HomeMy WebLinkAbout0224 PUTNAM AVENUE - , � , � � r
,}�^�\
r t ` � 1
'- � .. .. J '�,
.�
Town of Barnstable Permit: ;U"9 iz3
f f. Regulatory Services Date:
oF11HE t0� Thomas F. Geiler, Director z�
�� ~t Building Division Fee:
BAS1AB Tom Perry, Building Commissioner
9 nlnss. �,
1639• �m 200 Main Street, Hyannis, MA 02601
Arfpr a www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
Owner: 4� it 11 �J 4 !TM Phone:,-.,, D ��
Install at: 'Ptfrllll A-M y Village: 1
Map/Parcel:m` (0G10—(f / Date:
Stove '
A.(�/ Used
B. Type: adian /Circulating
C. Manufacturer: udD5-rc)el< -%t)N-NrQ1; ek Lab. No. U, L; 1� I 8
D. Model No.: l^t KC- i//r= rS`]'b U r-�.
Chimney
A. ww Existin (If existing, please note date of Iasi cleaning)v
B. Flue Si PpP��
b S-�v�t F—
C. Are other appliances attached to Flue? N0
D. Pre-fab Type and Ma ufacturer NA
E. Masonry: 13Rlct ine nlined mot'(Lfz_-
Hearth
A. Materials: 13 fu c<'f VZC0V\1e RE i r' &AR6(1)ukazK-;2957 2.Z (Mrl E S/ /VML
B. Sub Floor Construction: (,0NC9ET7P- ,If y''C,l✓Rf1MDG - ILE
Installer _
Namel)PWIt \XJ141'fM0R Address: 2-:X4 IP07`KJAY11 t47-
Phone:;5�� 4f�)_D b Z 4
Location of Installation:
H.I.0 Registration#
Construction S rvisor#
OR check Homeowner Installing, no license required
APPLICANTS SIGNATURE (v�
APPROVED BY: /ed-,-P—.,k—
Please make checks payable to the Town of Barnstable
*This constitutes an official stove permit after inspection, photographed, and approved by the
Building Inspector
Q:forms:stove
Rev 103107
ife
�. The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
+ d 600 Washington Street
Boston,MA 02111'
,�•�� www.mass.gov/dia.'
Workers}Compensation InsurAnce Affidavit: Builders/Contractors/Electricians/Plumbers
_Applicant Information .Please Print Leizibly
Name(Business/Organization/Individual): W.[it Vm"b R C_
Address: �Z4 F LIT O N n 1�LrT.`
City/State/Zip: C VTJ t T t /"),,4 Phone.#: 5b5, 4 �-` C
Are you an employer? Check the appropriate bog: .'type of project(required):.
. general and I
1.El I am a employer with 4 ❑ I am aeneral .contracto 6. ❑New construction .
..employees(full and/or part-time).* • have hired the stab-contractors
2.❑ I am a'sole proprietor or partner-
listed on the-attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have g, ❑Demolition
working for me in an capacity. employees and have workers'
g y P ty t. 9. ❑Building addition
[No workers' comp.insurance comp, insurance. 10. Electrical r airs or additions
required.] 5. ❑ We are a corporation and its ❑
=3. I am a homeowner doing all work . officers have exercised their 11.❑Plumbing repairs or additions '
myself.[No workers'comp. right of exemption per MGL 12,0 Roof repairs
insurance.required.]t Q. 152, §1(4), and we have no
employees. [No workers' 13.❑ Other W061) S 1U UT
comp,insurance required.] 2A)S7?-L�—
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowoers,wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
#Contractors that check this box mustattached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have
employees, if the sub-contractors have employees,they must provide their workers'comp.policy number.
I am* an employer that 1s providing workers'compensation insurance for my employees, Below is.the policy and job site'
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State
Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date).
Failure•to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK,ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the WA for insurance coverage verification.
I do hereby certify under the pains•andpenalties ofperjury that the information provided above is true and correct
Signature:n Date: _
Phone#: 4 L-L{ 0
Official use an1y. .Do not write in this area, to be completed by.city or town official
City or Town: ' Bermit/License#
Issuing Authority(circle one):
•1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
a
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hiie,
express or implied, oral or written."
An employer is defined as "an individual,partnership,association, corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to•operate a business or to construct buildings in the commonwealth for any
applicant who has not produee&acceptable evidence of compliance with the insurance coverage required."
Additionany,MGL ehapter..152, §25C(7)states"Neither the commonwealth nor any of.its political subdivisions shall
enter into any contract for.the performaince of public-work until acceptable evidence-of compliariee with e insurance
requirements of this chapter have been presented'to the contracting authority."-
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,it
necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s) along with their certificate(s)of
insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members'or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the pemut.or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate-line.
