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HomeMy WebLinkAbout1276 MAIN STREET (COTUIT) /d7(p />lr��� Uyra�' li 1�r Town of Barnstable . ��� y{ Expires 6 moldhs jron 'sne dole X B, STAer Regulatory Services Fee M & ,A Thomas F. Geiler, Director �OTfot" Building Division Tom Perry, CBO, Building.Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Q Not Valid without Red X-Press Imprint Map/parcel Number an Q D Property Address sa--7114 mokR 5 /_DTV residential Value of Work Minimum fee of$25.00 for work under,$6000.00 Owner's Name& Address �V 17LIrt �u/ I�ih�(/7 Contractor's Name Telephone Number SDS 3&7'.�-LOB Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) [Q e X-PRESS PERMIT ❑Workman's Compensation Insurance Check one: S E P 14 Z0.09 ❑ I am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTABI [Z4-1.have Worker's Compensation Insurance Insurance Company Name G-'��N1J�11f /f✓�7 Workman's Comp. Policy# 4�&GW 4AL j! Copy of Insurance Complia e Cert��must be on tile. Permit Request(check box) ®-Re-roof(stripping old shingles) All construction debris will be taken to 4p-C>F-Y 4 Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value - - (maximum•.44). *Where required: Issuance of this permit does not exempt compliance with other town department regplations,i.e.Historic,Conservation,etc. 'Note: Pro ro erty Owner Letter of Permission. c rs se & Construct Supervisors License is required. SIGNATURE QAWPFILES\FORM ress�EXPRESSP MIT. C Revise060409 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 `N www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Bus iness/Organization/Individual): ( � Address: 767 � Q Q City/State/Zip:. &DAU LL Phone #: J�"W �0 - D Are you an employer? Check the appropriate box: Type of project(required): I. am a employer with_2=- 4. ❑ I am a general contractor and I employees(fall and/or part-time).* have hired the'sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees . These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required:] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other, comp.insurance required.] *Any applicant that checks box#l.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. tContr actors 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 any employees. Below is the policy 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. I do hereby certify unde pa enalties f ryur at the information provided above is true and correct. Signature: Date: c1' I Phone#: �O Official use only. Do not write in this area, to be completed by city or town official.' City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: L 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(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings 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 insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town'Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications 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 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 Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia �YHE T° Town of Barnstable Regulatory Services yS&M Thomas F. Geiler,Director 16396 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, -AU-0 R IwPcZ90-01 , as Owner of the subject property hereby authorize � �. ( (b to act on my behalf, in all matters relative to work authorized by this building permit application for. 1a-7( �u 5 i L o�Cv (Address of Job) —qll Yloct Si nature of er Date -1 Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION r YE ! Town of Barnstable �FIKE ram, "o Regulatory Services � II saxxsrast I Thomas F.Geiler,Director Mass. 9�p 1e39• s`�� Building Division rEo � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and 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) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\F'ORM S\homeexempt.DOC "-IPR t' 3M54 GS� DA,T..E(MM/DD./Y... n 'BI RTIICa.40 ACDRD,M s LA SRAN E 6/30/2009��yPRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GERMANI