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0041 HILLSIDE DRIVE
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Town of Barnstable Building Department Brian Florence, CBO Building Commissioner 200 Main Street,Hyannis, MA 02601 www.to wn.b arnstab l e.ma.us Pre-application for Business Certificate Date /����- �c1 Map Parcel Applicant Information Applicants Name (/ ` ,�✓{/ (� Applicants Address `71 //j//S,� �� �e✓'� �i/1 '1 C �'1/-}5 V �'?j Email Address 1�(UC(}V✓S'��rU �,o�/ ft(( vrL. Telephone Number —7'1 d 6 D?13 Listed Unlisted ❑ Business Information New Business? --------------------------------------- es No Business is aregistered corporation? ---------------- ------. Yes. / o If yes Name of Corporation Does business operate under the registered corporate name? Yes No Is the business a sole proprietorship or home occupation? -_-_-_-- No If yes then a Home Occupation Registration is required—See Building Division Staff Name of Business&f/e f' D e( w4roc_bcvu Business Address l i L9-& '/ I r C eW ['ear �p Type of Business uilding CominissioneT O ice Use Only Conditio S'414 Building Commiss o Date Clerk Office Use Only Town of Barnstable Building Department �ppTHE Tp� o Brian Florence,CBO ` Building Commissioner MRNSTABLE. '' 200 Main Street,Hyannis,MA 02601 MASS. $ i639• A www.town.barnstable.ma.us ArED Mph Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: f'I �►9 �V`�f�CQ�� Phone#: / �v� �b9 0-76 Address: L11 Az/,5/we Village: r✓�V�V� �fc Name of Business: (fj►,n— y D / f 1 Type of Business: ��-J hl S'�'v-u G •T��-?, Map/Lot: 1 q 62,5-2— INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation " within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use, • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke, dust oT other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation, and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree wit above restrictions for my home occupation I am registering. Applicant: /%%c Date: G �,^'11 _ Homeoc.doc Rev.10/17 MUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO MAY RFSI)LT IN FINES. 1 ? "r 7 Town of Barnstable *Permit# — o Yres 6 months from' ue date ee Regulatory Services s MAM �, Richard V.Scali,Director i639. Building Division ✓,QjV ' Paul Roma,Building Commissioner 1 c� 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us ^ Office: 508-862-4038 - Fax: 508-790_:iL23,0 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number (�Property Addies`s i�e �eiL ❑Residential Value of Work$ /Ul dam® Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address L/42 .T Bln-K e All Contractor's Name Telephone Number Home Improvement Contractor License.#(if applicable) Email: Construction Supervisor's License#(if applicable) *orkman's Compensation Insurance Check one: ❑ I am a sole proprietor X,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) ,9-Re-side Replacement Windows/doors/sliders.U-Value �r" (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Pro erty Owner Letter of Permission.. A copy of the Home I ov ent Contractors License&Construction Supervisors License is required: SIGNATURE: QAWPFILESTORMS\building permit forms\EXPRESS.doc 06/20/16 I Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Paul Roma,Building CommissionerMAM y , e39. &� 200 Main Street, Hyannis,MA 02601 0�p www.town.barnstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION . Please Print DATE:-JOB LOCATION: �/ /I��ll S��/e number T' ` street village "HOMEOWNER": //4 r/d✓ A61a,:!