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Q , - �� ,-.,, , I�L4 1�i�,,­��'_�_L__11111vlk ,� �, , 11 �,,,,,, , . ...... 15 to it W� _�,� �, - , �_�- � I "., 7�Z" i, ,.� ' '�...�. .%� -,�, "� , 1, N i � , 5�,_�, ,'.),,,e�q� , , . , ; � � . , ", - , 7, - - , Ali 5 _�: :�, _t�- �L_ ._' �i _.��� " " Y Town of Barnstable *PermitS - 406 Expires 6 r uths rom issue date Regulatory Services , Fee Richard V.Scali,Director Building Division 'Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 1` www.town.bamstable.ma.us Office: 508-8624038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid wit/rout Red X-Press Inn int Map/parcel Number Property Address to pwx4w�-KResidential Value of Work$ &.Ob0 Minimum fee of$35.00 for work under$6000.00 err"` � Owner's Name&Address 0i �Y1 I Contractor's Name CO-Asi q ' o,i Jt 0 Telephone Number Home Improvement Contractor ti ense#(if applicable)&I Email: t }yl ''�.1%-y)e ns i,P- 1 /I C-Cc,i. e 1 Construction Supervisor's License#(if applicable) c7. Workman's Compensation Insurance Check one. ❑ I am a sole proprietor ❑ I am the Homeo er I have Worker's C mpensation Insurance i Insurance Company Name J 01� '�t 4: 1� W- t� .ttis � Workman's Comp.Policy# LL 500 14 C1 Do q Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ (check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to '- -t . ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) r t • ❑ Re-side - 1 ❑ .Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ ,Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission., A copy of a Home Lnprove 7tCtractors License&Construction Supervisors License is required. SIGNATURE• C:\Users\Decollik\AppData\Loeal\Microso indows\Temporary Internet Files\Content.0utlook\2PIOI DHR\EXPRESS.doc Revised 040215 r .\ Ae C'ommon"vealth of Massachusetts` Departinetit of Ixulttshial Accidetrts office of Investigations tiatl Washington Street Boston,M4 02111: tl~hvrc.aaaass.g0V1dira Workers' compensation Insurance Affidavit:BmiderjCGontractordEkectr clans/Plumbers Applicant Information Please Print Le ph Name(Busale-WOWnial�vfivid wl): Address: to City/StatefZip: Ph.#: F2. jr. employer?Check the appropriate box: Tye of project(required): 4. ❑ I am a general contractor and I New construction employer with 6. ❑ employs(full andlor part-time)-* - have hired the sub-contractors listed on the attached slater_ �. ❑RemodelingI am a sole proprietor or Partner- These stab-cofactors ha'T g_ ❑Demolition ship and have no employees • employees and have workers' 9 ❑Building addition working for me in any°capacity. [No workers,camp.insurance We are a cortdse z 5. ❑ We are a corporation and its 10-❑Electrical repairs or additions required.] of ui ers have exercised their 11 ❑Plumbing repairs or additions 3.❑ I am a hoMeawrder doing all work right of exemption per VIGL 12.❑ m myself.(No workers'cAap- c. 152,§1(4),and we have no Rgo repai insurance required.]1. a 13- employees.