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0080 CONNERS ROAD
_� ..�, �,• , . , : ., . ,- �, - _ �• �. ,. .• :_ . . ., • r� .. , ., r � _, r . o � :1 � ., � .. re-� r.. � �' .' .h .. L - ._ � _. � - � � i . ��u I'�' - ,_ _ _. n _, ,. � � i .. A4 ._ ? Il � 4 1il U 4 Ad lo�W- -d�L v_mlo_t 40 N 1, or so/ Town o 200 Main Street, Hy a Application r Application No: TB-18-1942 Job Location: 63 ENTERPRISE ROAD, HYANNIS Permit For: Building Sid ing/Windows/Roof/Doors Contractor's Name: BRYAN E LAUZON Address: South CARVER, MA 02366 (Home)Owner's Name: LAUZON,LINDA& MAHAN, LAWRENCE JR TRS (Home)Owner's Address: 443 FLINT ST, MARSTONS MILLS, Work Description: Roof Total Value Of Work To Be Performed: $24,000.00 Structure Size: 0.00 j VILOU AR - UO gaf P>;C ?. fb (� A LOT LOT V \ vS op 9'� 20, DgC� DECK ` W \ O � \ t9 12 LOT 63 glJ R'255 NOTE.- PRE—E' ISTING NON-CONFORMING c 0� RES. ZONE. i4D-1" This_ MORTGAGE INSPECTION BanklUseoO FLOOD ZONE.• "C" nl G TOWN: _�C10vTt-9PLLL1c_ _ _ REGISTRY OWNER: EDWARD 1 JR & EILEEIV A MAR5�t1AL_,L DEED REK 79�4,2 — --BUYER: _R08 RT—F_R07�NE — — _ — — — _ DATE: _4/1 i!97 PLAN REF: .,8.9,/63___ _ � — -- - — -- -- -- CALE]„= 4Q I HEREBY CERTIFY 1 U 5_�1VDWI ��O THAT THE77 I BUILDING C__ � Ass9� J SHOWN ON THIS PLAN IS :LOCATED ON THE GROUND AS ti� Y ANhEE SURV L� SHOWN AND THAT ITS POSITION DOES. CONFOR\4 PPAUTA. CONSULTANTS TO THE ZONING LAW SETBACK REQUIREMENTS OF THE MERI7f•EW TOWN OF ---BAWN TABLE____ Na320 jfs 40B INDUSTRY ROAD __AND. THAT A ARSTONS MILLS, MA.' 02646 IT DOES_ NOT _ LIE WITHIN THE SPECIAL FLOOD HAZARD ��FE55���PQ TEL: 428-0055 AREA AS tHOWN ON THE H.U.D. MAP DATED_B�19185 _ Y q l� SIJRVFj. FAX: 420-5553 Panel ,.50001 0005 C _� _ �-� THIS PLAN NOT MADE FROM AN INSTRUMENT PA L A. MERITHEW, PUS _--- SURVEY, NOT TO BE USED FOR FENCES, ETC. -90671 JF { t � r '� � mac �. �` � .�. 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S:w � r, .�ss�c B•£ - �:•efz^ a, ��- ��' �,. �.�a _ ;,. • � tit f r �r - can ICY gn fj`{ ♦ I - Y • v a. a . ' Town of Barnstable Buildln .: BAR .. �R ..P_oo�;h et:T edhs NsA aiUs CnCteairlr tdFif iinScaoa,ltTlenh,,.osa..pft eOrtcc t�csi�o�uV n�.as Hinb.a�c,ls:e:B°iFsert�o=eoR..n;me,a M s,tauha,�rede�eSdt rs euectha�y BA;u;Pp�ldromv esdh Pallal nNso�Mt�bues tO bcec`�uR re�rtea�dm Fu:_eh n"dt�,iol nar�JF.oinbRa a nInds�t`heicst Ci,oa*nr�°�.dh'aMs;u°bse,,:t e�bne m..Kaed p`te 163 Permit Pste W Permit No. B-18-2298 Applicant Name: ZEVITAS,JOHN T&EVERDINA Approvals Date Issued: 08/02/2018 Current Use: Structure Permit Type: Building-Restore to Single Family Expiration Date: 02/02/2019 Foundation: Location: 80 CONNERS ROAD,CENTERVILLE Map/Lot: 251-022 Zoning District: RD-1 Sheathing: N •� 111 Owner on Record: ZEVITAS,JOHN T& EVERDINA • Cortractor Name�,, Framing: 1 Address: 80 CONNERS RD Contractor Dense{ 2 x CENTERVILLE, MA 02632 Est Project Cost: $0.00 Is Chimney: ,Per Description: RESTORE TO SINGLE FAMILY BY REMOVING STOVE ermit Fe $85.00 ,HOOD AND REMOVE KITCHEN SINK. INSTALL NEW COUNTER TOP FOR STORAGE Insulation: Fee Paitl $85.00 UNIT. REMOVE REGRIGERATOR AND'INSTALLrSHELVES UPPER Date �. 8/2/2018 Final: Ll STOAGE TO REMAIN. _ p, _ add smoke co/heat7-37e �- ' Plumbing/Gas Project Review Req: Rough Plumbing: - t Building Official Final Plumbing: r Rough Gas: Final Gas: II This permit shall be deemed abandoned and invalid unless the work a Ahonzed by this permit is commenced within sik,Mbhths afterissuance. Electrical All work authorized by this permit shall conform to the approved applica, h1'6'nd the,approved constructionit ocuments for which this permit has been granted. 4 t.� 3 Service: All construction,alterations and changes of use of any building and structures'shall be incompliance 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 b'e rnamtamed open for public Inspection for the entire duration of the work until the completion of the same. - Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Final: Minimum of Five Call Inspections Required for All Construction Work: Low Voltage Rough: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Final: 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 Health 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Final: 7.Final Inspection before Occupancy Fire Department Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). r 7 r ill �t �G - M,CO2F/L r POD ySTi�.� J.GS PAS S //O.2/Z. jiccL .P IiJ�O,•�G//L� T2U55-TY,?= Z- 6 ewes C&L f0.-- �yF2Y Z f0�2�c S ' SQL/D A�JUI/D epe5�F,Eb.rs Fooriw G To r3�B1.00F! W, :G • - /9�3r - �,eos7- Y,t9LL -/v" x,a'--tv r i /fl 2aI 9 Giv-o ccrye— 4 POG 7- 6 D,L:�,uIX- � i ,O ri[.L �Co ,LDS �c,LJD 9.c'�rJUD 2acTs xIfLQ•✓c,2ETc' � { Q' FLP�-2 ✓oi.Sr/ -2 x 8-/G'lJ.C.^. � � � - Co�'T. s--9 r G.eariEL FO�JN0,9T/O/J e I 9�F•77.;7 G��2 � _ T:I N_ e i OI� - O t ' Tn✓vs rirSTi;G ixu Dili.=LL,CIS ��SFENT Y�GGn2 W 2,J/L J a1... �6�,5//GH�%G, X j%2-%J3�23�J AP,✓2T N9 I _ - 2�0 {`� LJ Jj 9B� .b Bc0,2COiL1 � �� " �i p.Fis7ovS 6USTi�iG /1C.1. .