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0075 SANDALWOOD DRIVE
�� E, I�i Town of Barnstable R EyC E IIPT_; $A 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-18-365 Date Recieved: 2/6/2018 Job Location: 75 SANDALWOOD DRIVE,COTUIT Permit For: Building- Insulation- Residential ZZ y_y I Contractor's Name: Carl J Rebello State Lic. No: CS-08, Address: Swansea, MA 02777 Applicant Phone: (508) 56 109 z� O -n (Home)Owner's Name: COTTLE,EDMUND C JR TR Phone: (508)274-2424 (Home)Owner's Address: 7 CURLEW WAY, COTUIT,MA 02635 = n Work Description: Insulation,Air Sealing& Door Weatherstripping ,� co t% r n Total Value Of Work To Be Performed: $4,642.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). 1 understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Carl Rebello 2/6/2018 (508)567-4109 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $4,642.00 Date Paid Amount Paid Cheek#or CC# j Pay Type Total Permit Fee: $85.00 2/6/2018 ? $35.00 Paypal Paypal Total Permit Fee Paid: $85.00 2/6/2018 $50.00 Paypal I Paypal F y, THIS IS N9.T..A PERMIT ntci TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Oil Application # v Health Division �f Date Issued ' Conservation Division ��� 0� Application Fee nn Planning Dept. yQx, �� '� ,� Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project.Street.Adaress- _1 `Village - Owner r .,"Mti/SW Address LU✓ ew W dD w /40 D,ZG3ra e hone .5'0&' ,2 74`.Z_4/.2 y n Per-it-Request 4 D �a✓ vt' .�' > S Q LD SQ o-p- d ,Y,/� � �s � � ��.- off'��o✓ �'� � � Square feet: 1 st floor: existing proposed 2nd floor: xisting proposed Total new Zoning District Flood Plain Groundwater Overlay Project_Valuation mo► Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 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: 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 d � Telephone Number � o Address �C�r�-`'� y ► License# �y �► � 2 � 5� Home Improvement Contractor# J 'G( -� ®�I�lYC,4 ;/,�/d�Worker's Compensation # Email �t7+�.t�� , G�� ALL CONSTRUCTION DEB IS RESULTING FROM THIS PROJECT WILL BE TAKEN TO f, e t SIGNATURE DATE /Oh i FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME b � INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT I ASSOCIATION PLAN NO. i was -itisetts uepartment or VU1311C batety Board of Building Regulations and Standards License: CS-050457 Construction Supervisor PETER M POMET F7 PO BOX 2066 COTUIT MA 02635 Uri 2 , ��`/^►�^^� �./� Expiration: Commissioner 04/19/2018 . �%�e�ar�ztrtr.Jzr�,etctl�c�^!t'�zo�tcc�atit:lr. Office of Consumer Affairs&Business Regulation 'i� HOME IMPROVEMENT CONTRACTOR Reg�strat�on 109606 Type: Expiration.; `912112018 Private Corporation A I ENTERPRISES INC.• PETER POMETTI i 140 LITTLE RIVER RD _,,,... COTUIT,MA 02635 Undersecretary � a License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,NIA 02116 Not valid without signature i" .IL License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid without signature ACOOR ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) L� 1 10/13/2016 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: RISK STRATEGIES COMPANY PHONE FAX A/C No Ext: AID. ID No): 15 Pacella Park Drive E-MAIL Suite 240 ADDRESS: Randolph, MA 02368 INSURERS AFFORDING COVERAGE NAIC# INSURER A: INSURED INSURERB: AmGUARD Insurance Company 42390 A I Enterprises Inc INSURER C: P.O. BOX 2056 INSURERD: COtuit, MA 02635 INSURERE: 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 I TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYY MMIDD/YY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 0 CLAIMS-MADE 1-1 OCCUR DAMAGETORENITED PREMISES Ea occurrence S 0 MED EXP(Any one person) $ 0 PERSONAL&ADV INJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 0 - POLICY❑PRO JECT ❑LOC PRODUCTS-COMP/OP AGG S 0 OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT S Ea accident ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED id P BODILY INJURY(Per accent AUTOS ONLY AUTOS - ( ) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE S DED RETENTION$ - - $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I AER ANYPROPRIETOWARTNER/EXECUTIVE E.L.EACH ACCIDENT S 1,000,000 B OFFICER/MEMBEREXCLUDED. �N NIA AIWC753038 07/18/2016 07/18/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101.Additional Remarks Schedule,maybe attached 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 Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD r , ' TV wnof Bairvitable ftwator Services NOT 1*41 s.. m o �� �l+� ': RX SW7004nol 3 r Mush to b, f dms a jo / *P' g. .d W1mmm s the,. s aqibiht f the li p,Pools P p „ ` c fAp . t 1;;�rel RV16 77;� TP The Commommeakh ofManwJHtwffs Aparim gt o}' vf?id Acddwz& 600 Wmbfiigion S6ew Boston,CIA 021II •. wrv��r.m�g��a Wurlmrs' Compensation Insurance Afdwit Sanders/Canh=tns/Mec&ransOmmbers APuliC2Mf Iuformatinla Please Fries E.e�llv Na= F1 <71t/C Add,re= /"0 Are you as employer?Cbrecktbe appra'priate b I. I am a emplo y _� 4_ ❑I arc a ge�al eonhmctar and I 6. [ of[]New Co t(uCtion l)_ employees CTUM andfor park-time). * Ire hired ffre sulncosit 6. ❑ldeuv won: 2.❑ I am a sole psu�ietw orpartaer- listed on.tb8 attarl>ed shbeet_ 7_ Ret9aade g ship and have no employees These zb-caa4sacta:s have 9- ❑Demolition wasidng for me,ia any capacity- emplayees andhaveworkers' pfa wadmw oonzp �comp.n+ +C I 9. Suil add6on . reTiie�] 5_ ❑ We are a cmporafi=aud ifs Id-❑Eleducai repaim or add hom 3111 am.a 1, =-y mer doing all va& oMnm have exercised then 1L01%mbiagrepaim of ad&fiams =ysdf[No. •comp_ rigbt of esempfiau per 1tiMM- 1?❑Bflofrepaics in, d-]T. a M,§lM andweBwemo employees.[NOwodoe& 13_El,o&er ' cam-msumme require&] 'Aap C—=tcbed6bazfflmasta]ssfiIlc�thescBoaheTaar gdies�dces'�•nmfi,,.pey� � #Nd=eoarffiwha submit dus affidaca`i g 8�ep axg daiao stFwa�c amdt5�7rize amadeco snmst sv5mitamema�daeiR iadi 5 rCaftRCba-ff=d—kt}ds6mtmastattarit =arlaffi lshed dzmiagtLeaam cfft sab-cxxmtmc1zicssmdstafevrhed.marmotihose hsM employees.IffineavB-tax_*=_�Ixmia3glafen,dwymusrpmxide&w wa&W wmp.galky=—beL lam are eriipsr f7�atis pruuidirfg workers'casatiart insnrarrts for BsTaev is iiTEapzrFtcp and}QFi sits irzforr+rcfinet - IssasanCeCoenparryXame: O(1Y . Pgficy#or isrs.11c. 757L EXPiEHfOXEDate_ Job SiteMdre= /LiW Attach a copy of the workers°cbmzpensationp'olicy declarations pagt(showing fhe poficp mmber and ezpuation date). FmIum to serum coverage as requirednudes SwEen 2 5A of MM c.1M can lead#o Sse imposil of csimi nni pevaljies of a fma up to$UOD_OD an&ar or e-Tearimpdsortzoent,as W&as civil penalties is the fb=of a STOP WORK ORDERand a firie of up to$25GM a dog against the violatar. Se advised that a copy o€this statemeu+t sway,tie fkwarded to the Office of Iuvestigations ofthe DIA for covemge verific #ion- I t£o&ea-sb,y eerinfy tJts ,prsraaItaes 4qfFzdk.F fhatfbes inf brma6mprm•ded abory fs hue and correct A- 0jokidweanly. Do not writs in ffa s areq,to be cozapW d by city artoorn a;g1dat City or Taww - PerndtUcense# Inuing kufh rity(cadeone): L Sid of Heafth y BTrmg Depazbnent 3.CA�Yruwn C3erk 4.Electrical Iuspedne 6.'Phumbineg l respecter �.oar Contact FeMO= MOM#: 6 11; '�= _tltA:1.. ■ - .■"••{�. :.••/1�•- .I 'rlt■ •'iR 1• •I • ■- •••I■1�•. r/1/t1■�. :I.