HomeMy WebLinkAbout0614 MARINER CIRCLE I'
Town of Barnstable Building
iPos"This Card So That it�s,Visible From the Street Approved Plans Must be Retained on.Job and this Card Must be Kept
' iPosted Until Final Inspection Has4Been Mader, T .:LLk �d`,y k .
k Permit
VUhere'a Cert�ficete of,Occupa4ncysRe quired;a� uchyizBulldng shall!Notbe.Occupieduntil a Finaf Jnspection tias.been made `r
a,
Permit No. B-18-2210 Applicant Name: Jonathan Whipple Approvals
Date Issued: 08/01/2018 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 02/01/2019 Foundation:
Location: 614 MARINER CIRCLE,COTUIT Map/Lot: 023-056 Zoning District: RF Sheathing:
Owner on Record: AGRETELIS,ANNA&NICHOLAS S& � q Contractor NameJONATHAN N WHIPPLE Framing: 1
Address: AGRETELIS REALTY TRUST L k r ;Contractor License CS 078683 2
SOMERVILLE, MA 02144-1516 �'" ,YEst Protect Cost: $3,396.00 Chimney: "
Description: Insulation 5° Permit Fee: $85.00
f Insulation:
Project Review Req: �� Fee Paid $85.00
8/1/2018
Final:
Plumbing/Gas
�" � Rough Plumbing.
xBuilding Official Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authonied by this permit is commenced within six months after'issuance.
t Rough Gas:
All work authorized by this permit shall conform to the approved application Arid the;approved construction document _for which thjs permit has been granted.
All construction,alterations and changes of use of any building and structures`shall be in compliance with the local zoning by laws and codes. Final Gas:
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for�public inspection for the entire duration of the
x� M v a
work until the completion of the same.
., Electrical
"A
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are_ provided on this permit. Service:
Minimum of Five Call Inspections Required for All Construction Work: '
€�
1.Foundation or Footing ` Rough:
2.Sheathing Inspection
3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final:
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection
5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough:
6.Insulation
7.Final Inspection before Occupancy �� �,� Low Voltage Final:
Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. ,�,v1� L� Health
Work shall not proceed until the Inspector has approved the various stages of construction.
Final:
"Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department
Building plans are to be available on site Final:
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT
z,
a
ofTHET , Town ®f Barnstable *permit
Regulatory Services ►.rsGmaat ronrysrredat
t >> nsts, Fee
Thomas F.Geiler,Director
Building Division dR 7�30%3
Tom Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038
EXPRESS PERMIT APPLICATION '- Fax: 508-790-6230
RESIDENTIAL ONLY
6Nnt Valid without Red X-Press Imprint
Map/parcel Number, 92) 0
Property Address
{residential Value of Work '
Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address `
Contractor's Name
Telephone Number "
Home Improvement Contractor License#(if applicable)
G
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance X-PRESS PERMIT
Check one: ,
n❑ I am a sole proprietor
m the Homeowner JUL 2 9 2913
F211] have Worker's Compensation Insurance
Insurance Company Name � �/"�� •rf)WN 0ARNUA R-11
t
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must accompany each permit..
Permit Request(check box)
roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ #of doors
Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows
"Where required: Issuance of this permit does not exempt compliance with other town department regulations;i.e.Historic,Conservation,etc.
-..a
***Note: Property Owner must sign Property Owner Letter of Permission.
A copy of the Home Improvement Contractors License& Construction Supervisors License is
equired. / y
GNATURE:
Construction Supervisor Home Improvement
License Number 008267 OSHA Approved Contractor Registration#114813 Home Phone 508 420 5131 Member of the B.B.B.Cell phone#508 420 5131
ESTIMATE
James Danforth
P.O. BOX 973
COTUIT, MA. 02635
. {
Nick Azretelis 508) 420-5131
4 Dear Path
Bolton, MA. 01740
July 11, 2013
Work to'be completed on the entire house roof, as follows.
Remove the existing roofing shingles.
Install 8" aluminum'drip edge at the roof eaves.
Install ice and water shield 3ft. up onto the roof.
Install a 151b. felt paper over the remaining roof sheathing,
from the top of the ice and water shield to the roof ridge.
Install a 30-year Architectural type roofing shingle, using CertainTeed Landmrk,
which are algae resistant shingles.
Shingle weight is 240lbs, per square.The standard wind warranty is 110 M.P.H.
I will use CertainTeed starter shingles along the roof eaves and rakes.
I will also use CertainTeed shadow ridge for the roof caps, over the ridge vent.
This process will increase the wind warranty to 130 M.P.H.
Install new aluminum vent pipe flashing.
Install a ridge vent on all roof peaks, using Air Vent Shingle Vent 11.
House and shrubs to be covered with tarps while work is in progress.
Removal of rubbish.
Material and labor. $6,100.00
This price includes the building permit.
Insurance certificate will be issued prior to the start of the job.
There is a limited lifetime manufactures warranty on the shingles.
I will provide a seven-year warranty against any roof leaks.
All materials are guaranteed to be as specified.All work to be completed in a workmanlike manner
according to standards practice.Any alteration or deviation from above specifications involving extra cost will become an extra charge above
the estimate.Our workers are fully covered by Workman's Compensati n insurance.
Date of Acceptance� 6/ CustomerSignat ' ntractor Signature
CJQW
The Commonwealth of Massach usetts ,
Department of Industrial AccidentsVJJ
-
t Office of Investigations
11
k ti— 1 600 Washington Street
Boston AM 02111
X
t z" www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Cont ractors/El ectr><c>lans/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
fe
Address: r
City/State/Zip: Phone #: ��=�
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ 1 am a employer with_ 4. ❑ I am a general contractor and I 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. 9• ❑ Building addition
[No workers' comp. insurance. 5. ❑ We are a corporation and its
required.] officers have exercised their 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL ]l.❑ Plumbing repairs or additions
myself. [No workers' comp. c. 152, §1(4),and we have no 12.�of repairs
insurance required.] t employees. [No workers'
comp. insurance required.] 13.❑ Other
. .
*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.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins. Lie. K-W —�'� Expiration Date: C �,
Job Site Address: l /�; j�l�l/.� City/State/Zip
Attach a co of the workers'compensation policy declaration page(showing the olio number and expiration'date).
/v
copy P P Y P g ( g Policy )
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 n r the p ' s a d pen !ties of perjury that the information provided above is true and correct.
Si ature: Date:
Phone#:
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
1 6.Other it
TRAVELERS�
J
WORKERS COMPENSATION
AND
EMPLOYERS LIABILITY POLICY
TYP 11 E AR INFORMATION PAGE WC 00 00 01 ( A)
POLICY NUMBER: (6KUB-4861 P48-8-12)
RENEWAL OF (6KUB-4861 P48-8-i1 )
INSURER: THE TRAVELERS INDEMNITY COMPANY
1.
NCCI CO CODE: 11347
INSURED:
PRODUCER:
DANFORTH, DAMES DBA PAUL PETERS AGENCY INC
JAMES DANFORTH REMODELING
PO BOX 973 680 FALMOUTH ROAD
COTUIT MA 02635 MASHPEE MA 02649
Insured is AN INDIVIDUAL
Other work places and Identification numbers are shown In the schedule(s) attached.
2. The policy period Is from 09-29-12.to 09-29-13 12:01 A.M. at the insured's mailing address.
3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers
Compensation Law of the state(s) listed here:
MA
B. EMPLOYERS LIABILITY IN Part Two of the policy applies to work in each state listed
Item 3.A. The limits of our liability under Part Two are: s ed in
Bodily Injury by Accident: $ 100000 Each Accident
Bodily Injury by Disease:. $ 500000
Bodily Injury by Disease: . $ 100000 Policy Limit
Each Employee
C. OTHER STATES INSURANCE: Part Three of the policy applles to the states, If any, listed here:
COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A
D. This policy includes these endorsements and schedules:
SEE LISTING OF ENDORSEMENTS -- EXTENSION OF INFO-PAGE
4. The premium for this policy will be determined by our Manuals of Rules, Classifications,Oates and Ratin -
Plans. All required information is subject to verification and change by audit to be made ANNUALLY.: 9
DATE OF ISSUE: 08-23-12 CP
OFFICE: ORLANDO INDUS AFF 161 ST ASSIGN: MA
Q0�1(�Ilf`CR• DAI11 D�TF►?� +y Mr
28LBR
fix (trirtmrw recl���k rl d�,!ldsGW [t9Frt: > _.— ---- _
ofCronsun: %m s,ti u ntia �fl SSiGt1WSL�ftB - �Er .,_ .
HOME IMPRCVI F;EN=CORT,RACT6F, Sct�rct o8 S;tsitfirs Er,t.; .
Registration: T,4S'1 Type:
40
CS-008267
tr D DANFOi i H REIVIOD
JAMES D DANF TH
PO BOX 973
bLL nST R.L. f' COTIJIT 0263;
'(?TUIT Mrs 0263E —��_•..
Untfer-secretar ,
05i20i201 a
E x c e i l e n. c e
1 n S a f e t y
This certificate is 4presented to
For completion of Exceile:-rce in Safety's
FALL PROTECTION TRAINING COURSE 9ar+w1F
held at Shepley Wood Products, Hyan~rs, MA
M� •
w' .- xZO o-safety :. Training Date
OpIKKE Tp� Town of Barnstable *Permit# o8o_
Expires 6 m oaths from issue date
Regulatory Services Fee r7�,
xxsrns Thomas F. Geiler,'Director,
MAss
�P 019• A, Building Division
rEa rw't
Tom Perry; CBO, Building Commissioner
200 Main Street, Hyannis, MA 02601 w
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X=Press Imprint
Map/parcel Number 6
Property Address rj ! rl v14,j:�- &l
Residential Value of Work 5—,. G 0 D Minimum fee of$25.06 for work under$6000.00
4.
Owner's Name&Address
Contractor's Name (,eEQ ( S _Telephone Number
Home Improvement Contractor License# (if applicable) 0 ® 3
L I
�rkman's Compensation Insurance a
Check one:
❑ I am a sole proprietor 6 �008
❑ AUGa
the Homeowner a
I have Worker's Compensation,Insurance o wN OF BARNSTABL�
Insurance Company Name �4,tMC,
Workman's Comp. Policy# �� / '�70
Copy of insurance Compliance Certificate must be on file. "
Permit 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)
Re-side
Replacement Windows/doors/sliders. U-Value, 1 _ (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 Improvement Contractors License is required.
SIGNATURE: _....._
OFFICE: (508) 997-1111 NO owl MA. Builder's Lic. #021330
FAX: (508) 997-1297 CAREleromes
FREE Home Improvement
,
s License
TOLL FREE: 1-800-407-1111 inc. Contractor's
MA.
WEBSITE:
www.carefreehomescompany.com 239 HUTTLESTON AVE. (RT 6) • FAIRHAVEN, MA 02719 #15179 R.I.
y�J n ,
NAME .I IC K l/ �pK CT641 S DATE /r d�9 d?
f/ � ULTC�/ZI
ADDRESS '7' ✓� PrT/�I .�I��I�. ZIP CODE 40//'7O
ADDRESS OF JOB C I� E f �/V�ie ��. �rUdr, �. TEL 97,'' 49,�- /0Iv2 M
JOB DESCRIPTION ���_ _aJrQ 0)
+ REMOVE INr"E12tQP_ GU?NDQQJ 5-1VPS IlAlll 5 /,P b0U&6 «UNG !fir
7 PI MA5-7 %uJ1V 1)0•() � FW OM 5,0 hS AJ61 TE1111IV 615
/� /gels- ce,45_61 db& lJi✓ rS
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M er_ ,VAICRS 17 WZ) 3/ZILS, lAlf7-Atet- -55046
�tF/Ylf�(/E �,�IST/il/�r- �t✓�-TES � ��GC/�c/S'��'C/TS � ��/J/�1� �/fSG',//�
90IMbS* FR`ZC- &f,E7Mr kS GUiAl1QaW
&AS/i16r5 , .hook. e4SIIV6r5 )qyD 6W1-7 -e bao,4e
70 ,54-62c l�elhzCJA/ 42� � 107416
l k),. - '�4-X_ At..CZA T 3 WhOrT: SOFFIT PlW iFL 7z)
.F.9. IAIC 1u755 ��t��
L (rr
Sc ,eu _/ Z .��(�-�N — scheduled Completion
A. Replacef missing or rotted lumber is not included unless specified.
B.Ali start& completion dates are approximate and could change due to weather conditions.
C. Stripping of roof includes removal of up to two (2) layers of shingle`sy e fyh additional layer to be charged @ N ft2.
D. Replacement of rotted roof boards/plywood to be charged @ /V /� ftz.
E. Existing chimney(lashings will be reused; replacement, if necessary, is not included.
F. Care-Free Homes-Inc. is-not responsible for mold/mildew conditions-that are preexisting or result from'leaks not brought'to the `
attention of C.F.H., Inc. promptly.
The Company hereby proposes to furnish labor and.material to complete the above work for the amount herein. Fulfillment of this
order is contingent, however, upon the want of strikes, fires and any natural disasters, the ability to obtain materials, or any other
conditions beyond the control of the Company. n. y
Cost of Project$ �i.), E PAYMENT TERMS T�/� O�'/ ✓"/1• /50
w
W.5 ON O'c'IP _ " O
Date 0�
1. You,the Owner,may cancel this transaction at anytime prior to midnight of the third business day after the date of this transaction.
2. You,the Owners,agree to pay any and all expenses incurred by Care Free Homes,Inc.in collecting money due under this contract
and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees, interest and court costs.
DO NOT SIGN THIS CONTRACT'IF THERE ARE ANY BLANK SPACES
CARVFE HOMES, I .1/,, /�/� �(_7
B `� �'dsC'/ fir/✓�✓ Buyer acknowledges OwnedX&W
y receipt of fully completed
CARE FREE HOMES,INC.
copy of this Agreement, O ef.
All contractors and subcontractors shall be registered by the director and any inquiries about a contractor or subcontractor relating
to a registration should be directed to:
Director, Home Improvement Contractor Registration
One Ashburton Place, Room 1301
Boston, MA 02108.
Tel. (617) 727-8598
� ., J� -Pom�rcoouueah� ����e�
• � Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Registration: 100503 One Ashburton Place Rm 1301
EzpiratIon 6/19/2010 Boston Ma.02108
Type Supplement Card
CARE FREE HOMES !NC
DANA PICKUP
239 Huttleston ave
Fairhaven,MA 02719
Administrator L Not valid without ' nature
The CoMtHorcweaXth of Massachusetts
Deparfinent of Industrial Accidents
TjOffice of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Assurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Lnformation Please Print Legibly
Name, (Business/organizstion/fndividuaI): `�Q
zill
City/State/Zip: V4 /� Phone.#_ � ?'����
Are n an employer? Chec' the appropriate bwc Type of project(required):
1. I am a employer with 4_ ❑ I am a general contractor and I 6 ❑New.coustraction
. employees (full and/or part.timc).* have hired the s>sb-conhactors
2.❑ I am a sole proprietor or partner-
listed on the attached sheet 7. emodeling
These su]i conlzactors have g, Demolition
ship and have no employees
worlang for mein any capacity. employees and have workers' 9 Build. g addition
[No workcm' CQmp.-mnn-anr_c comp-Lusuranco.
5. F] We arc a corporation and its 10.❑Electrical repairs or addition
rtqurred] officers have exercised their 1 LE]Plumbing repairs or addition
3.ElI am a homcowncr doing all work
myself [No workers' camp_ rigbt of exemption per MGL 12 ❑goof repairs
incnrance r t c, 1S2, §1(4), and we have no
rimed] croployees. [No workc ' 13-❑ Other
ns
comp,mcnrancc require&]
*Any applicant that cl=t x box#1 must also fill out the acctian below sbowing their wor-kaa'c6mpmi& 4on policy information_
t HmT=wncrc who cubrait this a$davit indicating drey arc doing all work and then hire outSidc canh-aetors must submit e-ncw affidavit indirat g meh
4--=tractors that cbrxk this box must soothed an additional shed showing the name of the sub-contractors and state whcthcs or not thosd entities have
curployees. if the sub-mnh-aet am have anployccs,they must pruvi&their woTi=-s'comp.policy nm-nber.
I am an employer that is providing workers'compensation_hasurance for my antprayees Berattw is the porky and job site
information. /
immnanao Company Namc: GL�--rA>
Policy#or Self-ins.Lie.#: 1/� v Expiration Date:
fob Site Address: b s9 I l^ C r City/Siatc/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 erinarial penalties of:
fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a t
of Up to$250.00 a-day against the violator. Be advised drat a copy of this statLmcrit may be forwarded to the Office of
Investigations of the WA for incrrramr,coym-&gc verification.
I do her c fy under the -and penalties of perjury that the information provided above is true and correct.
Si c: Date.
Phone#
O facia!use only. Do not write in this area, tb be,compMfed by city or town officiaL
City or Towa: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3. City/Towu Clerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
�OR-14-2004 01:57P FROM: TO:15087906230 P.1/1
.4 ®RD_ CERTIFICATE OF LIABILITY INSURANCE 09/18/20000MID1�
09/17
PRODUCER (508) 679-6418 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Frank X. Perron Insurance Agency,. Inc.. ONLY AND. CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1311 Bedford Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
P. 0. Box 4156
Fall River b!A 02723-0402 INSURERS AFFORDING COVERAGE NAIC•
INSURED INSURERA: National Grange Mutual
CARE FREE HOMES I= INSURERS: Star Insurance
239 HUTTLESTON AVE . INSURERC:
INSURER D:
FAIRHAVEN MA 02719- INSURERE:
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 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION
LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE MMIDD DATE MMIDD LIMITS
A GENERAL LIABILITY M80779830 09/Ol/2007 09/01/2008 EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY PREMISES EeEocccuErrrence $ 50,000
CLAIMS MADE Fx_1 OCCUR / / / / MEDEXP(Any oneperson) S 5,000
PERSONAL BAOV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000
X POLICY JEC LOC
AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT S
ANY AUTO (Ea accident
ALL OWNED AUTOS / / / / BODILY INJURY
SCHEDULED AUTOS (Per person) f
HIRED AUTOS / / / / BODILY INJURY
( S
NON-OWNED AUTOS Par accident)
PROPERTY DAMAGE
S
(Per ecadant)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S
ANY AUTO / / / / OTHER THAN EA ACC f
AUTO ONLY: AGG f
EXCESSIUMBRELLA LIABILITY / / / EACH OCCURRENCE f
OCCUR CLAIMS MADE AGGREGATE f _
S _
DEDUCTIBLE
-RETENTION f _TVCSf
B WORKERS COMPENSATION AND WC0378035 09/01/2007 09/01/2008 TORY LIMITS X ER
EMPLOYERS'LIABILITY
ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT S 1,000,000
OFFICERIMEMBER EXCLUDED? / / / / E.L.DISEASE-EA EMO 1,000,000
If yes,descdbe talder
SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
OTHER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLEWEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
Officers Included for Workea Compensation
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
„ -0�,7q v Ce a EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT
Town Of Barnstable FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
Building Department INSURER,ITS AGENTS OR REPRESENTATIVES.
367 Main Street AUTHORIZED REPRESENTATIVE
Barnstable MA 02601-
ACORD 25(2001108) 0 ACQRD CORPORATION 1988
�n:INSa25-01De).a5 ELECTRONIC LASER FORMS,INC.•(SM327-064& Page I of 2
r
1 �
4 Assessor's map and lot nu
m / ...�..
THE
SEPTIC SYSTEM
Sewage Permit number .�- ..�.......�./'S� � ♦�
INBTALLEO IN CO
.�
WITH TITLE BARNSTABLE.
�se number. .......................................... .. rhea
Ho . ....
d INVIRONIVIENTAL C
a' h' EIULATI® n
TOWN OF BARNSTAILY
RUILDIN.G INSPECTOR
APPLICATION FOR PERMIT
TYPE OF CONSTRUCTION
............. �1.�4:.v...........19........
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location .J� .... �"v.... ......... .. .......•f. .. ........... ...................................
ProposedUse .........,l...l................ ................ ... .........0......
Zoning D�* tnct �......:... Fire District .....:... J. '..............................
... .... ....
Nameo Owner .. ... ....... ....... .......................:............. ....:Address ................... .......... .G? .�.. . .. ..........
e
Nameof Builder . .......... ....................................Address .........................:..........................................................
-Name'of Architect ........... µ.......................................................Address ....................................................................................
Number of Rooms ...................C�.................�.......................Foundation ..� ....sr!' ......................... ...................
Exterior ..1.... .•.... .....�� . .....................Roofing ... .
Floors �.. . .. ...� .'%�W'................... ..... .Interior ........:
C s�/
Heating .1. df.....�"..'........ .. .. .... ...............:......Plumbing .............:....... ./ .................................................
� -;,(-el
� ..... f.
Fireplace ..:...........................&.-!.:,rl.....:...............................Approximate Cost .........J.4! ..®00.:................................
Definitive Plan Approved by Planning Board ___19 �. 4v Area 13g .....
Diagram of Lot and Building with Dimensio aa �"
g g Fee ......J�..:.
SUBJECT TO APPROVAL OF BOARD OF HEALTH
71(YIe-o
7vf
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstabl egarding she above
construction.
r
Name .... . .... ...... . . . . ... ... ....... ........ .................
.THEO CONSTRUCTION
4
N"-;�25D.-.--�)ermit for ..9!19...;�t-.Qr.Y.........
10
"Single F MilV Dwel
a
... jg...............
................ ..........I..................
Location Lot #114...614..Ma
...................... ........ . ..Xirler...Cdrcle
...............Cotuit................................................................
Owner .....Theo. QQ.1.1-9, truction................
Type-of Construction ....FrPXW.................
4
................................................................................
j
Plot ........................... Lot ................................
• Permit Granted .... .....19 80
•
Date of Inspection ....................................19
Date Completed ...................................:..19
PERMIT REFUSED
..................... ..... 19
...... ................................................. "ee
.... ....... ........................................................
,. ..... ...... ..............................................
..`.:. .a - - _. _ . - ! x
J�
.....2.. ............ .................................................
'N'Ap proyed .................................................. 19
............ .............................................
...............................................................................
0
T" MOT PLA fq W-A i5 P40T MA F?E F`tr C3�
Ott t1H9]`RiJ ldT ll gVf+Y AfdID IS
FfJ12 THE i7S
' OF THIF Pl 14W— Ot4LY., uNo-ZFZ-No CjgCUW
brGm, e
. � M
M LOT l
ti
0Its
3/
SNOWING PLAN
FOUNDATION LOCATION
COTU1 T, MASSACHUSE T T S
j & �?aYVNED BY: Goya S'riz . a c.
,O
SCALE: ' jo DATE: Sr' VZ .�950
NORMAN GROSSMAN---- REGISTEREDLAND SURVEYOR
I HEREBY CERTIFY THAT THIS FOUNDATION IS LOCATED
ON fifE LOT AS SHOWN AND CONFORMS TO THE TOWN �� OF 4f
OF BARNSTABLE ZONING REGULATIONS REGARDING ,a
SETBACKS FROM STREET LINES AND LOT LINES . mA�GROSSMAq
,
127/5
NORMAN GROSSMAN R.L.S. DATE
bn SOIR! -
__ a
—1
•e TOWN OF BARNSTABLE Permit No. -----------_----------__------
s,un.� Building Inspector cash
----------------------
�`°"°Y� OCCUPANCY PERMIT Bond ____------- / 51X
No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Address
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
.....................................................1 19......_.._ ...................................................................»........._.........:.....:..............._
Building Inspector
L
Assessor's map and lot number .... ......
Sewage Permit number ... ........... ........................
.... .... ........
EARNSTAMLE.
House number ...................... o ...................................... MAG&
... .........
f. 2639. 't
mxf
TOWN OF BARNSTABLE
BUILDING. INSPECTOR
APPLICATION FOR PERMIT TO .......................7-)1,46.......(.............................................................................
............. . ......
TYPE OF CONSTRUCTION .....Z44 b�y................ ......................................................................
,Oz(............19........
.............7............ .. ....
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ...... ..........................................................................................................................
...............................................................................................................
Proposed Use ........... ..........................
Zoning District .................. ...... ........................................ Fire District ......... A.e........................................................
W
Name of Owne ......................................................................A .......... ..................
r ddress ..................................
Nameof Builder ..................................Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Numberof Rooms ..................................................................Foundation ... ........................... ..........................
................................ Roofing .... ........... -4C....................
Exlerlor / 1�............................. �.4kZ�4 ......."A
Floors ..............................
................Interior
................................... .. ....................................................
4 PlumbinHeating g ...................... .................................................
Fireplace .............................. .....................................Approximate Cost ...........
..... ........ ................................................
Definitive Plan Approved by Planning Board 3---19 Area ..........................................
Diagram of Lot and Building with D.imensiorys Fee .............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
NV
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. sr
Name ... . ...... .........................
A=23-56
THEO CONSTRUCTION
No for ...
Sing.j.q...Family
.............. ...............
Lot #-1-444 Marliae-r...Circ.l.e..
Location ....................................
Cotuit
............................................ ................................
Theo Constrz,
Owner .................................ct '
. ...... Q.n.....................
Type of Construction ..../F...r.Ame.........................
................................................................................
Plot .......................... Lot ..................
Permit Granted ....Sp !.k-K...2.6.,...19 8 0
Date of Inspection .........I........................19
Date Completed ....... 19
..........................
PERMIT REFUSED
.......... .. ......... .......I.......... ..... ..0'.1...... 19
61
............. .......... ................ .... ..........................
......................................................................
...............................................................................
...............................................................................
Approved ................................................ 19
...............................................................................
...............................................................................