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0675 MAIN STREET (COTUIT) (2)
I /I , I PL76 fl2a-' " TOWN OF,BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel00 Application # Health Division081fe Issued Conservation Division �� O&�P Application Fe Planning Dept., �� Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address C2 Village ir ntu-i � Owner$?L r8 BL L7.c4 �C, Address _ I Y►1 �� Telephone�6-( - 7 7 _4 i 77 Ll to S � 0r_1 1.��l C� Permit Requester nJ a`� (o -- L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new 12117 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 ❑ No Basement Type: A Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)_ //2 n Number of Baths: Full: existing new 2— Half: existing new f Number of Bedrooms: existing Anew Total Room Count (not including baths): existing new First Floor Room Count _ Heat Type and Fuel: XGas ❑ Oil ❑ Electric ❑ Other T Central Air: XYes ❑ 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 �I Mc (-�CA-Wn Telephone Number ® - 77 7(, Y,45-?T Address -3 (-_)aqD 6E License f, 2 a 1'r of M a`5 Home Improvement Contractor# 17 _ Email IN o C(9r /nQ hP f,7f*�1" rRer's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO e SIGNATURE J M DATE , l FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER • DATE OF INSPECTION: FOUNDATION t FRAME s INSULATION FIREPLACE 'ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0,2C, Parcel Application # I Health Division Date Issued Conservation Division Application Feel Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board , Historic - OKH — Preservation / Hyannis Project Street Address C��� �� ^ � i�) �+�'�•@� Village co+o t Owner��. 130 ZZc c LLC- Address 12D EA5t AlQf 3ra 6j< Prinpi+e/ y 14616 Telephone_T Permit Request Square feet: 1 st floor: existing proposed "2n 2nd floor: existing proposed AV?0tal new Zoning District Flood Plain Groundwater Overlay Project Valuation '' 000 Construction Type _�Cl�,�oL Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Type: Single Family yp g y Two Family ❑ Multi-Family (# units) _Dwelling C Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway` ❑Yes ,❑ No Basement Type: ,N Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sg ft) Number of Baths: Full: existing new C Half: existing view Number of Bedrooms: existing gnew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: AGas ❑ Oil ❑ Electric ❑ Other Central Air: , Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Nhed: Pool: ❑ existing ❑ new size Barn: ❑ existing ❑ new sizeAttached garage: ❑ existing 56new size� ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number 77(, - s Address CA✓►IJ2 License # C_S I( :7 5?a`7 Home Improvement Contractor# It Email c(5� « brf,znJ.0-LCOrker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE WArldig) DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER k 4 DATE OF INSPECTION: t FOUNDATION f FRAME y 'y� E a a INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ��) �� (� ! 'u rCt'Lla_il �4 ICI DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 260 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-700-6230 Property Owner Must Complete and Sign This Section If Using A Builder I,:TOOM A S DQ A S AcC as Owner of the subject property hereby authorize (.,( (9 r a±f=f to act on my behalf, in all matters relative to work authorized by,this building permit application for: (Address of Job) Signature I OvZe; at Print Name ' : If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORWbuilding permit formsTYPRESS.doC Revised 061313 a V-ramAx V1 Jl7fi111IJ�.iiR/l[V Regulatory Services ox�"E •, Richard V.Scali,Director _ Building Division BAaris A19A ' Tom Perry,Building Commissioner lines %639. 200 Main Street, Hyannis,MA 02601 6 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION I 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. „ t The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) Tlhis ilack 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. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 • - rnec�u tg7�r�ci - Wm-ke&C—mpmmafx ce dam BuAdErsf . ecfr=�u hers • �.�o�F�atrmaf�ug - Pipe-Frin��ih� ' -776 Am y sip empkn;r"Ch=Vtha xppvprizh�bcr T of P19ject = 2❑ I am a cmploycsw 4 I mitegm=rl cznhmciar=UfL MXPIopefs{fall-worgatfrM4 hail f6e Z❑ I�La a&ole.giapri ar nrpar€ner E%fed on the af#acbed sheet: 7- ❑R,- o lg ship mad hate no employees T sub dui hn-ve ❑ mug fafineiaaagcaga�- adddifion I . 5_ We ace a c aparaticnand iEs 10-0 F1ed ical regaiis LSr addi ians s_❑ I am a hams doing a1I wosl c seers have•:sed ffieiz 1LO p�mg mp�or additions =Y.Ctf. [ND" Mr ftca'Mn3p- 120$nofrepaim emplvpem-[Nawor:eml I3-0 odmr 'r &.�chec�csbarfl�Stalso�outer atC Ln 9oRrshwzh3g ffidr vd�Y C9ID�Fxror3.rvtPp�- �•' ;ffg�v1IIELSU-hD Sri L�LS arLL II� •�F:IIZ:-^*�Tr•'_'if'L hTME MdnancoutramY�St Svbcr�BaeWF.IIFIi'iittmdiCBt 5F�1_ ` fC'•..-A.vrn,Tc'$L'R C�l$2E T?a:C ID'¢St SCSCfSP�i3:rirtifirm 1�e�r�yp .��j�py�Ep�ff7E�-�d4�m�511�R}1eT312f 0.'DIIL$HiSE�'1P5fi-+'Y _ - �Svp - Ifthe 51 c shy- r�Io�t$egaust 2-3 tb.