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0050 ELLIOTT ROAD
SO ' o r, 0 e w a � o Assessor's map and lot number Sewage Permit number ................................. THE O�O I EARNSTADLE, i Ho**2 number MAOa o�oo,1639 �f0 MAY a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....................,,,.... .:.:........ Q ........................................:......... TYPE OF CONSTRUCTION ....................... ................................................................... .................. .. ................9. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for apermit according to the following information: l Location ........................................ A. . ............. .......................t................4,fJ ......................................................... ProposedUse ....................` .,.......��Q: ::.......................... ........................... ......... .............................................. Zoning District .................... ..............................Fire District ..........Yt Y 1C �l� f� Name of Owner ........................... ..........................................Address .......................................P........................................... . rt Nameof Builder................................. .I, ..............Address ...... ....... ........... ........... It 1i Nameof Architect ..................................................................Address ............,........................................................................... Number of Roos,—.—......—m ..................................................Foundation ........:.............(............:.......................................... `{ 11 Exterior "`..,.. -*..........................................................Roofng .................. c ...................... Floors ...... ..... .................Interior ......................r.a/..'Y ..ri...�................................................. Heating .........Plumbing.............. ................................. ................ ...........��. ............................. mot' Fireplace ................ .......•....�..................................................Approximate Cost ......... ..... ......................... Definitive Plan Approved by Planning Board __________________________ ------1 9--------. Area ..�..,_]............. ................:..... Diagram of Lot and Building with Dimensions Fee-.... A '......�.....( ....�....... .................. SUBJECT TO APPROVAL OF BOARD OF HEALTH Z Z r ti � a i � 1 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 .... ,. .......,. ................... LYONS, HENRY A=248-172 ; 23E,� _' DITION". No ...........� ... Per it for .. ................................. Garage to D elling ........... ................................................................. Location- 5. OElliott Road ................................................................ Centerville ............................................................................... Owner Henry Lyons .................................................................. Type of Construction Frame ................................................................................ Plot ............................ Lot ................................ Permit Granted „. December1 1, 19 81 ............ Date of Inspection ...................�................19 Date Completed .................. ..................19 �• Assessor's map and lot number ��. ....�: Sewage Permit number `...:................................................... row o� BARNSTABLE. i M AB Ho a number ............... :.........................................,...........:. r & Apo,039. \00� z TOWN, ®F ;:BAR.NSTABLE : BUILDING 'NSPECTO APPLICATION FOR PERMIT TO . ... ...: :..: TYPEOF 'CONSTRUCTION ...............:.....:.............. ..... .......... : +.....`.:.:.................................................:.......... ............ .. 19. � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �/JJ � Location ..-............ .. K�•l .....�.......... ........ ... ......... :........................:.......................:.. Proposed Use .................... ...... ............ :..............:..... ..... . ..... Zoning District ........................... .�. .:............................Fire District .................... Name of Owner .:T!-P�')V 1 ..:...6�`.. .1 .5-........................Address ...................................... .................................. :.::..::..:.t I\.. �..0..............Address ......... . ............ .................. ..... ............ ( � Name of Builder II Nameof Architect .................................................. '.Address............... .................................................................................... Number of Rooms .......................... .......... ..............................Foundation c�� )) �'Exterior v ...�................:....:.....:...............................Roofing .... ... ........... Lqz.T......................................... ........... L-�� -� .Interior .. Floors ..................... .. ..............:........................:.. ......... . . ........ . ..................................................... c — .................. ........... ............... Heating .........................:................................:.......................Plumbing ................... ... Fireplace //��� ....................................................................:......................Approximate Cost .........��:.V...l................ ........:...... Definitive Plan Approved by Planning Board -----------19________. Area .... i/. :.. ...:...... . ..... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Z X tj Y TTr ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. ......... ......................... LYONS, HENRY 23 ADDITION No ........ Permit for .................................... Garage to Dwelling ............................................................................... Location .Elliott Road ............................................................... Centerville ............................................................................... HZInry Lyons Owner ................................................. Type of Construction ....Frame ..... .................. .............................................V.................................. Plot ............................ Lot .................... ........ F77 December' l Permit Granted ...... ..................................19 Date of Inspection ......... .............19' Date Completed ................ .. .. .. .........19 r 4 ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- Parcel Application #a o/qQ cm Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation/ Hyannis Project Street Address ,6 z=�I er Village Owner2r/ ,< Address Telephone_ Permit Request _ f' �li A"-Ivelel� a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed ' Total new Zoning District Flood Plain Groundwater Overlay w70 a: Project Valuation 4�-DlD,, Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documer-tation. e i'qJ' Dwelling Type: Single Family Zr Two Family ❑ Multi-Family(# units) Age of Existing Structure ' Historic House: ❑Yes .B'No On Old King's Highway: ❑Yes ,O'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) Name �' C jLGf� b� Telephone Number -576 Address I �°!�/��,���i License # /1� fn Sc Y F /J Home Improvement Contractor# /.-'Y_S1 7 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO U U SIGNATURE DATE i FOR OFFICIAL USE ONLY APPLICATION# - -- `DATE ISSUED MARV PARCEL NO. ADDRESS, VILLAGE OWNER DATE OFINSPECTION: FOUNDATION FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING:• DATE?•CLOSED,OUTS ASSOCIATION PLAN NO. �., Housing ,assistance Corporation Cape Cod HOME OWNER t RESIDENT WEAtTHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. I HENRY LYONS hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation (herein after referred as "Agency") on-the property located at: 50 ELLIOT RD CENTERVTLLE MA The weatherization work done will be based on programmatic priorities and availability of funding and it ' may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalls & basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be-done at my home I agree to the following: t. I give permission to the"Agency"its agents and employees to travel onto or across said property- with such equipment and materials as may be necessary to perform weatherization work on said property. ,. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no.more than five (5)years after the weatherization work is completed. r I have read the provisions of this regiment as listed and fre give my consent. . Home Owner: (Signature) �°'/f az Date: 4/14/14 Agent: (signature) Date: 4/14114 HAG approved Weatherization.Company : 0AI-110 T } ,,,�,, ` Adam T Incorporated All Cape Energy Alternative Weatherization Building Performance Contracting LLC QCape Cod Insulation Cape Save ' Frontier Energy Solutions Lohr(Home Improvement Resolution Energy: t Massachusetts -Depaf`tm •nt of Pjjblic Safety 1 , 8oard.of Building Regulagons end Standards l Construction Supervisor. �� w s License: CS-100988 r HENRY E CASSID'Y' rs 8 SHED ROW r WEST YARMOLFfH I :.y 2 Expiration Commissioner 11/11/2015 — Office of Consumer'Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Con,traetor Registration 1 Registration: 153567 x Type: Private Corporation Expiration: 12/15/2014 Tr# 233831 CAPE COD'1NSULATION, INCH ; HENRY CASSIDY "1 18 REARDON CIRCLELFVY_ ;. . SO. YARMOUTH, MA 02664 t — ` " ; Update Address and return card.Mark reason for.change. SCA 7 io 20M-05/71 Address Renewal Employment- Lost Card - � - • c�T e��irz-nrr�rrawal��i d�C/�Ccrddczc�ccael�. q"51"' Office of Consumer Affairs&Business Regulation License or registration valid for individuluse only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: I'53567 Type- • Office of Consumer Affairs and Business Regulation xpiration 1211`5=14 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION INt; HENRY CASSIDY 18.REARDON CIRCLE SO.YARMOUTH,MA 02664 h Undersecretary 4valitho t Wnatre `-r The Commonwealth of Massachusetts Department of IndustrialAccidents H Office of Investigations d I Congress Street, Suite 100 Boston,NIA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): 'AUI —WL Address: V l/G G(�i Cit / b 6va& 0� 5 State/Zi 1�'�/� y p. . Phone#: Ayu an employer? Check the a propriate box: Type of project(required): I. am a employer with.' 2G7 4. ❑ I am a general contractor and I employees (full�and/or part-time).* have hired the sub-contractors �' El New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in an capacity. employees and have workers' g y p y 9. ❑ Building addition [No workers' comp. insurance comp.insurance.$ required.] r 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ l am a homeowner doing all work officers have exercised their I I.[] Plumbing repairs or additions „ myself. [No workers' comp. right of exemption per MGL 12,❑ Roof repairs, insurance required)t c. 152, §1(4), 13 Othe and we have no 'v 1A r (i1 employees. [No workers' .�. comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they 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 provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Naine: . Policy#or Self-ins. Lic. #: �C (fit j 2 � ' Expiration.Date: W _q ' Job Site Address:40 t Z A& llzee; City/State/Zip: I' Attach a copy of the workers' compensation.policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition'of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine t 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 1 do hereby cer tfy the pains and penalties of perjury that the information provided above is true and correct. t Si nature: Date: Phone#: Official use only. Do not write in this area,to be completed by'city or town official. r 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#: k �I J CAPECOD-27 CVANGELDER DATE(MMIDDIYYYYI -' CERTIFICATE OF LIABILITY INSUPANCE 4/1/2014 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 TW N THE ISSUING INSURERS AUTHORIZED f l ), 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 _cartiticate holder in lieu Of such endorsement(s). PRODUCER CONTACT - NAME• Cape Cod Commercial _ Rocars S Gray Insurance Agency, Inc. PHONE FAX — -- 4Mte 134 J& No ExtlI — _ — -'----�Aic�Nu)n(877)81 b 2156 SOUth.DeoniS,MA 02660 EMAIL - ADDRESS: - 1 SURER(S).AFFORDING COVERAGE NAICH _—__-- INSURERA:Peerless Insurance Company_--' INSUY__ti - INSURERB:COMMERCE INSURANCE COMPANY .._... Cape Cod Insulation Inc INSURER C:Evanston Insurance Compat _ _ 111 Reardon Circle INSURERD;ATLANTIC CHARTER INSURANCE GROUP 5O[tth Yarmouth, IVtA 02664 INSURERE: --._..------------ - - INSURER F:. - - COVERAGES _ CERTIFICATE NUMBER: REVISION NUMBER: I HIS IS 10 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INOICAI ED. NO'rWITI-ISTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICA'I V. 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. cN51't! ... .---....—_._.._.—..—____l,CD1lL.SlIBR POLICYEFF^—POLICVEXP —'-----_. t.TR! IYPe OF INSURANCE INSQ vvvn POLICY NUMBER - MMIDDIYYYY MMIDOIYYYY - LIMITS - A rX COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,00 CLAIM$MADE I OCCUR CBP8263063 0410.1/2014 04/01/2015 PREMISES -anc9L 100,000 MED EXP(Any one person) $ 5,000 ;! PERSONAL&ADV INJURY S 1,000,00 �(!EN'. GG,RH(.A)L LIMI I APPLIES PER GENLRAL AGGREGATE $ 2 000 000- LOc. - - -----'--- ----._--_2,000,000X JECT PRODUCTS-C is i r;Irn':R _ AUTOM)�OBILL LIABILITY COMBINED I GLE L MIT $ Ei yr ino 14MMBCKVMK - 04101/2014 04/01/2015 BOD,ILYiNJURY(Perparaan) $ AL I.OVVNED -X SCHEDULED IUS AUTOS BODILY INJURY(Par accldanp $ 1,000,000 ll - .__ _ _ X X NON OWNED PROPERTY DK14Xd:_ $ ul U;'AI) AUTOS Peraccidant -- _ $ UMURLLA LIAR O EACH OCCURRENCE 1,000,000 C EXCESS LIALI CLAIMS MADE R/O XONJ453512 04/0112014 04/0'112015 AGGREGATE !I =1) 1 X I IRE IENI-ION$ 10,000 Aggregate $ 1.000,000 WORKERS COMPENSATION I PER - OTH- - r ANU tMPLOYERS'LIABILITY STA.T TE _ ER__ _ D �aNr r RC)I RIEFORIPARTNERIEXECUTIVE YIN WCA00525904 06/30/2013 0613012014. .E L EACH Acc,IDENT _$ 1,000,000 i)HlCci2/MEMHER E.KCLU UED9 . - NIA — '---'— - .._•' '-1,000,000 . (Mandatory In NI-1) E.L.DISEASE.EA EMPLOYEES 10ESCRIPI'ION Ur OPERATIONS balow- E.L.DISEASE-POLICY LIMIT S' 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS.IVEHICLES (ACORD 101,Additional Remarks Schsdula,maybe attached It more space Is required) ! .— Workars Compensation includes Officers or Proprietors. Ad(litl ldl I115uled status is provided under the General Liability and Auto Liability when required by written contractor agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE a EVIDENCE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL:BE DELIVERED IN ACCORDANCE WITH THE POLICY'PROVISIONS. . AUTHORQED REPRESENTATIVE —^ ©1988-2014 ACORD CORPORATION. All rights reserved.'* ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD _ E + �OFIHE T Town'of Barnstable *Permit# Expires 6 monthsI ron:issue date O P . Regulatory Services Fee p��� ---- .MASS LE • �� fA "'� Thomas F.Geiler,Director l�`/�'—J4 1639. ♦0 Building Division X-PRES,S PERMiT Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 FEB 08 2010 www.town.bamstable.ma.us TOUVIV OF 6ARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY - Not valid without Red X--Press Imprint_ Map/parcel Number IL4 < E Property Address l .