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Home My WebLink About0116 OLD KINGS ROAD 1 (� Old killer s -&., i Elie lip - Town of Barnstable *Permit# l o Building Department ee zmonth from issue date BARNSTABIA ® + tl�Blrian Florence,CBO 0t- --N `0� Building Commissioner 15 2 00 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4�0 ��NI�1 ��t' ��t�iuSjABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 Z Z - Property Address JM 41 dt"�&47t2 [Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ,��—� Out k+ntilo& & 9�o 6n; Li Contractor's Name �a,Zi� 17fa V ,��P Lt,[ Telephone Number Home Improvement Contractor License#(if applicable) 7Y�� Email: A� p Construction Supervisor's License#.(if applicable) Workman's Compensation Insurance ' Check one: ❑ I am a sole proprietor ❑ Lam the Homeowner I have Worker's Compensation Insurance Insurance Company NameTjLi�L Workman's Comp.Policy# 2 Oo Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) [e-side Replacement Windows/doors/sliders.U-Value - ZV' (maximum.32)#of windows c7 #of doors: *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 opy of the Home Improvement Contractors License&Construction Supervisors License is aired. SIGNATURE: C:\Users\decol likW ppData\Local\Microsoft\W indows\fNetCache\Content.Outlook\9NNOKXYW\RESIDENTILONLYEXPRESS.doc 09/26/17 ` AC�c CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD"YYY) 12/20/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANDS CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 CONTACT NAME: Donna OstrowSkl Mark Sylvia Insurance Agency,LLC I 404 Main Street PHONr o E : 508 957-2125 I IAAic .t No): 508 957-2781 E-MAIL ADDRESS:mark marks Iviainsurance.com Centerville, MA 02632 INSURER(S)AFFORDING COVERAGE NAIC9 wsuRER A:Farm Family Casualty Insurance INSURED INSURER B: - Complete Home Group LLC. t 770 B1 Main Street INSURERC: Osterville,MA 02655 INSURERD: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: I 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 BYjTHE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP - LTRVGEN'L TYPE OF INSURANCE POUCYNUMBER MM/DDNYYY MM/DDIYYYY LIMITS A MMERCIAL GENERAL LIABILITY 2001L6914 12/4/2017 12/4/2018 EACH OCCURRENCE S 1,000,000 CLAIMS-MADE X�OCCUR _ DAMAGE TO RENTED PREMISES Ea occurrence S 100,000 MED EXP(Any one person) S 5,000 PERSONAL BADVINJURY S 1,000,000 GREGATELIMITAPPLIESPER: GENERALAGGREGATE $ 2,000,000 ICY JECT LOC PRODUCTS-COMP/OPAGG S 2,000,000 ER: 5 A .AUTOMOBILEuaewrY 200105913 2/11/2017 2/11/2018 COMBINEDswGLEUMrr 5. 1,000,000 Ea accident ANY AUTO - BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY Per accident 5 AUTOS ONLY X AUTOS - ( ) HIRED NON-OWNED M PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident 5 S UMBRELLA LIAR - - I OCCUR EACH OCCURRENCE 5 t EXCESS LIAB CLAIMS-MADE AGGREGATE S DED RETENTIONS $ A WORKERS COMPENSATION 2001W8025 3/23/2017 3/23/2018 X STATUTE ERH AND EMPLOYERS'LIABILITY - Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT 5 1,000,000 OFFICER/MEMBER EXCLUDED? FY] NIA (Mandatory in NH) E.L DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ - 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) General Contractor 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. , i . CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable Town Department ACCORDANCE WITH THE POLICY PROVISIONS. Buildi200 Main Street , Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE I � • ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD it n Commonwealth of Massachusetts - y icensurO Division of Pesssional Land Standards Board of BuildingRegulation.,;,�.,. rvisor Constrriuct�rt SbP9 12/22/2019 EXpires; y - CS-0943 2 _ ADAM HOSTETTER 1 A • ',- 77061 MAIN ST 02655 ,,� • OSTERVILLE MAps � .� Commissioner .. ' _ ��r• t/�n rrr irrnirrnrrr�l�c�n!'l rrJJric�rr9r•//J I I . •..Office of Consumer Affairs&Business Regulation i License or registration valid for individul use only -HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 1 Registration: 178455 Type: Office of Consumer Affairs and Business Regulation y Expiration.:-...4/.16/20.18 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 COMPLETE HOME GRQUP LLC.y'., ADAM HOSTETTER; 770 ALMAIN ST .c •,_ _'=�..a-- I OSTERVILLE, MA 02655 Undersecretary Not valid without signature F i `'Ire Corr nonweaalth of Massac iusetts - Departxawit of Indusoial Accidews Df ce of I,nw gations 600 Washington,Str eet s Boston,.MA 02111 vvirvl7J rnasmgov/dia Workers' Compensation Insurance Affidavit. BuildersJContractor lectriciansiPlumbers Applicant Informatian Please Print Legibly Name(B e�gan zaSionandi,Till) � Address: "bb City/Stat&Zip: Phone-9 Z Are you an employer?Check the appropriate box: Type T}p e of project(r equired): 1.D I�m a employer with i L4- ❑ I amageneralcmntractoranlI 6. ❑New con.struction employees(full and/or part-time)-* have/tired the sub-cofactors I❑ I am a sole proprietor or partner listed on the attached sheet. 7- ❑Remodeling strip and have no employees Theme sub-contractors have g_ ❑Demolition. working forme in any capacity- employees and have worlmrs' 9. ❑Building addition No workers'comp.insurance: comp-insurance 1 rewired.] 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 mayself. [No workers'comp- right of exemption per MGL 12-[_1 Roof repairs insurance rewired.]1 c, 152, §1(4�and we have no employees.[No Wofkers' 131_1 Other comp-insurance required_] •Amy applicwt that checks Eton f1 nmst also fill out the section bela.v sbowmg th&workers`compenszf n pahcy mformatitm- i Homeowzws who submit this affidavit ima6k=Z they are doing all work and than hire outsi contractors mast submit a now affedamt ia&caun sach- +C'outractoas that t.hak this boric must attached m additional sheet showing the name of the sub-contucturs and state whether or not those eutitie,have eamployees. If the sub-contractoss bane ermplo-1ees,they u=pmvide their wurkers'comp.pGhcp nuunber- I aln an einpWer that is proW&ug workers'coca rsafion:fimira c-4 my.errrpwees.. Below is tare policy arzd job site in,forrnadon. Insurance.Company Name: l Policy#or Self ins.Lie.ft: 2010 �b ZS� Expiration Date: Job Site Address: 1/b OLel:> City/State/zip: �o,r� Q 5- 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 ingrisonment,as well as civil penalties in the form of a.STOP WORK ORDER:and a f ne of up to S250-00 a day against the violator. Be advised that a copy of this statement may be forwarded too the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify ides the pains d penalties o,f pednry that the i foratation protdefed above is tnw and correct Si tune: Date: Z Phone Offi dal use ants. Do not write in this area,to be completed kv city of town vfrCia£ (City or Town: PermitUcense# 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#: I . oFTME o� * BAMSfABM • ' Town of Barnstable Building Department Brian Florence,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 as Owner of the subject property 6, 13i ^ � hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signal of Owner Date M�l D I W Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollikWppData\Local\Microsoft\Windows\INetCache\Content.Outlook\9NNOKXYW\RESIDENTILONLYEXPRESS.doc 09/26/17 y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION li✓ Map Parcel Application ' Health Division Date Issued I Conservation Division Application Fee Planning Dept. Permit Fee V>3 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis C� Project Street Address 11b old kfti9s 1?d ��'� M,4 a 1-(g3s- Village Cokvi�' Owner Address 11 to.UId 6,, 19 itd M . 