*wotL Camp.Pak3`member. zi'cezF ar Inp ihrrtislrrrriss trvrkers'c• rt FnsuFrrgca far rrzp P. Layces Beiaty is thepaFry aad jab sits lusminm CrO=LpRMYxa=(d_' POficp t4 oz SIf Ii� fiiaaT}ate_ Io'b life {�n`-esr CzfglStafeiCp: A-i#acTE z cDpy of t-wcrkersi caiupeusation prIiLT deterration page-(sh��td=F-0b-c3'xrrmrTxer=a mT�x atiou tsfe): . Failure fo sett¢c cage�s.rtxj�iedundes�eCEi�reS$of l r c I�can lead ffi id�e impasiii�.o£�aI penaEfias of a Erne ug ffi ISDa Q[Y andlar one yearim as t�eIl a rI ge�ald�m ffie fo--of a STGP WOFX ORDIM and a fin, of up fio 4_E)O a day against fhe viDLdoL Be advised#at a cog of it is stat=nent maybe warded to the Office of InresE p6ons of fac DTA€nr iusm-anr_z-cwm=ge vcc�,Eca#io.-. Fc�a harefxy r tkir andpsa r atfheu prnza#xaaprcn r ak his truce an c r�ct S`;Rnsrfnr� DAr-- M , E f�`ci�use arrf Inc tFat wribr €Fur area Ete�•,fu bs canT by clip cr tnm u,�cinT Cog ar Town: R�rcniiJTargue� F��t'fxrfhu-ri�{rn cIC ont�: . . L BI-X'a If Hllll±E 2.RM-FFgDcparfm_Ial-pFawnO=k 4-ElectiicalE=pettor S_PFM-finglaT�ctur �.cwht=-r Thous hfmmnjy Lwr chapter 152 re pz=all eraployeas to provide work='ccmpemsation for$cz=±ploy=s,' purm ant to this ate,an=p&yrz is defined as 0—cvcry.pion in fhe-M-Fice of another under any cont -it of 7zi express or flied, oral or . t An ezpT6y�is d�fined as`pan indrnidoal,partum�sbm,a=fidion,corporation or oiiier.legal entity,or any two or morn of$se foregoing engaged in aJaiD±Mtr pzise,and inclIIdinig the legal re se�fives of a deceased employer,-or the receiver or trvsb=of a a fila ldaal,per,associatioa or other legal entity,ezuploymg employee;- However the ovrner of a dwelliagbouse having notmore than.three aparim�s and who resides theram,C the occngant of isle dwe[m house of another who empIoys persons to do maintenmm,constructioi,or repair work on such C!WCl n_g house or on the gm-La s or budding apptrinnm:ittbemto shaIlnotbecause o-isuch eozploymmtbe de medto be an employer." MGL chapter 1521 §25C(t]also States that every state or local licensing agency shall withhold the issuance o r renewal,of a lic�se or permit to operate-a bns�ess or to consti¢tt Tinildings in the commonwcaIth for airy applicant WHO has not produced acceptable evidence of coiapHan.ce with f3ie MITQr*xnce.cover�ge requu ed' A&E#onally,MGM chapter 152,§25C(7 states-Neither the commoawealthnor any of itspolitical subdivisions shall enter into arry contract for the pence of public work unt�1 acceptable evidence o f compliance vrith the;n ^ce requsem.ents of this chapter have been presented to the contracting authority.' Applicants - Please fill o-ot the woikers'compensation affidavit complet�ly,by checlang the boxes chat apply to your siturtion and,if necessary, sapply sub-mntzacbr(s)name(s), addresses)and phone n=ber(s)along with their ceru scat-ets) of rasurrmae. Limil�d Liability Companies(LLC)or Lbm 'Liability Pa tacisbips(I LP)wt�hno employees other an the members or partaers,are not required to carry workers' compensation in�rr�ce_ If as LLC orLLP does have employees;a policy is requu-eL Re advised that this affi m davitay be submitted to the Department o- Industrial Accidents for confirmation ofin ce Coverage- Also be sure to sign and date the affidavit The affidavit should be rot maed to the city or town that the application fur the permit or license is being requested,not the Departneuf of I-adustial'Accidents. Should you have any mi ons regardm-the law or if you are_ d to obun a ?*orkers' comp ens ationpolicy,please call the Department at the nmnber listed.below..Self-i'an ed.companies should_ent.�r their self-;,,�=license numlier on the appropriate line. City or Town Officials Please be sure tTiaf'the provided a space at the bC3uBU R of•the affidavit for you to fill out in the event the Office ofInvestigations has to contact.yon regarding,be applicant Please be sure:to fill m the penait/ieense number which wM be usad as a reference number. In adEEDn,an applicant that must bmit multiple penriitllicense applications in any given year,need only submit one affidavit indicating curren su t policy mfo=aafion(ifneccssary) and under¢Job Site Address"the applicant should unite'all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by fhe city or town may be.provided to the applicant as proof that a valid affidavit is on file fur future permits or licenses. Anew affidavit must be rolled out each year.Where a home owner or citizen is obtauring a license or permit notrelated tn'any business or commercial venue (i-e•a dog license or permit to bum leaves etc.)said person is NOT req� to complete this affida-ni The Office of lavestigatiom would at to thank you in aa7mce foryom-moperation and should you have any questions, . please do not hesitate�give ns a ca1I_ . The Department's address,telephone and fix numbr- . D uat c f hj&nt ial A=ideata ' aff!(�a oflu7c�s�- tFaui F=.617-`27-' 49� :R-evised 4-24-D7 Massachusetts -:Department of Pudlic Safety Board of Building Regulations and Standards .6 n,-Irucliiin Supervisor... License: CS-107897 - DANIEL MCGRATII 312 CAMP STREET :. . West Yarmouth MA 02673 J..G.:.�iCJ •.. `:X01r3t;o orrmass«ner: 06/13/2018 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116: Home Improvement Contractor Registration Registration: 179293 Type: Individual Expiration: 7/15/2016 Tr# 254877 DANIEL J..MCGRATH DANIEL MCGRATH 312 CAMP STREET WEST YARMOUTH; MA 02673 .-' „Update Address and return,card.Mark reason for change. 