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Home My WebLink About0033 CONANT LANE °� �-. ,; c _. ._ _ Town of Barnstable Building rnaxrAe ` Post This Card So That it is Uisible;From the Street-.Approved Plans Must be Retained on Job and this Card Must be Kept 1 Posted Until Final Inspection Has Been Made , o Where a Certificate of Occupancy-, is'Required,such Building sFall Not be Occupied untiha final Inspection has been made. ,' ' Permit Permit No. B-19-2576 Applicant Name: HOMEOWNER IS APPLICANT Approvals Date Issued: 09/03/2019 Current Use: Structure` Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 03/03/2020 Foundation: Residential Map/Lot: 173-076 Zoning District: RC Sheathing: Location: 33 CONANT LANE,CENTERVILLE Contractor Name:,,;HOMEOWNER IS APPLICANT Framing: 1 Owner on Record: BURNETT-MORLE,MAKIESHA S& E, Contractor License; EXEMPT 2 Address: 33 CONANT LANE - w e "^ Est Project Cost: $6,000.00 Chimney: CENTERVILLE;'MA 02632 Permit Fee: $85.00 v Insulation: Description: Creating a rec/playroom area for the kids basement t` Fee Paid': $85.00 Project Review Req: PREVIOUSLY FINISHED. NO SLEEPING IN BASEMENT! Date: 9/3/2019 Final: SSE p, /9� Plumbing/Gas Rough Plumbing: Building Official - Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced withiws,ix months afteriissuance. All work authorized by this permit shall conform to the approved application"and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. .i Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on-this,Permit. Minimum of Five Call inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection i Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final' 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages ofconstruction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: }.J ' FLOORPLAN SKETCH Borrowef:rye.s a..-W-w a xa—o Tom a14 251- se No.: 51-5437445 ^ File No.: 5 Pf Address:33 Conant Lane Ca City.Centerville Slate:MA Zip 02632-2181 Lender:Stearns Lending-Vdttalesale r _- 20.0' FIRST FLOOR 16.0' Deck 16.0' 48.0' , ( 20.0' Bath Dining Kitchen Area Family 20.0' 24 A' Living Bedroom 4.0' 16.0' ,I 32.0' I 8.0' SECOND FLOOR Barnstable Bldg.Dept. i 12.0'4.a Bath 4.0' 12.0 Approved by'. Permit#: �� Bedroom 12.0' Bedroom 12.0' NOT TO SCALE i Basement BUILDI G DEPT 24.0' 24.0' MG 9 2019 TOWN OF I ARNSTABLE SKETCH CALCULATIONS Perimeter Area Al:48.0 x 20.0= 960.0 Al A2:32.Ox4.0= 128.0 Fist Fkxw 1088.0 A3:&0 x 4.0 32,0 A9 A4:32.Ox 12.0= 3M.0 Al Second Floor 416.0 Total Living Arm 1604.0 J P.O.Box 455 Forestdale,MA 02644 Phone 617.775.4415 Fax 508.8..33,8789 t( v L - Q Nu PISv p ® Q_ I r } The Commonwealth of Massachusetes Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/din Workers' Compensation Insurance Affidavit:Bwlders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizagontindividual): ► r 1 GA l .�?_LC, t�G •�' �r 2� Address: 32 Cm&O 1A Y, City/State/Zip: 6 i a, D, Phone#: 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 constriction employees(full and/or part-time).* have hired the sub-contractors 2.0 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 employees and have workers' working for mein anYca capacity. 9. ❑Building addition [No workers'comp.insurance comp.insurance.: ] S. ❑ 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 instaance required.]t c. 152,§1(4),and we have no employees.[No workers'> 13.❑Other comp.insurance required..] `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 ate 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 isproviding workers'compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/Stawzip: 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;,is 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 correct Si Date: S Phone#- Official use only. Do not write in this area,to be completed by city or town ofj`icial City or Town: Permit/License# _ Issuing Authority(circle one): 1.Board of Health 2.Building.Department 3.City/Town Clerk,4.EIectrical 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 iii 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 herein,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 he grounds or budding 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-cunt uctoi(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 he application for the permit or license is being requested,not he 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 he affidavit for you to fill out in he 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 CommaaVtWth of Massa&usetts ! Department of IndustrW Acddents Office of Investdgatienns 600 Washington Street - Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAM Fax#617-727-7749 Revised 4-24-07 wwwxam.gov/dia OF 114E i p Application ....................q.I........��7 s 9...... MASS. Permit Fee.............PPO..............Other Fee. .. Total Fee Paid.................... ........ ...... l TOWN OF BARNSTABLE Permit Approval by.... .. ........................on... /. .�9....... BUILDINGPERMIT �4/.j Map.................. .. .. .......Parcel......�.... .. ............ - -- APPLICATION )5�'MA-J--L- s 9C--7- Section 1 - Owner's Information and Project Location Project Address_33 C6ja 0,4 LN Village L&.", Owners Name p ru- — r aL 2 Owners Legal Address City ('o,,n��ryi��e. -.State (Vl,iq Zip 0 11 -3a Owners Cell# `l1ToZpg - 31-1 a E-mail f a1 ig.66� r, +a7 66A gj . Goiv► Section 2 -Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ,❑ Commercial`Structui-e under 35,000 cubic feet Single/Two Family Dwelling Section 3 -Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) Finish Baserrrbnt ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment © Spriz IQ r D E PT, ❑ Addition ❑ Retaining wall ❑ . Solar AUGQ,"l 2019 ❑ Renovation ' ❑ Pool ❑ Insulation Other-Specify TOWN OF BARNSTABLE Section 4 Work Description cka -. I P60 room 0. �Azedffl=4 " Application Number... .............................................. Section 5—Detail Cost of Proposed Construction 11(000 ca Square Footage of Project Age of Structure - Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors [ f Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom i Water Supply Public ❑ Private Sewage Disposal ❑ Municipal �On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: 13 a f A 5 it,61e I am using a crane ❑ Yes dNo Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information 3' Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed . Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes. ❑ No i act,mriat-4- 11/1 il,)nl 2 Application Number........................................... Section 9- Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell # 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.Attach a copy of your license. Signature Date - Section 10--Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors 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.Attach a copy of your H.I.C... Signature Date Section 11 -Home Owners License Exemption Home Owners Name: r 1 V2 A�('YW:1"t o r-�� Telephone Number -1-1 - aL og- 3-) 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 'i� APPLICANT SIGNATURE . Signature CAL Date ' 5 Print Name A A kZE51 1 KAVS EIT- ffl l(L E Telephone Number TILL IQg-3_1 12 E-mail permit to: 1)�Q.►Q'SL�'LnQ4 21A-Mr,`' • Corn Section 12 -Department Sign-Offs Health Department Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department . ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13 — Owner's Authorization i i I, (8A ; sip, , k , - rn o 2i. , as Owner of the subject property hereby authorize to act on my behalf, in all matters.relative to work authorized by this building permit application for: S C,0VLDAA ld_�4 l�'��Alf 1�1� I Y L� O aG 3a (Address of j ob) Signature of Owner date M AKLes}ANxaNG i i- moOwE Print Name 11 7P4g y Application number...................................... .......... AAY ..® Date issued.:..... ....... ............................ 9 3RARNSUBLE -• ... r JUL 1 0 2039 .Building Inspectors initials... .,., TOWN �� Map/Parcel....... . .3... .