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I.., LL Occupancy;TYpe 9ud�ing Type:,' cPermtt Far. Date Sulsmted: RE DER RNEW IKR CHEN 8-16.-.Zg y1 ti a .. r r SLl - 2 t' ResidentialmglpAn%y l8ililding=AdditidnlAlterafion BATH'ROOti1S INSTALL � € r,`T_. - - FLOORING ,'-uPDATE w 0 Water$uPRh'» -_.x Se.wac�e0�sposelSistem:., tp�rstmn{Date SMOKES DEMO BASMENT, i � ;Pubbc ,C� Private Welf {l unicfpel , ``On Sde DIs anal f 7 �_— - ' i g Otivner Name ;Address;#' � � City ,, '`State�Zfpa; ��Phone�Na� ��� . DEIdONT,PATRICK tfs�COTTONWOOD LANE- t-CENYERVILLE fb1A 7n.@^t5....r'✓.,. r:. 1 Applicant Is:(select on'e},f .. AppllcantrEmail ;. . k Ovmer C 3 Contractor' Other e17� Applcart Neme .i4ddhess. ` �6ityr State ,Zlp: Phone Ma`k �,# *hit;seldet - DEANFSYANCEY} µ �yGenterville MA a2&32 k,_-_ :{ r ,, Fra'ect Name, OevelopinentrT�tle �`:ShowAIl Types : omrrtun`ity Dev. + ki - —�--- -✓,:: Tenant Name;. Phone'tJa; 'Asslgnec4lnspector ;`s �BllI��I119 ��.c , �� ` ��� � - �� � � , i r • o. TOWN OF BARNSTABLE Permit No. Building Inspector �.n�r.a i Cash g tejp \�' D MAI OCCUPANCY PERMIT Bond Issued to T' Address lot #Dx -�6 G^t*nr.=.,00f' Lane- Centerville Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ....................................................... 19............ .................................................................................................................. Building Inspector FROM TOWN OF BARNSTABLE BUILDING DEPARTMENT Mr. Francis Lahte m 367 MAIN STREET HYANNIS,'MA 02604 Tty#m Clerk Phone: 775-11`20 SUBJECT: FOLD HERE 'DATE 4c r '4, 1984 MESSAGE Work has bLri Pen[rt 's 26460 wand'2688 Trust) „ {J & D Real r-Mmst)-:x-Please release Bps. .. +k+»W.F+lx#fTYr eYW ils.sl'T!F}l'iF•$!$P.�.##Y!i 494c�jyFFat#S'"3' itk"M�l SIGNED { . 5 DATE f REPLY . SIGNED N87•RMI RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. w -. a: c E P4_r IF R v_r i.__i_._1 ,P. m 94 a. J & D REALTY TRUST, OWNER DAVID C. THULIN, P.E. 478 ROUTE 6A, EAST SANDWICH, MA. �aT ►.g 4 110 S2' 6,33 m Lb`r 177 LOT rn � O N __EXI CST O N 179 O O N FND N O 19' 13 _ 30' i d' m OF oC�WI�LIANIss�c� GOTToKj WOOD L�l ZF C. f N Y E ,p No. 19334 /STeF� f su SCALE I CERTIFY THAT THE EXISTING PLAN._REFERENCE** LC 20239 C FOUNDATION ON THIS LOT IS AaSESSgfS_.LOT NQ_._25.1-167__._...... LOCATED IN RELATION TO THE MOTES: EXIST MONUMENTS AS SHOWN w INDICATES-_STAKE R NAIL FOUND THIS_LOT..._TS._.._N0T. IN�A FLOOD PLAIN..__ DATE_ �' ' ' d�- __._......_._.._.....-................. 4., .. ii -fi'.,.;,,5' .,✓..V �. .. k k:� f >5! '•ar �T, 9 a ,��Fk c r , Assessors map and,lot number ��. ... �. ._. E -'tC PSTE oho • g S�ewt3ge Permit number• y cop ' ff r INSa,� .6.ED 2 Bafi99T/1DLE, i f r'House number ............... `�...F. .a, !$ '�` `�� � ,, Me 9 NVIRONIN TOWN OF BA:RNST��B `�yE _ - �'♦ r fir'�? ' ♦,` - 10IL�DING ."'INSPECTOR Y ' APPLICATIONFOR PERMIT TO.°..........................:.................................................................................................. r. TYPE OF CONSTRUCTION ................................................. ............. .� ..................19.: TO THE INSPECTOR OF .BUILDINGS: �. The undersigned hereby applies for a permit•according,,to the following information: Location .... Q .:. ..... ?. .........�C ��•}U:.. '? ....... .............. . ................... ......... ............ ProposedUse ........lh ........ ........ .. ......... ............. .... ....... .............................................. Zoning District ............. ....... .Fire' District ...................... ..... .. ............:............................ Name of Owner .J.. ':. . ..pyUS :Address ....i. � ��eJ........ fkM¢. ....... p LA 'A P- Nameof Builder ............ ...............:..Address ...............:.,...........................,...................................... Nameof Architect ......... ........................... ...Address ......... .. ....... ............................................................. 2�d1n Numberof Rooms ....... .. ........ ..:.. •..:.........:..Foundation . ... . ....... _ ......................................................... Exterior ..eC.Y�r.Gc a!!... ...................................... .:.Roofing ....... . ..................................................... �- Floors ...... .... . ...... ..Interior ....-Ship.0 ...... C Heating /� h�- ....... ..Plumbing ...........C)........... ................................................ ...!�'3 ........... ......... i � '� ............ .........Approximate. Cost-.. 5.14�.5 l................................... Fireplace .............. ........ J .. ., ...... Definitive Plan Approved by Planning Board ______--------,----------19________. . Area .... ......::...� �o Gs Diagram of Lot and Building with Dimensions-' • s fee ....... . ........ SUBJECT TO APPROVAL OF BOARD iOF HEALTHa 0` OCCUPANCY PERMITS.REQUIRED FOR NEW DWELLINGS I hereby agree to conform to'all ,the Rules and Regulations of the Town of, BarnstaZinge above i construction. r, No . ..................... ��� Co st uction: Supervisor's License .... ....... A. :... J & D5 REALTY TRUST tJ " . No a6460... Permit for ....12 StorX.............. Single.Fam lv Dwelling....................... i. Location ...wit..IT. ......w.gqttonwood.L??... " Centerville................... ................... s , .Owners...J....& D Realtyffrust..................... t'` Type.:o"f Construction' ............................ r.Pr6t `' .. . ... ......... Lot y, ............................ Permit Granted ......M�?�' 18r ...............:.19 84 ' _ Date of Inspection ..... ..��..��.................:......19 17 ;�Date Completed � v'.... ................19 : ' 11 OR TOWN OF BARNSTABLE BUILDIKO INSPECTOR TO THE INSPECTOR OF BUILDINGS: T he undersigned hereby applies for a permit according to the following information: Proposed Use ... JCIT th Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS | hereby agree to conform to all the Rube andRegulation's o6ove � cons�uc,ion. / mo —.--__~ ' � Supervisor's License .................................... - « J & D REALTY TRUST A7--252-167 No Permit for ..lt2..Story.................. ........ ....................... Location Wt..17.a......56..Cc)ttonwood Lane ................................. ............. . ................... Owner .......J...&...D....Realty......Trust ................. . .. ............. .... ...... Type of Construction Frame.............................. ........... . ........................ ....................................................... Plot .............................. Lot ................................. Permit Granted .... ................19 84 Date of Inspection ....................................19 Date Completed ................... ..................19 Mckechnie, Robert From: MacNeely, Martin <mmacneely@commfiredistrict.com>` Sent: Tuesday, October 17, 2017 5:35 PM To: Mckechnie, Robert Cc:. Shea, Sally Subject: Fire Alarm Approvals ' The following two properties have been inspected and approved 16 Cove Island Road, Centerville—10/4/2017 �6TCottonwood Lane, Centerville—10/16/17� e . Thanks, Martin , f f 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLfCATION D Map � Parcel _ Application Health Division Date Issued Conservation Division G ,� Applica 'o e Planning Dept. ® Permit Fee Date Definitive Plan Approved by Planning Board? Historic - OKH _Preservation/ Hyannis Project Street Address ;77� Village Owner rL`2 AddressAA w►lle Telephone 5O�6' �1��� 4r�� Permit Request `�q 6,44, qp,;;, � fay C Z,t_k,S�A�� ��oocz.�r► o� m '0�� �fl�R�-� M�1 �s Square feet: 1 st floor: existing3�proposed 2nd floor: existing proposed —Total new n Zoning District Flood Plain Groundwater Overlay Project Valuation a��C�r`� Construction Type i,��1E)rh In Lot Size \` \°`(!5 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family )k Two Family ❑ Multi-Family (# units) Age of Existing Structure ',�30 Historic House: ❑Yes WLNo On Old King's Highway: ❑Yes A No Basement Type: Y1 Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) ® Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 'L— new (!C> Half: existing d new <:!:n Number of Bedrooms: existingO new Total Room Count (not including baths): existing _S new First Floor Room Count Z Heat Type and Fuel: AGas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes YLNo Fireplaces: Existing ,_New Existing wood/coal stove: ❑Yes )kNo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed:Xexisting ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes *No If es, site plan review# Current Use S \ S M e Proposed Use -APPLICANT INFORMATION- (BUILDER OR HOMEOWNER) Name Telephone Number Address �� `� License # U 350 S'-I, �k v��\� Home Improvement Contractor# \!Sa \mod Email ��F41� `�� � � Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO�tt L SIGNATURE IA4 DATE �� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 2 ,jL so Qc—v-,, n gl a v pI�sRf cues e E OKE D -CTQRS REVIEWED F-ly '7 BARNSTABLE BUILDING DEPT. DATE FIRE DEPARTMENT DATE BOM SIGN OITURESARE REQUIRED FOR PERMITM f f Town of Barnstable Regulatory Services dFtK Richard V.Scali,Director Building Division �sxsresc�. * Paul Roma,Building Commissioner 200 Main Street, Hyannis,MA 02601 3 � www.town.barnstable.ma.us Office: 508-862-4038 Fax: 50&790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: c�l> JOB LOCATION: C C � number �` street village "HOMEOWNER": v > name home phone#. work phone# P. O CURRENT MAILING ADDRESS: t r ' t` /r 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 e "gned` meowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pro d es d r e and that he/she will comply with said procedures and requirements. ZdA Signature of Homeowner S 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 lackof 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\ENPRESS.doc 06/20/16 Town of Barnstable ' Regulatory Services t '"emu' Richard V.Scab,Director 63 Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 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) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of.Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPWLS f MORTGAGE INSPECTION PLAN (THIS PLAN WAS NOT CREATED FROM AN INSTRUMENT SURVEY AND IS FOR MORTGAGE PURPOSES ONLY, MACDOUGALL SURVEY WILL NOT ASSUME LIABILITY FOR ANY OTHER USE). N U 00 VO \ LOT 177 ' G p� #56 _ G� LOT 195 P � . 1 LOT 179 LOT 178 LOT 194 SECTION I CERTIFY THAT THIS MORTGAGE INSPECTION PLAN WAS PREPARED IN ACCORDANCE WITH 250 C MR SEC N 6.05 OF THE MASSACHUSETTS RULES &REGULATIONS FOR THE PRACTICE OF LAND SURVEYING. THE BUILDING SHOWN IS NOT AFFECTED BY A SPECIAL FLOOD HAZARD AREA AND DOES -CONFORM TO THE LOCAL ZONING BY-LAWS IN EFFECT AT THE TIME OF CONSTRUCTION WITH RESPECT TO SETBACK REQUIREMENTS OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASSACHUSETTS GENERAL LAWS CHAPTER 40A SECTION 7. REFERENCED DEED SUBJECT TO AND WITH THE BENEFIT OF ALL RIGHTS, RIGHTS OF WAY, EASEMENTS, RESERVATIONS AND RESTRICTIONS OF RECORD, IF ANY THERE BE AND INSOFAR AS THE SAME ARE OF LEGAL FORCE AND EFFECT. a TOWN: BARNSTABLE (CENTERVILLE) DATE: 07/12/17 APPLICANT(S): DEAN F. STANLEY CERTIFY TO: EMERALD FUNDING, INC. SCALE: 1"=30' S� of 'VAS TITLE REF: CTF# 200838 MacDougall Surveying PLAN: LCP# 20239 C SH.9 „ & Associates EDWARD s FLOOD ZONE: X' A COMMUNITY PANEL: P.O. BOX 2428 Y S70 E 25001CO562J Mashpee, Ma. 02649 DATED: 7/16/14 � ph. (508)419-1086 ZONING: RD1 & RC1 fax. (508)419-1087 s, 5 email: macdougallsurvey -• LAN° InA4 111 R-i Ocomcast.net The Comnzormvea&*,q,tf-Massadrus&&. _ i��i�k�r�t cr,�'1Fr�f�clria�`�ccia�e�s - - fa ce o, IMTS69afiam . . 600 Washington&reef Boston,AL4 02111 • tPFfJt1L TltaTs_,�'fTP�[l�rt1 , N%"w-,e& CmnpenszHcm Insurance Affidavit S`Eil er-dContraciars/Mecbicians/Phmihers AppEcantlufm=fing Please Print Nye S Address: 'S ei Ce �`AK e ns - 3 c.a Areyou an employer?Checktheappropriateban ' TP?eof project r el�e : L lama emplo rwit o 4. I am a general contractor and I 6_ ❑New cons5�tioa employees(full andfor pad-limed* have l�ired4xe snlr-co�rahcactoss ' 2.❑ I am a sole prpprietot orgartuer- Tisfed oaihe aftarbed g1 �. ❑Remodeling These sub-confractars have ship and have ao ernglayees - • $.'