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Assurant Use Only VID.# -89910 '. WO# 24199074 PID# 2139742 Regular Mail
Town of Barnstable 1200 Main St. I Hyannis I MA 1,02601 1,508-862-4038
REGISTRATION AND CERTIFICATION FORM
FOR FORECLOSING/FORECLOSED PROPERTY
' Thank you for registering in accordance with Town of Barmtable Code chapter 224
sections„224-3 and 224-4. Please complete one form for each property'in foreclosure
(section 224-3)or.alreadyforeclosed for which possession has been taken(section 224-
4). Please file the original with the Building Commissioner and a.copy with.the:Chief of
the Fire District in which:the:propy is.located:
If you claim you are exempt from:registering under Massachusetts law;please state the
reason(s)and complete section T(property information)and the first paragraph of
section 2,(foreclosing party; court;etc.,and foreclosing party representative;but not other
representatives and attorney)so that the Town can review the exemption and update its
records: N/A
Section a -Pro e .. Information
105 Stub Toe Rd
Property Address: Cotuit MA : 02635-2421
- Assessors Map#:. N/A Parcel# M040L106
Land area and description N/A: : 0
Building(s)description and contents N/A in Z
CD
N
Occupied: N/A Occupant(s)(if borrowers so state and include names z
Borrower.;if known:.FERREIRA IRAN b
r
Phone: N/A email N/A other: : -� en
Vacant: 'Yes Date' Anticipated Length of Vacancy: N/A
Last occuparit(s):)(if borrowers.so state and 'include name(s)) :N/A
Phone:800-468-1743 email: AFSVPR@assurant.com. other:
Has possession been taken Yes If so,please explain and complete and file the
maintenance and security plan form(unless exempt as stated above)
The property is vacant.and will be maintained.
Section 2—Foreclosing Party Information
Foreclosing Party(full name/title) Mr.Cooper . _.
Foreclosure'Case Court: N/A Docket# N/A
Please forward all notices/confirmations to AFSVPR@assurant.com,
101 W Louis Henna Blvd,Ste.400,Austin,TX 78728,800-468-1743.
.. - .. -.
PID# 1 2139742
Date filed: N/A Current Status: N/A.,
Foreclosing Paity's representative(s) for property(entry,management,repair,"
etc.)(name,title,):Assurant Field Services c/o.CHRISTOPHER SIDEMAN.
Company(if different from foreclosing party): Assurant Field.Services
Address:268 MAMMOTH RD LOWELL MA 01854
" .
Phone:: 8007468=1743. email: AFSVPR@a, ssurant.com . , other: '
If an exemption is claimed,please do not complete the.remainder.
Other.representative(s)(if foregoing representative.is primarily:responsible for
property and/or foreclosure and is most likely to be able to address town matters
concemina the.property and/or foreclosure,please.so state.and do not complete
contact information(i. e: "none or."see above"))
Name;title;-other: N/A
Company(if different from foreclosing party): . N/A
Address:N/A""
Phone(s): .N/A email(s): N/A other;
Name,title,other: N/A
Company. (if:differerit from foreclosing.party) N/A
Address: N/A
Phone: N/A email: N/A: other:
Attorney representing foreclosing party N/A
Firm name(if different from attorneys name): N/A
Address: N/A
Phone(s): N/A'. email(s)`:. :N/A other:
1 acknowledge that the informatlonproVided is accurate and correct: I also understand
that any inaccurate*information will result in non-compliance with section 224-3 of
chapter 224 of the Code of the To"of Barnstable.
Date: December 27;2018.
Name: Eric Knudtson
-Title: Assurant Field Services Manager
1:
Please forward all notices/confirmations to AFSVPR@assurant.com,
161_W Louis Henna Blvd,Ste..400,Austin*TX 78728,800-468-1743. .
PID#J 2139742
I hereby certify that the above-named foreclosing party is in compliance with the.
pro'visions_of section 22.4 3 of chapter 224 of the Code of the Town of Barnstable:
Date:
Building Commissioner;Town of Barnstable
ASS U RANT '
BUILDING PLAN]. STATEMENT OF INTENT
Occupancy Status: Occupied Building Plan
t
Property Address: 105 Stub Toe.Rd-
Cotuit r. . MA 02635-2421 .
L _ ..
