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HomeMy WebLinkAbout0038 CENTERBROOK LANE 3 $ ���-e�-b�k 1.a.�n a�, 0 on ... 9 O ,. v �, ° V u � .. .. .. U .. C o _ ., 1 _ _ _ O i,- oFt rq,,, Town of Barnstable �O* Expires 6 months f, miss ate ♦i a Regulatory Services Fee JL HASS � s �o� Thomas F. Geiler,Director j°lFo r�+a't� 1!�10'►� 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 PERT APPLICATION - RE MI SIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1 -7�;Z Property Address � tiHj r'O 'Residential Value of Work Vv Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address_HP-AT 0a I DATA JP)I(,L.� Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License# if applicable) ❑Workman's Compensation Insurance QV ... ❑°l� Check one: ❑ I am a sole proprietor , OF ❑ I am the Homeowner. isAl � ❑ I have Worker's Compensation Insurance nsurarice Company.Name Vorkman's Comp. Policy# :opy of Insurance Compliance Certificate must accompany each permit. ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑.Re-roof(not stripping. Going over existing.layers of roof) e-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A c py of the ;rement Contractors License& Construction Supervisors License is r uir 3NATURE: WFILESIFORMSIbuilding permit lbrmslEXPRESS.doc rised 070110 z s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Na7Ile(Business/Organization/Individual): Address: - Z C—ity/StatelZ 0: Phone#:Are you an employer? Check the appropriate box: 4. [] I am a general contractor and I Type of project(required):I- I am a employer with employees (full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, Q Demolition working for me in any capacity employees and have workers' [No workers' comp, insurance comp:'insurance.# 9• ❑Building addition r uired.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions t"3` 1 am a homeowner doing all work officers have exercised their 11_❑Plumbing repairs,or additions Myself [No workers' comp, right of exemption per.MGL insurance required.] t c. 152, §1(4), and we have no 12.[]Roof repairs employees. [No workers' 13.[] Other comp.insurance required.] Any applicant that checks box#] must also fill out the section below showing their workers'compensation policy information. t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,, $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde pains penal' s rj ry that the information provided above is true and correct /J Si ature: n % Date:- Phone FFy only. Do not write in this area,to be completed by city or town official n• Permit/License# hority(circle one): Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.PlumbingInspector son: Phone#: VET Town'of Barnstable Regulatory Services .. • BARMABLE, * Thomas F. Geller,Director y MASS. 1639. Building Division �a tiuci°i _ Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE- QOB-LOCATION:", number sheet C" Qvillaaggel, ,.HOMEOWNER'::'%C� 0 46�1 'name home phone# work phone—# — CURRENT MAILING ADDRESS=,, ` city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides.or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be r=onsible for all such work performed under the building_permit (Section 109,1.1) I The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mum ins ection procedures an equirements and that he/she will comply with said procedures and requir e - -+gnature-o-Homeowners Approval of Building Official Note: Three-family dwellings containing 35,060 cubic feet or larger will be required to comply with the State Building Code Section127.0 Construction Control. HOMEOWNER'S EXEMPTION . The:Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1.7 Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the.last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt -b I"E' Town of Barnstable Regulatory S * »txsr�+at.E, g ry Services MASSThomas F. Geiler,Director i6Jq., `fig Building Division ,Tom Perry,Building Commissioner 200 Main Street Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623 0 Pr�operty,,Owner Mu' t Complete and Sign This Section �• �, r If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters.rela.tive to work authorized by this building.permit (Address of job) ) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be, utilized until all final inspections are performed and accepted. a Signature of Owner Signature of Applicant Print Name Print Name Date QTOPM&O WNERPERMISSIONP00LS y' IME Town of Barnstable *Permit 4 ti Expires 6 months from issue date Regulatory Services Fee snatvsrABU, � 1639. ��� Thomas F. Geiler,Director r ArFO MA't� Building Division /�6n Tom Perry,CBO, Building Commissioner I 200 Main Street,Hyannis, MA 02601 �'1-1 11 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 lit �� 2 Property-Address �Zdential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address bGt�nt� ih I.�t �1" �� r /? Contractor's Name_ ae - PV 4v4m, Telephone Number � i Home Improvement Contractor License#(if applicable)_ Construction Supervisor's License#(if applicable) �S 2 �rkman's Compensation Insurance. Check one: ❑ I am a sole proprietor X--PRESS PERMIT ElI.am the Homeowner #�t have Worker's Compensation Insurance AUG Q1. Insurance Company Name A .3 TOWN OE RAPK Workman's Comp. Policy# 4, j :2 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to l?Ke-roof(not stripping. Going over I existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value #of doors (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: �~ P.r'operty Owner must sign Property Owner Letter of Permission. ,A copy of the Home Improvem on ctors License& Construction Supervisors License is quired. SIGNATURE: Q:IWPFIL� uilding permit formslEXPRESS.doc Revised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Fe VW Phone #: Ar e employer?Check the appropriate box: qq � 4. I am a eneral contractor and I Type of project(required):. 1. m a employer with [/v ❑ S employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. modeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any.capacity. employees and have workers' [No workers'comp.insurance comp.insurance.$ 9. ❑Building addition required.] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doingall work . officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs c. 152 ` insurance required.).t ; §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. lContractors 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 pro .idi g workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section.25A of MGL c. 152 can lead to the imposition of criminal penalties of a' fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigatio DIA for insurance coverage verification. I do here cer, fy under the aims enafti of perjury that the in provided abov is true and correct Si atur . Date: � G Phone#: �� �Z/ Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Oth 'er Contact Person: Phone#: ,off ✓� � � ��� __�.."_ _� _._�.�_._ _ .�.�.�. � _�� -� Office of Consumer Affairs&BusinesvRegulai on m License or registration valid for dividu!use only" HOME IMPROVEMENT CRACTOR before the expiration date. If found return to: I Office of Consumer Affairs and Business Regulati Registration _150 003 Typ k« 10 Park Plaza=Suite 5170 Expiration �6/19/2012 Suppleme`n fard: Boston,MA 02116 3 CAREFREE HOMES GNC DANA PICKUP JRr�. 239 Huttleston ave Fairhaven, MA 02719 r Not valid wit out siona Undersecretary / b !1Iassachuutts=Departmen Puhli Board Of Buildiw,-Relyulatioris and Standards F s Con_structio Supe or License License: CS '95228, Restricted to:_ 00 DANA PICKUP . , r 19 HAMLET STREET ' - FAIRHAVEN, MA 02719 F c Expiration: 3/22/2012 C'!mmissi1°cr Tr,":.18680 Client#:33723 CAREF ,ACORDr. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 09/08/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Herlihy Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 51 Pullman Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Worcester,MA 01606 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 508 756-5159 INSURERS AFFORDING COVERAGE NAIC# INSURED LINSURERA: Interguard Insurance Company Care Free Homes Inc ERS: General Casualty Insurance Companies 239 Huttleston AvenueER C: Fairhaven,MA 02719 ERD:ER 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. LTR NSR TYPE Of INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION - DATE I MIDD DATE MW LIMITS GENERAL LIABILITY - EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PREMISES(Ea occurrence) PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC - JECT B AUTOMOBILE LIABILITY CBA0816810 - 07/01•/10 07/01/11_ COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS - $ - X SCHEDULED AUTOS BODILY INJURY- - (Per person) " X HIRED AUTOS - BODILY INJURY $ - X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ " (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ F1 ANY AUTO OTHER THAN IEA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MA.DE AGGREGATE $ DEDUCTIBLE - - $ RETENTION $ $ A WORKERS COMPENSATION AND CAWC134O97 O9/O1L1 O O9IO1/11 X WC STATU- OTH- LIMIT EMPLOYERS'LIABILITY - ANY PROPRIETOR/PARTNER/EXECU VE E.L.EACH ACCIDENT $1,000,000 . OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS i VEHICLES/'EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION - Town of Barnstable,Bldg Dept DATE THEREOF;THE ISSUING INSURER WILL ENDEAVOR TO MAIL .10 DAYS WRITTEN 367 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Barnstable,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. . AUTHORIZED REPRESENTATIVE ACORD 25(20011,08)1 of 2 #M42357 PB2 © ACORD CORPORATION,1988 OFFICE:(508)997 1111 MA.Builders Lic.#021330 FAX:(508)997-1297 CARE FREE Home Improvement TOLL FREE:1-800-407-1111 times Inc. Contractor's License WEBSITE: #100503 MA. www.carefreehomescompany.com 239 HUTTLESTON AVE.(RT 6)•FAIRHAVEN,MA 02719 #15179 R.I. NAME /� DATE ADDRESSff� LiG7V�ZL/'�1V:c/% '�"V� u//E 71PCODE ADDRESS OF JOB <TAW-- TEL JOB DESCRIPTION � 17 fA.PT F�6�14 CA7 �- A-,tv (oa Scheduled Start Scheduled Completion _3 DRSi A.Replacement of missing or rotted lumber is not included unless specified. B.All start&completion dates are approximate and could change due to weather conditions. C.Stripping of roof includes removal of up to two(2)layers of shingl s, ch additional layer to be charged ft'. D.Replacement of rotted roof boards/plywood to be charged® i ftz. E.Exisiting chimnet flashings will be reused;replacement,if necessary,is not included. F.Care Free Homes,Inc.is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the attention of C.F.H.,Inc.promptly. The Company hereby proposes to furnish labor and material to complete the above work for the amount herein.Fulfillment of this order is contingent,however,upon the want of strikes,fires,and any natural disasters,the ability to obtain materials,or any other conditions beyond the control of the Company. Cost of Project$ [1—t1—CO C PAYMENT TERMS Date 1. You,the Owner may cancel transaction at any time prior to midnight of the third business day after the date of this transaction. 2. You,the Owners agree to pay any and all expenses incurred by Care Free Homes,Inc.in collecting money due under this contract and enforcing the terms of this contract,including but not limited to,reasonable attorney's fees,interest and court costs. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CARE FR MES,INC. ACCEP ED: �L�Uw soya acknowedges o— By: V eceipt of my camplete0 copy of this Areement owner. All contractors and subcontractors shall be registered by the director and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director,Home Improvement Contractor Registration One Ashburton Place,Room 1301 Boston,MA 02108 Tel.(617)727-8598 i TOWN OF BARNSTABLE 27890 „ e Permit No. ---------------------------- l Building Inspector cash 019. OCCUPANCY PERMIT Bond ----------------- Issued to Greenbrier Corp. Address lot #12— 38 Centerbrook Vane'." Centerville Wiring Inspector / � Inspection date rPlumbing Inspecto �r Inspection date Gas Inspector !) ( , � p� r Inspection date -4 A,n e- 3�" (Engineering Department Inspection date Board of Health YAK C (r--T- 1 Inspection date �0,1945 IT i/v J THIS PERMIT WILL SNOT 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. 3 19 l (�' Building Inspector f:: ,� .{ _ t 4" i'. ...t *.B h Y �.0 .a.-y`•74.#,�,l��s .".h�.^ �' -.s $r- � � r �' �._. k'.,.'F2�3:���='..��.,..��.n ��Qy�f ro`.ew TOWN OF BARNSTABLE BUILDING DEPARTMENT S assaeT : TOWN OFFICE BUILDING � rua HYANNIS, MASS. 02601 ffi t .F Z MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit'has been issued for the building authorized by Building Permit 1SSlled t0 .......... 