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HomeMy WebLinkAbout0550 PUTNAM AVENUE 19 Y11 �. II 0 Const-orvism' . o s, w 11/14/14 Thomas Perry, CBO Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 RE: Insulation Permits Dear Mr.Perry, This affidavit is to certify that all work completed for insulation work at 550 Putnam Avenue (application#201300984)has been inspected by a certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds federal and State requirements. Sincerely, F' Conor McInerney ConserVision EnergyCD sn 376 ROUTE 130,SUITE C SANDWICH,MA 02563 508-833-8384 WWW.CONSERVTODAY.COM qf Town of Barnsabie • . Regulatory Services Fa 'i"isoew F.Genet,Duidar "dbg Devi OD Tom Perry,CM Bund8 loner 200 MeD StV4 BY=*MA 0260E www.wvALbwnmz"w Fax: 508-798-6230 ogim,. 508-862.4038 Ngaeber U� Not i�aiNi adx.�r�rt e<m�of 536.00 I r work under s6000.00 binvdeow V6w of wads Minh► ow,Ws A4dmw Comore s N•me... .,. U� 'k "YOlephon0 Nwuber,r �S>-�l � ' %r�T �yp�yopepy tQM..Mw Lima 8(if aMUmblo)_„ C,000n gypwvdor't Lioel�. epp �)��� ❑ar '� p zn"°"s°' OCT -9 2014 tM TOWN.OF BARNSTABLE con CtNnp1�GORIfttf I aced accoupaey eaeb malt Permit ( � Dot( ewe (Mpom old s6 nSW) All*=&add=debris wtit be Wm to - ❑ae oot aorr�aue�osfled)(no asrSp b& G*bg over exiting*M of roof) #of doom (' uphom"wb6pvvev/doo WoHdara.L=Vaiaa (zeadamum 3� oiariada�va r„� ❑ / +(J t=MttNO&dKeobao 4 Mar piety marlaed wuh red S land�nrp�s regagred. 8epssale Ithwa i a mm Permit req tr a. twhm> otd o port door go mourpt *As odor tows dwww mt taodda %i a HWwia.Cumovadm as . +re•N010: PraplfRy,Oe►See a®et�Propeety Owner batter adPw'oniadOuu. A 9M Kfts Home tspz*vmmut Coetradora Lke C4mI&uet%ft Supwvbora L,ke m Is SIGINATUIM e Town of Barmstable Regulatory Services "an"F.Geltar,�irvelor Building Divlaion . 'Tiwasu 8err7,Cis® W"ng commiedooer 200:Main Stvee,'Hyannle,MA 02601 www.wwu barw%bie.ma.as Oillos: Soi-M-4038 Fax: 508-7W6230 Property Owner Must Complete and Sign This Section If Using A Builder T. U Owner of the subject propem hereby authorise to act on my bah" in all noaMO nktive to wozk zutbosiaad by this bu4ding pun*aPP&Ilion for (AA&as of)ab) AS' Syaature of Owaer to Print Name It Prop"Owner is app"I fpr perui4 phm.aomplete the Homeowners Lice"s gxeiaptlea Form am the nVtTN s1de. . 4 he Com%rrforvveaLcf j hsarsa,^hr'etty •"'' Department of Fndurtr'ictl,4ccidents OVice of Investigations 600 M.,hington Strew, Boston,M4 02M www,mass:gov/dia Workers' Compensation lamrance Affidavit: Builders/Contra ctors/Zlectriciaas/plumbers AV21itant Information EWE grint LtgiblY Name (susiners/Orgenir2tion4ndividuai):_�J�✓� Address. City/State/Zip; l�.�7.�, �9 rz Phoae#: r2A Are Zou an employer? Check the appropriste box; -----, 1.VI am a employer with�_ 4, � ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).+ have hired the sub-contractors 6, ❑Now construction 2.111 am a sole propridtor or partner- listed on the attacbed sheet t ?. f2"Romodrling ship and leave-no employees These sub-ooatt'actors have 8• ❑ Demoiitioir working for rue in arty capacity.~ workers' wrap.imsurattre. [No workers' comp, insurance 5. ❑ We are a oorporatloa and its 9. Q Building addition regnlr'ed'] Offiicen have exerdsed their 1 Q-❑Bisctrioal repairs or additions 3.11 I Btu B b0tneowner doing all work right of exemption per MOL. 1 I.❑Plumbing repairs or additions myself, [No workers'comp. c. 152,§1(4),'and we have no Insurance required.]t' employees.