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0051 EAGLESTONE WAY
_,___ _ ._ `Ri .�� ����� s/ �r�� � ��r� _ � �1 �: y I 71,z i 'y 1 I 6 I i 7.1A�o r i 1 r earn_ 1 -0-Y- a Ocf y _ . f 9 11617 0,70, VI -O)Q TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map cK 6 Parcel �� " Application #aQ/36 02T O Health Division Date Issued Conservation Division Application Feed Planning Dept. Permit Fee �g Date Definitive Plan Approved by Planning Board ow ,5lull3 Historic - OKH _ Preservation / Hyannis Project Street Address l9ML&SIC Village Owner ` t7/T ¢ ��CYO.A(4-S-S Address f— Telephone ' 68' f cl) 19 61 -7 - 02 T ' / �hl��fLltl� i Permit Request4 _ - S f7 zp(_A�,A /'AI; CL4-a� Square feet: 1 st floor: existing 3Rkproposed O 2nd floor: existingl��proposed O Tota new O Zoning District Flood Plain Groundwater Overlay Project Valuation '�dOOTDConstruction Type '�i'l�. Lot Size qq o 7 Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family X Two Family ❑ Multi-Family (# units) Age of Existing Structure 6VRS Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing 0 new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas f<0il ❑ Electric ❑ Other Central Air: > Yes ❑ No Fireplaces: Existing New _ Existing wood/coal stove: ❑Yes)4No {Detached garage: ❑ existing ❑ new size_Pool:,*existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:*existing . ❑ new size _Shed: ❑ existing ❑ new size _ Other: o Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ? w Commercial ❑Yes ❑ No If yes, site plan review# r-a --Current Use, Proposed Use fin � --i APPLICANT INFORMATION W rn (BUILDER OR HOMEOWNER) Name C��/l V TT' Telephone Number Address04TVIILicense# r � Home Improvement Contractor# Worker's Compensation 36 -3-ig to I -oI2- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1 Z- CAL 3 cry IS FOR OFFICIAL USE ONLY } {T APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER d. DATE OF INSPECTION: �[_FOUNDATION FRAME INSULATION FIREPLACE ` p ELECTRICAL: ROUGH FINAL e ` .PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING b DATE CLOSED OUT - f ASSOCIATION PLAN NO. '` I - The Commonwealth of Massachusetts Department of InduytrialAccidents Office of Investigations y 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information. / Please Print Legibly Name(Business/Oro n�on/Individu0): �f 4 Address: ' J City/State/Zip:.M Sf"rs 41. A 0, 'Phone#: `t 7,Q_ �S' Are you an employer? Check the appropriate box: Type of project(required): 1.WI am a employer with 4. I am i general contractor and I employees(full and/or part-time). * have hired the sub-contractors : 6. 0 ew 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 g, 0 Demolition working for me in any capacity. employees and have workers' 9.. M Building addition r [No workers'comp.insurance comp. insurance required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myselfco o workers' right of exemption per MGL comp., 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no :. employees. [No workers' 13.0 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 afc doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. / Insurance Company Name: -/� �'I/4td o,4 ��(J C..�i .Policy#or Self-ins.Lic.#: ��'S, J1 s ' 3'c910/'61 'Expiration Date: J Z ' z 6 �3- Sob Site Address: �� �� �� '�a '� 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 adu nal 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 violatot. 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 c n�er the penalties of perjury that the information provided above is true and correct Si e: Date- �'/3 Phone 2 Of use only. Do not write in this area, to be completed by city or town official - City or Town: Permit/Liceme# Issuing Authority(circle one):. . 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector A5-Plumbing Inspector 6..Other Contact Person: k. Phone#• Information and .Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. . Pursuant-to 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(t7 also states that"'every state or local Iicensing agency'shaIl withhold:the'issuance or renewal of a license or permit to operate a business or to construct buildings in 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 certificate(s)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 rnsrance 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 enterthei.r self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for:you to fill out in the event the Office of Investigations has to contact you regarding the.applicant _ Please be sure to fill in the pera it/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit`indicating current policy information(if necessary)and under`Job Site Address"the applicant should write"all locations in (city or. town)."A copy of the-affidavit that has.been officially stamped or marked by the city or town may be.provided to the' . applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each- year. Where a home owner, or citizen is obtaining a-license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questioas;- please do not hesitate to give us a call. z' T The Department's andress,telephone and fax number: S ; The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFB Fax# 617-727-7749 -vise d 4-24-07 www.mass.gov/dia /i!!zU13 10:00:13 AN PST (GAIT-3) FROM: 100GC5-TC• 15084205856 Page: 21of 2 " moo CERTIFICATE DATE QNWDD/YYYY) OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S}„ AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED the oli p cy(ies)must be endorsed. If SUBROGATION IS WANED,-subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not cotnfer rights to the certificate holder in lieu of such endorsemen s. PRODUCER DOWLING &OWEIL INSURANCE AGENCY INC - 973 IYANNOUGH RD CONTACT NAME: HYANNIS, MA02601 PHONE AX(A/C,Ne>: (508)ZZ8-1 218 • E-MAIL ADDRESS: { INSURERS AFFORDING COVERAGE i NAIC A INSURED INSURER A: I' utualJ J DELANEY INC INSURERS, 20 RASCALLY RABBIT ROAD UNIT 2 NSURERC: MARSTON MILLS MA 02648 NSURERD: NSURER E: I NSURERF: COVERAGES CERTIFICATE NUMBER: 15704474 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. i INSa LTR TYPE OF INSURANCED SUBR POLICY NUMBER roDIYYYYL EFF N9�N�CDI n�YY LIMITS GENERALLIASILTTY .. _ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $IDAMAGE TO RENTED + PREMISES a occurrence $I CLAAa1S MACE OCCUR MED EXP(Any one person) $f PERSONAL&ACV INJURY $ GENERAL AGGREGATE $i GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $I POLICY PRO- LOC AUTOMOe1LE LIABILITY AN AUTO a acci enn .I G A9 $i BOCILY INJURY(Per person) t ALL OWNED SCHEDULED $I AUTCS AUTOS SOMLY INJURY(Per c Jont I HIRED AUTOS NON-OWNED ) $i AUTOS PRCePE TY DAMMGE $ r F�9 - UMBRELLA LIARH,OCCUR EACH OCCURRENCE $ 4 EXCESS LIAB LAMSav1ACE ——— — AGGREGATE $ I DED RETENTION$ $ I $ A riORXERS COMPENSATION - $ 1 AND EMPLOYERS,LJABIUTv WC5-31 S-318101-012 11/212012 11/2/2013 , oC a TU_AKYPROPRIETOR/PARTNERIEXECUTIVE YIN - � OFFIC ER/NEMBER EXCLUDED.) rN] N/A _ - E.L.EACH ACCIDENT $j. 5�001)Q 1 (Mandatory in NH) 1 yes,dasonbe under E.L.DISEASE.EA EMPLOYEE $�_` 500000 DESCRIPTION OF OPERATIONS below E.L.DISEASE'-POLICYL.MIT $ 500000 DESCRIPTION OF OPERATgONS lLOCATIOHS!VEHICLES(AtlachACORD 101,Additional Remarks Schedule,U more apace Is requlretl) Workers compensation insurance coverage applies only to the workers Compensation laws of the state of MA. - t CERTIFICATE HOLDER rACCORDANCE NCE CATION TOWN OF BARNSTABLE . HOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HE EJfPIRATION DATE THEREOF, NOTICE WILL BE ]DELIVERED IN ATTN: SALLY SHEA WITH THE POLICY PROVISIONS. 200 MAIN STREET HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE UIC Jeff Eldridge 01988-2010 ACORD CORPORATION. All'rights reserved. ACORD 25(2010105) The ACORD name and logo am registered marks of ACORD N3T e0.: LS1C94,74 CL'Ev4 ConE: °6 Di di Dangfls 9/1:/2C13 9:55.53 At'. Paq L of t is cextlt_Cate cancels Ala:d supersedes ALL pxeviously lssugedcertificates. - i a C i 3" ff OF- b w 1LC '[!1LYI1Z47Zf}9tI� - O i Office of Coosgmer.Affa� B ✓ess 4 Lo + kIf311AE11fAPR01lEMl*�CONT.BOi�T.OR�. � L o .fl c Reg[stiahan 52g Type: w ; Cd y Iff ont4" IndividuaP ,; o 0 Owni.r.ati .. o d d Jfl J.DELAN zi? ' ® J,OHN DELANEY a d •YC C' N O { 271 PLUM ST o'' L U. z ;I V11.BAftNST�iBLE, e.' Undersecretary n y y L C w N i Massachusetts'-Department of Public Safety .Board of Building ng Regulations and StandardB Construction Supen•isor License:CS-009961 ``SETTS �rA JOHN J DEL, y 271 PLUM Sr wBARNST $ z s_. h z Y y � o Commissioner Expiration W1412014 Town of Barnstable Regulatory Services MASS. � Thomas F.Geiler,Director ATE b. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 - www.townbarnstafile.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A-Builder as Owner of the subject property hereby authorize s ' I—, to act on ray behalf, in aIl matters relative to work authorized by this building permit (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Ownex. ignature fAppficant N Print Name Print Name �l Date QIORMS:OWNERPERMISSIONPOOLS 62012 Town of Barnstable Regulatory Services * Thomas! F. Geiler Director ReRiucPARr.R- s 7 MASS. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:.508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: M 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,p:ovide'd 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 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 iZder the building permit (Section 109.1.1)'t. The undersigned"homeowner"assumes responsibility for compliance with:the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner t Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction ControL HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner.shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a.supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed `» Supervisor. The homeowner acting as Supervisor is ultimately responsible: ; t ' To ensure that the homeowner is fully awareof his/her responsibrlities,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 j several towns. You may care t.amend and adopt such a formr/ceriification.for use in your community. I Q_forrns:homeexempt k -' if15•Ju4 �^ 1 i 1 1 pl 1 i O I IYa1FY SIf<E ua- . •� a 'r - ° .. b ` '1,n1S Rmsrw TPR; 0.� p I � NAT- 3114 70 $(LOK�N (/JArzPG L. AN �NSPjcN Or=i7+ts F{t�cG G>�4S —R�y*wEtPLP4kE GYp`�h I ;aor ' eae+m•awt �G—f� cc�a►r �{L3�rS E y RD Carr Rrr s w�,hr.�c�� { wwca_ ! o evlin 67LNa-0 Cooec OF Ccnu i i.- L7 -[Gp,LZC t FzePcaCc' c w_ t 1 ol.sro,n N�J - /ACK— � .y&2&t OF J.J.h ZJ4NEy 0�.,�,oQtVG � .. B resigns _ Co, rn oN S .A4-TCK- ,,H S p t _ 51 [-7�GLEs�w�E �r�y `�`Z3113 P r r ' • ' �- ,._ '.,. a i,. . - - - --I r--- - —� r—. k r 1}J"f��210� F-+Gl"tOVGZf►f�j I-u vt. $ y .. '. _.FFrY•'tQlc ♦-�] /ZD OG4�I-�1 C3_ I '' - P - r �j ♦ N a - - . • .. ^FP�'tOJE Ihk-Qa WpO�� FCrJOO�LtFLG»- - ♦ .. f., blQl 000•aso- -„� -srmm-Lt> waa -' y _ —Rf.4p.1E [N5&LMnO7J' Imagism e f��c Cc.c'14N!uP' rq . l . •-. • � - - Yv�r ru..emrn vtAan b Prxvtn w ' EAGLc-ern►-fie CcT, MA = r • 61 I- A1 e � I Liz r-h ph df ITill S b ` Q c ( uwm n TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. Parcel 10 p cato�#" ; �. Health Division Date Issued Conservation Division _ Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation / Hyannis Project Street:Address -Village Owner RLA_a14&&W-S-2s: Address A6 Telephone Permit Requestloor r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation_F6130, 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 s Highv�ff: ❑-4es ❑ No x. Basement Type: ❑ Fu!I ❑ Crawl ❑Walkout ❑ Other � s - Basement Finished Area (sq.ft.) Basement Unfinished Area?sq.ft) vi Number of Baths: Full: existing new Half: existing mew. Number of Bedrooms: existing new w m Total Room Count (not including baths): existing _ new First Floor Room Court `�' Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New _ Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ®new size_..Pool: ❑ existing ❑ new size __ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal #_ Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name�L'P4.f/1� e /.�C Telephone Number So -77/-3/10 Addressc1/7 7�d e—v y Af Xe- l yA�W-3_ License # e,!�' 47-M9 7 Home Improvement Contractor# /� 211 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATIJFiE ®ATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. n ADDRESS VILLAGE OWNER ' ' DATE OF INSPECTION: —FOUNDATION d F . FRAME .'INSULATION; _10. FIREPLACE Y ti ELECTRICAL: ROUGH FINAL ' t r PLUMBING: ROUGH FINAL GAS!:,,;, ROUGH ; r ,- FINAL r • :iFI.NAL BUILDING",c�1 7 t r DATE CLOSED OUT ASSOCIATION PLAN NO. L The Comammveatth of Ma. rachusett t ° DeP=�rMW of fndzrS&W Aceider to of�m�estigafiorrs 600 Washington Street Soto , MA Q2IIZ ' tfw►t.mass g�/r�tr s Workers' Compeasxtion Insurance Affidavit: Builders/Contractors/EIectti�isns/plt�ers A ficant h2formataon Please Printit&ll �ol f Name �. on�ndividuaI):: A ----------------- dckess: City/State/Zip: Phone# ''.SlJ�-77/ L2T an employer. Check the appropriate box a 4. I am a Type-ofproject(requirewig ❑ general contractor andloyees (fan and/or ait-tie * have hued the sub-cQntracttnrs 6 ❑New constzvefian a sole proprietor or partner- Iisted on fm attached shet. 7. ❑Remodeling and bave no employees 'these sub-contractors have ing for me•in any capacity° employees end have worh=, g' [1 Demolition workers'comp.Msur=5 comp,insurance.