be in full force and applicable. For our title see Deed of David S. Dodge dated July 13 ,19.91 and recorded with Barnstable Cotuity Registry of Deeds.in Book.7616, Page 222. 4 Cn a Z a i WITNESS our hands and seals this,61h day of April,2012 J.P. Anselme arie-E' 1 ne nse ine COMMONWEALTH OF M�ISSACHUSETTS NORFOLK, ss On this 6`' day of April,2012.before me,the undersigned notary public,personally appeared J.P. Anselme and Marie Celine Anselme,proved to me through satisfactory evidence of identification to be the persons whose names are signed on the preceding or attached document, and acknowledged-to me that they signed it voluntarily for its stated purpose,, t olnl J. Mc cholas Is Notary o Pu lic, My Commission Expires:--, .2 : BARNSlABLE REGIS RY OF DEEDS a • Declaration of Marie Celine Anselrne 2012 Irrevocable Trust Whereas the Grantor, Marie Celine Akselme,of'Newton,Massachusetts,is about to transfer and deliver to the Trustees certain funds and/or properties; ' ? Now, therefore,the Grantor declares that the Trustees shall hold and administer,the property which is now'or hereafter may be transferred to them as such Trustees, or in any way acquired and held hereunder, in Trust for the purposes,and in the manner;--and with and subject to the powers and provisions herein contained,as follows: Words or phrases as used herein importing the singular number inay extend and be applied to several persons or things, words importing the plural number°may include the singular, and words importing the masculine gender may include the feminine and neuter.' FIRST: TRUSTEES A) The term "Trustees" as used herein and any pronoun referring thereto,shall mean the person or persons who from time to time will be serving as Trustees hereunder,or any,of them, " as the context admits. B) (1)Veronika Testa of Medfield, Massachusetts shall serve as the Original Trustee of this Trust. t . (2) In the event that Veronkia Testa shall be Linable or unwilling to act or continue x to act as Trustee,then Fabienne Madsen of Needham, Massachusetts, shall serve as Trustee of this Trust. Q This Trust is irrevocable and shall be known.as The Marie Celine Anselme t 2012 Irrevocable Trust and may be referred to as such: . ' 1 1 f i SECOND: BENEFICIAL INTEREST The Trust property shall:be disposed of in the following Harmer`, A) During the life of the Grantor,the Trustees shall periodically distribute as much of the net income only of the Trust property as they in their sole discretion deem necessary to or for the benefit of Marie Celine Anselme. There shalt,be no distribution of fprincipal to or for the benefit of the Grantor during her lifetime. B) The Grantor reserves to herself the right to reacquire particular trust assets by substituting assets of equal value. (E C) (1) The Grantor shall have the right to reside in the properties,located at 133 ( Eastbourne Road,Newton,MA 02459 and 137 Debbies Lane,Marstons Mills, MA 02648, j and/or any other residential property owned or hereafter acquired by the Trust for the rest of her life,PROVIDED;however, that she is mentally,physically and financially able to maintain the property and voluntarily chooses to do so. 2 The Trusteesshall not sell or otherwise dis `ose'of or encumber O p any residential property without the written consent of the Grantor or her personal representative. U) (1) In lieu of paying rent to the Trust, said Marie Celine Anseime shall be solely responsible for the payment of all mortgage loans; utilities, insurance,real estate taxes and ' normal maintenance and cosmetic repairs for as long as she shall occupy the property. (2) Capital improvements,and major structural repairs in the'nature of capital improvements,shall be made in the sole discretion of the Trustees. The cost of such capital improvements shall be paid by the Trustees either,from the gross income or the principal of the Trust. j E) In the event that the Trustees sell either of the above-referenced properties and purchase a subsequent residential property;the-Grantor shall have the right to'reside in.that ! property upon the same terms and conditions as set forth above: F) . Upon the death of the Grantor,the Trustees.shall administer and distribute the principal and undistributed net income of the Trust property according to the then current -� Schedule of Beneficial Interest executed and filed with the Trustees. Once such distribution has i been completed, the Trust shall be terminated and appropriate notice recorded in any Registry of Deeds in which this Trust is recorded. 2 r y . n • r G) The Grantor shall have a special poweiof appointment'of trust principal. This power may be exercised only in favor'of the Grantor's children and other issue,and the spouses of such children and other issue,:ill such amounts,proportions and manlier, intrust or otherwise, as the holder of the power may designate. The holder of the special power of appointment may not exercise the same.in favor of herself, her creditors,her estate or the creditors of her estate. H) No person to whom any reversionary,future or expectant interest is,given, nor any person entitled to any income, shall have the power to alienate or dispose of such interest or income by anticipation or to subject the same to his debts or liabilities and no.such interest or income shall be liable for his debts or liabilities . THIRD: POWERS AND OBLIGATIONS OF TRUSTEES Y A) The Trustees shall have; in addition to those powers conferred by law or~ otherwise,the following discretionary powers,privileges and exemptions incidental to the management and distribution of Trust assets as set forth in paragraph SECOND: above: s (1) To sell;convey,transfer;,assign;mortgage,loan or otherwise dispose of or encumber all or any part of the Trust estate,to execute and deliver leases and subleases', to borrow money and to execute.and deliver:Notes or .other.evidence of such borrowing. . �( (2) To administer,invest and reinvest the Trust fiend in any state or jurisdiction and ill } any property(including investinent'conipames, money market funds and common trust fiends with notice to beneficiaries)Whether or not of a kind',or in:a proportion ordinarily considered suitable for Trust investments and whether or not productive or marketable,and may,permit all or any part of the Trust property to be held in the custody of a banking institution or brokerage house. The specific,nature of the trust investments shall be determined, and any changes in the,fform or type of } trust investments shall be made, only with the knowledge and consent of the j Grantor, or his personal represeiitative: r n (3) To participate in any reorganization;recapitalization,merger or similar transaction;to give proxies or powers of attorney, with or without power:of substitution,for.voting upon any shares or certificates of interest belonging to the Trust. (4) 'To make any payment or distribution directly to any beneficiary,`whether or not competent;or to'apply`the same for his benefit and, in the case of a minor,to deposit the same ilia savings bank in his name or to invest the same in E "custodianship or Trust for his benefit. (5) To determine in"accordance with reasonable accounting practice what shall belong and be chargeable to income and, in making that determination, or for any other purpose;the Trustees may employ an accountant or attorney-at-law and;rely �. uponhis or her opinion . . (6) Subject to the terms and conditions of paragraph SECOND: above,it is the _Grantor's intention to give the Trustees wide discretion in matters of management of the Trust property and the foregoing enumeration of powers is not intended to exclude any powers reasonably incidental to such management { .B) Notwithstanding any provisions herein to the'contrary no Trustee shall.be required to take any action which will, in the opinion of such Trustee,.involve him or her in any ( personal liability unless such Trustee is first indemnified to his or her satisfaction. Any person dealing with the Trustees shall be fully protected in accordance with the provisions of paragraphs i FOURTH: and FIFTH: hereof. _ ! C) Any and all actions tak.6 f by the Trustees, whether pursuant to the powers and authority granted above or otherwise, shall be in their sole discretion as determined unanimously by the Trustees in office at the time the action is taken. D) ' No Trustee shall be liable for the acts or omissions of another Trustee or'any prior Trustee. Further, no Trustee shall be liable for any error of judgment nor for'any loss arising out of any act or omission in the execution of the provisions of this Trust so long as he or she acts in good faith, but shall be responsible only for his or her,own willful breach of Trust. E) No Trustee.shall be required to give bond or-furnisli surety on''any bond required by law. ``' FOURTH: BINDING AUTHORITY AND VALIDITY OF TRUSTEES' ACTIONS A) Any deed, mortgage, lease, note,easement or other instrument, similar or dissimilar to the foregoing,,executed and delivered by the Trustees on behalf of the Trust shall be binding: B) No purchaser,transferee;mortgagee, lender,'lessee or any other person or entity dealing with the Trust shall.b.e xequired to,inquire into the authority of'any Trustee to take any action or make any decision hereunder,or to inquire into the autlnorization of'any Trustee to execute and deliver any instrument and the signature of the Trustees shall be sufficiently binding upon this Trust. I FIFTH:. RELIANCE ON RECORD AS TO TRUST STATUS I A No urchaser t p raansferee,mortgagee, lender, lessee or any other person or entity dealing with the Trustees as the appear of record in the Registry of Deeds of any county in which this instrument is recorded shall be bound to ascertain or inquire further as to the persons i who are then Trustees hereunder and such record shall be conclusive evidence of the identity of said Trustees at.,any time,*and any record of the due execution and acknowledgment of this Trust duly recorded in the'said Registry of Deeds and the absence of any record duly dissolving this Trust recorded therein or in such other Registry of Deeds in which this Trust was.duly.recorded ;_m ] a . shall be conclusive evidence of the existence of the Trust, and any purchaser,transferee, mortgagee, lender, lessee or any other person or entity dealing with the Trustees as they then appear of record may rely thereupon as conclusive evidence of the existence of the Trust. B) A written statement of any Trustee at any time as to any facts relative to the Trust may always be relied upon and shall always be conclusive evidence in favor of any transfer agent and any other person or entity dealing in good faith with the Trustees in reliance upon such statement. C) The receipt of the Trustees for monies or things paid or delivered to them shall be an effective receipt on behalf of the Trust with respect to any person or entity paying or delivering the same. No person or entity from whom the Trustees or any one of them shall receive any money;property or other credits shall be required to see to the application thereof. SIXTH: DISCLAIMER OR RELEASE OF TRUSTEES' POWERS A Trustee may, at any time, disclaim or release any power in whole or in part by an instrument in writing,duly signed, acknowledged before a Notary Public,delivered to any Co Trustee and if none, to any beneficiary, and recorded in the Registry of Deeds in the county where this Trust is recorded. Such disclaimer or release may be for such period of time as such Trustee may specify without in any way affecting the continuance of the power,in any other t Trustee. I SEVENTH: DELEGATION OF TRUSTEES'POWERS An Trustee may,from time to time,,delegate ate in writing the power to si n checks or � - Y Y, g g p g withdrawal orders and the custody of the Trust fund to a Co-Trustee for such period or periods of time as he or she may determine, and similarly may delegate snch other powers and discretions " for periods not exceeding one(1) year at a time;provided,however, that any powers or discretions witl-lield from any Trustee by the terms of this Declaration of Trust shall not be delegated by such Trustee under this.Article. EIGHTH: RESIGNATION,DEATH OR REMOVAL OF TRUSTEE;, , 1 APPOINTMENT OF SUCCESSOR r. H A) Any Trustee hereunder may resign by a written instrument signed and acknowledged by such Trustee and recorded with any Registry of Deeds in which this Trust may be recorded. B) Any Trustee.may be removed by a majority of the beneficiaries or their personal representatives,as their interests may appear at the time of the removal,by written instrument signed and acknowledged;delivered to the Trustee and recorded with such-Registry of Deeds. C) Upon the death,resignation, or removal of any Trustee,the named successor: Trustee or Trustees shall forthwith.be appointed. A written certificate signed and acknowledged I by any Trustee naming the Trustee or Trustees appointed or removed and, in the case of any appointment,the acceptance in writing by the Trustee or Trustees appointed, shall be recorded with said Registry of Deeds.. 