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HomeMy WebLinkAbout0132 CLIFTON LANE F D Application number. . ..1. ............ .....i�... AUG 0 7 2018 Date Issued.......^.�.. .:— ............... ...... . .. .. ..... su�rrsz�asr.e' QWARNMASS N OF iABLF Building Inspectors Initials ... h.......... L Map/Parcel..... DC� TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WIND O W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION `� �/-Cbm�., Address of Project: ,�c C/ ti z NUMBER STREET VILLAGE Owner's Name: le-K C SC*!rt ip t/ Phone Number Email Address: Cow Cell Phone Number Project cost $ �0 ®! Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby.authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: �7, 12, 14E TYPE OF WORK ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review ZRoof(not applying more than 1 layer of shingles) n �� Construction Debris will be going to � � De� _5 CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable) # W 0y3 (attach copy) Construction Supervisor's License# �06 ® `o (attach copy) Email of Contractor gwecocfl Po(-,"1 000 7 69®l d 2- �� Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT; YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ T *For Tents Only* Date Tent (s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab 1 ` Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections`and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date 0Im Sign t All permit applications are subject to a building official's approval prior io issuance. F 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): tCt Address: Cf 7 G� City/State/Zip: Phone#: —30 d 4(6!9 OAD 'Z- 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 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• ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• $ 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.[:1 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 andjob site information. • p /� Insurance Company Name: Policy#or Self-ins.Lic.#: ®l Z_ Expiration Date: 22 P 1 Job Site Address: �J � � LI City/State/Zip: Z9P/yv/ !le 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties perjury that the information provided above is true and correct Signature: Date: 0W o Phone#: 0/0 '2 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#: 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 be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,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 permit/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 Accident Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.##617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia ., Commonwealth of Massachusetts Division of Professional. Licensure Board of Building Regulations and Standards C®nstruci , 1� T , v :r Specialty r-tpires: 061100 41, _ 1 F�' y s ANATOU SIVITSKI, ' A 27 MILL PON MRD T 7ST YARMOU , Commissioner 6�e Office of Consumer Affairs and,Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusett's 02108 Home ImprovementyC�ontractor Registration Type: Corporation Registration: "168043 CAPE COD HOME IMPROVEMENT,INC. i a Expiration: 12/06/2018 27 MILL POND RD WEST YARMOWTH,MA 02673 ,, d Update Address and Return Card. SCA 1 0 20M-05117 ��c�c»rrnnr»rurea:���i.o�'C-%�liratnc�zu�ella Office of Consumer Affairs&Business Regulation KOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:,.=.-.ation before the expiration date. If found return to: RegistratlgCExpiration Office of Consumer Affairs and Business Regulation ?68043E ff. 712l0612018 10 Park Plaza-suit CAPE COL)HOPAE11�1PROU- MEN7,INC. Boston,MA t kr,-A�y b t ANATOLI BiVI i UKI�<.