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0033 SCHOOL STREET
�-13 J'cnoa l U-ircef .A Town of Barnstable Building 7p '. PostaThis`Gard, or.That it�s Ursrble;,Fromihe Street-:A roued�P,„,Ians�MustbeRetamed on Joband,this Card MustbeKept :'; Pp.z + �ARNlSYhDti.. • ae Poste'dUntilFinal,lnspection Has Been Made - A : Where a{Certificate ofzO.ccu anc is Re aired,such:Bu�ldmgshall Not.be Occup�ed;unttl aFinal lnspect�onhas been made Permit , >, � . � , , � xp�.a�Y:... ,a q ,N ,..,, ., 1 ..� „ � ._ :, .� -Paz •,... Ps - -. �.� �_ �.. ._„ _� Permit NO. B-19-2206 Applicant Name: CAREY GROVER DBA GROVER BUILDING+ Approvals REMODELING Structure Date Issued: 07/10/2019 Current Use: Foundation: Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/10/2020 Sheathing: Location: 33 SCHOOL STREET,COTUIT ;`< Map/Lot' 035 013 Zoning District: RF Framing: 1 Owner on Record: RAPP CHRIS P&ELAINE D Contractor Name; CAREY C GROVER Address: 3 FOXGLOVE COURT y E � - Contractor E censer; CSFA-077754 2 Chimney: NASHUA,NH 03062 x"` Estes Profect Cost: $2,500.00 Description: REPLACE WINDOW TRIM w r Permit Fee: Insulation: $35.00 Project Review Req: ? Fee Pard: $35.00 , final: 7/10/2019 5 4, Plumbing/Gas E > J /-.. Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work adthdeized,bythis permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and�theapproved construction documents"for whrchrthis permit has been granted: - Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearlyroa_ visible from access street or d and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. r Electrical Y �� � � Service: The Certificate of Occupancy will not be issued until all applicable signatures byfthe Building and Frre50fficia`s4�a a provided o this permit. Minimum of Five Call Inspections Required for All Construction Work ,: Rough: 1.Foundation or Footing ;' ram;' A If L,_ - 2.Sheathing Inspection Final: 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 Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application nu ..... ... . Fee.................. .......................... MAM Building Inspectors Initials....................................... 163 N?0 Date Issued. ;.............................. Map/Parcel.....03b. 65............................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDINGIWINDOWS/DOORS/TENTS/STOVF,SIWEATHF,FJZATION PROPERTY INFORMATION Address of Project: NUMBER STREET VILLAGE '2,4V Owner's Name: gQ Phone Number Email Address: Cell Phone Number Project cost$ 01co Check one Residential Commercial OWNER'S OWNER'S AUTHORIZATION As owner of the above pro e hereby auth rite ,&/-- to make application a din accordance with 79dCMR g p E Owner Signature: Date: TYPE OF WORK Siding E-1 Windows (no header change)# Insulation/Weatherization ED Doors (no header change)# Commercial Doors require an inspector's review ED Roof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Con tors Registration(if applicable)# (attach copy) Construction Supervisor's License# ✓ (attach copy) Email of Contractor 0 USVgjAl it Plione number ALL PROPERTIES THAT HAVE STRUCTURES OVER WARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. rE APPLICATION NUMBER *For Tents Only Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X. Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLIC T'S SIGNATURE Signature Date All permit applica ' ns a subject to a building official's approval prior to issuance. = Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Construction S.V*-4br,1 & 2 Family CSFA-077754 y l/ . Arpires: 11/22/2019 CAREY C GROVER'r PO BOX 1080 K COTUIT MA 02635 ALI Commissioner /,e�omvntuoreunci�l�a���iaaac�uee%/�t ' + office of consumer Affairs&Business Regulation 9 HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. H found return to: Reaistratfori,ati €xairation Office of Consumer Affairs and Business Regulation 144g22 09/22/2020 1000 Washington Street-Suite 710 Boston,MA 02118 CAREY GROVE, xkt�as; DB/A GROVER BUILDING;+REMODELING i 4� CAREY C.GROVER 56 BOWDOIN RD w t, �-3 Not w without signature MASHPEE,MA 02649 - Undersecretary. r 41'R . i aC(:>R D° CERTIFICATE OF LIABILITY INSURANCE DATE""'" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLMR. 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((es)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: PHONE AWlied Risk 1nouranCe Services, ,Inc. (A/C No,Ext): _ (A/C,No): 10825 Old Mill Rd E.MAtL Omaha, HE 68154 ADDRESS: PRODUCER CUSTOMER ID# (877)234 ,4420 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Cont-Ane"ll..al Indemnity Co- '28258 Gwover Building and Remodeling Inc. INSURER B; dba Grover B113.1ding and Remodeling IIIC. INSURER C: 444 Poponessett Rd INSURER D: Cotuit, MA 02635-3216 INSURER E: CTL 1273 1474912 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/OD/Y MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS ❑ PREMISES(Eaoccuvence) $ MADE OCCUR MED EXP oneperson) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: IGENERAL AGGREGATE $ li PRODUCTS-COMP/OPAGG $ POLICY PROJECT BLOC $ • AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO ❑ ❑ (Eaaccident) $ ALL OWNED AUTOS BODILY INJURY Perperson) $ SCHEDULED AUTOS BODILY INJURY Per accident $ HIRED AUTOS PROPERTY DAMAGE (Per accident) $ NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE ❑ ❑ AGGREGATE. $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION VIVC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TO IM E ANY PROPRIETOR/PARTNER/ A ExecuTlvEOFFICER/MEMBER ❑y N/A 46-805700-02-02 .08/31/2018 08/31/2 E.L.EACH ACCIDENT $ 100,000 EXCLUDED? (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $ 100,000 II yes,describe under SPECIALPROVISIONSbelow L E.L.DISEASE-POLICY LIMtT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION Gar Build]Ag and FAMOdeling I=. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 4" Pt7)p0t eswtt B3 EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 00tuit, M-02635-3216 AUTHORIZED REPRESENTATIVE Attu: Projelct ftinva ' / 1783i18 ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD ©1988-2009 ACORD CORPORATION.All rights reserved. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map d✓ , Parcel - Application # < Health Division Date Issued Conservation Division Application Application Fe Planning Dept.. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street/Address ? �C%dew Village < ;ddm!�" Owner 44,4%S Z44W , Address�. ,5_5G8G1D���S Telephone�0. L�� 7}o?67-- Permit Request Zal'kz D"�I A91 �/[ �` AOyI.01 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ot� Project Valuation Construction Type 416 0�0ww 0. Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family L Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full W-(�-ra'wl ' ❑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 Rgom County c� Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stoyg: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑iexisting 0 newb size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 4 Y• . E:7 rn Zoning Board of Appeals Authorization ❑ Appeal # Recorded 0 Commercial ❑Yes ❑ No If yes, site plan review_# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address Z4FZ2 License # �� � Home Improvement Contractor# l ���y1 Email ;dc) 6157�IWJ"" dqAlallrker's Compensation # ALL CONSTRUCTION DEBRIS RESULTI G FROM THIS PROJECT WILL BE TAKEN TO is. /00 SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED, MAP'/PARCEL NO. E ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 5�.5or�s J7I6)iY r FRAME Z!dyljq INSULATION FIREPLACE ELECTRICAL: ROUGH i FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 3 q DATRpCLOSED OUT } ASSOOFATION PLAN NO. r t -t v.., The Commonwealth of Massachuselfs Department of IndusirialAccidents Office of Investigations ` 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance-Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information - "Please Print Legibly Name(Business/Organization/Individual): Address: -P e Aw 969 City/State/Zip: hone Are you employer?Check the ppropriate box: Type of project(required): 1. am a employer with_ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity, employees and have workers' [No workers' comp.insurance Comp. �$ 9. El Building addition n required.] 5. 0 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 13.❑Other employees.[No workers' comp.insurance required.] *Any.applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the 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. hmirance Company Name: Policy#or Self-ins.Lic.#: ,�,/ ��oJ/ 7��l�d�� ' Exp. .on Date: Job Site Address: ��1�<"l� 7— state/Zip © v d j Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cerfi der the pains and pen . of perjury that the information provided above is true and correct. Signature: - Date: Phone#: — G 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"'an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged m-a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(i7 states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants PIease fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line.' City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permiVlicense number which will be used as a reference number. In addition,an applicant that must submif multiple permit(license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of l vestigations 600 Wwhington Street. Boston,MA 02111 TeL#to 17-727-4900 ext 406 or 1-877-MAS8AFB Revised 4-24-07 Fax#617-727-7749. WWW.m=gGV/dia ACORDI CE T RCC 01F ALIAB0L11 g INSURANCE _ as 2R Twin CERTIFICATE IS ISSUED AS A wATTER OF INFORIdAT RI_N tJNLV AND CONFERS NO RIGHTS UPON YHE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND E.YTOND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT=NSTITIJTE A CORAACT BETWEEN THU ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT:If the castifleMo holder is an ADDITIONAL INSURED,the polloypes)must be endorsed.If SUBROMATION IS WAIVED,cUblecl totho ttemo end cond1tl0ne al the policy,�_RBIo polldw may requite an ettdamemenl A statement on thin c%AM=to dose nat center Inghts to the cerfHicffie holdsf in UQU of such Ondoreemame), PRODUCER COMPACT NAME:. PHONE FAX applied R$D)b 4G 3=dw® make 3r Idea WC•No,EJs1' (077)236- 430 .(AM-NO: 877 a34-44921 3.0923 Old BUM Rd E-MAIL Emig M Sam ADDRESS: PRODUCER CUSTOMER ID a (S77)R36-6420 INSURERS)AFFORDING COVERAGE NAIC D INSURED INSURERA: Cont3aonea2 Indsmity Co 3BZ9 INSURER B: dbacravew Building arA Romftibe INSURER C: PO 2= 1080 INSURER 0- cat f!.ft, ice. 01635-2080 • INSURER� , CTE 1273 767949 INSURER E COVERAGES CERTIFICAT E NUMBER: REVISION NUMBER: T141S 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 REOUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLiOICS 006014060 HEREIN Is SUBJECTSO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITS SHOWN MAY HAVE BEEN REDUCED 13Y PAID CLAIMS. an i TYPE OF INSURANCE It1SR WVD POLICY UhIB13t POi1C EFP I fBfNDDJY 1UMI rs - GENERAL LIABILITY I ". EACH OCCURRENCE 5OMMERCIAL GENERAL LIABILITY � �I PaEMI E TO RENTED S COMMERCIAL L J PAEMISES ooa++ ) J TRIADS OCCUR LIED EXP(Any orsasrson S PERSONAL 8 A13V 8WI URY S GENERALAGGREGATE 13 `GENLAGGREGATELIMITAPPLIESPER: i ; PRODUCTS•COMPIOPAGO Is i FOLIC`:�PROJCCF�LO S AUTOMOBILE LIAB1613Y !COMBINED SINGLE IJYII'I ANY AUTO L J ❑ I lfsacoaooml S BODILY INJURY Pm S IALLOWNEDAUTOS SCHEDULED AUTOS BODILY d�JU Y Pa esrldvat S PROPERTY DAMAGE i8 HIREDAUTO9 ! t 4 (Par acGdeN NOR-OYlNED AUTOS S S 1UMBRELLALlAB OCCUR EACH OCCURRENCE S E#CEBSUAB CLAIMSAIAS1E AGGREGATE S DEDUCTIBLE I 15 RETENTI0�7 & I � S WORKERS COMPERRATIOU WC TORYUNIMP, OTH AND EMPLOYERS'LIAt31t.iTY YIN s 3,00,000 ANY PROPRIFTORIPAFRNER! NIA E.L.EACHACCID ExCLD�EEOPPICl MIEMBUk q 1 ; I =00�5 D@�O�m00 0 �3 933 6/3b/:LO , (Mndalary in tdN) LJ F E L 018EASEeAEsaPLorEE g �O Q e 8 00 ni ra%descnbaunder j E.L.DtsEAsE-PoucYuutr �s S00,0O0 BECIALPROVISIONS Wlow I 1❑i I _. DESCRIPTION OP OPERAITONSILOCATIONSIVE➢IeLES{AltarAAeord1M,AddlD5112lAamsrkeSchE:dule,lim0na8I3M McItdlsd) CERTIFICATE HOLDER CANCgLUMON bKOULDANY OFTHE ABOVE DESCRLOW POWCMS BE CANCELLED 8MRSTHE Q' DATET E F,NOTICE WILL BE DELIVERED IN ACCCRDANCEWITH w "SO THE POLICY AUTHORIZED REPRESENTATIVE mtms pwimt Ls 3783138 ACOAD7S(2QOttJ09} TheA60ROnamsantllC§oararztitatetedmerksotACORD ar9Bl 2NDACOROCORPORATION.Atlew-6tawai F C?//r tGorioirunrrr,cri///n.C%�rntsrrc/rrfr/f registration P_\ Office of Consumer Affairs&]Business Regulation License or g valid for individul use only _ OME IMPROVEMENT{'ONTRACTOR before the expiration date. If round return to: - Type: ( Office of Consumer Affairs and !Business Regulation Registration A44322 YP /expiration 9/23/2014 DBA 10 Park Plaza-Suite 5170 „ 5 Boston,.NIA 02116 GROV..R BUILDING+:REMODELING= : CAREY GROVER 56 BOVVDOIN.RD. MASHPEE,`MA 02649 L, j IJrldcr�ecrcfary i Nnt v d without signature' a 14>� Massachusetts Department of Public Safetya , Board of Building Regulations and Standards Construction Supervisor 1 & 2 Famili License: CSFA-077754 " CAREY C GROVER - { PO BOX 1080 s ` COTUIT MA 02'35 `• 4 Expiration Commissioner 11/22/2015 w Y Town of-W-amstable RegIato ry.S ervi_ces crass Thomas K;Ceffer,Director Building Division P' Tom Pen7,.Buildmg Commissioner 206 Mai.Sit,Hyam*-MA 0260I o wwWtnwn barnstablema.us Office: 508-862-403-$ Fax 509400-623.0. Property Owner Must Complete and Sign.This Section If Using A Buildex as Ownet of the subject property t/G,e of S TorVj hereby azrthonize �C �� .J y Jr� to act on my behalf; / in all matters relative to work-authorized by this'bwI&ig permit. 