INSURANCE AGENCY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 908 MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. OSTERVILLE,MA 02655 COMPANIES AFFORDING COVERAGE - COMPANY A AIM MUTUAL INSURANCE COMPANY INSURED COMPANY PETER D. FIELD B DBA PETER FIELD BUILDING& RESTORATION COMPANY PO BOX 16 C COTUIT, MA 02635 COMPANY - D p, 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 B Y 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. CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ CLAIMS MADE []OCCUR - PERSONAL&ADV INJURY $ OWNER'S&CONTRACTOR'S PROT - EACH OCCURRENCE $ FIRE DAMAGE (Any one fire)- $ IVIED EXP (Anyone person) $ -. AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $(Per person) HIRED AUTOS BODILY INJURY $' - NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ - ANY AUTO - - OTHER THAN AUTO ONLY: .. EACHACCIDENT $ AGGREGATE $ - - - EXCESS LIABILITY - _ - EACH OCCURRENCE - $ - UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND -AW C 7023784012009 05/16/2009 05/16/2010 TOWC STATU OTH- Ry uMITS ER EMPLOYERS'LIABILITY - EL EACH ACCIDENT $ 100,000 THE PROPRIETOR/ INCL - EL DISEASE-POLICY LIMIT $ 500,000 PARTNERS/EXECUTIVEEl � � - OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ _ 100,000 OTHER DE II SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS - - - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES*BE CANCELLED BEFORE THE - JARED`KELLEHER E1PPIIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL _ DAYS WRITTEN,NOTICE TO THE CERTIFICATE HOLDER'NAMED TO.THE LEFT," - ' - BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY - OF ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. ° AUTHO�p R�TATIVSG�� AC,ORD25w,S 1/95 ,v t �•ii////F fi r .. ., -" �,. � .. ,.�"_.s, ,°'ra " a.. .._•.. `�,� .�ti®AGQRD,�CORP,ORA�TI,ON1988" Boar�of uilding Regina on and Standards One Ashburton Place- Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 120362 Type: DBA Expiration: 41/30/2009 Tr# 261156 PETER FIELD BUILDING & RESTORATION PETER FIELD P. O'. BOX 16 COTUIT, MA 02635 Update ress and return ark rea for change. Address Renewal Emplo ent Lost Card DPS-CA1 is 5OM-07/07-PC8490 - " Massachusetts- Department of Pultlic SatktN . Board of Building- €te�,ulations and Standards C<)nstruction SuAervisor License License: CS 65638 Restricted to: "1G K PETER D FIELD PO BOX 16 COTUIT, MA 02635 � Expiration: 7/15/2011 t'„nnnisinner Tr#: 19280 •P JUN 0 ? 2 Town ofB ;. r®wN o06. Barnstable *Peru# o7 OFSARIV Expires 6 a:onths from issue date �,.j, 87"AS&gUlatory Services t�V T17omas F.Geiler,Director Fee 2 p W G Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 V11 Office: 508-862-403 8 wWw'town•barnstable.ma.us Fa EXPRESS PERMIT APPLICATION _ x. 508-790-6230 ©,3,303F Not Valid witltoutlZedX-Pres,.r, �Snt�ENTIAL Qnrj,y ap/parcel Number operty Address Residential Value of Work QQ<' i Minimum fee of$25.00 for work under$6000.00 er's Name&Address ntractor's Name ,�l/�+ f Telephone Numbe me Improvement Contractor License#(if applicable r�� truction Supervisor's License#(if applicable) orlonan's Compensation Insurance Check one; ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance ance Company Name ---' 's Comp.Policy# Of Insurance Compliance Certificate must be on file. 't Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over_ existing layers of roof) 2"'Re-side ❑ Replacement Windows. U-Value --- (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic con servation,etc. Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. ITUM: expmtrg 1405 ' The Commonwealth ofMassachusetts Department oflndustrid Accidents Office of Investigations 600 Washington Street Boston,MA 02111 y www massgov/dia' Workers' Compensation Insurance Affidavit; Builders/Contractors/Electridans/Plumbers Applicant Information Please Print Legibly Name pusiaess/ora T1izatioa/li&Aduan: .7XIV4/ e ', Vz -222 i Address: City/Statd74: , - one#: Are you an employer? Check the'appropriate box; Type of project'(require:d): 1,` i am a employer with_ 4. ❑I am a general contractor and I 6, ❑New construction employees (fall and/or part time)* have fired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on The attached sheet t �• El Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for mein any capacity. workers' comp,insurance, 9. ❑ Building addition [No workers' Comp,insurance 5, ❑ We are a corporation and its officers have exercised their 10,❑ Electrical repairs or additions required.] 3.❑ I an a homeowner doing all work right of exemption per MGL ME] thumbing repairs or additions myself.[No workers' comp, c. 152,§1(4),and we Lave no 12.❑Roof repairs insurance required.]t , employees.[No workers' l3.❑ Offer_ comp.insurance required.] *Any applicant that checks box#1 must also fin out the section below showing their workers'compensation policyinfoxrnation: ` t H eowncm who submit this affidavit indicating they axe doing all work sadt'hen hive outside eoatraotoss must submit anew a$idae mdicatYag Buck tContracton that check this box mnst attached an additional sheet showing the name of the sub.coatractors and their workers'comp,policy faforn3 ation. tam an employer that is providing workers'compensation insurance for.my employees. Below is the pallcy and job site information. , .Insurance Comp any Name: 7X1S 41iC;T rr101'Sff-iv .Lie.rr. Job Site Address: %?,27d"Z"'�ils'i' �T ��_City/State/Zip`: Ol" x . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to seevrc-coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.90 and/or one year imprisonment,as well as civil.penalties in the.forrn of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statemerri may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and r the pains and penalties of perjury that the information provided above is true and correct Si tore: Date: Phone#: c,V6 usb . Da c ire this ww4't,to&reed b'c,'�'or rid City or Town: Perm#t/License# Issuing Authir3ty(circle one); 1.Bazrd of.health 2.Building Department 3.Cityl—I own Clerk a.Electrical Inspector 5.Plumbing inspector 6. Other Carr.act Persan: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compemsationfor-their employers. pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire,. express orimplied,.oial 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 t ustee 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 mi inch dwelling house or on the grounds orbuilding appurtenant thereto shall not because of such employment be deemed tobe an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall witbhold 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 Tate commonwealth nor any of its political subdivisions s11211 eater into any contract for the performance ofpublic 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 Munber(s)along with then catifccate(s)of insurance, Lumted 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 L12 does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for ccnfirmation of insurance coverage. Also be sure to sign and date the affidavit. The•affidavit should be retuned to the city or.town ftiat lie application for the p ermit or license is being requested;not lie;DcWfinent 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 mm3ber listed below. Self-in cd companies thotd s;nter 1beiT self-insurance license number on-the appropriate line. City or Town Of 1cials. Please be sure that the affidavit is complete and printed legibly; The Department has provided a space i t the bottom. of t�affidavit for you to fill edam.the event the Office of Investigations has to contact you regarding lie applicant - Please be sure to fill in the permi9cense amber wlach wrh be used as a reference uambear. lh addidon;an applicant thatmmst submitmultiple permitnicense applications in any given year,need.only submit one affidavit indicating mix rent policy mfoimation(if necessary)and under"Joh Site Address"the applicant should write"all