� f q x 4 SUFRMT D� � yr ro zirye/Ear,V svos i A^ c 1_� � EXIST//JG /sr FEU Pam, - y a� t Application Number. .. ... ......... + � . Bull-DING,DEPT. Permit Fee ..................... ... sees. .......Od=Fee .. ....:...... JUL 312010 TOWN OF SAMSTABLE Total r=Paid..... . ... •--....... . .......... TOWN OF BARNSTABLE " Permit Approyalby..... ....................... o�... .................... BUILDING PERMIT Mv.....C ...............Pam....:....: C��....... ...:.. APPLICATION Section I—owner's Information and Project Location Project Address D �y�� S I Village ti ,.Owners Name oAll Owners Legal Address City - -s State zip ���l�=- Il# 1( E-mail G= f TZ Owners Ce —� r Section 2-Use of Structure Use Grroup _❑ Commercial Structure over 35,000 cubic feet Commercial Structure 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 Basement ❑ Family/Amnesty ❑ Fire Alarm ` Rebuild ❑ Deck Apartment. El Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Renovation Pool ❑ Insulation Other—Specify Section 4 -Work-Description Woo v�Q Tact nndafed-219=1 8 -Application Number.............................., .................... { Section 5-Detail moist- frogoseck 4 'o i Square Footage of Project g Age of Structure 4 Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms(proposed) t _ 110 MPH Wind Zone Compliance Method E IMA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District [] Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information 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.liad-relief from the Zoning'Boaid in the past? ❑ Yes ❑ No Last undated_n2018 '.. -' 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 Tip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contwtors 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 HZC... Signature Date Section 11—Home Owners License Exemption Home Owners Name: Telephone Number, — 71 .E G/gam Cell or Work Number s j ��l d� it 7/ 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 b 780 CMR and the Town of Barnstable. Signature Date 7,1 Z APPLICANT SIGNATURE Signature Date Print Name Telephone Numbera " 2 E-mail permit to: J 7Z �U P r-..a....a-.-a.It mnni 0 Section 12—Department Sign-Offs Health Department ❑ Zoning Board Cif required ❑ E storic 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 L , 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: (Address of job) ' Signature of Owner daze . i Print Name Last=&ted 19/201 S r .9 z ,. ,*.• ,.,yam.. 3v •E. .r 4¢ S1 ' r, 1 ,1 Assessor's offioe (1st floor): Asses{or's map' and lot number .... , ...� C--k— ail > Q�pfTNEtO`1 .... ,Board f Health (3rd floor): �Au.-- M CORAPU Sewage Permit number ......... ................. VATH TITLE 5 t BaaaszAM, Engineering Department (3rd floor): c �.`F, �wqh ® gm rasa L ��V ; - r F6t sE�u�EE TAL COD ��0 1679. �00� House number ................................................................• R ..� p OYpY d' E G��'6A REGULA,�°0 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M.- only, apPRQV1r.D e �onaervatio3t T N OF BARNSTABLE � Date INSPECTOR APPLICATION FOR PERMIT TO ................. 1 ..........r'................ :: ............... TYPEOF CONSTRUCTION ..................................................................................................................................... ..Z �.............19....87 TO THE .INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ^ .. ... .... [(.� ............ Proposed Use /............... sL% .:... .. . / ...............................................Fire D' trict.. ..... ..... ................................................... Zoning District ..... Nameof Owner ..... ....... .. . .. . .....Address .................................................................................... Nameof Builder .... ...... ...Address .................................................................................... Nameof Architect ..................................................................Address ............../...................................................................... Number of Rooms ..................................................................Foundation ....... ..................................... Exterior ..........t.4P�J It?. .. '-5...............Roofing ..............Sp�c /9L7 .. f/t,��S.......... Floors ..............0 AK4.�.-r6...................................Interior. .........A; A)4.................................................... Heating :..........~................................................................Plumbing i Fireplace ..................................................................................Approximate Cost .. ...(..S d6 Definitive Plan Approved by Planning Board ________________________________19________ . Area ........ � /.... Diagram of Lot and Building with Dimensions Fee © b® SUBJECT TO APPROVAL OF BOARD OF HEALTH ke f / v �Il OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . . .... . Construction Supervisor's License .... K! ............ BOZENE, JA0E BROWN . Permit lild -~ ' Accessorv- , . .~=x =' Location ....}0...��g[yi���� ------- ' . ' ` ' ��� .............................. p� ene - ''— -----.. ' —J-me ------- ^ ^- Typeof_Cnns�uc�on . ........................... � -----------. .-- ----------. . ~ F1o* ........... .----- b» -- ' --------' .^ 'u ` ' Permit Gronlexd --.Octobe�-2�l.r—]9 87 -` ^ . . ` ^ � Done of Inspection ------' ---lV no Date Completed `---^�- ^.��r —]c�$�� . . ^ ^ . ' ^ `^ . ~ ' I Assessor's offioe (1st floor): —'� _ ,. p�y ,Asssor's map and lot number .... '`'� se FtNEro� 1. Board of Health (3rd floor): iO Sewage Permit%number ......... .r. .!..'. .7..................... Z BARNSTABLE Engir►eering Department (3rd floor): ras r ' o �Oo 1e39. Houstnumber.' ........................................................................ APPLICATIONS?PROCESSED 8:30-9:30lA.M. and 1:00-2:00 P,M.'' only I TOWN OF ' BARNSTABLE INSPECTOR APPLICATION FOR PERMIT TO ................ Alt f ......G.................................... E'.. ............... TYPEOF CONSTRUCTION ............................................................................................................ `.� �...`-�- / --........-- 19.... . r— TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..................... ......... ... 1 .r. ..... --r�..................!....';.. !.. �..P.:. r..: �*: .. 1,/i�5............. Proposed Use °a' ..... ... ...: �..........:,.......................................... y Zoning. District._..... tl, tP i ........... .. .... A Nameof Owner L .................: . ..... A�ddress .................................................................................... Name of Builder s- n ..:Address .................................................................................... Name of Architect ........................:'Address C'Dn1 Cg,7 Number of Rooms .............:..... ............................ ....Foundation Exterior .......... /:�./.u.4 .�..�"� %... Ro'oflngI•........... �Z47"...J /W•�•�.......... x ,..r Floors d/•v •/ T ........:.........Interior' �.............. ...... ........: t _. . 1116 A) — -FteatFng Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .. ...`5 OO.C� 2...........................�.. ,Definitive Plan Approved by Planning Board--------------- --------19-------- . Area .......(m.. ..T...... .'. Diagram of Lot and Building with Dimensions Fee ............ ....""................ { SUBJECT TO APPROVAL OF BOARD OF HEALTH t - OCCUPANCY PERMITS REQUIRED 'FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above --construction. r ` Name w .... ..........." a. ' Construction Supervisor's License T ROZENE, JANE BRUvVN A=25,L-022 L No Permit for B U-1 1VG*a*ra ge. Accessory :�txn ,1D-*w***e 11 ing ........... ........1........................................... Location .... ..,.......W-.C.9nr.s........o R.. ..a..d ., .................. .. .....n...e... Centerville ............................................................................... Owner ....Jane Brown Rozene .............................................................. Frame Type of Construction ........................................... ....................................................... .............. ........ Plot ............................ Lot ................................ Permit Granted ...October 21..........19 87 ........................... . Date of Inspection ....................................19 Date Completed ......................................19 X A 7 t E gineering Dept. (3rd-floor) Map �J Parcel Permit# - 4 House# 2-0 0` Date Issued Boak of Health(3rd floor)(8:15 -9:30/1:00-4:30) ,0 7 0, s Coii�servation Office(4th floor)(8:30-9:30/1:00-2:00) - �� 88'I Planning Dept. (1st floor/School Admin. Bldg.) �� ►q /� Definitive Plan Approved by Planning Board 19 € ' WIT NCE ' IRONME TOWN OF BARNSTABL E AND r ✓,' n Building Permit Application OWN REGNLATIONS Project Street Address Village Owner �(��Y12� {�/}(�$ /�� Address �y ijn "Telephone v Permit Request � �- (#t � 4r�( /�i"m 47_j U tic-5 t"C�lAcr _ i Q161� .First Floor Z01 a square feet Second Floor NIA square feet Construction Type M A SorJ Q-y ALoc (a/+ 5 EM .,� E Kf577NY�— ( • OL'Ea_A^E 151-RzWk, Estimated Project Cost $ Jr-S'000 Zoning District ��_ Flood Plain 64 Water Protection Lot Size APP2a d 2WO so.F7: Grandfathered ❑Yes ❑No Dwelling Type: Single Family W Two Family ❑ Multi-Family(#units) Age of Existing Structure AFP"x Historic House ❑Yes No On Old King's Highway ❑Yes .®No Basement Type: ❑Full ❑Crawl ®Walkout ❑Other Basement Finished Area(sq.ft.) ; (SOX Basement Unfinished Area(sq.ft) AffkOk 1V 1,5 Number of Baths: Full: Existing New R Half: Existing New No.of Bedrooms: Existing�l" _New Total Room Count(not including baths): Existing _New _ First Floor Room Count Heat Type and Fuel: Q9 Gas ❑Oil ❑Electric ❑Other Central Air X Yes ❑No Fireplaces: Existing ! New Existing wood/coal stove ❑Yes No Garage: ®Detached(size) 02 �A&r r2 STt��y Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes a No , If yes, site plan review# Current Use 1IDStA Proposed Use e.Si rX°Pw+ jj Builder Information Name /fi C_ Telephone Number .Ire 3- �'Cj8=�01 /9 Address tl License# �a(aL S C 3 Home Improvement Contractor# 1;?-5 6�o Worker's Compensation# q' NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO f SIGNATURE Jp, DATE 7Z4/�2 BUILD4NQ PERMIT DENIED FOR THE FOLL�I G REASON(S) JFOR OFFICIAL USE ONLY i 1 _ Y PERMIT NO. zl DATE ISSUED t l MAP/PAR CEL NO. ADDRESS =`i VILLAGE OWNER - DATE OF INSPECTION: FOUNDATION �� q 1 ( * , x v n4 n ," ,,• - ' FRAME INSULATION FIREPLACE '- ,'ELECTRICAL: ^ ROUGH * FINAL-, PLUMBING: ROUGH>- FINAL; 17 1 GAS: ROUGf�I FINAL _ " r + f FINAL BUILDING .i ~ wr M 1 - r 7 DATE CLOSED OUT t ASSOCIATION PLAN;N(3. r ' r Building Sketch Borrower Client Marshall Edward & Eileen Pro Address 80 Connor Road City..Centerville COUrdy Barnstable State MA ZI Code 02632 Lender Anchor Mortgage Company, Inc. Wood Deck 38.0' Bedroom Living Room 12.0' 22.0' 20.0' Bath Bedroom 16.0' Kitchen Wood Deck 12.0' 18.0' I 26.0' f Bedroom Family Room 112.0' i 12.0' Den F 12.0' Wood Dbck at 12.0' 32.0' NFEW wogs- SKETCH CALCULATIONS Al :38.0 x 12.0= 456.0 A2:12.0 x 12.0= 144.0 Al A3:58.0 x 16.0= 928.0 A4:32.0 x 12.0= 384.0 A3 A2 A4 . First Floor 1912.0 Total Living Area 1912.0 Form SKT.BOM—'TOTAL 2000 for Windows'appraisal software by a la mode,inc.