[No workers comp.insurance required.j *Any apphc=that chmcks bm#1 mug also fill am the secu m belaw sbowing wear workers a mpensation policy infammatim 1 Hamemmers who submit this ofiida it imdi-ftg they are doing all woaia smd then hie wide caatracmis must submit a new affidavit indicating sach- ;r_omuscross that check this bar must anchpd an addinumal shot shins ug the same of the sub-cantrsctors and state wheel w ar not those entities bare employees. If the sub-cmMctnrs have eiaploy'ees,d Ley must p vide their n wkws'camp.policy member. .[am are employer that fs prost tag workers'conTeddsatr rusaranee fora eprpd�$edods is file polio., d job Sete irefbraeai'ion. Iasuaance Company Name: Policy#or Self-ins.Lic.#: ® Expiration Date: Job Site Address: (P TT' ®�— Cityt'State zip: Attach a copy of the workers'compensation policy declaration page(showing the Policy numbs expiration date). Failure to secure co umage as required under Section 25A of MGrL C. 152 can lead to the imposition of criminal penalties of e fine up to$1,500.00 andlor one-year itnpxssonxrdeut,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 DU for injuance coverage v aria I do hemby ce#W,4,under the "its and penalties perpa that the arrformado.n providedd aboire is trade.earn!correct Signature: Date: L z.. i l Phone#- official use only. Do not wilte in this area,to be completed by.city or town ofeciai r City or Town: PermitIl icense issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Ph Contact Person: one 6 f CONSTRUCTION . 776 Main Street Osterville, MA 02655 508-428-0458 Tim@Meagherine.com Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and.Standards Constr tl tSi�s S 3gvisor CS4102260 11/0612020' MICHAEL S.MEAGHER�JR 97 EMERALD��ANE• MARSTONS MILIiS`IIAA*02648 's = ' CoMnl'issioner v 2u ona�reoracae�r./�a10- 1taea WA6 _ office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR 4 TYPE:Individual R i r io ira'on f, 1822J38 _ 04/26/2019- MEAGHER C0N8T.Ijij,CTflE)N-;z 4NG. MICHAEL MEAGHER 776 MAIN STREET +_;a ` OSTERVILLE,MA 02655 Unde�ry Client#: 16665 2MEAGHERCO DATE(MM/DD/YYYY) ACORD,. CERTIFICATE OF LIABILITY INSURANCE 10/31/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling 8,O'Neil Insurance Agy a/c°NN Ext:508 775-1620 FAX aC,No: 5087781218 973 lyannough Road E-MAIL ADDRESS: P.O.BOX 1990 Hyannis, 02601 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Penn-America Insurance Company 32859 INSURED INSURER B:Associated Employers Insurance Company 11104 Meagher Construction Inc. Timothy Meagher INSURER C: 776 Main Street INSURER D: Osterville, MA 02655 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VVITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP /Y LIMITS LTR INSR WVD POLICY NUMBER MM/DDYYY /Y MM/DDYYY A GENERAL LIABILITY PAV0186320 0/16/2018 10/16/2019 EACH OCCURRENCE $1 00O 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occuence $50,000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $5 000 X BI/PD Ded:500 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PROE El LOC $ JCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED - PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC50050054422018A 6/23/2018 06/23/201 W X R8TATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N ~" E.L.EACH ACCIDENT $100 000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100 000 yes,descdbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE f THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.,AII rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S222476/M221069 RPSW1 � ���s�v^m� ..