City or Town Officials
Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city'or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture
(i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone-and fax number:.
The Commoiawealth of Massachusetts
Departinmt of IndusWM Accideents
4f€iee of Investigations
600 Washinpli Street
Boston,_ 02111 • .
T O.#617-727-4900 ext 406 or 1-877 MASSAFE _
Fax#617-727-7749
Revised 11-22-06
www.mass.gov/dia
PERMIT PAYMENT RECEIPT
TOWN OF BARNSTABLE
BUILDING-DEPARTMENT
200 MAIN STREET
HYANNIS, MA 02601
DATE: 01/13/09
TIME: 10:39
--------------------TOTALS--------�----------
k,
PERMIT $ PAID 25.00
AMT TENDERE9: 25.00'-
CHANGE�LIED: 25.0000,
,r
APPLICATION NUMBER: 200900123
PAYMENT-METH: -- •c'H�A
PAYME"N i-•Rr�:
"• 1
_._ ------ - ----------------- -
Town of Barnstable *Permit#QW2116666
a Expires ifmonths from issue date
EE-PS ERR Regulatory Services Fee a S c 00
g Y
O C T 2 2 2007 Thomas F.Geiler,Director
Building Division.
TOWN OF SARNSTABLE Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstablema.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
// Not Valid without Red X-Press Imprint 1
map/parcel Number
6
Ma / � 66
P P .�y � h J-
Property Address mln {r1
[E]'Residential Value of Work �, r Minimum fee of$25.00 for work.under$6000.00
Owner's Name&Address C 01VI or iJ l Il lm/61`56m (l.yl 1- l 0✓r\/
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
1<,
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
'Check one:
❑ I am a sole proprietor
ffI am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workmati's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
E�`Re-roof(stripping old shingles) All construction debris will be taken to CSC(IYIp•s-
❑Re-roof(not stripping,_Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
e Improvement Contractors License is required. .
A�copy of the Horne p
SIGNATURE; .
Q:Fm 11 :expmtrg
Revise061306
u wF. The Commonwealth of Massachusetts
Department of Industrial Aecidents
Office oflnvestigations
606 Washington Street
Boston,MA 02111 ,
www.m ass.gov/dia
Workers"Compensation Tnsurance.Afidavit. Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
,,CNN ffie(Business/Organization/Individual): ._I(A�j om) k .) J`t''i),�V
•Address: 'OL� %(,1, C2QY1
CCit/sti't i'p: �b'tt,�`-f" MPf Phone.#:
Are you an employer? Check the appropriate box: -Type of project(required):.
1.❑ I am a employer with 4. [] I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6 ❑New construction .
2.❑ I am a sole proprietor or partner- listed on the-attached sheet, 7. E]Remodeling
ship and have no employees These sub-contractors have g. Demolition
working for me in any capacity. employees and have workers'
co insurance,$' 9. D Building addition
[No workers'comp,insurance comp.
q ] �. 5. [] We are a corporation and its IO.�Electrical repairs or additions
3 ►LJ' �I am a homeowner doing allwork? officers have exercised their 11.EJ Plumbing repairs o' additions
'+ right df exemptionper MGL
yseli�`[No workers_comp. 12.❑Roof rrpairs
insurance required] t =� > c. 152, §1(4),and we have no
employees. [No workers' ..13.0 Other
comp, insurance required.] .
f=
*Any applicant that checks box#1 must also fill out the section below showing thcir workm'cvrnpmsation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
XContractm that cbcck this box must attached an additionalshect showing the name of the sub-contractors and state whether ornot those entities have
employees. ft'the sub-contractors have omployces,they must pravidb their workers'comp.policy number.
X am an employer that is providing workers'compensation insurance for my employees Below islhe policy and job site
information.
Insurance Company Name:
Policy#i or Self-ins.Lic.#: Expiration Date: y
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date),,
Failure•to secure coverage as required under Section'25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be for-warded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify,:rnder the pains•and penalties ofperjury that the information provided above is true and correct
. Cam- ��� � •
Sienature: �Dat /6~�aa 'D �
Phone #:
Official use only. Do not write in this area,Yb be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one);
1.Board of Health 2.Building Department 3.City/Town CIerk 4,Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone M
37q
/uo
30 ,
Lc
2.3
12 IL
®�� )7 X , I
r) Map S / Parcel , P Permit#" 3 �-
House#; C� Date Issued
Board of Health(3rd oor)(8:15 -9:30/1:00-4:304
PIS RI
f�G Conservation Office(4th floor)(8:30-9:30/1:00=2:00) - � /�'`�'� ��. '�Lat/O'`
Planning Dept.(1st floor/School Admin.Bldg.) . ,�0- co
a`CST BEDefinitivePlan Apr b Planning Board ` 19 -INSTALLIANCE4WTOWN OF-BARNSTABLL��!�0.NDEAND
� i uilding.Permit A plication �_ �,' '`.� PeS
Project /t ddress
Village,-41- - .
`Owner Address;
//�16f� �%l��d�.� . .
Telephone ' - O
Permit Request 1`e olJ U e— zd.�r
r
J'Ojiz��
I
First Floor 6.7G sk �e4 square feet Second Floor 6`76 square feet
Construction Type
Estimated Project Cost $ cl, z O cUcJ. y
Zoning District Flood Plain Water Protection
Lot Size ;2 j i¢�'eS p Grandfathered ❑Yes ❑No
Dwelling Type: Single Family & Two Family ❑ Multi-Family(#units)
Age of Existing Structure ad ,�,S Historic House ❑Yes A No On Old King's Highway ❑Yes id No
Basement Type: ❑Full V Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) — 4�9 � Basement Unfinished Area(sq.ft) 5-24-
Number of Baths: Full: Existing / New /o Half: Existing Q New /
No.of Bedrooms: Existing New
Total Room Count(not including baths): Existing 3 New First Floor Room Count
Heat Type and Fuel: ❑Gas ❑Oil ❑Electric 00ther
Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes o
Garage:)p Detached(size) -;20 X X y Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes No If yes, site plan review#
Current Use _ /� Qni. _ Proposed Use c�
Builder Information
Name d,�,�r,� ��jjy,, �� Telephone Number %�1�2 d — ,3 j /A
Address , e_/ License# d$/;2 f! dZo
�&`/Home Improvement Contractor# f/d1l
Worker's Compensation# �
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESU TING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE ��. DATE �5./
BUJUDING PERMIT DENIED FO THE F LOWING REASON(S)
I
FOR OFFICIAL USE ONLY
FERMIT NO.
DATE ISSUED
MAR/PARCEL NO;
'. .
ADDRESS VILLAGE
OWNER .- , . j i - __ 4 • .., � Y - •`r
DATE OF•INSPECTION:.
FOUNDATION
FRAME !
INSULATION
FIREPLACE
(ELECTRICAL: ROUGH - FINAL
PLUMBING: ROUGH. FINAL
GAS: RO14GH s' FINAL
r FINAL-BUILDING
rj
DATE CLOSED OUT' -
' ; 1o0 � E ,
ASSOCIATION PLAN
l TI e
I DEPARTMENT OF PUBLIC SAFETY
a
CONSTRUeTj_k SUPERVISOR LICENSE
Number: Expires:
5 J 'ar
` =4HOMAS P DAHELIO
`68 DORY CIRCLE
MARST08S HILLS, HA 02648
—
7
" HOME'IMPROVEMENT CONTRACTDR
��Re9istration 118952 ;
y : Type INDIVIDUAL
zpiration':$ 05/08/99
`zE w v .
� THONAS P.rDAMELIO ,s
>THp���AS P..DAMELIO
6'DORY CIRCLE
nDMINIs7�+TOR � MARSTONS MILLS NA 02648 `
• The Town of Barnstable
�$ Department of Health Safety and Environmental Services
Building Division
367 Main Sims,Hyammis MA C60I
Raiph Crosson
Offscc SCS-790-6227 Building Commissie
Fax: 509-790-6Z30
For oMce use only
Permit no.
Da:e AFFIDAVIT
HOME IMPROVEMENT-CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 14 .A requires that the "reconstruction, alterations, renovation, repair, modernirition.
conversim improvement, removal, demoiltion, or construction of an addition to any pre-ezisting
owner occupied building containing at least one but not more than fbur dweiiing units or to
structures which are adiacent to such residence or building be done by registered contractors, with
certain exceptions.along with other requirements.
s
Type of Work•' y� Est.Cast L Z/Aw
Address of Work:_
Owner's Name � ��
Date of Permit Appiicatton:
I hereby certify that:
Registration is not required far the following reason(s):
Work ezciuded by law
_Job under SI.000.
Buiiding not ownner-occupied
Owner puilimg own permit
Notice is hereby given than. OWN PERMIT OR DEALING WTI'H QNItEGW EKED
OWNERS -PULLING THM HOME _ _
CONTRACTORS FOR��N PHOGZA M OR CiJARAN'TY wORK 00 tJNDER MGLO 14ZA �
ACCF55'TO THE ARB
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a.Permit as the at the er:
neon Na
Daze
Contractor Yame
OR
Date
Owners Nome
77ie Commonwealth of Massachusetts
Department of Industrial Accidents
: offer atloyesdustloos
600 Washington Street
- Boston,Mass. OZlll
Workers' Compensation Insurance davit ,
Me
IMEMEMMEMMEMEN
fie. �I y�r¢ S ��✓•,�' /� J
location: /•� 2-y l-�2['
city / �, ohone ,2- —3,J '/6
❑ I am a homeowner performing all workAlqself
❑ I am a sole proprietor and have no one woridn in any capacty
11
❑ I am an employer providing workers' compensation for my employees working on this job.
comnnnv name•
address:
dtv phone
insurance cn. niicv#
am a sole propri general contractor or homeowner(circle one)and have hired the c antzactors listed below who
have _..
the following workers' compensation polices: 17. -051
ar
comoanv parr
ss. 'oo,
addre /�''` e�i►)9�� ��04
As
d •�r1rJl Ld-- - 4 honelh „
insvrnnce ctt. ,:•.�...:. ... - • �•��e•i'S let# •;/ ;.«:«j,,: 7`",M.:«�'• ' .....
cam anv namr.
address:
dtv phone#-
•• •��.:. .: :^::,,„�,:.�:... x...:;,,�..,.;.��:... ... let# • ..,.:r;�•..�•: .y�y �.
ruvrance ca
Paibtre to coverage=req=nd under Section 2U of 11GL 152 can lad to tha imp=Wm of ertmind pensddes of a Ban up to s1AU9 aadfor
ere yearn,imprtsonmmt as well sa drd peoaitla is the form of a STOP WORK ORDER and a du of t100A0 a day sgakm me. I understand that a
co"of chit stesenum may be forwarded to the OMcs of Invesdgedow of the DIA for eoraa0e verideadm
I do hereby cmify rrn the p ' mid p of pedipy that the information provided above is trw mrd torsert
r0cdbweck
Phme
e oadY do not write is this area to be eompietsd by city or town omdal
wn: a pB Bo�d�
ftomtedists response is regaietd CI eleetntm'a Oise--
Health Depaetimtmon: Phone* 00ther
:. ..... .. ...
Umm 9193 P1AJ
Information and Instructions
Massachusetu 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 cm= --
of hire, =Press or imPiied, oral or written. ,
An employer is defined as an individual. partnership, association, corporation or other legal entity, or any two or sore of
due foregoing engaged in a joint enterprise. and including the legal representatives of a deceased employer, or the re=mr.
7vstee 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
:J1; !ays peace sa
to do maintenance, conuction or repair work an such dwelling house or an the grounds a
building appurcaumt 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 renew
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha
not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the
nor any of its politica
commonwealth l subdivisions shall enter in o any contract performance of the perform of public work until
the insurancerequiremenu of this chapter have been presented to the
acceptable evidence of compliance with
authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checidag the box that applies to your situation and
. suppl g company names,address and phone numbin
ers along with a certificate of insurance as all affidavits may be
-,.submitted to the Department of Industrial Accidents for confirmatiaa 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 Accide=. Should you have any questions regarding
the'law"or if You
are required to obtain a workers' compensation policy,please call the Deparaneat at the number listed below.
Im
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the ba=m of the
affidavit for you to fill out in the event the Office of has to carrtacs you regarding the applicant. Please
be sure to fill in the permz lio=c number which wdl be used as a refineac a number. The affidavits may be sroaaed fn.
the Department by mail or FAX unless other ananacra is have been
The Office of Investigatins o would like to thank you in advance for you cooperation and should you have nay questions.
please-in not hesitate w givens a call
�. .
WEEK FROM
The Depmr-tmeat's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Once of Imesagadow
600,Washington street
Boston,Ma. 02111
fax#: (617) 727-7749
phone #: (617) 7274900 eat. 406, 409 or 375
DATE(MWDDIYY)
A_CORD,. CERTIFICATE OF LIABILITY INSURANCE 325/98
PRODUCER 508-790-1030 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
MCSHEA INSURANCE AGENCY,INC. HOLDER.
HTHIS
ER CERTIFICATE
DOES
BYNOT
THE AMEND,
EXTEND
OR
320 WEST MAIN STREET ALTER HYANNIS, MA 02601 COMPANIES AFFORDING COVERAGE
COMPANY A NATIONAL GRANGE MUTUAL
INSURED COMPANY GRANITE STATE
RON'S EXCAVATING , INC. B
PO BOX 1167 COMPANY
MASHPEE,MA 02649 C
COMPANY
D
COVERAGES
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 8 Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Co TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MMIDDIYY) DATE(MMIDOIYY)
GENERAL LIABIunr MPJ92563 7/17/97 7117/98 GENERAL AGGREGATE s 1,000,000
A
X COMMERCIAL GENERAL LIABILITY PRODUCTS-COMPIOP AGG $ 1.000 000
CLAIMS MADE a OCCUR PERSONAL&ADV INJURY f 500,000
OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE S 50O 000
FIRE DAMAGE (Arty one fire) 5 500,000
MED EXP (Anyone person) $ 10,000
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT f
A ANY AUTO M9J92563 7/17/97 7/17/98
ALL OWNED AUTOS BODILY INJURY f 100,000
(Per person)
X SCHEDULED AUTOS
HIRED AUTOS BODILY INJURY s 300,000
(Per accident)
NON-OWNED AUTOS
PROPERTY DAMAGE t 100,000
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT s
OTHER THAN AUTO ONLY:
ANY AUTO
EACH ACCIDENT S
AGGREGATE S
EXCESS LIABILITY EACH OCCURRENCE i
UMBRELLA FORM AGGREGATE
OTHER THAN UMBRELLA FORM $
- - WC STATLL OTi!•
WORKER'S COMPENSATION AND 6026253 10/11/97 10/11/98 mar ulerrs ER
B EMpLOYERS'LIABILITY EL EACH ACCIDENT S 100 000
rr E PROP WMfU 8 INCL EL DISEASE-POLICY LIMIT S 500 000
PARTNER IEXECUTM EL DISEASE-EA EMPLOYEE S 100,000
CER
OFFIS ARE EXCL
I
(OTHER
F
SCRIPTION OF OPERATIONS(LOCATIONS/VEHICLESISPECIAL ITEMS
1-585 7099
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
TOM DAMELIO 110 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
683 DORY CIRCLE BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
MARSTONS MILLS, MA 02648 OF ANY AND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES.
AUTHORIZ REPRESENTATIV
ACORD. CERTIFICATE OF LIABILITY INSURANCE 08/28/98'
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Edward A. Grazul Insurance Y .enC Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
PO BOX 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Marstons Mills, MA 02648 INSURERS AFFORDING COVERAGE
INSURED INSURER A: Savers Property & Casualty Insurance Co.
American Foundation Company, Inc. INSURERB:
22 Union Street INSURERC:
Yarmouthport, MA 02675 INSURER D:
INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR I DATE 0
LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE .POLICY EXPIRATION LIMITS
GENERAL LIABILITY EACH OCCURRENCE S
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $
CLAIMS MADE OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
iGENERAL AGGREGATE $
GEN-L AGGREGATE LIMIT APPLIES PER:I PRODUCTS-COMP/OP AGG !$
POLICY
— PRO. LOC !
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT i
ANY AUTO (Ea accident) j$
I ALL OWNED AUTOS
i i BODILY INJURY ;$
SCHEDULED AUTOS i(Per person)
! ! HIRED AUTOS BODILY INJURY i$
!NON-OWNED AUTOS I (Per accident)
PROPERTY DAMAGE i$
(Per accident)
GARAGE LIABILITY ! AUTO ONLY-EA ACCIDENT $
L AGG S ANY AUTO ;OTHER THAN ACC:$
--j ! AUTO ONLY:
EACH OCCURRENCE S
EXCESS LIABILITY
!OCCUR
CLAIMS MADE i AGGREGATE $
$
~^ DEDUCTIBLE S
I RETENTION S I $
WCSTATU- iOTH-
I WORKERS COMPENSATION AND TORY LIMITS ER
' EMPLOYERS'LIABILITY I E.L.EACH ACCIDENT $100 000
E.L.DISEASE-EA EMPLOYEE S 100,000
E.L.DISEASE-POLICY LIMIT S 500 000
OTHER i
I
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER ADDITIONAL INSURED:INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Tom Damello DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
68 Dory Circle NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL
Marstons Mills, MA 02648 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.ITS AGENTS OR
REPRESENTATIVES
AUTH16RIZED EP IV E
ACORD 25-S (7197) llJ ACORD CORPORATION 198.
�t P.
' ISSU
E DATE(MM/DD/YY)
98
ilT
:::::::::::::::::::::::::::::....:.::..::::.:............................................................................................................................... ......................
............... ........................
/ /
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND
CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE
THE FREDERI CKS INSURANCE AGENC ,DMT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE
1046 MAIN STREET COMPANIES AFFORDING COVERAGE
OSTERVILLE, MA 026550427
CODE SUBCODB COMPANY A EASTERN CASUALTY INSURANCE CO
LETTER
COMPANY B
INSURED LETTER
MARKWOOD CORP. LCOM
ETTER Y C
110 BREEDS HILL ROAD CLO PANY D
UNIT 10
HYANN I S, MA 02601 COMPANY
z�TER E
C 'YRA
.::::::: ......................:::::.::::.....: ::.::::::::::::::..:.......................................
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 017HER 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. LRAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIO LIMITS
LTR DATE(MM/DD/YY) DATE(MM/DDNY)
GENERAL LIABILITY GENERAL AGGREGATE s
COMMERCIAL GEN.LIABILITY PRODUCES-COMP/OP AGG. s
CLAIMS MADE ❑OCCUR PERSONAL a ADV.INJURY $
OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $
FIRE DAMAGE(Airy one rue) $
MED.EXPENSE(Any one person) $
AUTOMOBILE LIABILITY COMBINED SINGLE
LIMIr $
ANY AUTO
ALL OWNED AUTOS BODILY INJURY s
SCHEDULED AUTOS (Pa Person)
HIRED AUTOS BODILY INJURY $
NON-OWNED AUTOS (Per Accident)
GARAGE LJABILUY
PROPERTY DAMAGE s
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
STATUTORY LD.:ITS
WORKER'S COMPENSATION WCP 0 012 7 6 0 0 2-01-9 8 0 2-01-9 9 EACH ACCIDENT $ 100, 00c
AND DISEASE-POLICY LIMIT $ 500, 0 0
EMPLOYERS'LIABILITY DISEASE-EACH EMPLOYEE $ 100, 0 O
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS
�ay�{�.......... ...... .. .......................................:..............:...:::::::::::::::::::::::::::::::: ..�,yy#y{•y; h..'..t.:::::::::::::::::::::::.::::::.>.>::;::::....�:::;»;>:»::;::»;:.>;»>o-::;�:::ao-:;;:•::•>:•;:;:;;:o-:>:r;o-;::•::::a;;:::;o:•;;:rr::
:.:....:.................................................................................................::.:::...:::::....:::::.:::.::...:..................................................................................................:::::::::..
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
THOMAS DAMEL I O #? EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO
MAm l 0 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TOM
68 DERRY CIRCLE LEFIT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR
LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
MARSTONS MILLS, MA 02648 AUTHORIZED RRPRESEP,TATIVE
##4526-6*
A ...................(....... ................... ...... ....... ......... .. .................................................
:::.AGGRO:CO 1 ' �
Q:
•
MASckleck COMPLIANCE REPORT
Massachusetts Energy Code Permit #
MAScheck Software Version 2 .0
1
Checked by/Date
CITY: Hyannis
STATE: Massachusetts
HDD: 5973
CONSTRUCTION TYPE: 1 or 2 family, detached
HEATING SYSTEM TYPE: Other (Non-Electric Resistance)
DATE: 9-9-1998
DATE OF PLANS : 9/9/98
TITLE : TOM DAMILLO
PROJECT INFORMATION:
224 PUTNAM AVE. COTUIT
ADDITION t
COMPANY INFORMATION:
M.A.P. INSULATION CO.
COMPLIANCE: PASSES, O
Required UA = 241
Your Home = 204
Area or Insul Sheath Glazing/Door
Perimeter R-Value R-Value U-Value UA
`CEIL'INGS 596 '30_ 0 0 . 0 21
;WALLS :' Wood Frame, 16" O.C. 1435 j13°":_0' 0 . 0 118 .
GLAZING: Windows or Doors 117 0 .320 37
FLOORS): Over Unconditioned Space 596 T19 .0: 28-
- -
COMPLIANCE STATEMENT: The proposed building design represented 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 i'f 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 design load as specified in
sections 780CMR 1310 and J4 .4 . _
Builder/Designer Date
MAScheck' INSPECTION CHECKLIST
Masszchusetts Energy Code
MAScheck Software Version 2 . 0
TOM DAMILLO
DATE: 9-9-1998
Bldg.
Dept .
Use
CEILINGS :
[ ] 1 . R-30
Comments/Location
WALLS :
[ ] 1 . Wood Frame, 16" O.C. ,- R-13
Comments/Location
WINDOWS AND GLASS DOORS :
[ ] 1 . U-value: 0 .32
For windows without labeled U-values, describe features :
# Panes Frame Type Thermal Break? [ } Yes [ ] No
Comments/Location
FLOORS :
[ ) 1 . Over Unconditioned Space, R-19
Comments/Location
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 .51,
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:
( ] 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 and glazing U-values must be clearly
marked on the building plans or specifications .
DUCT INSULATION:
[ ) 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.
•H`VAC EQUIPMENT SIZING:
Rated output capacity of the heating/cooling system is
not greater than 125% of the design load as specified
in sections 780CMR 1310 and J4 .4 .
MISC REQUIREMENTS
] 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) -------------------------
4.
