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0611 SANTUIT ROAD
r.IrnIToF � "�i l.�/, WORK• I � � _ _ .1 : r t�,�� C�-�C-t� (�i4'�'!p �� �� , � .' -'�11�t. t-O`�`/�-R{FI..Q�t• �� � � � � "' � t.a ��� x.e�d: ' �IVLa x''�7r ';,' �� .� � t � +S 1 �i•� �r a[:E( •ra "e„ �; ;y 4� ��nt qpp- ell R /_�i�•_' �T. ��' I {{fOF 4,p , �Ji�.�11ON1 �'�{ ale,,`'ftt .. ! � •iY. ..1 }� L ._ i.� ��I(� a TV _•"�! :. 41 �r ' N\ `'V�� a ryry' [ i .•t �suµ�+1 sf}}�}, � � k • �' &,r t. 1iltjils 44&1'L'' I�p — z- No 11bo vat AOL {' ' `Pam`,1,�.P-7- I 'TAI;4106M~ go,1�- . 1 �1= 'EFTy L1H.r.- � :A.fiii �/ ToF�brl?�Pi{"� '�`•�i FC�'•Y�l� ?�'G � � ►�'�•'J ""i'�p_R � � � p` S"T�u•'=T101�7u12��o e' Tv ge wrw ;i. Pa,4NKc e i nyoi 5"TS ' �� WORK P.t _ ---�, LING17 J -'�I•I P'ti L/4, r ZOOM � �.:.4 t5#,H-rtAlT RCaA� oo-7 I � ==oTU!'S' _hl`,aSs•. - 611 SgNrv�r�a .. �-.•�t vet. -3'on� �. �I ref-r-M I T r ec e- 00.5 'IIn11 ' W �.._. "CAN kiNIN�Q i' -\A(kJy 1, � :, 3?r�l:rn�:! �•�rl,,ltd,-.... �....i ���� S/�•�/Tu/T jrdn wirra e7j Ji�+ M •.r�,�: nw�e /YO C/S��e�t/G E /ic! QR/6/Ne9L .. 77 -. d- ` ��vL.r J'T/1..4.d dPA-G✓�tl G� �G POoQ/ClJ -11V-- � �o-si ' u°'' ; %2.aic.. /S/�/GNT ���0 J�,tJa TUBE✓ 0.41 Ta GaNFO/t-AZ TO C of '° $CJ I f- /AJG G cb b4—C e �/OIS 1 �4yn-9GY✓ to �c 1t-JG j�✓t�h (v'��/�Cr dG✓C yl SPAc� �G\vcah 1 ) ..... ._....._. .36 i i O In - i 2 2'Y r f .�xlD 0 w CIQ qx q1 A� A rj - � All 9 -�/ r / ��/�E.fd cr2tZE wood /�1rov5Ko✓t 1I` COMMUNITY ENTERPRISES Estimate 19 CAMP ST. _ HYANNIS, MA. 02601 j DATE ESTIMATE 1-508-778-9300 2,9.!00 ( 12 NAME /ADDRESS Al Henn 611 Santuit Rd. Cotuit i PROJECT DESCRIPTION i TOTAL Removal of existing deck. To be replaced with deck of exact same 45200.00 dimensions. y I i � I I I I I I I I i i I j I ( i I i ( i i I i I I i I i I I I I I I i i I VIAL j $4,200.00 � ' L TOT 3! II .SAN TUIr KOA D Kay : ._.._...._. _ �. _. ._...... ._ Cord r, MA ozc3s" 6t Cl r-LOWC FGACC W1TN T M494f AT $Alf i (a�.Sc.o�co�ilD �✓ 0t<N FENtE �2G�►rE'.t� 10 C.e 4 - 5rK. SET ^ 1 CID I GAI?AG� + L sA�rN1A�.sr: _ I - srF-Ps eET WING WALL AI ew,oy EL4 EL all ID r� c O L i,1.1 10 I<ErAftJlwh WALL 4.0 POST5 6:a.1 1 _ • 2 � �t. L o�oo \ STK. 5 E T (Fr,a) • . !g 20 $I S4 !i Ai j M-��-�• 1, .67AC. I 1l .67".A. /OO , �� I 8i .L7ie .bT.wa I'. MAP OF v cr-f o 611 V4N7��7 2D ---- -� g •Are N� �j 19 81 o -I 1. L o 1 q-! DR, C'. OU f o.� � 6!AC. 2. LOT PAPA✓ (PAPA 7A4jJAJ*10 0 16 30 j 8 .63 AC. ' P A I A Y O I 3'. L o r ^ 17 °o ^ . 10 .A6 AC• 16 !!AC. ' .93AC• p � /y 4 O �y - jp y,-' r� •' `p ono J` P 270-$ O 6� 200-S I91-> q ,� 64 ® A 13 , 2 3 � ^-�°� � ,wrilfo�28 ri4 i /.42AC. .SSAC, .93 A6• e v � Al REV. BY AV/S /970 ll 60 200 ropo"ESSEti nw ORIGINAL ISSUE: /968 , 7-1 r•an -- i AUtO Nef TAv.Y hA.y Out ( SCALE 1"•100' ♦ 20 t 6 16 7 \ III C �a °D 611 q 1.1T��T �Z. 1^ o a m C� Z F^ CIS J\ c o �� •J ri - Oo \ F- J U 11 W O r sh �,pve Q a 'i:, 1�a` 0`0 !Sd Pin9uticks t L j= ool ulk Gµer `^/ c ,J y � ,g ` — -- —CZ - �' 7saoy / ° `. `� j��c: ` s"•,O, �Pucis od x �,� °s =:1 `S o a a ,Lam`` - \' C —_ 1'i•b J rka� o cto�y f__,// o O `u •o_ � ( 1\`(i' �fL v�'i. �. •.�•�a--•" �� �o ��'�� � I'•�`�'�.,�' MASHP �_ NECK •� ` �� rn � 'n o, \i` -�- f [J '� I . '� ''•�'•:�.. , i',=;���� �U. '� .< L o �yJ u_.° 5 , o�_R✓' 4' K .(. L , ,tl r _ ' ).`...` ��}� __ JFF+�=_J�lv� I _ ,'o OA � �YI ��� �� �J � � �,tO --.(O-- -- --- --, o �1 �ti'`��i�/ �•_.--7/� I 'T 2 ag fY. o o // ° O � � � ===i •II 1� V a FL. �..J O �• T1 � /r I`�'��• ,1�� /.�:.-< T OOA 0 0 �ni0 _ =,a II o 0 ° o vm� .o °� •moo � no •"°' � � �" oa o 0 o Qo � n \,`, J�- To M,i•1,�tJ, ILIMITOF � � Tif}s fYz -ro ea �A•Tlo -t'wn ter. ITT WAU__ I � , TO 'r1,+ — -zo Y O PLA • � �-_. 'tom'.� _�g' -41 .ter,�;a� �•�� � ,_,_ ._.-- f _-� _- � -- --z.� SL -� '!` _ f� i✓T-f^NiFr�1.1u��t-f OWN��FC 32, — — h{• ft _ t'L+L A1�E3/a: 915-rU R e Tr1u=TrD►i To Ze t.op,�sn 'M ?-5 nPt'n3tT�'v Gj-_ f=�LIFJ�F.TIOr`�. I LIINI-r Gf-- t UMI`r' LING G i7 G-t t tr-ic- PTT 11'J IT :gplr vJ -3'on w 62 �GT �1=�V'�I c4•�• � /Y.A�..'y' . .,. vV�t6 .� P( �,p� -- 1 I N�YEN��TL i�6o SIB f� 1�} i"> ,Assesg'c�'s"map and lot number .A ..,... *THETp�I Sewage Permit number ...... ...... Z 333 STADLE, House number ......:... 1�................................... ................ 90 rasa 4 i639• `�� - �YPY a' TOWN OF BARNSTABLE 11.1II DINS INSPECTOR APPLICATION FOR PERMIT TO .. "'.: ......./. ............. .t" �................. ........... TYPE OF CONSTRUCTION ...... ..i ` F.......................................................................... ................ zz TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies,for a permit according to46fi following information: j Location ......4A.(.......<,::?A m?.:i`4?..?X........I................ ......C-10.77-s+l..2.17...H..AS:*.................... .... ...... ..... Proposed Use i........ ...... ..... ...........` ............... ............................... .... ......... .. . . Zoning District :::...:::............:............Fire District _....... ':P: ? .............:.................... Name of Owner .......Address :. � ..z:I�................... .� .i.....:.: Name of Builder" ...:....................Address . -t.. ✓lvplfi. �.... i *� ✓ .�. �.: ! / Et/ze%t! Name of Architect ..... .............................'..:.::.".Address ..................... ............................................................ Number of, Rooms ........:,r7:77 ................................Foundation 71f.�✓ 0 e- A+� :.:...Roofing .:'. s'6 -?,Exierior ............................:: ::............................. Floors.... .......... ............................................. a: ... .. 'P/j!-c'� :5r'7s` ':............... ntenor Heating . ............. ... ......... .:.............Plumbing ................................ .... ....................... Fireplace ...............er:<..................................................:...::...Approximate Cost ........... � . Definitive Plan Approved by Planning Board ________________________________19-____ Area .....: ..s: ....�.. OO Diagram of Lot and Building with Dimensions Fee . :: SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam ......... . ............. i MANESS, DAVID .... Per it fo' Build Frame Garae No m r .................................... g ....... Accessory......to....Dwe.1 1.i)�Sr.............. ..... .... .. . .. .. ....... .... .. Location . 611 Santuit Road . ............................................................. Cotuit . ............................................................................... Owner ....6avid Maness ............................................................. Type of Construction ... ......................... ................... ............................................................. Plot ............................ Lot ................. ... ......... v . October 2 8', Permit Granted ........ ......................19 81PermitPermit Pate,at-Inspection .............................I.......19 Date'Completed ........................z 9 Xv, • Assessor's map and lot number ........................................... �- F fNE t . , Quo r o� Sewage Permit number ............. ...f!..*.... /! Z HAWSTABLE. i House number ...........61'........................................:./.......///......... y MU& OD,s,1639. 9� am a TOWN OF BARNSTABLE BUILDING INSPECTOR n APPLICATION FOR PERMIT TO , r! Tl?vim... LC ................................................ TYPE OF CONSTRUCTION ......WOOD.. A'4.0................................................................................................ ................G.......3Z�.............19 ,. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location tr, (f t- . t r ?".......�9Y J P 1`xa ....&.�...19% Proposed Use :!? !�=.... rc f ZoningDistrict ........................................................................Fire District Cin.A- ....................................................... Name of Owner^-. ttc �€;+ :? •............................Address /... rsvi, :....s� ta'1 +�i, !'? :....... Name of Builder" ...0 0.1, asf....CA 4-.1;0.''t" Address fits �Atl _c r��- `> r.1u .F. ............... .. ..................:...............................i... ............ Nameof Architect ...............::. ...............................................Address .................................................................................... Number of Rooms r....�"..................................Foundation ... Exterior ..... " � ....................................................................!�.........................Roofing Floors Interior ... .../.r....rr ....�. ..........�5'................ Heating .....��..........................................................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 r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .................. '"-: :. rr r.:::.'