AS OF: December27,2018
THIS BUILDING PLAN SERVES:AS OUR STATEMENT:O
•. ;F INTENT
TO MAINTAIN,SECURE,AND INSPECT PER ORDINANCE:
f .
: THIS PROPERTY WILL NOT.BE DEMOLISHED.
THIS.PROPERTY WILL BE LISTED FOR SALE.
IF OCCUPIED,THE PROPERTY WILL BE INSPECTED ON A MONTHLY BASIS UNTIL VACANCY.
OWNER CONTACT: Mr.Cooper
350 Highland Dr.,Lewisville,TX 75067 '
AGENT CONTACT IS:
ASSURANT FIELD SERVICES
101 WEST LOUIS HENNA.BLVD.STE.400
AUSTIN,TX 78
728
T:.800.468-1743
E AFSVPR@assurant.com
; .
DATE(MMZM9/DDDNYYY)
`..� CERTIFICATE OF LIABILITY INSURANCE
THIS CERTIFICATE IS ISSUED AS A.MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE'HOLDER. THIS
CERTIFICATE DOES.NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR.ALTER THE,COVERAGE AFFORDED BY THE POLICIES
BELOW.,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED.
REPRESENTATIVE OR PRODUCER,.AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.if.
SUBROGATION IS WAIVED;subject to the terms and conditions of the policy;certain policies may require an endorsement:A statement on this.
certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER _ _. _. _ __ NAME:.
CONTACT
AOn Risk.services south1est,'Inc. - PHONE- - FAX
Dallas TX Office - (AIC.No.Ext): (866) 283 7122 AIC.No.. (800) 363 0105 m
CityPlace Center East �L p
2711 North Haskell Avenue. Ss:: _
suite 800
Dallas.TX.75204 USA INSURER(S)AFFORDING COVERAGE NAIC N
INSURED INSURER a Great Northern Insurance Co.. 20303.
Nationstar. Mortgage Holdings. -Inc. -INSURER Bi 'Chubb Indemnity Insurance.CO. _ -- 12777
8950 Cypress waters Blvd .
Dallas.TX 75063 USA INSURER.c. 'XL Specialty Insurance Co 37885
.. - INSURER D:- .. ..
.. .. . .
- INSURER E:
INSURER F: -
COVERAGES. CERTIFICATE NUMBERt-570072097262 ' REVISION.NUMBER:
THIS 1S 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: Limits shown are as requested
INII LTR - TYPE OF INSURANCE. INSD WVD .POLICY NUMBER (MWDDNYYYI IMMIDDNYYYI - - -LIMITS
X COMMERCUILGENERALLIABILfTY .- - 357,57429 071111Z018 071111ZO19 EACH OCCURRENCE - $1,000,000
CLAIMS-MADE X. OCCUR • - - $1,000,000
. . PREMISES Ea occurrence
MED EXP Any one person) $10,060
'PERSONALB ADV INJURY $1,000,000 ip
- GEN'LAGGREGATE LIWAPPLIES PER:. - GENERAL AGGREGATE $2,000,000
- - POLICY PRO- EX LOC PRODUCTS-COMP/OPAGG- - Included n _
JECT .
. OTHER:.,
t`
A _ AUTOMOBILE LIABILITY- ' - 73542588 07/11/2018 07/11/2019 COMBINED SINGLE LIMIT
Ea accident $1,000,000
X ANYAUTO.
BODILY INJURY(Per person) - Z
' 6WNED- . . .-SCHEDULED
AUTOS ONLY AUTOS _ - BODILY INJURY(Per accident) m
X HIRED AUTOS NON-OWNED - _ PROPERTY DAMAGE - V
ONLY AUTOS ONLY - - - Per accident
m
c 'X UMBRELLA LIAB. X OCCUR . U500079378L118A. 07/11/201807 11 2019 EACH OCCURRENCE. $25i000,000 V
EXCESS LIAR CLAIMS-MADE AGGREGATE - .$25,000,000
. . . . ..
