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N �:.. •, „ ,. n „'fL.I�i/ y.!In`' w'. a"�`Y+ i � _ ,: . !'er .r.L", ",,.. �F .rmt' , r t / spa -r ., `+ Assessor's Office(1st floor) Map Lot Permit# ���� � '•, Conservation Office(4th floor) Date Issued —R-O �L? Board of Health(3rd floor)(8:30-9:30/1:00-2:00) Fee 5-0 ' 0 Engineering Dept.(3rd floor) House#1 rig Planning Dept. (1st floor/School Admin.Bldg.) BARNSTABLE• MARFC Definitive P(l�n�ppro by Planning Board 19 Eo 39. I TOWN OF.BARNSTABLE Building Permit Application Project Street Address Village Owner ,���{� ���P� Address Telephone p Permit Request Lb:j-f i2Q,WZV4 2QQ 762 v-- Total 1 Story Area(include 1 story. garages&decks) square feet JAW Total 2 Story Area(total of lst&2nd stories) square feet Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths). First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name i::�2 19 S-g Q �5 Telephone Number Z J _ Address 7/ License# Home Improvement Contractor# //06�3- ✓yi(+ 6 Worker's Compensation# &C 3�a 66 a 07 S� 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 SIGNATURE DATE 7 �� BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY f PEFM1T NO. 9146 } DATE ISSUED 7/2 0/9 5 MAP/PARCEL NO. 148 090 254 Cedric Road Centerville ADDRESS - VILLAGE . OWNER John T. & Mary C. Eckes A� DATE OF INSPECTION: � r� ~- FOUNDATION FRAME INSULATION FIR3EPLACE I - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r t DATE CLOSED OUT Z.� i r ASSOCIATION PLAN NO. 11/02'04 1'1 :02 'Z`6177277122 DEPT INT ACCID Z 001 `� �01i11)i0/1(i%F'Qll.{1. O �lJapartmer�l o��n�u�tria[�cCu�en�s 600 UVa6knjton S1.1 James J.Campbell l.. ton, //lamaslwuM 02f f Commissioner Workers' Compensation Insurance Affidavit 1, CIO �- with a principal place of business at: F cc�yist:wzfal do hereby certify under the pains and penalties of pieriury, that• I am an employer providing workers' compensation coverage for my employees working on this job. h 14a Insurance Company P l�Humber ' O lamasole proprietor and have no one working for me in any capacity. () I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation polities: Contractor Insurance CompanylPolicy Humber Contractor Insurance Company/Policy Humber Contractor �Irsur?r_-e Company/Poliq, NLmber O i am a homeowner performing Al the work myself. copy of t±-:<_s_te:nent x•il;teeny.-arced of Im•esti��cons of d:e D1A for m•erage verification.and that failure to seccre ce.c age reC.:,.ed onCer SCL'—;Or,25A of MGL 152 can k2l.to Lem inpesition of aiminai penzWes eonsisrne of a fine of up to S i,soo.w acd/er cn= yezrs' im�rcc--Ent well as c,✓i1 penahiei in ite form cf;!STOP WORK ORDER and a fine of S 100.C10 a ory against me. S, day of LicenseelPermittee VBuilding Department Licensing Board Selettmens Office Health Department TO VERIFY COVERAGE INFORMATI01,11 CALL: 617-727-4900 X403, 404, 405, 409, 375 TOWN OF BAP'\STAB?-E BUILDING PETTIT dry The Town of Barnstable MNAM ,$ Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 z Office: 508 790-6227 Ralph Crosses Fax508 775 3344 Building For office use only Permit no.__ AFFIDAVIT HOME IMPROVE1VIENT 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 soractt m which are adlaaat to such residence or building be done by registered contractors,with certain eac gdons, along with other Type of Work: Est.Cat I 00, Address of Work:= �o Owner.Name• Date of Permit Application: �S I hereb<•certify that: Registration is not required for the folio Aing reason(s): Work excluded by law ' Job under S1,000 Building not owner-occupied Owner polling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CO RACTORS ,� FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL a 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the rnvaer. Date Contractor name Registration No. OR Date Owner's name d' •i:vN' t 'x^ ., �'k�'-�•i Y�' � P/ ,�».r„a'i- �G e4.lty d ems.. ,:y...( x +, -f i �'• �k '`�, r /A...,�/��A J` ; ¢c}�.4, .. k {}v x ._. •n t L.'"f+} N�_: DY+1 I7•`� r""� r .,fir,..}'i;.f, r ifiayy�ik. ' ' �t4 VA�g_, :t+.ad s1s r �r ' ` G -^k:P l 'A7� t'S V//-9 O•, i (''.� r .r.:i;, �,.- K,. z � rr,� r '{�' f 'a•.. �#z.•.�\ c aJ JL(4 7V/1 g 3.+. s"�`s^ .1w>r �y 4� �t• a ssa�� ¢'Y"t� .1�0 3�f"•. *. � '�`. �!�{ "' r x `' « 4• R �a iR t n x S: �s¢s tea.�:g;'. Ir 3r.r t�rr. r ��r ARE" 1J: +Y Y 1. .�` r _* d.:•.. .aGi ,.kY:.>; # Z t r31' !•n' #5,"� f kiDMEr IMPROVE N g,GONTRACTORS REGIST_F >. E3oYard 'of Buis u�l ulat ons" arrd}`5tan�ia_rds w'���" f �a0. J -66 : :.• ,iAb"g. tYs� � s¢ t �' y�`:•:._ ' t a. wAgshm Ulf' On Place a w5'r c ,..i x • �{ 74.9;i�•',4� .' ir`.t.i�e4�k `f`+G",. � f}' ,;»? ,ry�+" j'�^ q a.'%.fs�'k E3o t0, r s ass�acnuettYs O22�8 ... d -...��..� -� nri`^�r•'F <e �� -;c� '� °'F vr�f'$t� � '� 6j+�,Y:irtL �':.. ivba�w�,,� r-` .et".a' .N � ¢��.B.�k�'�i"`.:f"r��, ,- '�`�5: .a.' ���' :r:t 4 •.� ,,��•pp_�� �"�`rx # e. ... k .k �s a + is`t"tea V' rye '.; �.m a..ri .. vr. r`:;.;y c ;;a Y� 01 3 HOME P�PROVE:R`1Ei��T�NCO RAC Q,R.. : fV 1 � , k j f � WNW ;- �- rw -.� F::- i R trat�on ,1Ir2536 Ex ration 04/0 gF � kr '> i i ri ,Jt. y $ "< S «p. �+'T"t Type ,:: '{[)BA�J�4�� ��-:��, ��x �,r!� ��F f x� ��KS; ^w� Wrtm '.h 4f', ;GNOME IMPROVEMENT.CONTRACTOR � � xbRegisECation 112536 . i�EAN C 'FRASER QBA t r, s "�:;'' } s v+1 i- # .