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0797 OLD POST ROAD
,��.`�--�--Ate':` 'Z' ����7 �1C�= , e--a°s� r�_��� .�.� � '_ �- �"� ►.� _ Town of Barnstable Building r Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept JAMS Posted Until Final Inspection Has Been Made. Permit 1 Mo+' Where,a r Certificate of Occupancy is Required,such Building shall Not be Occupied until Final Inspection has been made. . Permit No. B-20-935 Applicant Name: ted titcomb Approvals Date Issued: 04/10/2020 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 10/10/2020 Foundation: Residential Map/Lot: 073-008-002 Zoning District: RF Sheathing: Location: 797 OLD POST ROAD(CT& MM),COTUIT Contractor Name: Framing: 1 Owner on Record: TITCOMB,.TED& DORSEY K Contractor License: 2 Address: 18 OLD COUNTY ROAD -- - Est. Project Cost: $30,000.00 � Chimney: EAST SANDWICH, MA 02537 Permit Fee: $203.00 Description: remodel 2 bathrooms and add a closet and a partition wall: Fee.Paid: $203.00 Insulation: Project Review Req: smoke alarm co combo alarm required in the new" estibule" Date: 4/10/2020 Final: on the second floor Plumbing/Gas Rough Plumbing: Building Official w _ - a Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. 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 Final Gas: work until the completion of the same. - — The Certificate of Occupancy will not be issued until all applicable signatures by the Building—and Fire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining-is-installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "P sons contrac ' with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Department Building plans are to be available on site Fire De P �` All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 673 Parcel 0�0$ 0012 n\4&- Health Division Date Issued Conservation Division I Application Fee / Planning Dept. `" i Permit Fee Date Definitive Plan Approved by Planning Board i ` U 44 r. Historic - OKH _ PreservatioT 0 W141 Project Street Address 7 9 7 046 Village�,E9`TGLl7� Owner RQZMT —rkTW Address 7q7 p14 tver /*4 Telephone_ 7 7Y— 2 Z-Al Permit Request hAymom Pik Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning Distric �JO, F Plain Groundwater Overlay A/ 3 Construction Type-.Project Valuati n � yp ; BUILDING DEPT. Lot Size Grandfathered: ❑Yes ❑ No attach supporting documentation. Awl 7 0'6 Dwelling Type: Single FamilyX Two Family ❑ Multi-Family (# units) TOWN 0 6 Age of Existing Structure Historic House: ❑Yes ❑ No Sn C�IM09Wghway: ❑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 Number 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 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) NameeS /11Qi Telephone Number 401-71V 437 Address 0� � tl' License# �`� 0 t Home Improvement Contractor# Ia 1tf3 Email „�3�1' QQ�A7 �/IIL Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO h SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED, MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER - DATE OF INSPECTION: T FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' DATE--CLOSED OUT A-,Oa,AM- ON PLAN NO. , k 8/3f2016 scan 2016 08 02 1426 48.jpeg IIIIIIIkII (Z 1-77 I 42249984 M77422499 $738M1 5 "787 Home Hnprovemerrt Agreement;S2 Barth RemoMing ROBEftT gNBUt1 Fug � 2 t-774P2499B4 last Name "...�� �� 797 Oji Poe Rd - Leadd# CrrsboamrAddresa Q.! � ad y Sbft $ t Br6rtgMm'Brrg Addreea(i<dyhamafront Sarvtce Address? Customer B3rmg Address "—� � Sti0dfi43 a Zp Home Phmre# Work Phora9 Cea phono# j Customer rsBAddresa _ BY INffmuI4G;YOU AGRtETHAT BYYom sumTtm BELOW,mmm DEPOT,ns AFFL IATE5,OR ANAUMqR0p CONTACT YOU BY PHONE,FAX OR 64ML ABOUCOTHER SERVICES TFiATMAY B6OF IN`FRESTTO YOU YOU MAY ALWAYS r( {p ypj/q CUSTOMER'S 0YnTALs: MM LATM-�T LET US*MW P nt: Due in fun uncrtediatey. f/ f v P If applit�bre. Fnanang Program: Q4 ,! T ount of Sale: Includes all rebates,and !applicable discourRs,. dudes finance charges., 'Airy ai Tbu charges yxMo determined by Your separate cardholder or ban agreemerd.Home Depot is NOT.a General Terms and Corlddlons foflowin9 ltes page for mom derails regarding other gtarggs which may.appiy. ICY to Y019 d MIder or loan agtow PlefIft We the . Please nrxe Brat nailher name Depot nor trLslallatipn PrD(e �e rr►�hte for days resulting from Start () eyerls be�rtd Blair corlrpl:etdt�irng,but ttot lrtnited tO,Change Ordets,irtoarrect.infomlatton You provide,legal J(0 eruz,mbranoes an Your property or irs►fat ,with bw7ding cede or zoning rquirernems.Your c r ed-d/ finamang,acts of riattlre,9ovemment or arty mud parties,Tabor slide,hidderrhalton l Phy t�rdou Fnish Dale: c�rtditiorts,including.but not limited to,environnl hazarr such as mold,asbeos and lead nonoontpiianoe ttrith this Agreemerr� Per or Your EINImni You amanmwtoapapereo"eftMSAgKeamrtir You ehooas Blpucornan;maneomlteacoP),Y�+r t aub8aassrtt dow mft and written aomMMtWanom related to Oft ovemmeft By eardaedeg your service Provider, applies to utis Agreeamad aadeL Der eePl ortha Ageamgdur rWated att g m Yoe my update yowaapB ed&es%WMdraw y�+t> R or obtain a wcetve�oparreamisanti VDFAdobeAcrebetVeWott7A:8m YOuruaBggandvorBydnByoWeamfladMrssabov�youwMtrratlmtyouhaaeacaeaato.semnpulsrtRatmn y ll dadmtwda,eti up�alingthis paAgramy 1 m racalva omy dew racards relstedto tMs tmrtaeo>ion, '•t�.t�1_lunttfat '.. of"EEMMYou. ys an a orrmr dried shove mea118 the trtsla11etiart Services spaoifled In tliie Agreement IftMb letPon Ptroiesslor W p�derit corib�tor atdhortred by ttorna DBPot(kermed ard htsured as required by Moms D9pat and appm,,"!gory dthe er►edtoas"F6ome Depot7, to sthLs Seniceaftme ImplAveRM4 A between You and Mnata pappt Us.A.,lheardowmentsexpnassyrrnedea.partattll� 'theS+ aiTtmmaimKlCoodiNwo%RotiYin�ttdspage.the9FaiePlease aeettrasoft tecla�ordar balotiy,You antltwme Home Depot to(e)wmVo for htetellatlm pmfmat "*to Parrorm Irtstaltstlon