1 D) Upon the appointment of any succeeding Trustee,the title to the Trust Estate shall thereupon and without the necessity of any conveyance be vested in said succeeding.Trustee ` jointly with the remaining Trustee or Trustees, if any: Subject only to the terms and conditions set forth in Paragraph THIRD: herein, each succeeding Trustee shall have all the rights., powers, authority and privileges as if named,an original Trustee. E) In the event that neither the original nor any named successor Trustee continues to serve hereunder, any further successor Trustees shall be appointed by a majority of the beneficiaries, or their personal representatives, as their interests may appear at the time of the` appointment, subject'to the provisions of Paragraph EIGHTH: C)above. I� NINTH: ACCOUNTING The Trustees shall render accounts of the administration of the Trust annually. The . assent by all persons, or the personal representative of such persons who are.not of frill age or legal capacity, who for the period of any account were entitled to receive the income of the Trust and on the last day of the account would have been entitled to'receive the principal of the Trust if it had then tenninated shall make such account, in the absence of fraud or manifest error,binding and conclusive upon all persons then having or who may thereafter have any interest, vested or contingent, in the income or principal of the Trust estate. The failure;of any person or their personal representative to object to any such account by a writing mailed to the Trustees within thirty (30)days of the receipt of a copy of the account shall be deemed to be an assent by such person. TENTH: IRREVOCABILITY I The Grantor expressly waives any and all rights which she may-have,by operation of law or otherwise, to revoke,alter,amend or otheiwvise change this Declaration of Trust:. ELEVENTH: CONSTRUCTION; CONFLICT OF LAWS jThis Trust shall be interpreted in accordance with the laws of the Commonwealth of (� Massachusetts and its validity and administration shall be governed by said laws except with respect to such assets as are required by law to be governed by the laws of some,other j jurisdiction. 6 IN WITNESS WHEREOF,the Grantor sets forth her hand and seal this 6" day of April, 2012. i arie Celine Anse { COMMONWEALTL-I OF MASSACHUSETTSL, NORFOLK, ss i. On this 6`h day of April, 2012, before the undersigned notary publrc,''ersonally appeared Marie Celine Anselme; proved to me through satisfactory evidence of identification to be the person whose name is signed on the preceding or attached document, and acknowledged to me j that she signed it voluntarily for its stated.purpose: f - 1 Olin J. holas. Notary Public tMy Commission Expires: 12/28/lu f IThe Commonwealth ofMassachusefts Deportment of Indu trial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgo-pMa Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizalim/Iadividual):�u Address: l{' d ' City/State/Zip: ;�� 1 I f!— Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑I am a general contractor and T * have hired the sub-contractors 6. New constructionemployees(full and/or part-tie). . 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. employees and have workers' 9 *Building addition [No workers'comp.Mi nzance comp.insurace J ❑ g required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work 11.❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12.0 Roof repairs , 14 ,a inGlTrance required_]t c.152 § ( nd we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fD1 out the section below showing then-workers'eompcnsafion policy information_ t Homeowners who submit this affidavit indicating they are doing all wordc and then hire outside contractors must submit a new affidavit indicating such_ tContractws that check this box must attached an additional sheet showing the namu of the sob-contractors and state whether or not those entities have employees. If the sub-contractors have employ=,they mast pmvide their workers'comp.policy nmnber, I am arc employer that isproviding workers'compensation insurance for my employees. Below is thepolicy andjoh site- information. Insurance Company Name:_ ��(/� otv�l Policy#or Se1f-ins.Lic.#:— `1 9� Expiration Date: Job Site Address: J_ /�C4�1t°S �"I'1 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 fins up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the foaa of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify the ains and penalties of perjury that the information provided ab a is Ve and correct: Signafore: Date: Phone#: �~ Official use only. Do not write in this area;to be completed by city or town ofji W City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.BuildingDepartment 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: f -Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pvrsuantto 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 local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings for the commonwealth for any 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 t _ 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 is any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant shoe-rd 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 like to than you in advance for your cooperation and should you have any questions, please do not hesitate to gyve us a call. The Department's address,telephone and fax number. The Commonwealth of Massachusetts Depa-dment of Industrial Accidents Office of Xnvestigations 600-Washivon.Street Boston=MA Q1 if Tel.9 617-727-4M ext 406 or 1-8.77-MASS Fax#617-727-774-9 Revised 4-24-07 www.m=_gov1dia MMV A x CERTIFICATE OF LIABILITY INSURANCE DATE 120/rYYY, 04/15/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone.(978)263-3500 Fax:(978)263-1438 CONTACT Gallant Insurance Agency,Inr. N ME* GALLANT INSURANCE AGENCY,INC. PHOAC FAx (978)263-1438 199 GREAT ROAD/P 0 BOX 975 autL� 978 263-3500 Arc Nm. ACTON MA 01720 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 9 INSURER :Central Mutual Ins.Co. rusuRED HURLEY-TESTA CONSTRUCTION CO INC. 