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HomeMy WebLinkAbout0455 PUTNAM AVENUE 4 � r Town of Barnstable .Permit (�� 0 o� Regulatory Services 6Fapires e • $ARMSMASK ; 639 a�� Thomas F.Geiler,Director M1d 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 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 3 8/01 2 Property Address 455 Putnam Ave, Cotuit Ma 02635 ®Residential Value of Work 6000. 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Linda Harmon 455 Putnam Ave. MA 02635 Contractor's Name Nnrt here Colony Builders LLC Telephone Number 508-400-7075 Home Improvement Contractor License#(if applicable) 167739 " Construction Supervisor's License#(if applicable) CS 53638 f4Workman's Compensation Insurance -PRESS PER IT Check one: ❑ I am a sole proprietor MAY ElQ I am the Homeowner 2012 I have Worker's Compensation Insurance Insurance Company Name Central Insurance Co. `SOWN OF BARNSTABLE Workman's Comp.Policy# 7 7 4 9 01 4 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All'construction debris will be taken-to .• ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side r. #of doors. 2 ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *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%qjred. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary IntemetFiles\ContcntOutltwk\DDV87AAZ\EXPRESS.doc Revised 072110 The CoRtrrrorn vealth of Massachusetts \--- -Depaphnent ofIn dushia, Acrideri& agree of Invesfiga6ons 600 Washhugtorr..Streed Boston,MA 02111 evft%9r mas&gov1 dun Workers' Compensation Insumuce,Affidavit.Builders/C-antractors/Electticians/Plumbers Applicant Information Please Print Lexibl Name(&miwsstorgattizationllndivido4 Northern Colony Builders LLC Address: 1 694 Falmouth Rd. #. 135 City/state/zipiCenterville.MA 02632 Phone 4- 508-744-3362 Are you an employer?Check the appropriate box: 1. I am a employer with 2 4- ❑ I am a general contractor and I Type of project(required): employees(full andlor parttime).* have hired the sub-contractors ti• ❑New construction 2.❑ I.am a sole proprietor or partner_ listed on the attached sheet_ 7. ❑Remodeling ship and have no employees These sub-contractors have : ❑Demolition working for met in any capacity. employees8 and have workers, . ❑Building addition (No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ 1 am a homeowner do" all work. officers.have exercised,their � .11_❑Plumbingnepairs or additions myself[No workers'crop. right of•esenption per MGL insurance required.]-1c..152,§1(4),and tune have:no 12_❑Roofmpaizs employees_[Noworkers'_ "I nX Other S i d i n g comp.insurance required-] 'Any applicam that checks box#1 IMM alvo fill out the section belawsbowimg their soakers'co pamsa ion policy iaformatiatL 1 Homeowners who subma du Iflidaca imaliu=g they are doing all wails amd then him outside contractors mtmst submit a new afdaeit andicating such. tcatstractors that check this bas must attached an additional sheet showing the name of the and state whether or not those eNoties hm employees. Ifthe stab-contractors have employees,they must provide their workers'.comp.policy number. I am an emptnyer that is providing neorkers'congwnsatrpn iirsnr ace for my angAkl,eeL J3e&w is the padiry aratjob.site iidfotYiFratrlJ�F6 _ " Insurance.Company Name; rum n t-r a t T n G u r a n r A C c) Policy#or Self-ins.Inc. : WC 7 9 9 7 4 9 01 4 Expiration Date: 7/8/2 01 2 Job Site Address: 4 5 5 P t l t ma n aye City/StatelZip: Cot ui t,MA 0 2 6 3 5 Attach a copy of the workers'compensation policy declaration page(showing the policy.mutmber and eapirationdate).. 