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Home My WebLink About0108 SCHOOL STREET PF l D �5'choo� r�e � 19 i I , Town of Barnstable $RECEIPT " S"KAs� 200 Main Street, Hyannis MA 02601 508-862-4038 A lication for Building Permit PA - g Application No: TB-17-3530 Date Recieved: 10/12/2017 Job Location: 108 SCHOOL STREET,COTUIT Permit For: Building-'Siding/Windows/RooVI)oors Contractor's Name: ARMEN SAFARYAN State Lic. No: CSSL-106102 Address: Hyannis, MA 02601 Applicant Phone: (508) 776-2900 (Home)Owner's Name: RAPP, KEITH M&ROSEMARY A Phone: (508)428-6765 (Home)Owner's Address: P 0 BOX 357, COTUIT,MA 02635 Work Description: Remove and haul away all of the old asphalt roofing shingles from the main barn house roof. Total Value Of Work To Be Performed: $5,000:00 Structure Size: 0.00 0.00 0.00' ' t--- M Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in.work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by - filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a.permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Armen Safaryan 10/12/2017 (508)776-2900 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $5,000.00 Date Paid Amount Paid # Check#or CC# # Pay Type Total Permit Fee: $35.00 10/12/2017 $35.00 X3O0{-XJO -X30IX- Credit Card ......1 ......... i............. .8664 .. ..... ......... Total Permit Fee Paid: $35.00 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel � _ .Application # �16�� Health Division Date Issued Conservation Division Application Fee v Planning Dept. - Permit Fee 4 Date Definitive Plan Approved by Planning Board l� Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner ° Address %i Ork Telephone L Permit Request v V Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family., Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count not including baths): existing new First Floor Room Count ( 9 ) 9 Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other 4 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stfte: JYes ❑ No � o Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑ existin4� nc&' size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 3 �Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ s. Commercial ❑Yes ❑ No If yes, site plan review # co rrn Current Use - Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number ` Address � ALicense # �A�j Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �mAll ' ' S FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED • ` t ` MAP_/PARCEL N0. _ADDRESS . VILLAGE OWNER - DATE OF INSPECTION: FOUNDATION - FRAME INSULATION':. FIREPLACE ELECTRICAL: ROUGH FINAL P PLUMBING: ROUGH FINAL i r GAS: :ire: ROUGH »L ', FINAL BUILDING; - .. = `l •Q l s „ DATE CLOSED OUT - ASSOCIATION PLAN NO. u c RUG-17-2010(TUE) 09: 32 C. H. NEWTON, tv. FALMOUTH P. 003/OOA Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensadon Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name (Business/Organization/lndividual): C7 H /V ALA-) ✓1 ;�3u l d sale`5 Address: Xa 11n061L 1"6;4 44�•4 City/State/Zip: Phone#: Are u an employer?Check the appropriate box: Type of project(required): 1,L'� 1 am a employer with� 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time)." have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition workingfor me in an capacity. employees and have workers Y p tY• 9. ❑ Building.addition [No workers' comp.insurance comp. insurance., required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1.1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c• 152, §1(4),and we have no employees. (No workers' 13.[► Other�ogfil� ..M comp.insurance required.] - sAny 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 providi►ig workers compensation insurance for my employees. Below Is the policy and job site lnformatlon. insurance Company Name: 4 -x d Policy#or Self-ins. Lic. #: ,��°�✓' 3 e174"7 Expiration Date: Job Site Address:l a1. c1 City/State/Zip u� f 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 aga'nst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA. r insur ce coverage verification. 1 do hereby ce tfy u - p and-penalties_,of perjurylhat-the-infar-,n w.io&prnyided above is true and correct- Date, Phone C Official use only. Do not.write In this area, to be completed by city or town offlclaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone M. AUG-17-2010(TUE) 09: 32 C. H. NEWTON, W. FALMOUTH P. 001/004 3 Nlassachusetrs- Department of Public Safety L. Board of Building Regulations anti Standards Construction Supervisor License License: CS 46192 Restricted to: 00 DAVID L NEWTON PO BOX 922 FALMOUTH, MA 02541 Expiration: 9/19/2011 ('ununi�wiunNr Tr#' 5610 4 ' r,rt RUG-17-2010(TUE) 09: 32 C. H. NEVITON, W. FRLMOUTH P. 004/004 3248 2NEWTONCH ACORDTM CERTIFICATE OF LIABILITY INSURANCE 110 1201IYYYY) ovo5/zolo PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling m O'Neil Insurance, ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIL t1 INSURED INSURER A: Acadia Insurance C.H. Newton Builders,Inc. INSURER e: 98 North Washington Street,Suite 202 INSURERC: Boston, MA 02114 INSURER D: 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, NSRE TYPE OF INSURANCE POLICY NUMBER REARM PDOLAITRYMMVLIMITS A GENERALLIABILITY 13INDER301752 01101/10 01/01111 EACH OCCURRENCE $1000000 rXEC MERCIAL GENERAL LIABILITY E f RENTED 62 CLAIMS MADE U OCCUR MW EXP ona pariah) 6 00 PERSONAL 8 ADV INJURY $1 000 000 P GENERAALAGGRrmAtr. 