$ 9• ❑Budding addition 5. ❑ We area corporEoon�and its IO:�Elcairepaffs or additions a homeowner doing an work.. officers have exercised theirL(]Phmmlainlf [No workers' comp. right of exemption per MC3Lg repairs or additions nce required,]t c. 152, §1(4), and we have no 12.0 R.00frepairs employees. [No workers' 13.[(Other O�if10 4� cs�id// comp.MIsuran.ce regT'ic�d] / Q,(� e- *Amy applicant that checks box#I nest'also frIl ont tho section below sbgwing their w�Lers'o �t,.H,� m` e m�m=who sabmit this of davit is D they an ompensation policy iafnrmatioa -wnaacmla that cheer this box must attached sa additio¢eal shcat h w ug and then offtm SUB ca raCt=rs must subarit a now affidavit indi-t ig such. amployera. If the sab� ntmctnn ho,employees;they must h name of the end ststz whether ar wt those entities have. Provide their wod3=.romp.policy numbor. lam an employer that is praridncg workers';campensafion insurance or in}`orrrrafinn. f my employees Below is the po&cy and job site. InMMnce Company Name: — .�J7d�•4/�rr�S Cam, Policy#ar Self-ins.Lir. Expiration Date: Job Site Ad±-ess_�'/ ZC14 City Attach a copy of the workers' compensation policy declaration page('shoring the Fsl e to secure cov as re ( g Po��Y number and expiration image gutted under Section 25A of1e�CrL c. 152 can lead to the n3pD ion of anal penaltiest of a .: . fine up to$1,500.00 and/or one-year m isonment; as WO as civil penalties in the form of a STOP WORK.ORDER and a fine Of up to$250.00 a day again&the violator. Be advised that a c of this opY statement ma e be luv 'ons o y frnwarded f the to�tr DIA for marmmre coverage verrficaiion. the Office.of I do hereby under the pains and penaffies o fP�17' the information prarided above is sae and correct Sienature: � - Date: Phone Jr 77/ .3iYb �ffeci¢I use only. Do not Write in this area,.tn be completed by city or town offcci¢L City or Taws: Fss¢iag A¢fhority.(cu cle ones: permrt/l�certse.# L Board of Health"2:B¢iI Department 3. City M F /I`own Clerk 4.ElectriC-21 Impector,5.Plumbing Fuspectnr 6. Other Contact Person: Phone#; tlNtB�RItX4f'fr631f'bMLOfF:JTI.yt%.V`..Sl+.R3r'-.fy-cam\. Massachusetts - Department of Public Safety . Board of Building R"egulations and Standards s of 3E? Construction Supervisor Ak= -CS073097 E - License: �.� 1��. i. PETER A LAROCOE - •, 18 CEDRIC ROAD Centerville MA'02632 1 �„� �� ►41 Expiration Commissioner k` ffce oI'Consumer.Affairs & Busyness R ulatton IiIIE IMPROVE CONTRACTOR F eglsfrat+o _. Type r., Supplemenfi:� f PETER LAROCHE �, 217 Th6th Dr Hyannis, MA 02601 Undersecretary.. Client#:23059 OCEAINCI ' ACORD. CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) 1/02/2013 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 Rogers&Gray Ins. Kingston PRO e . 434 Rte 134 (AIC,No.Ext a,No: 877 816 2156 E-MAIL erS ra r0 .com South Dennis,MA 02660-3700 ADDRESS: mail @ 9 9 Y 508 746-0055 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Co 17000 INSURED - - INSURERB:Everest National Ins.Co Oceanside Inc. 217 Thornton Drive INSURERC: Hyannis,MA 02601-8105 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. INSR - - - ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY - LIMITS A GENERAL LIABILITY 8500053796 1/01/2013 61101/2014 EACH OCCURRENCE $1 OOOOOO X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $100 000 CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY F CT LOC 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 PROPERI AMAGE $ AUTOS - Per.cadent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION CF4WC00045131 1/01/2013 01/01/201 X WesTATUj oTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT s500 OOO OFFICER/MEMBER EXCLUDED? I N I A (Mandatory in NH) NO