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HomeMy WebLinkAbout0095 HUCKINS NECK ROAD .. � III _ �� � � � a Ili TOWN OF BARNSTABLE BUILDING PIERMIt APPLICATION Map S _ Parcel y � TOWN OF BA:R STABLE X_J Application # Health Division 1 �, " ''ij -}� Date Issued 10-7 Conservation Division Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address P ULl l/o Village_ G A IvM/Z U/W Owner (,ff ag dL Address Telephone Permit Request l L. IDRA11011S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed 0 Total new Zoning District Flood Plain Groundwater Overlay Project Valuation G0 �dConstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 14 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.) D f Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: _ _7 existing 0 new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes QXNo If yes, site plan review# Current Use I`rz_l p'pkr Proposed Use APPLICANT INFORMATION _(BUILDER OR HOMEOWNER) - Name C 4L A-w Telephone Number Address -yV oll_4 �� � V License # Home IImprovemme t Contractor# Email��� ^� � ��� VAT . /�I W ker s Cmpensation # AICC9 O0S 010011'1d 16 A' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN T63 SIGNATURE DATE 7 G r FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME ,INSULATION FIREPLACE _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. _ Bk 27085 t=944 �633�fr 01-29-2013 ai 11 =29a DEED RESTRICTION Whereas,David W.Jackson,Trustee of Provident Realty Trust,formerly known as' ' Jackson-Malden Realty Trust(see name change recorded with the Barnstable County Registry of Deeds in Book 1912,Page 242),under declaration of trust dated August 22, 1962,and recorded with said Registry of Deeds in Book 1462,Page 451,of 87 Broadway,Malden,Massachusetts 02148,is the owner of Lot 49,as shown on a plan of land recorded with said Registry of Deeds in Plan Book 21,Page 93,located at 95 Huckins Neck Road,Centerville,Massachusetts (hereinafter,the"Lot');and Whereas,David W. Jackson,Trustee of Provident Realty Trust,as the owner of the Lot, has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on the Lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15,000,State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage;and Whereas,the Town of Barnstable Board of Health,as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code,Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the Lot be put on recorded with the Barnstable County Registry of Deeds and/or the Barnstable Registry District of the Land Court,as applicable,by recording this document. W. son Trustee of Provident Real Trust does hereby lace Now,therefore,David Jack Realty y p and impose the following restriction upon the Lot in accordance with his agreement with the Town of Barnstable Board of Health,which said restriotion'shall run with the land and be binding upon all successors in title: The dwelling constructed upon the Lot shall contain no more than four(4)bedrooms unless and until it is connected to"the municipal sewer or the Board of Health of the Town of Barnstable permits otherwise. Property Address: 95 Huckins Neck Road,Centerville,Massachusetts For-title,see deed recorded with said Registry of Deeds in Book 1462,Page 449. f Bk 27085 Pg 65 #6334 Executed as a sealed instrument this 3 day of N U 2013. , ProAdent Realty Trust 1 13: David W. Jackson,Trustee COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. On this 23aD day of Y ,2013,before me,the undersigned notary public,personally appeared DaNid W.Jackson,proved to me through satisfactory evidence of identification,which was PtRSoa;ay kyoa►n! ,to be the person whose name is signed on the preceding or attached document,and acknowledged to me that he signed it voluntarily for its stated purpose,as Trustee of Provident Realty Trust. N My Comm ssio &pires� MARYELLEN SHEEHAN ' •.. , c�. Notary Public Commonwealth of Massachusetts W s My Commission Expires July 20, 2018 BARNSTABLE REGISTRY OF DEEDS Massachusetts -Department of Public Safety Board of Building Regulations and Standards l.11II1L1 tl l.11l/11 JII IICI Y11111 � License: CS-070321' MICHAEL J PATYtN 146 QUINAQUISAT � MASHPEE MA @264 -X` Expiration Commis�si'o7ne^r` 03/15/2017 Office of Consumer Bus�nessegLI iacfccoe�. OME IMPROVEMENT CONT ow f egistration: g110 RACTOR T xPiration:m,� YPe: MICHAEL P Individual ATERN&INN-i MICHAEL PATE ;1 AQUISSE 4 146 QUIN =MASHP EE,MA.02649 \<,•`P '� — � t Undersecretary' t 1 J Massachusetts -Department of Public Safety Board of.Building Regulations and Standards ' ' • - Cl/II1L1111 Lt1111 JUIICI Y1.\III � License: CS-070321 �``}LfIR QR.A MICHAEL J PATE-kN \ r, 146 QUINAQUISgETF MA5HPEE MA (F264��� Expiration J1 P Commissioner '03/15/2017 j License or registration valid for individul use only j before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 1 10 Park Plaza-Suite 5170 j - Boston,MA 02116 j i w I Not vali without signature i M A i pl 7 PATERA OP ID: DS ACORO� DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 09/28/2016 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 endorsements . PRODUCER - CONTACT NAME: Hyannis Office Bryden&Sullivan Ins Agency PHONE FAX 88 Falmouth Road (AIC,No Ext:508-775-6060 A/C N.: 508-790-1414 Hyannis, MA 02601 E-MAIL ADDRESS: Hyannis Office INSURERS AFFORDING COVERAGE NAIC# INSURER A:Associated Employers Insurance INSURED Michael J. Paterno III INSURER B:NGM Insurance Company 14788 146 Quinaquissett Ave Mashpee, MA 02649 INSURER c INSURER D: " INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS B COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ' 1,000,000 CLAIMS-MADE � PREMIS OCCUR MPF6296P 08/05/2016 08/05/2017 DAMAGEES TORENTED Ea 500,000 occurrence $ X Business Owners MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED 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$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN❑N N/A WCC50050100112016A 05/16/2016 05/16/2017 E.L.EACH ACCIDENT $ 500,000 D?OFFICER/MEMBER EXCLUDE (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L".DISEASE-POLICY LIMIT $ - 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Certificate issued for insurance verification CERTIFICATE HOLDER -CANCELLATION BARNS-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Dept. rr ' AUTHORIZED REPRES 1.-"I VE,) .,.. s+y J Y;_ j•.t J�, ��,.. 200 Main Street € ��, / '• t Hyannis, MA 02601 Hyannis Office +• 4. ©1988=201aACbRD;.CORPQf2ATIQW-ahll rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD VieProposal �_ •.� y��;T �� 5tr David Jackson ymashpee,Ma osas 85 Huckins Neck Road Centerville, MA , 617-966-5000 DWJ8@aol.com Remove and replace insect and rot damaged 4x6 sill-/header on top of block wall at crawl space to right of water heater,with pressure treated material. Remove and replace all staples in wire on material to'be replaced Remove and replace end_joist at same wall between newer addition floor joist $3,.120.00 Support floor joist as needed to perform work. plaster n crack during is work.Please note: Sheetrock or pto ca c ck du. ng th Repairs to sheetrock or plaster are not included in this proposal Material: $325.00 Total: $3,445.00 NOTES • Proposal does not include painting or prep. • Does not provide for rot or insect damage repair not listed. above. • Please review carefully. This proposal only includes items listed above. • Any work above and beyond items listed in description will be . at cost of materials plus 15% and a labor rate of$65.00/hr. Payment Schedule: / Deposit of$1,000.00 due upon acceptance of proposal. PD 8l2 Y CK 13766. Balance of$2,445.00 due upon completion of work. Acceptance of proposal: Date: David Jackson Submitted by Michael Pat r o 8-18-16 'Michael J. Paterno Please make check payable to: Michael Paterno 146 Quinaquisset Ave Mashpee, MA ` August 18,2016 "^ Town of BarnstableREG �PT 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-16-2843 Date Recieved: 9/28/2016 Job Location: 95 