Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0134 COTTONWOOD LANE
s ' ot6 ,66 , � s. Cape Save Inc. , 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 3/20/17 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 16-3726 ' Dear Mr. Perry This affidavit is to certify that all work completed for 134 Cottonwood Lane, Centerville has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. " Sincerely, CO 01- William McCluskey o C'3 CDP ..T . .. '..'CAB^- � • F^eg } • e. • - r , Sdarcity January 3, 2017 Town of Barnstable ATTENTION: BUILDING DEPARTMENT 200 Main Street Hyannis, MA 02601 RE: 134 Cottonwood Lane, Centerville Permit Nos.: B-16-2331 E-16-1628 Our lob No.: JB-0263238 NOTICE OF CANCELLATION This letter is to certify that our proposal to install Solar(PV)at the above- referenced property has been moved into a cancellation status. SolarCity Corporation and Paula Beasley will not be moving forward with the proposed installation at this time. If you have any questions or concerns, please don't hesitate to contact me Thank you for your attention to this matter. a Sincerely, z� 01 _T CheryCGruenstern . , Cheryl Gruenstern Permit Coordinator Direct Line: (508)640=5397 cgruenstem@solarcity.com 112 Great Western Road,South Dennis,MA 02660 T (888)SOL-CITY solarcity.com AL 05500,AR M-8937.AZ ROC 24377VROC 245450.CA CSLB 888104.CO EC8041,CT HIC 0632778/ELC 0125305,DC 410 514 0 0 0 0 8 0/ECC902585.DE 2 01112 0 3 8 6/T7-6032,FL EC130061226.HI CT-29770.It 15-0052.MA HIC 168572/, EL-1136MR.MD HIC 12B948/11805.NC 3080141.NH 0347C/12523M.NJ NJHIC#13VHO6160600/34EB01732700.NM EE98-379590..NV NV20121135172/C2-0078648/B2-0079719,OH EL.47707.OR CB18049B/C562.PA HICPAO77343.RI AC004714/Reg 38313.TXTECL27006.UT 8726950-5501,VA ELE2705153278.VF EM-05829.WA SOLARC•919OVSOLARC'905P7.Albany 439,Greene A-4B6.Nassau H240971000Q Putnam PC6041,.Rockland H-11864-40-00-00.Suffolk - 52057-H.Westchester WC-26088-1173.N.Y.0#2001384-0CA.SCENYC:N.Y.C.Licensed Electrician.#12610.#004485.155 Water St 6th Fl..Unit 10,Brooklyn.NY 11201.#2013966-0CA All loans provided by SolarCity Finance Company.I.I.C. - CA Finance Lenders License 6054796:SolerCityFinance Company.LLC is licensed by the Delaware State Bank Commissioner to engage In business in Delaware under license number 019422,MD Consumer Loan License 2241.NV Installment Loan License IL11023/I1.71024.RI Licensed Lender#20153103LL.TX Registered Creditor 1400050963-202404,Vr Lender License#6766 Town of Barnstable Building g Post This Card So That it is Visible From the Street-Approved'Plans be Retained on Job and this Card Must be Kept Posted Until.Final Inspection Has Been Made. L eeaysrwer.e: � Permit i639 16' +• Where a Certificate of Occupancy is Required,such Building shall Not be Occupiedµ�until a Final Inspection has been made. Permit NO: B-16-2331 Applicant Name: Cheryl Gruenstern Map/Lot:. 252-147 Date Issued: 08/22/2016 Current Use: Zoning District:: RD-1 Permit Type: Building-Solar Panel-Residential Expiration Date: 02/22/2017 Contractor Name: SOLAR CITY CORPORATION Location: 134COTTONWOOD LANE,CENTERVILLE - ;.. ,, .; •,Est. Project Cost: $ 15,000.00 Contractor License: 168572 Owner on Record: BEASLEY,PAULA C Permit Fee: . `�,. $ 126.50 Address: 134 COTTONWOOD LANE 1 Fee Paid: �t$ 126.50 CENTERVILLE, MA 02632 i - ``Date: 8/22/2016 f \ Description:. Install solar panels on roof of existing house,with any upgrades,if applicable,as specified by.PE in Design;To be interconnected with home electrical system. 6.095 kW 23 Panels JB-0263238 Project Review Req: Install solar panels on roof of existing house,with any upgrades;if applicable,as specified by PE in Design; To be interconnected with home electrical system:-6.095 kW 23 Panels JB-0263238 Building Official This permit shall be deemed abandoned and invalid unless the work authorized by,this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.' All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all.applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing 2.Sheathing Inspection 3:All Fireplaces must be inspected at the throat level before firest flue lining is installed 4._Wiring&Plumbing Inspections to be completed priorto Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 5 a Parcel Application &Al —3-7 Health Division BUILDING DEPT Date Issued Conservation Division DEC 212016 Application F e Planning Dept. TOWN OF BARNSTALLE Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis r( 0^ Project Street Address N N C6thAyth 6A "A� Village C 2 As"U L Owner; wt1 a, �e o,61 e Address 5 a MC Telephone 5 O R ' I 5 6 IA 1615 Permit Request P�c C - _ c� a ?--X1 A,, lk* -ro -rk - L_few+, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District q Flood Plain Groundwater Overlay Project Valuation ` 1 Construction Type Lot Size Grandfathered: ❑Yes_ ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool:-❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) n m I o Name I1 �`C ��f r`� �w`'� ��� Telephone Number Address ttW►►Rn,�-o n N ve License # -C I S.. V M � Home Improvement Contractor# 0 Email Worker's Compensation # (A Q&5 5 q p160 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO t A Nh om,4� SIGNATURE 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 i` DATE CLOSED OUT ASSOCIATION PLAN NO. Office of Consumer Affairs.and Business Regulation: J l 0 Park Plaza- Suite 5170 Boston,;Massachusetts 02116 w Horne Iriprovernent Contractor Reglstratlor Registration 171380 T ype Corporation y a + ' . Expiration 3114/2018 Tr# 419291 CAPE SAVE.INC: ` WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH=YARMO:UTH, MA 02664, ' _ � a y1 s x r Update Address and return cartl Mark reason for::change. - Address C:Renewiil Employment ❑ Lost Card ScA1 0 20a-05i1i �e�Q9IL7IG697L!lGCGI.IiLQ�C�/llic.r�ac�u�e _.Office of Consumer Affairs B c Business Regutahoa - License or registration valid for individuluse only _. HOME;IMPROVEMENT CONTRACTOR before the expiration date. If found`;return for Registration 1713g0' Type Office of Consumer Affairs'and Business Regulation Expiration 3MW2018 Corporation , 10 Park Plaza-Suite 5170` Boston,MA 02116 - CA SAVE INC. { 'z PE �� f WILLIAM McCLUSKEY 770 HUNTINGTON AVENUE SOUTKYARMOUTH,MA 02664 Undersecretary Not validi i signature . Massachusetts-Qepartr ent of Public Safety Construction Supervisor Specialty Restricted to: .Board of Building Regulations And Standards CSSL-IC-Insulation Contractor -L1i 111[I 1f 1t11/.11 au. ).Y 1111/"'ai-fed Afov *3F%3Y,,�•nA x•pt: License: CSSL 102776Ze • .ti riff �� rR WILLIAM J MC 4�tU '�. . 