❑Denwlifiou wail g fornm is any amity employees and have wodwrs' •9: ❑S•uilding ad3iiica INo warlcets comp.Mamzn comp-°ffiP-M=rance regnred] 5. ❑ Weareacorpoxafimandits , 1O Rler ical r _ or addr=- - 3 ❑I an a bameowmet doing ali work officers have•e=cised their 1LQ Plumbiagrepaim or additions. myself[No - tight of exemption per MGL 13❑Roofrepaim irm suIr ce retzUmyed]f c.152,j1(4�and We have no employees-[NI o workers' 13-❑o&er c0OP-.MSUrance raerluired_) • fl�pEi�itti7at chedshaa IIID. also ffiOtTlfi sectFOn.br7aw�wxiayP iF1eiI WarJGe2S'mmpeaSeLaIIpaIicp]I¢aLla9i[QL #ffameoaraers�e3�o snbmiit ffiis zffida<<u inffrztmg they azedoing mUwcA=Atbea}ire outsideco=txct=xMLst sa'nmitanewafMjjVt indicsfiao scuff fGaatacfo6i'rxtebeckthisboxmaststtach rusdditiona2 sheet sha ingtbanmeofthesob-cwtmcitasmdsWawhetherornotfhaseentitieshrm emp9ayees if thesnvcoatctorsi=e mpIaSta they==pm,&thw wwkea'imp.policy aumbw- I ars arc elrtp�r$�trl;isprmzidu�;n�ari€ers'cotrrperesrriiort irrsuraires�'or m}*elrrp�}�es �Seto�v is fhega�ficy curd jab szta . in°�ormalinrL - InsamaceCompanyName: P ficy or self ins__uc_I \SO !i 8�1 ig� 5 Vo F-VirationDate: \� cab Adam 5 c�eaa� �.,,A a�a� ci�yistatefp: ���`v Aftach a copy of the warkers'coanpensationpolicy-declarationpage(showing the poricy number and expiration date).. FaRnre to serum coverage as requirednuder Section 25A of MGL c_15'Z can lead to the imposition of cdminal penalties of a fme up to$UOO OU ai d,'ar one-yearimpnsonmeat as well as civil penalties is the fazm of a STOP WORK ORDER and a,fm of up to$25O-Da a dap aaaiwd the violator. Be advised that a copy of this slatemed maybe Enwarded to the Office of Inestigataons of the DIAL for insuc moff mverage wascahnn- Iida ifff b, jrdrer s panalffies ofpcimy flies As i formiitivapmt•' abatis is bars acid carrer-t Simatore: Date: o� Phone jk O,Iial use wiry. Do ziot orate fit this area,to be cmmpieted by city artown ri,okifiL City or.owa: PermitUcense 4 Leg Aufharitty(circle one): L Board of Malth I BuRdIng Departmeat I City1rown Clerk 4.Electrical Iispector rr.Piambmg lector 6.Other Contact Person: Phone#: r. formation and Instrriefions Mass=hnsett s Geheral Laws c aka 152 requires all emploY=to provide worms'comp tan fart it employee s_ pi-to this sue,an�Iay�is defined as¢; eiyP�soam 13�e sedvice of�othernuder any co�iact ofliire> express or iniplicA oral ar wra naf AIL eu Shyer is defined as man individual,pares �>assoc�on,CM 01-1 tton or atber legal may,or ffiY ivvo or mare m a oint and incbdbg iho legal=es�ives of a deceased employer,or$ie of tin a faregoiag 3 Vie, �o�g e�ploye�s. However the receives or t-.t=of an bavidaal,pa=tntaship,msociafim or otherIegal enfiiy, owner of a dweIIffi:ig7=e having notmore thS tI,apartm=ts andwho r=&s Ih=ic,arthe occ¢panL of the- dw thug house of anoiber who employs peaSans to do .ce,caosh-action or repair wok on.such dweIlbg house or on the grotmds or bm�app�na Jh r,b shaIlnotbecanse Ofsach employmentbe deemed to be an employer." MGL cbaptea:152,§25C{6)also stafes that¢every siaia or Iocal firms agency shall�3ihoId$ie issuance ar ewal of a Beene or permit to operate a hvskess or to construct b�dbigs iu thr-commonwealth for any ren a.Pphcantwlio has aotprodnced acceptable evideur=of compliance WraL tba m=r=ceLcovemgerequited- L A&RdDnany,MGL chapt=152,§25C(7)states'W6iiher the _ nor�y Of its political subdivisions shall enter m�any=atzact forthep�ce ofpublio woikurE acceptable evidence of camPliancewith$ie r,cn,mmce�. r e s of this cbaptCZ have been p=M3trd b the coniracting.aaiii&i Y: " AppHcaats -. Please fa oi± $Ze worts'compaosatlon affidavit completaly>by ch=c ibo boxes that aPPl9 to Your nt2atOIL and,if sob-contr O , es and e�bm(s) aIongwithiiieacer��(s)of necessaxY>SnPP�Y r(s)nam�s) ) pbon _ L=atedLnbiiMy Companies(LLC)or LiabiIitY•Parta=lcps(LLP)wiano=:ipIoycesother than the members or parbaers,are not regain=d to cauy wadaze compe on.ingo:ran . If an LLC or LLY does have Toyees,apoIicyisregahed. B0advisedtbafthisaffidxytmaybesnbm2te;dto the Degar[mentof Indz�l Accidents for conE=.ation of insurance coverage Also he sure to sign and date-the afllda4it The affidavit should be r etnmed to!he chy of town that the application for the pew or license is being recjaestA not the D epa=tmeat of Irhnst nal A_cci dents. Sbnuldyou have any questions regarding the