�e - name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildingpermit. (Section 109.1.1) i 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 ° P/4-1 Approval of Building Official 4001 Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states 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.. r 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 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. Q:\WPFILESWORMS\building permit forms\EXPRES&doc 06/20/16 a� xi <j Town of Barnstable Regulatory Services ` Richard V. Scali,Director . sb39� Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (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 all final inspections are performed and accepted. Signature-of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNE"ERWSSIONPOOLS 77ke ColTtlli!ompe,aM of-QSsadt1Yft`Y Deparbueut ctfl'udustriatAccidents _ - 1 Q, e Of rMw4mdon ' �a0 Washingimt Shwzt Boston,MA 02111 -- mvina iamgovldia , Workers' Campeasaisun Insurance Affidavit:Bmlder-s/Co-ntractursMec6cicianrJPhu nbers Applicant Inform,atcan Please Print F �bly Nsme = �a Address: �/ le 1 , phone Are you an employer?:f fteckthe appropriate box: T of ect r � - I.❑ I am a 1 wi& 4 ❑I am a general contractor and I E New { e4 " employ(andfor part-time)-* have lured1he subcontractors G. ❑l�e�coma an 2.❑ I am a sole proptdetotr orpartaer- listed on the attached sheet I- ❑Remodeligg ship and have no employees • Mese mb-•contractors have g- ❑Demolition w for mein enTloyeesandhaeewodwrs' 'fig �Y�4Y 9..❑B.nil�addition ems'Comp.Wince comp-insa ance$ I 5. ❑ We are a•corpozatim and its 111❑Electrical repairs or addslions 3: I am a homeou*ner doing all vrork officers have exmised their 1L❑Plumbing repairs or additions myself[No wozimrs'camp- tight of exemption per MGL M❑Roofrepairs im%xr=erequired]Y c.15.2, §I{4kandwe have no employees-[NowoAPss' 13_❑other coup-iasmanw required-) 'Aupapg5c=tfiatcbeckssbas?lmastalmMouithe section below sinmd dieirwo&es'campmxmfi=po1kyiuftmmafioxL Hmmeoatnum vho submit dris sfddaed ix g they axe doing all vra k and lien hire outride comtoictms l s submit a new affida,&%dirok sack ICox asthst checktldz box snached sa addili-al d wet dmwlmg the=ne of the sdl)- jmd s tewhether oanott mse eoiidesb.we employees.7fthehaceemPdoF�s,tfie}'mustpmuidex�ir ssado�s'•mmp.gali�mxoilser_ ' lam an i2wurance,for wy emplay em zdDiv is thapasky and job site informalian. • Insurance company Name. Poficy AT'or Self--iris.Iic- l pit iaaDate: Job Sate Addre= Citv1Statiel7.tp- a Aftach a-MPY of the wurkETe compensationpolicf declaration page-(showing the policy number and expiration date). Fa&m to secure coverage as required under Section 25A of MCL c.157 can lead to the imposition of criminal penalties of a fine up#o 1,SOQdQ and/or ane-yeariurgrisoumet as well as ciQil penalties in Ifie form of a STOP WORK ORDER and a$ae of up-to -0!1 a dap against the violator_ Be adidsed that a copy of this statemEmt maybe forvmded to the Office of Investtations ofthe DIA far inst=ce coverage verifficabom lido kersby under die pains p9 1 1aiiiss afpet�ury that the irafarma6=prmiiWabmv is thus and correct Si Date ti Pbnm " Off Edd wjljr Da fiat writs in f ih area,€a be cmnpleted by city artown officral ,Qty or'Idww Perrmtf kense Issuing?1.udwrity(caste one): L Beard of$ealth r.Laing Department 3.QWrown.clerk 4.Electrical Inspector 5.Plumbing Inspector 5.Other CORtWt Persons I"honE 9: 6 hafoTmation and 11astructions ' Masmch=ests Ce=rg Laws chapter M rmq=m all=Ploy=to provide W=Icc 'compensation f -then-egpla5n= pUrMIZMttr this St2t0te,an Moyer is dafm ed as=every person in ffie scdvicc of anotivr under any conixact cfhirey r express or implied,oral or Wifthm" An mmpIvyyer is dcfined as-an mffir2nal,partnersbip,assocfion;amPoraifou or other legal e t iy,or any two or more of the foregoing a joint ,andinnclndmg tine legal Feprese�afrves of a.deczased employer,or the rcmiv=or tmstee of as mdxvkbA palt=shiP,association or othealegal entity,employing effipin9ces- However the owner of a.dwuHb g house having not more tbaa three apartments and Who resides tberem,or the o=Taot of the - dwelli ag house of anon who cuploys persons to do mah±mmnce,ceash7act on or repay wow an such dwelling home, or on the grounds or bm7dmg apputtma�thereto sballnotbecanse ofsach employmeatbe deemed to be as employer." M(3L chapter 152,§25C(6)also stem th s at"every state or local licensing agency shall wifihoId$ze issaance or renewal of a license or permit to operate a business or to construct buildings iu the comsnanwealth for any applicaniWho has notproduced acceptable evidence of cdmpinaneswith tIre insurance coverage requir " the r�*�***m ter ISZ,§25C(�sues Neither weah nor a'uy offfr poIhical subdivisions shall Additionally,MGM chap enter into any contract for the perfrmnance ofpnblic work mltn1 acceptable evidence of compliance With.$ne ice.. reTnrements of this chapterhave beenp==Ctrdto tine confr�anfhomty." Applicants - Please fill o:r± the wort=' compensation affidavit completely,by doer long fig-,boXes that apply to your srtnation and,if necessary,supply sab-contactor(s)name(s), addresses)andphonenInnber(s) alongwrLtheir certffic3b*) of insurance_ Limrted Liability Companies(ILQ or Limited LiabiliVPartners s(LIP)wino employees other than the members or pa rha=s,are not required to corny wotlre&campensatim iasara c& If an IJ C or LLP does have employees,apolicyisregoaed- Be advised that this affidayit maybe sabmith--dtothe Department of Iudustrial Accidents for con—Emmafm of mstsmce coverage Also be sure to sign and date ire ar=davit The affidavit should be mtrmmed to the city or town that the applicafion for the permit or license is being requested,not the Department of ; Indrsstxial�4_ccrdents_ Should you have any questions regarding tine law or ifyou are required to obtain a workers' compensation po&ey,please call the Depart err at fhe nm be r listed below. Self-rosured eampanies should ear their self i IM=ce license number on the appropr zfn line. City or Town Officials f _ Please be sore that the affidavit is complete and prmdrd legibly. The Departmenthas provided a space st the bottom of the affidavitfior you to fa out in the event tine Office ofInvestig3±i=has to con tac.'tyonregardingthe applicant. Pleasebesvrefnfillinthepr lIicensemanbezwhichwiillbeusedasaref�ncemmmber Inaddition,anapplicant that must submit mu bl ple permi Ilicen se applitaiions is any gmen yam,need-only submit one affidavit indicating cent policyr information Cif necessary)and under'lob Sits A &c&*tie applicant should�"aR locations i a (may or {own).'A copy of the-affidavit that has been officiaIIy stamped or marked by tine city or town may be provided to the " applicant as proo-fthat a valid affidavit is on file forfirtm pe�ris or licences Anew affidav>tm7lst be fn-Iled out each year.Where a home owner or citizen is obtaiIIing a license or p=k not related to any business or commercial verte Cie.a dog license or peunit to bum Ieaves eta.)said person is NOT required to complete this affidavit The Office of Invesliganons wouldlilm to tTiank you uu advance for your cooperation and should you have any questions, please do not hesifatm to give me a call The Department's address,telephone and fax rtumbCC of Massachusem Departumt oflad lAoratdeut% 10ffl=of InV tioa -1i ` 6M waahgtoa t BQstm.MA Oil II Tt,-L 617 -4 oil 4-06 car I-97 M SS� Revised 4-24-07 - cmgt CQ0 X&T � 7 Town of Barnstable .7 *Permit# Expires 6 months from issue date �T Regulatory Services Fee , STABIX 163 Richard V.Scali,Interim Director PERMIT ED� Building Division Tom Perry,CBO,Building Commissioner Nlr,i' " 2 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 TOW 0 JO NWABLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 1 9�3—2 9 2_ Property Address 41 AsideDrive Centerville, MA 02632 Residential Value of Work$3 0 0 0.0 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 381 OLD Falmouth Rd. Marstons Mills 02648 Contractor's Name Nourthern Colony Builders LLC Telephone Number 508 400 77075 Home Improvement Contractor License#(if applicable) 1 6 7 7 3 9 Email: danwbcc@comcast.net Construction Supervisor's License#(if applicable) C s—0 5 3 6 3 8 Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner KI have Worker's Compensation Insurance Insurance Company Name Southeastern Insurance Co. Workman's Comp.Policy# we c—5 0 0—5 01 2 2 8 0—2 01 3 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side - ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property.Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: �. TAKEVIN MBuilding' es\EXPRESS PE RES .doc Revised 061313 77je Commonwealth of Massachusetts Department of Industrial Accidence Of ice of Investigations 600 Washington,Street Boston,.K4 02111 ww"tmass.gov/diia Workers' Compensation Insurance Affidavit: Builders/Contractors/P.lectrieciansfPlumbel<'s Applicant Information /Please Print Legibly ga�i�tio Name(Businesslorn(Bndeuidnaq_�. L '-d entw ��,� 1) _,. Address: U-) z311 �`j S5 City/State/Zip: - Phone Are you an employer?Check the appropriate box: Type of project(required): 1.ZI am a employer with � 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time)-* have hired the sub-comtracttus 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 we in any capacity. employees and have workers' 9. ❑Building addition. [No workers'comp.insurance comp.insurance.x required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their l l.❑Plumbing repairs or additions myself o wormgyp's' right of exemption.per MGL 12. insurance[No 6 c.152, §1(4} andwe have no Rodfrepairs G ther 13_❑O employees.[Na workers' comp.insurance required.]. 'Any a"Ecai t that checks boot N umsi also fill our the section below showing their warkere comrpenmlion policy information_ i Romeo nos who submit this affidwiiit u dksfmg they ate doing all yr a$and then hire outside caatractors must submit a new affidavit indicating such. kontractors that check this box mast attached an additional sheet showing the name of the sub-counmctors and store whether air not those entities hate employees. If the subcontractors hake employees,they mast provide fir workers'comp.policy number. I am an employer that is providing workers'congeasation inu rance for my etnploywm Below is the policy and job site information. Insurance Company Flame. C��677 Policy#or Self--ins.lac.#:UJ_T_ -6ZD S d 4 X;1.8i O O-i 1 Expiration Date: Job Site Address: ` � N�GI S `, r- Q.lA-V, CitylStabet7ap:�/l►4 ` 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!t cerh;�y ender eke pan s penalties ofpediuy that the informationptwvideda is and correct Si tune: Date: Phone#: 06 Official use only. Do not write in this area,to be completed by city or town oficiaL City or Town: PerwitlUcense# Issuing Authority(drde one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: - - --- - - - .. - -- — -- 6 f oF� MAN& M Town of Barnstable Regulatory Services Richard V.Scali,Interim 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 I, Harry J Blake ,as Owner of the subject property hereby authorize Nourthern Colony Builders LLC to act on my behalf, in all matters relative to work authorized by this building permit application for: 41 Hillside Drive (Address of Job) 11 .114 S}g O ne Date Harry J Blake Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEWN_MBuilding Changes\EXPRESS PERNIIDEXPRESS.doc Revised 061313 f ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 07/30/2013 PRODUCER 508.997.6061 FAX S08.990.2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 439 State Rd. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR . P.O. Box 79398 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE # INSURED Northern Colony Building Co LLC INSURERA: Arbella Protection Insurance NAIC NAIC P.O.BOx 278 INSURERB: Merchants Insurance Group 41360 W. Barnstable, MA 02668 INSURER c: AEIC INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' PO ICY EFFECTIVE POLI Y EXPIRATION LTR INSRrGENERAL I7NSUNCE POLICY NUMBER DATE MM/DD/YYYY DATE MM/DD/YYYY LIMITS 8100019899 07/08/2013 07/08/2014 EACH OCCURRENCE $ 1,000,000Y PREMISES Ea occurrence $ 300,OOO MDAMAGE R MED EXP(Any one person) $ 5 OOO A rPERSONAL&ADV INJURY $ 1,OOO OOO GENERAL AGGREGATE $ 2,OOO,OOOR: PRODUCTS-COMP/OP AGG $ 2,000,000 C AUTOMOBILE LIABILITY. MCA7013965 01/05/2014 01/05/2015 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,00 