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HomeMy WebLinkAbout0367 GREEN DUNES DRIVE I 0 t . rr v P v s G)vd Ad �0. 1521/3 BGR ESSELTE 1 0 i �hR, .J Town of Barnstable ,*Permit#901�5 16 Regulatory Services Expires 6 months from issue date Fee + BMWnABLM ti Mari 1°.� 205 Richard V.Scali Director IOw� aF B I1 Building Division Tom Perry,CBO,Building Commissioner 200 Main Street;Hyannis,MA 02601 ` www.town.barnstable.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 / p Property Address �`N(_7 C-, L"�i JM a g residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address < �'��� AV• ° Contractor's NamekKt1L"%J4. TL.L- Telephone Number Jx--7 9 Home Improvement Contractor License#(if applicable)` <t,,�S(j Email: (1-�� �,� �` A A Atom; Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: )I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. ' 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) Re-side r Replacement Windows/doors/sliders.U=Value '(maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S ind'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 co y of the Home Improvement Contractors License&Construction Supervisors License is req i d. - SIGNA I Q:\WPFILES\FORMS\building permit forms\E RESS.doC Revised 040215 i 27ze Comnronirealth of Vassachusettsi Deparanewt of industrial Accidents �► - of -ce ofLnxestigations 600 Washington Street y Boston,MA 02111 IVIVIV:MaSMgnyldiri Workers' Campensatian InsQ ce Affidavit:BE ilders/Contra.cturs/EIectricianslPlumbers , Applicant Infmainatian Please Print Le gib Nm=(Busi1�a1i23tionM3dividad): L- Address: �- CityfStatizip Phone-4,- � Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with. 4. ❑ I am a general contractor and I employees:(full and/or part-time).* Have hired the sub-contractors 6. ❑New construction2. a sole proprietor or partner- listed on the attached sheet. 7- El Remodelingskip and have no employees . These sub-contrac#ors have 8- ❑Demolition working for roe in any capacity- employees and have wodaTs' 9. ❑Building addition [No nrorkm'camp.irasmMme comp-insurrancel required-] 5. ❑ We are a corporation and its 14-❑Electrical repairs or additions 3.❑ I am homeouuer doing all work officers have exercised their 11-0 Plumbingrepairs or'additiom myself[No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required]6 c.152, §1(41 and we have no employees.[No workers' 13.❑Other comp-msurance required_] *Amy WKcsatdiat checks box O.El mast also fMoutthe section below showing theirwodies'compensation policyinformations lLame hers who submit this dfidat u imd xtmr they axe doing all wal and then hire autszze contractors n=suhn=a new affidavit indicating sz>ch- fCan=tors Yhat cbec]r"this box must attadhed m additional sheet showing the name of the sub-conita cton and state whether or not those entities ham employees. Ifthesub-contractors have employees,they nnrsrpravi k their workers'comp.policy number- lam an eiiipLqer tliat is pr4n dirzg it�orke-rs'coatgwL,;iE our iiLwirance for uzy enrpIay�es Below is the policy curd job site informatiom Insurance Company Name. Policy 4 cr Self-iris.Lic.#. F—xpimtion Date_ Job Site Address- City/Stateaip: ' Attach a copy of the workers'compensation policy declaration page(showing the policy number andexpiration 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$1,50a00 and/or one-year imp.isonm mf as well as chril penalties.in the form of a STOP WORK ORDER and a fimc 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 forr insurance coverage verifcaticn- I do hereby cerfzfi,r td the is and penaWes ofper'm y drat the urfarn afzon prmiiW abm r fs trug acid correct e. Date: �- Phone Offs iai use only. Do ztot write in this area,to be campleted by dly.orloirm afj4c at City or Town: Permitff icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Qtyffown Clerk 4.Electrical Inspector S.Plurnbmg Inspector b.Other Contact Person: Phone#: Information and Instructions i Massachusetts Geheral Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,as e nplayee is defined as."