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HomeMy WebLinkAbout0160 GUILDFORD ROAD i .;�.«°� .� yRw., '�• ,� „ y�..-,a.a l-7?;�'. .2 .t,. 3 + ,: :..s • 'i+..��' e« i.r-'i c* _ _. ^"�: ."t .:f' r� `A - fir, t,•y.•" .• '..i" r _; a 4 e•�i1 i .. ,t". 9 ..�• . - �,: C .e .,-, � , a, r2�Sy-, oaf °� t,� a< +� �r �., w+ � . {6t`�M. .d ..: :,. v4 r._�, ,., t.. ,; 1. + .nt'4 'd'�5�i'` f<,. �k#(� , ♦ t. ... •x.. �.; ;,x`+s ,.,-.',',. ... -:;„'e. .:.,'p.. ,. .� , x2 ^6 ,a`. , '- v. ian .'�+' A. � - -.{+': -;w'• �rt `.�• 6.+ �'.+�'; n., ,, ... 7tg,.. -*o.. z �"'+i ,. ., "�Y ...a*,rt�i,'!' �.s»4 fit d 5..`:k :» <% ,,,q�r. r_• .t. r s i#..'" - '�4."p. .+l �y � 4. tt .�'„ ,f .. ''l� .:et• ;a+A� � �+ tyt�' :. : .e, -.,- o-..ay�°- '.�. ,a*r.. �� tJFg.�,n- Sx.�t�kr d�Fo ..t.'.. �. _;+,'k4'1,. .tYt.:•' a' •.�. �. .rd:.- n F, 1"TO tar , e - x t a � r - r, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 1 � Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address I lL ILLILbrOr j 1�_D Village Owner G Wtl. �Aej & :To In Address nco n tY-- 0, A"nT4 Telephone ��d 1�0 I I_n Permit Request IMoval 5 In h,br W .t',4S . h om , wit,1;q MM � a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new — Zoning District Flood Plain Groundwater Overlay Project Valuation 47KM .03 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 1 71 Historic House: ❑Yes No On Old King's Highway: ❑Yes ❑ No.. Basement Type: Full ❑ Crawl ❑Walkout ❑ Other ' —i Basement Finished Area(sq.ft.) Basement Unfinished Area(sgQ1 -< Number of Baths: Full: existing new Half: existing ne/V :cam Number of Bedrooms: existing _new �r Total Room Count (not including baths): existing A4 new First Floor Roo Count q; T t,n c= Heat Type and Fuel: X(Gas ❑ Oil ❑ Electric ❑ Other w ' Central Air: ❑Yes ANo Fireplaces: Existing ZNew Existing wood/coal stove: ❑Yes YNo Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION T _ _(BUILDER OR HOMEOWNER)_ Name 12iOA '' ���/� Telephone Number �0 //7� Address C.{hC l�, License# 7P- Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �.3 FOR OFFICIAL USE ONLY APPLICATION# _ 4 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER D DATE OF INSPECTION: v :FOUNDATION i FRAME E IM _ a` INSULATION FIREPLACE ` ELECTRICAL: ROUGH FINAL Ir F , ? PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL FINAL BUILDING - lit& �o� ao131 13 ;t DATE CLOSED OUT ASSOCIATION PLAN NO. Fr Y - - The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations y 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A" licant Information Please Print Legibly Name (Business/Organization/IndividuaI): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer.with 4. ❑ I am a general conttactor.and I employees (full and/or part-time).* have hired the sub-contractors 6. Now 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. ❑Demolition working for me m any capacity. employees and have workers' coin insurance.$ 9.. 0 Building addition [No workers' comp,insurance P• . required] 5. ❑ We are a corporation and its 10.0 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 in 12.❑Roof repairs insurance required..]t c. 152, §1(4),and we have no 13.7 Other . employees. [No workers' comp.insurance required] *Any applicant that checks box#l-must also fill out the section below showing their workers'compensation policy information. t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. - tcontracturs 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.#: Expiration Date: Job Site Address: City/State/Zip. .Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of 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 violatot. 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 herebq�c n the p penalties of perjury that the information provided ab ve is true and correct l-Si ature: �jj "Phone#: ")l/(� Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitlLicense# 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: ti. Phone#: Information and .Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. . pt,rs ian�to this statute,an employee is defined as"...every person in the service of another under any contract_of hire, express or implied,oral or'-written." partnership,association,corporation or other legal entity,or any two or more ..' An employer is defined as an individual, representatives of a deceased employer, or the of the foregoing engaged in a joint enterprise,and including the legal deceased 1 ees. However the' receiver or trustee.of an individual,partnership,association or other legal entity,employing p oy owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the ons to do maintenance, construction or repair work on such dwelling house dwelling house of another who employs pers ereto shall not because of such employment-be deemed to be'an employer. or on the grounds or building appurtenant th " MGL chapter.152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C()states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of Public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking-the boxes that apply to your'situation and, if. necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of u1surance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of mmir'ance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of ?ndusirial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enterthei.r self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at$se 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 sine to fill in the parmit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating currezrt. policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or. ' town)."A copy of the-affidavitthat has.been officially stamped or marked 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. Anew affidavit must filled out each year.Where a home.owner or citizen is obtaining a-license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions; i please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,MA 02111 - Tel. #617-727-4900 ext 406 or 1-977-MASSAFE Fax# 617-727-7749 .eviscd 4-24-07 www.mass.gov/dia Town of Barnstable VE ri o� Regulatory Services V1 ` Thomas F. Geller,Director MAM * RdRNf.TARfx!. � Building Division �fD a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:•509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: I �u r � I t LL number street village �Ilol�EowNirR°: ( ��.I7/1 Alfa � In t- 7?4f—H7 name �l home phone# work phone# CURRENT MAILING ADDRESS: -n 0 7v1 citAwri 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 enders' ed"homeowner"certif es that he/she understands the Town of Barnstable Building Department rninimnm" tion procedures and requirements and that he/she will comply with said procedures and require nts Si of Hom er Approval of Building Official Note: Thee-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 Tle Code states that Any homeowner perforcimig 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 persons)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 2.11) 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 respansrbtlities,many communities require,as part of the permit application, i ` that the homeowner certify that be/sbe understands the responsibilities of a Supervisor. On the last page of this issue is a farm currently used by several towns. You may can t.amend and adopt such a form/certification.for use in your community. i i Q-forms:homeexempt I oFTKE Town of Barnstable �. Regulatory Services t R�RNSTARf.R. a MARS.�, Thomas F. Geiler,Director _ s63fl• �� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Ownet of the subject property Hereby authorize to act on my behalf, is all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and 0 final inspections are performed and accepted. Signature of Owner Signature of Applicant i � Print Name Print Name . II Date QFDRh&:0Vn4IWERMMsr0rPoois 62012 N old CA a T Jz- N v 1 W 3 � � 2 1 I i�. TO5at� fly s�t! T ??t l.... :; _. u� QUITCLAIM DEED 160 Guilford Road, Centerville, MA 02632 I, DORIS L.DRISCOLL f/k/a DOR L i* W,individually, individually, of 3 Field Island Point, Sandwich, MA.02563 For consideration paid of TWO HUNDRED AND TWENTY FIVE THOUSAND (225,000.00) DOLLARS,hereby grant to GLENN E. TOBIN,individually, of 160 Guilford Road, Centerville, MA 02632 N with QUITCLAIM COVENANTS M o The land together with the buildings and improvements thereon, situated in the Town of Barnstable (Centerville), County of Barnstable and Commonwealth of Massachusetts, being shown as LOT#167 as shown on plan entitled"Subdivision Plan of Lumber Mills' in Centerville, Barnstable, Massachusetts for Peter G. Sheaffer, et al, Scale 1"=100', May 28, 1971, Barnstable Survey Consultants, Inc., 608 Main Street, West Yarmouth,Mass.", said plan being recorded with Barnstable County Registry of Deeds in Plan Book 247, U Page 84. Together with the right of way over the roads shown on said plan for all purposes for which ways are used in the Town of Barnstable. b 40, Said property is conveyed subject to the restrictions and reservations as more fully set forth in