•lt i■t [■- . iff■U • - '• - ■�F•■ It tl - • :t.1)• tl•• .1■ r.f■It r ■ ■t1 - •11 ■Y■■1 ■. !1 A YI■■li .•r L.1) •- fl.:• :A age ■ Ii II / •J •�7).!i■ : -it ■.It• /I.Y •1:/ ■■ R■t1r :v,r wY1■.■ r.l •• .t■•/• •1 r■■ -'J% atl.1 • •1 _r/• ••• • sale, i• t• : •■/ �Ilt:! •If/:i .■■■ .■ tt•■{■' tl- .1 �•. •tY••w • •� I i• :i1■■• ••� ■I [• also In r a • • ■ • /�" • :■1 Il/!• •1■. ..■ •■rR■tlr .Aw•wY.t■•It •1 •r■�: � _ •` •••/ �• ■• - I ■•• ■•1 - •- t■• t• 1.■1 - ■a:.1 .II .lr:1 ■■1 itt< :.1/ •'tl. wY• it:' N■■ tl t■ • V.I..ttl • ■■ •• - It ■/•A • :t•■t■ !• mil/1. •• 1�R/1■ It •• I/-.1•Iro/.Ir r- •1• f t r■•■ •) - ■•tt •'•). •1/ II . ■^- I.1._ ■••A" • ••Il I■ J •■1•• /7 ■!1 ■■I •1.••1 I:i•.1/I .!��:Ir ) I •/ •ter:!• ■ • .l .i1../ •'[.�t1 •- 1 i�:)t i• ■• • :t! �Itt. •• oo a- ,I ■ �If - ■ t- Il I ■• . r t- . 14Y•1 i..v. t 1t r/.Y• 1 Y • 1/ 1 ■1 _ 11 )! r•■!/•• • •■ I�•/. 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U r•■ inn..•n • n n 4!r ••- ■ ■' .[ - u v: ■ . ./ ■ - •-'-■■ ■[■- ■: % il■•. 1 ■• • •- ■nn�■ r• t/" 7 • u 1 [■Mrsketi ■- .n r.r•:•q. •1 i1 - .�ntt • t :1■ •uu �•/:�{�. t • !t- O�r.t m�/ • m. ■■ .■■ .n• • ...)w -:a nu n- -• • t .• ;. - �•nl �■ n •.•:■n ••.f.�a r age 1 973 1 v..1 mrn u- nnn• /.1►[ •- •• - n •t �• o•lun.n .•1 ■ �• :+ u' t n n _n - a� - unn• 6I1 Be- .n a••n�.n- n" - . •1 - 1! ••IIIli/ "'J. • u /n/- •I • r■ n 0I ■ A .. u: •:.I a OG•r • .•..•_.un■ t: a r.nr •t _atu_ n n■ r:■ ' K . t - t■ ■■ t■ t!- .1/1[ R �l - tlt Uf■V ••at .a I • /1.�■ t� �■ ■P■t1•:7 • •i I■/• :It ..• .ttt I1.f !/ ■ "■•1• 1 1■ l ■Ir - r •1l It if• - ar■ r:tY•7• t• .II• 1•�■ a•..■ /• • n- �Y• )t. /. r ter. •�)w.I rn.n►• n n.n.f.■ •' n - rtl N ■/••■ n- r- r •• •- • ■. O- • n•: 1 ■. i7 a uun - ■:+m .. • ►�■ 1 G■•.• I nt/ .- .11.• • 1 r ►i1■� Id r ii/lt 1 1• ti■ l/ d1 r/Y11 w`w • r•L1t/■�', w •ilt tt1 - ••• r.o r i1Y1t 1 is ■ Ir! �{ • ■�. •7. �.■/■■ r/ it r•11■1• �•.- )■. ■■•. ■- • ■) • ■ •w■•%1.•t •'•t • .7 I■ 11.1• •• t1 • .11 r •S ./. r/.•�! ./•■ta .t■/ ■■1 / ••• 1 •- .■■' •/w!•7• go 0 ■" ��'.:t ■t1�?• �•/1 :..w ■' ir•••I■- .It• Y- .Itl[t•r 's• ii_a �J � The Camwonweaht tf Maysadmse!tft DeparIIf ent afludasbialAccidaer OjTwe qf ad&= 600 Waslm�gtoR,S`treet Boston,MA 02111 IPFV .mass_gM1idia Wurkm' Campensa fm Insar=6, fiizvi_ $�ngdersiContra hers Plese Print LU'; .4'a 'o -PhOEO.14F Are�u au employer?f ire appropriate bay Type of graject(re rm�ed}: L El am a employer 4. ❑I am a general cord acf�and I . employees(fall aulfor part--fum). * have hired ffie sum 6. ❑New corlstudim 2. I am a sale prop:d*r or listed oathe atbm'W sheep 7- ❑Rffiodeliug and�e no 1 These mb-canftw un hate �P �P�� & ❑Demolition iv dnv for me i a any rapacity- emplares andbzve wodmm- R^;4,�,,T INC '�mP-i Ce camp.%n¢Rtrarxrp!I • . g- El`u&rmg addifiou. reTIiM&1 •. 66qe I ❑ We are a cmporatiom.and ifs 10-❑Electrical repairs,or adc5tions officers have exercised 3.❑ Iamafiomeo�daing�tgork 11-❑Plvmbiagrepaissars:ddifiams my-self[No 'gip- sight.of emecapg m per M(M 1-❑Roof A /W, �- employem[No was' - c 'Aap sppficsutfiwt ch. baarl elsafllo�tlresec oabeTawshshiag�ea.ao�Ces'�p�•�n�••porscgi aom Nameuaraeaiad+o sahmmt ffis zffidacis mpg bey om.dam.-egwa k=a ffim biro aatsi&c Mffmnkanem _Smfs c3�ecic__�tis b mast auactted mr:addid -sheet sfl ea�of the amri slatzwLethe;ur=ihme.e�ies1 s . ('�emP_Ioyees_Iffhess�5baveempIoF?zs,ffieYimFmsideta 'tomP_PalicSa�lsez lam all anpZujw du tisprariffycg workers'coa an=' Irauw or my etrrgt:�Wm Below is fJca prrlicy asd job sfte hzzbrraahas. Ias�eComgaIIyivlame: 'Po-ficp A'or Self--ice€Iic-47- nDate: Job Tife Add CifylSkaf�l.rp Atch a copy of the workers cnmzpensatioapolicy d ageeclara4iaa p (shOWing the policy der and cxpaa#ion date). Fail=e to serum coverage as zeq ' Swtica?SA of MM a L52 am lead to the imposit of mimhi2l penalti of a fide up to$UOD DQ aadfor " one,as well as civil penslfics Ja ffie form of a STOP WORK€?RDIRand a fine of up to -QQ a clay ffie vio a Graf a copy of thn smut maybe forwarded to the Office of Imtestsg R&M of the D for" nn Fdo hereby the abon i€ we aq correct Pbane jai use ay*.,Do not smite is dds areq,tit b =pleta by city arta irn ajq"reiat Oty or Town: p'e r:cease - Lwaing quflrarity(dude one): L Board of Heal& I Buffirmg Deparftment I Cdyffuwn Clerk 4.Electrical bspettur S-Ping fimpectnr Coact Person Phone#c 6 laformation and Instructions . MFtce come ft Geb=,A Laws ffisjY=152=pi=all=q:aV`Yeas m pravide oamprasatton fisfien'emplcgy _ pnrs'aaotio this ,an�Ioyee is defined ash.e�y p�s�m$le s�vi ce of err Mader nay wire ct oflme, =gal=or innpliedt',oral'or Tnit . . er is deaned as-am figfindnal,pmt=sbjp,asso�u*+-,razpar�iom or atb=legal eaEiy,or My tWo or mane O f m fi= $he eatteiiyes of a deceased eu3plcycr,or fire of�foregoing m aJ���,aadinchz�g legal Fees rtxeiYer or trastae of an im dividnaI,p �blp,assoaiz±ion or othM Iegal may,�oymg=Ploy- Aowever$ie ow=ofa.dweIfmghansehavingnotmorethinthreeapmtneolsandwhoresides re air orfheoca�tofthe - &7CM33g house of anoffier who employs p=S=to do mah tMan�coon repair work.an sock dwelling house or on.the grotmds or bmZd+mg appz�antifimrAD&gnnntbecanse of snrh employmeatbe daemedto bean employee" MCSI.cbapt'r 152,§25C(6)Rho stafos t at�everp state or local£rceasarg agency shall withhold$ie zsstzanq.or renewal of a Tcease or germif tooperate a_btedness or to consirarf,btnZdiugs is fhe commoae�ealfh for any applieantwh.o has notproduced acceptable eYidea�of cdtupFxabc�with the n.cffrancE coverage reclaired�' 25 states�Teifher the nor nay of, political snbf Vi!,. us shall AddhionaIly.MGZ chapter I52,§ C(7) ce f3ie insm�ce. enirr mfo any,conirart for the prance of public wolictmill acceptable evidence of cainp3ian will regt�r�enFs of-dais rlispira have bey prese�ed'to the g�ho�3'" • ''•' �c ` - �pIicaafs please fiIl oil f3ie Volk=,compensation affidavit completr:Iy,by g Vi.e boxes that apply to yo=sltna snd�if necessa IL SUPPIY s)name(s), address one es)and ph ntmmber(s)along with their=ffficatr-(S)of i msmance. LimitedLbsbdrty Companies If or LiabiTri P�b�s.PX)wiffmo eaPloyees other tl anihe If an Id.0 or FZP does have m=±jb rs or paw,are not ti cazry workers' eamP"'aa iasmm ce- =PToyees,a.policy is rMFdrCd. Be advisedtl2dfhis aftidaykmaybe sabmiffz d to the Department of hdusfrial Accidents for conEm afro of ins¢rance eoveaage` Also be sure to sign and daferthe afidavt The affidavit should be r$t=ed to�e city or town that the application for E=permit or license is being retjnes uof the Dep�[mew of Tnr�rtcfi-i ShanIdyou have any gnesti.Ms regM: m the law or ifyon sie regaizef in ob�in a wozi�e DepartmetatthenumberliStCdbeIow: Self-msaredc ariessbnnldenterflieir; �ea,ca i m policy,Please callfhe self=msmance license j=n B a on fhe Ime. a Comfy or,Town Offidals Please be sore that the affidavit is'comple#e and praatedlegibly. The Departnenthas provided a space at.th=-bottom of f r-affidavit for You f)01 out is the event tho Office ofInyesfigations has to cow you g the BFPb � please be mm tl)fM is the p=mWHcense rnrnbes which vM be used as a l'aB=mce numbm- In.addition,a a aPphcant ffist mnst submit m_UbipIe permWHoense applibaians in any give.year,need only submit one affidavit irdicating end policy information Cif necessary)and under`mob Addre:&I$e applicant sbotld "aII Ioc:aibe; in (cY Or_ town)_'A copy of-far