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Home My WebLink About0089 NARROWS WAY �. �� i Townof Barnstable Building� <..;5^ •,sax > ay�,� m •wa;mar 3°... °","Ry„ .tk�• mac.:.;+�-„�x, .,�K4^m ... ��xx.R..4�.tea' '•v` '�mow. ,�,.3� .'�,,.��:,a�• " =3 . :^ .,�xsre Post This=Card So That it is�1/isible From the Street Approved:Plans�Must be,Retamed on Job and this Card Must be Kept �, ,Posted Until Final..<Insllection4Has:geen IVYlade `` "� � '; a §. SG'.fV' 'ro , ,«`.. ;� '...x ✓?:^t ,.1.c,..','.,.. ,'x.i1.'S.';hi,.,9 ar F.3 < � ..,�a S i <." 'y `dk y,:..�. "� .a"; .a t:,,.` "'i, sx i. "� x>k..'i` �' `. .,-, yam a7 R Where a Certificate of Occw anc F^is Re uired suchiBuildm shall Not be Occu red until a Final Ins ection has b en n aiie 3, ;,' 1 p e mit j �� x ,a .::::�.�.+,.va..a'v.,a,`?v"�:w<ia p�ta...., w.,�a z Sp;+"a.' .a:.s..r arrts dsak ka «g..+ :....,.;A> =a as ., .«:�':<e:sap..:«k'. €.a x. lza,>�.s., :k>.�• s sa�..,�.»..:...a. .;:`::a x '�, ,. Permit No. B-18-2461 Applicant Name: HENRY E CASSIDY Approvals Datelssued: 08/01/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 02/01/2019 Foundation: Location: .89 NARROWS WAY,COTUIT Map/Lot: 021-111 Zoning District: RF Sheathing: " �` Owner.on Record: NICOLAZZO,RICHARD,TRUSTEE a Contractor Name CAPE COD INSULATION, INC Framing: 1 5 Address: 405 WALTHAM ST#177 r R Conttracto�r,License 153567 2 LEXINGTON, MA 02421 Est Pro ect Cost: $4 800.00 > 1 Chimney: ' a Description: Basement Ceiling Encapsulated R19 F9 Batt. � ;5 Perrnit�Fee: $85.00 1 Insulation: Project Review Req: ( �� FeePaid $85.00 8/1/2018 Final: Stt Plumbing/Gas IN f Rough Plumbing: Building Official Final Plumbing: y This permit shall be deemed abandoned and invalid unless the work authored b%this permit is commenced within six months after";issuance. Rough Gas: All work authorized by this permit shall conform to the approved application�and�the approved construction documents for which thi's permit has been granted. All construction,alterations and changes of use of any building and structures shall�be in compliance with the local zonimggby laws and codes. Final Gas: = � ji`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 work until the completion of the same. t Electrical �. .a ~� The Certificate of Occupancy will not be issued until all applicable signatures by the Building andHre Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: F -_ 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. 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 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4WMap Parcel Application Health Division Date Issued C Conservation Division Application Fee Planning Dept. Permit Feed" 5 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address 2 4V_X,X 41.-r � Village 6,0 iv�� Owner %i A?J 42 efQ lA;X ia,�2 Address ;Dim Telephone f�7�lZ f Zd Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Lot Size . Grandfathered: ❑Yes ❑ No , If yes, attach supporting documentation. Dwelling Type: Single Family kr"- Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes LI No On Old King's Highway: ❑Yes p-No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new RIJILDjl j4eIfbgisti g new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new U� 3 � 1irst Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Others 0 8ARNSjfASLi= Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT-INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address i e gfwig� G2 12 License # Home Improvement Contractor#,,_-� Email GL/i C��¢G�� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE :712 J//-Op FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT `' ASSOCIATION PLAN NO. f Docu8ign;Envelope ID:2A6FOD21-C737-4008-9981-10680801B9EF r Permit Authorization 4W C rr�ass save Form ' > Site ID: 3418672 Customer: Richard Nicolazzo I, Richard Ni col azzo ,owner of the property located at: (Owner's Name,printed) 89 Narrows Way Cotuit, MA 02635 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. by: Owner's Signature: [—;DocuSigned &44 MCb V EA5DA72EA1424DE... Date: 7/12/2018 1 7:36 AM EDT 000000a0000000000000aaosoQoe00000000®o•ooaoaa000aooa00000aoa000aoaaao FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Cape z�� Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: For Off-ice Use Only Rev.102015 I h e Co r DoPP( nt ofzn�dustr al�faolde yfsts 1 Congress stle et, S'utle 1'40 Boston, 1�1A OZr14�201'r wwwlmass,�'ov/dla 11'otkersr Compensation Insuranoa Af(1davltt;,Bullders/Contr.,actors/�lectrlclans/Bl,umbersl To BB 71LB$W1TP1T p RMI' ('Ilya ACiT oItI�Y Name (guslness/OrganlzlkioNlndividual.); e Cod Imulatlon Address) 18 Reardon Circle Cky/StaWZIpl South Yarmouth,-MA 02$$4 phone #I 608.775-1214 Arn yov an rmployarP CbIA fhe IpproprIIII bozi imltmbrmgloyarwlt}t� �„ernployees(Nllend/orp6rlllrne),r �`Yp60�pro�act (requlrad)I t,❑I bm a role propr9afor or parvtarsltip artd htYe na employees workln4 forme In 7 CD New oonstruodon . any o6ptalry,(No workers' oomp) Insurbnoe r�uirad,) 8, ❑ Remodeling � (]1 em a homeowner doing e11 work myaalP (Noworkarsr oomp, Ineurenoe requlrcd,)1 9, ❑ Demolition [)I vn a homeowner end will ba hlr{ng ovntmp4ora to ponduot dl work on m roe 10 $ulldla addition 6AIVI1 Utll VI OOnitao{OrJ alUter hbYO worklyd� e 00mp11et*n WWII w b/e so l prop I will ❑ g rlelorrwlUl no anployaes, 11,❑ ir(eotrlogl repairs.or add) S Q I b'enrrbl oontreotor end I heye hired the svboonveotort listed ❑plumbing on the exeohad shear, �t it M oontibotora 9teYe empioye�as eatd hbYe Wof�bi �pp�p In�Utblipell 2, rapalrs or add) 13,6, []Roof repairs ❑We ue b aarpondon and Ita of oert have axaralsed their H0 of wmpdon per MOtr e, 14, ,� p ISt,91(4);utd we hbve no omployeae, NO workenl oomp, In�urnnoe required,) ❑I Cher Weatherizatio 'Any�ppl obn4 thbl b�aaks x I mutt oleo AI out. e saol on be ow show n�their workers oorr,penseticn polio ►nf 1 Hom>owmn who rubmi��Jr1* dbvlt Indloating th b1`e dolns all work and then hire outside oonatiotore mutt rConhroo�rr Vul oheok t}tls eox mw.t attavhed art bddlonbl sheer ahowing We nbme ONO avb�oontrbators�,d net onnbUon ampioyaer Itthe suta�concreotota rya 10 tee th rubmlt a new etfldavlt lndlabtinS euor ►Y mw� rovlda their workers)oom , Ito number, a whe!her or.nol IMo l andVea hays !am an employer galls proyldtnj,workers+o0 1rvormallorG ¢nsu�lon Insurance for ,y employers, glow Is the otic and Insuranoa company Name) Atlantic Charter p y /ob st, '' Poiloy k or Sslf�insl �Iol,�I WCE004� 190Z -"" , ,. , �xplration bate 06/30/201� Job Slla Address) r2 i�,f �t�16 �opyofteorkersr aIW npolicy deolaratio>i page show C�ty/State/Z1pi "'o �. Failure to saaure ooverage es requlrad under MOL a, 1p the policy number and ezpiretloa d;. „ ; '''r�' arjdlor,o�atyaar Imprisonmont, e.s wall as olYil ponaltles2n§ha f Irm c��Sna) Yiolallon punlshablo by a t3no up to Sl,sOo, day agalns9 the Violator, A oopy of t}t�is stat,em�nt may be forwarded to TAP WOE O�sR and a fine of u to Mo ooYarago