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, I;,.I,,�:I ANN? �
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TOWN OF.BARNSTABLE BUILDING PERMIT APPLICATION
Map.;- Parcel GppVati n
o '�
Health Division Date Issued Z �3
Conservation Division Application Fee
Planning Dept. Permit Fee tic
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation / Hyannis
Project Street A dress l
14, 11 ( b
Village P U i
)19
Owner 004 IItl( Address �� o_TL/ lk,1����
Telephone -�D�ld'7 c - /f,/& /
Permit Request94146'. G'�l z'�T ��O l I �G 0 O e i(/i P (/
q«
-00 0 P -5 I 4 J �6 q_1 /0se-Ce g ple
aN sire ��QG� MArrlot oJQ l�/ ��r�oQ9 � ® ����5
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
.Zoning District Flood Plain Groundwater Overlay
Project Valuatio c e6%5 UvConstruction 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
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sAp. wa
Number of Baths: Full: existing new Half: existing `'"; new "
C"'
Number of Bedrooms: existing —new
Total Room Count (not including bath 3): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Z5
--
Central Air: ❑Yes ❑ No, Fireplaces: Existing New Existing wood/coal stove' Q 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
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name qpqol NStf UC�t N Telephone Number r 1/d Y^®56 CP
Address 712 Hiq1tJ 51 License# 10ANo C)
P ((P (11P Home Improvement Contractor#
Worker's Compensation # (U
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE /I
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
k
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
k__-FOUNDATION
`= FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
;r
k
PLUMBING: ROUGH FINAL
`r
GAS: ROUGH FINAL
`? FINAL BUILDING
" DATE CLOSED OUT
G "
ASSOCIATION PLAN NO.
E •
b --
6 •
,t
l
ha,J
Rze Cony mo;, twa h ofMrassachusetts
01 l)epartawmt of lndmstrial Accidents
Office off"esfigafions
s 600 Washington Street
Boston,A4 02111
rvnmw.m ass.gouldia
Workers' CompensatiouInsurance-kffidavit:BuildersfCantractorslElectricians/Plumbers
Applicant Information / Please PrintLegibly
Name a sinesslOrganizafionllndividnal): d ' ,% p- -+ t,e-N
Ad&e.ss:-'-2-7 0 t Kl S�
Citytsta&Zip: Phone So ` d 51�
Arepyou an employer?Check tho appropriate box T : of. o ect r uire
Ylre P�' 3 �� d =
4. I am a contractor and I ❑
1- Lam a employer with _ ❑ 6_ New construct
employees(full aridlorpart-time).* have hied the sub-cantractors.
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling
slip and have no employees These sub-contractors have 8- ❑Demolition.
w for me in an capacity- employees and have workers'
otirrng y l 9_ ❑Building addition
[No workers' coinp-insurance comp-insurance.
required-]
5- ❑ We are a corporation and its 10-❑Electrical repairs or additions
3_❑ I am a homeowner doing all work of cers ha-.m exercised their I Lo Plumbing repairs or additions
myself[No workers'comp- right of exemption per MGL I2_.0 Roof repairs
insurance required_]F c.152, §1(4),and we ha-.m no
employees [No workers' l3_❑Other
comp_insurance required-]
*Any appbc&w duet checks boa#1 mast also fill out the section below showing ilea wozkes'compensation policy Mfnrrnatiob
T Homeowners wbo submit this affidavit mdicstiag they are daing all~mart amd diem hire outside contractors mast submit anew affidavit and rstin sac!_
ICoutdacmrs that check this baar mast attached an additional sheet showing the name of the su motto=tors and state whether ornot those eutities have
empluyees. Ifthe sul-contracts have employees,they must provide their warkers'comp.policy number.
I am an employer that is prmiding workers'cots m?uYL6on insurance for my emplayeets. Below is Ste policy anal job site
information.