37..NAUSET ROAD West Yarmouth I%A Failure to possess a current edition of the Massachusetts - J,,(,,, Expiration State Building Code is cause for revocation of this license. Commissioner O6/- W201.7 DIPS Licensing information visit: WWW.MASS.GOVIDPS - _ To of u stable, �, - ' 'Ytirltatst''V`.Ste,bii�cfoc T.om Pvrry,$ud€ng Couussloner 200 Strut,LIIyaneus�It���2601 ��^Y:to�vn bat'nstablcarays ' lif.fiee. 508 62-038 Fax. Q8.ego-6-30 ope t, own us W,Oee d Say �C S %a if USA twider I��` '1. ► �.e s1� �O-w f the si t drop �e�byaiciaize t�a•aet t�3d:,,tnjrfa i ;a matters reatv+�to worl�avorzeii by r �,c bue peu= hcatm fay: 13� "Pool f and f is s o of e. �i t Pooh re,i �tci` e eked cr' c�1 ore"f Isklaed .a `a�l finial Ac of er Signatum Ott ,; She _ ofAPP pxi�tt Jaime: I'�iat Name Dal e �i�uxra&o�vr �xtstss�ozarvois . F r { ._ ? T J_.'"a .tFel'.t��sJ{r 6�e^"� -it..� 't;.� ws `�F4 wS�"" � 4i.�rtJ t •� � . .� �- - , . .. _ '� .._�..;:t,�-Tlie.Corrimon><v"ealth of Massachuse Sets�_�,t,t; , �,,���,•']a r _ , �;;. '-�_ r;'� , Departm'erit'of lndush iW,A&idents A t• ., r ^a ..+f, .. � yI._ ti.,�l, ' i F . •. e 1 Congress Streei,'Suite 100 I �'ilz` r 3: ;g'+Boston;N1A 0211'4=2017;. ,,,�+� �w::s �,iv:x: y ,�,``-r� _� " . -- -: S ... ..u. .. k .p I. ', tF-C L tr M"'p it • ..'�_ .r. + y wwwunass g`v�dta : 'tr•„r i, try•� l'r i •`;a.rri s3 {. 'NA'orkers'Compensation.Insurance"Affidavit-Builders/ContractorsZElectiricians(1?lumbgr`s. TU BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information, i Please Print Legibly 4 Name (.Business/Organization/Individual):Cape Save Inc Address:7'D Huntington Ayenue City/State/Zip:South YarmoutK,MA 02664 tr ,,, ,. -e ,phone,#:508 398-0398 i Are you an employer?Check the appropriate box: . i _ t Type ofpro�ject(requned) c• -.E]I-m a employe w_itTh.. , tones(full and/or part tune)* ; ` ILT0N w.construction 1 F 2.0 lam a sole.proprietor or partnership and liave no employees.working for in �J Remodelirig any capacity.[No workers'comp.insurance required) { _._. _e re . s ; 9:�Demolition. L �+ 3.Q..I am a homeowner doing all work myself.[No workers comp:insurance required]t ' r , r.. • , _ 10,Q`Building addition - "4.❑I am a homeowner and will be hiring contractors to`conduct all work on my property: I will— ensure that all contractors ither.have workers'compensation:insurance.or are sole 11. Electrical repairs or additions t { ' proprietors with'no employees. � t 12.Q Plumbing repairs.or additions 5,❑1 am a general contractor and I.have hired the sub-contactors listed on the attached sheet.. 13. Roof repairs i These sub-contractors have employees and have workers'comp.insurance ❑ { t 6 We are a corporation:and its officers have exercise 14.�Other Insulation_d their of exemption per c; 1 152, 1 4;and we have no employees. x r� § O [No workers'comp.insurance required,] • I .,<*Any applicant that checks box#1 must also.fill out the section below showing their workers'compensation policy information V,k,,u.R ` t Homeowners who submit:this affidavit indicating they are doing all work and then hire outside contractors must submit a'mew afftdavit.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. r _t 1 . employees. If the sub-contractors have employees,they must provide.their workers'comp,policy-number. lam an employer that;is providing workers on'compensati insurance for my employees. Below is the policy and iob site , `inforin_dhon:f - .: _'.. _. ._ _ ,.. Insurance Company Name; Star Insurance Co i� Policy#or Self-ins Lic:#: WC085540700 .•Y- - Expiration Date. 4/9/2017 { Job Site Address: 134 Cottonwood Lane r f . ':C i •' city/State/Zlp:Centerville ,..,- -• u { .Attach a copy of the workers'compensation policy declaration page(showing the policy number and;expiration date)._. Failure to secure coverage as required under MOL 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 dayagainst the violator_:A,copy.of•:ttus statement.may be forwarded io the Office of Investigations of the DIA•for insurance .•--- i coverage verification. t' , ,x N d .x.. m iF r Uf '1 • C I do hereby certify under th .pains and'penalibLa of perjury that the information provided above is true and.correct i - ! Si attire: Date: 1 21/1 Phone#:508-398-0398 t , Of 6ial use,only.'Do not write in this area;to be completed'by c:ty or town-offllcial 'Cityor Town, , „ ; s, ud .� , "+� "., s" PermitlLicense# i Issuing Auth.6.1ty{circle - 1 1 Board of;Health_2:Building ilepartment,3 Cityl.Town{Clerk 4.Electrical Inspector 5.Plumbing,Inspector .� j 6.Other t ►,_x'r t1"- c Contat Person: " 5....•..._ ._ _ ._w.•,.. phone*: r,aG, :. 'sit_rt'.i,. t t. 1*fs:,'rc,`•. tSx..'t ' `4.,l ` r' tit.,,,sty ORU® DATE(MM AC IDD/YYW} 4k. CERTIFICATE OF LIABILITY INSURANCE 10/24 2016 Dryy 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. .• Y 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 endorsements. PRODUCER NAME:CT Colleen Crowley Risk Strategies Company RCN E (781)986-4400 FAC No:(781)963-4420 15 Pacella Park DriveE-M ADDRESS; rowley@risk-strategies.com - Sui to 240 INSURER(S)AFFORDING COVERAGE NAIC Randolph MA 02368 INSURER A:Liberty Mutual Insurance Co INSURED INSURER B Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INSURERC:Ohio Casual t /Peerless Insurance 24074 7 D Huntington Ave INSURERD:Star Insurance Co INSURER E: r South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL16101422377 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INTRR TYPE OF INSURANCE POLICY NUMBER MPMIL& EFF MPMOI�EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENT D- A CLAIMS-MADE X❑OCCUR PREMISES Ea occurrence $ 100,000 BL91757246490 10/16/2016 10/16/2017 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 NPOLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS ANNA46796600 11/6/2016 11/6/2017 BODILY INJURY(Per accident) $ , NON-OX HIRED AUTOS X AAUTOS�ED (P80acadT nt DAMAGE $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2 000 000 C EXCESS LIAS CLAIMS-MADE f ' AGGREGATE $ 21000,000 RETENTION 10000 $DED X WORKERS COMPENSATION'•. PER OTH- AND EMPLOYERS'LIABILITY "'` Officers included for X STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE Y/N NIA Coverage E.L.EACH ACCIDENT $ 500,000 D OFFICERIMEMBER EXCLUDED? (Mandatory In NH) r VC0855407 4/9/2016 4/9/2017 E.L.DISEASE-EA EMPLOYE $ 500,000 It yes,describe under . . DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS)LOCATIONS l VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Evidence of Insurance / Insulation Specialists CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation 711E EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Barnstable County ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact 460 Plain Street AUTHORIZED REPRESENTATIVE Hyannis, P& 02061 Michael Christian/CLC '� @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) Town of Barnstable di �Post7his'Card So That�t-� V�s�bleuFrom the Street A roved Plans Must be+++-Retarned:.on,;Job;and.this Ca'rd_xMustFbe-.Ke' t _F v fPosted Until>Final Ins ectionHas Been,IVlades y, �� fi • yam ► Where a Certificate,of Oecu anc �s,..Re uired,,siach Build�n shall,Not be Occu ied uritil.a Final lns ect�on,has been;made� Per mi!. Permit No. B-16-2331 Applicant Name: Cheryl Gruenstern Map/Lot: 252-147 Date Issued: 08/22/2016 Current Use: Zoning District: RD-1 Permit Type: Building-Solar Panel-Residential Expiration Date: 02/22/2017 Contractor Name: SOLAR CITY CORPORATION Location: 134COTTONWOOD LANE,CENTERVILLE Est,.—Project Cost: $ 15,000.00 Contractor License: 168572 s � Owner on Record: BEASLEY, PAULA C Perrnit F e $ 126.50 Address: 134 COTTONWOOD LANE Fee Paid ." $ 126.50 17 CENTERVILLE, MA 02632 Date. >: 8/22/2016 Description: Install solar panels on roof of existing house,with any upgrades,if applicable,as specified by PE n Design;To be interconnected with home electrical system. :6 095 kW 23 Panels 1B-0263238 �: h Project.Review Req : Install solar panels on.roof of ex sting li�ouse;�' any upgrades,if applicable,as specified by PE in Design;To be interconnected with home electrical s yste�m6095 k1N23�Panels JB-0263238 Building Official sk This permit shall be deemed abandoned and invalid unless the work authorized by thi permit'-is ommericed-within sixmonthsafter issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and struuetur s shall be incompliance with the local zoning by Iaws�and codes. This permit shall be displayed in a location clearly visible from access street oroaand shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ,. The Certificate of Occupancy will not be issued until all applicable signatures by the Suildmg and Fire Officials are providedon this permit. Minimum of Five Call Inspections Required for All Construction Work- 1.Foundation or Footings 2.Sheathing Inspection ' 3.All Fireplaces must be inspected at the throat level before firest flue ImingLis,'installed A ; 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) ' ' 6.Insulation 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 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). Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of .Barnstable -AECEIRT KAs& ' 200 Main Street, Hyannis MA 02601 508-862-4038 63A 1b� Application for Building Permit 0-ou PP g Application No: TB-16-2331 Date Recieved: 8/12/2016 I I v Job Location: 134 COTTONWOOD LANE,CENTERVILLE Permit For: Building-Solar Panel-Residential Contractor's Name: SOLAR CITY CORPORATION State Lic. No: 168572 Address: 24 ST MARTIN STREET BLD 2UNIT 11, Applicant Phone: (508) 640-5397 MARLBOROUGH, MA 01752 (Home)Owner's Name: BEASLEY,PAULA C Phone: (508)564-1515 (Home)Owner's Address: 134 COTTONWOOD LANE, CENTERVILLE,MA 02632 Work Description: Install solar panels on roof of existing house,with any upgrades,if applicable, as specified by PE in Design; To be interconnected with home electrical system. 6.095 kW 23 Panels JB-0263238 Total Value Of Work To Be Performed: $15,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to 'accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. I Signed: Cheryl Gruenstern 8/12/2016 (508)640-5397 Applicant. Date Telephone No. Estimated Construction Costs/Permit Fees ; Total Project Cost : $15,000.00 1 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $.126.50 8/12/2016 $126.50 XXXX-)0M-)0M- Credit Card 8975 Total Permit Fee Paid: $126.50 I _ • ♦rFy TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,,,_ ti. Map a� Parcel.'- Application # ��� Health Division Date Issued Z Conservation Division Application Fee Planning,Dept: -,Permit Fee, Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation / Hyannis VV Project Street Address ��' C07y4f Woo Village CE/JaP_VILLB: Owner CULL-Y 1�?i,�mh'V Address Telephone M 0603 03 Permit Request CoNUFPT 6,PtRA6_E_ 1AIM 14"1 :1 PtA-YP' '� �jr Ida tT1 3�3 �3 r il 7 -- M �KUv� Oat— I A toV� - Square feet: 1 st floor: existirkCW-f proposed O 2nd floor: existing proposed Total new Zoning District. Flood Plain kO Groundwater Overlay Project Valuatio Construction Type—f$ ' Lot Size Q On 0 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .Pd' Two Family ❑ Multi-Family (# units) A —3 .. : G? Age of Existing Structure Historic House: ❑Yes i;Mo On Old King's;Highway.❑Y &NO r= a Basement Type: ❑ Full ❑ Crawl UValkout ❑ Otherou n Basement Finished Area(sq.ft.) 2C9D Basement Unfinished Area (sq.ft) 266 Number of Baths: Full: existingnew� �_ Half: existing nay = Number of Bedrooms: 3 existing a new ;! Total Room Count (not including baths): existing —7 new t9 First Floor Room Count Heat Type and Fuel: RGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes a*&o Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑//existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size— Attached Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ``Commercial ❑Yes, ❑ No_ . If yes, site plan review# Current Use JUA/ Proposed Use Mal 1 EQOL J_ : APPLICANT INFORMATION n (BUILDER OR HOMEOWNER) _ Name �(�f_C.if l Telephone Number Address 3 tt COm4f 000b LAVE License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO [ f ( SIGNATUREJ��k/ADATE — 140 ` a l r FOR OFFICIAL USE ONLY „L APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER •DATE OF INSPECTION: FOUNDATION FRAME �lS10� INSULATION ZY lX 6 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING z A DATE CLOSED OUT' ASSOCIATION PLAN.NO., x f 3 Beasley 134 Cottonwood Lane Existing Basement Garage has the following: 1. Finished.5/8 sheet rock on the ceiling 2. 3 walls finished with sheet rock. 3. Exterior 3' 0"door 4. One 2' 6"window 5. One 10' Garage Door Requested Plan: Replace garage door with three 2' 6"double hung Anderson windows. Stud/insulate sheet rock remaining wall. Install=bathroom in basement. Work: All interior framing walls to be completed by homeowner using 2 x 4 construction 16" OC. Pressure treated lumber to be used when in contact with basement floor. Licensed electrical/plumbing contractors will be used to complete work as necessary. Existing Basement Layout 9 1-0 r I 00, 1 r- UP Beasley 134 Cottonwood Lane Centerville, MA Planned Changes d. J � ( aa � �` UP ,CoN F Beasley 134 Cottonwood Lane Centerville f � N O o N U -..._:._..... }; 9 � _a p ikk I 619 Z f liV �.