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0049 LAKESIDE DRIVE EAST
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"`; X `'s � Posted Until Final Inspection Has Been Made... mit N" Where a Certificate,of Occupancy is.Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit NO. B-17-4302 Applicant Name: Approvals Date Issued: 12/14/2017 Current Use:- Structure Permit.Type: --Building-Siding/Windows/Roof/Doors 'Expiration Date: 06/14/2018 _... Foundation: Location: 49-LAKESIDE DRIVE EAST;CENTERV.ILLE Map/Lot: 2527098 Zoning District: RD-1 Sheathing: Owner on Record: V.ANDEMOER,1•NICHOLAS&SUSAN C.. Contractor Name: BRIAN D.DENNISON' - Framing: 1 Address: 49 LAKESIDE DRIVE EAST' Contractor License: CS-095707 2 CENTERVILLE, MA-02632t Est. Project Cost: $5,863.00 Chimney: Description: new windows(2) .29-uvalue „" Permit.Fee: Insulation: Project Review Req: Fee Paid: $35.00 Date: 12/14/2017 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after.issuance. Rough Gas: _ All-work authorized by this permitshall conform to the approved application and the approved construction documents for which this permit has been'gra6ied. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gasc - This permit shall be displayed in a location clearly visible from access street or road and shall be.maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work; 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplacesmust be.inspected at the throat level before firest flue lining is installed final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT- ISSUED RECIPIENT I l yoFti Town Of Barnstable `Permit it _/ ,�f Expires 6 etonjits from issue dote 41 Regulatory Services �1� �Ekemb 3S BAMSMOLS. + A L659. Richard V.Scali,Director ® T� � Fc Building 32017 Building Division Tom Perry,CBO,Building Commissioner 4/�r�/ �, 200 Main Street,Hyannis, VfA 02601 /1 "SIA&t www.town_barns table_ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Inip►znt tvfap/parcel Number o2-S Z 0-Q g Property Address cF 1 [Residential Value of Work$ �,8(9 3 — Minimum fee of1$35.00 for work under$6000.00 Owner's Name&Address i h�2ld S I,6/1de,"or 9 L/Q Za1(eSiJe ✓I.Ve �'PN, p j-le 37_ Contractor's Name AfE 'ndv,J rL-tii ( //r;spl( Telephone Number No( 2- Home [mprovement Contractor License#(if applicabie) Email: Construction Supervisor's License#(if applicable) 7 07 (T \Norkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ m the Homeowner I have Worker's Compensation Insurance Insurance Company Name F; r am&_ n Z-)SU °a,--,a P_ C C] Workman's Comp.Policy# W C A 31 5 8 7 2-9 - 2•:L 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) side Replacement Windows/doors/sliders.[�-Value • 2-'9 (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 cRthe home Improvement Contractors License&Construction Supervisors License is require SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\2P10!DHR\EXPRESS.doc Revised 040215 Renewal Agreement Document and Payment Terms Andersen. dba:Renewal By Andersen of Southern New England J.Nicholas(Nick)Vandemoer %�j� i Legal Name:Southern New England Windows,LLC 49 Lakeside Dr.East RI#36079,MA#173245,CT#0634555,Lead Firm#1237 Centerville,MA 02632 wINoow NE MCEMEN, 10 Reservoir Rd I Smithfield,RI 02917 _ _ - - H:(508)737-2045 - Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com C:(508)771-8017 . Buyer(s)Name: J. Nicholas (Nick)Vandemoer Contract Date: 12/01/17 Buyer(s) Street Address: 49 Lakeside Dr. East, Centerville, MA 02632 Primary Telephone Number: (508)737-2045 Secondary Telephone Number: (508)771-8017 Primary Email: vandemoer@Comcast.net Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal By Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,any documents listed in the Table of Contents,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference(collectively,this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $5,863 By signing this Agreement;you acknowledge that the Balance Due;and the Amount Financed must be made,by personal check,bank check,credit card,or cash. Deposit Received: $2,931 Balance Due: $2,932 Estimated Start: � Estimated Completion: 6-10 weeks 6-10 weeks • Amount Financed: $5,863 Method of Payment: Financing We schedule installations based on the date of the signed contract and secondarily on. the date in which we complete the technical measurements.The installation date that' we are providing at this time is only an estimate.We will communicate an official date and time at a later date. Rain and extreme weather are the most common causes for delay. Notes: 50%deposit-GREEN SKY; 50% balance due upon completion-GREEN SKY Buyer(s)agrees and understands that this Agreement.'constitutes the entire understandings between the parties and that there are no verbal' understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will.be valid without the signed,written consent of both the Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO BUYER: Do not sign this contract if blank.,You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER,MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT. OF 12/05/2017 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT Legal Name:Southern New England Windows,.LLC. . dba:Renewal By Andersen of Southern New England Buyer(s) Signature of Sales Person Signature Signature Chris Hutson J. Nicholas (Nick)Vandemoer Print Name of Sales Person Print Name Print Name UPDATED: 12/01/17 Page 2 / 10 . Massachusetts Department of Public Safety Board of Building 'Regulations and Standards License: CS-095707 Construction Supervisor BRIAN D DENNISON 7 LAMBS POND CIRCLE CHARLTON MA 01607 (�•.� Expiration: Commissioner 09/08/2018 Office of Consumer Affairs nd Business Regulation 1.0 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvenrent Contractor Registration Registration: 173245 Type: Supplement Card .