HUCKINS NECK ROAD,CENTERVILLE Permit For: Building-Addition/Alteration-Residential f Contractor's Name: MICHAEL J PATERNO State Lic. No: CS-070321 t Address: MASHPEE, MA 02649 Applicant Phone: (508) 246-3306 (Home)Owner's Name: JACKSON,W H TR Phone: (Home)Owner's Address: 87 BROADWAY, MALDEN,MA 02148 Work Description: REPLACE ROTTED SILL UNDER PREVIOUS EXTERIOR GABLE END Total Value Of Work To Be Performed: $1,500.00 Structure Size: 0.00 0.00 0.00 Width .' Depth Total Area ' I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: MICHAEL PATERNO 9/28/2016 (508)246-3306 Applicant Date Telephone No. .Estimated Construction Costs/Permit Fees Total Project Cost : $1,500,00 Date Paid Amount Paid 1 Check#or CC# Pay Type Total Permit Fee: $85.00 9/28/2016 $85.00 r , Cash .............. ............. ....._._.................._......................x................._......._...................._.-_-........_._.._........_......_.._............_._......................_......... ...-----......---.................._......._......... Total Permit Fee Paid: 385.00 F d 7 t Department&fr nsftid Accid - 600 Washfi*- ,ionStreet Boston,MA 02HI . . kVFPR4L7l7IIS��flP��Q . Warkers' Cam pensa Ia. ce Affidavit SkffdeFSIQMtr��,R..;s.,�.�� ers Appcam#Tnfarmafk Please Print Env N �"* � T � GDP LfJ- v-,L, �- t :�aemplayer?Checkthe apprapriate bayType of project(required):I 1 �w `v —P 4- ❑ a I mn a gex6 caafirsctar and I . employees(fall.anxliorgart-time)-* havehiredMe sub-cOmt G. New 2. ] I am a sale PmPlietar arpartuer- listed omthe attached sheeL 7- ❑ReimaaeHng / Iship and have no 1 These sob-c nfractars have fees aadhave xvorrs' $ ❑Demalifion wcddng farmm in any capacity [N4 Wado5w Comp.ice Camp.imaranc, , g- ❑Butlm ad3ifiou -� 5. We are a cnaporaficnand its 16❑Elec cal repairs or adcrilions Officers have exercised their 3.0 i am a homeamer doing 0wont 11-0 PlmmbingrepaiM Or$dcpfiams ' MYMAf[NO - of ese pSm per MGL ME]Roafrepaizs iima anrP r d-]i c-M glt4�and weImeno emplayem[Nowodoe& Camp-msarance mqdu,5&1 ;AU alrp�t�t fat cbec�Cs bos tl tm+st also ffiauftfie 5e:tioabelawslr�dag�e¢waniceis'm�P,•�fi,••pofiegia� FF,,.l...�--eo--arss�e suit this af�da�a ig Snep axgdam�alFsRa�c andB�l�e aecauhvc�sssamst submitanEwa�dae�t mdi Sari+ ' 'tAm�$R91 C11K1«lYiS TICS ffiIISC Yf1�ffi9dtI7�9I 5lIEEI cTt��y�£Of 1l7E a0fI 5f8LE�SWII[JC'Q]II5EE��1S4� Employees.iffiem -ra=�bwemq&ye?--,dwy=xC =&&w wm-k '-�•Palk5--har -Tam ate ernp ar 9�is prauidirrg�tmrkexs'caa peresrdirrn ursrirartcs jvr cmg gees. SeIaav is�J�spa&cy alai jaFa site €s�orm�nn . Tasmance CompanyN2MW AS so e-nymp )2 ML'—O y/LP--f y d, P4ficy 41 orSelf-jM€Iic. sob Site Addre= 9-S H V e-A si rs lei Bch a copy of the workers°cbmpeasationpolfcg declaration page(showing the policy number and expiration date). Falnre to serum coverage as requirednuder Sew 25A of MGL a 15 am lead to t$e imposition of ctinmumal pew Of a fine up tD$UOD-O D amVor one-yearimpasormenk as w&as civil peed it is the fo=c)f a SI1[)P WORIK ORDERand a f of up to$250..l7Q a day against the violaiur. Be advised that a copy-of this statemet maybe fmwarded ta the Office of' W laves ans of the DIA for firm a coverage ve :an- _ Ida herafyy cer#50 under tips ' andpeziaMwafFedkuy tfi&tlie ire,farmabaxpromW abmw is trans mid correct ,�ioe,at„rR Date- Phone rk Orwi d am anly. 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I u■ r:na n■ a r:RMI. n .■.• l•mil •i:l lair •■ - �rwX.. .n t In a.:r •• 11- ■■t i..R i - .1/. r:ul s• . pf" :..r ral. : .1 •• - nr : ":. ��.if - ■•1. •^1 i! • MIR /i+■ ••Y./■aOa� Imo■� .1 r�■■■1 .• - .•• ra■ - . r.pan 1 n r In .- , iR • / •.+■-as■1 •••• ■ 1- [• a.n '•, t! ■ .er r' U .al r••.iS ...•1■ :t■• ■1■ • •■1 ..• .1■ •l�■•IM r-- r rr�tr r_r ••�o-� n r �:wv; r r�.