_.every person in the service of another under any contract of hire, express or hnplied,oral or writ" An errrprLyer is defined.as"aa individual,partnambip,association,corporation or other legal entity,or any two or more of thee foregoing engaged is a3oiat enbaTrise,and inchiding the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the groimds or building appu tenanttlicmto shall not because of such employment be deemed to be an employer." f ' MGL chapter 152,§25C()also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit-to operate a business or to consfraEt burTdinigs in the commonwealth for any applicant who has not prodnmd acceptable evidence of complianm with the insui-.mace„coverage required." Additionally,MGf ctraptrr I52,§25CM states"Neither the commonvv-ealth nor aniy bf its pol cal'subdivisious shall enter int.any contract for the perfomoance ofpublio work until acceptable evidence of compliance with the in�ce. regtm emeuts of this chapter have been presti'ied to the contracting authority" N� Appficaats Please fill out the workers'compensation affidavit completely,by chm1dag ha boxes that apply to your situation and,,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificates)of inn -ance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)wimno employees other than the members or partners,are not required to caar<y workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation ofmMrance coverage. Also be sure to sign and date-he affidavit The affidavit should be retramed to the city or town that the application for the permit or license is being requested,not the Department of ayh-rst -jal A_ccidmts. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their• self-insurance license number on the appropriate line. City or Town Officials . Please be snie that the affidavit is complete and primal legibly. The Deparlmeathas provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple pmnrUlicense applications in any given year,need only submit one affidavit m&czt;,,g current policy info ation(if necessary)and under"Job Site Address"the applicant should write"all locations in � (may or town)-"A copy of the affidavit that:has been officially stamped or maiced by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses new ne affidavit must be f td out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial Yenture (i.e. a dog license or permit to bum leaves etc.)said person is NOT regtziL�to complete this affidavit The Office of Investigations would lake to thank you in.advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The f�a=10atealtIT of Masmchus,�ils f ine of�t e ti all f ° ` Bow MA G2I l l Tc,-L 1617 27-4900(-,xt 406 or 1-9 IIIASSAF Fax#617`27 7M R.f vised 4-24-07 .maw gavfdia p , y t Cdmplete and. Q Section IUD¢ of ;w 25ftma Pjw to on mybe6l� r ��ie tQaryrnaorocuealC�a�Caccc�uteGTs V �. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only I ' • before the expiration date. If found return to: t ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation egistration 105530 Type: xpiration 7/1T/2016 DBA 10 Park Plaza-Suite 5170 / Boston,MA 02116 MICHAEL A. BINNALL ADDITIONS,REMOLD f Michael Binnall 25 Geneva Road• South Yarmouth, MA 02664` Undersecretary Not vali ithout 'ignature" ' an Massachusetts -Department of Public Safety' • Board of i3taild' • • Building Regulations and Standards iiri�truCi�f"n.s➢rier-isor i arc 2 r anlihv License: CSFA-045408 MjCHAEL A B 25 GEIVEVA RD S Y �N �'` MA Commissioner Expiration 04/22/2017 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map z Parcel 2� Permit# A ' I Health Division Date Issued Conservation Division Fee f A� Tax Collector Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 3t1,9 (Z ��20 Dl/�zQ,� Village C'.t�✓I�l5�l//z1.1-5 Owner �'t� z/ //I��/9� Address ��� �'1?ISC /�✓lS�` .