law or i fyou are required to obtain a wozlc it compensation policy,please call the Depaitme t at tip nnmbmu lisiEd below. Self-insvx�ti companies should tll ea self-m sm-mce license mmnber on the appropnete Ime. City or Town officials r Please be sure that the affidavit is complete andprhtedIegbly. The Dcpartmenthas provided a space at the bottom f the affidavit for you u to fill otrt in t$e event the office oflnv��ons has to comtact you regarding&o applicant o lease be sure to fr the peamitllicease ntnnba which will be used.as a refetance rmmber. In addition,an applicant that must sobmiL rattltiple pC=nVHC use appliesions in a�given year,need only submit one affidavit indicating cnzr ent policy inforsa.atian(if mY)and und=-76b 5"Le.A_ddr "•tie applicant rhor A write"all locations in (crLY or .town):-A copy of IhD aff davittbat has bea officially sfalnped or madced by the city or town maybe provided to the applicant as proofthat a valid affidavit is on EIe for frame-permits or licenses- A new affidavitmust be filled out ea ch year.V7heze a home owner or ciii=is obtaining a license or permit not related to,any bn�e sSs or�mmeraal v a dug license or p=k to bum leaves said pexsou is NOT reT*ed to camPlet O this affidavit and sbonld on bane any quesilans, co ce fouror erafion Y IIld.hketo thank uin advan Y oP e Office ofInvesfiga�.onswo Yo 'Ih P Iease do noth.MSi atEto givens a caI 'the Departmmfst address,t vlephoue and faX=a3berr . Ca�Qrt ihE of MRW t ' Deparftnmt c&libs rid AoDidents (ice Qa �tiD;A2 Ta 4 617- -4-9W cat 4-06 or 1-8-77 MA S&� Fax#617 727'749 Rzvised4-24-07 WxnxWg[dia �■■� r 1 ✓ DATE(MWDD/YYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE 1 o/31I201 s 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 poltcy(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 NAME:CT Kathleen Geddis NORTHWOOD ESHBAUGH INSURANCE AGENCY, INC. PHONEEffi, 508 771-1632 FAX No: E-DDRMAILESS: k eddis.north24 insuremail.net A 540 MAIN ST. INSURER(S)AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: DEAN F STANLEY BUILDING CONTRACTOR INC INSURERC: INSURER D: 359 CAPT LIJAHS ROAD INSURER E: CENTERVILLE MA 02632 r,NSUR.RF: COVERAGES CERTIFICATE NUMBER: 98719 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 SUBR POLICY EFF 77. LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ DAMAGE TO RENTED CLAIMS-.ADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ nLOC PRODUCTS-COMP/OP AGG $ POLICY 1-1JECT J $ e OTHER: AUTOMOBILE LIABILITY Ee accideDtSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED` SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident) $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS W18 CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X I STATUTE I I ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ l OO,000 A OFFICER/MEMBEREXCLUDED? WA WA WA 7PJUB2E49857516 10/08/2016 10/08/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govltwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town'Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 230 Main Street AUTHORIZED REPRESENTATIVE , Hyannis MA 02601 Y Daniel M.Crow y,CPCU,Vice President—Residual Market—' WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r 4 ��s5 s wr l - 2 3 27'-fir4 3 � 8,-83'4 WArrR6S STATION L-----------J .11 KITCHEN (M SF) 1 1 jM=MMM0MMMMM 72'-V:k i soIFy* I.-,. WOM MEN 1 OM ■ ---- (.s 9, Y i 8v I 1 00(►Z 1 �?pJt ovb . v G. 00, eV E DETE TORS-REVlEWEp �. . . _BARNSTAB-E BUILDIN.G_DE T. . _ ......... . .. . DATE' FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR f E-041TjNG �L OCO�S lb -E-- , n PC-6 -AMlS MA QO� av IST - . .S E DE T -ORS REVIEWED. �..; - -BARNSTABLE-BUILDING UPT. DATE FIRE DEPARTMENT .. _. DATE .. . BOTFISIGNATURESARE REOUIRED;FOR PERMtTING f i00, o G,L -Tom ot: o—AMs -- , �oTT�e�w00:D- 7 ► 7 TNa:P't4TOn Pr6 i . Z _ r NOJt o`, - - ------ _ - • _.. _ ABA�NST E DE TORSREVIEWED ABLE B DING DEPT. DATE FIRE DEPARTMENT- DATE. BOTH SIGNATURES ARE REQUIRED FOR PERMlTING Qe _ 7d� co C'oT poa�WO�� 'D04 _ z ► -7 TNa PU470» P(-6 CiTc�V 9 I ..ro 1 , --;�_._.r--. �. ... ___..__._._ __•_. _ � .. - .=-•--T---- -- ___., .-- - - -.