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0832 PUTNAM AVENUE
Town of Barnstable _ _ _M _ Building 1 RnsrsTAHLF. ; Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept s Posted Until Final Inspection Has Been.Made. °39, Where.a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit Permit NO. B-19-586 Applicant Name: DARNELL CAULEY Approvals Date Issued: 03/18/2019 Current Use: Structure Permit Type: Building-Smoke Detector-Fire Alarm Dection Expiration Date: 09/18/2019 Foundation: System Ma Lot 039 073 Zoning District: RF Sheathing: Location: 832 PUTNAM AVENUE,COTUIT Contractor Name: DARNELL CAULEY Framing: 1 Owner on Record: PROUTY, GERTRUDE M Contractor License: 11662 2 Address: BOX 592' Est. Project Cost: $ 1,000.00 Chimney: COTUIT, MA 02635 § Permit Fee: $35.00 Description: ADD SMOKE/CO ALARMS Insulation: _ fee Paid:, $ 35.00 Project Review Req: 2nd smoke detector required in basement if over 1000 sq/ft. ..�� " Date: 3/18/2019 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed.abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for Which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion ofthe same. I Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: ' Service: 1.Foundation or Footing 2.Sheathing Inspection 1., m "' Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6..Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site _ Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 5�% V� ~O Application Number............... BAJt?W * MAe9`�� �;,. Permit Fee....................... ....Other Fee........................ 1�Ate` Fig `� i............ Total Fee Paid................................................................ ... TOWN OF BARNSTABLE';L_acF Permit Approval by....... .................on.... � . ..�. ... Y BUILDING PERMIT Map...................l.J../� M......Parcel..:... ............................. APPLICATION Section 1 — Owner's Information and Project Location - Project Address Via ?0�mn Ave- Village &rn5+4ir- Owners Name Owners Legal Address_ $3a ?O)rr, AviZ City C64u:Ir State Zip Owners Cell# J E-mail Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two'-Family Dwelling Section 3- Type of Permit 4 ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty Fire Alarm Rebuild ❑ Deck Apartment ® Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description /Vew SmaKt C Co akArm5 Last updated 1 11,1 5/20 1 8 i s � ` Application Number.................................................... 4 Section 5—Detail Cost of Proposed Construction Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) j 110 MPH Wind Zone Compliance Method ❑ MA Checklist WFCM Checklist ❑ Design w Section 6—Project Specifics JR Wiring ❑ Oil Tank Storage y Smoke Detectors ❑ Plumbing ❑ Gas r ❑f.Firr i e Suppression � ❑ Heating System ❑ Masonry Chimney " ' ❑ Add/relocate bedroom Water Supply ❑ Public ® Private Sewage Disposal ❑ Municipal ❑ On Site g P P Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required " Proposed' Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 Application Number........................................... Section 9 Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor ! Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date e APPLICANT SIGNATURE Signature DwytittrlC Date Print Name act,` �w�eV Telephone Number 774-353- 6516 E-mail permit to: "B1 u e 1 4-34 7 C°,Yahoo. Co n Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13,- Owner's Authorization j , I, as Owner of the subject property hereby authorize 2 a z I 0-,-j Ld u to act on my behalf, in all matters relative to work authorized by this uilding permit application for: �-AL� Ma d 0-7. . (Address of job) r 2� Signature of Owner date Print Name r I Last updated: 11/15/2018 SMOKE DETECTORS REVIEWED - f3 ! ' UI ING DEPT. DATE FEB 2s 70iO _ ��----•--- DATE -'PAR�i1�i1"ICI' FIN; "Rf f�IrU OPF_r)FOR PERMI . 130TH SIGNATUHE"`�H-� T, c.m �. 5 ate" c� ... _. oll o �oj i ------------------------- The Commonwealth of Massachusetts Department of IndustrialAccidenis Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizadon/Individual): 7Da yWkX C"Lt%l E14C;6-,*C1'AA Address: cJ Gkokk% 3e,55c �dl City/State/Zip: �j acmao! MA 0*4hone M )24` �s53.:(0546 Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I 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.M I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.ftLs ance comp.insurance.: required.] 5. ❑ We area corporation and its 10.[�Electrical repairs or additions 3.El I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.