33 SC'�a�� 5 G'o ru�� jlijq {Address of Jo Pool fences and alarms are the:responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are perfomm4 and accepted. Sig 2 re Pf Owner Sigma of Appli=nt PrintName Print Name Date QTORMS:OWNMFERN=IONPOOIS&2012 Town of Barnstable Geographic Information System April 16,2014 035024 035050 #7 _ #40 035051 Z #889 035052 N #20 035053 1 #12 SCHOOL Sr 035098 #905 035013 #33 035102 #21 035014 #45 035099 #911 035012CN D #925 0 20 Feet DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:035 Parcel:013 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map tAf - Owner:RAPP,CHRIS P 8 ELAINE D Total Assessed Value:$505600 are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.31 acres Abutters boundaries and do not represent accurate relationships to physical features on the map `Location•33 SCHOOL STREET X" such as building locations. _,. - "*'•--—nfr— Buffer sJ: j Town of Barnstable rmit Expires 6 mo Exp n m issue Regulatory Services FeeRARNRUBLt e e yc� 1 ��� Thomas F:Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-403 8 Fax: 508-790-U30 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY D r Not Valid without Red X-Press Imprint. Map/parcel Number O w`�, , Property.Address �- d ` esidential . Value of Work �. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) xpRPSS PERMIT ❑Workman's Compensation Insurance Check one: S E P. 6 2012 ❑ I am a sole proprietor ❑ I 2part Homeowner ave Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roo urricane nailed)(not stripping. Going over existing layers of roof) R ide #of doors Replacement Windows/doors/sliders.U-Value `e (maximum.35)#of windows 0 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 own department regulations,i.e.Historic;Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. . A copy of the Home.Improvement Contractors License&:Construction Supervisors License is ed. . SIGNATURE: Q:\WPFIL'ES\FORMS\building permit fo 1EXPRESS.doc Revisecd:053012 The Commonwealth ofMassat hraetts Dtepartme>nt oflndustrial Accidents f),,We o,f In timations 600 if'ukington,street - Boston,MA 92111. wmgovIdia. Workers'Compensation Insurance Affidavit BTailders/ContracbarsfFlectricians/Plumbers . Applicant Information Please Pr ut I.embly Name(SusineSJII0I 7 konIidividual): � �A/ Gitylstatedzip: it: Are employer?Checks the appropriate boa: Type.of project(required): 4. I am a_ contractor and i I_ I am a employer with ❑ 6- ❑New construction employees(fail andior part-time)_* have hid the sub-contractors 2-❑ I sin a sale proprietor orpsrhmr- listed on the attached sheet. 7- ❑REmodeling These sub-contractors have ship and have no employees 8_ ❑Demolifian wading fad me in any capacity. employees and have workers' [No vvorloers'.couap.inc�rrRnrg camp.itistira"_1 9- ❑Building addition required-] 5. ❑ We are.a corporation and its 10-❑Electrical repairs..or additions 3.❑ I am a homeowv!r doing all:wo& officers have exercised their ILL]Plumbingrepairs or.aMdom myself[No worlaecs'CIOMP- right of exemption per MGL 12.❑Roof repairs insurance required..]S c. 152, §1(4),and we have no employees.[No worlmrs' . 13_0 Other. comp.inmu required.] ` Y applicsa!<mat checks box#1 must also fill out thie section bebw showing ilea wadies'compensation policy iafurmatitm. Homueoameis ubo submit this dfidaAr mbcatiug they are doing all wa l and then hire wtsiae contmc=unlit submit a new affidmit indicating sucb- tContracnas that check this boa mmst attached as additiaual sheet dhowmg the name of the stab-camtractm and:Ftzte whether arniut those entities ham empluyees..Ifthe sub-cant dais boos empttrgees,they nnstpwvide their eke s'comp.policy number I am an ernpinysr that is providing workers'compensirh'on.insurance for my emplajees. Below is the policy and job:site. information Insurance Company Name: Policy##or Self i2]s.:U,6.#: ` � �' �® Expiration Date: j O Job Site Address. .�j �Zs��s�' f_.�� GitylState/Zip: Attach a copy of the workers'compensation policy declaration page(shGwing the policy number.and expiration date). Failure to secure coverage as requiredunder 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 imprisonflient,is well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to$250-00 a day against the-violator. Be advised that a copy of this statement may be forwarded:to the Office of Investigations of the DIA for insurance coverage verification_ I do hereby certi a pains and apses perjury that the inforvtQdion proW&d above.fs true and correct Date: �S Phone t,►,fficial it`xe onF� De not Write in M&area,to be cornpTeted by city or town officiti City or Town: PermitiLicense# Issuing Authority.(circJe one) 1.Board of Irealth 2.BuildingDepartment 3.Citytrown Clerk tElectricai Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: b� 6 i .1 Town of Barnstable Regulatory Services sexHs�aex� _ Tihomas F.Geiler,Director u.�ss Building Division. j Tom Perry,Building Commissioner 200 Main Strut;HYannis,MA 021601 wmvw.town.b srnstable.ma.bs Office: 508-862-4038 Fax: 508-740-6230. Property Owner Must ' Complete and Sign This Section If Using A Builder ice, r-NP gas Ownerof the subject property r J•f; -a, 7 , to act on m behalf, herebyauthoMe r b s � �� �h'io Y m aD matrtrs.relative to work authorized by this building permit application for: 554, ; (Address of Job) PtL signature o Owner Print Name ' 7f Property Owner is applying for permit:please complete the Homeowners License Exemption Forms on the.revene side. j Atca CERTIFICATE ®F LIABILITY INSURANCE O ATE( mew" /3012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COOIFERS NO RIGHTS UPON THE CCRTIFICATE 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 INSURERS),AUTHORIZED REPRESENTATIVE 0R PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the eertif este holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If BUBROGATION IS WAIVED,subject to the terms and conditions of the palisy,certain pollcles may require an endorsement A statement on this certificate does not confer rights to the cart(ticate holder In Bee of such andoreemmrga). PRODUCER CONTACT NAME'. AWlied Risk Mw=az= Services, 2$C. PHONE FAX (AIC,Ne,Eatt) _(s77)23A-aaz© _(arc,Ne): (e77)_234-4421 10825 Old KMwd — O r E$ 68134 ADDRESS^ PRCCUCER - - ---- _.. — CUSTOMER ID N (877)234-4420 -- INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURERA: Continental indemnity Co. 28258 Greweire COY INSURER B: dba Grover MAIM amd RaOtolina INSURER C: PO Box 1080 _.... .. .....-- -- -' INSURER D: Cotuit, N 02635-1080 1 INSURER E: _ CTL 1273 659657 INSURER --- -- .. 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 REOUIREMENT,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 ADDL SUBR POLICY EFF POLICY EXP _ LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MlWDDIY MMODIYYY LIMITS' GENERAL LIABILITY i EACHOCCURRENCE S CQMMERCIALGENERAL LIABILITY ❑. ❑ i DAMAGE'TO RENTED MISESIEamwn 221 S CLAlAAS (�`� PRE - MADE u OCCUR MED EXP(Any one $ --,- PERSONAL&ADV INJURY S -- GENERAL AGGREGATE 5 GEN'LAGGREGM'E LIMIT APPLIES PER: PRODUCTS-COMPA�PAGG $ POLICY PROJECT LOG _-- $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT �.. . EEa aaAOntl _ ANY AUTO ALL OWNED AUTOS SODILYIN{tIRY1Per 5 SCHEDULED AUTOS 9ODILYtNjUw a=a%M 3 HIRED AUTOS PROPERTY DAMAGE $ NOR-OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE I AGGREGATE - -— $ I DEOUCTIBLfi RETENTION $ i $' WORKERS COMPENSATION l WC STATU- TO AND EMPLOYERS!LIABILITY T4RY_ ITS IER ANY PROPRIETOMPARTNER1 Y7N. EL.[:ACHACCIDENT $ 500,000 EXECUTIVE OFRCER/MEMBER N/A — EXCLUDED? k] 6-805700-01.-05 � /31/2012 /31/2013 (Mam1 toryInHH) �E,L,DISFASE-EAENPLOYEfi. 