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0352 LAKE ELIZABETH DRIVE
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N .. .. s�;- a# `t is C , — r•' 'Y,.I 4N 0A Al ,rr .r _ - k .� {, R' s�+i ;�'.. xi! ;� w ., a`•'h�.a, F"& �' \, ^,..,(k - c :,.r a'' _ T i .tik. � " i'^-C r. fi�'e ,:{..-� '•�' ., r ^ , s > ��`�" v ` �; .:z. a p'+ y k,i ae: v , t. { = J L ' a ,t :.�• Y• { -ar -moo " ,. , ' d9 it r. x, , oF�rati Town of Barnstable *Permit# -13� E�Tres 6 months from issue date Regulatory Services Fee Ate. l ✓/�y P 6,19 I . $ Richard V..Scali,Director / a3q. �m _ � � p D �• Building Division " A_ Paul Roma,Building Commissioner, 200 Main Street,Hyannis 0260A Y Os stabl www.townbam �®f7 Office: 508-862-4038 � �u y Fax: 508-796-6230 EXPRESS PERMIT APPLICATION - RESIDENTI � IY Not Valid without Red X-Press It rhd Map/parcel Number 1 Property Address-----•C �-�.2 �. ___ GQr 1 41�_.V_kI k [Residential Value of Work$ '��,Q90. 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address LA��(t N tt t* vk Contractor's Name Cj Ft, Telephone Number 7�$, �6g "-0 Home Improvement Contractor License#(if applicable) 16 g©t13 Email: Col Co G1't an C.� �nQr-t Co Nt Qj Construction Supervisor's License#(if applicable) 4066LC . f VWorkrnan's Compensation Insurance , Check one: 1. ❑ I am a sole proprietor am the Homeowner ' have Worker's Compensation Insurance" Insurance Company Name 4, J Workmen's Comp.Policy# *4 G 3 CJ 2- Copy of Ins ance Compliance Certificate must accompany each permit. Permit Re est(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to SkL� 1cCe Mir,S ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof). ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value {maximum 32)#of windows #of doors: *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 rovement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:1WPFn, W0RMSlbuildmg permit formsUTRESS.doc 01/25/17 w 27w CFJt7mm f E oyfAfazadrxu tfs ♦♦ ���C� ltRat e�CC��'ItS , ._, 600 WashfiW M,STfta Bostoi;M4 0211 jvrsnvwmxgvofdz Wcwlm& CorapensafianIusurauce Afffdbrv�t Bugdvi-dCnntrachmsMecftician&ThmLiker7s AppHcamtforma an / Ple2se Print I Tame - C ca T -vb ve CitgjS Il�t . `�(G1.21 -e wC``1 02-6�.> Phew L165—(Y O Are�II an employer?Checkthe appropriate berm Type of project(req�e=q-- L L"1 I am a employer v 5— 4. ❑I am a geieaal cw2csctar and I 6. Dons[ employem(tall anilbr part-�i�ime).* have hired gm� ❑Ides lo.g Z.❑ I am a sale propmietas arpmt=r- listed cadre attached sheet ?- ❑7RPTn deEigg. slap and Dave no emplyees CM&;act=have aadl>ave xvo�rs' S- ❑77emalififla ' wai-Ing forme is any mF�Y- 9::❑Bud additi INe wad'comnp.iasmance comp.iasari m•# reg3!Ted.] 5.0 We area capom im and its 10-❑Electrical nepaim or adc5Hons officers have exercised f 3_El ama laameo�r doing all�eark 1L❑I'himbsagrepairs or$dchlioas as er]ifQ. 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FaRum to sem-e cavmww as requa-ed.un&r Serb=25A of Mtn.m M can lead to tie imposition of criminal peuallies of a fine up to$Lr5Qb Oa sadtar osiayeasimp sm3ment,as weft as rivd penalises Jn the farm;of a STOP WOKK flBMand a f of ug bcs$ZSQOa a day agaiizst the violabr. Be advised fliat a aapy of tbis.statement maybe Rmward A to the OffuEe of Insrestrgations of1he MA Ex snsumaca:mvemge,mom.. 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'+: t ■ u1 1- • n • . •v.•.n u■ ••.1 • 1.• ■• n_n. ••1 n :.•.1..� n •a. r•.■r .0 m _n■ a.. • •.1 •_+ .n • ••-••••1■ r. �., ...�. 1 ..I i S 1 Y...1. ■.. .Ilia,. 1•:•fa ■.t:■ a ■Innav■� ■c■ t• .■ all Sir, Y ,t • . cmrEPcOD CAPE COD HomE IMPROVEMENT Tm 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710-100 9 (508)469.0102 CAPECODINC@GMAIL.COM, WWW.ROOFC.APECOD.COM, WWW.FACEBOOK.COM/CAPECODHOME THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOLI "TONY" SIVITSKI ACCEPTED BY SIGN DATE I ACCEPTED B ��Y SIG -DATE 4 �. •�� F i - CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY - PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE i `+office of Consumer Affairs&Business Regulation-Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home Improvement Contracting Home Improvement Contractor Registration Lookup To search by registration number, enter the registration number in the textbox below and click the 'Search' button. Search by Registration Number r-� �Search You must click the "Search Registrant" button to search by name or location. Search by Registrant Company name -� Search by Registrant Last name ivitski City/Town Search Registrant State Zip code —� Click on the registration number to.view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Thursday, May 4, 2017. Search Results RESPONSIBLE REGISTRATION EXPIRATION RegistrantName INDIVIDUAL NUMBER ADDRESS DATE STATUS CAPE COD HOME SIVITSKI, ANATOLI 168043 27 MILL POND RD 12/06/2018 Current IMPROVEMENT, INC. WEST YARMOUTH, MA 02673 ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. https:Hservices.oca.state.ma.us/hic/licenseelist.aspx 5/5/2017 r ixnF'o.ei�4� ,• ,. ' Mas,sac'husetts e artye of Public Safety Boa'rd Bulkdlohg and Standards Convstructlf.) n SupervIsor Specialtv, » CSSL-106040 .1,4 ow, .fit ANATOLI . � Y Tom' * - 222 BUCK ISLA -D RID`6 y a ` !YL WiestYarmouth016 # - Ex p- t' r tJ o t! Commissioner 05/1412018 . f� ACC>RD CERTIFICATE OF LIABILITY INSURANCE u""(MmuUITYTT) 111,1--f 06/08/2016 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsemetlt. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. ' PRODUCER CONTACT DOWLING&O'NEIL INSURANCE AGENCY r NAONE--Christine Davies PHONE • (508)775-1620 — — �F. EA DREss: cdavies@doins.com 973 IYANNOUGH RD. -------IN SURER(S)AFFORDING COVERAGE NAIC& HYANNIS _ _ MA 02601_ INSURERA: AMGUARD INSURANCE CO 42390 INSURED —_-� - INSURER B: _ __^` ----- CAPE COD HOME IMPROVEMENT INC INSUREFIC INSURER D: 27 MILL POND ROAD INSURER E WEST YARMOUTH MA 02673 INSURER F: — COVERAGES CERTIFICATE NUMBER: 59476 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�--,n,pE OF INSURANCE• :AD DL SUER POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS IYYYYI COMMERCIAL GENERAL LIABILITY ': - - EACH OCCURRENCE S I i DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMlaESAEa occurrence — S ` MED EXP(Any one person) $ N/A' 1 PERSONAL&A_DV INJURY____$ _GEN'L AGGREGATE LIMIT APPLIES PER: i GENERAL AGGREGATE $____ hI POLICY PE� LOC ( PRODUCTS-COMP/OP AGG Is ff OTHER: I$ . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT `Fr ---I I - (F�.accidentL._._-- $ �—;I ANY AUTO BODILY INJURY(Per person) $. I i ALL OWNED SCHEDULED AUTOS AUTOS N/A -BODILY INJURY(Per accident) S HIRED AUTOS NON-OWNED PROPERTYDAMAGE AUTOS I i , Per accide t $_ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ R EXCESS LIA I--� M _ - i - - '- ^ CLAIMS-MADE I N/A I - AGGREGATE is DED !RETENTION WORKERS COMPENSATION i. X PER OTH- ANDEMPLOYERS'LIABILITY Y/N ANYPROPRIETORfPARTNERIEXECUTIVE ! I A OFFICER/MEMBER EXCLUDED? N/A wA ! NIA R2WC746392 06/03/2016 06/03/2017 E.L.EACH ACCIDENT __ $ 1,000,000 (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEEI$ 1,000,000 R yes,describe under i. DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) - Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy Rrecedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www,mass.gov/lwd/workers-compensation/investigations/. 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 , Daniel M.Crowl'ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. _ Ar incin ox i,)nlA/nil _ Thn Ar`non oomn onrt Innn flrc ronicfnrcrl ma k4 of Ar`nOn TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION' Map Parcel Application #1 Health Division Date Issued 7 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis (Project Street Address �_�� �� l 1tf �7 D3 Village L 01W lr- Owner jo ( Z A li SDh awn-e-i- Address Telephone ( Ll ® '7 (` �Permit.Request tool L`/_ I S442 ' y'" Clif®17 ) Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation fAg,,000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Oth r �iLDI4`,C'aEV . Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ APR 14 2011 Commercial ❑Yes ❑ No If yes, site plan review# TOWN O�E3AR�S AB'� Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ; it)e Telephone Number Address . 3S L4L4- �tI uL -uq-h License# �__ __j C6.n46,r V/�- A4 02-W- Home Improvement Contractor# Email L_ ma rcorn I'1D'i 1YIa I, COW Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE .1- DATE` S j FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER • DATE OF INSPECTION: FOUNDATION FRAME P 's. INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f - .77w Commortireakh of assachusettr*. Deparhrfent�r,f I'tt tria1Acdderd - -- Qfue a,f 1it gatEWU _ 600 Washingion S'ti eet _ Bastoul CIA 02M wymn rrtax%gorldia Warrlmrs' Campensaffma Insurance Affidavit Bu@Uder-s/CnntractursJElec ri,cianslPlumhers AppEcant Informafraa Please Print PINY Nmm Address: fCit�l�tatef _ Phony�. , / Are you an employer?Check the appropriateba Typeof project r I_❑ I am a employer with 4. gal am a general cmtmctor and I 6. Ide4v aconsiz z i employees(full and/or part-time * liave hired the sub-contractors 2.❑ I am a sole proprietor orpartner- risted oa the.attached sheet :. y7. ❑Remodeling stint and have no employees These sub-corftaclors have 8.'.❑Demdaba Working employees andltave workers' or37nb farme in any capacity. 1 9. Building addition, a INQ 4y kem, camp_insurancecomp-enartrarrt5r ❑ f r ed. 5. ❑ We are a corpomfion and its 1 ❑Electrical repaiis or a des officers have exercised their 3_❑ F am a homeawn�r doing all;wad I Q Pluimbingiepairs or additions. myself[N8 woikers'gip- Tight of emampfion per MGL 17❑Ito ofrepairs insurance required.]T. c.152,J1(4k and we have no i employees:[No workers' 13.❑Other J cow_insurance required_) •Any Wffcsmtthat cbecUbox ft1 mast also fMcutthe sectionbgawsbaning dmkv+arters'compoxmticapaRcy iaEomnsgmL H=MM euerswlto submit dds of&v9 indicating they Rmdaia;allwat at A&enbim outsidecont a mrsmast sabmita newaffidaeit iadicatiao smcTL . fCanr&a=iff=cbedi1d box mustMacheaaaaddi5-al shed dboumgthanaaeofthesnb-comtrzaarssndstate whether arnottlLoseentitkshaw empiayees.If the sub-caa�hwe emgIoyea%they ymi&their sackers'camp.pormy number. I scat arc erligLayer that isprvtzdirtg warka s'cott2pe udian irmirance for nzy rxWh;yem Hetoiv is the pv cy artdtab site . ir�formrrfart ,' . Insurance Company Name: Tflficy il'or self--ins.Lie-A&L - FxpiEatianDate: Job Site Address citylstatet�.tp: At{ach a copy of the workers'compensationpolicy-declaration page(showing the poricy number and expiration date): Failure to secum coverage as