&..;kvpSX 4 k_. �f� {, - - DEAIV. C ERASER �r x n� �° z �f ' 1Ezplratlon 04/06/97 71 TARRAGON CIC ,_� Rk - i x. ,. qtlr it COTUIT MA, 02635 r°= rx ? EAN C ERASER h " _T, 15 DEAN C' ` t Y Y M=� ,a �,.:{ , ERASER r r a ti X x se�71TARRAGON CIR ADMINI z OTUITkMA�02635.��'a� 7 r ff� 1� �-�,�'� �:,,f,� .• t _• y._. .._.—.-.. �..ty^-•'4u�31+Cawt._..e�:!t�:.� � .'�..+,��.i:-_:, �,.t�,.a..u:S�jWa.`ds.:c+i �-s4, � . . . _ �� ,� _ - i.Y"^:'�.^b't TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 148 090 GEOBASE ID 8437 ADDRESS 254 CEDRIC ROAD PHONE Centerville ZIP LOT 10 BLOCK LOT SIZE________ DBA DEVELOPMENT DISTRICT CO PERMIT 9146 DESCRIPTION REMOVE AND REPLACE TO CODE PERMIT TYPE BROOF TITLE BUILDING PERMIT. ROOFING Department of Health, Safety II CONTRACTORS: FRASER, DEAN C_ and Environmental Services ARCHITECTS: TOTAL FEES: $50.00 ' BOND $.00 p� CONSTRUCTION COSTS , $1,500.00 750 ROOFING AND SIDING 1 PRIVATE F-dw''E�w * 1ARNSTAI)m • MASS. OWNER ECKES, JOHN T & MARY C 1639.p ADDRESS 254 CEDRIC RD CENTERVILLE MA BUILD1 DI �I ION DATE ISSUED 07/20/1995 EXPIRATION DATE B11, o'i DIVISION APPROVALS FOR CERTIFICATE OF OCCUPANCY TO BE SIGNED BY EACH DIVISION HEAD UPON COMPLETION BUILDING::'" �4 DATE: y. COMMENTS: f 1 /l•� PLUMBING: +� �' DATE: COMMENTSI r _ . ELECTRICAL: DATE: COMMENTS: GAS: DATE: COMMENTS: CONSERVATION: DATE: COMMENTS: OKH: DATE: COMMENTS: HISTORIC: DATE: COMMENTS: FIRE DEPT.: DATE: COMMENTS: OTHER: DATE: COMMENTS: *.., TURN THIS IN TO THE BUILDING COMMISSIONER AFTER ALL SIGN-OFFS ARE COMPLETED.A CERTIFICATE OF OCCUPANCY WILL BE ISSUED AT THAT TIME. a BUILDING PERMIT 4�RCEL' ID_148 090 GEOBASE ID 8437 aAI31yR .55 : 2'54 CEDRIC ROAD ,F PHONE , _` �Czit'erva, 1 f zip LOTS i0 BLOCK LOT SIZE 'DBA DE ELC)PMEN DISTRICT CO .0" _. HERMIT .9i46 DESCRIPTION REMOVE AND REPLACE TO CODE PERMIT TYPE-- BROOF r TITLE BUILDING PERMIT ROOFING ' Department of Health, Safety ,-,'CONTRACTORS: FRASER, DEAN C_ and*Environmental Services TOTAL FEES $50.00 1� BOND $_00 CONSTRUCTION COSTS $1,500.00 750 ROOFI G°`AND SIDING 1 . PRIVATE P (*, .. �. BEIRNSTABLE, • MASS. >tbg9. 10� OWNER ECKES' JOR T & ..MARY O FF ADDRESS 254 CEDRI.0 RD` C;ENTERVILLE MA w BUIL � D ON DATE ISSUED, 07/2 1995 EXPIRATION DATE BY" THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE.BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED. FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED'ON JOB AND WHERE APPLICABLE, SEPARATE THIS CARD.KEPT POSTED UNTIL FINAL INSPECTION 1.FOUNDATIONS OR FOOTINGS 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU PERMITS ARE REQUIRED FORELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. e BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS � 1 1 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 1 2 BOARD OF HEALTH I OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE STRUCT16N WORK IS.NOT STARTED WITHIN SIX CARD.CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC MONTHS OF DATE THE PERMIT IS ISSUED AS. TELEPHONE OR WRITTEN NOTIFICA- . TION. NOTED ABOVE. TION; 5W790-6227 i i i i BUI LDING PERMIT '� I 0 f IRE Tp� Town of Barnstable *.permit /,-Q/n A0 Erpires 6 month r i cue to Regulatory Services Feejr • ELABNSTesr.e,MASS ; 9c� , Thomas F. Geiler,Director plE'D MA'S A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA-02601 www.town.barns table.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-1� Oq �/ Property Address 01A C.r'i? esidential Value of Work Q Minimum fee of$.35.00 for work under S6000.00 Owner's Name &Addre SS L 'Contractors Name �'ri P-I �. kj,�,j L) Telephone Number sz,2)•-"1`� Home Improvement Contractor License# (if applicable)_ �U.(� C(9 Construction Supervisor's License#(if applicable) orkman's Compensation Insurance - : ' Check one: - �m a sole proprietor. gY ❑ I am the Homeowner Z��Z ❑ I have Worker's Compensation Insurance ^�® Insurance Company Name j ''t z L /V olt Workman's Comp. Policy a Copy'of Insurance Compliance Certificate must accompany each permit. Permit Request (check box) ❑ Re-roof(stripping old shingles) All cons tructton'debris will be taken to ❑ Re-;roof(not stripping. Going over, existing layers of r6oi7 ❑ Re-side #of doors replacement Windows/doors/sliders. U-Value-k (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.lmprovement Contractors License & Construction Supervisors License is req.u'red. .GNATURE: License or registration valid for individul use only I ! before the expiration date.-If found return to: ' ! Office of Consumer Affairs and Business Regulation � '.;....,,,.., .,, ,.-.----,--.,-..--..--._..—.-^- -�,G^*^�^^--• - � i _ r 10 Park Plaza-Suite 5170 Boston,MA 02116 dae;ar�asaapun /f.`, 1 bW'3l1IA2131N30 ' !