'NsuRERe Central Mutual Ins.Co. P O BOX 615 INSURE=:C MEDFIELD MA 02052-0615 WURERD: INSURER E • INSURER F COVERAGES CERTIFICATE NUMBER: 39275 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 A(JY 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. N R TYPE OF INSURANCE IANNSR W RI POLICY NUMBER POLICY FFF POLICY EXP I LIMITS A GENERAL LIABILITY (( CLPM0917 04/06/14 04/06/15 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY 1 � ES(ED cca rer,rxl I S 300,000 CLAWS-MADE ®OCCUR MED.EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AM S 2,000,000 ROI 'POLICY J CT I LOC S AVrOMOBILE LIABILITY OWBINEO SINGLE LIMB (Ea 80*11:) Is I�AUTOS ANY AUTO BODILY INJURY(Per person) S ALLO%VNEDq0T1-OWN HEDUED OS BODILY INJURY(Per accidenp S HIRED AUTOSED PROPERTYDAhtA E S TOS i (Per eeddertt) S UMBRELLA LMS �OCCUR - � � EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE _ AGGREGATE .I S I I ED I IRETENTION S I S UI B WORKERS COMPENSATION WC8450918-17 04/06/14 04/06115 X TORYLIMITTS ER S AND EMPLOYERS! LIABILITY ANY PROPRIErowPARTrJ�EXC�TLVE YIN - ELL EACH ACCIDENT S 1,000,000 OFFICHATIMFSER EXCLUOED7 N/A E.L.DISEASE EA EMPLOYEE S 1,000,000 (temw�sorytntttt) - Itym.desadleundu L, IELDISEASE-POUCYLIMIT (S 1000000 DESCRFMON OF OPERATIONS below , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Record Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE VZIA�Q Attention: Theresa M.Farrah ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD L �1 J: t. 9 +Massachusers _; �epa-.men of?� c_- ' Board of 3uildina R, , �bl.c Safety a�iaicns and,StandarrS CUnstrnclilln Supei-Visur _ice:use: -089604 REGORY A TUT,4 7 STAGE COAcldii _ r ;,+t Cornmissio • t �io;i aer 0247/2096 ,a ��e`Fa�i�.rirnii�aeril(�r�^-j`�s;;rzc�rrcftt Office of Consumer Affairs&Business Regulation d OME IMPROVEMENT CONTRACTOR . gistration: 146172 Type: , xpitabon:; 3/30/2015. Private Corporate, HURLEY TESTA CONST CO INC GREGORY TESTA 7 STAGECOACH RD MEDFIELD,MA 02052 ' Undersecretary -Office of Consumer Affairs & Business Regulation- Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) t. Consumer Affairs and Business Regulation � Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints II a Registration# 146172 Home Improvement Contractor Registrant HURLEY -TESTA CONST COMPANY, INC. Registration Home Page Name GREGORY TESTA Address PO BOX 615 City, State Zip MEDFIELD, MA 02052 Expiration Date 03/30/2017 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=46803 4/6/2015 Assessor's office Ost floor): G} Assessor's map and lot number;.:.1,�. y7 / („ StiC' �FTMEtO`` r 0 Board of .Health (3rd floor): � tii`�"t$�LED ' C o" t Sewage Permit number ...,... �.��,.. ..... �.. O P WITH T! Tsnce Engineering Department (3rd floor): ® �o ' j '. r a s EtZE s6 q. 0� House 'number ..... .:....... 1.1.. .....: . , Y a� �T��. Ci�D A Definitive Plan Approved by,.Planning Boo rd.: ______________________19 _-- TOWN REGULATION 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 ...4.0 ......?�FCO it//�:; G�02 TYPE OF CONSTRUCTION ...........:.Wao 6�M , : ....... ...... ............�?. . 19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for,a_permit according to the following information: / 3 7 /fir'— 3 S L/� r�/25*o�r, Location .........................-> .....1 .....:... ......... .:....,.. ........... Proposed Use Gt/ L L/.f/� ........... ... Zoning District .................. ................... .................Fire District ....... Name of Owners e...... !4✓lP..... ................Address .`,....4. ........V l/1S LL { Name of Builder .......(..v.. . LNG..........:.:.....•.......Address k//.v/�/�0/�G...? /? lfd�S7atis .evii�g ... .... Name of Architect ................................................................:.Address . , Number of Rooms ....:... .. . .y .` .Foundation :��/�'vG ou/Z•4d. �O�/C2ETP� , Exterior ..'.l�� y..e.....:5'�. /tt//r. ........... ...Roofing` ....:.. :�� T ... Floors ........ ! A'-T..a:..!...!. L...................................Interior . ?Y:LGL ...... ..,:..................................... Heating �LEG ...Plumbin l/G fC-PPE? T . ..... Fireplace ....................../" ..... ......:............ Approximate Cost ..... .. .................... Area. L.... . Ar ...1.[/. ....... . 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 Supervisor's License © Z�7 .;....... DODGE, DAVID No'c` 3188.2 Permit for ...Add•••2nd Floor = Sing•le Family Dwellin ..... ` ....._.... ..... c ........ te s ' Location 13 �� Lane .. .... ................. ar. tons Mille/ Owner .......... David Zodge.... ....:... - .... .. .,. ..... Type—of Construction Frame �. k, Plot;....... ...... lot .....`.. ..... ........ r, , Permit Granted ....May ..J 0:," ..... 1.9 88 - IV Date of Inspection 52..:�C�r 'b.Q.............19 r . Date' Completed ...... ...... .J,9 117 •rn I► � T 5 , ., ,�..,,•N,.tt-.-+s ,l.., �+ *. vti.� +'.a'Y� .A:,4•�1lµ. .� r},r'{'rs .;.r . :�:;'z«+ .0 ... ..,, . Assessor's office (1st floor): .� , TNE FT�} Assessor's map and lot number ... . o Board of Health (3rd floor): Sewage Permit number ' ........... rasn Engineering Department (3rd floor): moo +e 9• House number s, �0 ......'.................................................................. QED MAY d' 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 INSPECTOR APPLICATION FOR PERMIT TO .. .:.. .......S ........................................................... , t TYPEOF CONSTRUCTION ............ ...... -'................................................................................... ............/T..-zo... ..................19;.�.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... ...... !=:!3! ��...5 ......1. !7iP-...............i li�7A?C5 ��q l�%/L L ......... ' ..:............................... ......................................... .. .. ProposedUse (/4L'e L G/.1/� /................................................../`...............................................................................y........... ......................... i Zoning District .Fire District .......1/..:f.. ..............�................�. ........................................... Name of Owner/l1.�/.t:1......:P,900.....7,.tal. .................Address �3.7...!�iri3! u.r.S..%;:/�, .......° "'..::... ' S Name of Builder :..,f�tJ✓ Caw /A/G.........................Address k/ir �ih'�G... r�i�f?h" ;:✓�i i�`>? "'S i�_� 5 ...... .... Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ........ :... .................................................Foundation ".......................�/S;�is.,; ...�G�1✓ci?lTtf— Exterior ... yC......`71. ...ti.:✓-.........................................Roofin 1.4.....�.......................................................... Floors ........:' !i�t7r�(rT...>....Vl..:'�.. 'G...................................Interior ..