62 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS--COMPIOP AGO 62 000 000 POLICY D YleT 7 LOC A AUTOMOBILE LIABILITY BINDSR301753 01101/10 01/01111 COMBINED SINGLE LIMIT X ANY AUTO (Eseuvident) �1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTO$ (Per paman) B X HIREDAUTOS BODILY INJURY X I NON-OWNED AUTOS (Perawldonl) X Drive Other Car PROPERTY DAMAGE (Par eeddent) i GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 5 ANY AUTO OTHER THAN EA ACC E AUTO ONLY: AGO 9 A EXCESSIUMBRELLA LIABILITY BINDER301756 01/01/10 01101111 EACH OCCURRENCE 110,000,000 X OCCUR ❑CLAIMO MADE AGGREGATE $10 000 000 S DEDUCTIBLE $ X RETENTION 30 A WORKER$COMPENSATION AND SINDER301757 01/01/10 01101/11 X RYLIM OTC EMPLoYLRS•LIABILffY E.L.EACH ACCIDENT $500 OOO ANY PROPRIETORIPARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? 6,L.DISEASE•EA EMPLOYEE $500 000 If yyeeaa,daecdba under SPr%dA low E.L.DISEASE•POLICY LIMIT $500 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Insurance coverage Is limited to the terms,conditions,exclusions,other --�-11Rdtations-an'd-endorsements, Nothing contained In the certificate of Insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Falmouth DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL ,10_ DAYS WRITTEN 59 Town Hall Square• NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 80 SHALL. PO Box 922 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Falmouth,MA 02540 REPRESENTATIVES. AUTHORIZED YPRESENTATNE ACORD 25(2001/06)1 of 2 #864583/M64582 LS1 0 ACORD CORPORATION 1288 AU6-17-2010(TUE) 09: 32 C. H. NEWTON, tv. FALMOUTH, P. 002/004 Office of Consumer Affairs and Ifusiness Regulation 5 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Replstratlon: 107888 Type; Private Corporation Expiration: 8/9012012 Tr# 201382 C.H. NEWTON BUILDERS, INC. -' David Newton PO BOX 922 -- Falmouth, MA 02541 --- — - Update Address and return cnrd.Mark reason for change. LJ Address' Renewal n Employment ❑ Lost Card PMAI 0 9oM-o4J04-0101216 lr °�'�� License or registration valid for individul use on Ofllcc of Consumer Affairs&B slness Regulation g y. HOME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: Registration: 107888 Type; Office of Consumer Affairs and Business Regulation Expiration, 811 012 0 1 2 Private Corporation 10 park Plaza- to 5170 Boston,MA 021 VCNEWTON BUI<-IJW5,TN4."`.: David Newton 549 Main Rd 28A W. Falmouth,MA 02541, Undersecretary Not valid without signature .. t . g , ' J ENO SEEM M m EMS MMMMMMMMMMMM MMMMMMMON ME m M MMEMMMMM ME MEE ME MEN ME ME ME MMMM MOM MEESE M ■■ MMMMMM m ME No M NONE MEN MEMIMMMMMM MIME ma MMEMIMMMMMM MEi vMOM MMMMMm mmmmmi M ME MOM EMMOM MOMMMMMM .IMMMMOMMM MEEsMMMMMMMMMMMMMMMMM ■ MEMO ME Emil M ME ME ME ME MMMM E � . IN MEN immmi M mom M NONE MENNEN MENEM M 0 ME No MMME 0 No 0 MENEM ME ON ME MEMNON MEMEM No No momom ME mom ME mom ME OMEN m 0 No NO MMMMMMmMMMMmMMmM mom 0 ON MENNEN ME ME 0 0 MENEM MMONEENNEEN No NO 0 M MENEM MMMMMMmMMmMMm ME mMmMMMMMMMM MOM MENEM M 1 0 0 OMEN 0 MMMMMMMMM ME MENEM M M MMMMlMl M IMMMMMMMMMMS`EMM 0 MENEM M ME NEENNOMEN ME mom ME MMMMMMMMMMMMMmMMMmM MEN mom mMMMMMM MMM NO No MOM M ■ ININE C:.o .00. ...0 .. NO MENEM MEMNON NO so NO MENEM m ME mom ... �::: o' off:" :::: OMEN MMMMMMMmMMMMMMM MOM .aa .. MEMEMEMEMME MEN MEMMEN SOMEONE 0 ME mmmmmmmm�mm -MENNEN MOEN ■ MEMEN MENEM MENNEN lmmm�mmmm M . 0 ONE MENEM No MENNEN MEN OEM MEMEMIMEMEMN ONE M MOEN NONE MEMOMME ME ME m MEIN NONE NNE M ■ MEE No MINE ON MOMME ME NONE ME 0 ME NONE OEM MENNOMMSOME NO IMMEMEMEMOMMEMEM ME M ME No IN EMMEMMEMMOMMEMEMSEN MEMEMMEMEME ME NONE ME ME ME ME ME ME MEMEMEMEMEMEM ISME ME ■ IESOEMMMMMMSEE OMMMl MEN 00 No M MOMMIMMEEMEM NONE MEN ii�iiiiMi�� 0 mommummommummoom ME M ONE mommommoommom ME MEN MEN mom ME MEN ME ... CCU .. 'C.�n. 0 ME moomm MMMMMMMMMMMMMMMNMM ME ME ll N NIMEMEM ME ONE No ME MEMNON momom MEMEMEMOMMMM MMUMMOMMEM ME MOENOM MEMEEME ME MENEMONEMOMEM 0 M ME MEN MOMEMEM MEN NNE M MEN No ME SOME ME 0 0 mom ME ME 0 No ME 00 ME MEN ME MEN M ME ME.. . ... ..... ....mommoommommommommommMMEMMEME ME MEN ...... MEN ME ME ME MENOMME ME ME MOMMMMEMEMMEMMMOMM ME No ME MEMENNOMMEMEME ME mommom momms 0 0 0 ME ON ME ME NEON ME ME No ME ME MENEMENNOMME ommommommo MOMMMEMOM MEMME ME ME No ME moommommoommom ME M ME ME No ME MMMMMMMMMMMMMmmmmMmM ME 0 ME 0 MEMO mommoommoms MEMEM ME �EMMMMMMMMM No MEON MENEM MOOMMOOMMI 0 ME ONE ME MEMO ME MEMEMEMEMN ME MEN ME EMMEMMEENEM ME NEOMMOMMEM 0 ME ME ME ME MOMEMM ME MEN mommommomommommom 0 momtr ME I 1 0 ME 0 No MEN ME ME No �. .. ..mom, moommm�0.oE::�...0 � . ' C. H. NEWTON BUILDERS INC. MAILING ADDRESS: W. FALMOUTH OFFICE: OSTERVILLE OFFICE: BOSTON OFFICE: P.O. Box 922 549 West Falmouth Highway 919 Main Street 98 North Washington St. Falmouth,MA 02541-0922 West Falmouth,MA 02574 Osterville,MA 02655 Suite 202 TEL:508.548.1353 TEL:508.428.5528 Boston, MA 02114 EmAIL: FAX:508.548.5330., FAX:508.428.9245 TEL:617.723.4567 info@chnewton.com k FAX:617.723.2190 August 16,2010 Dr. &Mrs. Keith Rapp P.O. Box 357 Cotuit,MA 02635 Via email: roskrL1conicast.net Dear Dr. &Mrs:Rapp: Re: 106 School Street,Cotuit We are pleased to submit this estimate for miscellaneous exterior trim repair and front porch post replacement: $500, This work will be performed on a cost plus basis'which consists of a labor charge of$50/hour for labor,$57/hour for mill work,and 5%profit and 10%overhead on all labor, material and subcontractor costs. Subcontractor's rates vary per trade. All lumber costs are good for thirty(30) days. This estimate is for budget purposes only. All figures include labor,material,supervision, profit and overhead. - If this estimate meets with your approval,please sign below and return to our West Falmouth office by mail,email (smackev(a'ch,ie"wton.com),or fax (508-548-5330). If you have any questions don't hesitate to call. Respectfully submitted, Brian Lafauce R General Manager \ All of our workers And stllxron ctors are fully insured. 