__'-.....ice-_�._ - -- •--•-_-._..__._- -'- •- - -. _'_ LI �_I-T ,'c� lilt 1717. "CA ire,4 rT '�'^"�t� ,•^^'e+.,.�—`r••—_-4—.__ .�{._... i i �` if V ` '� if i tom._ — 1 } 1 3 f i -•j-.`__fir- i_.___;..�_'�- i_ 3 � , r - E � -#---- I .}�:E_',—.._f-__ i OCR-ROBS(4!i -4 _ Ie7 ry�) ADJN " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6�� Parcel 16D / #, s r a,, Application,# ✓1 Health Division Date Issued /4-��"'<G y 2016 Application fee 'Conservation Division �{rrII Planning Dept. TOWN OF SA;RNSTABLe Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village (' 4 �1'1U / �'� Owner ��-T' C � �/�� Address J�� /)Dni, �n32 Telephone Val?Ol? 7 d,,i,2,a 0:2� 6�1, �lfT2_3ral7.Q.^PO Permit Request 1140-ky-Y�) en_71�2 a? E7Z cX2�" .« /, /vipi � roo �� -�v Ck r-e - Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District PC-- 2 Flood Plain Groundwater Overlay Project Valuation QQ4- Construction Type xy Lot Size I c 7 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes V No On Old King's Highway: ❑Yes X No Basement Type: I 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: I existingAew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: R/Gas ❑ Oil ❑ Electric ❑ Other r4o ❑ r Central Air: Yes No // Fireplaces: Existing ( New��,,,,, Existing wood/coal stove: ❑Yes ANo Detached garage: ❑ existing�0 new size_Pool: ❑ existing�Tnew size _ Barn: ❑ existi�/, /new size_ Attached garage: ❑ existing❑ new size _Shed: ❑existing(��new size_ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes N& If yes, site plan review# n Current Use Proposed Use ` dIQ Q �l -APPLICANT.INFORMATION (BUILDER OR HOMEOWNER) NameLe� / o /U� �� Telephone Number 7_Z/- Address (50 ya�m�� v�lLicense # i Home Improvement Contractor# Email �SC.Qe, /l� Q�S/G��f'��COla'Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �-J SIGNATURE DATE � �4 1 6 r FOR OFFICIAL USE ONLY APPLICATION # 1 C DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE s ESS a s, OWNER DATE OF INSPECTION: FOUNDATION to FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL Y j GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT i ASSOCIATION PLAN NO. Z ' V�B IQQ477AI2(y%2L!!G(,G���P����QddCI,C/ZLI,JG��iJ •. flee of Consumer Affairs&Business Regulation License or registration valid for individual use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ;•.' Office of Consumer Affairs and Business Regulation Registration` {_00;121:; Type: 10 Park Plaza-Suite 5170 Expiration 6/9/2018 ,'; Supplement Card Boston,MA 02116 OCEANSIDE, INC. D.SCOTT MURDOCK.. :�`--,-- . 217 Thornton Dr ? a-:� � _ —•= Hyannis, MA 02601 Undersecretary - Not valid without signature. r X N) v O C c r+ m + cn JTnj�'1i � w *modtitre Q D t N d g I rj N r co a CC ei s v m m � n ,.� M m ! Fa,' xt p7 a �i. C�L� M (p to to Re 0 z CL CL a A °cam. 5 e� ��'.iP•' 7 A) 0 rn A7 C1 a� THE RIGHT CHOICE i----------"-----, Since 1971 Qffice use Only � c�eanside ; JOB NU Restoration - 217 Thornton Drive,Hyannis,Mass.02601 508-771-3110 800-464-3318(MA.Only),77"70-2211 Fax ASSIGNMENT AND AUTHORIZATION TO PAY The undersigned, herein called claimant, has authorized and ordered from Oceanside, Inc. , the materials and/or services requested. Undersigned hereby assigns to Oceanside, Inc. any unpaid proceeds due or to become due, under the claimant' s policy with the insurance company to pay direct to Oceanside, Inc. or to include its name on a check or draft, for all requested work. In the event that .Oceanside's claim herein is not covered by, or paid by, an insurance company, claimant agrees to pay Oceanside, Inc. within sixty (60) days after work has been completed: Claimant understands that Oceanside, Inc. is working for them and not the insurance company or the adjuster. Payments remaining due and payable after the claimant has .received payment from the insurance company shall bear interest at one and one- half (1-1/2a) percent per month. In the event that there is a breach by the claimant of any of the conditions of this agreement, Oceanside, Inc.