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1075 OLD POST ROAD
io �� 62u P� AGRIBALANCE Company Name CAPE COD INSULATION Phone Number 1-800-696-6611 08/28/2018 Keith Dacey Installation Date �10 57 01d_P_o.st_Road—- Cotuit PA86001691 Jobsite Address `—"" A-Side Lot#'s Permit Number B-Side Lot #'s P3246016617 E�oc�tiion Thickness: it, 5.5 R-24 320 square feet Roof Line Outside Walls square feet Floor square feet •. -• Location • Blazelok TB Attic 17 mils wet/23 mils dry Sherman Williams Vapor Barrier Paint Ceilings 17 mils wet/23 mils dry www.Demilec.com MSDIEMILEC Town of Barnstable PostThisxCard,So That�tisVisibleFFromthe Street=A roved Plans;Must be Retamedo`n=Jobxandah�s Card Must be'Ke' tr Building RnnMwe�e P1639. osted U't IFinal iris ection Has Been MadePp £ > ' P ?r • Where a CertificateofOccupancy<is.Rega�red;bsuch Building skall Notbe®geu ied,,untd a Final;ln's 'ection has:been`made Permit Permit No. B-18-1469 Applicant Name: SCOTT E CROSBY Approvals Date Issued: 06/11/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 12/11/2018 Foundation: Location: 1075 OLD POST ROAD(CT&MM),.COTUIT Map/Lot 074-027 X02 Zoning District: RF - Sheathing: Owner on Record: AMMEN, DAVID L Contractor'Name�`��.SCOTT E CROSBY Framing: 1© g Address: 412 MAIN ST 'Contractor=License CS O43556 2 GROTON, MA 01450-0489 ,,, Est Project Cost: $65,000.00 Chimney: Description: Remodel the Existing Garage/Cottage. Rem o4 Existing=Living Space a Permit Fee: $381.50 vr in Garage Area.Gut Interior of cottage,replace(5)windows and all Insulation: Roof Shingles Install new Electrical and Plumbing as needed,install Fee Paid $381.50 Final: new insulation&dry wall. no area change of footprint change Date," 6/11/2018 Project Review Req: ACCESSORY STRUCTURE NO FOOD PREPARATION AREA TW® u < i/ 111- 141- -- Plumbing/Gas CAR GARAGE TO HAVE PROPER FIRE SEPARAXIOM FROM" Rough Plumbing: LIVING SPACE.SMOKE DETECTOR UPGRADE REQUIRED w Building Official s Y Final Plumbing: �� Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months�after issuance. g All work authorized by this permit shall conform to the approved application anted !*approved construction documentsIlk,for which this permit has been granted. All construction,alterations and changes of use of any building and stituctures shall be in compliance with the local zoning by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for pdblicinspection for the entire duration of the work until the completion of the same. z Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Bwlding and Fire Officals are provided on'thi's permit. Minimum of Five Call Inspections Required for All Construction Work:;;k � 'K Rou 1.Foundation or Footing x ' g h- 2.Sheathing Inspection Final: 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 Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) t.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health 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. Final: ItPersons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: y All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp�� � � arcel .�A licati ` # Health Division ��l��l JVGIrat�- Ostued AV- Conservation Division '- MA aQ Iication Fee Y, 7 Tax Collector T®VVjV ePermit Fee Treasurer �C Planning Dept. r Date Definitive Plan Approved by Planning Board r rf'Ap- S Historic-OKH Preservation/Hyannis Project Street Address M VillageII (U� Owner I/il rb b4w l Address 66f Oat, - Telephoneb Permit Request MDarL`r�£ c1SiuU 6RQA(16C" IE'/#�mcF—AIs—INi bVily� S)7AGL I! � 6APA6-C-AR9QA , GV_rIN__M1D120Eri n C,gcp�c�� _) WINDD0 SADti Ra)( 5NIP&Z, lmrrii l ,NEW opal A,I�61VD Pb QWL AS PMW 1-6157 ILNOAJ 103VIA 19rJ ¢ 09V A1, Iyt7APa C Hta ry F�:: o P- oT VR ECG A F Square feet: 1 st floor:existing 8 o!_� proposed � 2nd floor:existing 0. proposed 6_Total newer Zoning District Flood Plain Groundwater Overlay Project Valuation ;L Construction Type W OV 17 &am 25: Lot Size , 0,5- 1qg!G,F_S Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family a/ Two Family ❑ Multi-Family(#units) Age of Existing Structure A( Historic House: ❑Yes YINo On Old King's Highway: ❑ I9 Yes No Basement Type: ❑Full ud Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) r Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new 0 Half:existing © new C7 Number of Bedrooms: existing_ new _ Cs.)cD RM5 MAIN Total Room Count(not including baths):existing / new (' First Floor Room Count Heat Type and Fuel: ❑Gas ElOil Electric ❑.Other Central Air: ❑Yes I(No Fireplaces: Existing f' New D Existing wood/coal stove: ❑Yes dN 0 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 Appeal7N'o horization ❑ Appeal# Recorded El Commercial ❑Yes If es, site plan review# Y -Current Use ),Al611 4N Ml l W Proposed Use BUILDER INFORMATION - Name 0� f I Telephone NumberDb Address �`i �l��y1 .;. � ►U�' License# - Pf� 35C� RAHome Improvement Contractor# Worker's Compensation# 6 J r'o D (1 i a 3M ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE k` FOR OFFICIAL USE ONLY ti a4 APPLICATION# _ DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER _ r DATE OF INSPECTION: FOUNDATION FRAME INSULATION ` FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _ , DATE CLOSED OUT y. 4 ASSOCIATION PLAN NO. ';f Town of Barnstable MAM t639t6l �' Regulatory Services � �� fD � Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner = 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I E, Aaw-e as Owner of the subject property hereby ereb authorize L. c �iro's heA to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) . l Signature of Owner Date Print Name Q:Forms:ezpmtrg Revise071405 �L The Co.�lnaort+ve�alth of Massachusetts �. Department of Industriad Accidents C?fl�ce of Inves4gations i .600 Washineon,Street B&toh,MA 02111 immmas&go►ldia: i Workers' Coffipensation Insurance Affidavit:Bmlders/Cu.nti actiarsJElectricQahs/Phumbers Applicant Infoaahon Please Prntib Nagle(BusinelOrganiahan/todiv�doalY. _ O S - �' Address: l R .�Aft 1. CityJSta&ziP Me Ui11 Hj� Phone# i °�" 60;.. . Are you an employer?Cher approprrate boz. T}use of project.(regmred}: ' I am s aeral contractor and I [ I ❑ I am a employes with e El g employ ees{full and/or par3 hate hired the sub-contractors 6. ❑Ne�v consfnchon 2. I Ain a sole.piop #or of parer .. lid on the attached sheet 7. �e1mg shicontractors hwe p and Dave no 'loyees e mPt o Ysub- avid have O'beniotticin ii fiYc dY addition .9w .. _ [No w orlcers'to i uisman. . comp MsuramlpI j'�r? -] 5 ❑ �Ve are a corporation and its. 10A Elefitncal r spars ors hoes oflxcers have egercrsed their 3 ❑ I am a homeowner,doing all word 1I ❑Plumbing repairs.or additions 1£ o workers uisauanceieriauad]3 _ —right of Oinpu pco mp; 6152 haven' 12:❑Roofrepaits. 1i Other employees [No warkers comp_msurauce - _ 'Aayapplicantthatcb &s box#1 fill outt}te5ecte¢nbelaivs>nevv�ngfo rara¢Iters �omp�ssaaigapahcq afar�teab T H0Meownff5 who submit this atfidat4 nazcsUng ti<wy are doing au word;and than hire outdde contactors mQsq submit a nen,zhi&wft k&d* inch:ra*Vj.of Hie stib cmmactriis and'staieivi°eth�,at aot tbnse dd itiies have employees. If tZee sub caatraceoos bMPIos,th?y nnast pipv�de heir.a�orkxs'comp:.paldEp abEr.. Ism an einpinyer that that mprondmg ti�ortrers'conk ertsahvai rnsrara icO for ray ontptoyec keioty is tltep©licy atzd jpb site inforrrtatlorr. Inatgance Company Name: AU �-:��.Y� - Polic�*r#or Self-ruts.Lic:# n��,0 C�, - .'�L � .�. uahonIlate Job Site Address: �;a'� L CitylSW02Z p: 1 t �,I F'I. . Attach a copy of the workers'compensation policy declarpoon,page(showing the policy numlfer and ex'tration date). Failure to secure coverage as required under Section 25A of MGL tc 152 can lead to the pupo�atioia of cram'�Al pedaloes of a fine up to$1,500.00 and/or one-year inapi soiu a as well as civil penalties in the form of a STOP WORT ORDER and a fine of uP to S250.0�0 a day against the violator. Be advised.that a copy of thus statement may be forwarded to�e Office of Investigations of the DIA for insurance coverage verification.. Ida hereby cero the ndpenaIties of pegnry that die information proWded a aue hire and correct Signature: Bate. ftow Ojficiot use only IJb rrof rorite to dais urea,t i be canipleted:by city or&VII o,,(jacvat City or Town: . . ... _PerutffitlLicease#.. . Issuing Authority.(cii cIe tire): 1.Board of Health-1 Ba:idrng Department 3..4pityl'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other _ Contact Person:. ., . ' Phone.9:. . AC�® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F11/16/2017 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 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 endorsement(s). PRODUCER CONTACT NAME: Germani Insurance Agency A°Noe . (508)428-9194 a/c "o: (508)428-3068 908 Main Street E-MAIL ADDRESS: r-erts@germaniinsurance.com INSURERS AFFORDING COVERAGE NAIC# Osterville MA 02655 INSURER A: SAFETY INS CO INSURED INSURER B: Hartford - Scott E.Crosby Builder,Inc. INSURER C: 1112 Main St.Unit 7 INSURER D: Osterville,MA 02655 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. INSR XP LTR TYPE OF INSURANCE INSD SUBR POLICY NUMBER MM DDNYYY MM DDPOLICY EFF NYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ A BMA0022636 10/12/2017 10/12/2018 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JEC LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COa MBINEDSINGLELIMIT $ 1,000,000 E accident ANY AUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED 3953278 09/07/2017 09/07/2018 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ A EXCESS LIAR HCLAIMS-MADE CMU0001805 10/12/2017 10/12/2018 AGGREGATE $ 2,000,000 DEO I I RETENTION$ $ WORKERS COMPENSATION - X STATUTE OERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBEREXCLUDED? NI N/A 6S60UB4727P23817 06/23/2017 06/23/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 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) Workers Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance).The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION I , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED'BEFORE THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Scott E.Crosby Builder,Inc. 1112 Main St.Unit 7 AUTHORIZED REPRESENTATIVE - 1 Osterville,MA 02655 Fax` Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD i �e Gananzoreraecclfl��ICCJJCGC�cr�el•Z� �. Office of Consumer Affairs&13llS1ness Regulation License or registration valid'for individual use only `— HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: -_' . 151882 Type: Office of Consumer Affairs and Business Regulation NZ Expiration:.--.;7L13/-2018 Private Corporation 10 Park Plaza-Suite;5170 SCOTT E CROSBY BUILDER ING Boston,MA 02116 SCOTT CROSBY = 1112 MAIN ST UNIT#7 OSTERVILLE,MA02655 Undersecretary Not valid without signatbire / Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-043556; Construction Supervisor §t SCOTT E CROSBY 62 CROSBY CIR OSTERVILLE MA 0265b Expiration: Commissioner 12/1312018 Town of Barnstable Page 1 of 1 i l Go Back Building Details Land }�j l�6 I I Building $477,700 Bedrooms 5 USE 1090 value Bedrooms CODE i Replacement 3 Full+ Lot Size MT ,41 $488,210 Bathrooms 3.05 Cost 2H (Acres) I I Total A Model Residential 11 Rooms Appraised$ PP Rooms Value 1,938,600 Style Conventional Heat Fuel Oil Assessed $ 8 :PTO 1 ' Value 1,938,600 Grade Luxury Heat Type Hot Air Year Built 1880 AC Type Central 34 1T Effective Interior T' depreciation 10 Floors Hardwood g Stories 2 Stories Interior Plastered Walls Living Area 3 723 Exterior Wood sq/ft Walls Shingle Gross Area 6,696 Roof . Gable/Hip I sq/ft Structure Roof Asph/F Cover GIs/Cmp B Iding. Details_ Land,.. Building- $477,700� Bedrooms 1--- USE -----1090� '� value Bedroom CODE Replacement $35,576 Bathrooms 1 Full Lot Size 3.05 Cost (Acres) » - Model Residential Total 2 Rooms Appraised $ _ Rooms Value 1,938,60d „ \` Style Cottage Heat Fuel Electric Assessed $ _ Value 1,938,600, Elec xvF4° Grade Average Heat Type Baseboard Year Built 1980 AC Type None Effective 13 Interior Carpet t depreciation Floorst+ ' Interior Plywood I Prti 15 Stories 1 Story Walls Panel j -` -- -41 Living Area Exterior Wood sq/ft 265 Walls Shingle Gross Area 805 Roof Gable/Hip sq/ft Structure Roof Cover Asph/F GIs/Cmp http://www.townofbarnstable.us/Assessing/printsketch.asp?mappar'074027X02 1/5/20181 Print Page, Page 1 of 4 Print this page • Owner Information -MapBlock/Lot 074, 027/X02,,- Use Code: 1090 Owner Map/Block/Lot GIS MAPS 074/027/X02 AMMEN, DAVID L Property Address Owner Name as of 412 MAIN ST 1075 OLD POST ROAD (CT & 1/1/17 GROTON, MA. 01450- MM) 0489 Co-Owner Name C/O INSCO Village: Cotuit Town Sewer At Address: No GIS Zoning Value: RF • Assessed Values 2018 - Map/Block/Lot 07�4//027/X02-Use Code: 1090 2018 Appraised Value 2018 Assessed