4 Home Irrinrovenient License 107888 ' • CitstonrHomes . Historic Restoration & Period Building • Estate Care 0-c( 3 Town of Barnstable' *Permit Expires 6 months from issue to Regulatory Services Fee HARMABM a i r� ,� Thomas F.Geller,Director �A 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 O 3� Property Address l O E C-1-Lc3c) i Co 7'V I - M A O 245 3 S residential Value of Work y / 6 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address f- l./- 0 S L�_M09 P Ll 'pip Contractor's Name • �• E-tw 7'27, L N 13b&--b L-X_f Telephone Number Home Improvement Contractor License#(if applicable) �O 7O S k Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance -PRESS PERMIT Check one: ❑ I am a sole proprietor ❑ I am the Homeowner NI have Worker's Compensation Insurance J'owN �F��R Insurance Company Name AC-6-() i A NS T46L F Workman's Comp.Policy# E/ 0z)Z`f—'(31 r)r? -1 7 Copy of Insurance Compliance Certificate must accompany each permit. Permit R=(hurricane k box) nailed)(stripping old shingles) All construction debris will be taken to -7?bve-/ � ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission: A copy o the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: C:\Users\decollik\AppData Loeal\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 4 77te Coninronxlealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 92111 mot.rttass.govldia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electeician&Tlumbers Applicant Information Please Print Le-gib Name(BusimwJorganizatiwVbdMduaD: Address: peg City/State/Zip: 1/�/ I. �iq&PL10 y7-H Phone*. . 6-7)9 Are you an employer?Check the appropriqe CbDII Type of project(required): 1.❑ I am a employer with 4- m a general contractor and I employees(full and/or part-time).s ve hired the sub cQanactuis 6- ❑New construction 2.❑ I am a sole proprietor or partner, listed on the attached sheet 7- ❑Remodeling ship and have no employees Them sub-contractors have S. ❑Demolition working for me in any capacity. employes and have worms' comp,inspranee.I 4. ❑Building addition "1 �� a 5. ❑ 11Ue are a corporation and its M❑Electrical repairs or additions officers have exercised their 3 am a homeowner doing afl wadr l I.❑Plumbing repairs or additions if o workers' right of:egempgon per:MGL Q insurance��&j 1 c. 152,§1(4),andwe have no 12. Roaf employees.[No workers' 13.fqtlther &,f comp-insurance required.] *Any applicant Beat checks boa#1 Must also fill out the section below showing&&woakew compensation policy in—wtion- 1 Hamemnas ubo submit dus affidnit indicating they ate doing aIl;eotk and den Lae ouftide canttactoas mast sabmit a new affdarit indicating sock LCoattactots that check this boa met attached an addition sheet s1mving the name of Bic sub-contractors mnd state wbelher at.not those entities bare employees. U the sub-conuactom bane employees,dley tmtst pmuide their workers'ramp.policy number. I am are employer that is providing workers'eonWensadon insurance for tray enrplo,fee& Below is die policy and job site information.Insurance Company Dame: A t,41 / . Policy#or Self-ins.Ur—* //VQ e'er Z/ /1 ct Expiration Date: . . Job Site Address: �� s� S CO 7U City/Stateizip: G0 TV ?7 14A 0 24 35— Attach a copy of the worlaers'compensation,policy declaration page(showing the policy number and expiration date).. Failure to settee 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 ORI.)ER 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&e DIA for insurance coverage verification. I do here under t e pains d penalties oJpetjetry that the infor mationprouided abovi is i nmi and correct Siena Date:. / Phone 0,,UWal use only. Do not write in this area,to be completer)by city or town oficiat City or Town: . PermitUcenie# Issuing Authority(circle.one): 1.Board of Health .2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Rx Date/Time RU6-03-2011 (WED) 13: 1.1 5087710663 P. 001 08/03/2011 13:14 5087710663 SCHLEGEL_INSURANCE PAGE 01/01 CERTIFICATE OF LIABILITY INSURANCE PATFOOMI"I" 103/16/2011 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: the COMC to holder Is on ADDITIO I URED, the pollCypeS) mrmt be endorsed. If SUBROGATION IS WAIVED, subjeet to the terms and conditions of the pollcy, certain policies may require an ondorssment. A statement on this eertifleats does not center rights to the cortiflosta holder In lieu of such endoresment(s). PRODUCER CONTACT NAME: Schlegel 6 Schlegel Insurance Brokers Inc PHONE 34 MAIN STREET Alc N"ox ADDRESS: CUSTOMER M __.._ _... West Yarmouth, MA 02673 -� INsurlEwsl ArroRoaaG eovERAOE N=X INSURED INSURERATRAVELER9 Tommy Steaio Dba Johnny Banks Construction INSURER B: 85 Carl T,aWdi, INSURER C: INSURER o: East talmout:h, MA 02536 INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS To CERTIFY THAT THE POL1068 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, LTR TYPE OFINSURANM INBR I woo IIwLIerNUMOER "MIDDIYYI'T') IMMID M'm UM" OENERAL LIABILITY EACH OCCURRENCE $ COMMCRCK GENERAL LMLITY PREMISE31Eaeeamrma S —_ — euvaamAoe ❑OCCUR MEDEXP(My oft pemon) S _PERSONAL A AOV INJURY S GENERALAGOREGATE _ OENL AGGREGATE LIMIT APPLIES PER: PItODUCTa-COIaPIGD qp0 S POLICY J@�CT Loc s AUTOMOBILE LUanm COMBINED SINGLE uMrt s ANYAUTO RUM" ALL OWNED AUTOSBWILY INAIRY(Par