[No wolf 12.❑F�oofrepairs comp.iasrzraaDo requiral 13•0 Other Any apptlunt tbu eheekt boat g i rr;wst List fill nut the seatlon belaw showiq ldelr watieas'"ensatioe policy intnrmsdon t td ee+Wwmm"who submk WN affidavlt lndl=hq they in doing All work and rhea hire oftide contactors tCoctneten that sheep dW box taunt attaobad an additional sheaf sh must submit a tow sffldarit indicatiq awias the nsmc rt'tha sub-contract r3 and their warlerr'camp,#allay L*nnatica I am laMn��e)�mployer that U prOYtdiny workers''compensatlorr buWa ice formy employers, Below!s the policy and job site i'rfforrrtcagn, Insurance Company Name:_ T.P. � Policy#or Self ins.Lie.0:��� /zVk 4 B%piration Date;_ J Sob Sita Address:�c5t) e��/��'8�.�,� �71,� city/State/zip. /� / � V r Attach a copy of the workers' compensation policy deciaratioa page(shoving the pallcy number expiration Failure to secure coverage as requited under Section 25A ofMGL o. Ise can lead to tho imposition of criminal penalties of a fine ap to S 1,500.00 and/or one-year imprisonment,as well as ciril penalties in the form of a STOP WORK ORDER and a fzca of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Oface of iaveldtalions of th a DIA for iosuraaos coverage varl6celion. Ido hereby cartlf}+Yung?thepaLw andpenalttar o,/perJury.that the information provided above it true and correct at' O.potat wag only. Do not write in this area; to be Completed by 04 or town Officiad City or Town: PermltUcaase# Lstuing Authority(circle one); I L,Board of Ffeaitib 2, $utldtngDapartzheat 3.C`ity/Town Clerk 4.Electrical Inspector S.l'lurabing inspector tS.Other, Contact Persoti•: Phone#: dF/4 License Afbirs&business Regulation eanse or registration valid for indivldul use only ME IMPROVEMENT CONTRACTOR before the expiration data. It found return to: Wratiot: 1CQ97 Type: Office of Consumer Affairs and Basins=Regulation ImMorn: 3125/2019 Private Corporstiot 10 Park Plats-Suits 5170 Boston,MA 02116 DAVID COX,INC. r David Cox 10 LAVENDER LN �..«�.•seA66�. _ W.YARNQOtJJl't!,AAA 02873 Undersecretary Plot vatld without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Conktruetion Supervisor License:CB-0i3$637 `�,_ 1P0 BOX 401 X //~c South Yarmouth MA Commissioner 10f1liJ�Q1S r.n u.r•,mu,y wvu,a i w.... tea-�� - __._..._..._. . ..._. .... _,. _._ ,,•� DAVID-2 OP ID:KG A E CERTIFICATE OF LIABILITY INSURANCE DATE(1221201� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOER 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 INSURERIS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT,. If the centntate holder ls.an ADDITIONAL INSURED,the poticy(les)must be endorsed. 11 SUBROGATION 18 WAIVED,subject to the terms and Conditions of the policy,certain policies may require an endorsement A statement on this certifloate does not confer rights to the certilloate holder In lieu of such endorsements). MODUCER NAME: Northwood Ins.Amtle ,Inc. s�:SO B-T71-163Z — 640 twain Street,aufte 0 a _ ! u•►:SOS-39�9-29W +IyaTlwt,MIA 02801 A TNlURA3gS}AFFo+mt;+to covaUoe vAIC r. INSURFRA;TMvelers Insurance CompaMy mskm David Cox,Inc. - — i� INBURERa _ P.O.Box401 mtC: $Yarmouth,MA 02464 Nardi 1:: NSURSR E: OiBURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TH4 13 TO CERTIFY THAT THE FOL;CtO OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED: NOTWITHSTANDING ANY REQUIREMENT,TERM OR C IhDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIM THIS CERTIFICATE MAY SE ISSUED OR MAY PGRTAI;,1-HE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUNiIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Nill Of N0.'RANOa POLICY HUMMER IY Fly LIMIT Colloe iA6 GENERAL V"ll.ITY 'EACH G ,JR rE�': I S 7,CDtl,� 1 1 !6801481AA78fi 109N4/2014 03/14/2015 FvRE0.ti 6 fiao un'nca _ s 300.00 CI.AIMSMADE bCCUF X w"otte Ownem I MEDE.KP!An cnyperwn}�s _ 5,00 w, I ,eE�I'AL&.AD'J IM.ILFY I S GENT AGGRF.3A'E.IRRNI'ADR!?I?.S? i ! I I CGENERAL AGGREGATE S�_ Z,000,00 J8 ICJ LOG I I ( PP,UD� UCTS�;Ok+�;r)P aC•v 2,00,00 AVMWIILB 61ABIWTV II ! S TH �--j-— I ��IaaCent�7 AN)AV-D I I i B4DI_Y IN 1}RY,Per peryx) ALL?WN2L7 '�'I SCHEDIJiCC f ` j BODE./IN" (Par r,:adant) S RUTDS AUTGS NON•CVd1JEU PN nccrcienti HIA_DA6"rOS AUT49 — 1 iS UMtR ILLA LEA/ Q:CUF EACH_,'::;JR4Ed:E � E%ElsaLAA H0.A?A5G1ADz I I AGGREiiATC �_ =T N F alp ANDS KOY3RI'LIA11 ITY YIN I - _a ATU?E P_ A Ary PROFRI�ORiPARTNCItr,11=T.VB �-1I �81"THWIN"5 FOLLOW FROM oo d7MG/2014 07/16/20151 E'L.EACI-gCCI�,- 100,00 >FICERIVIEVB=R EX:..W1. N I A!, - t= pNrutd6hry h NCI) DAYS � EL D SEABE•E+E`AFLOi EEI a _100,00 r 96,7e6CI1De LfldBt I J ��- OF Ft34A'ION IPw I E L.DISEASE POLICi UMIT S 0g#CRrT1CN of AERATIONS I LOCATIONS I V1KdWS 41ACORD1011 AddMoomM%wealu 8oheduts,may be attached F men"we in required, r,EBMFqCATE HOLDER CANCELLATION TCWNBAR ` 61N0ULND ANY OF THE AIIOVE DFACRISE'O POUCIEB®E CANCELLED BEFORE THE EXPIRATION DA118 MMOP, NOTICE WILL ME DELIVERED IN Town of Barnstable ACCOROANCE WITH WE POLICY PROVitioNt. 230 Main Street Hyannis,MA 02M AUTHDRIUD RSPRENWATIVE 1890.2014 ACORD CORPORATION, All rights reserved. ACORD 26(2014M) The ACORD name and logo are roglatered marlds of ACORD -t ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel —Application # Health Division Date Issued. o� Conservation Division Application Fee aV Planning Dept. Permit Fee �3� Date Definitive Plan Approved by Planning Board / ?zll3�� Historic - OKH _Preservation / Hyannis Project Streee�t' Address 5's o FAhuyv-1 A V-2. Village Owner V&* nH�A4-\ Svo Yv,,,a/yi vi Address S 5 ?u+kNCk M Aye_ Telephone � Permit Request �-nn t-g CP i jyi uS� `�� d! B i C 11it✓ a'13 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z3OD Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach su rting doc"amerigtion. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) '? ; Age of Existing Structure Historic House: ❑Yes ❑ No On Old King'sA hway: Yes ] No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement_Unfinished Area(sq.ft) C. i Number of Baths: Full: existing new Half: existing news Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name / r L Y� Telephone Number Address "l LO V-0 U C o License# 1 \ W cl\ MA OZ,S& Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ou I VP, mA SIGNATURE tn4 DATE 13 t FOR OFFICIAL USE ONLY i « APPLICATION# DATE ISSUED t MAP/PARCEL NO. ' i . t ADDRESS VILLAGE _ OWNER r s DATE OF INSPECTION: •r FOUNDATION T ` FRAME { INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL { GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth ?f'iVassachdcsetts 'PrintRForm Department of Industrial Accidents Office of Investigations i 1 Cvngress,Street, Suite 100 Boston, MA 021-4-201.7� www..niass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/ind vidudi):CONSERVE ENERGY INC, d:b.a CONSERV1SION ENERGY Address: 376 ROUTE 130, SUITE C City/State/Zip:SANDWICH, MA 02563 Phone M 508-833-8384. Are you an employer?Check�the appropriate box: Type,of project(required),- 'I.® 'I am a employer with 6 4 '0 t am a general contractor and t employees(full and/or part time): x Have hired the sub-coritractors 6. ❑New constriuction 2.❑ 1 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 wagers i [No workers' comp. insurance comp insurance.; ❑ wilding addition required.] 5. F-1 We are:a corporation and its i11.❑ Electrical,repairs or additions 3.0 1 am a homeowner doing all work. officers have'exercised their 1,1. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs. insurance required.]t c. 1.52, S 1(4),and we have no WEATHERiZATION employees. [No workers' 13.I outer 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 autside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the,name of the sub-eonu•actors and stoic whether or not those entities have employees. tf the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer thatis providing workers'compensation insurance fir my employees. Below is the policy and job site information. Insurance Company Name: SELECTIVE INSURANCE COMPANY OF THE SOUTH Policy#or Self-ins.L,ic.#:WC7956539' Expiration Date'3/15i13 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.Md L 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 D1A for insuranccecoveraoe verification. I do hereby certi .under the sins and enaltie.s o/ er'ur that the in orrnation.provided abode is irue and correct Signature' Phone#:50&833-83.84 Official use only. Do not write in this area,to be completed by city or town of eial. City or Town: PermiULicense# Issuing Authority-(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.;electrical Inspector 5. Plumbinganspector 6.Other Contact Person: Phone#: Client#:68880 CONSER ACORD. CERTIFICATE OF,LIABILITY INSURANCE DATE(MMIDDNYYY) 03115/2012 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. - R- .. IMPORTANT:If the certificate holder is an ADDITiONAI INSURED the,P_olicy(i--.._ es)must--- h-ee-endorsed.-- li SUBRO_— GATION 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 I NAA4E: __- Rogers&Gray Insurance.Agency;Inc. s PHONE o.E a} 508 398-7980 iA FAX No: 434 Route 134 i E-MAIL AaoaEss: ___..._. _._._.__. --...-- _ 508 3 -790Dennis,MA o266Q INSURER(SI AFFORDING COVERAGE NAid 0 508 398-7980 _-- --— —�— _ �INSURER A:Selective Ins.Co.of the South_ INSURED - INSURER e Can—Serve Energy;Inc,- 376 Route 1.30.STE C i INSURER c Sandwich;MA 02563 #INSURER E INSURERF:. .�'. 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 CONTRACTOR 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 - ADDL SUBR - '- POLICY-EFF POLICY EXP LTR TYPE OF INSURANCE .INSR WVD POLICY NUMBER MM/DDiYYYY);(MMIOD1Y1'YY LIMITS GENERAL LIABILITY 1 A f X S2011299 03/141'2012"0311412013 EACH OCCURRENCE s:1s000 OOO X CUMMERCIAL GENERAL.LIABILITY 't - IPP�PA,}ISETO EaoccuRencey $100,000 CLAIMS MADE, OCCUR MED EXP(Anyone person) ;S 10,000 I PERSONAL&ADV INJURY I c 1,000,000` ` �_,,........ -... _.__. + GENERALAGGREGAT,E. s3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: i _ 4 Ir—PRODUCTS-CQMPrOPAGG'x.53,000,000 X POLICY' JECOT- 17 LOG i ! is -_ AUTOMOBILE LIABILITY --� - I. COMBINED SINGLE LIMIT . - �Es_ecc�darit ' ANY AUTO r6401LY INJURY(Per person] i_.v—�-_-ALL OWNED 1 SCHEDULED BODILY INJURY(Per accydent),t S I AUTOS AUTOS 1 I --_—I:NON-OWNED i PROPER TYOAMAGE _t5 - HIRED AUTOS �.AUTOS I lPei.aeadent} j is X OCCU— a j ;S2011299 03/1412012 031.1-4i201 EAGHOCCURRENCE S1,000.000 A utnBRELLA LIAR } X EXCESS LIAB CLAIMS-MADE I:AGGREGATES1$3,000,000 _ DEO_ X RETENTION$O ( ' _ ....... I t$ WORKERS - �_.•. :.:: ,._..;,.:-. . ......:: _^---- -,.•--....i AWCSTATU.. iCTtl•J A I WC7956539 03/1412012103114/2013 X AND EMPLOYERS'LIABILITY YIN t yy- - —xO�r Y11Hj1LS_.._--! _2 ANY PROPRIETORIPARTNERIEXECUTIVE f I E i:EACH ACCIDENT .I AOO OOO OFFICERIMEMBER EXCLUDED? N i A { (Mandatory in NH) {E .DISEASE_EA EMPLOYEEi S100,000 yyeess descdbeunder I--"- DESCRIPTION OF OPERATIONS below ( _... _ E.L.DISEASE-POLICY LIMIT J,S5O0,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) Excluded officers under workers'camp-Conor and Courtney McInerney. Blanket additonaf insured'coverage applies under CGL: CERTIFICATE HOLDER CANCELLATION Thielsch Engineering, HOULD ANY OF THE'ASOVE DESCRIBED POLICIES BE;CANCELLED BEFORE Inc,. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 Francis Ave; ACCORDANCE WITH THE POLICY PROVISIONS; Cranston,RI 02910 AUTHORIZED REPRESENTATIVE ©It -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 Of 1 The ACORD name and logo.are registered marks of ACORD #fS78899/M78898 DOR F Ma saci�usa#ts -Department of Public Safety Board.Of Building Reguiations and Standards Cstr�s=ruc•tiur3 :�c,Iatrrti�a� Spy:t'i,21t'c L censer CSSL-102778 CONOR D MCI-N -RNE.Y 39 SIASCONSET.DRIV:E SAGAMORE.BEACH-gMA.02`562 d lit Expl;ation uanmisioner 08/19/2014 w c SO - 1�oosurner {[��rs�aY`73uatness�e�ta�oi� HOME IMPROVEMENT CONTRACTOR t) k � i3 Registration 3171251 Type: Expiration 3/1/2014 1 Partnership C6"ERVEENERGY a i CONOR MCINERNEY:j _ t 376-ROUTE 130 SUITE C { :SANDWICH,MA 02563 .- Undersecretary: OWNER AUTHORIZATIOM FORM (Owner's.Name) owner of the property located at ow p p y '5-sc) oa PA ,, - (Property Address) (Properly Address) t hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on gbehalf to obtain a building permit and to perform work on my property, v»er's Signature - Date t 2012 r Assessor's map and lot. ber ...... 7�ty • �� :.. LLFc l � CE Sewage, Permit number #69 N TARY CODE AND TOWN ................... s REGULATIONS. "ET°�o TOWN: OF,,,, BARNSTABLE 9'° •i6° B W L D I H G,� INSPECTOR BARNST� TO AP�r ABLE CONSER'VA" APPLICATION FOR PERMIT:TO ...Cft�S <!C°�%' f�/� .P!/%S ... v. ,., G` ..... TYPE OF CONSTRUCTION .. pC1l. ..CCl1�?1.. ............................ 7 . ............. ......... . ..... ........................... ................ .rt-..`1..................197 TO THE INSPECTOR OF ;BUILDINGS: , The undersigned hereby applies for a permit according to the following information: Location .ADT.. ..... 7 �$lJ .424.4GCz...I^XvaeGr...............C. d�/. ................................................................. . .. ........ ProposedUse ...... ................................................................................................................I.......................... /� .�c o , Zoning District .....C.. ..G� .................................................Fire District ...... t zz ..74 ................................................. Name of Owner ....(. ..!' 5.........Address .// .... .� .... Name of Builder ...(.r...1..... ��. ....Address Name of Architect ` . R�U nalAk,'Address ..��' s�C� .� .... Number of Rooms ..... ...Foundation 169... �p l Exierior a..G. ` ..!G��.1. i'// Yl/...................Roofing 4 ,`� �:..��,d? .................................... Floors ..,r ....................................................Interior .... �..� ................ 5. p. Heating ,. X,53-G.• .... .. ..0 .y� ..Plumbing .................................. Fireplace ... .................................................................Approximate Cost ... .................................... Definitive Plan Approved by Planning Board ------------------------------19--------. Area ,/�� T.. .. ..r..... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH D . 1 l°� • I hereby agree to conform to all the Rules and Regulations of the.Town of Barnstable regarding the above construction. Name ..................... 'p C & C Homebuilders 0475 - - two story - -: No . ......... Permit:for siagle, family dwelling _ Samadrus Road Location .. T Cottiit" ......... ...................................... ..., ................. O 7 c Owner ..........C..&..C..Homebuilders w"..........: Type of Construction ..........frame' u� m o 3 ' 5 0 .... .... ................................. .`................ Plot ............................ Lot ................................ Au ust 5 77 Permit Granted g.,:::.. .................... Date of Inspection a'1 19 rx •mow � / .. .... .; w Date Completed ......,/ .. .... .19 • E *.PERMIT`REFUSED ......................................? .................. 19 .....� ..... .............. ................ . / Q .......................................... .................... m .......... ....... ........ ....t........... ..................... .......................:Jy ... .W.=. ........... ................. rn Approved ...............t.... . . ............. 19 rn .......................... f. 4 0 7D Assessor's map and lot number ... ....... ;5�........ Sewage Permit number ..........4re-�.q........................... TOWN OF BARNSTABLE I DARNSMULL .,639- BUILDING INSPECTOR DMAI APPLICATION FOR PERMIT TO ....... .......................................................... TYPE OF CONSTRUCTION ......................................................................................... 7 ............... ......... ...-.....5/ ................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ;7 , ............ . ................................................................. Location 44?.7.......................57,'..... ... Proposed Use ..... ......................... Zoning District .... ..........................................Fir'e District ......../.....,. ........................................... Name of Owner .... .........Address Name of Builder ... .........Address Name of Architect Address .. ........ ............. .. ............/ Number of Rooms Z-2 .... ......................Foundation .... Exterior ... .... . u. ...Roofing 1;.4. .................................... Floors z) ................ ..............................................................Interior ... Heating .... Plumbing .................................. ................. Fireplace ...KZf,-4�1, Approximate Cost ... .................................... Definitive Plan Approved by Planning Board --------------------------------19--------- Area Diagram of Lot and Building with Dimensions Fee ..............t/....................... ......... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....o....... * .......... ..................... C & C Homebuilders,- 4 38-5 19475 two story No ................. Permit for .................................... single family dwelling .... Location .................................... .csT Cotuit ............................................................................... • C & C Homebuilders V/ Owner .................................................................. frame Type of Construction ........................ .......................................... ................................... . Plot ................. Lot �7.......... August 5 77 Permit Granted .... 19 Date of Inspection ....... . .. .........................19 Date Completed ............. .......................19 PERMIT EFUSED ................................ ........................ 19 ......... ............... .1 .V'....................... r ....... o ........1 � .............................. .1.. ................................ Approved ................................................ 19 ............................................................................... .................I................. . ...................................... gj77 TOWN OF BARNSTABLE 19475-----M53/77 Y` Permit No. _____ _ N.ZIn.0 Building Inspector cash • - — -- NAM OCCUPANCY PERMIT Bond i 7 No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to C & C Homebuilders Address Kingston, NIA lot #71 Samadrus Road, Cotuiitt At Wiring Inspector �f / e .� �� j.-R Inspection date -iR -Plumbing Inspector Inspection date Gas Inspector t Inspection date t Engineering Department ' /V/X Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. / ............................. „ ..�.......... ......., 19.....� ............./Building..Inspector. ..................._... 1 yJ_ Toy TOWN OF BARNSTABLE OFFICE OF i BAB39TASL Y w�a A BOARD OF HEALTH i639 397 MAIN STREET"Q 9AY ts- . . HYANNIS, MASS. m6ot To : Building Inspector SUBJECT TO APPROV& OF' From: Health Department BARNSTABLE CONSERVAT[OIY Subject: Test hole and percolation Test COMMISSION examination of the soil at (Lot) t?lddress) ( Village). was Made on ��` 7� _� and found to be (da,e) suitable for sub-surface sewage, at sate of test hole. Building Permit All riot be a proved or sow age permit issued until steal i."_ 17EDc-'- Z-t-lment receives tu-o coj.-es of flan shoeing building, sewage systems and all other details llstecl in Board of Health instructions .`o sellage ap-olicants. This a-o-oroval does not constitute a final decision concerning the ?nstallat Lon O'f a sew age syster.l. All State and local Health regulations aip y Lo r;naT approval . rGj71 ttti ) 6/20/75- - - HOC vs \ \oDji M c/' G xs;IA-C Ar-4 P t�-- ti 1t `+ un QA'F tQ A f,w, litt - t i pp,\ a .� O cam, �L. w i CERTIFY THAT TNT.. r-OUNkD/-TjOR 5140ww 1 � - N ANC? SET©ACK R F-Qut REME%,.lT5 Ofr THE TOWN QF. �' f�Ta.N 5'"�'fi E31.._'�.. AX✓ D A'-T E �1 -7 �G.4G�' I I A/ _ ,3 0 X-r CL. 3.S 57' • f "VO THIS PLAN \S NOT BASE© Ohl AN tNGTR Unn E.N'r SORvEY - T►4e- OFFSETS S q U LC) - NOT BE USED To flETr--rRMlNE LOT LJ►JE� M Z}�ueq G w DF4A 1A) Ze-55 77 A4 yEG�.ovV F a.34.o Fc.33.G Z M/r/ EL . 35.0-= � AAN z317r i TNJK 3/.523 LEfk.�Y�, 4, 27.77 /000CAt. v 0/Ir T ST/-/0L� ' A4, 51- i Cf 4. � �`'�� .fir •�`� ��4f'- � �.�s-'a G/L /�✓1�,�� �.` �-- t :S v E ' SSroY3AL Et'�� ,9,4 T6' 4.Z9.77 710Po ,?y f. A x7t -6 Nye, 1,AIC. _-- o,7G!?� I