�:�............................. TOWN OF BARNSTABLE KI5 6 d EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 33 (r�a„� NUMBER STREET VILLAGE Owner's Name: Phone Number S off'- 6 S= 17 3 Email Address:✓ay, r,o�{� co Cell Phone Number Project cost S 3 ,g 00 — 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: 5 e,- 0,A4 Date: TYPE OF WORK Siding 0 Windows (no header change)# Insulation/Weatherization Doors (no header change)# I Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) l / Construction Debris will be going to Gr1 it she-/''?G/?a 9 P.y/P17 CONTRACTOR'S INFORMATION Contractor's name ; ai, So,r -e cr, Afej Frl (r14 J'n chow S Home Improvement Contractors Registration(if applicable)# 17 3 2 q_5 (attach copy) Construction Supervisor's License# 09 Y 7 07 (attach copy) Email of Contractor Ct ref- 9 qS �. C M Phone number q0J- 2- 2- ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR IF THE.SUBJECT PROPERTY/S 11V A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *For Tents ®illy* 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 XW®®D/C®AL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab 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 CMIt 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 PLICAN T'S SIGNATURE H • Date Signature All permit applications are subject to a building official's approval prior to issuance. ' 1 ' Renewal Agreement Document and Payment Terms byAndersen. dba:Renewal B Andersen of Southern New England YKemar Morle LA Legal Name:Southern New England Windows,LLG 33 Conant Lane RI #36079, MA#173245,CT#0634555, Lead Firm #1237 Centerville MA 02632 WINDOW 10 Reservoir Rd I Smithfield,RI 02917 - - - H:(508)685-1737 Phone:866-563-2235 I Fax:401-633-6602 I sales@renewalsnexom Buyer(s)Name: Kemar MOrle Contract Date: 06/30/19 Buyer(s)Street Address: 33 Conant Lane, Centerville MA 02632 .. Primary Telephone Number: (508)685-1737 Secondary Telephone Number: avinmorle@ ahoo.com,. Primary Email: 1 Y Secondary Email: Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"), in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document, the terms of which are.all agreed to by the parties and incorpgrated herein by,reference(collectively, this "Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all A work under this greement. Total Job Amount: $3,800 By signing this Agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $1,900 Balance Due: $1,906 Estimated Start: Estimated Completion: Amount Financed: 6 to 8 weeks 6 to 8 weeks $3,800 Method of Payment: Flnaneing We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing at this,time is only an estimate.We will communicate an official date_ and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: Depo paid Gsky bal paid gsky tax centerville Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s) hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written' above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 07/03/2019 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT Legal Name:Southern New England Windows,LLC dba:Renewal By Andersen of Southern New England Buyers) Signature of Sales Person Signature Signature Cory Scanlon Kemar Morle Print Name of Sales Person Print Name Print Name UPDATED: 06/30/19 Page 2 / 13 o� GG/,UGG��P/UGrJ Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS Expiration: 09/18/2020 10 RESERVOIR ROAD SMITHFIELD, RI 02917 - -05/SCA 7 0Update Address and Return Card. 20M1-�7 ///GP. �C/77/YL/'?-[G•P.O.LIJJ C�G�QiVI%LC/I.IGJCGGl Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Supplement Card before the expiration date. If found return to: ReaisfMion.. Expiration Office of Consumer Affairs and Business Regulation 1:Z3245 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD U SMITHFIELD,RI 02917 Undersecretary vv without Signature 5 I Commonwealth of Massachusetts r' Division of Professional Licensure Board of Building Regulations and Standards Constrw::tsbin anerviser CS-095707 sR. ap i res: 09/05/2020 i; t - �.-Q• BRIAN C DENNISON 8 BLACKWELL-DRIV8 , CHARLTON MA f01607 p Commissioner c'L r The Commonweakk of�Ylassachuseits Deparhnent of Industrial Accidents 1 Congress Stree4 Suite 100 Boston,MA 02114-2017 www mass gov/din Workers'Compensation insurance Affidavit.-Bnilders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNUTTLYG AUTHORITY. AnoGant Information Please Print Legibly Name(Business/Organization/Individual): S G` her►-- lieu) t-nalead //1 r] i is Address: City/State/Zip:_S t � f t 7 Phone#: /O/-ZZ�f- Are _ you an employer'Cheek the appropriate box: Type of project(required): 1 am a employer with 20+' mployees(full and/or part-time).* 7. New Construction 29 am a sole proprietor or partnership and have no employees working for me in any capacity.[No workers'comp.insurance required.] S: Remodeling Irl I am a homeowner doing all work myself(No workers'comp.insurance required.)r 9. ❑Demolition 4.❑lam a homeowner and will be hiring contractors to conduct all work on m 10 D Building addition Y P�nY• twill,. ensure that all contractors either have workers'compensation insurance or are sole 11. Electrical repairs or additions proprietors with no employees. S.Q[am a general contractorl2.[]Plumbing repairs or additions and i have hired the sub-contractors listed on the attached sheet � . These sub-contractors have employees and have workers'comp.insurance.t 13.M f repairs <3 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.ff0ther &AJy'y IA§1(4).and we have no employees.[No workers'comp.insurance required] /q/ C - *Any applicant that checks box#l must also fill out the section below showing their workers'compensation policy mf rruation. 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 mme of the sub.contacwts and stave whether or not those entities have employees. Ifthe sub-coaacactors have employees,they most provide their workers'camp.policy number.lap"an a Wloyer that is prolriding workers'compensation insurance for my employees: Below is the policy and job site in,formation. Insurance Company Name: ( Q/ �p . WA Policy#or Self-ins.Lic.#: Cjq Expiration Date: 33 f Job Site Address: n f or,mot fi ill City/Stabzip: Ce, /,W;,/�1vTv�-(/� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration slate). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year itnprisaftatenk as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby c underthe p ' penalties of pei jmy that the information prrsovided above is true and correct SignatureD ?— d — Phone 9 M Oft-vial use only: Do not write in dds 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 DATE(MWDWffYY) 12/28/2018 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 BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holler 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 CoBiz Insurance, Inc.-CO NAME: FAX 1401 Lawrence St.,Ste. 1200 303-988-0446 A/c No:303-988-0804 Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER s:Firemens Insurance Company of WA,D.C. 21784 Southern New England Windows, LLC.dba Renewal by Andersen of Southern New England INSURER c;Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 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 SU R . POLICY EFF CY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMRXVYYYY MWDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/1/2019 111/2020 EACH OCCURRENCE $1,000.000 DA AGE RENTED CLAIMS-MADE a OCCUR PREMISES occurrence $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2.000,000 X POLICY❑jECT Fl LOC PRODUCTS-COMP/OP AGG $2,000,W0 _ OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/201 COMBINED SINGLE LIMIT9 1I1/2020 a accident $1 000 0 0 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOSSCHEDULED AU BODILY INJURY(Per accident) $ X HIRED AUTOS X AAUT OWNED PRerr aEccident) GE $ $ A X UMBRELLA LIA13 X JOCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $15,00Q000 DED I X I RETENTION$n $ B WORKERS COMPENSATION WCA315872924 11112019 1/1/2020 X STATUTE ER OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,0m OFFICERIMEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 N yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT 1$1,000,000 C Pollution Liability 7930073340000 1/1/2019 111/2020 Each Occurrence $2,000,000 Claims-Made Policy Aggregate $2,000,000 Retroactive Date 06120/2013 Daducfible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED RIB D POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD - Town of Barnstable Building Department Brian Florence, CB Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Pre-application for Business Certificate Date q I `b Map Parcel Applicant Information Applicants Name 08 61(.. n L �U (A---K ' Applicants Address 33 l e�fa n C ljl Email Address Telephone Number Listed ❑ Unlisted ❑ Business Information New Business? ----------------------------------------- Yes No Business is a registered corporation? ______________ ________. Yes If yes Name of Corporation Does business operate under the registered corporate name? Yes Co t Is the business a sole proprietorship or home occupation? __-____-- Yes No If yes then a Home Occupation Registration is required—See Building Division Staff Name of Business Business Address 33 Co ,4 (."1 . U Ili}M O (o Type of Business WA wilding Commissiogfr Office Use Only diti ansdrn' Building Commissi Date Clerk Office Use Only Town of Barnstable Building Department FtHe rti Brian Florence,CBO Building Commissioner r r eaxxsTasLe, ' 200 Main Street,Hyannis,MA 02601 y mass. $ 1639• �� www.town.barnstable.ma.us prED MA'S A Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION ti Date: I I3118- Name: Kau ,D,O Phone Address: 33 l-.a► 'p"+ Village: e:o,�S Name of Business: M o,2 6,0A (AA LLC Type of Business: � Map/Lot: 1 13 "6 7( INTENT: It is the intent of this section to allow the residentsi of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: 3 C6 MUST COMPLY WITH HOME OCCUPATION Homeoc.doc Rev. 10/17 RULES AND REGULATIONS. FAILURE TO ;0WJ..Y MAY RESULT IN FINES. C Town of Barnstable Building Department Services FS►+e r°kq, Brian Florence,CBO o* Building Commissioner BARNSTABLE, ' 200 Main Street,Hyannis,MA 02601 Mass. 9 1639• �� www.town.barnstable.ma.us �AlE ,1 w MP Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: 11 ! `!