0 SCA 1 0 20M-05l1 7 Address ❑ Renewal 0 Employment Lost Card ' _ , C��e l�ci�rnrn�rracrrl��a/lG%llruric�rue(t� . -------° - ---.._._ - ---------�- — - - Office of Consumer Affairs&Basi3SessRegulation Liceuse or"registration valid for mdividal use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: : — egisbation: 179293 Type: .. Office of Consumer Affairs and Business Regulation iration: 7/15/2016 Individual 10 Park Plaza-Suite 5170 T• Boston;MA 02116, DANI J.MCGRATH' DANIEL MCGRATH 312 CAMP STREET C WEST YARMOIIfH,MA 02673 ry Not valid witho s' to Uridersecreta . L i a✓x �E s GA h _ J BARS ua. 57074'OA ... 244.04• o #67 ,D 675 13 21 -z,. aWNO -- ---- - -- " _ ' ® per. W i OLFLE( ®T GARAGE A) ® 675 fi-1 GAR ( 61bfiW B+MMP AmEA BENrm ixu ro eE RErAwEB IN NnTuuL�niT¢ p ® .I CplMAv TnL RESTMc9w ro rc mMhB. s LJ PY PROPOSED PAl£0 PMNI.YC I g :w.: —� Lot Area d �—ft-� 'lr-fr-� :. CONSERVATION '' -z 11101AL ACRES `. O. `O - - EASEMENT. ' I.OS U N! F COTIT FIRE DSTRICT/WATER ry• Q I g[( a NEPt. xoRX UWx M2, '�,{y/� 675 C- 9� 675 A- � B roE IP x HE BO P �ARFWC �PLEX .D11RE)( L L nY 10E ALN CU— T u I P prPE LWx 75 C-1 _ sc NA%.s o W9 0 A YNr o"" E 1#675A-1 nAN1Lv R 'rENx ) �E� GiS arnlBw „R Pn,a OF m ocNa srsrT / 'a ur E ,. P f is°rw e rc/ REoaoaM ec nr N 1/0 a n�.P..,xus N Nam' YWAElL u arc 1.�-- n /r _ ✓ A e,AYAmcr,ewer I1' 51 ..1 ucsPNee sG ..es I ` . I ZONING SUMMARY mMND DISTRICT.RI RESIDENRAL INSTRwT E%IS1A+0 PROPOSED .. .. .-. RAIN GARDEN-PLANTS :.. '_.. . .. : .. .... .. •. USE:.NUMBER OF DWELLING:UNITS ::.:.:.-2 .::B... :.: .. ' .. - .. :: - PLANT N LIE A SIZE p liO LOT SIZE 87,120 S.P.(R.P.0.0.) tO3.BIJ SF IU3,91J'SE CLETRA ALNIidJA p2 18 ����� _ T'EIt RESIDENCES TBA FROLOT FRONTAGE 15a " ' (H'IiI.�N.�Al'1'®II101 '1'®W1ii.IIIIOUSES FRONT �.• - BI,SO' 1BI,50' - - VACCINIU4 CORWBOSUM p2 13 WSIDE SETDALSL 1V • - 5.1 S4.5' REFERENCES - / .REM SEiDACN IS'• SEE YULIBAMKY RECS. 5B' S.3' - ICX VERIIULLATA L/6Y®U�'&LANDSCAPE 52B' 2Sa.B' ASSESSORS NAP 036 POlI5 M RET1051ER RED T1nG DOCW'OOD SUE 5 OG TED MTKN RESOURCE PROTECTION OYERLA ,. PIE,AN BED ON 1051PAGEGSg310 - ° DlsTe cT - .. :.. SITE IS LOCATED WTHW THE WP GV,,A�WSTRICT. ... .. : .... :. SITE Is LOCATED ixiTRN PENA ZONE c IS sNLixNa+ ... . .. :OWNER OF RECORD .:.:... ...... :: . _ SITE PII.AI�T OF LAND IN ()L —UNIII'PANEL NUMBER 25 1-D D REMSED DULY :COPUIT (BARNSTABLE) MA .. :. .BAY PONT.LLC .. .. . 297 NORGI STREET PREPARED FOR 1 r HYANWS.MA WE0,, • .. PLM HUZZY, LW 2604 ELMWOOD AVE. SUITE 352 BARKING CALCULATIONS: LOCUS A.•j• B ATTACHED DWELLING UNITS.X IO) .1.2 SPACES S ROCHESTER NY 14616 G Cntrpit ., VISITORS AT(T2.%1Dx).+1.2 SPACES � - � � - - I3.Z'SPACES REQUIRED ✓ #671 MAIN S7REE7,CO ITIT,MA Day.(. ,1 B D 16 SPACES PROVIDED ... .. ...... .. SCALE: .2 c q 1' 0' DATE: 11-22-04 SITE COVERAGE: J REVISED.. I 19-OB REVISED.:5-30-07 0WO COD& f4gh7fflpOB h7t. REVISED 4-6.06.REVISED. 8-19-OB LOCUS MAP TOTAL BUILDING FOOIPR NT. IJ 4BR_F SF-i3.OfL CIVI/ @ngln@@rS - REVISED,2-27-07 REVISED. 4-10-09 SCALE l" 2W0' PAVEMENT,WALKS h PATIOS I civil lond Sub inee�S REVISED 4-5-07 REVISED:5-8-09 TOTAL INPERNWS COVA'RAGE], 0 �� 'l�f 1t a g0%O.N, : OaiE 9J9 M 'n S(rdeL(Nee tiA) Sak I-20' REVISED.: 12-10-14((TOWN COMMENTS) ASSESSORS NAP 036 PCL 15 NATURAL STATE:45,611t SF-44.1%PROVIDED. D-M A,W.A.PE.PLS. REVISED.. 12B-15(H E/'S,GAR.) r NMOL/INPOR) MA 015>$ �r�GP_`�� .. .. .. .. SHEET 1 0 ,r, f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��, Parcel �'�,/,� Application b 1 Health Division Date Issued ( 1 F lJ Conservation Division Application F M p PlanningDept. Permit Fee y o�5 V 1 t •U Date Definitive Plan Approved by Planning Board C d Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner?1_M o7_7 . LL C-, Address qA041—elmabd Telephone Permit Request JF:nu au Di4-�'o-oz) RQ t-) ni,e1 l T-nc ( L.IY 2 7 ri d:5 C= / J C- Square feet: 1 st floor: existing proposed i'06 2nd floor: existing proposed OzTbtal new Zoning District Flood Plain Groundwater Overlay Project Valuation 500 6 Construction Type Lot Size G eS Grandfathered: ❑Yes ❑ No If yes, attach-`supporting documentation. Dwelling Type: Single Family ❑ Two Family 9 Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Krng's Highway: ❑des ❑ No Basement Type: /76 Full ❑ Crawl ❑Walkout ❑ Other s Basement Finished Area (sq.ft.) Basement Unfinished Area (s q.ft) Number of Baths: Full: existing new Half: existing = new- Number of Bedrooms: existing 2new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: (,Gas ❑ Oil ❑ Electric ❑ Other Central Air: AYes ❑ 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 V new size 0d: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes X No If yes, site plan review# n_ Current Use &5S AVAJ' ;ad Proposed Use Re&/�L) :4,4 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name C Telephone Number � , �� 7 e� 7'5® � Address i nam License # C.�_� Idu 1 `l Home Improvement Contractor# /:7 � Em N �,�a, � wen: c 0�/Vorker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,rT 4/7//(�_ 1 SIGNATUR DATE i, r FOR OFFICIAL USE ONLY APPLICATION# DATE.ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER � 1 x. DATE OF INSPECTION: fy �FOUNDATI.ON j A_" MIA FRAME f , .INSULATION i FIREPLACE a ELECTRICAL:. . ROUGH FINAL �r. PLUMBING: ROUGH FINAL _GAS: ROUGH FINAL FINAL BUILDING` -DATE CLOSED OUT ASSOCIATION PLAN NO. f.