perum) SCHEDULED AtRDa BODILY"RY(Par aceldo"p = HIRED AUTOS PROPERTY DAMAGE S Per denq NCNZM90 AUTOV S f uMaRRLI p UAS OCCUR EACH OCCURRENCE t 9XCBSS LIAR %A W AGOREGAT@ 1 DEoacnlne _ R�ENnoN s s A INORKFM ANDEMpLOYEWIm"n0N WC2-0378687-2010 03/12/11 03/12/12 �( G .,M ANOEMPLRFETOR ARTNER YIN T'.VrR ma ER _ ANY PROPRIEroR 11)(CrNERIEXECIlrrvE EL.EACH ACCIDENT s 500,000 OFFICERA�AaSF,R BXCLIXIEM � NIA I(yaA,(Man @KKb8 In r E,LOMWE.EAEMPLOYEE S 500,000 If yaa,deeCgbe urWar r OF.r MP71ONOrOPERATPOWbMaw EL DISEASE.POLICY LIMIT a 500,000 DEaCOMON OF OPERATIDM r LWA"M I VCWMZB(AdaieA ACORD 11T.AddMa"RNMAQ Schedule,Raom apace to Ap:do" TCbW STEELE HAS EJECTED COVERAGE ON HIS WOMM'S CoMpENSATION CERTIFICATE HOLDER CANCELLATION CH NEWTON BUILDERS 98 NORTH IMSRINGTON STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 9E CANCELLED 6EFORS THE EXPIRATION DATE THEREOP, NOTICE WILL BE DEUVOW IN SUITE 202 ACCORDANCE WITH THE POLICY PRQVMNS. BOSTON, MA 02144 AUTIM m arnl: nX # 61 -723-2190 0ISM-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registers S of ACORD MassachuseUs- Dep. tment of Public Safety. Board of Building Rclul rtions and Standards �Construction,Supervisor License Xicense: CS 46192 .T Restricted to:_00 ',�,..e..,.,.,w. ^ . eDAVID, L 'NEWTON s z PO BOX 92215 IFALMOUTHIMA 02541 Expiration: 9/19/2011 ('gmnussii�ner !tE Tr#: 6610` I 1 ' Office of Consumer Affairs and usiness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Reqistration: 107888 Type: Private Corporation Expiration: 8/10/2012 Tr# 201382 C.H. NEWTON BUILDERS, INC. David Newton --.._..___---..------------------------- --- - -PO BOX 922 - - ----- --------- - -- --- ---------- Falmouth, MA 02541 -- — ---------- --------- ---- - Update Address and return card. Marls reason for change. PS-CA1 0 50M-04/04•G101216 Address L_� j Renewal [ Employment i Lost Card po �� ,,,.,,\ ✓�e '(Domvn:o�nruelz`<•� a�,Gla4dlGClluJe�iJ Office of Consumer Affairs& Business Re;ulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: Office of Consumer Affairs and Business Regulation 9 107888 Type: .= Expiration: 8/•10/2012 Private Corporation 10 Part(Plaza- to 5170 7Boston,MA 021 C.NEWTON BUlJ-QERS,•INC; r David Newton 549 Main Rd 28A — -----------..--- --------- — W.Falmouth,MA 02541 Undersecretary of valid vithout signature t '� i�l.ra.rrrhusctt� - Diltartrtunt ot,f uhlic S:rt'ct� Btru'd OI BUtlllrfl� Kll�tllal'lons ,Intl �ttrnd.rrrls w Construction Supervisor License License: CS 104217 - — JOHN STEELE 85 CARL LAND CIRCLE E FALMOUTH, MA 02536 Expiration: 12/3/2013 (" inn,issiuucr Trk: 104217 lAa1�TA�1.E,'� Town of Barnstable Regulatory Services Thomas F,0clier,Director Building Division Thomas Perry;-C13o Building Commissioner 200 Main Street; Hyannis,,MA 0260i wwwtownbarnstable.ma.us Office.•508-8624038 ;Fax: 309-790-6230' Property:Owner,Must Complete and:Sign This Section If Using A Builder K F—i 'PP ,as-owner ofahe subject property hereby:authorize e V i=LpF . ,to act on my behalf, in all matters relative to work authorized by'this badingpermit application:for: (Addresg of rob) -Signature of Owner. Date Print Name if Property O*ner is applying for permit,please complete tht Homeowner"s License Exemptlon.Form on'the reverse side. C\Users\decollik\AoMtatLocal\MierosoRlWindow`s\Temporary Internet Files\Co"nteiit:OuHoak\DDV87AAZ\EXPRESS:d6c .Revised 672110 Ct1��/� ,,oF�THE °wti !� Town of Barnstable *permit 'P Expires 6 months from issue date IARNSTABLE, MASS. Regulatory Services Fee _i63g - .. - Thomas F.Geiler,Director MAC a Building Division Tom Perry, Building Commissioner Aw 200 Main Street, Hyannis,MA 02601 PR Office: 508-862-4038 Fax: 508-790-6230 SAP 1 .005 EXPRESS PERART APPLICATION - RES1Dj#VftQay Not Valid without RedX-Press Imprint A6� Map/parcel Number d 2-0 I O 3 Property Address 1 O g' S C.h oca j S 4'vlP 2-t �o+vt i- M A ® 2- Residential Value of Work Owner's Name&Address �DR = 10E k VA f, cozL er o-z ,F 7� Contractor's Name C- H N e wt 0 yl (mok i t ci P v-s p > Tele hone Number50g- Lf 2- l� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 04.6 q Z ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 1 N C- ArNl O TJv i Workman's Comp.Policy# VV C 9 -7 9 S-0 4:4- 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) Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance ithis permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature 0�✓L� / VU�/ Q:Fonns:expmtrg Revised121901 9)1 2,005 .. >! U14 FF..,-,M: EC:' PG: `;OLi 19241 'r"A:3E: 0.) ;OL 09112/2085 14:06 5084280800 CH NEWMN BLL-M' IW PACE 02 Town of Barnstable # Reg►Watvey Services >� �a�es�'.mar,Dbmctor B-titIftZ Division Tom Perry, DWIdtmg Cmeamisalaner 200 Meese ruff 1#y2V=.MA OZ601 www.tewi Lbw=t&bls.wt u& Office- 309-862408 Fox., 508-790-6230 Pmperty OWM r Must Complete and S*n This Sec If Using A Builder ?