—1-800-ALAMODE The Town of Barnstable Department of Health Safety and Environmental Services - '°lfo Mos' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MG-L 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. Type of Work: �dl(x('t1�'1 Est.Cost M;S5000 Address of Work: 114,6_0 ONn)C)tS AOMS Owner's Name I✓-t)Lok L'b I V`Negbm' L_ Date of Permit Application: 3 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: 3 ems. mac. - 06 7066 Da a Contractor Name Registration No. OR Date Owners Name .w,.,w•.,,,s�..p,.'4 „+..,..ya.. r^• yr „ ...-s:,r b v�F ktno^�rcv.';\�' r +1+;+�,.. . .. $ • .• .. .. a .. ` The Commonwealth of Massachusetts Department of Industridl Accidents 600 Washington Street Boston,Mass. 02111 Workers Co m ensation Insurance Affidavit name location: rtl' v ' city J'l � phone# S 7/ `❑ I am a homeowner performing MI work myself. ❑ I am a sole proprietor and have no one working in any capacity Q I am an employer providing workers' compensation for my employees working on this job. company name JAL P o les hVC address f.�i.::Qee c E/iE�eeir city /'M eel ffri 7— /��' 61-77)(3 phone#: �����1��' �1/� insurance co. T O oiicv# le. ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: .......... company name: address: city: _... phone #: insurance co. ohcv# r cam anv name: - address: city. phone#. olicv# insurance co. . Fallure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties ofa-tine-np46-- 500 00 one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Me of SI00.00 a day against me. I understand that a copy of this statement ma ed to the omce of Investigations of the DIA for coverage verlflcadon. I do hereby rtify un the p d i of perjury that the information provided above is tru.-and correct Signature Date Print name 1-e Phone# � official use only do not write in this area to be completed by city or town official city or town: petmitNcense# ❑Building Department QLicensing Board ❑check if Immediate response is required ❑Selecunen'a rtmmice ❑Health Department contact person: phone#: ❑Otfter (revered 9/95 P1A) r' Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their ", an employee is defined as every person in the service of another under any coz�ac employees. As quoted from the "law 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 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 o: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor anv 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 - r r authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns 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. The affidavits may be returned io the Department by mail oress.other arrangements have been made. - The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. NMI The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Invest1gallons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 `.r MAScheck COMPLIANCE REPORT Massachusetts Energy Code Permit # MAScheck Software Version 2 . 0 Checked by/Date CITY: Hyannis STATE: Massachusetts HDD: 5973 , CONSTRUCTION TYPE: 1 or 2 family, detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance), DATE: 4-6-1998 DATE OF PLANS: TITLE: COMPLIANCE: PASSES Required UA = 126 Your Home = 125 Area or Insul Sheath Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 386 30 . 0 3 . 0 12 WALLS: Wood Frame, 1611 O.C. 428 15 . 0 3 . 0 29 WALLS: Masonry 256 15 . 0 3 . 0 15 GLAZING: Windows or Doors 185 0 .340 63 DOORS 24 0 .250 6 . HVAC EFFICIENCY: Furnace, 80 , 0 AFUE COMPLIANCE STATEMENT: The proposed building design represented in these documents is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate has been determined using the applicable Standard Design Conditions found in the Code. The HVAC. equipment selected to heat or cool the building shall be no greater than-. of t de gn load as specified in sections 780CMR 131 nd .4 . Builder/Designer Date " 4//,� r MAScheck INSPECTION CHECKLIST , Massachusetts Energy Code MAScheck Software Version 2 . 0 DATE: 4-6-1998 Bldg. Dept. Use CEILINGS: [ ] 1 . R-30 + R-3 Comments/Location WALLS: [ ) 1. Wood, Frame, 16" O.C. , R-15 + R-3 Comments/Location [ ] 2 . Masonry, R-15 +' R-3 Comments/Location WINDOWS AND GLASS DOORS: [ ] 1 . U-value: 0 .34 For Windows :without labeled U-values, describe features: # Panes Frame Type Thermal Break? [ ) Yes [ ] No Comments/Location DOORS: [ ) 1. U-value: 0 .25 Comments/Location HVAC EQUIPMENT EFFICIENCY: [ ] 1. Furnace, 80 . 0 AFUE or higher Make and Model Number THERMOSTATS: [ ) Adjustable thermostats required for each HVAC system.- AIR LEAKAGE: [ ) Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. Recessed lights must be type IC rated and installed with no penetrations or installed inside an appropriate air-tight assembly with a 0 .511 clearance from combustible materials and 3" clearance from insulation. VAPOR RETARDER.: [ ] Required on the warm-in-winter side of all non-vented framed ceilings, walls, and floors . MATERIALS IDENTIFICATION: [ ] Materials and equipment must be identified so that compliance can be determined. ` Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment must be provided. Insulation R-values, glazing U-values, and heating equipment efficiency must be clearly marked on the building plans , or specifications . a DUCT INSULATION: [ ) Ducts in unconditioned spaces must be insulated to R-5 . Ducts outside the building must be, insulated to R-8 . 