� * Regaktory Services Thomas F.Geffer,Dh=Wr - Building Division Tom Perry,114dmg Commissioner , 200 Main Sttwt,Hyamis,MA 02601 wvrwaown.barnsfable.ma.us. Office: 508-862-4038 : Fay 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, I LI ones 1'�ASI s'��►i , u Ownet of the subject propeitp r hereby authorize' ��t� � to.act on my behalf; in all matters relative to work authorized by this building permit -M (Address of Job) **Pool fences and alarms are.the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner ignatare of Applicant ©w1�s INI AsA-"i Print Name Print Name Date. QFORMS:OVTZWERMISS102QOOL4 62012. F -1own oI 15arn.SMMe =. Regulatory:5ei-v�ces : . Thomas F.Gerler,Director Kass 6 ,,•� 130dink Division . Tom Perry,Badmg Commissioner 200 Main Street; Hyannis,MA 02601 W W W.town.barnstable.rna.us Office: 508-862-4038 : Fax 508-790-6230 :. HONM0WNM LICMn E mlI mm Please Print . DATE: JOB L LOCATION: numbs - street. �'B� "HOMBOWNER": name home phone# work phone# CURRENT MAnM40 ADDRESS: city/tawn state zip code The current exemption for"homeownerg"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. DEFINMON OF HomEOWNER Persons)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 pefomned under the building permit'.(Section 109.1.1) The undersigned`ILomeownee'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 ofBamstable Building Department minimiml inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Not: Three-family dwellings confaming 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEovilm's FXEMTION The Code states that "Airy homeownerperfbin g work for which a buildingpermit is required shall be exempt from the provisions of this section(Section'109.1.1-Licensing of construction Supervisors);provided that if the horneowner engages a person(s)for hire to do such .. work that sucb Homeowner sbaIl act as supervisor." Many homeowners who use this exemption are unaware.thatthey are assurning 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 4 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 coror unties 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 se0eral towns. You may care t amend and adopt such a fotm/certificatim for use in your commnnity. Q:fb=.-hamnaxnrrrpt f Daniel McGrath 312 Camp Street West Yarmouth, MA 02673 CSL#CS-107897 _ Home Improvement Contractor# 179293, (508) 776-4577 i April 7, 2015 Town of Barnstable Building Dept. '200 Main St Hyannis, MA 02601 Dear Sir: am submitting the attached application as a general contractor and will be hiring subs to complete the work. 1 understand that they must possess Workers Comp coverage for their employees. Due to the protracted nature of this application process, subcontractors have not been retained yet. When they are, I will-be able to provide documentation to that effect. Sincerely, Dani cGrath r 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-107897, r DANIEL MCGRATII 312 CAMP STREET �:' l West Yarmouth MA 02673 ;� �,•�,.. �Jf- r� "''` Expiration Commissioner 06/13/2018 Office of Consumer Affairs and Buslness Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration "" T Registration: 179293 Type: Individual Expiration: 7/15/2016 Tr# 254877 DANIEL J. MCGRATH r1 — , DANIEL MCGRATH `Y" 312 CAMP STREET WEST YARMOUTH, MA 02673 1, f L Update Address and return card.Mark reason for change. Address Renewal n Employment Lost Card SCA 1 44 20M-Wit V/as lRn���nftairs&Bl/4ss Regulation License or registration valid for individul use on Office of Consumer Affairs&Business Regulation g IY _ - ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration' 119293 Type- Office of Consumer Affairs and Business Regulation _ xpiration 7115/2016 Individual 10 Park Plaza-Suite 5170 , .— Boston,MA 02116 DANI J.MCGRATH x ; t DANIEL MCGRATH�� , r ' 312 CAMP STREET WEST YARMOUTH,MA 02673-' Undersecretary Not valid ho sig towi -- f t The Commonwealth of Massachusetts. Department of IndustrialAccidents 4. - Office of Invesfigations t. 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/orgmizationandividual): Address: (oL IftM j2 ; City/State/Zip: y �/,dgM(jldj!I A& &(jil Phone#: ® `7 ;j 77 Are you an employer?dheck the appropriate box: Type of project(required): 1.El am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. 0 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 g. Demolition working for me in any capacity, employees and have workers' 9 ❑Building- [No'workers' comp,insurance comp. insurance. � . •- 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.[]Roof repass insurance required.]t c. 152, §1(4),and we have no. 13.❑ Oilier employees. [No workers' 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 praviding workers'compensation insurance for my employees. Below it thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification 1 do hereby erti under th ains and nalti perjury that the information provided above is true and correct Si Date: Phone �S�77g - rft S_77 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/Tow n Clerk 4.Electrical Inspector. 5.Plumbing Inspector., 6.Other Contact Person:. Phone#: Affidavit of Substantial Financial Interest �. 1, t�id w 6 r of i , on oath depose and state as follows: 1. I am an applicant for a building permit for the property located at Map , Parcel , _. The address of the property is t 2. 