�( PZ� , dResidential Value of Work (0 i UUn Minimum fee,of$25.00 for work under$6000.00 Owner's Name&Addressh� Contractor's Name L Telephone Number J Q�j Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) � 5 M'W"'orkman's Compensation Insurance. ClIeck one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insu1ranc\e'r Insurance Company Name 1�% �i C\`(%f�l i4 Workirian's Comp.Policy# °-t�t� X 1%��1 _ � �� 02 (U Copy of Insurance Compliance a tficate 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) ❑ Re-side _ q #of doors Replacement Windows/doors/sliders.U-Value r ` (maximum.44)#of window' .,*Where required:.Issuance of this permit does not exempt compliance with other town department regulations;i.e.Historic,Conservation,etc. '"Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is 1 re aired. SIGNATURE:\ 1 C:\Users\decollikWppData\Loc I\Microsoft\Windo \T porary Internet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 AN Tfae Commonwealth of Massachusetts .Department of Indissoial Accidents t3 Office of`.Inuestigadons 600 Washington Street F Boston,AL4 02111 ` ✓ owmnlass.gou/dia Workers' Compensation Insurance atfida'v'it- builders/Contractw-s/'Electticiansll'lumbeils Applicant Information Tease Print LeajblT Name(Businesvorgaanizatiowin&iduai): _ �i l{�(�j 4�.�� LI&LLl0:7, f m c Address: -' 1 City/statefz p: l ' O Phone* - -7 Art-,you:-,in employer"Check the ap ropriate box: Ty7e of project(requbvd). 1.[V(I am a employer with tQ 4. ❑ I axe a general contractor and I t -contractors 6 ❑New conshutt%oo employees(full aitd c7r part-time).* have hired the sub ,-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet_ 7- D"RR odeiing slip and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity.ci employees and have workers' 3. '❑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 1 l.❑Plumbing repairs or additions myself o workers' right of exemption per NIGI. Y � cc'mp- 12❑Roof repairs insurance rewired:.]7 c. 152, §1(4),and we have no employees-[No workers' 13-0 Other comp.insurance.required.] •clay applicant Ghat checks"hers#1 most also fill=the secdost below*shoving ureic workers'compensation policy information. r Hameovniers who submit this af5dm it indicating they are doing all work.and then hire outside coatractors.niust submit a new affidavit indica=g such Gomtra€rors that chuck this box must attached an additiomal sheet showiog the nameoftie sub-cootractm amd state whelher or not those entities have employees. If the sub-contractors have employees;they must provide their workers'comp.policy mamber- I atta an ettrpdvrer that is prodding workers'cotmapensradan insurance for nky Pitapk-m. Bedaty is tlmepvhA7 rxrmrd jab site information. / n^��� a, Insurance Company Name: I QCi, un),e f t.0 ,� ;5 Policy#or Self-ins.Lic.#: &J L —01—Oz-1 0 xpirat on Date: Job site Add r, : &o 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 udder Section 25A of MGL c.. 152 can lead to the imposition of criminal penalties of a Tine up to S 1500.00 and,or one-year imprisonment,as well as 661 penalties in the:farina 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 Pe DIA for insurance coverage verification. I do he bys c, irtl the pram attrd petiaad#es ofvMtiry di attlte iatforrmatioat prma'dedbai i is/ttrue and correct Si tore: Date: ! v Phone#: 1 Official use only. Do not write in this area,to be completed ky cif or to vi aft fat City or Town: PermnitUcense# Issuing Authority(circle one): 1.Board of Health `t.Budding Department 3.City Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.C}ther Contact Person- Phone#: 6 THE Tp� * BMWffrABM • 9� ` ,. Town of Barnstable RFD MA'S A Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO. Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, � I ��® , as Owner ofthe subject property f�f hereby authorize Liu to act on my behalf, in all matters relative to work authorized by this building permit application for: did Z1-eft4-(U[ (Address of Job)' AinNJme of Ow ate WOO If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\4STGU5QO\EXPRESS.doc Revised 090809 g ® Circle Insurance Fax;978-777-4898 Feb 8 2010 12;d9pm P001/001 CERTIFICATE_ OF LIABILITY INSURANCE °AT `"`�`°°"�`Y' ODUC R 2 8 010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ,.ircle Business insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE i 47 Newbu HOLDER_ THIS CERTIFICATE DOES NOT:AMEND, EXTEND OR St' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I Danvers, MA 01923 978-777-7030 INSURERS