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.Ua and/or one-year impnsm=ent,as well as citvil penalties in the fozzn 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 D1A for insurance coverage verification_ I do Ireret»y certify a er thepaiats d penahies ofperiztry that the h1formation protzded above is trine and eorreet Si=2t1re: Date: Phone#: 508-744-3362 '— Cel # 508-40077075 offleiat use onto: err not write an.this area,to be completed by city or totter offleiat City or Town: Perntitf kense Issuing Authority(circle one): 1.Board of Bealth 22.Building Department 3.Chyffown Clerk 4.Electricallnspector S..P 6.Other Iu®rbing Inspector Contact Person: Phone#• -- 6 w BA@NSPABLF. • A, Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Linda Harmon , as Owner of the subject property hereby authorize Northern Colony Builders LLC to act on my behalf, in all matters relative to work authorized by this building permit application for: 455 Putman Ave Cotuit (Address of Job) 5/8/12 + Signatur f Own r Date Linda Harmon Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppDataV-ocal\NLcrosoft\Windows\Temporary Intemet Files\Contentoutlook\DDV87AAZ\EXPRESS.doc Revised 072110 nv5r LJ• L , �40i1j AGuxU �r-ATIFIC ATE OF LIABILITY Ifi SURA 06'' 09/23/2011 �� PRODUCER 508.997.6001 FAX 508.990.2731 THIS CERTIFICATE IS ISSUED A5 A MATTER OF INFORMATION Southeastern Insurance Agency, Inc, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 439 Sfate Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Boti 79398 North Dartmouth, NA 02747 INSURERS AFFORDING COVERAGE i NAIC# INsuRee NOrCFFE:rn Colony BuiTcTiny Co LLC su4E=^a Central Insurance Companies 20_30 - - ----- ---- ------- -- -------I--- .._. ---- 1694 Falmouth Road #135 rsupEPs Merchants Insurance Group Centerville, MA 02632 IN UREFC IfIJ LE D. i V ISUPER E I _. COVERAGES -- - A ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEP!ISSUED TO THE INSURED NAMED _ 1 RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT V�/ITFI R_.. MAY PERTAIN,-HE INSURANCE AFFORDED SY THF.POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.ACGREGA.TE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ ------ T__•— .-- TPOLIFYCfFECT!VE POLIC-YEaPIIH-ff 11• --- INSRrADD'L TYPE OF INSURANCE POLICY NUMBER DATE(MMICO 1' ) DATE(MMIDOm'YYI LIMITS LTR 1NSR ---__ —r f---- __ ^_ i�GEI+EPI-uABIUTY —CLP79974&91 07/08/2011 107/08/2012 .,��:H a� c,�e �g 1,G00,OOG Sr? E-.nF.r11cD—--r--------- - --� �x G.rdER.ct.L,Fet:'r REn1!SES(Er�xx_urren<=!- —5------ 300,00_0 MED ExP.Any one parmi) 5,UC'0 A j ---— i f - : ;;r a.,_nV Ir_.iI:P _ 'c 1,000,OOC --— ---- j I--= — :,ENEF;�AGGRErAT.E T{ 2,000,000 j r r ----2 -0-0-0,-OO E =x;D crs-ccr prop ac: J c -- tr:r —':—"T------�- -•— MCA7013965 61/G5/2011 01/05;Z012 � t AUTOM031LELIABIL iTY ::Cf.IB¢�EG SiN�3L Li:�''T Ecuaade,!1 ' 1,000,00�? � r =CDi-Y I I;Per pei or;! J GARAGELLIBILITY - --------._....._ g mil,?C.�'JI_'r E- ...;CCIDE"iT -I--- —_.__....._r I rreR THVI F:�cc —t-- j EXCESS IUMBREL°-ALIABIUTY I -----_....-- —.--- -----._....--------_...._ in I - - i -- -- � 1 WORKERS CoWPENSATION I W,099749014 07/08/2011 1 07/08/2012 , X I AND EIAPLOYER?LIABILITY •Y I N j .r'-RUB:rT' '-N_F'•EYE^.rJT:\`E I �-' H r r`IGENT �1 )00,000 A :(rFir❑ E a •.tlOE L�I Di EL SF-FA EMPL:) FCI t 100,000 (Mandatory in L 500,000 i I I j I I I i i i DESCkIPTION 0,CPERA I IONS:LOCATIONS 1 VEHICLES I EXCLUSIONS:DDEO BY ENDORSEMENT I SPECIAL PROVISIONS i • CERTIFICATE HOLDER CANCELLATION — SHOULD ANY OF rHE ABOVE DESCRIBED POLICIES BE CANCEL:CO BEFCRE THE EXPIRATION DATE THEREOF,THE ISSUItIG INSURER WILL ENDEAVOR TO MAIL 10 DAYS'NRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FA.LURE 70 DO So SI-ALL VOPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER.iTS AGENTS OR FOR INFORMATION REPRESENTATIVES. PURPOSES ONLY - AUTHORIZED REf RESENTATIVE Karen Bernier_ ACORO 25(2C09r01) 01988-2009 ACORD CORPORATION. All rights rasewed. The ACORD name and logo are registered marks of ACORD =� Office of Consumer Affairs and ffusiness Regulation 10 Park Plaza - Suite 5170 Boston; Massac -;setts 02116 `Home Improvement q tr"actor Registration Registration. 167739 Type: LLC - '-- =J Expiration: 10/25/2012 Tr# 205252 NORTHERN COLONY.BUILDERS;�L;L��- DANIEL GALLAGHER ! 