and/or(b)order and merchartdiae.indudiAg speclat order marchandisa tfret may be WMm made,as spedtisd-et tars Agreement.You urderstand arrtira tI" IntI +Yar arts Home Depot and may Orly be amemled by a Charge Order signed by Moore Depot(or by of representation owde by HOM a rePr vO on'Home DePaNs t>ehelfl ark You.This Agreement expressly supersedes all prior wrRtert or varher agreemmtts represenudiom Orr OSPot.;hnthition Plviesslonal,You,or=yon*aim Ezel as got tortlt in this Agraernartt,You .express or hnpUed,bt My Tray aondoom"tl�Agreammrt.air You agrre there met orar a tartan tnoompW-(hmtaa dwo P"deasionays perttuitli�ititir pn may need to be hr dhte�btt their exl Do not sign ff blank or accept this Agmemem in its.moiety.You fmrther a a ZQ You low.)f3y Signbg,YOU acbl"edge tfol You have vend,iatdarataa�d,and c"oPmeeopy-KeePittoprot yourtegid F 71 Prahm*mft Frig 8t errntdeNa m,Adilmm and Lloerrse/s asA �V' HIPCDNSTi C1,ONLLC LL4M2 custotnartssrgrlawra. - �( lu U�9nA mYouAHHMmom Vm—VFMERCHANDISE ist t�rs07aadtinitial; )(p$ TOSSMMADORESSP ABOYEY M—. L "� OBTAINMGDELIVERYAGMTS:SMAIURE AND AWIEETO INDEMNIFY AND HOLD-HOME DEPOT HARMLESS:FAOM ANY RESULTING "0' 'onoAuMmtmdRM m veon"ms DeAora MIKE Fmmy ymwftlPwmrrw Name frrOt r . PleeseP�JLYaurSalaspeaods Ltxvse#gAppCx�ple � HOWDEP01 LNaS MLmFmmEANNDrt BUYEWSRMffTOCAW=1:smaENoLftT ?MOM CLIS" ter Cafe.-1-877467 2581 H HS 24S(�+g)ntami t oMe Depot"2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 30339 https://mail.google.cot/maillca/u/0/#inbox/1565(70786lb6boe?projector-1 1/1 I Scope of Work Customer Name Robert Turnbull Service Address 797 Old Post Road,Cotuit MA PO/Contract# Sales Agreement Date 7/10/2016 Estimated Start Date of Install: 8/8/16;objective to finish.by 9/1/i6(week of) Contractor agrees to complete the work and install the materials listed in this document:. 1 2 Demo: 3 60X36 Shower Stall and Associated Door 4 Wet Wall for new plumbing 5 67.5X21 single vanity/sink/fixtures 6 Toilet 7 Jacuzzi Tub and surrounding cavity 8 171 SF Tile Floor 9 46X21 Vanity/Countertop 10 Tiles under Windows within the back of the jacuzzi tug 11 12 13 Plumbing: 14 New Shower Fixures which includes Symmons Degas Shower Head/Mixing Valve 15 Install Double Bowl Sink,where single bowl was;use 8"Symmons,Chrome Degas Fixtures 16 New Kohler San Raphael Elongated 12"Toilet;K-3722 17 New Staffordshire 12, Polished Chrome Soaker Tub Fixtures 18 Electrical:(3)New Light Bars;supplied and installed by HIP/Home Depot(Hampton Bay Chrome) 19 (1) Nutone Exhaust fan to existing location;round,204748896 20 Installation: 21 New 60X36 Shower;Marble tile throughout, includes Ditra Pan,Tile and Marble Curb 22 *Arabascato Carrara mosiac 2X2 of floor base and Ceiling Tiles 23 *12X12 Arabascato Carrara on walls 24 *2X2 Onyx Grigio Mosaic Tile=6"Total Accent Tile in Shower 25 20X20 NAVONA LUNA,ON SQUARE with Snow White Grout,1/8" 26 New York Soaker Tub,Matte White Color 27 New Staffordshire 12,Polished Chrome Soaker Tub Fixtures 28 New 67.5X21,White,Saginaw Door Front -(2x)VSB24DD(1x)VDB18(1x)3" Filler Strip 29 New 46X21 single door with 4 drawer;White,Saginaw Door Front-VBR42 with(1)3" Filler Strip 30 New Quartz 67.5X22 Diamond White double sink countertop with backsplash and side splash 31 New Custom Fit, Frameless Door with Clear Glass 32 New Chrome 18"Grabbar in Shower area 33 New 12X20 Niche in Shower area 34 (2)New Corner Shelves in Shower area 35 New Chrome(2)Towels Bars and Toilet paper holder 36 (2)Undermount White Sinks 37 Prep and Paint Bathroom Walls,Ceiling and Trim(using Faded Pink#RL4059 Color); 38 New Wood Baseboard where needed throughout Customer Initial Page 1 of 2 I ::" Scope Of Work Cont. Customer Name Robert Turnbull 39 (2)Mirrored Medicine Cabinets(16")and(1)Framed Mirror 40 This includes wall repair within alcove under Windows to make paint ready 41 (2)2-bulb light bars;Model#HD337 42 (1)4-build light bar;Model#HD-318 43 44 45 This proposal includes a licensed plumber and associated permits needed 46 This proposal includes haul-away of all debris created by this project 47 This proposal does not include any Wainscoting or taking down existing wallpaper 48 49 Page 2 of 2 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR � QUALITY ORIGINALS) I A , I m / �C(�J L DATA i e � 4 [s: f i 1 r s I —- -- _ Office of Consumer Affairs and Business Regulati on 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home ImproveiYicQontractor Registration Reqistration: 126893 err — o Type: Supplement Card ` Expiration: 8/3/2018 THD AT HOME SERVICES, INC. ANDREW SWEET - - 2455 PACES FERRY ROAD, HSC , 11 ATLANTA, GA 30339 41 Update Address and return card.Mark reason for change. �.Address [] Renewal Employment Lost Card SCA 1 0 20M-05/11 %1r. (fn�rr,�iemzru�rc�/�,c/C����'aorrc�.uaell<� V ifice of Consumer Affairs&Business Regulation License or registration valid for individual use only 3 before the expiration date. If found OME IMPROVEMENT CONTRACTOR return to: Office of Consumer Affairs and Business Regulation -�VIPORegistratiom-nj 26893 Type: 10 Park Plaza-Suite 5170 " Expiration F8%3/20°i St> Supplement Card Boston,MA 02116 THD AT HOME SERVICES IWC' THE HOME DEPOT`AT.HOME SERVICES - ANDREW SWEET ,f 2455 PACES FERRY ROADS HSC = E ATtANTA,GA 30339 Undersecretary Not vali without signature I fl § ': Massachusetts Department of Pull�c Safety ®� Board of Building Regulations.and.Standa�ds License CS 105405 ConstFuction;S uperVisor `.MARK R PIETROS "156 MORGAN MILL Rd ` 'JOHNSTON RI 02919 � � a f Expiration Commissioner. 03108/2018 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street; Suite 100 Boston,lllA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Legibly Name (Business/Organization/Individual): The Home Depot At-Home Services Address:908 Boston Tpk City/State/Zip:Shrewsbury,MA 01545 Phone#: 508-962-6942 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 200, 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑■ Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.