(1 'Name: tL,P 0 Lo, r✓I-Lo Phone#Q-1 OS Address: 613 CJ21�v,.7 l (l� ��-t V V 1.A Village. Co,,J-0r h -JL Name of Business: Type of Business: �-OS�a C P' fQ,OOwr CUB • Map/Lol �� 0 1(D INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. .After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. - • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one. pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. y • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included • No person shall bg employed in the-Customary Home Occupation who is not a permanent resident of the dwelling unit. r I,the undersigned,have read and agree with the above restrictions foamy home occupation I am registering. Applicant: Date: l k -01 Homeoc.doc Rev.06./20/16 f F YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do'by M.G.L.-it does fiot give you,permission to operate.] You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed:form to the Town.Clerk's Office,, 1st FI., 367 Main St., Hyannis; MA 026.01 (Town Hall) and get the Business Certificate that is required by law. DATE: I � ,Q Fill in please: 06 T ; I ' APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS: SA COLAA Azk LM3 TELEPHONE # Home Telephone Number 0r3� r. 'tar'�! ElN #: E-MAIL: NAME OF CORPORATION: (li A d U NAME OF•NEW BUSINESS TYPE OF BUSINESS FQe, rQ, p SOu r`� _ IS THIS A HOME OCCUPATION?___Z YES NO ADDRESS OF BUSINESS.,. — eMA MAP/PARCEL NUMBER, O 7•� (Assessing) When starting a new business theme are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable• This form is intended to assist you in obtaining the information you may need: You MUST GO.TO 200 Main St. - (corner.of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to Legally operate your business in this town. MUST COM LY REGUITH LATIONS E FAILURE TO OCCUPATION 1. BUILDING COM.MISSION.ER' FF E RULES AND This individual has been i, r f any permi uirements that:pectain to this type of business. `OMpLY.MAY RESULT IN FINES: orizedSl nat a** ' r r COMMENTS: G.ZG9r � 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: . �1" o)yl r Parcel Detail Page 1 of 4 FTHE f "'..'rt "'^+►--.._...� F,_ lam'' Il O! © °& r PZEI(TABLE, 1439. Logged In As: Thursday, January 12 Parcel Detail f 2017 Parcel'Lookuo Parcel Info Parcel ID 173-076 iI Developer Lot ILOT 16 Location 133 CONANT LANE I Pri Frontage 122 Sec Road l I - Sec Frontage I �I Village lCenterville I a Fire District C-O-MM Town sewer exists at this address INO —il Road Index 10341 I Asbuilt Septic Scan: c ` 173076_1 Interactive Map 'f 173076_2 �, � Owner Info - ---^- - — Owner IBURNETT-MORLE, MAf� owner KEMAR O I Streetl 133 CONANT LANE^!I Stree6 City CENTERVILLE � state MA Zip 102632 Country I Land Info Acres 10.47 I Use ISingle Fam MDL-01 I, zoning IRC 71 NghbdS 0105 �I Topography Level I -Road Paved` Utilities IPublic Water,Gas,Septic) Location I , I Construction Info - Building 1 of 1 T , Year 1979 I Roof Gable/Hip I Ext Wood Shingle I + Built Struct Wall Living 1520 Roof Asph/F GIs/Cmp AC None Area Cover Type �— ypK. Be Style lCape Cod Wald Drywall I Roome 3 Bedrooms �I Model lResidential Int Carpet iI Bath 2 Full-0 Half Floor Rooms FAT+ . B SY 24 PAS. Grade Average I Heat Hot Water I Total 7 I 4. WTI Type Rooms Esc. Stories 11 1/2 Stones Heat Oil }w Found Mixed Fuel ation Gross 3264 Area Permit History , Issue Date Purpose Permit# Amount Insp Date Comments , 3/30/2016 Alt-Int work-Res 16-533 $5,000 weatherization 2/10/2014. Demolish 201400810 $7;800 http:Hissgl2/intranet/Propdata/ParcelDetail.aspx?ID=12086 1/12/2017 Parcel Detail Page 2 of 4 V 5/9/2014 WTR DAMG 12:00:00 AM DEMO 5/2/2005 8/20/2004 Addition 78738 $37;000 12:00:00 AM 16X20 FAMRM Visit History Date Who Purpose 8/14/2014 12:00:00 AM Mike White Bldg,Permit'Completed 4/30/2014 12:00:00 AM Jeff Rtadziak In Office Review 8/31/2012 12:00:00 AM Robin Benjamin In Office Review 10/3/2008,12:00:00 AM Paul Talbot Cyclical Inspection 5/2/2005 12:00:00 AM Martin Flynn Bldg Permit Completed 2/29/2000 12:00:00 AM Paul Talbot Meas/Listed-Interior Access Sales History ' Line Sale Date Owner Book/Page Sale Price 1 1/7/2015 BURNETT-MORLE, MAKIESHA S & 28615/253 $260,000 THOMPSON, KAYE, LAUIRE E & MELTZER, DONALD 2 11/13/2003 E J R 17922/28 $100 3 11/13/2003 KAYE, LAURIE E 17922/26 $20,000 CARTMILL, WILLIAM A & LAURIE E 4 10/15/1988 KAYE 6501/23 $130,000 5 1/15/1986 BURKE, JOHN M & LEE B 4906/6 $108,000 6 7/15/1984 PECKHAM, DAVID P & LYNN J 4189/347 $0 7 5/10/1979 BERGIN, LYNN 2914/209 $0 (� Assessment History Save Building Total Parcel # Year Value XF Value OB Value Land Value Value 1 2017 $124,100 $18,500 $3,500 $110,700 $256,800 2 2016 $124,100 $18,500 $3,500 $111,700 $257,800 3 2015 $127,800 $17,100 . $4,300 $109,300 $258,500 4 2014 $132,400 $18,400 $4,500 $109,300 $264,600 5 2013 $132,400 $18,400 $4,600 $109,300 $264,700 6 2012 $109,200 $19,700 $3,600 $109,300 $241,800 7 2011 $127,700 $2,300 $1,400 $109,300 $240,700 8 2010 $127,200 $2,300 $1,400 $109,300 $240,200 9 2009 $142,600 $2,300 $700 $146,300 $291,900 10 2008 $148,100 $2,300 $700 $152,500 $303,600 12 2007 $147,700 $2,300 $700 $152,500 $303,200 13 2006 $151,800 $2,300 $700 $157,900 $312,700 http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12086 1/12/2017 Parcel Detail Page 3 of 4 14 2005 $112,500 $900 $700 $143,500 $257,600 15 2004 $100,300 $900 ' $700 $107,600 $209,500 16 2003 $81,500 .$900 $7010 $48,000 $1.31,100 17 2002 $81,500 $900 '$700 $48;000 $131,100 18 2001 $81,500 $900 .$700 $48,000 $131,100 19 2000 $61,000 $0 $0 $33,200 $94,200 20 1999 $61,000 $0 .` $0 $33,200 . : $94,200 21 1998 $61,000 $0 $0 $33,200 $94,200 22 1997 $59,900 - $0 $0 $22,100 $82,000 23 1996 $59,900 $0 $0 $22,100 $82,000 24 1995 $59,900 $0 $0 $22,100 $82,000 25 1994 $62,800 $0 - $0 $33,200 $96,000 26 1993 $62,800 $0 $0 $33,200 $96,000 27 1992 $71,500 $0 $0 $36,900 $108,400 28 1991 $70,900 . so . $0 . $59,000 $129,900 29 1990 $70,900 $0 $0 $59,000 $129,900 30 1989 $70,900 $0 $0 . . $59,000 $129,900 31 1988 $59,500 $0 $0 $221100 - $81,600 32 1987 $59,500 $0 $0 $22,100 $81,600 33 1986 $59,500. . . $0 $0 $22,100 $81,600 Photos --- - - fit¢. �•� _ 'dr _ � . k .1.. n• i 6 r� r a r http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=12086 1/12/2017 a rY' i°�3/lOM/20d• �` 03/10/2014 nil Rt pi x :0311101201 '� �r�`rtr��t�/S�r � �. 031"I-0120A4�l- Axa.,P,,�r__��r��1 t`3('�f0°T,y:k ?�sjyi�n'4.`e°8?1 r 4f/•,: - '�"w" r �`` T: `r',, j :Y �• � + � 'Bey k�! 03/10/2014A(=v, i Ar �{ � •� is � t�.�• ��' ��t��,�T a��.'k� y,� •�i: �#�€tii'' i�,�,`M��i�f��r ��f�*��.t ��'�4 L ♦ y .- .�,. ea ' Vi 41 '1i Sig r1 .f . 4 Y H•• • 11! wl�� '" _ �EiW .. � •.... y�.-..fir I�i�tr •` jr ' r i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map IL - 3 Parcel d b Application # Health Division Date Issued 3/2-7 /(o Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board /U o E�+AZ L_ Historic - OKH _ Preservation / Hyannis Project Street Address c o n L w� Village CeA+e Owner _ (�1 �. I eS k a n e± Address s ►e Telephone al0 Permit Request V. 30 c.ellw�ese + 46a ac{ is r Sea 4 ne xn� m w t-K e-'NLAP1 - Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 5 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ 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 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: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing anew size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: aCD Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ s Commercial ❑Yes $(No If yes, site plan review# � Current Use Proposed Use rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) C c V Name e. JAY `�'_� f""l-Telephone Number Address 7"1i License # Home Improvement Contractor# Email Worker's Compensation # WV C 313 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �an"1 au"I SIGNATURE DATE ! t F FOR OFFICIAL USE ONLY f APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: 4` y FOUNDATION FRAME :1 INSULATION FIREPLACE 4 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 1 FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 2 HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic& basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 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 and give my consent. Home Owner(signature) Home Owner email: n Date: Agent:(signature) II Dater Weatherization Contractors: Adam T Inc Cape Save. All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement Building Science Construction ` Tupper Construction Cape Cod Insulation I N a loniveclfh of Massachusetts ° I Ts,= ;} .►`i.� �� jDepartinen't of Al Industrial Accidents,"' ' i:` ` `~'' s 1 Congress Street,;Suite 100 1 Y:1=s 4, :.w 7; �'• -~i Boston,MA 02114=2017` ' 'e b •.. a. a - .. i �' .: s ° !r ,. :Y:p'r`� s ..R p•r .y- i. T [.Y aaa www massgov%dia WorkeTs'Compensahon.Insurance Affidavit'c BuilderslContractorslElectricians/Plumb..ers. a r TO BE FILED WITH THE PERMITTING AUTHORITY. Apolicant Information Please Print Legibly Name (Business%Orgatuzation/Individual).:Cape Save Inc Address:77D Huntington Avenue =wi + ,•�. , City/State/Zip:South Yarmouth, MA 02664 phone#:508-398 0398 n Are you an employer?Check the appropriate box: ' _ of project(reqd):uire E. _ 1.