vorli3oetlon, hs OmoO of Cnvestlgatlons of the D1A or Insurer 1 do I►¢r¢by oer under ¢ alns and p¢nallles of p¢r/uey (hot the trtl'ormatlo n pravtded a�OYe is true and corrce� 508 G�Yi,I GI'�'J"�''""wv+oWuwy. h,WIM ojJiclat use l ony, Do not write In rims nrra, to ba oornpt¢l¢d by oily or tow n olYlotal, City or'fownl issuing Authority (oircle ono)I Pormit/Lioense � I, �osrdof�ealth 2, Building Department 3, Cltymown Clark 411�leotrloa 6101her I Ynspector+5, Plumb Ih5lnspecto r �1 CAPECOD-27 MAHLER CERTIFICATE OF LIABILITY INSURANCE DATE F /05120Y 0605/208 18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER C TACT Rogers&Gray Insurance Agency,Inc. PHONE FAx 434 Rte 134 A/C,No Ext: A/C,No:(877)816-2156 South Dennis,MA 02660 -MAI .mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC A INSURER A:West American Insurance Company 44393 INSURED INSURER B:Safety Indemnity Insurance Company 33618 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURERD:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 NSR A&DTYPE OF INSURANCE INSD SUER POLICY NUMBER POLICY EFF POLICY EXP WVD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000- CLAIMS-MADE [X]OCCUR BKW(19)63328281 04/01/2018 04/01/2019 DAMAGE TaESO RENTED 100,000 _PBoccurrence) $ MED EXP(Any one erson 5,000 PERSONAL&ADV INJURY 11000,00- GEN'LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE 2,000,000 X POLICY lder oiler PRODUCTS-COMP/OP AGG 21000,000 X see holder descrip of operations OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident)ANY AUTO 6232707 04/01/2018 04/01/2019 BODILY INJURY Perperson) �IUTEO�S ONLY r AUUTNOpSWULNEEDpX AURTOS ONLY AUTOS ONLY BODILY INJURY Per accident $ P�OPERTY AMAGE er acciddent $ C UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAR CLAIMS-MADE EXC10006635003 04/0112018 04/01/2019 AGGREGATE 2,000,000 DED RETENTION$ D WORKERS COMPENSATION PERTUT, 1 OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WCE00431903 06/30/2018 06/30I2019 E.L.EACH ACCIDENT 11000,000 9-14aFFICER/MEMBEREXCLUDED? ❑ NIA 1,000,000 tory In NH) E.L.DISEASE•EA EMPLOYE It yes,describe under 1,000,000 DES RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. Excess Liability is follow form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RE—PR-ESSEENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. ( c' Commonwealth of Massachusetts l� Division of Professional Licensure -Board of Building Regulations and StandarUs Cons`,g-&Mr3'I�b'p€,rvis.or CS•100988 �r fp�lres: 11/11/2019 HENRY E CASSID. 8 SHED Y,`rk� ,/�;.• ��, ROW l�y •, WEST YARMOGTt MA`0 67t1 ' Commissioner -- Office of Consumer Affairs and Buslness Regulation 10 Park Plaza • Suite 5170 9 Boston, Ma ; °6'brusetts 02116 Home Improveme. : .o�ltractor Registration Type: Corporation Cap Cod Insulation Registration: P n Ir1C 1535t37 18 ReardonuClrcle .f(':;.'1�r: ;'`` Expiration; 12/14/2018 So, Yarmouth, MA 02664 ;', wn ': ;CA4 0 20M•05/11 �' �� Update Address end return card. Mark reason for change, .. --• _ ___ ......... . do�'iarrYncoaaruurrl�u�c�/G�rfaou.�(rdetly •,,,. /mart Ll-l.�,gt;.�,�r�!.. office of Consumer Affairs&Business Reguletlon HOME IMPROVEMENT CONTRACTOR ' Type; Corporation Registration valid for individual use only ',:,. before the expiration date. If foun >......;w A 941AUZI Office of Consumer Affairs end urn to; �3• b? 12/14/2018 10 Park Pieza• sl ss Regulation e 5170 Cape Cod ........ Boston,MA.. 11 Henry Cassidy 18 Reardon Circ /4 So,Yarmouth MA'\61.Vy a• Undersecretary _ t al hout s( atu TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �Parcel Application # Health Division _ -Date Issued ` Conservation Division i Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis �. Project Street Address �� &L61d5 42d UQ! Village 6 r 6v f Owner �� - ye;h _ Address 011j2- Telephone Permit Request jA,�- � e,✓s ,o Y et r Square feet: 1st floor: existing proposed 2nd floor: existing /06proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation/ Construction Type--Ae, Lot ,' (S Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. J Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure i Y3� Historic House: ❑Yes U'No On Old King's Highway: ❑Yes 6 N' o Basement Type: 'Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) 4rv! Number of Baths: Full: existing new Half: existing �- new ✓'. Number of Bedrooms: _ existing knew Total Room Count (not including baths): existing -7 new First Floor Room Count Heat Type and Fuel: *15a's ❑ Oil ❑ Electric ❑Other Central Air: 6'5e's ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: fisting ❑ new size _Shed: ❑ existing ❑ new size_ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review,# o Current Use Proposed Use a s APPLICANT INFORMATION Y (BUILDER OR HOMEOWNER) Name i /` Telephone Number Address . � �h �D �C License # �ooy 7 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ah-a l 1 � SIGNATURE DATE �l / 1 FOR OFFICIAL USE ONLY � r APPLICATION# S .F : DATE ISSUED MAP_/PARCEL NO. s , 4 ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: _-FOUNDATION '-oNO5 oK FRAME �xCk INSULATION FIREPLACE 4 ELECTRICAL: ROUGH FINAL Ply u PLUMBING: ROUGH • FINAL 'GAS:,- Y1= ; ROUGH FINAL r ,} -'FINAL.BUILDING (' DATE CLOSED OUT ASSOCIATION PLAN NO. F - • The Commonwealth of Massachusetts _ ;Department.ofIndustrialAci dents �� "�3Qt. Office of fiMadgadairs -600 Washington Street Bastorty MA 02111 www.mass gmdia ' Workers' Compensation Iusur nCe Affidavit; Builders/Contractors/JIIectricians/Plumbers 43pheant Information Pl=e Print Le Name(Business/organizetim,�*+ ;9; ,an; City/Stata/zip: Phone.# Are yo an employer? Check the appropriate bog: -Type of project(require 1. I am a employer with �� .4• ❑I am a general contractor and I �:� • employees(BL and/or part Vie).* have lured me 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-contactors have 8. ❑Demolition working for me�any capacity, employees and have wor)=' [No workers' camp.insurance comp mcirranee$' 9• ❑Binld— addition 5• we are a c requ>red J ❑ tarporatinn and ifs: 10.[]Electrical repairs or additions '3.❑ I am a homeowner doing all.wark officers have exercised their 11,❑Plumbing repairs.or additions Myself [No worms' comp. right bf.exemption per MGL 12. Roof in. rnce requited.]t c. 152, §1(4), and we have no p� 1. employees. [No workers' 13.[] Other cow,insurance required] *Auy applicant fhat ckshec box A=st also fill out the secfion below showing their wmjo,&c mpmsatim policy iufumoafion. Hmmeowmca who submit this affidavit indicathig$icy are doing all work and ihea hire outside conhactma.must suhoat a new affidavit mdicatng such. �Comtractmrs that check this box mast atfacbed an adffd. al sheet showing the name of the sub—_umtracfnrs aid state whCI urnot those entities have ampleyoes. If fhe sub-camfractun;have employees,they mustprovidt their workers'comp.policynumber. I am an employer that is prm!irlirtg workers'compensation insurance for my employees. Below is the policy and job site information. 