0 . DUCT CONSTRUCTION: [ ] All ducts must be sealed with mastic and fibrous backing tape. Pressure-sensitive tape may be used for fibrous ducts . The HVAC system must provide a means for balancing air and water systems . TEMPERATURE CONTROLS: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. HVAC EQUIPMENT SIZING: [ ] Rated output capacity of the heating/cooling system is not greater than 1250 of the design load as specified in sections 780CMR 1310 and. J4 .4 . MISC REQUIREMENTS: [ ) Refer to 780 CMR, Appendix J for requirements relating to swimming pools, HVAC piping conveying fluids above 120 F or chilled fluids below 55 F, and circulating hot water systems. ----NOTES TO FIELD (Building Department Use Only) ------------------------- t . �• I•,� ✓� ZJOO)L)JZCY)tll�P,ILGUL O�✓GGIZJcIpT�lll4P�.if i v�i� .i \ MOART41ENT OF PU3L'IC.SAFETY '4 %uhSTRUCTION SUPERVIS OP."LICENSE. ulvr--- 'N ;,Expires: If Re' t'I j tetl To 00 18HN q LEOLA..NC 13 R,LUEBERRY UR . 'f i1CUSHNE"J" NFl 02143. t; , ��I •�,r w +.a._....• .. ..., .: ��y Ad,N.,l�yix4tivam'�r..,+v..�+w� Y t� Y� Restricted To: 00 1 - 55810 t � 09 - None 4 lA - 14asonry oily s LG - 1 , c i agflly iC e, Failure to t ` j �'O.Se7S d Cul i t edition of the 7 Yd55Z(hutiPi t' RI!lliiat);i Code g e fr• 'c!i'' utlQli of this ii "i�:; rL,{ � ✓ice�� �a��zi �� . HOME IMPROVEMENT CONTRACTOR Registration 125662 . Type - INDIVIDUAL Expiration 02/12/00 JOHN M. LEBLANC 13 BLUEBERRY DR . �coM 07� U�HNET MA 02743 ADMINISTRATOR IN License or registration valid for individual use only before expiration date. If found return to: One Ashburton Place Rm 1301 Boston Ma.0 1.08 Barnstable Assessing Search Results Page 2 of 3 Exterior Walls Wood Shingle Bedrooms 4 Bedrooms Roof Structure Gable/Hip Bathrooms 1 Full+ 1 H Roof Cover Asph/F GIs/Cmp living area 2168 Replacement Cost $239579 Year Built 1950 Y3 Depreciation 20 Total Rooms 6 Roomsf fir_ 333 p Land f CODE 1090 Lot Size(Acres) 0.55 " Appraised Value $579,100 Additional Sketches 1 ? Click Here for print version that displays all ske Assessed Value $579,100 $View Interactive Maps > tt. Sales History: Owner: Sale Date Book/Page: Sale Price: ZEVITAS,JOHN T&EVERDINA Nov 7 2000 12:OOAM 13351/144 $825,000 MARSHALL, EDWARD M JR&EILEEN A Apr 24.1997 12:OOAM 10715/199 $385,000 ROZENE, ROBERT F&JANE MARY Mar 15 1992 12:OOAM 7946/042 $ 100 ROZENE, ROBERT F May 15 1990 12:OOAM 7153/080 $ 1 BROWN,JANE M 2976/124 $0 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value BFA Bsmt Fin-Aver 1200 $ 14,400 $ 14,400 DKFL Dock Float 1 $37,500 $37,500 FPL1 Fireplace 1 $2,400 $2,400 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area UST Utility Area(Unfinished) (Finished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic Full Upper 2nd Story http://www.town.bamstable.ma.us/assessing/assessO6/displayparcelO6map.asp?mapparbac... 8/17/2006 Map Page 1 of 2 Town of Barnstable Geographic Information System New Search H. Parcel Viewer Custom Map Map Size [3 Zoom OutlIg" MMIMMUIn he(IF 49 lima""ry +- JPG Map: 251 Parcel: 022 F r F Location: 80 CONNERS ROAD I 251025 *50 Owner: ZEVITAS, JOHN T& EVERDINA 251024, #60 1 F Location Information Map &Parcel 251022 251tf2$.` Location 80 CONNERS ROAD 251028 #51 70; ': Acreage 0.55 acres ......._.........___...... ..___._,._...... ...................._..._..__._....._. 25102�3 Current Owner #61 Mailing Address ZEVITAS, JOHN T& EVERDINA s 80 CONNERS RD 25101. CENTERVILLE, MA 02632 \ � Appraise Value ( Y 200 ) 251021 251030 69 Extra Features $16,800 Out Buildings $37,500 m Land $579,100 41, 101 � Buildings $258,500 11 ` W, v # 480 " Total Appraised $891,900 5113 1�031 � Assessed Value ( Y 20 ) 1t} 72510 , Extra Features $16,800 251032 �� 97 Out Buildings $37,500 120 87 25103 Land $579,100 #74 Buildings $258,500 _. Total Assessed $891,900 Set Scale 1" = 90 I Aerral Photos ' Copyright 2006 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v0.2.8 [Production;] http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=251022&mapparback=address 8/10/2006 J f Barnstable Assessing Search Results Page 3 of 3 FEP Enclosed Porch PTO Patio UUS (Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/assessing/assess06/displayparcelO6map.asp?mapp arbac... 8/17/2006 Barnstable Assessing Search Results Page 1 of 3 r2 Home: Departments:Assessors Division: Property Assessment Search Results New Search New Interactive Maps >> Owner: 2006 Assessed Values: ZEVITAS,JOHN T&EVERDINA 80 CONNERS ROAD Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $258,500 $258,500 251 /022/ Extra Features: $ 16,800 $ 16,800 Outbuildings: $37,500 $37,500 Mailing Address Land Value: $579,100 $579,100 ZEVITAS,JOHN T&EVERDINA Totals $891,900 $891,900 80 CONNERS RD CENTERVILLE, MA.02632 2006 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $ 149.89 Fire District Rates Town Barnstable-Residential $1.90 $6.31 Barnstable-Commercial $2.51 Commei C.O.M.M. FD Tax(Residential) $945.41 C.O.M.M.-All Classes $1.06 $6.54 Cotuit FD-All Classes $1.33 Persona Town Tax(Residential) $4,996.26 Hyannis-Residential $1.61 $6.49 Hyannis-Commercial $2.50 Other Ri W Barnstable-Residential $1.60 Commur W Barnstable-Commercial $2.46 Total: $6,091.56 Construction Details Building Property Sketch Legend Building value $258,500 Interior Floors Typical This property contains multiples Style Ranch Interior Walls Drywall Please use the navigation below the sketch to bra Model Residential Heat Fuel Gas Grade Average Heat Type Typical Stories 1 Story AC Type Central http://www.town.bamstable.ma.us/assessing/assess06/displayparcel06map.asp?mapparbac... 