� Telephone Permit Request y Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type ' Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No A\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 BUILDER INFORMATION Name Telephone Number Z L5-� _16! Address License# CS e16 c-35,� L�1_Y�,c�.�OIJ�� Home Improvement Contractor# //)��� Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOi�l �9D�T� SIGNATURE DATE FOR OFFICIAL USE ONLY - c C' YERMIT NO. t DATE ISSUED MAP/PARCEL NO. S ADDRESS + VILLAGE OWNER r "` �+ DATE OF INSPECTIO FOUNDATION FRAME - INSULATION f • FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL _ x` GAS: ROUGH FINAL FINAL BUILDING w DATE CLOSED OUT t ASSOCIATION PLAN NO. 'F 671 :. OEPgRTMENT OF PUBLIC SAFETY CONSTRUCTIOLF SUPERVISOR LICENSE -' Number'_ Expires: s - des4e4 ro 00 z PO BOX 481... g S_YARMOUTH, ,MA 02664 j r-OL HONE IMPROVEMENT C 97TRACTOR Registration 1004 A � Vie" ;;;INDIVIDUAL , fir. colratian 06/18/00 a J;-a x DAVID R COX ' 9 AVENDER Lfi ceM�o ARTMOUTH MA 02613 R gpMINiSTRATO I The Town of Barnstable Department of Health Safety and Environmental Services ram, ► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 " Ralph Crossen Fax: 508-790-6230 Building'Commissione: Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing 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: 2&0_,� Estimated Cost—AK eyo zo Address of Work: -7- 6;6&L1;F2 Owner's Name: /� .lJ �i r-/z5 wv/_J Date of Application: /'©f L./9!�? I hereby certify that.• Registration is not required for the following reason(s): Work excluded by law [3Job Under$1,000 Building not owner-occupied [30wner 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. Apq Date Contractor Name Registration No. OR Date Owner's Name q:fomu:Affidav The Commonwealul ofMassachusetts Department of Industrial Accidents :�_ •; t � •���-.�-::_�� Offlie nllnyestigatiaas � - s; .600 Washington Street Boston,Mass. 02111 -= Workers' Com ensation Insuralnnrccee Affidavit/�//////////// ��� ���� rriiiii....,..,,,,;..,,,,/i��IIL�/��������i � ��������MUM/ nicaniemf"arurautmz.�/ / name: Jd///� Li location__/�,� city /i ,!�a�;l l4//�/ phone# 27 Z ❑ I am a homeowner performing all work myself. ❑ I am a sole prmrictor and have no one working in any a acity ❑ I am an employer providing workers' compensation for my employees working on this job.. comnnnv name: �% l 'llll J�'??LSD? ��fl city phone#- insurance cn. J� � policy# ZlOC, �t ��� • ___•-. ------------------- ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the.contractors listed below who have , the foIloning workers' compensation polices: ' comnanv name: city phone#- .... imurnnce cn. ''�/,�:. :�/i/////.U//////ii:�G.v.:c%//%%%/%i%�i///.lr.✓,✓/.11llii/rir�ii///////.a'///.�/////i//%//////.�//////.�'r//�/////.�l/��///.%//.�///// //�/%% camnnnv name: address- citF- phone#' irunrancc co. go l//%//%///%G Faaure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penaties of a fine up to S1S00.00 and/or one years'Imprisonment as wen as civil penalties in the form of a STOP WORIC ORDER and a tune of 5100.00 a day against me. I understand that a copy of this statement maybe forwarded to the Ounce of Investigations of the DIA for coverage verification. I do hereby certify raider the pants and penalties of perjury that the information provided above it true and comet Simature Date Print name M&h 1-�— Oindal use only do not write in this area to be completed by city or town otndal dtv or town: petmitAlcense# ❑Building Department oLicensing Board ❑ check if immediate response is required ❑Selectmen's OtSce ❑Health Department contact person: Phone q: ❑Other�,�. I (tevuea 9,95 P1A) • Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th-.: employees. As quoted friom the "law%an employee is defined as every person in the service of another under any cow- of hire, express or implied, oral or written. An employer is defined as an individual partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the rec�.z•e: trustee of as individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work an such dwelling house or as the grounds c. building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local Iicensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neid=.the commonwealth nor any of its political subdivisions shall eater into any contract for the performance of public worm mr? acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contrac=z authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Deparmnemt of Industrial Accidents for canfirmatiaa of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be remrned to the city or town that the application for the permit or license is .,.being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if S��u are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. the Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicarlL PIease be sure to fill in the permit<license number which will be used as a reference number. The affidavits may be rctzracd to the Department by main or FAX unless other arrangements have been made. The Office of Investigations would lake to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax member. The Commonwealth Of Massachusetts Department of Industrial Accidents 0mce 0f luesugadens _ 600 Washington street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext 406, 409 or 375 *Permit# 7 O OF THETpk, Towl, O� i`drl]St�1blC Expires6nwntbafrour issue date Regulatory Services Fee pARNSTABLE. ` v MASS. $ Thomas F.Ceiler,Director T 1699 X-PRESS PE Drnat" BuildingDIVISIQII r Tom Petry, 13uildi1g Commissioner JUL 2 8 200 200 Main Street, I-lyantnis, MA 02601 Office: 508-862-4038 TOWN OF BARNST Fax: 508-790-6230 EXPRESS PI'JIZMIT • A.PPLIaAR O � SIDENTIAL ONLY Not Valid / er Press Inr illt Map/parcel Number nes Property Address - yf Value of Work ❑Residential owner's Name&Address "� G T L4 q qa_-ex�,exL (C- Telephone Number Contractor's Name Home Improvement Contractor License„#(if applicable) Construction Supervisor's License#(if applicable) 21�0_rkman's Compensation Insurance Check one: ❑ I am a sole proprietor ` [] I m the Homeowner I have Worker's Compensation Insurance Insurance Company Name C Workman's Comp.Policy# lU . Permit Request(check box) ❑ Re-roof(stripping old shingles) r ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ` (maximwn.44) ❑ Replacement Windows.,U-Value l , ' SI (S - OYU ther(specify) n department regulations,i.e:Historic,Conservation,etc. *Where require) sissuance of this permit does not exempt compliance with other tow `. Signature Q:Forms:expmtrg .,' CAPIZZI HOME IMPROVEMENT INC . SPECIFICATIONS AND ESTIMATES PAGE 6 OF 6 STATE OF MASSACHUSETTS LETTER OF AUTHORIZATION TO APPLY FOR A BUILDING PERMIT OWN THE PROPERTY LOCATED AT IN 'S aM�SSACHUSETTS. I HAVE AUTHORIZED TO ACT AS MY AGENT TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSTTS STATE BUILDING CODE. I GIVE MY PREMISSION TO LESSEE TO APPLY FOR A BUILDING PERMIT IN ACCORDANCE WITH 780 CMR, THE MASSACHUSETTS STATE BUILDING CODE. SIGNATURE OF OWNER: OWNER'S ADDRESS: OWNER'S TELEPHONE: LESSEE'S SIGNATURE: LESSEE'S ADDRESS: LESSEE'S TELEPHONE: APLLICANT'S SIGNATURE: 1u�1 APPLICANT'S ADDRESS: 1645 NEWTOWN RTi_ , C.f1TTTTT a MA 02635 APPLICANT'S TELEPHONE: 508/428-9518 RESPONSIBLE OFFICER: RESPONSIBLE OFFICER ADDRESS: RESPONSIBLE OFFICER TELEPHONE: ACCEPTED BY DATE THIS PAGE IS PART OF AND IN CONFORMANCE WITH PROPOSAL # The Commonwealth of Massachusetts Department-of industrial Accidents Office of Investigations r 600 Washington Street Boston,MA 02111 Workers' Compensation Insurance Affidavit Applicant Inffoorrnation: PLEASE PRINT NA."AE I U Wl QS n 17 Z 1 •� '� LOCATION _ CITY STATE ZIP CODE A�Z PHONE O I am a homeowner performing all work myself. O 1 am a sole proprietor and have no one working in any capacity. O I am an employer providing workers' compensation for my employees working on this job. Company Name ( 1 nw 1'0 Address I S__ & VJ r7 K, _ L, p C` 2 a�y U i U State VIA o Zip Code j�3 S Phone Mr ✓�b —95 City '/ 2 Tn W C ,U 1 U"l > Ex iration Date Insurance Co. lid Policy T C `� p O 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation policies: Company Name Address City State Zip Code Phone.r Policy T Expiration Date Insurance Co. Company Name Address City State Zip Code Phone 4 Policy 4 Expiration Date Insurance Co. Failure to as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to Faillure tosecure coverage Fai and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a f this statement may be forwarded to the Office of Investigations of the DIA for coverage day against me. I understand that a copy o verification. I do hereb cerri under the pains and penalties of perjury that the information proov]id d abboov is true and correct. Date ( Z Signature L� nn,!,, 1��� C 1ZZl Phone Print name OtTicial use only—do not write in this area—to be completed by city or town official Permit/licenseO Building Department M City or town w 0 Licensing Board O selecumn's Office 0 Health Deparm=t 0 other 0 check if immediate response is required Phone Contact person t' ✓�C t00!lNl101dtM.ILIA/L O��.Q�ldd9� hoard or ilullding Itegulations and Standerds p. HOME IMPROVEMENT CONTRACTOR Registration:g 100740 Expiration: 6/23/2004 Type: Private Corporation , CAPIZZI HOME IMPROVEMENT, Thomas Capizzi,Jr. 1645 Newton Rd. _..--X- Cotuil,MA 02635 Administrator f� � �p �o�►.l�ion�ue�llll o�',/Jfoed�e/rudel7e 130ARD OF BUILDING REGULATIONS r 1 License: CONSTRUCTION SUPERVISOR r 5' Number: CS 057032 .rak Expires: 09/26/2UU3 Tr.rro: 5790 Restriclod: 00 TFIOMAS X CAP17_Zl JR 200 PERCIVl11_DR W DARNSTAUE, MA 02660 Admini^sl for ♦ 4 , - .. ,uui••u. I iUl,L ICU:7J a LLIUI I I UI`! VAUL U.I. ACORv_ CERTIFICATE OF LIABILITY INSURANC „pzz °" 'vlRRroucER 71116 CERTIFIOATII 18 1ssuE0 AS �1INFORMATION o3 Noraroe s C Leighton Cape Loc. ONLY AND CONPERS NO RIGHTS UPON THE CERTIFICATE C.J.KoCarthy Ina.Agency,Inc, HOLDER.TM5 CE'RTIFICATIL DOES NOT AMEND,EXTEND OR 437 Station Ave ALTER THE cOVERAOE AFFORDED BY THE POLICIES BELOW. So.YAzmouth MR 02664 Phone: 508-394-0946 T&x:508-760-140'i INSURERS AFFORDING COVERAGE INSURED INSURER A. National Orange Mutual. Ins. Co NSURER 9: Nafety Insurance C M an CIIJ22i Roma improvement Inc. INSURER C: Guard Insurance Oro 5 awto Ip INSURER D: Cotuit mh 026 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO T)1E INSURED NAMED ABOVE FOR THE POLICY PERIOD INDIOATED.NOTW►THSTANDING ANY REQUIZZINT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I&SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AOGREOATE LINTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER T M IN— LIMITS OENERALLIABILITY 6ACNoccuRRtNCE 11000000 A X COMMERCUILG64ERALUAWLITY NP502733 04/01/03 04/01/04 FIRSOAM 01!(Any an*fife) i 300000 CLAIMS MADE Q OCCUR MED EXP(Any Ona poaen) 110000 PERSONAL A ADY INJURY f 1000000 OENERAL AGGREGATE f 2000000 GERL AGGREGATE LIMIT APPLIES PER: PAom=s•CCMPlDP AGG f 2000000 PRa LOC AUTOMOBILE LABILITY COMBINED��SINGLE LIMIT H ANY AUTO 1601064 04/01/03 04/01/04 f ALL OWNEDAVTO$ - BaolLrINIURY t 1000000 X SCHEEkILED AUTO$ (P-PMOn) X HIREDAVTOS BODILY INJURY X NON-OWNED AUTOS pwaftwe"p f 1000000 PROPERTYDAMAGE 1500000 (PM 000ldalQ OARAOE LIABILITY AVTO ONLY.GA ACCIDENT f ANY AUTO THAN &A ACC i AUTO ONLY: AGO f EXCE70 LABILITY EACH OCCURRENCE i 60CUR CLAIMS MADE AOOREOATE f DEDUC'TIsLE i RETENTION i f VM RKERM COMPENSATION AND X I WV*61 C EM►LOYERWUABILITY CAWC401043 01/01/03 01/01/04 E.LEAC14ACCIDENT f 100000 E,L.pl&GA36.EA EMPLOYE f 100000 F.L.DIs6ABE•POLICY LIMIT f 500000 OTHER DESCRIPTION OF T-IbNKOCATIONLIMICLE aVS10N9 ADOED BY ENDORSEMENTASFECIAL►ROVIS S, CERTIFICATE MOLDER p ADDITIONAL INSURED;INSURER LETTER: CANCELLATION &MOULD ANY OP THE ABOVE DESCRIBED POLICIES OR OANCELLED BEFORE THE E)(PIRA DATE THE RWF,TUB IRSUINO INSURER WILL ENDEAVOR TO MAR. -12--DAYS*MWTEN NOTICE TO TNB CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 80 SMALL IMPOSE NO OBLIGATION DR W,BILITY OF ANY KIND UPON THE INSURER.ITS AOEIRB OR ° REraL:B1:/1TAmL�s. AUTHORIZED RIVREMOATME ACORD 24-8 p/971 OACOM CONPORATION 1Hll Alfc � e Q�ofTNEtp�� TOWN OF BARNSTABLE �v O i BARESTOHLt. QYae�� BUILDING INSPECTOR APPLICATION FOR"PERMIT TO ... . ,?..v':l. ... ... ...... . `""' :~...................... TYPE OF CONSTRUCTION ............. / ,e'm'..... ........ § `.......................................... ............. !..... ...19.Z3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ALocation ...../.47710..... ..... ...... ..... .... .......... r ................ • V Proposed Use .... .............. ...... a.................................................................................................................................. ZoningDistrict ......f\..b......................................................Fire District. .............................................................................. lx..� G- f- ewe. JAI Name of Owner .............. Address ......O.&W. w.-I.... . ............ . .......b/.IrVs-4..... Name of Builder .. .. ,� �N ��Address 3 ��+• �+'� `S • / a"� Nameof—A*@ i ct ................ ............. -................................Address ........S Q.r• .................................................... Number of Rooms ...8.........................................................Foundation ....140. ...... Exterior ........... ..m.ok.........................................................Roofing ....0. ............................................. Floors ....00.................t..PI.Y.........................................Interior ......jx ... .. .................................. HeatinglJ,�... ........................................................Plumbing ....f�. . ...... ............................................ Fireplace ..../..... .........................................................Approximate Cost .......S...7 ..................... ................... Definitive Plan Approved by Planning Board ---------------_______-_______19 Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH l Ss Q lit-STALLED.LE ry e I?; Art' A /O /• r,"'..:YID �...��n.t', 3 ZG��w a 11,217.3 2.0 qV It I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above - construction. ���� � 1�� Name .4VA~ ...........L...*trfob- . .... . ?..... I Deveau, Ruben G. & Aerie H. IA)510��CTI0- 1 808 No .....5.......... Permit for 1 1/2 story ...... single family dUaelling.................. !Location .. .::...Green Dunes Drive (/^`Location ... . . .................................................... 1 ........... Owner Ruben G. & Anne M. Deveau Type of Construction fame.............. I ................................................................................ Plot ........................... #10 Lot ................................ Permit Granted January 2 73 1 _ 4 Date of Inspection :?':. .. Date Comp t�...l�e�.. ...A......19 PERMIT REFUSED ................................................................ 19 :. .................................................... .... ................................................... .............................................................................. ti ............................................................................... �. O� Approved ................................................ 19 .......................................................................... I E ...............................................................................