✓tom C (M �ea.ia-Z, t=co�Dr. G�. ?cite O `"f- 4'rr 5k0CAJ/J Un/ I�19 7�dn/At� �a�iJr r Gd(7J 1r �� ' CAOY7. GN S U12/BI L' I2`�7� .NQ e '3CS �►!n/ ��ytu✓�`L.4n�� \\ r ZSn00 — 66 20—/ �A /G i4 Ui d,a, -jk ors � � �r �,�� G,- �tN of Af CERTIFIED PLOT PLAN I?� /49-r-4w, cFrrArr. L�irvE . J p� ,ROBERT NEW. CONSTRUCTION ONLY EL UCE TOP OF FOUNDATION? 19_ .._, FEET. , _ IN ABOVE 'LOWS POINT OF ADJACENT 'Y si. ROAD. $CAiE+ 'D ATE � I CERTIFY2TH T THE PLAN CLIEMT��us i f � R E®L�TREO 'REGISTERD �"" t:8M0 .N ,OAi; YH.IS, PLAN IS LOCATED CIVIL JOs:;I�tO: ,�.. .� B.AOUND.•A9 INDICATED A � 'ENGINEER SURVEYOR k :4,' :r CANPQR�09<<TO, :THE " ZONINB LAW x DR.B tl► PI y H1, i .�.;. I•iti 'mot wY 'Yi av /► Y .� R TAI L , DNA$ , { 712 MAIN STRJEET°. t _ i r H YA1 N hl I r p r S MASS ,� LAND r3URVEYOAft ; :; pkSHE *Permit# Town of Barnstable {. Expires 6 months from issu ate Regulatory Services Fee Thomas F.Geiler,Director l60 Mph:; Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us -Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERNHT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 21esidential Value of Work` ��J - Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address do V 15L m ccil 3 i 3 Cg�6 t,,3a� NNA C)20 Z Contractor's Nam lo e,_ [6Me_- TVv-, Telephone Number5(A- -7 -7.5-'I l 17 8 .Home Improvement Contractor License#(if applicable) 10 3 7 5 7 Construction Supervisor's License#(if applicable) 5' (Cc m, m vpFEb �� � Korkman's Compensation Insurance Check one: ; J `� L U l o ❑ I am a sole proprietor ` ❑ I am the Homeowner I`OWN OF BARNSTABLE DThave Worker's Compensation Insurance Insurance Company Name Q11950Gi C:_-A _j__V1CyL4_S4 5 MPr Workman's Comp.Policy# P L K, 7 C6"y 9 4 3 b(oZ 00c] Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box). ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over• existing layers of.roof) (fd Re-side #of doors 6'Replacement Windows/doors/sliders.U-Value o 3� (maximum.44)#of windows *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. o e Improvement Contractors License&Construction Supervisors License is re e SIGNATUREc Q:\WPFILES1FO1tMS\buildingpemritforins\EXPRESS. c Revised 090809 r • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 : www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please,Print Legibly Name(Business/Organization/Individual) S {, 1-12 T fbV2[1rte�i� Address: L99 ` W' nrAk4a6lew Qoar City/State/Zip: 4 i5 ' Oa(00 Phone#: - .40�' Are you an employer?Check the appropriate box: Type of project(required): ,4.. I am a general contractor and I 1.IU i am a employer with & Q New construction employees(full and/or part=time).* have hired the sub-contractors 2.❑ I am a sole.proprietor.or partner- Theselisted on the attached sheet. 7. .�Remodeling ship and have no employees `sub-contractors have._ g, [],Demolition working for me in'any capacity. employees and have workers' 9 0 Building addition [No workers'comp.insurance comp.insurance. t required.] 5.. We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeownerr doing all work officers have exercised,their 11.❑Plumbing repairs.or additions myself. [N right of exenlptton per MGL o workers comp. 11C]Roofrepairs insurance required.]t c 152,§1(4)i and we have no' �` employees.(No workers' .13.W OtherSC&Ay j W yA) comp.insurance required.], *Any applicant that checks box#1 must also fill out the section below showing their workers'comparsadon policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors 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�contrsctors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers':compensation insurance for my employees. Below,is the policy and Job site Information. n Insurance'Company Name SSoC Q. �--4 Sync a,�5�ftGS'` a'Y Y`n�t t Policy#or Self-ins. #:A l�G' 700�!9 b�e1Cb lid Expiration Date: O l - Job Site Address:. 3�� CO 1 ?y�xl� City/State/Zip: t���ex�(��le; 68 Q)G3d, 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$I 500.00 and/or one-year imprisonment,as welfas civil penalties in the form of a STOP WORK ORDER and`a fine, of up to$250.00 a day against the violator. Be.advised that a copy of this statement may be'forwarded to the Office of Investigations of the DIA for insuzAre coverage verification 1 do hereby a under e p and penalties of perjury that the information;provided above is true and correct: t�� Signature: Da e• f� Phone#: f. , Official use only. Do not write in this area,to be completed by city or town offlcial, City or Town: Permit/License'# Issuing Auth' hors circle one): 1.Board of Health 2.Building Department-3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone.# Town of-Barnstable Regulatory Services nAarrsreas.E Thomas}? Geiler,'Director MAas $ o Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis;MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 Propexty Owner Must omple nzl rgn Tlves 63 Uon---- — --- -----If Using ABader as.Owner of the subject property hereby authorize n f n � = T�t wee to act on my behalf, in all matters relative to work authorized by this building permit application for .(Address of Job) Signature of OKmer are Pnnt'Name If Property Owner is a plying for `ennit lease com lete the . PP YYng PP P Homeowners License Exemption Porin on the reverse side. -, (1•FCIRMCf1WTJF.RPF.RIvfi.CC1ON ' 11aSsa ehusctt ihp:ir tnrcriF of Ptrhlit 13uartl ofBiril(lin llc, ulation• trial S.tandar,•;el• Construction Supervisor` License _ Licens�: CS 6643 'Restricted:to: 00 BRAD K S-0 -I(�KLE' 190 LOTF4xC3.Rs LA . p A 02668 ,. W BARN57A411 IUI M; .. Expiration: 10/8/20.11 Tr#: 5478 Restricted to:..00, '100-+Unrestricted u 1G-1 2 Family Homes Failure to possess a current edition of the j Massachusetts State Building Code I is cause for revocation of this license. Refer to: WWWMass.Gov/DPS j Board of Buildln j Regulations and Standards -ROVE IMPROVEMENT CONTRACTOR � s` Rogistt� 107 1�01�"ralst�t3� tS' a � �ensc rregls - • efoe Cite ezpiratioai:date If found return to: oaf 1 nluiding` etilatitins and Standards ,. 