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HomeMy WebLinkAbout0020 LAKESIDE DRIVE EAST ��T _ _ _ _ _ _ - � t _ - - - - _ - � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel T Application # �- Health Division Date Issued 3 Conservation Division Application Feel Planning Dept. Permit,Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address VillageU1 Owner_ C\,,JM C&,8 Address r -4 �, e, Q f V�4 LOW V0 es MA W63A Telephone 0 Permit Request _ - � v46\ Square feet: 1 st floor: existing PC'S proposed 2nd floor: existing proposed Total.new Zoning District Flood Plain "" Groundwater Overlay �Project Valuation �b.�a Construction Type lx\5u�Aorl\ 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 Jid No On Old King's Highway: ❑Yes �d No Basement Type: .4 Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft.) ALre%S 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 !X No : Fireplaces: Existing New Existing w od/coal stave: ❑ 'es ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn AO existing[�=J ne- w size_ Attached garage�4 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: t Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w Commercial ❑Yes ❑ No If yes, site plan review # �- —Current Use -- _ Proposed Use APPLICANT INFORMATION GUILDER OR HOMEOWNER) Name 15 (A Telephone Number (� y a 3 ^ 0(4 10 Address Sol CA_4_L��(ice �c� License #_ I-0 5q"I I M Home Improvement Contractor#. Worker's Compensation # _ I S. S0 1 a®� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE `t t FOR OFFICIAL USE ONLY `APPLICATION# �t�DATE ISSUED :; Yet.= r MAP/PARCEL NO. i S. .ADDRESS VILLAGE' ` OWNER a . DATE OF INSPECTION: FOUNDATION 4 FRAME INSULATION: r - I FIREPLACE ELECTRICAL: ROUGH FINAL k PLUMBING: ROUGH FINAL r — ,,GAS ROUGH:-.• FINAL 21.,�,F_INAL_DUILDIN,G DATE CLOSED OUT r ASSOCIATION PLAN NO.. The Conunonwealth of Massachusetts Department of Industrial Accidents Offce of Invesdgations 600 Washington Street Boston,MA 02111 Mww mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1 Please Print Legibly Name(BusinessDrganizationandividual): 1Eno(�\/SdK�on--� Address: � lrt City/State/Zip: �� Phone#: 7 C1 Q 3- .- OH M Are you an employer?Check the appropriate box: _ Type of project(required): 1. I am a.employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.El am a sole proprietor or partner- listed on the attached sheet.# Remodeling ship and have no employees These sub-contractors-have 8. ❑Demolition working for me in any capacity. workers' comp.insurnce. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t `employees. [No workers' comp.insurance required.] 1.3.❑ Other ;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 their workers'comp.policy information. I am an employer that is providing workers'conWensation.insurance for my employee& Below is the policy and job site information." Insurance Company Name: �,` 1 A 6k,� �� C 0 Policy#or Self-ins.Lic.#: �j Q"4 3 0 J C) a .Expiration Date: 3 a y 3 Job Site Address: �O l.�f ltlJ1_)5"1 J k) � &�5 City/State/Zip: CkIAMi6 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under fiv pains and penalties of perjury that the information provided above is true and correct Si afore: Date: 3 , Phone#: 04 Official use only. Do not write in this area,to be completed by city or town offl iaL City or Town: Permit/License# ' Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - Contact Person: Phone#: 4/25/2012 3 : 41 :33 PM 8975 12 02/02 DA18(M6 MWYM s CERTIFICATE OF LIABILITY INSURANCE ON292012 THIS CSNSIPielm I6 288NBa.As A HMEM OF IHFORNMON ONLY AID conrow so SIGHTS UPON TRIM caHTIFIQdT6 EOLO8R. 21XB CHWMCMM DOW NOT AHFiMMIVELY OR s8UMXVHZY AMED, BXQSSD OR Alm=mm Commas AFPowun sY TB$ PoLumes HHLOY. ma cour ICS4B OF INBNRAHCB DOHS s03 CONS?ITM A CosPHACT Rff�ff THE ISMBING INS M19), AMMOUMM RIMMUM TIVE OR PROWCOR, AND M CSRIMCME HOLOHS. Maroarwrz. If the certificate bolder is an ADDMOUL IRSOSBD, the policy(ies) must be endorsed. If SVMGGHTIos is I&TM, subject to the terms and conditions of the policy, certain policies may require an endarsemeaft. A statement on this certificate.does not confer ricfirts to the certificate holder in lien of such endosssent(s). Rogers & Gray Insurance Agency � na f Inc cue.an.art): e aaa PO BOX 1601 aa9aa®l South Dennis, H& 02660; COMM no. ZMEM(s)XMMUM a eon one a FOB m,nm x B.I.M. Mutual Insurance Co 33758 Frontier Energy solutions Inc 502 Haxwich Road Ismano, Brewster, IM 02631 Zonamot a: . 