❑Other employees. [No workers' 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 hue outside contractors must submit a new affidavit indicating such.. *Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si >QAM4 Date: 0 Phone#• ��`l •" Jr� �(' Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License N. 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#' Information and-Instructions 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 hire, express or implied,oral or written."w 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 with employment be deemed to be an employer." MGL chapter 152,§25C(6) u also states that every state or local licensing agency s)tiaII withhold the issuance or renewal of a license or,permit to operate a business or to contract 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 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 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 5 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 to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would bike 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 1-877-MASSAM Revised 4-24-07 Fax#617-727-7749 - www.mass.govfdia tiel t� c a— a—t y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0.2 q Parcel d Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Feed Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Village C i)/,°- Owner ,�i�z, Address f�o� Telephoned 0 9 Permit Request /2%"6 —I �64�� ,� � 5/tea��-s����p� 1�f / )0 �G22 y�//Ze6`i i2i 7��,� --, ,ram/ � ���fiL-,--y e -,,4)7 7�L ,*7-,e f�y./; ��/l�% fu S'� / iL� �®/ ate l�D T���ZZ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation l e e! ® Construction Type_ Lot Size Grandfathered:, ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Jai. Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes A No On Old King's Highway: ❑Yes 3dNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed:❑ existing ❑ new size _ Other: BUILDING roc❑T • 8 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ DEC 02 2016 Commercial ❑Yes ❑ No If yes, site plan review# TOWN OF BARNSTABLE Current Use Proposed Use APPLICANT INFORMATION - - (BUILDER OR HOMEOWNER) Name e19Z Ci4a / '�����;o� Telephone Number �,7�%Z/� Address Ze 4 ,, A/ License# xe.)1� Home Improvement Contractor# Email Nl1d /1,AY Worker's Compensation #142,: ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ZJU4 DATE f S,.r /Jt� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL I' FINAL BUILDING I DATE CLOSED OUT ASSOCIATION PLAN NO. i HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. i hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: The weatherization work done will be-based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic&basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. 1 give permission to Housing Assistance Corporation the property with such equipment i and materials as may be necessary to perform weatherization. 2: The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5)years after the weatherization work is completed, i have read the provisions of this agreement and give my consent.' v �l Home Owner(signature) Home.Owner email: Date/� j Agent:(signature) Date: Weatherization Contractors: Adam T Inc Cape Save All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement Construction Tupper Construction Capes od Insulation I ti w , The Cornmonl•vealllt o Massac hu,f setts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 IvW,mms,gov/dia 11'ut kers' Compensation Insurance Affidavit; Bdilders/Contractors/Electricions/Plumbers, Alicant Information TO BE FILED WITH THE PERMITTING AUTHORITY, Name(Business/Organization/Individual): C/ G Please Print Lc ibl Address: / /'. ' 2 --- City/State/Zip: "�, / ,G t /0� 2� phone #; Are you an employer? C eck the appropriate box; Type of project (required): i.Z-I am a employer with .�✓ employees(full and/or part-time).' 7. 2.❑1 am a sole proprietor or partnership and have no employees working for me in ❑ New construction any capacity,(No workers'comp. insurance required,) $• ❑ Remodeling ).❑I am a homeowner doingall work i .myself. o workers'ers comp. insurance required.)r 9, ❑ Demolition I 4.[]1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 proprietors with no employees: I I.[] Electrical repairs or additions 5.Q I am a general contractor and I have hired the subcontractors listed on the attached sheet, 12'❑Plumbing repairs or additions ' These subcontractors have employees and have workers'comp, insurance) l 3.Q Roof repairs 6.[]We are a corporatron and its officers have exercised their right of exemption par MGL a ,.� 152,§1(4),and we have no employees.(No workers'comp, insurance required 14' Any applicant chat checlubox N I must also till out the section below showing their workers'compensation policy informa `"� r Homeowners who submit"this affidavit indicating they are doing all work and then hire outside contractors must submit a new tion.affidavit indicating such.- IConuactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether of f iho employees. If the subcontractors have employees,they must provide their workers'comp.policy number, se entities have 1 ant an entployer that is providing workers' compensation Insurance for my employees. Below is the policy anti 'ob site injorvrratt'on / Insurance Company Name: l2• Policy a or 3elf•ins. Lic. 9: -� Expiration Data: ; Job Site Address: ;�� -92L . Attach a copy of the workers' compensation policy declarationpage (showing the Policy number-and x�ration date), p ) Failure p secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to s l,500.00 and/or one year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fi day against the violator. A copy 0.,this statement may be forwarded to the Office Investigations of the ne of up to$7.S0;0U_a " coverage verification. DIA for insurance 1 rlo hereby certify under the pales nrtrl penalties of perfury that the information provided above is true nett Signature: i correct, Phone b: Dat ; / ZI J 4, Ofj7cial use only. Dq..,hot write in this area, to be completed by city or to 70f,1101a4City or Town; Permlt/I,icenIssuing Authority (circle one);i, Board of Health 2, Building Department 3, City/Town Clerk 4, Elrcal Inspector S, Plumbic 6, Other g Inspector• Contact Person; Phone#t Vi � e Massachusetts Department of Publlc Safety Board of Building Regulations and Standards License:'CS-100988 Construction Supervisor. HENRY E CASSIDY.0 8 SHED ROW WEST YARMOUTH 5 71'151 0 , Expiration: Commissioner 11/1112017 Office of Consumer Affairs and Business Regulation 10 Park Plaza -' Suite 5170 Boston, Ma Musetts 02116 Home Improveme rize., tractor Registration Type: Corporation Cape t Ix ` - Registration: 153567 ap Cod Insulation, Inc n, -= ; _ 4� Expiration: 12/14/2018 18 Reardon Circle M - So. Yarmouth, MA 02664 a c — Update Address and return card. Mark reason for change. 3CA 1 0 20M-05/11 U/ZB�QO?YI/Y12092C08CLGLIL O�C%//(.000QCGC�CIOEGZd Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only Type; Corporation before the expiration date. If found return to: =: Registration Expiration Office of Consumer Affairs and Business Regulation �- 10 Park Plaza-Suite 5170 � _ � 12/14/2018 Boston,MA 02116 _ Cape Cod InsulatlonJjte Hen Cassid ry Y ` 5 ` .>. = ai i 18 Reardon Circteif ��.e CCQ�� So.Yarmouth,Ma 26 Undersecretary Not valid without signature 1 CAPECOD-27 DEATON ,a►�o�zo� CERTIFICATE OF LIABILITY INSURANCE DATE 1 7/291229/2016 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. a IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 4g NAME: 34 Rte 1�3 ray Insurance Agency,Inc. PHONE Exth a/c No:(877)816-2156 South Dennis,MA 02660 E-MAIL RESS:mail rogersgra .corn INSURERS AFFORDING COVERAGE NAIC q INSURER A:Peerless Insurance Company INSURED INSURER 8:SafetyInsurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY-PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 17- CLAIMS-MADE r OCCUR CBP8263063 04/01/2016 04/01/2017 PREMISES DAMAGE TO RENT rrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 0 PRO ❑ JECT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO 6232707 COM.01 04101I2016 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 2,000,000 C [�hEXCESS LIAR CLAIMS-MADE EXC10006635001 .04/01/2016 04/01/2017 AGGREGATE $ D X RETENTION$ 10,000 Aggregate $ 2,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY AT ER D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WCE00431902 06/30/2016 06/30/2017 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CLEAResult,Eversource and National Grid are listed as Additional Insureds on this policy on a primary,non-contributory basis. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rinhta racarvwri Town of Bar nstable *Permit a Expires 6.mon s jrom i ue d Regulatory Services. . Fee 1AMgrAB MASS. Thomas F.Geller,Director o r�r►+' Building Division T✓� Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0 3 / 3 Property Address 239, AVE AIAI Qd- r 00 Minimum fee of$35.00 for work under$6000.00 (rResidential Value of Work ('. [70. Owner's Name&Address G ERkv v �ROU Telephone Number SaSf'9ya Contractor's Name p Home Improvement Contractor License#(if applicable) Construction Supervisor's License;#(if applicable) G R<Vorkman's Compensation Insurance Check one: MAR. 22 2012 [r I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance . Z, Ak� iRS TOWN OF BARNSTABLE Insurance Company Name / Workman's Comp.Policy# LU r 7 l Ul3 A/19 fZOS Copy of Insurance Compliance Certificate must accompany.each permit. Permit Request(check box) 3 Re-roof(hurricane nailed)(str pping old shingles) All construction debris will betaken to (O r' 1� o e ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) 1.• ❑ Re-side #of doors' ❑ Replacement Windows/doors/sliders.U-Value (maximum.35),#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *.**Note: Property Owner must sign Property Owner Letter of Permission. A copy o the Home Improvement Contractors License&Construction Supervisors License is requi e SIGNATURE: 24 _ C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Interne iles\Content.Oudook\DDV87AAZ\E}PRESS.doc Revised 072110 .� -62 Office of Consumer Affairs and usiness Re_ ulation .g 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169184 Type: DBA Expiration: 5/25/2013 Tr# 212648 DCM ENTERPRISES DONALD MCCARTHY ^ ' 24 MCCARTHY LN. E. FALMOUTH, MA 02536 Update Address and return card.Mark reason for change. . Address Renewal Employment Lost Card 'S-CA1 Co 50M-04/04-G100�11Q216 Office ot` omei' 1E airs f$dsineh License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: , .169184 Type: Office of Consumer Affairs and Business Regulation Expiration: .5/2512013 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 DCENTERPRISES. :: DONALD MCCARTHY_:-;;=,_ 24 MCCARTHY LN. E.FALMOUTH,MA 02536 Undersecretary Not valid without signature lassachusetts - Department of Public Safetl Board of Building- Regulations and Standards Construction Supervisor License License: CS 84678 DONALD C.MCCARTHY 24 MCCARTHY LANE EAST FALMOUTH, MA 02536 Expiration: 2/12/2013 ( nimisi ner Tr#: 10827 i 7 ® DATE(MMIDD/YYYY) A CERTIFICATE OF LIABILITY INSURANCE F3/16/2012 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:CONTACT Sherry McNally DFM Insurance Agency, Inc. PHONE (508)540-4555 aC No:(soa)sao-9zss 668 Main Street E-MAIL .sherry@cape.com INSURERS AFFORDING COVERAGE NAIC# Falmouth MA 02541-0656 INSURERA:Patrons Group INSURED INSURER B:Travelers 39357 DCM ENTERPRISES, DBA: DONALD C. MCCARTHY, DBA INSURER C: 24 MCCARTHY LANE INSURER D: INSURER E: EAST FALMOUTH MA 02536 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1231634263 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I DDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 500,000 DAMAGE TO E TED 50 OOO X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE F_x1 OCCUR CTR0004332 0/16/2011 0/16/2012 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 500,OOO GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,00O X POLICY PRO JFCTLOC $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ Hf EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WC STATUS OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ NIA -6499R056-11 /30/2011 /30/2012 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable 367 Main Street Hyannis, MA 02 601 AUTHORIZED REPRESENTATIVE D McCarthy/DFMCEO ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD the Coninionwealth of Massacdiusetts, Departinew of Indrishia►'Accideiils Office of Investigafions .600,Washbigton Sheet Bosto i,AA 02111 e4 ivri,.n;ass.gor/rdarr Workers' Compensation Insurance Affida-vit:Bu®lders/Contractor-s/1�-lec-tszcians/Plumbers Applicant Information Please Print Letibly Name(Bussmes/Organizationtlndividuai)_ �� EgkgR��sE5 ' Address:AJMCCA4z� L.Aag City/statetZip: 4-r-M Phone#: Sol(- 5P&12- 51t5 Are.you an employer:"Check the appropriate boa: Type of project(re quired): 1.El I am a employer with 4. � I am ageneral contractor and I 6. ❑NeA'construction employees(fall and/or part-time).* have hired the sub-contractors 2.W(I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition workingfor me in an capacity. enTloyees and have workers' y � t3'- Y 9. ❑:Building addition [No workers'comp.insurance comp.insurance. required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]plumbing repairs or additions myself.[No workers'comp. right of exemption per MOL 12.[ Roof repairs insurance required.]s c. 152,§1(4),and we have no employees.[No workers' HE Other comp.insurannce.required.] •Any applicant that checks box#1 roust also fill rout the section below showing their workers"cvmpeasationpoliey infonnation. Homeowners who submit this affidavit indicating they are doing all work and then like outside contractors most submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or am those entities have employees. If the sub-contractors have employees,they mast provide their workers'comp.policy number. lair an emplo er that is pros4diiig workers'congmusation iinnra eR for iity eiaTEq-eem Below is the policy anal job site igforivaden. 