EXCLUSIONS E.L'.DISEASE-EA EMPLOYEE s500 OOO If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500 OOO DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION The Dartmouth Group, OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE p Inc.IrIC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4 Preston Court-Suite 101 ACCORDANCE WITH .THE POLICY PROVISIONS. Bedford,MA 01730 - AUTHORIZED REPRESENTATIVE ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S92189/M92188 CJF THE RIGHT CHOICE i sirue.1971 Office Use Only j node= JOB NUMBER a a Restoration. L-----------------I 217 Thornton Drive;Hyannis,Mass.02601 508-771-3I10 800-464-3318(MA.Only);508-775-2848 Fax MASS.HOME RAPROVEMENT CONTRACTOR REG.9100121 MASS.CONSTRUCTION SUPERVISOR REG.g000043 ASSIGNMENT AND AUTHORIZATION TO PAY , The undersigned, herein called claimant, has authorized and ordered from Oceanside, Inc. , the materials and/or: services requested. Undersigned hereby assigns to Oceanside, Inc. -any- unpaid proceeds due or to become due,.. under :the claimant 's policy with the" insurance Company to pay direct to Oceanside, Inc. or" to include its name .on a - check or draft., for all requested work. In the event that Oceanside's claim herein -Is not. covered by, or paid by, an insurance -company, ., claimant :agrees to pay .Oceanside, Inc. :within sixty (60) days .:a.f ter .Work has been completed. Claimant understands that Oceanside, Inc. is working for them and not the "insurance company or the adjuster. Payments remaining due and payabl"e after the claimant has received payment from .the insurance company shall bear interest at one and one- half (1"1/2%) percent per month. In the ..event, that there is. a.. breach by the..claimant of any of the conditions" of.. this agreement, . Oceanside.,. .Inc, shall be entitled to recover, as additional. damages, attorneys ' fees,, costs and any other collection expenses. reasonable and attributable to said breach. If payment is not received within 60 days, collection action will commence without further notice to the claimant. DATE: PHONE: (0� <2,q0-.(p(o�F� CLAI NT'S SIGNATURE PRINT NAME S 2 S MAILING ADD ESS (BILLING) CITY STATE ZIP LOSS ADDRESS INSURANCE ADJUSTER S. NAME/CO. INSURANCE .AGENCY NAME CCI(TNMF.NT`201Ldoc 4ermit0 � or) Map I Parcel ".`J # Hou 1 Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00 ) �' "r� ee �� .S�D ` Conservation Office(4th floor)(8:30-9:30/1:00-2:00<1 '>C �_ 96 Wk SEPI.IC SYSTEM MUST FJE Planning Dept.(1st floor/School Admin. Bldg.) TALLE®IN G CE Definitive Plan Approved by Planning Board 19 WiTli TI D ENVIRONMENT TOWN OF BARNSTABEV" REGU ` Building Permit Application Project Street Address _So:�E Village Owner S` N CC�O-\�0 Address .`:D, Telephone Permit Requester i First Floor square feet Second Floor square feet Construction Type C®lvc,_Q,�e Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing'Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type:°',O Full ❑Crawl ❑Walkout ❑Other Basement FinishedArea(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New k No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/copal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structure Pool(size) Zs� ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of peals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use pg1Acs-T Builder Information Name Q)�N C sb3-, -' Qk3d C Q Telephone Number Co LQ �p Address 0 -z9 cb�_IL ��J License# ` ►�,�`�j Q n\ C �2.Lo3� Home Improvement Contractor# 115 69 Worker's Compensation#(-JC 61 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES OJR9J ALL CONSTRUCTION DEB ISFROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR#F ING REASON(S) r FOR OFFICIAL USE ONLY PERMIT NO. 3 57 DATE ISSUED MAP/PARCEL NO. ADDRESS + VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION.' w - FIREPLACE ELECTRICAL: r ROUGH FINAL - PLUMBING: - 'ROUGH FINAL GAS: RO;UGH€+- FINAL..FI FINAL BUILDING -�1 L qn DATE CLOSED OUT 'ASSOCIATION PLAN NO. - P AR-24-199b 14:U9 HRIACY SHIEL 508+420+04E,9 P.02,02 4414-1 'A OF ROOM A. t� w �� A avoAr/a/v .CoG4T/© ,Cd ANC SG 7,6A C.�C . p E �P.F.✓� / S. ,�'CQU/,C��E_ �%TS.. Ors �-,�,i� 7 mat-t�it/,OF • �.L.��(.