8/17/2006 r ��FTHE 1p�, Town of Barnstable Regulatory Services ' sA �'MASS. � Thomas F.Geiler�Director 9 MASS. $ QD'OIF1 39- 0.O Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA'02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 August 14, 2006 Mr. John Zevitas 80 Conners RoadRoad Centerville MA 02632 Re: Illegal Apartment: 80 Conners Road Centerville Ma. 02632 Map 251 Parcel 022 Dear Property Owner: Our records indicate that your house at the above-referenced location is currently being used as a multi-family home,which is contrary to Barnstable Zoning Ordinances. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. Sinc el , Li dson Amnesty Zoning Enforcement Officer Building Department gforms:zoning3 ' 80 '..Conners d Cent 8-21 -06 a as Y � l z j s r , _ Y � a � _ � M a". r ' wr. S�Ft7 t�. a as � � \ \ ,\f �\ •1 1" VIA i4 yy ti u v ce; -_ - "` -� 3r�!;"1-- =- t= .,,c--•� r- _'c"'x"�,; 5��^�xs-++-- ._,s�..3' �.�: t a::.-o, r `'a.—r" _ �''.' '�Y: .zx�.t� _ - ,C�^.�c r� �r��'—'s` :'. £ r x's�',��''��.^ �-1- -� �' a �s�, Ly.4�' �`r�,�t...f,,+�ev.• ` :y7 � '� �"aCr .y .:sue ji � IN mil.. 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I I il ; ' i � � I '• II II NOT E C �,iY.a7.zT•`, E.oTd S/JS // ' 1) The following openings in exterior building3 envelope - / �_Zr ,,,�;T%,; �..;•(, .shall be chaulked, weatherstripped, foamed or otherwise �O i sealed to limit infiltration: :A.'Around window and door frames, between the _ - `� Fi• %5��- -:unit and the rough framing I - (,-30) ,B.Between allrexterior wall 30leplates and the structural'floor,.using two rows of chaulking or.alternate.approved procedure y /x CL/,2.2!c/G `7 C.Over all.1raming joints where floors over. .conditioned "spaces intersect exterior walls, using-a water vapor permeable infiltration barrier or alternate approved technique p�� - D.Around openings 'for plumbing, electricity, telephone +� S and gas lines in walls, ceilings and floors E.At openings in the'ceiling, such as where the - :ceiling-panels meet interior and exterior walls, - - _ - ��-2�CaoT c,4'v£ Y,vT W�SC.2E�tl it exposed beam*and masonry fireplaces .. 'GyF�✓A.F.T.. . .. r-�'�� F.At the mud31ll, ,.in addition to normal sill - ti:'-<5 „Ec��<•�✓tip _-. 3!0_.�. x-f M/a.:LS�/a�D.C. . sealed in conditioned basements -�_ r" G.At all other openings 'in the exterior building - 2 �'•�•X. (<XT.� envelope 7 CK 6XT O�P6e 2) Electrical outlet plate gaskets shall be installed on �y✓i/C,LES m2 G[9P9PDS the receptacle, awitch, -or other electrical boxes in �•• /'— exterior and interior walls.*-.. . q Dew y-•1 Z X;7—_� �' 3) Heating ducts shall be sealed at all joints and corners - specified in 2010.9. 4) ,Interior'openings between conditioned and non- C A;;. /1.S5V4 f conditioned space shall be sealed using sea lant,closed cell gasket material,'permanent tape, or another method that limits infiltration. 5) .Chimney firestoppinq; all spaces between chimney and 7-9n floors and ceilings through which the chimney may pass, shall,be firestopped with non-combustible material. 6) Firestopping; Firestopping shall be provided both vertical and horizontaly and form an effective fire barrier between stories,'and between the top story and the roof space:: It-shall also be used in;A.Stud malls at ceilings and floor levels B.in walls parallel to stair stringers - �F•��=% /'�^-�- . `C.Firestopping shall consist of approved non-combustible materials f _ IYO_/1"all II k:- f N � �3 Cn J j0c- Hf A v) < •�L J� Q �11 � � v { `k �tgbx am,.oi-77arff lgOG�Y o � a I - 1 %1..9/-&I t h anti � F ry q• cn��) � � e s , 1 ./rorliOvN -- � Q Q N \ o k 'tl - x 2 r--�ti I I LN����� 6{I .Uiu&4 o--,Fr A r h� 3� "L 1 � � v . � \�� ;+,� '". r ,M, .� as •,`",��.� t }'^« •�`'�l' x_ ',+. ,•� <(' `�" "-•t..� `' - -.4w, r« fit, .".. `:�� i ,' '•t c. i��+ S,;�' ^�'>R4 � �'�r R ++ ,O I ',+ 'j!,�� , lra,l� rk.�I�t , il� . 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'i •, •~, 1�" Y.- ' • r ' 4t •>t ii G Is)I& of Town of Barnstable 'Permit Oz Expires 6 nwnths from issue date Regulatory Services Fee HARNST v Mb '� 0EMARIard V.Scali,Director 3 JUN 0 8 2016 Building Division TOWN OF BAMSTA "CBO,BuildingCommissioner ain Street,Hyannis,MA 02601 www.town barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY V Map/parcel Number ('1 L 7 Not Yalirt,4hout Red.X Fress Imprint Properly Address '�-D 0D)J,0F_?_ t Residential Value of Work$ �` ,�e�y Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address J061 2(N\TRS OD,&�M W, CysvTE9VILLY,_ Contractor's Name 1"TEV [ -t—y-D��/ Telephone Number 's e�� �?JiJt Home Improvement Contractor License#(if applicable) `i 1- Email: Construction Supervisor's License#(if applicable) CS 106 —ac)q ❑Workman's Compensation Insurance Q&k.one: (� I am a sole proprietor ❑ I am the Homeowner ❑ f have.Worker's Compensation Insurance Insurance Company Name Workman's Comp..Poficy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Re rest(check box) ,/ El Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 7olR.1'1 q!!. q ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.32.)