...` •............................ MANESS, DAVID �A=7-5 23597 Frame Garage No ................. Permit for .................................... Accessory to Dwelling ............................................................................... C611 5antuit Road Location ............................... Cotuit ............................................................................... Owner ....David Maness ............................................................. Type of Construction Frame ................................................................................. Plot ............................ LZ ...................... Oct 28, 81 Permit Granted ....................... ................19 Date of Inspection ............... ....................19 Date Completed .......................................19 D �� Town of Barnstable *Permito/� Expires 6 months m's ate Regulatory Services Fee ,l w snxxsrnat.e v Mass. $1639. Richard V.Scali,Director .0 1°rEn Mop" Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X--Press Imprint Map/parcel Number On 7 DD,5� Property Address G/t S hi-fi U/1 �,�_ colt' N Residential Value of Work$ ZU, OZ70 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address kyzl S T A 4 C c tfrd l)L'r Z � I L SIfi-(ru l'1—►'1>. C OiV I i. ✓lq/¢ UZG 3� Contractor's Name `A t CIL L&FMI00 S Telephone Number. Home Improvement Contractor License#(if applicable) b Email: Ot(ICOK 11 Cape col� Vl PT Construction Supervisor's License#(if applicable) r S —Q 1-24 S 3 Oworkman's(Compensation InsuranceFORESS Check one: ❑ I am a sole proprietor ❑ I am the Homeowner S+Ce I have Worker's Compensation E"" Insurance T pARNTABLE 12015 Insurance Company Name (Y C Zt O W'V Or D L�. Workman's Comp.Policy# �� — boo ! m —DI --o z Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to kiJ64C ❑Re-roof(hurricane nailed)(not_ stripping. Going over existing layers of roof) Rf Re-side ❑ Replacement Windows/doors/sliders.U-Value 2 (maximum.32)#of windows J� #of doors: 3 ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ** of : Property Owner t sign Property Owner Letter of Permission. A copy the o e Improve nt Contractors License&Construction Supervisors License is requir SIGNATURE: C:\Users\DecollikWppData\Local\Microsoft\ i ows\ porary Internet Files\Content.Outlook\2PI01 DHR\EXPRESS.doc Revised 040215 • BnstvsrnBLE, "'"SS Town of Barnstable i639• �� ArfD MAC A Regulatory Services Richard V.Scali,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, (��('tS�' ���cy l ,as Owner of the subject property- hereby authorize �L L ��� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Si ature of Owner Date '�(2cStla�l -X'Vtr,J�� Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 104804 Type: Private Corporation Expiration: 7/15/2016 Tr# 255509 LAGADINOS BUILDING & DESIGN, I.NC Nicholas Lagadinos 13 Thankful Lane Cotuit, MA 02635 Update address and return card.bark reason for change. Address Renewal ❑ Employment F� Lost Card SCA 1 t5 20M-05111 U126�QM727726J'LLUCCLll O �%I�GCY:JJp.0 GLJ .iJ• License Or registration valid for individul use only Office of Consumer Affairs&Business Regulation g OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 104804 Type: Office of Consumer affairs and Business Regulation expiration: :7/1:5/201.6 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 LAGADINOS BUILDING:&DESIGN,:.INC Nicholas Lagadinos 13 Thankful Lane Cotuit, MA 02635 Undersecretary Nott ignature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-012653 Construction Supervisor NICHOLAS A LAGADINOS;�, 13 THANKFUL LANE, COTUIT MA 02635 ,JT x Expiration: Commissioner 07/16/2017 v The Commonwealth of Massachusetts �r Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,A" 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): VftV[0S 1 V 1 L_bl q( Address: City/State/Zip: COV I i 6 S Phone#: cZg5— 2 - O1 Are you an employer?Check the appropriate box: Type of project(required): 1.[.I am a employer with /0 4. ❑ I am a general contractor and I have hired the sub-contractors 6. ❑New construction employees(full and/or part-time).* . 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 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 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 employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #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 job site information. Insurance Company Name: le Ills x�u c tJ rQ yj�,,. 