��..Y Heating : ............................................Plumbing 7o cr. �t)1� ........................................... Fireplace ......................ei Z;:�: yi...............................................Approximate Cost �i/ (f 0 > J..................................... /.......... Area .: _ Diagram of Lot and Building with Dimensions g 9 Fee ....... ..............:C.!✓.............. 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 ..G�.n.7.��,1.......... DODGE, DAVID A=027-129 " No ..3.18.$2.. Permit for .....Add..2n.d...F.loor . ....Single...F.amz.ly...Dw.e.11i.ng.......... its Location ....13.7....D.ebb.r.-Lrs...Lane.................. .................. 5: 5��s.. �. Owner .....1).ay.id...D.odge................................ Type of Construction Frame ............................................................................... Plot ............................ Lot ................................ Permit Granted ......MaY...l.4.�................19 88 Date of Inspection ....................................19 Date Completed ......................................19 Zoe Assessor's map and lot number? Q � /�S / .�14.. Ft?HE T U81e ,g Pao o�y Sewage Permit. number ..........g.......� .T..!a.................... 33A < � . : tHBST 4D3 . �pVHouse number . ....... . ............................. .............. a TOWN •• OF, . *BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....� UiG.; .. ......14.......�....1� .�. ....... G � 1.! .............................. T+PE OF'CONSTRUCTION ......��.Got�....... ..:....:................................................................. P. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 1 { a Location -�.. . -,-Z&�'.........." rl�rr'G!�'... .. . `..'.%✓`fC1't� ..:�.fi'��..... ..../. ..... ........ ....................... ProposedUse ... ... f'/'ll. ....... ?°L���-:......................................... ................................................. ..... Zoning District ......Iff........................................................Fire District _" (:.� -r ...Vzlle Name of Owner ... .� ........ . c . .Address .... . ..... n Name of Builder ......� /'t/ �� ....An/W.I..S.Address .... Igfa� ......`,5Z......... �/l/.:r 1�. r... l.C�........ 1�� / !' ��»L?5......Address f Name of Architect ... ... ....... .. .. ......,�`/.........�.�(...:. �r......f.. C.(�.:... Number of Rooms ..:....6.....................................................Foundation ..l��/�r� Exterior `. � L......... 1x .!.r1 ...................`.................Roofing ;f..11?L.....�C/�/�! ��`............................................... Floors ;..�tit(�"� ?.5�.. /f�i (Cr`.r.......................................Interior ....& ................... Heating ��'®�.f!� .!c................................. ............ Plumbing G'1 ? ................... ..© �.�............. .� Fireplace N. .........................................................................Approximate. Cost ......................... Definitive Plan Approved by Planning Board __ ___________________________19_______. Area ,', r�;'.. ..... .. Diagram of Lot and Building with Dimensions Fee .......... . �.. .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH a' 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 Namexr Construction Supervisor's Licens Single Family Dwelling Location --���.�.��.....�--�.�.�_^�.�--� La�� � ------- .................... ............. ' Ovvner --..Danid Dod8e __________. ' Type ofConstruction ---�z�me............................. ---.--.�-------.------------.. . r Plot ---------. Lot —'--------- ~ - . Dece�ber l9 8� Permit Granted . � lV . ---------' --' Date of Inspection ------------lg . , Dove Completed ---�---------.l9 � . ' � . ' . - ' - / N . ` � . . \ � XL— _ r X4PRESS PERMIT Town'of Barnstable *Permit O C T 2 2 2007 Expires 6 months from issue� Regulatory Services Fee �— TOWN OF BARNSTABLE Thomas F. Geiler,Director Building Division Tom Per ,. BO, Building Commissioner 00 ain treet,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONL Not Valid without Red X-Press Imprint Map/parcel Number O Z Property Address433 be�L,C! s Residential Value of Work ,S� Minimum fee of$25.00 for work under$6000.00 �Owner's Name&Address t Ain J e (!I_e l z�� Z�J/40 Ulll e_ Contractor's Name ley �s Lnil— Home (ClTelephone Number Improvement Contractor License#(if applicable) / % ( zzi:� Construction Supervisor's License#(if applicable) S 06Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Q5,I have Worker's Compensation Insurance Insurance Company Name i r — r �'?-S^• f� Workman's Comp.Policy# �/��G� tf ( -) l�) Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) e-roof(stripping old shingles) All construction debris will be taken to�/7 ❑Re roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope 3the er mu sign Property Owner Letter of Permission. A co H eZI=mvement Contractors License is required. i SIGNATURE: i Q:Forms:expmtrg Revise061306 r d 't The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 021I1 , www.mass.gov/dia Workers" Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bI Name (Business/Organization/Individual):, •Address: City/State/Zip. Av `Phone.#: S� Are you an employer? Check the appropriate box: -Type of project(required):, 1. I am a employer with 4. I am a general contractor and I 6. ❑New construction . employees(full and/or t-time).* have hired the sub-contractors par ❑ I am a•sole proprietor or partner-. listed on the'attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' [No workers' comp,insurance comp.insurance. $• 9. 0 Building addition required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance,required.] t c. 152, §1(4),and we have no employees, [No workers' 13.❑ Other comp.insurance required.] , ''Any applicant that checks box#1 must also fill out the section below showing their workers'campensation policy information. t Homeowners who subrait this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating•such. 4—Nntractors 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 isthe policy and.lob site information. Insurance Company Name: S U Policy#or Self-ins.Lic.#: ✓ fz� Expiration Date: / v Job Site Addresj /��. if_r 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 tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, 16 hereby certify- r the inSp d penalties of perjury that the information provided above is true and correct: Signature- Date: dr Phone [6. fficial use only. Do not write in this area,'tb be completed by city or town official ity or Town: Permit/License# suing Authority(circle one): Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other ontact Person: Phone#: �Of-THE �y Town of Barnstable. ° Regulatory Services . SAMSrnarE, MAS& Thomas F. Geller,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 "w.