�or. 1•:Ira rr1:,i i r gn�.yr�� ► i c;r as%l i t -Vllr` . r • 7 rli sills• Iri r »_1 NO ' rll caa ' BAN • tY��. '•r • rtrs M�lv i 'TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � F Application 00Map Parcel '4f`0O 91 ARNSTABLE Health Division ``' Date Issued 1,7 Conservation Division ,fT P Application Fee Planning Dept. Permit Fee 1• D Date Definitive Plan Approved by Planning Board Q T6 11 Historic - OKH _ Preservation/Hyannis Project Street Addrel ' k&�nS 1Q-e6L Village &,U4PVU'1 Owner A kSU1ti—l4CxIo6e I vW..+ Address Telephone -420 SU a-106 Permit Request 1Zei?L4cL 10 feex oP C*Tenor- wall `A` �iaQ wIi4svLA-rt 2.@ L,4-(V_ 14LT-GLLA C,ch�Q�✓ters �- c��a-rcas Re®tae� V(Vgt icir- 4 foI- c Square feet: 1 st floor: existing 500 proposed 2nd floor: existing4 proposed Total new Zoning District k'0 '" Flood Plain Groundwater Overlay Project Valuation 10,ODD Construction Type a� .Lot Size , Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family ] Two Family ❑ Multi-Family (# units) Age of Existing Structure 111 Historic House: ❑Yes �'No On Old King's Highway: ❑Yes ❑ No Basement Type: 91 Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) S O D Number of Baths: Full: existing 0� new _ _ Half: existing O new Number of Bedrooms: Y existing jxew Total Room Count (not including bath.,,): existing (::� new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ,® Electric ❑ Other Central Air: ❑Yes �No Fireplaces: Existing I New �� Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 4 No If yes, site plan review# Current Use 1 Proposed Use !1/ APPLICANT INFORMATION- - -- (BUILDER OR HOMEOWNER) Name �e ti(JJ�I c \ylr- / Sie ue-Twiey Telephone Number Address DP-elle(' Cill' c W ddb 661'D License #- 6 S 6 5 S S f k 2( dVVI-�t� I�vl u'� Cif QYl!1 I S Home Improvement Contractor# 01) 12 Worker's Compensation # IMS4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / v s FOR OFFICIAL USE ONLY f 4 APPLICATION# 7 DATE ISSUED MAP,/'PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: r —, , FOUNDATION FRAME r INSULATION FIREPLACE S t ELECTRICAL: ROUGH FINAL r: PLUMBING: ROUGH FINAL GAS: ROUGH FINAL y �i FINAL BUILDING J'3 1. ;. i DATE:GLOSED OUT ASSOCIATION PLAN NO. t 4 Oct 261502.-55p ' JACKSON 7813247755 p.1 ` M Town of Barnstable Regulatory Services Richard P.5caA Dk=tor b }�� BII.I ding DIVISIon Tom Perry,Bu ldiug Commissioner 200 Main Strect Hyar i*MA�02601 www.town barnstabI&M: Us i Office: 508462-4438 Fax: 508-790-6230 Property Owner Must Complete and Sign'This Section If Using A Builder I, I)Ayti UUo as Owner of the subject property hereEiy authorize i7 f ew ,t i D @. �n C to act on mybehalf, in all matte-s relative to work authonzed bythis building permit apphcatma tor. . �� i��(Nl `y tGf� 17A• (Add=ss of Job) ""Pool fences and alarms are the respousibilitj of the applicant Pools are not to be fi ed or td�zed before tense is installed and all final ' i.nspe=ons.are pedonned and accepted. i Signature fwner Signatnraof Applicant - F Paint Name Piitxt Name Date . Q:FORMSOWARP�MNPOOLS RECEIVE : NO. 1404 10/26/2015/MON 03 : 19PM Oceanside J ` r J A D Q a � � s CL S s � k � 7 j Client#: 586925 20CEANSIDEIN ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDlYYYY) 3116/2015 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($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 CON ACT NHAME: Dowling$O'Neil CA1tQNNo El,508 775.1620 Marc No): 5087781218 Insurance Agency E-MAIL 973 lyannough Rd., PO Box 1990 aDD E INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A:Arbella Insurance Company INSURED INSURERS: Oceanside,Inc. 217Thornton Drive INSURERC: Hyannis,MA 02801 INSURER 0: INSURER E: [INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. INSR ADDLSUBR POLICY POLICYEXP LTR TYPE I S WVD POLICYNUMBER MM/DDIYYYY MM/DDN LIMITS A GENERAL LIABILITY 8500061423 011D112015 01/01/201 EACH OCCURRENCE $1 000000 X COMMERCIAL GENERAL LIABILITY DAM E•f RENTED PRE�I ES E.0. rancs $100 1 000 CLAIMS-MADE EX�OCCUR MED EXP(Any oneperson) $5 000 PERSONAL BADVINJURY $1,000,000 GENERAL AGGREGATE $2,000 O00 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG $2,000,000 POLICY PRQ LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) t ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aocidenl) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY TO E ANY PROPRIETORIPARTNERIEXECUTIVE —] E.L EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE -r I ©1988-2010 ACORD CORPORATION.All rights reserved, ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S 1479191M 147918 CB D _� ��ce writrnn7rcuerc�C�c�C'/f/�cfrac�cc�r/t. _ ffice of Consumer Affairs&Business Rcgot,tiop i ME IMPROVEMENT CONTRACTOR W' 'Reg istration;,_fp01.2 Expiraf(4i1`'61 Type: OCEANSIDE, INC, '' ' `.: = ?