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HomeMy WebLinkAbout0041 DOGWOOD LANE T Town of Barnstable *Permit# 7 Expires 6 months from issue date Regulatory Services Fee �3 S tKass' Thomas F,Geiler, Director 16 Building Division Tom Perry,CBO, Building Commissioner `.K.5 2,00 Main Street, Hyannis, MA 02601 �� .� Z0 www.town.bamstable.ma.us Office: 508-862-4038 �' 7iJ'Jj - �Fat )g,-� (1-rL_i0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Q LD Q 7 Property Address 41L p W ©pq/ g, eeleuil— /1�Q []'Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address elleho r mi l_(+e.r Contractor's Name 13C�1S-'~�F r cmke Telephone Nwnber �C Home Improvement Contractor License#(if applicable) �CO Ol tp ©y Construction Supervisor's License#(if applicable) 7 ! �l orkman's Compensation Insurance Check one: ❑. I am a sole proprietor ❑ I am the Homeowner i []have Worker's Compensation Insurance Insurance Company Name o�a�p� ��� 1�� ,i' Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to__......._. ..- ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof). ❑ Re-side #of doors ..._ Replacement Windows/doors/sliders.U-Value --_—(maximum .35)4 of windows �d *Where required: Issuance or this permit does not exempt compliance with other town department regulations.i.e.Historic-Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors-License&Construction Supervisors License is fired. SIGNATURE: C:\I.Isers\decollik\AppData\Local\Microsoft\Windows\'I*emporary Internet Files\C'ontent.Outlook\DDV87AA1,\F.XPRFSS.doc Revised 072110 Tice C;ommon"wakh of Massachusetts 'Department of Industrial Accidents Office of Iwestigatious ,.. 600 Washington Street z = Boston,►IA 02111 y n:^nnr.rtiass.gowldia Workers' Compensation Insurance Affida-vit- Builders/Contractors/Elec.tt-icians(Plumbers Applicant Information Please Print Legible Nurse tBusiaes,,Orga=ationln&,, dual):idahcr ------- Address // - --- -- 1�_�l an employer Check the appropriate box.: Type of project(required): 1 m a employer with_�_ 4- ❑ 1 am a general contractor and I 6- New canstnution employees(full and.'or part-time.' ti * have red the sub ctaat�actors 2.❑ 1 am a sole proprietor of partner- listed on the attached sheet_ ' 7- Remodeling slip and have no employees These sub-contractors have 8. ❑Demolition, employees e and have workers' Work= for rue in any capacity � 9. 0Building addition [No workers,' comp-insttrartce c°mP.insuranae..i • ree{tared.; 5; ❑'We are a corporation and its 10.❑Electrical repairs of additions 3. 1 am a homeowner doing all work officers have exercised their I Ln Plumbing repaus or additions . myself [No workers' comp. of exe fficm per MGL 12.El Roof repairs �l insurance requited.}' , c. 152, §1(4} and we have no employees-[No workers' 13.D-o h . comp. insurance:reguared.] •Auv applicant that checks box=1 must also fill our die 5ecmmon below showing their waders'compensation policy information.. Honzeow m-1 who submit ibis affid-m it intlicatmg they are doing all walk and then hire outside coattactors tnmt submit a new affidac•t itrdicatmg such -Coutraaors that check.thss box must attached an additional sheet showing,the tonne o€the sib-counactors and stare whether or not those earmf 3 bs,.e ewplo},ees. if the sun-contractors have employees;they must p mmde their workers'camp.policy umber. I ant art enrpiot'er that is pros-iditig rttortcers'compensation insuraance for m►°emplMes. Below is the polio,an4 job site informatto)t Insurance Company Namie-J4 ��/I�OXiI — � -- --- Policy w cat Self-ins'Lic.M:�t1�C� lD/ 0`I Expiration Date: 'Y a L� for site:address: �C����'< ��� �-(Lj L/.C� City.+staterzip: Attach a co y of.the wor ers'con ensatios licy declaration page(showing the policy number and expiration date). p. p Ps p g f � l� aP 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 S1,5t0.00 and.or one-year;i q sonment;as well as civil penalties in the fatrm of a STOP IWORK ORDER and a fine of up to$'?5000 a day against the.violator- Be adi ised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. [do hereb• ft•tinder the pains and penalties of pedupy that the information protided above is tine and correct. Date" Phone 4, 0 tlfjtt.iai tree vrtlt. Do not write in this area,to be completed by citt,or town 4t� at C:in-or loom: Permit/License _—_-- Issuing Authority(circle one): 1.Board of Health ?.Building Department 3.UptlTown Clerk a..Electrical Inspector 5.Plumbing Inspector b. Other Contact Person: Phone#: _--- I tSn;rr(I ,i I�uitdin� Iti�ula(III n. 