1 have % legal or equitable interest in the real properly which is the subject of the building permit application which is identified in paragraph 1 above. 3. Within in the last twelve months from today's date, which is / , the following individuals or.entities have had a 1% or greater legal or qui able interest in the real property which is the subject of the building permit application which is identified in paragraph 1 above: Name Address 4. Within the last twelve months, from today's date, which is 5 /eA , I have had :a 1% or greater legal or equitable interest in the following prope es ich have been the subject of a building permit application: Map/Parcel Address i A>)e_ 5. Within this calendar year, I have submitted building permit applications for property in which I have a 1% or greater legal or equitable interest. 6. Within the last ten days, i have submitted U building permit applications for property in which I have a 1% or greater legal or equitable interest. 7. Within this month, I have submitted 0 building permit applications for property in which I have a 1% legal or equitable interest. , 8. Within this month, i have received V building permits for property in which I have a 1% legal or equitable interest. Signed under the pains and penalties of pe/q'drX,,this7 day of Ate, 20d-5, 2001-0050/affin Q/LOTTERY/AFFIDAVIT i REScheck Software Version 4.6.1 Com Ii ' 'ance Certifi p Cate - - Project Energy Code: 2012 IECC Location: Cotuit, Massachusetts Construction Type: Single-family Project Type: New Construction ^1 Conditioned Floor Area: 2,200 ft2 Glazing Area 6% Climate Zone: S (6131 HDD) Permit Date: i Permit Number: Construction Site: Owner/Agent: Designer/Contractor: �jj 'MAIN STREET BLDG#1&2 : DANIEL MCGRATH '(&IJIT, MA 312 CAMP STREET 'WEST,YARTMOUTH, MA 02673 Compliance: 1.9%Better Than Code Maximum UA: 365 Your UA: 358 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Envelope Assemblies Gross Area Cont. Assembly. Cavity or U-Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 3,000 49.0 0.0 0.026 78 Ceiling 2: Flat Ceiling or Scissor Truss 768 30.0 0.0 0.035 27 Wall 1: Wood Frame, 16" o.c. 2,605 21.0 0.0 0.057 139 Window 1: Metal Frame:Double Pane with Low-E 150 0.330 50 Door 1:Solid 21 .0.320 7 Floor 1:All-Wood joist/Truss:Over Outside Air 2,200 38.0 0.0 0.026 57 Compliance Statement: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application.The proposed building has been designed to meet the 2012 IECC requirements in REScheck Version 4.6.1 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist. Name-Title Signature Date Project Title: Report date: 06/16/15 Data.filename: Untitled.rck Page 1 of 8 aW TOWN OF BARNSTABLE Building Department - Foundation Permit Date 1 ) ��� I s Permit # Name L C_ G �� Location ATom' S L1> C_ Insp. of Bldgs. i Town.of Barnstable FS E T O Regulatory Servi-(es Richard V.Scali,.Director * BARNSCABLE, < Building.Division 1639. �� - w.wrr n- r.•aa»r- a.umm. iDlfD�p`l om Perry building Commissioner 200 Main•Street Hyannis,MA 02601 4 www.town.-barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 COMPLAINT/ NQU `�'I PORT Date: Z S a 12ec'd by: Complaint Dame 11/`�O/�I�� 1 L/J MapLPaa ce1 Location ,� /�— //v/� Address:' /V CC /�C%> l �����J Originator Name: '5treet: . Village: State: Zip: Telephone C mplaint Description:.(—, �2 / JIG L C. P���/G �y K. iTCS /2 / FOR OFFICE USE ONLY Inspector's Action/Comments ::Date: Inspector: .Additional Info.Attached Q:forms:coniplaint Revised 040414 nThe Comrrtomvealth gfMa-4madiuset& Department ofIadus&id Acddex& Office offn gations DUILDI�rr n�P7 600 Washington set Boston,CIA 02111 . AU6 0 4 2016 ummmma=gov1dia TQVVN Ww-kers CamzpEnsafe®I ce Affif avit-BuiIderslCOnfracinrslEIectri iiiLslPlmmber_s A�plir�at Infarmafian Please FFint E,eIv Na= D6)PJ;Q,( Addre= �� r�i C(�/►') --—City/ — -- `� J=- —� --- -- rare you an employer?Check heck a appropriate bay Type of project(required}= L❑ I am a employer with. 4 I am a general contractor and I employees(full andfor part-4ime). * have hired the sub-contractors 6- 0 New comsaucficcU 2.❑ I am a sale propdetatr orpartuer- listed an the attached sheet. 7- ❑Remodeliqg and leave;no employees These;sub-contractars have�p ffiP�I'� S_ ❑Demolition wcd:ing for use is any capacity employees and have waakers' INo , comp.fi,sa,re camp_msara. ce 1 9. ❑B.ui1dmg addition reqmire&] 5. ❑ We are a corporation and its 16-❑Electrical repairs or adctions 3_ I ama hcmaeoumer ofce rs have eme rcised their ❑ doing all u� 1L0 Piumbsagrepaizs or$dditioms might of es�tion per MGL € o worms'cQmF- c_152 §1(4) andwehaveno 12_❑Roofrep. airs fxtc�irassre Teti+Ts'd.�1 , . employees.[Na�vork.Pss' 13-❑£?ther 'AspsppffCMt6=1tChedMbGa#1—stalsafMouFtheswdcmbelowshumiagtie7mwuder' mot; icgiafoamsian ?Saweawners wisp subunit dris dEdavil-gXcatiag dwY axe dcsia.