>f U31 NNV 3INVW 08 i y� �: (.' - �.a,atT.a "'1tls. .a,- A NuyQ Luy0^I '`Not valid without signature V9` _ Wna'd Nwor4 lenpinlpul ZLOZI9Z •:uopejldx3 r. :adAl. 64LLOL :uol;eJ;sl6aa H010"1N0011431M13AOMMI3WOH k uoguin2ag ssaa!s g T s�!1mv�awnsuAj 3o am}Ip Restricted to: 00 00- Unrestricted - 1G-1 Z Family Homes W04Z W.I. t- . < `jauogssr tutu q) I ZLOUSZ/S :uollendx3 Failure to possess a current edition of the. - Z£9Z0 VW '3111A213160, Massaclusetts State Building Code , " a31 NMd 31?ItJW 08/bZ6 X08` is cause for revocation of this license .' t; Fx;;i NNfla d NHOf,Refer to: WWW.Mass.Gov/DPS t' °' 00'cot paial�;saa f »"' LOObL So :asuam asuaol- �oslnjadns uolhnl;suoj� 'p. sp_ncpuvIS pur suoilrin;aB :uippn8 jo p vo8 ' Clih'S a!I(Ind.lo auami.ncdia sllasny�rssr.lt The Commonwealth ofMassachusetts ^, 1 Department of Industrial.Accidents 2 � a j; Office of Investigations 600 Washington Street Boston, MA 02111 ' { www.mass.g ov/dia ' Workers' Compensation Insurance Affidavit:,Builders/Contractors/Electricians/Plumbers Applicant Information Please Print-Legibly Name (Business/Organization/Individual): NJ Address: So ):!1m i a- ka V4 Phone City/State/Zip: OD�M N i�-k-� �� Are you an employer?Check the appropriate box: Type of.project(required):' 1.❑ I am a employer with ' 4. ❑-I am a general contractor and I 6. ❑New construction , employees(full and/or part-time).* have hired the sub-contractors, .. 2.�L1 am a sole proprietor or partner- listed on the attached sheet. t ?• ❑ Remodeling ship and have no employees These sub-contractors have 8: ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] of 3.❑.I am a homeowner doing all work . right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers'.comp- c. 152, §](4),and we have no '12.❑ Roof repairs insurance required.) t employees.[No workers'. 13.M�Other COMP. insurance required.) *Any*Any applicant that checks box#I 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 their workers'comp.policy information. I am an employer.that is providing workers'compensation insurance for my employees. Below is the policy and job site information.. Insurance Company Name, so °Ct Mez, Pam) ' 1916R.'a/Irm. Policy#or Self--ins. Lic. #: �° ' 1_I Expiration Date: Job Site Address: q� t City/State/Zip( eA� 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 0ffice-of Investigations of the DIA for insurance coverage verification. I do hereby ertify unde the pains and penalties of perjury that-the information provided above is true and correct.. Si ature• - Date: cl Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: - Permit/License# Issuing Authority (circle one): I'Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6-Other c 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 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 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(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 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 checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)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 besubmitted 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 pen-nit/license number which will be used as a reference number. In addition,an applicant that must submit 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 burn 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 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 Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE RPv;zPrl Fax # 617-727-7749 DATE(MMIDD/YYYY) A(-oR� CERTIFICATE OF LIABILITY INSURANCE 10128111 `*iIS CERTIFICATE IS ISSUEDO AFFIRMATIVELY ER OF OR NEGATIVELY ELY AMEMATIOND, EX CT OR ALTER CONFERS NO TIRE COVERAGE AFFORDED ABY THOE POLICIES CERTIFICATE DOES N BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER 508-771-1632 NAME: FAX Northwood Ins.A enc Inc. PHONE (Air. No g . y 508-393-2955 AIC No ExI: 540 Main Street,Suite 9 E-MAIL Hyannis, MA'02601 ADDRESS: INSURERS AFFORDING COVERAGE NAIC q INSURERA The Norfolk& Dedham Group INSURED John Dunn Aluminum and 2INSURERET: loyers Ins. Co. Vinyl Products P 0 Box 924 Centerville, MA 02632 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 SUB i, POLICY EFF POLICY EXP LIMITS TR: TYPE OF INSURANCE I POLICY NUMBER MMIDO/YYYY MMIDDIYYYY i GENERAL LIABILITY I ! EACH OCCURRENCE ! $ 1�������� 09123111 09123/12 DAMAZYb� N l R1051735A i PREMISES Ea occurrence I S i A I CO'MM_RCIAL GENERAL LIABILITY I - i — —� (-1• I j MED EXP(Any one person) j $ ! i CLAIr:1S-r.1A.DE '_ OCCUR I PERSONAL&ADV INJURY I S X i Business Owners —� GENERAL AGGREGATE I$ 2,000,000 -- — -- I PRODUCTS•COMPIOP AGG $ GEN L::GG.?EG%+--Llt✓i:":.PPUES PER: ^i PRO. $ I POLICY cr- LOC ! I COMBINED SINGLE LIMIT C ? AUTOMOBILE LIABILITY .I I i 1 I Ea accitlenl BODILY INJURY(Per person) I$ ANY AUTO I ALL O::�r•:EO -1 SCriEDULED i I )-BODILY INJURY(Pei acaoenl),$ AUTOS I_�AUTOS ! { PROPERTY DAMAGE !$ I - j ' NON-OVVNED i IPer accident HIRED AUTOS 1 AUTOS I I I - , $ EACH OCCURRENCE I $ UMBRELLA LIAR` OCCUR ' EXCESS LIAR ^—I CLA;MS-MADEI ! AGGREGATE i $ $" I DED Rz_TEtdT;ON . WC STATU- ;OTN I WORKERS COMPENSATION = Imo_ :TORY LIMITS AND EMPLOYERS'LIABILITY I YIN i IW C5004658012011 ! 