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using.A Builder 1, ,as Owner of the subject property herebyauthorize to act on my behalf, in all matters relative to,work authorized by this building permit application for, , L3 �c46'c 2� (Address of Job) Sig e of Owner ate 41 z4l je�k--C-- ame Q:FORMS:OWNERPERMISS i0N /tC T/�O�I➢7iI720i/2Cl/ O�i///�q,Qaq,�LCC6Y.GC4 - :4 --.-....--_-_._ Board of Building Regulations and Standards I HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. If found return to: Registratio.��''146172 Board of Building Regulations and Standards Expiration 3%30(2009 Tr# 127575 One Ashburton Place Rm 1301 . { Type Private Corporation Boston,Ma.02108 a I HURLEY TESTA CONST CO INC�L' GREGORY TESTA°M t'' 7 STAGECOACH RD'�-, t ' f MEDFIELD, MA 02052 Administrator Not vali without signature 10/16/2007 10:34 AM FROM: Gallant Ins Agcy Gallant Ins Agcy TO: 915083598730 PAGE: 002 OF 002 ,. ACORD DATE(MM/DD/YYYY) TM. CERTIFICATE OF LIABILITY INSURANCE 10/04/2007 PRODUCER Phone: (978)263-3500 Fax (978)263-1438 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GALLANT INSURANCE AGENCY,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE I 199 GREAT ROAD!P O BOX 975 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ACTON MA 01720 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Central Mutual Ins.Co.' HURLEY-TESTA CONSTRUCTION CO INC. INSURER B: Central Mutual Ins.Co. PO BOX615 MEDFIELD MA 02052 INSURER C. INSURER D: r INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER "' POLICY EFFECTIVE POLICY EXPIRATION " LTR INSRD DATE MM/DDNY DATE MM/DD/YY LIMITS GENERAL LIABILITY DATE 04/06/07 04/06/08 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 300,000 PREMISES(Ea OCCurence) CLAIMS MADE F OCCUR - s - MED..EXP(Anyone person) $. 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP ASS $ 2,000,000 POLICY PE0. LOG �' - + AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANY AUTO - - (Ea accident) $ .. ALL OWNED AUTOS - - - BODILY INJURY - SCHEDULED AUTOS - _ (Per person) $ HIRED ALTOS - � - BODILY INJURY NON-OWNED ALTOS (Per accident) $F1 PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ , ANY AUTO OTHER THAN EA'ACC $- +. AUTO ONLY: _. ASS $ EXCESS/UMBRELLA LIABILITY - - EACH OCCURRENCE $ OCCUR F-1 CLAIMS MADE * AGGREGATES $ DEDUCTIBLE - $ RETENTION $ WC WORKERS COMPENSATION AND WC8450918-10 04/06107 04/06/08 ORY UNIT OTHER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ B ANY PROPRIETORIPARTNER/EXECUTIVE - E.L. 100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below - - E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER: DESCRIPTION OF OPERATIONSILOCA IONS/VEHICLES/EXCLUSIONS ADDED BY NDORSEMENTI SPECIAL PROVISIONS job location:138 Debbies Lane Marstons Mills CERTIFICATE HOLDER CANCELLATION s SHOULD ANY OF THE ABOVE DESCRIBED POLICIESBE CANCELLED BEFORE THE ' - EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO Town Of Barnstable DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS Building Department - AGENTS OR REPRESENTATIVES. 200 Main Street Hyannis MA 02601 - AUTHORIZED REPRESENTATIVE' Attention: Ray Gallant ACORD 25(2001/08) Certificate# 5409 ©ACORD CORPORATION 1988 t _ , • I J.D.G. CONSTRUCTION COMPANY REMODELING CONTRACTORS ' ■ 160 MacARTHUR BOULEVARD BOURNE, MA 02532 (508)759-8580 (508)759-6118 ST�vc �� %�L•�� ,.r 6� ea1� ST�UCTI/�L-' af�O.G axc f w 9u Srt.�P 714.E /ice M/fi?a 4jAf �► CODE UA11W /�y✓/� 6 �E -- — _ ----- —- ---- i paaec7 Corve. 6-'444.At I . „mac. 600 TiNG • �� TOWN OF B":.RNSTABLE __24786__ Permit No. _ _ _____ Building Inspector saanria Cash --___-- � /Yl sue`°"Y OCCUPANCY PERMIT Bond Issued to David Dodge Address T of #101, 117 nay,: i a8 Tana, E i-c,14c .1431s; Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date / Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. l9 _ '' ...............r._..........._................................. Building Inspector ., r 3�. .p"•.. c .xl .. 5 _ t � �. �:� �°� "7y,4 1Ap.x* .4`:44 �`A � ,'C,�r, � .n'. a �u r r'�; a Ir . 5 Pao '°• TOWN OF BARNSTABLE •� °" BUILDING DEPARTMENT = sAaaaTAU TOWN OFFICE BUILDING NYl .639' HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: Ail Occupancy 4Permit has been issued for the building`authorized by ,. 1 BuildingPermit ` „» ................ .........................................................». .»....».....................»»». issued to .: ... �° ' �� .................................................... ...»......._.......... .»....».»..........».......».».»....»....» Please release the performance bond.sr - 3 s f+d ♦ z s xj >t r < f` Tn 7 in Y* °x a .. t r rr,rr f x; er 1 - }' 3 i,h 5F rw rr c + 5 7;7# �v (`i'! of r .�'s u a. 2'r y '3`fr ';�' x j t t w �Ff� i A k +'�.: .r x 2 iil . .r » CIS a�:;�,. •. -., _ - �'t,a} ,�,"sr> + s�,-� �� 4�, y- c i,ot y _ ,� AA Y t i C,E,eT/F/E'D f�L aT �L A/V PREPARE D Fo)2: L 0cgT10A./<L 5rT$ 10b rn4515S W :M ILI.o Z By CEBT/FY Tf•IoiT T.AIE 6U/La/At/4Cr- St/olVti/ O.V T///S PL Ate/ /5 LOGHTEa Oil/ THE - y.eOt�,./D AS --.rNOWiV `�N Of MASsgCti ARNE G,rt OJALA '^1 o #26348 i cvi i cam en9irreer�r�9 �9�.rF� �ECI$TE��� / \ se C/V I— E.VG//./EELS EOtJTE G4.^-Y!?e/✓1tauTs-�, .�ILaS:�. aerdL- Assessor's map and, lot number ...................... ANTS�.ALLED IN COMP �J' / (� � WITH TITLE Sewage Permit number ...............:........... ... ..... ' ENVIRONMENTAL � TABLE House number �/37 TOWN REGU A►. t a i639, 9� aYP�p\ TOWN OF BARNSTABLE BUILDING .INSPECTOR APPLICATION FOR PERMIT TO ................................... .. .............. .................................................. TYPEOF CONSTRUCTION ..................................... .... .. .. ................................................................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ermit according to the following information:. .... Location .......... f ..l�.. -............!�:�.. : . .'S...... ............d.�'�r/—C r ��? 7...�/7 ..,�1'�� ProposedUse ........ \. .r,� �' .{'�.1.(. :r. ......................................................................................... ZoningDistrict ................�...:......t .........................................,.Fire District ......