3 __500,000 tl yes,describe under SPECIAL PROVISIONS below E.L.DISEASE POLY Lsnn S a 11 DESOR"ON OF OPERATIONS I LOCATIONS I VEHICLES(Attach Amore tilt.Addttond Romance SchWule,N more space Is required► CERTIFICATE HOLDER CANCELLATION COL M SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE +M EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN ACCORDANCE WITH pp $= 1080 THE POLICY PROVISIONS. ODEUlt, DtDI 02635-1080 r AUTHORIZED IiEPREBENTATivE Attt3t P>ioJecC 17 03118 ACORD 26(nDSlrM The ACORD name and logo are registered marks of ACORD woe ACORD CORPORATION-AB rights reserved Office of Consumer Affairs&Business Regulation License or registration valid for individul use only = OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 144322 Type: Office of Consumer Affairs and Business Regulation xpiration: R 9/23/2014 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 GROVER BUILDING±REMODELING' r CAREY GROVER 56 BOWDOIN RD F Q�IQ MASHPEE, MA 02649 Undersecretary Not v d without signature Massachusetts- Department of•Public Safer" Board of Building Regulations and Standard' :r Construction Supervisor: License One-and Two- Famlly.Dwellings License: CS 77754 CAREY C :GROVER, . PO BOX 1080 COTUIT, MA;02635 � u. Expiration: 11/22/2013 ', II (untnnssivtncr 7r#: 7083 J ' , I 7D oF� r Town of Barnstable *Permi \ �p Expires 6 month`Lrom issue da + r Regulatory Services Fee w EAR E,IASS. + f. �� 1 Thomas F. Geiler.,Director a Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 - EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not[valid without Red X-Press Imprint S E r I b H I O Map/parcel Number 3 TOWN OF BARNSTAB E Property Address S - — Fi� ' esidential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address Contractor's Name Telephone Number`&'` Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ��` ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ Iaffrthe Homeowner ` have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) e-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#.of Windows *Where required: Issuance of this permit does not exempt compliance with other town,department regulations,"i.e.Historic,Conservation,etc.. 'Note: Property Owner'must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is, fired. SIGNATURE: Q:\WPFILES\FOR 4S\building perm' orms\EXPRESS.doc I' Revised 090809 i The Commonwealth of Massachusetts Department of Industrial Accidents 4 m ,' Off ce of Investigations 600 Washington`,Street 1 =Boston;lt�A 0:2111 g �` yy www mass.gov/dia Workers' Compensation Insurance Affidavit_: Builders/Contractors/ElectriciansMumbers Applicant Information. ,: '` + Please Printe bl Naive (Business/Organization/Individual) ¢ ". G Address: L��' - (�9f 9 City/State/Zip: Phone Are you an employer.? Check the appropriate box: " �. d Type of project(r.equired) 1.Lid�i am a employer with 4• _I•arn a,general contractor and.I 6, New-'construction employees'(full and/or part-time}: have hired'the sub=contractors 2.F1 I am a sole proprietor or partner- These on the attached sheet 7 ❑ Remodeling ship and have no employees .' "These sub-contract ors,have g, ,0 Demolition_ working for me in any capacity.:-{ employees and have workers 9..D Building addition [No workers' comp. insurance comp.insurance.$ , _ :We are a corporation and its 10 [] Electrical repairs or additions required.] , 3,❑ 1 am a homeowner doing all work.. _officers have exercised their `` 1 L0 Plumbing r ep airs{or additions myself. (No,workers'�comp. -right of exemption per IvIGL t 12:0 Roof repairs insurance.required.] t ,c, 152, §1(4), and we have.no .' r - employees: [No workers'' <N 13.❑ Other k'comp.insurance require, d.] Any applicant that checks box#1 must also fill out the section below showing their Workers'comp ens atioYn policy information. t Homeowners who submit this affidavit indicating_they arc doing all work and then.,hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached anadditional shref'showing the name of the sub-contractors and state whether or not those entitieshavot employees. If the sub-contractors have employees,they must'provide their.workers'comp policynumber.` z I am an employer that is providing workers, compensation insurance for my'employe'es. Below is'the'policy and�ob site information Insurance Company Name: mil/ ExpirationDate Policy# or Self-ins,Lic.#. : ./ Job Site Address: /D= CityCState/Zip, Attach a copy of the workers' compensation policy declaration page (showing the policy number an,d expiratio"n date). Failure to secure coverage as required under Section 25A ofMOL c,?152 can lead to the imposition,of criminal penalties of.a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of:a�STOP WORK ORDER and a fine of up to $250.00 a day against the.violator. Be advised that a copy of this statement`may be fcrwarded.to the-Office of ,af Investigations of the DIA for insurance coverage verification. : I do hereby cerfify a r.t e pains nalties eriy that the information proytded abo " is trice and correct. , Si nature „Phone#: Offtcitzl use onCy .Do not'wriie to this drea,.to bee completed by;cht or town offciaL 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.Otfier Contact Person: ._. Phone#: Information and hStructions for th Massachusetts General Laws chapter 152 requires all employers to provide w oker an otheprennderoany contrac opflh fees. Pursuant to this statute an.employee is defined as ...every person in the sere e express or implied,oral or written: otheror An employer is defined as "an individual,'partnership; association, corporati ntalives of a deceased employer op ore he Of the foregoing engaged in ajoint enterprise, and including the legal rcpres ther legal entity, C receiver or trustee of an individual partnership, association m'ents and who resides heroein, or he occupayi_Dg employees, nt of then the owner of a dwelling house having not more than three p . •n house of another who employs persons to do maintenance,coostniction or repair work amo d Lo b dwelling house d eilr employment b w o m g m1 uch e appurtenant thereto shall not because of s p Y L or on the grounds.or building pp the uance MGL chapter 152, §25C(6) also states that "every state or local eruct builensing dings inthe comhmonwe lthsfor any r renewal of a license or permit to operate a husiness or,to cons g applicant who has not produced acceptable ates "Neitheridence heoconimonwealth nor any of its polit calliance with the,insurance g ubdigvisions shall, Additionally,MGL chapter 152, §25C(7) states enter into any contract for the performance of public-work,until acceptable evidence of compliance with the msrirance requirements of this chapter have been presented to the contrac.tmg authority." Applicants . rkers' compensation affidavit completely,by checking the boxes that lapply to your s1wat on and, if Please fill out the wo necessary,supply sub-contraetor(s) name(s), addresses) and phone numbers)along vn insurance, Limited Liability.Companies (LLC)or'Limited LiabiliatY�na�suranepes If an)with no emplOYe LLC or LLP does have I es other than [he members or partners,are not required to carry-workers compens of employees a policy is required. Be advised that ]Alsodavit be surge to signkan submitted date the nafrdavit ntThe affidavitlshould onfirmat Accidents for cion of insurance coverage, be returned to the city or town that the application for the ce apd nbi the or license,is b law or if you acirire r requested, to obtain Ia workers't o industrial Accidents. Should you have any questions g g compensation policy please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate lint, City or Town Officials bottom Please be sure that the affidavit is complete and printed legibly. f Ibvestigatihe Donph sntont has contact your ga ding the applicant. of the affidavit for you to fill out in the event the Office an Please be sure to fill in the,pennit/license.number which any kvensedaas need only.submibone affidavit n�dicating]currrent that rnust,subrnit multiple permit/license applications y g Y _(city WTI policy information(if necessary)and under"Job Site Address"tcd one anpP l'c by aot thecaty orttown locations provided to the or town),""A copy of the affidavit that has been.ofho fic y pst be r liCeDS Cs. A new affidavit mu applicant as proof that a valid affidavit is on file for Muse orr M]rmiot not related to any business or commerc al venture year. Where,a home owner or citizen is obtaining a license p (i,e. a dog Ucense or permit to burn leaves etc.) said person is NOT required to complete this affidavit. tion and should you have any questions., The Office of lnvestigaho s would,like to thank you in advance for your coopera please do not hesitate to give us a call. The Department's address,telephone and.fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston; MA 0211e1 Tel. # 617-727-4400 ext 406 or 1-877-MASSAFE Fax 4 617427-7749 Revised 4-24-07 www.lna5s.}?OV�Cha, ' i YHE Tp�� Town of Barnstable Regulatory Services a�xr�sTAsiE Thomas F. Geiler,Director Mwss i639. Building Division Tom Perry, Building Com.-mssioner 200 Main Street;Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 O f F Property Owner Must Complete and Sign This Section if Us ing A B uilde r I as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of Job) r Signature of Owner / e Print Name If Pro pea Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. ,r �I:i..aiitu•�•tt. - I)rttartntrni nt f'uitiir' �afcl� � -� F3n;trtl iif t3uiltlin_ t2c�ulatinn. ::tF!i.�tanti:u•ti: Construction Supervisor 'Lice:nse License: CS 77754 Restricted to: 1G CAREY C GROVER PO BOX 1080 COTU IT, MA 02635 �- -� Expiration: 11/22/2011 ( ,ininisi nu•r Tr=: 7783 :�y\ 13u�f©"o�'�Bt�f1$ffr�'f2'e�iS��ti(risa�d'Sf5(6'�fi(rd HOME IMPROVEMENT CONTRACTOR Renistratinn: 14 C -2.2 e:~ Expir-tioti: of.3!2C1C Tr# cr; Type: nBA DROVER BUILDING+REMODELIKG CAREY GROVER 56 BOWDOIN RD MASHPEE, MA 02649 Administrator c i A00RD. CERTIFICATE OF LIABILITY INSURANCE DA08/17/2010 ` PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Applied Risk Insurance Services, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 10825 Old Mill Rd CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE Omaha, NE 68154-0646 AFFORDED BY THE POLICIES BELOW. (8 7 7)2 3 4-4 4 2 0 INSURERS AFFORDING COVERAGE t NAIC It -- INSURER q: Continental Indesttnity Co. INS $ver, Carey -- - — dba Grover Building and Remodeling INSURERB: PO Box 1 0 8 0 INSURER C Cotuit, MA 02635-1080 INSURE_RD: CTL 1273 520498 INSURERE: 1 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED'BY PAID CLAIMS. INSRADD' POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE ( POLICY NUMBER DATE MM/DD/YY DATE IMM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence)' S CLAIMS MADE❑OCCUR _ MED EXP(Anyone pe=son). S PERSONAL&ADV INJURY I S. GENERAL AGGREGATE IS GENT AGGREGATE LIMIT APPLIES PER: - ,PRODUCTS-COMP/OP AGG IS — PRO- I I POLICY JECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE L'MIT ANY AUTO (Ea accident) ALL OWNED AUTOS - Y I BODILY INJURY SCHEDULED AUTOS - - I (Per person) i S, HIRED AUTOS I BOO!LY INJURY NON-OWNED AUTOS (Per accident) i S ! PROPERTY DAMAGE I- I(Per accident) . is GARAGE LIABILITY I I -AUTO ONLY-EA ACCIDENT I$ ANY AUTO ' EA ACC I S _ OTHER THAN ---_.,_— AUTO ONLY: A.GG I S ' l$ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE r ' OCCUR ❑CLAIMS MADE I AGGREGATE DEDUCTIBLE I -_ - I I '- ---)---I RETENTION $ WORKERS COMPENSATION AND ICTr_I EMPLOYERS'LIABILITY I- I I T RY LIMITS _____ iEN . ANY PROPRIETOR/PARTNER/EXECUTIVE 46-805700-01-03� 08131/10) 08/31/111-E 500, 000 E.L.EACH,ACCIDENT �S OFFICER/MEMBER EXCLUDED? __-- —'—'—- If yes,describe under I , I DISEASE EA EMPLOYEE S 500, 0 0 0 I I E.L. - SPECIAL PROVISIONS below E IS EASE DISE-POLICY LIMIT I S 500, 0 0 0 F OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD.ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE - Grover Building and Remodeling EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 PO Box 1080 - - DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION ORLIABILITY OF ANY KIND UPON Co t w i t, MA 0 2 63 5-1 0 8 0 _ THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE ""� Attn: Project Manager 178311.8 ACORD 25(2001/08) ©ACORD CORPORATION 1988 \i:�..aihu•�II• I)cI)Art mk-w Ili 1'uiilii �:Ifrl � � 1311;u'll ui l3tlil!lin_ Kr�_tilaliun. :illli.�tantlar�l: '- Construction Supervisor . ce;'Ise License: CS 77754 Restricted to, .1G CAREY C GROVER PO BOX 1080 COTUIT, MA 02635 Explranon: 11//22/2011 ! ��1111111��1��11i'I' I r-. 7783 13iia o 13(iiiaffia f jz -. HOME IMPROVEMENT CONTRACTOR ' Ex r lion: +; TrjV cr Type: DBFk GROVER 13UI1-DI•NG + REU!OUEUI•.G CAi BEY GROVER 56 BOWDOIN RD /H.; us,_ t.a•....... MASHPEE, MA 02649 �tlmini�iratnr AC0.RP,, CERTIFICATE OF LIABILITY INSURANCE DAT8/l/D 0 /17/201) 2010 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Applied Risk Insurance Services, Inc. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS 10825 O l d Mill Rd CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Omaha, NE 68154-0646 — (8 7 7) 2 3 4_4 4 2 0 INSURERS AFFORDING COVERAGE NAIC # _ _.......- INSURER A. Continental Indemnit'OSMy Co. 2 8�38 v e r r Care — -- --. -- - - ----- INSURER B dba Grover Building and Remodeling - ----- ------- ------ 1-- ------ PO Box 1 0 8 0 INSURER C: . Cotuit, MA 02635-1080 INSURER D: - CTL 1273 520498 - ------ INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DIP �- POLICY EFFECTIVE !POLICY EXPIRATICNI LTR NSRD TYPE OF INSURANCE I POLICY NUMBER DATE MM/DD/YY I DATE IMM/DD/YY) LIMITS - _GENERAL LIABILITY I EACH OCCURRENCE Is - i DAMAGE TO RENTED,--..T ----------------- COh4MERCIAL GENERAL LIABILITY LPREMISES(Ea occurrence) I S JCLAIMS MADE r J OCCUR MED EXP(Any one person) (S_ FP ERSO-NAL&ADV INJURY I S " -- '-----`I -- --- --- --- --- ! - GENERAL AGGREGATE- IS ' GENT AGGREGATE LIMIT APPLIES PER - I PRODUCTS-COMP:OP AGG S —1-------- - POLICY JECOT LOC I I ----— AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO I(Ea accident) I S r------------'--- ALL OWNED AUTOS (. (BODILY INJURY SCHEDULED AUTOS - (Per person) S HIRED AUTOS �--- 60D!L1'iVJURI - I NON-OWNED AUTOS I (Per accident) S I !PROPERTY DAMAGE S I I(Per accident) I !GARAGE LIABILITY ! AUTO ONLY.EA ACCIDENT I S ANY AUTO I I I-� OTHER THAN EA ACC!