- DED.- RETENTION -
'B WORKERS COMPENSATION AND . 71701785 - - 07 11 2018 07 11 2019 X .PER OTH- -
EMPLOYERS':LIABILITY, - YIN STATUTE
ANY PROPRIETOR/PARTNER/EXECUTIVE. - E.L.EACH ACCIDENT - - - - $500,000
OFFICERWEMBER EXCLUDED? - El
NIA - _ _ - - _
(Mandatory In - _ - - E.L.DISEASE-EA EMPLOYEE - $500,000
If es,describe under - - - -
yy
DESCRIPTION OF OPERATIONS below " -" - - E.L.DISEASE-POLICY LIMIT - $500,000-
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be-attached if more space is required) - -
.. --•
CERTIFICATE HOLDER. CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
_ -EXPIRATION DATE,THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE ■-
• - - .. - - •. POLICY PROVISIONS. - -
Nationstar.Mortgage LLC - _ - - AUTHORED REPRESENTATIVE - - -
8950 C press waters Blvd.
y
Coppell Tx 75019 USA. -
'
.0198 2 1 AC R C 8 0 5 0 D CORPORATION.All rights reserved.
• g
ACORD 25(2016103). " The A.CORD name and logo are.registered.marks of ACORD
- -'' Town of Barnstable *Permit#
Expires 6 months from issue date
1'Regulatory Services Fee 0 `3)
w
Thomas F.Geiler,Director
2001 Building Division -
rry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
�Q www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
(� _( 0�Y J ( � Not Valid without Red X-Press Imprint
p/parcel Number "
�perty Address
Residential Value of Work -610- e-d Minimum fee of$25.00 for work under S6000.00
mer's Name&Address ��r'°t ►' - �s �"`'L
ntractor's Name Telephone NtiTumbeT -
Ime Improvement Contractor License#(if applicable)
$ _. '-s-Liceiizzr-n-(�app�;eabie)
lWorkman's Compensation Insurance.
Check one:
EI/I an a sole proprietor
I am the Homeowner
I have Worker's Compensation Insurance
;urance Company+Tame
prkman's Comp.Policy#
rpy of Insurance Compliance Certificate must be on file.
rmit Request(check box)
Re-roof(stripping old shingles) All construct debris will be taken to /
[�Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/dooTs/sliders. U-Value (maximum.44)
+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 Im rovement Contractors License is required,
GNATURE: -
Forms:expmtrg
;vise061306
I
' eq �\ .a•ram. vv• vr. rr•. J .....�.....-�..--..�.__
Doartmir t,ifflri;dustriaZAccidents
' w Office of Investigations
a' + 600 Washington Street ;
Boston,MA 02111
M www.mass.govldia '
Worker" Couipensation 14sumace Affidavit: ]Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeQiJbly
Name(Business/Orgenization&dividnal): t
Address: 1p �l e I•A _6'
tate/Zi L11 T 0 Phone:#: �' �.b (� .
City/S p
Are you an employer? Check the*appropriate box: i -Type of project(required):,
1.❑ I am a em Io er with 4• ❑ I am a general contractor and I
P Y 6..❑New construction .
employees (fall and/or part-time).* have hired the stib-contractors
2. 1 am&'sole io rietor or partner- Listed on the'sttached sheet, 7, ❑Remodeling
❑ P P
These sub-contractors have
Demolition
ship and have no employees � $. ❑D n ,
working for mein any capacity. employees and have workers' 9:.:❑Build�ng addition
[No 4forkels' comp.inSUIanCe comp.inen ce t'
We are a c
required.] 5. [] orporation and its 10.[]Electrical repairs or additions
officers have exercised their 11. Plumbin repairs or additions
'3. I am a homeowner doing.all work ❑ g P
myself[No workers' comb, right of exemption per MGL` 12.❑Roof repairs
c. 152,§1(4),and we have no
• insurance required.]t . 13:❑Other .
employees, [No workers'
comp,insurance required.]
*Amy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infonnation.
t Homeowners who submit this affidaVit indicating they are doing all work and then hire outside contractors must submit a new affidavitindicating such.
$Contrzctors that check this box must attached an additional sheet showing the mama of the'sub�ontractors and state whether ornot those entities have
employees. If the sub-contractors have employes,they must providtr their workers'comp,polidynumber.
I am.an employer that is pro-!iding workers'compensation insurance for my employees.-Below is.the policy and job.site
information:
Insurance Company Name:
Policy#or Self-ins.Lie,#: Expiration Date'
lob Site Address City/State/Zip:
Attach a•copy of the workers' compensation policy declaration p age'(showing the policy number and expiration date).
Failure.to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine u 'to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORE.ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of - -
Investii?ations of the Mk-for msurrance coverage verification.