` Supplement C STEVE TESSIER 217 Thornton Dr Hyannis,MA 02601 �' Uodersecretarp • Massachusetts-Department of Public Safety Board of Building Regulations and'Standa_rds Construction SupervisorY3 License: CS-055571 STEVEN M TESS$R Is DEE BEE CU r MIDDLEBORO 19A c 3 Expiration Commissioner 09117/2016 r License or registration valid for indtvidul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation T 10 Park Plaza-Suite 5170 •)rd Boston,MA 02116 ,. of valid without signature { ; The Commonwealth of NXassachusetts Department of dndtastrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 ..�' www mass.gov/dia Wiaekers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aanlicant Information Please Print Legibly Name (Business/Organization/Individual): CGC��1 Address: 21-1 t,J<-7- City/State/Zip: 4_A .nrrvt),—rY)a M(co[ Phone#: '71 -,51 J V Are you an employer?Cheek the appropriate box: Type of project(required): IVI am a employer with employees(full and/or part-time).* 7. New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8.'®Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition IM I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10 Building addition 4.[]I am a homeowner and will be hiring contractors to conduct all work on my property. [will ensure that all contractors either have workers'compensation insurance or are sole I I.Q Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached shect These sub-contractors have employees and have wodters'comp.insurance.t 13.E]Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other_ _ 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors 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. 1 am an employer that is providing workers'compensation insurance far my employees Below is the policy and job site information. Insurance Company Name: A .21, M , MU+u Cl.-l -Z�V?SU ra nC2 Cc»/i n �/ Y 12- 100 —�vUI cjSr71-a(�/�/� Expiration Date: /l/ a (� Policy#or(�S�j/elf-ins.Lic.#:1/ ■ l f Job Site Address: 1^le 'tr1"S IUP City/State/Zip: �f('�I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). t� p3 Failure to secure coverage as required under MOL c. 152,§25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify adder 1, ains and penalties of perjury that the information provided above ds true and correct Signature:— / _ _ Date: � zaalJ5— Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: ,4c�R CERTIFICATE OF LIABILITY INSURANCE DA 01/151DDIYYYY! vls/za13 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). GpNTp PRODUCER 04740-001 NAHM�E}�:CT Miller McCartin dba Dowling&O'Neil Ins.Agcy LNo. (sae)778-1620 No.; 9731yannough Road ADDRESS: kbolton@doins.com Hyannis,MA 02601 INSWUE19 Sl AFFORDING COVERAGE NAIC# A.I.M.Mutual Insurance Company INSURED INSURER B; Oceanside Inc INSURE 0, 217 Thornton Drive INSURER Hyannis, HA 02601 INSURER E: INSURER F' COVERAGES CERTIFICATE NUMBER: 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 CLAIMMS.� ILTR TYPE OF INSURANCE 1 SR WVp POLICY NUMBER MOMf�DlYYYY MMIU�IYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY D G TED $ PREM SES Ea occurrence CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ ENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AG $ F_lPoUCY 0- OC AUTOMOBILE LIABILITY CEOs aocdII SINGLE $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODI LY INJURY(Pot accident) $ AUTOS AUTOS NUTOS ED PROPERTY DAMAGE $ HIRED AUTO5 AUTOS tPor ccldent UMBRELLA LIA8 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ yypRKDEERDg RETENTION$ y�5Tg7U $ AIJD EAROR�s�Cl$.