7691mt re ZEMM t: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TSLS Is 2D C '$MT MW ME Pads=of mUMUMS I=MO MMOR MW WHE ZS M TO"M Zak MM MM FOR 288 low=mum ZNOICB�. 71Nr MOPMUMMM, "M on cozarnas LT or Xor CaNalB OR OMM noCOvotiP armRBSPBLR 20 Warom THIS CHRMMMM saY NB IM aR MW P MMU, UMZ aOMM EY TSB POLL =N eBesai IS sw=to M&MM—, zW=SMM am CMMMM OF sum PO=M-LffiRS SHOHH Wr nu H NBOmm HY PHTD CWIIS. tnr TSB OF mVa/tttn ae/al+evi 6�8YaL I,LIBaA2r MH occou mm a ❑CMUMIM oeaoa to m» f esunssfi..smr�) 00—.GME paaaa adr—P--) f rmsom a MW laws f 0 Gomm aaistana f �eDbitT ❑eRo7t_i - YROaCK-CM/M mas ; $L Comm®Smta LJOW i - El- 0- (a amideIItl, . 2V10 a®IL4 Too(P�s i®m� i HODLS neansta� 1 f ❑sreecaGfu awns caraESItz uennd 01111M Am fos tau�q [aOa-MZa soma f . aIF affiISLA Lena ❑oc= nen f [1.nun ❑d.nB,wz f - ❑flMESTS® S ; fABa885 ® math Q alm SHPAO'ss;5 LZa� " eaorRter—/rn --0 a c.ARM MUM= ; 1,000,000 A eZBCVrive OMCEM use ❑ incl ® earl 6015315012012 R.L.otso 9L-R=Ci Rim f 1,000,000 03/14/2012 03/14/2013 R.L.M085$-n SmP.aMEa ; 1,000,000 eos¢arsI IMMAUTIEUM ae an racmiaa: FRAHCIS SHEEHAN IS NOT COVERED BY THE SWRSERS, CO1PENSA7ION POLICY CERTIFICATE HOLDER CANCELLATION THE DEP! OF LABOR STANDARDS SOMD may or MM MM BOLO=s MICUM MOM M BsetaaM=aura TBHf�DF,Notes�. 88 Nsstvsa®a ecoc vi'81 THB 19 STAHIFORD ST nor=PRWzsnoNs. 2ND FLOOR aonaoR:zm BOSTON, M 02114 � � r 8772 � �A�ia�ulGl'1ld�^tG.y—Lao' s:+G13"#'(tiff,.ZIP S:YI ;�WI)Ii": 1iF'!t;`•i Guard cif Bi-011dinti .Ind Restricted To: CSSL-IC-Insulatlon Contractor R i...ic.:ouoe: CSSL-105941 FRANCIS S, EIAN 502 H'ARWIgk RD s Brewster M*0701 Failure to possess a current edition of the Massachusetts eie•a >?:?i r?c ?t1 State Building Code is cause for revocation of this license. 02/1712018: For DPS Ucensing Information visit: www.Mass.Gov/DPS ,.. Me n�'4 lladaa�uactfd +«»� Office of Consumer Affairs&Business Regulation Liaanso or registration valid for Individul use only I ' ; OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ! Office of Consumer Affairs and Business Regulation Registration:.`100864 Types1. 10 Park Plain•Suite 5170 1, � •�o ,. Expiration: 9/812012 Supplement Gard Boston,MA 02116 \FRONTIER ENERpY BOLLiTIONS FRANCIS SHEEHAN ' D SUITE#4:. 136 STATE R _ SAGAMORE BEACH,MA.026S3 . Undersecretary f Not val ithout signature OWNER AUTHORIZATION FORM } Lo nQ lUQw M." (Owner's Name) ' owner of the property located at (Property Address) (Property Address) t� 1 hereby authorize l lrPin l2 , (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my be alf to obtain a building permit and to perform work on my property. Owner's Signature Date SOV' 5: D EAR, 2012 es f • Date: Thomas Perry, CBO Building Division 200 Main Street Hyannis,-MA 02601 RE: Insulation Permits Dear Mr. Perry; This affidavit is to certify that all work completed at: o L. ce.st e � s� Ce �4-e-w tl� has been.inspected by a certified Building Performance Institute (BPI) inspector-All work--.7 ,performed.meets.or_exceeds federal and,state.requirements Permit application number: 1-612-0 K 3 7 Issue date: -7 7- Sincerely, Francis,Sf1 President `V Frontier Energy Solutions, Inc. Office: 774-237-0410 _ Email: fssfr.o renrgy@gmail.com ,,, �1 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION e� + �J11 � S Map Parcel ! � ... Application # Health Division Date Issued ' _ Conservation Division ` Application Fee Planning Dept. OU Permit Fee 2,C Date Definitive Plan Approved by Planning Board 7/2,q)6� Historic - OKH _ Preservation / Hyannis w t-K Project Street LitAddress 2 4AL4 n�. it /O Village 1��J't-r✓ifit Owner JZyIr_ & •ewPL� Address I)r< Telephone Svc' Permit Request Square feet: 1 st floor: existing proposed U 2nd floor: existing D proposed U Total new 6 rr— Zoning District Flood Plain Groundwater Overlay Project Valuation 1 4 x6o d� Construction Type Lot Size L1K act 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 ighway: O YesEb No Basement Type: *Full ❑ Crawl ❑Walkout ❑ Other t 0 —, Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.fty.! V9 Number of Baths: Full: existing `2- new Half: existing news Number of Bedrooms: 2 existing _new �? Total Room Count (not including baths): existing 6_new First Floor Room Count Heat Type and Fuel: ' Gas ❑Oil ❑ Electric ❑ Other Central Air: 0,Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ANo Detached garage: ❑ existing ❑ new" size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage:Aexisting ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) — - Name Telephone Number 7 §Z 1 - Address _ �Icw.t� ,�'' �. � License # Q &6 3 d2,tan 1 Home Improvement Contractor# I y7C2�1 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7 �!