1694 FALMOUTH RD #135 a j i CENTERVILLE, MA 02632 Update Address and return card. Mark reason fur chan;e. \ Address F- Renewal i Employment Lost Card Ps-CAI C� 50tA-04/04-G101216� Ofncc��C�ontsume rsd lsuslnes�gu ahon License or registration valid for individul use only _ before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR -�Registration: �167739 Type: Office of Consumer Affairs and Business Regulation Expiration: „1.RL251,2012 LLC 10 Park Plaza-Suite 5170 Boston, MA 02116 IT'R COLON.Y`'B"I{"JJI;�E:RSrIy�C. DANIEL GAL LAG HER:,..h_ 180 HIGH ST .f - — —-- — W. BARN, MA 02668`. `` Undersecretary of valid withou lg ature 4 i += iVlussuchusctts =Department of Public 'atel Bom-d of Buildin!u Regulations and Standards : .Construction Supervisor License. ..' License: CS 53638 ,, F 'DANIEL J GALLAGHER PO BOX 471 i W BARNSTABLE, MA 0.2668 i -- —�e� ` Expiration: 10/27/2013 ('i nunissiuncr Tr#: 5259 J ,ram 'Town of Barnstable * 'erm�-i�t'-#` 6 3>�� �F THE Tp� Expires 6 months from is date Regulatory Services Fee i Y + BARNSTABLE, " MASS. a6g9• Thomas F. Geiler, Director Ar fD MAt A - OI- Building Division (j Tom Perry, CBO, Building Commissioner ' 200 Main Street, Hyannis,-MA 02601 www.town.barnstable.ma.us ' O ice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL.ONLY. Not Valid without Red X-Press Imprint Map/parcel Number 1 Z Property Address (Residential Value of"Wort._5 56 0, Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address Imo► l( 1r ljo, Agen Contractor's Name (-� 1`A�VI� i ,��� � t `�1 Loot -Tr)[ �Telephone Numbet q(�) 7��S I lomc Improvement Contractor License#(if applicable) ADI 9 '`I (C � Construction Supervisor's License#(if applicable) CS5,36 �j� ❑Workman's Compensation Insurance Check one: X-PRES.S PERMIT ❑ I-am a sole proprietor JUL 200g ❑ 1 am the Homeowner . I have Worker's Compensation Insurance , STABLE ' UVN'OF BARN Insurance Company Name d �i1 PAA - Workman's Comp. Policy d C�19.cl, �� Copy 9f.Insurance Compliance Certificate must be on file. Permit Request(check box). Re-roof(stripping old shingles).All construction debris will be taken to V y ❑ 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. A copy of the Home Improvement Contractors License is required. SIGNATURE: i�.'\k l'hII.I:S\PCIRMS\huilding permit forms\B PRESS.doc Revised 100608 " The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/Plumbers Applicant Information p` c Please Print Legibly CAName(Business/Organization/Individual): Address: City/State/Zip:(� c����5! T'1r7e Phone.#: jZ� Are you an employer?Check the appropriate box: Type of project(required): 1.5ZI am a employer with_— 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors ..2:❑ I am a'sole proprietor or partner-' listed on the attached sheet 7. .❑Remodeling ship and have no employees These sub-contractors have 8..[]Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers',comp.-insurance comp.insurance t required] 5. We are a corporation and its -10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right 6f exemption per MGL 1 Roof repairs insurance required.] t employees.[No workers' 13.c. 152, §1(4),and we have no ❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employecs,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:62 AP a S �5 [A n .�0,Q R XA fi Policy#or Self-ins.Lic.#: Expiration Date:]— --O Job Site Address: 'T 5 s T oyop-mil �V Qn 1'�- City/State/Zip:0 06,► A 6 Q 2brj Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure io secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of erimirial penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a-STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do r e t e -and penalties of perjury that the information provided above is true and correct. Si tore: Date: Phone#• Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health'2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M t r , Information and Insttuctions � Massachusetts General Laws chapter 152 requires all cmployers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other.legal entity,or any two or more of the foregomg-engag inalom -enferp�nse =melu3mg tfie legal-represen%Attu-Uf-Y-ileceas�d'empioyer,oithe=.