locations in_ '- (city or town)."A copy of the affidavit$hat has been officially stamped or marked by the city or town may be provided to the applicantas proof that•a valid affidavit is on file for future permits or licenses. Anew affidavit mustbe filled out each ' year.Where a f ome owner or citizen is obtaining a license c r permit notrelated to any business or commercial vent re (Le. a dog license or pew it to burn 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 questions, please do not hesitate to give w a call. The Department's address,telephone and fag number: The CO:onwealth of M- Usacltt Department of Industrial Accidents Ofmce of 1R 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1 077 MASSAFE ' Fax IM" 617-727-7749 Revised 5-26-05 -VrWW.M2-.S5.Cov/C1ia s ' vaF�„ETo�, Town of Barnstable tiT P Regulatory ServicesRutNST . 9 MASS.i'E'� Thomas F.Geller,Director 1639. l E Building]Division. a►aA Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as.Owner of the subject property hereby authorize 7 J" ZdNC to act on my behalf, in all matters relative to work authorized by this building permit application for' (Address of Job) Signature of Owner at Print Name Q:FORMS:OVJNERPERMIS SIGN � r y � , e �!e-�omvnzo7iu�eaLdc o�.i�irvoac�uaelta _ _ _ _ _---- Board of Building Regulations and Standards s License or registration vale for,indwidul use only HOMEMP OVEMENT CONTRACTOR before the expiration date,If found return to: ': Repis roe, - 4 j ' Board of Building Regulations and,J taudards t� ' 1T 2066 One Ashburton Place Rm 1301 - =Type f irate Corporation Boston,Ma.02i08 �_� ---. ¢ DAVID COX, ING::'� —,_ David Cox ' 1x` 19 LAVENDER IN 7 � { W.YARMOUTH,MA.02673 � � .: Administrator of valid without signature r ' Date:6l7/2006 10.39 AAA Sender's Fax ID:508862927C Page 2 of 2 AC0847- CERTIFICATE OF LIABILITY INSURANCE CSR KG DATE(MM/DDIYYYY) DAVID-2 1 06/07/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE• Northwood Eshbaugh Ins. Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 805 West Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Hyannis MA 02601 Phone:508-771-1632 Fax:508-778-1789 _ INSURERS AFFORDING,COVERAGE NAIC# INSURED — INS_RERA. NORFOLK & DEDHAM 23965 INS._REF:F:: ST PAUL TRAVELERS T— -- David Cox, Inc. S_ _RERC: P. 0, BOX 401 I INS_REF•G S Yarmouth MA 02664 — INS_RER Ii COVERAGES THE'OLICIES OF INSUR.A'.CE LISTED P=LGdv HAvE BEEN ISSUED TO TH°INSURED NHd=D•ABO'!E FOR T-E POUC-"PERIOD NCICAT'_D NOTWI-I-STANDING ANY REOU REMEN_.TERM OR 0OND!TICN OF AN"CONTRACT OR OTHER COCUWENT WI-H RESPECT TO WHICH THIS CERTIFIC!-E WAY BE ISSUED OR PAA"PER.-AN,THE NSURANCE AFFORDED_Y THE POL CIES DESCRIBED HEREIN IS SUBJECT TO AL_THE TERMS,EXCLUSION_AND CONDITIONS OF SUCH PCLICIES.AGGREGATE LIMBS SHOWN MA,'Y HAV°=EEN RECUCED BY PA D CLAIMS. MR 27 LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DO(YY) DATE(MMtDD-Y LIMITS GENERAL LIABILITY EAc.Hn;ruP;E!4cF ,s 1000000 COWMERr_IAL 3ENERo.L LIABILITY' I E PREPdiSlEzoccu•enc=i 150000 _ �, LA P tS MADE �� X RJR NED ExP(Any one per=on; $50 0 0 A X Business Owners I R00309545 03/14/06 03/14/07 PEP AL SPD'-1 N.J_Rr Is1000000 J G=NER.ALASG:ZEGA-E j S 2000DO0 GEPJLAGGREG.'+.TELiMIT APPLIES PE<: PRODUCTS-C{d,11`101`,G S2000000 POLICYLl 2&, 1, -_—_----.—... -----_ JECT LoL CSL 2000000 AUTOMOBILE LIABILITY I AN"AUTO COMBINEC=1\GL__TWIT S I � t I(Ea accicent) I ALL 0A144ED AUTOS I BCD L'r INJURE SCH_DLLEDAl1-OS I (PorPera) '( 1HIREDA-TOS ---- -- - [BCD LY INJUR" NON-�iWNEDAUTOS I Per acd:lert) PROPERTY DAMAGE Q . (Per acciyert) GARAGE LIABILITY AN`AUTO AUTO CAL"-EAACCIUEPQT S II OTHEFT-WJ El,ACC S AUTO OIL" AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURREI•JCE S OCCUR CLAWS MODE �J I AGGREGATE g I DEDUCTIBLE --- g RETENTION --'- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY TORY LIMITS ER B AM'PRCPRIETO lPART�EP.rE>(ECUTVE 6KtT8910X742205 07/15/05 0?/15/06 EL.EACHACCIOE\T $100000 OFFICERIMEMBEP.EXCLUDEC? If yes,des:ribe older i I EL.DISEASE-EAEWLOYE= 1100000 SPECA_MOvlSIONSbelrw EL CI=EASE-POLCY JWIT s500000 OTHER - I •- t C DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES i EKCLuSIONS ADDED BY ENDORSENEN7/SPECIAL PROVISIONS 5 5:: I T7, CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAtIELUED BEFWR; THE E' *]RATION DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR T MAIL 20 DAYS WRITTEN TOWN OF BARNSTABLE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 367 MAIN STREET IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR HYANNIS MA 02601 REPRESENTATIVES. AUTHOR*] CPR eNTAT - ACORD 25(2001/08) 1r CI ACORD CORPORATION 1988 I a I � �, ..- • .. .. -.f: •. ._.,. .''��5's"',�q vw`'-ti�;,a.. 'w.-tt' '«�a+,•�5#. ,.:"c. 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MA 02635 PLEASE'.rNQi =-�£ i�CREASE PHOTO(BLASTING OPR ONLY) FEE, 10D.00 f. �� ; t z E fCTI �► EW 7989 =t a 'NOT_ VALIO'UNTM SIGNED By LICENSEE AND OFFICIALLY HEIGHT; STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB: §ICENSE 01 /25/1949 � ¢� � D NOT DE �H'. STUB THIS DOCUMENT MUST BE` �X y SIGNATURE OF LICENSEE M SIGN NAME IN FULL-ABOVE SIGNATURE LINE - CARRIED ON THE PERSON OF, THE HOLDER WHEN PATI, N._. /A') �'I�c...K."•— OTHERS-RIGHT THUMB PRINT ED IN THIS OCCUPATIO a /U/ ✓ COMMISSIONER 20OM-2-87-81429 ✓Xi CO—novaalcal(lb o ./I/oa 11&/ ea HOME IMPROVEMENT CONTRACTOR Registration 188835 Type — INDIVIDUAL Expiration 86/08/94 Roger g r B, Reid Carpentry Roger Reid 126 Lewis Pond Rd ADMINISTRATOR _ 4OtUlt MA 02635 y 4 't•� +*..>±s � '� zroa y, ... •'., "x;:F r ,. •.4 Mf�,srxfi..]"' �u'.,�.,c L'�•C �,valc�.a':- .w �.i' -v - - � :: �'. , ->a' ,.:.,.., v - <,., a "-- �.�- ,...y,.x's �. '.? Y -.a.•^-.+.w'� �+ x,lwn +� E .. r ,7 .. �:. ;,�., ,a..•'�;..X. ..t,'J,dw.. .. :,...- ..;... .,� ,.Tl,r.... �F ,.�.,..,.:' ,2'{` _ Y,`a� �,x"�.kx_ „'e -a4" F. .•r. .. «. ,.. -. N.....r. -,. M�•,>:.a-. 6 -.,.. &,,.,,r - <. �.�. �.;.� { .s-F?, s"v, � �S, .•-.t*� •xi`: s.,.:,!`4i` `�-c: � r a.. .,,.,.p.,e� r7 'tea i+^ �' µ�.a... ?i=s � s• as _...,. r��"s,'- '.r ,., _ ., ,:,..,. - .,..,�e "., .+;a., x.. '.. '.�:.�S rr �+` y,�i o:=�'r�'..•"rk �+*!.�t«i•`. ,;ss. J- �' :..4� v� a�..,.°+ '�`•,�m'�: wr x.. ,,}� � ��- '„• k.I S"' *• .-. r.. - •-fix" ,. +` '14 t•a� :r' <,c ?{,,,'.. A _ .3 a 3;;;,. i ..^I` <i�-�.. x.,,. �`' ...xA�,.M�S^,:.) .c:... i.a; _ �>.I i'r.. a r:••a ��>�� ��'':C'3.� ':•'.� � y?1:,-'4„t ���'�k -..i .p:.y��:fJ''/'y 4.r;�--.1. .,- ... e,e.i '�1.;.P. -sy. ... < t•- � A»-"> ��r' .a �.�f,>? '� C a s. � -^ti., .S ��:tM1' asa.'u.,...r:,`S.m�:*��;."+L'1�;f5.ti•'S� s�`i_`r '.',�.,.,.�'i��'.�.'.�r.:�(?£.�:?��.,:,c;�....r'L'�v.,f��'.:�..-... .._ - �,.s_,.::scK'�1.�.�. �,<'R',9f�.".,._.�..r;is:..''�:'.ti',�5."•�.r� .tf�"�;=`r.ar.,a±�"4,�a.4.. ��,�•u ��'c r_r.. �.x'e.{ur<'<,ss�s.-'�r,. -. .s-;.�.l.�r±•� a Assessor's office(1 st Floor): U Assessor's map and lot number V J -77 �Q�oi THE Tod o Board of Health (3rd floor): d Sewage Permit number t DSHa974DLL Engineering Department(3rd floor): ,L !�ry� NAB& House number G 0 1639' Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING- INSPECTOR v APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION �� � 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location —" �/�f�/� /Ly -� Co To f j Proposed Use 50 AA P 0 rJ Zoning District C I / Fire District Name of Owner!�8 —S V,1A /\ \,,&,zG'C Address Name of Builder `'� 5 �' r Address/ - 4 J-'e-- �v ,' �� ' �2�� ry t Name of Architect Address Number of Rooms Foundation S Exterior 6°"� S e c Roofing S Floors �/�/c Interior ? q Heating Plumbing Fireplace � Approximate Cos , Area ' Diagram of Lot and Building with Dimensions Fee ' li I I j i _ I I i .3 5 A/, A i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License i t SWARTWOOD, JUDITH F. r . i F No 35711 permit For Re—ROOF Single Family Dwelling ' Location 1276 Main Street Cotuit Owner Judith F. Swartwood `p Type of Construction Frame Plot -F Lot Permit Granted March 22, 19 93 +y Date of Inspection 19 I f Date Completed 19 t _ 1 4 6 }