deed from NORMEST HOMES, INC. to Robert Brown and Joyce Brown duly orecorded with said Deeds in Book 2000,Page 162. For Grantor's title see Deed of Richard P. Cazeault dated January 31, 2002 a recorded with the Barnstable County Registry of Deeds in Book 14772, Page. See also Certificate of Marriage recorded with said Deeds in Book 27037, Page 328. Property Address: 160 Guildford Road, Centerville,MA 02632 WITNESS my hand and seal this /�7 day of Apri12013. Dons L. Driscoll COMMONWEALTH OF MASSCHUSETTS Barnstable ss, On this l;7 day of April, 2013,before me, the undersigned notary public, personally appeared Doris L.Driscoll,proved to me through satisfactory evidence of identification which were a a'�6�141 / �{ to be the person(s)whose name(s) is/are signed on the preceding or attached document, and acknowledged to me that they/he/she signed it voluntarily for its stated purpose. Notary Public: a My commission expires: MICHAEUGILL Notary Public f commonwealth of Massachusetts My Commission Expires Feb.1 S;2016 Q0130cDSa Town of Barnstable *Permit# TF1E Expires 6 months om issue e e Regulatory Services Fee!ZT3 � s • BA NSPABIX • MASS. $ Thomas F.Geiler,Director 16.19. .�� X-PRESS PERMIT Building Division Tom Perry,CBO, Building Commissioner APR 19 2013 200 Main Street,Hyannis,MA 02601 www.town barnstable.ma us Office: 508-862-4038 TOWN Of St U AN-C EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number (e!2 I O Property Address ❑Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name ,,1 �iii�d'PQ��,t��• �1�r2?.r,l�- Telephone Number 74 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C 5 7 9 "or s C ensation Insurance one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name S Workman's Comp.Policy# �. (Ol� J Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) r ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to�G "A(, ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ��v WRe-side �" ��q�4 L ( UD A& (AAAWO i•,pl�'� y1 of doors Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows 1 dt N P,4M&LY . APO V � ljl%G ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *where required: Issuance of this mpt compliance with other town deparhnent regulations,i.e.Historic,Conservation,etc. ***Note: operty Owner m sign Property Owner Letter of Permission. A copy of the ome Improvement Contractors License&Construction Supervisors.License is require SIGNATURE: ^:%"rn r❑ornV xXon)...;Uiina hermit fnrmsXF{XPRESS.doC The ComMCr sW' fh of massachuseffs �1 Dgmr bnmt of ln&s€ial ccidena Office ofr Invesrgataons 600 Waskington Street Boston,M4 011.1 wiF w jnm,&gvv1d2aU Workers' Compensafian Insurance Affidavit:Buitders/Contractnl-sM Cians1PIumbers Aughcant Infer 3tI0U . . Please Print I h Name : C%k LT ?��� Address: ��� � C 'z?>0C -SbC7 City/Stafiel = AliLIS A- ao Lle# ✓C7 >�� Are yo pleyer?check tj&approAiate box Type of project(required)_ 1.EffI am a employes with 4- ❑ I arty,a gezeral c-cntractor and I 6_ ❑New construction employees(fall an&or pwt-time)_* have hired the sub-contractors 2.❑ I am a sole proprietor-or partner- listed an the attached sheet 7. ❑Remodeling slip.and have no employees These sub-contractors have g_ ❑Demolition wodring- forme in any capacity- employees and have v cdcers' 9. ❑Budding addition .o 1md=s'comp.insurance comp-iasuzaaml required_] 5. ❑ We are a cozporation and its 1 •❑Electrical repairs or additions 3_❑ I am a homeowner doing.all wadc afbcers have exercised 6wir 11.❑Plumbing repairs or additions myself. [No workers'comp- right of exemption per IAGL 127.❑Roof repairs im%z once required,]L C.152,$1(4),and we have no �F�Y� erpure ] -[No,workers' ME]tither II comp_insur am required.]*Amy app&mit that shed a box Frl m rl% ais o fill out-&e sectim below showingder waders'C9mpensafian p,7' l fian- I liaaiemners who submit tbu affidavit i miming they see dnmg sF wet wd d=hue autside coauscmrs mast submit a new affldacit indicating such tC4a=ciars that rhark this box mast amcbed as aaditiand shm diowmg the name of the end shame whe&u ar not moose entities hn e employees. lfthe sub.rnatmaas have employees,auey_=piav2de&= w-k—'camp.policy number- 14un an employer that isprovialing workers'congwasrrlion insurance for uW employmm Brdaw is the pricy and job site infortrratiern. . Insurance cam,N r e: 54V&j r �� Policy-9 or.Self-ins-Luc. 4 lJ WO ( �7 Expiration Date. ` /s Job Site Address_ k O I I ��- City/State/zip- Attach a copy of the workers'compensatim paNcy declaration page(showing the pofiicy umber and expiration date). Failure