-0 waoit and dim buns autsiae cano3adors— avbmit a new affidaeiS indiesting sacT, T b=lctua$oat chedr IM5 boat ssso st xUarly saaddiii®al sheet sh=!ngd enassseof the and state whether ar not tbase entitiesbsme employees.IfthezuB-caa�rtatsseempIafers,tiieymastpxasidet wadtr�'tomp•pelicgaumiser I am all erlrploysr flirt is pro�adircg� rkris'eotrrlreresafiart iresriratFce jnr sty carpFvpee $eTvty is�7ce prrFic�arzd jQta she information. Insurance company hame: A Tolicy it'or Self-ins.Lic-;: F�piratiaaDdte: Job Site AAHre= citylStal:el2�p: Attach a copy of the workers'cozIIpensationpolicy declaration page(showing the poficp mxmber and expiration date). Failwe to sectrre coverage as required under Section 25A of MGL a.1572 can lead to the impositim of criminal penalties of a fine-up to$1-50D OD asdlor anie:yeiLrimprisonment as W811 as civil penalties in the form of a STOP WORK ORDER and a fine of up to$2aDO a day againd the violatar. Be adiised that a copy of this zbkxnent stay be R wave ed to the ofaice of Iuvestega�afthe DIA for insurance coverapp yerifficati Ida her, a etti tinder&F avdpell a fit trio urfararafian prot'7ded abmv h;tras and current Date: Phone 9-7 0,okial use wily. Do not write in fbis mea,to 5e cmnpleted by city ar fawn affrciat My or Town: Permiffiieense;ff Issuing A afherity(rail€tare): L Board of Health 2.RueTalfng Dq rftment 3.Qtryffown.Clerk 4.Electrical Iuspector S.Plumbing Iuspeeter 6.Other Contact Person Phone it: DATE(MM/DD/YYYY) A�o® CERTIFICATE OF LIABILITY INSURANCE 6i9/15 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(es) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer riots to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Donald J. Medeiros Insurance A PHONE 508 678-1271 1 F°x N (774) 365-6552 154 Rhode Island Ave E-MAIL ss: don@donmedeirosinsurance.com Fall River, MA 02724 INSURERS)AFFORDING COVERAGE NAIC# INSURERA:American European Insurance INSLRED INSURERB:Safety Indemnit Edgar Mauricio Agudo Ortiz INSURERC:LibertV Mutual dba Ecuamerica Construction II INSURER0: 39 Seymour Street -INSURER E: Berkley, MA 02779 INSURERF: 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 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MIDDY MM/DD/YYYY LIMITS A GENERAL LIABILITY SKP2000957 10, 4/23/15 4/23/16 EACH OCCURRENCE $ 1,000,000 �{ COMMERCIALGENERALLIABILITY DAMAGE TO RENTED PRE I S Ea oca nce $ 100,000 CLAIMSaNADE 51 OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000 000 GENERAL AGGREGATE I$ 2 00Q 000 GEN'LAGGREGATELIMITAPPLIESPER - PRODUCTS-CO MP/OP AGG $ 2 000•'00O X( POLICY PROT- LOC - $ t B AUTOMOBILE LIABILITY 6223581 5/17/15 5/17/16 COMBINde.)INGLE LIMIT $ 1 000 000 ANYAUTO I BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS .,accident $ UhBRELLALIAB OCCUR I EACH OCCURRENCE I$ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WC231S372831 5/5/15 5/5/16 X WCSTATII- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCICENT $ 500,000 OFFICE R/MEMBER EXCLLDED? N/A (Mandatory in NH) E.L.DISEASE-EA EIVIPLOYEEI$ 500,000 KyyS describe under DESCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Residential Management INC ACCORDANCE WITH THE POLICY PROVISIONS. PLM Buzzy LLC 2604 Elmwood Ave Suite 352 AUTHORIZED REPRESENTATIVE n Rochester, NY 14618 Heather Williamson ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: ACORO® DATE(MWDD/YYYY) `� CERTIFICATE OF LIABILITY INSURANCE 110/16/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(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 endorsements. PRODUCER CONTACT : The Driscoll Agency, Inc. NA ME PHONE .7 Kelly ll S21 Sei 2490 FAXLAM,N :781 421 2491 93 Longwater Circle E-MIL Norwell MA 02061 A .kseip@driscollagency.com INSURERS AFFORDING COVERAGE NAIC# FNSURERA:HDI-Gerling America Ins Co 41343 INSURED 218590 INSURER B:Navi ators Insurance Company KOBO Utility Construction Corp. INSURERc:The Charter Oak Fire Ins Co 25615 4 Victory Drive P.O.Box 578 INSURER D Sandwich MA 02563 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1697556991 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�TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD ADDLSUBR POLICY EFF MM/DD POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EGGCC000107815 10/1/2015 10/1/2016 EACH OCCURRENCE $2,000,000 CLAIMS MADE ❑X OCCUR DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 MED EXP(Any one person) $excluded PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY�JECT LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ INED A AUTOMOBILE LIABILITY EAGCC000107815 10/1/201 cci 5 10/1/2016 Ea adentSING LIMIT $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ AUT OWNED SCHEDULED BODILY INJURY(Per accident) $ X HIRED AUTOSX NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident A UMBRELLA LIAB X OCCUR EXAGC000107815 10/1/2015 10/1/2016 EACH OCCURRENCE $10,000,000 B X EXCESSUAB NY15EXC7901951V 10/1/2015 10/1/2016 CLAIMS-MADE- AGGREGATE $10,000,000 DED I x RETENTION$0 $ A WORKERS COMPENSATION EWGCC000107815 10/1/2015 10/1/2016 X PER OTH- AND EMPLOYERS'LIABILrrY YIN STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,desciibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Contractors Equipmment QT6606B268829COF15 10/1/2015 10/1/2016 Special Form w/Theft 2,160,412 Installation Floater Install Ea jobsite 450,000 Leased/rented equip Leased/rented 250,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) RE:671 Cotuit Road Residential Management Inc &PLM Buzzy Inc.Are included as Additional Insured for Automobile Liability on a Primary Basis for the conduct of the(Named)Insured,but only to the extent of that liability. See Attached... CERTIFICATE HOLDER CANCELLATION 30 Days except 10 days for nonpaymen SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Residential Management Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 120 East Ave