ALL OWNED AUTOS BODILY INJURY B X SCHEDULED AUTOS (Per person) $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY(Per (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO i OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ WORKERTION AND YERS'LIAILIT WCC-500-5012280-2013 07 O8 2013 07/08/2014 AND EMPLOYERS'LIABILITY Y/N / / TORY LIMITS X ER ANY PROPRIETOR/PARTNER/EXECUTIVEr—]C OFFICER/MEMBER EXCLUDED? E.L EACH EACH ACCIDENT $ 1,000,000 (Mandatory In NH)Ifs,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 ye SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS -ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Town Of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Attn: Building Dept. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main Street REPRESENTATIVES. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Karen Bernier CORD 25(2009/01) FAX: 508.790.6230 ©1988-2009 ACORD CORPORATION. All rights reserved. . The ACORD name and logo are registered marks of ACORD Massachusetts--Department of Public Safety Board of Building Regulations and Standards Construction Sulm-N isor License: CS-053638 DANIEL J GALLAtH ' PO BOX 278 s West Barnstable FAA "Vi . Expiration Commissibnef 10/27/20.15 4 i r f Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C or Registration Registration: 167739 Type: LLC s Expiration: 10/25/2014 Tr# 234303 NORTHERN COLONY BUILDERS LGC.. DANIEL GALLAGHER 1694 FALMOUTH RD #135 CENTERVILLE, MA 02632 Update Address and return card.Mark reason for change. l Address Renewal Employment D Lost Card SCA 1 0 20M-05/11 (fairs&Business License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Ulepgistration: r.1'67,739 Type: Office of Consumer Affairs and.Business Regulation `°' 10 Park Plaza-Suite 5170 iration:,�1_0%2 d&14 LLC — Boston,MA 02116 NORTHERN COLONY BUIL�LLC. DANIEL GALLAGHER' (v' 180 HIGH ST ,; W. BARN, MA 02668 - Undersecretary of val tho t signa fe l Map Parcel Permit# :a2.7 i House# Date Issued $ l`a 8 Board of Health(3rd floor)(8:15 -9:30/1:00-4 30) - Pe <270 ® Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) 7 pMie,ISYST' T BE L° °' )<leg�loaxtSchool Admin. Bldg.) IIVSTALLED I NCE . _ d by Planning Board 19 'WIT , } ENVIRQNM AND TOWN OF BARNSTABLET03 s Building Permit Application Project Street Address Ln [;11 s, l Village CQr� vl/t 5• t Owner_ Q�(514t4p Address Sc� Telephone 36.1 - &3 t.g Permit Request / Ra,,,,,,,P to, )( I at' r 4r 01 fL.It Co,-s ¢-uc4 0T AJ deck ofj ✓eA& First Floor goo square feet Second Floor 30o square feet Construction Type luoo d Estimated Project Cost $ __65 oo-00 Zoning District �2 c _ Flood Plain Water Protection Lot Size l ,Q 3`( S,r Grandfathered ❑Yes ❑No Dwelling Type: Single Family or,"" Two Family ❑ Multi-Family(#units) Age of Existing Structure j j %s, Historic House ❑Yes Uallo On Old King's Highway ❑Yes UN Basement Type: ❑Full ❑Crawl Walkout ❑Other Basement Finished Area(sq.ft.) 300 s�P Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing 3 New — Half: Existing New No.of Bedrooms: Existing 3 New Total Room Count(not including baths): Existing New — First Floor Room Count 3 Heat Type and Fuel: Wedas ❑Oil ❑Electric ❑Other Central Air E Yes ❑No Fireplaces: Existing , New Existing wood/coal stove ❑Yes p-No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) (Attached(size) /,2 ' X Zo` ❑Barn(size) ❑None p,Shed(size) g'X/o' ❑Other(size) ---= Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name -DA,,;d L Telephone Number 4 a?