# required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box 41 must also till 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: New Hampshire Insurance Company Policy#or Self-ins. Lic. #:WC 015519215 Expiration Date:311/2017 Job Site Address:�77 City/State/Zip:I* A�w ' GUIN 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 D A f r nsurance coverage verification. I do hereby certif=Ur ins and penalties of perjury that the information provided ab a is /e and correct Si ature: Date: b 6 Phone#: 401-714-6 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#: !J Dare(M MIODIYw`n -3211812015 ,ACC?R CERTIFICATE OF LIABILITY INSURANCE TE HOLDER. THIS THIS TIFiCATE !S ISSUED .4S A MATTER OF WFO tO ONLY AND CONFERS NO AMEND, EXTEND OR ALTERTIHE COVERAGE AFFORDED GHTS UPON THE. ABY TIS HE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AUTHORIZED B ELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS, ESENTATIVE OR PRODUCER,.AND 17 THE CERTIFICATE HOLDER. ies must be endorsed. if SUBROGATION IS WAIVED,subject bD RTANT: !f the certificate holder is an ADDITIONAL INSURED.the pdicy( 1 therms and conditions of the policy,certain pollcles may require an endorsement A statement on this certificate does not confer rights to the :bider in lieu of Such endorsement(s}. ONTACT NAME: FAX ER PHONE A(C No. H USA,INC. ALLIANCE CENTER ll ADDRESS:l3lOXROAD,SUITt?400NTA,GA 303Z6 26387 INSURER A,Steadfast insurance Company !iV92•Hame0-GAW-16-17 t6535 INSURER B:Zurich American Insurance Co NSUR� New Hampshire ins Co 23841 THD ATtICME SERVICES.!NC_ INSURER c: 3817 It DBA rHE HOME DEPOT AT+IOME SERVICES INSURER D:illinas National.Insurance Company 2690'CuMaEiu wD;PARKWAY,ARKWAY,SUITS 300 .ATLANTA,GA 30339 INSURER E INSURER F: COVERAGES THIS CERTIFICATE NUMBER: ATL•003746646-14 REVISION NUMBER:1 THIS IS TO CERTIFY THAT THE STAND NG APICI REQUIREMENTED ABOVE FOR THE N TERM OR CONDINT,ION OF HAVE aANY CONTRACT ORUED TO EOTHER DO INSURED CUMENT WITH RE PECT TOUWHICHCY RIO , INDIC_-ER-n IGA N MAY BE CERTIFICATE MAY ON ISSUED ORMAY PERTAIN,D)T[ONS OF SUCH POLICIES,�I.IMITS SfiOWN MAY HAVE EBEEN REDUCED BY PAID CLAID BY THE POLICIES MS. HEREIN IS SUBJECT TO ALL THE TERM XCLUSIONS AND C SUB FOUCDY EFF POLIM C LIMBS 1fISR TYPE OF INSURANCEPOLICY NUMBER 9,000,000 LTR I I IGLO4887714-06 0310112016 I01111.12017 EACH OCCURRENCE '•'E A I X !COMMERCIAL GENERAL INABILITY ` i .D. E 1,�0,000 P ISEs oca EXCLUDED I~CL:aIMS-MADE 'OCCUR I LIMITS POLICY XS I MEDE%P(Airy ono person) I. _— i 9,000,000 . 1OF SIR:VM PER OCG PERsoNAI S ADYINJURY a i y I 9,000A00 j GENERAL AGGREGATE 3 I 9,000,000 •;EWL AGGREGATE LIMIT APP, UES PER: I I I PRODUCTS.COMPIOP AGG :S SRO- 1 s . POLICY EJECT '-� ` I `OAR' jBAP 2938B63t3 �0310112016 103101'2017 COMBINED SINGLE!IMtT I s 1,000,J00 Ea accident�� 9 AUTOMOSK.E LIABILITY BODILY INJURY(Per person) 1 r - ( ( I ODILY IN (Per accident)•E 'IL �AUTO IF-i SCHEDULED I SEL INSURED AUTO PHY OMG ROPE II l j JURY AUTOS �--f AU ED. '' .P-or. DAMAG . S _ i C _ $ HIRED AUTOS I:�.AUTOS EACH.OCCURRENCE UM$RETL1 LIAR AGGREGATE OCCUR t �. ( I E � � � EXCESS UAS HOLAIMS-MADEl! i E 031011Z0t6 0310112017 X. oTH- DIED RETENTION S ,WC015519215(AOS) STATUTE. ER C WORKERS COMPENSATION I 0310112016 0310112017 1 t t.ona,ao0 AND SWLOYEw LIABII:1TY Y I N'I IWC015519217(AK,KY,NH,NJ,Vi) E.L.��DE� `0310412017 5 1,000:000 C ANY PROPRIETORrPARTNE4rEXECUTIVE N I A iWC01 551 921 6(FL} a�03101/2016 �. _.L DISEASE-EA EMPLOYE D OFFIC ERIMEMBER EXCLUDED' i I - 1,000,000 (Mandatory in NH) E.L.DISEASE-POLICY LIMIT E If yes,de•,crmbe raider Conitnued on Additional Page i. F DESCRIPTION OF OPERATIONS below 'I I i I ce is required) TIONS!IOCAT10N5!VEHICLES (ACORD 101-,AddiUoreL Rerperlrs Schedule,.may ne attached d more spa red) i DESCRIPTION OF OPERA ! EVIDENCE OF INSURANCE CANCELLA' N CERTIFICATE HOLDER THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ON DATE THE DBA THE HOME DEPOT AT-HOME,SERVICES THE EXPIRATIREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 2455 PACES FERRY ROAD ATLANTA,GA 30339 AUTHORQED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1968.2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ACORD 25(2014101) 1 • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 c; www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): mar Address: 6 8 City/State/Zip: J6719S7-Btil R-T ©a919 Phone#: Oa3Q Are you an employer? Check the appropriate box: Type of project(required): 1.El4.I am a employer with I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 10,❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and me have no employees. [No workers' 13.❑Other 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. 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 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. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenaldes ofperjury that the information provided above is true and correct Signatore T Date: g J(o l6 Phone#: 40t-�5a3 -O a&?, 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#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��� Parcelpion # ) 06 Health Division '' � ' ®ale Issued / Conservation Division Application Fe' Planning Dept. "° Permit Fee 47 � CIS era Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Village Nlb 'I Owner f9tA t2Lr f"11 C Address T,S I O. Oul-A Telephone 15 .5bLtAJ Permit Request _/ �� 7`5 ND A:� ) l`S orv`�h �s nib mock" v E)rlSri hi sq T- LoyasI rJ )RCS t(a7A Mk Q ,5:!f0 Square feet: 1 st floor: existing proposed 2nd floor: existing_proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation )000 XbConstruction Type Lot Size Ole,d eG 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 Kin '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 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type anYes I: ❑ Gas i ❑t Electric ❑ Other Central Air: ❑ No Fireplaces: Existing I' New Existing wood/coal stove: ❑Yes Uk o 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 If yes, site plan review # Current Use ` -N( Proposed Use to 4 m APPLICANT INFORMATION (BUILDER OR HOMEOWNER) — —- - -- Name ql)ILNCS&� 9 :LAe—Telephone Number Address vl✓��I--..._I.wl l License# Home Improvement Contractor# Is—� Worker's Compensation # ����a " L) ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � � B cuv-1� (�-e_ SIGNATURE DATE 9/3-2 FOR OFFICIAL USE ONLY APPLICATION# rt DATE ISSUED a MAP/PARCEL NO. Y" ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION f t FRAME t INSULATION s-- FIREPLACE ELECTRICAL: ROUGH FINAL r s . ' PLUMBING: ROUGH FINAL ti GAS:: ROUGH FINAL ' � r } FINAL BUILDING 4� �Z? T O DATE CLOSED OUT ASSOCIATION PLAN NO. :! r t � r f 1 The Cotrsntonspealth of Massachusetts assachusetts Departnewt of Industrial Acciden& Office ofIn vestiga ions 600 Washington Street. Boston,MA 02111 >Fti*wtt:atass govl'dia Workers' Compensation Insurance Affidavit:B�ders/Cau ractors/Electricians/Phmbers Applicant Information Please Print L embly Name(Bk4nes-lorgmiizationin&vidnal): al oc- Address: City/State/Zip: A-Srtv 0 ,/_lA 600 Ph ne 4 _ 4 S ! d A n an employer?Check th-appropriate box: Type of project(required): 1. I am a employes with 4- ❑ I am a general contractor and I roarpact=time}.� hmm hired the sub-contractors 6. ❑Ne employees(full and ctansfruct ou 2.ElI am a sole proprietor or partner- listed on the attached sheet. 7. oozing shipand have no l ees Thfne subcontractors have 8 emp ❑Demolition working for me in any capacity. c - employees and have workers' [No workers'camp.insurance. � insurani,.l 9- ❑Building addition. required.] 5..❑ We.are a corporation and its 10.❑Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work 11.❑Plumbing repairs or additions myself [No workers'comp. right.af exemption per MGL 12.❑Roof repairs insurance required.]I c.152,§1(4),and use have.no employees.(No workers' 110 other Comp.insurance required-1 0-kay applicant that checks box#1 mast also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidm it indicating they are doing all Work and then hue outside contractors mast submit a new affidavit indicating such. tContractors that check this box must attached,an additional sheet showing the name of the sub-contractors and stage whether or not those entities have employees. If the sub-cantractats have employees,they nmst provide their warkers'comp.policy number. I ant ati entployer tliat is proi idf ig it,orkers'eonWe.tsation irrsrrrance for utv eniplot°eeL Beiosw is the policy and job site informadmL Insurance Company Name: ��gjjk�asi :K j Ira — Policy 9 or Self-ins.Lic.#: `"f�r� .PQ 3- 15 l . . Expiration Date: r->. Job Site Address: I q1 rI"I'd-"i� CifylStatelZip: l Attach a copy of the workers'compensation policy declaration page(showing the policy number and a tion 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 S 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 against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations o 16, . IA fort insurance coverage verification. I do hereby�VL the pains n pen Ties petjrtry fJrgt the informationprovidedabodeis free andcorrect. Simature: Date: i Phone#: l.')6ON'4�-{G®. Official use only. Do not write in this area,to be completed by city or town officiat City or Town: PermitUcense Issuing Authority(circle one): 1.Board of Health Building Department 3.City/Town Clerk 4,.Electrical InspLxtor 5.Plumbing Inspector 6.Other Contact Person: Phone#: r COP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/24/2014 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(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: Germani Insurance Agency PHONE FAX 908 Main Street c o 508 428-9194 A/c No: 508 428-3068 E-MAIL ADDRESS: Ostervllle,MA 02655 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Essex Ins.CO. INSURED INSURER B: Scott E.Crosby Builder,Inc. Scottsdale ins.Co. 1112 Main St.Unit 7 INsuRER c Osterville,MA 02655 INSURER D: Hartford 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MMIDDOLIY/YYYY) (MMIDDIYYYYl LIMITS A GENERAL LIABILITY 2CN6590 10/12/2013 10/12/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE �X OCCUR - MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ POLICY I I PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _ Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident C UMBRELLA LIAB HOCCUR XBS0025685 10/12/2013 10/12/2014 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED RETENTION$ $ D WORKERS COMPENSATION 4727P23-8-11 6/23/2014 6/23/2015 YVC sTATu- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L.EACH ACCIDENT $ 500,000 (Mande oOFFICER/ry in NH)MEMBER EXCLUDED? _ E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF 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 required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE Scott E.Crosby Builder,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 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 4 JIM Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-043556 SCOTT E CROSB) 62 CROSBY CIR OSTERVILLE WA 02 `5 - ' i Expiration i Commissioner 12/13/2014 ,f� C�//ie�anvrraoaacaea�G/z-d�C��aoJacicc�e� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: �51882 Type: Office of Consumer Affairs and Business Regulation =expiration: Z/;13/201i Private.Corporation 10 Park Plaza-Suite 5170 Boston MA 02116 SCOTT E CROSBY BUILDER INC r + SCOTT CROSBY 1112 MAIN ST UNIT#7 OSTERVILLE,MA 02655 Undersecretary Not valid without signature d, I i I O4° Town of larnstable Regulatory Servieps { �b�eobi� ♦Q T6omasR.,GeW.Director Ring IDWWon Tom Perry,CB0 Building Commissioner 1 200 Main Street, Hyannis,MA:02601 M _ �nvw.tossri.barnstable.ma:its Office: 5084624 Faa t SQ819"230, I'taperty Owner Must Complete and Sign 7Clus Secori_ ?' if Usauii9 A Bulkier f i f� is Owner of".t3ie subject properi hqe authorize i ° F / E actommybehalf in all mattexs relative to ,po'rk authgziz ad by this building pe�rsit application; 6h (Address of job) Signature of Oevner 6 topt Prlat Nar<e Q3'ordu:ptpm�g Revise0T1405 i L d ,r ., � axa S P►�`91.