/ i' 1. FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED s MAP/PARCEL NO. y ` ADDRESS VILLAGE 'f OWNER r DATE OF INSPECTION: i; #� FOUNDATION FRAME INSULATIONS „+ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:r, ,+r# ROUGH FINAL -FINAL BUILDING; ` Zdr, sl F d DATE CLOSED OUT ' t: ASSOCIATION PLAN NO. i s i� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,�,�AJ NAA AA Address: 7� V�v►�cro,,,a�- (.� City/State/Zip: 94anais /k.4 02,kolPhone #: 7711 521- 74 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or 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 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.$ 9. ❑ Building addition [No workers' comp. insurance P� required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct Signature: D Date: Phone#: 7 _sZL—?#J 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#: ,r co�TME annr�srnata, MASS Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 308-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, - d''� ,as Owner of the subject property hereby authorize ( to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date -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 Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 ram` I r Massachusetts- Depar-tment of Public Safety Board of Building Re-ulations and Standards Construction Supervisor License License: CS 96833 SAMUEL NAOOM 102 CAPN CROSBY RD CENTERVILLE, MA 02632 Expiration: 11/10/2012. Commissioner Tr#: 6739 f HIC Registration Lookup Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Mass.Gov Consumer Affairs and Business Regulation Home>Consumer> Home Improvement Contracting> .............................................._..............,..................,.._.................................._....................................:.................._..................................,............................,..:.:................ _ Home Improvement Contractor Registration Lookup E The list is current as of Thursday,July 21, 2011. .. You can search/filter the registration list by any of the criteria below. RELATED LINKS Search by Registration Number 7624 � I�1- .-._---.._...._.__.-j Home Improvement Contractor Search Registration Number Registration Home Page Search by Registrant Name Search by City i Zip Code�— I Search Registrants) Click on the registration number to view complaint history.You can also view arbitration and Guaranty Fund history. I Search Results REGISTRANT RESPONSIBLE REGISTRATION EXPIRATION NAME INDIVIDUAL NUMBER ADDRESS DATE STATUS 76 VANDERMINT LN. SAM NAOOM NAOOM,SAMUEL 1147624 I 7/25/2013 Current I HYAMMIS,MA 02601 ©2011 Commonwealth of Massachusetts http://db.state.ma.us/homeimprovemeni/licenseelist.asp 7/21/2011 TORN OF RNSTABLE t "MI JUL 21 Am 8: 02 C _ vis,10IN cA k a� L Lc� Town of Barnstable *Permit# Expires 6 mw9hs from issue date ` Regulatory Services` Fee� � n"9. Thomas F.Geiler,Director sue¢ �� ' Building Division X.PRESS PERMIT Tom Perry,CBO, Building Commissioner z 200 Main Street,Hyannis,MA 02601 :y www.town.barnstable.ma.us RN STA5� E Office: 508-862-4038 TOWN 0�6B 08-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not.Valid without Red X-Press Imprint Map/parcel Number Property Address 20 Lakeside Drive East Centerville Massachusetts 02632 ZI Residential Value of Work $5,775.00 Minimum fee of$35.00 for work.under$6000.00 Owner's Name&Address Arlene Newman 20 Lakeside Drive East Centerville Massachusetts 02632 Contractors Name Bates Remodeling,.LLC Telephone Number 781-341-2414 Home Improvement Contractor License#(if applicable) 104183 Construction Supervisor's License#(if applicable) 051530 ❑X Workman's Compensation Insurance Check one: ❑ I.am.a sole proprietor ❑ I am the Homeowner ® I.have Worker's.Compensation.Insurance Insurance Company Name Associated Employers Insurance Company Workman's Comp.Policy# WCC 5008429012010 