-'a P IP ,as Owner of the nlbject Property hexbym3dwfiw C- to my behall, it all era rem to vtarkwhorized by this buZ&g pew app2u adon for. •ir ra:-k V—t A Gg—"i�S' 3�R Ear Date Peat NAWR Ne In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number is that the debris rrsultins from this work shall he disposed of in a 150E1. prope;fy Hczased solid ;,rite dispes:j- Iscility as dcBned by ?YfGL c 111 S • The debris wi11 b�p disposed of in: Bourne Pcation Of Fader;) �rature of Fc:mit Appiicant David L. Newton • - I_l"aiC i r .. ... �J/1t� �OOJUI72(1�2CIlP.CLLLfL o�J m BOARD OF BUILDING REGULATION cense: CONSTRUCTION SUPERVISOR Number: CS 046192 ;A:.. irthdate:,09/19/1960 Expires: 09/19/2005 Tr.no: 5031 Restricted: 00 DAVID L NEWTON PO BOX 922 � FALMOUTH, MA 02541 Administrator I a tJ m A Ln �TGG ��V! L�f"LiL�(iiKil��i�illiTANPiLTiV� + � I' .Board of Building Regula ions and Standards One Ashburton Place - Room 1301 OD Ln kvw Boston_ 1.Vla!v$achusetts 02108 Home Im roverueinWc l tractor Registration Ln L . _4— - Registration: 107888 Type: Private Corporation -_? -' Expiration; 8/1012006 C.H, NEWTON BUILDERS, INC., y4— ------ ---- -- David Newton PO BOX 922 ----------------- Falmouth, {IAA 02541 Update Address and return card.Mark reason for change. n Address (j Renewal ❑ Employment U Lost Card m OP&('.;tt 0 50K605434-G90FZ16 'tYYlId9ACQ9Et1 e. � , Hoard of Building Regulations sod Standards License or registration valid for indfividul use only HOME IMPROVEMENT CONTRACTOR before the expiration date: H found return to: ward of Building Regulations and Standards Regislra11loir: 107388 One Ashhurt;on Place Rn 1301 ?? 1J112006 E3asfou"LKe.02108 - ` � :_A;rivtate Corp�ral2un C.H.NEWTON QUIL[7C David Nmvton 549 Main Rd 28A =! ZZ .+ ✓ __ �� V'"` W.Falmouth,MA 02541 Adffiin;xtrstor Not valid withouI signature -0 tTl - t^v N ._.-.,. �r_U.�i., +d{:tar ,:�✓i.'LH.»..,i��. R.r". - -•.,,x,..-,P.-Y „w .. ..� -, _ ... � a y,t; .y�:�..r.• hi y« _..+✓��.S�r--r �*". T"E'°'�+ The Town of Barnstable 9 BARN STABLE. Department of Health Safety and Environmental Services MARS- t6y9. �e '°rEo .y1, Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice j Type of Inspection Location Q`3 �C V��,t,( C_.. ,�` Permit Number 6.3 U rrY4- Owner Builders_'. 1 4 One notice to remain on jobsite, one notice on file in Building Department. owing items need correcting: t�C,O-N ( v- <i-.,r l l G (J e f C— 4• 3 G ! \ Yam. C r�,11Ca'k✓c+' t c lYl C, 11 Y1 3 Lk t A(",A. —1 C �c� "� r , (,�— !�1. � bpi r 1� � t> r '�Ij r•� j j►`1 Spa � C 'J V! �`a��a� _ r�E' S Se c'ti "'�� x''k�LJY'� � . Y by Please call: 508-862-4038 for re-inspection. Inspected by OC�-dAJl,�' Date A9 `oF�NErq;�o� The Town of Barnstable '• BAE. RNSTABL MASS. Department of Health Safety and Environmental Services t639• P A. lFo►�� Building Division - 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection /a r elf\ Location Permit Number-*: (cam 5 ) 8 4 Owner Builder C . 0 wv-w u. v,\ One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: m f' n A re u lA U L Y C,. Gomo 1 G n a f ss t k r ,a v-c _ x G i r `4 C�) U��n- CC��, Q�r y"C� C e Clye r C;J Please call: 508-862-4038 for re-inspection. Inspected by h Jr At , e A-Al 0,0 Date -// — C - i � , F 0-2e �anamanureall�i o�✓G`aasac�cwetla 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: 07888 Board of Building Regulations and Standards Expiration: Sl One Ashburton Place Rm 1301 i0/2004 Boston,Ma.02108 Type: Private Corporation C.H.NEWTON BUILDERS,INC. David Newton 549 Main Rd 28A GG•. � eV W.Falmouth,MA 02541 Administrator Not valid without signature Assessor's offioe (1st floor): - O 2 THE Assessor's map and lot number ....... ................................ Board of Health (3rd floor): Sewage Permit number ........................................................ t B9S39T1►DLL S Engineering Department (3rd floor): oo NAB •� House number ........................................................................ ' D 39. APPLICATIONS PROCESSED 8:30-9:30 AM, and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING "INSPECTOR APPLICATION FOR PERMIT TO .......�D.......!i1 . .- .5..z.............. . ....................................... TYPE OF CONSTRUCTION �� cz-=- .... ............19.X.9 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .........................`.. ...C ............. ...4-.........................................t............. ...t.1 1..� I r— ............. �d ProposedUse ............................ .................... .................................................................................................................. ZoningDistrict -..F'-................. ..............................................Fire District .............................. ............................................... 11ll .. Name of Owner .• •-•--..,... ...... �. . .................Address .2. ............................. Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ...........................77 .-.......................Address ..........................A..........................................................41k Numberof Rooms ......................�..........................................Foundation ................... .............................................. Exterior ............. ................Roofing C>;SI ).......��'L .L!�9 ..1.. ................ Floors yy -.........................................Interior .................... v . . " Heating �. ..........................Plumbing ..................... ......... ..................................... Fireplace /05 ...........Approximate Cost � QQ Definitive Plan Approved by Planning Board ________________________________19________ . Area ....... CJ....r�. ...... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of B rnstable regarding the above construction. ti Name .. .. Construction Supervisor's License .................................... K. M. RAPP No 31655 Permit for .....E.n.c.l.o.s e....Patio Sin le Family dwelling ........... ....................................................... Location ..1.0.8....School.....S.....tr...e.et .. .................. . .. ..... .... . ............... cotuit .................................................................. Owner ......K.........M•......... Rapp ... . .................................... Type of Constru ction .........F...r.....am.e.................... .. .. zi ............................................................................... Sll� n Plot ............................ Lot ................................. Permit Granted ......March 3. .........19 88. ....................... Date of inspection ............. . . ..................19 Date Completed ......... /_�r............19 Assessor's offioe Ust floor): c ,Q 0 of TNET Assessor's map and lot number ..'..1...................................../ Q off` Board of Health (3rd floor): Sewage Permit number i BAHd9T1►�LL, 2 ............................................ Engineering Department (3rd floor): moo Me 9• House number �0M hr. � APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BA-RNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .........0....... ............`.. .. ....................................... TYPE OF CONSTRUCTION �--- .... �........ .........., TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location t .. f........................... ..8........... moo..L....................................... t ...........................1.(.�..................... .. d - Proposed Use ....................................................... Zoning District Fire District .............................�.�.... ............................................. Name of Owner .�— � ................Address ............ 1M..fit?..........q.......................................... Nameof Builder ....................................................................Address ........................................................................ Nameof Architect ............................"".........'.........................Address ..................................................................................... Number of Rooms .......................?..........................................Foundation ...................Alk............................................... Exterior Roofing ...................... ..................... ........................ Floors ;� -.........................................Interior .............. Heating i �. .......................Plumbing ....................(� ....v. ............,�;...................... ........ .1............................. Fireplace ........................; ...............................................Approximate r _ F Definitive Plan Approved by Planning Board ________________________________19________ . Areci ......� ............ t Diagram of Lot and Building with Dimensions Fee ............. ... ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 ... ......................................... ...................... 1 Construction Supervisor's License .................................... K. M. RAPP A=020-039 No ...31655 Permit for ...Enclose Patio Single, family,.._Dwellinq .Location .....108„, ,,,,,,,,,,,,,, Cotuit ............................................................................... Owner ......K.!...M. RaP.P.................................. Type of Construction ....Frame.... ........................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .........March...3.............19 88 Date of Inspection ....................................19 Date Completed 19 i cS � S S �u �vu'V\ Uv� I 1 VAS <2-7 4 c-� f b g" S c��o 1 5-4- . `} l�3 0 8-�1- U� 1 (� - II -UZ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 020 Parcel 0 3 9 Permit# 130O Health Division R� v. Date Issued Conservation Division Application Fee 0 Tax Collector 0/< / 7 L;�,, 0: Permit Fee Treasurer Planning Dept. frviS'T1 LLED IN COMPLIANC Date Definitive Plan Approved b Planning Board WITH TITLE 5 PP Y 9 Etll�IF;C��„ NTAL CCDE °t» ti€ t i CrL. r Historic-OKH Preservation/Hyannis CNS Project Street Address 108 School Street Village Cotuit Owner Keith & Rosemary Rapp Address 108 School St. Cotuit Telephone 508-428-6765 Permit Request rempdel kitchen and add 1 new window ( same type) proposed square footage: 380 I Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total'r(ew Zoning District Flood Plain Groundwater OverlayI NO Project Valuation $3 o ro o o _ Construction Type wnr,,J frame c, Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting do umentatiatt. v"F N � f" Dwelling Type: Single Family [2 Two Family ❑ Multi-Family(#units) M Age of Existing Structure 283 y r s Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 3 new Half:existing 1 new Number of Bedrooms: existing 3 new Total Room Count(not including baths): existing in new First Floor Room Count Heat Type and Fuel: ®Gas Cl Oil ❑ Electric ❑Other Central Air: CRYes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage::]existing ❑new size Shed:®existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ rCommercial ❑Yes UcNo If yes,site plan review# - Current Use Proposed Use BUILDER INFORMATION Name C.H. Newton Builders, Inc. Telephone Nu er 508-428-9013 Address 919 Main St. Osterville MA 02655 License# CS046192 Home Improvement Contractor#1 A-7 g 8 8 Worker's Compensation# wC 9 7 6 9 5 o 4 7 ALL CONSTRUCTION DEBF IS REST ING FROM THIS PROJECT WILL BE TAKEN TO Bourne /A SIGNATURE A DATE : Z�.