to secure coverage as required under Securer.25A of btl:GL c- 152 can lead to the imposition of criminal penalties of a fine up to$1,500-00 and/or one as well as cavil penalties in the Than of a STOP WORK ORDER and a fine of up to$250-00 a day ustigi the violator_ advised that a copy of this stazl�t shay be forwarded to&e Office of Immst,gatioms of qriliA for e c verifcaticn- ' T do hereby eey under the xirlpaaaes ofsr provir£ed®above rs true aid carrot 5i Date: Phone A- Official use only: Do not write in ibis a eC4 to be campWod by tdty or tmm offleiat . City or Town PernfitUcense# Issuing Authority(circle one): _ I..Boarcl of H.ealtb 2.Budding Department 3.Ctyfrawn Clerk d.Electrical Inspector S.1 hunbing inspector 6.tamer.. :... _ Phone#: * BARNSTABLE. 1639. Town of Barnstable 'OrEa neap" Regulatory Services Thomas F.Geiler,Director Building Divisibn Thomas Perry,CBO Building Commissioner 200 Main-Street,' Hyannis,MA 02601 www.town.barnstable.mi.us Office: 508-862-4038 Fax: 508-790-6230 PropertyOwner. Must Complete and Sign This Section If Using A Builder l• r�LEi�"/ /e,6 ;as Owner of the subject property COWL- M4ZZOM) hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: GV 1 V:0a 6t Rb^ olikha\11)je (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on.the reverse side. Q:IWPFILESTORWbuilding permit formsTYPRESS.doc Town of Barnstable Regulatory Services * snaxSTABM " Thomas F.Geiler,Director 1639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m.a.us Office:. 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTIO Please Print 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 extendeXne owner-occupied dwellings of six units or less and to.allow homeowners to engage an individual for hire who doess a license,provided that the owner acts as supervisor. DEF HOMEOWNER Person(s)who owns a parcel of land on which he/she rtends to reside,on which there is, or is intended to be,a one or two- family dwelling,attached or detached structures accessuse and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a houch"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be or all such work performed under the buildiri ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibi ty for compliance ith the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he he'understands the Town o Barnstable Building Department minimum inspection procedures and.requirements and that he/she 11 comply with said procedure and requirements. Si of Homeowner Signature Approval of Building Official Note: Three-family dwellings ontaining 15,000 cubic feet or larger will be r uired to comply with the State Building Code Section 127.0 Construction Control. ; HOMEOWNER'S.EXEMPTION The Code states that: "Any homeowner p orming work for which a building permit is require all be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors),provid on s or hire to do such work,that such Homeowner shall act'as supervisor."M- ' any 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 ceitify 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. . 4, s 1. [3® CERTIFICATE OF LIABILITY INSURANCE o/22/ATE �013 �� 4/22/2013 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 CONTACTA Kathy Silvia The Fair Insurance Agency Inc. PHONE (508)775-3131 FIAr No:c508l790-1677 619 Main Street n' :kat:hy@thefairagency.com Suite 7 INSURERS AFFORDING COVERAGE NAIC 0 Centerville MA 02632 INSURERA:Savers Property & Cas.—ARWC 31771 INSURED INSURER B The Waquoit Group LLC, DBA: GCI Builders DBA INSURERC: PO BOX 509 INSURERD: INSURER E: Marstons Mills MA 02648 INSURERF: COVERAGES CERTIFICATE NUMBERCL1341600470 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS.SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LLTRR TYPE OF INSURANCE DLSUBR POLICY NUMBER MM/DDT MM/DD E'iP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG "$ POLICY PRO COC $ AUTOMOBILE LIABILITY OMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION WC STATU OTH- AND EMPLOYERS'LIABILITY YIN I ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBEREXCLUDEIr 0002374 /28/2012 /28/2013 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE- DELIVERED IN Glenn Tobin ACCORDANCE WITH THE POLICY PROVISIONS. 