� 36 u 73 SPA S iZAml�j TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map40 Parcel U DIto _ �PpolicatlioLR# a(� Health Division Date Issued S 17�/�� Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village @ ,-4 _ Owner b _Address �� PUS Telephone g O R 31 Permit Request 45,-1AT) &9,M /ems(At, Square feet: 1 st floor: existing proposed 2nd floor: existing. proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatior��,0 0 0 Construction Type ho �+r Lot Size ii 3 5- Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U , Two Family ❑ Multi-Family(# units) Age of Existing Structure �' Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes C9'No Basement Type: `h Full N4 Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new V Half: existing new Number of Bedrooms: existing Onew Total Room Count (not including baths): existing new First Floor RgoTV Count Heat Type and Fuel: ❑ Gas 2 1criI ❑ Electric ❑ Other , Central Air: 'Yes ❑ No Fireplaces: Existing New Existing wood%coil stover❑Yes=❑ No w Detached garage: dexisting ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ exi ting ❑ new sAe_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: w Zoning Board of Appeal uthorization ❑ Appeal # Recorded ❑ Commercial ❑Ye dNo If yes, site plan review#Current Use S W Fn Pn Proposed Use APPLICANT INFORMATION (BUILDER-OR HOMEOWNER) Name ��' � Rj(rr4cA Telephone Number Address Lit`j � i:1P1 /1 r�L License # - (A 04, e( Home Improvement Contractor# Worker's Compensation # 41 Pa:3 S— AL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I &V t) OF L . need& Le-- ` i I SIGNATURE DATE v�C I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER " DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ?.x llq DATE CLOSED OUT ASSOCIATION PLAN NO. 4 , 1f 7lre Contrttoniv alth of Massachusetts Department of IrdiishiaiAccidents 09we o dmTesfi ations " 600 Waslxing[on Street Boston,AL4 02111 tit n n n as&gov1d a (Workers' Compensakan Insurance Affida-vifi BuildersfContractorsl`Electricians/Pl tubers Applicant Information Prase Print L . 'bt f Name(BusinEavrganizadoa%dividual): L Address: 11 CZ Hahn � f h1+ 1 CityfStatefZip: ' Pbone4 LID-& rgc)go Are a yo an employer?Check th,�.�ppropriate boa: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I = employees(full andlorpart-#ime). have hired the sub-contractors 6- ❑� ctioie I El am a.sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship hint have no employees These sub-contractors lave 8. ❑Demolition working for rue in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance:( 9. ❑Building addition required] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions xlf o workers' right of exemption per MGL �`' � c°�- 1'2.❑Roof repairs c.152, 1(4),and use have no insurance rec�uiied.)l § 13.❑other employees.(No workers' comp.insurance required.] ;Any appUcaur dh3t checks boxrl amst also fill out the section below showing their workers=compensation policy information. i Homeowners who submit this afndn it indicating they are dai h_all wort end then hire outside conttactors m ,submit a new affidavit indicating sach- tPontractars that check this bm must attached in additional sheet showing the name of the sup contractors and state whether or not ihose amities have emVlayeU. -1the sub-contractor have employees,they must provide their workers'comp.policy number. I am a!i employ"tltat isproslidin,g siparkers'coniperrsation ilis!lrmtc--e far ir!y elirpLryees. Below is the policy and jab site i!lfarlfEQtia!!. ' Insurance Company Name: Policy r or Self-iris.I.ic.-�: 41-0 Expiration Date: E Q,, Job.Site Addres:__Tyl� ly �����1�,I7 CityfStatelZip: J t 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 S1,3SKOO andlor 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 iiolator. Be advised that a copy of this statement may be forwarded to the Office of luvesfigationf`olohee DIA Or insurance cos erage verification. I do Ile by c fjf nlcde the phi nd alties 'n!y that the infarinafion provided above is bw and correct Si Date: jid cite 149 -- 4�0 40 J 0 use onty. Do not trrite in this area,to be completed by city or tatcrt official City or Town: PermitUcense Issuing Authority(circle:one): 1.Board of Health 2.Building Department 3.Cityffown Clerk 4.Electrical Inspector :.Plumbing Inspector 6.Other Contact Person: Phone#: -- 6 f l ® DATE(MM/DD/YYYY) CERTIFICATEIOF LIABILITY INSURANCE 10/28/2013 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(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: Gerrllanl Insurance Agency PHONE FAX 908 Main Street 508 28-9194 A/C No:508 428-3068 E-MAIL ADDRESS: Osterville,MA 02655 INSURERS AFFORDING COVERAGE NAIC# INSURER A:Essex Ins.Co. INSURED INSURER B: Scott E.Crosby Builder,Inc. 1112 Main St.Unit 7 INSURER C: Scottsdale-.Ins.Co. Osterville,MA 02655 INSURER D: Hanford INSURER E: J 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MMIDDIYYYY A GENERAL LIABILITY 2CN6590 10/12/2013 10/12/2014 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE 'OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Peraccident $ C UMBRELLA LIAB HOCCUR XBS0025685 10/12/2013 10/12/2014 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000 000 DED RETENTION$ $ D WORKERS COMPENSATION 4727P23-8-11 6/23/2013 6/23/2014 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑N N/A ` (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,descr be