- shall be entitled to recover, as additional damages, attorneys' fees, costs and any other collection expenses reasonable and attributable to said breach. If payment is not received within 60 days, collection action will commence without further notice to the claimant. 5 Co A w ' 9, A LOSS/DAMAGE ADDRESS Sce cat-VC(\Wd L-J 4062R MAILING ADDRESS (BILLING) CITY STATE ZIP INSURANCE ADJUSTER' S NAME/CO. LOCAL INSURANCE AGENCY NAME PR NT05 INS. CARRIER/POLICY UNDERWRITER ' DATE: CLAIMANT'S IGNATURE PHONE: EMAIL:aAA k A The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street;Suite 100 Boston,MA 02114-2017 www mass.gov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbem TO BE FILED WITH THE PERMITTING AUTHORITY. "plicant Information Please Print Legibly Name(Business/Organization/Individual): ' Q n,<s(de- --rrc , Address: c91`7 rho rr14o n D 6 Ue, — City/State/Zip: Q n lS M(L OZGC) I Phone#: 1 — 51 10 Are you an employer?Check the appropriate box: Type of project(repaired): L[a am a employer with c&Lemployees(full and/or part-time).* 7. ❑New construction 2.D I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling arty capacity.[No workers'comp.insurance required.] 3.[]I am a homeowner dot all work myself 9. ❑Demolition doing y [No workers'comp,insurance required.]t 4.❑[am a homeowner and will be hiring contractors to conduct all work on my property.ro 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. ❑ S.Q I am a general contractor and I have hired the subcor►tractors listed on the attached sheet. 12. Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance i 13. Roof re airs / v 6. We area corporation and its officers have exercised their right of exemption per MGL c, 14. Other D E2— 152,§1(4),and we have no employees.[No workers comp.insurance required.] [ Ct,rY12Q *Arty applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. U 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, lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �n / Insurance Company Name: A Z. M . fUo I Policy#or Self-ins.Lic.#: (,e.�C'' — /DD '"!oG}/9$D�' o�OI(p Expiration Date: 1 Job Site Address: fr57 19(-&42C 201 l_.L/ City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and txpiration date).�Z� Z 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 of this statement may be forwarded to the Office of Investigations of the DIA,for insurance coverage verification. I do hereby certi r the pains and penalties ofpedury that the information provided above is true and correct S i ture: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: . Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i_ Client#: 566925 20CEANSIDEIN ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 04/04/2016 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 endorsement(s). PRODUCER OFT Dowling&O'Neil Insurance Ag " 508 775-1820 973 lyannough Rd,PO Box 1990 E-NI iio Arc Ne: 50$7781218 Hyannis,MA 02601 ADDRESS: 508 775-1620 INSURER(S)AFFORDING COVERAGE NAIC tF INSURER A:Arbella Insurance Company INSURED ' Oceanside,Inc. INSURERS: 217 Thornton Drive INSURER C: Hyannis,MA 02601 INSURERD: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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, NOTWTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUE6 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 ppREDUCED BY PAID CLAIMS. VTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER MM1DD F MPOLILICCY EXP LIMITS A GENERAL LIABILITY 8500061423 D1101120116 0110112017 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY i �Ea�,D�,,a $1 p0 g00 CLAIM84AADE 51 OCCUR MED EXP(Any one peracn) $5 000 PERSONAL&ADV INJURY $1 00O 000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMITAPPLIES PER PRODUCTS-COMPlOP AGG $2,000,000 POLICY 7 PRO LOG $ AUTOMOBILE LIABIUTY Ea eBINED SING LIMITedd $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS ANOOSOWNED PROeP=DAMAGE $ a UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS-MADE AGGREGATE $ DED RETENTION ' $ WORKERS COMPENSATION WC STATU• OTH- AND EMPLOYERS'LIABILITYTORY LIMITS ANY PROPRIETORIPARTNERIEXECUTIVEYIN E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N I A (Mandatory In NH) EL.DISEASE-EAEMPLOYEE $ Ifyes describe under DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terns,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of Insurance shall be deemed to have altered,waived,or extended the .coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©.1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010106) 1 of 1 The ACORD name and logo are registered marks of ACORD #S167993/MI67992 LS1 ACO® DATE(MMIDD/YYYY) �,� CERTIFICATE OF LIABILITY INSURANCE 03/30/2016 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 - O 7AC Linda Sullivan DOWLING &O'NEIL INSURANCE AGENCY PHONE 508 778 1620 PAX EMAIL ADDRESS: lsuffivan@dolns.com 973 IYANNOUGH RD. INSURER 9 AFFORDING COVERAGE NAIC 8 HYANNIS MA 02601 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: OCEANSIDE INC INSURERC: _ INSURER D: 217 THORNTON DRIVE INSURER E: HYANNIS MA 02601 1 INSURER F: COVERAGES CERTIFICATE NUMBER: 41040 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. LLTR TYPE OF INSURANCE D S BR POLICYNUMBER POMLLID EFF MMLIDCD EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE F OCCUR TrEr PREMISES a omrrartcel $ MED EXP(Any one parson $ N/A PERSONAL&ADV INJURY $ ~ NEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JET LOC PRODUCTS-COMFIOPAGG S OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea accident) $ ANY AUr0 BODILY INJURY(Per person) $ ALL AUTOOSMED AUTOS ,N/A- BODILY INJURY(Per accident) $ AUTOS NON-OWNED HIRED PRO PERTY DA MAGE AUTOS $ j RELLALIAB OCCUR EACH OCCURRENCE $ ESS LIAR HCLAIMS-MADE N/A • AGGREGATE $ RETENTION$ �/ $ WORKERS COMPENSATION X gE_T E ERA AND EMPLOYERS LIABILITY YIN — ANYPROPRIETORIPARTNERID(ECUTiVE E.L.EACH ACCIDENT $ 1.000,000 A OFFICER/MEMBEREXCLUDED? NIA NIA NIA VWO10060198022016A 01/01/2016 01/01/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB $ 1,000,000 .. N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddtUonal Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the Insured hires,or has hired those employees outside of Massachusetts. Thiscertificate of insurance shows the policy in force on the date that this certificate was Issued(unless the expiration date on the above pollcy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored dally by accessing the Proof of Coverage-Coverage Verification Search tool at www•mass.gov/lwdtworkers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.' AUTHORIZED REPRESENTATIVE `Dj - . , Daniel M.Cr y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved: ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD , I $v f The Town of Barnstable NAM Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Grossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION �o � tTd►JLupo� �� ����lti u-L Location of shed(address) w r l\c,c, f Property owner's name Telephone number Size of Shed - Map/Parcel# �f ^ qq Signature Date Hyannis Main Street Waterfront Historic District? ►Iv C) Old King's Highway Historic District Commission jurisdiction? C) Conservation Commission(signature required) THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN S Q-foams-shedmg STANDARD LEGEND w OIFII OH FAD Fpp- F w 252 o� T�COURSE FAIRWAY DECIDUOUS TREES �� EDGE OF BRUSH lJ" ORCHARD OR NURSER'! CONIFEROUS TREES ' r!,J MARSH AREA 7 I # / EDGE OF WATER M DIRT ROAD AP 252 P 252 a P H lKk Dom PATH/TUL — PROPERTY LINES # 6 # 62 �-- \ 3��AR(FI NUMBER � HOUSE XUMBFR 2 FOOT CONTOUR LINE �. TOFOUFCOKDURUNE X« SPOT ELEVATION STONE WALL `l FENCE ---� RETMNINGWALL / RML ROAD TRACE /� / �� STDNESETTY •2.5-2 \\ ld� \\ $. SWIMMINGPOOL J POROI/BECK 1 52 0- BUILDINGS/STRUCTURES JJ {+Hi DDR/PIER/1E,lY Q ASSESSMAMPBOUNDARY ✓JR o 6 VALVE ® MARROUS o POST O" How # e SIGN � STWALORAINS Ay IN TOILER O LET O am= SITE MAP M 2 52 AP L 52 T.O.B.GEOGRAPHIC INFORMATION SYSTEMS UNIT SCALE:in feet 1 M 52 0 to 40 1 INCH—40 FEET 4 # 90 N IUMM PARCELUNISAREOMORMItUtM URNISOF "mFOROUIU/a .APENOfTMXU1GIUFSoAB391 • VB$UIUBWDINOBANNOaAUOBPIEi®FtOR 1989AEa1LN1016t 2 IxmMKIMS,a IDG ATI-WIRTAOI U"`MT`UTV- NR pHOUSIN010fiMPMa1•�d00'.BWRAWP®al'm 100. MPMO@IN Dd01101-IW ewER GASSFSSORSAUS IPPA. AA A D rl DmMVPrcar_Iay.MDBMroFwesPmnmaANNmRI saENa jsitemapsTublidnn252p167.dgn Aug. 02, 1999 09:02:50 r r ' 1 i T