require3 utzder Section 25A o€MGL c�1572 can lead to the imposition of criminal penaNes of a fine up to$L50D UO andr'or one-yearimprimnnient,as w6H as civil penalties,ia the fog of a STOP WORK ORDERand a fine of up to 0_00 a clap against the violater. Be advised that a copy of this statement maybe forwarded to the Office of Itrvest gations o€the DFA for insurance coverage yerification_ I do heraby c f}�tx .surf pstrah�res a.Per ttry fhatflte innf`or+na#im}pratzrTed wig trace wid earrect Sitatirre: Date 1 PhGffE w 7 rrlf�ciaL use cat£y. I7a not arrrte Fat trite axes,tar be coirspfetesd lip city artotrn nf,�rcuit - - Cif or Town: Pernzitd icense;9 Imning (dad r one): L Board of$edit h .Building Department I City1rown Clerk d:Electrical Inspector s.Plambing Inspector 6.Other Contact Person: Phone#: InformatioA and Ilstructi-ORS Mass r_hncE t Geheaal Laws chapter 152 regazes all engloyers Yo provide workers'compensation for flier empIoyee s_ P tr this Statafe,an Mr V&yee is defJned as.¢_.eveaypersonin the sm-vice of another under any cont-act,ofhire, Mpress nr iiupliexl,oral or writ f -7 An employer is defined as"an individual,partnership,asso®iion,corporation or other legal e�y,or any two or more of 13ie Ex-egoing engaged in a Joint ,and inchndng the legal representatives of a deceased employer,or the rmei4cr or trastee of an individual,pmtim ship,association or other legal entity,emplopmg employees. However the owner of a.dwt- ing hone having not more than three apartments and who resides therein,or the occzpant of the- dweIIing house of another who employs persons to do maintenance,conskaction or repair work on such dwehling house or on the grounds or bmZ mu apgudenzot themb shaU nDt because of such employment be deemed to be an employer" MGL chapter 152,§25C(6)also sfa:tcs f12t leverystafa or local firms agencyshall withhold fhe issuance or of a ficense or permit too operate a business or to contract bruildags in the cornmDnwealth for any. renewalP P applicant who has not produced acceptable evidence of compr=m wits,the ffism-ance-coverage regnired" AdcHtionally,M(r•`L chapter152,§25C(I)stirs¢NDjffimthe rrntt mwran nor�y ofitspoIitical subdivisions shalt enter into any contract for the pmrforro auce ofpublio wmk umbl a cct ptable evidence:of compliaD ce with e ice. req�enfs of this chapter have 1ietn presented to&e contacting anth oayf Applicaut� Please:fiIl out: the worlten,compensation affidavit complet4y,by c.he �the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)landphonernimber(s)alongw&their=tJfIcate(s)of n,ace. Limited Liability Compames(I.LC)or Limited LiabrH4 Pa rft=sbTs(LIP)wino employees other than the members or partners,al a not mguired to cagy workers'compensation i asoiance. If an LLC or LLP does have employees,apolicy is rupfted. Be advised that this a$dayit maybe mbmitted to the Department of Indusfrial Accidents mr .confumation of insurance coverage Also be sure to sign and date the affidavit The affidavit should bez•etrmmed to ffie city or townti>st the application for thepennit or Iicense is being requested,not the Departmmaf of Ln2nstriat A_ccidenfs- Shouldyou have any questions regarding the Iaw or ifyou are regm a to obtain a workers' compensation policy;please call the Departmemtofthenamber listed below. Self-fi nredcompaniesshouldentertheir s e1f-fi SU17ar,ce license nnmber on the appmpiiats line. City or Town Officials t Please be sure that the:affidavit is complete and pried.legibly- The Department has provided a space at the botfam of the affidavit for you to fM out ia the event the Office oflnvestigafiom has to contact you regardm. g the applicant- please be sine to fill is the pen�>t/licemm mmmbm which will be used as a rmfe ce namber. Tu addition,an applicant Boat must submit muldple pennNIicense applibations is any given year,need only submit one affidavit indicating can: t policy inirnation(if necessary)and TMd `lob Situ-Affdm&*the applicant should write"all locations n (may or town)."A copy of theaffidavit thathas been.officially s tamped or mmked bythe city or town may be provided to the applicant as proof that a valid affidavit is on file for futm: 'perni4s or.licenses A new affi.davitunrst be f c d out dash year.Where a home owner or citizen is obtiiaing a license or permit not related to any bnsmcss or commercial ventro (ie_ a dog license:or permit to bum leaves On said person is NOT iequiced to complete this affidavit The Office of Inves:flgafions would hie to thank you in advance for your cooperation and should you have any questions, please do not hesifate to give us a cal The Deparfinemt's address,telephone and fax number: 'I f�a=ffiDOn 1jj of Massachnse s ' Degadamt of lidustda Agents fiw� Of of Xu. esCzgm �4�aslzi�.�#an Tf,-L#617' -49W i=t 4-06 car 14' I LA SSAF Fax#617`27 7M xevise4-24-07 .m -g(2gf�Ia CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) `..