� �*-"�'` � �,���` ,*� wK�„��` '�-�z���s:•.,- .�}, ��. t?�,���� r :..�'xz ".jw�'�'�,., a�. �„��-. � _.'.� +�„`` ,>� rTi��a "�'r� '�°� "s4° k wF'" r ���c r a ES w Pi �:''d��' �;,5�' � ��`�'u:,`f.�'h .:,�e`.�#�• q ' 5� . MR �s a3 qua ! rl lT 71r� L T tr CttTL�(+ rha ....... - But(dtn #J�r� tt�n K�ut j,k r �i _ u- z r +tr �sT�v� � r .t� 1' y°r,�r i Fi'` x✓��_ a.. `2-;r� �� 4s.x�.�c .�, 3 sa�.�. �� �,�� �k 3 ' Via' �-� �� xs .#,��y, ;�,�, �,. �, r_ a�K '•-� .FYI s°4,� 3 .:�: u, *� 7 s was � $�1 i� cAlEtli��I�C e�? � l R .. �. �t yL�,'%-. `�' le It SL[t�71 zll� �tt,�l.T�� r�l „w� � ��•ti- �`"¢� 1 L y a �t . �'"K �. �� t@i1�[{1,�11Lis- CJ l(}1L fLA� TTP� tLil�lt,)rtlt.tlr�4[�11�. �LtfJtJl#1 1� i111.11 ltl}ttR if tl�la �U - a> � - � `z .� . ` - �. - �� �' � .c•k ��,� ��` �.� � x���r � �,�.r-`�� �@;>tr - �� �i � �'C � �rs� _�,�,i;'„� ����'�a-.}�,�, r,,.tea.. �y y .,�f ''�} � ''� c� �.--� � .•'_��� �i2'. rn �c: � ��y. ,f; �x. ;,:�, t ^� ��'''�',..� a,{,T, ri � ,�i'^` ;:. as ,�� r °.v � �� �� � i " ���-£_ "`$�Ef i ref}Aei-t�z()�+o�.+'t�u�i�lhtn;�;�,�'r �eu,Iii"�Rf}t'� a e'crtYrl��lr�t,�l ���=��,2��1� �k1�� r .;►�4;t. >,ctt�ev'.�rki S1�Ir�i t��a � �:�:,� �-� � 1 �4�`� 6 Town of Barnstable *Permit# Expires 6 months fro issue date �7 Regulatory Services Fee • snxxsTnsLe, s.Mas 1639. Richard V.Scali,Interim Director ,FD Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 4 ,`.7 l 0 0 a Not Valid without Red X-Press Imprint Map/parcel Number o�y Property Address 4 6 fq r M � ! 1) �_ vCL- C-2411 _F Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Ili 'n`e' 6 YY1 0 n Contractor's Name /I"r Telephone.Number -7 Lf 10—D`10q Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance PON Check one: I am a sole proprietor 2 2014 I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name �0 hamgOLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. h Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑Cleplacement 2 rf Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required&U�_ . SIGNATURE: T:\KEVIN Ch D\Buildin ges\EXPRESS PERMIT\ XPRESS.doc Revised 061313 Y V Town of Barnstable Regulatory Services oFTM� Richard V.Scali,Interim Director Building Division anaxsrnBLE. ' Tom Perry,Building Commissioner MAE& i639 �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION O `q7' Please Print DATE: // 'p`/ JOB LOCATION: l!G �✓YYj (� 'i�lJ" t.0 / I I r Y �w number street village «HOMEOWNER': !V" ne ,5I do '" name '] Q` home phone# work phone# CURRENT MAILING ADDRESS: i I S I JV 71 r7k t ri, �l 11 as y11� aa� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection pro dures and requ' ments and that he/she will comply with said procedures and requirements. Sig 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 thai; "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. TAKEVIN_D\Building Changes\EXPRESS PERMIT�EXPRESS.doc Revised 061313 i The Co man h of Massackuseta Deparmmt of IndmstFia[Ac ode& Office of lnvenstage7faons IF 600 Waskington Shwt Boston,M,4 02111 rvww gouldia Workers'Compensation Insurance.,Affi&vita.BmMers/Can lumbers: Applicant Information Please Print Lezihlv Nanm �1 Ae&ess: 15- B 0 I a Lice; crty/St p: I1� �I c 'Il'� �( #- Are YOU an employer?Cock the appropriate lion: L El am a employer with 4 ❑I am a contactor and Iemployees Type of project(required):: Crave faired the 6. ❑New (full ausd/car Pact-tasxaj- s construction 2..