Insurance Company Name:
Policy 4 or Self-ins-11C,4: (o (C U R it Expiration Date: 1ct
114
Job Site Address: �r� 9, 11,4 / L dy CitylS tatelZip:(�Q. fJ� r y
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 31,500.00 and/or one-year itnprisonment 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
fin-restigations of the DIA for insurance.coverage verification_
I do hereby cc U theptuns andpenal#ies ofpetjury that the information protdde<d abase is true and correct
Si tore: Date: [
Phone#-Sox - C/o,?-G. /S(f
IJaI use only. Do not write in this area,to be completed by city or town ofrciaL
City or Town: PerraitlLicense#
Issuing Authority(circle one):
1.Board of Health 2.Bunding Department 3.City/town Qerk 4.Electrical Inspector 5.Plumbing Inspector'
6.Other
Contact Person: Phone#-
6
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Pursuantto 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."
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
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 grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or Iocal 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(7)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-coatractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. 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 insurance 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 Departrent of
Industrial 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 enter their
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 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 permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that 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. A new affidavit must be 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 burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like 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 Commonwealth of Massachusetts
Department of Industrial Accidents
O ice of kvestigafioas
600 Washington Street
Boston,MA 02111
Tel.A 617-727-4900 W 406 or 1-877-MASSAFE
Revised 4-24-07 Fax## 617-727-7749
www.mass_govldia
;�p CERTIFICATE �F LIABILtY LNSURANCE ;111-2013
THIS CERTIFICATE IS ISSUED AS q 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 INS IRER(S),AUTHORIZED'REPRESENTATIVE OR PRODUCER;AND THE CERTIFICATE HOLDER.
IMPORTANT: If the ccAiificatc:holder is an ADDITIONAL INSURED,trio Policy(igsl mustticcndq.rsed. If SUBROGATION IS WAIVED,
subject to.the terms and llific conditions of the Policy contain policies may rc4tiire an enddrsement.A statement on this certificate does
not confer rights to the eeititieate holder in lieu of suchentlorsement(s)..
PRODUCER CYIl;PA_Ci _
OLDE.CAPE COD INS AGO.Y. NAV
196 WINTER 5T
- A r 7s -i• - � rsr g:ri�
HYANNIS,ran 62601
[NylfiFR P:THE 1,1Ji^iS! zr_.#.P;! +e CC ?a.. —.• —.._...._._...._.,.....
'
INSURED
EIEAGHER MICHAEL.DBA aasJl{t>ftl+•
NIEAGNER BROT14FRS CONSTRUCTION INSURER
97 EMERALD STREET
MA STONS MILLS,MA 12W
dY1fi1?f'i,1 •
COVERAGES>�__.,._,. CERTIFICATE_NUMBER:_,.�_, _ REVISION NUMBER: __ _
THIS 1S TO CERTIFY Ti-IAT THE POLICIES',Or• INSURANCE LISTED 13ELOW HAVE UEEN IS:3IlEO TO THE INSURED NAMED
ABOVE FOR THE PER IJ UfRED 1.;INDIC11. NOTWITHSTANDING ANY REO.UIREMENT..TERIM OR t:ONbITION bF AN CONTRACT OR OTHER DCTCUrtEtVT:WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE.ISSUED OR MAY PERTAIN,THE.
INSURANCE AFFORDED BY THE:POLICIES=DESCRIBED ►tEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS. AND
CONDITIONS OF SUCI t POLICIES_LIMITS S116V W MAY RAVE BEEN REDUCED.BY PAID CLAIMS:
tLTR .. . 'ADDL,S.UBR _
NS TYPEDF UlSURANCE. ?INSR ►VVD 1 PfriK;Y NUMBER p YpJ ryy i �LfCY EXP
GENERAL LIABIL1IY 4 1 i MMrDOtYYYL1At11'S,.
IU ttt iF hr'h�_f' NF trtii.inYfiiry:� I � i CaJ,H_sYi`IUt`R(-"Y.I.L.