03-4, S- Telephone 17--841-103 Permit Request ,ky-St.1,M. G21,, 41�. ►�uh� a,. h k�a�� tird t- �,�,1� ta� "'1� 45 !0-1 U�7 6, C.lbJ�aYlata- ?it Gd� 2 ^S o4 l� Ci mac✓1 SpdGC V�0 s�I(S r�`ai 61 h 64,h Square feet: 1 st or: isting proposed 2nd floor: existing .proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatiot Q01 3 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other ��gg�� Basement Finished Area (sq.ft.) Basement�Unflnishle�AQgrsc..ft) Number of Baths: Full: existing new Hapff t,492w—new Number of Bedrooms: existing —new TOWN OF BARNSTABLE Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other 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 -R41&J U yin Telephone Number Address Q1,0 bra, St License # &LI A Home Improvement Contractor# I gb?y Email �le'soh r ��n�u(��e2s�-e, Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 10$o Air aad I-d F-Xit R r,...r Z L 2)-p SIGNATURE �� /� DATE Ys&-7 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. • i DEBRIS FORM In accordance with the provisions of MGL c,40,s.54,a conditlonrof Building Permit Number is that the debris resulting from this work shall be disposed of in`a property licensed solid waste disposal facility as defined by MGL c. 111,s. 150A. This Debris will-be disposed of in: Republic Services Dum ster:. 1080 Airport Rd Fall River, MA 02720 (LOCATION OF FACILITY) Signature of Permit Applicant Date IF DUMPSTER IS USED IN EXCESS OF SIX (6) CUBIC YARDS A PERMIT'FROM THE FIRE DEPARTMENT 1S REQUIRED FOR COMMERCIAL,INDUSTRIAL,INSTITUTIONAL AND MULTI-FAMILY RESIDENTIAL OVER;20 UNITS DEMO, RENOVATIONS OR ALTERATIONS OF THE EXISTING BUILDING > CIRCLE ONE 4*,H VE YOU:SUBMITTED THE A 06 NOTIFICATIO TO THE MAS AC US S DE;? YES NO r The Commonwealth of Massachusetts x Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-201.7 www mass.gov1dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE I'IL'ED WITH THE PERMIYrING AUTF1012ITy. Applicant Information Please Print Legibly Name(Business/Organization[Individual): Insulate2Save Inc. Address: 410 Grove Street City/State/Zip: Fall River MA 02720 Phone#: 508-567-6706 Are you an employer?Check the appropriate box: .Type of project(required): I.E]I am a employer with 20 employees(full and/orpart-time).• 7. New construction 2.❑f am a sole proprietor or partnership.and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] 3.[J I am a homeowner doing all work.myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 n Building addition 'I. I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.Q Electrical repairs or.additions proprietors with no employees. 12. Plumbing repairs or additions 5. t am a general contractor and I have hired the sub-contractors Fisted on the attached sheet. ❑ 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.[ 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[Other Insulation 152,§l(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information, e 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. l am art employer that is provirling►vorkers'Compensation insurance ftrr my einployees Below is the polley and jah site information. Insurance Company Name: Liberty Mutual Insurance Policy#or Self-ins.Lic.#: XWS 564.18741 Expiration Date: 12/10/2017 '� Job Site Address: (P� �n�nS City/State/Zip: CAIA hA_ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).. Failure to secure coverage as required under MGL c. 152,y§25A is a criminal violation punishable by a fine up to S1,500.00 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I tto hereby certify under the rt' s an yen tie's of perjury that the information provided above is trite and correet. Signature: ' Date: to 7 Phone#: 508-567-6706 Official use only. Do not write in this area,to be completer)by city or town officiaL City or Town: PermitlLicense# 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#: -- Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, e"1k Massaghusetts 02116 Home Improvem tractor Registration Type: Corporation Registration: 180747 INSULATE 2 SAVE , INC. w Expiration: 12/28/2018 410 Grove St ' Fallriver, MA 02720 Update Address and return card. Mark reason for change. 'CA 1 w 20M•05111 - __.�._____._..__..�__.._.___. �._:.T(�.A_ddr��s�'Ftenewal � Em {o mant '[�'LostCard C✓Jt�a LDryr�mrfvtau.�trlf�� d:fe�c�u�acsl�3. Office of Consumer Affairs&Business Regulation _ HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only ;; TYPE-'Corporation before the expiration date. If found return to: . $- Office of Consumer Affairs and Business Regulation expiration 10 Park Plaza-Suite 5170 1 i, w 1807 rr, 12/28/2018 Boston,MA 02116 INSULATE 2 SAVE (NG �f, Roland LangevinraF .0071 410 Grove St Fallriver,MA 02720 , Undersecretary Not valid without signature Conmonweatth`of Massachusetts . Division of Professional Licensure I -'t Board of Building Regulations and Standards Con �;}'"ti " �r�viscst CS-103861' ' * Epres 08/24I2019 ROLAND LANGEV NI 56'I IGHCRES I R011D a ' FALL RIVER MA>0,2720 -` Commissioner rt A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/1D2 8 ,16 16.� ii THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPOWTHE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Anthony F. Cordeiro Insurance PHONE FAX 171 Pleasant Street 1AIC,IN. (508) 677-0407 / No: (508) 677-0409 E-MAILIL ADDRESS: hsouza@cordeiroinsurance.com Fall River, MA 02721 INSURE S AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance INSURED INSURER B: Insulate 2 Save, Inc. INSURERC: 410 Grove St. INSURER D: Fall River, MA 02720 INSURERE: 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. rA ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE IN R D POUCYNUMBER MM/DD/Y MM/DD/YYYY LIMITS GENERAL LIABILITY Y Y BKS 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES rr E occurrence)ce $ 300 000 CLAIMSTNADE Fx—]OCCUR ME EXP(Anyone person) $ 5 000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APP LIES PE R PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABIUTY Y Y $AA 56418741 12/10/16 12/10/17 EOtt�16�NIDtSINGLELIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED I PROPERTY DAMAGE $ X HIREDAUTOS X AUTOS Peraccident $ A X1 UMBRELLALIAB I X OCCUR Y Y USO 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 2,000,'000 EXCESSLIAB CLAIMS-MADE AGGREGATE $ 10,000 DED RETENTION$ $ A WORKERS COMPENSATION XWS 56418741 12/10/16 12/10/17 X WCSTATU- OTH AND EMPLOYERS'LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLLAED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yyes,describe under _ DESCRIPTIONOF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is requ red) "For Insurance Purposes Only" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELJVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: DocuSign Envelope ID:62AAF256=ADE9-4544-829B-OE64E2FE24BD RISE Engineering RIS E 5 Dupont Avenue,South Yarmouth,MA 02664 ENGINEERING CONTRACT 508-568-1926 X-6610 FAX 508-568-1933 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CLC-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT# WORK ORDER COREY JOHNSON (617)869-2613 10/02/2017 197099 03603 SERVICE STREET BILLING STREET 116 Old Kings Road 116 Old Kings Road SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP Cotuit,MA 02635 Cotuit,MA 02635 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed $320.00 in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (4)working hours. A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed $320.00 in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (4)working hours. A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. AIR SEALING:Provide labor and materials to install Q-Ion weatherstripping and a doorsweep to(1)door(s)to restrict air leakage. $80.00 REPOSITION EXISTING INSULATION:Temporarily re-position(224)square feet of existing insulation in the kneewall slopes to $56.00 allow installation of weatherization work. KNEEWALL SLOPE:Provide labor and materials to install 2"rigid board with the required fire rating to(250)square feet of kneewall $962.50 rafter area. VENTILATION:Provide labor and materials to install ventilation chutes in(24)rafter bays to maintain air flow. $83.76 Provide labor and materials to install(486)square feet of 10 ml polyethylene over open ground in designated crawlspace/earthen $471.42 basement areas. CRAWLSPACE:Provide labor and materials to install (425)square feet of 2"rigid board with the required fire rating to the crawlspace $1,721.25 perimeter wall up to the sill and against the band joist. CRAWLSPACE:Provide labor and materials to insulate(1) back of the crawlspace door with 2"rigid Thermax board,and seal the edge $60.00 of the hatch with weatherstripping. DocuSign Envelope ID:62AAF256-ADE9A544-829B-OE64E2FE24BD RISE Engineering RI S E 5 Dupont Avenue,South Yarmouth,MA 02664 ENGINEERING CONTRACT 508-568-1926 X-6610 FAX 508-568-1933 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CLC-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT# WORK ORDER COREY JOHNSON (617)869-2613 10/02/2011 197099 03603 SERVICE STREET BILLING STREET 116 Old Kings Road 116 Old Kings Road SERVICE CRY,STATE,ZIP BILLING CITY,STATE,ZIP Cotuit,MA 02635 Cotuit,MA 02635 JOB DESCRIPTION YOUR INCENTIVE EXPLAINED: RISE Engineering will apply all applicable,eligible incentives and you will be billed only the net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$4,000 per calendar year,and an incentive of 100%for the Air Seating measures. LIMITED TIME SPECIAL INCENTIVE: The Cape Light Compact will waive the$4,000 limit towards the weatherization work. RISE will reduce your cost by 75%on all the weatherization work outlined in this proposal.This special incentive is available to homeowners who sign their weatherization proposal before December 31,2017 and submit to RISE by January 8,2018. i i Total: $4,074.93 Program Incentive: $3,312.05 Customer Total: $762.88 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF 'Seven Hundred Sixty-Two &88/100 Dollars $762.88 ON FINAL INSPECTION AND PROVAL BY RI GINEERING.CUSTO R AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY D BALANCE AFTER 3 EE R E FOR IMPORTANT INF MATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. Z i ned RISE REPRESENTATIVE LD0,C'USi: g1 401 10/6/2017 8:56 AM EDT NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT XECUTED WITHI DATE OF ACCEPTANCE SIGN DATE 30 DAYS ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE r DocuSign Envelope ID:62AAF250-ADE9-4544-829B-OE64E2FE24BD of 1HE To Town of Barnstable Regulatory Services BAiNSTABLE, Richard V. Scali,Director 9 MASS. a ao 1� 9. - ,,� Building Division Paul Roma 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 I, COREY JOHNSON , as Owner of the subject property hereby authorize Insulate to Save to act on my behalf, in all matters relative to work authorized by this building permit application for: 116 Old Kings Road Cotuit, MA 02635 (Address of Job) J^D�ocuuSSiggnedby: 10/6/2017 1 8:56 AM EDT ---"-3479F7DFEOBE401-:: Signature of Owner Date corey johnson -,PrintName If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. C:\Users\decollikWppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2):doc 01/25/17 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel y Application 4X Health Division O�z Date Issued Conservation Division Q Applicatio Planning Dept. rp t Permit Fee Date Definitive Plan Approved by Planning Board Ord Historic -•OKH Preservation/ Hyannis Project Street Address Village Owner Cb��, -Tol-tt-g 6yo Address G t Telephone Permit Request f wm (eJlkLe eA1JA:1tJ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2,5' i,000 Construction Type W Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family &f Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: AFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft) ��1� Basement Unfinished Area (sq.ft) 2-0 Number of Baths: Full: existing i new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas 0 Oil ❑ Electric L]Other Central Air: UYes ❑ No Fireplaces: Existing 2i New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage:)O existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 'ANo If yes, site plan review# Current Use �J`�S I Ak XfiL Proposed Use ._ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name AONV\ kta Telephone Number Address �70 54 ` License# f ` �� 0 ?Z oSk° �'�� Home Improvement Contractor# qe Email �-��"^ k`')4 A- Worker's Compensation # u 0 i W 6 Q 2 5, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Crdokew— SIGNATURE DATE t FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT. ASSOCIATION PLAN NO. SHEY, Town of Barnstable Regulatory Services BAMSTST&BLE, • Richard V.Scali,Director Building Division EQ MA'S� 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 l (Ve ?v nrS0r'/ as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: 6 0a,� ryas 07v►T- (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final spections'are performed and accepted. Signa e of Owner Signature of Applicant C04-�(Y. AbAi4q Print Nkne o Print Name Date - — . - The=Commonwealth-.ofMassachusetts— _ Deparbnent 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/Orooanization/IndMdual): D� Address: T70 - ,rv1tb N S� City/State/Zip: 6 k_ /__V7/A �' % Phone#: -2-7y' Ore you an employer?Check the.appropriate box: Type of project(required); 1.(� I am a employer with 7il' 4• [� I�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- listed on,the attached sheet. 7; X'Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity, employees and have workers' [No workers'comp.insurance comp. insurance., 9• ❑Building addition required.] 5. 0 We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work 1 officers have exercised their M❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.[] Roof repairs insurance required.]t C. 152, §1(4), and we have no employees. [No workers' 13.0 Other " 5 comn. insurance required.] 'Any applicant that checks box#I 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide.their workers'comp.policy oli 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: F&r►'✓b 1k, � Policy#or Self-ins. Lic.#: Zoo l (/1/ Expiration Date: 3IZ 3 Job Site Address:_ / D�/A N 65 t'V City/State/Zip: (1AA1I 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 S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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. .rdo hereby certify under a pains and penalties of perjury that the information provided abo cis rue and correct Silmature: //11 Dater t hone m: U �U 2V Flofjfilcialluse only. Do not write in this area, to be completed by city or town official own; Permit/Licenseuthority(circle one): • i L6. Board of Health 2.Building Department 3. Cityllow-n Clerk 4.Electrical Inspector S.Plumbing Inspector j Other ntact Person: Phone r; I i C /�r 0iniii0/1114- 1111 c C-, rrrt:uc-rr:Jr//.f / License or registration valid for individul use only Office of Consumer Affairs&Business Regulation i g y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: Office of Consumer Affairs and Business Regulation 9 178455 Type: g ' 10 Park Plaza-Suite 5170 Expiration.: :..4/.16=18 LLC' Boston,MA 02116 COMPLETE HOME GROUP LL�C,_..:1 ADAM HOSTETTER 770 ALMAIN ST r OSTERVILLE,MA 02655 Undersecretary Not valid without signature l . k * n Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-094302 �- Construction Supervisor ADAM HOSTETTER 770B1 MAIN ST r'- OSTERVILLE MA 02656 Expiration:, Commissioner 12/22/2017 L— f 03/31/2017 14:42 5089572781 MARK SYLVIA INS AGCY PAGE 01/01 ACC>pQD 64 ,., - CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmYY) THIS CERTIFICATE IS 133UE0 A3 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.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 p011cY0e9)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 ri hts to the certificate holder in Ilea of such endorsements. PRODUCER Mark Sylvia Insurance Agency,l lC �°+Me�cTKris Ko reski 404 Main Street PHONE FAX tr4 M FaX )• 508 967.2125 1� ND• 508 957-2781 Centerville. MA 02632 '. moo. Ress;mark marks Iviainsurance.com INSURER S A. ) FFOROING COVERAGE NAIC M INSURED INSURERA:r d"Family CaSUBIIY Insurance Complete Home Groap LLC INGUReR 9: 770 B1 Main Street INSURERC: Osterville,MA 02655 INSURER D: INSURER E: COVERAGES I CERTIFICATE NUMBER: Nsu F; TH15 IS TO CERTIFY TSION NUER: HAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSEDENAIMED A OVER OR THE POLICY PERIOD INDICATED• WI NOTTF UED 70 THE INSUR ISTANOING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY DE 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 SEEN REDUCED 8Y pglD CLAIMS. INSR A BR �—LTR TYPE OF INSURANCE POLI Y POLICY HX A COMMERCIALOENERALLIASILITY PDUCYNUM6ER /YYYY MIDDI -X 2001Lfi914 12/4/2016 12/4/ 17 uMITs CI,AIMS•MADE T OCCUR EACH OCCURRENCE S 1,000,000_ P MISES(Ea Dcaurrent E 100,000 MED EXP(An v ano parson) 3 5,000 GF,MLAGGRF,GATELIMITAPI�PLIESPER! PERSONALS ADV INJURY 9 1,000,000 X POLICY iUT L—J LOC ' GENERAL AGGREGATE S 2,000,000 OTHER: PRODUCTS-COMP/OP AGO S . 2 000,000 A AUTOM09ILEUABILnY g 200IC5913 2/11/2017. 2/11/2018 CO BINEDSI LELIMIT ANYAUTO EsaceidenlI_ S 1,000,000 OWNED SCHEDULED BODILY INJURY(Par pgreDn) 5 AUTOS ONLY X AUTOS X HIRED NON•OWNED BODILY INJURY(Poreccldenq s AUTOS ONLY X AUTOS ONLY - P OPERTY CIAMAGE - P.e acc UMBRELLALIA9 OCCUR . 8 EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE ! DFD RETENTIONS - AGGREGATE S A WORKERS COMPENSATION 2001 W8D25 AND EMPLOYERS'LIABILITY 3/23/2017 3/23/2018 Pie F ETH- ANYPROPRIETORI?gRTNER/FxECUTIVE rY—/N� OFFICE R/MELA9CREXCLUDF07 I N I N/A ndato E.L.EACHACCIOENT (MYaary In NH) E 1,000,000_ D58CR PTION OF OPERATIONS IwlDw E.L.DISEASE•Eq EMPLOYEE >I _ 1,OOD,0DO 'E.L.DISEASE-POLICY LIMIT S - 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD/Di,Addidallal Remarks SModula,may bo anached If more epaao la retlVlrod) - General Contractor Insurance coverage is limited to the terms,Conditions,exclusions,otherlimliations 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 t CANCELLATION (506)790-6230 Town Of Barnstable SHOULD ANY OF THE ASOVIE DESCRIBED POLICIES BE CANCELLED BEFORE THE THEREOF, Building Department ACCOROAINCE WITHDATE THE POLICY PROVfSION3 NOTICE WILL BE DELIVERED IN 200 Main Street Hyannis,MA 02601 AUTHORRED REPRESENTATIVE gCORD 25(2018/03) The ACORI)name and logo are registered marks of ACORDORD CORPORATION. All rights reserved_ _ 17VOVLI> 0 C71- sit.---*, (�----30 ---�--f !~ z Y ----•( `---� ' Ott NON O77/( 7 /IIA :. U ui T S _ _ x 1 ✓�, `T _ ,r x 1. F lov Fri, �p/,TS - C,� J� TONIN OF BAR STABLE on ,U.,ry,4 ZL� k/ og, IL b 1 a i s at { r�J - 4 w y 6} F �h �� ,�►,ems �� _. : • � � � - � � . • i 6 �-' • � "`' } •� ° _.. �-� _-__--cam.. t t _ f f off' a THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / �C(�`J LI DATA Page 1 of 1 V z s r x Ilk, . r frf ikil, "4x > i� s. a. r' f;' //isvi: inru '07, 71%'65.jpg 9/27/2017 Cf THE T� . : The"Town of Barnstable • BMNSTaec.E. - 1639. �0�' Department of Health Safety and Environmental Services 'OrFo " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only 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 exceptions,along with other requirements. Type of Work: Est. Cost r Address of Work: O 10 S Owner's Name Z;[)Alj /��W-.ram Date of Permit Application: i I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 PROGZAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY 1 hereby apply for a permit as the agent of the owner: Dafe Contractor Name Registration No. OR Date Owner's Name J ,: , I �� r: - =:-—:__: The Commonwealth of Massachusetts t' -- 1 <� ' _ Department of Industrial Accidents x' - ? office allnsestigatiens 1 _ : -= 600 Washington Street '; ,r '/ Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit WA name: 1•1 1 C'eCVV P✓L� l c location: /I T /v-- 11Z city C6 4-g4M M A . phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole ro r. for and have no one workin in any ca acity %//%////%/%%%/%%% %%%%%%%%%%%%%%/%%%///%��/%%///%%%%%/%%///O%I%%%%///%/%%%%%%%%//O%%%%��%%%//%%%%%%%%%�%%%%%%%%%�%%%�%%%///%�%////// G I am an employer providingiworkers' compensation for my employees working on this job. I. COmpanV name. ' Gl A w , C address.'` city. phone#. insurance co.. `. olicv# S ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have . the following workers' compensation polices: company>name. .. . address. city. phone#. insurance ca oiiev# ......I.... : /,%////////////i campanV<nameI ; address. city phone#. .. ilisarance co. olicv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that s copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby ce un t .ns an aloes of perjury that the information provided above is true and correct Signature Date � e— _ _ Print name f Q 0+AJ C f-✓L&_0,4 \ Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# []Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 PJA) . Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 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,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 r Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be retinmed io the Department by mail or.FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Oftice of Invesugauens 600 Washington Street r, Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 VVI/�IiVJt��.r1�LL�G.t0 F ,!Y,. YtTl , 'r 1tL:k P`, • S t� S ,� � x >.� hex v v L a;# .� t aM.ha,�i� � a d } � .. . 'P ♦ 5, p, *. .-.: bt,+n,. ?:., a} tit 4,,.'S°N iY,. �r^ f a -:9 - :�. HOME.lIMPROVEMEN*it CONTRACTOR$�VREGI_STRATION ' t A Board 'ofr:Bui'lding Regul+ations and' Standards r One .Ashburton Place u Room S,. , k Boston , Massachusetts "O21C?8 _' - � � _ '. .' •' •� - r az` 1 Y+f �,�'��,trG�•�" ,}`;' Y'�I rT" i' a as 7' ;HOME "IMPROVEMENT 'CONTRACTOR €,v b r lSt12536 '-Y n a r on 11 Reg rate �* a{t 2536�� f� z Expiration 06 �'� �Y? 04/ /99 �77 _p TYPe --;:DBA 4 a, .. , r f, Jv s. k S W:,� t Ott 4 y. w"�j'`. ::� �,:�, G':/Aee'�P ahaKoxtuea .`7'.`��i } t. Yr i ika i:i.a c r .v `c° ,: �T � �� ¢ P�'' � x L• 4h- } 'S ; � � � ate. �. Tea � y Mk+ ��t ��,�,; i �1,: "t ." i. : "^, a . ,HOME IMPROVEMENT CONTRACTOR ERASER` CONSTRUCTION k Registration 112536 ' k x } °t{d'£ ( _S,' rr fl �i- !; .mL .�.x' I. t ; f 3 .. •>, DEAN C , .`ERASER i ' , ' s;{A ,c y +, z �,u r k V . yz ;:TYPe OBA j h r'��,y a�} r• +k" °w ys� 71 TARRAGON'`,CIR I y Expiration 04/O6/99 P k 7 COTUIT.i MAh 02635 � :r� x :FRASER:CONSTRUCTION C.'-FRASER 1 TARRAGON CIR l�. -COTUIT MA 02635, •.'�► r) Map Q Q • Parcel 69Y Permit# a (Q House# / p Date Issued 2 Board of Health(3rd floor)(8:15 -'9:30/1:00- �36j� Fee Conservation Office floor) floor)(8:30- 9:30/ 1:00-2:00) w. Planning Dept. (1st floor/School Admin. Bldg.) �TNE►pr,_ Definitive Plan Approved by Planning Board 19 r - �, RNSTABLE. ' / MASS. P -` TOWN OF BARNSTABLE Building Permit Application , Project Street Address //6 0/0 Village--- !417!4 � o Owner ?y�iv V - 4 2.v1 Address ^{ Telephone Permit Request } First Floor sq re feet Second Floor square feet -Construction Type Estimated Project Cost $ ` onn " Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name CQ A hi �' �� Telephone Number Address -7 j Jig/Z(d d (i/2. License# C) Gc,c - Home Improvement Contractor# Worker's Compensation# G,C 3/.5 fii 6/7 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR T FOLLOWING REASON(S) 't� Y .r +x .r FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED ". i MAP/PARCEL NO. ADDRESS -s ', VILLAGE s i _ • . OWNER DATE OFINSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH ' FINAL { PLUMBING: ROUGH 4 FINAL GAS: ROUGH FINAL FINAL-BUILDING DATE CLOSED OUT + ASSOCIATION PLAN NO. `. 77 Assessor's map and lot number .. .... SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE :..WITH ARTICLE II STATE Sewage' Permit number � SANITARY CODE AND TOWN 5 T"Er��y �? TOWN- - OF BAR=NSTABLE Q 8JHH9TAIiLE, �u M GU LDING INSPECTOR 9pp 1639: `� PY APPLICATION FOR PERMIT TO ..... .SI aL:.�?. ..... i/v...1�L.i.1; .... 2 c:, .. e TYPE OF CONSTRUCTION / .. 1!°Yl,/..lS�U.�r!ol........ '...,.. �C r i ................. .�'... ... .19..7.7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: a�� Location .......7;�.......................1.!.... ..... ........................../, .................:.......................................:.......................... / � f� L Proposed Use .......l.. .,...!Y. © ..... .!. .�!U��j.....-,400 ..,.:. ......... ............................................... .. Zoning District ............. . , ........................... .Fire District Name of Owner � '� �' .....�.....................1-714....1t.. ...............Address ....7c�.... ..............1..!S!�°-:�....� ......1.�..[.5�. .�....... Name of Builder ...... A. �LN.�.h�t'..t�p...-�!�!CrAddress >rZ�....�-'f�.h .V.s........e0al.........�r.............. Nameof Architect,..................................................................Address ................................................................................... Numberof Rooms .............................................:........:...........Foundation.. .............................................................................. Exterior ..................................................................... ..............Roofing ....................................,............................................... Floors .............................................................. Interior .................................................................................... Heating ..................................................................................Plumbing .......... Fireplace ..................................................................................Approximate Cost ........ '!P�J.f��.. ............................... Definitive Plan Approved by Planning Board -------------- ........ �. : ------------------19--------. Area . . .................: Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH yob . 3 ; w 5 7 a 0 4d k'i ivlq s P hereby agree to-conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ./y�. !� /✓ i ..:��... ................. ` Harvey° John V. � 19641 private swimming . No ................. Pmrnnh for .................................... ` pool '-''-'-'-----'-'----'---`--^-'~-'- Kings Road Location ....----..-.---.--..--------. . Co%moit ..-.'.-.----.-.----.------.-----. ~ . John V. Harvey � ' Owner '---..--------..--------.- Type of 'Construction -.----.--------.. ` ----..~-----.---.------------. ~ . Plot --r--..--.. Lot ................................ ~28- 77 _ Permit-Granted ---��---.'1g ` ^ I Date of Inspection ...........................�-.�]9 ' _ a -Do� Completed ..��( .�/�---.--. . .JA ~ ' . ' i~~ / ~ - - ��0[ �� ~ � �/ �~-~---� ^ ^ ` ' | ~-- � lA �----. ............................................. ... j , ............................................................. -..~.,...---.--.--'------~....-'.. ---.. '--_.-.,._.'~_..-......-_-.---^�.-.---.-., . ^,7 ---..~---_-.---.-.......-.......��' r Approved ................................................ lg ...-----.--.-.-----...~~--~~.-.-. ----.---.--..-.-.----.-....,...�;. ` . | / - Assessor's map and lot number .........- ..`... ...... . _ - f, �• ,! ��✓1 -�� r2 7U Sewage ,`Permit number-:.. !. ...:!?!I..q� x ' °FT"Er° TOWN OF BARNSTABLE Z BARNSTOIILi, i r, s639. BUILDING IN-SPECTO.R 0,,�0 Mar a APPLICATION FOR PERMIT TO .... .''.f...::... .......... .?-?.�![ :...................... .............. TYPE OF CONSTRUCTION �f�f !6'r r` . ..................................................... .� .19 w TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r Location L. z�) 'v r,'- ..................... .........................`....,...!,...................................................... ..................................................... ProposedUse ................... !�...".r...............'..T! 0 f?4t% ........................................................................................ _ .... Zoning District Fire District �--. � Name of Owner C/1.41,0....�'+ .\i ..............Address ...(;,,,1.02�G11 Nameof Builder ..:........... Address .................................................................................... Nameof Architect ..................................................................Address ...................................................................:...:............ Numberof Rooms .........................................:........................Foundation ...........:...._,.,........................................ Exterior �� ...........Roofing...... ...... .. ......................................................... or ) }} Floors .2X/, i�T / � ..........................:Interior ........ !. ,T=lIV/.C.�.�..R�.................................. . ............................:........... Heating ........................... , .:....:.......................................Plumbing ............................ ............... � r ............................................................. Fireplace i [^ pp fC ............................................................Approximate Cost ........................ Definitive Plan Approved by-Planning Board --------------------------------19--------. Area ....t..4 ........................... Diagram of Lot and Building with Dimensions Fee .......K..':A...... .. ..................... SUBJECT TO APPROVAL OF BOARD OF HEALTH C h { - -- -1- `f Net✓ 20 n , e • kf /V, oA Q I hereby agree to conform to all the' Rules and Regulations :of the Town of Barnstable regarding the above construction. Name ... ...............................................d''LPt r. ��'::'......... Harvey, John V. /A=22-94 r J ✓ No 18007 , Permit for.....................................arage & add o ' a deck to dwelling .Q......... ;...,;.. : . ......'.. . ................ Old Kings 'Road Location ................................................................ 1 Cotuit ::................................................................ John V. Harvey Owner ....... Ti a of Construction f ra e YP .............. .................. ............................................. ............................. Plot ......................... ot ................................ T 15 Permit Granted .... Octobe ....r.....21............1975 1' Date of Inspection Date Completed .................. ...................19 _ V pp� rc. t PERMI REFUSED f I ................ r i ..........�. .. ..��.1...... ... .:.'.k....�....'....:.. ................ Approed ................................................ 19 ............................................................................... ` .................... .......................................................... `/- : (�/y, Assessor's map and lot number ....... ............:................... Sewage Permit number -.r.....,^..!?ry .... .........- !. ..... ......... . THETO TOWN OF BARNSTABLE Z BARISTABLE, i "b 9 ILDIHG INSPECTOR V DU O G A39 p T APPLICATION FOR PERMIT TO ....... %'a c................................................."1 4 .......r!?. !-...................................... .... TYPE OF CONSTRUCTION ............ ....�.... �.��!!�! �- .........../ ..............9 ...... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location /4 0 �r n S cY .................... ................................... !...!.......................................................................................... i r ProposedUse ......... ........!....`. ................................... !..... 'd ............................................................................................. ZoningDistrict ............. r.. .................................................Fire District .............................................................................. Name of Owner �01 k-).....V ..1�t,Mkt✓'rle.�................Address ��.....b<c� `f nio s..��!.......(-L. .'.j........ ....... . .. Name of Builder 0I.I.,..,. .4..... .'? .!! ..?' � Address ....,I��R s (>( . . . M ....................... .i ................ Nameof Architect .......................................:..........................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ....... 0 4,, 4 O .................................................. Definitive Plan Approved by Planning Board ________________________________19________. Area ........ ..4"")...'7 ............... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH you v5 (:f 7 a o4d k1 Al q S - l t' I hereby,agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name r�r.!vet. ...... .C`. ........ .................. i -/ Harvey, John V. )s3€IUM - A=22-94 No ... .,19641Permit for ......swimming tool ................... .4. .............................................. !10141.Kings location ......... ,,, Road ...........Cotuit.. ............................. Owner John V. H Vey Type of Construction .......... ............................... ..... Plot ........................... Lot ..................... O` September 28 77 Permit Granted ........... ........................19 Date of Inspection ....................................19 Date Completed .....................................19 r f PERMIT REFUSED .............................. ........... ........ 19 � ...... .�. .. ............. ..........................y. ....�,:........................................ ............................................................................... .................................:............................................. Approved ................................................ 19 ............................................................................... ............................................................................... -+.. -w: .,' �� i�.�rir''`��t':ti�'!�+, tyre " �'+-.1..�'%+.. �l``?tq.` d� �' ,°r, n►.,. y; n:t..-y �..�,?,..kt ,':::_...8-:;rq..a-:.. w .,. .c_d' -,. Assessor's office (1st floor): a� Q Assessor's map and lot number ...... ................................... ({' (-� • �OFTNEtOfr ��Q ♦� Board of Health (3rd floor): ^�� Sewage Permit number .......... S BAUST&BU, S Engineering Department (3rd floor) //_ �� 039 House number �o �b}q 0� ........................................................................ Definitive Plan Approved by Planning Board --------------------------------19-------- . APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00.2:00 P.M. only _Z TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... :. ................ TYPE OF CONSTRUCTION �.. .... •.R ................................r..` ........19.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies �for a permit according to the-following information: Location ...... .P.< if �.f..!. -!..t �....... .�.......'............ � , .1 .. ................................. Proposed Use .".' u ....................................................... Zoning District .........!..I.... Fire District .................... � Name of Owner .....J0,M........ ...Address ................... ...!! Name of Builder ................................. .Address Nameof Architect ..................................................................Address ..................................................... .............................. Number of Rooms rf Z.?��? '^? ..................................................................Foundation ..........w..T .. ..............� .......:......!.f...�....... Exlerio. / +.d�. r ................ f... ...............'.............................,.......Roofing ............... .... i ............................................... Floors .......................f, ` ..........................................Interior .............(V , ............................................................ Heating ...........................................................;.......................Plumbing !" :.,... ....................................................... Fireplace ........................' ....... ............................................Approximate Cost ....... !... . ........... Area Owl% .......... .......... lip Diagram of Lot and Building with Dimensions _ Fee ' 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. No .......... .................�..........................., U C/� % / I-4 ' Construction Supervisor's License .................................... HARVEY, JOHN A=022-094 No .31899... Permit for ....Add Breezeway. Single Family..Dwellin Location ....116 Old Kinq' s Road Cotuit ............................................................................... Owner .....John Harvey............................... Type of Construction ........Frame.. ....................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .......May..16.,...............19 8 8 Date of Inspection ....................................19 Date Completed .................I...................:.19 r� Assessor's map and lot number ..........1......�Z..........f,�..1 �".. i . If Sewage Permit numbers/.r, SYSTEM t-�.. ..�... .. S S EM MUS . 6 a CAMP BSTABLE, i House number V4TM TWLE 6 9�0 M639 ......................................................................... E MINMENTAI CODE A ""Y TOWN 'OF BARNS TiONS BUILDING INSPECTOR APPLICATIO { N FOR PERMIT TO ..... � ....... ...Q.w.. /...1..... . .. / d..�.� . TYPE OF CONSTRUCTION ..:..........C�.. .i s�-'s .....®.A/...4,10,o.�.�.......F2 W 1111, ............... ....................... . .. LfJ....19 o TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... .. ........C� ..l :...R .................................................. .... ................... Proposed Use .........F... !! .F,.............� Z..,I/le 4.............................. ............................ Zoning District .............. .. . :. ....'... .Fire District ...........a7-017 ................................... Name of Owner .. :. A. .; . . ......... ....Y41?Vo6." ddress .................4...f®1... 1.1............:........................:..... Nameof Builder ....................................:...............................Address .......................:.......................................:.................... Nameof Architect ..................................................................Address ....:............................................................................... Number of Rooms .......................... ....................................Foundation ......cavcee- /..� ��L.. ..... ............ Exterior ........................... .S'............. ..Roofing ! �T ... Floors ....................... y®�a.1--r..................................Interior qkl Heating .................. IVl � "".......................................Plumbing ........................1! .. ................................... Firelace ..................... .............................. p M.) .�.... ........Approximate Cost r_........ � ................................ Definitive Plan Approved by Planning Board ________________________________19--------. Area ........, . ... /. , Diagram of Lot and Building with Dimensions Fee ...... t.................... . SUBJECT TO APPROVAL OF ,BOARD OF HEALTH B /A L-DIr 1/L/& I?o.*0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Na ................ ..... ........... ................... HARVEY, MAJORIE M. No .2252,1.. Permit for ADD SOLAR GREENHOUSE .................................... Sinqle Family Dwelliag............... ..........?.. ........................................... Location .11.6...Old..K.i..n.gs. Road ............. . ....................C.0.tqi.t.:.......................................... Owner -Malorie M. Harv ' .....J................................f�Y................. Type of Construction ....G 1 a ss... ....... ............ ................................................................................ Plot ........................ Lot ................................ September 23 , 80 Permit. Granted .............................. .........19 Date of Inspection .............. 19V*6- Date Completed ................... ERMIT REFUSED ........ . ..... .... 19 .5... ............................... ........... Ct • A* W............................................... . ....................... ....... ........... .............................................. Ck) A ApproA ..................................... 19 ...........n................................................................ ........................... ~ � Assessor's map and lot number .. .. .' ?l ..... ' -a �f/f � _ Oft14ETO 1 �y Sewage Permit number ...'::.......,r..:�!?..........r`.....�...............�': � BA"STADLE, i House number ............:........................................................... y MAB6 G� i639- 'Fp NO a -TOWN OF BARNSTABLE BUILDING INSPECTOR _ ,,g f . APPLICATION FOR PERMIT TO ...............f,-' ,- ?........ ..`......... `..........`......%......'1.... . TYPE OF CONSTRUCTION �' f.........................................................,........................................ ................19........ TO THE INSPECTOR OF BUILDINGS: +, The undersigned hereby applies for a permit according to the following information: Location ... ' �' '........1 f. ..... . e i ..... ( ............................................... ................................... Proposed Use � .{ ':' ? .'........... /- !k, .., r l 1 :=t—................. ................I......................... Zoning District .....................! -�: /.� .......Fire District ...........( �1.7 1!1. M..................................... 7' ... Name of Owner .: '... .. ..... ^3+'.........."� T...t, y'Acldress ................ .. ....f..f rf T .................................... Name of Builder ....................................................................Address .................................................................................... 1 ► j. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Foundation � ::.:. �' �:» ......................................................... ......... ........... r- {/Exlerior ................ (Ffi �......... rr............ ................................. Roofng ..................... ' ....................................... Floors � .� .........r....................................Interior ............................. .. ................................................. ...................... - �....t /c Heating .....................:cif. r)fv'. ............................................Plumbing ........................ =.............................. . Fireplace .............:....... !n? .......................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area `"r Diagram of Lot and Building with Dimensions Fee , ......................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Lr T I e f 15 j I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .........-. No 2.2.521.— Permit for —5.0LJ2...GREEMBOD6IC _ ---Gigglg�..IpMU].y D.Wal.ling............ , � LocohonI.��-{�l�...]�j��..Ro��d-----.. -----.{lJt]jit.---------------. Owner ...N�k 'p?�' ..X^.. ................. Glass 6 Wood ` Type of Construction ' ---- ' -----' ' Permit Gro PERMI REFUSED ' .. lA ' / ..�.�____ _____ .................... .. ...................................................... " | -.._'.—~..-. ..—.—~.--...—~.--.-. ............................ � �..—.- - . —. ' Approved ................................................ l9 _~ -------.--------.----..--.—.—.. ' ----------'----'---'--~~^—'~^'' � . ' Assessor's office .(1st floor): 0 0 Assessor's,map and lot number .....aaA.r 0 4 T:^. tS �Y 11F4. p MORM�pU�1r �E `T"ET Board of Health'(3rd floor):. Sewage Permit number `...... .. \^ LE .5 Z 321AL33TAO Z. i Engineering Department (3rd floor): - ` Au��1TAL CODE ,�,'V® �'v 1639 House number ........,x.....