Rochester NY 14604 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE AGENCY CUSTOMER ID: 218590 LOC#: ACOREP ADDITIONAL REMARKS SCHEDULE Pagel of 1 AGENCY NAMEDINSURED The Driscoll Agency, Inc. KOBO Utility Construction Corp. POLICY NUMBER 4 Victory Drive P.O.Box 578 Sandwich MA 02563 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Residential Management Inc &PLM Buzzy Inc.are included as Additional Insured for General Liability and Excess(Umbrella)Liability,for ongoing and completed operations,as required by a signed written contract or agreement with the Named Insured. The Additional Insured coverage for General Liability&Excess(Umbrella)Liability detailed above applies on a primary,non-contributory basis where required by a signed written contract or agreement with the Named Insured. The General Liability,Excess(Umbrella)Liability,Automobile Liability,and Workers Compensation/Employers Liability Policies include a Waiver of Subrogation in favor of Residential Management Inc &PLM Buzzy Inc.on whose behalf the Insured is required to obtain this Waiver under a written contract or agreement executed prior to a loss. Notice of Cancellation provision is 30 days except 10 days applies for non-payment of premium. ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ` D IDDYYYY, k.. CERTIFICATE OF LIABILITY INSURANCE 16/3/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(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 CNAMONTACTE: Karen Bernier Southeastern Insurance Agency, Inc. PHONE . (508)997-6061 FAx (508)990-2732 439 State Rd. E-MAILAUDRESS,kbernier@southeasternins.com P.O. BOX 79398 INSURERS AFFORDING COVERAGE NAIL 4 North Dartmouth MA 02747 INSURER Arbella Protection Insurance 41360 INSURED INSURER B R J Bevilacqua Construction Corp. INSURERC: P. 0. BOX 626 INSURER D: INSURER E: Forestdale MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1542700879 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. ILTR ADDLSUBR MDYMLODYP TYPEOFINSURANCE POLICY NUMBER MDIVYY INY LIMITS GENERAL LIABILITY EACH_OCCURRENCE _ $ 1,000,000 X COMMERCL4L GENERAL LIABILITY DAMAGE TO RENT PREMISES(Ea occurrence occumencel $ 300,000 A CLAIMS-MADE OCCUR 8500019147 /15/2014 /15/2015 MED EXP(Any one person) $ 5,000 X XCU Included PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLK Y X 1 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT c�g0, _ 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED rx SCHEDULED 020014548 /21/2015 /21/2016 BODILYINJURY(Peraccident) $ AUTOS AUTOS X HIRED AUTOS NON-OWNED PROPERTY DAMAGE P $ AUTOS Uninsured motorist8l split limit $ 250,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 t>ED I X I RETENTION$ 10,OOC 4600062061 /15/2014 /15/2015 1 $ A WORKERS COMPENSATION X I WC STATWUJ X OTH- AND EMPLOYERS'LIABILITY Y I N EEL ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1 00O 000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) 088680414 /27/2015 /27/2016 E L_DISEASE-EA EMPLOYE $ 11000,000 I(yes,describe under - DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,I1 more space Is required) Project: 671 Main St, Cotuit, MA Email to: Danno.McGrath@verizon.net and MLuttrell@dhdventures.com CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DHD Ventures ACCORDANCE WITH THE POLICY PROVISIONS. 2604 Elmwood Avenue Rochester, NY AUTHORIZED REPRESENTATIVE Karen Bernier/KABJ/v ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005)01 The ACORD name and logo are registered marks of ACORD i I CERTIFICATE OF LIABILITY INSURANCE DATE'Mw°°"""' 04/29/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(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 PAUL SCHLEGEL NAME: SCHLEGEL INSURANCE BROKERS INC -PHONEi- FAX i— (A/C.No,Erdg 508-771-8381 (AIc,Ne�508-771_0663 34 MAIN STREET E-MAIL ADDREss: SCHLEGELINSURANCE@GMAIL.COM WEST YARMOUTH MA 02673 INSURER(S)AFFORDING COVERAGE NAIC9 INSURERA:NGM INSURANCE COMPANY 14788 INSURED INSURERB:NGM INSURANCE COMPANY I 14788 Gary Matsik Dba Matsik Concrete INSURERC:NGM INSURANCE COMPANY � 14788 185 Barcliff Road INSURERD:NGM INSURANCE COMPANY 14788 INSURER E: Chatham, MA 02633 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 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 I D POLICY NUMBER (MMIODPOLICYNYYY) (MMIDOIYYYY) LTR TYPE OF INSURANCE INSR SWUM"! LIMITS A GENERAL LIABILITY MPT0078H 01/22/2015 01/22/20161 EACH OCCURRENCE {S 1,000,000 X t rITAUA7GETO-R1=— f -j� -C—O�MMERCIAL GENERAL(EX PREMISES(Ea occurrence I$ 500,000 Ir ! I CLAIMS-MADE I x f OCCUR ! , !MED EXP(Any one person) S 10,000 PERSONAL 8 ADV INJURY S 1,000,000 1 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I I I PRODUCTS-COMP/OP AGG S 2,000,000 POLICY PRO- JECT I ( !$ $ AUTOMOBILE LIABILITY i M1T2489L 09/05/2014109/05/2015I ' $ 1,000,000 — (Ea accident) I ANY AUTO I I BODILY INJURY(Per person) I S III ALL OWNED I�SCHEDULED AUTOS I AUTOS ,BODILY INJURY(Per accident) I$ . NON-OWNED OP RT'(DAMAGE ) — )[ HIRED AUTOS ��AUTOS i(Per accident) I$ C h UMBRELLA LIAB !