5�
W
w
0
LOT 3
I.,Ile1.24 ACRES
m
3 "7 - I6 - Z
N
LOT 2
N 1.25 ACRES
a \
LOT Qto
1.22 ACRES CP
OD
�4!
W
OD
N n
L�
-
t� /
��� � 2� •�o� ,�, - \50• ci
Pal
61
1 2•
tt �
!. 9yt-39ii
1 •
o �
_ 508428
- - ---
\ -
ustor
esigi
.i —_ v.<.I- R.�s '%(•' S .i.,..�w i.e.. w.c.wujuc>
1 66 cec
Rol
SL
® ® JNCOCIl1xTw5tl .. �-4wl.HC� ..
<vnt�cN t< _. ... .. .. _.. ... ._. ... _. _. .. -
� E, LEVnTiON � r �4 ;:��. /•� �'.
ji � � � �bLa:cuw.K�uorso.w'ccurx. �nsnc ._...... � \1) `:•'tl --- � i � / } t.,
r'i.
r
y
a `
�r
h•yr vo ��_., � a.r:uncK;� '7•¢�4�®lncc.: 11
I
k � I �=:'(t0 ipsfR Vd\EYr 3u354LLr 10 S ..
t.t F0.illE
. "m-Am OM1 WyDAG -
VWVFM dw
ffI7I 6
.. � 3 c �I s i j �� Irv'• � a,
0
ai `♦y
•
i
v I ooea. _.. { —
o' �.
E' : -;_rtQC
w
J !t
r
I. eta R FIRST rwclR ILw _ al
• i
t �
•'r vu .v•�
i
IJ
�4
P 015 493 811 r .>
Receipt.for
Certified Mail .>>
*� No Insurance Coverage Provided
Do not use for-International Mail
(See Reverse)
Sent to
David. R. o e
Street and No.
224 Putnam Avenue
P.O.,State and ZIP Code
Cotuit MA 02635
Postage
Certified Fee -
Special.Delivery Fee
Restricted Delivery Fee
Return Receipt Showing.
to Whom&Date Delivered
Return Receipt Showing to Whom,
r- Date,and Addressee's Address
TOTAL Postage
C &Fees, r S
00 Postmark or Date
M
E
0
U
ti
STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front).
N
1. If you want this receipt postmarked,stick the gummed stub to the right of the return address �
leaving the receipt attachtid and present the article at a post office service window or hand it to i
your rural carrier(no extra charge). Q
2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return rn
address of the article,date,detach and retain the receipt,and mail the article. m
3. If you want a return receipt,write the certified mail number and your name and address on a C
return receipt card,Form 3811,and attach it to the front of the article by means of the gummed
ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT
REQUESTED adjacent to the number. O
O
4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M
endorse RESTRICTED DELIVERY on the front of the article. E
0
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL
return receipt is requested,check the applicable blocks in item 1 of Form 3811. rn
a
8. Save this receipt and present it if you make inquiry. 1025e5-93-z-0478
: . The Town of Barnstable
• ,�xsrsai.S, •
Department of Health, Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-775-3344 Building Commissioner
December 7, 1995
Mr. David R. Whitmore
224 Putnam Avenue
Cotuit, MA 02635
RE: Map/Parcel 037-016
Dear Mr. Whitmore:
This office has no record of a building permit being issued for the
structure being constructed on the above referenced property.
Please contact this office immediately regarding this matter.
Very truly yours,
4Afed E Martin '�
Building Inspector
AEM:lb
P 620 563 995 rA
5
RECEIPT FOR CERTIFIED MAIL
1
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
r Se to
C -
e Street a No.
� B
P O.,State and ZIP Code
O Qa2 6
a
c7 Postage $
M
7
# Certified Fee
' 1
Special Delivery Fee
Restricted Delivery Fee
Return Receipt Showing
to whom and Date Delivered
04 Return receipt showing to whom,
o� Date,and Address of Delivery
TOTAL Postage and Fees $�
U. '
gPostmark or Date
E i
0
L
to
a
r
S
STICK POSTAGE STAMPS TO ARTICLE TO COWER FIRST CLASS POSTAGE,
CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES.(see front)
1. If you want this receipt postmarked,stick the'gummed stub on the left portion of the address side of the article
leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier. j
(*no extra charge). iJl
2. If you do not want this receipt postmarked,stick the gummed stub on the left portion of the address side of the
article,date,detach and retain the receipt,and mail the article.
3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card.
Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix
to back of article. Endorse front of artile RETURN RECEIPT REQUESTED adjacent to the number.
4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, endorse
RESTRICTED DELIVERY on the front of the article.
5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If return receipt is re- /
quested,check the applicable blocks in item 1 of Form 3811. j
r Save this receipt and present it if you make inquiry.