09129/11 i 09/29/12 1 E,L EACH ACCIDENT , $ 500,00 B ?JY FRO?R!ETORr'rARTN RlE 7:ECUTIVE -- I OFFICERIMEMBER EXCLUDED? IJ I NIA! I E.L.DISEASE-EA EMPLOYEEI $ 500 00 I (Mandatory in NH) i 500,00 II yes,Ce=_tnoe unaer ! E.L.DISEASE-POLICY LIMIT i $ ' DESCRIPTION Or"OPERAT;ONS oelo• I DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) i I I j CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED /REPRESENTATIVE / 1 ! _ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010r05) The ACORD name and logo are registered marks of ACORD Town of Barnstable o Regulatory Services • IARNSTABLF- r . u�as Thomas F. Geiler,Director i63p- �m Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, MAR y z= itr"s , as Owner of the subject.property hereby authorize ? to act on my behalf, m all matters relative to work authorized by this building permit application for. asp ����►� � � ����2v���� (Address of Job) Signature of OW4r Da Print Name If Property Owner is applying for permit pleas e complete. the Homeowners License Exemption Form on the reverse side. Town of Barnstable 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: B-17-837 Date Recieved: 3/27/2017 Job Location: 254 CEDRIC ROAD,CENTERVILLE Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: JAMES P CURLEY State Lic. No: CSSL-099138 Address: Centerville, MA 02632 Applicant Phone: (508)790-4508 (Home)Owner's Name: ECKES,MARY C Phone: (508)420-1773 (Home)Owner's Address: 254 CEDRIC RD, CENTERVILLE,MA 02632 - Work Description: Strip and re-roof approximately 20 square of asphalt roof shingles. Total Value Of Work To Be Performed: $7,500.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). 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: James Curley 3/27/2017 (508)790-4508 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $7,500.00 Date Paid Amount Paid Check N or CC# Pay Type Total Permit.Fee: $38.25 3/27/2017 $38.25 70XC-XXXX-)DDIX- Credit Card 5483 ......... . ... ............ ......... .... `:.._ ............................... Total Permit Fee Paid: $38.25 A se sor'sa map; and.lot number .. .... .. SEPTIC :SYSTi�l`i';=19 ST f ` � t INSTALLED IN COS Ifs IAiVC£ Sewage Permit number ........... WITH AiMTJ_E II STATE G'I'DOF THE CZ c3 A`�w r'QD.G. AN " �IV r°�� ? i -; TOWN O F B) ANSTABL E� ,.` i EAWE3 TAELE, • ,y C, ,.�' a BUILDING INSPECTOR�O t.639• �00 �-� c1 r � .. D IIFY r N t •t, a ,t �r " r APPLICATION FOR PERMIT TO ..... .. .... ... ... .. ................. ... ................. yTYPE OF CONSTRUCTION ..................................... ... . ................................... .. ........... ............. 7� J 19..:.....` TO THE INSPECTOR OF BUILDINGS: The undersigned he by lies for a pe it according to the following information: Location .......... .................../........................................: ..... ............. .. ......Y.................................... ProposedUse ........ .. ....... .......................... ........ ........... ... . ......... ....................... Zoning District ..............................................::Fire District ... . .... ... Name of Owner ....... ..9..................Address .... yG2C../4f.. Nameof Builder ...................................................................:Address .................................................................................... Name of Architect ............: ..Address ................................................... .................................................................. ................. Number of Rooms ............................ .....................................Foundation .. ......... Exierior ............4slF.�'Z:C.... ........................Roofing .. . .......... ...... .. ....................... Floors ..............................Interior ..................................... Heating ........ ........................:....Plumbing ...............2.............................:...............:. Fireplace ......... ................/....................................................Approximate Cost ......... .3� ................................ /�� Definitive Plan Approved by Planning Board __________ ____________19_!J . Area Z Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH • r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding a abov construction. J Nam /....... ........................... Capewide Development 18096 one story, N 'Pbrmi,.a .................`Permit for..................................... single family. dwelling r. . ............................................................................... Cedric, Road Location ................................................................ Centerville .. ........................................................:.....................Owner I .....Capewide...Development. . . . Z-) ................. ...... . . ...... . Xj frame Type of Construction .......................................... n................. ............................... •h ^ , ",-,Pl.ot ........................ # 0 Lot ........ ...De cemberm3- 1 75 ... - �/' Permit Granted .... .fl. ... .....................19 I., Date of Inspection .... ................. Date Completed ...... ............................10 PERMIT'REFUSED/V4 .................................................. 19 4 1111r-17 I ...............n................... ....... 10-4 ................................................................................ ................................................................. ..................................................................... ......... Approved .................................................. 