� e _ �- 4oc,grev 7 �.4 The Town of le Th �arnstab • �tuvsrnHi.E. • 9eb '& ,m�' Department of Health Safety and Environmental Services 'OrEo " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only , Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION! MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. C Type of Work���l �p1�� �C � Est. Cost r Address of Work: Owner's Name ��lcwe.S �� C C. 01%�_C) Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name r • -_ =_'_ __ The Commonwealth o Massachusetts .� =- y� Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 —" Workers' Com ensation Insurance Affidavit name: l�C`�C� �� G G L 0-71-0 location: city \ `� phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole P.r rietor and have no one worill in any ca achy ❑ I am an employers providing workers'. compensation for my employees working on this job comuany name:: 'N �-'• G R G'�`�:: �1 address. .......... ci r Jl ('f hone#. -1�J insurance co. ohcvOR # � � 000/0000/1 ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comoanv name: address: city phone#. insurance co 'oLcv# . comaanv name: address: city: >ahone# insurance co. olicv# Failure to secure coverage as required der S on A otMGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as d penalti s C oC a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forty ed to th OfIIce tigations of the DIA for coverage verification. I do hereby certify under the pai an penalti o p rjury that the information provided above is true and correct. Z l` Signature Date 1 1 l q C� _ Print name Phone# �� 4 �,D official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (mixed 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any 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 section 25 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 in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of 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 peinn license number which will be used as a reference number. The affidavits may be retmrned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. /% The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Ottice of lmlesduaflons ^ . 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 -4, a r ro. i` ._ ` .. a • '..l f. •• r • .! I- ♦ r�ry.�fN'�''•n'�t'♦ , "E 1 The Town of Barnstable • RAMMBLE, '� epartment of Health Safety and Environmental Services A�FD MAC" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner PLAN REVIEW Owner: 1�i C^.G 1 0-1T O Map/Parcel: C) —C)o 9 0 C)5 Project Address: �I EIV,GESTOWE, \N(N`f Builder: N-NC"-oR Pc-)jL- The following items were noted on reviewing: 7-a) C M a \-k( T(,A > ( 'R E-�C-C cz� c)t,- � Please call 508 862-4038 for re-inspection. J.nspectedaby: 'P , SLR Date: 2- / q:building:fbnns:review 'P Restricted To: 00 9 9 6 6 7 00 - None { IA - masonry only 1G - 1 & 2 Family Hozes 1 Failure to possess a current edition of the ' Massachusetts State Building Code j is cause for revocation of this license. I ,I I ✓/tlt 100 J/tdI[U/t1[H,'IIGI� [w lC[[JJQCI7L[JP.�IJ - 1 DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE Nuaber: ' Expires: ; r Restricted To, 00 HARE J COLEMAN 2 BARBLBY NAY N HARNICH' HA 02645 HOME IMPROVEMENT CONTRACTOR Registration 118507 Type - INDIVIDUAL _ Expiration 03/28/99 ` MARK 3 COLEMAN J. O RARKLEYNAYCN ADMiNISWToa NO.NARHICH MA 02645 lug . - 11.'02 •94 17: n2 Z'61 7-0;7:°° DEPT IND ACCID p o /J u:: •__.. �,;:_ L.oi:2a:wnu-Falf11. i��a��acl.u�et� aUtt,partmenl 01...!'ndct�trcrz� /dcc�denfi 600 !/i/cul:in�tnn Shwet James J.Campbell &fort, V--Mac" 02 f f f Commissioner Workers' Compensation Insurance .Widavit (IloeaseclpQmiacee) with a principal place of business at: (Ctty/Sutcll#p) do hereby certify under the pains and penalties of perjury, that: () I am an employer providing workers' compensation coverage for my employees working on this job. Insurance Company Policy Number r f 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 Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number O I am a homeowner performing all the work myself. :.'