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0029 CHEQUAQUET WAY
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A ,o I �' ` -I' , " , , I , ,� , SP y P � .,� A, U 1 J� Q, A V 007 �� , � , --,., ,,-- L��`_'_�� ,�,_-, 4,�',:� �� ',� , , - , ,� � , , 11 :��,,�'_:',�, ",:� ) I " _,", L" ,,���",�,,��,,�""",�""�,',,,,,,,,�',�,�,,,,�� !;1 .,� . �,L ��. �,, ",, - �� 1� "I �,I'' � .- , � m Q its, , - -, ,""�"'I"i",��, ,: , , � ", I --�l - � ,, , _', � ,_.."�,,_�"I�.-.,"",�" ,�_� , - - -�_- -, � -- :" k V A _,,�, 7 L�. ,:,_, J ,,��.,�'., , - �� ��,!.. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION :r Map )OW Parcel.' 009 .Application #�xV ,.r �O Health`Division Date Issued O Conservation Division Application Fee 50 Planning Dept. `PerMit Fee' Date Definitive Plan Approved by Planning Board Historic .- OKH Preservation/Hyannis CP_r_oject_Street Address C e 9a u� U-Ti 1"_t � a-Vil —,�lage -:- r,e,4arV, 11 .e. Y � 1 Owner- C Ki O a l S �,. ���77T^��""��,^^^ Address `f�,'0, n k ZZ`� �;5°�_TT T leephone PermitaRequest tf i 7�°s� I k-t Ce l lu G S 9.5 Z Gf -a Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Prol'ect Valdation-:,� . Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family; y❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new f Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: :0 Yes--rj No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new she_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: ° Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# -- ; Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone-Number5i, ._. A dress� �, License # 7 Z ;dA (z Home Improvement Contractor# l Z GT Worker's Compensation # C G 0c_t i G g Z ALL CONSTRUCTION DEBRIS RESULTING FROM YP ROJECT WILL BE TAKEN TO SIGNATURE+ t... ZZZ DATE �f f � r FOR OFFICIAL USE ONLY APPLICATION# -DATE ISSUED a MAP/PARCEL NO.:., i ADDRESS VILLAGE OWNER '.� DATE OF INSPECTION: r:�FOUNDATIONX) . `y FRAME '"'INSULATION-, FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL =:GAS: z {- ROUGH FINAL �iFINAL BUILDING L a2 ' . .DATE CLOSED OUT.. _ ASSOCIATION PLAN NO. r l 77ae Commonstwalth of Massachusetts Deparnnent of Indusa al Accidents O,,(jtice of Ins"estigations VJ_ 600 Washingtou Street Boston,MA 02111 tivmr.n amgm,1daa Workers' Compensation Insuxance Affidavit: BuildersJContr►ctorstlectriciansiplwnbeis Applicant Information . Please Print Legibly Name(Bvsinessforganizatimvbdivednao: V'G Address: L !,, 0 City/State/Zip: h-_o ' _ Phone#: �- Are you an employer?Check the appropriate box: Type of project(required)- 1.F I am a employer with 5 4• ❑ I am a general contractor and I employees(full andlorpart-time). * have lured 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 8. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workem'comp.insurance comp.insurance., 10.❑Electrical repair-,or additions required.] 5. ❑ We are a corporation and its rep 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.]I c. 152,§1(4),and we have no employees.-[No workers' 13.9 Other v-,S comp.insurance required.] t *Any applicator thatchecks box#1 amst also fill oat the seedoabelow sbowing thekworker'coatpensatian policy infanziadan. t Homeownm who submit this affidavit indicating tkey ate doing all wary mad then like a=i&contractors mist submit a new affidavit indicating suck 'Contractors that check this box must attached an additional sheet showing See name of dte sub-caoiatactars and state wbedw or not those amities have employees. If the sub-co=actars have employees,day amut pmvide th&warkets'camp.policy number. I aeee are cinployer Cleat ispronfd kg ct,orkers'coanpmesafian insurance for my outplayeeL Below is f tepaliq raid fob site informddon. Insurance.Company Dame: 6,rl C, -A- Lv.;S C-c:, Policy,#or Self ins.Lic.#: L o 4,/ C, t 1 Expiration Date: l Job Site Address: 7--'1 C- yl CA c�J,if-A k LCc,am. CityfState/Z p. c- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). O 2'(3 2-- Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 andfor 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 advisid that a copy of this statement may be forwarded to the Office of Investigations of the D* for insumpce coverage cation. I do hereby cardh and the ' and penalties Ferleary that the information prosided abem s is bras and correct Signature: Date: �t L Phone#: S �- C� . -Z 3 Official use only. Do not write in this area,to be completed by city or town official City or Town: PermiVUcerese# Issuing Authority(circle one): 1.Board®f Health Building Department 3.CitylTown Clerk 