�1.1 ::. . `� TOWREGULATIONS ,0,�0 v a� e t Definitive Plan Approved by Planning Board.-------------------- -------- APPLICATIONS PROCESSED 8:30-9:30 A.M.. and 1:00-.'2:00 _P M only.. TOWN OF }, BARNSTAB-LE gUILDING"-kNSPECTO-R APPLICATION FOR PERMIT TO ,.... ... .. .. . . ... . ............... ....:.. ....................:................ . TYPE OF CONSTRUCTION ... ....................... ....� ........19.....4 TO THE INSPECTOR OF BUILDINGS: The undersigned'hereby applies 'for-a permit ccord diing to th flowing infor on: 04'Location ...... . . . ...... 1 .:.... .... ...'...., .. .. .V. .�.. ......:............... ErZProp osed Use ......... ............ ........... ...:... ...... ... ::... ..........................Fire District ............Zoning District ...... ,. .. .. ......:.......... .. ....................................... Name of.Owner .:... .. ............ Address ,........... . .. 1 �1 .................................. Name of Builder .....................Address ............... ....t........... .. Name of Architect ........... .. .. ......::.Address .........::......................................................................... 4 , Number of Rooms ..................... ................................ .:........ ...............r . Exlei for .. Roofing l� ....... ...........:....:........:....... r••i ....................... . ..............................,......... ::...... ...... ........:..................................... Floors .Interior Heating ..................................................................................Plumbing ........................ Fireplace .:........................:....................`......................:...........Approximate Cost ............/....5/!a`..p................... Area ...... .............. Diagram of Lot and Building with Dimensions M1 Fee :.:.,: ............. OCCUPANCY,PERMITS REQUIRED FOR NEW DWELLINGS El I hereby agree to conform to all.the Rules and Regulations of the�,Town of,Bornstable-regarding the above ' construction: Nam ......... ... ........ Construction Supervisor's License .................................... HARVEY, JOHN gy No :3189.9... Permit for ...Add. r= ::.. Single„ Famly..DWo ........., 116 Old Ki Location ...............................cJ...S...k�ia.a�l........... rCotuit........................................ x Owner ...:John. . Hart.e�y...........:........ ........... r . . Type of.tConstruction ,.......F .ame........:........... ............................................................{� .. +{ ........ • - Plot .... ...................... Lot........... _ 1"M4Y 16:.. 88 - r Permit Granted ............ ... ... ..........19 ,y Date of Inspection .'......:............................19 r !1T Dbte Completed ....... Ic r f� � � . i � ..� . --__ ------- r - ��' �� . � __ C� O/✓Jl/e C°`t"(ci�' Pit,/ /� 1 �_ �� t 1 �� 2� oW-5060 87"6-9l00 9,9 s.. / c z4 a c � t a Assessor's map•and lot number ....... 2 '.' �� : .... �'��, �� -�� SEPTIC SY T2,'N INSTALLED IN CC'fl, IANCE Sewage LPermit number -" /..,..'�... ./jg1 .: ,•• l"�Ii4Tl I T 1 V A TI CODE y g E I} S�g4 T 1W^ y�fTHETO� A ; TOWN -, ' OF' BARNST �B�LE 3AHBSTA DL'Ej ' 9�o M6 9• �e� ' BUI��LOING ' INSPECTOR �104 Or APPLICATION�FOR'7 PERMIT TO ... .............. ...., .T .......... t; TYPE OF CONSTRUCTION ............ ....' ...a................:..........:....:.....................:..............:.......:........ r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies rf,�o)r�a permit according to the following information: Location ...... !/......... b�+ .�.........�,t. t.............................................................................................................. ProposedUse ....... f v .�...............6,.7 . .4:6.6.�................................... ....................................................... Zoning District ........................................................:...............Fire District ....................... �Oj�.�l.....4!�.....�,4p V.G ....:.........Address �QName of OwnerL... ... .... s•�..,Cj/. ........................................................ Name of Builder ....... ...........Address ..........S.4N "✓/7........................................... Nameof Architect ..................... ......................................Address .................................................................................... Numberof Rooms ..................................................................Foundation. t'.........:....................L-:......... r Exterior ..............W,000..................................................Roofing .............W..J..Q.0................................................... Ir Floors .2.X&......T ..4;........LAPO...........................Interior ........(/. .. /.{ I�' ....................................................... N ................................Plumbin f � ...............Heating .......................... ....+... ............. g ............... ......... 1. ..... ................... Fireplace ...........................1�!'..�. ..................................Approximate Cost ............... .:..:...... -.1..........V ........... Definitive Plan Approved by Planning Board ________________________________19________ . Area l!.1�....�... ...............'. Diagram of Lot and Building with Dimensions Fee / �� SUBJECT TO APPROVAL OF BOARD OF HEALTH Ir ' �/E�✓ a0 N grid 21 a yet I hereby agree to conform to all .the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...� .. .... Harvey, John V. 2-0 18007 garage and 1 ....... ............Permit for. :................................. add `deck to .dwelling ..................... ................I.................. ............ ..Old 'Kings Road .. Location . ....................................................... Cotuit ......................................................... ..................... Owner .............John...V....Harvey arvey... ........ ... .. .......... ...................... Type of.Construction ...........frame............................... ................. ....................................................... Plot ........................... Lot .......... ..................... - Permit Granted ........Ociober 21 .........19 75 ....... ......... Date of Inspection .....1........1 ... Date Completed L .. ..............-19 PERMIT REFUSED ................................................................ 19 ......................................................................... ............................................................................ ............................................................................... ................... ......................................................... Approved ................................................. 19 1.............................................................................. ............................................................................... O o a00 NEW METAL• or 701P SFP 28 Pill 4: 15 �,' � � cc N � NEW SIDING AND ASPHALT ROOF °O 00 TRIM � W � N .� � �r 4. E..r c� 00 o r"TVI ION w c O Q0 a IAWN4947 IAWN4947 IAWN4947 CSPD6065 X0 SUNROOM RIGHT SIDE ELEVATION. SUNROOM FRONT ELEVATION SUNROOM LEFT SIDE ELEVATION t a C Q z FRIDGE FEE.] w IAWN4147 IAWN4147 KITCHEN ELEVATrION SCALE: 1/4„ = 11 -0" DRAWN BY: CBH ! DATE: 08/22/17