�t,,-+�_��.. 1?� �.L.-C-t'.�+�,�i�-�--•-` 27mil- PONDRD WEST Y.ARh•10'_'TN,h^A� 2s3s Not valid without signature Undersecretary COD 1� d-ApL!IR hn�fi8Y6fifi1R.t CAFE CO HOME IMPROVEMEN TM, . 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710e 1001, (508) 469.0102 CAPECODINC@GMAIL.COM, WWW.RoOFCAPECbD.COM, WWW.FACEBOOK.COM/CAPECODHOME .. -------------------------- --------- ------ PROPOSAL a 07. 1 2.2018 TO A ALEX GUSINOV LOCATION: 132 CLIFTON LN, CENTERVILLE WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR . MAIN COMPOSITION SHINGLE ROOF: r.. • REMOVAL OF ALL EXISTING ROOFING AND FLASHING MEMBRANES TO THE PLYWOOD DECK SURFACE. _ • REPLACEMENT OF ANY DAMAGED OR DETERIORATED PLYWOOD DECKING AT AN ADDITIONAL COST. DECKING-._ , WILL BE REPLACED IN WHOLE SHEETS ONLY IN ACCORDANCE WITH RECOMMENDATIONS BY BOTH THE NATIONAL ROOFING CONTRACTORS ASSOCIATION(NRCA)AND THE AMERICAN PLYWOOD ASSOCIATION (APA). NEW DECKING SHALL BE APA RATED FOR STRUCTURAL USE. DECK FASTENING WILL MEET OR EXCEED LOCAL BUILDING CODE REQUIREMENTS. • REPLACEMENT OF FOLLOWING FLASHING MATERIALS:STEP FLASHINGS, PIPE FLANGES, PERIMETER DRIP EDGE Al MATERIAL AND ALL SKYLIGHT FLASHING MATERIAL.ALL MATERIALS TO MEET OR EXCEED MANUFACTURER'S REQUIREMENTS. ti • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED IN ALL L VALLEYS AND AROUND THE CHIMNEY. • ONE ROW OF ICE AND WATER PROTECTION MEMBRANE SHALL BE INSTALLED ALONG ALL EAVES AND SHALL EXTEND PAST THE INTERIOR WALL LINE A MINIMUM OF 18 INCHES TO PROVIDE PROTECTION AGAINST DAMAGE r FROM ICE DAMS. INSTALLATION OF ONE LAYER OF ROOFING UNDERLAYMENT ON DECK SURFACE NOT COVERED WITH ICE AND WATER PROTECTION MATERIAL. • INSTALLATION OF NEW,ARCHITECTURAL-STYLE ALGAE-RESISTANT CERTAr 1NTE D SHINGLES.SHINGLES WILL BE INSTALLED IN STRICT ACCORDANCE WITH THE MANUFACTURER'S SPECIFICATIONS AND SHALL BE FASTENED USING SIX NAILS PER SHINGLE. • COLOR OF ROOF PENETRATIONS AND FLASHINGS TO BE CHOSEN BY OWNER. ' u�`n • INSTALLATION OF A SHINGLE-OVER RIDGE VENT.VENT IN THIS AREAIS CONTINUOUS AND WILL CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAG APE OBI °® CAPE COD HOME IMPROVEMENTTM 27 MILL POND:ROAD, WEST YARMOUTH MA.02673. (617) 710.1001, (508i 469.0102 CAPECODINC@GMAIL.COM, , WWW.RoOFCAPECOD.COM, www,FACEBOOK.COM/CAPECODHOME PROVIDE MAXIMUM INTAKE VENTILATION FOR THE FULL ATTIC VENTILATION SYSTEM. • REPLACE ANY DAMAGE FASCIA-BOARDS OR RAKE-BOARDS AT AN ADDITIONAL COST. a • ALL GROUNDS TO BE CLEANED UP ON A DAILY BASIS.ALL BUSHES,SHRUBS,AND FLOWERS TO BE PROTECTED. HOMEOWNER IS ASKED TO SUPPLY ELECTRICAL POWER IF NEEDED. OP N 1 CERTAINTEED DMARK S LES 50 YEARS NON-PRORATED AN RABLE WARRANTY LABOR AND MA IALS: $8, OO DUMPSTE 50.00 TOTAL: $ 00.00 OPTION 2 Sao.. Rio i�F c��cLS CERTAINTEED LANDMARK SHINGLES 40 YEARS PRORATED WARRANTY(10 YEARS NON-PRORATED PERIOD) LABOR AND MATERIALS: $7,250.00 DUMPSTER: $750.00 TOTAL: $7,900.00 *WE WILL MATCH OR OUTBID ANY LEGITIMATE COMPETITOR CAPE COD HOME IMPROVEMENT TM IS PROUD TO PRESENT YOU WITH SUPERIOR 10 YEAR WORKMANSHIP AND SERVICE WARRANTY.THIS WARRANTY IS IN ADDITION TO,BUT RUNS CONCURRENTLY WITH ANY MANUFACTURERS'WARRANTLES. IT COVERS ALL SERVICE CALLS,RELATED TO WARRANTY REPLACEMENT AND/OR INSTALLATION ISSUES FOR THE FIRST TEN YEARS AFTER PRODUCT INSTALLATION CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE tb FA COD t roveln CAPE COD HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710.1001 (508) 469.0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD,.COM, WWW.FACEBOOK.COM/CAPECODHOME PAYMENT TERMS: 50%AT DEPOSIT; 4jb 50%UPON COMPLETION. JOB IS