__ 77 receiver or ffi stee 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, lling construction or repair work on such dwe house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)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 UP does have employees,a policy is required.-Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom oftu G tm1uoma_V_.1cV__1 _y_-__ _ 'all .:_.t-Cvi"UU 1u lilt UUL ui uu: t�Ll�l e nvcx a VA Please a-rnnrl— ir�t, 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 maybe 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia THE Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town-barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder I,i. - , as Owner of the subject property hereby authorize o ova ac' AOL to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address�IY -,of Job) ignature of Owner Date • �� � mil,� � h� �- /'//�2� �- . Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. ll.t;llbllC.h TIII.TLD DCb IITCC`I/11.1 Town of Barnstable Regulatory Services " Thomas F. Geiler,Director • uxxsrenLe, 161 ��� Building Division .DIED a Tom Perry,Building Commissioner 200 Main�treet--Hyam3is,MA 02-601 _.._. . .. _._.._..... www.town.barnstable-ma.us Office: 50 8-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATIO - num street village "HOMEOWNER name home phone# work phone# CURRENT MAILING ADDRESS: eity/wv'm state zip code The cturent exemption far"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 Persons)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 siructures 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 be/she shall be responsible for all such work Performed under the buildffi permit (Section 109.1.1) The undersigned"bo_meowner"assumes responsibility for co=liance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned."homeownee'certifies that.he/she understands the Tpwn ofBarpstable,Buildia 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 abuilding 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 argages a person(s)for hire to do such work,that such Homeowner shall ad as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Rcgulatims'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 kvuld with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To cnsurc that the homeowner is fully aware of his/her rrspmm'bilitirs,many communities require,as part of the permit application, that the homeowner ea-tify that bdshe 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 four 1rca-tification.for use in your community. Q:forms:homccxcmpt Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 162946 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 4/27/2011 Tr# 283446 Type: Private Corporation Boston, Ma.02108 GALLAGHER SHIELDS BUILDING CO INC. DANIEL GALLAGHER i 180 HIGH ST WEST BARNSTABLE, MA 02668 Administrator Not va I i lio::t si nature 71. Board of Building 6��u�Qd � aa Construction Supervis' n,and O Licensetandards ILicense; CS 53638 Expiratton"`%0127/2009 Tr# 8586 Restrlctlo ; 00 " j _:. r DANIEL J GALLAGHER. PO BOX 471 W BARNSTABLE, MA 02668 Commissioner t ^ J u l. 2 2. 2009 4: 2 9 PM N o 1861 P. 1/2,IDDIYYYY) M um �.cRTIFICATE OF LIABILITY INSURANCE 07/22/2009 ODUCER (508)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION i_ outheastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 439 State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOWt P.O. Box 79398 ? N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE IC# INSURED Gallagher Shields Building Co Inc. INSURER A: .Central Insurance Companies 20 E-A V,! ►. ' 1694 Falmouth Road #135 INSURER Merchants Insurance Group Centerville, MA 02632 INSURER C 4 INSURER D: 1 INSURER E: - COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED 9,TITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BEf