❑✓ I am a employer with 20 w employees(full and/or part-time)A° '_ r A c T` i r 7 Q New construction `x'- ' .;, .. .. ,' t.w"-,� � ti. .�ti •:t' 1 Is r i ",1 is 2. I am a sole," or partnership and have no emplo ees working for me in € ` ❑ Y g u ' Remodeling f, r t 8 ❑R elm any capacity.[No workers'comp.insurance required] t,, , 3 9. Demolition 3.❑I am a homeowner doing all work_myself.[No workers comp:insurance required:]t j .7 r� .;3 v „w 10[]'Building.addirion � ; 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I w.11' ,. 1. ensure thatall conirac;ors either have workers'compensation insurance or are sole I Ln Electrical repairs or additions proprietors with no'employees. ,L.,. : • `�; , ._. ,,, 12.❑Plumbing repairs.or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. . 13.�ROOf repairs These sub-con tractors have employees and have workers'comp:insurance.t 7 14.0✓ Other Insulation 6.❑We are a corporation and its officers have exercised their right of.exemption per MGL c. t 152,§1(4),and we have no employees.(No workers'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.ar&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, 1 I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information: ; . _ _. ._ _ .. . . - .�, t .. ..{ Insurance ColnpanyName;Wesco Insurance Company u Policy or .Self-ins_Lic.#:WWC3136274'�'�"�" "' `" _ ` � , , , - -,Expiration Date: •� _. 04/09/2016�. Job Site Address: 33 Conant Lane r- t > City/State/Zip: Centerville- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date):' t ` Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,5.00.00 and/or one-year imprisonment,as"Wel]_as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the.violator A copy,of this statement may,be forwarded to the Office.of Investigations of the D1A.for insurance.- coverage verification: r , �, r 1 do hereby certify under h patns and penalties of perjury that the information provided above is true"and correct Si mature: Date: 3/8/16 ; Phone#:508-398-0398 J Official use-only.-Do not,write in this area,to be complete"d by city or town offlciaL 1 CityFor-Town, =_� _ 4 .J Permit(License# i rr .,_, ? a 1 ;:x .tie at -ir. r �'.: r 7 ,l.•'�';r,., ;r,- 1 � 'L �'J�4 Issuing Authority(circle one):•AO;,MIT 1.Board of Health 2i Building Department 3 Cityao",Clerk 4.Electrical lnspector 5 Plumbing inspector T " Contact Person y - Phone:#i x7 7 w.t, DATE(MMIDDIYYYY) .4co o� CERTIFICATE OF LIABILITY INSURANCE 10/14/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: Colleen Crowley Risk Strategies Company PHtAIOI� E : (781)986-4400 FAC No: (781)963-4420 15 Pacella Park Drive _ aot�SS:ccrowley@risk-strategies.com Suite 240 INSURER($)AFFORDING COVERAGE NAICS Randolph MA 02368' iNsuRERA:Selective Ins. of America INSURED INSURER BAllmerica. Financial. Alliance Ins Co 10212 Cape Save, Inc INSURERC:Wesco Insurance Company 7 D Huntington Ave " INSURER D: INSUR ERE: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL15101402127 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MMOI ICY EFF MPMOJDD EXP LTR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO R ENTE A CLAIMS-MADE �OCCUR PREMISES Ea occurrence . $ 100,000 01994480 - 10/16/2015 10/16/2016 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JEC7 . LOC X X PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIM Ea accident) $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL X SCHEDULED ANNA46796600 11/6/2015 11/6/2016 BODILY INJURY(Per accident) $ AUTOS X HIRED AUTOS X AUTOS NON-OVMED Pera atl nPERTYt DAMAGE $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 'AGGREGATE $ 1,000,000 DED RETENTION Nil S1994480 10/16/2015 10/16/2016 $ WORKERSCOMPENSATION officers Included for X AND EMPLOYERS'LIABILITY STATUTE ERH YIN ANY PROPRIETORIPARTNERIEXECUTIVE NIA Coverage E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? NWC3136274 4/9/2015 4/9/2016 (Mandatory in NH) E.L DISEASE-EA EMPLOYE $ 500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included as Additional Insureds with respects. to the General Liability coverage of Named Insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 460 West Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, VIA 02601 AUTHORIZED REPRESENTATIVE Michael.Christian/CLC O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) • , • �G-/ :� ,��2�_ Cam}� q � - 3�G�i > (71 1 Office of Consumer Affairs and Business Regulatton. -10 Park Plaza- S: to 5170<; Boston- Massachusetts 02116;;. Horne Improvement:Contractor Registration . �. w -•� - Registratwn 171380r. _ Type :Corporation . ��gi �f ' r•, Expiration 3/14/2018 Tr# 419291 CAPE SAVE ING. l f,$ T _ WILLIAM McCLUSKEY, • 7-D HUNTINOTON AVENUE , SOUTH=YARMO'UTH, MA 02664 � Update Address and return card Mark reason for'change. v ri" Address. C1,.Renewat: Employment Lost Card: SCA 1 v 20M-05/11 lC (L'OH1NIl4'J2LQCC!(.�IL-O�C-��CC:UC[Cfl7C1C�f - _Office o -Consumer Affairs&Business Regulation License or,registration valid for mdividul.use only `<7 • HOME=IMPROVEME,N CONTRACTOR beforvthe expiration date If foun.returiri Registration-, T ei Office of Consumer Affairi and Business Regulation i71380 Yp 4/ Expiration 3/14/2018 Corporation. 10 Park Plaza-Suite 5170` Boston,..MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY iF x 7-D HUNT[NGTON-AVENUE s;_. . :r- SOUTH YARMOUTH,.MA'f)i Undersecretary Not valid; i signature . Massachusetts 7 Department of Public Safety Board of Building Regulations and.Standards 411J I�tf ll[11U 11 JLLIICI Y i1t1/.'JIIGI:I'['U LY- ��. License: CSI,L 102776 � V1.1 - WILLIAM J MC 37.NAUSET ROAD West Yarmouth 1VIA Expiration Commissioner 06/28/2017 I � 3 Co� A,-Y7 G��u SMOKE DETECTORS REVIEWED< - -- "DING _l z�isll y LF Fes a ,r B G DEPT. DATE a FIRE.UEPARTMENT UATr- BOTH SIGNATURE ARE REQUIRED FOR PERMITTING d Dec.:11. 2014 5;Q1PM Century 21 COBB .RealEstafe.'com No. 1496 P:. 2 a p� a O Dec. 1.7 2014 5:07PM Century 21 COBB Real Estate. com No: 1496 P, 1 NJ VJ LIP a ` R ° 4 OFSHE Tp1 own of Barnstable ' *Permit#a�' �y �� rl+n'�[e Expires 6 months from issu e ?014 Regulatory Services Fee anxtvsrns ' nI 9� 639 ,�� ®�Rtl/s'�'n p Richard V.Scali,Director r'iDC� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 Property Address 33 CQ G y. `ice Cep 7'-P_rV1b4 ❑ Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address L, G;o ti r t KC, CY( 33 C C ek\ 4Tul1 �t Contractor's Name 1 I C E W o C� S Z.p it Telephone Number 3106, S 6 6 6 S 9� Home Improvement Contractor License#(if applicable) ' �--& Email: Construction Supervisor's License#(if applicable) toy�r ❑Workman's Compensation Insurance Check one: ' �] I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name s CUP5Q4 SG 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-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows CkC A 0he SrinD4 refec}CA #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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, f the Home Improvement Contractors License&Construction Supervisors License is re u SIGNATURE: Q lr QAVYTFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 The Commonwealth ofMassachusetts Deparhnent oflndustr*d Accidents Ofjue of Investigations 600 Washington Street Boston,MA 02111 www.mass govldia Workers' Compensation Insurance Affidavit:-Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly' Name(Business/organizafionan&vidual): W�'`i c 1•�. \ o C S 2 Q `C _ Address: 9 C c,pl C 4z,-, L u iV n vi a L City/State/Zip: G 6 m v v` 4 4 f, Phone#: ��C� SRO 0. fo 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(fall and/or part-time)' art time). co * have hired the sub-contractors 2. ❑New construction2.[ 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 m any capacity. employees and have workers' [No workers'comp.insurance comp.inrance- # 9. ❑Building addition str 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 woTkers'comp. right of exemption per MGL 12 []Roof repairs I insurance regaired.l t c. 152, §1(4),and we have no employees. [No workers' 13.❑Oilier comp.insurance requirea_l *Any applicant that checks box N 1 must also fiIl out the section below shouting their workers'compensation policy ffikrmz5on_ t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suclz_ :Contractors that chxk this box must attached an additional shoat showing the name of the sub-contractors and state whether or not those entities have employers. If the sub-contractors have employecs,they most provide their workers'comp.policy ntmrber. I am an employer that is prav&ing workers'compensation insurance for my employees. Below is the pofky and job site information, Insurance Company Name: Policy#or Self-ins.Liu#: 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$1,50.0.00 and/or one-year imprisonment as well as civil penalties is 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 DIArfbr insurance coverage verification. I do hereby certify un a pains and penalties ofperfzcry that the information provided aba a is frzl a and correct Si ature: !