�/D FOR OFFICIAL USE ONLY PERMIT NO. i DATE ISSUED MAP/PARCEL NO. ADDRESS : VILLAGE 1 OWNER DATE OF INSPECTION: _<FOUNDATION FRAME INSULATION j` -," •�,': �._� FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i , r � DATE CLOSED,OUT; r r ASSOCIATION PLAN NO. t' r r t r RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE - New Buildings,Additions $50.00 Alterations/Renovations $25:00 �- Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE 3 g 0 square feet x$64/sq.foot= `f 3�D x.0031= `�� 37 plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft.l >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= . STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool. $25.00 Relocation/Moving $150.00 (plus above if applicable) 3 Permit Fee 7is projcost °FIKEr° Town of Barnstable Regulatory Services '* 1ABIQSTABLE, ` Thomas F.Geiler,Director y niAss. g' i639' �� A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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: remodel kitchen/1 new window Estimated cost$30,000 . Address ofWork: .1 08 School St Cotuit MA Owner's Name: Keith & Rosemary Rapp Date of Application: i— 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 UND R PENALTIES OF PERJURY I hereby apply for a permit as the age f the wner 107888 Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav • - - u-_ The Commonwealth of Massachusetts w =T !�`�p?artment of Industrial Accidents . >i == ' _ - Oltice olloyestlffadaas _ . 600 Washington Sheet . -' J Boston,Mass. 02111 Workers' Compensation Insurance Affidavit . fie. location - ' city phone N ❑ I am a homeowner performing all worm myself. - . - ❑ 1 am a sole p etor and have no one wormisl in capacity "///%/IIIIII/%//////////l,llllfZI-//%/,u�///lll��l0///O%//%%�%zlllI//%%///%%- ----- /�G//%/%///%%/%%%///////////%%//l///%O%l//l/O%%//////////l//%/%//////%% ❑X 1 am an employer providing wormers' compensation for my employees_working on this job. :: i I1.1"2:};;: :!_.__.;;; ;j: :;::`' < f?s2 `' 2 `2 % >`: y :S2'r`::_ > ` 2 2� 2. :? ' ? '«:' ": : ........ ::::><'::: : .... . ,;>:>::<::'::C':::: I E....... ..... dk'l�Sr.....I171£'.c.............................. ... ......................... .company:name.. :: ::::::::::::::.:::::.::::.:::::...: :......... ................:................................................................:.................,,:.:...........:...: .::.::.:.::::::..........::.:.:.:::.:. :::::::.::,:::::::.:::.. ..:::::...... ............ 5 8 . �48 atv-;....:.....:::........ ............ .. ..,.. .... _.... . : thane#... .. . __. . :.;::!::.:>;:::::!............':;I uIa r1. >::>Agci:.:.*0-*-Neu-. ..::: .... ::.::<:;;::,:,:::::.<::::::,....::::::...::.:: » IC9 5:E14' ......... .:..........:.:_:...........:.:................. :lnsnranceco.::::::.::::. .:::::::.. ,..:::::.:::::...:::::.:::... ....::::::.:.,..:.......,:.. ............ ...:........ olicv.#......................... ...........::::.:,::.:-:::::..::.:::::::,::.::::::.:::..;:;.:.:: ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hued the contract listed below who have `�' , the following wormers' armpensation.polices.:::. :.,.::.:::.:::::.::::.:::::::..::.::::::::..::::::.: ::::......:::::..:.:.:::::,::::::.:::::::::::..:............. ::.r-:1.:,.:::,.::.. company n :;25 %`'> ':<>> fr'< ?j ? } .T`t??: 2 : ii><>'a>:i2i:<2<% ?%'::2%:>4c:? < ::>iv>?%+[ t2a : [:Y?` < ['c2t >:s : :': 2a ?si"[jr' ti1: addi <: :y >w <=':.'S ...<Y..2..':e :k�:::' .:�::.:....... ............::::" 1-1111 % :... .. .. ................�.�......: ::::.................... . ................................".. ............ ... ... ..........., ...:::. ..::::::........................... ... .. ...... ::.;. ..... 1. ::` ;':.';::::' 5:;}:::::::::::':: .,''%:::::j::::.::::t ::::':::::",*%,:::.'-..—':::':':i:;:y:'f ir:?:::::::'>::::''':':::':::;: :: 2i;;:;i,.-.-.:-:�::i:::';'j;: j:: ........... .�::::::::.�::::.�:..:...............y;;..;;..::.:::.:,.: ...... ...................,:.::::.:�::.:::. ... ........ .................... .. ..,..: ........... ......................................x....•r:::.::...:.............................:...... :.:r::.�:::: :•::::::;::. ..... .. ....:•:•.::•r:::. .:........:•::::::...::•.:::..::•::::.:.:.:......,:.:. ::::::::::::.�:.:•......: :::::::,•-............. :::::::::::•::.._:::::.>:.::.:...::.:............ ...r.�'•:is hsnrnIIce..ca............... ....... .... 1'i :. ......_ . .......................................... > '. . ...... ::::........................:.:::,:::.::::.:::..................................................:..::.::....:....:...:....................................................:.;.. ................................ :::...:..:.:::.::.•:::. campsavnsme:..............................:...... .... .:........:......:..........:.........:........:. .. ...........:........ . ....... .:::..:....................... ............. ...................................................................................,. ......:...................................:::....:;::............ .... ....................;;: :..::.:..::::.:.....,. .,,:.,,.M:.,,.,.�.:,w.::::..;;;:€ iii�^iii-.m:.':i! ....:.................::............................... ...........................:.:...::::::::.-.-,:::::.�::......... .. :.::::v.�.�:.�::::.�::::.�v::::w:v:: ::::::::::,...............:...:.......�:...:............:.......... ....................................................... ........... .....:::::..::::•:....... ..:: .............................:.................................................:.....:.,.." -..::..::*.::::::. :.:::::. ::..................................................:.......::.:-..:,,w:::;.�:..................... addres �7 'on ....:::::................................ ........... ... . :.::........:. ::: :: ..:::::::... .........:... ......:.:.. ............... .:• ..:: .... ,:x� <: '' `: ,.►.........,.. :•..'