19 ....................................................... ....................... ..................... .............................................. •r^ ti Zr7S kyy"p Ig lZ to 1� S h GG fit' n ZO'f x S .✓t r;: 1v rr � \ �Z�,� �1 � "shy '� 4Y:. ! a; • ,�.� F '. r rAx _ Hsi `� ��'aYGi•�� ✓ �§ K�rtt� /t d.�Y IS�'�_ `FS.. 4�r(; }Y ..• `. * 45 +^T k j'��jYr�1: }, �M � Ltd.'i , $ 04CA?77OA.1: CE�TE�?✓/�G am. �. — iaoo A E�TiC T.9ii.�' 4OT io .oL.404/ �iT v✓iT,y /'oia-li►/�5� � s'�A/ 72, a�CeeY' ce,�Yi�Y 7'1-Vog7- TAIC- 49U1l-a1rv49-' 9 SA-IONVA./ ©ate r wIs 924 a*A/ IS L o c/4 r61 a o.v ? CYEyt (✓.6/� A ea6d®eq/N NEBB®/L/ �idVa TAIgT' iT 6 � / r�ey� o A,, /+V�V� olw. .Riar�y//"V�i10+S�1 4.. ARN� .r 1 � '' L<a�vD su�vsy-oes //�Z>�� q� •:Ef r����:a ��� F�" ' a U TL 4:;,Q 455 Q . •r 7E'MOG%Tf/�iN . / Asses nap and. lot number ..._.� �. : `- ..,..... Sewage Permit number ..................... �!.�......................,:... yofTNETo�° TOWN OF BARNSTABLE "6 9 BUILDING INSPECTOR o a MPY a' 4e4-4e APPLICATION; FOR PERMIT TO .. �.::..................... .. ............:.................................................................. TYPE OF CONSTRUCTION .. +c.............................. .,...................... ................................ 9........ TO THE INSPECTOR OF BUILDINGS: The undersigned hee,rebyy q; plies for a perm-ittaaccording to the following information: Location ....... .,l:G�` ,� ................ .... ^.................... ............ .../...... ,.. ......... ... ........................................................ Proposed Use ..........`.c!I!['['i'l�s+ /.. .... lJtfT .,er -�' .... ! .. ;P' ......?, s................................ 4,. Zoning District ..............`-......... ......... ................................Fire District .. , ....... J Name of Owner .... `c"�- �` .........•.....•••.Address > f l +.. �t 3 .............. r y Nameof Builder ....................................................................Address ..................................................................................... Name of Architect ......................... ..............................Address .............................................., Number of Rooms ............_.....................................................Foundation !rr r......��.. .ram.................. /_ f Exterior ..................................................j;.......:........................Roofing ......:�..,i.//............................................_..................... Floors .......Z.- 4> ...........Interior .... Heating ..........4-ZQ ..44-/!......ate..............................Plumbing ........Z......................................................................... r" Fireplace ......................................................Approximate Cost �f Definitive Plan Approved by Planning Board __________`J_______________19_ j. Area ..................................... Diagram of Lot and Building with Dimensions Fee '........_ .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above/ construction. Name �Y 104 iC .. /I r ✓r . . . Cmpew1de Development A=148090 ~~� � 18096 one story, . . ' singlefamily dwelling ' . ' ��.--------- ---------. �� �� ��a� , ' � Location --'��r�...�.�.�----�-------- . ` ^ Centerville ^`~------'------~----------- ` ' Capewldm Development Owner ..................................... ^ — . ' . � z '. — ---.. . ' me ) . . ' / . \ � ' > / \ ' December 10 75 ` Permit" Granted - ^ = Date of Inspection / � ootu completed ' ^ ` ' PERMIT . . . , . . ` / f Y // / / � / `^ . ' . '------ —^'' . . Approved ................................................ lV ' ' /y ---------' --'0^--^—''~----' ' . ' --- ............................................................ . ^ — - +t Rr€ 'E CAPE Cow"t,' O"INSULATION � n ` _ 27 Ll LA IIYEY plA31 ���Sf---A---MIf---SS��� fPNAf FOAM 7YSPENOEp ' YARf t:URfYf INSYlAN4N CfIE1Npf 1-g00-696-6611 rI�tT � l� — e 'Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 62601 Date: y �l Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Perfonnance Institute f (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address . Village Job•� i- �rllis a1s y G�� �o x ��',�`'"'i/�.,hifl j Insulation Installed: Fiberglass Cellulose R-Value Restricted,; Unrestricted { Ceilings f Slopes 'iltNx ( ) ( ) ( /o ) I Floors Walls ,At t �I/V f 5 Sincerely Fie ry E Cas y Jr, President C e Cod I I ulation, Inc. r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION D9ZMap Parcel Application # Health Division - Date Issued Ali)) Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project.Street Address 2.r �, I�f G Village MA Owner k kva AddressG + Telephone Permit.Request k,6*1 A/4AV Tdk-�_ , kw atv j I 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 C/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King s!Highway,. Ye: ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other - j a p Basement Finished Area(sq.ft.) Basement Unfinished Area (sq,f) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new 3J a Total Room Count (not including baths): existing new First Floor Room Counter Heat Type and Fuel: ❑ Gas 0 Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals A thorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Nam Telephone Number $' 7 t2, Address �� l�Gl-L License # d0 e(f Home Improvement Contractor# /3.56 7 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY a APPLICATION# DATE ISSUED- MAP PARCEL NO. k ADDRESS VILLAGE OWNER it • d DATE OF INSPECTION: wFOUNDAtTIONju z mtj�w,wDAqw,.l­. Y - FRAME A.:INSULATIONj,,A m%- <)Lh tIp_-: t V FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL + • FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. OWNER AUTHORIZATION FORM` /14 R 99'e.RL rs 7 C? C 1C t, 5 , (Owner's Name) owner of the property located at Z 5 L Pc�r,'c (Property Address) (Property Address) hereby authorize (Su ontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Sig ure " Date Massachusetts -Department of Public Safety • t Board of Building Regulations and Standards Construction Supervisor License: CS-100988. HENRY E CASSII ' ' 8 SHED ROW. . WEST YARMOUTH Expiration Commissioner 11/11/2015 i r .J C�WY /�: r+� I C)l:[ic �_ c>l C,unsutner Affairs and Huslne.ss 10 Park Plaza -Suite 5170 Boston, M1HL`1ChQSett9 02116 l-paie l riProvQment Contractor Registri'ation RegisU�ltion: 153567 1 Yue: Private Cori:)ot atioii Expiration. 12/1 a/2t)14 1'rrr 2�sts t -\PF' CID INSULATION, INC i(=NF�1` CASSIDY 1ti f�F A R D 0 N CIRCL.F ` I). YARM0UTH, MA 02664 UpsimcAdclress nud return carat. Mark I-cusuu Gn dwil i.. Address [j Rencwaal I-._I Emlaltryntcut I .I LustCnrtl .. �� 'Ir r�:rruenirr'r-rrrf(fe <!,':)��t.airtr,�teJrsi(J �� Affairs S. Business kegulatiur, License ur registration valid for irtdivirlul use unly ��a1epUale IMNttC:aVkM NT CONTRACTOR TRACTOR belu!l for espiration date. ll I'uuud rr 111,11 tu: �I t�u�utruUu„ 1535d7 Type: Re6„lution LU Pa,k Plaza-Suite i 170 {a!,ia;aluan 1 '/15!_U1Q Private CorporaUcii Bustun,NIA 02116 INC, i. ;.'•.5 '::t^,'ail l}' ._._. _._ ........, . Il u d V.rscr rcia,r')' _ Ot Pad 11'IttlQ t-' Twit Ill . The Commonwealth ufAlassachuserts I: Department of Industrial Accidents Ojft e of Investigations 600 Washington Street j Boston, IVA 02111 www,yrrass.gov/dia tiVorke:rs' Compensation Insurance Affidavit: BuildersIContractors/Electrriciansi-Pl tubers �. y1.ia::ttrt i<t�iforY�wa�ioaa Please Plri !� N.t.titc �I3u�iucssJOrbaniratiori/iudivicival � ��' .��y G/ / � v At1LifCSS: CityiStati/2i Phone z c y our uu enoplOy r? Check the appropriate box: 1.{ t-t.oil a employer with. �) ❑ I am a general contractor and I77 [] Typeofproject (required):. I _ c atpluyccs (fit11 andstotr part-time).* have hired the sub-contractorsw construction U l am , sole proprietor or partner- listed on the attached sheet. u'16deling ship'and have ao employees These sub-contractors have g, ❑ Demolition 4vorkmg for me is any,.capacity. employees and have workers, [No workers' comp. insurance comp. insurartce.t g ❑ Building; addition required:] J. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.[] 1 am a homeowner doing; all work officers have exercised their .❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs I insurance rcquircd.] t c. 152, §1(4), and we have no 3a. I tun is homeowner acting as a employees. [No workers.' 13:13 Other Z,--', 71-4Gd smeral contractor(refer to #4) comp,insurance required.] ' try applicaut tout chn Ys t>vx r trust also fill out the section below showing their workers'compcD utiodi oticy information, Hunicuwucrs who submit this atFidavit indicating chcy arc doing all work and then hire outside contractors must submit a new affidavit indicating such, :Cunuactora that chuck this box mutt at-tached an additional sheet showing the a=x of the sub-coamx-tors and state whether or not those catitica have cufployccy. It the Sub-conm%crorra hove etnployecx,they must provide their worker'comp-policy number, l um an employer that is providing workers'compensation insurance for my employees. Velow is the policy and job site ;nforrrtutYarc, . 111SUnUICC Company Name: Policy of Self-ills. Lic. Expiration Date: Jobtiitr.address: ��[t% T\, City/State/zip: .attach a copy of the workers' cornpensatfoa-policy, declaration page(showing the policy utimber and expiration date). Failure to sccurc:covcragc as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a ring up to b1,500.00 and/or one-year imprisonrrlent, as well as civil penalties in the form of a STOP WORK ORDER and a tine Of up to S250.00 a day against the violator, Bc advised that a copy of this statement may be forwarded to the Office of lnvc3tigations of the DIA for insurance coverage venfication. !do hereby certify, nder J / nd penalties of perjury that the information provided above is true and correct. phorig 4 Of j7HC y, Do not write in this area, to be completed by city or town official CityPertnit/Llcense# Is tity (circle otxe): 1 1.tialth 2. guiltiiing Department 3. City/To'vu Clerk 4.ElMe'trlcal Inspector S. Plutaabing Inspector 6.O l:ow : Phone#: ^may y. CAPECOD-27 MYOUNG ' I'��;�'���/L-�• -. - _ '.DA1F:IhI M10D1YYYY) `.._ CERTIFIoCi4fE' OF LIABILITY INSURANCE 718/203 _ THIS CL'RI IFICATE 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 BLLOIN. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,SUbjuct IQ I tho tUrnrs and conditions of the policy,certain policies may require an endorsement. A statemont on this certificate does not confer rights to the cortihcatu holder in lieu of such endorsements . T ,t OUCErt CONTACT Licentir f PC-514062 _RAMS, Margaret Young. Rugefs rX Gray Insurance Agency,Inc. PRONE IFAX I434 Rtu 134 AIC o Ext: ---_—� —�_ __—�_ 1JA C Not __. E-MAIL lsouth Dennis,NIA 02660 - - ADDRESS myoun a@ geragr�jxorn { - - INSURERS AFFORDINGCOVEIZAtat ,__NAICIt_A j _.-._---.. .._ .-.---.---_._.._.__....'...._...._._.._ INSURER A:PEERLESS INSURANCE COMPANY _ INSURERS:COMMERCE INSURANCE:COMPANY INSURERC.Evanston Insurance Company i;apn i..ud Insulation.-Inc. . �_.___--�,------------_._.__ _. ---- IR Rea'r'dori Circle INSURERD:ATLANTIC CHARTER INSURANCE GROUP-. _ j South Yarrnouth, MA 02664 ---� — --" - — , INSURER E: - ......... . _ ._—..,.._.--__—.—.r__ _ INSURER F ------- -.— --- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _._........._..._.— ][if"; 15 10 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTVJL'I'1"15TANDING ANY.REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RLSPEC I"f0 WHICH 1'I11S CkK'I IF'(CA I E MAY L E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORD66 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. IIN>rt _...____.__ _ -- 1CDD SDBR POLIC EFr POLICYEkP LIMITS I rR IYPIE OF INSURANCE POLICY NUMBER IMMIDDIYYYYI IMMIOD/YYYY1 GENkItAL LIAUILITY EACHocG.uRRI NCL $ 1,000,000 IUAMAGETO RENTED (A X Ci)MMtRL;WLGENERALUABILITY CUP8263063 411/2013 4111�a'14 PREMISES F:eocwrrenco $ 100,000 CLAIMS MADE I X J OCCUR ME;D EXP(An-Y ata�rorwn) j PERsoNAL a ADv INJURY $ 1,000,000 I I GENERAh AGGREGATE_ $ __ «,000,000 �._ PRODUCTS- � I UNIv't AUl,hl-.GAI'k LIMI I AI i t I_ES PER: TS COMPIOP AGG $ 2,000,000 i1 J PRO- 1 1L�L LO_C—....--... T POLICY _ ffaL aufOhIUBILE LIA_0LITY --- —1,000 000 Ea _------•-- B ANAAU1u 13MMBCKVMK 4/1/2013 4/112014 'BODILY INJURY(Perplaon) $ ---� I ALL.OWNED - SCHEDULED - BODILY-.INJURY(Par acCidant) $ ` AMOS X AUTOS j .._.. NON-OWNED N - RRORECCID I $. X I INED ALI I OS X AUTOS PER ACIOLNTI -_ ---___- l)( untt htLLA LIAt3 X OCCUR EACH OCCURRENCE $ — --- - -. j rxCES3LIAFJ CLAIMS-MADE XONJ453512 4/1/2013 .-411/2014 AGGREGATE WORKER �AYr STAMT_l�'1- I S COMPENSA nON AND EMFLorERS•LIAOILITY YIN 1,000,000 D ANr FKOFRIE:fOR/PARTNER/EXECU FIVE '--":. WCAU0525904 613012013 613012014 E.L.EACH ACCIDENT_ )FFICERIMEMSER EXCLUDE07 NIA i 1000,000 E:L.DISEASE-EA EMPLOYEE' (hlandalury In NH) - � _ $ ._.._.._... .� If joa,desama undar 1,000,000 nESCKIPI'ION OF OPERATIONS below - E.L.DISEASE-PDL0.;Y LIMIT $ — • R bUCRIFIION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1Q1.Additional Remarks Schedula,If morn*Paco Is raquiradl' Workers Compensation includes Officers or Proprietors. Addtional Insured status is provided under'the General Liability when required by written contract or agreement with the Certiticate Holder. I . i I • I CERTIFICATE HOLDER_ _ _. —_-T_ CANCELLATION SHOULD ANY OF THE ABOVE:DESCFIQFD POLICIES FIE CANCELLED BEFORE Ca n Cod Insulation IITC THE EXPIRATION DATE THEREOF, NOTIC E WILL BE DELIVERED IN N ACCORDANCE WITH 1'HE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE-- 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(201 U/05) The ACORD name and logo are registered marks of ACORD F: t: 7 � ''s ,r J `i i � F ZDr�, - + .�H Y •t �, �. r ;r {ram: rh FMIR B ¢ f'a �s <' - y ran "r '•r -k _ 6`•9 ," r` ``•�/ y Z�' rM ��,},.. L n�j. If IJ y .k. P k l} + •} ;1s[;.C _ '� F 4. ,\ P`: }rce a z _ _ /F � J � i r V�lti t ,,i11, e KJ Wsh vy .t• _ r w' •00 .. 5 f r' ;.:zeZ '}„x r a• •} i Chi ;{ F Y` >, nq}G= �.It'„ sh r r.x r r,4 • ' "` � ry Y ..k._ �Y Yy�Y.0 e`. r)r��s ,# �T � t'�a ri '. a �. <,y•z' * x 3 i. „t ¢ •..0 a.S.r a�Sv 'F �r'u F�?� �� Y" ^*�•�.•- ���t_ire-•-,•�-•tk �'•r8�' � ..4'� i �` + ' ® �. T ,� v✓qC G °r"Fl tit r}�'��[e xxt�y�A'pI "T>! �64° C,�/C/7'�C'}'`'•`�.'l��pG.G.� Mom.s ° /o4a ,�3L. .'aP"r `r�v'`so�,• °noa'0✓ � r �� G..+�-dT"o�P�^- :�.�.qt,/ .�ors.�' 2�/� OiT;/�✓il.�,} ! ©.�W./�13��,� ,�e%4 r i• r x x: ,p{ .CENT/FY .6A.1 Ts;✓i5 ,=L A.v IS L O CAP TE D OA1 �T', •CCa/,4=*®,WA-9 ro T-vejg �e.v/�v L P�111 M�tS� w} ��Y � , .�/ d�1lS a®may- Tiv�E 729l�i/A./ OF" ��.�/9✓CS�.xi.�� r yyEF J�/ +�• ,fin �•�• !� /�Rp��'• iwu d k� ����� >rrw���/ ���/ v."6✓° . x �\ �''/9llFY t�.� Vl1,� �S h' •� r h � fiT• t L. C/V/4 �PolJ- '7°Ei r�E'MOCJ7'"s:/; >��5: --aAT,C- ` 1 � 4ses^, s.o_ffice (1st floor): �(/(�.r� �D C ��1�•p�� �A��� D�THETO` Assessor's map and lot number .. .......d.......... .......: �ft?�.' ' W/ q� ` �g Boat''!c of Health (3rd floor): �Fs� � _: Sewage Permit number ....i `.. c-.f�g.a. .....:....... a E E y; Z BAUST&BLE. Engineering Department (3rd -floor): �` `1L CODE AND Apo "639• eye Horse number ...... ............................. ... .. ..: r GULATIOIVS '�aYpr°� 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 BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ���0�1 ........ ..�.'�........ ...i!!'!`? F TYPE OF CONSTRUCTION .. ........:.::...................................................:..................:....................... ..................•-- ...............----......•---19........ TO THE INSPECTOR OF BUILDINGS: D The undersigned hereby appliqp fpr a permit according to the following information Location .. ` .. .............. i?!! ru ,(/.1............. 't .:......... :d .......... .... . Proposed Use ... . .......... .......:.