� r Expiration: 9/19/2018 SOUTHERN NEW ENGLAND WINDOWS'}L" 1 BRIAN DENNISON 26 ALBION RD �,� H�r LINCOLN,AI 02865 (', Update Address.cad return card.Mark reason for change. SCA 1 c 20n-05111 [I Address ❑Renewal (—i Employment ❑Lost Card -IT or coosomer Atfnirs&Bavaess Regulation- Registration valid forindividual use only before the IMF. -, expiration date.If found return to: OME-IMPROVEMENTCONTRACTOR Office of Consumer Affairs and Business Regulation Registration -173245_ 'type: 10ParkPlaza Suite.5170 P�cpiratlon_8%19/26-)v Supplement.Card Boston,MA 0-116 SOUTHERN NEW ENGLA_NDW_INOOWS LLC. RENEWAL BY AND ERSONgAZV_-'- - - BRIAN DENNISON 'c:-,'3' 26 ALBION RD LINCOLN,RI 02865i a`"' Not valid without signature ` The Commonwealth of Massachusetts .l Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FII.ED R'ITH TBE PER1vIITTLN'G AUTHORITY. Applicant Information iv Please Print Le 'b dame (Business/Organization/Individual): e t,aJ "!,F OW's Address: ? ALt1120 City/State,'Zip: L&IJP Phone 4: -%01 - 2 Are you an employer?Cbeck the appropriate box- Ty pe Of protect(required): l.�l am a emplover with ZO f-emplovees(full and/or par-time).- ?. New construction 2.�I am a sole proprietor or partnership and have no employees working for me in S. Remodeling any capacity.[No workers'comp.insurance required.) 9. ❑Demolition OI am a homeowner doing a!!work myself LNo workers'comp.insurance reouirec._ 10 Q Building addition 4 I am a homeowner and wili be hiringcontractors to conduct all work or:my ro ern•. I will _ P P _ ensure that all contractors either have workers`compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.QPlumbing repairs or additions 5.Q 1 am a genera]contractor and 1 have hired the sub-contactors listed on the attached sheet. 13_❑R of repairs These sub-contractors have employees and have worker'comp.insw-ance. I E.�we are a corporation and its officer have exercised their right or exemptFor:per MGL c. 14.Vtber G/d/1 O y kj 15=_€1,(4)_and we have ne employees.[No workers'comp.insurance requirec.j trC'e rIR(,Pr+t''1 'f S l Any applicant that checks box.I!must also fill out the section below showing their workers'compensation police information. Homeowners who submit this a$idavit indicating they are doing all wort:and then.hire outside contractors must submit a new affidavit indicatinE such. 1Contactors that check this box must attached an addition:sheet showing the name of the sub-contractors and state whether or not those entities_have employees. Lithe sub-contractors have employees,they must provide their workers'comp.police number. I am an emplover that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Dame: `lie ne S - oom — Policy or Self-ins.Lic.4L A 3L� z 1 — Z-6) Expiration Date: / O Job Site Address: yg ,C feeAlale a./e. Cri S City/State./Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and eapir lion date). Failure to secure coverage as required under?MGL c. 152,F25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment.as well as civil penalties.in the form of a STOP'WORK ORDER and a fine of up to$250.00 a day against the violaior_A copy of this statement may be.--forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certif}'under th ains and penalties of perjure°that the information provided above.is true and correct Signature: a Date: Phone Official use only. Do not write in this area,to be completed by dV.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 t: ESLERCO-01 SANDERSO DATE(MMID�rn A CERTIFICATE OF LIABILITY INSURANCE 06►0712017 R-THIS THIS CERTIFICATE IS ISSUAFFlRMATIVR THIS E�Y OR NEGATIVR OF ELY AMEND,TION LEXT NDY AND OOREL TER THE COVERAGE AFFORDED ORDED BY TH NO RIGHTS UPON THE CERTIFICATE E POLICIES CERTIFICATE DOES NOT hold , AUTHORIZE BELOW. THIS CERTIFICATE.OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER{S), ions 0, REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. SURED provisions or be endorsed. IMPORTANT: If the certificate D holder is subjecis t an ADDITIONAL t s d INSUcondiRED, of the policy the )muscertt policieshave lmayNrequiAL �re an endorsement A statement on If SUBROGATION IS this certificate does not confer rights to the certificate holder in lieu of such NnAdorsement(s). cT PRODUCER NAME 303 988-0804 PHONE 303 988-0446 FAX No):( ) CoBiz Insurance,Inc.-CO (AIC,No,6d):( ) 1401 Lawrence St,Ste.1200 a MAa COMaII COblzirlsurarlce.COm ADDRESS: Denver,CO 80202 NAIc a INSURERS AFFORDING COVERAGE 31325 INSURER A-Acadia insurance Corn- an INSURER e:Firemen Insurance Company Compapy of WA D.C. 21784 INSURED SouthernNew England Windows,LLC.dba Renewal by INSURER c:Liberty Surplus Insurance 110725 Andersen of Southern New England INSURER D: I 26 Albion Road,Suite 1 INSURER E: Lincoln,RI 02865 INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: IC BEEN ISSUED O THE INSURED CUMABOVE POLICY THIS IS To CERTIFY THAT TEOLICOINSURANCE BELOW HAVE N, THE INSURANCE AFFORDED BY THE OR OTHER DOMENT WITH RESPCT TOWHICH TH S INDICATED- F REQUIREMENT TERM OR CONDITION OF ANY CON CERTIFICATE AND BE ISSUED OR OF UCH POLICIES.I MATS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. C HEREIN IS SUBJECT TO ALL THE TERM EXCL UBR POLICY EFF POLICY EXP LIMITS 1NSR I TYPE OF INSURANCE tNSD INVD POLICY NUMBER MMIDD MM�D 1,DDD,000 L EACH OCCURRENCE S A X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 300,DDD 0110112017 0110112018 PREMI E Ee ocanrence S CLAIMS MADE OCCUR CPA3158728, 5,000I i MED EXF An one erson S 1,000,OOD PERSONAL S ADV INJURY S —I I 2,000,0001 GENERAL AGGREGATE S 2,000,000' F •L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG 'S j X POLICY �Eef ❑LOC I EBL AGGREGATE 5 ?