Value Past Comparisons Building Value: $ 412,400 $ 412,400 Year Assessed Value $ 42,600 $ 42,600 2017 - $ 2,613,000 Extra Features: 2016 - $ 2,613,200 2015 - $ 2,652,400 $ 193,700 $ 193,700 2014 - $ 2,657,100 Outbuildings: 2013 - $ 2,661,900 2012 - $ 2,803,400 $ 1,965,700 $ 1,965,700 2011 - $ 2,863,400� Land Value: 2010 - $ 2,891,300 $ 2,614,400 2009 - $ 3,622,200 2018 Totals $ 2,614,400 2008 - $ 4,106,300 2007 - $ 4,104,700 Residential Exemption Received $93,229 i Tax Information 2018 -MapBlock/Lot: 074/027/X02 Use Code: 1090 _. Taxes Cotuit FD Tax (Commercial) $ 0 Cotuit FD Tax(Residential) $ 5,934.69 Community Preservation Act $ 726 85 Fiscal Year 2018 TAX RATES HERE Tax Town Tax (Commercial) $ 0 http://w,ww.townofbamstable.us/Assessing/print l 8.asp?ap=0&searchparcel=074027X02 1/3/2018 Print Page Page 2 of 4 Town Tax(Residential) $ 24,228.45 30,889.99 • Sales History -Map/Block/Lot: .'074%02"'J"' - Use Code: 1090 History: Owner: Sale Date Book/Pa e: Sale g Price: AMMEN, DAVID L 1996-07-31 C141562 $1 CURTISS, FRANCES A&AMMEN, DAVID L 1996-06-24 C141145 $1 SHAWMUT WORCES.TER COUNTY BANK NA TR 1988-10-19 C115764 $0 AMMEN, IRVIN G 1950-03-16 C11409 $0 • Photos 07411027/X02 -Use Code: 1090 • Sketches -Map/Block/Lot: 074/027/RX02 -Use Code: 1090 This property contains multiple sketches. Please use the navigation below the sketch to browse sketches. >f / g j . Additional Sketches 1 1 2 1 http://www.tow-hofbamstable..us/Assessing/Printl 8.asp?ap=0&searchparcel=074027X02 1/3/2018 Print Page Page 3 of 4 Click Here for print version that displays all sketches at once AsBuilt Card N/A • Constructions Details -MapBlock/Lot 074/027/X02-Use Code: 1090 Building Details Land Building value $ 412,400 Bedrooms 5 Bedrooms USE CODE 1090 Replacement Cost $540,287 Bathrooms 4 Full-0 Half Lot Size 3.05 (Acres) Model Residential Total Rooms 11 Rooms Appraised $ Value 1,965,700 Style Conventional Heat Fuel Oil Assessed $Value 1,965,700 Grade Luxury Heat Type Hot Air Year Built 1880 AC Type Central Effective 30 Interior Hardwood depreciation Floors Stories 2 Stories Interior Walls Plastered Living Area sq/ft 3,671 Exterior Wood Shingle Walls Gross Area sq/ft 6,884 Roof Gable/Hip Structure Roof Cover Asph/F GIs/Cmp • Outbuildings & Extra Features Map'/Block/Lot 074/027/.X0i- Use Code: 1090 i Code Description Units/SQ ft Appraised Value Assessed Value FPL1 Fireplace 1 story 1 $ 3,700 $ 3,700 GAR Attached Garage 480 $ 12,100 $ 12,100 FOPC Open Prch-roof; 60 $ 2,200 $ 2,200 ceiling Flagstone Pavers PATF 663 $ 11,400 $ 11,400 on conc PAT2 Patio-Good 783 $ 6,100 $ 6,100 STRS Stairs to Water 27 $2,300 $ 2,300 GEN1 Large Generator . 1 $ 22,900 $ 22,900 FPO Ext FP Opening 2 $ 2,600 $ 2,600 PAT2 Patio-Good 980 $ 7,500 $ 7,500 http://www.townofbamstable.us/Assessing/printl 8.asp?ap=0&searchparcel=074027X02 1/3/2018 ., Print Page Page 4 of 4 DKHD Dock-Heavy 1 $ 143,500 $ 143,500 FPL3 Fireplace 2 story 2 $ 9,500 $ 9,500 BMT Basement- 540 $ 12,500 $ 12,500 Unfinished • Sketch Legend Property Sketch Legend 1132N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area SOL Solarium (Finished) BMT Basement Area FUS Second.Story Living Area SPE Pool Enclosure (Unfinished) (Finished) BRN Barn GAR Garage. TQS Three Quarters Story (Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine, Unfinished I UUA Unfinished Utility Attic FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in PRT Portico I WDK Wood Deck Porch PTO Patio I i I i i I i i f http://www.townofbamstable.us/Assessing/printl',8.asp?ap, 1/3/2018 - '` ».. - � .r, +. ,..ems �g,. ^' w �•yv 4*y� 'S,w + + • -{'1' r♦w' y`:. , 4.p� p�,r `. y1L � w�«r' v'"«....,-. .+I'r' '.ui�r t ,,�,� � y• :f �t :2 � r �i � :-t � e^"'a,,L•''w ' .«.,. •r .••�'! «:w�. • � ' � wy:. � . ..3°" '�a - ,+r rlty f, .._.aa:/ �p r :} x� 1 .A;'� � . :'s . /"��x...*.z±•+ �'��•. ..•L � 'ys+_ 3 a� � 'r �.f Y },�f i��,.w *f�•,�, �:,t ,����,r,-y^ .� c„1r n,�^, r/`.'�J!s .j y• ! tr�`•` y �' �« � 'yt�'' r�'rr� . � '" i' � •'�i9J� ,�f ,?r' 4 '•"'� •/'x"• a.?r �,r �.�, rt�';F"'�r "a , . •+,� { .l� a '' . /„ a •..,r•� per "�' / w r't�t �� r> y • w ..,, h 4 a M •a. �'""�,.�• �,}� d } � 1`rr j, l�.,y r»•✓ f �,� _f s � / :�=� _ «, I y� t/ �i I.- � rht -'; . 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WHIMS Date Definitive Plan Approved by Planning Board ENVIRONMENT'ALCODE AND TOWN RpULATIONS Historic-OKH Preservation/Hyannis `� '� APR 4 2001 `''Project Street Address L— Village Owner L- Address . � Telephone Permit Request `T [�` �I� , 6 Square fee • 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation' ZoningDistrict Flood Plain Groundwater Overlay y Construction Type r_. Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family '21 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) e. C 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: Cl Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing Cl new size Barn:❑existing ❑new size Atiached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If IIff yes, site plan review# Current Use Proposed Use V j� BUILDER INFORMATION Name /�� Telephone Number Address , License# '�� Home Improvement Contractor# �2r Worker's Compensation —#�Ihpi'W ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO1 SIGNATURE DATE FOR OFFICIAL USE ONLY - - a PEdtMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS - we,„ VILLAGE OWNER F �� � � . . ` •• ,� ' . - - ' e DATE OF.INSPECTION: - FOONDATION FRAME INSULATION ' FIREPLACE 4 ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH r FINAL tc 3 GAS: - ROUGH A � FINAL- FINAL B ' FINAL BUILDING r 44 DATE CLOSED OUT �' W t <� ASSOCIATION PLAN NO. ' i 20-00 10:31A P_04 vv co run rttUP tH I Y LINL ::?---.-WA I IUN btL LAND COURT PLAN 15b93-D AT j/• THE BARNSTA13LE COUNTY REGISTRY OF DEEDS. SOUNDINGS BASED ON M.L.W.DATUM. gAXTERS FOR PROPOSED PIER SEE SE3-3240. 0 NECK ROAD r FOR OVERALL SITE PLAN SEE SHEET 2 of 3. 00 A . ` LOCUS NORTH _TOP OF BANK_ _�:i— BAY PROPOSED 3'WIDE r FOOT PATH ' LOCUS PLAN BOTTOM 6 SCALE 1=25.000 COTUIT OU[ r!T EXISTING FOOT �ff Y C 1( PATH Ak 7c I PROPOSED 3'WIDE — BEACH 4� BOARDWALK GRASS — •TL \ M.H.W. ACCESS STAIRS — — — 5' o a I PROPOSED 4'WIDE •M L.Y� PIER B �i a -- �-- ir 2 4 PROPOSED 3'X16'RAMP rPROPOSED 10"-12"OUTHAUL \ • POSTS(4 REQUIRED) . `4 _6 PROPOSED 8'x 16' FLOAT 20' 8' 20' L-4- NORTH BAY PLAN VIEW -j0_ SCALE= I"= 40' 0 20 40 60ft. Gi � PLAN ACCOMPANYING PETITION OF SHEET ! of 3 DAVID L. AMMEN 1075 OLD POST ROAD MARSTONS MILLS , MASS. FOR CONSTRUCTION 81 MAINTAINING A BOARDWALK. PIER, FLOAT 81 OUTHAUL POSTS IN NORTH BAY AUGUST 18, 2000 SULLIVAN ENGINEERING INC OSTERVILLE . MASS. N O a 188' TOTAL 5 BENTS Qt7 10 = 50' 7 BENTS 16' _ 112' EL.9.5 10' 16' —HANDRAIL 100'FR OM M.L.W BOTH SIDES r: EL. 6.5 �r 3'x16' RAMP H.T.L,3.2 ---�-H.W.2.2 BEACH GRAS —3'MIN. ACCE. _0„ BOTH IRS 4 B H SIDE ---- ---� SECTION A -A DECK SPACING ON, 2"x 4" SCALE: I 20' FLOAT TO BE 1',MIN. p - RAILING „ 2 x 6"DECKING,I" SPACING MIN. 3'-0" 0 2 4 E L.6.5 WATER 8 ft. ELECTRICITY 2"x4"RAILING 2-4"x 10"LONG LEAF , " 0 10 20 mi1Y Oft SOUTHERN PINE 3-4"xl0"LONGLEAF M 2"x6"DECKING,I" No. 2 SOUTHERN PINE No.2 SPACING MIN, 112°0 GALV.THRU BOLT W/ M.H.W. 2.2 — II WASHERS(4 EACH FLANGE) o: ELECTRICITY 1 w 2.. 8"s WATER 11 -1 4"x 4"CEDER POST 11•—6---,I 11 H12x53,A36 STEEL (CROSS c� BEACH I _! p SECTIONAL AREA=15.6sq.in.) GRASS (a] 10 O.C. M.L.W. 0.0 II II SECTION C-C 100' TO M.L.W N SCALE: I 4' 10' 16' M 0'y1--DK= SECTION B- 8 -=mr X K m - """'�� PFIEOF RAMP FLOAT co mm SCALE: I" = 4' O�rrz0Z�,i ° �� "0PILES ON rn o R (4 REQUIRED) N0 w 1)cmm I— 1. 1 O"-12"0 OUTHAUL POST(4REQUIRED)� N PARTIAL •PLAN grAl F : I 2O' The L'umrnonwealdsN ivassact:users . Department o•f Industrial Accidents _ Menallarestlfatlaas N_ 600.A,�shington Street , Boston,Mass. H 02111 4 i'��• of 4x.4 Workers'RCom msation Insurance Affidavit, T. lip • . ,. ; . . :,.�, ra:.� ... -yr-', }� y k..:+.L. •.;.�: � ``.,,; t9 4.ri ,1g..+,.r.+1i2« t OC8$tn1. 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I aadsrstaad that e "'`f'eop>•of thM ttataaeat raa�bi forwarded to'ttie OIDee of Ia®adv1doas I do hff*card the ofpadWY that the infomiadon pms i*d abvw ir'trru a.. 31= 4. `� �� ...,�..�y� 1 ,: �s,� PhM1G N. i"•:mt: �t 1 1 Q ----------------------- Cd : 7 do not write in thb area to be completed bFdly adF or town oIDdal .,, „ ", .. ;peradtAlcense II ❑�g Department ❑Lceami=Board ty mediate response it required Sdecunea't OMce ❑He&M Department : (jera.e 9M P1N • 1 a.. • Ilpl•- i.• . . • • 1 � / , � • - elp�. • -'!• •1 - •p-f • • •r.N .0 •11 • •• • • 1 • • 1� ! :f•11 • .11 • • • /•• • • • • /• • V: • �• • I ] .111 �/ • 1 • 1 • If • 1-. :.y � • �+�If/Y, • w • • - • �IH1. • • • • • 1 U •. •1 1 01";1 1 U M • •11 • • 1�1 •I: :1•Uf :f11.• • If • ;••Ilf • • • A I • • •A • • • wl. • . • '/ 11 • • /1 •' 1 1 1 .19 .• •p•w11 .11 • 1 • r • 1.4 �f11 •1 /1 • 1 fl • 1 • • •• •• . 1• p.1 1 • :Ip11• • ..•I• A • 1. / • « •II • 1 «: •11 •1 • 1 • .. •11 1 1 • / • 1 • • •t/ /• •/ • •• f • If • • • .�f. fl i. -1• 1 • • / 1 �ffl• IJ �11 • •_w11_• • • .11 wall • _1 f • Iw _M• 11 • Y._I: ;i/.1 .: /' 1 1 1 V 1 • 1 :1 i 1 1 1 1 1 : 1 1 , ,1 1 f,' 111 'I 1 1 1 .1 1 'Y 1 1 + 1 •1 1 1 • 1 iY is 1 1 1 J. 1 /1 1:i l `I:;1`,1 1 1 1 1 ' 1 ► / 1 1 1 1 1 I . : / 1 1 r' 1 1 11 I 1 •1 11 ..1 - 11 1 r 1 1 ..I • • 1• •11 I 1.•II/•.1 1 post •11 ••_'% 111 1 •1 .11 • •1 1•, •• 1• W. 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I. • fir w•r. ull • 11 •I 1.fll • _• 1 � 1_• 1 I - - .1 _• 111 _• /• • / Y.11. •I....••. r•11111 Lv;l• •11 • 1 � ✓• I 11 , ..••Y. 11/�.fl .',1 IIIUI 1_1 /_• • • ' • v / 1• 11 .1 11 • . •) Y.1111„ tolf-ttle0zk1&vjqfill(of-:* • r .1 11 ••• •111 i/• . 1 I11 • • 1 n 71 •11 II ii _n i• r •1 I ' ..n r.if1 •n;• r, f• Y•111✓. •• 1 •r.. pill /I u • .- ill •-r r..1 /11111 ' I 1 I f 1 V_1 �11_f _•• 111111 1.i. I ./ • 1.- Ilk p •1f••_• 11 f. 11I 11 .1 1.91111 11 1 • .1 •1/ ..•1 • • to . 01 -41mill ��/�• ./. `1 •I�.. ..11•. /✓• • __./ 11 Y. . 1 .• • 1 • 1• •11•I: • 1 • II .11 • 11 1 ' .11 M •1 • • 1 Y•• 1�1 .11 •11 .1,--.1 1 • • • 1 .11 • w •./ .�. • • • • 1 wiY.11 Is . 1 1 • •f1«11 1•1 k / 1 1•11 .11 p:►' IIIU .�1 i t 1 1 I 1 , 1 1 1 1 The Town of Barnstable 1 59. ,0$ Regulatory Services '�fo ter' Thomas F. Geiler,Director Building Division Elbert Ulshoeffer, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires than 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: Estimated Cost Address of Work: 5,7 Owner's Name: _P_2W_kC_) Date of Application: I hereby certify that: Registration is not required for the following reason(s): Y DWork excluded bylaw , []Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRAC a'ORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereb apply for a permit as the agent of the owner: ,11 Dad Contractor Name Registration No. OR i Date Owner's Name q:forms:AfUav ,�1Le "�oa��t,�:tu,7Lu��Llf apt.%��n7J:J.u,'ILLt;JeCtiS BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 068433 Birthdate: 06/10/1955 Expires:06/10/2002 Tr.no: 26808 Restricted To: 00 GEORGE R GILLMORE PO BOX 940 "� ! COTUIT, MA 02635 Administrator ' � ,J 128 V/O%7l.!!L4/I,(C6CLC��, O/J✓�/,!/Jill/,f,11,ILJ6�0 .. Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR . Registration: 123494 Expiration: 02/26/2003 Type: PRIVATE CORPORATION Gillmore Marine Contracting,Inc. George Gillmore 37 Bowdoin Rd � ,,: Mashpee,MA 02649 Administrator c 711(o, A �„ T Town of Barnstable *Permit# ;0 b N 0 7) Fapires 6�,�5—s� S-Sug� O �T Regulatory Services Fee (U� 1639. Richard V.Scali,Director ESS Building Division JUL 0 9 2015 Tom Perry,CBO,Building CFmlmfissioner UY114611 1 �1 �1r BARN 200 Main Street,Hyannis,MA 0201 S TABLE www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Vp 1 Lj r O � 0 Valid without Red X-Press Imprint Map/parcel Number Prope Address %D �j�S' Residential Value of Work$ �� /j.i Minimum fee of$35.00 for work under$6000.00 z Owner's Name&Address 12 2:!Z 01W ES-1 Adol ii 7' Contractor's Name Telephone Number U Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance ChKeone:a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ (check box) a./ ,�S,-� �✓✓ Re-roof(hurricane nailed)(stripping old shingles) All construction debris wilt be taken to ,, , �l MY ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission., A copy of the Home Improvement Contractors License&Construction Supervisors License is re fired. 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D'Ed=or other legal a3ty,or any t VD or mDre l • An FSI�IdfE�IS d�.ed as�1 mdrzrdnal,per, ,�P bff3e kTCgDing MgRg-d m a3oin±=='i and �e legal.rives of a deed cmplDyq-or the rtxeaveg rsr trostee of an .P M ar Uffim legal mtdy,employing MIplDye�s be 110 Y?T � OW=of a dVtM g-hDm5 ha vi agnDtm=ffim ffn-=apm m=ds and whD resides i m-c;m c r iha Dcmip- . of the dwelling hD=ze.of aaotl3ervvhD flays pm m='to do nmitmance,qongtuctiom or repair Volk on sach dweffi g hDvse or on ffie:graunds or building appmtmait&=Tto shan not becsnse of M h employn=t be deemed to be-an mnploy es." MM rj � 15Z, §25C(6)also stairs the¢every staff ar lnral li�msing agency shall wr[iihold ffie issQance or reaewal of a bemuse or permit tD operate a b=iness or to mnstruct buildings in the mmmDnr-rraIth for any appBcznt who has not pikumd acceptable evidence of coinpbaace with fe mtrrra =coverage regttn--ed.� . AdT#aaag5,,1,dM chaptra 252,§25CM stBJ=-Nt fher the commonwraltirnor any of its Political sirbdivis= shall e�teir inin ffiiy mmtact for!ffiz pin ce of puhlra workuntil aoeept$ble evidence of campIimm With the msm-mm r�ruteme�s o#'ifris r.�bx have been presenjad to the cor�•aci>ng��3'•� . . - please fill cot 'die wags'cDmpensatiDn affida7&completely,by checking ftM boxes tA app2y to your Sft= Dn and,if necessary, stjFply sub-.contatnr(s)name.. addrers(�s)amlphone mnnber(s)along vviihtheir cerincate( of Limed Liab�y Compames(LLC)or Limited Liabil*Parine�ps(I I P)w�n o emp2 ogees other man the members ar partners,are mtregrated to cmY wulk=' cDmp=safi.on insri,Ct- If an LLC or LLP d te does ha employes;a policy is required. Be ay be sobmitfed t advised i�t this affidavitmD t3�e Department of Indusiuial Accidmts fbr ennEMZEon ofm Tee coverage~ AIsD be sm-e to sign and date the affidavit The affidavit should be renamed to,the city or tin that the application for the pert or license is being requested,not the Depmtn ent of Indtzstria?Accidents. Should you have zny qaEgdons regal to law Dr 2f yDu are r DgnIItsd to obtain a_WMI tIS' eome�psation polity,please call the Department at the nmmber listed below. Self-ins�ed companies should eni r their self-insurance license numbcr on the line. CTity or Town Offici-Is Please be sure the affidavit is complet m and legibly- The Department has provided a space at the b of the affidavit for, in fill Dui:m the event the Office of fnycstg has to contact you regarding ih-e applic E Please be=r _. n fia.in.the p c„-,�;a=-===bm which wM be used as a reference n=bm. In addition_an sppli-* that must submit mn tt Pit pe6itlIioense apphim ions many given year,need only sob f one affidavit indicafing cunmt = policy information(ifneassay)and under'Tob Site Address"the applicant should write¢all locations in (may or town)."A copy of the affidavit that has been offiria]Iy stamped or mar$ed by the city or town may be provide&i)$re applicant as proof that a valid affidavit is on far,for fvt=permits or licenses Anew affidavit must be J IIed Dt±each year Where a home owner or citizm is obtaining a license cr permit notrelate&to-any business or eammezotal Yeutzlre Cie,a dog license or P=it to bum leaves eta.)said person is RIOT rmqah:ed to completes this affida:N it The Office of.Lrve*�s would IDM to thank you in advance foryour mopmation and sTouldyou hai e any.quesEons, please dD nothesiiste to givens a call_ The Departmemfs address,telephone and fsxm=be$: Depfr met ofhidmh%sIA t� _ n= A G211I Rvvistd 4-24--07 t p � r - a * BARNSTM14 MASS. i639. Town of Barnstable ,e� Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02661. 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, ,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: (Address of Job) ` Signature of Owner Date ' Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services • Richard V.Scali,Director Building Division r 6' Mass. Tom Perry,Building Commissioner 1639• ��� 200 Main Street, Hyannis,MA 02601 s www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 I HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOwNER": name home phone# work phone# . CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official. Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such homeowner shall act as supervisor." ' Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the . permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. j Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 1 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standard's Construction Supen-isor License: CS-017232 14 LAWRENCE A PERRAULT 10 DEACON PATH ` SANDWICH MA;:0256�3 Expiration Commissioner 09/03/2015 Office of Consumer Affairs and Business Regulation _ - 10 Park Plaza - Suite 5170 - Boston, Massachusetts 02116 Home Improvement Contractor Registration _ Registration: 137897 Type: Individual Expiration: 1/23/2017 Tr# 264560 LAWRENCE A. PERRAULT LAWRENCE PERRAULT 10 DEACONS PATH _- SANDWICH, MA 02563 - - y Update Address and return card. Mark reason for change. scn i 0 tom-osni (—I Address Renewal Employment Lost Card _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: registration 1,37897 Type: Office of Consumer Affairs and Business Regulation �£xpiration 1/23/2017- Individual 10 Park Plaza-Suite 5170 ,,. Boston,MA 02116 LAWRENCE A. PERRAULT, F LAWRENCE PERRAULT / 10 DEACONS PATH SANDWICH,MA 02563 Undersecretary Not valid � out Signature i David Ammen 50842887451 . p.1 Jul 03 15 08: 20P Perrault Builders 5088335185 P• 1 IVwB ofAvRstable. ° Regulatory Services Thomas R.Geller,Director rae Binding Division TomPen7, Iall ing Commissioner '.� 200 Mam Reef, Hy=ii.%MA 02601 www.town.barasta5le.ma.us A Office_ 5&862-4038 `.. Fes: 509-790-52.3Q '—R oo erty Owner Must Complete and Sign This Section If Using A Builder as Owx=of the eet PmPem' bezebpaLthoaze /�rY'. �/!� ►�:.'ridF+�- act on my,behaL, in all uat n relaBve to WO&authorized bytbis biaUng permit ap*.ation for. (Address of job) Kjg a- u.-e of Owner print Nam ci•��s_o���sloza F _ TOWN OF BARNSTABLE B��U��IIL��DING PEt�RMIT APPLIt'CgATION r-� reap U?y Parcel Q� Xs� i �� S�^�"@� �R' T 11 ; 3 ;# `` "'t INSTALLED IN f Health Division � in �,- fate Issued Conservation Di 'sin ENV@�®�@ � G'�'TAL Cc ,fee : `7 O Tax Collector Treasurer rl A-A /I ��y' Planning Dept. } Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis ` Project Street Address 0 c pe9s4i r. C L arx a.1 Village C d110 Owner 4A k7 �>>!'� I� w►v►n en Address S'czM Telephone 4Z A --6 I O6 Permit Request A f` X 30 zrl'i � troy 04& L� S-k Square feet: 1st floor:existing 166 3_ proposed _-i0 2nd floor: existing l2-(,,? proposed n _ Total newer Estimated Project Cost s'gPonn Zoning District 1_F- i Flood Plain Alt) 'Groundwater Overlay Construction Type n(nd C Lot Size -1 .9 . Grandfathered: ❑Yes O No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 90 Historic House: ,❑Yes ❑No On Old King's Highway: ❑Yes J4 No Basement Type: @J Full ,❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) e) Basement Unfinished Area(sq.ft) / 110 Number of Baths: Full: existing Z new e9 Half:existing 1 new O Number of Bedrooms: existing_ new —0 Total Room Count(not including baths):existing 10 , new_A* First Floor Room Count _ Heat Type and Fuel: ❑Gas P(Oil ❑Electric ❑Other Central Air: Q'Yes ❑No Fireplaces: Existing _ New 0 Existing wood/coal stove: ❑Yes )i No Detached garage:Wexisting ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size ' Shed:.4 existing ❑new size" .Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes a'&o If yes,site plan review# Current Use -S - L`—rj. ,l - Proposed Use BUILDER INFORMATION R Name C. Telephone Number 06 Address x 5 f© License# [ n 01,41- , lN� ►A- Home Improvement Contractor# m2 6_�— Worker's Compensation.# LUC q52!??00 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKENN0' 6ytNt�yvv�b SIGNATURE ATE 10 Z ?, 9 ,r FOR OFFICIAL USE ONLY - IT NO. A.y-.e., T .+�s . + .A ,, ti ` , + ' • Rom. v , h` r, 't `. �-a! ... .>, ' DATE ISSUED MAP/PARCEL NO , ' 1 t Y ADDRESSt �� r VILLAGE' j •: 4 a' . . ' OWNER t` 14 M` _ t w"', r + , _-, . � r Fir ' ' f .. = � '� ,�._.." F• + DATE10F INSPECTION: - ' i t� t~ 'FOUNDATION t ' + L - y, •t S 17 FRAME. .. =• c l 2- ` ' _ t -- •,I d a -- INSULATION .. . �V _ FIREPLACE � SS ,• - . '. 1 ^ f i• r g w � . .. '• ' +. f+ y, :'i � 'lii y <: f. ,t" 1. - { {.. ' ELECTRICAL: ROUGH FINAL' , s r i t PLUMBING: ROUGH FINAL, I GAS: ~ - ROUGH FINAL FINAL BUILDING` DATE CLOSED OUT _ ASSOCIATION-PLAN NO. ' 01/06/2000 13:15 50842033550 ROGERS AND MARNE'Y IN PAGE 02 MAScheck COMPLIANCE REPORT Massachusetts Energy Code MAScheck Software Version 2 .0 permit # AM In -®(� A2 -2S 0,0/ Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE : Other (Non-Electric Resistance) DATE: 1-6-2000 DATE OF PLANS : TITLE: COMPLIANCE: PASSES Required UA = 156 Your Dome = 149 Area or Insul Sheath Glazing/Door - ---_-__- mm-- - --_---- -_` - -- Perimeter _-R-Value R-Value U-Value UA CEILINGS -=--- - --- --- - - ---- -__ 630� 30 . 0 0 . 0 .--- ------ - ------ WALLS : Wood Frame, 1611 O. C. 22 GLAZING: Windows orDoors 19 . 0 0 . 0 34 213 � 0 :330 70 GLAZING: Skylights $ 0 . 640 g FLOORS : Over Unconditioned Space, 54C 30 . 0 HVAC EFFICIENCY: Boiler, 87 . 5 AFUE 18 r COMPLIANCE STATEMENT: The proposed building design represen.ted' in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the deei9p load as specified in sections 780CMR 1310 and .4 . Builder/Designer r Date r 01/06/2000 13:15 5084203550 ROGERS AND MARNEY IN PAGE 04 6)n DUCT INSULATION: L ] Ducts in unconditioned spaces must be insulated to R-5 . _ Ducts outside the building must be insulated to R-8 . 0 . DUCT CONSTRUCTION [ ] All ducts must be sealed with mastic and fibrous backing tape. Prissuxe-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means fox balancing air and water systems . TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone .or floor shall be provided. HVAC EQUIPMENT SIZING: f 7 ; Rated output capacity of the heating/cooling system .is not greater than 125k of the design load as specified in sections 780CMR 1310 and J4 .4. MISC R.EQUI.REMENTS: [ Refer to 780 CMR, Appendix J for requirements relating to swimming Pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F," and circulating hot water systems. -NOTES TO FIELD (Building Department. Use Only) ------ _ _--- --- - - _- ---- - i 01/06/2000 13:15 5084203550 ROGERS AND MARNEY IN PAGE 03 MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2 . 0 DATE : 1-6-2000 Bldg. Dept . Use CEILINGS : t ) 1 . R-30 Comments/Location WALLS : [ ) I . Wood Frame, 16" O.C. R-19 Comments/Location f ) IWINDOWS AND GLASS DOORS: 1 . U-value: 0 . 33 For windows without labeled U-values, describe features : # Panes Frame Type_ Thermal Break? [ ] Yes [ 1- No Comments/Location _ SKYLIGHTS: [ ] 1 . U-value: 0 . 64 For skylights without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ) Yes ( ) No Comments Location FLOORS . Over Unconditioned Space, R-3p Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1 . Boiler, 87. 5 AFUE or higher Make and Model Number THERMOSTATS ; [ ] Adjustable thermostats required far each ,HVAC system, AIR LEAKAGE : C ) Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 . 5 clearance from combustible materials and 3" clearance from insulation, VAPOR RETARDER: [ ] Required on the' warm-in-winter side of all -non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION; [ l Materials and equipment must be` identified so, that compl-iance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications. 01/06/2000 13:1.5 5084203550 ROGERS AND MARr,AEY IN PAGE 01 FAX COVER SHEET ROGERS & MARNEY, INC. 445 west Bar,rstaUle Rood P,0- Sox 3 10 Osterville,Mj 02655 50a•42a-610G _ FAX-508-420-3550 SEND TO Liu- Mention p�rQ 000 Orlico/nGafiori Fox t;urn6or- Nh4rec iwn�bor Urperrl Reply ASAP Please comment PfCase review For your Inrorrnallon 7ol01pa9os,incivOing cover COMMENTS �! r ... . Ce ........ w_.... ... .., .. Q.,A)c ....... .................................................... ... .............................. 10/29/1999 16:00 5084203550 ROGERS AND MARNEY IN PAGE 03 MAScheck' INSPECTION CHECKLIST Massachusetts Energy Code - MAScheck Software Version 2 . 0 DATE: 10-30-1999 Bldg. l Dept. Use CEILINGS : [ ) I. R-38 Comments/Location WALLS ; [ ] 1 Wood Frame, 1611 O.C. , R-21 Comments/Location WINDOWS AND GLASS DOORS : ( 7 I . U-value: 0 ,33 For windows without labeled TJ-values, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments Location SKYLIGHTS : ( ] 1 . U-value: 0.64 For skylights without labeled U-values, describe features : # Panes Frame Type Thermal Break? [ ] Yes [ ) No Comments Location FLOORS: [ ] 1. Over Unconditioned Space, R-30 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ) 1. Boiler, 87 . 5 AFUE or higher Make and Model Number THERMOSTATS: ( ] Adjustable thermostats required for each HVAC system. AIR LEAKAGE : [ ] Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed, Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0.5° clearance from combustible materials and 311 clearance from insulation. VAPOR RETARDER: C ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors. MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided, Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans or specifications. 