5f_'{LU i 1. Policy#or Self-ins.Lic.#: (a S$O t, -D 1 —0 Z Expiration Date: Y z ZD/ Job Site Address: 6f I(� Olr j Yt 9 A 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. e advised that a copy of this statement may be forwarded to the Office of Investigatignqf the DIA for insurance o rage verification. I do he y c tify unde the ain ed penalties perjury that the information provided above is true nd correct. IhSignature: Date: l Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 9 1/0 /�� CE ITIRCA tl E OF � AMU (( l`i �fl��l�J(I�i�`11Y CE 0DATE /DD/ . 1/0 /201515 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!San 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: Applied Risk Insurance Services, Inc. PHONE 10825 Old Mill Rd (A/C,No,Ext): (877)234-4420 .�C,No); (877)234-4421 Omaha, NE 68154 E-MAIL ADDRESS: PRODUCER (877)234-4420 CUSTOMER ID# INSURER(S)AFFORDING COVERAGE NAIC# INSURED , INSURER A: Continental Indemnity Co. 28258 INSURER B: Lagadinos Building a Design, Inc. 13 Thankful Ln wsuRERc: COtuit, MA 02635-2616 r INSURERD: INSURER E: CTL 1273 970254 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS --- ——CERTIFIC-ATE-MAY-BE-ISSUED OR-MAY-PERTAIN,,—THE-INSURANCE-AFFORDED-BY THE-POLICIES DESCRIBED HEREIN-IS-SUBJECT TO-AL-L—THE TERMS;--- EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUB - POLICYEXF POLICYEXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DDNYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY' ❑❑ DAMAGETORENTEDrca FS(FA nnnurrp. a) $ CLAIMS MADE❑OCCUR MED EXP(any oneperson) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $. GEN'L AGGREGATE LIMIT APPLIES PER: - ; PRO PRODUCTS- OMP OP AGG $ POLICY JECT LOC $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT ANYAUTO ❑El - Ea accident $ ALLOWNEDAUTOS BODILY INJURY Perperson) $ SCHEDULEDAUTOS - s - D I (Per accident) $ HIRED AUTOS PROPERTYDAMAGE Per accident $ NON-OWNED AUTOS - , - $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE ❑ AGGREGATE $ DEDUCTIBLE $ RETENTION $ TH $ WORKERS COMPENSATION OR SLIMIT rR AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N 'N/A A OFFICER/MEMBER EXCLUDED? 4 6-8 8 0 9 0 6-O 1-0 2 01/02/2015 Ol/02/2016 E.L EACH ACCIDENT $ 500,000 E. (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $�5 0 0,0 0 0 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 E]P DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord i Ili,Add itional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANYOFTHEABOVE DESCRIBED POLICIES BE CANCELLED 200 Main St. BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED ' Hyannis, MA 02601 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1783118 ACORD 25(2009109) ©1988-2009 A ORD CORPORATION. All rights reserved F' Town of Barnstable cam, rpr Expires-6 months from issue date „is, Regulatory Services Fee rA BARM MAM $ Thomas F. Geiler,Director Building Division Tom Perry, CBO, Building Commissioner 200 Main Street Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL, ONLY Not Valid without Red X-Press Imprint Map/Parcel Number 007 005 Property Address 611 Santuit Rd. Cotuit,MA 02635 ®Residential Value.of Work $5,000.00 Minimum fee of$25.00 for work under$6000.00 Owner's Name_&Address Kristan Schoultz )* (n/� 5_4 0--4 r t fZrj /'I)i U 0- 0?/!? Contractor's Name Lagadinos Building and Design Inc. Telephone Number 508-428-4097* Home Improvement Contractor License#(if applicable) 104804 Construction Supervisor's License#(if applicable) 12653 ®Workman's Compensation Insurance Rt;, I Check one: ®p a ❑ I am a sole Proprietor ❑ am the Homeowner 5EP _ .2 2009 have Worker's Compensation insurance Insurance Company Name AIG ["OWN OF SARNSTASL Workman's Comp. Policy# WC6940601 e Copy of Insurance Compliance Certificate must be on fide. Permit Request(check box) ® Re-roof(stripping old shingles)All construction debris will be taken toCasella Re-roof(not stripping.Going over existing layers of roof) _ Re-side ® Replacement.Windows.U-Value .30 (maximum.44).. *Where required:Issuance of this permit does not mpt compliance with other town department regulations,i.e.Historic,Conservation,etc. * * *Note Property o e m sign Property Owner'Letter'of Permission. Ho rovement Li rise is required SIGNATURE: i 1 ne c,ommunweacrn uj.,Y aasacnuseccs Department oflndustrialAccidents Office of Investigations W " d 600 Washington Street Boston,M4 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: ]builders/Contractors/ElectHcians/Pluiin�bers Miglicant Information Please Print Legibly Name (Business/orb nization/individual):_ L.Nft'N•l D S VJ Ln 1 V1& E �t y tick 1' Address: /3 L..A/. City/State/Zip:_ o-md-, M6 QZG3I Phone#: SOS- yZB - f/of Are you an employer? Check the-appropriate box: Type of project(required): 1. I am a employer with 13_ 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. [1 New construction 2.