3tte As4bur4ori P�a¢e Rni 1301 r"Bdstoti} g}02f 08' is i r ``, x of wati8 we wit r :.i,.J•. rCORO® l- - - . CERTIFICATE OF LIABIL-ITY-INS.URANCE OP ID DATE(MM/DD/YYYY) l Ol/05/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency' HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE-AFFORDED BY THE POLICIES BELOW... . Hyannis MA 02601 Phone: 508-775-6060 Fax:508-790-1414 INSURERS AFFORDING COVERAGE, NAIC# INSURED INSURERA: Associated industries of t7A ;• INSURER B: Sprinkle Home Improvement Inc. - -INSURER-Cr 199 Barnstable Rd INSURER 0 Hyannis MA 02601 -- -_----- _ - INSURER E COVERAGES t THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.-NOTWITHSTANDING ' ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL.THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDIYYYY• DATE.MM/DDO ICY � LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence). $ CLAIMS MADE OCCUR i MED EXP(Anyone person) $ '. " PERSONAL&ADV INJURY $ IY GENERAL AGGREGATE . . $ ` GEN'L AGGREGATE LIMIT APPLIES PERT. i PRODUCTS-COMP/OP AGG POLICY PRO- LOC `'` — Nw ! JECT AUTOMOBILE LIABILITY I'- - COMBINED SINGLE LIMIT -ANY AUTO I- I (Ea accident) $ ALLOWNEDAUTOS j BODILY INJURY SCHEDULED AUTOS ' (Per person) $ HIREDAUTOS BODILY INJURY ` NON-OWNED AUTOS I- - - R I.(Per accident) - PROPERTY DAMAGE • . .. —�-- I. . > (Per accident) j.5 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $.' ANY AUTO OTHER THAN. EA ACC g. -. - - - AUTO ONLY: - '..AGG $- EXCESS/UMBRELLA LIABILITY Y EACH OCCURRENCE jS OCCUR ❑CLAIMS MADE. I AGGREGATE $ $ f. DEDUCTIBLE - $ RETENTION $ WORKERS COMPENSATION TORYlJA UT ER TH- AND EMPLOYERS'LIABILITY YIN I A ANY PROPRIETOR/PARTNER/EXECUTIV AWC700494-3012010 ./01/10 01/0i/11 E.L.: EACH ACCIDENT $.500000 FMBE (Mandatory En NHj EXCLUDED? LJ r E.L.DISEASE-EA EMPLOYEE $500000 If yes,describe under - -! - SPECIAL PROVISIONS'tielow' E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS'.' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SPRNKHO- DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 ' DAYS WRITTEN' NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT;BUT FAILURE TO DO SO SHALL Sprinkle Home Improvement, Inc IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Fax #508-775-1350 'Margo Mack _ .REPRESENTATIVES. 199 Barnstable Rd. AUTHORIZED REPRESENTATIVE r Kelley A.Sullivan.. annis MA 02601 ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD-. •` TOWN OF BARNSTABLE Permit No. ----------------------- Building Inspector Cash ------------------------- °wY,, OCCUPANCY PERMIT Bond __.-------- _ Issued to Address Lot 169, lid Cottonwood 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. .....................................................1 19......_... ...................................... ...................__............._..................... Building Inspector �. essor's map and lot number ....:....................................... ''^t SEPTIC SYSTEM MIST� Q�'°fTHE TO`' g ., .. ...41. J INSTALLED COIVIP A�f �� Sewage Permit number ......... .... .. ....:....... f = . �!. WITH TITLE 5 BAaBAG�LE. House number ..........................r...............:... .. .............._ t ' '' � �� 'a0 to 9. > t ENVIRONMENTAL �aMa-1A,.0� , TOWN OF BARNS Xff fV BUILDING " INSPECTOR APPLICATION FOR PERMIT TO .........SS'........�lC�......................... .. ( T i cur �/�. G � .` �/............ ............... ............. .....joy .... TYPE OF CONSTRUCTION ��...00...:.�`�,A`r��!°........................................ 1. ........ ................................. i } 4F'7.....a?.............19�'3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: T �o® /TDi✓ 4.L� G/s4 1•V T .cst C .....4.0. nn Location . .....�.................5,��............ICI.Q...................:�.................... ..C�.............................. ProposedUse 6....... ........................................................................................................................ ............................r ZoningDistrict• ...... . ........... ...................................:..............Fire District ....... ...s.................................... Name of Owner'av� ....1U..!. C�i%L!�.../i`?✓S. .......Address ....... � t�l.................. ujIJ�C.O/�t.� v.s% ��a't/Y' Name' of Builder ......................................1........................Address .................................... Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms ....li!.eF ................................................Foundation .....e:pe.v f. gt.,*f............................................... v .° Exlerior, .......... r...!1,� ..........................Roofing .... 5.�f�i. :.��....................................................... Floors ,� �iPL�. ........................................................Interior ....�;1`�Y :�� .......... . ............................................................. Heating .......~ �!�...... �...�`�S............................Plumbing ..... ........... .� .......................... .` ............................. Fireplace / K.. :..C).�(.l' L�.....................................Approximate. Cost. ��flC1 ........ -- Definitive Plan Approved by Planning Board -----------____---------------19________. Area 3. Diagram of Lot and Building with Dimensions Fee SUBJECT T APPROVAL OF BOARD OF HEALTH at.I( f, / main 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. I Name ..... ............................................. Construction Supervisor's License ............................. i AVID BUILDING TRUST 4 2..568... ...7. One Story . ... Permit for .................................... Single Family Dwelling............... .............................................................. Lot 160, 134 C' k Location .....................................o.t.tq.nwo.od,. Lane .. .. .... ....... .... ...............C.e.nt.e.rvi.1l.e...................................... .. .... .. ....... .... .. David Building Trst Owner ... g u ............. . ......................................... Frame Type of Construction .......................................... < t..................................................................... Ylot .............................. Lot ................................ �J- October' -25 83. Permit Granted ....... Date of Inspectio—n' 19 4' Date C -npleted .... ......z/49.4.000�..... 194L .. .. .. .. rj lei O/o If "Ot A7, e� AZA OF A14 n, ERMCA ` ELUS 29874 0U �.. �n LO Q�BTWE�� �0 - ODIN 0 k .� o .I•`� 'p 0 ' �o�F �`' v� 9 N Y 0 Aw a 1 -Y .�..° .,' �1d L Zo oc�a S.:F IQS"w D-r+� ' a,. , eo PeorEc7,o�i ,�,s��. nRr• TTr Crl A-P7, rl Pr44 rtfae , .