$--"--- -------_�_I I --,- 11 j i I AUTO ONLY: ?.CG I.S I EXCESS/UMBRELLA LIABILITY i I EACH OCCURRENCE .S - j ._ _...._ - -._--- ---- ---- OCCUR CLAIMS MADE i I AGGREGATE S - --- - �j DEDUCTIBLE I'--- --L- (RETENTION WORKERS COMPENSATION AND 1 I ]( WC STATU - C t I EMPLOYERS'LIABILITY I _j OPY AANY PROP RIETORiPARTNERiEXECUI'IVE I 46-80 57 00-Ol 03 ! 0 8/3 1/10 j 0 8/3 1/11 c L EACH ACCIDENT c - 5 0 0 000 — - - 500, 000 OFFICER MEMBER EXCLUDED? E.L.DISEASE-EA EI1P OYFE y It yes,describe under 500, 000 SPECIAL PROVISIONS below j . I E.L.DISEASE-POLICY LiFAIT S OTHER - --- - - — — w I I I DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Grover Building and Remodeling - .- EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL_ 30 - PO Box 1080 - DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON CO t ll1 t, MA 0 2 6 3 5-1 O 8 0 THE INSURER.ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESEN Attn: Project Manager !/�f 1783118 ACORD 25 (2001/08) ©ACORD CORPORATION 1988 W DEPARTMENT OF PUBLIC SAFETY !� I COMMONWEALTH ` OF 1010 COMMONWEALTH AVE } � BOSTON,'MASS 02215 esry s x MASSACHUSETTS. . - CK ENCLOSE CHE ObNEYORDER 14 LICENSE t ;k t. y�''?" CONSTR. SUPERVISOR FOR REQUIRED FEE EXPIRATION DATE •T ,. / MADE PAYABLE TO RE 3 0/ EFFECTIVE DATE LIC NO RESTRICTIONNSS "COMMISSIONER OF PUBLIC SAFETY" NONE 006/30/1991 0098$9 mTHOMAS A NELSON (D.ON6T SEND CASH). . 14. ICE VALLEY RD SS 024-44-4147 OSTERVILLE MA P EA pL O,TF� f_fF .INCREASE . A� � a PN Lr1 FEE: j 100.100 r.-y E SECT - >E ". 1 . 1989 NOT VALID UNTIL ED BYAYCENSEE AND OFFICIALL t HEIGHT: STAMPED-OR SIG ?ORE OPTHE COMMISSION �. DOB: 05/2$/1957 0 NOT - OE;TAC L'ICENSE.a.STUB THIS DOCUMENT MUST SIGN NAM E`1N.FULL ABOV9 SIGNATURE LINE w E -. CARRIED ON THE PERSON j F LICENSEE THE HOLDER WHEN ENGq- I ` r i. - .. I OTH - GlUNT ED IN THIS OCCUPAVII( . IONER { 20OM-2-87-81429 !I ���} aFTW _ .. ..-... '�..: ,�:.-:w ::.' P- �•,;;,-w.ru �..:' .:�,: ,_.� may �` {' ty� ,d' �t x.E '.l. £ Yt.Y F 3 '.p4i _,r^I r' .:! 9�"F ::3 lh .'st•. S 8 ..o":.': -'. i '" •f' :y a J•. .ruY 4 ! y:. 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CGNE. `—� __, I �• w.ver.�� Wave.av r4aeagwb er Aa w,.mn C w tacv:o,maacm aacvaro m w lm.xo - w e b 2. vx+vum euifao Cwa . wo a..s�a " Addition to Residence - .— - - Lucille H. Rapp - - Cotuif, Massachusetts Albert Harkness & Associates - - Site Plan -_.. Architects and Planners - °a1e'T"'°'"'i7'` Al 2 Central Street Ipswich, MA 01938 _ stole: 1/e"=1•-0' _ Y �c A:rf GK a FwNw77 C�[ !j r.i ♦r f r r. „/, t t-� I II _ ,i x - _ a y •nT,� Roam FINISH'stHE� .T Fz'IIF-I { �. . _I i -Pyyt � .,ac .K—',[ v[c. s a. sn/wr.lr,.•rYr') F _4 M � � � _ ry L No�/� - a GPvwL S n.t � r�I \. %ir.wi r�m.6iro-pi:¢•Rs a v/ - - �t fA' 9t t �) �3 _ e MoR SCHEDUL" rr• NSaRf.•G rJ� frp 4 .rI-L 9Er,T J 1. o •:. 5'e-F PO .14.. II ..Scgkr E. 1 P H 1�IA11 CE lS -(T\_1HrLRlcfi CLEVAT.ct� ...`' f. .. S .._ GALE a --. Y -:' �: � I ��. ..� _. ibtt.P1[L V•F '-'�`�Q_l}` i. 5GR-A D 5 arcs - I 2 _wL-'x a..4 2'1[ '4:Pi�r NT•m� r Z I �— - , 3 � L1 � -� —-1 rrE _ wUNa �-IX rI"•I y vim'^ (..+�-�f .77t1 ° �-.1, J — I � I C i cL F F�:.+✓N Yi-.::1 �/ �L.0 oF�F !• FK( —FICRTH ,. Addition to Residence - Lucille H. Rapp Coluit, Massachusetts _ Albert Harkness & Associates. : Floor Plan Architects and Planners - _ DO.:", "'jt17L A2 2 Central Street Ipswich, MA 01938r-o- „ n _ �� `# n..w�r•r=i},we - —In1a w,TaH - .•/-'.+/ wvi.. ___y � --Te•Nao R'Mu. � y i� w/LuuNFL+OnP � � `rIGM xHy - / Kwin MlC�ax•s}y Gct PYW.� - I -- •, '+ �� _ y DOW l.L wo.TR all .. .. n >i({•�Nl�h'4 TRH -"R' 1\ 1 as -�{ ff �-4.— "e#1ua.T 5N�MfafL Il \ J bl Aj �64me- 21, NOLCXa• TMM y W Mr�fNf6 f. t 1 �._ sfi va I _ TF - 3'Ewc C•l a” �. 1 1 \1 flip -r-r_-_-- . - _. -_l. �- - r 4 VD.j14N - I ._.f'{••d w 2a'E 41n.ais CCxfC - „ IY� SE-TIo1J THRU GcNnl ?cF�� - I i1rr+TFI - ! WF=T_6LF'IPT�Gf7 , 1 M/16n._LN-- ' - vn ffa1fa11+.4 .. t z, '1M, 1 _ +� .: 1 _.-vr• 4-Mu_—ryy. - � -; -- kY iil 1 M k 11 f3 f �Rh ., TV: f s --_ fP �I fI I ;j+ 1 (• H f!/'� Ii p1� _ -- - --__ _ - - - __-- :4��.�.,' .1�: .� ' i`�www t`_�Tln+.�x.4"•wR}�t:1L �•.�d�i�! - _-" T , -:- - - NSW�I-E.'r•..w 1 Addition to Residence Lucille H. Rapp COO, Massachusetts Albert Harkness do Associates - Elevations Ipswich, Architects one Planners4' oat"`"'R•`-"�R'� A3 2 Central Street Ipswich, MA 01938 � " Z 5"1, A, I J, --7,7,7 4� C; A 1 1F.7, ................ .............. -r.A I L W 4 '15AVE De- it -Aw '10 4 7 iy, z -4. -law' s-" I K- w. -A4 j Vi 4, ---------- ? Q Addition to Residence Ak� Lucille H. Rapp cotuit, M.—ch—tts Sections Albert Harkness & Associates Data: A4 Architects and Planners 5_1.:As..t,,d 2 Central Street Ipswich, MA 01938 :,'TY:n ia. A ;.n^$,. 7 ....:, .. ,..7YV ',( .. :, '{;.,. 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Rapp -- - Cotuii, Massachusetts Ru Albert Harkness & Associates - - t Site Plan ' ' Architects and Planners - Do1''`'"-1,.'1?i Al 2 Central Street Ipswich, MA 01938 = s—'.: t/8"=t•-o' lr , 77 I ' iLey _r f 0 ••. _ ]l'. � L ROOM iiNISH SGNEDUIE ti' !'i 1 ----)I -v b vc , ` i I " ti• MT r 1L—LK s�we Sionc CINe.IY) ,. , I I {- �a4 Ruurc �---tl 1� - � ��q ♦-� �OOOe SCXEOULE T -' R+Lv vM Cnf WCR I f It; tr'k•� ®.. t QtMRIr EL '� 1 2 _SLAECI!PO�'H Plan CE�A LS � /F�=QtfERI R CLEVATIct�I \�- � w�, � �6CALL 1 l o 7. - 1 - Wd r �- f 11aTt FlCL V�0. 1`j - z'µ - Ii v✓'r.N� Nr s v Firr. „y .(a_C�--' K I — 1 a. t of - f' � •�i .. `� 'I .1 1 iq. - r A. dy Ric Addition to Residence - Lucille H. Rapp - Cotuit, Massachusetts Albert Harkness & Associates. - _. 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' .-. :� ...-. - .- -i',uhu`.ti+ �•'n s y e .A� a, s-: '-J -•cc rYwo ; 3 - 'ecas..e bEa rno+c.-. /< _ r y dy 5e is c 1 yl .� _, }r _,.r_ , _ 1—ij — __ .r—.. `•b IF S,I�c Na�uuNr _ q '[' r I La-T E N t - ...:-. -TI G•I THRU GCPNFLT • }J..FTN ELEVATIo1J � �L t < �, 1�'tY c(ANEL4ING� ui t r wE T.'ELEVATIa N- I =R A26n J r i t _ r , t —>t �r 67 } I F Rn f �� I I I _ ♦• - - . � tl_ - -. III - t fi-'l - Addition to Residence Lucille H. Rapp - Cotuit, Massachusetts ' ' Albert Harkness. & Associates - - Elevations Architects and Planners - Datea•rF..�6,Rva 2 Central Street Ipswich, MA 01938 A3 s..1.: t/<•= 1•-T r a sff XV e. 1yP t ..� �`'a f".tf t ,,.` :�' .., r.� :s I d:;; ,� �.i 1., t 5 't..,+ �$S.; .:'.ib•w:re*ue-exL:rmwe B� -t{c; 6T�i; e45 1 � ) rR YI' -::4 4, a vc�r. -: ✓\- - TY P.6LP4 Wane — - r X, TR'4 N .- T77\ 11 r0 Q yl P N � •. :'-\ eJ lOtc� - �TYPnR PSLO;'{(lr WLnP--�- ;/ ! /'n���1 I hv.Jn+Ca� CY L J. F•e -tE"L%RW :. _. .. mn c o uP� .. - . �.2:G• U Ire o.c. --_ Y.� •.... ;• NT£F.v�RN IOv.t n+IC Pwi.MP.eER .- 4"Xr[R�e'F. rJV./ �AVs�D I,TAIL 3I SLL DETAIL �Auo MMI%S1 91 LL:.=TYH-:n' _ NcwFR:•' 4 _ H Y r • 1 i . F —L1 — +2 G , - � - - 1 4(A4 u,1�y R - -f-rY-�' - _ - �lsJ.1 f 1. .. '�1_ ::< _ -� >2'r�i.+(.T. -Y.e t\ .�\Flet_N t IYl r _911— ar<4M1 �a-K -� -4/4.1 N it--;M �.'