under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Scott E.Crosby Builder,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 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 I Massachusetts -Department of Public Safety Board of Building Regulations and Standards - 9 9 Construction Supervisor License: CS-043556 SCOTT E CROSB)- 62 CROSBY CIR OSTERVILLE Na 02 ` Expiration Commissioner 12/13/2014 �e�powvi�taietaea�l a�C�aaclivaeCt� �' Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: .151882 Type: Office of Consumer Affairs and Business Regulation .n 10 Park Plaza-Suite 5170 ;, xpiration: d131201:4 Private Corporatic Boston,MA 02116 SCOTT E CROSBY BUILDER'INCaIM y: �( i SCOTT CROSBY ' = :<' i \ . :�; 1112 MAIN ST UNIT#7c ice- OSTERVILLE,MA 02655 "- Undersecretary Not valid without signature 07/02/2006 16`t43 7278659W, AMAUPMATK PAGE 01/.01 a r 9 Town af Baxs�abe _400k, : Gezleru Dsrceirnr Rnild,ing`IaMAOU Tempe rky' CBQ. Buu��gcoz�a„n3ssi�acr 20011�iain'S�ecS Hyr�nuars,N!A 42601 ' v:tovv�a,k►nm�stabicma,ms aff= Sof� sG2-4038 Rax: sa8 79aG230 FX013eriq OVMei MUSt Conn Iete and Sxn' s` ecv 3 �Odex sChvn�r"_oftk��:subjecCpzoett► h=by avd orf� to ace°aiq ioap bc1Ya1F, �1 311.ct�atfce relative to tvork.autliazizcd b+p thss k►u�Wog c t app tC=Qn f.01. (A dress $t aisare'of Owner a Pr ritNitw x�w�aa�aus . IRU28 RAFTER HANGER TYP. • 2X8 RAFTERS 16'O.G. •� MSTC26• STRAP IV H6 HURRICANE - - CLIP TYP. .- - EXISTING BUILDING tX6 AZEK DECKING 8•—D" 4 X 4 POST EXISTING - - RIM y BOARD - - ABW44RZ POST 6•TIN4TdO s THROW"RIM. St . SASE TYP. FINISH GRADE CONQ P.T. •:!: ... SONOTUSE JOISTS - .. 616, BIGFOOT M OR j O.C. . FOOTING BOLT ANCH . . - FRONT ' . SECTION - CIL VATION Assessor's offioe (1st floor): 00 SEFMC ,"TES W THET t Assless`or's map and lot number .:00 -. ...........`.................. OF ".Y., :.a IN COMPLI off`° ,; d °� Board of Health (3rd floor): '�t S IT H TITLE 5 Sewage Permit number ........81:7.2.43......... ,. ....... . �;��• .`.Q ;DENTAL CODE 9TSDLE. i Engineering Department (3rd floor): 797 �K K' TOWN AEQt�iL,A'CIONS °o 03o• 0� House number ........................................................................ o gar a' APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .,,Build Two car garage 24 ..........X...24............................................................................................ TYPE OF CONSTRUCTION WPod...Frame...... Res........................................................................................... .........._. Apri1..1S..............19.88.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 797 Old Post rd. Cotuit /-OT ..................................................................................I.................................IL.................... Proposed Use .Garage ....................................................................................................................................I......................... o u Zoning District R.F...................................................................Fire District ...........C....�......it............................'.......................... Name of Owner Kaneb ....Address 140 Orchard Ave. Weston MA 02193 .............................. .................................................................................... Name of Builder Rogers and Marney, Inc. Osterville MA ........................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... ) nce Number of Rooms .(0.................................................................Foundation ..........Co........r........te...4'........X......8.."................................. Exterior Shing.les ...Roofing ...Asphalt Shingles. ... .................................................................. . ......................................... Concrete Wood Frame Floors .....................................................................................Interior .................................................................................... ----------- ------------ Heating ..................................................................................Plumbing .................................................................................. Fireplace -- .....—... .Approximate Cost 12,000 Definitive Plan Approved by Planning Board ________________________________19-------- . Area '5.76... q. ft . ............... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH H o v _ 1R 1 v j ISO �' • 10 0 S}41UGl�s - — Op qx-, a t< OCCUPANCY PERMITS REQUIRED FOR NEV DWELLINGS J1G- 12y �*-,'�.4 1 hereby agree to conform(to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Namecg!(,a..���.r ........................................... Construction Supervisor's License (C .� . K�ANRt3 Noj................ Permit for ......2...G.ax:...Gax.a. e ...t,o...pwP-1'.J.i a ; Location 797 Old Post Road Cot Owner Kaneb r ;+ ....� z Type of Construction ....F.K.(A Q......................... .................................................... 2 n 4 F Plot ............................ Lot ................. _ ............... € 4f Permit Granted .,..,,April 2ly 19 88 ..... .. Date of Inspection ........................... lam t ........... ...... . .........19 €., 9 t Date Completed ............. .............1 I • Il' { Assessor's offioe (1st floor): 0 0 FTNE. T Asse's3or's map and lot number 7 .008_2 �Qo ono Board of Health (3rd floor): d � Sewage Permit number ........ �.7:n?.4.3.......(� = EMUSTA ME, Engineering Department (3rd floor): ' K' �o a House number ..............................797 op,0 s9 • .......................................... �E�yAY pry APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00--2:00 P.M.'only y _ TOWN - OF ., BARNSTABLE J BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. Build 24 X 24 Iwo car garage ....................................................................................................... ' TYPE OF CONSTRUCTION Wood Frames...Res. ........................... .................................................................................................... .............. l.1...15..... --.....19..88- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: i — C M 797 Old P• st ;'rd. Cotuit Go / y { � Location ......... .......r......:.................................................................... •..........................�.............................. if ' Proposed Use ..Garage................................. ...................................................................................'.................................................... Zoning District RF 1 ..............................Fire District .........,CO.Llit j... .................. ............................ Kaneb I� � 140 Orchard Ave. Weston MA 02193� Nameof Owner ......................7..............................Address .................................................................................... ' / / Name of Builder Rogers and Mar�ney, Inc. Address Osterville MA ............... ................................................................. t Nameof Architect ........................ ...... ...................................AddFess .................................................................................... (0 ) F a ( � Concrete 4' X 8" Number of Rooms .................:................................::"�:.............Foundation .............................................................................. Exlerior Shingles Asphalt Shingles ................. ..................................................................Roofing .................................................................................... Concrete Wood Frame Floors t ............Interior .............. r ----------- ------------- L__ Heating_ ...................:........._.......................::...:....:........ ;....,..:Plumbing Fire,,. $ 12. .,..000. '� `� .......Approximate Cost ... .... place ........................`................................................... PP .. . .. . .... .............................................. Definitive Plan-Approved by Planning Board ------------------------_-------19________ . Area 576 sq ft Diagram of Lot and Building with Dimensions g 9 Fee .. . .............................. SUBJECT- TO APPROVAL OF BOARD OF HEALTH �- llll , j 2,41 1 � 1 .!1 p�` �jla I IJ�liS� _ .. •� rf ,3 ` tg77S�fl<1�� qx-I x OCCUPANCY PERMITS REQUIRED FOR Nf DWELLINGS - 2y �el__24 I hereby agree to conformito all the Rules and Regulations of the Town of Barnstable regarding the above construction. "" ............................................ Construction Supervisor's License ................ r KANEB A=73-008-002 ,t4,/..•31823. Permit for ...Two...Car.............. ................Gar.ago....:.................................... Location .....797 Old Post Road . „ Cotuit ............................................................................... bwnerK.aneb. �.. .... .................................. ............. Type of Construction ....Frame ............................................................................... Plot ............................ Lot ................................ . i Permit Granted ........April., 21. 19 88 t ' Date of Inspection ....................................19 Date Completed ......................................19 0 �� F TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION 'Map 0,q 3- Parcel 0 O 9 -00 T o j_, c: Permit# Z 0 2$ Health Division - �"2`13 Z� 03Q fLtN °`"t Date Issued 1 L 3l 03 ^ Conservation Division -�� �O9 03 .� ."03 D6a SIS %'L ; rFee f, 25 Tax Collector al,;f Treasurer �l jw,sf.0 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis , Project Street Address CL 1. OLD Poc;r 12 t� . Village C',omu%T' S/SI • Owner tZo[3G9_-T- [', . -ruR N%u W_ Address 2 2.51A tCc y jaLvo. sT 7�?S13t�26 IC'L 339/S'_ Telephone So 8 YZ 8 -,16 Permit Request C'OdlVEgl- ay( ISTi,,V4 5412fcN ftRcd IA4TO CjAt6(0,1TFb r PLANS IJ.V TIT 9 23 03; Square feet: 1st floor:,existing 252 proposed O 2nd floor: existing 0 proposed _cq) Total new Valuation 16, ,2$ Zoning District _ Flood Plain - Wtp6. Groundwater Overlay AP Construction Type w/ocoD A.wtf Lot Size 1.W r1G Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U Two Family ❑ Multi-Family(#units) Age of Existing Structure SO Historic House: O'es ❑No On Old King's Highway: ❑Yes &lo Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) ZS 80 Number of Baths: Full: existing new 0 Half: existing new h Number of Bedrooms: existing new ep Total Room Count(not including baths): existing 16 new n First Floor Room Count $ Heat Type and Fuel: ❑Gas ❑K ❑ Electric 0 Other Central Air: des ❑No Fireplaces: Existing New 0 Existing wood/coal stove: ❑Yes La<o Detached garage:9existing ❑new size Pool: ❑existing ❑new size Barn:0 existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# /V�/-�- Recorded❑ Commercial ❑Yes CIH16 If yes, site plan review# Current Use ZINGLF_ Fi4tqj1. V Proposed Use 5ALA4E r 1 BUILDER INFORMATION Name RobseS Xnlr, Telephone Number so S qzs •6i06 Address J3 X 3 t O License# C S 0S'TS2V t t_L e =M A• oZ4,SS Home Improvement Contractor# 1 DOlay Worker's Compensation# \Afc G2S-1 Y�2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKENX N 1*cdy'l c.2 VE S SIGNATURE DATE 9 2S 03 — FOR OFFICIAL USE ONLY PERMIT NO. DATT ISSUED' s MAP/PARCEL NO. r , ADDRESS " '''� f VIL'LAGE OWNER ^' DATE OF INSPECTION: FOUNDATION FRAME ,, t. INSULATION _ FIREPLACE ELECTRICAL: -ROUGH FINAL ' PLUMBING: ROUGH FINAL t{ - GAS: ROUGH FINAL FINAL BUILDING — DATE CLOSED OUT ASSOCIATION PLAN NO. - f RESIDENTIAL- BUILDING PERMIT FEES • APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations S25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031 plus from below(if applicable) AL,TERATIONSIRENOVATIONS OF EXISTING SPACE oo � o0 Z,.S L square feet x S64/sq.foot plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.1 , • >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.003 1= STAND ALONE PER'NMS Open Porch x$30.00= (number) Deck x$30.00=. - (number) Fireplace/Chimney (number) Inground Swimming Pool . ,S60.00 Above Ground Swimming Pool S25.00 ; • RelocatiomriNZoving S150.00 (plus above if applicable) Permit Fee projcost Mop 73 _ - - d #aso / Nco 13 #33S -Nab 3 #a21 MaQ 73 #a00 ` A�q Q` #79V7:: Nap 13 #791 Map 13 Map 73 # i N MAP 073 PARCEL 008-002 SCALE: 1 -150 w � . E 100' BUFFER *NOTE: Planimetrics,topography,and **NOTE: The porcal lines are only graphic representonons. DATA SOURCES: Planimehics(man-made features)were interpreted from 1995 aerial photographs by The James it vegetation were mapped to meet National of property boundaries. They are not true locations,and W.Sewall Company. Topography and vegetation were interpreted from 1989 aerial photographs by GEOD Map Accuracy Standards at a scale of do not represent actual relationships to physical objecs CarpCiahon. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards I r,=I C0 on the map. at a scale of V=T 00'. Parcel lines were digitized from FY7G03 Town of Barnstable assessor's tax maps. I i F jHE Tp� j �° The Town of Barnstable • 'IIA1tNYCAllLE. 9 °'"� Department of Health Safety and Environmental Services PrfoM,y" 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 MCL c. 112A requires tlint the "reconstruction, it renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing nt 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 csceptions,along with other requirements. Type of Work: ALT E-9-a 't0W rst. Cost4l!, a a is Address of Wori(:qR7 cn— D PAST �•� Owner's Name Qogf-Wr G. $ 1MA¢'? -rQ9_N13U1.1.._, Date of Permit Application: C • e-T• G3 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not o)yner-occupiccl Owner pulling own permit Notice is hereby giveli that: OWNEIZS PULLING TIfE1R OWN PERMIT OR DEALING WITH UNREGISTERED CONTIZACTOIZS FOR r1PPLICABLE .1I0iTIL ItiIPIZOVEl1ENT WORK DO NOT HAVE ACCESS TO THE :kninTrATION'I'It IOCIZA 101' CUARINTI' FUND UNDE11 iYICL c. 142A SIGNED UNDER PENALTIrS 01'. PERJURY I liercby:ii:ply fora permit as the al;ent of the owner: • Date Contractor Name Rcgistration No.' OR I):ite Uwrier's Nanic _ jMassaeh usetrs The Commonwealth o Department o Industrial Accidents _ ofllce of/nyesUgadoos 600 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit f�R It nt; ::77.:v -=F tbly. - _ _ - _ -^ name* location: ciR' I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity �} I am an employer providing workers' compensation for my employees working on this job. comoanv name: `ROGERS & MARNEY: INC.'. P.O. BOX 310 . address: - city: OSTERVILLE MA.02655 phone° ( 08) 4 8-6106 insurance co. AMERTCAN TNTERNATTONAL _nolicv# wr •6751 A0 I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed beIfow who have the following workers' compensation polices: company name: address: R.. _phone 9• insurance co. Rolicv comnans• name: _. address' city: phone= insurance co. oolicv# Failure to secure coverage as required under Section 25A o(MGL 152 can lead to the imposition of criminal penalties of a fine up to 51500.00 and/or one years' imprisonment as%ell as civil penalties in the form of a STOP WORE:ORDER and a fine of 5100.00 a day against me. 1 understand that a copy of this statement may be forMarded to the Office of Investigations of the Dt.a for coverage verification. t do hereby cerifi'under tr,e pe{ns nd penalties of perjury that the information provided above is true and correct. Sienatur: Dare q •2S'•03 Print nam:_ 00r-- Phone = �O S YZ8 •�t l06 .._. j' 0f 621 use only do no rite in.this area to be completed by city or town orricial cirn or to-n: pc�mitlicense d ilding Department E° CjLicensin;Board ff check if immediate response is required . CSelectmen•s Offic- [Health Departmer,t • p phone Mothe contact erson: r i Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 100134 Type: Private Corporation Expiration: 6/9/2004 ! ROGERS & MARNEY, INC. Charles Rogers P.O. BOX 310 Osterville, MA 02655 Update Address and return card.Mark reason for change. Address ❑ Renewal Employment ❑ Lost Card • pp / t ✓�ae "C�ammaxule¢�i a�./Claaaac�u�aetla . m Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: .100134 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 6/9/2004 Boston,Ma.02108 Type: Private Corporation , ROGERS&MARNEY,INC. �harles Rogers 445 WEST BARNSTABLE ROAD " ,i Osterville,MA 02655 Administrator Not valid without silffature I i t BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 016174 Birthdate 05/07/1939 Expir4:.05107/2004 Tr.no: 124057 j Restricted 00 CHARLES D ROGERS 1 • PO BOX 310 (. a- TA - OSTERVILLE, MA 02655 Administrator l i w f1HFr�,, Town of Barnstable Regulatory Services • RAWISTABLE, � MASS. g Thomas F.Geiler,Director �A i639. �0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A k Builder L C. T'c,¢�•(gu�L , as Owner of the subject property hereby authorize ROGERS & MARNEY, INC. to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job) Signature of ner t Dat v r Zy Print Name Q:EORMS:OWN'ERPER MISSION HOUSE HOUSE .SCREENED ._PORCH SEASON ROOM EXISTING CONDITION i PROPOSE FLOOR PLAN III i c i a � SECTION = B C SIDE ELEVATION FRONT. EL EVATION .o �4ao e.,...... ..... .W..ea...u..,- � r `..r.....3�rco.,...� .. •-ti. .?.- .. >.as 77 lu A�= m TURNBULL RESIDENCE �.u.4k•�e PROPOSED ALTERATION 797 OLD POST RD A—I �. r I .35 '. '• ��id0I1 V�iY �V`�"ale ' _ .d� , Pin Fr)set) w sv) � A MA OIL \. � � � - I: 45t 1.Y • to 1 r4r '�'-''n�,11�L�, � h It• 1•J•.� 'lV ' ./f ,. ;l 4 1 11 i I M1.�7 '-. 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