L-A ;s(t
f! 'f S I FER:.aQPth�&r5D\I t�.:tlt;r.
e1j! A?LICE } 1If i
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3.
.AVOMOBILE:LUIEU-TY
7 e
L rY r I Auuf v!*WRr"Verao,l
\.+. s,rhgt_-,T
UMBRELLA LIABitC•g;ui{
°F,XCESS LIAR e + l,lk S-Jr1,iE.
-� j rnrAc,1RT^ g.
TOED tt-;F.N.IJNg
i rO KERSCOMPENSATIOH�~
AND EMPLOYERS`UAMUTY ��v �.i.;.G r+!!: A'1}Tf{ .'-.•..
AL>a�RDPRICTOR`+,srt♦'�gJ:Et< 1 -v{ i riw t l'.Ir Ck- -
Ci"`It;C'f P.El,.fLR?"74t.J.1cr? !Nl!N/A- i 1L,��LC+t0.0 IrFrk':r
ty'argi,d r��Nt,, I«-+€ t 6KUD 77-99 2fi11 11-09- t7.1•t $100•rJ0(I
s 4LI39P@dA I C I Dlse sE ✓E.+�Lgrcr 55t1Cf.t1{i0
t 1.,t�fa,r !L-1t-v t!4•r; S iDU,U{Il1
i 1
i
DESCRIPTIONOFOPERATtONStLOCATIM.IVEHiCLEs(Ai 4CORD.1Rt:AtiLJttlona(Rornetks.Scl,o6tdoipmorespatelsrogW>+ -MEAGI IER:h91. 1-IAEL IS r,C)1,ERED.t3Y.THE 4N(aRKERS''COMPENSATION.POI:ICYj -
LAB_. — - C L
TOWN OF BARNS TAt3Lk 11UILDING 0EI.T SHOULD .ANY OF TI1E ABOVE..DESCRIBED .POLICIES. BE 230 SOUTH STREET CANCELLED BEFORE .THE. EXPIRATION DATE ,THEREOF;IIYn4hiS;Mh172G01 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 'THE
POLICY PROVISIONS:
AVTHORMO REPRESENTATIVE - -
ACORD 25:(2610/05j 0:1988.2010 ACORO CORPORATION,All rights reserved.
The ACORD.namc and togo are registered marksofACORD'
ri
Unrestricted-Buildings of any use group which
contain less than 35,000 cubic feet(991 m3)of
enclosed space.
t - _
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
For DPS Ucensing Information visit: www.Mass.Gov/DPS
S
' I
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suit 170
Boston,MA 01211 i
;'
r_ No alid thout signature
/
' i
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS402260
MICHAEL S MEAaGIiER
97 EMERALD LANE ' s
Matstons Mills MA 026a8,' .i
!a
� i. ti 1
J,,(,,, Expiration
Commissioner' 11/05/2014
- � �✓!�!L TCiYJZJ/I,O/7/URCL���[/J(J/
Office"Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR
egistration: 162938 i Type:
xpiration A/27/20.15 DBA'
MEAGHER BROTHERS CO'N'ST .TION
MICHAEL MEAGHER JR: !'
97 EMERALD LN
MARSTONSMILL, MA o2U8 " "
Undersecretary I
3
j_
oETME Town of Barnstable
Regulatory Services
KAM BARMAB14Richard V.Scali,Interim Director
z63q. �
Building Division
Tom Perry,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,Jq0 I �Pr , as Owner of the subject property
hereby authorize -Pt AA13 mmed t0 OJ to act on my behalf,
in all matters relative to work authorized by this building permit.