ESTIMATED TO COMMENCE APPROXIMATELY 2 TO 8 WEEKS AFTER DEPOSIT RECEIVED WORK IS SCHEDULED TO BE SUBSTANTIALLY COMPLETED IN APPROXIMATELY 1 TO 2 WEEKS. ANY WORK ABOVE AND BEYOND THE SPECIFICATIONS WILL BE PERFORMED AT 56.00$PER MAN HOUR PLUS MATERIALS OR PRICED ON REQUEST.ALL ADDITIONAL WORK,INCLUDING TRAVEL TIME AND LUMBERYARD RUNS, MOVING ALL PERSONAL OBJECTS, FURNITURE,ETC. FROM WORK AREA,WILL BE SUBJECT TO EXTRA CHARGE.IN THE EVENT OF ROT REPAIRS, ROOF REPAIRS OR ANY RELATED WORK REQUIRING IMMEDIATE ATTENTION,WE WILL PROCEED WITHOUT CUSTOMER APPROVAL. CAPE COD HOME IMPROVEMENT Tm WILL PROVIDE CLEANUP ON A CONTINUING BASIS AND ALL DEBRIS WILL BE REMOVED FROM SITE(PROFESSIONAL CLEANING DOESN'T INCLUDE).ALL PRODUCTS INSTALLED BY CAPE COD HOME IMPROVEMENT TM WILL BE TO MANUFACTURER SPECIFICATIONS.ALL WORK WILL BE PERFORMED BY INSURED PROFESSIONALS. ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED,AND THE ABOVE WORK TO BE PERFORMED IN ACCORDANCE WITH THE DRAWINGS AND/OR SPECIFICATIONS SUBMITTED FOR ABOVE WORK AND COMPLETED IN A SUBSTANTIAL WORKMANLIKE MANNER. OWNER TO MOVE ALL PERSONAL OBJECTS, FURNITURE,ETC. FROM WORK AREA.ALL ITEMS AGAINST WALLS SHOULD BE CONSIDEREDFOR REMOVAL DURING ANY EXTERIOR SIDING JOBS,ADDITIONS,ETC.TO GUARD AGAINST DAMAGE. IN THE CASE OF ANY ROOFING AND RIDGE VENTING,DUST AND DEBRIS SHOULD BE EXPECTED AND ANY ITEMS IN THE ATTIC SHOULD BE REMOVED.CAPE COD HOME IMPROVEMENT TM IS NOT RESPONSIBLE FOR ANY DAMAGES IF SAID ITEMS REMAIN IN PLACE. CAPE COD HOME IMPROVEMENT TM IS NOT RESPONSIBLE FOR ANY DAMAGES THAT MAY OCCUR DURING CONSTRUCTION TO LANDSCAPING OR ANY FINISH GROUND WORK,PLANTINGS,ASPHALT OR STONE DRIVEWAY, ETC.FLOWERS AND SHRUBS AGAINST HOUSE MAY NEED TO BE REPAIRED OR REPLACED BY HOMEOWNER. ANY.ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN ORDERS,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.ALL AGREEMENTS CONTINGENT UPON STRIKES,ACCIDENTS OR DELAYS BEYOND OUR CONTROL.OWNER TO CARRY FIRE,TORNADO AND OTHER NECESSARY INSURANCE UPON ABOVE WORK.WORKMEN'S COMPENSATION AND PUBLIC LIABILITY INSURANCE ON ABOVE WORK TO BE PLACED ON THE RESIDENCE AS A CONSEQUENCE OF THE CONTRACT.OWNER WHO SECURE THEIR OWN CONSTRUCTION-RELATED PERMITS OR DEAL WITH UNREGISTERED CONTRACTORS WILL BE EXCLUDED FROM ACCESS TO THE GUARANTY FUND. CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PA `x , FACOD ` CAPE COS HOME IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (61'7) 710.1001,, (508) 469.0102 CAPECODINC@GMAIL.COM, ' WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME COSTS OFF COLLECTION,INCLUDING ATTORNEYS FEES WILL BE RECOVERABLE,IN THE EVENT OF NON- PAYMENT. WE LOOK FORWARD TO WORKING WITH YOU: PLEASE CALL IF YOU HAVE ANY QUESTIONS. SINCERELY CAPE COD HOME IMPROVEMENTTM THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOLI"TONY"SMTSIC I ` ACCEPTED BY "in IRI'yi IGN DATE ACCEPTED BY (� �i.4Sliyl/✓ �SIGN DATE dTld ACCEPTED BY SIGN DATE CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS . PLEASE INITIAL THIS PAGE , . o�® CERTIFICATE OF LIABILITY INSURANCE DATE(MM D°YYYY) 06/15/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED TE THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING IN BY 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). PRODUCER CONTACT NAME: Linda Sullivan DOWLING&O'NEIL INSURANCE AGENCY FHOHN Ext (508)775-1620 FAX E-MAIL A/C No 973 IYANNOUGH RD ADDRESS: lsuilivan@doins.com INSURERS AFFORDING COVER AGE NAICA HYANNIS MA 02601 INSURER A: AMGUARD INSURANCE CO 42390 INSURED B CAPE COD HOME IMPROVEMENT INC INSURERINSURER c: INSURER D: 27 MILL POND ROAD INSURER E: WEST YARMOUTH MA 02673 1 INSURERF: COVERAGES CERTIFICATE NUMBER: 281511 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 UBR LTR TYPEOFINSURANCE POLICYNUMBER MIWDCDNYYY MM/DD/YEFF YYY LIMITS COMMERCIALGENERALLIABILITY EACH OCCURRENCE $ CLAIMS-MADE 1-1 OCCUR DAMATE TO_ PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED - _ PROPERTY DAMAGE AUTOS Per accident) $ I UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE `N/A AGGREGATE DED I I RETENTION$ WORKERS COMPENSATION AND EMPLOYERS'LIABBJTY Y/N - X STATUTE EORH ANYPROPRIETOR/PARTNER/EXECUTIVE A OFFICER/MEMBER EXCLUDED? WA WA WA R2WC940123 06/03/2018 06/03/2019 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH)yes,describe under E.L.DISEASE-EA EMPLOYEE $ 11000,000 ' If DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached it more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/Workers-compensationAnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Anat011 SIV1tSkl ACCORDANCE WITH THE POLICY PROVISIONS. 222 Buck Island Road 6-8 AUTHORIZED REPRESENTATIVE - West Yarmouth MA 02673 Daniel M.Cro(vfey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD /SAssessor s map; and lot number 'd THE w .� 3 o* ropy Sewage Permit o^ ° e � tSj.�BAAj�B.�MH M9TA Yd E 4 yr �f�J� House number .... .. apt 69 io W9T4H E 5- OF" BAR C DE , .TOWN i a B'UI:LDIG :INSPECTOR APPLICATION FOR PERMIT TO TYPE OF•CONSTRUCTION u/o4 v`. ..... ........ .................................. .................................. TO THE INSPECTOR -OF BUILDINGS: r The undersigned hereby`applies for a permit according to the following information: Location ............... C,..WGG7.0'% . !`' ............. a ...... ................................... l Proposed Use ....... n►n c�-»......................................... ......................................................................... ..... 6......�/ o . a g f :.. .....Fire.District 6•n.�t U.lI�L'..n..�J:S.t'er%�1/, .. Zoning District ............................................................ .......... Name of Owner .ri/ ll. .tj.... .G..1�G1 MI..�.... _ Address ..:.���..... . ������!... . i-4-t.....G t...... ' Name of Builder ..... �j /'Grl�rtvr Address loll ...." ?P!v...L�...................... ..............;. .......................................... Nameof Architect ............IVIA......................:.:...........:......Address ..........:...................:................................:.................... ; Number of Rooms , ....^....Foundation .......CE'I» .i.T SLA ................................... j'! .......... .. ............ Exterior ..lr{Jvo0 Stf/NG-Gc.....................................Roofing . ........................ .................................. Floors .............t..........Interior Sh t' 'T/2t�c ............................. >• Heating H A E/e XTE S/mow g ........!V��?. o> W...T.......................'v ..:Plumbin ' . Fireplace .............Nl ...................................... . ........ :.Appr`oximate. Cost .......!f✓ 00....... .......................... ...... Definitive Plan Approved by Planning Board -'__---------___-___ • � S.. a -------1.9 -------. Area ..... Diagram of Lot and Building with Dimensions - •Fee ................ ..................... . SUBJECT TO APPROVAL OF BOARD OF .HEALTH T . { MA ►ni HSF ` & A RACsE � - Y . . . PRoP0SED'. nININ& R ooM µ //OTC PRoroSCD DINING Room s PRE5EN7-.41r A �CEhEy7' P/9T/o,. v .0 O OCCUPANCY PER EQUIRED FOR,NEW DWELLINGS I hereby agree to conform Il the Rules and, Regulations of the Town of,Barnstable regarding the above construction. Name . . ! .............................. Construction Supervisor's License • 1 ,MAT=VVS, LILLIAN 26995 ADDITION No .:.. -..............Permit,for .. _ ....... Ie.XaMily...Dw,,1•1-Wig...... ............ Location .:...::132 Clifton;Lane - r; ................... I11l5,,,; Yt.G Owner 'Lillian:: atthews.... .:.. , S Type of Construction .....Fri..... _ r. .� .• �' '`� Plot ........................... Lot................................. September 21, 84 4 •r Permit Granted _................. .... ...... 19 Date of'Inspection ..:. ... . .�....�. ....l 9 '� _ _. '� • . . e - ,- .. Date Completed ...1 W(,;, # r r' , f < ^. I r -+•� _ .� .� 41- t. 9 I Assessor's map and lot number .. ... ..�.. THE �o o� ` c Sewage Permit number/....�i. 4•.... .�-- '................... 'i w ' EJHHSTADLE, i House number .....a-� ..../..: - ,. ....................... 90 NAOIL 3 • p ypY a TOWN OF BARNSTABLE BUILDING-�- INSPECTOR APPLICATIONFOR PERMIT TO ....:..:...a..r..................�................................,.......................................................:.. tdoo c� TYPEOF CONSTRUCTION .............................:................:.........:..:...:..................................................................... ` Z- /U .................19.sg`�............. ................. ., TO THE INSPECTOR,OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............... ................................... ry WF�. ..... �• ?n .,, ......................................................... ....... Proposed Use ......................r o a ...�...... ..'........... .... 1 ........ ....... ... ... r . Zoning District ................ ......................................................Fire District 1� .t2 ✓„td/.1.� '...�d ��E'/✓1 ��� Name of Owner'. ................Address`i Name of Builder ....�u. '?�"�'''.......:............Address �L?/zNI7/..dLF ........-T3!�, ........ ....... Name of Architect A1/ ..........................Address Number of Rooms a N .......Foundation CG )*e v7' 5,Z o9a Exierior ,6Uv00 SN/N644 ..Roofing i3/i�9 Floors 4 UU 1� Interior St/t`t'T2 et ..................................................................................... .................................................................................... Heating Ho7' 1✓AT�rc E-YTEi✓Si✓. ... Plumbing .1V/A Fireplace .............!yh:............................................................Approximate Cost ....�H, oa 0 �. •......................................................... Definitive Plan Approved by Planning Board ________________________________19--------. Area �`` ��......`'�.. ..... OG Diagram of Lot and Building with Dimensions Fee ©."" �'r...................�. . r SUBJECT TO APPROVAL OF BOARD OF HEALTH i MAIN Hsi i (,•A RA GGE 737, PROPOSED 1�WIN(r 13' 6 " . /yo7'c PROP05ZD DINJAI& Rvo" s 1 PREs M III E T.t 7 A crmCmT PATIOA 4 PC OCCUPANCY PERMIT )REQUIRED FOR NEW DWELLINGS `U o I hereby agree to conform to�all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............................. Construction Supervisor's License v.... t ::....:.......0 nkT=ls LILLIAN A=247-13 26995 ADDITION No ................. Permit for .................................... ...........Single.x iY..)PW9U ................... Location ............................ ............................................ Owner ......�11i. .an..Matthews........................ .. .... .................. Type of Construction ....EK4mle........................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ...September. ..2.1.,........19 84 ..... .... .. Date of Inspection ....................................19 Date Completed ......................................19