�Tkgf�r X TORY LIMITS ER E L EACH ACCIDENT $ 1,000,000.00 A ot� ICP� Mr �CECUfIVE NN NIA VWC-100-6019802-2015A 111/2016 1/1/2016 (mandatory In NH) e1 E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 UgURN ON OAF OPERATIONS below E.L:DISEASE•POLICY LIMrl- $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ` C 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Asse�s%'s ;maps and •lot number ............................... ... r� L. sC�-� `�'� SYSTEM 'MUST BE Sewage`Permit number ... ` ..... �'�` �� /o�` •• �� y ` T J,�! COMPLIANCE I , �CL II STATE i THErp�I TOWN ' OF BARNST r ' , E AND Townt �Q o _.. D f, B>HH'9TODLS; 1 9 MAO& i pp i639. 00 9 I N • P E T O-R s R� ILL D I N S C U G M ij ^i . c) ca. ` at APPLICATION' FOR.i PERMIT TO: .... �f �...... ��C� ( 2v1............................ ' All TYPE OF-CONSTRUCTION ........ ...... ....h...........: ......... .............................................................. n , . .............�/.. ..........19.7. TO THE INSPECTOR OF BUILDINGS: The undersigned h reby applies for a permit according to the following information: r Location .................. .4r�.m. ... .. . L. .;... .......... ............................................................................................ A ProposedUse .......... ...... ...'-tn:C� ... :................................... Zoning District .:....................................... ........................Fire District m Nae of Owner . :..... ..........Address .........../ .. Gs .............................. Name of Builder .. �.. . :.......(. ���. ............A'ddress .......:...... `............................ r Name of Architect ........................................:.........................Address .................................................................................... r✓ Numberof Rooms ...................... ................................:........Foundation ........ ....... ..............l=. .................................. 7 Exlerior ............ .............. .....................:...............Roofing .............. .� .: +�....�............................... J , Floors ,/ ,tenor �' �ivL��G�i ...... .. .......................................................................In ;.7.......................... IHeating ............................... .................................. .........Plumbing ......:...... ................................'.......................... Fireplace ..............................................:...................................Approximate Cost`..:..... .......................................... .......... Definitive Plan Approved by Planning Board --------------------------------19--------. Area J Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT Ta APPROVAL OF BOARD OF HEALTH I � 1 3 k /n I hereby_ agree) o confor to all the Rules and ,Regulations of.,the Town of Barnstable regarding the above • construction. - ` ' :/61 ' � Na ►e.............,.:..................................................................... Jackson, Warren 18355 add to single rt No ..................Permit.for ................................. . T family dwelling-' - .................................... PHuckins Neck Road Location' .......... . _ . .. ............ .................. r Centerville - ............................ ...... ............ ... ..... ............. Warren Jackson` Owner .:......................................... Typef Ef Teonstruction frame ...... ....................................................... ........ .... Plot ................ ........ Lot .................. ......... ell Permit Granted .......AP.ril„29.......'.......19 76 1 Date of Inspection ... .19 t Date Completed � 1 ......... :19 ` ~PERMIT REFUSED ti ....................... 19 .......................... ...... r .`............................... :; ............ # , , . •...