❑ I am a sole pmprietor or partner- listed on the attached ssheet. ?- ❑ Remodeling strip and have.no employees T have 9. ❑Demolition, wodring for me in any capacity. employees and have workers' 9. ❑Building ad diticm [No worlans'comp.insurance comp. ] 5. ❑ We are a corporation and its: l{#_❑Electrical repairs or additions 3_hI am a doing all work officers have exercised their 11_Q Plumbing repairs or additions f o workere _ right of exemption per MGL myself� � l2. Roof � insurance regnsred_]d c-152,§1(4) and we haven ❑ ur employs.[No wadters' 13_0 Other coup.msuurar M requ re&] 'Amy appHfcau&M cbe€m boa#Y ato aril oar the scubas berms showing&&weaere CaMPEMdoopaicy Mkmaian who sit®it this aim umbcartog they are dw4 all worst and&m Lire stttsule 000tmic=mmst mb=a new afidsm imd Atmgg such- kanhmfmthat check this bay Est atudn d an addiroad strict dowimg the mammy of the and state whets or mot those ematies have enWhrien.If the sabcmnimcros bm hoyees;they inmost pwLn&its works'=Va policy.number %gate an employer that is providing nwkers'congwnsadon insurance for my angdoyam Below is ilia poticy m d job site informaatigau. Insurance Cclmpany Name: Policy ft of Self=ins.Uc.#: Date: Job Site Address: City/Statea'Zip: Attack a copy of the workers'commpensation policy declaration page.(showing the policy number and expiration date). Failure to sire coverage as nRunid under Section 25A ofMGL a 152 can lead to the uWasition of criminal penalties of a fine up`#o$1,500.00 and/or the-year imprisonment,as well as civil penalties in the foam of a STOP WORK ORDER and a fine of up to$250.0D 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 iaereby fy unAer the p7iandponabies ofperprry that the informationprovided a is buy nd souse Jul Phone IV U,j�tcial use only Da not write is this area,ter be fo;np&!e d by ciiy or town skis= K., . City or Town: PermitUcense 9' Issuing Authority(circle one): L Board of Health 2.Building Depwtnent 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector. 6.Other Contact Person: Phone#: 6 . . - Commonwealth of Massachusetts Sheet Meal e Map 247092 ' 8-4-14 � Gao � q —G'V S(0-0 waa .wjo'bcosts Fv — _ ZQI� Pla:ss ® � Plans R `k�_ o e Oewe.A! t►+/U 3480 Bt u #► ton.:: Property Owm,-z./Job Lpcafion Information: F ,PME�airt�9aend � ' Jane Simpson 87 Helmsman®r zy 60 Farm Hill Rd Yarmouth Port Centerville city° 0 - .-- — t ',�:ll 3: 508=771I-2'7581 508.40M943 '774-225-9565 ;�� b - TeIq- � Photo ID.�"�v it l �°¢f Ihoto I , a - x '�_ - - S�rtr or less and oomm-,rcial up aF I O GOO . fft ?