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 Dumpster/Childs ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ' #of doors ❑ Replacement Windows/doors/sliders.U;,Value (maximum.35)#of windows ;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: 5� c/ C:\Users\decollikxAppDataV ocal\Microsoft\Windows\Temporary Internet Files\Content.0utlook\DDV87AAZ\EXPREss.doc Revised 072110 r John P russell ins Fax:761-341-2563 Apr 15 2011 09; Oam P001/001 CERTIFICATE OF LIABILITY INSURANCE 4/15/2011� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGK 5 UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, OffEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT 80WEM THE ISSUING INSUREMS), AI)THORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the potay(ies)must be endorsed- It SUBROGATION IS WAIVED,subject to the tonne and conditions of the policy,certain policies i aly require an endorsement A statement an this cerfificate does not c owder rights to the certificate holder in Neu of such endo s. PRODUCER COKTACY NAXe Chri$tina NaGowan John P. Russell Insurance -(78i)3�a-0098 FAX cues>sai-25a3 .19Lc,.!ie,�:-- - . . i(?uf:Novi -- 65 Pearl Street crosogoasa@ jprussellirJs.ocna �a00005152 Stoughton__ _ MA 02072 -.._ .. "_ - •-----.... .._INSURggs)AFFORDING COVIeRAAGE_ _ N=# INSURED - OaSUaEItn:Penn America Insurance Co nllsawwTravelers Ca>#ualtt t`Ins-Co Amer_- 9046- Bates Remodelin LLC ---- -- �� INSURERC,Associated EW 40yeris iris Co0.1104 _ PO BOX 760 9 - — DI3tIRER D rRER E: r---- --- -------— ..- st:oughtOn M& ,02072 11i�RF: COVERAGES CERR'TIRCATE NUMBER34aster 2011 REVISION NUMBER: THIS IS 70 CERTIFY 1MAT 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. LTR TTPEpFUIBURANCE -- pO Y _'dOEICY ULITI'S nkmwnm GENERALUABILI T I I ; EACH OCCURRENCE 'S 1,000,000 � ----'-- - - '-ooMMERCIAt�ENERAI.unsa "GAMAC�'T6KMIt:U 5lTY j . j_PRHNISES-(Eaooe�weelceZ_-I•s_ 0,0o i A I CLAIMSdtMDE .X OCCUR I PAC6891444 '.11/29/2010 XI/29/2011 MED E%P Vq o TIT S 5,000 - ----- 1 PERSONAL 8 Anv BCJURv S 1,000,000 G04ERAL A0WEc,ATE _ s_- 2,000,000 t L AGGREGATE LUA T APPLIES PER: ' - • -— --- -- --0 .• I . J ;PRODUCTS-COMPbDPAGG�s _3C000,000 POUCY ^JECT PRO LOC. I AUTOMOBILE UA61LlTV COMBNEO SINIkE LIWr i$ ANYAUTO`- (6iaoddsarr?- -- ..I. .. ..._. 8 ALL OWNED AUTOS �' HA-24a9R216-1i-s8L M/3/2011 X/3/a012 I BODLY INJURY (per perwn) °S -500,000 I�' SG►IEOUI EO AUTOS I -GODLY INJURY(Pet eft}.B 11000,000 •J I I PROPERTY DAMACE X. II 19REDAUTO$ (P«aomenq :$ 500,000 4 I NON-0wrw Auros I I MO&APam - $ 5,000 Lk+k+ewvd molo'+�BI va lira I$20,000/40,000 UM9RE11J►4lAB ` I OCCUR I I I EAC"0OCLq0tENM S ---- EXCESS LU18 CLAIMS-MADE: i 'AGGREGATE —- S -- __....._. ... — l._OEDUCTiBU I ! i $ RETENTIONWORKEnCOMPENSA' _'9 C i E7 LOVOW UAIMY I I 1 a i l�YKLAJMJrs i —�4—-- _ ANY PROPRIGMFVPARTNEKMXECUrIVE rI N L Et EACH ACCIDENT _ `S 100.000 OFFICERIMEMBERExCLUDE7? ❑'NIA l�C 5006429012070 7/17/2010 7/i7/2011 (Man&—ginNNI E.L.DISEASE-EA1EMPLOMiE S — 100,000 DESCRIPTION OF OPERATIONS Wirm EL DISEASE-POLICY LUff°5 3001000 DESCRIPTION OF OP9tAT10NS/LOCATIONS r vOWASS(Attach ACORD 104,Adifi0one1 Remsift 56ho&.^NmeR slate is requb" CBRTIFICATF,HOLJ)ER CANCELLATION, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCLUSD IB€ ORE THE EXPIRATION DATE TKEREOF, NOTICE YYILL 13E DELIVERED IN ItISDR1;D'S COPY ONLY ACCORDANCE WITH THE POLICY PROVISIONS. AuriIORPJE REPRESENfATME - ! a A � John Russell/Cw-roCiP � - ACORD 25(200M) 01 -2009 A CORPORATION All rights reserved. INS025(2oo9w) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts _ Print Form Department of Industrial Accidents Office of Investigations - I Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Bates Remodeling, LLC Address: P.O Box 760 Stoughton Massachusetts 02072 City/State/Zip: Stoughton Massachusetts 02072 Phone#: 781-341-2414 Are you an employer?Check the appropriate box: Type of project(required): 1.© I am a employer with 2 ,: 4. ❑ I am a general contractor and I employees(full and/or part-time).* -have hired the sub-contractors 6. El 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 8• ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp'insurance.: 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.X❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑Other 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 suck *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. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Associated Compensation&Employers Liability Policy#or Self-ins.Lic.#: WCC 5008429012010 Expiration Date: 7-17-2011 Job Site Address: _ 20 Lakeside Drive East City/State/Zip: Centerville Ma.02632 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the gins and enallies qfpedury that the in ormadon provided above is true and correct Phone#: 781-341-2414' Official use only. Do not write in this area,to be completed by city or town official City or Town:. Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Y s� Ofliee 6P�o� 1�SYR�$tfi' i _ License or registration valid for individol use only r HOME IMPROVEMENT CONTRACTOR before the expiration date If found return to. '0_ x Registration 104183 ,Type: Office of Consumer Affairs and Business Regulation �'- Expiratiom 7/1,J9012 Partnership ; 10 Park Plaza-Suite 5170 BRA AEMODELlNG _ Boston,MA D2'116 STEPHEN BATES' W11ft 407 PROSPECT STs ' STOUGHTON,MA 02072 Undersecretary of valid without signature 451 Massachusetts- Department of Public Safetc` Board of Building,Regulations and Standar(k 4- Construction Supervisor License License: CS 51530 ` STEPHENIF BATES x 407 PROSPECT ST STOUGHTON,.MA 92072, �T • Expiration: 12(14/2012 {'nnuui innir Tr#•,8= - l I - ` dFn+E : :wetvsr,�s, 639. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office:`508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Arlene Newman ,as Owner of the subject property Stephen F.Bates/Bates Remodeling,.LLC hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: 20 Lakeside Drive East Centerville Massachusetts 02632 (Address of Job) - 5/25/2011 Signature of Owner Date Arlene Newman 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 Intemet Files\Content.Oudook\DDV87AAZ\EXPRESS.doc Revised 072110 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map O� O� Parcel / Permit# 3 1 �Z 7- Health Division� 1 .� G� Date Issued t Conservation Division : .' a �� Fee Tax Collect SEPTIC SYSTEM MUST BE 71 Treasurer —v2 ITALLE©IN COMPLIANC,E WITH TITLE 5 Planning Dept. IMRONMENTAL CODE J` " TOWN REGU,LAr10_Y"3 Date Definitive Plan Approved by Planning Board A� >�' � TO Historic-OKH Preservation/Hyannis Project Street Address (_Q( E)- C �,J � Village Owner Loinald, 1ffiJYU_'YU. Mdl e E Address A 1CcaC�Sl'C D, L. ell��Vi1 v Telephone .Permit Request �� Square feet: 1 st floor: existing i QQ 0 proposed 2nd floor: existing proposed Total new Estimated Project Cost 1600 Zoning District Flood Plain Groundwater Overlay 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 • �1610 On Old King's Highway: ❑Yes VNo Basement Type: ,6 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing % new Half:existing l new Number of Bedrooms: existing new 6 Total Room Count(not including baths):existing new First Floor.Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other Central Air: VYes O No Fireplaces: Existing' I New Existing wood/coal stove: ❑Yes INo Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use s p 940 BUILDER INFORMATION _ Name S C• Telephone Number. � o Add X <JW License Address .fte# Home Improveme ract # Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE n FOR OFFICIAL USE ONLY PERMIT NO. ' — DATE ISSUED r 7 MAP/PARCEL NO.' t ADDRESS VILLAGE <, � OWNER• �;; � e � . - -•�,�_ F,. � '. ,� •' �, � rr _ �_ DATE OF INSPECTION',- FOUNDATION • f ` FRAME 1 t INSULATION ' FIREPLACE �•, - ELECTRICAL: ROUGHS •^► FINAL — PLUMBING: ROUGH i 'FINAL GAS: ROLbG{� •``! FINAL FINAL BUILDING r+ Er '= DATE CLOSED,OUT, " I 1 ASSOCIATION PLAN NO. _ t r 2 L OT' / 9 1 , �J _L 9 - r4 l\ T 4 w y V s � r } ... p�19 Of ly :> RICHARDJAMES S v O'HEARN' .,. ra vsn doST .. y0 CERTIFIED -PLOT PLAN sURvv, ee./V Z 7n/JL W t+p►S S 1 f CERTIFY THAT- 'THE Foy''�oAT/DNHFARN, INC., RCS, RS SHOWN ON THIS PLAN HAS , BEEN 1348 .ROUTE-' I34 LOCATED ON .THE: GROUND. AS.., INDICATED. EAST,. DENNIS, MASS DATE B SCALE' .�t9 // JOB NO: �/,5'"�� CLIENT DATE ,_AEGIS RED LAND SU,RV y EYOR>• :. DR. BY : SHEET-L. OF _ .,1�71 � EAR Lam;RS cF Me 7; _ . The Town of Barnstable BAMMMSTAMBIZ 9�A � Department of Health Safety and Environmental Services Building Division 367 Main Street, Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ( �-� Estimated Cost Address of Work: Dr. Owner's Name: PJ A e-r j Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. U/ /Z 1q, q PhMAT&e D to Owner's Name g1orms:Affidav r. T _- -- srravrr.