-a
l�
°USNE
-ter'
The .Town of Barnstable
ELAMSTMM
'& ,�' Department of Health Safety and Environmental Services
prFDMA'tp Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
November 30, 1995
Ms Mary Ellen Leonard
409 Main Street
Cotuit,MA 02635
Re: 224 Putnam Avenue,Cotuit,MA
Map/Parcel 037/016
Dear Ms Leonard:
This office has no record of a building permit being issued for the structure being constructed on the above
referenced property.
Please contact this office immediately regarding this matter.
Very truly yours,
}
Alfred E.M in I
Building Inspector
AEM/km
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
M
DATA
APPLICATION FOR PERMIT TO INSTALL AND REQUEST
FOR ELECTRICAL SERVICE
Inspector of Wires 6377 , DAV Wiring Permit ` N.B.G. &E.L.Co. #
Town of Massachusetts Building Permit # Date
Customer. on(Street #) .!
Lot# in the village of utility pole number or underground number
Customer's billing address
Temporary New installation Change of service Starting date
Job description
Service entrance voltage Amperage Phase
Wire size(cu. or al.) Conductor per phase
Number of meters Water heater Off peak: Yes No
Estimated load: Electric heat kw, lights kw, Range dryer Motors, H.P. &Phase
Ready for first inspection Ready for final inspection
Electrical Contractor Lic. # Telephone #
Address
Additional Remarks:
Do Not Write Below This Line
ELECTRICAL WIRING INSPECTION CERTIFICATE
INSPECTOR OF WIRES
INSPECTIONS DATE FEE CHARGE
Temporary Service
Roughing in
Service and Meter
Off Peak Meter
Final Approval
Disapproved*
*For the following reasons
CERTIFICATE OF INSPECTION
Date
To the NEW BEDFORD GAS AND EDISON LIGHT COMPANY.The installation described above has been completed and has this day been inspected and approval
granted for connection to your service.
Inspector of Wires
WIRING INSPECTOR TO BE NOTIFIED WHEN WORK IS READY FOR INSPECTION
Permit Good For One Year From Date Of Issue
INSPECTORS COPY
-tie Commonwealth of Alassachusetts Penn Office u.e onlytitNo. W/�
Department of Public .Sofey Occupancy&Fat CheckM
BOARD OF FIRE PREVENTION REGULATIONS S27 CMR 12:W N90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All Work to be performed In accordance With the Mauachuserts Electrical Code. 527 CMR 12:00
(PLEASE PRINT IN INK OR TYPE ALL INFORHATION) Date &4.t:
TOWN OF BARNSTABLE _44
To the Inspector of Wires.-
The undersigned applies for a permit to perform the electrical work described below.
r.
Location (Street & Numbe ) " _* .0 Ll g_. a 9 g«
2h,
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit: Yes ❑ No (Check Appropriate Box)
Purpose of Building _Utility Authorization NO.
Existing Service _Amps Q 'O Volts Overhead MOMUndgrd❑ No. of Meters_
New Service I146 Amps J7) /2 Volts Overhead Undgrd❑ No. of Meters_
Number of Feeders and Ampacity
P
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total
KVA
No. of Lighting Fixtures Swimming Pool Above In-
grnd. ❑ grnd. ❑ Generators KVA
No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting
Battery Units
No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones
No. of Ranges No. of Air Cond. Total No. of Detection and
tonsInitiating Devices
No. of Disposals No. of Heat s Total Total No. of Sounding Devices
Tons KW
No. of Dishwashers Space/Area Heating KW No. of Self Contained
Detection/Sounding Devices
No. of Dryers Heating Devices KW Local❑ Municipal ❑Other
Connection
No. of Water Heaters KW No, of No. of Low Voltage
Signs Ballasts Wiring
No. Hydro Massage Tubs No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws
I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial '
equivalent. YES❑ NO[] I have submitted valid proof of same to this office. YES❑ NO
If you have checked YES, please indicate the type of coverage by checking the appropriate box.
INSURANCE ❑ BOND;❑ OTHER ❑ (Please Specify)
Expiration ate
Estimated Value of Electrical Work S 6Q4di-
Work to Start Inspection Date Requested: Rough Final
1-7142
Signed under t pen lties of rjury:
FIRM NAME LIC.•.10._�?�-& �
Licensee 017,1 Signatur LIC. NO. j
Address , 501 us. Tel.
Alt. Te . No.
OWNER'S INSURANCE WAIVER: I am aware he Licensee does not have the ins ante c verage or is su -
stantial equivalent as required by sachus tts General Laws, my signature on this permit
app ation wai s th requ remen . Amer Agent (Please check one)
Vaib Telephone No. PERMIT FEE S �J
Sign Cure of er or ARairt