. ,•<<� _ s_, co •y of&..a s_;ement K;l:_e ferrzrced is t e OMce of ir;vestiZ�,—cns of d:e 01A for cc%Trage verifies:ion and that friiure to secere CC---e4e:_c rec i,ec t^.eer 5cc--:en 25A cf MCL 152 un luc to t�;c 1mrc;icion cf c5minal peaal;.ies cone==of a fine of Up to S 1,500.00 anelcr er. yeas' irrprL�cn!ncn; weft as c:✓il Penzltie.;in ite fc r-.ef,STOP WORK ORDER and a fin of S 1a0.00 a Cay apinst me. Signed this C�4 3 day of y 19 �S Licensee Permittee Building Department Licensing Board SeIectmens Office Health Department TO VL:RIFY COVERAGE INFORMAT10111 CALL: 617-727-4900 X403, 404, 405, 409, :575 TOIN'N OF EA= '.E BUILDING ?LR°1IT vl WxL A STD. GRECIAN �� II i i s Office 1st floor Ma ` Evt' t 6Ogg Permit# � Conscrvatiorr Office 4th floor 3 �� ;\ Date Issued 3/oZ Board of Health Ord floor Engineering De t. 3rd floor House# Planning Dept. (1st floor/School Admin.Bldg.): e t- y/�=r c ,(j ,, r G x '0•` B[Al NAMBARN1l, _ Definitive Plan Approved b Planning Board 19 (Applications processed 8:30-9:30 a.m.& 1:00-2:00p.m.) '� DO ��► TOWN OF BARNSTABLE Building Permit Application Project Street Address 5 -�-O Oe7 oj r\ �l Village Co V l Fire District C -rL) t-v- Chvner- SEPI-1 e Epp �Al,��C�0 �'� • Address I00044 �)t�MFCt �t'�U Telephone k 424-`73;Z,9 Permit Request: i)9j;U W-rm-A56 TWO e-'4r2 G/w-w46-f. Zoning District 1 t'- Flood Plain -VA Water Protection �8 Lot Size 44, 477 54'T• Grandfathered Y55 Zoning Board of Appeals Authorization `�iEF Recorded FL 13k tf(o -7 3 Current Use VAV-%�+vT t c3- Proposed UsebWEc_t-titlf�- Construction Type �0001 r144144j5- / Ezistina Information Dwelling Type: Single Family r Two family Multi-family Age of structure N type9zt1 Basement 8- dyk'� bV060?-� o nJ Historic House '�/.4 Finished 1111A Old Kings Highway u(/� Unfinished A j� Number of Baths �•'f�/'y No. of Bedrooms 7 Total Room Count not including baths First Floor Heat Type and Fuel Central Air Fireplaces `TLC10 2 Garage: Detached Other Detached Structures: Pool ', 4 Attached Barn `111f None Sheds % Other Alf,+ Builder Information Name w k',L1 k A 'T', Telephone number .5-08 ^ 44Z9 --,?90 9 Address License# O 2 955 607V/T' 1-'2/9- 02y ZLjj Home Improvement Contractor# Worker's Compensation # 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 BETAKEN TO o�c3D6 v1-� Project Co ' OOd �' Fee SIGNATURE L )ATE r „ 2 3, 1025 BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T -* 3 73 FOR OFFICE USE ONLY 3/27/95 5�546- 054.009.005 ADDRESS 51 Eaglestone Way (Lot 3) VILLAGE Cotuit OWNER Joseph & Joan Dalton Jr. DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE/ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL f FINAL BUILDING: DATE CLOSED OUT: ASSOCIATE PLAN NO. ,, r I I1 51N61: : FAMILY , •.,W,i�y.; .GAlzF3A GE :•�R1�JpEK.: SE�i l C TA MC 4aCo.. I +. ...;...; ; j :Ur . v GQL 12ISPoSAL_ 'PiT -' st 2•�oo0 44c./z sI M WE E M!_L ' .;AR C= 31& S F: LoT mth E. TV IT- L' 516N (09 S TOrAC: :VA i~: �-ta�j�/.:. 66o. km : TE¢cDc.A Tt oN_ ATE :. i "��<�l 2N//✓ a.;�ASS F i _... RCNARD Y PETER e,uc s� a �� SULLIVAN Plo. N733 _ 4 • I E�oC.t-' i RT 52'. i ------------ 777 CAM. , . . .. I: : . . GIST�Nv ssi eat a doo de. 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COMMONWEALTH., F � - MASSACO DEPARTMENT OF PUBLIC SAFETY E77S _. E ASFfgORT0 BO111 PLACE RATION DATE EXPI ®� 7 STpNP MA 0210@ -� T- L I E E n�ip�$de 6 CJNSTR 03/1 l/19 9 N S E RESTRICTIONS • S U P E R y j$0 R NONE EFFECTIVE DATE J. QC/3 LIC-No. F h 0/ FOR RP 9 R . 3 012 PROTECTION q 9 -. _ TH G PQ13 EVER PRINTAPPROPRIATE THUMB �� X I APP , PH . . 134 TT o ROP oTO e k BOX ON LICENSE. TE (BLASTING OPP ONLY) F CO TUI T NA EE- 0263 j -To BLASTING 0 h . • ` " BLASTING OPERATORS HEIGHT, NOT VALID UNTIL SIGNED BY m MUST INCLUDE _ STAMPED- LICENSEE E PHOTO. - a. THIS DOCUMENT MUST r AR B RI E CA RRIED .. O 7 OTHERS-RIGHT THUM HE PERSCNOF - - B PRWi THE HOLDER WHEN.EN- r- - - - G AiJ+�.r,GE 1 DIN �s> TH IS r I S t?O C C UP N. NATURE TURE OF LICENSEE �` ?. I SIGN NAME 11.1 FULL qgO VE SIGNATURE- AT. U �. RE LINE SSIONER u PRa�IEMENTj , 5. 5 b u M � � •-� erlt.- �� . � r364ldP �,w s •� �it��MA 4 �3��� �� - M1.15( The Town of Barnstable BAE. ; Department of Health Safety and Environmental Services MASq. g i639. �0 °1Fn,r,o•0. Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection 12('(0, Location Permit Number 1 �Owner ID�"�--�� �`'� Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: 1! C" E 6\'P-f Please call: 508-790-6227" for reeinspection. Inspected by Date . tJ �` x, TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY R _ PARCEL ID 054 009 005 GEOBASE ID 42264 ADDRESS 51 EAGLESTONE WAY PHONE COTUIT ZIP - LOT 3 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT PERMIT. 