.:I I ♦— -.._ % 'Pi' If"I INlO T M1 .._ IC � .. C �orl Ic9F /i Z1Y1�Z%1J _l�J �� � I I t t L:L'IJ EGTI.JIJ . s """y- "t Addition to Residence Lucille H. Rapp — - - CO1uit, Massachusetts - Sections Albert Harkness &-Associates A Architects and Planners i,. Scale: A.Noted ' 2 Central Street Ipswich, MA 01938 j Assessor's office(1st Floor): ti Assessor's map and lot number 3�— �3 Q�oi T"f Board of Health(3rd floor): SEPTIC SYST Sewage Permit number r INSTALLED IN Engineering Department(3rd floor): WAS u T / YY/��E7 Y 639• House number Definitive Plan Approved by.Planning Board 19 ENVIRONMENTAL APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN REGULATIONS APPR t(�- OF BARNSTABLE 0arttsu t CW=rV on partmen; / BUILDING ' 'INSPECTOR APP'LLI T�ION FOR PERMIT TO ® �®�• ��l�S���5 s�� a� TYPE OF CONSTRUCTION S j9 1d 19 0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit ac ording to the following information: Location Proposed Use Zoning District / P Fire District Name of Owner�y /C Address �� L S� ✓ " Name of Builderl o44617 6400tAtldress Name of Architect k"!`G //1� �� Address � ��of Number of Rooms Foundation VInjq CO-77 Exterior ce/67" y��� Roofing Floors / Interior Heating PlumbingJr Fireplace AZI /t.L Approximate Cost zj"Ooo AreaOd Diagram of Lot and Building with Dimensions Fee ✓� N e IS �XfsA/4 /71 0e/ OCCUPANCY PERMITS REQUIRED FOR NEW D I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin a abov Name �Construction n Supervisor's License Constuct o Sup � ' RAPP, LUCILLE H. r; c No 35124 Permit F B LD ADDITION Single Family el ng' i Location 33 Scho_ol tr.A + Cotuit x� Owner. Lucille HS Rapp{ F' ! ; f _ � Type of Construction Good frame , , ti .� - _— _ Plot ;Pe3r;�i;G,,anted June 12 19 92 Date ofi`fr7spection 19 r Date Completed 19 . • ! i , � vv 1. �, y + r ,r , Property Location: 33 SCHOOL STREET MAP.ID: 035/013/ Vision ID: 2210 Other ID: Bldg#: 1 Card 1 of 1 Print Date:07/11/2001 :�f.a..t `:. .., 4 ., - ....< i - >r�" x.,r.,,.:.�- a '•. �. KAPP,L LUCILEE u is Water Description Coae Appraised Value Assessed value 801 O BOX 792 as ave ESIDNTL 1010 144,900 144,900 , OTUIT,MA 02635 ep is SIDNTL 1010 4,200 4,200 Barnstable 2001,MA ccount an Ret. Tax Dist. 200 Land Ct#er.Prop. #SR I S I OlN Life Estate DL 1 Notes: DL 2 GIS ID: old , 4 . r. Code Assessed Value r. Code Assessed Value Yr. Code Assessed value RAPP,WALTER P&E LUCILE 662/426 Q 0 Mull 10111 , , , 2000 1010 110,5001999 1010 120,0001998 1010 120,000 2000 1010 113001999 1010 1,3001998 1010 1,300 Total: Total. 172,800 . Total.1 .\.�.\ '> . ..`\.�:su .r:.:w, +e�?, s; \a4.,.a� ;: ,.. •'v.a.,, rein'. U S' 1AXis signature ac now a ges a visit y a ata Collector or Assessor °-- Year -Ty—pelTiescription AmountCodeCdDescription number Amount Comm.Int. Appraised Bldg.Value(Card) 144,900 Appraised XF(B)Value(Bldg) 0 ota: Appraised OB(L)Value(Bldg) 4,200 P11 Special Land Value raised Land lue(Bldg) 86,900 ECON.LOCATION.. 75%IS NOW 100% *REMODEL 50%COM COMP FOR FY94... Total Appraised Card Value 236,000 75%OVERALL 1/91 Total Appraised Parcel Value 2369000 *BLDG SHLD HAVE Valuation Method: Cost/Market Valuation BEEN 85%COMP ��o a Appraised ParcelValue , 00 \s 2 i Permit Issue ate ype Description mount Insp. ,ate o Comp.t Dote Comp. Comments Date Cd. PurposelResult eas is e B34016 10/1/90 AD 15,000 1/15/93 100 CO REMOD' 1/15/91 NIL �g \ : . .a � ti� . _ . >a� ..: a Use Coae Description zone D 1,ronlage Depth Units Unit Price L Eaclor S. actor lVbhd. /. Notes- peciaPricing [. nit rice an value I Will ,Single am o es: , otaCar an nits arce ota an �ra, Lota an Value , Property Location: 33 SCHOOL STREET MAP ID: 035/013/// Vision ID:2210 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 07/11/2001 y ... , a,�a .,, a � Element escrI tion ommerc:a ata Elements ty e ype Colonial Element Description 16 Model 1 Residential ea Grade B Custom Grade Frame Type Baths/Plumbing 10 16 Stories Stories ccupancy 0 eiling/Wall '2 BAS ooms/Prtns Exterior Wall 1 14 Wood Shingle /o Common Wall 8 7 2 Wall Height Roof Structure 06 Mansard 11 Roof Cover 03 sph/F GIs/Cmp interior Wall2 3 Plastered Element code escription tactor 11 nterior Floor 1 12 Hardwood Complex 2 14 Carpet Floor Adj Unit Location Heating Fuel D3 Gas 30 Heating Type 4 of Air Number of Units FUS C Type 01 None Number of Levels BAS /o Ownership Bedrooms 04 4 Bedrooms 3 Bathrooms 2 2 Bathrooms & . : .. ,YMA , ' ,; .y,., 0 Full na I. ease e S otal Rooms 0 10 Rooms ize Adj.Factor 1.00218 Grade(Q)Index 1.30 11 Bath Type Adj.Base Rate 78.17 1 21 Kitchen Style Bldg.Value New 170,489 Year Built 1880 20 6 ff.Year Built OV85)1985 nnl Physcl Dep 15 uncnl Obslnc con Obslnc d_ pecl. on Code AV o�a In, escri Description Percentage pecl Cond% mg a am Overall%Cond. 5 eprec.Bldg Value 144,900 gnv 1s Code' Description LIB Units Unit Price Yr. Dp Rt YoCnd Apr. v value Barn SHED Shed L 192 8.001940 1 100 600 Code Description Living Area Gross Area Pjj.Area Unit Cost Undeprec. Value --BAS—Mrst Floor , , FOP Open Porch 0 234 47 15.70 3,674 FUS Upper Story 803 803 803 78.17 62,771 M Gross LivlLease Area g a: 170,489 j, Board of Building Regulations and Standards HOMEIMPROVEMENT COCONTRAC Li OR cense T or registration Registrati n v Q ?49342 before the ex slid for Individul use only �Expjration Board expiration date. If found return Of Building urn to: = Type DBA One Ashburtong Regulations and Standards Place Rm 1301 FINELY FI Boston,Ala,02108 NISHEp 4� ' DONALD BOYTON 125 PINEY Rp COTULT MA 02635 Administrator I. Not valid without tb signare° F iwassaenuserts Department of IndustrialAccidents Office of Investigations 600 Washington Street a . Boston, MA 02111 ww massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AP-plicant Irsformntion - Please Print Legibly Name (Business/organization/individual): iC r44e7 I..26W 1%et4 �( Address: 14b /Ook City/State/Zip: (?7& C� Phone#: Are you an employer? Check the•approprlate bog: Type of project'(regaired): 1.❑ I am a employer with 4• ❑ I am a general contractor and I 6. New construction employees(fall and/or part-time).* have hired the sub-contractors 2. m a sole proprietor or pmtaer- listed on the attached sheet $ ❑ Remodelin g slop and have no employees These sub-contractors bane g: ❑ Demolition working for me in any capacity. workers' comp,insurance.. g. ❑ Building addition [No workers' gip,insurance 5. ❑ We are a corporation and its 10.❑ Electrical r airs or additions required,] officers have exercised their ep 3.❑ I am a homeowner doing,all,work right of exemption per MGL 11-❑ P1nmbing repays or additions myself.[No workers' comp, c. 152, §1(4), and we have no 12.RlGof repairs insurance required.] t employees- [No workers' 13.❑ Other camp. insurance required.] *Any applicant that checks box#I=ust also fill out the section below sbowmg their workers'compensation policyinforrnatiow t Homeowners who subarit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such rContractm that check this box must attached an additional sheet showing the name oftbe sub-contractors cad their workers'comp•poI cy.iaforrnation, ram an employer that is providing workers'compensation insurance for my employees. Below is thepolicy andjob site. information. Insurance Company Name: Policy#or Self-im,.Lie. #: Expiration Date: Job Site Address: City/state/Zip: Attach a copy of the workers' compensation p.vlicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 Zan lead to the imposition of criminal penalties of a fine up to$1,5001:00 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 kgainst the violator. Be advised that a copy of this statement may be forwarded to the Office; of Investigations of the DLk for insurance coverage verification. 