'Ind I.urii.li - Construction Supervisor License • t Ic:rnse`. CS 9714 Restricted to: 00 RICHARD P GARNEAU JR 251 WOODSIDE RD W BARNSTABLE MA 02 668 8 " •�'"` Exp i,.mor, 414i2012 u,,,,,•.;,„ 2531 o � Cif -� . �r.,,�cr�• .l� 1>c� of Consumer Affairs n , ,d B sines .Reg �lao( �r A 0 Park Plaza - SUItc .5170 Boston, Massachusetts 021 1 E, Home Improvement Contractor Re" gi 1011 Registration 162600 A Tvpe: Supplement BAKER & ASSOCIATES INC. Expiration 3/z6i2ot:� = RICHARD GARNEAU 521 SHOOTFLYING HILL RD CENTERVILLE, MA 02632 N Update Address`and return card. Mark icasuh InE ch;m Address . Rcncwai Pimp{n1 uu nt i,.,; t OIli,r of"f'omuurer:�flairs.� Kusincss Ref;ulation License or registration valid for individirl use(Inly. ,l HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return tu: I; t Office of Consumeres Affairs and Business Regulation e: Registration: 162600 TYP - 10 Park Plaza-Suite 5170 Expiration: 3/26/2013 Supplement Card � Boston,MA 02116 1'1•r A"S 0 GIATES INC. a l) (—uARNFAU ! rt `%IL11-- MA 026,11) l ndersecrctary Not valid without siknatui-c , . J cam. . •' ., x � ••i w ^ � v _ Client#:9742 2BAKERAS 'v ACORDTM CERTIFICATE OFLIABILITY INSURANCE DATE(MM/DD/YYYY) 05/02/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT - - Dowling&O'Neil Insurance NAME: PHONE FAX Agency <' 2 (A/C No Ext:508 775-1620 A JC,No): 5087781218 E-Mg Y _ IL ADDRESS:. - 973 lyannough Rd., PO BOX 1990 Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:National Grange Mutual Insuranc - INSURED - - INSURER B:Associated Employers Insurance Baker&Associates,lnc. INSURER C: - - P 0 Box 923 Centerville, MA 02632-0071 INsuRER D INSURER E: - INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT-THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN TYPE OF INSURANCE ADDLISUBR NSR WVD POLICY NUMBER MMIDDY EFF MMIDD/Y� LIMITS A GENERAL LIABILITY MPJ7223M 4/19/2011 04/19/201 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY - DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS-MADE F x1 OCCUR : - - MED EXP(Any one person) $11 0,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER:. - - - - .PRODUCTS-COMP/OP AGG $2,000,000 POLICY JEC7 LOC $ r AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED.AUTOS AUTOS BODILY INJURY(Per accident) $., NON-OWNED - - PROPERTY DAMAGE $ „ HIRED AUTOS AUTOS `. .. Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB - CLAIMS-MADE AGGREGATE DED RETENTION$' - t $ B WORKERS COMPENSATION WCC5002454012011 4/23/2011 04/23/201 X WC sTATU- OTH- ' _ AND EMPLOYERS'LIABILITY TORY LIMIT R ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N _ • E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) - E.L.-DISEASE-EA EMPLOYEE s500,000 If yes,describe under ;.. .. ,' " .E'.L.DISEASE-POLICY LIMIT. s500,000-. DESCRIPTION OF OPERATIONS below - i DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the ' coverage provided by the policy,provisions. 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 Thomas Perry ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 a, AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) of 1 The ACORD name and logo are registered marks of ACORD #S804021M80401 LS1 Authorization Form: as owner,of the subject property, hereby authorize Baker & Associatee to act on my behalf, in all matters relative to work authorized by this building permit application for Address of property: 41 Dogwood Lane Cotuit, MA �Sigriature+of owner: E-�Z- �in P-r-int Names /�? [Date / Q t„E i Town of Barnstable *Permit#c-;) l D6 d (O(� Expires 6 months from issue date °s Regulatory Services Fee BMMSrABLE, Thomas F.Geiler,Director y MASS. 1639• Building Division ������ "lEn n,ta+" BO, Building Commissioner EMIT Tom Perry,C 200 Main Street,Hyannis,MA 02601 MAR 2 7 2009 A www.town.bamstable.ma.us Office: 508-862-4038 �®TOWNfa{���� �30 LE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �_`� Property Address 4 %v000 �-kl. eoTu tt R Residential . Value of Work• 3—IC O. _ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address L.1 ACb. o t-0 . C010A D)A 0-a -5 S Contractor's Name �OG10l �J y)C, Telephone Number S�•3��' aA4S Hoine Improvement Contractor License# if applicable) ► &Aq4 dworkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner „ I have Worker's Compensation