� t' LEEND 9 OTGE4EVATION 0 0 .r g . �N M CERTIFIED PLOT PLAN EXISTING ,� P� qss EXISTING CONTOUR ——-- 0 —-. , ;` ���' qc n T G o co7r�R�-L10 L�•vE FINISHED SPOT ELEVATION , ., " A m c C�i"TL f V/ t_L FINISHED CONTOUR 0 --- SE ti No:10951 4 1 N APPROVES 60/1RD OF HEALTH q��Fc►sTEP�`�`�`� of 14 P 1 2' -e__t1A DATE AGENT SCALEI 3 0' DATE I DIA •— - _., .... ,. RDGE ENGINEERING Cat CLIPNTpb ...�s r I CERTIFY THAT THE PROPOSED . , EGISTERE FREGISTERED .' J®®, IdO:., BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING '-LAWS . OR.®Yf}1 .. " F .BARNsTAS E , MASS4. E -r ENOIN R { 0 712 MAIN STREET - -y L NYANN I S, MA9S. gHEET �. OF'Z DATE 0. LAND SURVEYOR ;�'� ��b �.. •�, vw'fro '..�n art,"+3� „ a ro ty t.s�. « �:'. *' y ... a: ., r;w 2Q �TO/1K ? MOTE /P E/T/'/E/�' TN,�S•-PT/C TANK�Q� L t, „ r °EAGN �EL®jV sd s*r.wyiw 1.4A of A 24'O/A.'f F rFa co 1 /�� 4'PYC PIPE .+J�lAL� ®E"®ROUGN<T ZAP To G.gAoz. �:.4 W/1/CRL'TD- M/IV /glTtil t1ERVy C/1 ST !.?O/Y G�YE.? C'�YEJeS P Fl. I /F f.Y oR/VE rV.4 y MIN. CCn.'C.2L�T� 4. Ll�t/io Ls�L 4'+ /J�OAf P1P� •�'` -, r < �cc�cRere` .:sr�..�j 2�Lv�YE.? f MJ� P b 1 'V/�. s � buy r • ��O Ghf'tMiJEY , ` � �, �� C� /IB•��ld- -^s.:: c -t: o .'xr*; rYs*...{ 3 1u -- -.c. , J.. tli�'ac10 aL'ACt17v..F f � •, :} i FffECT/Ve. 1 •. : • _ 4 ' ��• � -.?'id�l�S'ai�"�-:p>I-I��+�h' Y � L. -.x 4, '.,1 � �....,: i � ..,^ - :......' �a�..;� r"�,k;,sr„w�.i.ei;"�-:,-a�'.r�dt•s k.-i. '} S 1- . O•1;�_ � - OLpT/� v .STtJ.YE '� r�. w ,'i: �' :`S. �h'ns�" ��"' £'iM°� �-u�4�7KS���irn� '"+✓>,,.+ :;Axyr `,� � ..• �. • • O .t:: �t r,j" z>, �,,.�� � \ ,s- �n.� c� i nL Ks�"'{�,-,'.h r<°i�"s _t S/��,s„q^Q.i 'a �J 3 1-.e:;� *..�"E'i. S •~ •� � A ,y,:r' r..z�`•�'� Ftf...x=°' .-zr�,4 7x :S'^rt.fi-.'sf-,,:<�:i �Gl r -'f�W-.r;-Qi a .-;.t+ S ><'�.�� .�J q '�" ! 1_ �f • ����.r+r7 0 -; 11VV�:I�9"`.C.L.E6� .��� .�,��..��a� �,ty�. �: � y��=:,R � •��•� -� � z� z c�� n �If/1fT�. �. i,, h ',�.�-,v p T" �,_r� a_P`, .a� }. ra.,> I •,O • • • .1 f • • O O "I�/T OR 4eV I.//Y INA A,__,,. • .z.+r. �y._„ z. .....w'^�S .....� N:.,., ..:.v.�, ., --.Y...,r N ,..e. y n:,'.� .�, r. � €•. G . . _ _.�,.. .��,' m,,� � �ro,`,a,>, .;�: .?...� ,'y' :� �"`��, Via. A:��i�. . ,. ..y,°,. .r • EL $`�$" s, . r IJ��Tef f•. •r. 4i0 'rp.. _- :..'d: :Xtir :..- « �g i': .•�..-' rzr. ,.a i - -•5a 4•• F Y�4 ..ti;i;• �_.. +L'T '�'tt4ti. . �' - =S' „�.y��M ,rG .. F `.'t^' ` - 'lam i:�t /►T - , $ �ar L` �_ FL O.G4lN.;>- �:: :SgP TgCyL,AT�®1i/ xf . � `* t< z Ly�=-mow,. sR+�"c�^ :,e_- ;7s�"R-4:. �• _..--�- �'�t. � ;' r ._.....-s.. ,.. - .. ,,., .•...-�! .�;�. :a .>M.... ..:.: ., ,.�. ...-s•.. .'' _,. "a.,.. _� .. A„. .,, , .y. f... ,, Ki-Y.. .�,.. r,: _.,.Vr• .a....y°. 1. k_ <... .�..:, ..,.,... ..• .d.. .fix •q.. ..ro ti. ''"`" }.: .2 Mx..,..x ✓F -fn. `' '! `�.'. r: '• ..,,,'.s. ..dv. ^•t.� „s .. �',+o:�► -a� f,*�:,a.S.+a.*�e, _: p.. . ., Y'v -. ..<,.`. i .'-'J'•.'�{ .,C7C.48 y4 •,5 ...:.: .. .::..zF - ..r:• :•.:a :_.,_;.°I �-� � f.`�r-: }►'�Ta7a�' L ��� - -.s .,.>. , ,....- -•" a ...e,:. �ra. ,.- ...... .>�:+' el.. •"d a-tve _ ,#..''i+. :�fi.. r�._> - xa'Y.. .,�'?� ��4 xF:i.,,'ti .,;�= ,L";- .ate".':"r.:<-..�.. .•,i''.-� .r.. ..., .r r,-�..sf',�,. •; .,s� - =o���+.1-,., rsv+�{y..b:. �S •'v. 'J,I..;e'.Y�-+t. .x?�C }� _ a._ ... i. NZ:BF`Lb*ACJtiI„ � s . . kG .. �:.,. � •_ S::e,.r;,s.}. $... u•.r' .SR + ,n�.'.. ? 777 .. .'1 '.;.v e+�.. v, _a+•=2 .�"«. ..t,.... �d_ :- ..,.: i7.: . 4 .",2. . .,Y..._ . .. p-. z. .m..;:yw W: ,;t.,a •'11Y„,.: ..,4�> +�y, '.S"•y, - ,,. _'. .-c c.s:.,. : .a.v,4�„ .::. � r;.�,w- ."' ,� � 't •@�:,��; .�.:.ns- .p. t�. °tF,✓" � z ,v, :f'•.,7y:.k«. _.,..-•, .,. �.-,c u......r. j'., ... � 'S:;r. ..,. "Ssl�. ry•... �e w .,..�.,..,,y.K.- s, ._:. . ._x.....:rz'Ky � .�., '...-... .. .- t -., :.. .. �1.,br.:..•.-.w..� /��y...�.. ..d '`�. ..a.. ..r:_ '�'+ ���iP��R'�llfi�� T ...a i :,,. ...,,._ �!`^:3 '^ .: r-E. 4,'�_.. :.�: .. m^..st: �,..... ..... �����.`,::�:. ..'k:•�.s'k.:.ty, Y. .r�. .a+Y. l �. •k V''-�aS ,q: �t,u: .- .., 4 a.. .•-,a ......,. -.., ....;,�... .::.,.,r u._- -..„,7- x ...,�U..$..,v.l., _ <-.,:�... _ ram. �J: '�E: �.4 ..t`^w. � .'i^ ��� � "4- .. ...,..�. v1,r.-.. h. r.. @^r ._va. �.. -'� %R"ra�. �..^.,. / r T.-.. ,K- 'zti tw::'.. .•�.�� .':� y^ i <_ .. :.;F,rt"� :.�. ,s �.� .�' 'im. ,,r�,:qw• s;;;;- s� ^.4r. .� 9�. v`;ti ':a,_ ..��. � �/ � �p,.� ;y� 4. OINAUV`/ t_ `,a� • .T ';,,`a: .,-Y- %..,' n�... n. "b Y.:f,.. 1 -:,.,"-, S..a x#"S�. .S sl ..fiF' D� ys-., K �i S, a - 0/ s LOG TOT.�1 ESTlITEp FLp jy..3 3 o G,{ y t, . - z' �Y t/QA SO/L TESTt `SO/L TFST�r�? 3: r x ,5;:°S�/aC 7"E.ST` _ r Eki QF LEACJVtNG:.P/T3' slaE cr acH//va e��sY vrT .SYt. rT. t�✓. __ D�4Tg 10A A& L'TFsr Q% i + r .R 3o TTOM LEr'tCN/NG/���P/T l'3.'I _ r zslvLTS H//T/V&SSED By-, j.TdC'.)4 PT G-0/Pf/--,4 cl�. a ."'eNCOLAT/0M MATE Liss i T�TAG 1cTACN%A!G �REA ` '263.9 SQ. FT. s,�(� / --�.+i✓M/ /A/CK ?ES,E.4VELt�.4�`XJN6r'ARE.+ 263.9' FIE.ICQUT/DN RATE y�2 54. FT. 2 244. P�(H OFIlly MA S� r> s L T 160 Gorr r��r c�o�vv Ln�v� E G 2A VC-L_ C / ►' T�j�7//L G g o. MORSE ' y F.LJJS �; No.10951 Q Q o �NL2W4 c . A9- G/SSE�`��`�`` �, Ffs. ELOr?EDGE FNG/NE `7lJyG C40,/1YC. 6 7/Z AIAI" ST FS`10NA1 �a A/Q G/40fJNJ vY�4TER ENG'OUNTE.��® �Np suRV tL/ENT: F&L . Q GRO lJNO.'j'i!A TFR AT�LEV.' g� DRTE : ..k ' JOD ,1/D� $3Zz-3 SHEET Z-af �' i Assessor's map and lot number ............................................ of I To Sewage Permit number �Q s,{f, li BAUSTADLE, i ~House number ' `' S,yet{ - ' NAG& 00 i639 9� TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .........� / V 9 ......r �''�!.L�/..... G.`..'...e.............................................. TYPE OF CONSTRUCTION ...................(/QP.I?. .... !C'!9.° ` ......................................................................... ................................................ .3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......•(C/r`. A!2.......... I Tc�it/'/aD..c7G1.....L i9 C- L7c�-�c..jrE'�U... .............. .................................. .:.................................................................... Proposed Use ' ' Zoning District " �..................................................Fire District (.f. Name of Owner D,40/� 'Z?r✓iedl,'.{.r-c,.....T/c.!5. .......Address ....... �`t�.T............................................................. Name of Builder ..... .......%/c•S/ Address .........:.��:✓jam �. ..... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .................................................Foundation ..... 