-r =-... .-.. ' Department of Industrial Accidents -' ' ' e ce ofloaesuffatioos . '� _ . . 600 Washington Street ; c,� Boston,Mass. 02111 Workers' Compensation Insurance Affidavit Q0.//; name: � � / - location: �V Lao-5�� ' ✓Y_ 1 city u I L� /M phone# � /L9`7o (/ ❑ I am a homeowner performing all work myself. I am 7.:�/ employer providing workers'compensation f-.*-....'..�.:....or my employees working on this job. ::::::: ::.. :::::>::::...;;::;.....>::>::>::;:::. ....................:..... comaanv name.. )o <>;:»:>';;:<: ::;::. . address:.:: : : _ i .:.;. ..... :. ;::>;::;:>::>::> >:::<::<:»>::>:::::>::».<:...........:..'.:.>,::;.:.<:..>:::>.:>:<:::»»:»»::>::>:>:.;; >:: ;;>:;i:i:;::>:<:::>::>:>:<:>:»>:::>::>:»:::>:>:>:>:;>::::>.: ::»>;::»::>::>:<:: Clty::. " . .-_... r,phOIIC#.: �s :><:> ?< .»:>: ::>: :: .....::: .. Insurance co. b' _ . ": <: olicv#:: . .; »:::>;: %/ ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have . the following workers' compensation polices: ....:::::.::::::,:: :.::.;:.:;:.. :':::::::: are: .....:.::....::........:.: ,.::..:: ::.::.:.:.;:::.;... :>;:::::' >:::::::::>:»:......::: ::::::::.:..:. company n ;...:. ...........::::. .::.:.;::: .;:..::..>::.:;::>.:::....>:::::>:::>::::::;: ddress. :. ::.::::::::::::: ..:::: ...::::: :::::::::;::;:::: ;::<>:::>: .::;.•;.::>::::<•.;::;:::>:.:::.:......:... .. ..:: :•::..:...........",.:,*..... ....... :.:::: .. .:::::::.;.:.:::.::.:.::::.:::...........:::.::::.;:::::::a::... :.........................:...:. ..............::.�::::.: ..:.:........ ...........:�::.:::::::.�..... - :.:.. .::........... .................................::::....<..... - ........ ::::::............................................................................ ........ ................. ........................................ ... ..................................................::::.::.:::::::.:::::::::::::::::::....o.:::::.:::: :;.::::n:.:.:::::...................................................::::::.:::::::::::::::.:::::•>:•:;::;•::•:•:<;<•::;:•:r!:....:::<;c?::•::•.............. city:. phone#:; :>.:>.::;:;:..:........ :.:::<:::: ;:: :<:>.::>.... :.:; :;.:.: .. .::::....:.........................................................:... ..:::::. •:::..:::::::::•:::::•::::::::.y:•:::::::::::::.�:.;.•:.p:. II :•:••. :.y..::........... .. ................................................................................................... ...:•:::::.:....::"::,.;;. ::........•.:.:::•::::::.:.:::::.._:::::...:::::::::::•::::•::..::.:::.,.:w.,,,..::.::i:: ;+;;:::::::. insurance ca cmaaanv name: ._ _. address: .. city: :::. n hone e'. .<:>:....<;.>'>;>.:.: ::: :. : _.. . ::.... ...............:: .... .:;.;..::: ......:.::. .... .........:..................... . .. ..... ........ ?;3: .;:;.,- ...: :::::::::::. :•:::::::: :..•: :. .:::.�::::::::.... ......:.:: ............::.:::"'.:::::::..:::::::: ::.�:...:......I.:::.::.:.:::.. insurance co. �. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisom .as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby certify the pains and penakiee o perjury that the information provided above is/tr�rw and cqrrea tore5fio Dater lY 1�q _ . rmt name 1 Phane# 21-934(to official use only do not write in this area to be completed by city or town official / city or town: permit/license# OBufiding Department ❑Licensing Board ❑checkif immediate response is required ❑selectmen's Office _ OHealth Department contact person: phone#; ❑Other (revised 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to, construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimit/license number which will be used as a reference number. The affidavits may be retuned 1n the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Imlesduatlons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 • The Town of Barnstable TMF rO"'�.o Department of Health Safety and Environmental Services Building Division • > rAB. = 367 Main Street,Hyannis MA 02601 NAM Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION (� Please Print DATE: � "C JOB LOCATION: O a -P ( l number street village "HOMEOWNER": I d�' U l� 4 now / heshe phone# L work phone# CURRENT MAILING ADDRESS: opt Wo l It U Cc) city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied d_ w,ellingg of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached strictures 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 - reMonsible 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 minimum inspection procedures and requirements and that he/she will comply with said procedures and raga'77n2Z Signature of Homeo 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 filly 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 fort currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. -FRAM I NG SECTION ALL DIMENSION LUMBER SHALL BE KO SPF NO.2 OR BETTER. x COLLAR TIE @ 48" O.G. 2 x RAFTER @ ' O.G. SHINGLE 2 x CEILING JOIST 0 " O.C. W/IS LB. FELT � I � I Ix PINE FACIA R-30 KRAFT FACED FG amrs R- UNFACED FG BATrs -J SUFFIT VENT W/6•MIL POLY VAPOR BARRIER PINE SOFFIT (i 2ND FLOOR) I 1 I 2xJV FLOOR JOIST @ O.C. � I I 1 SILL SEAL 'L 0 ANCHOR BOLT @ 6,-0' O.G. ~CONCRETE e FOUNDATION WALL Lam e. 2,6 r Nbss.tchusetts- Department of Puhlic Sufetv Board of Buildin(-wSupervisor c^fulat ors and s eandards Construction p License: CS 96833 �. w SAMUEL NAOOM 102 CAPN CROSBY RDA' CENTERVILLE, MA 02632 Expiration: 1 1/1 01201 2' -r Tr#: 6739 ✓1. Board of 3otfrl' i °�/12�areacti�ia ding ,Regulations a,nty,tantlar ds j HOME IMPROVEMENT Re glStraboii COtaiTRt,�i JR EzP►ratron; 147624 7/25/2009 ;I TYPe` Individual Tr# 132193 k' . SAM NAOOM ` SA,GIUEL NA00 At 561COTLIIT.Rp M MASHPFE MA 02649 sue.t '= __ - - _�Admin►slr�to TOWN OF BARNSTABLE 2 3966 Permit No.I------ .... Building Inspector 1 swx.m Cash _---- — — •00 �6 9• OCCUPANCY PERMIT Bond --- "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector..No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Raymond Smeraldo Address Lot #125 20 Lakeside Drive Centerville Wiring Inspector Inspection date Plumbing Easpec Inspection date Gas Inspector , Inspection dateL4 X Engineering Depar t4�- Inspection date 21— � . THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN QUIREMENTS. .. ........._ .. �, 19_ 2 .... . ... ... .... ..... Building I pector u'� ,ry�r :5.�j��• 3��a, K Assessor's map and lot number. Bpi 1__1 E'TOE i v - H T Sewage Permit number: ..: Y BARNiT"LE' i House. number .....w`_ . ...........: ... : s v m,nss i. + 00 16'Jq \0m A INSTABLE -� t,E T A APPLICATION FOR PERMIT/TO `'r" � + TYPE, OF CONSTRUCTIOiV. fn } ' t .. • '�... TO:THE INSPECTOR OF BUILDINGS ; The undersigned:.hereby applies for a permit :according to :the following Iriforrriati,pn Location ........ �.. Proposed Use ...... ........ ....... .....:. ......:. ..... : .. . Zoning District- •...... ........ . ....... .................................... fire District qj Name'of Owner./ /�� (�F{l� / /' A / ? ..Address d o r.�IL/f f f 3 !l'1P�1 �J1�., 1it /� �fr irL' �1i �f f� �� r�'�/ "f� Name of 'Builder :!.a� +..... .....: .Address Name of.Architect Address ......... J tit , l 'Q�rG �F f...... Y f Number of Rooms ' Foundation f � f Exterior i (1 .: trn,. 11� .J�jrx?�, � {f)!�/G+ Roofing ........................................�f�� r•r r %'r'f lib r....:.IdAll t ; ., /1 L r � , ��f- ...::Interior y � , ! fi Floors ..., ....... i Heating r�lCt: s`�dr` f ..? .`! e! Plumbing ....................................................- .� , Fireplace.' .'.... �!cl, '.,. 1Y Approzimate''Cost F`�" / f . Definitive Plan''Approved by: Planning Board 1 Area Diagram of!Lot' and Building;vvith Dimensions :Fee Cyr SUBJECT TO APPROVAL OF BOARD OF HEALTH ? I ( .4. e r __.A,.s C-..�-ns-._._�� .ee--�.� —a=.....-_. .va-a->s r._--r-x-r".'—�• -�•u'a— c ti_,.�= -'_c-_ .. 5. y'��• ... OCCUPANCY PERMITS REQUIRED'.FOR NEW DWELLINGS + ; I hereby agree to conform to cill the Rules and Regulations,;of th`e:Town o_f Barnstable:regarding the•above ' construction. r! Name' . + .... SMERALDO, RAYMOND 4 3 �0a` 16 No ..,,23966 permit for „One Story ........... Single Family Dwelling b � , Location ..,Lot #125, 20 Lakeside Dr. Centerville Owner R.aymond. . ...Smeraldo. . . . . ....................... .... ....... .. ....... .. .. . .. .. { Type of Construction .....Frame ................................................................................ Plot ............................ Lot ................................ Permit Granted .................April....16.....,..............19 82 Date of Inspection ....................................19 Date Completed ......................................19 i � y F ` s' TOWN OF BARNSTABLE Permit No."'