Insurance + Insurance Company Name �ScJG 1 10 C' h Workman's Comp. Policy# O 1 00 Copy of Insurance Compliance Certific to must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingl s) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacemerit Windows/doo s/sliders.U-Value (maximum.35) "Where required: issuance of this pen-nii does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Own r must sign Property Owner Letter of Permission. ' A copy of the Flome Improvement Contractors License is required. I SIGNATURE: Q:\WPFILES\FORMS\bui tng permit form F.,XP .doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print-Legibly ziJGCName (Business/Organization/Individual): �e' R0 C 1Q-�'� -` . Address: City/State/Zip:6pr1,-e�� ►1+ I)GV03a Phone#: C�0B=�Coo^l•. aA y 5 Are ou an employer? Check the appropriate box: Type of project(required): 1.(A I am a employer:,A t 4. ❑ I am a general contractor and I 6.1❑New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached,sheet $ 7.. [d Remodeling 2.❑ I am a'sole proprietor or partner-" - ship and have no employees These sub-contractors have u 8. ,❑ Demolition working for me in any capacity. workers' comp. insurance 9. ❑ Building addition , o workers' comp:insurance 5. ❑ We are a corporation and'its [N 10.❑'Electrical repairs of.additions required.] officers have exercised their 3:❑ I am a homeowner doing all work right of exemption per MGL. 11.❑ Plumbing repairs or additions c. 4 ,and we have no . myself. [No workers'.comp: 152,§1O . 12.❑ Roof repairs insurance required.] fi employees. [No workers' •13:0 Other c < Comp.insurance required.]Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information Work and then hire outside contractors must submit a new affidavit indicating such Homeowners who submit this affidavit indicating they are doing all Contractors that check this box.must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. .'am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site nformation. t,, '�-• nsurance Company Name: YY1 10 l"S '1 ?olicy#or Self-ins.Lic. #:l�)C 506 ad15'g O 10'�b0 8 Expiration Date: _ 00,_ yob Site Address: 4 ►L00 NZOOIU)• ���'y t* 0 3 City/State/Zip: is ' kttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). aihire to.secure coverage as required under Section.25A of MGL c. 152.can lead to the imposition of criminal penalties of.a ine 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 )f up to$250.00 a day against the violator..Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. do hereb c nde he pains d en 'es of perjury that the information provided above is true and correct: 3i afore: Dater .J hone# `JO$• - g� , L se only. Do not write in this area,to be completed by city or town officiakown: l Permit/License#Authority(circle one):of Health LBuilding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Person: Phone#: f �FIKEro Town of Barnstable Regulatory Services ` HARNSTABM ' Thomas F.Geiler,Director MAS& i0lfo � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must mplete and Sign This Section If Using A Builder j e a,n O(-' 1' ► 1 e c-' , as Owner of the subject property hereby authorize &L c ASSOC IQ.AeS TrC . to act on my behalf, in all matters relative to work authorized by this building permit application for: A e1 c'300d. L.n. Co+U L A- (Address of Job) Signature of Owner Date � 1eQ�no� MMec Print Name If Propedy,Ownet is applying for permit please complete. the Homeowners Licc nse Exemption,Form on the reverse side. Q:FORMS:O WNERPERM ISS ION A Town of Barnstable THE Tp�� y�P Regulatory Services BARNSTABLE. Thomas F. Geiler,Director p MAS& g 1639• .0 Building Division TFD MA't e Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to ' be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be , responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner''assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and i requirements. Signature of Homeowner ti Approval of Building Official F Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form certification for use in your community. fornns:homeexem Q t P c;7_1Dater" 5-/bj2008 Timer 10:03 AN To: N 9,5083626115 Page: 002 . F: t Cliery :9742 2BA AC®RUM CERTIFICATE OF LIABILITY 1NSURAN E 05/05/08 '"' ' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIG ITS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE )OES NOT ND OR ALLTERTHE COVERA