• * . •••• •..• • • •• • •: � • •� � i� ` it s • f 1 . Approved ................................................ 19 .............. ..... . ............................... ............ ................ . .................................................... .... Assessor's map and lot number Sewage Permit number ! ..... .. ... `............. THE r TOWN OF BARNSTABLE/J Z E9HB9TODLE. i "6 9 BUILDING ' INSPECTOR ° am or, APPLICATION FOR PERMIT TO ......................P`.......r =�'1..........���....".................................................... TYPE OF CONSTRUCTION ............................r :..... ........................................ . ................................................. ........................ .. .............19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................... ...................... .............................` ................................................................................................... ` Proposed Use ............ ............."-. ........................................................................................................................ r ZoningDistrict ...............................I................ .....................Fire District ...........: .............................................................. ,.. C:-^` . �c�-��, .Address ..... �..r .' Name of Owner . ...... ...... �i Name of Builder �a .... = �-.................Address r.. n ...........................................:.. ................ .................................................................. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms .........................................Foundation .......... ' Exterior ....................................................................................Roofing .................. ....................:.......................................... Floors . ..................................................................Interior Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ________________________________19--------. Area ........................................ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH r+ r J r • 11�-, _ r y i i .I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. --.Name .................................................................................. - - � Jackson, ~ A=252-15 | 18355 add to single No -----.. Permit for .................................... | ' | ' fam1lv dwell1oo . _.---,---------------------. ^ ` ^ /lc� Bock1oo'Ne�k Road `Location -��.~�.-----------------. - ( . . ` � .........------ � �a ' Owner� ^ �. . - '. ' � . � ^ , Plot at . / ` ^ . ^ ' ' Permit Granted � l Date of Inspection-- ----' . . . � D"'= C="p==" PERMIT REFUSED \................................................... 19 --- .. —..=.-- '' ----'ly''^ ' '' —''~^�'''* '--^ -----' � ��.. � -----.--~~—.—.-------.----...—. , - � ` . . . . C � . lVApproved ---____________.. ~ ` ~ � ...................... ` . ^ , . `. . ` ---------------'^---~.—..---.. `. � . . . o BAAWSTABLS,MASS.O� 1639. CFO N(AY k' i TOWN OFFICES 397 MAIM STREET 4 (en) 775-1120 Ex. 12e'-129 HYANNIS, MASS. 02601 -.STIPULATION. AGREEMENT .,w I, James -D.. Lester, builder for Mr, Warren ,Jackson, do hereby. agree to the following conditions ,set .forth by. the: BARNSTABLE CONSERVATION COMMISSION;,,,, and intended to. regulate work done under my _authorization at property owned by Mr. Warren Jackson at Huckins Neck Road in Centerville, Massachusetts: 1. That the, proposed.addition.will not-exceed the twelve (12) feet noted on the plan submitted to the Conservation Cczr"lission ' 2. That no excavation arid/or:r fill will. be •allowed to the wetland side of theexisting building or .the proposed addition...:. . - _This agreement should in no waylbe construed as a waving of the rights•,of the BARNSTABLE CONSERVATION COMMISSION under'General.,Laws Chapt,r',131, Sec-, tion 40 nor under Article XXVIII of„the: Town of Barnstable-,By�Laws Should the conditions._set forth herein be violated, the Commission may exercize E those rights and requre'.complete:compliance with the .above stated statutes. ' I AI ` Signature . ,Address , On this Zg � Y_ a of Y ,hg76-,.