_ t - _Buildiug"Inspector ean —— aaam� Cash -.---- _-� - OCCUPANCY .;---PERMIT Bond No building nor structure shall be erected, and-no land,_building or-structure shall be used for a. new, different, changed,or enlarged v use without a• Building .Permit therefor first having been obtained from the"Building Inspector. No building shall be occupied until a certificate of 'occupancy has been .issued by the Building Inspector.". Issued.to Raymond Smeraldo y Address, F - Lot 125 20 Lakesa de 1Dr `ram.. elat r lie , d . Wiring Inspector �. �' Inspection date.✓-w Plumbing Inspector " Inspection date Gas;•Inspector Inspection datep,4 1, .e"f` 1 ; �,/ Engineering Depar`men Inspection date.'? THIS PERMIT- WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON�$ATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS.: y 4!. mg.�Pe Build' etor . O sessor's map and lot number ....�C-� ,�ti• ..:..... r. �F THE SEPTIC SYSTEM , Sewage Permit number ......:... a�.�./.. ..................... MUST Ned`` WITH I i T E TITLE STALLED IN COMPLIAN BAHHSTAMLE, ad V i T1E 9 t� House number. ........................._......:......................:................,. E�l�ll 90 "b a �0a 39- 1 TOWN, OF Al N am' � - ON BUILDING- INSPECTOR _ APPLICATIONFOR PERMIT TO ............. ... ............... ............. ............................ ....................................... TYPE OF'CONSTRUCTION ......... ........L:...l.. ........................................................................ TO THE'INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .Q. ...... 2•. ............... .i1Al :...........C./ :........... rl7' �/�.�. .................... ProposedUse ..............CS . �LL/��....�............................................. .......... .. ...................... . ......,......................... Zoning District ........... .%\.......�..........................................Fire District ..... . D...........................:...... Name of Ownerr�"1. ...:. �1` ( ...Address Z�®�...... �lC: /N�.L�.c�l n:.... Name of Builder'l..P!T?W......14 146/E .....Address Name of Architect Tp.`! (11.ZM....................::.Address 7�z...... .......... ...'..: I Number of Rooms ......16............................. .......................Foundation � !..... !^ifz�.�..�G/����� Exierior .W..�O .. r�hTt. ...`l Q (�. �nqI Roofing Pj�7WZ.7......................................................... Floors ..... u �¢.4.: ..-G..�....TI.!/�LZ ....Interior 12 oL.�.................... Heating' nCe.O /fQ li! (!`..-51Yf& ..Plumbing ...F�to/n 5 r Fireplace .......Y�� ONE Approximate Cost 5 ......................................................ry ....................................... ..... ........... Definitive Plan Approved by Planning Board ----------_____----_-----------19--------. Area 1.26.�..................... Diagram of Lot and Building with Dimensions Fee + SUBJECT TO APPROVAL OF BOARD OF HEALTH. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name�� ..... a .. ............. RIV-MOND' 23966 One Story ' NO. ..................Permit for .................................... Single Family Dwelling ............................................................................... Lot # 125, 20 Lakeside Dr. Location ................................................................ Centerville ............................................................................... Owner ....Ray,mon.d...S,me.r.al.d.o...................... .... ....... .. .. .... .. .... .. .. Frame Type of Construction .......................................... ................................................................................. Plot ............................. Lot ................................. Permit Granted ...APAZ i.1....16................19 82 Date of lnspection5.z........k-2r.2.....................19 .. Date Completed ......'If, . .......19 or o } n n i x 4 f 3t p# P s� - _ "" v' A s r w l i _'? a YIP Yl ei 6. t RICHARD = g .JAMES27871 r: O HEARN wV 9yq�s'' :CERTIFIED e .PLOT PLAN;{ z SURVEY Q1 S:S. ' wiz s 4 i` CERTIFY THAT- THE ���/D�►J R. OW EARN, INC, R!_5, RS co SHOWN ON THIS PLAN HAS BEEN 13.48 ROUTE 134 - .LOCATED`. ON THE GROUND A'S INDICATED. EAST DENNIS , MASS. 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