- 0rlcs OT less Residential-1-2 fenrlx =fal ° Condo; , Ot #>r Fire Dept �r`07Vaj' - I o i. Othel Sh t mew.work to becomplete& I Tb- ov Mxiy AC a Rfi ng Kitchen Sy. m cry I Vents� -Ahr Balancing, Provide dew descrip tol Ofob done: HVAC duct 1 INSURANCE COVERAGE: I have a current rMbil, insurance p oficy grits equivalen.twhich meets the cequii romerAS. •GIL Cb.112 Y Fx� o of you ,indIcata the type of coverage by&44--k-i :tie�ppe rig &�z'bei r: CWNEJVS INSURANCE.WAIVOt i am aware that the'Ii a does the required by Chapter 11-24ofthe NUssachuseft General laves,and thd my sfgmture en tfa rm-kapplication, this require Ck Oaf - -- --- Age Signaviree of Owner or Owners fteal Z�Y etseCkLjg thZ l= ,G I hereby het t t eti da ­s aAd infommban1haviDsUbmitLed true and _ rat?to then bee.&My knt at Alfa Metal W0*_ d€ under t ' ermi this af wal tre- liaatW a'I dpMv cn ofthe Malwelsagatm sull y Ccda and. ri I of,MeOvem L-- ta�tirls a i€i � f pig instaffiatiom.YES Dar comment DaEe c - • p. Type.eflicerlmW _ ;. FEB :0jameypermn 1Ii ; ee �. -- t mmi la mama MI Town of Barmsitab Regulatory Sery A -5 Ert s Building Division Tam Perry,BuildingCommais.siontr 20(a' win StrwL Hyannis, (12.601 'w.4U�v@ ar.?staEsEe. a.aas .DjVTV,W Fax: 508-790-62130 Complete andSign This Sectim Ur -g-A—Bum der JANE SHOPSON I, �) KEVIN SAUNDERS. SEASIDE GAS SERVICE hereby �i.u.t.hc.mizC�.--- —.......,,._...,.,..� .___..... ..., ----•E-G'ac:l ("'u 7.':C;v lL] ^unit i�13T.�Ls ralrwlvc Wf1:7.Jr, 2111 orizcd b 1:3i:1l±n jet.' f i 60 F.APPwIVILLE RD, CEN'E`E�MLLE MA 0263E �k 031 fences a.ra.d alarrns are t-he responsibility of the apj i=—it. .PoOLy: are not to be filled before fence is ins—L-aUed and pools are not t® be wiiized un l all final inspecdons are -performed acid A )4ed. 1� turc :?t t.}Ca7. : ']:E CF:C C::.A 7 JANE SIPJPSGN Kevin Sunders 6/4!2Ui4• . ..................... d'f'':;?1�4S:i�iVr'."Ti?.k� . .a qfMawackusetty 600 - kn Street � MA 02111- 9VIw` ` Workers'Co abdo g ee g o3aIra v Please Nuys Kevin Saunders 67 Helmsman Dr_ I;ityis-tai4o Yarmouth F,ort. mA o2675 P �_ 508-771-2768 _ 8 r.Ins'?'l �° Of pDj (Pcrea)' x MX ai . r4-, - `: C:I Rai* ,.., 9 L # wimlhm,!camp. n-'_.:. p e :, 3 a� tv Li@I awairs or addict ;F) hdaftg izi s J = = at _ � , 4wee c L° � �j � I��fAC installation im a- � MSA� uranee Co MPT4469F 7125114 NQ�€? L Adrm: 5D Farm Hill Fib G� �'� � Centerville,MA,02532 a cep of the—wadi . dwI=tion page sb pau ta-!Er 2adexpumuou ), _ m_t swure covmga.u.r s 25 W WL c, 152..€ i -W th!-' site of p f mat &Urand pie : 6AI2014 508-771-276 _4 or-it officlat ids - - "&OKHyI g one`:: fim 0 62r. _ Person. k Sc K � .rW. 4 x Lo Ail f� 3 ! b �C'!T1�i ♦ �"' dYINX ,� ,,,,,,c xMu • ,F`ltµ S'Z �lx `ts..'$ � -saw! t— fit+•#-- i s Q. Sol-Ii J p t 14 toy nwy^ zd IPA r SS a a s a dfc Own Q y.s rr'IF ^?'q. szs✓ dr r1-� t-T= v x -r* 'lia � £" 71 X. E ; f .. 7E k L? 4' A a 1�P :� X 'kf Tl '%% T�4 'Sp, VIA ug VE "M 7 '� ."€ f Y ^.L ' � r'. J A'f .';^ N � R a - t .c S. " '>---a a•s r r "# xxAW . ay'ag 4,0 '"E�` b 4� gv„�•xi *4'� 5� }' ,R`45yz"`} ,q Fe ``,,,SA. .,,� S, a 't -�Ys.a>t� *w 3ft�N4, i `-w I aaz.+px�1 r z., w`�Ya''r" t r .. .H t y.,,,•' �n �y�'...a.. .}n'; -�f z tom.. 'A sh sniz l ,s� - a'"�'v- d'sp,s*� �%��•e �'t vtrr". .x SSI -i^ .?. .rVV, 3•.G'� 0 �'�, ',3 s, Y'+P`a...�aaa�-t - T IMo '• �' b � F�a. '�' j 7+r a`x- - r2,{nr�+y'�'a. kZr,y fix. .[ }` s ,...' s p ,, ""'r* # ,�a "��sf"a+� ..a�( � �i� ,}�'o- 1,pp�� ,�-�� yr'��`r��,'",yy�• drr .n 'S, _ Fa Rfsa'.s k ,,f ., "Fy b7`".,, v "ate f++,ir -, t5 ' � d i ,+q,. .."