10/26/1999 17:13 5084283115 SULLLIVAN ENG INC PAGE 02 Ul]C s'r'� 1..5'�2 10-1'3-99 10'.S2 vi*twse allwwwabl Prataflao Dip Rt N ,f BUMw of Rmu=protection—Wetlands 351 Y WPA Form .5 .w Order of Condifians WDH;ureony - Oct. ),2, 1999 Massachusetts Wetlands protsctlnn Act M.G.L. C. 131, §40 Issued O U Appllcnntlnfa mallan -AND TOWN 'OF 'BON STABLE_pF�TNANCES ARTICLE XXVII Ftcstt The NCUA of Im m for ft 0*d was filed efr BARNSIABLE Aug. 25, 1999 The public hearing wu daatd on SE3-3575 Sept,28, 1999 _ ftow Pit Mxw Aw . Ta "Cate end Date of Real Pleas mid t7 u D=M= David L. Ammer., c/o INSCO Site P1an' Septic System Upgrade . 412 Main St. , Box 489 at 1075 Old Post Road, Cotuit for j GNw David L. Ammen MA 01450-0489 -- -AC" .Tune 3, 1999 the OmIl!Vb is tacetee es_ 1075 Old Post Rd„t Cotuit 74 27x01 and 27x02 Assessors Map Parcel and the pmpam Is rm dee ai ow psgfty at Duds tor. Barnstable ow i141562 �RAdlerps wrinermots,tttks Co(iraagat herby MU ft Me praleci,as RndlnOs purttrunt to da Umschlwtt Wetlands proposed.kc Pratetmn ACt (ehedc one of tits fadaw rp boon) ftUdvdttp the NvWw cf tM abow•refenssxd NOVA of IMd MMW aub(eR� Md tensed an dte WwI.ssnott pt0rtds0 rn tots tapltrsbon sad /' 01 1,1"1 a the pttp�hsarbzg,VU eofrdsidon finds tttaf the ' 21rm taboafig po ad=wft en Monty.y.to==r*mce min wft wft is propuaed Is s*,I&=tt to the f oaowiN Vft the Valwtttartce>dWAN At at fattlf In the Wsdw* Ituarem of ttn WOsta=Pnttlaa Act(ctmk all t W apply) rlptda20=t0 tb'r7tettfhoee tnaartfmI eltetirad slim. eft C*Taftskm a*"=rd1 the,soar etaa be pelt".. to P,ibtlowmr supply mocordatrce VO tn1 N06 od enter tttllet..Ike.d ebeft tlfe Pdrm waif sooply tduawtaq 64MV C«>mltmm,w d wW odter WKW protitrtarotaar t3ot t CotadlM=9=W loft thee.Taft manttttlt dte =46d Coesttil toaaft aonastla S fril ty or dft fm W plane. had Ca gWr4ttp Shdlft of otter pt>:poeeb aet terl�o wlth tits Notdfle of ft=t Uea=omm efiu oosrotai Comm" Ansetdlott of WA Me fto . arrzCt>'t 27 oar., ❑ ryes enit asw Ey' i.a+ oom VUhUA Trust ILLghtrti p s s e i►�s+ se 10/26/1999 17:13 5084283115 SULLLIVAH ENG INC PAGE 03 Massachusetts Department t EWetlandental Protection Bureau Of Resource Prote UUPA Form 5 - order of Conditions MiZndings chusetts Wetlands Protection Act M.G.L. C. 131, goo �(CO/7t-) - debris,inc!udinq but not limited to lumber:bricks.pl,ster. wire,lath,paper,cardboard,pipe.tires.ashes,refrigerators Dented because: motor vehicles,or pans of any of the foregoing. the proposed work cannot be conditioned to meet the 7 This Order does not become final until all administrative performance stnrtdards set forth In the wetlands regulations appeal periods from this Order have elapsed,or it such an to protect those interests checked above. Therefore,work appeal has been taken,until all proceedings before the on this project may not go forward unless and until a new Department have been completed. Notice of Intent is submitted which provides measures which are adequate to protect these Interests,and a final 6. No work shall be undertaken until the Order has become Order of Conditions is Issued. final and then has been recorded in the Registry of Deeds or submitted by the appl{cant Is net sufficient the Land Court for the district in which the land is located, the information to describe the site,the work,or the effect of the work on within the chain of title of the affected property. In the case the interests Identified in the wetlands Protection Act. fit recorded Land,the Final Order shah also f t noted to the Therefore.work on this project may net qa forward unless Registry's Granter Index under the name of the e. In h the and Therefore. a revised Notice of project is submitted watch land upon which the proposed work is to be done. In the case of registered land,the Final Order shalt also be noted provides sufficient information and includes meas-ifes on the land Court GaRiticate of Title of the owner of the Which are adequate to protect the Act s Interests,and a final land upon which the proposed work is done. The recording Order of Conditions is Issued, A description of the apecltic information stall be submitted to this Conservation Information which is lacking and why It Is necessary Is Commission On the form at the end et this Order,which attached to this Order as per 310 CM tt).05(b)(cy: form must be stamped by the Flegistry of Deeds,prior to the commencement of the work, central Conditions 1. Failure to comply with all conditions stated hei`ein,and with 9. A sign shall be displayed at the site not less than tivo squart all related statutes and other regulatory measures,shall be feet or more than three square feet in size bearing the words, deemed cause to revoke or modity this order. "Massachusetts Department of Environmental PrOtectlon' 2. The order does not grant any property fights or any or,"NIA DEP"j'File Number exclusive privileges;It does not authorize any injury to SQ-35 75 " private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of Complying with all other applicable federal, state,or local statt<�tes,ordinances, 1p.Where the Department of Environmental Protection Is bylaws,or regulations. requested to issue a Superseding Order,the Conservation Commission shall be a party to all agency proceedings and 4. The vrork authorized hereunder shall be completed within hearings before the Department: three years from the date of this Order unless either of the following apply. 1 f a7pen ccmpletion of the work described herein,the applicant (a)the work is a maintenance dredging project as provided shall submit a Request for Certificate of Compliance(WPA for In the Act:or Form BA)to the Conservation Commission. (b)the time for COMPIction has been extended to a, specified date more than three years,but less than live 2.The work shall conform t0 the following attached plans and years,from the date of issuance: it this Order Is Intended special Conditions: to be valid for more than three years,the extention date and the special Circumstances warranting the extended Finat Approved Plans(attach additional plan references as time period are Set forth as a specia condition in this needed) Order, see attached 5.This Order may be extended by the issuing autho►ity for bre one or more periods of up to three years each upon ,i One 3, 1999 application to the issuing autnOrfty at least 30 days prior to Direc the expiraton date of the Order: Peter Sullivan, PE 6. Any fill used In connection with t►ia project shall b!Clean 'Barnstable Conservation till. Any fill shall contain no trash,retuse,,.rubbisn,or on h:f WM Page 2 of 5 10;26/1999 17:13 5084283115 SULLLIVAN EHG3 INC PAGE 04 Massachusetts Department of Environmental Protection 4 Bureau of Reso urce Protec tion to ion— Wetlands WPA Form 5 Order of Conditions ' Massachusetts Wetlands protection Act M.G.L. C. 131, §40 --------------- t findings (coat.) 13.Any dtges to the plans identified In Condition 112 above Findings Is IQ municipal law,bylaw,or ordinance Shall require iris applicant to inquire of the Conserratlon Commission in writing whether the change is slpniticant furthermore,the enough to require the tiling of a new Notice at iMrIL Barne tab l e 14.The Agent or members of the CWSITYatton Commission Consev00 Carmbw and Departrreat of Environmental Protection shalt have the hereby finds(check one that applies): right to enter and inspect the area subject to this Order at reasonable hours to evaluate compilanu with the Bondi- that the proposed worr cannot be conditioned to meet the bons stated in this Order,and may require the submittal of sandards setlorth In a municipal law,ordinance•or byU, any data deemed necessary by the Conservation Commie- Specifically lion or Department tar trial evaluation. 15.This Order of Conditions shall apply to Iny successor In ,mN i4 xe,atRawl Am"W..o►aZMW Interest or suc=%br in control of the property subject to Tltemtore work on this project may not go forward unless this Order and to any contractor or other person pertornr and until a revised Notice of Intern is submtded which ing work conditioned by this Order, provides measures which are adequ9s to meet these 16.Prior to the start at work,and It the project involves work on".and a find Order at CondItan:Is issued. ascent to a Bordering Vegtrtaded Wetland,the boundary at ?J triat the following additional condiUons are necessary to Ina wetland in trte vicintry of the proposed work area stWI tomp�f wfth a municipal law,bylaw or ordinance,specnl- be marked by wooden stakes or flagging. Once In place, catty iris Welland bowntiary markars shall serve as the fimh of work(unless eutother itrri t or work line has been noted in Article XXVii of Town Ordinances the plans of record)and he maintained until a cartmou of hmmac�ona+0—wi ;amW,orert1iMae. Compliance has been issued by the Consevation Commis- lion. The Commission orders that WI the work shall be psrtormsd 17. All sedimentation barriers shall be maintained in good in accordance with the sold additional conditions and wtln repair utttil all disturbed arises have been fully stabitited the Notice of Intent referenced above. To the extent thatthe With vegirlafion or other means, Al no time stall sedimers 1101lowing icat! ooril dify or ditter proposals submm the plans, with the Notice be deposited In a wetland or water body. During construe of inset,the conditions shall Control. lion,the appllcm or hislher designee Shall Inspect iris erosion controls on a daily baaiS and sM:l remove teeumW=d sediments as needed. The applicant shah imnudiaiesy control any erosion problems that occur at the additional conditions relating to municipal law.bylaw,or 2"end Shall also immediately natty the Conservation ordinance: Commission.%tdch reserves the right to require additlonal see attached erosion and/or damage prevention controls it may deem necessary. Special Conditions(Use additional paper it necessary) see attached _ pap 3 of a 10/26/1999 17:13 5084283115 SULLLIVAN ENG INC PAGE 05 A SE3-3575•Ammen Approved Plan=June 3, 1999 Site Plan by Peter Sullivan,RPE Special Conditions of Approval: 1. General Conditions 1-12 on the preceeding page are binding,and demand both your attention and compliance: { 2. Within one month of receipt of this Order of Conditions and prior i the a ecommencement of any'work approved herein,General Condition number 8 (p d ng P S ) complied with. 3. The applicant shall pay for their legal advertisement as invoiced. 4. This permit is valid for 3 years from the date of issuance, unless extended at the request of the applicant. 5. The work limit shown on the approved plan shall be strictly observed. 6. The work limit line shown on the approved plan shall be staked in the field by the project surveyorlengincer prior to the start of work. 7. Prior to the start of work, staked strawbales backed by trenched-in siltation fencing shall be set along the approved Nvork limit line. Effective sediment controls shall remain until the site is stabilized with vegetation, g. There shall be no disturbance of the site, including cutting of vegetation, beyond the work limit. This restriction shall continue over time. 9. Prior to construction,a sequence of 35 mm color photographs showing the undisturbed . buffer zone shall be submitted to the Conservation Commission. At the time of the F request for a Certificate of Compliance,another updated sequence shall be submitted. 10. The Conservation Commission shall receive_I week advance notice of the start of work (our phone number is 508-862-4093) 11. All areas disturbed'during construction shall be revegetated immediately, fol!owing completion of work at the site. No areas shall be left unvegetated or unmulched for more than 30 days. 12. All proposed lawn areas shall be underlain with a minimum of 6 inches of organic loam. ];. Dr%�%-.ells or gravelled trenches along the drip lines shall be installed to accommodate roof runoff. 14. It is the responsibility of the applicant, the owner and/or successor(s)and the project contractors to ensure that all conditions of this Order are complied with. The applicant page 3a . 10/26/1999 17:13 5084283115 SULLLIVAN ENG INC PAGE 06 shall provide copies of the Order of Conditions and approved plans(and any approved revisions thercof)to project contractors prior to the start of work. is. The Conservation Commission, its employees,and its agents shall have a right of entry to inspect for compliance with the provisions of this Order of Conditions. 