W' UED1OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OFySUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L TYPE OF INSURANCE POLICY NUMBER DATPOLICY EFFECTIVE ICY IRAION LIMITS _ LTR INSR E MMIDD OATSPOL MMIDDEXP T GENERAL LIABILITY CLP7997489 07/08/2009 07/08/2010 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000 CLAIMS MADE rK OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO-- LOC AUTOMOBILE LIABILITY 7AM0277013965 01/05/2009 01/05/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY B X 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 $E AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 71 CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC799749012 07/08/2009 07/08/2010 XI OWC RY TATU- eR AND EMPLOYERS'LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd $ 100,000 If yes,describe under SPECIAL PROVISIONS below NO OFFICER EXCLUSIONS'' E.L.DISEASE-POLICY LIMIT $ 500,000 S OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Attn: Building Dept. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON.THE INSURER,ITS AGENTS OR 200 Main Street REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Karen Bernier ACORD 25(2009101) FAX: 508.790.6230 ©1988-2009 ACORD CORPORATION.-All rights reserved. The ACORD name and logo are registered marks of ACORD �� Or BARNSTABLE Town of Barnstable P�oFT►+e rgy�o erg th 25 AM 10* 05 Regulatory Services �* • Thomas F.Geiler,Director snaxMASSsznsi B 9 16 9. Building Division-- ' Ov' ISION Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERNIIT# FEE: $ �S SHED REGISTRATION 120 square feet or less UO&,LT7)A Location of shed(address) Village 141 Property owner's name Telephone number Size of Shed Map/Parcel# Signature a ��` ova Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:121901 r — 4 NOTE:not all symbols will appear on a map GOLF COURSE FAIRWAY t \ EDGE OF DECIDUOUS TREES EDGE OF BRUSH ORCHARD OR NURSERY " V EDGE OF CONIFEROUS TREES MARSH AREA EDGE OF WATER 1 DIRT ROAD ` DRIVEWAY PARKING LOT r j ) �PAVED ROAD MAP8 S[`1Pi — — DRAINAGE DITCH 12 l ————— PATH/TRAIL \ F PARCEL LINE 3 YAP IID -.<- MAP# III 21 —PARCEL NUMBER 1 E #186 0 -HOUSE NUMBER \ i --- 2 FOOT CONTOUR LINE —1.. tom— 10 FOOT CONTOUR LINE Elevation based on NGVD29 4.9 SPOT ELEVATION STONE WALL i 1 -X—X— FENCE ® ® RETAINING WALL —4 RAIL ROAD TRACK STONE JETTY i r `=oo + SWIMMING POOL PORCH/DECK [� ❑ BUILDING/STRUCTURE s I.: DOCK/PIER 1 Q HYDRANT 1 4 ❑ 1 1 P $ e VALVE O MANHOLE O POST p" FLAGPOLE T O W N O F B A R N 5 T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N 5 Y 5 T E M 5 U N I T .o SIGN ® STORM DRAIN IN PRINTED SCALE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representationsR10'rpotation. TA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James n TOWER 1"=100`scale map and may NOT meet of property boundaries.They are not true locations,and Sewall Company.Topography and vegetation were interpreted from 1989 aerial photogmphs by GEOD 0 UTILITY POLE w ` 0 20 40 National Map Accuracy Standards at this do not represent actual relationshi s to physical obaects Planimet ics,topography,and vegetation were ma ed to meet National Ma Acmrary Standards f:\dgn\conservation.dgn 06/25/02 10:05:38 AM ILI, Assessor's map and lot number ........I...`3 .....�.... ....... a� INSTALLED IN COMPLIANCE WITH ARTICLE II STATE SANITARY CODE AND TOWN " Sewage Permit number ......;? 1+v......................:.............. PEGULATIOIN11% yof711ETo�y TOWN OF BA.RNSTABLE BAHBSTABLE, • M6 9 ,,� �.UILDING INSPECTOR o G MPY a' APPLICATION FOR PERMIT TO ...� ..... . '. ....... .!!..... ...0 . TYPE OF CONSTRUCTION ....G.!'..�7!. =. 7.......F. .Y�. .-).0.0.6 . ........... .4.......... `............19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: .� Location ..... 5 ...... .v.t`:�. ..... � . ...T-..G �r.d.. ....................................................... ProposedUse ......... .' ...........rs?:AC...