-og35 Address a 3 A i6Be,j License# Q 5 2_ 2 2 2 Coy4,; / cs 3 Home Improvement Contractor#_11 YJ1p3 r 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 6191-1v.3�a ,c_' SIGNATURE DATE BUILDING PERMIT DENIED FOR E FOLLOWING REASON(S) � c� FOR OFFICIAL USE ONLY _ t , AWNT NO. DATE ISSUED MAP/PARCEL NO. - "ADDRESS ` ,VILLAGE OWNER ' , DATE OF INSPECTION: FOUNDATION l- g ., FRAME, ! _ 9 { s �. '" • '` � I - , INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL F F PLUMBING: . ROUGHi , FINAL . t • . � ~4 FINAL - 1 •� • 4 z - - GAS: ;&OI ; FINAL BUILDING; — Z DATE CLOSED OUT! P3 d ASSOCIATION PLA�NOS i r a • The Town of Barnstable �$ Department of Health Safety and Environmental Services 1"96 _ Building Division 367 Main Street,Hyannis MA 02601 ` RalphCrossca Office: 508-790-=7 Building Fax: 308-790-6730 Comniissio:::For office use only , Permit Date AFFIDAVIT HOME IMPROVEMEIIIT'CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. an conversion. improvement, removal, demolition,t least one but ot�more on f than fourn to any dwelling units orng to owner occupied building containing structures which are adjacent to such residence or buiiding be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: h ooa • Est. Cost 6o S0o,do Address of Worst: �I /�s,`e� ��,�^� Owner's Name Date of Permit Application: 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 Wrm UNREGISTERED CONTRACTORS ARBBr A17ONPRO RAM ORR GUARANTY FUNDFUND WORK UNDER MGL 142A � ACCESS TO THE SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a.permit as the agent of the owner: Da Contractor Name Date No. n OR Date Owners Name i r Lo-r 12 pro. ¢J 73.19 ' LET I e4 65 �' t L S" Lar 06 Z4!t 06 RICHARD c� BAXTER w. N0.210480 CTF ay'Lv- CERTIFIED PLOT PLAN I CERTIFY THAT THE F'ourJDAi ot�.l LOCATION (ZErS7e-9-, tL.LC ` mASS _ SHOWN HEREON COMPLYS WITH SCALE I ''= 4,o• DATE io 31 g THE SIDELINE AND SETBACK REQUIREMENTS OF THE TOWN OF PLAN REFERENCE SA 12t,1 STA ISLs AND IS K�o j— t_o-r %4 LOCATED WITHIN THE FLOODPLAIN, 1�LaN Foa 9, A olq�-V Sum DATE : I� 3, SSA '��n �`���,.��".4.._.Y.. BAXTER 4 NYE, INC. THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OSTEPVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LI N ES, IAPPLICANT t2 . A L.J, I • e COP, ®l j 4 At i , 7771 yt 5 F a 'Jxv / r MAhO on c M '. 2 3 2 X 12 S �-:n��vs IJ <<� � e i p7T s Tc ®.��s t 2 ' sum �®,.�•. Itil , ►act 2 ��o M Cuv����gK�. (�rm. 9 + a d 6"�� g . ot POS# ro%A P iv. 2V X K 1O rS CISJ %jy .� ®S fie✓'aC T l' a e. , F Gip. -- — -- j� � 1 a n — � � � C.`�r.1.,,�. �I.� �.� k( � ?�.•@ash:rq S . r J K (-f q 2 a Asswor's rhap and lot number ....1-33.........5.......... T BE oK �8 SEPTIC SYSTEM MUST �FtNETO� .-..7.�.. INSTALLED IN COMPLIAN Sewage Permit number ............ .... �...................... WITH TITLE 5 CODE STABLE, House number ...... .. ....................................................... ENVIRONMENTAL 90 b a TOWN REGULATIONS °�0 M Ar, TOWN OF BARNSTABLE BUILDING 1•111SPECTOR , P APPLICATION FOR PERMIT TO ....... . E14d................................................................................................... TYPE OF CONSTRUCTION ..............orcd... .............................................................................. :�'.....jJ.....192S. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: L_ / ,� Location .................. lfl.,S.d. . ........ 1 I7'. ,1 �.k^�'t.Fil. � ... ..... �^ l' ProposedUse ...... ..................................................................................... g.01Zoning District ...... .......................................................Fire District .............................................................................. Name of Owner ......;,"t'`'"s.Z. .....'.'•rZ&e.ml� ..............Address ... .�. Name of Builder .. r. I, f. F.. �i !��5".A)e Address . . .. It /......... ................ Name of Architect ........... 110 Al.je�...............................Address .................................................................................... 4, Number of Rooms ......7W. .. ?...... �j./.`:&—/............Foundation ..../0......,/.aye.x—.-' Y....LA*.sl.e.l' �..... a Exterior .. .! '..�. ,n.�z. l..l.!P✓ast.".�l. ..f�4( Rfing .......... .....................4 i � . ��/' �z�!t�<. ... Floors ....... . ........................................................Interior ........... .1/./.w...e-2�7..i/.S� :1/R.�H .. . ^T1•o- Plumbin �lrc�: a . Heating ..... .. ....................... ...