4.,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORD CERTIFICATE OF LIABILITY INSURANCE °"'�('�'"'°mm" T. tznanoto PRUDuCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Arthur D.CaNee Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT.AMEND, EXTEND OR www.calfeeinsurance can ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 336 Gifford Street Falmouth MA 02540 INSURERS AFFORDING COVERAGE NAIC# Lehr&Sons,Inc. INsuRet A: Guard Insurance Co. 185 Great Pines Drive INSURER Et Northland Insurance Co. Mashpee,f!A 02649 INsuRER a Arbella Protection INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICYNUl16Qt POLICY afE�TrvE POLICY EXWRATI�J �� TYPE OF INSURANCE GENERAL UABIUTY - EACH OCCURRENCE 1,000,000 B X commmaAL GENERAL LU an rrV WS09641S 12r1?MO 12122=1 DAMAGE TO RENTED rAmA s 100 000 CLAIMS MADE FXJ OCCUR MED EXP am s Excluded PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE s 2,000,000 GEML AGGREGATE UMIT APPLIES PER PRODUCTS-COMP00P AGG $OOO 000 X POLJCY M JRCT PRO- LOC AUTOMOBILE LWBRRY CONS SINGLE UMIT C ANY AUTO 0294940M 004120/0 004=1 (Ea $1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED AUTOS T'pw5^) $ X HIRE)AUTOS BODILY INJURY S X NON-OWNED AUTOS PROPERTY DAMAGE S (Pwaoddmt) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN FA ACC S AUTO ONLY. AGG S EXCESSIUMBRELLA LIABUITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S S DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND x WC 5TATU I JOT11. A EMPLOYERS LIAER.RY LOINC11e629 11ramo 11/23MI EL.EACH ACCIDENT FR $50Q000 ANY PROPRIETORIPARTNERfEJ(LfXIiWE OFFTGERNA MBEREXCLUDEYt EL DISEASE-lJ!l3NPL0 S OOO tl deunbe umler below EL DISEASE-POLICY LNrr S=,0w OTHER DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES I EXCLUSIONS ADDED BY E NDORSBIIENT t SPECIAL PROVISIONS Operations:Home Builder&Remodeler National Grid Corporate Services LLC d1bla National Grid,Action Inc.dlNa Colonial Gas Company and NStar Electric are induded as Additional insured in rasped to General Liability. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF Tim ABOVE DESCRIBED POLmm BE CANCELLEo BEFORE THE EXPIRATION Housing ASsIslam Corp. DATE THEREOF.THE MUM IINSURIER WILL ENDEAVOR TO MAR 10 DAYS WRITTEN 460{Ned Main Stred NOTICE TO THE CERTACATE HOLDER NAMED To THE LEFT.BUT FAILURE To Do so SHALL IMPOSE NO OBLMTM OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis,MA 026013696 REPRESENTATIVE& AUTHORIZED REPRESENTATIVE <EPM> ACORD 25(2001/08) CORPORATION 1998 a; Ln °. �. CA s f �r s Office of Consumer Affairs and usi.ness Regulation 10 Park Plaza- Suite 5170 Boston, Mass usetts 02116 Home Improvement ctor Registration Registration: 120439 Type: Partnership y Expiration: 12/20/2011 Tr# 291491 LOHR CONSTRUCTION �� u Wesley LOHR 800 FALMOUTH RD, UNIT 203A M M MASHPEE, MA 02649 Update Address and return card.Mark reason for change. Address [] Renewal f-I Employment Lost Card OP&CAI 0 80M-04104-G101916 �ee •CDo9tv»aa�tiueca/� g>°✓�aaeacs!,,ua� License or registration valid for individul use only office of Consumer Affairs&Business Regulation before the expiration date,"If found return to: HOME IMPR EMENT CONTRACTOR Office of Consumer Affairs and Business Regulation , Registratio 0439 10 Park Plaza-Suite 5170 Expira 11 Tr# 297491 Boston,MA 02116 Type M LOHR CONS Wesley LOHR ' W 800 FALMOUTH � -- 'MASHPEE,MA 0.2 ' w Undersecretary Not valid thout signs re l 460 West Main Strce't FU Hyl�tnois, MA 02601-3698 TASSISANC ENERGY &HOME REI'.r' - T (508) 771-5400 F (508)790-2425 CORPORATION TTY on all lines unvw.haconcapecod-o g HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER I _116 M 4 5 e 2LjP G L J S 1 f hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation(herein after referred as "Agency")on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may indude all or some of the following measures: Weather-stripping&c:aullang of windows and doors,insulation of attics,sidewalls&basements,attic and other ventilation measures and possibly replacement of badly deteriorated windows.In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the"Agency"its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five(5)years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent. Home Owner: (Signature) Date: 7 Agent:(signature) Lail Date: HAC approved Weatherization Company: j o h,- + S Caliber Building&Remodeling Cape Cod Insulation Cape Save Creswell-Construction Frontier Energy Solutions Lohr& Sons Peter Smith Resolution Energy Rock Solid Construction All Cape Insulation `sk il_•fil:s-it�t;T h�%Uushak.affm--ork permtre eatse doceoc