-- do 11V #1 fry, CeNleIr V Ar
(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.
dA
SignaU of Owner afore of Applicant
r
Print N . e Print Llana
Da e
Q:FORMS:OWNERPERMISSIONPOOLS 10/13 -
/.own oI Daiu3t"LyJ ,
Regulatory Services
tHE Richard V.Scali,Interim Director
Building Division
Tom Perry,Building Commissioner
MAM 200 Main Street, Hyannis,MA 02601
www.town-barnstable.ma.us
Fax: 508-790-6230
Office: 508-8624038
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB.LOCATION. village
- street
number
"HOMEOwNER home phone#": work phone#
name
CURRENT MAILING ADDRESS:`
state zip code
d to or less an
The current exemption for"homeowners was extended topossess a license,provided that the owners units s as supervisor ow
city/town include
homeowners to engage an individual for hire who does DEFINITION OF HOMEOWNER
such use and/or farm structures. A person who constructs more than one
Persons)who owns a parcel of land on which he/she resides Sr intends to reside,on which there is,or is intended to be,a one or two-
Person(s)dwelling,attached or detached structures accessory
on a form
ho
me in a two-year period shall not be considered a.homeowner. S oh.all su h"homeowner"
k' erformed and the shall submit to the uildin irrmrtl (Section
acceptable to the Building Official,that he/she shall be res onsible .
109.1.1) .
assumes responsibility for compliance with the State Building Code and other applicable codes,
The undersigned"homeowner"
bylaws,rules and regulations.
Department minimum inspection
The undersigne
d"homeowner"certifies that he/she understands the Town of Barnstable Boil ntsg
din
procedures and requirements and that he/she will comply with said procedures
Signature of Homeowner
Appi oval of Building Official
_ dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code
Note: Three-family d g
Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION
shall be exempt
The Code states that: "Any homeowner performing work for which a building permit provided thais t if the homeowner
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);p { ,
s a person(s)s)for hire to do such work,that such Homeowner shall.act as supervisor" t t # F supervisor
engage p
Many h omeowners who use this exemption are unaware that they are assuming
Se,Section 2t15) this lacklof awareness often
(see Appendix Q,Rules&Regulations for Licensing Construction Supervis. , case,our Board
results in serious problems,.particularly when the homeown licensed Suer hires uervisore The hmeownersacting d persons. as Supervisor cannot
t
proceed.against the unlicensed`person as it would with a lice p
munities require as part of the
ultimately responsible.
To ensure that the homeowner is fully'aware of his/her rstandsithetresponsibil ties of a Supervisor. On the last page
permit application,that the homeowner certify that he/she unde
of this issue is a form currently used by several towns. You may caret amend and adopt such a.form/certification for use in
your community. .
Q:\WPFILES\FORMS\building permit forms\E)pRESS.doc
Revised 061313:. ,K,
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�ZME r, Town of Barilstable
*Permit#
Expires 6 monfla from Issue dale
CAB Regulatory Services Xxss Fee
9�b i639• ,0�' Thomas F.Geiler�Director
prED MA'S A
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
.co: 508.-862-4038
r;
508-790-6230
EXPRESS PERNIIT APPLICATION - RESIDElv`iA&I
Q Not Valid without Red X-Press Imprint . . I ieAv I;
rcel Number o Q 9
y Address 5 'Aa�
idential Value of Work GOOD •Minimum fee of.$25.00 for work under$6040.00
s Name.&Address y'1
:tor's Name &2� Number
Improvement Contractor License#(if applicable)_-
action Supervisor's License#(if applicable) a`j.
:kman's Compensation Insurance
Check one:
I am a sole proprietor
❑ I am the Homeowner
'aI have Worker's Compensation Insurance
ace Company Name
nan's Comp.Policy#__
of Insurance Compliance Ce tfficate7 must be on file.
t Request(check box)
3ff-Re-roof(stripping old shingles) All construction debris will be taken to p
van —
(]Re-roof(not stripping, Going over existing layers of roof)
0 Rc-side
❑ Replacement Windows. U:Value (maximum.44) ,
r
•Where required: Issuance of.this permit dons not exempt compliance with other town departinmt regulations,i.e.Historic.Conservation,etc.