+1.................................................. ........................................................... Zoning District .................. ..........................................Fire District . ...:d Nameof Owner /.. -.1-.1. .. ..../ .......�]..A.K'�n.Address .................................................................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .kz.h't .............................................. Exierior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ...........................Plumbing ....:............................................................................. a Fireplace ..................................................................................Approximate Cost ��30 0� ............ ......................... Definitive Plan Approved b Planning Board -------------------_-----------19________. Area .:..:./fxor!:!..... PP Y Q Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH V` r YZ I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. , A/ Name GKf �............ ................... / ~ ' ^ Harmon, William A. prch l�^^ -- - .' . ` . / ^ \ ( t ` . - . i . . 8 � ' . / . . bate of Inspection ............................ 19 . . . Dote Completed ���-=�� lg . ----.—..�^^ --.-- ~. PERMIT REFUSED - . .—.--..--_,--..-....._.—.—..... ` lg ` � ---.----.—.---.-..—.....—,-..—..—. . `. ' —_—.---.. ....................................................... ~ } ' . .—..----------~—.,~..—.--.~--...��. - � . ` r --..—..~.'—�...,..--,----...—....... . - ^ ~ . Approved ................................................ 19 -----------'—'—''^'—^-----'---'`` . � . ----'---.-----------�~—........ ` � Assessor's map and lot number "-j`:f................ .................... Sewage Permit number .... .f.................................... �r y0F711ET0�I TOWN OF BARNSTABLE BAHBSTODLE. MAGIL 9 BUILDING INSPECTOR o'Ea NPR a' APPLICATION FOR PERMIT TO . }k=... f 1 l 1 ••••• ?.`....�.,•:L A C•r•••••i• 1......••......•/�c ,�•••••.r.G C.........11 TYPE OF CONSTRUCTION .... . .........! ......C.... ?..��.. "?..... ..'.. . ...: .::..... ? ... -�......L. ....... ................. ........ ......`.............19..,I.?i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location r S—:j J.....'. t....T- -I-�a-r,,n ....I.).v.L7- ,. .......t...'..(,), I -..!.:..'.. ........................................................ .Proposed Use ........:5 . ?-:..........!::...f.?..t2 ..4......................................................................................I......................... ZoningDistrict ..................�..p..........................................Fire District ..........C.—.. TL................................... Nameof Owner -„>- i �, ..... ...4?.V '. n?Address .................................................................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Foundation l'...!'.. r ................................................................. Exierior ....................................................................................Roofing .................................................................................... Floors ........Interior ............... .............................................................................. ..................................................................... Heating ..................................................................................Plumbing ..................................................1................................ s Fireplace ..............................Approximate Cost '`e , Definitive Plan Approved by Planning Board --------------------------------19--------. Area Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH c ?O , t � I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ,I Name E f�i /ter/ +.r..!.. ...... L .. -r..........r ' � - ml Owner .......William./A.....liarmom.............. PERMIT REFUSED ^^ ^' ---^—'—' -^--^' '--'----'' ---'`' Approved ---. -----------. lQ ` ----------~—^^--^^—^^~—'' ------^^----''—'—`—'---~^''