6(/(.PP.............................................. Exterior ' . f 1��� �P Floors .................�... ..T.........................................................Interior .... ...................................................... All e Heating i` N � % CfIS.............................Plumbing .. ..................................p.................. .................................................................................. Fireplace ...... .�.' ' ....................................Approximate. Cost4.�,5�,4-:.0 Q............................................... Definitive Plan Approved by Planning Board -----------_______-----------19________. Area ........ /...... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH J 1 Hum rAIA P l r i �d L 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 DAVID BUILDING TRUST A=252--147 No '.2 5 6 8�.. Permit for One Story .................................... Single Family Dwelling ............................................................................... Location ,Lot 160 , 134 Cottonwood Lane Centerville ............................................................................... Owner David Building Trust .................................................... Type of Construction Frame ................................ ................................................................................ Plot ............................ Lot ................................ Permit Granted ...Q.ctobar...25...........19 83 Date of Inspection ....................................19 Date Completed ......................................19 5-T So �l i 9S �o 6-- 1 f The Commonwealth of A,fassachusetts ,Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 021I1 ;. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organintion/Individual): [} L y FAS4a / Address: r?j CGrt'`tG�l/ I00p LIV City/State/Zip: C Al Url,� ' D2G3�hone.#: 5®c?2�-0s®� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor.and 1 6. ❑New construction have hired the sub-contractors employees (full and/or part.tirn.e).* ..2.❑ I am a sol :proprietor or'partder (� listed on the'attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have 8. ' Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'-comp.-insurance comp. insurance.$ required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.[�I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance require*] t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp.insurance required j "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. tContractors 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 providb their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site inform ation. hnsurance Company Name: Policy#or Self-ins.Lie.M 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 crimirial penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine. of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce and th ai'n 'and pe alties of per' that the information provided above is true and correct. si ature: Al� , fog — Phone Official use only. Do not write in this area, to be completed by city or town offcciaL City or Town: Pere-XLicense# 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 o'r 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." 'Neither the commonwealth nor any of its political subdivisions shall Additionally,MGL chapter 152, §25C(7) states enter into any contract for.the performance of public work until acceptable evidence of compliance vrith 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 certificates)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 permidlicense 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 ch applicant as proof that a valid affidavit is on file for future permits or Licenses. A new affidavit must be filled out ea year. Where a home owner or citizen is obtaining a license or permit not related fo 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: Thc, Commonwealth of Massachusetts Departnnent of Industrial Accidents Office of lnvestigatlans. 600 Washington Street Boston, MA 02111 Tel. #617-727-490.0 ext 406 or 1-877-MASSAFB Fax# 617-727-7749 Revised 11-22-06 www.mass..gov/dia ENVIRGY CONSERV'A` -ION APPLICATION FORM FOR ENERGY ErFXCXCIENCY FOR ONE; AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 clvru 6x.00) Applicant Name: C� �Lt (4 _ �S L& Site Address: CO /Q f1b'(D LAi print Town: Applicant Phone; SN((cbo Applicant Signature: Date of Application: Z NEW CONSTRUCTIOe 0 of the following two•o tions 780 CMR TABLE 6107.1 PRESCRIPTIVE E NVEI.OPE CON x'OIVEr:T CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM 'MINIMUM Ceiling or Slab Option 1: Basement Q Fenestration exposed Wall Floor Perimeter Wall AFUE HSPF SEEI U-factor floors R Value R-Value R-Value R-Value R-Value and De th National Appliance-Energy R-10, Conservation Act(NAECA)of .35 R-3 8 R-19 R=19 R-10 4 ft . 1987 as amended,minimums or caatr as applicablc Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: REScheckVersion 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck--Web which can be accessed at http-//www.enffrgycDdCS.gov/rcscherk/ ADDZ ' OlV5;OR�ALT tATZONS.TO EXISTING BTJ7Y,DZNGS.O V I2 5 YEARS OLD *buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b _ a) SF 100 x - _ % of glazing b a (b) Glazing area equals SF If glazing is 0%.u9e the chart below. If glaziDg is } 40 % rocee,'d to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTL4-L BUILDINGS MAXIMUM ram/ .Ceiling and Slab Perimeter �1 Fenestration Exposed floors -Wall Floor Basement Wall R-value U-factor R-Value R-Value R-value R-Value and Depth .39 R-3 7 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i.e. not compressed over exterior walls, and including any access openings). ' SUNROOM—An addition or alteration to an existing building/dwelling unit where the total F1 glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form found in Appendix 120.P Town.of Barnstable o Regulatory Services Y • Thomas F. Geiler,Director Y BARNSTABLE, • MASI q� 03 4• Division s6 ,�� ATf0 A Building Tom Perry,-Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print /�� DATE: / I� / / �J `7 JOB LOCATION: number street - village W / "HOMEO NER": 1. V U_Y P�hls UiY SOS name V home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such homeowner shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1,1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,riles and regulations. f The undersigned"homeowner"certifies that /she understands the Town of Barnstable Building Deparfinent minimum inspection proc'dures,and.requir ants and that he/she will comply with said procedures and require nts. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fonn/certifrcation for use in your community. Q:\WPFiLES\FORMS\homeexempt.DOC Town of Barnstable Regulatory Services " sasxsTABLE. Thomas F. Geiler,Director MASS. 0;p � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must mplete, and Sign This Section If lUsing A Builder as 04 er of the subject property hereby authorize to act on my behalf, in all matters relative to work authorize y building permit application for. (A ress of Jo Signature of Owne Date Print N e If Property Owner is applying for permit please complete the . Homeowners License Exemption Form on the reverse side. Q:FORMS:OWN ERPERMIS SION c�u/1Y1D S PERMIT Town of Barnstable *Permit 4620 Expires 6 months from issue date 9 2006 Regulatory Services Fee asps Thomas F.Geiler,Director ��� BARNSTABLF Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Tice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint arcel Number ` ty Address sidential Value of Work���w Minimum fee of$25.00 for work under$6000.00 ,'s Name&Address - m 4, &aS/T_L4 .ctor's Name (� 1�cJ L. Telephone Number 7W—V ZP t� Improvement Contractor License#(if applicable) ucct/tion Supervisor's License#(if applicable) tkman's Compensation Insurance ' Pone: m a sole proprietor m the Homeowner `�S e Worker's Compensation Insurance , ice Company Name tY�/V C.f'�� 77(.� aan's Comp.Policy#--p G(�� A r ,4--U' A Insurance Compliance Certificate must be on file. Request(check box). �C _roof(stripping old shingles) All construction debris will be taken to ❑Re-roof.(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) t , *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. ' Home Improvement Contractors License is required. �TURE: 11sawt, :expmtrg 11405 David Sawyer Construction 318 Meiggs Backus Road Sandwich, MA 02563 (508)-539-1992 Proposal Submitted To: Work Place: Datej-uo)—'S-6�9 �v - - r� Stnp,Remove, and Haul Away all old FT f shingles. SUPPLY&INSTALL: COLOR.: i�laGb S��-P� A ,, - Sc t-`M f3L��c 7�4,30 yvwko t C'1- eL4vta�Aeq(-. Pj a A CLEAN&REMOVE ALL DEBRIS FROM WORK PLACE AFTER JOB IS COMPLETED, ALL DEBRIS TO LANDFILL. TOTAL INVESTMENT FOR MATERIAL&LABORS_,,,$ '� All material is guaranteed to be as specified,and the above work to be perft6nid irw accordance with the Specifications submitted for the above work and completed in a subs tial wior ike manner. Payments to be made as follows Any alteration or deviation frotn th work sped ,cations involviutg extra will be executed oNy upon written order,and.will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control.Please remove and/or secure any fragile household items. Not responsible for broken or damage household items. 19YEAR LABOR WARRANTY/PLUS MANUFACTURES SHINGLE WARRANTY. 11ftroposal miey be w' Ibdrawn by as iif not accepted within 30 days. Respectfulty submitted 1®,� 1 ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the works specified. Payments will be made as outlined above. Date ILIt Signature Board of Building Regul 'ons and Standards One Ashburton Place Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 134313 Type: DBA DAVID SAWYER CONSTRUCTION Expiration: 10/2412007 DAVID SAWYER 318 MEIGGS BACKUS RD. SANDWICH, MA 02563 0 soonoaros•Pcesss Update Address and return card.Mark reason for change i [] Address ElRenewal Em to ❑ P yment Lost Card �� ✓fze"�a�nmznouaea�o�✓�acluaelta �= Board of Building Regulations and Standards = HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. If found return to: Registration: 134313 Board of Building Regulations and Standards Expiration: 10/24/2007 One Ashburton Place Rm 1301 Type: DBA Boston,Ma.02108 DAVID SAWYER CONSTRUCTION DAVID SAWYER 118 MEIGGS BACKUS RD. ; iANDWICH,MA 02563 Administrator Not valid without signature Oil' TRAVELERS WORKERS COMPENSATION AND R(aR EMPLOYERS LIABILITY POLICY 6pb TYPE AR INFORMATION PAGE WC 00 00 01 ( A) �A J POLICY NUMBER: (6KUB-8014AB8-A-06) RENEWAL OF (6KUB-8014A88-A-05) INSURER: THE TRAVELERS INDEMNITY COMPANY • NCCI CO CODE: 11347 INSURED: PRODUCER: SAWYER, DAVID R KERRY INS AGCY INC 318 MEIGGS BACKUS ROAD PO BOX 1945 SANDWICH MA 02563 NORTH EASTHAM MA 02651 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedules) attached. 2. The policy period is from 08-28-06 to 08-28-07 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA e B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in Rem 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A I D. This policy includes these endorsements and schedules: SEE LISTING OF .ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 08-31-06 ML OFFICE: ORLANDO INDUS AFF 161 ST ASSIGN: MA nortr 11/'CD• VCDDV TAIC Ar-rV TAIr 28SHB I ' e The Commonwealth of Massachusetts Department of Industrial Accidents t Office of Investigations 600 Washington Street .Boston, MA 02111 yr www.mass.gov%dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers licant Information Please Print Le ibl ame(Business/Organization/Individual): ddress: f4 Ci ity/State/Zip: Phone #: lmployer? Check the appropriate box: Type of project(required): mployer with . 4. ❑ I am a general contractor and 1 6. ❑New construction ees(full and/or part-time).* have hired the'sub-contractorsole proprietor or partner- listed on the attached sheet. t ❑Remodeling d have no employees These sub-contractors have 8. ❑Demolition g for me in any capacity. workers' comp.insurance. 9. ❑.Building addition rkers' comp.insurance 5• ❑ We are a corporation and itsd.] officers have exercised their10.❑Electrical repairs or additions homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp.insurance required.] y applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. rmeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. an employer that isproviding workers'compensation insurance for my employees. Below-is thepolicy and job site rmation. ance Company Name: // ff / y� icy#or Self-ins.Lic.#: �� ���`-1 �j "�_ Expiration Date: ✓u— Site Address: l City/State/Zip: ach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a e 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 p to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification. Lature: y certify nd a' s and penalties of perjury that the information provided above is true and correct. Date: one#• 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#: