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HomeMy WebLinkAbout1011 MAIN STREET (COTUIT) parr Ty Town of Barnstable *Permit# Expires 6 months from issue date yT Regulatory Services ' Fee • Maxsrnst e • NABS. Richard V.Scali,Director sb;q ArfO Mpr A , Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us F Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ?L, Not Valid without Red X-Press Imprint Map/parcel Number �J 1 d 21oProperty Address Residential Value'of Work$ lq,,000 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name (�' elephone Number• ,�0� � � Z ,6 Home Improvement Contractor License#(if applicable) /OY3D7?{ Email: 4m4gio eAftevuK Construction Supervisor's License#(if applicable) C.�J� I004? Workman's Compensation Insurance Check one: " ❑ I am a sole proprietor ' i l ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company.Name Workman's Comp.Policy# 7 Q - Copy of Insurance Compliance Certificate must leco'nif any each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ho � 037� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side t ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows '#of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: 'Property Owner must si ' Property Owner Letter of Permission. ; A copy of the.Ho I roveme t Contractors-License&Construction Supervisors License is rfte SIGNATURE: z QAWPFILES\FORMS\building permit fbrms\EXPR9SS.doc Revised 040215 n • y U a cI ' he+ omMann,errlt�i'of Mrissachusel s rt�rrrren of llidwhiaal Acct eats Drce.0}'Invstrgaturns , -. +600 Wasking Boston, i 62111 ww muxgov/dia Wor&ers'.Compensation Insurance Affidavit Badets/ConfiaciorsMwtricianslFlumbe€s Applicant.Information Please Print. 'b; NajineOP (Busroe�s1Ol iizah�/tudididual}: b hlddrt�s_ d�� +Cit-WStatelZap Fb,€me.# Are you an puployer?. :the appropriate tioz. Type gf project(requuireeti)_ 4_ I ara sa sonttactcr and I 1_ -I am a employer with ❑ t 6. New crisp ogees( }.* have lased the sub evatxac#ors ❑ I full astdlsu . 2-❑ I a:g a sole . or hated on the attached sheet. . .. 7. �Rt�todeliitg _ � F - sbip and have no. l sub-canttactms have �ems: $. ❑Demolititm o and have*od`ers' wing for me ut any capacatY ell jAto workers' ffiP msivance ::'- comp iflsBrar�ce l nilciing a 9. B ' tion`,. ed. ❑ nt'e are i corporation and its .: 1{}❑Electncal repairs ar additions re�gnrr j7777 nrj 3..❑ I a hcxrnebwuer dcmg a1I worfr txfbCceEs have;exercised their 1 I❑ t of ....MGL:. Plnmbin g repaus:or additions 'self [No work='comp_ :. h _12_❑Roof repaus irisivanctr l Y c 152;:�1(4�,andwe;havensi' - employees- t&= .(Now ' 3❑ 1 ' _ comp:insaraiice egtnred *Any apphcmt that diecks box#1mmst also faloatthe.sKfimbelmdowingtti&wodeiewmpeasaben policy inibnninon- :. HameaaDs who submit this affidavit indicating they are doing all woA aDd then hire ouw&coaotmcmrs mnstmast submit a new affidavit indicating sash: Icontiactors that cheer tins boa Est attached an additional sheet showttig the name'of Sic s 6b-CaM eactaas and state wheel or aot rwse Owties h3ve employees:If the sib cmmctots base employees,the}'must Qaivide their workers'coamp.policy Dumber. I am an emplo-w that is providing nvrliers'compenstrtion insurance for my employem Below is the p Ucy rind job sftu informat on. Lwmance,C as penyNairie'. .:. �� O. :..: . Poticy#. Self ms Iac # � 7� Expiratio a Date- Job Site Address ,— // /�//1 r`�� +Ctty/:Statelzip Attacli a c?ogY of wotls'compensatios3 policy tleclra#wn page{showing`the policy number anti esp�ton da#e) Failure to secure coverage as rep sued undeiSectivn Z5,t1 Of MGL a 152 can lead do the impositiah ofcriu�mal'*Aiies of a fine up to$11500 00"d/6r'one year impns # as wets.as Cavil pesalhes in the form of a STOP WORK ORDER and'a f e of up to$25tf 00 a day against the uaolator. Be advised that a copy of this statenstnt may be frnvmded to�Mee of k1lestrgahow of the DIA for kumanc e.covesa verrffration .... I do hereby eerh.&atnder is ' eat rl ttlie tnfar+oatran pmt �d abrrvg is hue and corm C: Date_ JX Phone#_:.' lJ�acial use anly D0 not write in fhis urea,to be�conlpleted by city ar to w:a,�ciaL Y City orsTozi. ".:.' Pertliicense'# Issuing Auth.G ty(circle one):..: - L Board�of Health 2.Bering Degnrtmerit° .Ci#y/Tov�ai Clerk. 4.Electrical Inspector.S.Plan Inspec#ar 6.Other,. - Contact:Petsonc P>tane tt .: _. • anstvsrMte, • "16.39 : Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO j Building Commissioner 200 Main Street, Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section x F If Using A Builder ., as Owner of the subject property y 1'`� y hereb authorize-- �> 1lG a'^ to`act on m behalf in all matters relative to work authorized by this building permit application for: o (Address of Job) ;S" fore of O er Date Print,Name If Property.Owner is applying for permit,please complete the Homeowners License Exemption Form on the " reverse side., " x. QAWPHLESTORWbuilding permit formslEXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services °Utz tqy� Richard V.Scali,Director Building Division &uwsrnsr.E, Tom Perry,Building Commissioner MAss. $ 1639. 200 Main Street, Hyannis,MA 02601 prEo Mph A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and'other applicable codes,' bylaws,rules and regulations. ,« ,'" '«": ,,;r ;-s r, 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 S 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. t . 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." r Many homeowners who use this exemption are unaware that they are assuming the responsibilitiesaof a supervisors (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2:15)'This'la&of awareness,oftem r 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 to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 tpamma'aruoealC�io�C�aa�ccaeCT Office of.Consumer•Affairs&Business Regulation License or registration valid for individul use on] rUqegi OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: stration: Y43074 Type: Office of Consumer Affairs and Business Regulai xpiration:----6PT-5Z2Q' DBA { 10 Park Plaza-Suite 5170 Boston,MA' 116 GARDNER CONST-,,j, RICHARD GARDNER ---Lm ;= 92 PARK PLACE WAY:3.., MASHPEE,ma 02649 Undersecretary of valid with. stgnatu � s Massachusetts Department of,public Stand ads y� Board of Building Regulations License: CSSL- 00471 Construction Supervisor Specialty RICHARD H GARDNER 92 PARK PLACE WAY MASHPEE MA 02649 ,tines Expiration:'' (� 01129/2018 Commissioner Y Construction Supervisor Specialty --- Restricted to: CSSL-RF-Roofing CSSL-WS- Windows and Siding Failure to possess a current edition of the Massachuse licen tts Wyy State Building Code is cabse for revocation of this DPS Licensing information visit: WM se. ASS.GOV/DPS ' rr A� CERTIFICATE OF LIABILITY INSURANCE DATE(nw14/�)16 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 CONS11TUTE 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 terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights tD the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Schlegel & Schlegel Ins Broker PHOONE (50 JIM HINDMAN r-AX 34 Main Street IfidaFldl. (508) 771-8381 N : (508) 771-0663 ADDRESS: schlegelinsurance@gmail.com West Yarmouth, MA 02673 INSURERS)AFFORDING COVERAGE I NAIC# r INSURER A:PHEONIX MUTUAL INSURED - INSURER B:TRAVELERS RICHARD H GARDNER INSURERC: MARA GARDNER INSURER D: 92 PARK PLACE WAY INSURER E: . MASHPEE, MA 02649-2725 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. ILTR TYPE OF INSURANCE_Yrv_------IADDINSR SUBRT POLICY NUMBER v PM//DDD1YYY I MMIIDDIYYYYYY LIMITS � GENEALIBTA 8/20/15 8/20/16EACH OCCURRENCE .10I 00,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea occurrence) $ - 50,000 1+ CLAIMS-MADE x OCCUR I ME EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER " PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY n PRO- CT LOC $ AUTOMOBILE LIABILITY COMBINED 51NGLELIMIT a accidert $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $HIRED AUTOS NON-OWNED WNED $ _ AUTOS (Per accident) $ I� UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE! ' I AGGREGATE i$ DED RETENTION S i $ B i WORKERS COMPENSATION I IWC-0179798 11/4/16 11/4/17 wCS7ATU- OTH- AND EMPLOYERS'LIABILITY Y 1 N TORY ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? Y N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If es describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ 500,000 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Renerks Schedule,if more space is required) RICHARD GARDNER HAS ELECTED NOT TO BE °COVERED UNDER HIS CURRENT WORKERS COMP POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED"BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PLEASANTWOOD HOMES LLC ACCORDANCE WITH THE POLICY PROVISIONS. 