I-do' hereby Gerd under the ains•and It' of perjury that the information provided above,is true and correct,-
-- �/? � e7
Date:
Phone 0:
®ffidal use only,.-Do not write.tn this area, tb be completed by city or town officiaL
City or Town: PermitUcense#
Is
Authority(circle or
hoard of Health 2.Building DEpartrnent 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector
6,Other
ContactPerson: Phone#:
Information And. In ktuctions
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 hiie,
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 in a joint enterprise, and including the legal representatives of a-deceased employer, or the
er� � �tee of an individual,partners ' ,association or other legal entity, employing employees. However the
owner.of a dwelling-house having not moie 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 appurtenanttl}ereto shah notbecause of such employment be deemed to be an employer."
Mr,L chapter 152, §25C(6) also states that"every state oi 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-accepiable evidence of compliance with the insurance coverage required!'
-Additionally,MGL chapter 152,•§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for.the performance of public work until acceptable evidence-of oomph"with the insurance
requirements ofthis chapter have been presented'tc the contracting autfiority."
Applicants
Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, it
necessary,supply sub-contiactor(s)name(s),addresses)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 orpartaers,are not required to carry workers' compensationinsurance. If an LLC or LLP does have
employees,a policy is required. Be advised that#his affidavit maybe 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,n&t the Department of
Industrial Accidents.; Should you have any questions regarding the law.or.if you.are requirea to obtain a workers.'•.
compensation policy,please call the Department at the number listed below; Self-insured companies should-6nter their
self-insurance license number onthe 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 permMicense number which will be used as a reference number. -In addition, an applicant.
that must submit multiple permit/li.cense applications in any given year,need only submit one,affidavit indicating current
policy'infonnation(if necessary)and under"Job Site Address"the applicant should write"alllocations'in (city-or
town):'A•ebpy 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 pe- 'st to bum leaves-etc.)said person is NOT required to..complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questio,M _
please do not hesitate to give-us a call.
The Depa;taent's address,telephone-and fax number;; '
' ��vz�t.a�u of l�assa�b.t�s�t€s • '
Dqpar�nmt dMuta 41 Aetnt
Gffit:l�d Innsfiga om
$o}t4n,MA 2111
Tel.#617-727-490•�ext 406.ar 1 V7 aSSAFE
f ax 617-727-7 f49•
Revised 11-22-06
yy�•3; TOWN OF BARNSTABLE Permit No. ._26709_
` Building Inspector
■�n� Cash
9'r0/►Y/�
OCCUPANCY PERMIT Bond
Issued to h� Address
�4•vti��.{-.
`.5 S4-lb The lbad, of-uli-
Wiring Inspector f Inspection date
Plumbing Inspector 1 a/ a t� ��, / _Inspection date
Gas Inspector f.� Inspection date
Engineering Department a1 {+y Inspection date
Board of Health Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE. /
_._.......... ....... :..., .. ................ . ............................................_.....�... �.
BiiiIding Inspector
L
FROM
r— TOWN' OF BARNSTABLE
BUILDING DEPARTMENT
Mr. Francis. Lahteine 367 MAIN STREET , HYANNIS, MA
Town Clerk ..'' -. "` `,. . Phone: 775-1120
+6+•'n b fr+*�f S R
�i't..Y..eais♦R4 Eewry-v.tlrU•<�•,}!l.^..fi�.+5 � �. .. - - '.
P
k
SUBJECT:
FOLDHERE
DATE -
MESSAGE
Under Permit #26709
'Please release,Baid. .
I
e F
SIGNED
. zw
DATE
REPLY
$SIGNED+
N87.RMI RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY
- PRINTED IN U.S.A.
SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND'PINK COPIES WITH CARBON INTACT.
�Ij�REBY CE/PT/FY Ti�4lT THIS LOT/J MOT rl rep /N FEpice, . L�iLO ap /aG1,�,�1141 P.
%W. WN ON Mg F£pERAL Al.00.0.INSURANCE RATE A4p FO/q rNE TOI N AF,
} , COAhfIUN/TY PgNLFFC�T/YE
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dE USED FOR SONG 4R PINPOSES Q
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C/RCUMSTgNCES ARF OFFSETS TO ae L�OT(Ji T CP�ft�Jc/ST -
UtiSE�O WA1, 9,
rC. OIY/VEo BY� a,✓�s S-- rz �siv�r, w
OF M4Ss9�6 AVIO)f 49644M ZgfivG INC.
a� ROBERT Gs / f.4�C Af H / 11
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�• FcrsT�" p�' / JO' _lam///S! �y� % G��
PLAIN Na ,
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A
Assessor's Office Qst floor Map Lot /(� Permit# ?g
o Date Issue
y'Board of Health 3rd floor 8:30-9:30/1:00- 2:00 -mod �w - Fee
Engineering Dept.'(3rd r) Housegn SEPTIC SYST BE
STALLE01 CZ
WITH �.