� 04/14/2017 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: annielukas T EDMUND GARRITY&CO INC PHONE 617 354-4640 ac No: E-MAIL ADDRESS: annie@garrity-insurance.com 545 CONCORD AVENUE INSURERS AFFORDING COVERAGE NAIC# CAMBRIDGE MA 02138 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: STG CONSTRUCTION INC INSURERC: INSURER D: 2 SPINDRIFT LANE INSURERE: BOURNE MA 02532 INSURERF: COVERAGES CERTIFICATE NUMBER: 143970 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. ILTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDY/YYYY M EFF M/DD� LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY 0 PRO ❑ JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident r 1 $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? NIA NIA WA AWC40070335782017A 01/02/2017 01/02/2018 (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 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can.be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. N CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Allison Turner ACCORDANCE WITH THE POLICY PROVISIONS. 309 Vale Lane AUTHORIZED REPRESENTATIVE Somerville MA 02143 Daniel M.Cr ,CPCU,Vice President—Residual Market—WCRIBMA Y ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AC®R� CERTIFICATE OF LIABILITY INSURANCE ""11l:(M lJW'""' 06/08/2016 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 pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsemehit. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Christine Davies DOWLING &O'NEIL INSURANCE AGENCY PHONE 508)775-1620 FAX p; E-MAIE : cdavies@doins.com _ 9731YANNOUGH RD. INSURER(S)AFFORDINGCOVERAGE NAIC# HYANNIS MA 02601 INSURERA: AMGUARD INSURANCE CO 42390 INSURED - INSURER B: _ CAPE COD HOME IMPROVEMENT INC INSURERC: INSURER D: 27 MILL POND ROAD INSURER E: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 59476 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP Jim virvn POLICY NUMBER LIMITS COMMERCIAL GENERALL'ABILITY EACHOCCURRENCE _ $ CLAIMS-MADE OCCUR DAMAGE PREMISES( aEoNTED $ MED EXP one arson $ N/A PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ — accident, ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOSL $ AUTOS a accide t $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION X I SPTATUTE I I OTH- ANDEMPLOYERS'LIABILITY Y/N ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT s 1,000,000 A OFFICER/MEMBEREXCLUDED? WA WA WA R2WC746392 06/03/2016 06/03/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000 000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more apace Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policyprecedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. 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. Is AUTHORIZED REPRESENTATIVE Daniel M.Cr0_Q6y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. Arnon oc mniA/nil The Amon nernn onrl Inn^ern reniefnrerr n�erYro^f A/`nOn Town of Barnstable Regulatory Services , pQ Richard V.Scali, Director r ` Building Division L►snrsr . + Paul Roma,Building Commissioner MAM $ 200 Main Street, Hyannis,MA 02601 fD Mla www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print �DATEt `JOB LOCATION: . Q— 1 �i(`� r�11 C ra i v! I P number street village) (01 ?_'fiSD- 02 � name home phone# work phone# CURRENT MAII.ING ADDRESS: > Dock' b e-CJ%P 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. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to -be,a.one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. . The undersigned"homeowner"certifies.that he/she understands the Town of Barnstable Building Department Weme es and requirements and that he/she will comply with said procedures and Approval of Building Official 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. 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 of 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. �tHE Town of Barnstable Regulatory Services * BAMS AEM KAM Richard V.Scali,Director o 19. Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Pro erty.Owner Mu t Complete d Sign TI i Section If Us A Buil er; I ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by buil g permit application for: (Address o Job) **Pool fences and alarms are the esponsibility of e'applicant. Pools are not to be filled or utilized efore fence is ins d and all final inspections are performed an accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNER M&SSIONPOOLS F O'R 1 E E MEMBER REPORT Level, Wall:Header PASSED f� 3 piece(s) 13/4" x 5 1/2" 2.0E Microllam® LVL Overall Length:6'5' 0 0 6'Y a o All locations are measured from the outside face of left support(or left cantileverend).AII dimensions are horizontal. Design Results Actual @Location Allowed Result LDF Load:Combination(Pattern) m _,I System:Wall Member Reaction(Ibs) 908 @ 0 5709(1.50") Passed(16%) 1.0 D+0.75 L+0.75 S(All Spans) Member Type:Header Shear(Ibs) 743 @ T' 6309 Passed(12%) 1.15 1.0 D+0.75 L+0.75 S(All Spans) Building Use:Residential Moment(Ft-Ibs) 1456 @ 3'2 1/2" 7333 Passed(20%) 1.15 1.0 D+0.75 L+0.75 S(All Spans) Building Cade:IBC 2009 Live Load Defl.(in) 0.057 @ T 2 1/2" 0.214 Passed(L/999+) -- 1.0 D+0.75 L+0.75 S(All Spans) Design Methodology:Aso Total Load Defl.