16. At the completion of work,or by the expiration of the present permit,the applicant shall request in writing a Certificate of Compliance for the work herein permitted. Where a project has been completed in accordance with plans stamped by a registered professional engineer,architect, landscape architect or land surveyor,a written statement by such a professional person certifying substantial compliance with the plans and setting forth what deviation, if any, exists with the record plans approved in the•Order shall accompany the request for a Certificate of Compliance. 10/26/1999 17:13 5084283115 SULLLIVAN ENG INC PAGE 07 M.U,vchuseM Doperpnent of Environmental Protection • Bureau of Resource Protection—Wetlands BUPA Farm - Order of Conditions t Massachusetts Wetlands protection Act M.G.I. c. 131, §40. Findings (coat.J �. This Ort'•er is valld tar three years.unless otherwise specified On this Sj— as a specfaf condition pursuant to General Conditions K from the date of issuaaca. Oct. 12, 1999 day of � uannr This Order must be signed by a majority of the conservation y4w commitaton.The Order must be mailed by certified M111 before me personally appeared (return reaalpt requested)or land delivered to the appl —�J A copy also must be mailed or hand delivered st tha same time to the appropriate regional Otte of the Department of Environmental Protection- to me known to be the person described in and who executed Sfgnatuns: the foregoing lastrument and",Wedged that he/she executedd the same as his/her tra act and deed. r�j,ca+*miWortuAYtl This Order Is issued to the applicant as WHO": by hand delivery on s by certified nail,retum receipt requested.on oct. 12, 1999 Detr Appeals The eppllcant,the owner,any person aggrieved by this Order. The request shall state clearly and concisely the objections to any owner of land abutting the land subject to this Order,or the Order which is being appealed end how the Order does not any ten residents of the City or town in which such land is contribute to the protection of the Utterests Iderdided in the located.are hereby notified of their right to request trig Massachusetts Wetlands Protection Act(MAL.c.131,§40 appropriate Depumrn of Environmental Protection Regional and Is inconsistent with the wetlands regulations(310 CMR (Mice to Issue a Superseding Order of Conditions.The request 10.00).To the extent ttut the Order Is based on a municipal must be trade by certified mail or r►arid delivery to the bylaw.and not on the Massachusetts Wetlands Protettlon Act oeouMmM with the appropriate filing tee and a Completed or regulations,the Department of Environmental Protection has Appendix E:Raquast for Reputmadal Action In Transmittal no appellee jurisdiction. FOrrrt,as pruvided in 310 CMR 10.03(7)within ten business days front the date of issuW of this Order.A copy of the request stroll a fare same time be sent by coMfied mail or hand daWM to the coeseMAM COrrntdsMiOA and to flu applicant• 9 h&VA Is not frill Appellam 00..l of d.. 10/26/1999 17:13 5084293115 SULLLIVAN ENG INC PAGE 08 lama Massachusetts Qepartment d BnViranmeatai Prate c?ion Bureau or Resource Protection—Wetlands WPA Form 5 - Order. Of Conditions t Massachusetts Wetlands Protection Act M.G.L. C. 131, g40 Is Recording information This Order of Conditions must be recorded In the Registry of Deeds or the Land Court for the district in which the land is fixated.within the chain of title of the attected property.In the case of recorded land,the Final Order shall also be noted In the Registry's Grantor index under the name of the owner of the land subject to the Order.In the case of registered land.this Order shall also be noted on the Land Court Certificate of Title of the owner of the land subject to the Order of Conditions.The recording information shall be submitted to the Ga�:v+non Commr»bn , on the form below,which must be stamped by the Registry of Deeds. Detach on dotted line and submit to the Conservation Commission,_.,,_ ^y _!_ _ To: BARNSTABLE Cp svwica CO,,nmasio Please be advised that the Order of Conditions for the project at 1075 Old Post Rd— Cotuit SE3-3575 Pt01"=`i'�itOrt OfA Fne+Nrnon has been recorded at the Registry of Deeds Of BARNSIABLE Eau^a and has been noted In the chain of title of tha affected property in sock , Pip in accordance with the Order of Conditions issued on if reccrje9 land,the instrument number which identifies this transaction is ; MJr9'!Y If registered:and,the document number which identifies this transaction is oU[uRl9 A'uircv Page 5 dI Pay.1 019e y 5 i 1 -- ��~ � `\ errs / - '•�..- _ �;\\�\ \ /._�...�; / 1��;,1v''1 I�i-^ / ,• ?•''� 11132 non i;' \,_,,l\`\\\ \\: h,�'..� v,� r /! ! \� - / �I w'•`` Ii ';'j%r: 40, lit ut nit Li . Q1 " y i / rt65 7 \ \�\ , `v _ r `\ OF 24— r \ . , \i� .•.../ :.�tr ,,, i i/rl i I I i I a+5 F �.:: .i` zy�` .Fy \ \ e,N'\ \ , r. • , _ Qt g17- 9 92 = OCPr1R'1h1EN'I OI' PUBLIC SAFETY* 176992 ONE (tSHBURTON PLACE, HM 1301 BOSTON, MA 0210; -161.i CONSTRUCTION SUPERVISOR LICENSE Number: Expires: GirChdage: CS 0161.74 OS/07/2000 :05 07/A939 Restricted To: 00 f /a 0 JD MAY CHARLE S O ROGER:. 300 BAXTER NECK RO 5. . - N1 RSTONS Pt):I_LS, MA 02640 Keep Cop for receipt and change of address notification. 777 OTI _ _ ✓/ce "eow")Io eveahi n?A0jacX(Meiqj -` HOME IMPROVEMENT CONTRACTORS REGISTRATION j { J Board of; Building Reoulations and Standards � One: Achburt;on Place ,, Room 1?01 EToct.on , Massachusei:Ls 02:1.0£3 HOME IMPROVEMENT CONTRACTOR I` Registration 100134 Expiration 0 G/09/00 ..J,//J Type: - PRIVATE "CORPORATION 1 - ".r` f - 11011E INPROVEI1ENT CONTRACTOR I - Registration 100134 ROGERS MArlNEY , INC . T Type - 'PRIVATE CORPORATION Charles D . Rogers _ 1 �1 - 51 Expiration 06/OWO0 445 OSTERVILLE PO BOX 010 I Osterville MA 02655 j ROGERS & IIARNEY, INC. 4r! e 45 OSTERVILLEPO BOX 310 AOMINI3111Af011 ' Osterville NA 02655 .. .. �,,,_,,.,r...v. ...:.. ....,. .. - .7:,:<..,..,.• .,,.r.y�.:.:,.•,.:n•../.. •.7•- ':nle•� .ic/`. t 'r,7;. .K - `-'$set •t.b';::w Fe vSil-"'r`?'�•-F ,'IT b�94.. N 7 A. '�t:• Y 'ti �.t: Y�. \ J CfA I YL 7 -. _ .. N/'Cn,e.e Fc YJ e, Td.� , >-Ee e-•. L,l,�eT/o 6. . 2)—,,r. -- ` s I--- �aP a �trr•o-(i - � ro' I � .w o' t<c,cp ee.mdx4. A/.J. n 6f� f�-Iv n1rl hKi./.ww.✓. •�.3 S • � •,t,t Tcc.}cc/ we. b/•kn�8•..x /f/y../ ��"'Yp(�y 1?a�' I� —J i o a GRAYS NEW STETS Xbf - W� W13 r— ._._ A .. - � xD r0 --- -EN rR Y. 7 ' ryvrr-eo,. BATH ���...... 'v�mesma an .. KI TCHEM.v..)�,.wn A wr u+o v.,.. i - STUDY WI .HALL j 72 PLANTING BEDS < D6 O -y - OIO - L Os \� M,blCw'p-w�/ws•.l.N Fy�r,. Dll r_ 4i�-BrLW-h)wa iY�w XO T GRAYS CO2 • ` XOF XDS EIVING bwl In Sk-f! ,itws _ C I DA - I BLUE 5»NE XD4 xb3 O nlAs rER BEOROOfl ..BULKHEAD i ( t !a w srevs s4 is-t-I r. eo do 7 � w .. xD2 PLAHT INC, - �_ !Lj NEW s7EPs BRICK WALKWAY II �aqb )ter.)) • -. HRICK MMACE am se sm. jMB Harney TuA- 1 Fbw Pl -M—Level rr h � - r Z S- ht � zc ._ _.. .. 71 -M Rpgcrs&Mamey w wa e.,,d.u.fwa oe.�u.,fu axff - pm)93tdlm . . ^nf ow rwfw.cw.Y.fts Elfv«ion i ' . . Bid Be 8104M Rogue&Harney •u Wm aerswk ROM Oaarvilk.Mw V3633 13GPI.33.61a6 10130tl Pu�RAe Am ms eoiI,CMKY. Elerri-r �_AJ F7 - ._........ ..._ - Ib y � i L em sat MA" MS Wu B�udls Put Ona+iW,AN alE15 (WG)�2L6106 taflOYt�a lut.C1M,a1w .h9-.-. t• m i is I i r c. t ,,,' _ �. •� � ... <- ,,yyam� � w4 - I I \ ✓ ,fi.�.rH.w��Io:w/n �Q of <:y• j gully 1 -- --— .t__— -:��c< M�•�F�lf.(J 1 p<n J,w.<...1.�..y�v �.)•l .1�. /irk/ %WN `r.�..f�ihw.f(w., .[r< •J.-/k �.../.,r.u,ss-rrrA a on 6"c.4.... EMS Slt&?� 6 ,a1i.(s.f�r�m../-r.46 t4�%,.., A „t e„i/.� .�,✓.�..� .. . ssl..n e•s J rw — a.Mx,Na avr " TOWN OF BAARNSTABLE BUILDING PERMIT APPLICATION Mapo r] S Parcel �z-) ✓/0 6 f 9 �i r)ckJ-X (e m, Permit# Health Division WITH ITS�. Date Issued � L:NARONMENTAL Conservation Division h. T01NN REGAL e ► Fee Tax Collectoi�_, - . a -s Treasurer` U Y Planning<Dept. 1 j Date Definitive Plan Approved by Planning Board r Historic-OKH Preservation/Hyannis. Project Street Address 1(3 f Village coc L2 Jr j Owner Ny% 0 AV I A -Avyt a n Address _ _S o-%m Q__ -« s ' Telephone q z 8 6106 Permit Request E"e—kern Re-.V_ee florc\-% U1c+�ZT�ic'� 4nnXS, 12enoxxJ2. �1.w e, m ylA . t\\Cs r e CZc�.x�� C7Y1 &8wwyA S(9iJ:L S\AQLA 9Y�k Ck-1 0C,Als n[9t N04e- al vyj«fl,& v►.tto Square feet: 1 st floor: existing t L(a I proposed •4S6 2nd floor:existing k1G,2 proposed O Total new 4S0 Estimated Project Cost o Zoning District 11~ Flood Plain �jo Groundwater Overlay Construction TypeoCXA 'ivK e Y Lot Size _A 9q Grandfathered: ❑Yes ❑No .If yes,'attach supporting'documentation.. « i . Dwelling Type: Single Family 2' Two Family,. l7 Multi-Family(#units) Age of Existing Structure M µ Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes a No Basement Type: 20 Full 0 Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Z new r Half:existing ( new Number of Bedrooms: existing new R-- Total Room Count(not including baths):existing j l new l® First Floor Room Count 6 Hgat Type and Fuel: ❑Gas g4 Oil ❑Electric ❑Other . Central Air: Yes ❑'No Fireplaces: Existing .I New Existing wood/coal stove: ❑Yes )d No Detached garage:Pq existing ❑new size Pool:0 existing'❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size; Shed:)J existing ❑new 'size Other: vo6 CooIT. Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes X No If yes,site plan review# Current Use — .l Proposed Use _!�a. �e , BUILDER INFORMATION. &A'A4'j Telephone Number ' Address License Home Improvement Contractor# tc5nkaq t = Worker's Compensation# On 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN c)Y IN�c�c c�war SIGNATURE C DATE FOR OFFICIAL USE ONLY, A, - , ./. + .. `,q ♦ - - is • v, . 1 ' PERMIT NO. _ ' DATE ISSUED ,F. ", n`°c d # f r..r' tt _ t r,t -i ° 't� f +•t 1 '� MAP/PARCEL NO ADDRESS; t " =" ,VILLAGE OWNER _ ` :r.• ,. . A ' ` i - - t - ..l _ Y 4 'ram , t ,a e _ r ` ep rfi DATE OF INSPECTION: 4'" -• - FOUNDATION �0 ` ' FRAME 'Xi. •i .o FIREPLACE .x - ELECTRICAL: ROUGH Y FINAL -} , f r - y ""L ram• _ PLUMBING: ROUGH` FINAL i" • a � '} , �;� ,i• +, _ • + _. ` � .. '!tea m -4�. * '1 -' . t � . GAS: ROUGH FINAL `= '' Nil FINAL BUILDING. DATE CLOSED OUT - -. _ .• •t ASSOCIATION PLAN NO. I,M - • 1— �pSHE Tp� The Town of Barnstable � IIARN9TABLE. • 9 MSTA Department of Health Safety and Environmental Services ArEo yt. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 y 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. j Est.Cost 4 S Type of Work: 1�C�.CF`1��csv\ <1 CIO CO+ Address of Work: i C» d�� ����- GG�u i4_ Owner's Name ((V�t- 1`7 ��"�c Ar U11VIX e n Date of Permit Application: i C) 2 ct I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ' 9-4� Date Contractor Name Registration No. OR Date Owner's Name 10/29/1999 16:00 5084203550 ROGERS AND MARNEY IN PAGE 04 DUCT INSULATION: [ l Ducts in unconditioned spaces must be insulated to R-5. Ducts outside the building must be insulated to R-8.0. DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts. The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS : [ Thermostats. are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 125k of the design load as specified in sections 780CMR 1010 and J4 ,4 . MISC REQUIREMENTS : C ] Refer to 780 CMR, Appendix J for requirements relating to swimming Pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. -- - -NOTES TO FIELD (Building Department Use Only) ------------------------- The Common wealth of Mass ash ciseUs Department of Industrial Accidents ' Office 17//nres0stlons 600 Washington Street 4 Briton, Mass. 02111 Workers' Compensation Insurance Affidavit ❑ame: location: city phone# _ 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity &J-,Tam an employer providing woikerrs' compensation for my employees working on this job. ; company name: e3q e rC-� address.: X`` a I C) city; 0S te'ev%.11 e— 71 &SS phone fs SD g. q Z 8 610 k insuranceio C 4SST9-V—M G t+kSt B ELT Y policytl We-- 9 577 9 A 0 0 --;k I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who hs,. the following workers'compensation polices: compapv name• �'7 2°e Q"�'ti3 n1,e D(\ coin� address:. phonek ia&arancesco_. . .pop licy tl< comnanyxame city...:. phone#• insurancevo policy# Failure to secure coverage as required under Section 25A of A1CL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains d enal 'es of perjury that the information provided above is true and correct. Signature Date ;Z Print name '• V C_ OCR�C Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license q OBuilding Department t=- oLiccnsing Board I]check if immediate response is required OSelectmen's Office Health Department 4> contact person: phone q; nOther (revised 3/95 P1A) 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 hav been presented to the contracting authority. Applicants ? ' 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 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, n6t 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. Pleas be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to 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, tole phen and fa:: :r. The C*otT:a1 :I::W-..ilk i Mice of Mvestinatiolts 600 Washington Street Boston, Ma. 02111 fax:# , 617 727-7749 .......... ::: .. A ::: .: DATE(MM/DDIYY) CORD ... . :::::::.:::.::::.:::.:......... 