Definitive Pla ved by Planning Board 19 Ei�1l� ONMEN r e �,NO
TOWN OFBARNSTABLE
Building Permit Application
Project Stre ess 03� ���-y,� ��G �A. CG+0,
Village l 0-T'U 14 s
Owner ;1 p 61 w Har� 3AO n r:�_ Address I t75 ('01u,
'Telephone
r
Permit Request -e i?C-lose- 0- - ,i 07 i rAo Q ' �O no% Av r a o n,94,4/Y R 9 i X a l Jfio,-<--
14 ba ywo+ ; alit) orcl i;ia , u>,A,1-12 _H41i �&ce a 'Xs I lxx-moan/
� orllef, _' n and Jhvlv�r,
"Total 1 Story Area(include 1 story garages&decks) square feet
Total 2 Story Area(total of 1st&2nd stones) square feet
Estimated Project Cost $ 1 rj, p0 Q
Zoning District Flood Plain Water Protection
Lot Size 4 t7a 900 Grandfathered ?
Zoning Board of Appeals Authorization Recorded
Current Use _3 w!q �e1;, I,t 0 t'a1 Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family ✓ Two Family Multi-Family
---Age of_Existing Structure I A l/ ,g ; Basement Type: Finished
Historic House n O Unfinished al pre,5 erl
Old King's Highway A 0
Number of Baths.-_ No.of Bedrooms .�
Total Room Count(not including baths) r First Floor �5_
Heat Type and Fuel q5 Central Air f1 0 Fireplaces k
Garage: Detached. Other Detached Structures: Pool
Attached 1 car Barn
None Sheds
Other
Builder Information
Name::F0A4 PS 1q& 'QfW Telephone Number ,,y U t - L179 112`]�
Address a I lel Uf 20(1 "d License# n- 2/� j2
./,46A ae a Home Improvement Contractor.# //y/&D
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
IGNATURE DATE
,
BUILDING P IT DENIED FOR THE FOLLOWING REASON(S)
t
f,
i,
FOR OFFICIAL USE ONLY
PERMIT NO. #87.81
DAT9 ISSUED July 12, 1995
MAP/PARCEL NO. .
040; 106
ADDRESS 105;Stub Toe Road VILLAGE Cotuit, MA 02635
OWNER John Pi & Mary M. Paorie
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION �
FIREPLACE a
t
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: - ROUGH c Q FINAL � 4
FINAL BUILDINGt_
f
DATE CLOSED OUT
ASSOCIATION PLAN NO.
11,02'94 17:02 '$8177277122 DEPT IND ACCID 0
d �
CoIjunoiuvealili. ol Wa1Jac1zu6etb
' ..L.)apartinenf n��ndu�EriaL.../�dcc�d�/�i
600 W.44nflon&.1
James J.Campbell &Ion, MmagwA 02 f/f
Commissioner
Workers" Compensation Insurance Affidavit
1, -J lit.rvt,e sL3 r n rye j7 e
(Qoi:nseelpamates)
with a principal place of business at:
4(,e f+IaminUtM o2/ �IUL'r !�',�r► (CAI /'9L!•Aa-ge— l o-?-(,�2
( /st"JAP)
do hereby certify under the pains and penalties cf perjury, that:
() I am an employer provid'mg workers' compensation coverage for my employees working on
this job.
Insurance Company Policy Number
I am a sole proprietor and have no one working for me in any capacity.
() I am a sole proprietor, general contractor or hog owner (circle one) and have hired the
contractors listed below who have the following workers' compensation policies:
1
Contractor Insurance Company/Policy plumber
Contractor Insurance Company/Policy plumber
Contractor C Insurance Company/Policy Number
O I Am a homeowner performing all the work myself.