COVERAGE AFFF RDEDBYTHE EPOL IEICCESEBE OW. 973 Iyanough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVER kGE NAIC# HIRED INSURERA: Harleysville Wor or Insurance Co. Baker&Associates,Inc. INSURER B: Associated Employ rs Insurance Compa P.O.Box 923 INSURER C: Centerville,MA 02632-0071 INSURER D:, INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY P ERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EX L-SIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EMRATION LTR ^`TYPE OF INSURANCE POLICY NUMBER DATE EFFE DATE LIMITS A GENERAL LIABILITY CB831748 04/19/08 04119-09 rDEXP URRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY TO RENTED ail $1 OO OOO CLAIMS MADE R OCCUR one verses, $5 000 X PD Ded:Z50 &ADV INJURY $1 000 000 GGREGATE s2.000.000 GERL AGGREGATE LIMIT APPLIES PER: 4RODUCTS-COMP/OP AGG $2 DOD 000 POLICY ,E� LOC AUTOMOBILE LIABILM COMBINED SINGLE LIMIT ANY AUTO a accident) $ ALL OWNED AUTOS BODILY INJURY Per person) $ SCHEDULED AUTOS HIREDAUTOS 1110DILYINJURY e:accident) $ NON-OWNED AUTOS OPERTY DAMAGE $ eraccident) GARAGE LIABILITY I &ITO ONLY-EA ACCIDENT $ ANY AUTO - TI-F-R THAN � EA ACC $ fC UNL'Y: AGG $ IEXCESSIUMBRELLALIABILITY iACH OCCURRENCE $ OCCUR CLAIMS MADE kGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ B woRKERs COMPENSATION AND WCCSW2454012M 04/23/08 W23109 WC IMff Iola EMPLOYERS'LIABBJTY L.EACH ACCIDENT $100 000 ANY PROPRIETOWPARTNF.RIEXECUTIVE �ICERIMEMf�EXCLUDED? NO L.DISEASE-EA EMPLOYE $100 0W If yee,describe under L.DISEASE-POLICY LIMIT $500 000 SPECIAL PROVISIONS b OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Officers are included under the workers compensation policy. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the (See Attached Descriptions) CERTIF-_A-"L a0LDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBE POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER FALL ENDEAVOR TO MAIL In DAYS WRITTEN Thomas Perry NOTICE TO THE CERTFICATE HOLDER I AMEO TO THE LEFT,BUT FAILURE TO DO SO SHALL 200 Main Street ILMPOSE No OBLIGATION OR uABlLfrr C F ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis,MA 02601 REPRESENTATIVES. AUTHORIZE PRESENTATIVE ACORD 25(2001/08)1 of 3 #S519221M51911 S1 ® ACORD CORPORATION 1988 Board of,Building Ptc,.yulations and Standar& Constru Pion Supervisor L- cense L tense: CS 74477 - 4 BRETT J BUSSIERE 111 WAREHAM LAKE: K, Y EAST WAREHAM MA 02538 .. . . .�✓ Expirat ori: 1/672011' C' ►nn�wis1 T 8715 r VI_ - p� ✓lie 'V�anrorrancveca`Cl a���i��2akzG�u�ael� =- Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration .162600 Board of Building Regulations and Standards Expiration. 3/26/2011 Tr# 282115 One Ashburton Place Rm 1301 Boston,Ma.02108 Type P(Nate Corporation BAKER&ASSOCIATES INC,.. MARK BAKER 521 SHOOTFLYING HILL'RD CENTERVILLE, MA 02632 Administrator Not valid without signature lie 19arn rrcaruueat o�✓I[addaclde Board of Building Regulations and Standards License or registration valid for individul use only y' HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ` Board of Building Regulations and Standards Re&tratton. 162600 One Ashburton Place Rm 1301 Expiration 3/26/2011 Boston,Ma.02108 Type Supplement Card BAKER&ASSOCIATES:INC BRETT BUSS IERE: 521 SHOOTFLYING HILL RD CENTERVILLE,MA 02632 _ Administrator Not vali ithout signature 5 The Commonwealth of Massachusetts William Francis Galvin j Secretary of the Commonwealth,Corporations Division One Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617) 727-9640 BAKER & ASSOCIATES, INC. Summary Screen O Request a Certificate The exact name of the Domestic Profit Corporation: BAKER&ASSOCIATES,INC_ The name was changed from: BAKER CUSTOM ALITMINU�M&VINYL_COMPANY INC. on 1/8/2004.. Entity Type: Domestic Profit Corporation Identification Number: 000522085 bid Federal Employer Identification Number(Old FEIN): 0000000,00 `Date of Organization in Massachusetts: 01/01/1996 Current Fiscal Month i Day: 12/31_ Previous Fiscal Month I Day:00/_00 The location of its principal office: No. and Street: 521 SHOOTFLYING HILL R.D. City or Town: CENTERVILLE State: MA Zip: 02632 Count_ ry: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country:. Name and address of the Registered Agent: Name: No. and Street: City or Town: State: Zip: Country: The officers and all of the directors of the corporation: Title Individual Name Address (no PO Box) Expiration