#of windows #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: jcopy ty thvne ust sign Property Owner Letter of Permission. of the o e Improvement Contractors License&Construction Supervisors License is d. SIGNATURE: C:\Users\Decollik\AppData\Lora]\Microsoft',Windo sUemporary Internet Eiles\Content.Outlook\2P10IDHR\EXPRESS.doc Revised 040215 DREAM HOME IMPROVEMENT 60 Franklin Ave, Hyannis, MA 02601 PHONE 1-(508) 332-8119 CERTAINTEED LANDMARK LIFETIME-ALGAE RESISTANT ARCHITECTURAL STYLE RE-ROOFING PROPOSAL November 4, 2015 JOHN ZEVITAS 80 CONNER R® CENTERVILLE, MA DREAM HOME IMPROVEMENT herby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and haul Away All of the Old Asphalt Roofing Shingles. Supply and Install CERTAINTEED LANDMARK AR: COLOR: MOIRE BLACK. Supply and Install 8" WHITE ALUMINUM DRIP EDGE on All of the Eaves. Supply and Install ##15 BLACK SATURATED FELT ROOFING PAPER. Supply and Install CERTAINTEED WINTER-GUARD (Ice & Water) WATERPROOF UNDERLAYMENT SYSTEM on Roof the Eaves & under the Step Flashing on the Chimney Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on the Entire Main Ridge. Aluminum and Neoprene Soil Pipe Flashing Supply and Install ALUMINUM WINDOW & DOOR FLASHING Clean and Remove Debris from work area after job is completed. TOTAL INVESTMENT -----------------------------$ 17,250.00 PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final payment for the Balance is Due Immediately Upon Completion. WORT( SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 45 Days of Acceptance'and Receipt of Deposit Providing the Materials are Availableo Please make Checks Payable to: ALEXEY LEBEDEV DREAM HOME IMPROVEMENT Warranties the Shingles and Labor for 10 Years. CERTAINTEED Warranties the shingles and labor 100% for the first 10 years and the shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the shingles up to CATEGORY III HURRICANR-130 MPH WIND WARRANT. CERTAINTEED Warrants the Shingles to be Algae resistant for a Full 10 Years. DREAM HOME IMPROVEMENT Carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: ACCEPTED BY: -�9y�� 2c�►�1��3 JOHN ZEVITAS ALEXEY LEBEDEV HOMEOWNER DREAM HOM MPROVEMENT f [ Massachusetts -Department of'Public Safety Board of Building Regulations and Standards Construction Supemsor 'z License:CS-108208 ALEXEY LEBEDEV 60 FRANKLIN AVENUE it . Hyannis MA 02601 Expiration Commissioner 11/27/2018 L/12•P `�fy`�'Yl-/j'd2�/J?�G(�G�CG117/fG t�i �^��%LLdi:�C?iG1?iLG.2P�/,� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 176777 ` -.. Type: LLC Expiration: 9/25/2017 Trk 270447 DREAM HOME IMPROVEMENT LLCj' - ' a , ALEXEY LEBEDEV w $ 60 FRANKLIN AVE. HYANNIS, MA 02601 "� - ----- Update Address and return card.Mark reason for change, SCA 1 c, 20M•05n1 Address [1 Renewal ❑ Employment Lost Card --- _�__ __ __����t`avrrr:ra�ervefr�C�o�C�/f(rsstrc�rr�r•/f ��� � >y �.y Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: �17fi777 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration::' 9/2e12017 LLC Boston,MA 02116 DREAM HOME IMPROVEMENT-LLC.' ALEXEY LEBEDEV t 60 FRANKLIN AVE. } _ HYANNIS,MA 02601 Undersecretary Not valid without signature The Commonwealth of Massachusetts W Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 "r www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/organization/Individual):Alexey Lebedev/Dream Home Improvement LLC Address:60 Franklin ave City/State/Zip: Hyannis, MA, 02601 Phone #:774-208-3589 Are you in employer?Check the appropriate box: Type of project(required): 1.®I am a employer with employees(full and/or part-time).* 7. New construction 2.[:]I am.a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3.®I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition 4.®I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions proprietors with no employees. 12.E]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-contractors have employees and have workers'comp.insurance: 6.r�We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 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 are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the'name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certify un er the p in and penalties ofperjury that the information provided above is true and correct. Signature: Date: re Phone#:774-208-3 89 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board ofl-ealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person; Phone#: '`�c R CERTIFICATE OF LIABILITY INSURANCE °A `M"11°°"YYY) `� 1 12/15/2015 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(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 NAMEACT Ashley Paiva Southeastern Insurance Agency, Inc. PHONE (508)997-6061 FAX (506)990-2731 ,No (AtC.Nol: 439 State Rd. ADORESS:apaiva@southeasternins.com BOX 7939E apaiva@southeasternins.com ff INSURERS AFFORDING COVERAGE I NAICA North Dartmouth MA 02747 INSURERAArbella Protection Insurance 41360 INSURED INSURER 8 AEIC Armen Safaryan, ABA: Corey and Corey INSURERC: 67 Sea Street INSURER 0: INSURER E: Hyannis MA 02 601 INSURER F: ��--- .COVERAGES CERTIFICATE NUMBER:2015 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. ILTR POLICY NUMBER MM/ DMIDD LIMITS TYPE OF INSURANCE ADD $ BR POLICY EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE Is 1,000,000 �7r D''�� 100,000 A ��CLAIMS WADE a.00CUR DGEli PREMISES Ea occurrence 1$ 9520046441 9/18/2015 9/18/2016 MED EXP Arty one person) $ 5,000 H E PERSONAL&ADV INJURY S 1,000,000 GEKL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 11f O. X i POLICY JET LOC PRODUCTS-COMPIOPAGG $ 2,000,000 i i OTHER: Employee Benefds S AUTOMOBILE LIABILITY COMBINED SINGLE LIMB $ Ea__ Aew ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOSNR3EU PROPERTY DAMAGE S Per axkiem !