06 28 1999 PRODUCER ('508)994-.9688 FAX (508)991-5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION UTKOWSKI & KESTENBAUM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 414 COUNTY STREET HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1 BOX 5911 COMPANIES AFFORDING COVERAGE .... .............................................................................. �,. BEDFORD, MA 02742-5911 COMPANY Granite State Insurance Co Attn: Ext: A ............................................................................................................................................ INSURED ..................................................................................................................... ......................................... Randall C. Agnew Electrical Contractors COMPANY . B 94 Furlong Road ............................................................................................................................ ..............._...... Cotui t, MA 02635 COMPANY C ......................................................... COMPANY D C.OVE:A. ES.....................................................:.:::::::::::::::..:................ ............ ......................... THIS IS TO CERTI FY THE POLICIE S OF INSURANCE�LIS T •BELO� HAVE BEEN ISSU •ED TO THEM � URED NAMED ABOVE FOR THE POLICY PERIOD ............... INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR C ITION OF ANY CONTRACT OR HER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DES RIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY AID CLAIMS. .................................................................................................................................................................................:.. ................................................................................................................... CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE ' OLICY EXPIRATION: LIMITS LTR- DATE(MM/DDIYY) DATE(MM/DDIYY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG :$ CLAIMS MADE OCCUR , PERSONAL&ADV INJURY $ OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ .......................... FIRE DAMAGE(Any one tire) :$ ........... _........_............. MED EXP(Any one person) $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANY AUTO $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) .................................................................................... HIRED AUTOS I NON-OWNED AUTOS (Per Daccident) INJURYILY I .................................................................................... .. ........... PROPERTY PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY EA ACCIDENT `$ .._........................_....... -.: ANY AUTO oT HER THAN AUTO ONLY: .................................. EACH ACCIDENT:$ ......... AGGREGATE:$ EXCESS LIABILITY EACH OCCURRENCE $ _................... UMBRELLA FORM .............. _....._._..... ... AGGREGATE $ ..............................................:;........ ............................... OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND WC STATU- :OTH- %:isi9:<::;:::::::;::::;::>.i:i:;;:;.:::z::: TORY LIMITS: : ERa. :; <::::: >::�:::::::::�:�>�:�>:�>� EMPLOYERS'LIABILITY ..................... ...... ........:.::.... .....:..::.:............. A - PENDING WC 06/23/1999 06/23/2000 i..EL EACH ACCIDENT $. 500,000 :THE PROPRIETOR! .....INCL i - Y $ 500 Q�Q PARTNERS/EXECUTIVE ....EL DISEASE....................POLIC..........LIMIT..........:.............................+........... OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE:$ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSfV 71CLES/SPECIAL ITEM CAT. :;^:;::•> .......................... :::..:::::. .::::::::::: :::::::::. :::: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 1 - 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Rogers & Marney General Building Contractors BUT FAILURE TO MAIL SUCH NOTICE SH ALL IMPOSE NO OBLIGATION OR LIABILITY PO Box 310 OF ANY KI E COMPANY,ITS A NTS OR R R SENT TIVES. OSterVllle, .MA 02655 AUTHORIZED NI IVE _ JYVC� t111,d 'ACtJRD:28<S :: ..........................................:...:..:RO;�t)RPOF2�1'�I.0�1.:'1.988 ------------- Prnrinrur; - Iis I codiflr;_•t is i_ened as r matter pf r,pfnrfrr,.tipn nnl•. and rnrlfer: . °4` I nn rloht� agar tl�e r rt ✓:II to ll, Irler. Thl, lurllftr tr. ,ina� 'rinl arlull�; < SOU NFA�TFfN IIJ� !'G(:`{ L urturl pr „,�}pp thu ur_.yN'_.ffnfd_I hp +hO ,fa'Irl�- hul^t�; PO PDX 7610 i-- --- --- ------- - ---- - - --- - --- - Cd1 IAIN ST 1 f(1MFAIlIF` GCFCIR[!Ildf, CCIIIFRA6{ NrAVINI CIA OHM Code: Sub-rude: I fp•I,tr A, ; ARP(LI A CRCITCGTICIIJ .. ------------------------ ----------------------------- ---- ----- -- - -- ---- --- - ----- -----•- - lMll,rp,d: I fn It'r [' N(ll_fQMF PI 11R k. NrlJI; i I CoI.t r fi. GRF 1T AMFR I f 1' .. _ . [IUU I ft NCILfCII^P I-- - ----. P 0 BOX No � - - Al y Q;TFPl111 1 F I^iA 02-0170 I-- ----- -- -- - -- ---- - - -- -- ----------. COVERAGES This Is to 000h that Rnll rN of I1 W& 11 to h loy h e been As t„ the insl!ed n !f!e A hnn rlfrr h0 pf.14i r.r"ourinrl I Yi rlI1. tell .I iltt)IfI'r} .0�i u7 .nY Ngllli Nri N(l G i fli/�It tiLl of 5n4 ri lit l` 1 i itli 1 'luIIIii. G111 WI l i -.OPI' }!� I Oda }Ills rar{Ifl..9tu rnAv hN I a rr rrl.;p o rhlr the imur re` ' hp' hee I- nh t a 1 t@ tam, Fn ; i [bal iwf w,, h,{l� h f„,Ii :W fn I I I. +�f III irl^ I Fnl l ' . T,1 i I y a I rlt 1 -y LWrow of Injll nrr. I' F rllfnlvr I ffo •j a to Ir.,f {11,11 Ire fhlol. ands A If NERAI LIABILITY If 1 fufQ Glen lei ',Prle tnl I15r11l I}1 I i ,ri If 1{f 17,007 FYI ILrur !<r � i• IFvle ail ri{ r{'I 1 y (i" II 1 hl�'ri Gi' � i'il tl n`'.1 Qr' O''ilt I ' I r :I + ,. If It li'f lli r•i '.P %,�I�f) K Il1e^li ,.i ------------------------------------------------------------- - IAIITQIt[1P1 C LIABILITY I T'f I I I II -mhl n,i I ( If 1 Any Alit(, I I � I � �IGln�lg llrrlf' � ' it 1 aj� n, �l ;�nl ; 1 �• �i - i IF,II{!y ;nfv . i � If 1 Sfhp•luIPA ,ut o If 1 Nlra•1 ,lime I r• I r , ''I ;°; `,I�nrlilp Inllu ' I 1 llnrl-nl^nui -rutl : I �I +�, i .� I(Fu y..l IrlYn�l _ I II I j IFXCESS_ I IA"II ITY I I I I Each If I i {� • i i' {� I Il rnir�rlr.p r A�grnr,�nra}'F Clthar that Umbrella fofla e ------------------ .. ____._____.._._._.___._ _ __. .-._ _._ ------------ ___. __.._ ___..__ .__ D I LICIRI!F(''_, fAl^FFf! AT1QH ',I �tflC,t"�'rf)1 I a 1%./1P/GU " I 1r/MAG r O.f!Itpl4 f----- --- ------------- - flho- (FAc-h A r,IP1)f1 I EMPLOYERS' LIABILITY I I Sf1f1 fIllc w r, lil llrlifl as a Harp empl nvaal --------------------------- - ---- 1OTNFP 1 s_ , De5rf l Gtiot of iifiNf.t,L.i;ililfnt lfflC{{IGi,li'.IF'ifp:{-f li tlprrci-uGf1 n,I' I te!f!s: 417 A L L PI1111f;IliA 01) }1CATINh 11PFPAT1ONS _____________________ _.__-_.____-___-_--_-___ -_____- f _____ ___ ___._.__ ---__.___-_-____________ CERTIVIPA`:rr, TIf-)I,T13='j.'; CANC.ET,LAT,1nN a •'k - - - �.,.. S!Vou1d AnVb•if, thiL hr,i;lF ({NSCr IFrr�� not LI.I Ns be inrr.✓l ed befnfe the +I F GI ,;tioi a„t lhelal� lil, )liarJ r,fur ua iji11 F,tl11 ' n'I• NCB A� 1A L l't�ir llntll_v t^ +h _rr fl '�tw I ;1.1,. taf(!ed to the ROGE S 9 MARMY Ildf. a. ! 1a(tl 'hnt f;illn'N tn .rl.,ll 5n[h l;ntlra ih,ll iwHe to Aliya• Qv nr P II Box 71G �, i l labr !Iti if i q I.I la um; the c u. r }: agents nr r'- ,rr,sert.t hes, ' CI,TCRUII I C MR QN,552 I---- - - --- ..._.. _ .__.... -- ----- _ ------------- ------ .. : DATE(MM/DD/VY)PIDO2LIABLITYINSURANCA�� CERTIFICATEOF -1BAYC0 03/17/99 PRoZ a, P THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McAlpine Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE John McAlpine HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR `D Post Office Sq ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. iterville MA 02632 COMPANIES AFFORDING COVERAGE John McAlpine COMPANY Phone No. 508-771-0105 Fax No. 508-771-1258 A Trust I surance Company INSURED COMPANY - - - B Sav s Property&Casualty Ins C COMPANY Bay Colony Concrete Forms Inc C 32 Third Ave COMPANY Osterville MA 02655 D COVERAGES: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN/OLICIES TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANYACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY TH DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEENED BY PAID CLAIMS. CO PO/IEFFECTIVE POLICY EXPIRATION LTP TYPE OF INSURANCE POLICY NUMBER DAMM/DD/YY) DATE(MM/DD/YY) `.MIT" GENERAL LIABILITY GENERAL AGGREGATE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY TMP1004315 /03/30/99 03/30/00 PRODUCTS-COMP/OPAGG $ 2,000,000 CLAIMS MADE El OCCUR PERSONAL&ADV INJURY $ 1,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1,000,000 FIRE DAMAGE(Any one fire) $ 50,000 MED EXP(Any one person) $ 5,000 AUTOMOBILE LIABILITY A ANY AUTO C00387000 03/30/99 03/30/00 COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS (Per person) $2500000 HIRED AUTOS BODILY INJURY 1 (Per accident) $ 5000000 NON-OWNED AUTOS (Per- ( PROPERTY DAMAGE $ 1000000 GARAGE LIABILITY 1 AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: „ • EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND X WC>TATU- OTH- TORY LIMITS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100,000 B THE PROPRIETOR/ }{ INCL WC 0 007 -01 03/31/99 03/31/00 EL DISEASE•POLICY LIMIT $ 500,000 PARTNERS/EXECUTIVE — OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Concrete foundations. CERTIFICATE MOLDER CANCELLATION ROGERS 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Rogers & Marney 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, FAX#5 0 8—4 2 0—3 5 5 0 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY PO Box 310 _ Os tervi l le MA 02655 OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE John McAlpine ACORD 25-S(1/95) "' ACORD CORPORATION 1988 .FROM :yNQEI.HWOOD ESHBAUGH FAX NO. Mar. 15 .1999 -12:46PP1 P1 t8...'..,:. .D/'''� Y'y 44 ra '^r^•y^'"•..{�.�.,,'. q £ d,:,f, t r d s.i ATE �ts ^ O/TVu wtgdf£SiF' �E �, ��} j1s4t sf _. -- fdth"J OIYY) ! ,.. ... ...... ... .. •i. . ra .tn "U: 1 ..:: ., k <>a, . ,v:a< .F..rc..S ..y • PRODUCER f THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION W. H. Eshbau h Insurance 'A enc Inc. ONLY ANO CONFEfiS NO RIGHTS UPON THE CERTIFICATE ` 9 9 y, I HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR J 805 W. Main Street t ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis, MA 02601 _connPa�, oFtplluc COVERAGE COMPANY Travelers _ _,... _...._.. ......._...... A INSURED _ j'COMPANY ..._.. David Cox dba �_ _B_ David Cox Remodeling COMPANY P. 0. Box 401 c S. Yarmouth, MA 02664 COMPANY a a� D r `.�iI3 '•�"��i�3E� €I$6,IIii,��I:3$3�9}ilsEs�til$€ !$€'i� i��;: S �5.3�y( g i'; ,a a 3 ( s�f ip 3 1 d•aFS {y �4 t5y €€a€!. '}{ x r: $ ,S l p � - r..a�ir.l,..i.r..rriFi6i da,r< h{.P:,ii>Y f.£f,d£31nv 3Fltif...Ln9Q�$.A$i�£$:�}f$.k4413$lI:3�f�i,�'l��§k�lf$fti$E�♦3+:dF€L� ��fFM{�S>"w1A#�:.$.�Efr�r�££$3�f�D�3; i'It€$.$9�Vf.�$�A$Of�i35�1'.:F.`f.��: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTEC BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT YVIT'H RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBUD HEREI &SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITION$OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURAMCE POLICY NUMBER CID POLICY EFFECTIVE I POLICY EXPIRATION I ---_ LTR I DATE(MM/DMYY) GATE(MWlDDfY uMr7s A I GENERAL LIABILITY I I GENERAL At R6 AT ( 1 ,0001000 12 COMMERCIAL GENERAL LIABILITY ; (�' 'CBD 3-14-99 -14-00 r5S20t10TS,C,.OIdP.OP AGG i 1,000.0(TO yA'(S)i CLAIMS MADE _I OCCUR ' PER OVAL A AOV 1 OOO ,.:.... (jam 00 OWNER'S A CONTRACTOR'S PROT, EACM OCCURR2�K SV/�0 — ........ .. . ............._._ I FIRE DAMAGE(All.,6 100,000 I I 'MED EXP iAmy Oro ma F 050 AUTOMOBILE LIABILITY I i ANY AUTO COMBINED SINGLE LIMIT I¢ ALL OWNED AUTOS 0006Y INJURY 601-1EOULe'D AUTOS i TO,person) 8 i�HIRED AUTOS BODILY INJURY l S �- NON-OWNEDAUTOS -j (Poravcidenu PROPERTY 0AMAGE $ _GARAGE LIABILITY - I I AUTO ONLY•EA ACCIDENT ANY AUTO I I OTHER THAN AUTO ONLY aR)i?€ j3eas 'Elglil 4AOH A=DFNT AG RE TE . EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM I AGGREGATE GTH R THAN Uhl R• LA PQRM WORKERS COMPENSA NAND' I WCSTATU• ,OYH EMPLOYERS'LIABILITY _ TOfiY LIMITS I..__EA 'HE PROPRIETOR/ Is PAR MpR&EXECUTYE ''INCL I I CL DISEASE•POLICY LIMIT I OFFICEP. ARE:---.. FJ(CL I —�EL DISEASE-EA E MPLOYEE OTHER DESCRIPTION OF OPERATIONSA.00ATIONSYEMICLESJSPECIAL ITEMS 7Y14.£RR'�!"�^ xrrrtce�,>rt sg 1s a ,'4PEI �t f a ..r...a,+,,. .... .k :.bi.w.e.kaa.