�}( �.OCCUR CUTOO78H 12/17/201412/17/2015�EACH OCCURRENCE EXCESS LIAB L-1 CLAIMSMHDE - - • AGGREGATE I S DED RETENTION S S D WORKERS COMPENSATION - WCT0078H 01/21/201501/21/20161 x ,� oRYLIMTS _ER AND EMPLOYERS'LIABILITY Y/N ANV PROPRIETORlPARTNERIEXECUTIVE f E.L.EACH ACCIDENT $ 500,000 OFFICERWEMBER EXCLUDED? N I A (Mandatory in NH) I E.L..DISEASE-EA EMPLOYEE S 500,000 If yes.describe under I DESCRIPTION OF OPERATIONS be!ori I E.L.DISEASE-POLICY LIMIT S 500,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if mom space is required)- GARY MATSIK HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMPENSASION POLICY CERTIFICATE HOLDER CANCELLATION DANIEL MCGRATH CONSTRUCTION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 312 CAMP STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN WEST YARMOUTH MA 02673 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE DANNOMCGRATH@VERIZON.NET I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered U.,k. f ACORD i Massachusetts -D,:aartment of Public Safety Board of Building Regulations and Standards • E,:- Cun;tructi:n.Super%wir i License: CS407897 k w DANIEL MCGRATH � 312 CAMP STREET r, � ► a West Yarmouth MA W673 j %,Z ,l1ir 4' Expiration 06/13/2018.` C6.nv ssioner .... .. Office of Consumer Affairs and Business.Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 179293 Type: Individual Expiration: 7/15/2018 Tri# 419291 . DANIEL J. MCGRATH DANIEL MCGRATH.. . 312 CAMP STREET WEST YARMOUTH;.MA 02673 =? � ' , .;. r .. a ... ... ,.-..-.. /:•r ::: - i i,=, +.` Update Address and return card.Mark reason for change. SCA Ca20M-05111 " Address E j.Renewal Employment: Lost Card . d/n t�antr�rc-�ra���l/olC/111&aar/u.:ellt ` - ice of Consumer Affairs&Business Regulation: : License or registration valid for individual use only . @HOME IMPROVEMENT CONTRACTOR before the expi ` ' ration date. If found return to: 'Registration- ` 17920 Type office of Consumer ABairs and Business Regulation , Expiration: 7/15/2018 Individual 10 Park Plaza-Suite 5170 MR. Boston,MA.02116 . DANIEL J.MCGRATH DANIEL MCGRATH 312 CAMP STREET WESTYARMOIITH,MA 02673 Undersecretary Not valid wrt t Jignature NC S. 'COTUJIT CEN RIIESID '67.1 _MAIN 57WET, COTUIT,. BUILDING #_ GENERAL NOTES FEES: SM®K� DETECTORS REVIEWED POINT - gEMEi. Contractor shall obtain and /pay for ray perms!a,[eese , �/� L L C . ' 1- All construction end procedures tenet., royalef es and Gases, //A//sue�y//` . ` ehal 1:meet the requiramant of rgaired {or'construction and the Ma....haaetta state building occupant¢. D + s coder the local jurisdiction of BUILDI DEPT. ®ATE the ro,-3 ..CC Aifr, hH,and any ( Other applic:.l. jurisdictions. 297 -NORTH STREET 2_ All ll material e and Hama shall be i. Contractor .Aallvldo perform all l nstalied or .plied as Per the work and provide ail materials manufactures instrsetiona,dlrec- in compliance.ith ail app11- _ Clone:and recommendatieae and - - - cable Co". and jurisdiction FIRE DEPARTMENT DATE ' as Per the beat.practice of the Sneluding the lateat Sanue , j a /� �� � H ETTS _ , trades - of The Building CsacT.aeeets State BOTH SIGNATURES ARE'REQUIRED FOR PERMITTING ` H ! /, N N I`'- C 3. Any reference_Co •Contractorl in._ Contractor hall /�.j` `V7 thear d[w;nga aoG notb .hall re - ' _ fer tb the contractor, his saployees, Contractor shall perform all his sub-contractors or their sub- rork and install or�pply a12 - _ evbeontreetors, his suppliers and - items and material. as per man- + - any other.lndividuals or companies afacturer•a Inatructibns and ce- - und.r,contract to him for this pro- commendations and as per praetia - j.ct ...the .9N may apply, of the trades. - a. Contractor shall provide all n.c- - 'e..ary labor,mat:rIal,oquipaent, TEMPORARY SERVICES: items tools and up.rwi.ion as re- quit" to perform and eompi.te the 1. Contractor shall provide, 1..1.1 work as shown or intended by the and pay for.a.y and all rem dra.ings- .. porary services as r.quirad for construction including rater•. SAFYEY: .2ectriclty and telephona. d_ - ' _ rra i 'l. Contractor aha11 carry out pro- PETER-, � ! D .r • - vSalone of•The Monual o[ Accident STORAO E: G C vision.of In Con.Ernctio Accident pub- 2Leaed by The Associated Oenerai 1. Temporary storage of materiais Contractors of Amxrica,inc. a.d�a.y debris and --.a materials 1 � � �� � aO$ praeauranuf a ra nail D. allovr4 ed the pro- quiredaby anY applleeDl. jssriadictions ject site on2Y in a location including OSRA,and manu[acturer'a' previously approved by owner ! aerety recaemendetiene for equipment cool..or materials. Alta .—,,,OSHA TEMPORARY SANITARY FACILITIES: Y _ Safety and Nea lth Standard. 2207 (29 - ARCH ITECTS-ENGIN EERS app i1.9 c.be9tOF or lateat edition a Caniracior shall provide Cem- 0 a pp3icable. sanitarp al ea to con- 'pd sal? . - formicy withith all l state and lo- 406 IWN STREET SHORING SHEETING AND RRACINGc cat laws, -�T�i� ter• iv����ayeea�. 1, Contractor shall provide,ln.tall �APOLOING: ._`.SC' '� and remove and pay for any sheets-. provide.erect L�us ( Oil Q� shoring and bra Cl nq as required I. and tdismantieractor aan and all Inter, IW _process portions of the construction' - I— and exeerioryscafolding and _ Q Bay staging aa,regaired for ....tr- - 2. Contractor shall check,varify uc Lion and Incompliance with TGIw.TS 1-�r+�.a^!��� and coordinate ai; measurements, C applicable 2ara,orainanc9 dimensions and report any-discre- codes.ea-ety rules (including 1 ,sass. pancles dlrectly to the Arch l tact OSHA) and other applicable jur- /�a�►��� immediately- I diction._ Lyyyv MAP . 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