(.................Ikk...................................:.. Name of Owner ... ............ M I. ......... 'Address .. 1...........�0..!.. .. �..................t..�hY.. Name of Builder . . '�!r! ....... l •...........Address ,�y}..-..('cf��4 ....A.)J... ....... .... . Name of Architect ..................................................................Address ............... ..Number of Rooms .................. :......................................?.Found .....115 ation .... .. ..................... ... .. .........................:....... Exterior ..........�U• ..I �1e.l � ..Roofing J �. Floors .............................:..Interior ....................... . . . .. .... .. .. ................................. Heating ::.... .... -..:`J.-Plumbing ... ...........! ................................................ T Fireplace ............ .....:� ........................Approximate.Cost ...... .�.�?�.OUO.................................. Definitive Plan Approved by Planning Board ------------_—---------------19_______. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH i s 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 49 . ..... .... ........................ Construction Supervisor's License .. p a J No Permit for r ` Location ......................................................... .................... Owner ...................... ..... ...... Type,of Construction ........ .:. ............................... ................................... Plot .......................,..... Lot ........... ................. = Permit Granted ........................................19 Date'of Inspection, 19 Date Completed ....................... ..........19 Sewage Permit number TOWN OF BARNSTABLE BUILDING INSP,ECTOR 19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Name of Builder ..........ie 4-.wo�...... FA ............... . k2a.,.....!;7 -Approximate Cost .......A.0 SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 Supervisor's Ucenxay�7}�\. ��.��.�—...... � . � No ................. Permit for .................................... ............................................................................... Location ................................................................ ............................................................................... Owner .................................................................. Type of Construction .......................................... ................................................................................ Plot ........................... Lot ....................... ........ Permit Granted ..........................................19 Date of Inspection ....................................19- Date Completed ......................................19 / t ��//pp : Assessor's map.and lot numberAw.� ,,, , /.,,.... SEPTIC SYSTEM MUST T"ETo�y ... INSTALLED Sewage Permit number .........:g`J...~...... .................. IN COM LI WITH TITLE 5 House number .. ...13.,..........:........:.............. :......:..... ENVIRONMENTAL CO® �6 a L S B E TOWN REGUL TICN o way ale TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....: U/G. .:............................ '� .C.�........ G !'���'�r! j............................. TYPEOF CONSTRUCTION ..... C .... ........... . ..... ................................................................................... i ld-tea --- TO THE INSPECTOR OF BUILDINGS: The undersi ned hereby applies for a permit according to the following information: Mtt yy ., Location ... ...... l�S.r...� !! ............ !r.`....". .......... Proposed Use ... ... LG`/.......�� ?°1����t-.............. ............. / ............................................................:................ Zoning District .....Af.F. .....................................Fire District Cent f V/ — (/...5lz'(/VIlle .................. ..... .......... ...... ............. Name of Owner .....D..11. U.�D..........60.2�..2.Address ......aa.....J.�7catz n:l Name of Builder .....�,,�1 - f.. -< hO./.?(.t.,OS—Address C1.L-f t4l, � 1..: Name of Architect ... /� .�. ...(7Q.? ?.5......Address .. ... . . . . ...... ........ r Number of Rooms .......67...............................:.....................Foundation Ze :rl-7.`..........................................:............. Exlerior ......,7�l.�l..!l ....................................Roofing ............................................ Floorst...�V.&e . C! , (.�> ....................................:..Interior ....i+ .. ............................................................... Y Heating .....................................................Plumbing . ... JS� ....................................................... Fireplace No................................................................. .....Approximate Cost Definitive Plan Approved by Planning Board '________________________________19-------- . Area ....... /�.4�..J ............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �N 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. i Name .................. .... .......... ......... Construction Supervisor's Licens .................................... " DODUGE, DAVID No .....28786. Permit for ..... One Story............................... Sin- y Single Family Dwelling .......... ... ............................................................... Lot 103 137 Debbies Lane Location ..................... ......................................... .. .......................................................... ........ David Dodge Owner .................................................................. Type of C6nstruction .... Frame ...................................... .. ................................................................................. Plot ............................. Lot ................................ December 19, 85 Termit;Granted ...... ...... ...................I....... 19 Date. of Inspection......................................19 ...................Date Completed, .........19 14 A Cr r C. M, Asessorl,Office 1st floor Ma Lot L- Permit# 3 Z; �cJ Conservation Office 4th floor Date Issued Z / Board of Health Ord floor Engineering Dept. Ord floor House# INSTALLED IN (Ist floor/School Admin. Bldg.): H/ITH Definitive Plan A roved b Planning Board 19 ENVIRONMENTA * (Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.) TOWN OF BARNSTABLE Building Permit Application Proiect Street Address 137 /?rs 1-6 1 Village Awswlo Z IILZ r Fire District 0wner , {: ,i/s�i,v/F` Address %' 7 Inge � /C Telephone 4eB9e 211�p Permit Request: 'f S-17J// 6 L// ?"Y' Zoning District Flood Plain Water Protection Lot Size .2-2, 70 Grandfathered Zoning Board of Appeals Authorization Recorded Current Use IZz;zf Proposed Use Construction Type 4yood / Existing Information Dwelling Type: Single Family Two family Multi-family Age of structure /ij k;lz ' Basement Historic House Finished Old Kings Highway Unfinished ✓ Number of Baths ,? No. of Bedrooms .3 Total Room Count(not including baths) 'z First Floor Feat Type and Fuel Ole- /1.r.4J elhS.