.................... ..... ;.:.............. `' ,.. .........rn.4.4::::n•. :::•;4;4}r!ri!h:.i:i:i:•:}}:!•:i::!.'::i:}i:i!!4i::•yi:{v:n;;•'::......::?::::::,%:.:::i::'v::+.•::.�.�:::. jj Fdhuro to secure coverage as required under section 25A of MGL 152 can lead to the imposidou of eatmtad peaddes of a doe up to s1,%O.00 and/or one years'lmprfsomneat as weR as dyff penaides is the form of a STOP WORK ORDER and a fine of 3100.00 a day aphot me. I undeisrtmd that a • copy of this may be forwarded to the Office of Inveadgadons of the DU for coverage verific edam, . I do h erh a pains and penakier of pa7wY that the information provided above is tea,and coned ' Signa Date - Print name David L. IJewton phone# 08-548-1353 . o1 .fHdal use only do not write in thii area to be completed by city or town official : city or town: - . pernduncane# �BuNin;Depat�mt - . . . - - (]Ilcrosing Board ❑chedcif a respodse is required - " ❑stimbnen's Office " . OHealth Department _ . contact person: phone ❑Other ([m d 9/95 PIA) : . . . . . . _ x 01/02/02 FEED 14:3V_ W08 778 1218 DOWLING & O'NEIL 0 002 Client' . 324.8w 2NEWTON H 0 'ACORD. CERTIFICATE OF 'LIABILITY INSURANCE DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling & 0' Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St_ PO Box 1990 Hyannis, MA 02601 I - INSURERS AFFORDING COVERAGE INSURED - INSURERA:ACadia Insurance C.H. Newton Builders, Inc. INSURER�B: P. O. BOX 922 INSURER c: Falmouth, MA 02541 INSURER D: INSURER E: ' COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY 14LOUINLMLNT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WIII.1 RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED 08 MAY 1'FRTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I N�q !PO LICY EFFECTIVE!POUCT EXPIRATIO L? TYPE OFIN-SURANCE POUCYNUMBER ODIY ! DATE MM/ I OMITS A GENERAL LIABILITY '.BINDER189054 ; 01/01/02 101 01/03 EACH OCCURRENCE E1 OOO, 000 X:WMMEkCIAL GENERAL LIABILIT Y I FIRE DAMAGE(Any ono 11rc),E2 5 0, 0 0 0 CLAIMS MADC) X I OCCURI - I MED EXP(Any one person) :SS, 000 i PERSONALS AOV INJURY :S1, 000 OOO X!OCP j. GENERAL AGGREGATE $2, 000, 000 CEN•LAGGREGATCLIMITAPPL.IC�SPFR;I PRODUCTS-OOMPIOP AGO:$l 000'.000 I POLICY PNo- 1�G1,... _,...wLOCI A .AUTOMOBILE LIABILITY BINDER189055 �~ 01/01/02 01/01/03 COMBINEOSINOLELIMIT X ANY AUTO ' (Eaacclaent) a1, 000-, 000 Al I.OWNED AV'I'O`v BODILY INJURY i$ GCHEOULED AUTOS (Per parson) s t X YIIIiF 1)AlllD�: - BODILY INJURY S X NON-OWNED AUTOS - - (Per acclaent) X Drive Other Cat PROPERTYOAMAGf i (Pt-r ucideno GARAGE LIABILITY AUTOONLY-(iAACCIDENT S - ANY AUTO !OTHER THAN EA ACC S AUTO ONLY: AUG $ EXCESS LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE DEDUCTIBLE - R[Tf.,NTION i - S ,� A WORKERS COMPENSATION AND BINDER189056 O1/OZ/02: 01/01/03 WCSTATU- .OTH- IroRYUMITS ..: ER EMPLOYERS`LIABILITY IE.L;EACH ACCIDENT Y500, 000 a E,L DISEASE-EAEMPLOYE_ 55 O O, 0 0 0 ` E.L.DISEASE-POLICY LIMIT $500, O00 OTHER DESCRIPTION OF OPERATIONS/LOCATION S/VEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Operations performed by the :named, insured subject .to policy conditions and exclusions- CERTIFICATE HOLDER AD DITIONAUNSURED`INSURER LETTER- CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION - Town,of Falmouth Atten: Gall DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTOMAIL1.O ..DAYSWRRTEN , 59 Town Hall Square s NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUTFA(LURE TDDOSOSHALL Falmouth, MA 02540 IMPOSE NO OBLIGATION OR LIASIUTYOFANYKINDUPONTHEINSURER,ITS AGENTS OR RfiPRESENTATIVES. a AUTHORIZED REPRESENTATIVE ACORD 25-S(7/87)1. of 2 #2 4 8 3 2 o ACORD CORPORATION 1988 L ✓!LC VO%J..a d�✓�it[Cd�[6 BOARD OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR Number: CS O46192 Bi rthdate: 09/19/1960 Expires: 09/19/2003 Tr.no`. 3500 Restricted: 00 DAVID L NEWTON _ PO BOX 922 FALMOUTH, MA 02541 Administrator 9 � Board of Building Regulations and Standards) One Ashburton Place - Room 1301 Roston , Massachusetts 02108 Home Improvement Contractor Registration 1 Registration. 107888 Expiration: 8/10/02 ! Type; . Private Corporation 6 C .H . NEWTON BUILDERS , INC . 1 David Newton PO BOX 922 Falmouth MA 02541 t f :e' r ......... ..._. ,1 i f � ! � j f 7 � (,-._ter,. �_•�_ .. - =A �,c(„� !' `-+A,. _�� _-- -- ! ( ? . 1 . o x : a _ - t t F t i , 1 1 r , 1' i F F 1 � � .._�_ - •„•�. - ..l � �u+wr_�- f- tom`-��+j - .._ ...._.. ...._ ._ / ��' - �i I F y - -- - _V tf i 1; I 7 1 i� rr \ y , 1 _ 1 i uu SS n . r1r .. } i ;�_._._...�._. _._ � __ •� - � ... .._ `�i�l..�..�i it . ;i Jt • � # � .;� i-I � � '� � ,N � , { fir _ _ } �, I 1 • _ 1 _ --� it 1 , •} �� i i 3 � i { ' µ 1 - f 9 .j t . r t 1. 1f 1 A -- f M • I y , 1 . - w t 1 t y • — y c � r - f , r . Y1 , v y v t a Y3. L ' — t , r• $ r r- z , _ I • , a — Y , y , - 1991 ,. - , � �•__-___,—,fir_,_ _—. �_ � - __, �_ `� t > h L I t O 1 , , t I f 73 . I _ a I I t w + n I t' , — ti y ° 4_ n' •2 r R ; • I -- . . L==L JL i 4. -ice,,.-i..7 k} _. - -! /r.G•"f�� y. _. �...-..—_. ___ I - -. - ti , .. it 1 , y{: t , IF 177 ,. 71, .t: .•�,+' yY" , .ram' � �. \\ �{ '�. .. � a I i ' _ .t : ,., •/°.. - / \mac, I I' i t - ,! vi {' f n EL • ;:".: - ::'', .is ..,. .-.. :.�.;r tick ,`i i 3 i f I ., { l _ - 1 I o j - f - ;f i , I r �.,►�� +' 3 t � +t !fS� ',7 ;! t{ �t t, , i !� �yy fS t '1 ( � yt �; � � � . � - j j , a { 1. , e t ay% 4 •_x 5 t, : LIT., t i � r 7-7 t - �- r ............. F�,Ir C ' , . ri i f ! h - ........... 7777= s I � !1 r i y1 f 1 4 1 1 � V�•at�� C_ . ITr� _ M./� r 1 l ' ll 1 � , lZ +1 �F 1 (I � 7 y... .. r ` i s a ii