10 Pleasant Wood Drive Forestdale, MA 02644 AUTHORIZED REPRESENTATIVE ©1988 201 ACID D CORPORATION. All rights reserved. ACORD 25(2010/05) . The ACORD name and logo are registered marks of ACO Phone: Fax: `(774) 238-2825 E-Mail: rgardner2008@comcast.net X-PR pERMiT° To of Barnstable �� 07 �o *Permit# r. �EC 7 2007 Expires Ewnflisfrom issue date 1 TO Regulatory Services Fee N OF BARNSTABLE ';Thomas F.Geiler,Director Building,Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.townbsirn tabie.ma.us Office: 568-862-403 8 Fax:508-790-6230 EXPRESS PERMIT APPLICATION RESD7ENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Prope Address La l� �l i1J i_j —, ea kit, esidential Value of Work - Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name 6��4 A4441� * - Telephone NumberOSr_:�� � Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable)_ . y ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am th omeowner ve Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# 3ev Copy of Insurance Compliance Certificate must be on file. Permit Request(c box) ILI Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(no stripping. Going over existing layers of roof) e-side Replacement Windows/doors/sliders., U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Imp o ment Contractors License is required. SIGNATURE: �:Fomms:expmtrg tevise061306 ' The Comnrionwealth of Massachusetts Department of.Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111, wrvw.mass.gov/dia ' Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Infhrmation Please Print Le ' 1 Name(Business/Or mizahm3,ndividual): •Address• City/State/ 1 CAD Phone.#: Are you employer?Check the appropriate box: ;Type of project(required)-. 1, am a employer with_ Z— 4. Q I am a general contractor and I 6. Q New construction . employees(full and/or part:time).*• have hired the stab-contractors • . . 2.❑ I am a'sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling Partner- ship and have no employees . 'these sub-contractors have S. ❑Demolition' Y for me in ancapacity. employees and have workers' corking 9. ElBui'lding addition [No workers' comp.nminance COmp.inanranpo ' 5. We are a corporation and its 10.❑Electrical repairs or additions itions required.) officers have exercised their 11. Plumb' repairs or additions ' '3.❑ I am a homeowner doing e"ll•work . ❑ � P myself:[No workers' comp. right df exemption per MGL 12.❑Roof repairs insurance.required.]t c.152, §1(4),and we have no 13. Other ' _ employees.�a workers • comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their wmi=s'compensation policy infmTm6nn. t Romeowoera who submit this affidavit indicating ley are doing all work and tlien hire outside contractors must submit anew affidavit indicating'such. xContractm that check this box mutt attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. lfthe sdb-ccntxactozs hate employees,6uymust provide their wn i=l comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site, information. Insurance Company NMne: Policy#or Self-ins.Lie.#: COD�� — Expiration Date: Job Site Address: /D// / �J City/Stat Izip. D Attach a copy of the workers'compensation policy declarafion page'(showing the policy number and expiration date). Failure,to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.o0 and/or one-year imprisonment,as well as civil penalties in the foam of a STOP WORK•ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the-Offioe of - Investi.aations of the bIA for insurance coverage verification ' I do hereby certify under t 'ns•aiid pen es of p r' that the information provided above is tr7/7,1/ � Si afore: Date: _ /01 Phone#: Official use only. Do not write in this area, to be completed bycity or town:officiaL City or Town: ' Permit/License# Issuiag Authority(circle one): ' A.Board of Health 2.BuildmgDepartment I Citp/Town Clerk 4.Electrical Inspector 5,Plumbing Rispector 6.Other ` Contact Person: Phone M I '• PN�]U-�F�-�kjL1 i V_}�:_�nr r r:ui•n _�_. .. _. _ � �r Town of Barus$ab e Regulatory Services 6 i r unnxsrAi3 T'hr�m is F. tiler, Ores or 0. Building Division Toni Ferry,Building Commissioner 200 tvtain Street,Hyannis,NIA 02602 www.tow s.barnstable-ml-us Fax: 50&-790-6230 Ot'tic:e: St78-RUA038 property Comer lust Mplete and Sign ''his Section. If using;A BLlilder 6 r _ as Owner of the Subject Property f S—k to act on my behalf, hereby authorize rn all rnatLers relative to work authorized by this 6u.ilding pe rrrut application for. (.dd css of Job) Date igna i Prin tame Corner is applying for permit please complete the if rop - P O MCO ers License Exemption I�o111, on the rCVe side. 12/11/2007 TUE 15. 