(in) 0.080 @ T 2 1/2 0.313 Passed(L/963) 1.0 D+0.75 L+0.75 S(All Spans) Deflection criteria:LL(L/360)and TL(5/16"). Top Edge Bracing(Lu):Top compression edge must be braced at 6'S"o/c unless detailed otherwise. Bottom Edge Bracing(Lu):Bottom compression edge must be braced at 6'S"o/c unless detailed otherwise. ! - — - Bearing Length Length _._ ___ Loads to Supports(Ibs) i Supports Total Available Required Dead Floor Snow Total Accessories Liv 1-Trimmer-SPF 1.50" 1.50" 1.50" 258 289 578 1125 None 2-Trimmer-SPF 1.50" 1.501, 1.50" 258 289 578 1 1125 None Tributary Dead Floor Live Snow Loads Location(Side) Width (0.90) (1.00) (1.15) Comments 0-Self Weight(PLF) 0 to 6'5" N/A 8.4 1-Uniform(PSF) 0 to 6'5" 6' 12.0 15.0 30.0 Residential-Attic and Snow Weyerhaeuser Notes l SUSTAINABLE FORESTRY INITIATIVE Weyerhaeuser warrants that the sizing of its products will be in accordance with Weyerhaeuser product design criteria and published design values. l Weyerhaeuser expressly disclaims any other warranties related to the software.Refer to current Weyerhaeuser literature for installation details. (www.woodbywy.com)Accessories(Rim Board,Blocking Panels and Squash Blocks)are not designed by this software.Use of this software is not intended to circumvent the need for a design professional as determined by the authority having jurisdiction.The designer of record,builder or framer is responsible to assure that this calculation is compatible with the overall project.Products manufactured at Weyerhaeuser facilities are third-party certified to sustainable forestry standards.Weyerhaeuser Engineered Lumber Products have been evaluated by IOC ES under technical reports ESR-1153 and ESR-1387 and/or tested in accordance with applicable ASTM standards. For current code evaluation reports refer to http://www.woodbywy.com/services/s_CodeReports.aspx. The product application,input design loads,dimensions and support information have been provided by Forte Software Operator Forte Software Operator Job Notes 4/1 3/201 7 2:37:19 PM Brian Bourque Forte v5.2,Design Engine:V6.6.0.14 Bourque a Paine Rebello lake Elizabeth.4te (508)400.5105 — bbourque7l@gmail.com Page 1 Of 1 -712-0l1, pFtHE Tp� Town of Barnstable *Permit P� Expires 6 months from issue date Regulatory Services Fee * BARNSTABLE, "�;1639. � Richard V.Scali,Director __ ATFDiNip'��A o� m� Building Division v� Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 , www.town.bamstable.ma.us fffhva50 `8638 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number 9 �7 1 z o Not Valid without Red X-Press Imprint Property Address L5 a 0, ❑Residential Value of Work$ 41000 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address &oel \i-4rNe-c- l7 (iv- �:h 0,je-C PIA G r-�-o:so Contractor's Name JPqr,v-, S CySTaw� &y-,e,S Telephone Number 508' SU 00T S Home Improvement Contractor License#(if applicable) L1y l 5a Email: Sc Ae �Jc :5ec-sn C v s:12:� Construction Supervisor's License#(if applicable) C5 O S�1 S3 21 Vorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 2-I have Worker's Compensation Insurance Insurance Company Name kmeidA GA6a^ L jvcc-^Ge. Ayev. j T-vn cG 1 . Workman's Comp.Policy# Wcc Soo 5o h 3y 9 ao BA Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side [replacement Windows/doors/sliders.U-Value - o (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 Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Piry C:\Users\DecollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 Office 0 nsEnz'r A���"�C�B nests 3;eg tion a License or;Te rat;oa Valid for individul use only 4iUtA1'eStehP4tO�fEt9rStbj COlBSrRACT04t beforetbe If-found return to: ' Offi Registration: -174152 Type ce of Consu'wer €rs-and Business Regulation s, Expiration: IM2017 DBA !ti"Par)f Pig Sew•g 3 ( ? 6 = $assort: M116 SEaFI WATTS CUSTOM HOMES _ SEA" WATTS 30 BAPTISTE LANE EAST FALMOUTH,MA 02536: Uaderwretarp '"fe*� y -Leo ri' Uhrestricted-°Buildings of any use group which Ulassachuse_ts Board of 3a;:�s,: e < contain less than 35,000 cubic feet�p91M )of enclosed space. CnnSmetrt�r. ace. _:cerise' CS-.0 Sg, D WATTS 3010 L' _ East PsimoU. Failure to possess a Current edition of the Massachusetts State Building Code is cause for revocation of this license �.• A ' ° For OPS•Ucenstng inforntadon visit: wwwmm.Gov/DPs- bF W. l . .. .. 27ke Cornnionwedth of A?assaclrusetts Department of Industrial Accide ats Office of Investigations 600 Washington,Street Boston,AL4 07111 wv.inassgov/dia. Workers' Compensation Insurance Affida-vit:Builders!Conti actors/E ec.tricianslPlumbers Applicant Information Please Print Legill Name(Bvsinesstorganizationandividual):soc.n Qtx.*S CvS12M HrI�e S City/StatdZip: G���dhv�}4• A-NA oa5�iL Phone#: 505T 56 6—OO 7 T Are you an employer?Check the appropriate boa: Type of project(required): 1-2011 am a employer with 4 4- ❑I am a general contractor and I employees(full an�dfor part-time)-* have hired the sub-contractors, 6. ❑New construction. 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity- employees and have workers' [No workers'camp.insurance comp.insurance-I 9. ❑Building addition required] 5; ❑ We are a corporation and its M❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself No workers'MUIR right of exemption per MGL insurance required.]i c_152,§1(4� and we have.no 12.❑hoof repairs in 13.❑Other employees.[No workers'. comp insurance required.] 'may applicam that checks boat#31 must also fill art the section below showing Meer workers'comrpensationpolicy infomutim Homeowners who submit ibis affidavit indicating they are doing all work:and them hate outside c.onuacwts mamst:submit a new affidavit indicating such. iCCtmtractors tbxt check this box must attmched an additionei sheet showing the name of the sue-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they mm®st provide their workers'comp.policy comber. I am an employer tit at is providing workers'conWensation insurance for wry ewpL9jw.