affidavit that has bees.officially stamped or mad -d by a.0 city or town maybe provided to the ' applicant as proof that a valid affidavit is on file for fotare pm=#s-or lice cs- A new affidavit tmzst be filled out each year. Where a home ow=or citizen is obfaining a license or p==h not r@z±c;d in any btzsincss or commercial (ie-a dog license orpe<mit to btmz leaves etP_)said gexsm is NOT regrmzd to complete flis affidavit The Office of Inver woul3bke to thank You ia advance for your cooper ion and should yom have any questions, please do not b csf cite to give us a caM i The Department's address,telephone and =Mber- Thd - co� t of I c31> ant cuff Ii� k Atg , ti 641wadfig*n MA Oil II Tf,-L•4 617-727-49W egft 406 car 1-47TMAS9 4 Fax It617` 27'749 Revised424-07 w g-irk • Town of Barnstable Regulatory Services dF Richard V.Scali, Director Building Division =A81''�` • ` Paul Roma,Building Commissioner 63� �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION �O D Please Print DATE;. JOB IACATION: ! �^�[�/G•V OO� I^�Y� '04 / _ ;?;1W4V4/ streetvillage SOWN rx": LGd7494e, name n home phone I work phone# CURREM IviAII;ING ADDRESS: city/tMM state zip code .The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) r, The undersigned' omeowner" sumes responsibility for compliance with the State Building Code and other applicable co ,bylaws,rules ns. The and fined"ho c e and nds the Town of Barnstable Building Department inspe pro dare he/she will comply with said procedures and, e . ign -of- Jmeo erj� Approval of Building Official Note: Three-family d ellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required . shall be exempt from the-provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act . as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns_. You may care to amend and adopt such a form/certification for use in our community.p Y Town of Barnstable Regulatory Services MAW Richard V.Scali,Director. & Building Division Paul Roma,Building Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 � ;, . j \ Fax: 509-790-6230 Prop� Owner Must ComP lete and'°SiTlis'Section �. I/f Usin-&A,�Builder as Owner of the subject property hereby authorize to act on MY behalf; in all matters relative to worm authorized by this building permit application for: (Addiess of Job) Pool fences and alarms are the responsib>lity of the applicant Pools , are not to be filled or utilized before fence is installed and all final` 11 inspections are performed and accepted. Signature of Owner Signature of Applicant - Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS r � � e l o . � o all Z 0 C r Q I111 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel a `C '��'� c F)��FTAB? Application 1 '# -� N Health Division fy , - 19 Date Issued i Conservation Division Application Fee Planning Dept. � Permit Fee 2Z� . Date Definitive Plan Approved by Planning Board $���`(` Historic - OKH Preservation / Hyannis 00 4�:_PEA J Z_ Project Street Address Village C U L Owner c'cLrrk.)nC:f 029-'l 3S Telephone -/ -c��� °y - Permit RequestLJ �►'>"�c-� �- �P �O/G�C� �-��-� �/�Ct ���� �- %ter Uj a 1 eel a s Square feet:. 1 st floor: existing 4Zdproposed 2nd floor: existing 760 proposed Total new SO" .Zoning District I Flood Plain Groundwater Overlay. Project Valuation Construction Type a Lot Size 157 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �P Two Family ❑ Multi-Family (# units) Age of Existing Structure 1?U / Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: )CFull . ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing C new (2� Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths): existing new 0 First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other H fi Central Air: ❑Yes No / Fireplaces: Existing New Existing wood/coal stove: ❑Yes No Detached garage: ❑ existing`❑ new size_Pool: ❑ existing ❑ new h/19— Barn: ❑ existing ❑ neAW"/'1s1ze_ �/ ' u1� Attached garage: ❑ existing L.�new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ONo, , If yes, site plan review # Current Use C 67--k'L Proposed Used APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address License # CS"' 6SLS M1JC1 _l1_ bCYC) / 7Qa 07_ — Home Improvement Contractor# Email Worker's Compensation # 'i00-�o0/9RoO/(p/� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS ROJECT WILL BETAKEN TO SIGNATURE - DATE 1' FOR OFFICIAL USE ONLY APPLICATION# OATE ISSUED ,.a MAP/PARCEL NO. I ADDRESS VILLAGE OWNER E. F } DATE OF INSPECTION: I - FOUNDATION s FRAME 1 INSULATION FIREPLACE a } ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL' FINAL BUILDING D�rTE_CLOSED OUT _ ASS{ ,0 TION PLAN NO. a The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia NY,arkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. ; Applicant Information Please Print Legibly Name (Business/Organization/Individual): ncea n<,,,icke =rc , Address: c9 '7 ThOlrri4o n D 0 ue City/State/Zip:H va nq I-5 M(, oz-G a 1 Phone k 8 `7 _7 1 — 5 j j 0 Are you an employer?Check the appropriate box: Type of project(required): L[5 am a employer with employees(full and/or part-time),* 7. ❑New construction 2.[][am a sole proprietor or partnership and have no employees working for me in 8. , emodeling any capacity.[No workers'comp,insurance required.] 3,E]1 am a homeowner doing all work myself.(No workers'comp,insurance required.]t 9• ❑Demolition 4.❑I am a homeowner and will be hiringcontractors to conduct all work on m 10®Building addition y property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.[]Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I must also till 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. $Contractors 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 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 jab site information. Insurance Company Name: A —• 10 . M i J 1 06L t Policy#or Self-ins.Lic.4: WC- /(�Q -lpC /q ©,� - aQ I(� Expiration Date: Job Site Address: 7�� LC.�UI�� f 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 MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerli r the pains and penalties ofperjury that the information provided above is true and correct: Si ature: Date: ~ Phone 4: f 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#; Print Page Page 1 of 4 Print this page • Owner Information - Map/Block/Lot: 010/011/-Use Code: 1010 Owner Map/Block/Lot GIS MAPS COTTLE,EDMUND C JR& 010/011/ Owner Name as LORRAINE TRS Property Address of 1/1/15 7 CURLEW WAY 75 SANDALWOOD DRIVE COTUIT, MA. 02635 Co-Owner Name E & L COTTLE REALTY Village: Cotuit TRUST Town Sewer At Address: No GIS Zoning Value: RF • Assessed Values 2015 - Map/Block/Lot: 010/011/- Use Code: 1010 2015 Appraised Value 2015 Assessed Value Past Comparisons Building $ 119,800 $ 119,800 Year Total Assessed Value: Value Extra $ 25,300 $ 25,300 2014 - $ 262,700 Features: 2013 - $ 262,700 $ 3,200 $ 3 200 Outbuildings: 2012 - $ 245,5002011 - $ 246,000 Land Value: $ 114,400 $ 114,400 2010 - $ 245,500 2009 - $ 294,100 2008 - $ 305,900 2015 Totals $ 262,700 $ 262,700 2007 - $ 305,100 • Tax Information 2015 -Map/Block/Lot: 010/011/- Use Code: 1010 Taxes Cotuit FD Tax $ 583.19 (Residential) Community Preservation $ 73.29 Act Tax Town Tax(Residential) 2,443.11 Fiscal Year 2015 TAX RATES HERE $ 3,099.59 http://www.town.bamstable.ma.us/assessing/Printl 5.asp?ap=0&searchparce1=010011 4/13/2016 Print Page Page 2 of 4 • Sales History- Map/Block/Lot: 010/011/- Use Code: 1010 History: Owner: Sale Date Book/Page: Sale Price: COTTLE, EDMUND C JR& LORRAINE TRS 2013-12-20 27898/108 $1 BARRY, LORRAINE 1986-03-28 4987/87 $1 BARRY, MICHAEL L & LORRAINE 1981-11-06 3391/113 $0 • Photos 010/011/- Use Code: 1010 • Sketches -Map/Block/Lot: 010/011/-Use Code: 1010 PT y S�U say F1� � y As Built Cards:Click card#to view: Card. #1 • Constructions Details -Map/Block/Lot: 010/011/-Use Code: 1010 Building Details Land Building value $ 119,800 Bedrooms 3 Bedrooms USE CODE 1010 Replacement Cost $137,758 Bathrooms 2 Full Lot Size 0.57 (Acres) Model Residential Total Rooms 5 Rooms $ 114,400 http://www.town.barnstable.ma.us/assessing/print 15.asp?ap=0&searchparce1=010011 4/13/2016 Print Page Page 3 of 4 Appraised Value Style Cape Cod Heat Fuel Gas Assessed Value $ 4,400 Grade Average Heat Type Hot Air Year Built 1981 AC Type None Effective 13 Interior Carpet depreciation Floors Stories 11/2 Interior Drywall Stories Walls Living Area sq/ft 1,444 Exterior wood Shingle Walls Gross Area sq/ft 3,408 Roof Gable/Hip Structure Roof Cover Asph/F GIs/Cmp • Outbuildings & Extra Features -Map/Block/Lot: 010/011/-Use Code: 1010 Code Description Units/SQ ft Appraised Value Assessed Value BMT Basement- 1064 $ 21,300 $ 21,300 Unfinished PAT2 Patio-Good 520 $ 3,200 $ 3,200 FPL2 Fireplace 1.5 1 $ 4,000 $ 4,000 stories • Sketch Legend Property Sketch Legend 132N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area SOL Solarium (Finished) BMT Basement Area FUS Second Story Living Area SPE Pool Enclosure (Unfinished) (Finished) BRN Barn GAR Garage TQS ' Three Quarters Story (Finished) CAN Canopy GAZ Gazebo UAT Attic Area(Unfinished) CLP Loading Platform GRN Greenhouse UHS Half Story(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UST Utility Area(Unfinished) FCP Carport KEN Kennel UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility Attic' FHS Half Story(Finished) PRG Pergola UUS Full Upper 2nd Story (Unfinished) FOP Open or Screened in PRT Portico WDK Wood Deck Porch PTO Patio http://www.town.barnstable.ma.us/assessing/print l 5.asp?ap=0&searchparcel=01001 l 4/13/2016 Print Page Page 4 of 4 http://www.town.barnstable.ma.us/assessing/Printl 5.asp?ap=0&searchparcel=O 10011 4/13/2016 Client#: 586925 20CEANSIDEIN ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 04/04/2016 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. 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 CONTACT NAME: Dowling &0' Neil Insurance Ag PHONE,Ext:508 775-1620 I'ac,Ne: 5087781218 973 lyannough Rd, PO Box 1990 E-MAIL ADDRESS: Hyannis, MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# 508 775 162620 INSURER A:Arbella Insurance Company INSURED INSURER B Oceanside, Inc. 217 Thornton Drive INSURER C: Hyannis, MA 02601 INSURER D: 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 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. R TYPE OF INSURANCE ADDL SUER LT LTR INSR WVD POLICY NUMBER MMIPOLICY EFF POLICY EXP DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY 8500061423' 1/01/2016 01/01/2017 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrence) $100,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $5,000 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 $ JECT AUTOMOBILE LIABILITY (Ea accident)D SINGLE LIMIT $ 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 $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY YIN T RY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms, conditions, exclusions, other limitations and endorsements. Nothing contained in the certificate of insurance shall.be deemed to have altered, waived, or extended the coverage provided by the policy provisions. 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 s� ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S167993/M167992 LS1 ,aco CERTIFICATE OF LIABILITY INSURANCE FpATE(MM/DD"YYY) 1 03/30/2016 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. 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 CONTACT NAME: Linda Sullivan - DOWLING &O'NEIL INSURANCE AGENCY PH°NE , (508)775-1620 FAx A/C No E-MAA DRIESS: Isullivan@doins.com 973 IYANNOUGH RD. INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: - OCEANSIDE INC INSURERC: INSURER D: 217 THORNTON DRIVE INSURER E HYANNIS MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER: 41040 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 DL SUBR LTR TYPE OF INSURANCE POLICY NUMBER MM/DOffYYYY MM`DDfYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADEFI OCCUR DAMAG TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL 6 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION - PER OTH- AND EMPLOYERS'LIABILITY •YIN X I STATUTE I J ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A N/A NIA VWC10060198022016A 01/01/2016 01/01/2017 (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 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. f CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable - Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE C / Hyannis MA 02601 �—""/) L"Q Daniel M.Cry,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ��e arccrreaurura�t� C�/1a jw,1,ct,�n/t free of Consumer Affairs&Business Regulation e MEIMPROVEMENTCONTRACTOR Expire Type: $IS/2a1t Typo: OCEANSI.DE, INC, AJ. Supplement G STEVE TESSIER 217 Thornton Dr Hyannis,MA 02601 Undersecretary Massachusetts-Department of Public Safety Board of Building Regulations and'Standards Construction Supervisor k �frYI License: CS-055571 ` a STEVEN M TESSVkR 18 DEE BEE CIR M1DDLEB0RO I6YA Per Expiration Commissioner 09117/2016 License or registration valid for indtvidut use only before the expiration date. if found return to: office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 wd Boston,MA 02116 Not valid without signature i Mar 1516 10:23a E.C.Cottle Inc. 508-627-8025 p.1 From: si^eree.lscceansideine.com Subject: aulhorizalion form as discussed Date: February 22,2010 at 12:02 PM To: edrnund.eotlleCa)verizon.net Please find the attached document for your review and signing.As discussed,this document allows us to perform work on your home and bill the insurance company directly for the work,in the event it is being covered under an insurance claim. Please fill out the form completely,sign and return at your earliest convenience by fax 774.470-2211 or email. Sheree Lancaster Operations Manager 217 2fiornton Drive lzyannis 14a 02601 Ceff- 774-836-7061 Thone; 508-771-3110 ExG 774-470-2211 www.oceansideinc.com r Since 19 1 r ` /,�Frh.Usc omly^ I : gcjeafisidev it Jt)$NUMB T]t Restora *on ---------------- .i'17rc+►Mnn Urrct,Kgrtngie,!+trt�s.D?L01 5pF•;ri7-327U J10i1`i64 XW18 J-.MA,0e1)1,77"74.221.1 r4R ASSIGWONT AND AUTHORIZATION TO PAY �tt��:l=!i:-,i Ft., n: e_ed .1ter- nis E:ta-r sce ::c;l. yereb; as�ig.-is z ocearc:r<4o, znc:. amv I.tnnald procccdr, dui 'fi r-C 6cC-Irrie Y';.. 'x1cer tte rlai firlt'-5 zolick+ h tBL :rtSli:r1."tC+_ RECEIVE: NO. 2581 03/15/2016/TUE 11 : 40AM Oceanside Mar T51610:23a E.C.Cottle Inc. 508-627-8025 p.2 to pay direct t:_, Cocean.9ide, t.o :.1'1!;'Iude . ... nar.e 0r: a in ".he eve-it. t: ..uL :c2an-s4_a'e's c1,_-.,. 