❑ I am a sole proprietor or partrier- listed on the attached sheet $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp,insurance. g ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10-❑ Electiical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL - 11-❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no UP Roof repairs insurance required.] t . employees.[No workers' 13,❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information; t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp;policy information. I am an employer that is providing workers compensation insurance for my employees. Below is the policy aaaef,l'®b site information. Insurance Company Name: �l Policy#or Self-ins:Lic. #: Expiration Date: Job Site Address:_ City/State/Zip:_ Attach a copy of the workers' compensation policy declaration page(showing the policy number and eacpirata®n 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 ORDE1R 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 covera verification. I do here ce fy under the pa d na es of perjury that the information provided above is true and correct Si ature: Date: _�44 Phone#: / Official use ondy. Do not write in this area,to be completed by city or town official City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing IMP-Qr 6. Other Contact Person: Phone#: Massachusetts - Dep i-tment of Public S dfetN Board of Building Regulations and Standards Construction Supervisoe- License License: CS 12653 Restricted to 00 k NICHOLAS'A LAGADINOS 1,3 THANKFUCLANE COTU IT;,MA-02635, s �- - -� --� Expiration: 7/16/2011 C:'cinuni�cwne.r:` Tr#: 19456 ., + �oFTME Teti Town of Barnstable " Regulatory Services j MASS. Thomas F.Geiler,Director ezass. �, Eo 9. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-79.0-6230 Property Owner Must Complete and Sign This Section If� Using A Builder i �r j I. y� ( 1 as Owner of the subject property hereby authorize E97a !`}'►�i ylU to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job). i i - ! i �414 S' tore of er Date I ! � j. Print Name i i ; I Q:FORM&OWNERPERMISSION 'Re r°arr��wruueat o�✓�aoeac�ucQetta Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration;,104804 Board of Building Regulations and Standards Ei Frrat an�; 5/2010 Tr# 270833 One Ashburton Place Rm 1301 Boston Ma.02108 Ir�f pet�P;tivate Corporation LAGADINOS BUG'°�"(:NG INC f° Nicholas Lagadinog; 13 Thankful Lane �r\ Cotuit,MA 02635 --' Administrator Not valid witho signature 01/12/2009 MON 14: 13 FAX 508 420 5406 Leonard Insurance Agency 2001/002 ACORQ CERTIFICATE OF LIABILITY INSURANCE 01/12/20) PRODUCER 000428-6921 FAX (508)420-5406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Leonard Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1 7 Wianno Avenue HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P 0 Box 494 Ostervil le, MA 02655 INSURERS AFFORDING COVERAGE NAIC# INSURED Lagadinos Building & Design, Inc. INSURERA: National Grange Mutual Ins Co. 14788 13 Thankful Lane INSURERS: AIG XSB009 Cotuit, MA 02635 INSURERC: INSURER D: INSURER E: GOVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING 1 ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR 1 MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH i POLICIES-AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERALLIABILITY MSB87460 01/01/2009 01/01/2010 EACHOCCURRENCE $ 1 000 00 i X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 500,000 CLAIMS MADE a OCCUR PIED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,00() POLICY JEST LOG AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accdent) ALL OW NED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) I GARAGELUU3ILITY AUTO ONLY-EAACGDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ EXCE99fUNBRELLAL'ABILITY EACHOCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ LIMITS TH- WORKERS COMPENSATION AND WC006940601 01/02/2009 01/02/2010 WCSTATu- I 10FR EMPLOYERS'LIABILITY I B ANY PROPRIEfORMARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 I OFFiCER/mEmBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CANCELLATIONCERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Town of Nashpee BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 16 Great Neck Road North OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES. Mashpee, MA 02649 AUTHORIZED REPRESENTATIVE �,,,/ Robin Car enter/LEORC1 A4zuuA ,c ACORD 25(2001108) ©ACORD CORPORATION 1988 TOWN OF BARNSTABLE Permit No. -__-__-____---- +�- Building 1 Inspector"mam Cash 'Oe X" (r OCCUPANCY PERMIT Bond -- -- No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to David, kUn es s - Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. f ........................_........................._, 19_.......... ......................................... _ .�_.... . .Building Inspector Inspector I, �.j " I, I" 'I.;V.-1,, S.-,� , l O;--,�1.I1I,1',, P—fI :,.: 7 `-, "` -P.-I" : �', :.3"...I- .,1�.. �.,,, ,'.-�J1N,',I-j,.L,,k: � .:".., ,I_ �Y ,3�1I ,:",. - ' ,,fT , .'* _� " x , , , ,, I'� ,;T -� �L� �%.k i ", � 1 � " ,q,, ,�_ A,- o, � � ,� 0 IA 1 1 . , " f " " 1, ?- � " , ,".I'v,",IM; I ,F " ,,, N,,�," .1 t _1 1!,� 4 1Iy , r" ' ," .1,I,"" ,qr,, �. � I�T ,0 , � l,�. , , _" '. 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U,: , 1!I' , � 1 WAssesso ..... �_oi-7.......r's•ma' p and lot numberSEPTIC-SYSTEM M roe♦ Sewage Permit number 8s��.................................... INSTALUD IN COM 4 Z B AWSTAXE, WITH TITLE House number .......... /...................................:....... ENVIRONMENTALap. r �'1'1pvi.r r g:GIJ3 ATI i 0wara� TOWN OF . BARN�STABLE SUBJECT TO APP. 4,;VU 0I- 1� DARNSTABLE CONSERVA10 9 BUILDING INSPECTOR c°M 'O" APPLICATION FOR PERMIT TO r! Yal �S-T .... .. .1 . ..�C �'I�L ' -..'!NZ- TYPE OF CONSTRUCTION ..........t �. .c? .... !'?......:.. . ....... ` . 1...,Z�, ................... ............................ ...............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accofding•to the following information: Location .......1.44? , ........: !N "...9.4,*.0......... 1� ...................:................................................... Proposed Use ...... rZl e-4A.'l�?.� . ..... . . .. ............................................................................. ZoningDistrict .........., d"-... ...........................................Fire District ........CV.Dk.. .;................................................... Name of Owner 11.4P�. JV. ......:..........................Addres Weed �6rdl7 �/fS. l�.............. • •�� /¢Li�e�'�v3� r2rs91 l�l2fr�svdl,� Name of Builder ....Jf hil+/....../, Z.....4�aIZG Ll...........Addr ss �.. ...�. .. .Name of Architect ...........................................Address Number of Rooms ........... ...................................................Foundation Roofing Exterior / '�5u' !7�.. .... �/ 2..................... g .... ............ �7s!r.�.'G-a. ........................... Floors wao,o..&..e A P*,7................. ....Interior �13Uta./.7 f g vC !4T• P..P NIt4-e g /.. rr. .Heating 'Plumbing :..................................................... Fireplace ..:i�✓4'G.�7.... I,�V!�......................................:....Approximate Cost ............... .......................................... Definitive Plan Approved by Planning Board -----------_------_-----------19________. Area ...ZZY�s'....................... Diagram of Lot and Building with-Dimensions Fee ... SUBJECT TO APPROVAL OF BOARD OF HEALTH All I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Na .......... MANESS, DAVID o ..22.9.19.. Permit for ..QXI.e...1/2...S.t;Qr.y F ` Single Family Dwelling .............. .......... .............. ........ Location Lot #5 611 Santuit Road ................................................................ Y - Cotuit { Owner David Maness........ ................ w }' Type of Construction Frame ............................. Plot m. ... ................:.. .Lot ................._........... Permit Granted March 16 , .19 81 .. f Date of Inspection ��19�j r i3 Date Completed Z..............19 � • /7 «Ilk- PERMIT REFUSED .. .. ................ .. ..... .... 19 3 r 1 . ..'}RT..... x.. ........... .. ... .............. ✓• ! --`� ` _ - _ -. ."" .......................................................... • aft.x 4........................................................... �+ i MI ' •••YYu�. �. • Y.