0.......................................... .......... ..... r, Please release the performance bond. 7U Al 390 . /9.'o o.- E - M . 1 5.0 0 N � _ � U `•�1 r � � a L/� � LoT ,�2•• �V. � , 2 yin . - • � z2 � , 239, 00 v 539°�-90 ooy �l L.oT .� . L_ OT: 3 _ - 1 CERTIFIED PLOT PLAN �� OF b14S �� sqo O T /.2 QE H 77tf 9YA 0 o ROB EFsTIL 4 le E3 - ELDREDGE " t y No. 1s'1 7 IN IST - �. . .. SCALES � "�'® DATEi �3�� 111NEERINS INCCIiENT I CERTIFY THAT THE ®1$TERED RE013TER D SHOWN ON THIS PLAN 19 LOCATED �YOT6 ON THE GROUND AS INDICATED AND CIVIL LAND 408.NOO -�"[Iff-D ENGINEER SURVEYOR t�3,,8Y� � . CONFORMS TO THE IONIN6:I.A11Y0 A Of D RNSTABLE, MASS Tt 2' MAIN S T R E.E T CN. 1Y ,,.._.......,,... &AE HYANRIS, MASS. SHEET.�. OF. RES. LAND SURVEYOR Assessor's-swap and lot number ....171.71.o..... ..............:. �e tom. pp e7/EFT1 ST B� ��Q�OFTNE'tp�y� ...� �:_7 Sewage Permit number .......:....... ... I N S� � iN ® P I� Z BASH9TODLE, i House numberM�' "sa } M TOWN OF BARN STABL�E I BUILDING INSPECTOR yAPPLICATION FOR PERMIT TOe �.1 L�L...:� ... ... .....J . ... . ....................................... TYPE OF CONSTRUCTION .... 0.r ��f7 . ............................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereb applies for a per it actor ing to the following information: !7......... *21.. CCU Location ` Gl ...... .....�..�.,�TO ��Qrl .. / ................. T��Proposed Use ......�.�1... .,/...�... ..... .............. ......................................................... ........................................................ V Zoning District Fire District ... �. Name of Owner ...�.�.f.��'f..�/.��.. �/,���............Address .... .....,.................................. ..... .... . .. Name of Builder ......... .. ........Address ........... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............................................... ..... ............Foundation .... .. ��C�:�G.i':...... �����...�. Exterior .....vv ...sX�l�l. ....�.J...Gt.l...cl� ....Roofing .. \1....................................... S ��Floors l /. .. . ..... ..�... Interior .......... -- -Heating .... ......... ......................................................Plumbing .......;:;2 JcS, ...........:::.......................... . Fireplace ....��/L'.�!� d ��Y ...............I..........................Approximate. Cost ..........1...�J ..a �............................... Definitive Plan Approved by Planning Board -----------------L__ ---19 1. Area .....// .�. 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. r Name ............ �. :. ............................. Construction Supervisor's License ..f.. 7 4GREENBRIER CORP: \'r 27890 No ................. Permit foil..... .......... ! Sin le Famil Dwellin Lot 12 38 Centerbr Lane. ` Location i...................................oRk �, •_ _ y �- Centervill ."....:".... ."...: ......... Owner ...Greenbrier„Corp.. „•,,,• Type of Construction• :..EKAMe.......................... ............... .......:..................:.................... ' Plot .'.F...................... Lot y - r _ Permit'Granted ......'May ...16.!:.......... .19 85 Date of,Inspection ....................................19 p� Date Completed ;' d' • Assessor's map and lot number ....Z 1.i;�.... K. �. THE Le ) tp�y Sewage Permit number ....... _ z �� '~ Z BABBSTADLE,4VI i House number ..........................�.... E 3 I r rasa ...._............................:.... 9 A 1639.M00 A TOWN OF BARNSTABLE k BUILDING INSPECTOR 4 APPLICATION FOR PERMIT TO ... �'J/�:. .......... ..... � .: �. ......� . TYPE OF CONSTRUCTION .... �C�:IX.... �-� ............................................... ......................... ................... ........19......:S TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a per it according to the following informattiio�n: Location .C�`.. .. ..........................�......... ........1�............,..... ...........»....................... ,................ ................. 4 Proposed Use .......�J./.�.7 n� /� `'' l r.. ........ ...... .........'. ZoningDistrict ► ` .....................Fire District .... ...........................'.........'