14rein °.s nct covered; by, a, paLd 137, art _f CikCl.=n 001-1;l8ny, ecialma .t GgXaar to pe j '%eansi4e, IU: .. wit-hin S::ft:y {Ec}; a3}'s eftol w �F: 'r.3t3 bee! I_�`arlr-:�tar3. '.a'.-.ar.: _:r7F,:rst.mnci, tiai Cor Lhr;:n iiad coait74'rq os -.ha ad-urter.. 1 i Yc:`,1T:<:a.C.tS '•�.'al::ll:Zt'� dua, ar; ��,i�`iab7.,e„ :.�4::.:' 1;}YL? .'.':<51:;:I:l:.. I.:as recej.vod pray/ ic-t f. X"or t.-Ic. iw-i nravice ahn-1 bia r a z one and In rr` =vea: ` :at 7h!tT7` is U'` .a ;f; ti'±,1 _^r_ a aimznf. ai_ ary "ordf'1.jc:-Ls •�� th— agree enr., Dcc-af.urld_::, Inc. c; :. E7ti. r•.fP;:.lrra ;c, a 4aC._ii^.CLd 1 RL2ly!:Jr &t*.:°,,Yv,'_jy'1 any ather .G....-.-..•' 4 E': ;..r�Xi'.4t'.!.y rr,-'aso .i'ble and $-1tr"Lu',abIq c aalld hroeh.rh< wr p ayramnt I.$ rot. *''ou!ivekj within ro" -dayS. i r.•�.:`; .f s.r.:=;c: r_;)::ia to the _5 MAILMG .AMMSS (RtLLING) CITY STATZ ZTP S .rt:0. l':e:F., INSUPAK az AGEN''y NAM.-_ w`QkTe'F3t/P 'L 1. r.�l£xtva:z.r, S S tw 11241 RECEIVE: NO. 2581 03/15/2016/TUE 11 :40AM Oceanside - � � I � �'. k V f P �' 1 �_ Town of Barnstable Regulatory Services 'ns M Richard V. Scali, Director F s6;q. Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 � z NOTICE TO THE BUILDING DIVISION OF WITHDRAWAL;`OF . 'f LICENSED CONSTRUCTION SUPERVISOR FROM PROJECTou --- c.ra Construction Supervisor-License # 0507�95 , hereby certify that I am no longer the Construction Supervisor listed on the application for the project under construction as authorized by building permit # Rj- i(o 9 q , issued to (property address) 75 S6l N D A 0X0jD C o 1'u i f- on / 5D , 201 . I also certify that on _ J , 201 `� , I notified the property owner,that the project under construction must cease until a successor licensed Construction Supervisor, is submitted on the'records of the'Building Division. q� /9 LICENSE HOLDER' DATE q/forms/newcontr reference R-5 780 CMR rev:07/18/16 4 Town of Barnstable }{RECEIPT " 200 Main Street,Hyannis MA 02601 508-862-4038 1674 Application for Building Permit Application No: B-16-941 Date Recieved: 4/15/2016. Job Location: 75 SANDALWOOD DRIVE,COTUIT Permit For: Alteration INTERIOR Work Only-Residential Contractor's Name: OCEANSIDE, INC. State Lic. No: 100121 Address: 217 Thornton Dr, Hyannis, MA 02601 Applicant Phone: (Home)Owner's Name: COTTLE,EDMUND C JR&LORRAINE Phone. TRS (Home)Owner's Address.: 7 CURLEW WAY, COTUIT,MA 02635" Work Description: remove&replace water damaged drywall&insulation in walls&ceiling Total Value Of Work To Be Performed: $35,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area r I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept . coverage. I hereby certify that I am the owner of the property which,is the subject of this application or the authorized agent of the property owner and have been authorized to make this application: I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: OCEANSIDE,INC. 4/15/2016 - Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost: $35,000.00 Date Paid Amount Paid Check#or CC#� Pay Type Total Permit Fee: $228.50 � 4/21/2016^ $229.50' ^13200 Check Total Permit Fee Paid: $228.50 E THIS IS NOT A`PERMIT '� ' '� Town of Barnstable Building aAaNSeai a Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted MAS& $ Until Final Inspection Has Been Made. Permit h�o►�e.+• Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit NO. B-16-941 Applicant Name: OCEANSIDE,INC. Map/Lot: 010-011 Date Issued: 04/27/2016 Current Use: Zoning District: RF. Permit Type: Alteration INTERIOR Work Only-.Residential Expiration Date: 10/27/2016 Contractor Name: OCEANSIDE,INC. Location: 75SANDALWOOD DRIVE,COTUIT Est. Project Cost: $35,000.00 Contractor License: 100121 Owner on Record: COTTLE,EDMUND C JR&LORRAINE TRS Permit Fee: $228.50 Address: 7 CURLEW WAY Fee Paid: $228.50 COTUIT,MA 0.2635 Date: 4/27/2016 Description: remove&replace water damaged drywall&insulation in walls&ceiling- Project Review Req : :,1Z'0, Building Official. 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. t 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 work until the completion of the same. 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: 1.Foundation or Footing 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGl c.142A). Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT' f t. t' r Asses is map and tot number ®: .:��J(:. :....... yO*THE Sewage Permit number .` /. .:,,?� .......... MUST BEgric vs, House number ... :. .2 s.....::..........A1,.. E� 11� ® pL�� 9 Baaa�Ta Le ; ..... : ` INCT yV�T4 'f�'��E.S oho�av a� TOWN - OF --BARNS � T P 4 yd, BUILDING 11'MS'PECT0R' w� APPLICATION FOR PERMIT TO �-� ������ ....7� .�� fir'' A TYPE OF CONSTRUCTION Ti -.. ............. .......... ..... ................................................19........ TO THE INSPECTOR .OF BUILDINQS: The undersigned hereby applies for a permit 'according to the following information: Location ......... . .....��.�:.......................�...... ......... ........ :.......:. ProposedUse .. ............... ...................................................................... Zoning District .. . .: ................. ..... ..........Fire District ....1 ?' :v......T.............................................. Name.of Owner ...M.cc A �- �. ..... ....Address L"CS C�crw ..... ?�.A.T.......... r Nameof Builder .........., .¢ ............................Address .......................................................... .......... Nameof Architect .................................................. ..Address ............. , .............................:........................ ......... Number of Rooms Foundation P��rC..... .................. . ,.p........................ .. . ...... ... . .................. Exterior Ce.eJhk, ......�ff(aoF, t'.5 .Roofing ....It.T.. Lr��....�J�l�l.�r��.1............ Floors .................... ..........................................................Interior ..... . ! ................................ f Heating LPL D...N.V. �. .IT� . .. C- .Plumbing ........ ........ .. ........................... tt Fireplace :.............: ....1.........,...... ...,:..., ....:.. ..................Approximate Cost ........ ......�Gl�...V.............. ......... ............. . Definitive Plan Approved by Planning Board __ ____________________________19 ______. Area .......Al..... ...........� ....' Diagram of Lot and Building with Dimensions g Fee . ............... SUBJECT TO APPROVAL OF BOARD OF HEALTH k—) I hereby agree to conform to oil the Rules and Regulations of the Town of Barnstable,regarding the above construction. Name ! . ...... .%..... BARRY, MICHAEL L. v. f t • 23352 One 1/2 Story x No ................. Permit for ................. Single Family Dwelling............... Locdtion ..Lot . ...... 3 7.r�....Sandlewood Dr. .. .... .. .. .. . ............... r Cotui.t F Owner Mic ael..L....BarrX: ......... Type of Construction .,,Frame ..........y..�. .`./.......................... ... .i. ................ Plot .....J Lot ................................ - _ August10 v .� .. 19 81 Permit Granted ........................ . f 4,1 ' Date of InS e i �I"'91 19 Date Completed .......................................19 - j - r,• % 4 i rfD � �.h• l�i.