First,Middle,Last,Suffix Address,City or Town,State,Zip Code of Term PRESIDENT MARK BAKER 521 SHOOT FLYING HILL CENTERVILLE,MA 02632 US TREASURER CAROL BAKER MRS. 521 SHOOTFLYINGHILL ROAD CENTERVILLE,MA 02632 US SECRETARY' BRETT BUSSIERE MR.j — — L�T - 521 SHOOTFLYINGHILL ROAD CENTERVILLE,MA 026323 US DIRECTOR MARK BAKER MR. 521 SHOOTFLYINGHILL ROAD CENTERVILLE,MA 02632 US http://corp.sec.state.ma.us/core/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 3/25/2009 o TOWN OF BARNSTABLE Permit No. 25016 I 'AUSTAU g: Building Inspector cash ------------------------_---- OCCUPANCY PERMIT Bond _--- Issued to Cedar acres Realty Trust Address lot #8 ,41 Dogwood Lane, Cotuit i Wiring Inspector Inspection date Plumbing Inspector �1.' N Inspection date Gas Inspector Inspection rr� Insp date GT'- t"V„ Engineering Department,, ' s' n 'z Inspection date Board of Health �--'�--- '. ,r , Inspection date r 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 1.190,,OF THE MASSACHUSETTS STATE BUILDING CODE. JJ .>6.. 19..2 ......... Building Inspector FROM - _ _ TOWN OF BARNSTABLE' BUILDING DEPARTMENT . Fraficis Lckh e n ' 367 MAIN STREET HYANNIS, MA 02EB1` Town Clerk' Phone: 775-11'20 SUBJECT: FOLD HERE .DATE June 15, 119 MESSAGE Work has been-r,,o*le�ted -uhder Building Pemit 05016 (Cedar Acres Realty 'Trust) Please release Bond. .SIGNED DATE REPLY Ne7"Rmtl• RECIPIENT:RETAIN,WHITE COPY,,RET.URN PINK COPY PRINTED IN U.S.A. SENDER:SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. ` r G3.64 26-0 Q o v y � �W a jr LL ShIOW/NG ;= c � PLAN Af— U to �0 � , FO UNDA T/ON LOCATION azr'to G 0 7'4/r MASS . OWNED BY a SCALE "s DATE: k'd NORMAN GROSSMAN --------RE6ISTERED LAND SURVEYOR z m w ui zF- Qz zi.. }. W a0urLL I HEREBY CERTIFY THAT THIS FOUNDATION IS 'LOCATEDj4T ON THELOT ASSHOWN AND CONFORMS TO THE TOWN d'��,t OF ZONING REGULATIONS REGARDING SETBACKS FROM STREET LINES AND LOT LINES . No 127';: r NORMAN GRnSSMAN R.L.S. DOTE Assessor's ap and lot•number` �,�o.-.,�1 .......��., ;1 ... N ,Sewage, Permit number ......45'2'.: Z.1........::...:............ t " B 9TAD • House number .......:..:, �. ..........:. r' E s r. :o �aTA m� j L INSTALLED IN COMPLIANCE 11MarAr TOWN, OF -BARD 1B 5; • TAL CODE AN TOWN REGULATIO BU.ILDINI, INSPECTOR APPLICATION FOR PERMIT TO ..........:....Construct .................:. ............. ................................... ....,r TYPE OF,CONSTRUCTION .....WO(Dd Irame residential ' • • Nave nber..18.::....................19...82. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .40t...8.,.:.DCgwood..TAne,...C1atuit,..14a... :.........................................:................................:.......................•.......... ProposedUse .............residential............. ........... .......................................................... . .......................................... Zoning District F�yl Fire District, ....CAtidlt............................ ...... .......... G..................... Name of Owner Cedar..Ayes..Realty..rj'1Zast..................A'ddress 24••Gr eat.•pond..brvy• Yat outhy••Ma;........ Nameof Builder ..............c3airie..............................................Address• .. ........ ............ .................................................. Name of Architect ...........:..........................................:...........Address .................................... Number of Rooms 6 a ed concrete Foundation .... ............. .... cedar shingle Exterior asphalt shin le ...................................................................................Roofing ......,....... ....................g............................................. Floors plywood Interior sheetrock' :................................:.................. ......................................................................... Heating ..rr .�.. y``5..............................................................Plum.bing ........lJ_/ baths , Fireplace one. ......................................................................Approximate Cost ....................2 ,P ................ Definitive Plan Approved by Planning Board ---Sept,___2-------------1 q_ 73_, Area ..... .: ..................... Diagram of Lot and Building with,Dimensions': Fee 6. ✓� ............................. SUBJECT TO APPROVAL OF•BOARD OF HEALTH n f OCCUPANCY PERMITS REQUIRED FOR NEWDWELLINGS , I ,hereby agree to conform to all the Rules and Regulations of the,Town of Barnstoble.reg6rding the above construction. " No ............... . .......... ....... .... .. :. ..... .... a Construction Supervisor's .Licensea ............... CEDAR ACRES REAL TRUST N� 25016 permit f One, Story "1 Single Fami.ly..Dwelli.ng............. ........................... r ; ocation Lot. ... .........8 41 Dogwood Lane ...... .. .. . ......................................... Cotuit _ .................................. Cedar Acres Realty 'Trust Owner .................................................................... t Type'of Construction ...Frame.......................... ....... ............................. ................... . .......... r. Plot ..'r ..:... ........... Lot.. , ......:..................... April-- 29 , 83 t + Permit Granted .......................:................19 t Date of Inspection,,::...................................19 f p ,. - Date Completed ........40`"/.:7(5? .19 _ J / Assessor's map,and lot,,,'niaAber .,76....... 12 Sewage Permit number ...... ...�?. 1.......................... 1 33ARNSTADLE, i House number .......... � L........................................... NAG& 9 TOWN OF BARNSTABLF BUILDING INSPECTOR APPLICATION FOR PERMIT TO Construct . ..........::...............................................................................:..............................:.. f TYPE OF CONSTRUCTION ...............wood..............rame....residential..................................................:.................................................. Tc r1 .28......................19...8z TO THE;INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..................................... ............................... ................................... i Proposed" Use N........T1--sidentaal..................... . ................................................................................................................ r: Zoning District ........................Rt c.........................................Fire District ' Name of Owner Cedar..Acres..Realty..Txt7st................Address 24.4;ra¢at...Pend.�:,. ..,c:,...Y jouth... . ....... Name of Builder .............—Q .............................................Address Name of Architect n/a.........................................Address -Number of Rooms 6 .........Foundation ....Domed.COncr'ete ....... ........................................................ cedar shin le asphalt shale Exterior Roofing .......................... ........... ................:....................:........ Floors ....plow...�d.....................................................................Interior ..........sheet ock...................................................... ....... ..as .11/2 kathSHeating ......:... .. .................................................................Plumbing ...... . : . ..........................................I...... Fireplace One......................................................... . .............Approximate Cost .....................?5A Q00.................................. Definitive Plan Approved,.by Planning Board____Sgpt, 21_______ 19 73 Area . . .......... ................. Diagram of Lot and Building with Dimensions Fee ......-..................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH i a t 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 .`;,...,. ............... . ............��4*.:-✓✓.!f ................ Construction Supervisor's License7 �� � av ,...�.................... CEDAR ACRES REALTY TRUST A=40-76 25016 One Story No ................. Permit for ?................................... Single Family Dwelling ............................................................................... Location ......Lot 8, 41 Dogwood Lane .................. ....................................... Cotuit ....................................... ....................................... Owner Cedar Acres Realty Trust Type of Construction F.. .........ame.............................. ...................................... ....................................... Plot ............................ Lot ................................ Permit Granted ....AP 11...29.,.............19 83 Date of Inspection ....... ............................19 Date Completed ........ .............................19 40 �L �b U-o F e- V ailo�I'll ova F� ��