9 In ra=Cc=panyNamz:__. AAA Policy#ar Self=ins.Lic.P f eel 11 VZ611 A Expiration Date: . Job Site Address: Y�1✓ Chy/State/Zip: . tJ Attach a copy of the workers' campensafion policy declar on page(showing the policy number and ezpiraiian date). Fare to.secnre coverage as,reguired under Section 25A ofMCrL G. 152 can lead to the i Position of etinfial penalties of'a fine up to $1,500.00 and/or one-year imprisamme as wen as'civil penaltiss in the form of a STOP WORK ORDER and a Erne of up to$250.D0 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of . In7estigradons of the DIA for h2SUrd„ce covera e verification I da hereby certify under a s" p s of perjury that the information provided above is true d correct; Date: / Phone# D TC&use only. Do not write in this area, fa be completed by city or.town o�ial City or TDYPn: PermitUcense# •Issuing Authority(circle one):: 1.Board of Health 2.Bm'Iding Department 3.CitglTopen Clerk ,4.Electrical Inspector 5.f"' 6. Other Contact Person: Phone#: r W;-:Ui i '. 52 tIR!_COL h1 v. PFIRSQId5 ih-5!):RHNCE (.FRi;i171$1 441ic`_ F' OG1:'t;j'I ti WORKERS CCMPEI! SATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Assm iated Employers Insurance Company S41 hied Avenue,Suriington,Mausachuset'ts 01803 (800)876-2765 NCCI NO 40559 r� POLICY NO. WCr,5005114012011 ENTERED 01"T 7 4 G011 PRIOR NO. �Ci:5006 i 14012010 � ITEt<i 1. The insured Uch,ael Oaluga dbe Village-Craft Building Remodeling Mail Address: 568 Santuit Road Cocuit MA Street No. Town or City Count!t State Zip co'16 FEiN xxxxx2146 BrON dual LlPartnersh.p ❑Cary oratiun El Joint Venture CJAssociation 00ther Other workplaces not shown a0ove: 2. The policy period is from, ("`" t• to 12123r2012 12:01 a.m.standard time at the insured's reading address.. A. Workers Compensatior Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here; MA Q. Employers Liability lnsLr'an-.e:Part Two of the policy applies to work in each state listed ir.item 3.A. The limits of our I!ablBty unew Part rwo are_ Bodily Injury by Aecident 5 _,___a_Q ZQ each acc dsnt Bodily Injury by Disease S010,QO policy limit Bodily injury by Disease $ 100 0�}(Qeach employee C. Other yWtes InSuronoe Covorage teplared By Endcrsement WC 20 03 06A D. This polity includes these endorsai rents and schedules:SEE SCHEDULE 4. Tee premlam for this policy will be deter lined by our Manuals of Rules,Classifications.Rates and Rating plans. All information required beloly is subject to verification and change by audit. Classifications � Premium Basis '�Rates �r! Code Caiinwted Aer S1G0 Cntitrv�ivd tvo. T:,s. nnu:, R:marcra,ion Romuwrution Pmmiurn i INTRA 355380 SEE c(TENSION OF iNFORMATION PAGE I i Minimum;premium$ 500.00 Total Estimated Annual Premium $ 2;924,00 As Irid'cated Interim ae)ustmentc of premlum shall )o mad6' Ooposh Pram!um $ 3,076.00 © ,Annually +] Semi Annually [I 'Duarterly 13 Monthly MA Assessment Chg. 52,5?7.35 x 5.9GOC°h $152.00 This policy,including all endorsements,is hereby,ountersigned by tw:MrlZtad algrtckm Dote i GOV GOV ' KIND� F LACINt� Cf.A1P i TyAME $AF Y Malcolm&Parsons Insurance STATE { SS AIIUIT OFFICI; OFFIC= CHECK j CLA (;ROUE Agency Inc :AA 5EE45 �l -- 504— ---^ -' + 6 Fr4aman.Str68t P a Box 527 l -- �------ --- --I�- Stoughton,MA 02072 VVC JCS 00 01 A(7-11) I,rCWC9S GODYrl9htod matrmal at:ho riativiri Council vn:anpuv m IOSuronro, t:eea..Itn its p9nr101011. iilY 4, � .�s,',-± t :�' ,}{P` I� !'.1 4 1 �FR•e{'ttl�ltf�v'�129t (1!' 7�S!lT,,t'f�Vi(7�}'f Y'f� `� ..3i ,(r', - af C t pcliiutmcnt ul'Public Sdurtix IYl,tssuchuxctt - „ulttttunx ;uul Si ! Bu;u•d of Butldin,.s� ' rvlsor License•, , Construction P nse: 50234. Lice CS - ' �1'i!'il`t�il�,!tfil!�illl�:i�},I •,4�4' ''r'� ` . 568 SANT.V�YiIR, •4511�' :.,iu :'r'.' C� 1� 14iili!t1' `t!;.Ul 71912012 alien: '! c _c ! i Exptr T.4#: 31394 r . •- ' '��✓�e�'IDo?�nrai a�,��4a�tzc� Office of Consumer Affairs&Business Regulation, HOME IMPROVEMENT CONTRACTOR i Registration:,-PIQ5548 Typo; it Expiration, -7/-1.71",2012 DSA i �! VIL GE CRAFT ILDI, G R_II�ODELING Michael Deluga 568 SANTUIT RD. 3t1 _ lr COTUIT MA 02635 Under sccrclnry i , 5,7 Liccn,sg or rF, lstration valid for individul use only ` before the expiration date. If found return to: ` Office of Consumer;Affairs acid Business Regulation 10 Park Plaza-Suite 5170 4, Boston,MA 0211C a 1\ot valid will t signature 4� NAILING SCHEDULE 110 MPH EXPOSURE B WIND ZONE JOINT DESCRIPTION NO. OF COMMON NAILS NO. OF BOX NAILS NAIL SPACING ROOF FRAMING: 2-10d EACH END 2-1166d 3-16d BLOCKING TO RAFTER(TOE NAILED) 2 EACH END RIM BOARD TO RAFTER(END NAILED) WALL FRAMING: 4 16d 5-16d AT JOINTS TOP PLATES AT INTERSECTIONS(FACE NAILED) 2-16 d 2-16d 24"o.c. STUD TO STUD(FACE NAILED) 16d 16d 16"o.c.ALONG EDGES HEADER TO HEADER(FACE NAILED) FLOOR FRAMING: 4-ad 4-1 Od PER JOIST JOIST TO SILL,TOP PLATE OR GIRDER(TOE NAILED) 2 ad 2-1 Od EACH END BLOCKING TO JOISTS(TOE NAILED) 3-16d 4-16d EACH BLOCK BLOCKING TO SILL OR TOP PLATE(TOE NAILED) 3-16d 4-16d EACH JOIST LEDGER STRIP TO BEAM OR GIRDER(FACE NAILED) 3 ad 3-1 Od PER JOIST. JOIST ON LEDGER TO BEAM(TOE NAILED) 3-16d 4-16d PER JOIST BAND JOIST TO JOIST(END NAILED) 2-16d 3-16d PER FOOT BAND JOIST TO SILL OR TOP PLATE(TOE NAILEDO ROOF SHEATHING: WOOD STRUCTURAL PANELS(PLYWOOD), 8d 1Od 6"EDGE/6"FIELD RAFTERS OR TRUSSES SPACED UP TO 16"o.c. ad 10d 4"EDGE/4"FIELD RAFTERS OR TRUSSES SPACED OVER 16"o.c. 8d 10d 6"EDGElS'FIELD GABLE END WALL RAKE OR RAKE TRUSS W/O OVERHANG 8d 1 Od 6"EDGE/6"FIELD GABLE END WALL RAKE OR RAKE TRUSS W/STRUCTURAL OUTLOOKERS 10d 4"EDGE/4"FIELD ad GABLE END WALL RAKE OR RAKE TRUSS W/LOOKOUT BLOCKS CEILING SHEATHING: 5d COOLERS ---- 7"EDGE/10''FIELD GYPSUM WALLBOARD WALL SHEATHING: WOOD STRUCTURAL PANELS (PLYWOOD) 8d 10d 6"EDGE/12"FIELD STUDS SPACED UP TO 24"o.c. 8d 3"EDGE/6"FIELD 1/2"&25/32"FIBERBOARD PANELS 5d COOLERS --- 7"EDGE/101'FIELD 1/2"GYPSUM WALLBOARD FLOOR SHEATHING WOOD STRUCTURAL PANELS (PLYWOOD) 8d 1 Od 6"EDGE/12'FIELD 1"OR LESS THICKNESS 16d 6"EDGE/6"FIELD GREATER THAN 1"THICKNESS 10d 551 O I'05"E as 95.94' APN 2 1 - 1 1 1 4G,97G±5F (CALC) LOCUS 15 ZONED RF613 I- s 0 _ CjF�i9� lJj MOP05ED 6 X 2(7' I COVERED PORCH MG.STONE RTW z r MG.BPJCIC PATIO N GAR STONE OWMAY nj PROPOSED 0 X 14' (D PERGOLA m 2 2' rn 8 No. 89 xy 12 STY. WD. FR. 52.11_ w I s LU O U15TING SEPTIC 5Y5TEM w 0 o I I I i ° !_ 122.20 545'30'22"E IZ-° NARROWS (PRIVATE-50'WIDE) WAY rS I HEREBY CERTIFY THAT, TO THE BEST OF MY KNOWLEDGE, AND IN MY PROFESSIONAL OPINION, THE LOCATION OF THE PROPOSED ADDITION, AS SHOWN HEREON, CONFORMS WITH THE HORIZONTAL SETBACK REQUIREMENTS OF THE ZONING BY-LAW OF THE TOWN OF BARNSTABLE e . SITE PLAN JOB. No::. 