•••••.•••.•.•...••••.•...••..........•••..•....•..........• • �` • r •Q',y�• C vV Appr6ved rrs j ................................................. Assessor's map and lot number ..... .' C'�r�• s THE (6R ? I Sewage Permit number ... .....:............:............................... s Z BARNST/1DLE, i House number .........................: (i MA86 . .................. !� p 1639. `00� ��MPY M• TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO fr �$ .�•! ., L'w ;; ...................!. .. ............... ... .. TYPE OF CONSTRUCTION .:, .' r�! ..............................................:................................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... ...:'... alb...........`. tt::'..< r:'..:.? ....E':.:P :.:?....... '.' "::.:......................:............ ProposedUse .......� a ............ P........:�� . ................................................................................�. f Zoning District ................'..........................................:...........Fire District .......°-:'. -'.�.. .................................................. Name of Owner .) .`.'.....................'':.. '....... ...........Address ...� y nt!✓::: "";'.. ;:'.: ?::..,Z:."" �. Name of Builder ' ' f„• ;c' !. / Address ..::.!:�:°!i r ���r, l.r r ��•yf C �� ✓�..�.:� ✓ l+;, �. ........... .......... .................�...... Nameof Architect ..................`-............................................Address .................................................................................... Number of Rooms '`!..................................................Foundation .........��'. , . , .......... ................. Exterior !;�, t.:".............. �.......� .a ,:' .....................Roofing ....! �..��,�'J..'......:�...........:........... ...............: .�--s Floors ... . _ e.,..._ .Interior �1.. Heating :.:..................._ _ -............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 � J ,1t LI 1 l I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name-......... '� ..yt f ..!. .... ' , :: .:....... r.::................ MANESS, DAVID No Permit for One l/2 Story Single Family.. i Location ....Lot #5 611 Sant, RQA.(j cotuit ............................................................................... Owner ...David...Maness........... .................................... Type of Construction ... .......................... .................................... . ................................... Plot ...................... .1.. Lot ................................ Marc, 16 Permit Granted ............ ............I.............19 81 Date of Inspection ........ ...........................19 Date Completed ....... ..............................19 PE IT REFUSED ........................................... ...... 19 !� Vd ?/ . .Q.�??�J............ ..... ............................................................................... ..................................................0............................ ............................................................................... Approved ................................................ 19 ............................................................................... Dr. ALBERT E. HENN (MD MPH FACPM) - International Health Consultant } Email:Alberthenn@aol.com 611 S'ANTUIT ROAD Telephone:(508)428-9779 COTUIT,MA Fax: (508)428-6149 02635 USA r A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel V Permit# Z�� Health Division '� '� Z�/v�7�z�✓� '�'�- Date Issued Conservation Division -Z / Ap ( /C_ Fee Tax Collector Treasurer `i l� S R' 1� SYSTEM e . Planning Dept. ��STp�,�'E0'�N�MP NCE wn�t�n�c Date Definitive Plan Approved by Planning Board ENVIR " D Historic-''OKH Preservation/Hyannis rn � Project Street Address .6 I rA w T y I T 'Rio A S Village C O 'r V / T Owner ALBeAT NENN 4 &JTAW fCMoutTZ Address �S#QM0= Telephone (SO#) 4 2 eP 9 7 7 f Permit Request To Ar Q u s&-a E X s d rs nv G DECK r'o m EE r C vRrt.EM r Co'D E Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost </,;Zo Q Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. r. Dwelling Type: Single Family W-' Two Family ❑ Multi-Family(#units) Age of Existing Structure /9 YEARS Historic House: ❑Yes Zo On Old King's Highway: Cl Yes A o Basement Type: RIO ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing z. new Half:existing / new Number of Bedrooms: existing .3 new Total Room Count(not including baths): existing 9 new First Floor Room Count .3 Heat Type and Fuel: ❑Gas ❑Oil M lectric ❑Other Central Air: As ❑No Fireplaces: Existing New Existing wood/coal stove: ees ❑No ' R Detached garage:Zxisting ❑new size / Z 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 Flo If yes, site plan review# Current Use Proposed Use t BUILDER INFORMATION Name J Telephone Number Address_s � � �? License#)Q Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO IJ SIGNATURE 2� DATE _ U' r • FOR OFFICIAL USE ONLY a r _ J t PFRMIT'NO. ' DATE ISSUED j ~ ' MAP/PARCEL NO. x ADDS VILLAGE OWNER y` DATE OF INSPECTION: �. FOUNDATION FRAME INSULATION FIREPLACE ` ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH 3 R FINAL i GAS: ROUGH" -FINAL 1 � k t FINAL BUILDING ; DATE CLOSED OUT a leaf ASSOCIATION PLAN NO. IE . The Commonwealth of Massachusetts ter_ -- -� Department of Industrial Accidents Office 811085 l 8deffs 600 Washington Street Boston,Mass 02111 workers' Compensation Insurance Affidavit name: 0 Z location: '05,32 A` h��: S� city ce phone# ❑ 1 am a homeowner performing all work myself. , I am a sole rietor and have no one warku in anv capacitv I am an em layer providing workers' compensation for my employees working on this job.: : . :::::::::: :::::::::::::: : .. .: .:.:;: tom ant name:. :...:..: address.. . - ............................. .. ..::...:..:.. ..:.::. cv insurance co. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: -am vn caman ....... ..:.:...:. ..... :::.., address. city ..... ,. . .. . »>�: .......:....::::....................................................................... .................................................................................. .................................................................................................................................................................................................... ».. „ll/%%/%/%1 ............... c env name: >... »;;:,:.::; >..... . :. :;;.. address: Nm............... . ci ? > :::::.::::::::::::::::..:::.:.:....................................... FaOnre to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crhuinal penalties of a&a up to$1,500.00 and/or . one years,imprisonent as well as civil penalties in the form of a STOP WORK ORDER and a Sue of at 00.00 a day against me. I understand that a m copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby c. fy under the p ' and pen of perjury that the information provided above is trup.and coned Signature ate 4 _ - Print name / ?o Phone# _ZJ `-/ 3 6 o dal use only do not write in this area to be completed by city or town official city or town: pern*Mcense# OBading Department (jLicensing Board ❑check if immediate response is required ❑Slealth era's Office ❑Health Depardnent contact person: phone#; ❑other (Fevued 9195 PJA) The Town of Barnstable saRtvsTaa[.E, � A Department of Health Safety and Environmental Services rEn +a Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or.construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: n L Estimated Cost r 6� Address of Work: f f s" U Cy Owner's Name: ttf A) Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date t Contr ctor Name Registration No. OR Date Owner's Name q:forms:Aftidav Construction Super's License The Construction Supervisor's License of the construction supervisor to be used on the project by Community Enterprises is not available at this moment because the holder, Mr. Marcel Masse, is out of the country temporarily. However the Massachusetts State Board of Building Regulations and Standards has confirmed that the license in question is both valid and current. Unfortunately, they are unable to make a copy of the license available, but they are willing to confirm the existence.of the valid license by phone: (617) 727 3200 extension 25207. The relevant information defining the license is: Construction Supervisor's License Licensee: Marcel Masse License No:' CS056524 l� License Type: unrestrictive Expiration: 12/07/00 � _ Please accept this attestation of a Construction Super's License in lieu of a photocopy of the actual license and phone the State Board for verification/confirmation if necessary.. Thank you, Z�L7 _ f Albert E. Henn, MD. ' 611 Santuit Road Cotuit, MA 02635 2 I To)paovCm4F/4T C ENc�'E r 4 I f