+es. Below is the policy areal job site inforwration. A Insurance Company Name: f'C iMP�i`L t./��c' t., \5yro n c e f�c!t� 2:111 L Policy 4 or Self-ins.Lic.4:W C C,j O 0,j O 11 34,I.'X O i Expiration Date: Job Site Address:_3s a Lc.k �lizabah 04r- cityistateizip:(tvAer- i We MA 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 ci-61 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 Iinvestigatixms of the DIA for imwance coverage verification. I do hereby certify sander the ar canal penalties of pedury that the information prmvaded absve is tare and correct Sigtnatt 7 44-i Date: 7" 17— 1 5 Phone ©oqS t7Qia ial use only. Do not write in this area,taa by completed by city or town of dart City or Town: Permit/License# !swing Auth.arity(circle one): 1.Board of Health ?.Building Department 3.City/Town,Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 fNE 1p� * &mmirABLE, i 9. i639• Town of Barnstable �� ArED MA'I s Regulatory Services Richard V.Scali,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, 1 ���e� ,as Owner of the subject property hereby authorize ?PC� Ll�S ws-)rl� to act on my behalf, in all matters relative to work authorized by this building permit application for: 3 5 X Lc - B r ZCAO�-k\. OE- Ce'q1VeNA 1 e I-LA, (Address of Job) Si ature of Owner Date \fe �� �/ VI'�re ✓L Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOI DHR\EXPRESS.doc Revised 040215 . - DATE (fdtdIDD1YYYY1 RTIFICATE OF LIABILITY . INSURANCE 42IO�r2015 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 MPRESENTATIVE OR PRODUCER,%AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(ies) must be endorsed. if SUBROGATION 15 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 Phone:508-540.6i61 Fmc 508457-7660 �� Bob Ailietta _„ ALMEIDA&CARLSON INSURANCE AGENCY INC. PHONE 808.0550 A/c No Ea• 508 508 888-D207 NC�Nok ( ) P.O.BOX 554 tsitetbu@;Mmeidacarlson.com FALMOUTH MA 02641 EMAIL m WSURER(S)AFFORDING COVERAGE NAIC# INSURER A Arch Specialty Insurance Co INSURED - INSURERS :AEIC SEAN WATTS CUSTOM HOBOES PO BOX 737 INSURERC EAST FALMOUTH MA 02536 WSURERD: INSURER INSURBt F COVERAGES CERTIFICATE NUMBER: 29423 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 D CO DITIONS Q-E SUCH POL)C E5.L{MiTs SHOWN MAY HAVE BEEN REDUC D BY P ID CLAMS. INSRI ADIYL SUER POLICYEFF POLICY EXP LIMITS LTR TYPE OF INSURANCE 1 INSR I WIND POLICY NUMBER MIO a o A GENERAL LIAGUTY } AGL0008642.01 01/24/15 01/24/16 EACH OCCURRENCE s _ 1,000,000 'li A GE TO RENTED 50 000 COMMERCIAL GENERAL LIABILITY ( PREMISES(Faccaeenm) $ , C CLAIMS-MADE i X!OCCUR MED.EXP(Arty one person) S - 5,1100 _ X BLANKET ADDI INSUREDS (E PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE S 2,0110,000 GENL AGGREGATE LIMIT APPLIES PER I PROD IOP AGG S 2,000,000 i I POLICY I I I LOC _ I S AUTOMOBILE UARUM ! ((EaaacddEg WGLEL411R $ ANY AUTO I BODILY INJURY(Per person) !S (— ALL OWNED AUCTEOSULED ( BODILY INJURY(Per acddent)($ AUTOS OWNED I i ! PROPERTYDAMAGE I s IHIREDAUTOS UT� I (neracddent) _ I __._....— + UtdgRELLA LIAR I OCCUR EACH OCCURRENCE S v I EXCESS UAS - CLAIMS-MADE I ({ AGGREGATE - _- OED RETENTION$ I I _ i B WORKERS COMPENSATION WCC50050993492013A } 09122194 09122J95 + TORYTLARJ�ns I 1 EAR I s AND EMPLOYERS' LIA61LnV YIN ANY PROPRIE OMPARTNEREI�6UME E.L.EACH ACCIDENT s 100,000 OFFICERTMENSER EXCLUDED? f N 1 A E.L.DISEASE-EA EMPLOYEE S 100,000 Ifyes,desaibeundar EJ_DISEASE-POUCYLIMIT Is 500,000 DESCRIPTION OF OPERATIONS DCIM" ( j DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCER ED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ` ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEWATWE _ Attention: +, Bob Allietta ACORD 25(2010105) ©1988 2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Assessor's map ;and lot.,-number ........: ,. �.............. ......... �. THE f s I /,WD D pi tp �, Qy Sewage Permit number '"... ...:......::....,. DAR35TADLE; i House number .............................................. ......................... rasa �p 163q. TOWN OF , BARNSTABLE BUILDIN INSPECTOR LICATIONFOR PERMIT TO ............. ......6. ........................................................APP ........�................... ......... (...'� TYPEOF CONSTRUCTION ......................................................:..................................... .. ...,�............................ ,S 19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies ffor a pe"4-nit according 'to the following information: Location ............ CZ' �... fr........ � .. ../ : �..: '...I.,.C' .. .; ,.l_ v//.ff 3s i '. Proposed Use .............�,�:� . � .:(.. l .�........ ZoningDistrict ................ t�. / ... ..... ..Fire District ........... `:s`...... .. Name of Owner '.�.�l.Wclress ..> ......... t e.Name of Builder . ..,•i 1.,��1{ ........,..... .... ....G�......... ........Address ...... o�`ff .ral..../! .... Name of Architect .. �/ w .`' ,E. ,;.:7 y�i.1G'_ .......,. :Address ./....../... .... ` ? .f,. 1 �. .�.� . .. .. . .. . . . Number .of Rooms ...<.................(�.�..........................................Foundation ........,�...en). ..0 Exterior ... .�.�1 .........................y ....................:..Roofing ...... ,�r....yy ("-`F-''....... d . Floors + .. .� :............:.. :. Inferior. !' ....P... ... ....................................... ....... Heating{ .... ............ Plumbing le ........ .. - f,;{.l i� Fireplace. ........ . . 1.........................................................Approximate Cost ..................�.`:�.. f�f ` Definitive Plan Approved by Planning Board 19 __. Area Diagram of lot and Building with Dimensions fee SUBJECT TO APPROVAL .OF BOARD OF. HEALTH oob�A OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby--agree to conform to all the Rules and Regulations of the'o n of Barn fable regarding the above construction. Name ......... .. .............................................� Construction Supervisor's License .................................... PRESTON, ELIZABETH J. A=227-030 a C - 32892 No .... One............. Permit for ...............Story.....o St...ry.... I ... Sincjle Family Dwelling location ... ##2 .r......35.2 Lake. ......Eli. .zabeth. ,Drive .. ....... .. .. . .................Craigville................................... Owner .....Eliz.abeth. ...J......Preston. . . . .......... ....... ..... .. . .... .. .... .. .. Type of Construction Frame YP .......................... ................................................................................ Plof ......................... Lot ................................ Permit Granted .........M!Y... .............19 89 Date of Inspection ....................................19 Date Completed ....................�..................19 i . )� ��� ,_• kr.. „„.y,,.Y.„, x+..,`�.•.r.,..:...,�.'.. .i'—a,. -.;,.. �.,,. .z;:+ .. .X,PJ ,. o i<r�,r- .,„-..r - . _ __ _ fs .r- v :UT T4 4 ,f o TOWN OF BARNSTABLE Permit No. .3?:R9.2....... BUILDING DEPARTMENT g aeaarr I C8St1 s Q.; ,, ■wa TOWN OFFICE BUILDING HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Elizabeth J. Preston Address Lot #21, 352 Lake Elizabeth Drive Centerville, Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD 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. DG2E� 8 , l9 $9 . • ...... Building Inspector r lZ�',a'afs;�y,;m�N'a.t'1�r<r 1 _,- S+ +"� < t GT•+ r , ��k•��+��tom'�+' � 9 �r AWN OF,BARNSTABLE, MASSACHUSETTS, BUILDING PERM1' A=227 030 x 'L DATE' a� 1..5/ �g,.,e 89 PERMITha y APPLICANT' Rack so lows oxentervi�°ie ADDRESS / 104141 s « (N0.). - (STREET) (CONTR'S.LICENSE) ttr PERMIT TO Build Dwelling 1 Sin le) Famil DwellingMBER OF (_P STORY g Y a ELLING UNITS " .-..(TYPE OF IMPROVEMENT) .. NO. (PROPOSED USE) s 'AT:(LOCATION) Lot `f121, 352,Lake Elizabeth Drive, Craigville ZONING , , RC _ (N0.),. (STREET) 6ISTR ICT_ h BETWEEN AND -# - (CROSS STREET) s (CROSS STREET)SUBDIVISION LOT BLOCK', LOT ,a SIZE BUILDING. IS TO BE, FT WIDE BY FT. IN HEIGHT AND SHALL CONFORM IN,CONSTRUCTIC IFT,:LONG BY •� a W ro ` TO t TY Yy USE GROUP, BASEMENT WALLS,OR FOUNDATION Tl (TYPE)4 t � REMARK ` x .B�waae : 89-127 Appals z # 1987-39 4 � 0300:00) � AREA OR '' tltl , c y 9,} VOLUME 1500 $Q• ft• ESTIMATED COST $ 50 c 000• 00, MIT y t iCUBIC/SO DARE F PER 7. 9.00. t� s )A -.,E ET) FEE , - n t ` OWNER8b:�33� ;J� }+ r .ADDRESS L' t ya L8k@ Elizabeth Dr. Cra c�Vl 8 BUILDING DEPT; Est r j' } r_ - BY •; OF AN APPLICABLE SUBDIVISION RESTRICTIONS. e x,. 3 MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE ) E ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR + ;t ELECTRICAL, PLUMBING AND I. 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 a .3, MEMBERS(READY TO LATH). 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. •_,.',.I, OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I � 1 Y Stied. 2�.- %-q is 3 W Sv` HEATING INSPECTION APPROVALS t2 ENGIN R N DEPARTMENT C.d ` lv.a OTHER BOARD OF HEALTH WORK SHALL,NOT PROCEED UNTIL THE INSPEC- PERMIT W!LL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY•TELEPHONE OR WRITT * ,c is CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. r . NOTIFICATION. d , ri ate..-. .,. `- NI .' '"��.".�.h`.(�.�'<2 r.•.'.�::.r..,..ak:r".Vie.,. _•,_.:.,-a=�w�",....:.. ..•-� ,.«.-ru � sr i Anz. . IF THIS na DOES va BEAR AN'ORim'm BED SSAL AND $14NATM, THEN THIS PLMI IS AN UNAUTHORIy® M"'RODUCTION AIN'D J. M. MONAHAN, JR. do ASSOCU= AND(OR A PROFESSIONAL LAND SURMOR OR ENMMS06 WHOSE SEAM. APPE&tS HEREON. DO NOT ASSMIZ AU RESPONSIBILITY FOR ITS CONTENT. ,1 AS ' BU' f..LT PLOT PLAN FO-R BUILDING PERMIT' LOCATION: PURPOSES ONLY FOR: !!nm 7. SCALEt �'`� ' DATE: a /�S REFERENCE: �3�svG ��-Z/ A?SS,vaw� Z ,oG-a �Ec or�,� ,nr-�3/ -o u�sT•o B G� , 'es G.s7-i x I CERTIFY TO THE BEST'OF MY KNOWLEDGE AND BELIEF FROM INFORMATION ACQ THAT THE =S2y^1o,v7-A0-1 ' SHOWN ON THIS PLAN IS LO ATED ON THE GROUND AS SHOWN HEREON. / � ATE PR ESSlONAL LA D SURVEYOR JO�PH © MONAHAIN JR. J. M. MONAHAN, JR. & ASSOCIATES No. i3€�ID PROFESSIONAL LAND SURVEYORS & ENG !'iIEFRS e EGiSIER�oQ� TOWNE PLAZA • 900 ROUTE 134 SOUTH DENN.15, MA. 02660 � su 4. J.N.86-� Assessar's::,map and lot number ....... ' � THE �oF roe♦ �P o Sewage Permit number ,Sj/ z ,'--PT1C SYSTEM MUSS' F—J.j ; I"STALLED IN COMPLIA� M LE, Housenumber ......................................................................... . WITH TITLE 5 °o',F 639 ;�NWa,,ll )f � F I . d\ ST SUPERVISE TOWN . OF BARN;." E ER INSTALLATION AND CERTIFY IN WRITING THE SYSTEM WAS INSTALLED IN STRICT BUILDING I PEMR�Pam. 7 �-yAPPLICATION FOR PERMIT TO ..... / .............bal .... ......... . .... .......................... .......................... . Q� .. lam/ LJ TYPE OF CONSTRUCTION ............................................................................. ........................... ............... ... ...........19 TO THE INSPECTOR OF BUILDINGS: The undersigned ereby applies for a per it according to the following infa ma7t,on: Location ........... ..... ..................... ............ ProposedUse .............. �.!! . . ............................. .......:................... ....... Zoning District ................114 � 1�'�,�................Fire District v . Name of Owner ( .�z l�e y• . .I79.).Adress ..<... C.l.f e �� 1 ..OF-r—ok... . I . �,'p Name of Builder ... .L `.....� . .[0. ...........Address .�GY. .. )......./..1/ ,16.... Name of Architect .... /,E ��` . Y1�../.� �.1 .............Address ........... ..... . .V•../\e..41.�1 •i Number of Roo s ......................V........................................Foundation ........ ... ..vreo Exlerior ..... ... .� ................................................Roofing ....�/ d •/>,•••..�....�•' _.. Floors .......:.....................................Interior .... ,? P................................................. ......... .P. . Heating .................. .�.1 ........................................Plumbing .!/. ........ .......... N?l�......�. t..� -, Fireplace ........ ��........................................................Approximate. Cost ................... . ... . .. . . ..... ............. Definitive Plan Approved by Planning Board rr� E__f _____19 __ . Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 3n 1 �'� boa, C b OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations ofpthnble regarding the above construction. Name .. ............................................. Construction Supervisor's License ®. l„ PRESTON, ELIZABETH J. } _tl!t j,N 32892. Permit for ......One Story t i Single Family Dwelling . ... ......................... - Location Lot #21 , 35.-2...Lake: Elizabeth. Drive .... .. .. .................... J • -'Owner-- .4.E.U9A)?.e.t11...j......�K.� Q ........ r Type of Construction' .....Fxame...... �'. ............_ `..................................... . .... ................ Plot ............................ Lot ................................ Permit;.Granted May...15!..:........19 89 - Date of Inspection ...:................................19 - WDate/Completed ...........12,6......:.::.........19J� �... .� - 16. 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(r N of O Q 0F Or Z V a � a a O- Attic Space o s o C - o CO m CO Y Y Y cc CO m m c m N O ' ---- -—- Ufinished Area Existing First Floor Conditions ---- ---- �, - -- ---- U) o o Q ` U w O 7 w = N N 6Q O N 0 -- V .. - --- I 2 O t6 m 2 cy nila U 3 c U CO � � � m O ---- --- O -- ---- o Living/Dining --- --- un _--- Hall �;� Sloped Ceiling c a 0 a- 3'-T' \—_� _ v c CCcfl O.N C --- --- -- V UJ N O a O O C I U - I U 0) ----`1---- I �N ,N j Existing Second Floor Unfinished Space M w yy ' B • o s T-11" Sheet Scale 0--m w. 2 of 4 c� I , � tl I N 0 Z I 20'-2 1/2" N • o . o L Z o d o m o 3 - o New Family Room - � o CM o a � o U Attic Space a U —_ Q N a o: CO CO m s a , O (y Proposed First Floor Alterations -------- - ------ o 0- <_ V - I 0 O w o - Sloped Ceiling o m 2 m o v a U = U 3 n L Crm -- - O �e Attic Access U Attic Space Living/Dining in - ------ Hall cY) > o _ — m L a O I -- J•y--- I C N LL O Z U w a� Cc) OL Proposed Second Floor Space L a o¢ 3'-2 3/4" _ Sheet Scale OMWV No. j 3 —of- 4 nn -- Continuous Handrail General Notes a 1.3/4"Advantech Sub-flooring glued and nailed with 8d Ring shank. o 2.Wall framing:2"x6"KD SPF Z - Calculation Provided for Joist,'Rafter, &Header Spans 1/2"Zip WSP nailed 6"edge,12"field;8d Ring shank See Attached Sheets Fasten bottom plate to floor framing with Simspon Screws Sister new full length studs in existing exterior Gable end walls Stud on top of Kneewall interior gable at Attic Space 3.Ceiling framing:2"x 8"KID SPF#2 or better. _ Joist sating 16"O.C. 4.Roof framing 2"x 8"KID SPF#2 or better. Joist spacing 16"O.C.H2.5a connectors 5. Provide Cricket where new cheek wall meets existing roof o 6. LUS28 Joist hanger where not direct bearing. 7.Exterior Trim:PVC soffit,Fascia,Rakes,and comers 0 8.Wall Cladding:White Cedar Shingles over Triflex max.5"Exposure z Typical Header Detail Roof Cladding:Certainteed Landmark over Triflex 9. Interior Finish:Walls&Ceilings 1/2 Blueboard and Plaster t Flooring:3/4"prefinished hardwood • y m MDF/Pine baseboard and casings a 8 W o0 ---s :� N J N � 2 OI O Co M `�• Ir iI I i► I i�I — � Ir -1- I ii_r o I I Y Y - Y Second Floor Guardrail at Stair Opening " III ( S IS 5 .2 $ « Headers: >4.0" 3-2"x6"KID with 112 WSP flitch single jack rn 4'0"-TO" 3-1 3/4"x5 1/2"LVL with double jack .i � m m o a o = W O N N o Q j 0-2 C 2 m Shed Roof Cross section Detail a) M Lo r to 9 g First Floor Stair Guardrails Existing Front roofand Ridge to Remain a - r t > New Shed Roof C ui Ceiling tp and Back Wall f5U L Q N CU ' ; U W N 0) i o (1) c c NU Existing JoistIF �' , - _• - a a (y Existing 1st Floor s Sheet Scale mow. fi 4 Y of r 4