1 and::<_tar,G t=:t copy of dais statement will be fore arded to cite Office of investigations of cite DIA for coverage verification and that failure to secu:
coverage as recired under Sect;on 25A of MGL 152 can lead to the Imposition of criminal penalties consisan¢of a fine of up to S 1,500.00 andlor
years' imprisscrrtent as well as civil penalties in the form cf a STOP WORK ORDER and a fine of S 100.00 a day against me.
f� 19
Signed this day of -__J u 1 ,
Li a/Permittee Building Department
Licensing Board
Selectmen Office
Health Department
TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375
The Town of Barnstable
� NAB& DeP
artment of Health Safety and Environmental Services
1sAwe
� Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crosser
Fax: 508-775-3344 Building Commissioner
For office use only
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-eldsoing 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.
.*,h,J
Type of Work:fi2d J t �r�VA -add hcith Est.Cost #10 ,0 ov
Address of Work: 1(957 S+L)6 -toe- ZR d—, 00401
Ow•nerName: �/,- t ?a cq-o—
Date of Permit Application: j1 n 02�3• �=9
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under$1,000
Building not owner-o c-upied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor name Registration No.
OR
Date Owner's name
• ' , y
PREP
COMMONrt
WEAL79t•r" DEPARTMENT OF PUBLIC ' �OF SAFETY
1010 COMMONWEALTH AVE. 'J
MASSACHUSETTS BOSTON,MA 02215 r
�r L I -ENE ,
EXPIRATION DATE 04/L"�/19 /-, CONSTR. UFEF;V I,., §`
:a)�R CAUTION
REST
RICTIONS EFFE CTIVE DATE UC-NO: FOR PROTECTION AGAINST
& 2 FAMILY HOME _ THEFT P
11/c�1/1 9L, 05,, �,ry UT RIGHT THUMB
1 � PRINT IN APPROPRIATE
BOX ON LICENSE. r
,JAMES E MAC OMBER
# 1-50-5261 21 RIVER RIJN BLASTING OPERATORS
PHoro MA:=HpEE MA �a �4ri MUST INCLUDE PHOTO.
'I ceLASTING OPR ONLY) FEE: ..
NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY f'L.
HEIGHT. STAMPED-OR-SIGNATURE OF THE COMMISSIONER 7�
x DOB:
04/251/
E.
THIS DOCUMENT MUST BE •
r .CARRIED ON THEPERSON OF SIGN NAME IN FULL ,"
j THE HOLDER WHEN EN- SIGNATURE OF LICENSEE ABOVE SIGNATURE LINE
OTHERS-RIGHT THUMB PRINT GAGEDINTHISOCCUPATION.
C�OIN/��15�5
ION�ER
77
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12111
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5 X.t � ; iHOME IMPROVEMENT CONTRACTOR ..
1 x
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Registration 114160:
r
Expiration 08/10/97
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a< tr.1AME5 E.',MACOMBER
' 1 RIVER RUN;RD
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e ADMINISTRATOR MASHPEE NA 0264IV
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LO CAT fON SE 6 E PERMIT N
Cw :3 S T� 0 , -
VILLAGE
INSTALLER'S NA E & ADDRESS
bo 8 UILDE R OR OWNER
DATE PERMIT ISSUED _
DAT E COMPLIANCE ISSUED
r
Assessor's map and lot number 14o "
Iell
1� THEr��
Sewage Permit number ..............:5.zn.Z4�................
Z BA105TABLE, i
House number ....................................�.Jo.s..................... ro MAO&
6 3 q. \00
TOWN OF BARNSTAA-L .'D IN C0'4MP:,AN"CE
VOTH TITLE 5
BUILDING INSPECTOR-r0W`� ,J
";I LAC®OES N®
APPLICATION FOR PERMIT TO ..........Cons.truc. . .t
.... .. .. ............................................................................................
TYPE OF CONSTRUCTION Wood Frame
.....................................................................................................................................
�,..,� ......./.................19...:.'...
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ...Wt...�.$. ...5.t.4Ab...TQe...R4.aa. ...C.otu,it.r...:Ra,..........................................................................................
ProposedUse .........R.QS.i.4dQ??.. a..........................................................................................................................................
Zoning District .......ac.............I..............................................Fire District .......CQ—it.......................................................
Name of Owner .....T.hQQ...CQ.?lS.trqQ.ti.Q.n...Qo............Address 2. ...5i. Gs. ...P.Qn(�...Pr......... O.....Y.armouth,, Ma.
Nameof Builder ...S.ame.......................................................Address ....................................................................................