` Date: Phone#: Offzcial use only.,Do not write in this area,to be completed by city or town oo'kw City or Town: PermitlLicense#. RIssuing Authority(circle one): 1.Board of Health 2.Building Department 3,City/Town Clerk 4,Electrical Inspector S.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. pursuantto 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 insuranm 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 w in -with the surance.. 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 I sub-contractor(s)nam s address es and hone numbers along with their certificate(s)of necessary,supply � ) .� ), address(es) P () in�ce. Limited Liability Companies LC or Limited Liability Partnerships(LLP)with no employees other than the �3' P �- ) members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have a,ees ern Io policy is required. Be advise_d that this affidavit maybe submitted to the Department of Industrial employees, 'de or confirmation ofin��nce Coverage. Also be sure to s' and date the affidavit The affidavit should � Accidents f � � the permit or license is being este not the De artmeat of be returned to the city or town that the application for p g requ � P 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 lime. City or Town Officials f 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 shol?ld 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 that a valid affidavit is on file for future ermits or licenses. A new affidavit must be filled out each PP 'proofP - 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any 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 xuvestiptio= Goo wasbivon street Boston,MA 02111 Tel,#61'-727-49(0(�xt 406 or 1-8-77-MASSAFE Fax#617-727-7749 Revised 4-24--07 www.m=.govfdia :4 =� OF THE Tp� �Qv ti� * * BARNSTABLE, �$ 1639 ,�� Town of Barnstable prED MP't a Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner I 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize W 1\ l i c "� o 1 t cis -e'.a k to act on my behalf, in all matters relative to work authorized by this building permit application for: Co hc— (Address of Job) Z-2 14- Si ature of Own Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPHLESTORMS\building permit forms\EXPRESS.doc Revised 061313 Town of Barnstable Regulatory Services P�oFzne roiy,� Richard V.Scali,Director Building Division =ABNSTABLE, ' Tom Perry,Building Commissioner y MAss• �' �,, i6g9• ��+ 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: JOB LOCATION: number street village "HOMEOWNER": 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 responsible for all such work performed under the building permit. (Section 109.1.1) 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 minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 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-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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map d 7 3 Parcel 076 ApPica�# Lf,-66 Health Division Date Issued Conservation Division Application Fee F Planning Dept. Permit Fee _ Date Definitive Plan Approved by Planning Board \� Historic - OKH _ Preservation/Hyannis J Project Street Address 33 C.g OsriA&77 (, A AsGU C.Cs-NT-CYZ_U t ` [ Village C6AJ7-e-A-U I Owner c t/Cj4YE 1 L)ati wtc LTzc vL' Address rtS A ZOuE Telephone '7 7(o V Y S_�r Permit Request NkUI-C 2.toVL. tb vv 6 Or WA*t�v� ,),4v4A6( 6 Sf0.uc.,ru(iL6_ 14X1,&btPr, S'I�etT�Oc i< Cy]1a«S C E t �•^�a 5 41J6 tASu t,Q n a nv wdO8 . L Pw r,vA r"c: o4 VA G�Ric�'c:d �Lnc�s2c•n. Square feet: 1 st floor: existing proposed 2nd floor: existing 76 b- proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 179-60 Construction Type ttsDO& o Lot Size a 4 S& F-r' Grandfathered: ❑Yes ❑ No If yes, attach-sZpporting-_dbcuWntation. Dwelling Type: Single Family , Two Family ❑ Multi-Family (# units) C) Age of Existing Structure 3q Historic House: ❑Yes *No On Old King's'l Highways❑he *0 Basement Type: A Full ❑ Crawl ❑Walkout ❑ Other =2 Basement Finished Area(sq.ft:) Sd 5y f:-r Basement Unfinished Area (sgjft) a,- b Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: _ existing —new Total Room Count (not including baths): existing 7new First Floor Room Count Heat Type and Fuel: ❑ Gas �4 Oil ❑ Electric ❑ Other Central Air: ❑Yes * No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: U existing ❑ new size _ Barn: ❑ existing ❑ new size_ 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 W A%14,. ku\�or L ei�j Telephone Number 50 G O Address `a`a P.,8, ST- 6R ews License# G S - 0_7 y 9 a b- w4�A Lrsiv �Z� oyL Arb ry S6A.utc-L""S Home Improvement Contractor# _/9 2 ,D y V Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE (Q DATE b- L f -S { F i` 1` FOR OFFICIAL USE ONLY F APPLICATION# s DATE ISSUED MAP/PARCEL NO. 4 ;x ADDRESS VILLAGE OWNER F k 1 DATE OF INSPECTION: { FOUNDATION ,.x b 4 FRAME INSULATION Y FIREPLACE i i ELECTRICAL: ROUGH FINAL 'I PLUMBING: ROUGH FINAL r' ROUGH , h FINAL f if#NAL BUILDING-a z DATE'CLOSED OUT ASSOCIATION PLAN NO. — s • The Com monweahh of.Massachusetts Deporttwent of Indus&fd Accidents Offlce of brvesdgodons 600 ;P6A i j6'i#Street Bostoty'MA'02111 www mass gov/dla Workers' Compensation Insurance AfBdavit: Builders/Contractors/E1eddeioni/Plumbers Aondmt Wrmadon "p Please Print Levibhr Name(susinesaX*VnizstioWW&Vi"): Whalen Restoration Services Address: - 22 American Way Ci /$tatelzi .- South Dennis, MA 02660 phone#, 508 760 1911. Ariyos a 'employer?.Check the appropriate box: TypePre1 (nq layer with 4. I am a enarat,contrsctorsnd I{ t:( I am a e 25 S ., employ ( part ). have'hared die sub-contiactais 6- ❑New construction ees list!and/or time 2.❑ I am a sole proprietor or partner- listed on the atoiehad siiefi ` 7. ❑Remodeling ship and have no employees Thy v � hive S. 0 Demolition. working for me in any capacity. CUTbyie"atsd hive workers . [No drinkers'comp.insurance comp.iasureocat 9 [3Building addition ro4 J , S. ❑ We are a corp and its O.Q;Eloctricat repairs or addition 3.❑ 1 am a homeowner doing all work otRcers Hive eatercised tDoir 1! ❑Phunbing repairs or"addition myself.[No wow''comp. rigbi of ezentptio per.Mt3L 12.0 Roof ibpeirs insurance�1w�1► c. I SZ-§1(4);and we have no — 3 s.❑ t ass a homeowner acting as a einployeea:,[No workers, 13 & Other general=ntractor(refer to#4) .iaewraoce ;Any apokm tie cheeb boas N1 mnat aiw 8U o u dw aecdoa below t w ' _ tAeir ooaieedody�s>Iatsaeioe, Homwwneia who wbmit thia'atlWavit'i they sii&Ws M worlt'and then hiie ou"eaauscim mat wbotit a mw atlldavie tCosbseoas.dueeheekChla ban mnie attseberl sa add�ioad cheat tb Mai of*e sub4066aeois od i- M 6"err ooe t iw entities have Itdaatt�ooaa bwe �plorreea,dam►mart dsetr.wottteta namber. - .pre"'d'e t I an an emp&yer t o hp'k+d ww*ffs'.ee aePsr/iaairaj�r jar niy eerprioyeas Below Lt des slat Injonxoalora InsuranceCompanyName: Ace American Insurance Company. Policy#or.Self--ins.Lie.#:_ UB-5B894542-13 4/1/14 Expiration Date: Job Site Address: 3 3 C cV-AAjl—. CAtiE . 'City/3tatdZp:, C Ivn�'cYt-VW Attacb a copy of the worker'compeeeadoe policy deelandoo¢psgte 611, the polka number and es01r"ation date). Failure to secure coverage as rewired under.S&U6?�SA-of MGG c.'l32 inn cad to theoi tt oo of crimitii penalties of a fine up to$1,300.00 and/or one-year imprisonrrunt,as weq as civil penalties is ilia foint`of a STOP WORK ORDER and a fin of up to V50.00 a day against the violator. Be advised that a copy,of this stateneent rru;y be forwarded t4 the Office of investigations of the DU ._ rosurwe coverage veritication. I do Atirbj csiel�j nadir rhi palrar airl parea/Niit olPer/�!'rhat by�nayslow pro+�ii�ob�tt fs:Ana mini eairr+rs Siaaattue< L K3 Date- �� ,(�.O Phoneme [S' L q E .orrlyr' Do net writs In tit arm,AP b"Co Plsui%61 chy or rowir oJJlclatwn: - Permit/License# therlty(circle one): Mealth 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector S. Plumbing Inspector noo: Plane#: (:Theresa C FfVl 3_Wathleen S.1/1'5/�Lo Dr9/61 3T AM�CE508M/ 2 Fax Se0 26 01/15/14 EST Pg 4-14 ' a� /DD/YYYYI DATE(MM CERTIFICATE OF LIABILITY INSURANCE T RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERDEICATE HOLDER, IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must he endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the cerlificate holder in lieu of such endorsement a. PRODUCER CONTACT NAfAF: HUB WTERNATIONAL NEW EN PHONE FFACX,265 ORLEANS RD (A/C,No,ERI): No): EMAIL NORTH CHATHAM,MA 02650 ADDRESS: 77GIU; INSURER(S)AFFO ROING COVERAGE NAIC II INSURED INSURER A; ACE AMERICAN INSURANCE COMPANY 1\HALEN RESTORATION SERVICES,INC.WHAEL SERVICES, INSURER B: INC DBA CHE (DRY 13Y WHALEN SERVICES INSURER C: INSURER 0: 22 AMrRICAN 1VAY INSURER E: SOUTH DENNIS,NIA 02660 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: MEW— MmIgym E INSURED WIED ABOVE THE POLICY PERIOD INDICATED NOTIMTHSTANDNG ANY R EC"RMiWT,T1MI OR CONDITON OF ANY COtfTRACT OR O1HFR DO0UMENT%1TH RESPECT70%"Cti THS CERMCATE MAY BE ISSUED OR MAY PERTAIN,THEWSJRANCE AFFORDED 13Y THE POLICIES DESMSEDHEREINISSUBJECTTOALL THE TEPfMl ED(Cll610NSAND00NDITON.SO59"POU(iES LP.9TSSHOANMAYRAVE BEEN REDUCED BY PAID OEAI4LS IF6R ADD SUB POLICY EFF DATE POLICY D0'DATE LTA TYPE DfINSURANCE L R POLICYEMIaER (fA1+.D0YYVY) (NYilOD,YYYY) lltviTS GENERAL LIABILITY ZACH OCCURRENCE COMMERCIAL GENERAL LIABILITY $ CLAIMS MADE DAMAGE TO RENTED OCCUR. PREMISES(Cn occurrence) MEO FXP(Anyone person) S GENTAGGREGATE LIA1T APPLIES PER: PERSONAL BADV INJURY $ PID ENERALAG13REGATE 5 POLICYPROJECT❑LOT PRODUCTS-COMP/OPAGG S AUTOMOBILE LIABILITY COMBINEDSINGLE S ANY AUTO L1MT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCI IEOULE AUTOS (Per person) HREDAUTOS BODILY INJURY c NON-OWNED AUTOS (Pa Eccidenl) PROPERTY DAMAGE S (Pet mUdeir) UV•BRELLA LAB OCCUR EACH OCCURRENCE S EXCESS LIAO Li—CLAIMS-MADE AGGREGATF $ DEDUCTIBLE $ RETENTION S $ A WORKER'S COMPENSATION AND NC STAMCflY OTF¢R EMPLOYEITSLIABILITY YIN UB-5BB94542-13 04/01/2013 04101120W ti U'ATS ANYPRCPMTORPARTNFAEXEClR1VE wA L.L fJ1CIlACCIDENT S 1,000,000 CFTPCER,T,#BV�I E7.GLLETED7 (amatory in I" E.L.DISEASE•FA EMPLOYEES 1,000,000 k yes.desoibeirder DESCRIPTICNOF CPERATKM bdow E.L.DISEASE-POLICY LIMIT S 1,000.000 DESCRIPTION OF OPERATIONS/LOCA110NS/VFHiCLESJRESTRICTIONSJSPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TOTHE CERTIFICATEHOLDER AFFECTING WORKERS COAiP CO\T.RAGE. CERTIFICATE HOLDER CANCELLATION I r1URIE ICAl'E SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED S 33 CONANT LN BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B DEU ED 1 IN ACCORDANCE VATH THE POLICY PRO (O CEAITERVIII.E,MA 02632 AUTHORIZED REPRESENTATIVE ) a E ACORO 25(2010I05) The ACORO name and logo are registered marks of ACORD 1988.2010 AC( '0RP�RA��N. A�rights reserved. Restoration Services Inc. Fire, Smoke, Soot,Water Damage&Mold Remediation Services 040eaning Deodorization Reconstruction Specializing in Fire Restoration - All Work Guaranteed Access, Authorization and Direct Payment Request Form I (we) authorize WHALEN RESTORATION SERVICES to`perform work as per estimate at property located at 33 conant Lane, Centerville, MA 02632 to repair damage caused by Water on 1/9/14 As owner(s) of this property, I (we) understand that I (we) must authorize this work. I (we) hereby authorize WHALEN RESTORATION SERVICES to perform this work and accept responsibility for payment upon completion. I (we) authorize and direct my Insurance Company Narragansett Bay Policy No. 10459209 , to make payments directly to WHALEN RESTORATION SERVICES, Insurance Claim Specialists, for doing this work and to that extent I (we) assign the benefits applicable to this loss to WHALEN RESTORATION SERVICES. I (we) acknowledge receipt of a copy hereof: OWNER DATED 4 SIGN OWNER WHALEN RESTORATION REP. SIGNED 22 American Way, South Dennis, MA 02660 Phone: (508) 760-1911 Fax: (508) 760-9995 • 1-800-244-2598 • E-Mail: restore@whalenrestorations.com Web Page: http://www.whalenrestorations.com OFFICE COPY T irirer�caw&Arm!�� '; Ma8&aChUSCttB f iattrllent Of P•abllc Safety friceof Consumer AffairsS,R:usiuessRegulation Boa`cofBuitdiag'Regulationsand"Standards ME IMPROVEMENT '� ` sw �onstruetion Supe tsor' u� j trai3on 19244 Type 35 { !' , 4 tacense piration' 7J3=15 Private Corporator:` .�" • ,j�' i Whalen Res S nrrces�ir toration ` 122.POND STREET= • ;_ " �" <BREWSTER MA, William Whalen H ti � American Way i South'Cennis.MA 02660 `— • , c-� �,`��"' t Expirat * Undersecretary' "`"-"' ya� -.�:h , -, .1.�..+; •"ham' corrums � osrtor�o�a 4 ^4•+ ... .,. is V : •Urtrestrtcted-�tldutgs of any use group which, License or registration valid for indi+tdul use oni} � a Stan leis than 35 000 c_Ibic feet(991m,)of r. before the expiration date: if fonrad:-etrirp to: r' Office of Consumer:Affairs and Busk-oss Regulation } a 0 ,y. 10'Park Plaza-Suite 5170 , S 'Boston,MA 02116 1 ¢" •{ ^° < failure"to possess a current edition of the Massachusetts Jt "l/� --�f State Building Cade is cause far evocation Ott s'Ircense. Not,valid without signati re Fors DPS-Ucensing hformation wsit wwrw,Masi.Gov/DPS .1N All � ' •;wry F �, ^�. _ M ^ . _ ..rt+n-i•e.w.t....w.. ,y,e•.-..rs-x+...e:....r.,� ,. .r. T! w .. ".'° .. .. h.. I� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �`� �< Map+ � Parcel Apt; Permit# Health Division ,73'a 71 W 1&q $ Conservation Division 12, s f ® �g ot" d&k, iAppl ation Fee Tax Collector I A it '°\ `�" � �'�' Permit Fee N'J 2,S,95' Treasurer �/�� ~ n Must BE Planning Dept. INSTALLED IN COMPLIANCE Date Definitive Plan Approved by Planning Board NTH TITLE S ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address CCIAC OI�_ LRvVb - Village Ceb kC—V 1 k��- Owner T)Mjg d 1yd� 4- _� Lc�grtt kc,y U Address Lcv)e Telephone C'�,5 nFs�) Permit Request go LA AD)-i710PJ Square feet: 1st floor: existing proposed 2nd floor: existing proposed v Total new . Zoning District J. Flood Plain Groundwater Overlay Project Valuatio Construction Type Lot Size - 0 . 95.� Grandfathered: ❑Yes XlNo If yes,attach supporting documentation. Dwelling Type: Single Family JV Two Family ❑' Multi-Family(#units) Age of Existing Structure cS. Historic House: ❑Yes �No On Old King's Highway: ❑Yes XNo _ Basement Type: Full Cl Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ZZ� Basement Unfinished Area(sq.ft) 1 Number of Baths: Full: existing .7 new Q Half:existing © new Number of Bedrooms: existing 2 new r— Total Room Count(not including baths): existing new _ First Floor Room Count 3 Heat Type and Fuel: ❑Gas JI Oil WElectric ❑Other Central Air: ❑Yes 9 No Fireplaces: Existing New Existing wood/coal stove: 0 Yes 'j (No Detached garage:O existing ❑new size Pool: ❑existing ❑new size Barn:0 existing ❑new size Attached garage:0 existing ❑new size Stied:,]existing ❑new size 6 Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O Commercial ❑,Yes—O_No If yes, site plan review# Current Use Proposed Use i ry. BUILDER INFORMATION Name Telephone Number 1 S�K� Address aye sklw)b 111id , License# 6S07,6000 Home Improvement Contractor# ,3 Zfa 1 v Worker's Compensation# L/1A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO gMWS,"I� SIGNATURE DATE 716104 FOR OFFICIAL USE ONLY PERMIT NO. D el E ISSUED C. MAP/PARCEL'NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' .; FOUNDATION 911 DY AnAl FRAME roil s4'a - Ll INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL m PLUMBING: ROUGE,N FINAL GAS: ROUGIV- FINAL FINAL BUILDING , N � DATE CLOSED OUT. t co 3Pr � ASSOCIATION PLAN NO. l •} e v , t QFtHE rod, Town of Barnstable Regulatory Services vl + anxr�sTAS �. ' Thomas F.Geiler,Director ;�a�`� Building Division lfD MP Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date 7_ �&L0 AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. /� ' I Type of Work: 6 LA 0 A, A r70A) Estimated Cost 37 DUO Address of Work: Owner's Name: boNaa ►' I Date of Application: I I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: - - OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: y lflb/01 s L�� Date Contractor Name Registration No. OR Date Owner's Name Q :forms:homeaffidav r 7f0 CMR A endla J Table J&Llb(continued) prescriptive Packages for One and Two-Family Residential Buildings Hated with Fossil Fuels • MAXIMUM MINIMUM Glazing Glazing Ctiling Wall Floor Basement Slab Heating/Coaling Efficiency' Area'(%) U.valu� R-value' R-values R value' Wall Pesirmeter Equipment ElCicienry' Package R-vaiue� R valuer 5701 to 6500 Hating Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Narnai S 12% 0.50 38 13 19 10 6 85 AFUE T 15% 0.36 38 13 23 N/A N/A Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 l3 25 N/A N/A 85 AFUE W 15% 0.52 30 19 19 10 6 8S AFUE X 18% 0.32 38 13 25 N/A NIA Normal y 18% 0.42 38 19 25 N/A N/A Normal Z 18% 0.42 38 13 19 l0 6 90 AFUE' AA 18% 0.50 30 19 19 l0 6 90 AFUE 1. ADDRESS OF PROPERTY: 33 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: .56 3. SQUARE FOOTAGE OF ALL GLAZING: b 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-1980303a RESIDENTIAL BUILDING PERNIIT FEES APPLICATION FEE New Buildings,Additions $50.00 $6—D 00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE •pey� .3?-o square feet x$96/sq.foot= 3 01?-0 x.ee3-1— 44 ZS.9 S plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x AW 1 plus from below(if applicable) 4j0A+}EF}&(attached&detached) e�'11 square feet x$32/sq.ft. ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: •OeY� square feet x$96/sq.foot= x STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee proicost The Commonwealth of Massachusetts - Department of Industrial Accidents 0!flc0 alayestl9affens 600 Washington Street Boston,Mass. 02111 Workers' com ensation xnsurance Affidav i t ovation: 3 3 �n�A-nn �f- &��a�� M� �Zb3Z phone 57Id'�?9/-oZYl �i - � , ❑ I am a homeowner performing all work my-self , Mn a sole 'et and have no one worldn in ca a�tp //O //os w/orldng ass jab//%///!////////////////////////f/D//////// em 1 rovi g workers co ens nTY. ° ,T. ,''iT +fi {;.Y w: ' >,• '% :}• "•�;} an din zc.• e+ :` s. fi3`*a}a4 , }Y{ J 3 , + �7 < ❑ I am F ` g., 's .l ? c , s r} Y} 3 f>:�v.,,r�:.'r..�. 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'i'CY '�L`.y :,� ' { ?{.{vo. `.'