..;r' ,qM r e t 4 na.�,.,.�jr "' ��� � � ' tt. �: r r• r � .�r t ,��''•.� '�••'$ ,y{ a. �" .. n �y '�✓,;!�.fF.P�,'tin "^'`"` ,w',f.F�t 'Y .mow .: . . cAn aN®Ewe 1V�ut1 NN SLRANCE Pol icy. . �._.-I.1...._�_�I'I,_.,...�-.�I,-I._.7.I�&.W._­:��I�.:.-._.�­.,:U...: fNSURkNCE ,AR INF. 11OI11.PAI /758'J1ad9y R.OiA06 . ISsiJed by L>![ INSUPJURC.>IS CORPORATION 27293 ,,y . Policy Nurftr Nc.'5 31S-388919 014 Issuing Cff�:_016C RDNBTw1RI.. OF. TCS 3TS-3$8;919-013 Issua;Date 11-21 13 ..: Ac cunt Number 1-388919 Sub Account :AA0- ::. 1 insuredond IJlafkng Address .. SEASIDE GAS SERVICE 1NC -. '+RISK ID OA04�7:319 67 Di�IA�fiStiIAAI DR . r YARMOUTIE;PORT,M&02675: ,_ . , - .. . Status°:'A3 -`CORPORATIONI Other wcorkp .not shown above SEE ITEM 4 PREMBUM_ EXTENSION OF.tNFORMATION PAGE 2 `Policy pencil The poly penodasfrom.01-0S-2014 to t7:1 05=-2013 :12 Ot A`f,A standard tiri�s'at the Insurer's mailing adiress - 3 `Coverage r A Workers Compensation Insurance Part One of the pol16y.ap0l to the Workers Compensation Lii of the states .., listed here' PHA .. B Employers;:Lrability Insurance PartTwo'of the pol6y apples to work in each state Itsted i- Item 3 A "The prints of:our i�atirldy under Part Two are 1. Bccfify Inluryby Accident $ 500,000 each accident Baiify Inluryby D 5Q0,000 pocY I±put -- . .Bodily injury by Disease ,$ SAD,000 i h employee :C Other,Stems Insurance-Part Three oof the policy apples to the states rf any;tested here ._ . SEE END W, 20:83 06D3 D This policy includes these ertdorsements and schedu�.s SEE EXLEP., .O OF INFORMATION PAGEII 4 'Premcum The prerrrum for this::policy uutll be terrrurred by ouk Mantels of Rules Ctassd6tions.Rates and Rating P�nS 'All information required below is:subfect'to verrf .. , I acid change by audit Code , I:.m um t3asis Toted{ Fate pot$10D Estimated Annual Classifications Number `' Estimatad' nual Rsrnt+ne[atron ,` .'of RernurierMon Prerrnum ' See Extension of Infotmand Page 1. Minimum Premium. Sm. 3. (t�Fa} ' Tofai Esbmt.ed Annual Prengurn $ 3 25 Premium will be bi!!ed ANNUAL . FI��­..-j-�:,;_,I.I,-,..,;,_-�1f.1,­,1t.­.�`..-!,�'�:,-_,-,-.C,--_I,�-1.;,-.'�--�,���._.-­�.�-�!-�:�1­-���U,:;.-",�,�­..,.�m,1,�:,,-;'��._�.��_.,__,_�;,-�,.t-z,`",.,z-,:�.,,-�.;..,,�_�;,,,,-,-­�_�.i�,_��­::p_;­..,,­,_-.-,:­;-._�.-:�fK,_,-,-.-­-_-���,,_..�--,...,:�...7�-.-!��,,,.:.-�I,,*,,",.�.,-­i­,_....,.�.­.;,. Prodtroer :0004-005707 ROGSRS 6 GRAY,IDadst"dt AGF.triCY 'I1dC. .I:.-�-,�:�,��.�.,I.-_��......,­_��:.��-11�1,-.,..."..:..�:�-._:, I.,,:�­..'4I�!:�.-,...,..�,:..-1..:..��.,��,._-.2,�..-��:,.�,-.. �.t_.�­ %1�.. �,..,1.::.I,I,._��._:o:_�..:­­.*..I�.��:.,,.�.I,��—,.I'._�_.,�..,,.I,��..,�..I,...*�..,.:._�4:..�:..�...��*_..I.11.,'�!:..:--.."'..­.���:.,I_-,-..-,,1o�­�-.'...,,�:-.,,��,.�;.::���..-I,2-�-_.1-:�..�..-..­.....,'�-�-..--,-:-,­.-�:"W_.1��,�-_-:`,�:1--�-���1._.I:,I."�,_-'�-.,-I.�_� 434', 134:`SR'1l :E'1 - -I,,_I�.�-,I�:-�...:.,,..;:_..�,I..'._,.:.1I.�...�1,�,:�--..-.,....1"-�.I.,:��-`I­-��-IV I,--.,-..-.:- _.._,-�.;..�::-....-1.­�,�-_::I_....:�. .--..z.1:.-.___­-." .:....I..'