***Note: Property Owner must sigaProperty'Owner Letter of Permission.
Home ovemeat Contractors License is required,
.tore
nd:cxpmtrg
063004 • -
w '
rt
° Town of Barnstable
Regulatory Services
+SBA� BLE, Thomas F.Geiler,Director
o 59. Building Division
Tom Perry, Building Commissioner
200 Main Street,, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must Complete and Sign This Section If Using A
Builder
I, 40 rf—) 1,p/ 1 , as Owner of the subject property
c�
hereby authorize CJ to act on my behalf,
in all matters relative to work.authorized by this building permit app 'cation for (address of
�0 k/ i / d? C/ C�-n LS
yZz,nature of Owner Date
Print Name
Q:FORMS:OWNERPERMISSION
DATE(M
'��TM CERTIFICATE OF LIABILITY INSURANCE 8/24M/200
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
McShea Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
749 Main Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Osterville, Ma. 02655 INSURERS AFFORDING COVERAGE
508-420-9011
INSURED Paul J Cazeault & Sons INSURER A: LloVdIS
Roofing Inc. INSURER B: Traveler's
1031 Main Street INSURERC:
Osterville,. Ma 02655 INSURERD:
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 POLICY EFFECTIVE POLICY EXPIRATION
LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
1,000,000
COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $
CLAIMS MADE ®OCCUR MED EXP(Any one person) $
A LGL034776 04/30/04 174/30/05 PERSONAL&.4DVINJURY $
GENERAL AGGREGATE $
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $
1,000 ,000
POLICY JECT PRO LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $
ANY AUTO (Ea accident)
ALL OWNED AUTOS
BODILY INJURY $
SCHEDULED AUTOS (Per person)
HIRED AUTOS
BODILY INJURY. $
NON-OWNED AUTOS (Per accident)
PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO
OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESS LIABILITY EACH OCCURRENCE $
OCCUR CLAIMS MADE AGGREGATE $
$
DEDUCTIBLE
RETENTION $ - $
WORKERS COMPENSATION AND W TAT - TH-
EMPLOYERS'LIABILITY
TOR Y LIMITS ER
7PJUB-0095664A04 08/13/04 08/10/05 E.L.EACH ACCIDENT $100 ,000
B E.L.DISEASE-EA EMPLOYEE $9
•OTHER E.L.DISEASE.-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TOWAIL DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURETO DO SO SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR
REPRESENTATIVES.
AUTHORIZED RE �� I
i
ACORD 25-S(7/97) 0 ACORD CORPORATION 1988
v ,
-�
Board of Building Regulat�bnts-
an tan �rs
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement`Contractor Registration
Registration: 103714
Type: Private Corporation
Expiration: 7/9/2006
PAUL J. CAZEAULT & SONS, INC
Paul Cazeault
1031 MAIN ST
OSTERVILLE, MA 02658
Update Address and return card.Mark reason for chang
Il Address Renewal Employment C3 Lost Card
DP8-CAI Co 5OM-04104-GIOI216
��tC Lr o��LlftolttUCUtiC�t 0�✓vGUAdC1Gt![GP.�6 _ _------_ .
" Board of Building Regulations and Standards u
HOME IMPROVEMENT CONTRACTOR Liccusc ur rcl;isU anon valid for intlivid,Il use uuh
Registration-, 103714 before the expiration dale. If found rcturu lo:
Expiration 1037106 Board of Building Itcgulalions and Sland:Irds
one,\shburUn, Place Rill 1301
;Type Private Corporation I3o,tou, Ala.02108
PAUL J.CAZEAU,LT,&..SONS,INC.:
Paul Cazeault
1031 MAIN ST � ,u✓
OSTERVILLE,MA 02658 Administrator ✓�" �O"`�J1°""'�"� °�"`lu��«re/
)<ler BOARD OF BUILDING REGULATIONS
,
License: CONSTRUCTION SUPERVISOR
Number: CS 026325
Birthdate: 10/20/1959
Expires: 10/20/2005 Tr.no: 8603.0
Restricted: 00
PAULJ CAZEAULT
1031 MAIN ST
OSTERVILLE, MA 02655 Administrator
Board of Buildin egulations
'.y-jj♦ One Ashburton Pace, Rm 1301
. Boston, Ma 02108-1618
License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 10/20/1959
Number: CS 026325 Expires: 10/20/2005 Restricted To: 00
PAULJ CAZEAULT
1031 MAIN ST
OSTERVILLE, MA 02655 .
Tr.no: 8603.0
Keep top for receipt and change of address notification.
i
- The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street, fh Floor
Y Boston,Mass. 02111
Workers'Com ensation Insurance Affidavit:Buildin lumbin /Electrical Contractors
n
name:
address:
city state: zip: phone#
work site location(full address):
❑ I am a homeowner performing all work myself. Project Type: ❑New Construction Dike
❑ I am a sole ro rietor and have no one working in any capacity. ❑Building Addition
' " .'.^,Xd� .k?>ki�' -;=r`!, "�`•,i+y%' .. r.:: •x... ,,gyp;. ,t.. .k`:,a„r..�.a�;`,. "x't" Yc'!-da+
I am an employer providing workers'compensation for my empl11oyees workicng on this job. `� —
address:
,,/��1
insurance co. ` S oli # r Q ->
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers'compensation polices:
company name:
address:
city phone M
insurance co. volig#
company name:
address-
city: phone#•
insurance to.. ON#
Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify ul the pains and penalties of perjury that the information provided above is true and coTc
t
Li
Si stare Date
gn C —7
Print name P Phone#
official use only do not write in this area to be completed by city or town official
city or town: permittlicense# ❑Building Department
❑Licensing Board
❑check if immediate response is required ❑Selectmen's Office
❑Health Department
contact person: phone#; ❑Other
(revised Sept 2003) milloolm
I _ I
;"( • `��`.► Fee
Regulatory Services
9HAS& Thomas F.Geiler,Dtrettor
"rEo may►,. Building Division
Peter F.DIMatteo, Building Co=missioaer �����
36 7 yfaia Sttzet, Hyannis,MA 02601w a v
Office: 508-862-438 AIV 31 2002
Fax: )08-790-6230
EIPRESS PERI�'ITT :�PPLICaTION - RE�EI'' l ISt' NST4�
Not Valid without Fad X-Pram lmPfnt `
.Maprparcel Number
Properry Address '
Q Residential Value.of Work
Owner's Name&;kddress kj,�,
Co ntractor's Name—
Home impror enient Contractor Licens . (if applicable)
Construction Supervisor's License-(if applicable)
QWorkman's Compensation Insurance
Checkout:
I am a sole proprietor
[j I am the Homeonner
have Worker's Compensation Insurance
Insurance Coapanv Name
Workman Comp.Policy- A)
Permit Request(check box)
Q Re-roof(stripping old shingles)
Q Re-roof(not stripping. Going over wdstmg layers ofroof)
Q Re-side Jew
�
j Replacement W indo«5. U Value (=)dmtm.44)
Q 11
� lL
Q Other(specify) . .