1 do hereby certi nder the sins d pena 'es of erjury that the information provided above is true and correct: Si afore: Date: Phone#: Official use only. Do not r➢rife in this area,to be completed by city or town of ccial City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 3. Building Department 3.City/To'WM Clerk a.Electrical laspector 5.Plumbing Iaspeetor 6. Other ' Contact Person: Phone#: Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees' - Pwsuant to this statute, an employee is defined as"...every person in the service of another under any contract of hue, express or implied,.aial or written." An employer is defined as."an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engagers in a joint enterprise, and 'including the legal representatives of a deceased employer, or the . receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the e dwlling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on'the grounds or building appurtenant thereto shall not because of such employment be deemed to bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of it license or permit to operate it business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." AdditionaIl ,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority," Applicants Please fill out the workers' compensation affidavit completely,by checldng the boxes that apply to your situation and, if, necessary,supply sub-contractor(s)name(s),address(es) and phone numbers) along with their certificates) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP)with no employees other than the members of partners, are not required to carry workers' compensation insurance. If an LLC or UP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confumation of insurance coverage. Also be sure to sign and date the affidavit. The-affidavit should be returned to the city or town that the application for the permit or license is being requested,-not the Department of . Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies shoo-M meter lheir self-insurance license number on•the appropriate line. City or Town Officials. Please be sure that the afiadavit is complete and printed legibly: The Department has provided a space at.the bottom, of the affidavit for you to:0 out in the event the Office of Investigations has to contact you regarding the applicant = Please be sure to fill in the permit/license number which will be used as a reference number. In addition;an applicant that mast submit multiple permit/license applications in any given year,need only submit one affidavit indicating=ent policy information(if necessary)and.under"Job.Site Address"the applicant should write"all locations in - ; (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that•a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each ' year.Where a Home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this of idavit. The Office of Imrestigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give w a call. The Department's address,telephone and fax number: r The Commonwealth'of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Teli T 617-727-4900 ent 406 or 1-877-M-ASSAFE Revised 5-26-05 Fax l 6 17-727-7749 www.ri ass.crOv/Mia BIKE� Town of Barnstable Regulatory Services 9� I E g Thomas F.Geiler,Director A�FD MA'I A Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, G �� � O , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: 335cU0aL S 1?4p L (Address of Job) Signature of Owner Date Print Name Q:FORM&OWNERPERMISSION Assessor's office(1st Floor):number 3 s- d ( E 3 SEPTIC SYWEM M iTM Assessor's map and-lot [ ": ,,Q�►Lt UST BE p >o Board of Health(3rd;floor): INSTALLED IN COMPLIANC � �,_ �� � .. WITH TITLE 5 ow Sewage Permit number / s . , Engineering Department(3rd floor): ENVIRONMENTAL CODE A 11"g'9T°Bt` rrua House number , ;: TOWN REGULATIOR1� �°' 6�v.6\`�' Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF ' BAR.NSTABLE BUILDING INSPECTOR . APPLICATION FOR PERMIT TO ASP 0 TYPE OF CONSTRUCTION C 10 ' e 19 qd TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:: Location !S C-A0 &T �e��a'fl� A Proposed Use t,�l AL- Zoning District '�`C Fire District l7 L k Name of Owner 4.0CI LLE, 11 . DPP Address 7Z2_1 RICH ND f1VE "DAR1 EN ,lut. 66550t Name of Builder oftis at.> �n ` ddress 35 1AtU-lYnIJ -i•��.�AL A 025'6 Name of Architect Address Number of Rooms Foundation Jgeao b; U€ Exterior I LIE Roofing'A51 IAA - Floors Interior L-:t:j`9 Aofl g5'(',[le Heating Plumbing as Fireplace Approximate Cost ., . Area Diagram of Lot and Building with Dimensions Fee �o OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Bar toregarding the above construction. Name '�NX'� =563"S06 Construction Supervisor's License i RAPP, LUCILLE H. - r No 3.4 016 permit For REMODEL j _ -Single Family Dwelling Location 33 School Street Cotuit Owner -- Lucille H. Rapp s, Type of Construction Wood Frame r Plot Lot Permit Granted October 19 `19 9i0 } 's Date of Inspection. - 19 ^' Date Completed j• 19 M at M tq 3 � . cn Q, 2 4 A P R Ib P ,'i 3 9 Q0 N RE-BUILT EXIST.ROOF STRUCTURE . Q w TO REMAIN W m R Lo DECK -o BEAM W/SIMPSFASTEN EXIST. OH2 5-T ES�� -�.. fW N 00 NEW MAHOGANY OR CO a oO o IPE DECKING -� 2-1 3/4"x 7 1/4"LVL HEADER E-. ��X xTBEAD ON THREE SIDES.USE.SIMPSON . BOARD CEILING HUC412 HD HANGER AT HOUSE u rigen }' p SIMPSON-AC4/ACE4 P.T..4 x 4 POSTS W/AZEK �' COVERED POST CAPS A CASING& 1 x 8 BASE Al PORCH P.T.4 x 4 POSTS W/AZEK 10-0 10'-0, i CA SING& 1 x 8 BASE EW MAHOGANY OR 20'-0" IPE DECKING P.T.2 x 8's @ 16"o.c. 3-P.T.2 x 10's @ 16"o.c. . FLOOR PLAN N NEW3-P.T2x8's W �? r0 NEW 12"DIA.CONCRETE SONOTUBES F� TO 4'0"BELOW GRADE.USE SIMPSON ZMAX ABU66 POST BASE. FASTEN POST FROM ABOVE TO BEAM W/SIMPSON EXIST. 12 SQ.CONC. BC40 HALF BASE FOOTINGS TO REMAIN E EXIST. 12"SQ.CONC. I a FOOTINGS TO REMAIN BUILDING SECTION 0RC1 1 o 1 1-0" NEW 3-P.T 2 x 8's -o„ j Al w TeTl� Z c NEW P.T.2 x 8's 16"o.c. U) cn I NOTES: al w o s . { 04 x 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS & DIMENSIONS IN THE FIELD a' U A NEW 12"DIA.CONCRETE SONOTUBES r, Al TO ZMAX ABU66 POST BASE. FASTEN POST +BELOW GRADE.USE STEPSON 2.) CONTRACTOR TO VERIFY ALL INTERIOR & EXTERIORMATERIALS M�-I � co ZMAX � 134 co 5'-0" 5'-0" 5'-0" 5'-0" FROM ABOVE TO BEAM W/SIMPSON DETAILS, & FINISHES IN THE FIELD WITH OWNER BC40 HALF BASE 20'-0" 3.) ALL CONSTRUCTION TO CONFORM TO THE IRC2009 BUILDING CODE W/THE 8TH EDITION MASSACHUSETTS AMENDMENTS FLOORPLAN R 4•) 110 MPH EXPOSURE B WIND ZONE, nAT� 5.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION F, OF ALL SIMPSON COMPONENTS MCA. NO,: 6.) ALL CONCRETE USED FOR FOUNDATION WALLS, FOOTINGS & SLABS k TO BE 3000 PSIAl