.: ���-,--1.,­1­.",I;-_. .,I,III- --� so � s III ®a6�A -: = . WC 00 00 Ot A 01 U National Council on Compensation lnsurance,lnc`J WC W Da 016{f�J} f Ed 07/01:/_2011 AILR hts E�served age-I of 1: ti .. . ...: -<; _ _. _, . . ,.I.�s�-i-,.1 `. ... - _ _ %­ ­ ­. __ _ '­� . .­ ._._.� � archer copy .. ,_ . �:: ,ibllN STREET AMERICA ASSURANCE COMPANY �m�,y Nu b _... . .. . -. _.. > B�@P'54�69F } Ettect,ve Date Natned{nsurd SEASIDE GAS- SERVICES;, INC 07 25-2013__ Agent Name._. ROGERS` AND;GRAY ,:INS AGENCY I NC ' E Agent No 2 0 0 3 7 4 . :, �EC770N -UABKJTY-DECL�ftAT101dS cevEsMITs IL�ab►lity 8 AAedic-0 Expenses Each Occurrence $ 1-0 Q`0 0 0 0: E ' Personal Wyertising Injury Limit , 1 00,0 000 Damage To Premises I�nted To You $ ': ` 5 0 0 0 0 0 Aggregate.Limit-.ProductsCompleted Operations $ 001 000 r ete L>mmxt Except Rroducts-Completed Operations $ ', 0 0, 00., A99 e9 KWica1 Expense Limit "Per Person $ Z 0, 00.0 >. ..: STAT£ MA TERFgTQRY. 018 PFiENIItSt:S NO. 1 -1 `: .. , GLASSCOOE 74781 DEDUCTIBLE PROPERTY-DAMAGE UABIUTY NONE CiASSIEiCATIOC�: : HEP.TING COMBINE I]` HC►AC PREI�U�R BASIS EXPOSURE: RATE ADVMICE PREIRI, `;.. PAYROLL 28, 600 $ 1385 .. r STATE MA TERR1TdE�Y O 1'S P��SES MO: 1/1 'C, CODE: 7411- DkDUC 9LE PROPEFiT!'D"..-"UAIBILI- . NONE CLASSIFICATION APPLIANCES & 'ACCESSORIES. - IIJSTAyLATII , SERVICE & REPAIR 6; DM g S EXPOSURE . RATE - ADVANCE Pi�I�IUIdI .. 1 a "PAYROLL -° PREMISES NO: 2/1 STATE MA TE4TORY 018 "DEDUCTII_LE-PROPERTY DAMA�aE U .1. . NONE "CLASS CODE ` 74111 ' FICATIO6d APPLIANCES & ACCESSORIES INSTALLATION, SERVICE & REPAIR CLIISSI. PREOJ�t6RA BASES EXPOSURE RATE ADVMICE RREd�II!!� 1 ,., PAYROLL - - - ,.., �_` - = _ , 1 r 831!®UAB BXpT N15i1R© -. r 1.1 II ". ,. _ - - - mt I. S -9T-... M .5 ..,-.,F.. 1 Town of Barnstable "o Regulatory Services Thomas F.Geiler,Director = aaaxszwsM MASS. i639. Building Division 9 `0� 4�Eo► ° Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www,town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623( PERMIT# wool oS 3GI FEE: $ .S ' 0� SHED REGISTRATION 120 square feet or less U 1rG�w� r !I {�G{. Cl n I-G✓V l l CRr Location of shed(address) Village i Property owner's ndme Telephone number l� xr� 2�"l p�j2 Size of Shed Map/Parcel# . Si 7e I Date Hyannis Main Street Waterfront Historic District? y �� Old King's Highway Historic District Commission jurisdiction? yto Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN �- Q-forms-shedreg REV:042506 Map Page 1 of 1 Town of Barnstable Geographic Information System Parcel Viewer Custom Map Abutters Map Size Ell El r zoom Out fl fl E- fl In .r K. i;, , ! ® JPG Map: 247 s Location: 247097 AM 1 Owner: p 42 p 18 +� Location In Map & Parce fWADISOM AV Location Jo' +� Acreage 247090 f.� el ti r Current o% 247091 r; Mailing Addi #66 Appraised 247093 � 6$� -71 Extra Featur Out Building Ll Land Buildings �JItL RO 2 7094 Total Apprai 72 Assessed V 47067 My'"� Extra Featur 47 d 52 Feet24879 Out Building 247078 Land s!77 a Buildings Total Assess Set Scale 1" = 55'2''" F'A�prriill 22001 Hi Res {�7 Copyright 2005 Town of Barnstable,MA All rights reserved.Send questions or comment BarnstableMA VO.2.91 [Production] i http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=247092 8/29/2007