$ N UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAS HCLAIMS-MADE AGGREGATE $ DIED RETENTION$ S WORKERS COMPENSATION PER OTH- ANDEMPLOYERS LIABILITY YIN T STATUTE ER ANY PROPRtETORIPARTNERIEXECLrTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBER EXCLUDED? � N/A yandatdescribe (Mandatory WCC-500-5015091-2015A 9/18/2015 9/18/2016 E.L.DISEASE-EA EMPLOYE $ 11000,000 DESCRIPTION OF OPERATIONS baloiv I E.L DISEASE-POLICY LIMIT $ 11000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddttIonal Remarks Schedule;maybe attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Display Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ashley Paiva/AMP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2014o1) - ' Town of Barnstable *Permit# c. D U /b (-7W Expires 6 months from issue date '� Regulatory Services Fee 1 � ® 55S Thomas F.Geiler,Director JIJ 4 NO Building Division �LETomPerry,CBO, Building Commissioner ,I/ Uj l �i� 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 a 0� � Property Address 15-0 r_jj4, - ,ea Q MO C!,e�eiQ U j t t P ,1 • residential Value of Work 000 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address -1419 h `7-1�(/.17(-C Contractor's Name 7 L!i �� Telephone Number 157 —-2 7/ !27 C Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 0 07 ❑Workman's Compensation Insurance 2pekone: I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to �n Re-roof(not stripping, Going over existing layers of roof) Woo'ke-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *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 is required. SIGNATURE: Q:Forns:expmtrg Revise061306 Snow Construction TRIM COVERAGE SPECIALISTS • VINYL SIDING COMBINATION WINDOWS &DOORS• REPLACEMENT WINDOWS • SEAMLESS GUTTER SYSTEMS Licensed Massachusetts Contractor 8 Homeport Drive Lic. #007855 Hyannis,Mass.02601 Member of the Better Business Bureau Telephone 771-9366 Date ..61?...C.. ... .... Purchaser's Name d0A h {zZ;"-A Tel. No.,�;-C)k -7 Z/ — Address ffC0 fin PURCHASE AGREEMENT - - - CONTRACT AGREEMENT I/We, the owner(s) of the premises mentioned below, hereby contract with and authorize you as contractor, to furnish all necessary materials, labor and workmanship, to install, construct and place the improvements according to the following specifications, terms an onditions,on premises below described: Owner's name Tel. No. Job address ,!!�An71 City State REPAIR WORK: No repair work shall be done, except as herein specified and expressly agreed to in writing by the Contractor. SPECIFICATIONS o, /)( 7r//� S/f� 7-14-6 C 6/4r`f e /' A L C r5-1-r-C ,'/01-0 021416 � Uri�� 7�Yy� /� /��vt e --� _�y✓�f'' GY ) 5�'�S7-A C e`2 rlfi tirP�a o 4-- A C L -<A-" s v ti>/G Zouli-e/2 i Cc(2—ets",.4-16 /7—/* eAl't /&W( wal» (vti l/ot,-s-e x-w G11xJXG-e 1222 t 0 2C. G v L � =`,�{G —A-9/Eel e Cale Z--eft BUST S'vd°P�� A�cr� ti �-tA C._ 1/1�5/L SnI=/-/T �i��eG f ©1i --- G/7 /Sl?/tS -tri R-e 1 is r xq P o eon 'L 4A 6. C. I t cry vdp-er�, Gt c e S�v Materials and labor to cost$ � atbown Payment$ Balance of DUE UPON COMPLETION. (j 50 Contractor will do all of said work in a workmanlike manner: Owner agrees that in event of cancellation of this contract before work is started, Owner shall pay to Contractor on demand. Twenty-five per cent.of the contract price as liquidated damages for the breach. No work to be done on this property other than that specified in this contract without additional charges. All verbal or written agreements not mentioned on the face of this contract are void, and no salesman has any authority to change, alter or add to this contract in any particular. This contract contains the entire contract between the parties. A copy of this contract is hereby acknowledged to be received. ; --- This contract is subject to strikes, accidents,or other delays beyond our con o I WITNESS N' HEREOF the parties have hereunto signed their names thi day of '� %%� 20-- Rk Signed ftepr sentalive Owner Accepted: CONSTRUCTIONSNOW CO. signed _. By _ Business Certificate filed under Mass.General Laws with To •n Clerk of Yarmouth.' 1 B°a r r d°�Buildinga c Hph1E gutatin �MPRp s and St Regrs atr tr on:V EMENT CpNTRACandards ' lJ Exprat►on 1.12818 TpR ;• -1?7/20 p8 SNOW` Ow Type pBA Tr# 129 JOHN LOpNSTRUCTION 228 EZ 8 HOMEPORT p g' s HY R ANNIS' MA 02601 i Adnrinist ���� ator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,M4 02111 www.mass.gov/dia Workers' Compensation Insurance.Affdavit: Builders/Contractors/Electricians/Plumbers Applicant Information �^ Please Print Legibly Name(Business/Organization/Individual): Address: �14a4 2 Pti1:97` 0/2 City/State/Zip:A 1Z A,?.,�g 5 4owA_ 6Vz-,a1 Phone.#: d 9, 77/ 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. El New construction . employees(full and/or part-time).* have hired the sub-contractors 2.,k I am a sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, 0 Demolition workingfor me in an capacity. employees and have workers' Y F tY• $. 9. 0 Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its ME]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other_ yae At, -GL comp.insurance required.] . "Any applicant that checks box#1 must a'.so fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL C. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce ry:ruder t e pains and penalties of perjury that the information provided above is true and correct. Si afore: Date: Phone 1K 7 7/ — % 3 i a Official use only. 1)o not write in this area,to be completed by city or town ofj`1ciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two_or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states `Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. -The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 lnfttriaJ Accidents Off ee of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia