Loading...
HomeMy WebLinkAbout0027 FERNBROOK LANE .. � 3 C .r.. - �. � � e n � t i - �. 1. . .;.� .. � � .:.. :. e.. .. ;. .' Y .. Y �., '. �. � � Y t.' " ... .._� l ti � h � .. .� _ Y - - Q.. ., e � - .. _ �._ ., .. � - e �. �• � ,_ _ r. �� ., .. t. Ida � .. .. .. - �. + , . .. r - -. r _ � 4 .. .. p Town of Barnstable Building . e' PostT,hisCar �So.That rt isVisible=Fromahe Stceet�A�r,;oued Plans�Must�be�Retamed a'n,1ob,and'this Card Must�be Kept • MANtTCArtLB. ?'` ,;Fe�� �R;d .,, ". ,,,fib �,'.;�� ,• PP,. �. � .�� dig a �'a �. � "�"` s �� • r , 6 Posted Until-,,Final I spection H s.Been�Made � � � � � , � } '� Where a>,Cert�fieate�of Occu" anc •as Re""uired such B,u�ldm shall Not be�Occu� red until a F�n�l Ins. ectionFtas�been made , ,� i• ei lijlt Permit NO. B-18-1164 Applicant Name: VILLAGE CRAFT BUILDING &REMODELING Approvals Date Issued: 04/24/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Dater 10/24/2018 Foundation: Location: 27 FERNBROOK LANE,CENTERVILLE Map/Lot: 208 085-022 Zoning District: RC-2 Sheathing: a Contractor-`Name =,.VILLAGE CRAFT BUILDING & Framing: 1 Owner on Record: ROMAN CATHOLIC BISHOP OF FALL RIVER � � � F REMODELING ,, 2 PO BOX 2577 , Address: ��� �, � ' f, actor:License105548 FALL RIVER' List MA 02722 Chimney: ofect Cost: $3,000.00 Description: Add eggress skylight to bedroom legitamize 41, bedroom P $85.00 ermit Fee: Insulation: Project Review Req: t Fee Paid:' $85A0 Final: x31 Date 4/24/2018 .__. Plumbing/Gas Rough Plumbing: Final Plumbing: Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authoraed by ths'permit is commenced within six months after issuance. Final Gas: All work authorized by this permit shall conform to the approved application and theapproved construction documents for which this permithas been granted. All construction,alterations and changes of use of any building and structures sl all�be in compliance with the local z6nmg3by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and"shalllbe mamtainned open for public mspec#�on for the entire duration of th Electrical e work until the completion of the same. Service: The Certificate issued until applicable s ficate of Occupancy will not be id il all licablignatures by the�Building and Fire Official are,p rovided,:on this permit. ' � , � Rough: Minimum of Five Call Inspections Required for All Construction Work.x� a - - • - •• 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: fi z Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application Number..........................................................._ * s QP=e�=itFee.................: ......Oti�erFee............:............ R1g2 J�Tanal Fee Paid...:................................................................. -rowNOFg�it�,N� ,�,,, .... ............ ..........oa....y�' y Permit by .. TOWN OF BARNSTABLE b 4 BU-"INO PER UT a �j Map........_.....�...................Parcei......l.l..�v..»..�--........... APPLICATION Section 1—Owner's Information and Project Location Project Address V>71age LX�vD �/✓ r , 1&ev Owners Name 6 Owners Legal Address City Statezip Owners Cell# E-mail Section 2—Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet 0 Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ElChange of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire'M= Rebuild ❑ Deck Apartment El Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description w T jut nnda±ed 2192019 r ApplicationNumber..................................................... Section 5—Detail Cost of Proposed Construction Square Footage of Project Age of Structure Dig Safe Number - # Of Bedrooms g6) ' Total#Of Bedrooms(proposed) - 110 MPH Wind Zane Compliance Method F_MA Checklist O:WFCM Checklist ❑ Design . Section 6—Project Specifics ❑ Wiring Oil Tank Storage Smoke Detectors 1 Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom l Water Supply VPublic ❑ Private Sewage Disposal ❑ Municipal '❑ On Site i Historic District ❑ Hyannis Historic District ❑ Old Kings Highway I Debris Disposal Facility. I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone,Designation Within or adj aceit to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District Proposed Use .Lot Area Sq.Ft. a Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required, Proposed • 1 Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last tmdatad:2J9=18 -- --------- I Application Number............................................ Section 9-.Construction Supervisor E - Name % Telephone Number Address 5 ; , j City State zip k License Number S License T e. 1 ffi yp Expiration Date7179 Contractors Email Cell# F I understand my responsibulities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I R4derstand the construction_inspection procedures,specific inspections and documentation y CMR and of Bam_stable.Attach a copy of your license. Signature Date Section`10-Home Improvement Contractor Name 1� ►� q. Telephone Number • � . Address r f `�q�Wcity .state . r Registration Number 0 q Expiration Date V . r I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR-the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and docmmentation regmrei 780 the Town of Baunstable.Attach a copy of your H.LC... Signature Date , Section 11—Home Owners License Exemption 4 Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the roles and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date Print Name is 1C)6 Gl Telephone Number `50 1 e C�1, E-mail permit to: VP C✓ J ;� ` T D..F mmPIn-1 o Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) El 1 Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation For commercial work,please take your plans direcdy to the fire depm*nent for approval a Section 13—Owner's Authorization as Owner of the-sub jeat property hereby y to act;on m behalf, in all authorize matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name / I I J Y 1 Last undated:7J92018 1 r WMYYI I dd lt63 AVYI T q I'k r� O Vol ,/ I cp Y,�` i �-� wbKkEER'S COMMEN-SATNON ADD EMPLQYERS.LIABILITY:INV URA-dE PCTLICY I � A � �•p Associated.Er dyers insurance Commany A �tsuu) tsro,cio NCCTAIQ,4095 : POLICY NO. WCC-500-5006114-2017A PRIOR NO. I WCC-500-5006114-2016A ITEari 1- Tttc lh V-6d: .. 4Gh 'J :s-a. SSA. WilJage praf'tSuli ding&Remodefing '.S'T..0 iv<.;1:.:di'1. Cotuit,UA 026315 Legal Entity Type: Sole Proprietor Other workplac.,ei:not shown:abov,6, 2 The policy pen'od,is1rom i2/23/2017 to 12/23/20i8 V.-01 a.m.standard'time'al the insured's mailing address. ;�. .la.-: s" s [� fcaisrxrfrc�c t�rc�e Pair a t� P t :at'r� c,kerscs ;YEict�<La states listed*-..e: MA . , F_rrrployers' 'Liability M'surancePart'Two!ofthe. i)as;to. .wk ilmeach state listed in,,itemx3`.A_ The limits of liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily.Injury by Disease $ 500,000,policy limit .-Medilk I; Jriry�r,Lay rA:S a9a 1)nn)(?00 m2rhF+'m�6riy w C. Otber Slates Jrtsurance: Coverage Re0acedby Endorsement WC 20 03,06 t3 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.. All information required below is subject to verification and change by audit. Classifications Premium,Basis Rates Code Esfimated Per$100 Estimated i No. Fat FARiu:M,. 'A. Aanlra . r efauneramm, ?Temtrfteraiorr P'remf&M INTRA 355380 , JNTER SEE CLASS CODE SCHEDUI E 'Mjn;tVUxr' t&ir $500•• To).a3`JEsbriated Aric a)Preimitiim 53,'874 'STATE ',C.L/k1SS MA '., 5645" State Assessments/Surcharges $3,522.00 x 4.5600% $161 ��` �'�— I nis(poiicy,inciud.ing ail endorsements;is hereby;coun>ersgned`o 11IG7/Gi31 Authorized Signature Date Service Off!be: Mafco�mrl&Parson .!Mc mce Agpmcy yk 54 Third Avenue P b,:Box 521 ` Burlington`R4A U803 Stoughton, MA 02072 1 +.w4erlal of the National Council on Compensation Insurance, �et�_�th iffi.�rmis5ion. Massachusetts Department of Public Safety `Board of Building.} egulations and Standards License: CS-050234 Construction Supervisor ,i MICHAEL DELUGA i It 668 SANTUIT RD COTUIT MA 02635 .. i .ten lam— Expiration: Commissioner m 07/09/2018 v- Cal/zc�arrairacYri�ae�ilCl r�C�/�`a-�aczc�eraeC(J _ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR r r; Registration 'v105548 Type: Expiration "171:V20,18 IDEA VILLAGE CRAFT BqILD &iNG REMODELING Michael Deluga , t+ { 568 SANTUIT RD COTUIT,MA02635 Undersecretary License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston, NIA 0211E 4tNot valid wit lout t re F,`: QX 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:Burlders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/individual): per. Address: City/S /Zip: hh6i Phone#: 6A Are u an employer?Check the appropriate bow Type of project(required): l. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New constrrictian employees(fall and/or part-time).* have hired the soh-contractors Z.El I am a sole proprietor or partner- listed an the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition worming for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp. workers'. required.] 5. ❑ We are a corporation and its 10.Q Electrical repairs or additions 3.El I am a homeowner doing all work officers have exercised their 11.Q �.b Phing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.0 goof repairs insurance required.]t c.152,§1(4),and we have no 13.Q Other employees.[No wormers' comp.insurance required.] *gory applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. l t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sbeet showing the name of the sub-coutactors and state vyhether or notthose entities have employees. If the sub-contractors 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. �- Insnrance Company Name: Irv,7 Policy#or Self-ins.Lic.#: cJ Expiration Date: C. OLl Job Site Address: '�� L City/Stwzip: 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 e. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonrnent,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 certify under thpyazhs and penalties f perjury that the information provided above is true qq correc4 Si e: Date: t Phone official use only. Do not write in this area,to be completed by city or town official City or Town: Perinit/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#: �FTHE TOWN OF BARNSTABLE . F BUILDING DEPARTMENT . APPLICATION FOR CERTIFICATE OF OCCUPANCY Date Building permit application number map/par Address of structure Area of structure C.O.will be issued to Name of Tenant Edition of Building Code Use and Occupancy Classification Type of Construction Design Occupant Load Is the facility licensed by a State agency Yes ❑ No ❑ if yes If yes, name of agency Relevant Code of MA Regulations(CMR)that apply Automatic Sprinkler System Sprinklers provided? Yes ❑ No ❑ Sprinklers required? Yes ❑ No ❑ Building Department Use only Special Conditions: TOWN OF BARNSTABLE • PERMIT CHECKLIST Sign off hours- for Health and Conservation are 8-9:30 am. and 3:30-4:30 p.m. A complete permit applicaflan includes fli ing all sections 1-13 1. NEW STRUCTURES/REMODELING/RENOVATION/ADDITIONS ❑ Site Plan showing setbacks of proposed and existing structures ❑ Commercial—One complete set of full sized plans one reduced 11"x17"(plans may require a stamp by an architect or engineer). ❑ Residential -4 Sets of floor plans no larger than 11"x 17"smoke/co detectors marked ❑ Worker's Comp.Affidavit and policy(if required) ❑ Res Check or COM check from the 2015 International Energy Cod Council(IECC) ❑Letter of financial Interest for new houses only(not required for rebuild after teardown) ❑Performance bond made out for$4.00/foot of road frontage(new construction only) 2. DEMOLTION OF A BUILDING (NOT PARITIAL) ❑ Everything above plus shut off letters from following utility companies: ❑ Gas ❑ Electrical ❑ Water ❑ Sewer(if required) 3. DECKS/PORCHES/GAZEEBOS/INSULATION/SOLAR/POOLS/SHEDS ❑ Site Plan showing proposed location ❑ Construction plans showing framing detail(if new framing), ❑ Pools—Barrier details,pool specs (engineers design) ❑ Workman's Comp Affidavit and policy(if required) FAMILY APARTMENTS ❑ Section 1 Plus: El Family Apartments are subject to approval from the Building Commissioner. Agreement must be signed, notarized and recorded at the Registry of Deeds and returned to the Building Department. r QpZnt TOWN OF BARNSTABLE �•�-. F BUILDING DEPARTMENT APPLICATION FOR CERTIFICATE OF OCCUPANCY Date Building permit application number map/par Address of structure Area of structure C.O.will be issued to Name of Tenant Edition of Building Code Use and Occupancy Classification Type of Construction Design Occupant Load Is the facility licensed by a State agency Yes ❑ No If yes If yes, name of agency Relevant Code of MA Regulations(CMR)that apply Automatic Sprinkler System Sprinklers provided? Yes ❑ No ❑ Sprinklers required? Yes ❑ No ❑ Building Department Use only ` Special Conditions: I • I °p'ME r Town of.Barnstable ti Building Department MIAM9'"�'' '�• ' Brian Florence,CBO 059. prEp�a Building Commissioner ' 200 Main Sheet,Hyannis,MA 02601 G 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 I ! Q ,as Owner of the subject property hereby authorizelh�� /� to act on my behalf, in all matters relative to work authorized by • building permit application for. (Address of Job) **Pool fences and alarms are the responsibilitq'of the applicant. Pools are not.to be filled or utilized before fence is installed and all final inspections are performed and accepted. S a of Ow ; U Signature of Applicant �cr J���J Print Name. Print Name -1 Date Q:FORMS:OWNERPERMLSSIONPOOLS Rev: 10/17 Town of Barnstable FINE To Building Department ti ' c� Brian Florence CBO Building Commissioner NAM 200 Main Street, Hyannis,MA 02601 ArfDMA'tp a. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print h DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-ocgMied.dwellings of six units or less and 1 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 buildine Hermit. (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.procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic fed 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 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 to amend and adopt such a form/certification for use in your community. o PT M R7 P Ml T m c Z: cn rrl m � r r X _ ,A 3g � N 77 ------------ Yam. 1 a �d Re,.� 0e� 3 �d 2 O r. UU� 1 � ' Lot t Assessor's Office(1st floor) Map 0?0 d- Permit# /�0 1 Q. A• Conservation Office(4t� h floor) r 1- e .���� G�` S-x `Date Issued —9� Board of Health(3rd floor)(8:30-9:30/1:00- 2:00) e ` 6 j d Engineering Dept. 3rd o ) Hous #1 SEPTic , PlanLStrees or/ chool Admin. Bldg.) t��TA E0 g Defie Planning Board 19 a +TOWN OF�BARNSTABLL `'�° "� ' Building Permit Application Proj d�7 'R tax rwco t Ld Village (6,k1- 'Cr(V I e-C C'-- Owner Edyiq o Address Telephone Permit Request �(/�t !✓Cn - CAS �,(}(��jCr C/Ilg�/Q/� )CoAr c 6f4RYG6: 1/"�to F4M)I-v -Se a-0&Z' Po r Lk on - e-Y,Ic kg am Total 1 Story Area(include 1 story arages decks) square feet --,5-7 b Total 2 Story Area(total of 1st&2nd stories) square feet v pr© r`A Estimated Project Cost $ 0 , 000 Zoning District c Flood Plain Water Protection Lot Size ygG Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type C.o g t/ a(/i i 6w t4 C- Commercial Residential Dwelling Type: Single Family V Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway c Number of Baths � � No.of Bedrooms 3 Total Room Count(not including baths) First Floor Heat Type and Fuel 0- Central Air Fireplaces xC S Garage: Detached. / Other Detached Structures: Pool Attached Barn None Sheds Other ` Builder Information Uq #kT-r tJ Name d ,,e C� �� Telephone Number � 7 /) 45,39" / d Address =2 n,,$Js qojo Q2 License# 0 0 7 50 5— [Erypryd<10 kAryss (32 60 ) Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE /-� //J� DATE 71SI�S BUILDING PERMIT DENIED FOR THE FOLLOWING REASONS) r.r ' FOR OFFICIAL USE ONLY PERMIT NO. #8827 DATEISSUED July 12, 1995 MAP/PARCEL NO. 208.085.022 ADDRESS 27 Fernbrook Lane VILLAGE Centerville, MA 02632 _ OWNER Edward J./Anne Pacious ` i DATE OF INSPECTION: f 1 FOUNDATION _ FRAME i 4 INSULATION ' FIREPLACE I ELECTRICAL: ROUGH. FINAL y PLUMBING: ROUGH FINAL GAS: -,ROUGH ' FINAL t F .17 FINAL BUILDING:-1 DATE CLOSED OUT ASSOCIATION PLAN^NO. F 11%02'94 I7:02 '$8177277122 DEFT IA'D ACCID 0 y ConunOn-LVe:gltil of Wamachuieffi q 600 Walfton Stmet James J.Campbell &ton, ///aamachuaS 02f f f Commissioner Workers' Compensation Insurance Affidavit 1, 0 'M r ►✓l yt with a principal place of business at: -7 ` Qo�o� � �U�t�i�/Yt�(7 / . %�Vk I�OUJ�� do hereby certify under the pains and penalties of perjury, that: () I am an employer providing workers' compensation coverage for my employees working on this job. / Insurance Com arty Policy Number () a sole proprietor and have no one working for me in any capacity. I am a sole proprietor, eneral contractor r homeowner (circle one) and have hired the contractors listed belo�+v w o e re o lowing workers' compensation policies: ,o co)C-,As 007 90,9 L/ 6 i W_Ty Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor insurance Company/Policy Number O I am a homeowner performing all the work myself. I understand thit a copy of&is statement will be fbne.zrded to the Office of invesg2tions of[he DTA for coverage verification and that failure to secu. COVE-age Is rec_`ir ed under Section ZSA of MGL 152 can lead to the Imposition of criminal penalties eonsisdn¢of a fine of up to s 1,500.00 and/or years' imprisonment as well as civil penalties in the form of a STOP WORK ORDE and a fine of S 100.00 a day against me_ Signed this ' day of , 19 g S 06) �0 Licensee/Permittee Building Department Licensing Board Selectmen Ctffce Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY OF ONE ASHBORTON PLACE Prlhr�tm c•a;= �.r-^."rr• �t' MASSACHUSETT�S�? BOSTON,MA 02108 t-•''-" '- .: _; %...' $ IS r } L I C E A S E ,• ' CAUTION EXPIRATION DATE CONSTR. SUPERVISOR 02/03/1996 EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST RESTRICTIONS THEFT, PUT RIGHT THUMB NONE ,g O6/30/1993 007905 o PRINT IN APPROPRIATE�__.SOX^OI�?'Ci�ENSE �,. The Town of Barnstable • • L►Rrisr�. • �,S Department of Health Safety and Environmental Services 116 Building Division 367 Main Street,Hyannis MA 02601 Office: 508 790-6227 Ralph Chen Fax: 508 775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME EuROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement, mmo-val, demolition, or construction of an addition to any pre-Blasting owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: V., Est Cost" % Address of Work: 7 Fern t_7 rO6 ca n I- ce-J4 Owner.Name: Date of Permit Application: 3 I b I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-occupied owner pulling own permit Notice is hereby given that: ' OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: ' •Date , '7�3 �s Contractor name Registration No. OR Date Owner's name LOT" L OT 7 } rp Op '� W 2'stone STK D, D8 22 /247 S.ri 3 3s. �s0 %-� I . G.PD. SbO : /Soo 3. s�o (g liJ 2'STnNS I .. ... GSr. M� a� b � / ./o .S O 1 �. -•i IV IL ^ •8 18.4 SS.7 GAR. �.Ol G� ' SZZI as 490 S. ss `4, ss.7 377 Li tO /soa L4 h° Fh/D 1 �. . . PLAN SCA L PR4F/LE:-�N.o -SCALE 00 DAre : 5-:.3-B5' _._ ._: ....__.. ... _... . 2. CATct1 ',BA:5//IM3 SKETCH PLAN OF LAND. I N N.9 yILLEO A. . Soil FraR, MR.BOD 'Dumt-my ' s/qn-cIn/9i n o,8f avrn2s 7asb leh 0"yi' � 23aA,r.4r/�0�4 P OV' Subwlks/one T o Alyec, Or) 49 /-/,4R/4oie c'cw47 /JuqusT /oth /962, P/Q� �'/�97�E Shra /ol2. . E/e✓afivHs Sl+o,✓r) or-r•oe7 QSswi+sed galG/,". . p-�12�3 � /iTE.• 9Gn RNST BLE rta� o gcry TEST P/r DATA M4l4Ei 4-26-BS' ,,v/r. .r," cow/ate No t✓�+semis ervtu un t[�t8'�" ; porc.Rato '2 Mirt or /Cox&-p �a. ss,'z 7 WILLIAM 4y f� H. p FARDIE ti Mee/ ;p fl0. 8995�O Q FG/ST�Q ONA Vr-,wr, :. M 49 j r 4 — — __ -- — - --. -- — -�— -- — — -- -- — — — -- a , . �. op - ta ,NQ7� � � - - - ---- - - -- - . - -- ------ --- - - --- -- �-� , m I t j _ Rg 1 ' _ s , f , r a F _. t i1 � , es . 'ZZ rV -' ) , I t 1 v i E i s• t ^ CERTIFICATE OF INSURANCE ISSUE DATE 07-10-95 I PRODUCER ITHIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS I I INO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND I I HAROLD H. WILLIA14S AGENCY INC. (EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I 1 81 BASSETT LANE I I I HYANNIS MA 02601 +--------------------- -------------------------+ 1 (508) 775-3366 1 COMPANIES AFFORDING COVERAGE I II------------------------------------------_--_____ -+ I ICD LETTER A MERCHANTS INSURANCE GROUP I - ____-----_-_-- --------------------------ICO LETTER B I I INSURED +-____ ---------------- --- -_____--_- + I HOME WORKS OF CAPE COD ICO LETTER C I I D/B/A MARTIN AHEARN & R. DEMERS +---- ----------- 1 1 33 WINSLOW DRIVE ICO LETTER D I I MASHPEE MA M49 + I CO LETTER E I =_- -_ _ _ -_--------------------------------------_- (THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD I (INDICATED-NOTWITHSTANDING ANY REQUIREMENT-TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFI- I ICATE MAY k ISSUED OR MAY PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS;EXCLUSIONS I [AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I ------------------------------+--------------------------+---------------+-------------+----------------------------------+ ICOI TYPE OF INSURANCE I POLICY NUMBER IPOLICY EFF. (POLICY EXP. I ALL LIMITS IN THOUSANDS I ILTI I IDATE (MM/DD/YY)IDATE(MM/DD/YY)I I ------------------------------+--------------------------+--------------+--------------+-----------------------+- -+ I 16ENERAL LIABILITY I I I 16ENERAL A66RE6ATE IS600 1 IA I COMMERCIAL GENL LIABILITY I BIN-071095-113546 1 07-10-95 1 07-10-96 (PROD-COMP/OPS AGGREGATE IS300 1 I I CLAIMS MADE X OCCURRENCE I I I IPERS & ADVER. INJURY 1$300 1 1 1 OWNER'S & CONTRACTORS PROT.1 I I (EACH OCCURRENCE IS300 1 1 1 1 1 1 IFIRE DAMAGE(ANY ONE FIRE)IS50 I I I I I 1 INED. EXP.(ANY ONE PERSON)1$1 I +--+ -- -____------+------____--------------+--------------+------------+--------------------+-------+ I [AUTOMOBILE LIABILITY I I I (COMBINED I I IB I ANY AUTO I I I ISINGLE 1 $ I 1 1 1 1 1 (LIMIT I I I I ALL OWNED AUTOS I I I --------------+-----------------+ 1 1 1 1 1 (BODILY I I I I SCHEDULED AUTOS I I I (INJURY I S I I I I I I IPER PERSON I I I I HIRED AUTOS I I I +------------------------_--+ I I I I I IOODILY I I I I NON-OWNED AUTOS I I I (INJURY 1 $ 1 1 1 1 1 1 IPER ACCIDENT I I I I 6ARA6E LIAR. I I I +------------+------------------+ I I I I t (PROPERTY DAMA6E1 $ I IC (EXCESS LIABILITY I I I I (EACH OCCURRENCEI AGGREGATE I I I I I I 1 1 $ IS i I I OTHER THAN UMBRELLA FORM I I I I I I I +--+-----------------------+--------------------------+-------------+-----------+-------+-----------+------+ I I I I I (STATUTORY I ID I WORKER'S COMPENSATION I 1 I IS EACH ACCIDENT I I I AND I 1 1 IS DISEASE POLICY LIMIT I I I EMPLOYER'S LIABILITY I 1 1 IS DISEASE EACH EMPLOYEE I +-+----------_- --_+------------------------+----------+-----------+------------------ -----+ I I OTHER I I I I I IE I I I I I I 1 I I I I I I I I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS I I I t I t 1 -_=_=_--=____----__==--______=_- ______ _ =_�___=___ ---_---- 1 CERTIFICATE HOLDER I CANCELLATION I II--------------------------------------------------------I I TOWN OF BARNSTABLE ISHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THEI I BUILDING INSPECTOR (EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO MAILI I SOUTH ST. 1 20 DAYS WRITTEN NOTIU TO THE CERTIFICATE HOLDER NAMED TO THE I I HYANNIS, MA 02601 1 THE LEFT BUT FAI2ITY MAIL SUCH NOTICE SHALL IMPOSE NO I I IOBLI6ATI0�l OR LIABF ANY KIND UPON THE PANY ITS AGENTS I I IOR REPRESENTATIV I I +-------------- --IA ORIZED REP E I +-----=----------------------------------- ---------+- -- - - ----- ----- -- - - -----------+ TAS FORM 25-S (3/88) i t t r Town of Barnstable *Permit YO 3 Sa l ti0 Expires 6 mouths Jronr issue date Regulatory Services Fee EARNSrAaLE, Thomas F. Geiler,Director ,q b Building Division FD MA'1 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 Not Valid without Red X-Press Imprint Map/parcel Number 2ZD U�5 Q Z2- Property Address 21 Fe Yn V-- �ooy— L-an t Cent --Y-V 1 1 I, r M�+ ozb2og- c- , ❑ Residential Value of Work -� `/ SDD• —Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address RM12,0 rG( Q�, �. bi.sh o y Of F60 �INN K Contractor's Name T y So Uf o 111 C . Telephone Number n 77�3 L)e 1 7 Home Improvement Contractor License#(if applicable) ffWorkman's Compensation Insurance X-PRESS PERMIT Check one: JUL 1 2008 ❑ I am a sole proprietor . ❑ I am the Homeowner TOWN OF BARNSTABLE 7I have Worker's Compensation Insurance Insurance Company Name ran.( �e CCf' nsua nCQ Co Workman's Comp. Policy# Lh C, y ?)C1 13 Cr 9 3 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) [� Re-roof(stripping old shingles) All construction debris will be taken to � ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:buildingpermits/express Revised 123107 ° 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 Le iblTAV Name (Business/Organization/Individual): I? u 00 / Address: 1 Lo Te ( () I—6-e-- City/State/Zip: C•eV1k�VI I4`M)T 62&3,�- Phone #: tC ' 77 gj 'DM 7 Are on an employer?Check the appropriate box: Type of project(required): 1.1I am a employer with 3 4. Z'I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 'I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demo lition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition 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.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.9 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: W C_ q,�Cq Expiration Date': 2 Job Site Address: 9] �f 11 n bY0D Y- La y)e City/State/Zip: Ce r k_(- I I-, mn oz&3 Z Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above istrue andcorrect. Signature /JL�i�/%� C 'UL jl"— Date: l2 Phone#: 50� - 7 7 9- 6 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): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Board of Building Regulations and Standards Construction Supeniisor License Lioefisq: CS '72866 Blttl d Ai &6/1951 B=� 51$12009 Tr# 13670 W 163 TERN LANE CENTERVILLE,AAA 0263� CommissionerT' e Board of Building Regula ons and Standards One Ashburton Place - Room 1301 Boston, Mas chusetts 02108 Home Improveme tractor Registration Registration: 148201 Type: DBA X T Expiration: 9/13/2009/Tr# 133017 DAVID SAURO/ CONSTRUCTIO a� DAVID SAURO d 163 TERN LANE CENTERVILLE, MA 02632 Update Address and return card.Mark reason for change. Address Renewal-,0 Employment Lost Card DPS-CA1 0 5OM-07/07-PC8490 " j Sub Contractor W-9 and Certificate of Insurance i ?Insured.., `�+ r , Ce fiGat�of lnsura Ge irati'ia"Qaks Poli_OOin O W9,„ ..,,, m I #ma Ace Arborculture General Liability 04/19/08 NPP 1082374 X 04-319-4573 Phone: Automobile Liability 10/01/08, 07MMMM9021 025-48-7944 Fax: Workers Compensation 11/18/08 WC 844-99-24- Advantage Electric,Inc General Liability 01/11/09 MP095993 Phone: 508-326-7921 Workers Compensation. 01/11/09 WCC5005299012008 Fax: 508-394-9620 All Cape Garage Door Co.,Inc General Liability 06/01/09 168087K26379TIA08 Phone: 508-398-2757 Workers Compensation 06/01/09 WCC5002586012008 Fax: 508-428-1184 ' Associated Alarm Systems,Inc General Liability 04/05/09 CLS1489915 Phone: 508-775-3442 Fax:508-790-2330 Associated Elevators Companies,Inc. X 04-309-3454 Phone: 508-760-3875 Fax: 508-760-2809 Baxter,Inc. General Liability 08/01/07 SRSGLMA05092 Phone: 508-775-0375 Workers Compensation 10/06/06 US3796B81705 Fax: 508-771-7324 Riggers Coverage 03/29/08 QT6607344B865TIL05 Belanger,Susan X 020-70-7459 Phone: 508-776-9482 Workers Compensation 04/25/09 WC6007213012008 - Fax: 508-420-3568 General Liability 04/27/09 3600031197 Belanger,Steven General Liability 06/14/09 BP17034414 020-60-4983 Phone: 508-428-1389 Workers Compensation 02/04/09 VWC6002932012008 Fax: 508-420-3568 Automobile Liability 67/02/08 95375400001 Brennick Building System LLC General Liability 02/25/09 CB4E1820 Phone: 508-775-5111 Automobile Liability 04/01/09 T39797 . Fax: 508-896-7997 Umbrella Liability 10/05/08 5,16592 Brian Bolton Workers Compensation 02/23/08 UB7254B64A07 Phone: 508-776-3466 General Liability 02/18/09 MP690590 Fax: 508-362-4129 X. Builder Services Group,Inc.-Cape Cod Closets General Liability 06/30/09 MWZY55525 dlb/a:Quality Insulation&Bldg Prod Workers Compensation 06/30/09, TWXJUB122D027 Cape Cod Custom Floors,Inc General Liability 12/13/08 6802525C15A Phone: 508-778-1965 Workers Compensation 05/25/09 08WECKL1007 Fax: 508-778-5575 Cape Cod Insulation,Inc. Workers Compensation 06/30/08 WC8962496 X 04-271-5757 Phone: 508-775-1214 General Liability 04/01/09 CBP9587416 Fax: 508-778-5735 Automobile Liability 04/01/09 BA9587917 Cape Cod Welding General Liability 09/13107 TBD Phone: 508-428-3843 Workers Compensation 08/15107 UB-5520084-1-06 CapeCuts,Ralph Tovar Workers Compensation 10/06/08 7019907012005 017-72-6980 Phone: 508-726-4176 General Liability 06/07/09 SCP0661814 Fax: 508-430-0951 X Christopher N.Yerkes General Liability 09/10/06 MPB72549 231-35-3650 Workers Compensation 10/15/06 UB3774B94205 X Cloney,Kevin Electrical Contractor LLC X 04-349-9263 Workers Compensation 12/17/66 7015775012005 General Liability 12/16/06 Q811-17947811 David O Nordberg General Liability 05/29/07 2001XO450 X 010-69-8126 Phone: 508-428-4443 a' Fax: 508-428-8109 DeNardo Home Improvement of Cape Cod,Inc. General Liability 09/10/08 680883OA359COF X 030-40-3734 Phone: 508-477-5574 Workers Compensation 12/20/08 UB 0315B15407 Fax: 508-477-8999 Automobile Liabi I ity 01/06/09 PMC7191293 Downey,Wayne B. General Liability 06/06/09 53644633 X 02144-8836 Phone: 508-760-2091 Workers Compensation 08/19/08 6KUB692K742207' Finnemore,Joseph R. General Liability 08/06/08 MPS30346 X 20-3902628 Phone: Workers Compensation 01/01/08 UB-1323C97-1-07 Fax: Forest Keepers X 257-47-0515 Phone: 508-790-1620 Fuller Electric Company,Inc.., General Liability 09/22/08` MP080356 04-228-2361 Phone: 506-77570030 Worker's Compensation 09/22/08 WC080356 X Fax: 508-775-6977 , Confidential 06/24/08 a Page 1 Sub Contractor W-9 and Certificate of Insurance nsured� y.... Certificate of lnsuranpe,:?Ex,irationpato�",,,,Ip��C number, 9m Gardner Concrete Forms Inc. General Liability 04/04/07 1680346CC154 X 861141815 Phone: 508-759-5630 Automobile Liability 04/04/07 92079400002 Fax: 508-759-5091 Workers Compensation 05/01/06 WC6700475 Govini,Peter X 043250384 Phone: 508-420-9195 General Liability 05/31/06 20011-6220 Fax: 508-420-9195 Worker's Compensation 09/20/06 WC006804404 Gray,Ian General Liability 07/24/07 PX7843 X 014488938 Phone: 508-477-7696 Worker's Compensation 06/09/07 OBWECJN0285 Fax: 607-724-7759 Gregoire,Frank General Liability 04/01/07 BH003 52484287 X 043458812 j Harvey Industries,Inc. General Liability 03/01/08 710012316 Phone: 508-775-7788 Workers Compensation 01/01/08 WA711D254242037 Fax: 508-771-3217 Hickey Construction Company,Inc. Workers Compensation 01/17/09 WC8934821 X 042913741 Phone: 508-771-4128 General Liability 04/09/09 1680159513907 Automobile Liability 04/09/09 BA1944805A Hill,John General Liability 02/09/07 BP17041543` X 018381622 J.C.'s Concrete Floors,Inc. General Liability 11/18/08 NC 500372 Phone: 508-775-8371 Workers Compensation 09/20/08 AWC 7019708012005 Fax: 508-534-9050 Jesse Davies dba New Image Flooring General Liability 12/15/06 HJP371 Phone: 508-385-3727 Fax: 508-385-3496 JFM Flooring. General Liability 05/01/08 GL3326473 Phone:508-771-1608 Workers Compensation 06/28/08 6ZZUB-79821318 Joyce Landscaping General Liability 11/15/06 8500029622 Phone:5084284772 Automobile Liability 03/15/07 BA0837W91606SEL - Fax: 508428-4707 Workers Compensation 04/07/07 WC8954116 Kevin McBride Plumbing&Heating Inc x 20-477-1754 Phone: 508-7784556 General Liability 12/18/08 R0644392A- Fax: 508-778-2549 Workers Compensation 11/19/08 08 WEC KJ6536 L&M Glass General Liability 05/01/09 CCP9721358 Automobile Liability 05/01/09 BA9721858 " Workers Compensation 05/01/09 WCC5004479012008 Laferriere,Kevin X 013466674 Phone: 508-737-2454 General Liability 09/29/07 MPP83469 Workers Compensation 05/15/07 WC8945433 Lambros,George General Liability 01/10/09 CB834784 Lawrence Robinson Masonry Inc. General Liability 09/07/08 CB 7E 32 32 Phone: 508-524-1426 Workers Compensation 09/06/08 76 WEG NQ5620 Luiz Romcelli General Liability 10/01/08 GL3594203 Workers Compensation 03/11/09• WC000167884- Miguel Tatara Nato General Liability 03/14/09 BP00008250 X 017-90-0816 Phone: 508-360-8365 Workers Compensation 06/24/08 7PJUB7744A71203 Michael Mongeau General Liability 12/12/07 MPS57527 Phone: 508-778-9797 Workers Compensation 03/04/08 UB48OX760907 Fax: 508-778-9797 X 030401009 New England Landscape&Development Corp. General Liability 12/19/07 9946D5128 X 043016608 Phone: 508-420-5188 Automobile Liability 01/27/08 BA-2660C60A Workers Compensation 03/01/08 Wcc5001933012007 Northern Sealcoating&Paving Inc. General Liability 10/01/08 CLA019849410 X 042742821 Phone: 508-398-9474 Automobile Liability 10/01/08 MAA019849510 Fax: 508-394-0955 Workers Compensation 04/01/09 NOWC904736 Paul J.Cazeault&Sons Roofing Inc. General Liability 04/30/08 BINDER255115 " Phone: 508428-1177 Workers Compensation 08/10/08 UB0095B64AO7 Fax: 508-420-4555 Fires Construction Corp. General Liability 11/07/08 BP17040195 X 43499526 Phone: Workers Compensation 08/24/08 WC6876142 Automobile Liability Residential Development,Inc General Liability 07/25/07 CTR0006825 Phone: Automobile Liability 10/17/07 1628696 Fax: Workers Compensation 01/12/08 WCC5004174012004 Robert B.Our Company General Liability 12/01/08 . CPA13014281 Automobile Liability 12/01/08 MMA130144016 Workers Compensation 01/01/09 WC0008557 Shaw,Jeffrey P. X 018365674 Phone: 508-776-2347 i General Liability 01/23/07 BH00652460711 Automobile Liability 01/01/07 ZB142789 Confidential 06/24/08 Page 2 z• Sub Contractor W-9 and Certificate of Insurance Insured x Cartifite gfl surance Ex > tion DatPo Ic number ,,,W9 Employer`ID# Shorey manufacturing Co.,Inc General Liability 12/01/07 CPA130142815 Phone: 508-760-1070 Worker's Compensation 01/01/08 WC0008556 Fax: 508-760-5716 Automobile Liability 12/01/07 MAA130144015 Tanguay,Martin General Liability 06/19/09 SCP031530224 x 044-42-5987 Worker's Compensation 03/04/09 WC8737405 Top to Bottom Chimney Service,Inc. General Liability 07/03/06 PAC6506144 X 043508281 Phone: 508-394-7986 Worker's Compensation 09/29/06 7010131012005 Fax: 508-398-4328 Tuckahoe Turf Farms Inc. General Liability 12/31/08 ZDN4934142 Phone: 401-3644020 Worker's Compensation 12/31/08 MDA0274608 Fax: 401-364-6423 Automobile Liability 12/31/08 ABN4934082 USA Painting-Andre Luiz Costa Lessa General Liability 05/27/06 CPP0708740 X 919724280 UTS of Massachusetts Inc General Liability 05/01/09 C2094820462 Phone: 781438-7755 Automobile Liability 05/01/09 2094820459 Fax: 781-438-6216 Worker's Compensation 02/02/09 3102800710 Winslow Plumbing&Heating Co.,Inc. General Liability 12/01/08 CBP9919974 X 042846193 Phone: 508-394-7778 Automobile Liability 12/01/08 8218494 Fax: 508-394-8256 Worker's Compensation 01/01/08 1580A Wright,Richard X 135347631 � Phone: 508-246-1452 General Liability 10/14/08 MPB75769 Worker's Compensation 1 10/26/08 7017064012007 Confidential 06/24/08" Page 3 Town of Barnstable BAMMBLE, MAS& Regulatory Services Foµcta 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 eSJ 16 t , as Owner of the subject property j� 1 , p p �' gAhereby authorize IN�U Sau to act on my behalf, in all matters relative to work authorized by this building permit application for: 2 rn L Lavie Cenke ui I�e (Address of Job) a Signature of Owner Date Print Name , Q:Forms:build ingpermits/express Revised 123107 ,, .; - .. :�� .-�.:..--. .�..�^°�. X..�-.:'::� ft.� r+..�.{..1 ��;g. �,..:Y•`y,yp. ...�—oas+a....--�,. t,� - u �;�it TOWN- OF BARNSTABLE 28203 Permit No. .....---------.........--- Building Inspector @950.00) Cash (p OCCUPANCY .,PERMIT.,._,, Bond u' Issued to John O'Neil Address Lot #26, 27 Fernbrook Lane, Centerville Wiring Inspector Inspection date Y Plumbing Inspector Inspection date t Gas Inspector Inspection/date Engineering Department Irispection�date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL i SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY -COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. 19-- $ `_ B -ildin Inspector i ( z l TOWN OF BARNSTABl.E, MASSACHUSETTS woo t J08 WEATHff, CAAO- - • - Vitoz: DATE• t 19 PERMIT NO. ,3 ti:._. V• tt<�.i.l Y1' ui..�r .7.its f♦+u:l . s 1.-:Y�::���L.1 l APPLICANT ADDRESS ft _ (NO.) (STREET) (CONTR'S LICENSE) .Y• f; ? _c .,_... 4:__ ;1. NUMBER OF PERMIT TO c. (_) STORY DWELLING UNITS (TYPE OF IMPROVEMENT)' NO. (PROPOSED USE) 1'./....1.1k? ZONING AT-•(LOCAT]ON) DISTRICT k,(NO.) (STREET) BETWEEN AND ` (CROSS STREET) - (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: + t AREA OR PERMIT t .$ VOLUME ESTIMATED COST $ FEE +' -:(CUBIC/SQUARE FEET) OWNER 4 is - :a ro BU I I ADDRESS BY.S: _'.[k; . . THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR A`-` - ''.:'_,.p.ARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTE ` '�E AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LC _ .• ' 0 ` FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RE' OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. .... > •y,i._' < ; MINIMUM OF THREE CALL ; •- i« w3+-`3 - .'3 ' INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION "'': ,:'• s•, -e^ ": - `" _ - �DUNDATIONSOR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCC UPAN ""`�Y.;tti ' PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUP,?,: s..,. ',�•� '�' --MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. IN -uSPECTION BEFORE C [ur .Y. POST, THIS CARD SO IT :IS VISIBLE 13 UILD`NG INSPECTiOy ^v e, Sy PLUMBING INSPECTION APPROVALS ELECTRICAL INS. . ' / s oo f 2 y j �`'.. f fl- v 67 3 HEATING !NSPECTING APPROVALS REFRIGERATION INSPE TION APPROVALS t I1 1 �Q RD 0 �ALTH OTHE R,,IZI69 2 -- 2 INEERIR9 (4r 1 'NCRK :nAL_ NOT -ROCEEC' UNT:L THE PERMIT WILL BECOME NULL AND-VOID IF C^/'9STRUC f'0N iNSFECTIONSINDICATED ON THIS CARD NSPECTOF -iAS ?PPRCVED TLiE VA--CUS WORK IS NOT STARTED WITHIN SIX MONTHS`nj DAT': THE CAN BE ARRANGED FOR By TELEPHONE"" STAGES JF CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION, F , I _ I � t 4j�'�`.� I. T r.r p.J.�_a r �...+•_.t r T >:.:,1 ,1.....t. � _. I i 77 7 !!{ .�'(/,.� ! _/,/�� i• F. 't- t.� C � F_, I �T. 1-4 - Ao ` r # I rC� - f j { } FZi ; t } 00 H ' FouN?4rio+v I ,-.>., .t � .._ .. .... 4 � ' 'I , .� yt `1t+ Cam- -t• jV/'1R;� ,' t l:.O/' t .F j t t /� ' � r # � � } < + ,. �.... I � 4•_i ' 4 � }. ♦ � �Y . tt • + . ! < - . At JOB � � . , d � ' , � I ;'"' ZA 40 iQ-6-0 dui . _ f r { , t. Z CATcrr LaA.9'/n/3 f5 t�CFTC'Nl PL OF t 4 t�4 ' l F " b $4<b4q//sian 6 d� �uq�asT:/Ot�i r �/e.✓a.fivr►5 vctini.�n , .TEST p/.T; UA�,q._ The fou4dat on shdwrn ]:oca.ted ion th.e rQind I s sHdhereox . ' ' No t✓,w��iz trvcutyr►f�[�zT�O' t g I Z ' e f t }.spa' t �f } ' f t ,.i ._t ., :-L i.FA. .. ! } f �r'ct...vj. , �l•D; , E � � 4 F ,_t I _,L:.! t ,. « ,. Asses' r.' inap and lot number ...... .D....... Q..`�...-..G� sT Er Sewage Permit number` ....................... ............................. BAH i Z • B9TADLE, House number ................ .....7..................................., i6MAG 9 � 9�C S 'TOWN ®F' BAR Nr ,FF�,T°ABL�E� � �.��ta T. DUI -LDING; INSPECTOR APPLICATION FOR PERMIT TO ..r.,—. rJ......(1.::/..l..:e.............................................................................. TYPE OF CONSTRUCTION ...... 7..11..... ...C............ o. .l.. ..1 .................................................................. ...................19 �1-0'THE-tN5PECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following info r .�tion: Location ......f�.© ,o .� �� .. �' !............... ?........ ........ ........................................................ ... .... /� ProposedUse ... . .. -Ol e.....................................................:................................................................... ZoningDistrict ........... ...�.........................................Fire District ................(f... . ............................................. Name of Owne'rJ r!.o.......V...... :2�...�.L...........Address `! k e•�L,� /.. . /C �(/1 Name of Builder .......uxev .....................................Address ....... ........................... Name of Architecto7 .`r&l........fi1..#.Zd.. .`.:.........Address � ....................... ................................................... Number of Rooms ..............lP.................................................Foundation .......... .lrV ..T ................................... Exterior ..........U.V..L'w ....................................................Roofing ......(�.?. ................................................................ Floors vCw V...............:........................................Interior ... ... . .y....... Heating .... ,C1� 5..............................................................Plumbing . l .... ...... / ..� Fireplace •0- .....................................Approximate. Cost y` ICI `�l ..,�............................. �� `� Definitive Plan Approved by Planning Board ���(.�C`'_C___.I-�_____19 Area ......./.�..�C.2..-E... ......�... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH -VI , �O� tiD 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. Nam ... :... �`' .................. Construction Supervisor's Licens4/f ..:...................... O'NEIL, JOHN N. 8 2 0 3 No '................. Permit for ....TK9... R?:_v............ t't, Single- Family Dwelling....................... ,1��............................................. Location Lot. ...26.,...2.7..Fernbrook L e . .. ........................AR.......... Centerville ............................................................................... Owner .....John...0.'.Neil.............................................. ti Type,of Co6struction .....Frame ........................... .......... ............................................................................... Plot ....................... Lot ................................ ly,12, 85 Ju Permit Granted ........................................19 Date of Insp Wck' .....Fl..� ... Date 'Completed ... .......196 X Assessor's map and lot number ...... . THE pi tp �o Sewage Permit number ..... ,�.�........................... d 2 BAHB9TeDLE, MABaHo number ................, � L MA-4 a. TOWN OF BARNSTABLE 1K, BUILDING INSPECTOR APPLICATION FOR PERMIT TO .!�... . �J.....L�...l..�. /G--� ....... ..........................:.... ......... ..... TYPE OF CONSTRUCTION .X?./.:�. .. ..........Y"" �> .... ...................19Ca TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following infor ation: . tee" ° r ,� U llT�✓� U� j f D i �. Location .................•..............., .........., .....:........................................... .......................��........ ProposedUse ..... .;f6,9 f 2 f ...............................,................ ................................................................................................................. Zoning DistricY. ..... .............�........//.��.... ..l.1 .........L.`............Fire District � .....................................................� C. � ..:......�.(1,..!.�......7.1.0. fH. �/� .il �/Name of Owne�.af�1f ....... ...�.. ...........Address. ................................... ................ ..` .I...r y C\ ) . Name of Builder ..........,�...,�r.!.��:..�-�....r�....................................Address .......................'............ .............. - Name of Architect .... ........... . ...............Address......... ............ ................ ..... ............................. Number of Rooms .............. ..................................................Foundation ......... /)f7fYc Exierior !!� %�.................... ........Roofing ,;U n i r /�� /� Interior / , Floors /.. ....................... . ,/.... ._. ............ ............ ......... _Heating /T/..'�...............................................................Plumbing ...l..........� .... �,.............. ........ Fireplace ........................................Approximate. Cost .........::f;f .,...r�..` :................................... n Definitive Plan Approved by Planning BoardF________19:�Z . Area :............... Diagram of Lot and Building with Dimensions Fee r SUBJECT TO APPROVAL OF BOARD OF HEALTH ,?,57V6 v rC) awNEI OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS, a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. � .Nam .` ,.�.... .......... 4 Construction Supervisor's Licen.. ....................1.` ,........ _ O'NEILL, JOHN A=208-85-22 28203 mit for .,Two +Story Single Family Dwelling.. Location .Lot 26�.....27 Fernb ook Lane ......... ....... ................ ............... Centerville Owner ...... ohn 0' ...........Ne.......ill...................................... Type of Construction ...Frame. ............................ ................................................................................ Plot ............................- Lot ................................ Permit Granted ..JulY....12A.........`..........19 85 Date of Inspection ....................................19 Date Completed ..........._..........................19 t l ra'' s ,�° y^ "^& '+`G.�. .....a�'�'. .e a :, ,�..:,� r.Mw .e..,€��,