�. ej 11 PERMIT REFUSED Z ,» . J .... ` #`+.• �i ... ...�.. .``!�......... r .E � � Z. ................. ' ry ell "� X•` /Z +. Approved .........................................�.... 19 _ r� rs` �- M N . _ fl"+ ��P ,:w"4nnrn4.n ..,,.�.s..,..a...�;• � �.w' 1 2. iYt t .,�V 4 •. �� ri, M it - i= '. , a .. �1� yI�OO�i -sue Y'...{" t � - '• S- M �' � L{�0t�� w'J •�` QJC fl ;•t t«, af' a �e45, r#� r x " Oat '�Z �,sa.s _w..w K ik, �' •.` s r "Xa..s� --4,r- '+c _,^ 1 '{s. .,c � 1 40. ~a �,,; ism. � a.-T � •a"x. 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'' � r �- •.mL y � �a -�.rv,..:s�'� - �+zfa��+s�`�u CC � �.. .'_ s ,,,�y ��yE.� rt• �y'�~c���.,� ¢j ,: 5 d.. �..r:a.,_���J: h� JgsJ 41 WALTER�k OLD *�YY...Y �"R,F-ai .- .a�'4.y'`� � "k"{'/���i4 ��ii! �,q�� a - ";•°"x` :: �, Q' "�"�ru�J ' --i ,f k- i+ N',�. * - .. -f MA �'°'+.y�� -.t ,�y,, •� '� � •n,� x � �'` x• qtt £ �Li�3,r*s�.�.w.� �- �' n �-,yy `�s..7 f it it f -0i�>� mow. �• ..-• n � v; jx''� } � z,.e� aa. .r� � tc 3t�¢ "�, -�i^ 4w €t,*3 jx a �+a"€�' °��`y�- ' m :`e-., r+'r, '14.E,xr.;�} z,.':?`i. � +.t ,.� � ms:`�,4 7't "mac �*�� � ��� * `•rl� -'u��`""�i�, a r`3*" TOWN OF BARNSTABLE Permit No. Building Inspector cash _.-------------- /Y9 1639 ",,. OCCUPANCY PERMIT Bond Issued to 1 Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ......................................................1 19....._._ .................._.............................................................................................. Building Inspector v ,4;,,;b v,rwx+ ��P� �•.ew TOWN OF BARNSTABLE BUILDING DEPARTMENT i seaaer : TOWN OFFICE BUILDING rua �ajr i639• �� HYANNIS, MASS. 02601 �d tlAY M. It MEMO TO: Town Clerk FROM: Building Department DATE: . An Occupancy, Permit has been issued` for 'the buildingauthorized,.by . . . -°� Y . Y Building Permit w..._ _ S w.. ........ ...... .. issued to /Ci!ry' ,L L .... �!% n� ;1 Please release .the performance bond. 4 PAUL PETERS AGENCY, INC. _qni btanza wur AT THE PLAZA FALMOUTH, MASSACHUSETTS 02541-0669 TELEPHONE 548-2500 June 25 , 1985 "OV'71 OF BAIRNSTARE ' r;"I"crirg, S2,;# N N 2 6 985 Town of Barnstable Engineering Section 367 Main St. Hyannis, MA 02601 RE: Street Bond #423911 Michael Barry Lot 3, Sandalwood Dr. , Cotuit, MA Gentlemen: We understand that this Street Bond should be cancelled. However, we will need your release before we can cancel the same. Please comply and forward to our agency in the enclos- ed envelope. Sincerely, PAUL PETERS AGENCY, INC. pox Donna L. Bennett �iLQKRZ� �s jOr C/'�AUtt"f WLWig «— New Hampshire Insurance Companies a.e- x BOND RELEASE' FIDELITY .& SURETY DEPT. 4 June....25,...............19..$5... BondNo. ....................23911.................... . The ......... New...Ham. shire Insurance Co. a corporation organized and existing under the lawsof the .. ..... ......................................................... state of ..New Hampshire having executed its certain bond, effecti've.... July 31, lq 81 In the sum of ........ .. � Five Hundred Sixt and o0 100 Dollars ($....560 .00 .............................................. ................... ... on behalf of..........Michael...Barr................................................................................................... .................................. (Principal) in favor of ......Town .of Cotilit, MA .. .....................................................................................................................,................................... (Obligee) ' is hereby released from any and all liability under such bond arising from any acts or omissions of the said Michae.l...Barry.......................... ................................................................................................ (Principal) occurring after the............. day of.................................................. 19 ............ Witness our hand and seal this................. day of ...................................................19 .............. ...................................................................................... (Name of Obligee) By ................................................................................ ................................................................................................ ...................................................................................... Witness (Official Title) Stateof................................................................................ Countyof............................................................................. Before me this.............. day of............................................. 19........ personally appeared .................................................................... .......................:....who acknowledged the foregoing to be.....................free act and deed. ....................................................................................................................... Notary Public p My Commission Expires.......................................................19......... FS 4210 Rev. 8/73 __ `mac,.. .,ur"w5%..Lr,_..y.Ct;,°;ra, 'L':isw.^.u`t : "XA6. Yi901d~.` ':;?li...;`"•e�'m" momsa�vwr�' :`a' S1tiu"diY' Alum' ar'L4t yyr. No"=Hampshire insurance G Manchester, New Hampshire 03105 sni T KkMIT BOND i KNOW ALL MEN BY THESE PRESENTS, That we,. Mi�dhael Barry, . Box 1412� Cotuit,. Mass 02635 — Mailing Address; 159 Edgewater Driven- E. Fa]�mouth as Principal, and New Hampshire. Insurance Compaq* as Surety, are holden and stand firmly bound and obliged unto the Town -of . i► ` of Cotuit, Massa in the Commonwealth of Massachusetts, as obligee, in the full and just sum of Five Hundred. Si � OQ/.100 ` Dollars, ($ 560.00 ) ` Irdl money of tE�e United States pf America, 'well and truly to be paid and for the, p@yment'of which we jointly•and sssd►er�tse l end,oyrselves, our heirs, executors, admlB!s,_' -trdtors, successors and assigns, firmlyby presents: THE CONDITION OF THIS OBLICA 'ION $ UCR iY'HAT, WHEREAS, the above named Obligee has A;sit'd or is about to issue, or may from time to time hereafter. issue to the said principal a certain license or permit or certain licenses or permits for the use of streets and public ways of the said Obligee, (Lot 3, Sandel WOOd I}rit NOW, THEREFORE, if the said Principal shall faithfully% observe and keep each and all of the agreements, stipulations, conditions, specifications and provisions by the said Principal to--be kept and performed, contained in Mist>i•'licenses and/or permits issued to the said" Principal and in each and every extension of:same, according to the full extent and spirit of said licenses and/or permits and the ordithi ices_gf the said Obligee now relating, or., - 14 may relate thAreta and shall indemnify'end: save harmless the said Obligee from all ,'f l 'Ities, loss and expense whatsoever wh' he said Obligee may incur and suffer_ . arl Ing'out of the issuance of such licenses am/ permits and all extensions of the same• . and shall make no default therein; then this oblk tion shall be null and void; otherwise if shad be.and remain in full force and effect IN WITNESS WHEREOF, we hereunto set out hands and seals this 3lst day of July 19 81, G N ~/ ��✓ • R N PA L k a f New: H&npshire Insurance Company x?