121 1 G IN t DATE: OGAPR 12 SCALE: 1" = 40' BARNSTABLE (COTUIT) MA , �A.H OF M�sS PREPARED FOR �o`'� RICHARD�0, EUGENE R. VETO 'HOOD N ' rlchard j. hood, ply No. 35031 �o �r land surveyors - englneer5 N 22 deep wood drive - fore5tdale - ma 02G44 Ph: 506.833.71OO d� P TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i1 r 01 Map 7 Parcel � �• Application # - � Health Division Date Issued 4 Conservation Division Application Fee D Planning Dept. Permit Fee. �s Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address -C�r'rl�V>) 5 Village Owner sir- l J*T Address 21 _��a W axx Telephone - 2Lqv Permit Request i �r Square feet: 1 st floor: existingproposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 31 f9f7j— Construction Type f p Lot Size 11 ❑�r��. F- cs� P Grandfathered: Yes ❑ No If yes, attach supporting documentation.� Dwelling Type: Single Family III,' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 015o On Old King's Highway: ❑Yes &Wo Basement Type: CO7ct Full ❑ Crawl ❑Walkout ❑ Other _ Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) _� � ) Number of Baths: Full: existing_ new _(� Half: existing l new C� Number of Bedrooms: q existing( new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: nc/Gas ❑ Oil ❑ Electric ❑ Other Central Air: b'Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No CD Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: 0�existing '-0 new-size_ Attached garage: Wexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: ,Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes "o If yes, site plan review# ? Current Use f Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)- Name S u-p X::) MA O)c Telephone Number 77 v'l G 7 Address Pay r,_1111 License # LIT E W Dols P Home Improvement Contractor# Worker's Compensation # r7®ACC 385 01 W I 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A LAY SIGNATURE - DATE r' FORiOFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ADDRESS ! ' ` VILLAGE i ! Y OWNER ; i ?DATE OF INSPECTION: FOUNDATION FRAME lelAcic ' INSULATION � a t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING aft �I �//'It<�Q!/1'I� � O!R , 3 DATE CLOSED OUT ASSOCIATION PLAN NO. t . i f ✓he -coo<n�nnancoeallh off'✓(/Caaaczc/z�.�ae%la Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. 1f found return to: Registration .;:1,17610 Type: Office of Consumer Affairs and Business Regulation ? Expiration: 40/25/2012 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 ST EN L. MELLOR F !t STEVEN MELLOR 199 PERCIVAL DR W BARNSTABLE, MA 02668 k Oy Undersecretary Not valid without signature CJ -howin imassachusetts- Dep;irt,mcnt b1'Public Safeh Board of Building= + Re,,ulations and Standards Construction Supervisor License License: CS 49879 Restricted.to: 00 STEVEN L MELLOR 199 PERCIVAL DR W BARNSTABLE, MA 02668 Expiration: 5/22/2010 t UInn l ils iUller Tr#: 26789 156 " 5 2 55 49 M , Lei 1 9 L _,....,__...,.._...,......._....._.... __ __...._ ._._._....... ........ ....._............. ._,... ........__......._.._._..,_._.........,..,._.........._..._,.,_..,._.._._.,_.....__,........ _.. 1714 91 )) 15 ' U i Lf)1 U0 �.� CD LC� i t�7 I UC7 I CD cN 46 " 72_ P' V LTO 82 " 1°0WDFK Rao M The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_ L211C w� a- Address: City/State/Zip:w r Phone #: Z97q9 Are you an employer? Check the appropriate box: i Type of project(required): 1.IZI am a employer with .. 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ;❑ New construction . 2.❑ I am a sole proprietor or partner Misted on the attached sheet. 7. 'remodeling ship and have no employees These sub-contractors have 4 g, ❑ Demolition workingfor me in an capacity. employees and have workers' y p y• 4_ ❑ Building addition [No workers'comp. insurance comp. insurance.t ' 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 13.❑ Other employees. [N6 workers' comp. insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number, I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: ; , Policy#or Self ins.Lic. #: �D �a )a Expiration Date: IeDlO '1 Job Site Address:® tl VCV\1N UJGi.,, City/State/Zip:69&A ,4 Attach a copy of the workers'. compensat=iea 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 yerification. I do hereby cer ' under the pains and penaltiesCoperjurythat-the information provided above is true and correct. Signature: ll Date: Phone#: Official use only. Do not write in this area, to be completed Sy'city or town official City or Town: PermitJLicense# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector. 6. Other Contact Person: Phone#i 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'pemtit 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(ifliecessary) 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 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 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 • BARNS-rAJMF- hUss. Town of Barnstable Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,CBO 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 � f�I ,as Owner of the subject property hereby authorize sy d of Q/� to act on my behalf, in all matters relative to work authorized by this building perrrvt'apphcation for: ' fflll;,K �,Joj� no)L't (Address of Jo ) Signatu of Owner Date Print One If Property Owner is applying for permit,please Complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 5 1 �tHE Town of Barnstable Regulatory Services Thomas F.Geiler,Director BAMSTABLe, t6)9. 0. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILMG 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 wit-lr,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 persons)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. 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Back To Search http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=CSL49879 4/11/2011 . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' I a Map Parcel Application# D ✓Health Division Conservation Division Permit# JTax Collector Date Issued /Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board r1. Historic-OKH Preservation/Hyannis Project Street Address �51 4, Cfz Village / / Owner �,�� ` �� Address Telephonegyp' y O o Permit Request OI c�� r� X. PLC- e- 74 anti 71 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation&d, Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure If 9/ L,,W- Historic House: ❑Yes ANo On Old King's Highway: ❑Yes XNo Basement Type: gFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) p Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 7i new O Half:existing / new O Number of Bedrooms: existing new O Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas J4 Oil ❑Electric ❑Other Central Air: 1(Yes ❑No Fireplaces: Existing New O Existing wood/coal stove: ❑Yes ❑No w f Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new 4s�ze w C Attached garage:;4 existing ❑new size Shed:❑existing ❑new size Other: ► c , Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ _ I Commercial ❑Yes ANo If yes, site plan review# Current Use Proposed Use c BUILDER INFORMATION Name ` 4 ` ��v�1�7�v Telephone Number Address L `� ��V1 z//- `�19' License# O`•�Z �� Home Improvement Contractor# 11_Vi 652 7 Worker's Compensation# &GGSovO11ye/LO0i!r ALL CONSTRUCTION DEBRIS /RESULTING FROM THIS PROJECT WILL BE TAKEN TO ,�G.