.............. .,................................................................ Name of Owner ..�. �.! F'.i � 1 .: ��s.............Address ;�b, 2"f/�P .... ...... ................................... Nameof Builder ,��'.� ?. P.....................................Address .......... .: ... ................................................... Nameof Architect ........................................................ .........Address .................................................................................... ,r Number of Rooms ........ .........................f. .....•.....<............Foundation ;.rne,l E G'�?C�C'/ �" ....... ... ...................................................... Exterior .._............�/`� ....t�..�...... ...........:......Roofing ..........�'! Floors ...... ........../�/ �,.... G v ......................Interior ......J. (�� 1� / ....................................... ...... ....... /'S' ?�� Heating ��......... ..........................................................Plumbing ...................!....... ....... ............................................... Fireplace Cc,S..�.`!C../..�..........................................Approximate Cost l •................... Definitive Plan Approved by Planning Board __________________/v_____1-9 Area .......................................... Diagram of Lot and Building with Dimensions Fee r SUBJECT TO APPROVAL OF BOARD OF HEALTH � I . 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. ,�iT.� � Name ......... .................... ., . Construction Supervisor's License ......C'.G...lzI.` 7........ - uuEEmBRIE1{ CORP. �=l7 0 ~ �� =~xv�� No - � -- - Permit ror �1�. ^z�uc� - '~ � Single��� ����� Y '��� Location . '^ ' ------==,^°^"^^x'^ ------.. � C�wxx� .� ��..� .. ' Type of Construction ..........rracm&................... � --------------------------. . ' Plot ............................ Lot ----------' Permit Granted .....May-I6.�-----.lV 85 Dote of Inspection ------------lg Dote Completed ...................................... ' - ' ' � � Town of Barnstable 7e It �8cp� �OpCHi Tt�i Permit.# )•:spires 6 rnorrths e u issue date Regulatory Services Fee ]�ARVSLIgLE. b ��Poq Thomas F.� Geller, Director 0 2423b) LT Building Division , Tom Perry, CBO, Building:Commissioner. - 200 Main Street, Hyannis, MA 02601� www.fown.bam.stable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY /Vor Vaiirl tvif/rotrt Red X--Press 7inprint Map/parcel Number 79. a� VoRe yAddress g5 C.e_1 rctl)�/. (_7 .� 4,A ' sidential Value of Work Minimum fee-ofS35.00 for work underS6000.00 Owner's Nam e Address P: Ivy? e Contractor's Narne� / /)')e /l/ Telephone Number .0%-,� /'' Cj 0 Home Improvemcnt Contractor License #("if applicable)_ 3's_ Cons uction Supervisors License#(if applicable) 9 �� orkman's Compensation Insurance R Check ne: ❑ I m a sole propriefor ❑ am the Homeowner F I have Worker's Compensation Insurance 1, yfdixai t , 5j'ir.a Insurance Company Name �e Co y _ Workman's Comp. Policy# , Copy of Insurance Compliance.Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) . ❑ Re- tde .. _ #of doors Replacement Windows/doors/sliders. U-Value (maximum :35)#of windows *Where required: Issuance ofthis permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ** Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Constructio..n-Stipervisors License is required, GNATURE: � T The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/I ividual): J aO SSOG J./VC . Address: &3 21� I City/S to/Zip: (�(, Phone#: �tl//' ���^ ('�(r Are ou an employer?Check the appropriate box: Type of pr sect(required): 4. I am a general contractor and I 1. I am a employer with � ❑ g 6. ❑ w construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. . 7. emodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance.# required.] ' 5.-❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check-this box must attached an additional sheet showing.the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the'policy and job site information. Insurance Company Name: PC G✓V Policy#or Self-ins.Lic. Expiration Date: /a Job Site Address: b 'ePOd LIV City/State/Zip:&4 erym An, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expir tion date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine . of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correeik Signafore: .... Date: 0 J Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE OF LIABILITY INSURANCE oPID SR d/DATE(MDDIYYVY) MOORA-1 10/05/10 PRoo cER - THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville•RI 02838-0001 Phone:401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE NAIC INSURED Moon Associates Inc. - INSURERA: - Natiional Grange_insurance co 14788 DBA Gutter Helmet DBA Renewal by. Andersen of RI INSURER B: Beacon Mutual DBA Gutter Helmet Roofing DBA Moon Works INSURE RC:` 1137 Park East DriVe INSURERD: Woonsocket RI. 02895 INSURER E: - - COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED FO.TO THE INSURED NAMEDABOVE R THE POLICY PERIOD INDICATED.NOTWITHSTANDING .-. ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH. - PQLICIE$.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER.: DATE(MM/DDIYYYY) DATE(MMIDD/YYYY) LIMITS GENERAL uABILrrY EACH OCCURRENCE. $10 0 0 0 0 0 A X COMMERCIAL GENERAL LIABILITY MPS26.619 09/16/10 09/16/11 PREMISES S((Ea�occurence) $500000 ' CLAIMS MADE X❑OCCUR MED EXP(Any one person) $,10 0 0 0 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $-2000000 GEN'L AGGREGATE LIMIT APPLIES PER:. PRODUCTS'-COMP/OPAGG $2000000 POLICY ECT LOC - • AUTOMOBILES LIABILITY - COMBINED SINGLE LIMIT $10 0 0 0 0 0 A X ANY AUTO B1S26619 09/16/10 09/16/11 (Ea accident). . ALL OWNED AUTOS BODILYINJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS - BODILY INJURY - $ NON-OWNED AUTOS (Per-accident) . PROPERTY DAMAGE. $ (Per accident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC. $ AUTO ONLY: -AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $10 0 0 0 0 0 A X occuR cLAIMSMADE CUS26619 09/16/10 09/16/11 AGGREGATE $— RDEDUCTIBLE $ X RETENTION $10000 WORKERS COMPENSATION - X Toll I I Al LIMITS ER AND EMPLOYERS'LIABILITY YIN B ANY PROPRIETOR/PARTNERlEXECUTIVE 28586 10/01/10 10/01/11 .E.L.EACHACCIDENT $500000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-E4 BAPLOYEE $50 0 0 0 0 IF yes;describe under SPECIAL PROVISIONS below E.L.'DISEASE-POLICY LIMIT. $500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS - - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION MaQNASS DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMEDTO THE LEFT,BUT FAILURE TO DO SO SF+ALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR- REPRESENTATIVES. AUTHOR 2ED REPRESENTATIVE . 7 - ACORD 25(2009/01). ©1988-2009 ACORD CORPORATION. Ali rights reserved. The ACORD name and logo are registered marks of ACORD ww 4�� �. -•:- - �- _ M -- � gag y€CS AM ES k �N 4-3 PAIN ROAD - IE . f l 02,864 �no. 1137 Park fast thine - w...r. a::725e/D0839(moon bwc+nea a,r.) woonsod Aftde Island 0205 a e corm,t�056272s(Moan rNsoC ales fnc.i (8OON75-N" idass aoa 114s3sindoon Assxutes na.i Purdraserls)memo: lnstalbtionAddress MAPS Address: Norte ah _�i8 via w w,ax: 7 D 6 E rnaa: xe gcot�oc4'sT N�"r Year Moms Bulit• K Custatrter Inttiak: 7axas Paid In Town of: i/We,the above purchasers)("Purchaser(sri and the cr.,.J�J of the property located M the-hove i1'W19l-.tdresse hereby lofty and severally aVee to contract with Moon Associates,Inc.(Woonworks')to furnish,deliver,and install of all materials as described in this agreement('Agreement'),the attached Spec Sheet(s)and diagrams)which are incorporated herein by refetence and made a part hereof.A Completion Certificate will be executed for all jobs at the end of the Installation. Order Number: Order Number: Order Number: Protect Type: �/'190ta.5 Project Type: ProjW Type: Agreement Amount $}f Agreement Amount 5 Agreement Amount S i,LessOeposit*; S 4QQ tessDePM411 $ Less Deposit* $ 4 Balance Dice On Completion $ / saiame Due On Completion $ Balance Due On Completion 5 FMinimtan Ill%cf Aereemw Mnoum due upon execution. ,Minimum 33%pltyreemerH P�++ovm due upon mrecW,k.r. FMir,irt,um 98%of r�rxnwm amountd,e�pen,;recutfon: �� Stdkat!lhayrnern Method far taalartce IMaWt@PsynlstR Metllod For alkm Ntdicate PayMent M~For#stance ' Due at Time of Ingwiatlon: Due at Time of instaflatlon: out at Time of instanetion: Est.St rt Da Est. let' Date: Est.Start Date: Est.Completion Date: Est.Start Date. Est.Completion Date. / X/ /� DEPOSIT/PAYMENT OPT IONS lsnA m to fund valeumon and/or weft app WAQ (9Cashier's Check or Money Order Ck it 3.Rmndtq payabfeto Moonworkst Accra Approval Code 2.credit Card*(circiel Visa MasterCard Discover Actt I Approval Code 'Vwo agm to aaow Moonworlo to cMrae ft.rakerwwd a%*tcard for the deposit amount. cct A f Exp Date Securlty Code )'dated.aehrrce to be do td vedx craw upon romp""of ifflub en d cored atwre. ft a agreed by and between the parties that this Aareett nt constitutes the entire tatdarsfandtrtg betvsetel the pertles,attd there we rto verbal urdersUrAWW chatgfng or modMykt{arty of the terms of this Agreemef Purchaser(s)hereby aclmowkuEtes tlsai Puedus09s)1)has road the hunt and reverse of this AgreeVISM and has received a completed, s4ne4 and dated on of this AVOOMxttr tltcksft the two aOcoauprnfyinQ NO"of Wcallation forms,on the date first Witten above and 2)was orANy Informed of Maher eight to cant this traeaacdort Ind NOT VSN THIS CONTRACT iF TNERE ARE ANY BLANK SPACES. Pureh P Moonworks Ignature ature Print Name Prim Name Print Narne YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO AND"O T OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE NOTICE Of CANC tAyi"FORM BELOW FOR AN OW AkATM OF THiS RIGHT. a NtYTtCE�CAPIN�LLATi�i Date of transaction 2/ Date of Transactlon You may tent',this trap n,without any pertadty or oMi�t(w, Your quay cancel this trarasaut, uvitlroaat arty penalty or obligation. %vithin three business days from the above data:.If you Coate,any vAthIn three busirtess days from due above date. If you cancel.ant property traded N,arty payww"made by You under the Cordract or property trailed in,eny ptNRtwia nand'by you under th'Contract or Sale,and any negotiable InStrumant executed by you MR be retracted S#le,and any abk inatruontent executed by you vrta be returned within is days following receipt by the Seiler of Your cancellation days w Within 10 ing r+ecelpd by the Seiler of your c&nWFlation notice,and any security intema arising oset of the transaction will be notice,and any avKUMV kterest W%i%wA of the transaction will be wnceiad.if you cancel,you must stake awUabk to the Sailor at your► canceled.M you cancel,You swat task'available to the SeNar at your residence,in substantially ass good condition as when ctrcafaA acny tddence, in suinumt1 ay as good constlon as when reaxhred,any goods dettverad to you under this Contract or Sale,or you may,N You goods delivered to you under tbls cm*act or Sale;or you RW6 J!you Wish,comply with the Ittstruathons of the Seller regatdbm the return wish,comphr with the InstrwtIONS of the Soifer rvegardhrt the return shipment of the goods at the Sellers ea pease and risk.if You do make shipment of ttue goods at the Semis eetpectse and risk•N your do Make the goads anfafiatlde to the Setia and the Seller does not pick them up do goods a VS14 le to the Seller mad the Seller does not pick them tar wtthin 20 days of the deft of Your Notice of Cancellation,you may within 10 days of the aMte of your ttletiee It U"W113ttan.you may retain or dispose of the foods without any further Obligation.H You retain at dispose of the goods without any fmther O"Ptinn. If you If fail to make the goods available to the Seller,Or If You agree tO tab" fait m MaM the)Foods available t0 the Seller, n V you agree to return the goods to the Seller and fail to do so,then You remain doable forOft#saods to Ole Seller and fad to do Sol theme You remain Nabk urn performance of as obitgadons under ,fir CWWWO. To cancer tM perfonnence Of aN obBgatlons under tin Contract• To aneel this transettlpn, awn or deliver a signed and dated COPY of thus trans"04% "No or deliver a signed and daad mplt of this cancellation notice m arrf trifler written notice,of sarlo a telegrams to C&PORPadon notice or any odutr wriMen"notice,or saw a teim"to MOONWORKS, 1137 Parts East Odle, o Wand MOorwvorls. LW Pack EhsR 13tbee, Woonsocket, Rhode Island MOS,NOT LATER THAN MIDNIGHT OF (Dater{. MM,NOT LATER THAN IW DNWfT OF (Date? I HEREBY CANCEL THIS TRANSACTION. I HMMW CANCEL TINS n ANSACTIGIN• Camumer's Signature Date Consumes ire Dots 9 E P iPER soars