25842 DESCRIPTION SINGLE FAMILY DWELLING _#PM 7 PERMIT TYPE BCOO TITLE CERTIFICATE OF OCCUPANCY T 348) CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: INE BOND $.00 Ox ' CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY * ; + il1RN3I'ABLE MASS. OWNER DALTON, JOSEPR-M`JR & JOAN 1639. ADDRESS ED MIS 10004 WEATHERWOOD COURT POTOMAC MD BUILDING DIVISION BY 0 ---'-� DATE ISSUED 09/24/1997 EXPIRATION DATE TOWN* OF,'BARNSTABLE, MASSACHUSETTS BUILDING PE1NH-1 NQ 37548 A=054.009.005" DATE March 27 19 95 'PERMIT NO. William T. Everitt ADDRESS 1136 Old Post Rd. , Cotuit 012955 (NO.) (STREET) ICONTR'S LICENSE) PERMIT TO Construct dwelling �T,'NUMBER OF -(--L) STORY Single family residence DWELLING UNITS 1 (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 51 Eaglestone Way (Lot 3) Cotuit ZONING. STR (NO.) (STREET) D.I. I CT__ BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT, WIDE BY FT. LONG BY -FT.'IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP -BASEMENT WALLS OR FOUNDATION :(TYPE) REMARKS: Sewage #95-570 w AREA OR VOLUME 3,032 sq. ft. g260,000 PERMIT 243.75 (CUBIC/SQUARE FEET) ESTIMATED COST 'F $ OWNER Joseph & Joan Dalton Jr. ADDRESS 10004 Weatherwood Ct. , Potomac, MD 20854 BUIL BY R PERNIIA Ei T EN- THIS PERMIT CCNIVEYS NO R:SHT 00=M.'AN-Y S712ET,ABLE' OR SiDEV;'ALK OR ANY PART THEREOF, E;THER TEM..P L:lr. CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICAL.O.'PERMIT-1 ED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU_ ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INVECTION APPROVALS 2 2 2 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH *HER: SITE PLAN REVIEW APPROVAL *a2 40 WORK SHALL NOT PROCEED UNTIL, PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE a STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. TOWN'& BARNSTABLE, 'MASSACHUSETTS � BUILDING PERMIT J D T E J� 1 9 �P--EERRM II T NY O A)O-: 377 I� APPLICANT ADDRESS '7 I %�� (NO.) (STREET) / (CONTR'S LICENSE) NUMBER OF PERMIT TO ( ) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) DISTRICT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: 570 AREA OR PERMIT VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) OWNER BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. I. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO 3. FINAL INSPECTION BEEFORFOREE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POStTHIS CAR® SO IT IS VISIBLE FROM STREET BUILDING'INSPECTtONAA QP OVALS - 'PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS . -Z7 P �p 2 z ,0,o.0At 9 .� � l z APR 1. 1.997 3 HEATING INSPECTION APPROVALS ENGINEERING 136ARTMENT C BOARD OF HEALTH OTHER SITE PLAN REVIEW APPROVAL WORK SHALL NOT PRICEED UNTIL THE INSPEC- PERMIT W;L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED-.'HE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN 2 ONSTRUCTION. { PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. ( v tti BUI LDING PERMIT _ :TOWN OF BARNSTABLE, MASSACHUSETTS BUILDING -PE R NIi A=054.009.005 DATE' March 27 19 95 PERMIT NO. NO 37548 APPLICANT William T. Everitt ADDRESS 1136 Old Post Rd. , Cotuit 012955 (NO.) (STREET) (CONTR'S LICENSE)'• PERMIT TO Construct dwelling 2 Single family residence NUMBER OF 1 �_I STORY g Y DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 51 Eaglestone Way Lot 3) Cotuit ZONING DISTRICT_RF (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS, Sewage #95-570 AREA OR VOLUME 3,032 sq. ft. ESTIMATED COST $ 260,000 PERMIT $ 243.75 (CUBIC/SQUARE FEET) OWNER Joseph & Joan Dalton Jr. ADDRESS 10004 Weatherwood Ct. , Potomac, MD 20854 BOIL BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2.PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. Will Everitt Custom Homes &Designs P. O. Box 1340 Cotuit, MA 02635 Will Everitt, Builder (508) 428-7909 License#012955 Registration# 101645 Building Department Town of Barnstable Hyannis, MA February 5, 1996 Re: 51 Eaglestone Way Cotuit Building Commissioner, Please be advised that as of this date I am no longer builder of record on permit number 37548 for Joe and Joan Dalton 51 Eaglestone Way Cotuit, MA. Will Everitt