✓ylJl�yOG� � LS � < // SIGNATURE DATE FOR OFFICIAL USE ONLY ; PERMIT NO. DATE ISSUED f MAP/PARCEL NO. a -ADDRESS - VILLAGE OWNER- DATE OF INSPECTION: j FOUNDATION s FRAME i INSULATION i i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL F f , GAS: EkP%ALkU\!-" FINAL FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. s s Is r I _ C I G ru sl � cn R1 ---- tti r— a N h H I . C9 m I c m o ! .� r I _ .ta 011 - 1� CY cs cn Irl Ti SIZ I•- 0 i -----I I CD i C!k f' I m I W LV OOD PALAC&Kit CHE _NS INC.This. BLOCK ICITCHE N best ed:10J2 - r gn 5f2.00b drawing is an ar tistic rtlStic interpretation ofthe C Printed general appearance of thedesi 1012512t30b G grt.It is not t'AMELA 80LiCI:.CKD r-- ,. i meant to be an exact rendition and is not 1 j dmv6•n to scale. Q I "-" BLOCK FINAL KITCHEN BLOCK TINAL KITCI-tlzN FLOOR PLA142.kit Drawlne 1! l !1 ' `F— C;. R1 n ED c m fI J(71 F-� r. n`i m o Ou CO N i 0.i o m i =L i! CD C-a i m p i WOOD PALACE KITCHE1dS,I1YC.This BLOCK KITCHEN• Designed:1 0/2 512 0 0 6 a drawing is an artibile interpretation ofthe Printed:1 012 5120 0 6 gencral appearance ofthe design.It is nat PAMELA HOLICK,CKD � meant to tie an exact rendition and is not drawn to scale. �+ --- BLOCK FINAL KITCHEN JE OCK FINAL KITCIiEN FLOOR PLAN 2.tcit Dra,�,(no p 1 ro or.: m c � c cn r1J f-- i ~` i N H m ru - - - CO mi - i pz te GN / f M WOOD PALACE KIT!HETIS,IK'C.This I BLOCK KfTC[3EI�I Des{�ted I OJ25/2tlUG drawing is an artisitc interpretation ofthe printed:10/2Sf200G c ger'r-'appearance of the design.It is not PAMSLA I-IOLICCC,CKI] meant to be an exact rendition and is not drawn to scale. c r+ - __ BLOCK FIiVALKITCHEN BLOCK FINAL KITCI-ISNFLOOit PLAT!2.Ocii Di�wln�#: 1 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 Alterations/Renovations $50.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x .0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE G square feet x$64/sq.foot= /S x.0041= , plus Aom below applicable) GARAGES(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee Projcost Rev:063004 oF ,E,° Town of Barnstable ° Regulatory Services Thomas F.Geiler,Director v ••rn�►ss. � E 639, Building Division Tom.Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us )ffice: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction, alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units.or to structures which are adjacent to such residence or building be done by registered contractors,with certain excep eons,along ath other requirements. ( � �T ��"�'�� /��ti" 4 Estimated Cost Type of Work Address of Work: �y /l�� r� Y/s 4 c.y L �ov�-d" `✓� �1 Ti�c3� Owner's Name: �✓ ` ✓ G �G Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law OJob Under$1,000 Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the ent of the owner. Date Contractor Signature Registration No. OR Date Owner's Signature Qw. pMes.fbT=-.homeaffiday Rev: 060606 -C6 Board of Building Regulations One Ashburton Pace, Pm 1301 . Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE „ . Birthdate: 04/06/1957 .Number: CS 01�1243 Expires:04/06/2008 Restricted To: 00 GLENN S MAC IE xlIS= 3 MANNI CIR � 0 1 CENTERVILLE, MA 02632 ' ; r :ter fr, Tr.no: 21107 i Keep top for7ceip•any chan.ge of address notification. { `v i .• DPS-CA1 to 50M 04/05 PC8698 r _, Culu6e _ BOARD QP-BllILDING�t��TfO�IS �� Ncense CONSTRUGFLONSUPER�fISOR `_ Number CS 012243,E ,F i " Birthaat�e�486/1957 k ur i; Eitptres�yd4 2408. 1r:.no 21107 j 1 i . _ Restrjctek�QD� Est: GLENN S 'MACKENZIE z`'f '•, r 3[vFgNNI CER �f✓ C i C EST,ERVILLE `MA 02632?. Comm"ssloner I 1 t 1. .�..� ._f-.. x _ Board of Building R ;ula ions and Standards a One Ashburton Mace - Room 1.301 Boston. Massachusetts''02108 Home ImprovementfF ontractor Registration - Registration 1-A _ _ , Type Parhrtership i Expiration 101C/2007 MACKENZIE BROTHERS WE - GLENN MACKENZIE 214 RT 149 MARSTON MILLS, MA 02648 { . Ey r , , ' '� tlatc Andress and return cti rd. Mark reason for change. ""t Address !` Relic�� 1 yment Lbst Card DPS CA1 is SOM 04/05-PC8698 ✓hie �arr�nw�rurrea� o��/�ac�ucae%ta , � � Board of Building Reulations and Standards Ltcen{e or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR beforF;the expiration date. If found return to.. Registration: 114607 Board of Building Regulations and Standards i. One Ashburton Place Rm 1301 . Expraton 140L6/2007 Bosto.1,Ma.02108 Tjipe. Partnership li MACKENZIE BROTHERS GLENN MACKENZIE / 214 RT 149 — i rf //_/ 00 MARSTON MILLS,MA 02648 Administrator NW-valid without signature Dace: 5/22/2006 Time: 1:45SPM Tv: @ 7,15084201586 Dowling & O'Neil Page: 062-002 Client#: 10642 2MACKENZIEBR DATE(Mf ACORD,. TIFIC TE OF LIABILITY INSURANCE 0$122106DIYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling ES O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St. PO Sox 1990 Hyannis, MA.02601 INSURERS AFFORDING COVERAGE NAIC# INSURED' — -" - INSURER A: Acadia Insurance - MacKenze Brothers,Corp INSURER B: Associated Employers Insurance Compa 214 Roue"149 NSURER Marston'Mills, MA 02645 .-INsfJRERD INSURER E: COVERAGES I 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS:SH'OWNWAY:HAVE BEEN-REDUCED BY PAID CLAIMS. IN SR ADDA -; POCKY EFFECTIVE POLICY'FJCPIRATION' LTR INSR TYPE OF INSURANCE - POLICY'NUMBER DATE IMMICDIYYI DATE(MM/DDIYYI LIMITS A GENERAL LIABILITY CPA005193117 - 05/19/66 051/9/07 EACH OCCURRENCE $1 000 000 COMMERCIAL GENERAL LA DAMAGE TO RENTED BILITY PREMISES Ea ocourrencei $250 00® CLAIMS MADE ED OCCUR - MED EXP(Any one person) $5,000 I - PERSONAL B ADV INJURY $1,000000 GENERAL.AGGREGATE $2 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $2.000,000 POLICY 7 JECT LOC I - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ I ANY AUTO (Ea amident)ALL OWNED AUTOS BODILY INJURY $ SCHEDULED ALTOS - - I lPer person) a 111 HIRED AUTOS .. BODILY INJURY. NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE I$ ". (Per acciderfl i GARAGE LIABILITY _ _ AUTO ONLY-EA ACCIDENT $ ANY AUTO _ EA ACC $ OTHER THAN AUTO ONLY: - AGG $ EXCESSIUMBRELLA LIABILITY •EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE - AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ - - $- B WORKERS COMPENSATION AND -WCC5000664012006 02/04/06 02 O4107, - X ORY LIMITTH- S oER .EMP.LWERS'LIABILITY - .. - E.L.EACH ACCIDENT $500 000 ANY PRO'PRIETORlPARTNERJEXECUTNE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insurance coverage is limited to the terms, conditions, exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. . . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION .i Town Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL. 1 n DAYS WRITTEN i Building Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 200 Main Street: 1 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR . Hyannis Ma U2601• REPRESENTATIVES. AUTHORIZED REPRESENTATIVE r �H� Ct The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston, MA 02111 �c J www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /�e_IKK n 2.C__ gio Address: .Z/y 11 /Y9 � o Z City/State/Zip: ��s �oa //'�/s Phone #: Sdg- VZd- Are you an employer?Check the appropriate box: Type of project(required): rV 1. I am a employer with 4. K I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working fdr 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 I I.