`6,0 Central Air Fireplaces Garage: Detached Other Detached Structures: Pool • Attached � 'a pafG P Barn None Sheds Other Builder Information Name ��SC is/ Co//�rlill� � ?/(T. L�� Telephone number 76-Y —G//*c 75T1'gp1212p Address, 2142117�-6j!�-,oD —Z64 Nf nlr y License# d cy;-7 4i 7 /I1AA "!! Home Improvement Contractor# // Worker's Compensation # ©V, '74 -761 7 ?,�)003414a NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Al y C� Project Cost Fee SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ' BPERM T 5-V- FOR OFFICE USE ONLY 3/27/95 -3-7� ' 027. 129 7tDDRESS 137 Debbies Lane VILLAGE �Mills J. P. Anselme OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUa DING: DATE CLOSED oim. ASSOCIATE PLAN NO. r - TheBarnstable- RA a, r,�� . Town of ' AS& a Ue �ariment of health Safety Environmental and Eironmental Services 1 '^'�`~ ' litril<lirr;� I)i� i�iott 367 Main Strcet,Hyannis MA 02601 Offi=;508 790-6227 F= 508775 3344. For office use only Permit no. Date �3q AFFIDAVIT HOMEIMPROVF.MFNTQONTRACr0RLAW SUPPLERM TOE) ' 1 MGL c.142A toga m that the` ructio ah ,* i" ;•� ` , 4 i+�iq`modoq T mt. irmo%aL dMoutim arc of an additioa to:aay p owner ding containing at kart one but not more than four dudUgg units or to sUaas which ate to such reddenoe or bnilding be done by registered contractors,with eaten � atoug with other Type of Work AZI , EsL Cost I,5-V d, Addrrss of Work: f✓� 7 �!4.-� /�A/ / g '� 0%mcrNamc: mil . A Date cf Permit Application I hatby catify that Work adudcd by Iaw job underS1,U00 Building navama-ocarpied Ov mcr pulling own permit " Notice is hereby given that: ONVN'ERS PULLING THEIR OWN PERM UT T OR DEALING UgTH UNREGISTERED CONTRACTORS FOR APPLICABLE HOW IMPROVI .EN_T WORK DO NIOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. I42Aop { r.C�:SSat1G;7 1�G. ' Date O.-na s Turin 11.02 1P; 17: 02 1361717277122 DES !N-D ACCID Z 001 i117 r = —� l�Ori2/iilJll <•"QLL�. O �CI��LZC//Ct�C?� � r< oUaPa�ln�ercf o��ndusfriaL.:/dcccdenfl 600 W dw &n., h, t James J.Campbell &ton, )&macL" 02f f f Commissioner Workers' Compensation Insurance Affidavit with a principal place of business at: (Cay/st"izta) do hereby certify under the pains and penalties of perjury, that: ® i am an employer provid'mg workers' compensation coverage for my employees working on this job. Insurance Company Policy Number {) I am a sole proprietor and have no one working for me in any capacity. I 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 Plumber ContraIctor Insurance Company/Policy Number Contractor Insurance Company/Policy Plumber {) I am a homeowner performing all the work myself. c:"1-c ;'•_: cc:,y of t i<_ s_te-mcm wil:_e fe-w-rced ec e Of5ce of In•;eyd,�dons of&,e 01A for eowrage verifica,ion and that failure to secure cc.�-age 2<rEC�::EC 4nCer Sec cn 25A of MGL 152 c:a leac to tl�c inpesiticn of eimin-!pcnzl;es consisdne of a fine of up to 51,500.00 anc/er cn.: yea::• imprL<c'-Ent;S.well dS Civil penalties in itc fern:cf a STOP WORK ORDER and a fine of S 100.00 a day apinst mC_ 'gned this l day of ;y -: , - 19 5 ((' :, r `._�,i�nsEe/Pen lttee • Building Department •/ Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 TOI,'\ OF EAR-,=-sB'.E BUILDING FE?ufIT 37Sy,1— J.D.G. CONSTRUCTION COMPANY REMODELING CONTRACTORS 160 MacARTHUR BOULEVARD BOURNE,MA 02532 (508)759-8580 (508)759-6118 r�vcrv��- as�o.c. -dl axt,� ,w sl u SruaP , .. 7 4 Cam' d!� aX/p /G O•Cep COX aX� Pr r At `vo r/NG Elevation _ SHEET # l �l '4012>1 T/one i i c Sioi,�6 7 X2lml ,¢,✓D i • � � �✓qc�/,ti'ooF VEST t � I I II i jL 17 w 0 x � o yX 7 i✓ler�c iA✓s o-# ,ww i 9x 7 1�-��c I.Ic. Q IV. c to q m O Date /3�cE-' Scale Designed For t1{evation F SHEET # /�cg 2 t S'.�� o� r,1, / /v�(j 41�Dir/O/j I, r". • r 4 �D61776N G v s� U W N M u') 0 ao U) F � . i '60(op U w z x � ---- M o pa r , Date Sale a�3 9� c �y Designed Fo /3 7 'E l ev a t i o nS/� �"7�-�/s�Tio.�1 ` C ��A SHEET s . a � " - .. - / y aXiz �AA v o,c. ) i C�= � HEAH�• I-A[A-`'1 U CN M N F A D h a a -� E- 4 F cn EH M z � z Ln Ln - Date Scale Designed Fo r.. / 3 7 'Elevation�vND�Tio.v SHEET # i fr 17 a '+ s✓a�.gT/o..1 Ff aTi.�l' 7 #Poo 0 731 �� F 38, . 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A, �k�bs, 'a a'1 ►�•.-,Lla� •iqq� .� { `o i`r' .ja ,, ya<.1� �'f � vv 1� Cr 1.(.taC,__.� /'F�,,./J e a , •�-„a� tt�J � 43�t ).t�, � � .� t � `nyYQ� }'� A , ` ..�.+ \ /� ` ' x /;•, /(/per/�'/} v3.. jF 3p i}Y ' ,, �'�r A.,' ,'.•f; ZL-n4_t 7-V 'ty x WIWAM WARWICKNo. ism ai f r, E,p°p�fr+( TE4.O �•..j • � r ,��-•x �L.' _,-`.r�..,�•,w�.K'F ';�, 3,: Ls ! L�Q�vcJ G_-- _.._.-.-. ..�-1 v�f�1T'CtJ°' •f�l.�6rt,,;;.G` ' =ems sAP FOR y}, REGISTERED LAND SURVEYOR _., . ... ....... ZONE M A'� 5 M I LEI--s{ ;'MA•- _� -'� -- �' ,� ► xR '� PLAN .REF, DATE - .. t i .•._�v S 1i. �.; ,�'r u �tii p,,}y`�mw,5 iv✓" ';'�s ra��n. t $ r�. j L..)Nl C-,0 4,F BENCH MARK DATUM �` LSWARW/CK DOMESTIC WATER SOURCE R}TH..f��fLM, OUT FLOOD ZONE. 1�G7I�J• �►4 7-/�P=� C MASS, 02556ra� (6'lT)�J�'6a�3 Zf'38 14 m1 Elevation SHEET # - a >Z>/T/one — _ � � Cc�.vr.%uv vs R��• ✓���� cSiOit/6 TlZ/ml 4,✓P iM6 -A4 SST/.ti G x U I Eyco A ho _---- I yX�._i✓ler�1� i�✓s o.�{ , I I 9x7 �1�r�c iwc. Q if — --- a5< -- --- ------------ - --- C.) x z PQ Date ` S— ]-Scale / Designed For �TpNS�LH� Elevation ���fY2 f S'��� SHEET # i EEO 19 j ' .�..f fhl�f� ,S'T/,4i6 o i vw{ z > cv Ha u') ho 00 If E-4 o�P b0 top j o a w rn vx aU 0 Date �/3 �� scale Designed F o � 1137 6e,�i Elevations/D=— 6---ZcEk/A71o1j SHEET #. j /,Z>6C-. VG7Ji Vol, � - .02 �iZ /✓��'C ='Ly . $EAH �s0u0 ,a2/�J6id6 7-4 N p ,., a► i M H A L 00 cn F (o Date Scale Designed For . -:,—: Elevation SHEET # i 0jiJC. 02 p E,L L✓ irif /M/Sc2) GL///Z,t Al/c I a _ �,S'TE� v2 R 1�/J6/F� ir✓S'IJLA,T'�is•� F yteoT4 kiOke, ' ` � �� ✓ice LA OOJJ - w Z , M Ln / [�� l0 A7>RO�tI /.ate l�/�"7e.1 z H OPG W0) _ V x a Ir G'DNy'i/�D�S 'p pTi�b J rAj M Date 3 c15 Scale//,/ Designed For ---� 127 ZA/.