+ Y Shorn � Har A TTORNF_'Y-IN-FA CT , �r FS 4454 10/74 Mumbe("ul Amur a:an Irn,a rralion,al Group ' f , h PAUL PETERS AGENCY, INC. j _qn1uzan z AT THE PLAZA FALMOUTH, MASSACHUSETTS 02541-0669 TELEPHONE 548-2500 October 10, 1985 Maw 0 Eo§s 1 a L,ati4d4�/.3�C Town of Barnstable L OCT 5 5 Engineering Section , 367 Main StreetS^� Hyannis, MA 02601 Re : Street Bond #423911, Michael Barry Lot 3, Sandalwood Dr. , Cotuit, MA Gentlemen: Enclosed is -a copy of our second letter sent to you on July 19, 1985 , requesting that you complete the enclosed Bond " Release form .and forward it- to our agency. We have still not received this form, and cannot cancel the bond without it. I have enclosed another copy of the Bond Release .form, for you to complete. Please forward this to our agency upon completion. If you have any questions, please contact our agency. Thank you. Sincerely, PAUL PETERS AGENCY, INC. Donna L. Bennett Encs. 7/W 4 jot =JHjMt6Klj Wjd U.4 a New Hampshire nsurance Companies BOND RELEASE FIDELITY A SURETY DEPT.� Bond No. ...,,4.2..3.9.1.1 ...June 2 5 ,......•......,,19..8 5... New Ham shire Insurance Co. The ....................}?......................................................., a corporation croonized and existing under the lows of the New Ham shire Jul 31, to 81 state of ......................�..........................., having executed its certain bond, effective.............X...... ...... v Sixt .... Dollars ($....560 .00 i n the sum of .....Fi...........e..........Hundred............................X.........and.....o0..... 100. onbehalf of.......... j' chael Barr'........................................._. ....................................................................................... (Principal) in favor of ......Ton...o Cot. ...u.it. .,.... ........................................................................................................................ ........w... ......f........ .. .. .. . ...... (Obligee) ' is hereby released from any and all liability under such bond arising from any acts or omissions of the said .................Michael Barry........................... ............ ................................................................ ...................................... (Principal) occurring after the............. day of .................................................. 19 ............ Witness our hand and seal this................. day Of...................................................19 .............. ..............................................................................:....... (Name of Obligee) By ................................................................................ ........................................:........................................:.............. ...................................................................................... \\'itnns (Official Title) Stateof................................................................................ t Countyof.............................................................................s Before me this.............. day of............................................. 19........ personally appeared .................................................................... ............................who acknowledged the foregoing to be.....................free act and deed. ...................................................................................................................... Notary Public My Commission Expires......................................................19......... FS 4210 Rev. 8173 PAUL PETERS AGENCY, INC. ((//��]]yy�� }Q/L y� e.... ►cut ! �JIL3��Lii(r ...bj•..• AT THE PLAZA FALMOUTH, MASSACHUSETTS 02541-0669 TELEPHONE 548-2500 July 19 , 1985 Town of Barnstable Engineering Section 367 Main Street I Hyannis , MA 02601 RE: Street Bond #423911, Michael Barry Lot 3 , Sandalwood Dr. , Cotuit, MA Gentlemen: Enclosed is a copy of a letter sent to you on June 25 , 1985, requesting that you complete the enclosed Bond Release Form and forward it to our agency. We have not yet received the form, and cannot cancel the Bond without it. We would appreciate it if you would comply, and forward it to our agency. as soon as possible. If you should have any questions on this matter, please do. not hesitate to contact our agency. Thank you. Sincerely, PAUL PETERS AGENCY, INC. Donna L. Bennett Enc. )i ajs jOt C—/' tAlttLitf W6� UA FROM Ms: Donna L. Bennett BUILDING DEPARTMENT Paul Peters Agency, Inc.At The Plaza 367 MAIN STREET HYANNIS, MA 02601 Falmouth, MA 02541-0669 Phone-775-1120 L . SUBJECT: Michael harry/Street Bond #423911 FOLD HERE. - DATE - November 13 198 MESSAGE The occupancy permit for the dwelling located at lot #3, 75 Sandlewood Drive, Cotuit was issued on November 1, 1985. The Bond could not-be released until the occupancy permit was issued. Enclosed please find the Bond submitted to this office. SIGNED J e h DaLuz, Bld oimissioner DATE REPLY SIGNED Ne7•""" .RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY SENDER:SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. Assessors map and lot 'number ..............`.. r Sewage Permit number} ....`.�. I�,//.,�.��..��.,.....�.� ............. li BARNSTLUE, i House number ............{.......�. ..................4!..L............ 9°o MAOq,ems 1e 0� �E0 MA"a. TOWN OF BARNSTABLE . s. BUILDING INSPECTOR ��L.� f ZaI rh i c i cv r APPLICATION FOR PERMIT TO .��.....................................��.......�... .............� .� G�.0 TYPEOF CON$TRUCTION ..........E//6!? �— .......................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned- hereby applies for a permit according to the following information: Location :a......✓........ � ✓....r�r..........t......G�............ �'.�:. .....(.,��.�C/.� ..1.................................................... ProposedUse ...... . ., '..........................................................I......................... ZoningDistrict ....... ...,... ..................................................Fire District .....( .............................................. Name of Owner ...K it.f{1�1�.... t ... ����7.............Address! �!�✓�C�,Cc� 4�1�� �G I� t 'T Nameof Builder .............................Address ............................................. ................................... Nameof Architect ..................................................................Address ..............,...................................................................... Numberof Rooms ..................................................................Foundation .................................... Exterior C f' {3;�.... ..�((),�;.,1-A; 5; ................................Roofing .... (. } Floors ............................... . ....................................................Interior ........... ..................................................................... Heating ? .y..(1.... , ...l x. ....V9�j�...�Jt,�................Plumbing .................................................................................. Fireplace ....................................................................... ......Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH a i I hereby agree to conform to oil the Rules and Regulations of the Town of Barnstable regarding the above construction. AIAName yr . ,.............rr•! �''. J�:% •Y;. ••ya• /�......... . -.--_____~ 23352 ` No -----.. Permit for ..O�e—l��—St��v � ' ' Single ' le...F.aouily. ..Duxm.1J.i.ng.............. ' ' Lot vvm .� Drive Location ---.--�3---75--Sao�l�——_— —..����—Dzi—.. Cotoit ---..----------------.-----..' .^ ' D�io]zae . L. Owner ------,,�---...��.�.�'�--..�^--.. _ � .� � Frame Type of Construction ........................................... ----------.---------,------ � ' Plot ............................ Lot ................................ ' . - Permit G,onuaJ ......A14.9qP.t:...1.0..--.]9 81 � . Date of Inspection ------------lA � Dote Completed ...................................... - PERMIT REFUSED . ` ---.. —. lA ���'���4� ����������� n~ ---..�/a./a.�—.m�:vx .��--��.�^m ............ � --------^----^~^—~—'-------- ' --------.—.-------.~—..-----.. =` ' Approved � ---------------- lg < -------------^------^^—^---^ � -------'--.----------.....--- | ' ' 7 � , 41,a G ky 3 ail`'1 ,4 r/ C 6 0 0 I w gdQ rVM O_L oo fSr'� ® �N/Gii s q � , N 4 A/o V 1 O�Dv l� �, v� V�e� rah �r�` if a 1 ll� M H 4 v i n S: 17 5 el, 1. rr SYSTEM STEM PROFILEALL SYSTEM COMPONENTS SHALL BE MARKED WITH MAGNETIC TAPE OR NOTES (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. PROVIDE MIN. 20" DIAM. WATERTIGHT . PRECAST H-20 1. DATUM IS ASSUMED o ACCESS COVERS TO WITHIN 6" OF FIN. GRADE PRECAST H-20 RISER TO GRADE RISER TO GRADE 2" PEASTONE OR GEOTEXTILE \ 2. MUNICIPAL WATER IS EXISTING TOP FOUND. EL. 39.1' FILTER FABRIC OVER STONE ~ 36.5' MINIMUM .75' OF COVE '_ 3. MINIM "R OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 37 38 UM PIPE PITCH TO BE,1/8 PER FOOT. PRECAST H-10 NOTE: 2" MIN. WALL 4. DESIGN THICKNESS REQUIRED BLOCKS OR LOADING FOR ALL PROPOSED PRECAST .: RISERS (TYP.} p 2'0 PRECAST RISERS UNITS TO BE AASHO H-2.Q. (H-10 TANK �s 4"�SCH40 PVC MORTAR ALL._ H-4,0 ) `m .ocus p 6" MIN. SUMP PIPES LEVEL 1 ST 2' COMPONENTS i �..:•: 12" MIN. INT. DIM 4' (TYP. 34••Q 4' 5. PIPE JOINTS TO BE MADE WATERTIGHT. a �*35.58' ENDS DES 35.0'" 1500 GAL H-10 " ' ;0000.. '; °°°°°° _° CONSTRUCTION DETAILS TO BE IN ACCORDANCE 6. . . 35.12' TEE SEPTIC TANK TEE fl 34.$7' ° ° ®®�� ®® ® ®l��� -�I®®® ° ° ° ° WITH 310 GMR 15.000 (TITLE 5. °o°o°o WATERTEST D'BOX ;°o°°o°°0°°0� ®®® I��® ® � ® ®.®�.�® s°o°o°°o°°o ) Sc boo/ GAS BAFFLE..: �4o°°oi°a°O°o°o°° FOR LEVELNESS >$°o°�°�° ®�® ®EnE ®m® P� ®®�� i°o°o°o°o °o°g°o° 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND St. •°g°nag ®®®�®®®�®�� ®® ®®IRm NOT TO BE USED FOR LOT LINECOtuLt STAKING OR ANY 34.36' 34.19' °°°°° >° °°°°°°°° 32.0' OTHER PURPOSE. z.: 4 LIQ. LEVEL (ACME OR EQUAL) °°°0°°°° d °goo°goo �� ' � � Ba o y )oaaaaa°a°aao°a°o°000000a°a°oaaaaaa°aaaoc000c, _ 1� 0o0000000000a0000000000 L 8. PIPE FOR SEPTIC SYSTEM ^° ° ° ° ° ° ° ° ° ° ° ° ° ° ° ° °^° ° ° ° ° H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. TO SCH. 40-4 PVC. ,o^o^o_�.°„n.n,n q o 0 o a ^.^_^_ _n_n.o 0 3/4"-1-1/2' DOUBLE WASHED. STONE 4' MIN. . (5) UNITS REQUIRED ALL AROUND PRECAST STRUCTURES 9. COMPONENTS NOT TO BE BACKFILLED OR 6" CRUSHED STONE OR MECHANICAL OVERALL DIMENSIONS TO OUTSIDE OF STONE: 50.50' X 12.83' CONCEALED WITHOUT INSPECTION BY BOARD OF She// 6i�ff t- --- COMPACTION. (15.221 [21) ,n HEALTH AND PERMISSION OBTAINED FROM BOARD OF HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR 2 VERIFYING IGSAFE (1-888-344-7233) AND ( % SLOPE MIN.) ( 1 SLOPE) 1 24.5' BOTTOM TH-1 THE LOCATION OF ALL UNDERGROUND & ( % SLOPE) NO GROUNDWATER FOUND OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. LOCUS MAP FOUNDATION 23' SEPTIC TANK 51' D' BOX 21 ' LEACHING . FACILITY 11. ANY UNSUITABLE MATERIAL ENCOUNTERED NOT TO SCALE SHALL BE REMOVED 5' BENEATH AND AROUND THE *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL PROPOSED LEACHING FACILITY. UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS AN ASSESSORS MAP 35 PARCEL 61 EXISTING LEACHING FACILITY SHALL BE PUMPED � J� I PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM AND REMOVED OR PUMPED.AND FILLED WITH CLEAN A-p ZoNe C 1,wr^ �1JE� i=ssvgr+��. zonl,E. L E G E! V D ' *PLUMBING TO BE RE-ROUTED AND CONNECTED TO SAND. (MX�ST. C wx� EXIT ONE LOCATION AS SHOWN, INSTALLER TO 99- EXISTING CONTOUR CONFIRM FEASIBILITY PRIOR TO INSTALLING ANY ZONING SUMMARY PORTION OF SEPTIC SYSTEM X 99.1 EXIST. SPOT ELEV. "NICKERSON DRIVE" ZONING DISTRICT: RF RESIDENTIAL DISTRICT -L99]---- PROPOSED CONTOUR _. -"_ �' SYSTEM STEIYI DESIGN. 198.41 PROPOSED sPor EL. � - EXISTING 12' ROW TO MAIN STREET � _ MIN. LOT SIZE 43,560 S.F. TH1 _____ _____ -,---- "--- -- -- \ GARBAGE DISPOSER IS NOT ALLOWED MIN. LOT FRONTAGE 150' - -S87°18 QO W / - MIN. FRONT SETBACK 30' rEsr HOLE 118.00' ��' / / MIN. SIDE SETBACK 15' EXISTING 6 BEDROOM DWELLING MIN, REAR SETBACK 15' ?� SLOPE OF GROUND ,�, 1 , DESIGN FLOW: 6 BEDROOMS @ 110 GPD _ 660 GPD MAX. BUILDING HEIGHT 30, I GRAVEL 0 / USE A 660 GPD DESIGN FLOW UTILITY POLE DRIVE ° PROP. VENT WITH CHARCOAL FILTER FIRE HYDRANT AND BUGSCREEN (FINAL PLACEMENT BY 24.51 �` r. CONTRACTOR WITH HOMEOWNER I SEPTIC IC TANK: 660 GPD (2) = 1320 NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING CONSULTATION) ~� USE A 1500 GAL. SEPTIC TANK 100, 3d' " LEACHING: TEST HOLE LOGS N (0 o SIDES: 2 50.5 3 2 (.74)+ 12.8 187 GPD p N BOTTOM 50.5 x 12.83 (.74) = 479 GPD ENGINEER: CRAIG J. FERRARI, SE #13871 - x TOTAL: 901 S.F. 667 GPD DAVID W. STANTON RS BENCHMARK: Q � �,, WITNESS: EXISTIN PORCH L DECKS �,�o - USE (5) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) DATE: Cn 8/5/2016 -- CONCRETE BOUND - ELEVATION =34.6 TO BE �' x WITH 4' STONE ALL AROUND PERC. RATE _ < 2 MIN/INCH TH1 REMOVED 0o TH2 CLASS I SOILS P# 151 16 4, EXISTING _ _ _( P� c) 41 DWELLING `, c.,.w x ELEV. 2 ELEV. Q o ` O TOF = 39.1 27.6' fl,$ 36' 0�, 36.5' m p j APPROVED DATE BOARD OF HEALTH MA A q O j j x LS LS �ti ,� 70 28.7' 10YR 3/1 10YR 3/1 38.1 12,E 12.9 SLAB x B B „p J , PROPosEp TITLE` 5 SITE PLAN LS LS PATIO 10YR 6/6 10YR 6/6 �' PROPOSED PROPOSEDOF 29" 33.6' 2490 34.5' I s DECK �$6 3� PORCH #30 NICKERSON DRIVE W 411 COTUIT, MA C C - PERC ----- PREPARED FOR M5 MS EXISTING 12' ROW TO MAIN STREET N86°46'52"E (wv- JOHN MCCORMACK 118.00' no�M S 10YR 7/4 10YR 7 4 ate' DANI L 1 . / DANIEL A. � / Ts� DATE: OCTOBER 18, 2016 o O,ALAL_f1 u" off 508-362-4541 CIVIL a � No.46502 o No.409 0 , fox 508-362-9880 fop \o�� I downcape.com 138" 24.5` 132" 25.5' �sS/oNAL �G` sllR,t�� down cape engineering, Inc. engineers' N0 GROUNDWATER ENCOUNTERED Scclle: 1"= 20' � ,. ] �` civil 0-v6 Ac) - r land surveyors 939 Main Street ( R to 6A) DCE # ' -29 0 1.0 20 30 40 50 FEET DATE DARIIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 16-249 To Thomas Ribaga 20 Eastwood I»ane Cotuit,Mass* Speed Letter^ From Subject.House Lot 3 ,SaddXewood Rd.Cotuit >No.9&10roi,0 MESSAGE Gentlemen: TOWN OF BARNSTABLE The house bn Lot #3 SadXewood Rd.Cotuit,was completed and ready for occapancy on August 30,1977. REPLY -No.9 FOLD -No.10 FOLD Wilson Jones Company SRAYUNE FO^M U 9-FART c ifi7e*PRmr£DiHUM / Date 7/18/80 Signed' Date Signed SENDER—DETACH AND RETAIN YELLOW COPY.SEND WHITE AND PINK COPIES WITH CARBON INTACT.