.wt1G1e required: issuance of this pamit does not exempt junco with other town deputtneat tegutadons.i:e-Historic.Consen-ation.::-•
Sienamre
Q:Fomss:eccmtrs:r:�at;06�1
49
P O-Box 332•West Dennis,MA Q2670 ,s
-,PAUL HAYG ODAI
License#1317C Burglar
UL Certified Fire
Central Station i
r Medical
24 Hr.Monitoring, (508)394-0599 Temperature
Wo- &230
� � s
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y
FROM : SEASIDE NLRRMS Py�PJE"s 10." 509760283O Sep. 19 2000 03:29PM P2
C 3Y
/ 72_28 NATIONALFIFI-,ALARMCODE
1.7.2.3 Central Station Fire Alarzn Systems. it shall be 2.1.2,2 1 his chapter is primarily com4tr r eti with life saitety,
Sz conspi(mokisly indicated by the prime contractor lser, Ghaptei not with protr.,tion of property. It p:°esumcs rh,r a funilY
l)that the fir;:alarm system Providing service at a Protected has an exit plan,
prCttt;Sei complies with all applicable: requirements of dots -
code by providing a means of verification as specified in t 2.1.3 General. '
either I-7.2.3.1 of 0 2-1.3.1 h control and associated equipment, a r=lultipie or
The installation shall be certificated. single station al.arn,(s),or any combination thereof Shan 'r;e
I ,t permitted to be used m a household fire warning system,
1.7.2,11.1 Central station fire alarm systems providing provided the requirements of 2.1,3.7 die met.
service that complies with all requirements of this code shall
2.1.3.2 Detection and alarm systems for use within the
be certificated by the organization that has listed the prime protected household arc covered by this chapter.,
contractor, and a document attesting to this certification '
shall be located on or near the fare alarms stem control unit
Y 2.1.3.3 Supplementary functions, including the extension
or, where no control unit exists,on or near a lire alarm sys- of.an alarm beyond the household, shah be permitted and
tcm component, shall not interfere with the performance rcqui:ernenu of
1.7,2.3,1,2 A central repository of issued certification doc• this chapter.
: uments accessible to the authorityjurisdiction,shall
having j 2.1.3.4 Where the authority having jurisdiction requires a
be maintained by the organization that has listed the central household fire warning system to comply with the requirc-
station.
mcnts of Chapter 4 or any other chapters of this code, thc
1.7.2.3.x The installation shall be placrnrded. requirements,of Section 2-2 shall still apply.
1-7.2.3.2.1 Central station fire alarm systems providing
2.1.3.5 The definitions of Secton 1.4 shall apply.
service that complies with all requirements of this code shall 2•1.3.6 This chapter does not exclude the use of fire alarm
be conspicuously marked by the prime contractor toindicate systems complying with other chapters of this code in house-
.
cornpliance.The marking shall b•by means of one or more hold applications, provided all of the requirements cal this
securely affixed placards. chapter are mer.or exceeded.
1-7.2.3.2,2 The placards) shall be 20 in.' (130 cm2) or 2.1.3.7 All devices, combinations of devices, and equip•
larger,shall be located on or near the fire alarm System con- ment to be installed in conformity with this chapter shall be.
trol unit or, where no control unit.exists, on or near a fare approved or listed for the purposes for which they arc
alarm system compcment ands: shall identify the central sot- intended,
tion and, where applicable, the prime contractor by name
and telephone nunzbcr. 2-1.3,8 A.device or System of devices having materials or,
forms that differ from those detailed in this chapter shall be
1 •7,3 Records. A complete unalterable record of'the tests permitted to be examined and tested according to the intent
and operations of each system shall be kept until the next. of the chapter and,if found equivalent,shall be permitted to
test and for 1 year thereafter.The record shall be available be approved,
for examination and, where required, reported to the
authority having jurisdiction- Archiving of records by any 2'1`3.9 Equivalency. Nothing n1 this code is intended to
j` means shall be permitted ifhard copies ofthe records can be prevent the use of systems,methods,or devices ofequivalent
or superior quality, strength, fire resistance, effectiveness.
p,ovided promptly when regttoste.d• durability, and safety over those prescribed by this code,
F'.reeption, Where pfffireirzises mn7aiiorirtg is provided,rrrrrds of provided technical documentation is submitted to the
all signals,tests,and opemiirnas-itcorded al the.mjurucsing suction authority having.jurisdiction to demonstrate equivalency
shall be mainlainel.for not less than.1 year. and the system, method, or device is approved for the
intended purpose.
Chapter 2* Household Fire Warning Equipment 2.2 Basic Requirements.
._ .:.- 2-2.1 Required Protection.
j
�2.1 lntroducti . -
2-2. co a re in. detectors within
! 2.1.10 Scope. This chapter contains minimum require a family living unit. '
mints for the selection, installation, operation, and motile 2.2.1.1,1 Srnoke detectors shall be installed outside of each
nonce of fire warning equipment for use within family living separate sleeping area in rite immediate vicinity of the bed-
units.'1 he requirements of the other chapters shall not apply. rooms and on each additional story of the Family living unit,
L'rcepiiar„: Vvlterr specafica.11y irtn'ierxted, : including basements and excluding crawl spaces anti unfin-
- ished auks. In new construction,a smoke detector also shall
2-1.2 Purpose. be installed in cacti is
room. '
I l 2.1.2.1 laousehoid fire warning systems shall be designed--2.. .s. or fame y tvtng tin wi
and installed to provide sufficient warning e£a fire to enable` levels(i.e.,adjacent levels with less than one full story sel.
` occupants to escape It is recognized that household fire warn- ration between levels), a smoke detector required by
I ` ingsysteirtamightnotbeofxraaterialassistancewalloccupants, 2-2A.1,; shall be permitted for an adjacent lower level.
such as persons intimate with the ignition of a ftre. including basements, (See Figure A-2.221,12)1996 Edition i
a,
,
a 41
°f7HE.T°�. TOWN OF BAR.NSTABLE
BARNSTABLE, i
9� NMI
.a, BUILDING INSPECTOR
APPLICATION FOR PERMIT TO ..YY.!�L �.���..... .... .A.`-. .r.�L"'.....................................
TYPEOF CONSTRUCTION'........................ ............................................................................................................
..........(J ...... ...19.
TO THE INSPECTOR OF BUILDINGS:
The undersigned Jhereby applies for a permit according to the following information:
Location ... ur...!.:. .L. .'.. (_1.R. :...... -c.? l?' F.P�..?��.L�"�.............................................................................
ProposedUse .... ...................................................................... .. ..................................................................
Zoning District ............................................Fire District .. �'—' G�'�7-���viz-L-
........h............./.^.. �^ ...............................................................
Name of Owner1fY.� �¢-.�� F L(� Address lS �1�{�( l L�' .............
.......................................... .................. .............. ...........................
u l _1 7°
Nameof Builder ....................................................................Address ....................................................................................
Nameof Architect ..................................................................Address .............................................................
........................
Numberof Rooms ..................................................................Foundation .................................. ..:.............................
Exteriorsr ...Roofing ........................ ...............................................
Interior .........F
loors .................................................. ................................................ .........................
Heating ..................................................................................Plumbing ..................................................................................
Fireplace ..................................................................................Approximate Cost ...... �,:.., dG�
..................................
Difinitive Plan Approved by Planning Board ________________________________19--------.
Diagram of Lot and Building with Dimensions
Fb NV4.
L C I _
R w
/�
3
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name
Caldwell, Waldon S. (J '
or-'r sGv006-0, GAy dto�C, i
14194 tool house
No ................. Permit for .................................... -
............................................................................... t
Location 85. Holler Bill Road
.............................................
Centerville
.............:.................................................................
Owner ..........Waldon S. Caldwell
.......................................................
r+
Type of Construction frame
......................
................................................................................
Plot ........................ Lot ................................ aa
r
Permit Granted .......August 25..........„19 71
AO Aq-
Date of Inspection « �a............19 a
�ZS �Z,/�'�Q�oterp
Date Completed. ........ .............
.... . .......... 19
V
PERMIT REFUSED
................................................................ 19
............................................................................... -
1 .
...............................................................................
......................................................I.........................
• R
...............................................................................
Approved ................................................. 19
...............................................................................
...............................................................................