52 FAX 508 420 5406 Leonard Insurance Agency 10002/002 yacORDI CERTIFICATE OF LIABILITY INSURANCE 12/11/20o PRODUCER (508)428-6921 FAX "(508)420-5406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Leonard Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 7 Wianno Avenue HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 Box 494 Ostervil le, MA 02655 INSURERS AFFORDING COVERAGE NAIC# INSURED Carey Grover - _ 'INSURERA: Hartford Underwriters Ins-ARWC 80411 PO Box 1080 INSURER 8: Cotuit,`-MA 02635 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDN' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY - - DAMAGE TO RENTED $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE - $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S POLICY PRO- JECT LOC , AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT $ ANY AUTO - (Ea accident) _ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN, EAACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY - EACH OCCURRENCE - $ - OCCUR El CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $" $ WORKERS COMPENSATION AND 6S60UB-360IB46-5-07 08/31/2007 08/31/2008 we sTATu- X oTH- EMPLOYERS'"LIABILITY 1 A "ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ IOO,OO OFFICER/MEMBER EXCLUDED? . E.L.DISEASE-EA EMPLOYE $ 500,0O .If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 1001 OOO OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS This replaces any prior certificate issued to the certificate holder affecting Worker's Comp coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Barnstable BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 200 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Hyannis,"MA 02601 AUTHORIZED REPRESENTATIVE INancyHenderson/LEONHI - ACORD 25(2001108) ©ACORD CORPORATION 1988 M 12/11/2007 TUE 15: 52 FAX 508 420 5406 Leonard Insurance Agency 10001/002 n u u u 7 Wianno Avenue, P.O.Box 494 Leonard Ostervill e MA 02655. [ ree�o (508)428-6921•(877)428-6921•Fax(508)420-5406 ur r[rr�o INSURANCE AGENCY www.ieonardagency.com Destination & Fax #: 1-508-790-6230 Destination Contact: Sally Number of Pages in Fax: 2 Date Transmitted: 12/11/2007' Originator: Nancy Henderson . RE: Carey Grover Certificate of Insurance Attached is a Work Comp cert for Carey Grover. This policy is in force. Call me at 508-428-6921 with any questions Cow , MA- �lS fse-cnCtz �Zc�?Ai2 SE�n� G.7c�o� lu1 N V STc�QAGG (ol( N►A�N �, C67v t i, MA, Nc SCAe-E 146 H T Y Ir ("'fZ�oti1 i loll M4 i w St Lout RA No ScA Lc LEFT 0 7 i JI Assessor's map and lot number ... ....... ....... � .�� �• �' ���ir r+ SEPTIC`SYSTEM MUST BE ' IN COMPLIANCE Sew .r%Sewage Permit number 0NR. 0 INSTALLED "' WITH ARTICLE II STATE R T c;ae r + �:s TOWN . �oF off'. TOWN 0 � O F BAR a�U1- '-- !!� � ,� , nj L� i 89HHSTIELB • j �, "6 9 R-UtOING INSPECTOR � <l APPLICATION FOR PERMIT TO. ... ,...... `` 1 TYPE OF CONSTRUCTION .............9 9.. -.. .............1927... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .�.�....Mai\ ...&-�:........� t.1:................................................................................................................. ProposedUse .. ... . ..(• .VA. ..................................................................... .................................... �]� nn Zoning District ry' .............................Fire District ...4.. Name of Owner ..... .C1kr.M.UN....................Address .......................... e Name of Builder ...INC. ........Address ..„�,s�'�. '���� � ile.....x hm �s .............. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...... ........................................................Foundation /.... "--.fl,a............................................................ Exterior .....1j0.4.4..............................................................Roofing ..J••�«� �• �+i'.k�l�,J�a.................................................................Interior '....sue �1 ... . .... .fit.....Floors t Heating 6.�..�..........A%: .... !IG....................Plumbing ...... ................................. Fireplace ............. ............................................................Approximate Cost .......4 1 �i..................................... Definitive Plan Approved by Planning Board ________________________________19--------. Area ........ �.�� ................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 Iy ,4-c 1 , 0� _ s e I hereby agree ree to conform to all the Rules an Regulations of the Town of Barnstable regarding the above construction. Name ........................ Parran, Benjamin 19581 add to dwelli No ...................Permit for .............................. .... ............................................................. ............... 1011 Main Street Location ................................................................ Cotuit ............................................................................... Ownepa;;� Blenj amin..F.arran..- .. ............... .. ........... .................... f2me- Type of-,;,Construction .......................................... ............. .............................................................. Plot ...... ...................... -Lot ................................ September 12 77 Perniit Granted ........................................19 Date of inspeciion ....................................19 Date Completed J ........................19 PERMIT REFUSED . ............................................................... 19 . ............................................................................... .............. .......... ...................................................... . .......................... ................................................... .................... Apprqved ................................................ 19 .............................................................................. ............................................................................... Assessor's map and lot number `. ``.. ' ...` ...... Sewage Permit number ................. °`'T"ET° TOWN OF BARNSTABLE : ; { Z BARNSTAILE, i S 9° "6 Ya BUILDING INSPECTOR 0 NP I .? APPLICATION FOR PERMIT TO ...!.� :.�............................... ...'�14 ................................................... ............... t, c� j' TYPE OF CONSTRUCTION b- ................................ . .,92� . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ................... . /©�! �'Yta► h....:. ': �`�(.t.\, �s................................................................................................................. Proposed Use .. .................................• is I sl. I t,n ......... .................................................................... ...................................................... Fire District '°' ht x ` Zoning District ...................:.............................. ....................................................... Name of Owner r, �k� i,Glt .!d`4....................Address J.C�U MI: `,"fi ........................................................... J Name of Builder ! r. r� r t Vie'^; t I Rt ........Address .,. ,^ ?R _`del r S�C�r. '...... A�nC. ............... �............ r........... Nameof Architect ...................................................Address .................................................................................... Numberof Rooms ..... .......................................................Foundation .... ............................................................ Exterior .....:,Vv� !' ..............................................................Roofing ..^.!�I'*y M . . ......................... ............Interiors.., Floors ��- 4..::. ` ............................................................r......... ......,.......,...................... {( a Heating (j I 1` va � r--....................Plumbing ...7� k! .... . .. . .:?.�................................... Fireplace .............b............................................................Approximate Cost .......5452., ....�a....�.............................. Definitive Plan Approved by Planning Board -------------------------- � ------1 9--------. Area .................:........................ Diagram of Lot and Building with Dimensions FeeC/ X-............................................. SUBJECT TO APPROVAL OF .BOARD OF HEALTH • J ._ �617A r � FJ . to I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ....................... �-5,. . r ................... ......................... t Parr^n° Benj A~3426 19581 add to dnw»lliu� No --...--.`Perm it f6r�-----------.- . -------..`-----.------------.. . ' . . 1011 Maim Street Location --_—.---_--__.________� ' Cmtuit ------------.------------..-. ' ' ` Beujamin Parrsum Owner ........................................................ frame Type of Construction .......................................... ^ .............................................................. � . . � Plot ^ � . � . . _—, ~....~~ iDate of � Inspection ....................................19 . Date^ . ` . .� ` PERMIT R6USED . . ^^ � �7 ' / ^ | — -----' ' � � ..--...7.. �. .. '� ..................... � .-------,,.~----.....ƒ.--.---...~ ' ' . > | Approved ,'--- ................................... 19 ^ -------.------------------- . . / --------~--.-------------.—.. . . ' r� | _ '