Nameof Architect N/A.........................................................Address ....................................................................................
Number of Rooms .5...............................................................Foundation .......P.Q.I V.e.d... ...............................
Exterior ...................Q.QS. ar...S.Y1.1.I1.CJ.1.Q...............................Roofing .............aS.P ?.lt...! khi.ng.1.5................................
Floors .....................PlYW.Q.Qd...............................................Interior ..............She.Qt...r>-O.Ck............................................
Heating .................FHW...-...g.as.........................................Plumbing ...........1...1/2...hathS..........................................
Fireplace .................One.........................................................Approximate Cost ...525.,0.0.0..............Q........ .................
Definitive Plan Approved by Planning Board _S-ept____2-1----------19_-7_3__ . Area l F.lf..........................
Diagram of Lot and Building with Dimensions Fee ....7/' u
...........e ..... . ............
SUBJECT TO APPROVAL OF BOARD OF HEALTH
1r o
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.
016681 CONT. SUP. LIC.
Name_,............. ..................
E* CONSTRUCTION CO.
N4o .26.7.09.... Permit for ..Dne..S.tary..............
Dwt�.Jmq......................
Location Iot..38......105..Stub...Toe..Rjc d.....
.................c
.,O:tzj,.Ilt.................................................
Owner
Theo Construction Co.
..................................................................
Type of Construction .Frame
.........................................
.............................................................I..................
Plot ............................ Lot ................................
Permit Granted .......July...18, 19 84
Date of Inspection ....................................19
Date Completed 19
...............
a No
TOWN OF BARNSTABLE
BUILDING
� N N �� 0 �� INSPECTOR
�� `
��NN0N�NNN ���� N ������N= 0� 0NN ��
=� =� � ���� m m�.~ m mm��m ���� � �� mm
APPLICATION FOR PERMIT TO ...........C97l�trnot...........................................................................................
Wood Frame
TYPE OF CONSTRUCTION ����������.����������.�.�����.^�.������''������'
`�
� ..8L,����~^...,...,..—..l��....
` /
| TO THE INSPECTOR OF BUILDINGS:
The undersigned heva6v applies for o permit according to the following information:
Location ..l�7t.��Q�:-8to�.�g�...�o���.� .0��^-----------.—...—.—.--------..---.
Proposed Use ......... le .....................................
�
Zoning District --�X�.----......---.--�----..Roe District --.��+g.it..—.---__,_____.____..
Nome of Ovvne, —..���[l.�C��/� Yrn'---.A6J,mo 74..���/��±�. ..D�.�.�—S��:_ / !�:a.
Y
' Nome of Builder- —SjgMP........................................................Address ----------------..---..~—.~—.—
Nome of Architect NIA.........................................................Address -------------------.-------_
Number of Rooms .5.-----/--------------Foun6o�ion --� '���g����.----______
� '
Exterior ---- .. ----------RooGng ----.�� ..n�],Tole_________,..
. .
Floors ..................... ...............................................Interior .............. ............................................
-
- Heating � Plumbing� � ' l ��}l��`
_ ng '-----'���—�../���'-------------. ............ —...------_,___
|
Fireplace ..................n.re------------------'Approximate Cost ..............................
°�. ~ �
,�4� / |
| Definitive Plan Approved by Planning Board lg�Z�-. An*o '�—�'^.,:--------� |
� . /
Lot ���
Diagram of � and Building with CUmonsions Fee _.������.����__. _____ �
SUBJECT �� APPROVAL Of BOARD OF HEALTH
.
VX
. �
`
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`
| `
�
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`
/
. . `
�
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
| hereby agree to conform to all the Rules and 'Regulations of the Town of 8onnsto6|e regarding the above
construction.
'
CONT. SDP. I,ZC. 0I6681 '
Nome^ .—....~�.:.^�..�..�������.----.—.
THEO MNSTRUCTION CO. A=40-106
No Permit for ....Qjae..S.tQry.............
.........S��..!� 1Y..Dwelling.....................
Location .......WtAS....J.05.-Stub...'Ibe-1zoad..
........................cotlAt..........................................
Owner ......ThQQ...QMEitr-uctian..Ca...............
Type of Construction ......Fxam........................
................................................................................
Plot ............................ Lot ................................
Permit Granted ....��4y..1pc..................19 84
Date of Inspection ....................................19
Date Completed ......................................19