�ii5''e'` +fi:y'w`h'}.J.,`' '•,'•Yj l.,:'•:W, ttyarani:exaa oo mdlor Fafatr'e to i ecm'e coverage as required mtder section 25A of MGL 15S can Iead to the imp osition of�hsai p enAdes of a Sne up to s1,5°°. out yes bnpAgonmeat U tren a+civapenaities in the form of a STOP WORK ORDER 9#nd a Hne of al°°•°°a day against toe• Imtderstznd that a copy of this statement mq be fortfarded to the Otiice of Investigations of the mmur coverage ver0cadon e arras and pe 'es of perjury that the information provided above is truf and corned • I do hereby certify P Date signature print name Phone#_(bv(() 771-Oz-yl do not write in this area to be completed by city or town oMcial oifldaluseonly De artment petmit/licerue# • ❑Bniiding p city or town: ❑Licensing Basra [isciectina,Office chi if�tnedtate response is required []$with Depnhnent ❑Other #; contact person: phone 255,1551 k�;ua 9ros at.V °w 1xF rok� Town of Barnstable °.� Regulatory Services Thomas F.Ge-ner,Director HAM Building Division - TomPerry, Building Commissioner 200 Main Street, Hyannis,MA 02601 pff,ce: 508-8624038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section If Using A Builder P ,.1.0w-net.,of the.subject property- - - I, r ' C 'to'act on tnp.behalf,. hereby authorize is Matters relative to work authorizecl•by.this bunding•permit•applicat'tontfOr: j (Address of Job) r Signa�e f er Date Print Name 7 ti f{ Pi f aIp a 1�� Y t i ♦ �� ry rf t Xl t tr .. - .'/1 1 v .1 .✓ �• x i';."'"k d *4 n t. �, : r iti �. G ' IFS 7Aelf 71 9: Vic At i II V kt�, + 1. 9 � -�•' � T '� rx"fit Lw Ire 7 ' ..a / C 3Yp4A1.�* , ;w T. ,ELfVATI01 CERTIFIED PLOTh#`` ►,, ,� n cc NT�OUR:'- — Co NNT; ,o 6 £ t�O.T EL£:VATIflN 4 0� f�-�Q N'f Q U R t DBdO . 0'F HEALTH. 1 �A 1 N� +, GENT: SCA �'!..44f `DATE `. Af G/N ,ERING �� IN CLI£'NT � R TIFY THAT THEE '# #i~E' REGIST£�tEn J09 N0 �`Z ��? $� UILalN.G SHOWN ON TNkS _ ..: I:AND dt"U 040S TO THE Z0144NQ 1 4 EER SURyEYO"R DR QY ! OF BARN L E , SS �14I S�' j.' 712 `M CHAIN; ST 8Y ri Ri. TN, MAVko HYANNIS, MA; SHE, .T. :Of a AT`E; R G. SAND 7-4777. 7 17R �7-777— 7 01A� :� k Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Re al 132691 ?� r� 3123/200,5 ` * RIF- F�dividual SCOTT QUILTEE�a" i T SCOTT QUILTEi2` Ga zjf 247 STRAWSERRY�M CENTERVIL6E,MA 02632 Administrator (ems �a'rN REO ERVISOR B®x"Of B 11GTiON SUP GOt4s, k LicenSe: 7 078p00 Number 15527 SGO -fT VA O 727 ::6362 - PHYP NISPORT' W ` a 4!E' 2ND FLOOR FLUSH BEAM TJ-Beam(TM))6.10 Serial Numb^'r 77002103362 3 PCs of 1 3/4" x 11 7/8" 1.9E Microllam@ LVL UserPagel Engine Vers04 ion:29AM THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN Pagel Engine Version:1.10.3 CONTROLS FOR THE APPLICATION AND LOADS LISTED i Fil. b 16'31/2" Product Diagram is Conceptual. LOADS: Analysis is for a Header(Flush Beam)Member. Tributary Load Width: 10' Primary Load Group-Residential-Sleeping Areas(psf):30.0 Live at 100%duration, 10.0 Dead SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 3.50" 2444/955/0/3399 All: Blocking 1 Ply 1 3/4"x 11 7/8"1.9E Microllam®LVL 2 Stud wall 3.50" 3.50" 2444/955/0/3399 Al: Blocking 1 Ply 1 3/4"x 11 7/8"1.9E Microllam®LVL -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s):All: Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear(Ibs) 3329 -2864 11845 Passed(24%) Rt.end Span 1 under Floor loading Moment(Ft-Lbs) 13282 13282 26772 Passed(50%) MID Span 1 under Floor loading Live Load Defl(in) 0.333 0.399 Passed(U575) MID Span 1 under Floor loading Total Load Defl(in) 0.463 0.798 Passed(U413) MID Span 1 under Floor loading -Deflection Criteria:STAN DARD(LL:U480,TL:U240). -Bracing(Lu):All compression edges(top and bottom)must be braced at 2'8"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(TJ). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application,input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code BOCA analyzing the TJ Distribution product listed above. -Note:See TJ SPECIFIER'S!BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION:, OPERATOR INFORMATION: SCOTT QUILTER Bill Rubel emu, 33 CONANT RDA` Mid-Cape Home Centers �cv - BARNSTABLE MA' PO Box 1418 465 RTE 134 ? - South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright C 2003 by Trus,Joist, a Weyerhaeuser Business MicrollamZ is a registered trademark of Trus Joist. ' . �� /�► �/ 2ND FLOOR FLUSH BEAM e �/"�"er:700CB3362 3 Pcs of 1 3/4" x 11 7/8" 1.9E Microllam® LVL TJ-Beam(TM)6.10 Serial Number:7002103362 User:1 9:029 AM Pagel Engin2e004 VesioB 1.10.3 THIS PRODUCT MEETS OR EXCEEDS THE SET DESIGN CONTROLS FOR THE APPLICATION AND LOADS LISTED 0, z❑ b 16'31 t2" Product Diagram is Conceptual. LOADS: Analysis is for a Header(Flush Beam)Member. Tributary Load Width: 10' Primary Load Group-Residential-Sleeping Areas(psf):30.0 Live at 100%duration, 10.0 Dead SUPPORTS: Input Bearing Vertical Reactions(Ibs) Detail Other Width Length Live/Dead/Uplift/Total 1 Stud wall 3.50" 3.50" 2444/955/0/3399 Al: Blocking 1 Ply 1 3/4"x 11 7/8"1.9E Microllam®LVL 2 Stud wall 3.50" 3.50" 2444/955/0/3399 Al: Blocking 1 Ply 1 3/4"x 11 7/8"1.9E Microllam®LVL -See TJ SPECIFIER'S/BUILDERS GUIDE for detail(s):Al: Blocking DESIGN CONTROLS: Maximum Design Control Control Location Shear(Ibs) 3329 -2864 11845 Passed(24%) Rt.end Span 1 under Floor loading Moment(Ft-Lbs) 13282 13282 26772 Passed(50%) MID Span 1 under Floor loading Live Load Defl(in) 0.333 0.399 Passed(U575) MID Span 1 under Floor loading Total Load Defl(in) 0.463 0.798 Passed(U413) MID Span 1 under Floor loading -Deflection Criteria:STAN DARD(LL:U480,TL:U240). -Bracing(Lu):All compression edges(top and bottom)must be braced at 2'8"o/c unless detailed otherwise. Proper attachment and positioning of lateral bracing is required to achieve member stability. ADDITIONAL NOTES: -IMPORTANT! The analysis presented is output from software developed by Trus Joist(Ti). TJ warrants the sizing of its products by this software will be accomplished in accordance with TJ product design criteria and code accepted design values. The specific product application,input design loads, and stated dimensions have been provided by the software user. This output has not been reviewed by a TJ Associate. -Not all products are readily available. Check with your supplier or TJ technical representative for product availability. -THIS ANALYSIS FOR TRUS JOIST PRODUCTS ONLY! PRODUCT SUBSTITUTION VOIDS THIS ANALYSIS. -Allowable Stress Design methodology was used for Building Code BOCA analyzing the TJ Distribution product listed above. -Note:See TJ SPECIFIER'S/BUILDER'S GUIDES for multiple ply connection. PROJECT INFORMATION: OPERATOR INFORMATION: SCOTT QUILTER Bill Rubel 33 CONANT RD Mid-Cape Home Centers BARNSTABLE MA PO Box 1418 465 RTE 134 South Dennis, MA 02660 Phone:508-398-6071 Fax :508-398-4559 brubel@midcape.net Copyright v 2003 by Trus Joist, a Weyerhaeuser Business MicrollamS is a registered trademark of Trus Joist. °FTMET°�� The Town of Barnstable 6ARNSTABI.E. : Department of Health Safety and Envirolllnental Services MASS. Building Division 367 Main Street,Hyannis,MA 02601 :e: 508.862-4038 508-790.6230 PLAN laEVIEw Owner: NAU I-t Map/Parcel: 17"? '07 b Project Address: '!1 3 C-o Builder:_ J C-44 �-tr— i The following items were noted on reviewing: zc � - s? 3bx36� lzu Reviewed by: LIL . IgI �Z�.O j •/ i J3 Assessor's map and lot number f . Q Sewage Permit number ........................................................ Z BABBSTdI1LE, i House number ..................... .. .................................. 9�G "639 e�0 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... ........ G?°` �'.......... ..................... ............................... TYPE OF CONSTRUCTION . `'... n t........>.>..:: ...................................` �! q ................................................... j' U' . ..:...... ...........................19...... TO THE INSPECTOR OF BUILDINGS: The undersigned -hereby applies for a permit according to the following information: A Location / ........./ .,,� ........... �• :�'',��:......... ..............................................�a ..... ........... `................. ............ Proposed Use ... .....%r..! ..... gy ro s:-a:...` .... u� .11,12 zo.................................................... :...... ` .......^ Fire District Zoning District ........� ..•• � "• Name of Owner ... R614 ". �i)�1 .. ....`""...... ........Address ..... .........)4: .......:......c• ✓G f .f 1�5 ✓'�'% �. Name of Builder ' ..........................................Address ....................................:............................................... Name of Architect .......... 'Z.n- .{.........................................Address ....... ... ......'�............................................................. Number of Rooms ........... ...............................................Foundation Call........................................................................ 11 Exterior ..................... _......................,.................Roofing ......:......... .......... .:4r---W- 4e ... ................................................ Floors /�',-.I.AOA..?............................`.................................Interior �� Heating �., . .. � ............................Plumbing ..........tt l...2.--.... . f ...................................... Fireplace ......... .............................................................Approximate Cost ........1........................................................ f Definitive Plan Approved by Planning Board ---------------____-----------19________. Area � f'S ....<..?. ....... 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. f f: Name .......... ............................ ........................... Lebel, Douglas W. A=173-76 No ......20948 Permit. for .....1..112..story. .. ....... .. single family dwelling Location 33...Con4.nt. . . ..Lane. . ...... .......... ...... . ...... . .. .... . .. Cen.terv. ille ...... . .......... Owner Douglas. ...W. Lebel: . ................... . ......... . . . ............... Type of Construction frarie ``.................... Plot ............................ Lot ........��1 :... f. Permit Granted ......slanuar.y...4...............19 79 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................. . .�. p. .� 19 .................. C. ........................................ ................................................................................ ...................n..................`.............-................... tf! , A7 .................... j Approved ................................................ 19 ............................................................................... ............................................................................... w . Town of Barnstable *Permit# O� Expires 6 months from issue date MUMSTABLE, : Regulatory Services Fee v039.MAM Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 X-PRESS PERMIT Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONEV 22 5 2002 Not Valid without Red X-Press Imprint TOWN OF BARNSTABLE Map/parcel Number 7Residential perryAddress ON NT cs 02401 Value of Work� ,1, Owner's Name&Address �Q/J MW2W 33 CANANT S ►S MA U 0 t Contractor's Name xL Telephone Number/_600 77/•Q Home Improvement Contractor License#(if applicable) 13 2( I Construction Supervisor's License#(if applicable) 7,0000 ❑Workman's Compensation Insurance 7ChQCk one; am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) &�Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going aver existing,layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum,44) ❑ Other(specify) *Where required: isuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature Q:Forms:expmtrg Revisedl21901 •e TOWN-OF BARNSTABLE permit No. 20948 t LY7fT.Yi 3 Buiing ulspeCtor ...� .. .Cash -------6�, OCCUPANCY PERMIT Bond X _ . "-No building nor structure shall be erected, and no land, building or structure shall be used for a -new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building.Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Douglas W. Lebel Address Box 164, Marstons Mills 1 nt icl 6 T1 Conant Tana Centprvi l le Wiring Inspector F; -� Inspection date . ; g Inspector ;� Inspection date Gas Inspector ( lI r9 Inspection date /Engineering Department q. J Inspection date THIS PERMIT WILL NOT"BE VALID,'AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. N - � 19 .............. Building Inspector _ _. rt v ?a-:T k,c i°t,+P+ rt .,.mr c. j,,, •�,., f �ra�. A h ,:.r: � +�r�y; �'v '� j{:F ti i. i a A� �i+}, r B's�4 dt - +3 ty� �' r x 'r� �:'1 � + 3 :' '•f tx �� x ! .kr'." A.� �� -r �4 / ri+' !��' ,'M �'S ,,/� �'L a� -. z a :' i v :, + 4 €..7� t { s,•. t.w ,4+ •:�1zi�` €5 �""r �+* '�C� ��+{ x4#�' "a 1`*# Fy ��{�A 8y! �'Y r.�i„:;,Y s, -..! ;s -' °''t _ y ] ,. "'° �.:* �4 �v � t �t t k��rt R � � a�, r a�� ,?� .�f�y i,. �`�'ti � ,-} t t� • S t ��. i - sl •; !f � .t r - � r . 'r< �. ! a� uC :s y1 z 4 ! - .: r' is 1`� � •:� tintk su Ar.4 �� l r1 r• t ^n3 ? "<#c+.t t 'ki V t x r t S.£�, r• }'�' s•' ! r� � a =k is °,�.al`+^ a • z� ��`+r4� (x�fPr r l��j��.�*�1.✓ua� t�l?a � "' a#t n`Ft ! ! t i{ 5 �/Vj�, 'ta �� f o ,,� } 1 "y, t4 far ��jp r}7 is a by r r5rt fir .P"'r9F k�`T' #"'' �,}! �' y•.:'�`,vdr"`� eft-�"Y'r� f ar.s i$ � V ^� � i gt ' `� d1 > h �:1� �� S �t .+ ' ,Y_'a��t1 � dJ .• f .�[N, ?!'r 1 }r'y''} �x Y4" Sf � i:� r1 ) S ,t� ,. 2 t r 5 J k 4 q Y i _•p�,4•r y* .'%Yj�p!Ff 1 :Ara}� � }#5}7 y Is 1 t� ��,�' "' � .y�.r +f 7 ant. a__ � ! '.•n, �7 t r � Y ..1,5.•. A 1 �' '� �`t #y „��y i�3 Y v. :�f r �,•. .� ! ri a •�' r}t --..a f v. r yy'' rr \! [ �! 41 '' I � � t� ,a�_-.��.� -:. � a;., d 1 '17/Z ° y�r �+ rh N''t:'rt^�`� {S'a � S•ASn.a ,{d t'v 5 t Y y�A //��,,� Y},} '..'.�; �O 1 Y H E S kph t, t � ¢v�f�•O (� xt.�b '4 _ �{` � .# "--yF""�"�1{ �,�� --„�`�t"FSS"��„s"�^F�..,,�-,�,�^,�.}+y�, ��-w'�+,xa� `�;s�,�- t r,_•5- f �.,-.�,:,�,. -t v wt,r t e x ire:. i f •t � Tex � ..2 �y �Fh,Cfr z .� � ; 1 � zlJ"' a :. �^'t7 v `F { � , r 4;S Jt. /� ;-:•• iY ... � ,; ',/ � � fir {N I s: y �'.r ..� ~�ti ..;) "i •�. �.+'�{t .ft. �Q4 i Ai •t .x .dS y \ - t` v 4Y � � _ t , Q 'hi [ �.'' � •=t 1r,r ..�.�! '�y •� � - � � `"' t -x t tx +�I�lF SAS r !'2 s � ! a *F ti r Q91 o S4� ;?tt"�- ,.,a d� .� �� y. at •,' $ } t 1l•.. �. �t7�,.#t �tV[`.iJ r Str � � - Alt CERTIFIED PLOT PLAN, L 1/4 A/:T L.e4/1IC EW y,CONSTRUCTION ONLY CEA/7 L= d�/L.L:.:E' I / _ TOP OF` FOUNDATION IS FEET ' IN , A80VE , LOW POINT OF ADJACENT, , t F �' •�lF�� .�5� �1�� +1.' e A ROAD. ` t SCALE /''_y p .F DATE : 3 Z 7cl EL DREDGE ENGINEERING CO.IN =•,,:I CERTL Y THAT THE DVN�A-r/oAl, F CLIENT 4946E I EOISTERED� �REOISTERED — SH'0_WN ON THIS PLAN IS LOCATED CIVIL I LAND JOB N0. Z7�' ON THE GROUND AS INDICATED AND A ryt CONFORM TO .THE ZONING LAWS ENGINEER SURVEYOR, DR. BY —at - :.A R n�`T 't� -A -S 33 NO. MAIN ST ` 712 MAINST. CH. BY .� ?3 YARMOUTH, MASS. HYANNIS, MASS. SHEETS OF _/_, DATE REG. LAND SURVEYOR I A s ssor's map and lot number ................ 7 .. PfiiO SYSTEM MUST B THE Sewage"Sewage Permit ?rmrber ......................................................... INSTALLED IN COmPLIANC WITH ARTICLE II STATE - Z BAHHSTADLE, i House number ..................... , ... ..........................`......~ SANITARY CODE AND TOW 90 Mb a RECI,JLA•TI'ONS. o 139. \0� ' 11 Mpy TOWN OF B.ARNSTABLE DUILDI G 1111APECT0R APPLICATION FOR PERMIT TO ..... lay.c�4....... �:". :"S ......... .................... .............................. ... .:..:. .... TYPE OF CONSTRUCTION ... .il 7 .�G....... !�..c.. ........�t.•52 ...`. .................:............................... ...a^.............................19.�� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordin,q to the folLowincinformation: Location .....f .1....... 1. .........L '!.. ....... �.......... ...✓.4.`.. ..... . :.................................. Proposed Use ..... . ... . rG41.! Lc�r'.(!..`. ............................................... LA Zoning District ...... c............................................ .......Fire District ... {�l..i"` ....... ..... .....`. ... ..... Name of Owner ... . .. . . ...."`'`...... .......Address ..... .....1�. Z t .�`7!'/ ✓"! ..............�3,(0 ............... �...... C Name of Builder ........ ........Address Name of Architect .......... -0_f........................................Address ..................... Number of Rooms ............ 01............. .................................Foundation ...... Exterior /� �...' `f ,ll Cd..... ...a�� : � .1 ........Roofing .......At mac. t .................................... Floorsrs ........................................................Interior .... 44 ..V.—. Y, ............................................. ll Heating 4!1r.. .....�?�5. ... .fir �f............................Plumbing ....... p(�eS ��,. ............ Fireplace ..:.........e;V;C.-5...................... .....................................Approximate Cost .......A;�6...1 .0.a ....%.Q..Q.Definitive Plan Approved by Planning Board ________________________________19________. Area .....;F�....8. ....... �O Diagram of Lot and Building with Dimensions Fee .. .........3........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstab a regardin the above construction. Name ..... .. ... ...... Lebel, Douglas W. ^ / ' ! . ' 48 l I/2 story ` ...��h .-. Permit for .................................... oingle family dwelIin� .----��-----.---. ~---------. � - ' ^ 33 Conant Lane - Location ------...............----------. ^ ' Centerville -.---.------.----.---~--.�---.. . - Doo�lam V�. Labml Owner ---------------------'. frame ' ^ Type of Construction -------------... ' ^- '. . . --------------------------' . - #lb Plot ............................ Lot ................................ ~ Permit Granted ..........January..4...........l0 79 � Date of Inspection ------------lV - . - �� ~~'~ Completed ` ^ ` PERMIT REFUSED ' .l�--~-._-.^-----.--~---- / ` ' r __ � ---. -- � ��.. .-.._ - ' '--'�^^—cr-~'-~`r~`~-°v'''~- ~ -'-'' , | ^ � . `-,_.-- - ........................................... lg � . -------.--.----.---...~...-.--^- r , ' . ' ' , -------.---.------~.-..~......, . F ~ ' . ' ` . � . _ ,. .,, . . . .. . ,. .. . . .. . . . . .. Ala SMOKE DETECTORS REVIEWED' . : O RTAAI l' + . :: . 1 �P g DATE ,. TA . . ,.. REIIUI ANY CONSTRUCTION THAT INCREASES LIVING SPACE L BUILDING'DEPT BEYOND; 1200 SQ Ft PER LEVEL MAY RE THE ... INSTALLATION OF ADDITIONAL SMOKE DETECTORS'' p . .. , . , . FIRE DEPARTMENT DATE' . _ . 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