160 Guilford Road Centerville, MA 02632 AUTHORIZED REPRESENTATIVE Jackie Stewart/FAIMC, ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS0251gn+nnsi m Thu ArnRr1 name and Inns 2ru runicfururl mor4e of Af nRr1 �lltt3 t('Y�1?t�lt{ystttiNCt�Gl2 ir�<�il✓ttl...1tI.E�<26f"�r1 Office of Consumer Affairs&Business Iiegulatio �C IUIE;IMPROVEMENT CONTRACTOR egistrafion 152253 TYF►e xpiration: 8111%2014, Private Corperatioil, GCI BUILDERS INC PAUL MAZZ.OLA 644 RIVER ROAD MARSTONS MILLS,MA 01648 Undersecret _u Massachusetts- Depas"nient of Public �`iattta Board of Building Regulations and Construction Supervisor License. a ; One-and Two-Family Dweilings`'x License: CS 579M V07 PAULJ MAZZOLA PO BOX 509 MARSTONS MILLS, MA 02648 R� Expiration: 6/t�{2013 g- 1. i models BREWSTER °`TNE.r TOWN ,- OF BARNSTABLE AM BASHSTIIBLE, i 1639.�N BUILDING INSPECTOR BUILDING , APPLICATIONFOR PERMIT TO ................................. 'm,*...................................................................................... build came family* dwelling TYPEOF CONSTRUCTION .............................................................................................................:..:.................... wood-f ralaae ... .... :.................19 2" TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a�permit according to the following information: _ Location ..,'dt.. .�6: ..........Out/40'r.ty........PC.A.d�..................Ce.AeM.TCj ✓/,....:C..........::.................................... ProposedUse ............................................................................................................................................................................. residential ZoningDistrict ........................................................................Fire District ....................................................... .. ... ........... RD-1 aentrev111e-ostervii a... l..is..t. Nameof Owner ......................................................................Address .................................................................................... 'ormest Homes Inc. Ashley Drive Centerville Nameof Builder ....................................................................Address ..................................................................................... Hormest Homes Inc. same Nameof Architect ..................................................................Address .................................................................................... none , Numberof Rooms ..................................................................Foundation .............................................................................. b 1 poured concrete Exierior ....................................................................................Roofing .................................................................................... Siding Asphalt Floors ......................................................................................Interior .................................................................................... Carpet Drywall Heating ..................................................................................Plumbing ... .. .... .............................. Warm-Airba t ............................Wi Fireplace ........... ....................................................................Approximate Cost ..... cy000............................................ Definitive Plan Approved by Planning Board _______________---------------19______. Diagram of Lot and Building with Dimensions �S�a v / SUBJECT TO APPROVAL OF BOARD OF HEALTH �Z • O a IL fo L W i (I? W ® N LYt�y � CD ' M _ Q Li- LL- W 2 0 G to Q\�- -- - oU IX U)Uj Ul �L I� r Z Z ur (D z� cr' 46 >- z zap wr= - - � to 0 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ' Name Normest Homes Inc. No ...15534.. Permit for ... one ...story........... single family dwelling ............................................................................... Location "J.&V.G z l ...ford Road ......... .......... ................................... Centerville ............................................................................... Owner Normest...Homes Inc. ............... ....... { Type of Construction frame ................................................................................ Plot ......................... .. Lot ................. 167...... s j • Permit Granted ........ . . . .....19 72 pia , Date of Inspection .�eo .. ...z y. .....L....... Date Completed ..d.���. PERMIT REFUSED ........... ............................................................................... ................................................... ........................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... .................... ......................................................... ;