>A<ascasa Y..LS+stsrdax£$x.zxf....xaeo ': d z ,• a�.•. �€s1li�EI, 1 "•rney,. Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE +, Rogers' & Ma .. EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAR Hyannis, W. Main Street DAYS WRITTEN NOTICE TO THE CRFITIPICATE HOLDER NAMED Tb 7NB LEFT Hyannis, MA 02601 , BUT FAILURE TO MAL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LIABILRY F ANY K»UPON THE COMPA�NY-, ITS AGENTS OR RLPAESENTATIVES. ' AUTHORWEDPEP ENTAT€VE >' 5 If ss'sl ras a w;g'M. rr;rr 1•ss)Ys>gr gf&�1$I3$4:t ! zxt.sr EaaE v ar s s s x i .,�,i I§s�t� � -<+.I� a••w.,..., ,., } . ( 4 r. The Commonwealth of Massachusetts Department of Industrial Accidents _-- - Of/ice ollnresUgaUons 600 Washington Street Boston, Mass. 02111 Workers' Compensation Insurance Affidavit _ name: location: city phone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity [I-fam an employer providing workers' compensation for my employees working on this job. comQgIIY1!lm4� �bQ V S na 'mot address,: x 3l O city 0S V4e r V A k e— 6144TS phone#• SO 8 g Z 8 - insarant�.s4. C 14C--T-1;t2 fA G 14So w LT _q 5 71 J3003, EJ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who h"..: the following workers'-compensation polices: �. , ... comnanv name• , , y tiddress: ctty Phone# insurance co :: . _... _ . comnanv:name: adi#riss. c1tY:: . phone# inuranot co _policy# Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to SI.500.00 andi(J* one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00.a day against me. .I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. do hereby certify under t e pains n en ties of perjury that the information provided above is true and correct. #; ff ^:1 Signature I Date Pant name �v I t �� ��� Phone# G 7 S-G(�m " Fcontact ly do not write in this area to be completed by city or town official I: permit/license# nBuilding Department ty OLicensing Board mediate response is required oSelectmen's Office 011ealth Department ? : phone q; nOther k` R (triad 3ro5 PaA) • [nform'Mion 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 hav been presented to the contracting authority. Applicants 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 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. Pleas be sure to fill in the permittlicense number which will.be used as a reference number. The affidavits may be returned to 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, tultplicne and fa:c ❑u :r::t, _ na i. The COtt:a?::Lr'.� 1)cparrm-. at G? i-.71 dU t': MCC ei inuesticatious 600 Washington Street Boston,Ma. 02111 iDATE(MM/DD/YY) Ac v CRTIFICAT QF LIABILITY INSURANCEgAYCO?1 03/17/99 PRoP66ER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McAlpine Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE John McAlpine HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR �^`D Post Office Sq ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. !a iterville MA 02632 COMPANIE -AFFORDING COVERAGE John McAlpine COMPANY Phone No. 508-771-0105 Fax No. 508-771-1258 A Trust I surance Company INSURED - COMPANY B Sav s Property&Casualty Ins C COMPANY Bay Colony Concrete Forms Inc C 32 Third Ave COMPANY Osterville MA 02655 D COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY C TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE OLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN EDUCED BY PAID CLAIMS. CO TYPE OF INSURANCE POLICY NUMBER POLI EFFECTIVE POLICY EXPIRATION LTR DA (MM/DD/YY) DATE(MM/DD/YY) LLdITC GENERAL LIABILITY GENERAL AGGREGATE s2,000,000 A X COMMERCIAL GENERAL LIABILITY TMP1004315 /03/30/99 03/30/00 PRODUCTS-COMP/OPAGG $2 r 000 r 000 CLAIMS MADE ❑OCCUR PERSONAL&ADV INJURY $ 1 r 000 r 0O0 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 1 r 000 r 0O0 FIRE DAMAGE(Any one fire) $ 50 r 0OO MED EXP(Any one person) s5,000 AUTOMOBILE LIABILITY A ANY AUTO C00387000 03/30/99 03/30/00 COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY $2500000 X SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ 5000000 NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ 1000000 GARAGE LIABILITY AUTO ONLY,EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY. EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND X TORY L M TS OITATU ER EMPLOYERS'LIABILITY EL EACH ACCIDENT $ 100,000 B THE PARTNERS/EXECUTIVE S/EXERT }{ INCL WC 0 007 -01 03/31/99 03/31/00 EL DISEASE-POLICY LIMIT $ 500 000 PARTNERSIEXECUTIVE r OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 100,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS Concrete foundations. CERTIFICATE MOLDER :< ;; :CANCELLATION ROGERS 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Rogers & Marney 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, FAX#508-420-3550 PO BOX 310 BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY Os tervi lle MA 02 65 5. OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE John McAlpine AC'ORD 25,=S(1/95) ACORD CORPORATION 1988 .. ACORD� / RT� . : ::; i L � L: T .: . ::.. . �.....: ...... .....; DATE(MMIDDIYY) ...W.................... 06 28 1999 PRODUCER (508)994-9688 FAX (508)991-5461 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION UTKOWSKI & KESTENBAUM ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 414 COUNTY STREET HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1 BOX 5911 COMPANIES AFFORDING COVERAGE .. ..:................................................................................ .................................. . .'L.. BEDFORD, MA 02742-5911 COMPANY Granite State Insurance Co Attn: IExt: A ..........................................................................................................................:.......:...............................:.....:......................................................................................................... ..... INSURED ": COMPANY Randall C. Agnew Electrical Contractors B 94 Furlong Road Cotui t, MA 02635 COMPANY VL ._... ....................................._.................._..... C .............................................. COMPANY D .........::::::::::.:::::............::.::.::.:............:::.::.::.:::::::..::.;:.;:::;:>;::::;:;.;:.:::::::.::...:.;:.:.::::::.:: ;;.:;.:.;:;. »>::::;:::::;::;;::::.:::;<.;:. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIST BELO HAVE BEEN ISSUED TO THE I URED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR C ITION OF ANY CONTRACT OR HER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DES RIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY AID CLAIMS. ................................................................................................... ............................................................:.................... .................................................................................................................... CO : TYPE OF INSURANCE POLICY NUMBER iPOLICY EFFECTIVE ` OLICY EXPIRATION: LIMITS LTR: DATE(MMIDD/YY) DATE(MMIDDNY) i GENERAL LIABILITY : GENERAL AGGREGATE $ .. COMMERCIAL GENERAL LIABILITY l PRODUCTS-COMPlOP AGG :$ CLAIMS MADE OCCUR , PERSONAL&ADV INJURY $ _.... OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE :$ f .............................................................. FIRE DAMAGE(Any one fire) MED EXP(Any one person) $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANY AUTO $ ALL OWNED AUTOS i BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS o Y INJURY I '..._ NON-OWNED AUTOS _ _ (Per accident) .. ...... . 1 $ i..._.. ..................._............................_. : .• - i. PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ .................................. ANY AUTO .... ....... i OTHER THAN AUTO ONLY: .`.. .`. .. :::::`.:::`.::'.`:':: ......................................................................._.... EACH ACCIDENT:$ .......................... _............. ...... AGGREGATE:$ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE................_......$.............._....,........__. ....................................... . OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND _ WC STATU- :OTH-:::::::::;:;;:;i:::::::i:!:!:;i::«!:::::;;: EMPLOYERS'LIABILITY " : :.•••.•;.TORY LIM.• ............. ................................... ITS " ER A PENDING WC 06/23/1999 06/23/2000 ELEACHAcaDENr 500,000$ T14E PROPRIETOR; INCL EL'OISEASE-POLIG'YUMIT $ 5`JQ QQ0 PARTNERS/EXECUTIVE ..........................................................................,.......... OFFICERS ARE: EXCL - EL DISEASE-EA EMPLOYEE $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSN .ICLESISPECIAL ITEM C-Ft:y::1IdC ': :::. .: ........................................:: ................................ .. .... .........................................................................................::. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1 Rogers & Marney General BUllding. Contractors BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY PO Box 310 OF ANY KI E COMPANY,ITS A NTS OR R SENT TIVES. Osterville, MA 02655 AUTHORIZED REPRE NT IVE ACORDi25S:1t t?Atr012n..0�llRE?U.R�1710N.�19ft8 / -AC ORD. CERTIFICATE OF LIABILITY INSURANC�BSR ' DATE /9 'FiP.RMO-1 0 4/02/9 9 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE W.H.Eshbaugh Insurance HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency,Inc. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I 805 West Main Street Hyannis,MA 02601 INSURERS AFFORDING COVERAGE INSURED INSURERA: Trust Insurance Company INSURER B: Eastern Casualty Insurance Co. Harmon Painting r Inc. INSURER C. 707 Main Street INSURERD: Osterville MA 02655 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIC ED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICA MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIO AND CONDITIONS OF SUCH, POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY EFFECTIVE POLICY E IRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE /DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 A X COMMERCIAL GENERAL LIABILITY TMP100.033 6 04/01/9 9 4/01/00 FIRE DAMAGE(Any one fire) $5 0000 CLAIMS MADE LJ OCCUR MED EXP(Any one person) $5000 P PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG $ 1000000 X POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND _ TORY LIMITS X ER EMPLOYERS LIABILITY WC97798,07 01/04/99 01/04/00 E.L.EACH ACCIDENT $ 500000 E.L.DISEASE-EA EMPLOYE $ 500000 E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS/LOCATION S/VEHICLESIEXCLUSIONS ADDED BY.ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER N ADDITIONAL INSURED;INSURER LETTER: CANCELLATION ROGERS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOIS DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL �. Rogers &.Marney,r Inc. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR P. O. Box 310 Osterville MA 02655 REPRESENTATIVES, AUTHORIZED E SENT TIVE ACORD 25-S(7197) ACORD CORPORATION 1991 ' C-1ERIr I F' I C'P�.'TE c)F :E N1.Z—it7R PSI L`7G'E Is sue date, 11/11/9R Producer, I This certificate js issued as a. matter of Information only and confers I no rigghts on the certificate holder, This certificate does not amend, SOUTHEASTERN INS AGCy I, extend or alter the Coverage afforded by the policies below, POBOX 2510 !------ -------------------------------------------------------------------- E-41 MAIN ST I COMPANIES AFFORDING COVERAGE HYANNIS MA 02E,01 I------------------------------------------------------------------------- Code: Seib-code; I Co Ltr A; ARDELLA PROTECTION insured; I Co Ltr B; I---------------------------•--------------------------------'•--------------- HOLCOMB PL MR R HT0, Co Ltr C; DAVID HOLCOMB !-=----------------------------------------------------------------------- P 0 BOX 170 ► Co Ltr D, GREAT AMERICAN OSTERuILLE MA 02-0170 ----------------------------------- Co Ltr F; COVERAGES This Is to rertlfy that poi icl Ps of InGp.T'an ro listed below ha,UP been IGGII.Pd to the insured r13fhPd ahn,F thr the policy Ge(Ihd Indicated, noM.. tAndino, any r?QuIregent, term n ,'r condition of any contract np other document lv, respect to WIli-h this Certificate may bP issued oT' [flaypper'ta.!TI, the !IIGiI,(ajfP afforded by the policies described here .I Is sil,blPCt to all the terms, exclusions, aild condltions of such policies, Limits shown may have been reduced by paid claj s, ----------------------------------------------------------------------------------------------"-------------------------------------- Co I I ! Policy I Policy r LtT'! Type of ITlsara.nce I Pallcy number IeffectlUe date ►expiration, -tl. el All limits in thousands _____________________________________..______--_--_-__-_ --------------- ___-_-----_-_-_---_-____-___--_-_-___--____-_--_ A !GENERAL LIABILITY ! 070056474A ! 