-...personai],y`:appeared before me to me known to be;the pe n described in and who executed the .foregoing instrument and acknowledged that he did -same as his free act and deed. T _ .IU, ldtf2 ��DL�i[es Sept rZQ+n. Notary Public. ; My Commission Expires' r 4. - -:seal' �:_ j- /���� Assessor's map and lot number .. `� ......... ............... SEPTIC SYSTEM MUST IfE INSTALLED IN COMPLIANCE WITH ARTICLE II STATE Sewage Permit number ..... ' SANITARY CODE AND TOWN REGULATIONS,- = �PyOFTNETO�o TOWN OF BAR.NS'T'ABL i BARNSTAMr. i 1639. BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. � ....6. � ................................. `... .........&................. ' .....��....... ............................................................................................... TYPE OF CONSTRUCTION ........ ......... ... .........� ` r �..:��� .....................19.,1... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location � ��✓ ./ � ... .- ...C i� /�/G ........MOeAjs............................................ Proposed Use -' �d.v',.....�,I....................................................................................................... ..... ................ p .. Zoning District ...................................... .....................Fire District ...... ............................................. ............... Aka�Name of Owner .........................................Address .. Name of Builder .�'(.:>. r�`...... �.. GT Address ��... ............................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ......................................................................:....... Roofin Exterior ... ..................................... .. ........................ g ............................:....................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ..........................�..................................................... Fireplace ................................Approximate Cost o00 ......................... ............................. Definitive Plan Approved by Planning Board ________________________________19_______. Area (:44AI E ................... . Diagram of Lot and Building with Dimensions Fee .........j.. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the T of Barnstable reg?rdin a ab construction. Name ..... Jackson, Warren H. No ...162,31... Permit for ........add. ..2nd..floor..... .. ....... ...... ... .......to dwel.linp,...:..............:......... ... ........................... Location�5.....Hu..ckins. ... ... Neck Road ............ .... .... ....... . ........ ......... .... Centerville f ....................:.......................... Owner Warren H. Jackson i ...................................................... 1 Type of Construction frame................... I ................................................................................ 1 Plot ............................ Lot ................................ My 16 ..... .....1973Permit Granted ........ .. . ........ Date of Inspection ....................................19 1 Date Completed .... s ..?....19 PERMIT REFUSED ................................................................ 19 1 ............................................................................... ............................................................................... f ............................................................................... ............................................................................... f Approved ................................................ 19 ............................................................................... _ 1 ............................................................................... f