1 Insurance Company Name: �A��S�� ��( I�U E I C-RS Policy;9 or Self-ins.Lic.4: 1.3s - U13-6 W 9`t Ros6"/r Expiration Date: 7" 30- 0,d A Job Site Address: g-3n? 1� Aim IAy1^ CityfStatelZi--(!Au;� �7oZ�os� 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 citil 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. Ida dJere.y c eider the pains and penalties of p 'ii.ry.that the information prided a.boire is bate.and correct Si tore: Date: O Phone 4: ..SOS f r/o2- Off icial use ondy. .Do not iyrite in this area),to be completed by city or toitut gffl ial City or Town: PermitlLicense 0 Issuing Authatity(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1! snat�srnai,E, * , 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, G E&�&J It= hRo y hA ,as Owner of the subject propertyy hereby authorize .C.M L.Nk, all so to act on my behalf, in all matters relative to work authorized by this building permit'application for: CtQly_ M18, oa,63 f (Address of Job) Signature of Owner Date �. Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption°Form on the reverse side. C:\Users\decolliJAAppData\LocaiMcrosoMWindows\Tempordjy Internet Files\Content.Outlook\DDV87AAZ\E)PRESS.doc Revised 072110 Assessor's map and lot number Sewage Permit number......V/./.. % I"E.T°�� TOWN OF BARNSTABLE Z BARISTADLE, i "6 9 �•� BUILDING INSPECTOR �CEO YPY a' APPLICATION FOR PERMIT TO ........t "W'd L.L ` , 11A.1-1 .................................. ...... {,. ....................................................... . TYPEOF CONSTRUCTION ........ -a' ' '..................................................................................................................... .......: '�E............................19.7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for/a�permit according to the following information: Location �n �e� +� / . ....................................... ProposedUse ...... tie! �✓ s� as R,r�................................. .................I......................... Zoning District ....... .. ............J...........................................Fire District ....... ;.-^. ... r.............. �Yt Name of Owner r..i .....¢f;.!J/ 4....... A.......Address ...f Z...`j.............. x!+... -...... r cs.,.�, Nameof Builder ....................................................................Address .................................................................................... fi Nameof Architect .............I....................................................Address ..............f....................................................................... Number of Rooms .............................................Foundation 1� +.oA4,,4/4 !.' -.'�.1 1.......... �j 1r j� Exterior ....� .!�-+'"`,�. .......�.�... .. � Roofing .....:�',�11�4 .�.t'� Floors !! �� �"� .Interior .....f .......- hGG�.OIf��, ........................`................._.`................. ..........:.........:.......................................... Heating ..... .!P ' :../2.(�s �1/.....................Plumbing ..... ........................................................................... t..........�. ... Fireplace ..........................................................Approximate Cost ........�` T ) ........................ !.................................................. Definitive Plan Approved by Planning Board --- ----------19 `'� Area ....... Diagram of Lot and Building with Dimensions Fee ..... st SUBJECT TO APPROVAL OF BOARD OF HEALTH .3 UT- i d I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �y &,vl?. 4c.a 5/� � q. J ............Name ...... ....................... ............................ Dacey, William E. Jr. A 777- 17694 one story, No ................. Permit for .................................... single family dwelling ............................................................... Cotuit fines Location ........................ ........... . �410/� Cotuit ....................................... ....................................... Owner .............Wil.I.i.a� E. Dacey, Jr. ....... . . ......................................... Type of Construction ... .................. frame................... .. .......................................:"*\. ............................... 10A Plot ............................ Lot ................................. Permit Granted .........n '...1A 75 ...............19 Date of Inspection .....................................19 Date Completed ......................I..............19 PERMIT REFUSED ................................................ ................ 19 ................................................ .............................. ..................................................I............................. ................................................ .............................. ......................... ........ ............. ... .. .............. . ...... Approved . ....... ... ............................ ............................................................................... ................I.............................................................. �r LoC . La ! 4 j 211 3(,Z S r= j t3 .q'1�. f So 1 la I A= IZS,00 i?l, ,-,..,:y ,n:� vt:- 'CERTIFIED PLOP PLAN �rF' rc r�: ,S���ic^' r�� - : 'a .4 LOCATION t� SCALE I. . b-'.r. DA,T6'-.. A/1 .\I.. C•1 ?`.1 .1�.a F PLAN REFERENCE l ,� � V''.✓d 1, / - `� �. ..,) �i p LAA.'0. ti 7.i 'd?;` �'_I_t�.t,4 IL I CERTIFY THAT THE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND � WED REALTY T u s r AS. SHOWN HEREON AND THAT IT CON FORMS TO THE ZONING LAWS OF THE TOWN OF a Wr �LrAh!I E- DAcc—y Tkus1T'E;E -. :1�/l�'!l!�yTP% � .' ��:,, HE�I,CONsiR'UCTED- , ` / � � 570. WEST /�/f A t t..1 C�`j 1;.L!`i. DATE/f i!' ,/d !� �`'a % o,,F PETITIONER : k4I -A a; . REG LAND SURVEYOR j Assessor's map and lof number ..: . ........:"' V �°f°' SEPTIC SY lei BE ED Sewage Permit numb ....././..r% Vi1ITH ARM-LE II :TAI•E IaTR >t_GC TR;WN o�THE.r°�� TORN O F B Alt' � ` AxB'L E _X i i BARNSTABLE, i "6 9 o w •� BUILDING INSPECTOR � ar�'• • d�( .�Ll APPLICATION FOR PERMIT TO ....... .................................................................................................. TYPEOF CONSTRUCTION ........ :.`' ..... ... .:. .. .................................................................................... . .. ...... ... .............19.7 TO THE INSPECTOR.OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... 4t .& A ............ ............�� ......................................... Proposed Use ....r, .I-ec. . .....0 ��C ......... , ..................�, . . ............................:................ Zoning District /� ..................................Fire District ...... Name of Owner .. ✓44 .r....t..:.t.... .. .. r.......Address ...f�Z..G✓ .�L !�.. �... .i ...................... '. e Nameof Builder ....................................................................Address .................................................................................... '., // �,.. it s/ 1. !`...............6� !r Nameof Architect ...................... ...............................Address ................................. ................................ Number of Rooms ........... ...........................................Foundation ...� .... . ........... .......�:tC9 .......... Exterior ... ..... ..�,'�............................Roofing ..... ..... ...................................... Floors ........61 •� J..................Interior ,.... ......:. ................. ......�...................................v.y Heatin �r� a .........�lJ..................Plumbing .... ........................................................................... g .......... . ..... ............... Fireplace .........................Approximate Cost .......2 >.. ....................................... Definitive Plan Approved by Planning Board --� _______----19 72-. Area ....... -���.. ......`.V7.®`'�/ Diagram of Lot and Building with Dimensions Fee ........... SUBJECT TO APPROVAL OF BOARD OF HEALTH jt6 ;� �� � � I`•I 4 1 14q 0 )t5d I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............. .. ........ Dacey, William E. Jr. Nay. 17694 Permit for .....qn.e...s to.r..y.. ...... .......... .. . .. �;-.S�iqgle family dwelling ......... ......... ................... iaa Location ......... & ............................. Cotuit ............................................................................... Owner ...........William E. Dace ..................................Y. Type of Construction ........frame .................................. ................................................................................ Plot ............................ Lot .........10A ..................... Permit Granted .........Ma.y 15 .........19 75 Date of Inspection .......... Date Completed .. 19 PERMIT REFUSED ................................................................ 19 ti ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................. 19 ............................................................................... .................... ..........................................................