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof 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.c 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.Lic.#:,�w//GAS Oo O 6�'/D 1Z BD 6 Expiration Date: 2 /O Job Site Address:_�� /l�� .-mod�•/1 Al c. a e— City/State/Zip:o! vd/,.-01 f 7� 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 under the pains a d penalties of perjury that the information provided above is true and correct Signature: �/ 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 6. Other Contact Person: Phone#: Information and Instructions' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." n MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold theissuance 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-$77-MASSAFE Fax#1617-727-7749 Revised 5-26-05 www.rnass.gQvldia 20 1` X_,,/ CST 1 PMOUTH PAGE 01,'U1 I�t�• �• �Lt4=�F� �9t Er;._ ERhI I,"'d'= •`r'Y; - --- -- d --- DATE WKIDWA'YY) LIABILITYACD-RA, CERTIFICATE OF " 06 20/2006 PRODUCER 508•-398-6033 FAX 509-760-1667 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION insurance Group I ONLY'AND CONFERS NO RIGHTS UPON THE CERTIFICATE Eastern p LrC HOLDER.THIS•CERTIFICATE'DOES NOT AMEND,EXTEND OR 1 A-Cl antic Ave ALTER THE COVERAGE AFFORDED BY THE POU IES BELOW. ' Spy '";armuth MA 02664 � Cynthia Jenks INSURERS AFFORDING COVERACe I�BAIC# j INsumo Richard ] Cook 7r Electricians Inc INSURER A.- Commerce Insurance Company 34754 p 135 West Way INSURERB.- AIM Mutual - Mashpee,. MA..02649 INSURER C: INSURER : E INSURER : COVERAGES THE'POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO'THE-.*SURER NAMED4BflvcFOR:THE POLICY:PERIODINDICATED.NOTWITHSTANDIN ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH%THIS CERTIFICATE MAY BE(SSUr:D 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 D' IypE Of INSURANCE POLICY NUMBER EFFECnlE POLICY (RATION umrm LTR Min GENERAL LIABILITY YY7925 02127/2006 02/27 f 2007 EACH OCCURRENC£ Is 1,000,000. DAMAGE TJ RENTED X conmiERcln1GENERALUABILm r $ 100,000 I CLAIMS MADE ®OCCUR MEOW(Any one person) $ 5,00(9 PERSONAL&AOV INJURY S 1,000,000 GENERAL AGGREGATE $ z. 0..00 000 G£N'L AGGREGATE LIMIT APPLIES PER! PRODUCTS-COMP IOP AGG $ 2,000,000 X POLICY JECT El 4OC i — I AUTOMOBILE LIABILITY COMBINED SINGLE-IUMR- $ I 4m) ANY AUTO (F9 aC'Id (S 1 ALL O'NNED AUTOS '' I BODILY INJURY I$ I St142nuLED AUTOS (Per pemon)� i j I I HIRED AUTOS 8001[Y 1NUURY $ (Per accident) � NON-VANED AUTOS , f3 I P.ROF!ERTY D;.fAAG€ $ (}'nr�c<Iddntl 1 1I i GARAGE LIABILITY 9 AUTO ONLY-EA ACC DENT $ fl I ANY AUTO OTHER THAN EA ACC.( 1 AUTO ONLY: A I I I I EXCESSR"ABRELLA LIABILITY EACH OCCURRENCE OCCUR CLAIMS MAD I r AGGREGATE $ RETENTION $ - $ WORKERS COMPENSATION AND VWC600499401 02/14/2006 02/14/2007 X WC STATUS OER TH, BIMPLOYERS7 LIABILITY ORIGINAL TO FOLLOW FROM ILL.EACH ACCIDENT i 100,000 R ANY PROPRIETOMPARTNER,'EXECUTIVE OFFICERIMEMBER EXCLUDED? CARRIER E.L.DISEASE-EA EMPLOrYEE S 100,000 If unddr SPECIAL PROVISIONS below £•L•DISEASE•POLICY LIMIT S 500,d00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Evidence of Insurance I , CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 0 DAYS WRITTEN NOTICE TO THE CERT[VICATE HOLDER NAMED TO THE LEFT, MaCKenaie 9r05 COCA BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 214 Cotui•t Road OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. I �r5td]n5 Mills,15, MA' f52648 aUTNO REPRESENT 1�9 TIVE l i ACORD 25(2001108) FAX: (508)420-1596 (�� ` t� QACORD CORPORATION 198b. I T3Jdd 98ST08b80S ON8 3IZN3ADUW 2S:tT 9002-20-OT i A 01�°t? ONODIIAM TM CERTIFICATE OF LIABILITY INSURANCE E aATEnamoo li { PRODUCER PhOM:(6W) I'm ( )88t-MMI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ALMEIDA&CARLSON INSURANCE AGENCY INC. ONLY AND CONK NO RIGHTS UPON THE CERTIFICATE. P.O.:BOX 719 HOLDER. THIS'CERTFFICATE DOES NOT AMEND, EXT1:Na OR SANDWICH MA 02668 ALTER THE COVERAeR AFFORDED BY THE POLICIES 6E1.0ft INSURERS AFFORDING COVERAGE mmC i# INSURED INSURER A: SL PaUl TMVeleM3 M K PASIC PLUMBING 8.HEATING INC INSURER B: St.Raul Travelers P o Box an INSURER C: St.Paul Travelers COTUIT MA 026M INSURER D: AMERICAN INTERNJA11ONAL GROUP COVERAGES INSURER E:- THE POLICIES OF INSURANCE"LISTED BELOW HAVE BEEN mourD T'Q THE INSURED NAWD.ABOVE FOR-THE.POLICY PERIOD_INDICATED,NOTWITHSTANDINGANY REQUIREMEPI7, `fEitAlf OR CMITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY TKE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF $IXW P&ILICIE$.AGGREGATE LIMITS SHOWN MAY WAVE BEEN REDUCED BY PAID CLAIMS. ZLT - — TVPEOFIRSURAHCE POUCYRUM13ER POLM EFFECTIVE POIICY_EXP1WIM GENERAL LIABILITY _ 680936H3W 10101101'1 1WO147 EACHOCCURRENCE 's r Or000 X COMMERCIAL GENERAL LIAINIM owwGETORENIM 3 FREnusEe n ocuannos> S 110,040 CLAIMS WE OCCUR MED.EXP(Any aria person) _ $ 61000 A PERSONAL&ADV INJURY 8 1,000,000 LAM E B 2,000.000 OWL AGGREGATE LIMIT PER: PRODUOTS-COMPIOP A3G S 72,®pp. X POLICY JECT LOC 000 AVTOMOOLE L IADUM 810996H4009 101011®6 10101/p7 COMBINED SINGLE LIMIT & 1.000,000 ANY AUTO (Es Q ALL OWNEDAUTOS BODILY INJURY X SCHEDULED AUTOS (Pei pT) $ B x MIUM AUTOS BODILY INJURY $ X NON-QWNED AUTOS (Poi aoclaant) PROPERTY OAtuLAOts $ (Par aael�n0 GARAGE LLMULFTY _ AUTO ONLY-EAACCID'NT $ ANY AUTO OTHER THAN -9AA0Q $ AUTO ONLY: AGG $ 1 IUMBRELLALIABIUT'Y CUP936H3326 1=1106 10101/07 EACH OCCURRENCE s 1A00,000 x OCCUR CLAIMS MADE AGGREGATE + 7 0 DEDUCTIBLE RETENTION 0 _ S WORICERS aGMMPISNSATION AND WC9306154 10101106 40101107 mRviU% oTreR _ ENPLOYERS'LJASILLTY --- p ONYX CUTtVE E.L.EACH ACCIDENT $ SOO OOB N p.y,aaaa4pP unUar E.L.DISEASE-EAt�LOYEE $ 600,000 aPFOAL PW41ORMberovr - E.L.DISEASE-P000Y LIMIT $ 600,000 oTl♦�: DESCRIPTION OF OPERA`rIONS1LOCAT10NSNEHICLES1ExCLUS1 NS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS PLUMBING HEATING AND NVAC CERTIFICATE HOLDER CANCELLATION FA' D ANY Ol'THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS EN NOTICE TO THE CERTIFICATE WOLDER NAMED TO THE LEFT,BUT FAILURE MACKF.NZlE BROTHERS SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE'INSURER. 214 ROUTE 149 ENTs OR REmsENYATnrts. MA►RSTONS MILLS AlBA 048 RIZED REPRESENTATNE Afterltiart: MaureelT Souza ACORD 26(2001=0 Cemoate# 2054 ®ACORD CORPORATION 1988 T/Z:d 9e9T02b80S:01 'OSS0888809 SNI NOS16HO t10I3W-lH:W0NA 9T:bt gnPlp-�,-r)n " Town of Barnstable r, Regulatory Services ' Thomas F.Geiler,Director �pTFD Nay a�e� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 e: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section Tf U-*ing A Bt,;.I der as Owner of the subject property hereby authorize �►�+ /i�`/�L y y�� to act on my behalf, in all matters relative to work authorized by this building permit application for: v //// a2,vI35- (Address of Job) Signature of Owner Date Print Name Q:F0RM5:0W1,ERPERMISSI0N - w 112" 112" � U 27 3/4" 381/8" 461/8" 27 3/4" 381/8" 461/8" IN I I I - N c Ln cab cn C� Cl 7 BATH I' � osmetic I � r-- I 20 O I I I I N BATH � s N � ~`Drw babe ' jj in )rN base'�C m � � - I 3'-71/4' I I � Ln cab F Cq �c eF 26 3-6" 381/4" 47 3/4" ^' 26" 381/4" 47 3/4" x o � EXISTING FLOOR PLAN PROPOSED FLOOR PLAN N p U c ME �. I tea ro c m 1— fU () f_ i tom: 2� m �• N m Ot �^ m f-27$"— --384"—��6B$" .P cs OD c-n ml - - i� 3n V.