12/1B/9R I R/99 General a.gorega.te; 11 Commercial general liability I I ndlicts-cn I IPr rll, p gar-J '( h Clalr9s road? [XI 'ncr:p,( I I Ipersopal/adVertis!ng Iris; finer s & rantractor G Prot I I ►Each, occurrence: 2,QQO j ! I I IFirG damage: `4 ! I ! IMedical expense, 5 _________________________________________________________________ __________________________________________________________________ (AUTOMOBILE LIABILITY i I I ►Combined ' 11 Any a,Cl,tn ! I 15ingle limit, I !� All oW-ned autos I I " ! !Bodily injury I I ' Scheduled autos ! ! ► Per person); I� Hired autos I I( I I_ndily Injliry I Non-oyned autos ! 1 1,Per ac.cideritl; Garage liability ! If ! ! ! lPir'Perty damage: l (EXCESS LIABILITY I I I I Each 1 ( I I I Occurrence Aggregate ! Other than urmbrella. form ! I 1 ! -------- ----------------------------------------------------------------------------------------- D I I,InRKER'S COMPENSATION I IJC905143801' 1 12/18/98 I 12/18/99 Statutory I----------------------------- ! AND I I I IN lEarh accident) EMPLOYERS' LIABILITY !{{ I ! 500 Disease-policy limit) I I I I 100 Disease-each PmplovPP) ___________________________________________________________________________________-___----____--_____-____-__---_______---_-_-___-_ 1OTHER I I l ------------------------------------------------------------------------------------------------------------------------------------ Description of opepgtinnG/lncd}jnnc/uahjCles/r?strlCtlo(Is/sperja.l Items, ANY AND ALL PLUMBING AND HEATING OPERATIONS -------------------------------------=--------------------------------------------------------=------------------------------------- CERTIFICATE HOLDER CANCELLATION " I Should any of the above described pollcles be cancelled before the I expiration date thereof, the 'I! endeavor to I irr.11 lO days written noticP to the certificate holder to to the ROGERS R MARNEY INC I left, bu.t failure to ma!I such notice shall impose no obligation or P 0 BOX 731Q -liability of any kind upon the company, its agents or representatives. OSTERhILLE MA 02655 - ------------------------------------------------------------------------ Authorized representative; SCOTT ICI LOWE JA .. ,,.,,:e. .:••._ .,...,. ,.>Y✓Ro•,,..:c.. „•r •. 'r_:.� ^i�3iNL a,,;.. .,.. ia. .,vrgLaet• -5:r, 4.•b'=^?. ;h•4titt1�. h'F•?@'R •f ��✓. are yfi!`�,. 9 tF - s 1 5..nd en ,7 a:�ac �--- ao.q' ri5•__ i i w• 7-6�iff.Ka Falb " - DV 7 saf f C�'/•[lJ Aw _ Rwe r../Or •7 <ws Trw.did rP`dJ ;_{ �>;.,� ,F,.3/,f S/<6 'a.s T.•rafsd wer E1.•46.•8...,er(f/y...� Bftb{fAM! � }x rd f nc,4.$K,.: •K• rir.nJ,d x.d � tfM 1b., C-C (,cola r':a<) Msa..., f`1•"?•'`%nL ' r4 v�cl�d e I � � I 1 � 14! i; I. cr455 j rsy-r.r. NEW STEPS X(il I NI .ENTRY ;WT rw wa .. ii - KITCH£N:=-=-- R w�u�-vwr.n.r.s.e r.6GY. y w.rrno w,wo . XO9 Tel - dooms.xrair-r. - - I - - STWY Wl - PLANTING. HALL W2 BEDS .. 'I D7 D6 D _ XDR PORCH - rr � uo-e..a...a-ow.arM D/2 NNING .:. XD 7 .vsea an _ 4 GrA SS CO_ lCC py ' Grpmmllobi.ir. �-�-� xO6 I XD5 LIVING a alv swf wit �_.____—_ wr r ara•.�vi.r.wr.+n.v.a C/ W S yl,q c.ro care Woo-ram &. j BLUE .T')NE _ XD4 —XD3 i O - BULKHEAD..._ STEPSNASTER BEORO,,, E.1tA �lev�rr`°•.. I f d - ' —------ -- - rr raon - XD2 -` I `'PLAH71N6 POCKET - NEW STEPS ' BRICK WALKWAY bhp BrICk TERIIACE psnrwrm�p.r.em'a� w�a is .wni w.r-r:.q ww.. I .;Raac � � fos�®n �y Town of Barnstable , p4 Box 534 `n� °' Mf aea B::w,u.Rma_ Hyannis,Massachusetts 02601 (SW attf 106' Fax(508)775-3344 Phone(508)790-6265 • • r 9 . TH-151, - - 3 ��•{��• ti� ffy�rS (aep � is U'z�r" d.• o Lfli, i f awse504M - we.ma ww auss (lOtiU14,06 Ins ou hr o..4 c.aksu FJweim 1 . ,sJ=. 6 1 , V ogers&M�aay y aaf wn N a rta.a - Oaaril1q MA Mw W6f1 !e Amme el 1111 ON F-R-64 CN MA - El—l-I S n --- • - � ;_ i i 1 t i I l i -- Bid St&M4M Nf Wma.r.wi- OnaiW,SMMWS (lM)�II-6106 . ISt3OY t�{,tl,C.-4 NA'. Nk 14 .,PIP 14'.. _. — � - .. ` .- --- _ .- 1 \` `. ..,.... y,rJ•/,P/.... i F"..f.�..G...F.. 1 IL � R-3o ln,�7P•<1) I \!'�✓ 8 io'�.n f< f�6^��/�/rib ♦c.0 emu,/w-a{.1 i !"0•('1/ � _ ... `�'� r e..•..H.n( _. � .. a .., l' BA get dOeAB - � - s1,.n e•e &Mar-y �4Mw es(sf ' .an od l.r ia:e:dn�a..wx - DENTMAT OF PUBLIC SAFETY 176992 - ONE ASHBURTON PLACE, RM .1301 BOSTON, MA P2108-1618 CONSTRUCTION SUPERVISOR LICENSE Plumber: Expires: Gi,rL'hdaye: CS 016174 05/07/2000 OS107/1030 Rest.r•icted To: cAO MAY ; 2 093. CHARLE:S D ROGER:; ' 300 i3 r1 X•I'E R NECK Et O �a ����'o . - ...- ' ----.•.._____.__....._...-..----._.,_ �_ MARSTONS MILLS, MW 0214S - Keep top for receipt and change of address notification. at:i.on. 7. -77777. I. �_ �/l�i �Q�7�7��uU�Wlr � ti�� LLW.�GG(/l�. �iGGl1• ! HOME IMPROVEMENT CONTRACTORS REGISTRATION - Board of Building Regulations and Standards � One: Ashburton Place - Room 1301 ! Boston , Massachusetts 0210E3 ! HOME IMPROVEMENT CONTRACTOR ! Registration 10013E Expiration 06/09/00P Type - PRIVATE "CORPORATION HOME IMPROVEMENT CONTRACTOR ! - - Registration 100134 ROGERS & MARNEYj INC . - Type - -PRIVATE CORPORATION Charles D . .Rogers ! -W Expiration 06/09/00 445 OSTERVILLE Q BOX 310 i Ostervil:le MA 02655 j ROGE'RS & MARNEY, INC. G��M�o 445 Rogers OSTf.RVILLEPO BOX 310 ! ADMINISTRATOR ! Osterville MA 02655 /- Assessor's.Office(ls oor) Map*- 075 Lot "war yoff, Permit# -16 9�! ° r Conservation Office(4th floor) Date Issued <0`0 Board of Health(3rd floor)(8:30 9:30/1:00- 2:00) Fee /Engineering Dept..(3r r) House#1 y Planning Dept.(1st floor/School Admin. Bldg.) .` 3 Definitive an o e b Planning Board `AS& - P Y g 19 `'. i039., �. fEOMKt� ,. TOWN OFBARNSTABLE Builld/d��ing Permit Application Project Street Address Ad f S Z Village / Owner j,),4 D 4/1') n--?g V Address OA&,,C P 6,e,Z C. j�o=y ,�. c•�-fin no Telephone z,,�,pp� $ 7 5L$ / Permit Request 7fES� `n/►6, 2 F 9& Total 1 Story Area(include 1 story)garages&decks) /� square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ 5'4 a d 0'0 Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type x Commercial V Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other / Builder Information Name 5T-e,4d C-A* (I. Al 4 M 9 L Telephone Number -'r14 /Address 2 t},S" o o S -License# O l O P O 18 n k 9 2 Home Improvement Contractor# CD Z,3 6'6 C 6-7-cj ,T ))'1 19 O Z-(.3S `o 4 2 Z �Worker's Compensation# / ///4 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELLAS PROPOSED STRUCTURES ON THE LOT. I,/ t'L C ALL CONSIRUCTION DEBRIS RES TING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE✓ L DATE ?l 6- BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY - PERMIT NO. #10592•" ` DATE ISSUED Sept 26, 1995 r MAP/PARCEL NO. 075.001.X02 ADDRESS 1075 Old Post Road VILLAGE Cotuit, MA 02635 , OWNER Ammen Trust E t DATE OF INSPECTION: r - FOUNDATION FRAME ' 4 f INSULATION ' 0 FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f r .. r The Town of Barnstable bM Department of Health Safety and Environmental Sery 0s Mading Division 367 Main Skeet,Hyannis MA OM601 ' - 1phm C Office: 508-790-0= Ralph C � F= 508-775-33" For mM=use only P�imit no. Date____. AFFIDAVIT SOME nUROVENMNTCONTRACTORLAW SUPPLEMENT TO PERbffr APPLICATION MCL c. 142A requires that the"ttoonst:ncdon.altemdous re madon,:cpair,modantzan�, impruvetaeat, remov-4 danolition. or of an addition to any pse building caasaiaing at least one but not more Shan fourwith certain ebooeptions,along a� to such:e ddeaoe or building be done by registered conttactorz, al with ate. requirements. / 'ryPe flf Work: s &L Cosi� D� Address of Work: /0 76^ a t.0 P o s t (CA T-V: i z'Oarter.Name: J A-fL0 A nv LtAJ Date of Permit Application: U G• s T �, 1 _ ►9 4 J I hcrctm certify that: Registration is not required for the following rtasoa(s): work mftdedby law -_Job under SI.00o -dding aft°wna`°°capied owncrpollingompasnit Notice is hereby gi♦'ea d= OWNF3IS PULLING MMIR OWN PMM0r OR DEaWG WITH tINRECISTERF�CONTRACTC FOR APPLICABLE HOME MMOVeAnTr p UNDER GL cc 14ZA HAVE ACCESS TO " ARBMUMON PROGRAM OR GU,ARAI�TtY SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a penait as the agent of the owns: LAC. t � �. /oz3Y G Date tame Reams No. OR ])Err L"C0j)unanwPa& ol Maaach"dedi 600 Wkn#=Sired .Commiaiam Workers' Compensation Msm ante Affidavit A-rvLB c.tiJ with a principal place of i�ig �j0f3ax4$Z ,Zas 5" cso l S CO-r Pyl A- do hereby certify under the pains and penalties of pelrjurn that: (� I am an employer providing waricen' compensation coverage for MY CMfoyees this job. . Insurance Company Policy number . + am a sole proprietor and have no one wonting for me in MY capaat ' I am sole proprietor anal aoatraao or homeowner C�me) and cor:aa ow w o oilowing wormers' easaII acacia 1-i6d eTy Mery/aL 14Cc /�(�r,J �n7 c 1-l,Ynr� 5�r�a c�- A►�v►C'N C 1ti/C' ! z 494/WOD Conuaaor [use toaY Contractor [nnurance C mpanylPaiic Contractor Ilasuraace Company/PCHO a homeowner performing 91 the work myself. 1 uede.� t.Gnd u s tort of&is sruu"m"I be faerdrd to Me OMM of IMMWpd=af& O1A Cmftr a ft of °u and r wmnse as n�::td under sccsion ZSA of MGL l:Z ran lead to the km osidw of a'a e[cia tmeoiuo so s' �re:z' tm�isaar-gnc as wd,z civn ov+aWes in the toner.cf a STOP WORK ORDER Ltd a floe of 5100.00 a day opi�n+c 4� Signed tfiis� l s�- day of Au c. u s -r -►Lai— t S Licens Permittee Building 0�eat Liamsi 9 $oard a _ `' l k, I 1. L_ _ __ _ ,�/ie�oo„wno9uoealA4 o�✓uuaauc%uael! i HOME..I MPRO.VEMEN'V CONTRACTOR .;.Registration ,-402356 ;. .Type INDIVIDUAL i Ezpi:ratiort- 07/01M. STEPHEN:C HAMBLIN <P0 Box"482/205 School`St G� o ",ptuit.MA 02635.- ADMINISTRATOR OF THE Tp� • The Town of Barnstable HARNSrABM 9 MASS. Department of Health Safety and Environmental Services 10 A��,O 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. n Type of Work: AJkAA'.o,, Est.Cost Address of Work: I©'>S OkA posk Kc7aA - Cc n 0✓1 ok_: Owner's Name_ Oct- i d l�tvv�yyleCl Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied ' Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Ed��s ` 1N� v,e v 16 0 t 31 Date Contractor Name Registration No. OR Date Owner's Name SMOKE DETECTORS REVIEWED ; R UILDI GIV DEPT. DATE _ t FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING Barnstable Bldg.Dept. Approved by. Permit#: 22 a 4 A , ,v 0 1 _ AGL -.-A�.10�'tj 41-V—6 "D r i s • 3 /// - _.__. _ ==- i V A N 24044'09*IW 410'! 'Z LOCUS 0 I Semarys 1, PC Islamic! JP ) I Lot Area 4.89-tAc // l 1 �--- \ \ \ \ d \ v0 —LOCUS PLAN PITA Scale: I"=2000' q4c.1\1 e._4 Ili Assessor Map 74 Parcel 27xD1 5 27xO2 6 0 /-Connect Exist.House Sewer toNewSepficTonk F.G. 22.0 Ir L 19L 18.3 Top E 1. 19.3 P, 20.5 1500 Gallon 20.3 ov Septic Tank 18,7 18.5 Bot.E 1.161 4 Bedding i as ADO\710W T Per tle 10 5' 80, I OCATION' Bottom of Test Hole E I I I A No Groud Water. ly- / On , �'� Existing DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM "A House a,Z6 Not to Scale 0 C>074) 58 RV LE k A /� , \ � �oG Finish Grade Filter --Compacted Fill Fa b r I c li 'op r NOTES WIN Ak 1.Water SuPPlyForThis Lot is Py:vi-e eYell SIN:6 Family -6 Bedroom Pea Stene 2 Location Of Utilities Shown on This Mn I-s Approx. With no Garbage Grinder ,:iJ At Least 72 Hours Prior U rV to Any Excovat:on F�OrThls Daily Flow-I 10 x 6= 660 GPD Project The Cantroctor Shall Make The (Isquired Septic Tank' 660 GPD x 200%=1320 GPD Leaching 3/4"- 1 1/2" Notification to Dig Safe(1-800-322-0 644) Use 1500 Galion Septic Tank Chamber Double Washed a The Contractor is Required to Secure Ay9ropriah LEACHING AREA Stone PLAN VIEW Permits From Town Agencies For Com, uction SF Required 660 GPD/0.74 a 892 Defined by This Pion. 4-10" Use Botlorn, Area,Only 'toro4ewoy to Scale 1 50' 4. Install Risers as Require BottomAreac 12 x.76'= goo S F. 0 oslkng Road Finished Grade. d to Within la%,: 900 SY Total Provided 0�d post- 5.All Structures Bu'ried Four Feet or Vorio or Subject* . LEACHING CHAMBER DESIGN to Vehicular Traffic lobe H-20 Lwdh-. All Pipes to be Schedule 40. Use CROSS SECTION OF CHAMBER 8-5 Gal. Cm ino Septic System to be Installed in Accord<nc* With 12'x75'00 Washed StoLeachingne Fielhad asbe Shown NOT TO SCALE 310 CMR 15-00 Latest Revision And-'he Townof Barnstable Board of Heatth Regulo,jons T. AI I Piping to be ScIv 40 PVC -r,V4 , M L_ 2 SANSJv LoANA 13ROV,ON COAR-L7- S A N b I--,Y R 513 PEIER C, SAN L> I 0'y P, -5/t. NO. 29733 30 CIVIL rJ Bu C)VVN 1 S$4 Y6 L_ COARSE o e .:C r+ C SA N b 1 cD \o'R 1,/4. L_-r. V&LLC)vV1514 Ll-qsj , C-3 C1 AR5F_ SAHV) 10-YW yC7� NO GROUND WA7-F-P SITE PLAN SEPTIC SYSTEM UPGRADE AT 1075 OLD POST ROAD 7tiwo are wetlands within 100 feet of the proposed leeching faclilly. OOTUIT , MASS Thewe are no private potable wells within 150 feet of the proposc%A! septic system. ;:OR DAVID AMMEN The design of the system Is based on bottom area only. SCALE AS SHOWN DATE: JUNE 3, 1999 SULLIVAN ENGINEERING INC bef e is no increasi'in tl(m and/c)( &ange in use piropased. OSTERVILLE.MASS