AFFORDING COVERAGE NAIC# I N5URE0 TOBY W. LEAR Y FINE WOODWORKING, INC . INSURER A; Travelers Insurance Co, 46 LAFRANCE AVE INSURER B: Continental Inde=ity Co. HYANNIS, MA 02601 INSURER c: 508-862-0310 INSURER D: I COVERAGES INSURER E: THE.POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING I ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR i 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 REOUCED BY PAID CLAIMS. INS DD'L IT �NSRRRAN POLICY NUMBER DATECD, D ICmI�YWN LIMITS LGENERAIL I LIABILITY EACH OCCURRENCE 'S ]_ 000 000 I �XCOMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 300 ,000 CIAIMSMADE OCCUR " IVIED EXP(Any one person) Is Jr OOO � IA I 680--6065N355 5/22/09 5/22/10 PERSONAL aa°VINJURY $ _1 000 000 , GENERAL AGGREGATE S 2(000,000 j GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OPAGG s 2 000 QQQ POLCY PRO- LOC AUTOMOBILE LIABILITY P ANYAUTO COMBINED SINGLE LIMIT 5 ' (ES auidenq ALL OWNED AUr05 X SCHEDULED AUTOS BODILY INJURY(Per person) $ 100,000 A I x . HIRED AUTOS BA-3292M97A 04/13/09 04/13/10' J BODILY INJURY I X NON-OWNED AUTOS (Per Bcddenf) $ 300,000 ' PROPERTY DAMAGE (Per 2CCl4enl}' 0'000 I GARAGE LIABILITY AUTO ONLY=;EA ACCIDENT I ANYAUTO I OTHER THAN EA ACC i I$I ETA AUTO ONLY..;. H AGG. I EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 5 I I OCCUR CLAIMSMAOE AGGREGATE C9D r h DEDUCTIBLE RETENTION i WORKERS COMPENSATION STATU- AND EMPLOYERS'LIABILITY X T YLIMITS i I ANY DROvRIETOR/PARTNER/EXECUTIVe YIN - r $IOFFICI!RIMEMBER EXCLUDED? E.L.EACH ACCIDENT S ,IMartCatoryigNM) 1000QO46-809632=01-02 01/0>l I!f yes,describ®under /10 01/01/11 EL.DISEA$E-EAEMPLOYEE 100,000 i SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT S OTHER 500 000 . i Leased or Rented 680-6065N355 09 522 5 22/10 Equipment / / / $59,000 Value 2002 Genie S6S SIN 7744 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES i EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISION$ Town of Sarnstabl® is listed as additional insured. I CERTIFICATE HOLDER '. CANCELLATION SHOULD ANY OF THE ABOVE MCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION. �Town of Barnstable DATE THEREOF,THE ISSUING INSURER MALL ENDEAVOR TO MAIL 10 DAYS ITT WREN BarllB table, NIA02601 i NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 80 SMALL Attn: Building Dept. IMPOSE NO OOLIGATION OR LIABILITY OF ANY RIND UPON THE INSURER,ITS AGENTS OR Fax#508-7.90-6230 - REPRMENTATNEa. - AUTHORIZED REPRESENTATI ��' 0/ ACORn 2b(2009/01) 1888-2009 ACOR ORPORATION. All rights reserved. The ACORD name and logo are registared marks of ACORD Nla3sachuscfts- DCI)MInjent cif Publrc'Safch Board of Building Ret ul,itions nto iidartsCons Supervisor License License:,cs 84605 > Restricted to: 00 • TOBY W LEARY .46 LAFRANCE AVE HYANNIS, MA 02601`' c Expiration: 7/18/2010 � �Cbmmissiuper - - Tr#: 717 { pp i s 130 fF3' !,iOnse or r•egistratron v.i;i' for indrvidrl useorif . . HOME IMPROVEMENT CONi"I�AC fOk I" � •� � _ ��f�r e i e c.apiratior, date. 1f found"return to: Registration• 143942 ! Board:of Building Regulatii�ns and Standards Ex ira}ion� Gee A'shburtori Place Rm 1.301 - Yp '2 p 6oslon,Ma.02108 r e ;Private Corporation P $/17/ 01'0 TO 0 c ' . it 1 OBY LEARY FINE 1NOQdWR1<'1NG,'INC: j TOE3Y LEARY Ci'?` f r r✓ �6.-AFRANCE Al HYANNIS,MA C2(301 �.. �j 1' Idr iinrsh i't 'Not Val d with of t s na e . 8f ►� 1jy �r � Y i T + ory , CAPE CO® INSULATION F118SS6LAS3 SEAMLESS S►RAYEOAM SW►LNOM "M "11LA5 10"Y "" M6M$ - 1-800-696-6611 DlVjs of . Town of t1�,14314 Regulatory Services Building Division Address - Address 2 - - --Date Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed& completed the insulation and weatherization work,at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements.. Property Owner Property Address Village I�}eticy G�yv�S, So �� O—q X . C� Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted C.eilingsAx-,eMeN+ Slopes Floors ( ) ( ) ( ) ( ) ( ) Walls �1 over ZJo cu- Sincerely �. Hen E Cass Y Jr, President Cape Cod Insulation,Inc.