�000 PALACEIUryCHENS,LLVG. N :p Flo) DAMIQ/26/06 BRUNIHOLICJC.( SCfoFt) O Vl P �' �. SCALE 1/2"-110" cowFc f.LT Mro m ^� BLOCK r ors ' -1 a3o 1 ' Q amac - i © xGi da�lI BUILDEA:MAC1tEF1ZFE BROTHERS _ _ O•pgm�Jb! MkSIER BATH - C] i � p��`�` - OAHINETS EI'.GBASSY � [ri N DOORSTYLE:BI.IDOMMEFMEED O • - i - DRA%VSTYLE:OFtOOKSIDERAISED N' COLOR PEARLONI+tAPLE r C� CABINETS MNISH AT B4•'n M_514.1CROViH6 4V 1 OPEN ABOVE b . CEILINGI1dGFR:931/2'' 1•BAT1ALNFDB _ O r __ ty CO UK7EFYfCPS�NONE EDGE DETAIL- . BACKSPLA51t b t HARDwa4E: u� C.� D DDORS 131-6TID . • s lu DRAYJERS; `��131- O ' n _ k FL.00RiNGType PLAN ACCF.PTE08Y �f ��++C�<�� h . 15) m C r I ro cr) c cs: R1 I— N .r D mm z N U, m mIn « co o m cs, Js C-, R1 � o CO >=a ITi - - siz c� cn t7 c—r m c-} rri .. - k»on fALJkCBwSCfEE)IQtu0."b Et:.etet�4�Dalgaed:�awlwe �` _ * b,.ioysoo,nlr0a fr�t�yrnmcra�r &linrm[P4Er1006 poeHlrpyeunu of Oa drd[r�4:r cl ^� ' �smkb6�a�t:trt m�fiwnmEbnx I'�r ht4o10/�7C. C,w: - BLOCKDA7H fr.00[LP1.JUl,tt Ylkwr t>rtv1�6 F:1 _ N W it'-1 1/4" 11'-1 1/4" �I r�w�Il 281/8" 76 7/8" L 281/4" 281/8" 76 7/8" 281/4" _1 � U I LO - N I \ i � � o o I , ------I A I y KITCHEN I o I I 00 CN o EXI5TING FLOOR PLAN EXI5TING FLOOR PLAN c 4 � c / _p-O' tale• / "='-O' � ��" �yy W I3 I I— L•J C 1 C Ql C m v: n? - — --- - Ti I m e5r1 i XL 9 f/B 85Z9 IT1 �` DBLCif i NO PANEL IiPO WOOD PAEACEKEiCHENS INC. 1--• a ______________ DESIGNEE:PAMALABRLMMOUCICCKDIDPU - 4 I fI I E S DATE:10/xG/4G C I'll m I - >n� i /�i i t,-,Ecm aK SCALE 1f2"o1WY' 3; sail BEP3SJ8G �i HE ^I ARMURABARBARABLOCK 1 89 NAFMOV.S WAY !� m' i mNGzl jm COTUM.MA E— nz O I BULDER MACKEPIDEaROTHE►s _ C7 3 F,� ' 0[[[a1��u 1 CABINETS:SIGNATURE III � -l§�-' 4- x - DOOR STYiE NUL OVERLAYCOLONWL - WU 2 O''� N "PANEL RAISE LOUTS XBE c-t _ aW ®;p ',t x - x FRAMING BEAD:OGEE C"3 4Atltl5 uP-.PRsz &�j"' A r• D� DMAM STYLE:FULL QVERLAYTRRDMONAL m�S aI FINISH INENNvHrTEPAG/f1V/BRUSHED UMBER GLA7'E M -4 ON PAINT GRADE W/26 SHEEN ZfS CABINETS FINISH AT-90"PLUS-9SOUD STOCKS/4X 4X 96 %V/UP$S SSMEDNMCROY.NTOCERING ~ > i � COUNSHEIGEiT_931/2- C-3 A KICK I D� •..Yqq.fla.- xl x maph` ''1 2•BOATTEN Tl4X6X96 �zI L i :TOUCHUPKEf Z"i a� Q E-AEROSOL 'o�j; �i N E-FINT'CFGLAZE - . 1_ v CaUftYERIOPS�NOlf= -COLQR , �B99 1ELLTP 1 01 EDGE OETATL' 1Y/J RQS _i BACKSPLASH: . RE��BACK9" �p 1 �16L9•BS1JM(YBONJ HARDWARE - H DOORS:N r- _ O111 p0 DRAWERS: M ` 1 F14B339DP---- I- $.6 LElE000[tS p -pp - NOTE:2 HOED D FLGORING TYPE: IN 1/2" iVJSf1LID FL114H TOE KICK �ti`�D'1''u'lE 9 ` PLAN ACCEPT BY: �y`-O� •d�8� i REF::HBD b ' 1•SDUD SIYX'.K 314 X G X 96 _ ON PENN BEP2k. k. c BACKffEND e� l�9 PROJE MkM ADDRESS: v i PERMIT# PERMIT DATE W C -7/ ' M/P: LARGE ROLLED PLANS ARE IN: B® SLOT Data entered in MAP S program on.� BY: F a ° ��HeTti Town of Barnstable Regulatory Y for Services HAMSrABg i e Thomas F. Geiler,Director D MAC 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, -, c�v , as Owner of the'subjectTroperty hereby authorize ` / '• to act on my behalf, in all matters relative to wor authorized by this building permit application for; (Address f ob) Signature f Owner Date - U�1 Print N e w If Property Owner,is applying forpermit pleas e;f complete the Homeowners License Exemption Form on the reverse side.- Q:FORMS:OWNERPERMISSION �.t _ r p Assessor's ma and lot number .......... ....... � T E pit tp Sewage Permit number ............................. ........................ Z BARNSTABLE, i ,! � 5 F+' r raea House number �" ' r �FQm a\ TOWN OF BARNSTABLE r BUILDING INSPECTOR /� ' APPLICATION FOR PERMIT TO :.................G`R:.�.... ..............��(.......�?:::�.��.................................................... 7C ...................................................................... TYPE OF CONSTRUCTION ................... ........... '...................19. /1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... ...._..r.. ........... ........-' :...... .. ....................................................... ProposedUse ............. . .J� .............. ....... .............................. ..... ............ .................. .......................... Zoning District ........ ...........................r .�..........Fire District ... .� ............ � Name of Owner(�%V'�..... .....'A...................... .. ....:Address . t / ��. ....... '..... f Name of Builder '..: ..... tr..,lAddress ........C ./.,a !'�„ .. 7 Name of Architect .............. .5�f.-:.............................Address .................. I GS................. Number of Rooms .. �-�f ......,............... ......................................Foundation ..........�...................................,................................ i �/�2- ......Roofing fir% Exterior ..........:..�.... ..—.................................. ...............+......... . ...........,......................................... Floors .....1;;F! 1z'V,,,•,•............... .........e...............................Interior .........:. / .....'.`... !•.!7.``...:.................................... Heating ........................Plumbing .................. ............... .... Fireplace ................... G:.. ..-.-............................... ..........Approximate. Cost ............. ' ..'�-�.d ........� ........... Definitive Plan Approved by Planning Board __ -_ & ------19--------. Area ........................................... ; Diagram of Lot and Building with Dimensions Fee ...........r�.................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH r� 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 .................................... BERMAN, EDWARD G. A=21-11.1 No 3 4 21.6... Permit for .... 2'....5.t;.Q ry........... ............Si.ngjg...Emily...Dve.Uing........ Location ......Lot...................................................#23 & 23A rrows Wa Y Cotuit ............................................................................... Owner ........Ed.w.ar.d...G.... er.m.an................ .... .. .... .. .. . .. .... .. ..... Type of Construction ..F.ra.................................me .. .... ................................................................................. Plot ............................ Lot ................................ Permit Granted ... ...1.8 ..............19 91 Date of Inspection ....................................19 Date Completed ......................................19 1 i ••j/(� Y ' w �4 1.- '. ��•®� I _ t �!'�4 j -�t Assessor's,map and lot number ......... y, ::... a —� + " E TO e qq C�l • Sewage Permit number ....................................... y. House number ..... �:Y .. � f /S .... .... J .- t �SEPTICSY'STEMMUS 4DLE 79 • ' �. .., INSTALLED IN COIIAPLI TOWN OF -.:BARNCC „¢ �E�II�=LCODEAND TOWN RECULATACNS;a OU 1.L D"I N G .IN'SP;ECT{OR APPLICATION 'FOR PERMIT TO ...................... .......... . ............... . TYPE OF CONSTRUCTION ...4...Grp/ .i ..... it.l""" .... y x ` ..................19.. � -TO THE INSPECTOR OF BUILDINGS:' . The undersigned h reby applies for a permit according to,"the following i rm•tion c ...... .....� .................., . ...'..... .. Location ....d�Gt: .............................p��%`:�................ ... . ..... Proposed Use ............. . st .... :.. ......... .......... ............. k Zoning District ........... ` ... .......... .. Fire District ...... 6 ............................... ..Zo g s ..�... _ - Name of Owner. ./..Y.... f Builder ��!`4 �` �"'�- .Ad� .... /lf'tt�e .� o / . Name o � ............. ...... ... Name of Architect .......:.......6. ..VxAn-f-...... .................. Address ......... .............. ........-...... :.............. Number of Rooms ...... ......7..:.. :.........Foundation :........ ........................ Exterior `....... .....................................................Roofing ................. ..... . ... Floors ............... ........:.........Interior .......... ............................................................ ................ ........... ' .... - ........ x Heating .s�v Plumbing i 4. r'_........... ......... . .......' ......... ....... ........... ... ...................... :� .. .Fireplace ........... ... ...... Approximate Cost ....................... Definitive Plan Approved by Planning Board _ _ t 19--------• .. Area ., ..°.��..��..�.......:..... Diagram of Lot and Building with Dimensions Fee ` ...... ... ... SUBJECT TO APPROVAL OF BOARD OF HEALTH - - aixs .� 1:2 . Y r - ' - r • , 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. ' t t• Name .... ...... . -Construction Supervisor's License .........'../UrU .........� BERMAN, EDWARD G•. No 342s6 Permit for-J!...Sto ry,............ ............. Location ....Lot #2 3- & 23A,.... 9 Narrows Way ....................Otu•lt.... :.................. r Owner .. .•Edward G Berman. �...:...... ` - .... 'Type of Constructions. Fr........................................ ,r ........................... ...... . .... ............. t i �. Plot ......`........:......... Lot {'. r r ' Permit Granted '� March 18,,•• ••••••••lq �1 . s- Date•of Inspection .�. .3. 1 .....r1,9f + =Date-pleted 41)- ..... .••"l q - ti ^L7 .-� c " � .w`mob .. - • t - rw�=` sa} �r-lYi -. - _ ` ter .• ' .. � �'.. _•+ _ _. _ _ it - � � - � , a � ,}li4 ; �/lEE7` 'Z .of� � . . •: �, n�fiN. SOD 71 rg ram' si1.n h St1LL 1/r1N 1 fdo. 29733 J " �Ja lii '4l 1 TOWN OF BARNSTABLE Permit No. . 3 .16 BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ........... N� "�tor►r+ HYANNIS.MASS.02601 Bond X �7U CERTIFICATE OF USE AND OCCUPANCY Issued to Edward G. Berman Address Lot #23 .& 23A, 89 Narrows Way Cotuit, Mass USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE.,VALID, AND THE BUILDING SHALL,NOT``BE OCCUPIED UNTIL SIGNED BY THE BUILD ING..INSPECTOR'UPON SA TISFACTORY;`COMPLIANCE'..WITR TOWN: REQUIREMENTS"AND IN ACCORDANCE WITH SECTION 1190 OF THE MASSACHUSETTS'STATE BUILDING CODE SeP temb&r ,20 91 .... I9 . Bull dirig Inspector •�1, � .. .., � � i ft R,t} — � ..- - .. ,. hI rt.•..T.,`,j.�^ e ,. ' E . '� 4-e - - ��P�o '°•\.w TOWN OF BARNSTABLE BUILDING DEPARTMENT t saBasT : TOWN OFFICE BUILDING MYt t639• �� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department /77 DATE: a An Occupancy Permit has been issued?'fci • the building authorized by Building Permit $�. ....� :!_. /.... .. ...................................................... .r...... ... issued to ............ �L... ... w� � f�� ... . _ ... _ ._... . . »_ V f Please release the performance bond. A I, ,..... r ..•5^........... „T,-tom,_„ i rsTOWN OF BARNSTABLE MASSACHUSETTS BUILDING" A=i21-111 TERM ., DATE :11ar L:h 18 �{� f.� APPLICANT Archibald R�ia;.V j/ Trtt�L' � I�1 PERMIT'NO �• y r (�,a':•' rr ADDRESS Parker RUad Octerville #0189_ •:'. a INO.1 (STREET) $ UCEr (CONTR c ,'•' PERMIT TO Build vWE:l 111:(' c J ''(I , �--� 1 sTonv��•IlCI FaInily UWL?j]•111�f NUMBE NG UNITS '. .,,,. (TYPE Of IMPROVEMENT) , 1PRO105E0 USE) fy�wi'r,;: AT (LOCATION)LOt #�23 & 2aAP 89 Narrows Wz.Lv Cotuit zoNl �' : .two.) (STREET) DISTRICT 6i. gyy)41..••: BETWEEN' F , tt, AND 1 Cr;:,,.•. ,1�'. (CROSS STREET) - °++`•'"�'•,�.�,,-;')! - (CROSS STREET) SUBDIVISION LOT '. LOT BLOCK —SIZE ('�• BUILDING IS TO BE FT, (VIDE BY FT, LONG BY -FT, IN HEIGHT AND SHALL CONFORM 1N CON57RU TO TYPE USE GROUP YL BASEMENT WALLS OR FOUNDATION' .:I REMARKS: Sewage lt�a Y91_33 � (TYPE) , b+r Bond r !r.l,- " J AREA OR 'y� VOLUME 21685 :i(�• rf: 225, 000.00 (CUBIC/SQUARE FEET) ESTIMATED COST $ 4. 75 FEEM17 18 Edward G: t3c:r1(,s:1 OWNER �— �. tS:,F,�* Mrlr ADDRESS t: 04/3; ii_t' / >Cul BUILDING DEPT. BY 1 . 1 I ) i'b ie+ '•THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, A + 1+'�+( PERMANENTLY, ENCROACHMENTS.ON PUBLIC PROPERTY, NOT L SPECIFICALLY pL SIDEWALK ANY PART THEREOF, EITHER*TEMPORARIL lid rL i+_I -PROVED JURISDICTION: STItEET OR ALLEY GRADES AS WELL AS OEPTHEAND TLOCAT ONEOFTPUBB I SEWERS MAY BI FROM THE DEPARTMENT OF PU9LIRESWORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE.CONDIt 1 1 11 OF ANY-APPLICABLE SUBDIVISION R=STRICTIONS. S MAY BE OBTA i I}. I'll+ j�,r} •:MINIMUM OF THREE CALL INSPECTION'S REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APpLICABL:E SEPgRA' .,.ALI CONSTRUCTION.WORKt CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN E `REQUIRED FC I ;- n T PERMITS' AR .••�,t IJ1' 0'.1. ' I• FOUNDATIONS OR FOOTINGS. MADE. WHERE A,CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. °C+'1�I'•1;°�t,1�;: 1;' 2. PRIOR TO COVERING STRUCTURAL ELECTRI C.A L. PLUMBING. AN (�'�'+t'i MEMBER ('READY TO LATH). OUIRED,SUCH BUILDING SHALL NOT OCCUPIED UNTIL �i.i.:.9. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE, OCCUPANCY. POST THIS CARD SO 1T IS VISIBLE FROM 'STREET' .. '�Y�l:;t;i;4 >��+r{' '',• BUILDING INSPECTIO LS N APPROVA I:'.•,,'; !Nr� PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS' " � / J ,1 ipla.. IVEATING INSPECTION APPROVAI x ENGINEERING DEPARTMENT j2 BOARD OF HEALT OTHER SITE PLAN REVIEW APPROVAL ' Y � al .111 WORK SHALL NOT PROCEED UNTIL THE INSPEC PERMIT W; ECME TOR HAS APPROVED THE VARIODUS F.7Ac;LS OF WORK IS NOT LL 5 AROTEO'4 FHINNSDIXVOID IF MONTHS OF INSPE CONSTRUCTIONION OATE T CONSTRUCTION, PERMIT 1$ ISSUED AS-NOTED" ABOVE. RE CTIONS INDICATED ON THIS CARD C/ ARRANGED FOR BY TELEPHONE Oil Wm NOTIFICATION. r - - — - - - --- --- x, vy' 1 - h 00 z SIX s-s 5 ' 71. It 1-r,o t � 1 :c�� I� _t - u. 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