` ................. Zoning District .......................(,. ... ..................................Fire District f�j. Name of Owner ? ..:.f. . ...... :......::..Address . 1 Name of Builder ........ Address .................................................................................... Nameof Architect ...................:....................... .......................Address ................................ .............................................:..... Number of Rooms ..................................................................Foundation . ........ �. Exterior .......Roofing...................�...... . ........ .......... ... ... .. ... ...... .. . Floors' ................... . ..... . .... .......................................p.........Interior ;...... .. /,, Heating ........ ......'. Plumbing. .. ...� � ....... .. .. ... Fireplace ...................................................................................Approximate Cost ........ f.... 0................ Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS' REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tow o Barnstable regarding the..above construction: , Name ...: ..... . ...... . . . ........ . ...,. Construction Supervisor's License ... .. G... PARE, MR. & MRS. Permit for ... � -12214�' Remodel Garage to ... ' No .............. ................................ Family:Room/Single Family Dwelling " Location ...254 Cedric Road Centerville I _ Owner ....Mr..... & Mrs.....Pare..........:........... t ,. Type of",Construction "..,Frame........ 'f.......... - . ........................................................ , PlotT � Lot .- ......... C � � �� • .. �.� _ _ ....`...................... ............. .......... ....^.......... F• �� fit' F f - Permit Granted :Augus.t...3.0.,-�..... 19 88 'j: _ Date of Inspection ..�....... ... .......... Date Completed ..........F...... ........ ......19 Ch na...«....:x.�.r..e4.E,. ,M,.,.,,,, a �.:x•:-r.: ;s:t'.Aa'.+-.�+G.e'�it: .4.,N a''rs w: _ .*�,.:J;'L.&.> sl6F �u A. r P -. � _ ..:t,,:s r.r Assessor's map and lot T" v o �© , THE} c� to �sse"ssors office (1st floor):numbe"r .. .... .................................... � Board of Health (3rd floor): P Sewage ermit number .... g .:� yam. L MAR39TODLE, i Enkineering Department (3rd floor): -- rasa House number �. } �__ °0,,�163q 00� �.r.... .......... aNO a` 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 BARNSTABLa.E BUILDING INSPECTOR APPLICATION FOR PERMIT TO j !�V ... ' TYPEOF CONSTRUCTION —A/.. ........................................................................................................ ................................................19........ TO THE INSPECTOR OF BUILDINGS: ;f`✓ ` The undersigned hereby gpplies for a permit according to the following information: B Location ... .S.F�. .......:........L....... ...... .. .........sC�QceJ.:'� /'..........�� .�.. ......1�'��..... .. Proposed Use ... ......... > Zoning District ....................... L: .....................................Fire District Name of Owner ....../.... .... ...............:...Address �. J/_�_ Name of Builder "'.. .P�'�...............Address .................................................................................... Name, of Architect ..................................................................Address ......................................................... ......................... ' Number of Rooms ..................!...............................................Foundation .......... 1? ...................................... Exterior ...................rs. �yr, ,..........................................Roofing` ............. ���/f "1t!' %! .............................................. /7 V Floors ..._..................................................Interior ......, tee...... !!.'. .....................,.................... /.... Heati9 ..1� g =�-e�/` .y. �. �^ 'eti........ ng /.!,l.:r.C.R��.......��!��.... . ....................Plumbin .... .�.j- Fireplace ......-- / .•........................................ Approximate Cost ......... .........�....... ............ ,... .... Area /.!.l.....�,�w..' Diagram of Lot and Building with Dimensions i Fees... ............... _,3p_a � � F r • y/ y - i is } OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town"33f Barnstable regarding the above construction. Name . i. i s�... . ............ Construction Supervisor's License ...:,:..lA% ..........' ... ' PARE, MR. & MRS . A=14'8-090 �, - No .�-� .14`. Permit for Remodel Garage to Family Room Single„Family Dwelling......... Location ...254...Ce.dric. . ....Road...................... .... .. . ..... Centerville ............................................................................... Owner ....Mr.. & Mrs. Pare ..... . ......................... Type of'Construction ....Frame . ............................ ............................................................................... Plot ............................ Lot ................................ Permit Granted ...August„a0............19 88 Date of Inspection ....................................19 Date Completed ......................................19 f