�- g Fireplace ......... I- ,, /� p er►?, .�?t'l.�at./C ,............................Approximate. Cost .........�0t/6 41. ..... Definitive Plan Approved by Planning Board -----------_------_-----------19--------. Area . ................ . ........ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH l N, �1 h 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. Name ............. Construction Supervisor's License � I'm-WILLIAMS, KEITH JR_ 112 Story N(P Permit for .................................... ...........�ingle Family Dwelling ............................................................... ♦ Location .....Lot...1.4 4.1...Hillside...Drive Centerville ............................................................................... Owner ..... Keith Williams, Jr. ........................... Type of 'Construction .....Frame.......................... ....................................................................... Plot .... ....................... Lot ................................ k 'Permit Granted ... November November 5, ....19 85 . ...................... . Date of inspection ............................19 -Date Completed` M - A M Assessor's map and lot number .... .. ." CF THE t0 Sewage Permit number ...........��.'. .':...�.�:�...................... , li 33MSTAMLL House number `� s NAM ......... .../.................................................... �p 1639. ♦� o m a TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ....... 5�a „� .......................................................................................:.......... TYPEOF CONSTRUCTION ...............�.��...� r .,.............................................................................. ........./ .....................I9�s' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for, a permit according to the following information: j �— Location .. ll.rr � . .�.�Jr.�s:.'. -....... �.' �,U +•,rt�•�,R�, l� ;1.� �.�. r.:�!ll �...... ....... ...o. .. Proposed Use .......�\ t F �r �Y'c�s �, ,/....T,•, ..t,✓."?':?". -.3-en ..............j........ ZoningDistrict ..... .! .f.......µ............. /...........................Fire District .............................................................................. Name of Owner .... ..............Address .�.. ... ....r .,..4 �.F1'" .Name of Builder .. ?��,..�r!'.: /.� ..C..���1'..Address �..... %.!�7 .. .4.F ��:'f�/fb ................. ... .,....... f Nameof Architect. .............��-� .,� .:F� -'...............................Address .................................................................... ............. �� ��rr r-�n1 ( rain��► /"�e A Number of Rooms ..... .Jk•.,.r.�r.::��.'....... � � r-e`-r��..e.............Foundation ... ... ....... /s:........... o .............,........ � __� .... Exterior ....� r� k ........ IRoofing a� � A ���5/� frn ........................ s / / "' Floors :....r',.`gG .r`?. ................ .............................Interior ........ .A.LG�/......:F�"+-s —,.7 t ,i....................... Heating .... .��!� G... ��.1+.!`j a... `�`�:`, v7:7....... .Plumbing ... .. ..1 .................................. F. r Fireplace ..... .r�. ei .........................Approximate. Cost Definitive Plan Approved by Planning Board -----------_--_--_---_- DG� 4�l ..Sr+'� . ------�9-------. Area ................... ......... Diagram of Lot.and Building with Dimensions ,,�___^__ •,_,,�,_ Fee ........ .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH rb i 1� v I 7 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. ��/ ��VG Construction Supervisor's License .................................... WILLIAMS, KEITH JR. A=193-25/ No .................28635 Permit for ...........................Story ....... Single Family Dwelling ................................................................... ........... Location Lot 14, 41 Hillside Drive ............................................ ..... ............. Centerville ............................................................................... Owner Keith Williams Jr. ` .......................................................... Type of Construction ..,Frame Plot ............................ Lot ................................ Permit Granted November 5, 19 85 Date of Inspection .....................................19 Date Completed ......................................19 L-D r" 12. L oTT 11 0. 41 73.19 1 L.vT I y Y L Lar t 3 a7' +�of PUS t i iCHARD W a E3AXi ER No.24G48 � t } O CERTIFIED PLOT PLAN CERTIFY THAT THE LO C A T 10 N (2e K97---j-a Nj t t t9 w' M SHOWN HEREON COMPLYS WITH SCALE I ''. r DATE THE SIDELINE AND SETBACK 1 `� REQUIREMENTS OF THE TOWN OF PLAN REFERENCE BAR <--rAISLCc AND IS rat co j-- L o-r \4 LOCATED WITHIN THE FLOODPLAIN. 1�tAki F"o' -' �'' A �u-�,4 a � e DATE : Ip 3I Q, � V �' �` ��.-. _�...-v__ BAXTER NYEl INC THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OSTEPVILLE— MASg OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES, APPLICANT 12 . A LJ c, we.j,;„ a 7777 of , SULLIVAN BAXTER No. 29133 Na 2403 c i / f ss/ONA L Ehv �'0 S' R'° TQ�i R�.t_. `� ;• [S��c A�. $ � ``�-�...- ass v� c l� TEST f 4.4,E f t _" 4x-t�� 1.3JG Iu /J.dµ& 50.7 a9 G.E.2T/F/EO PG OT PL.Qit/ Y rt tie. -.o _ I � ELATO LocQT�as� �.Era��zv,u� Ile-dAl �pr�rL .SHav�.v G'OW,a4,Y.f_'W17I/_?,yE 5*14P91-IivE 8.exrE,e /,uc. 40 /DQV%Z iyle�,:iVTS°Off. 714 ,e,E6isr�,2r_'I,GONo,S!/,2vEyo,4S 1141. of �wj;4A%tG AAvo �sr�,eYi.. / W/T".s�/�t! :T1�/E .CLa+ooPt..Q/iV. - A,�.Lica.�r" VA.►-'�S +u t� ` .. 7 ///f / /(� /mod�G /` / / //���/�• /��I �/V /� I I o� j7 rY fro/J�Iw/✓ . -!/�1EiYT.Sv,2l��YsJit/O Tf/E O�FS�T,S Ta hi i3�ZC—AK-L9cATLo CoM PuT�"i"f O 7_—xt$T .d.FaGA r�aa:�,rsrx EL AZtl> Zs _.,.. ._. .._r _. c 6� 5,r' 6 �! N 70 S (v _ l � a+2_ � iF�uaN��Y4 -44 5� CA F 93.04k ,` 0 _Tk\ NLLNA No.. 9733 STS �SS70HAt E�'�'�` OA OF gas RICHARD I$4 L I3AXTER w a,,.�...-tea• S+E�E 1 Ir , p . UILDINU . S TOWN OF BARNSTABLE, MASSACHUSETTS PERMIT , JOB .WEATHER CARD ' OAT t 19 PERMIT NO. ?635;' + APPLICANT ADDRESS (N0.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO (—) STORY DWELLING UNITS (TYPE OF IMPROVEMENT) N0. (PROPOSED USE) ZONING AT (LOCATION) DISTRICT (NO.) (STREET) + i 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: PERMIT AREA OR VOLUME ESTIMATED COST $ FEE .� (CUBIC/SQUARE FEET) OWNER BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITION ' OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS.'OR FOOTINGS. - MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE— MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CAR® S® IT IS VISIBLE I:R®"" STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS lei HEATING 'NSPECTiNG APPROVALS REFRIGERATION SPECTI�_N APPR VALS , ------------- C^5 =-� _ ;aCT �pO=EE.l ::`?IL TrE PERMIT '+!lL BECOME NULL AND VOID IF CONSTRUCTION iNSFECTiONS iNDICATED ON TH!S CART WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR By TELEPHON PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. TOWN OF BARNSTABLE-fi r BU ILDING DEPARTMENT TOWN OFFICE BUILDING out HYANNIS, MASS. 02601 �o r��c r• MEMO TO: Town Clerk FROM: Building Department4l*--� DATE: �0 An Occupancy Permit has been issued for the building authorized by' BuildingPermit #........ 3s.._."................................................................................................... �.__... ...... » . . issued to 2i�� i�i/,95.. ........` :...... �...... .. jr�..' s.���... r_.. Please release the performance bond. .f- .-. ,. , -`'ii:. �`'.::.u.j r* ,:5 3`` � Kr' ., r...:..t.-•- -, .ds.�£a,r;�S'` . i TOWN OF BARNSTABLE Permit No. _____28635 Building Inspector cash -------------- gYL x OCCUPANCY PERMIT Bond Issued to Keith Williams, Jr. Address �a Lot #14, 41 Hillside Drive, Centerville Wiring Inspector"^� Inspection date Plumbing Inspector �,� l Inspection date Gas Inspector l` �� *Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. Q/ .......................... >.... Building `Inspector �'�--