-UUU ODO COMBINED SINGLE LIMIT 5 1,0w,000I OTHER: A I AUTOMOBILE LIABILITY � CPA3158728 01101/2017 01/01/2018 BODILY INJURY Per erson •5 X 1 ANY AUTO BODILY INJURY Per accident 5 SCHEDULED 5 C—OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS per accident NON-OWNED 5 I AIUTOS ONLY AUTOS ONLY - 1,000,000I EACH OCCURRENCE X OCCUk 5 A X UMBRELLA LlAB Cpg3158728 01/0112017 01/01/2018 AGGREGATE 5 EXCESS LIAR CLAIMS-MADE Aggregate; 5 1,000,000 X N S 0 X DED RETENTIO STATIffE ER B wORKERSCOMPENSATION c 1,oD,DDDI AND EMPLOYERS LIABIIITY YIN WCA3158729-20 10110112017 01101/2018 e L�, ACCIDENT 1,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE I NIA I EL DISEASE-EA EMPLO S 1,000,000 OFFICERWEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-POLICY LIMIT 5 It yes,desQibe under 1,000,000 DESCRIPTION OF OPERATIONS below CA3158730-20 01/01/2017 01/0112018 1,000,000 B Workers Compensatio 17 01/01/2017 01/01/2018 1 , DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLE S(ACORD 101,Additional Remarks Schedule,may be attached B more spare is required) ,17-11 Workers Compesnation Includes-All states except ND,OH,WA,.WV,WY I I I I CANCELLATION CERTIFICATE HOLDER i SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE ACCORDANCE WITH THE�6E E-OVI NOTICE WILL BE DELIVERED IN I (AUTHORIZED REPRESENTATIVE FOR I n I P ©1988-2015 ACORD CORPORATION_ All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION O 2 MaP5 Parcel Application # BUILDINGi�CPT Health Division Date Issued Conservation Division 2T MAR 2 2 2016 Application Fee Planning Dept. TnWN OF BARNSTABLE Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis /U0 ,i MA=1 Project Street Address �Z9 Village Owner _ ��I Va44n d evu-o t�v- Address Telephone Permit Request .s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type P.as Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 21' Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes q'No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl 44Walkout ❑ 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 _ 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 Address ���JCf ��y"�(� � i�v�e License# C S, 09/3R k C-Or Ld-V�'le a.Uc U f Home Improvement Contractor# /SUS 'Email Cf ud e_ A49 (0 qof LOB Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE`S > =� DATE '- e FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME S IN PLATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Ilse Conzrrrorrivealth of _ ass rclrrisetts ' Deparfinew crfrndustrid Acciderrtr - Of,,,�rr.e 0f InVVstigations 600 Waslaingtortj`freet - , Boston,MA 02111-: _ �G�rvrtiltrrss..govlrtirt • , Warkers' Campensatian Insurance Affidavit.Builder-s/CunfracturstEIectricians/Plumbers Applicant InfoI- afran Please Print Le-giblY 1`1ame,(Busiae�,'Drgantzattonlfnd Address: 16�1 (2, l� lg 11 CityfStat&22 pc ish!t PJione Are you an employer Cheekthe appropriate bom Type of project(requiied)c I.❑ I am a employer with 4. ❑I am a'general confractor and I 6_ Ej New constructionemployees(full andlor part-time).* have]fired the sub-contractors 2.R I.am a sole proprietor orpartner- Misted on the attached sheet. 7. ❑X Remodeling ship and have no employees. These sub-contractors have $- ❑Demolition wodring for me in any capardtr employees and.hnre woricers' [No woriaers' comp.insurance comp.insurance. 9. El Building addition required I 3_ ❑ lWe are a-corporation and its 10.❑Electrical repairs or additions 3.❑ Lama homeoum-er doing all work ofrrcers have ercised their IL❑Plumbingrepairs or additions myself:[No workers'comp-- right of exemption per MGL t i„� „�e required.]i c.152 §1(41 and we have no 12.❑1Zoafrepaiinsurance employees.[No workers' 13.00ther comp.insurance required.] •Aziy appEiciurdwt cbecksbox R omst also M outthe sectioabekwshuning the rwo&as'ca®pevsatina paliicginfamaieaL I Mmemmers who submit dtis affidat*=&catag they sre-doing sllwed=off enhire autMecontractmmust submit a new sdMdavk iadiczfing.sarfi_ IC'antrsctoeslbst cbea iIW box must attached saadditional sheet showing the—neof the sub-centrscfio-a sad ade whether arnatthose eutitieshave emplayees.I€thesub-c. tmctursluveempluyees,tbeynnstpmui&their xarkexs'tamp.palicgnumber. lain art eniplo}�ar tlratispratztinrg markers'cantperrsrrliort inrairarzca fvr rri}*cnrploy�es Beloav is fha policy rc►e,3 jab mite- ir�armaiwn. ; Ivsuraace CorupanyName 'Policy 4 or Self-in:s_Lic.;k Mxpuatiioa Date: Job Site Address. citylstate z' r Attach a copy of the worlrers'compensationpolicy decl2ration page(showing the policy number andexpiration date). Failure to secure coverage as required under Section 25A of MGL c-157 cm lead to the imposition of riminal penalties of a fine up to$"00M andrar one yearimprisonmeut,as we11 as cMI peualties.in fhe form of a STOP WORK ORDERatrd.a Erne of up to$250_DO a clay against the-violator. Be ad-dsed that a copy of this statement maybe brwarded to the Office of Iuvestigations o€the DI,A for imurancl coverage verification._ .lyda hereby c sander thepruris and pe►iahYes afpnjWy thattJte irrfonrtaiiorrprmzded abova is tare ac:ri carrect Sitnaature: Date: Phone AS-C t-. official arse drrFp: Da arot rvrke in this area,to be campteted by city artetrn officutL City or T'om u.: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CityfTowa Clerk 4.Electrical Inspector 5.Plumbing Inspeeter 6.Other Contact Person:, Ph-one 3�: -haformatiqu and Instructions . ;. . . M_3ssaolrasetts Geheral Laws chapter.152 requires all employers to provide workers'compensation for their employees. P,WsL=ttD this statute,as m ployee is defined as."_.every person in i ie service of another under any contract Ofhire, express or implied;oral or written." An employer is defined as"aa individual,pazinership,associative,corporation or other Iegal entity,or any two or more of the foregoing engaged in a Joint erifzrprrse,and mclndmg the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or outer Iegal 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- dwelTmg house of another who employs persons to do maintenance,construction or repay work on such dwelling house or on the grounds orbmldmg appurtenzattherefn shallnotbecanse of such emplaymentbe deemed to be an employes" also states that"every state or local licensing agency shall withhold ffie issuance or MGL chapter I52,§25C(f7 �Y g g y •'.-,. renewal of a license or permit to operate a business or to construct bwldiags is the commonwealth for any applicant who has not produced acceptable evidence of compliance with fire insurance.coverage requited_" Additionally,Md chapter I52, §25C(7)states"Neither the commonwealth nor any ofi s political subdivisions shall enter into any contract for the pmfonnaace ofpublio work unt it acceptable evidence of compliance with the rPZ re eats of this chapter have been presented to the contracting a fhozity." Appficanis ' Please fiDj obt the worker' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addresses)and phone number(s) along with their certificates)of ;nsT ce. Limited Liability Companies(LLC)or Limited Liability-Partnerships(LLP)withno employees other than the members or partners,are not mquimd to carry workers' compensation insurance- If an LLC or LLY does hate employees,a.policyisrequired. 13 o advised that this affida7yit maybe submjtted to thr,Department of Industrial Accidents for confirmation of finmiance coverage. Also be sure to sign and date+due affidavit The affidavit should be retraned 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 Iaw or ifyou are reginred to obtain a workers' compensationpoliey,pleasemU ieDepatnentatthenumberlisti--dbeIow. Self-iamred companies should eatertheir seIf-mmTr.an ce license number an the appropriate line_ City or Town OfFicials t - Please be s¢re that the affidavit is complete and printed Iegibly. 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 fM in the pen itllicrose number which will be used as a reference number. In addition,an.applicant that must submit multiple permiUlicense applications is any given year,need only submit one affidavit indicating cnsent _ v' tiara if nece and msder"lob Site Address"the applicant should write"all Iocations in (city or policy m� =a ssary) P C town)_"A copy of the-affidavitthat has been officially stamped or rrarkedbythe,city or town may beprovided to the applicant as proof that a valid affidavit is is on file for future permits or licenses_ Anew a$adavitmust be ,filled out each year."Where a home owner or cid=is obtaining a license or permitnot related to any business or commercial venture (ie_a dog license or permit to bum leaves etc_)said person is 1�IOT required to complete tins affidavit The Office of of Investigations would irice to thank you m advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number. Tht CmjaanWean of Massachmse,-tis - Depart lent cif J-�clust zal A Zents f�iiee af7�.v`e�?gafia>r� 60 4-Washington.st=t Bmtou�MA(M l l Fax It 617` 27 7749 Revised4-24-07 rria_e��gQ�fdin f Town-of.Barnstable of Regulatory Services , F su.s. Rirhud V.SeaA IYsednr m BIIRding DIVm—on TOM Perry,Ems CDnm&doner 200 Maim Sfreet Hpamms,MA.02601 www.towa3barnsfable ma_us J Office: 508-862--4038 Fa= 508-790-6230 PropeAy-Owner Must f' \complete and Sign This Section - `� zf Using AB 'Ide as Owmer of the subject ro . P PAY I bpamtlioaze '�� YSVIOi/4 to art on nvbebal&. in aH=tb=relative to work aurtboEzed bytbis bOdiag pemmit application for. . VAq (Add=ess of Job) _ ``-Poolfences and L=a are-die responsibELyOf the 2pplicant Pools are not to be fiffed or 416d before fence- installed and all final ' ins-pemons.are pedo=d and acceptei ignaiure f Owner a lgaatare p�iranf P=rntName ME=Name Dat . QFo�rs:owrm��sror�oozs .• .. r= TaNM,af Barnstable . RegIIlatory Services r � Eichm-d V.Sc dF Director , t 35�r�a Rr= Tom Perry,Building Cam-issionar' . 200 Main Sired Hyamns,MA 0260I �m Ww w.tovymL6ara-m�e.ma-vs Office: 50 8-96Z-4-03 8 - Fag: 508-79 Q-623 D HOMEOWNER r_UM=MOaR MN. . •pleZsePrmt JOB LQCA11O1`L ire number' NiED�11�R: . namr- h®ephonc 7. 7 # CURRENT MATT.aIG ADDRBS S: / - zip wda The cva ent exemption for`homeowners"was ndcd to mclpde owner�cc awe ' of six twits or Less and to a]Iow homeowners to.engage an individual for haewho es notposscss a license vided thatthe owner acts as ervisor- MON OBHO p emon(s)who owns a parcel of Iand oa which helshe esidea or intends reside,on which there is,or is intended to be,a one or two- f may dwelling,. welling,attachbd or detached strnct=s access ry to such vs; or Farm s ucto=s A person who cons[mcts more than one home in a two-year period shall nntbe consider d aho wner. 'homeownee'.shaIl snbmitto the Buildin g Official on a form acxeptableto theRd1cl- OfficKa hsthglshr shaIlbe ons a all suchwmk eafD=rdnadert c=k (Seddon 109.L1) • The vmdcrsigaed`,homeownee'==cs responSffiL—tp Iianco writhe SiaiE Bm-lamp Coda and other applicable codes, bylaws,roles and reg hb-Dns_ - '1�signed`•rhomcownee cedifies thathe! rim Tova ofBaxns[able Building Depaitmcnt minims inspection procmdn=andregnaemenfs andthathrlshe, comply with s procedu=andregaaeme=ds- sigaato=of$o rorowner . - Approval ofBm7dingOif<aal 'II==f=Dy dwe dc:onfiam%a 35,000 cabic fret ar wMbe regvicedto comply wffi o Sia.Building Codo Seddon W.0 CanStmc lnn. $on�owrz�s x The Code gtat es that:/ Any homeowner performingworkfor 'ch a burZdiag permit is regmred shaII be exempt from the provisions of this s (Section 109-U-Licemmng of co an.SQperdsors);provided tTiat if the homeowner engages a person.(;)for hire do such work,that such Homeowner shall ct as superv%sor." Many hom.eowncrs who use&is exemption.are unaware.that they a assuming the responsiblIlties of a supervisor (sce Appendnc Q,Roles&/Regulations r Limnsing Cons(racfMI'SiT is Section 215) This lack of awareness oftma results in serious pr'oblem"s,p when the homwwuer hires miens persons- In this case,our Board cannot proceed against the unlie�eased perso as it would with a licensed Supervisor_ a homeowner acting as Supervisor is vIiimat d.T responsible. To ens um that the homeo is folly aware of bislher responsrf�es,many communiffes regmhm,as part of the permit applicaiian,that the ho wner certify t��at:helshe understands the responsi�sTrtz'es of a Supervisor. On the Iastpage of tius issue is a form cnrretitiy used by several towns. You may cart t amend and adopt such a formle_rfifl afmn for use in your comm�uniiy. l4�PFII>�FORMS'L4""��r'"gP�itfa®s1�P8F�—moo Rmised D61313 . 'rS Massachusetts -Department of Public Safety f Board of Building Regulations and Standards i - License: CS-091391 g FRANK 1)ONOVAI �1 104 Carlotta Avenfie _` � s Hyannis MA 02601 r k rExpiration Commissio ner 10/28/2016 ` r' . ....,�.. t f (gxe Wparn'Yn01wvw,ll101Q1&aeaC11(&e1xa _Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: !1 Registration 16.4521 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 is Expiration,,. .,1 0/1 91201 7 Individual Boston,MA 02116 FRANK DONOVON FRANK DONOVAN 245 SO. MAIN ,r:z s= •. _ CENTERVILLE,MA 02632 Undersecretary Not valid without signature f I � ' I , LA VOA �� Town of Barnstable *Permit# � i y D 6 aEWbW � Regulatory Services 6 Richard V.Sear Interim Director Building Division Tom Perry,CBO,Building Commissoner 200 Main Street,Hyannis,MA 02601 \. www.town.barnstable.ma us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT WPLLcA= - RESIDENTIAL ONLY Not VaW wkkow&d X-A=bWft h6p/parcel Number Property Address 7 9 `— -Ms(0t 6-AtO mideotial Value of Wank$ ��3 fee of 00 f Mioimam S36. or work kader$6t100.00 Owner's Name 8t Address J-. I U I G#V 44 5 Sal- I/AA-1A f— In 0 Contractor's Name oe,�- t�`1y uPw lAiu W INc�pct�5 Telephone Numb "90/ d p�� Hone Improvement Contractor Lice#(if applicable) /73 ZY6" ' Email: Conshuciion Supervisor's License#(if applicable) .t7 9 f` w �Workman's Compensation Insurance APR - 4 2014 Check one: ❑ I am a sole proprietor I am the Homeowner I have worker's Compensation Insurance_ TOWN OF BA,R STABLE Insurance Company Name Worlanws Comp.Policy# .�-/�iQa Z- 'Lt3r2—3 f Copy of Insurance Compliance Certificate must accompany each permit. Permit R�uest(check box) [] Rs-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over eacisting layers of roof) Re-side Replacement Wi AnWdooWsliders.U-Value (maximum.35)#ofwind�5�- #of doors: ❑ Smok&rArbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. •Where reajtm & b a nw of fts pmut does not esmmpt COMPba=with c&er flown departme®uladam i.e.Historic,C.onswo n,etc.. o"Note: Property Owner must sign Property Owner Letter of Fermin. A copy of the Home Improvement Contractors License&Conshmcdou Supervisors Lkmu is fired. r SIGNATURE: TAEVD I111 uRding amwS3�S doc Ravised 061313 L WR-23-20M 31:+0 FROM I-A 50044-icAls TO:149I&MEE IR P.VT Renewal Rm.—M AL BY ANDER5� MM Maw dy ItU,3 hAnder n. e.TL;_�,mu"4�5 t ._ _.. ....... _,_,..._.�_:. Kshfr�inttltcNru +.T.iranrdn. RlA?RM iordilrmirtlt7 Phone R66.563-223 •Fax 401,633.6602 n%WT+F m440 aeec.� Southera.New England Windows,LLC d/b/a Rmtawal by Aedtesen of Soathcem;New Eoslsnd CUSTOM WINDOW AND DOOR UNIODEGTIVGa1C1BtM%LN"r Al is hot. lJeAj_j_ 4"Moe a arm dACftVnV%- .�1J2o�15C A. sr.wnar.0 ill��QAIdP.� `�Si ��.o.�����w�4to:ep�. ,31♦!$ �7OV+S' Bt�y�na}hrt rlry�rriafll r-nd sc�enlly°rgn 6 to¢o-uttitt ue tltrpn tdvt t�a-tri/ot ern+cars of Cnwhern Now Eng!and_WindoNn,LLC d/h/a kMLwal Iry Arnlrnrn nr"Soul-.crn New LnQland ri:,a.�incu,r"�m are�a,danca rrnh the te:'CY13 and c6aditions d alind on the limns ar-d Lite retier}'ul' this:pnrrnrnt aim]nn the atiac4wd%pacification slueU�)(cwlle tiwr!,ihia'i%1,'tnmrnt'l- O Hittteeie �Cettd4 d 1113A? Sey�rr /+g� .. Z4�!�S:bAmD9wK_'a-�.a5! lsaaatNS�eAT029V MeatedofPtymeoir. LJCll.et,c :J¢th finer H oemit Received(33%). 6—a aft MfiIL' Ci'eciECUfSareacxeptsdford'epaatcrty—rndmm li3atoo �lanaa 3►3 Paieat cost:(ftcm tee&Bdu Cad t'synient Foram By 24r12 ttia t+gsnnneicy,7nu xpicnvwtr�e v+at:m4 OQwna a:�u't m�q][�trt Betsnce am$veto �,p—$ u4tS' 8763W a1 Stonantial Ccrnpledan of jab ernt:at be made by eredh C Rrtplation of fob ):_Y ' card and m 9 be rude by Pomml ftk bank check,or QdL Buyer(s)agrees and undenMands that this Agreement comtkutes the mtim undeaytaadlng between the pwrtics,'and slat three are no verbal understandings changing any of the terms of this Agreement.Buyer(s)aelaecvidedges than SWgr(s) (t)ices raid this Ageeeme anderstinda the terms or rL;t Ag.b.r•••say and has reces"d a eosoplsted�signed+sad dosed copy of thisAgveemtny mcludingthe two attached sciences or Can4ei6aan,an me,.61,i arai written above and(2)"as candy infarmcll Of 8byer's t fight to cancel this Apyrveznc tt.00 NOT SIGN`1 MS COTFMOT IF THERE'AREANYBLANKSPACES. MA-4 44—d Swim,OsrW Notice in Buyem(1)Do sot tslgn ibis Agreetnesis If any of the$pact*intended far the agreed terms to the catcat of thca awmAnble information are left blank.(2),Yon are entitled to a copy of ttbis,"eumat at the time you sign UP(3)You may at any time pay off the fall unpaid balance dur.under Ihts Agreement'and in so doing year may be entitled to receive a patrdril rebuts of the finance ends insurance charSes.(4)The,ceLcr hum nu rlg%c to unlawfully enter your premlee® or commit say hrearb'of at peace to reposst"goads purchased under*s Agreerncut(5)You tray cancel t bh Agreement it it has not been tubed at the mao;n office or a branch.*Bier of the seller,provided you notify the seller at his or her mein office ar hrancll office shown in the Agrre- - lay registered or eenified rteailr which shall be posted not later than midnight of the third anhodatr'day after the day enwhich the:buyer signs the Agreement,excluding Saaday and an holiday on wbich regularsuza elciiverles are not made.See the accumisaayingnotice of etc noellasion form fee an explan�t boys ri5htts. A�t}rr{s)r,v bed the ennx,rnc^r ralucatiun tnxluialY mt9OM site Tthude tdand Commicto.n u~.:tiat't Bn,•.fd n b3 t'filtrittia3l Renewal by Andaman of South hew y-nand e1c 'adfs ur _ L3 ficrsat! Villuo�alta�� prin 1am t 1L of Pituduct A$arna Print;awe Print Nam YOU, THE BLiYI;R(S), MAY CANCI:t. 1 E27$'1 RANSKC€(07 AT ANY TIMB RUM TO 11RI MCHT OF THE.TW" BUSEIMS DAY Ar=TIM DffE OF TIiIS TRAlVS,1C770N.SEE THE ATTACIRED h'O'nCZ OF CAI CELT ATiON FORMS FORAM PMPLANATION OF THIS RIGHT; - - - 1%4- - - -- - - - NOYIE6 OF - — —— . — ZftMae � ION Date of TramaetiIan Al2.6 a You may cancel 1 Date of Tran LL saction You may,cancel this transaction,without ny p nal or oblig ee s{t+ ation,within this watinictiion,without CRY or Obligation,within thr busloon dAy m Life atb0+re----if)rou gamma,any, t three business days tram t9ie abatE date,IF Yo11 manna,any property,traded in,any palyment s made by you under the t iim"rcy traded IN any pa)nments made by you under the Contract or Sate.and any""Me instrument executed i Contract or Sale.and any negotiable instrument executed you win he returned,tYlthrn rptt hrttithaat,isle ttntle+trdng ! by yroer will bo eraattatod within tat butirtete d74rs following reeolpt by The Seller of your cmeellimon notice,and any t receippt by the Seller of your cancellation natrteo and any seeuritgr intersrR Apsutg oat of the transaction.will be security nett w arising out of the transaction v nu be carteole d.lfyou cancel.you must make available,to the Seller ! can€e ed.Ifynrr cwbm4yon must make available to the Seller at your residence,in substantialty as gaud condition as when ! as your rol idenoe,in substandatly as good motion as when received,any goods delivered to you under this Contract or l received,any goods delivered to you under rftls Contract or Sate;or you may ityou wish,comply with the InaructlOnS of I SaIC or YOU may,dyou wish,aomply with the instructions of the Seller regarding the return shipment of the goods at the f the Seller regarding the return shipment of the goods at the Soll&rV expense and risk.It you do Make the goods available .f 5etlees tc�xpeen o and,attic ltyou do male tt1+e rood a atraytablo to the Seller and the Seller deer not pick them up within 1 to the Seller and the Seller dots tt,4t pick them up rri bin twenty days of the date of tatncellatlon,you may retain or ! twenty slat,,of dw date of cancellation,you may retain or dispose,of the goods without any further obligatlom.If you l dispose of the-goods*khout awry,thw ter obligation.If you fail to make the goods available to the Seller,ar if you agree i fail to male the goods available to the Selle-nor if you agree to rewrn the goods to the Seller and Fat to do so.then you t to rC m the goods to the SdIer and hll m do sa then you remain liable for pterforntanoe of all obligations under the i ratmain(fable for'ertormanw of all obligatlonc under the C'antrrct.To cancel this transaetioty null or deliver a signed Cots,tra#.To cancel this tranmctim%mall or deliver a signed and locoed copy of tacit cancellation notice or any causer t said dated coyly of this'caneellatlon notice or any tour written notice orsend at:elegmm to Renewal byAndeersen of I wi4tben nat ic%arsetnd a tetegrw"to Rermwo) Anderum at Southern New Errand at Tb Albion Road, colnJU62665. i Southern Now end at 26 Alblon Road ne n, 1028651 Aate ND T LATER THAN MIDNIGHT OF I p�EATF.It THAN MIDNIGHT OF t HEREBY CANGELTH1STft�4idSAGTiON I 1 N(Daft) CANCELTHISTgANSACTION. 6�ary f�.atro trsnt Name nose atiq.rs siDrrctre Pdid Nam Date RbA CaPr.WhIto Buyer Copy:YelbN 91AW co":Pink . L r - v Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Superlisor License: CS-095707 BRIAN D DENNISON 1 7 LAMBS POND EIRCL"E s Chariton MA 015J7lk ' txz.r� . " 1 Expiration Commissioner 09/08/2014 �pa��rirr2oo��oeafl(�fy��/��aQafzudleG Office of Consumer A fairs n Business egu anon 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home improvement Contractor Registration Registration: 173245 Type: Supplement Card - SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 911912014 DENNISON BRIAN 1137 PARK EAST DRIVE WOONSOCKET,RI 02895 Update Address and return card.Mark reason for change. S,t O 11W-05�1 D Address ❑Renewal (]Employment D Lost Card ice orCoesomer Afhio&Rude-it gelotiaa Lireou or registration valid for IndWldul the only 2�1OME IMPROVEMENT CONTRACTOR before the expiration date.If found relum m: Cf. Office of Consumer Affairs and Bottom Regulation e9iatrsuon: 173245 Type; 10 Park Plum-Suite 5170 912 Expiration: 0/1o14 Supplement:lard Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. - RENEWAL BVANDERSON BRIAN 1137 PARK 113E PARK EAST DRIVE WOONSOCKET,R102895 Undersecretary _ Not valid without signature ( - The Commonwealth of Massachusetts Department of IndustriaiAccidents f Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers A licant Information Please Print Le-vibl Name(Business/Organization/Individual): A&l4ti,15 LcC Address: a City/State/Zip: L l/l/Co1N , •ie� 01.21-5 Phone#: !10 J )P g- ?YOO Are you an employer?Check the appropriate box: .Type of project(required: 1.11 am a employer with d`Z� 4. [] I am a general contractor and I employees(full and/or part-time). a 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 & []Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance comp,insurance.$ required.] S. We are a corporation and its 10 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.Q Roof repairs insurance required.]t c.152,§1(4),and we have no // / employees.[No workers' 13.�•Other GVP ow f 4dy�' comp.insurance required.] "Airy applicant that checks.box#1 must also fill out the section below showing their workers'compensation policy infonmadon. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mustsubmit anew affidavit indicating such tCoiWwors 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.Lie.#: /6" 7;?1 3 E9.3 Expiration Date: o� Job Site Address: / / /�1 �/�v� 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 ofa 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 beforwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and penalties of perjury that the informadonprovidiairbot is fue and correct c � Signature: Date: r/ _ Phone#: Llb�' a-9- 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 S.'Plumbing Inspector 6.Other Contact Person: Phone#: / Client#:30124 SOUTNEW ACORD. CERTIFICATE OF LIABILITY INSURANCE JDATE"w 'YY" 8/06/2013 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:Kthe certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.B SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER ME: Willis of New Jersey,Inc. NA Anita LittlePHONE 856 914.4660 No No):856-9144881 1015 Briggs Road,PO Box 5005ADMU: anita.little@willis.com Mount Laaure BOX Laurel, INSURER(S)AFFORDING COVERAGE NAIC i Mol,NJ 08054 INSURER A:Selective Insurance Co of the S 39926 INSUREq 1msuRER a:Argonaut Insurance Co. 19801 Southern New England Windows LLC DB/A Renewal by Andersen INSURER c:Beacon Mutual Ins.Co. 24017 26 Albion Road INSURER D: Lincoln,RI 02865 INSURERE: INSURER F: COVERAGES CER71RCATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT.TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD UB POLICY EFF POLICY EXP LTR TYPE OF INSURANCE g POLICY NUMBER M/DD IUD LIMRs A GENERAL LIABILITY S202945900 8/10/2013 08/10/2014 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY ,RED PREMISES noe $1 OO OOO CLAIMS-MADE FXI OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE E3,000 OOO._. GEN1 AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s3,000,000 POLICY PE O LOC $ A AUTOMOBILE LIABILITY S20294590001811012013 08/10/201 CIB�LD SINGLE-UMIT 1,000,000 X ANY AUTO BODILY INJURY(Per Pennon) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per acdderd) S X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Persocident $ a.. A X UMBRELLA LIAR OCCUR S202945900 B/1012013 08/10/201 EACH OCCURRENCE E5 000 000 EXCESS LW3 CLAIMSdNADE AGGREGATE $5 00O 000 DEo RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS'LIANUTY 0000068028-RI 8/21/2013 08/21/201 X WC STATu- oT►� B ANY PROPRIETORIPARTNERIEXECUTIVEY/N AIC927818352394 812112013,OW112014 E.L.EACH ACCIDENT $1 000000 OFFICERIMEMBEREXCLUDED? 51 NIA (MandatoryIn"") E.L.DISEASE-EA EMPLOYEE DESIf C�ORIPTION OF OPERATIONS below E1 00O 000 under E.L.DISEASE-POLICY LIMIT $1 00O 000 DES DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N more space Is required) CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. Lincoln,RI 02865 AUTHORIZED REPRESENTATIVE 0. ©1988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S215109/M215088 AXL 1 * � ss t i i 1 I 'i, �� I' _� .. atr. t ". �, .�, z ` � :; �� i ,-. � � . . � ,� i-,, �� � , . ,�A �, ��, � r. ; �. � ' i \ ( �, I1 • 9� f ~�e�� / `.F ��3i a.(*'•:gym,-'v,:.., - �.. � �' -_ �" `Y �� � � ��� ��i� �3r���� � TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2 Z Parcel C-),�; TC Permit# 3 4 17D Health Division �7 tO y I '��l3lc� �� S r �tE Date Issued 1 ��APR j 3 � - 14 - l� � Conservation Division s/�3�6S/ • o5wO � f $; s Application Fee �5 U Tax Collector � ,%dS'� /� US— --- Permit Fee W�), 2 Treasurer o/C 57'1'1 S/Q� SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Planning Dept. WITH TITLE 5 Date Definitive'PlanApproved by Planning Board ENVIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATI S TS Project Street Address Village G�� Owner Address Telephone Permit Request A,0,0 t/, >liVc 101111V1 C e-a se ��6W- Square feet: 1st floor: existing proposed .14 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z S Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ;ff- 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 WrOther > 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 Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use ��// BUILDER INFORMATION Name AT ' Telephone Number Address_ Z_4� License# 3 � 4 AUK Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO %�� Sidirr3Lf� '27,K SIGNATUR DATE 911,_ � 's FOR OFFICIAL USE ONLY / M1 PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION-0 f�S FRAME l� p INSULATION K. FIREPLACE .c ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH /f) FINAL' m GAS: ROUGH FINAL mo r FINAL BUILDING nMa .s. } �me�tt DATE CLOSED OUT �:3�0 ASSOCIATION PLAN NOS< EMt''!= • f ; W y rr,A ` Town of Barnstable Regulatory Services i BAWWasrE, Thomas F.Geller,Director rinse. Building Division lfD MP'� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 Permitno. ' Date " AFFIDAVIT HOME IMPRaVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION xa MGL c. 142Arequires that the"reconstruction,alterations,renovation,repair,modernization,�conversion,- -existin owner-occupied f an addition to an re g improvement,removal,demolition,or construction o Y P 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. �Q Type of Work: /� � t Estimated Cost `Z Address of Work: Y 6v-ner's Name: y_ Date of Application: I hereby certify that: " Registration is not required for the following reason(s): []Work excluded bylaw []Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DE WORK G WITH GO NOT HAVE CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDERMGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the en of the owner: Contractor Name Registration No. Date , OR Date Owner's Name Q:fomis:homeaffidav _ The Commonwealth of Massachusetts �. (� Department of Industrial Accidents f� == Office of Investigations 600 Washington Street, 11h Floor _L iw Boston, Mass. 02111 Workers'Com ensation Insurance Affidavit Building/Plumbin /Electrical Contractors y, g� �--t�` 1'T��ti�3� Syr!w•j�P^ 'kw ,�� t',�"f �. C,s5.��i•+ i��'. � ,.� �..�a r3 )�1$77,1♦'>�EQ1D�1���##'`/':v'.'•w .•ld�4yti�^ .'�y �'` �„ a..tit�: name: address: � state: zip:i� ®phone work site location(full address): t! �G�SIb� "��• ���1 1e,0t ❑ I am a homeowner performing all work myself. Project Type:' ❑New Construction❑Remodel , Q--am a sole proprietor and have no one working to any capacity. Building Addition ➢F,.�;4'.i.."��a�..'s....i'�..-_"'...:+..Aa. .v ..r.,:.^�.,'w4`�"dl'`�'' .?`-�UZS'.. �Y�'.:.' � .... ..2+..t ... •.1 .a .. �:.ri .. ..... ,. .,.....:, .1. ..,. ..r'.',i.. 1R,1�..� ❑ I am an employer providing workers' compensation for my employees working on this job. _ company name, address: city phone#: insurance co. Vollcv# ❑ I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: , company name: address: city: phone# + insurance co. policy# company name: F address: city phone#• insurance co. ]DOUCY# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 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. 1 do hereby c under the pains and penalties of per' ry that the information provided above is true and correct Signature ell Date Print name l ��Gi� C�J Ci�i/% Phone# - i` ;•official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department L ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; ❑Other (mised Sept.2003) - 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. Please supply company name,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 permit/license number which will be used as a reference number. The affidavits may be returned to 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 Investigations 600 Washington Street,71h Floor Boston,Ma. 02111 fax#: (617)727-7749 phone #: (617).727-4900 ext. 406 E"D''ti Town of Barnstable °;. RegulAtory Services BAstysrAstE, Thomas F.Geller,Director • 9 MASS `� sd3�. p•�� Building Division _ RFD MP2l Tom Perry, Building Commissioner 200 Main Street,_Iiyannis,MA 02601 www.town,barnstable;maxs office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize to act on my behalf, in a]l matters relative to work authorized by this building_permit application for: (Address of Job) t2 ignatur of Owner Date Print -...,,,,:a.minaofl�C9AdTfiCTf1N - ,• .• RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 a Residential Addition $ 50.00 . Alterations/Renovations $50.00 Change of Contractor/Builder $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 14 square feet x$96/sq.foot x .0041= �' plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTINGSPACE square feet x$64/sq.foot / = / Z 'rev, x.0041= -Z plus from below(if applicable) GARAGES(attached&detached) 2 2. O 1 0 V. l square feet x$32/sq. ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= (number) S Deck x$30.00= ` (number) , Fireplace/Chimney x$25.00= (number) Inground Swimming Pool _ $60.00 . Above Ground Swimming Pool'. $25.00 M Relocation/Moving $150.00. (plus above if applicable) o hh Permit Fee / U. 26 , Projcost Rev:063004 - ... y tAK.E �t1 - Ilk r c Y � - - � �, •,fig �: f �7 ZIOC47 1 Q A a S w -C CEJVTt�iPYf�l ;�r � e SCRG f:/•• 4d' DEG 1977 ,� M -,.. :� y���, JVVcyPMAN GRcSSM,�3N i2.L•S: r o L - ��•� f` a• �oX 39.E ; -�. MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code 1 Permit # I MAScheck Software Version 2.01 I I I I Checked by/Date I I I CITY: Barnstable -STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 4-11-2005 COMPLIANCE: PASSES Required UA = 33 Your Home = 26 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA ------------------------------------------------------------------------------- CEILINGS 96 �,R•0 0.0 3 WALLS: Wood Frame, 16" 0•C• 196 3.0 0.0 16 GLAZING: Windows or Doors 12 1" 1 0.310 4 FLOORS: Over Outside Air 96 30L0 0.0 3 HVAC EQUIPMENT: Furnace, 84.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4- Builder/Designer Date i MAScheck INSPECTION CHECKLIST Massachusetts Energy Code MAScheck Software Version 2.01 DATE: 4-11-2005 Bldg. 1 Dept. 1 Use I CEILINGS: 1 I 1 1. R-30 I Comments/Location I WALLS: E I 1 1. Wood Frame, 16" O.C., R-13 I Comments/Location I I WINDOWS AND GLASS DOORS: C I 1 1. U-value: ❑.31 1 For windows without labeled U-values, describe features: I # Panes Frame Type Thermal Break? E I Yes I I No I Comments/Location I FLOORS: E I 1 1. Over Outside Air, R-30 I Comments/Location i I HVAC EQUIPMENT: C 3 1 1. Furnace, 84.0 AFUE or higher I Make and Model Number I AIR LEAKAGE: E I I Joints, penetrations, and all other such openings in the building I envelope that are sources of air leakage must be sealed. When I installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: 1 1. Type IC rated, manufactured with no penetrations between the I inside of the recessed fixture and ceiling cavity and sealed or I gasketed to prevent air leakage into the unconditioned space. 1 2. Type IC rated, in accordance with Standard ASTM E 283, with no I more than 2.0 cfm (0.944 L/s) air movement from the the I conditioned space to the ceiling cavity. The lighting fixture I shall have been tested at 75 PA or 1.57 lbs/ft2 pressure I difference and shall be labeled• I VAPOR RETARDER: Q I I Required on the warm-in-winter side of all non-vented framed I ceilings, walls, and floors. I MATERIALS IDENTIFICATION: E I I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values, glazing U-values, and heating I equipment efficiency must be clearly marked on the building plans W I or specifications. f I DUCT INSULATION: E 3 1 Ducts shall be insulated per Table J4.4.7.1. I DUCT CONSTRUCTION: 3 I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I TEMPERATURE CONTROLS: E 3 I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I HVAC EQUIPMENT SIZING: E 3 1 Rated output capacity of the heating/cooling system is I not greater than 125% of the design load as specified I in Sections 780CMR 1310 and J4.4. E 3 I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20% of the heating energy is from I non-depletable sources. Pool pumps require a time clock. I E 3 I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.) : PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2^ RUNOUTS 0-1^ 1.25-2^ 2.5-4^ 1 Low pressure/temp. 201-250 1.0 1.5 1.5 2.0 1 Low temperature 120-200 0.5 1.0 1.0 1.5 1 Steam condensate any 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 1 E 3 1 CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water pipes to the following levels (in.) : 1 PIPE SIZES (in.) 1 NON-CIRCULATING I CIRCULATING MAINS & RUNOUTS I HEATED WATER TEMP (F): RUNOUTS 0-1^ 1 0-1.25" 1.5-2.0^ 2.0+^ 1 170-180 0.5 1 1.0 1.5 2.0 1 140-160 0.5 1 0.5 1.0 1.5 1 100-130 0.5 1 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)------------------------- < 92. 6.anu—/,lfa 1KA_4j a k"& BOARD OF BUILDING REGULATIONS 4 License: CONSTRUCTION SUPERVISOR _ 2 Number. CS 015834 l , Expires: 10/30/2005 Tr no: 6048 ui Restricted: 00 '. HOWARD W WOOLLARD , PO BX 263 3219 MAIN ST BARNSTABLE, MA 02630 Administrator F ,per �6ee�arvnza�zuea� o�./�aaaae`ucaefla \ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 106615 Expiration: 7/24/2006 .-Type.-Individual HOWARD W WOOLLARD,.- wward Wooffard. 236ICENTER STREET i YARfoiOUTHPORT,MA 02675 Admin;strator, Est EXIST. HO J5E PROP05FD REAR ELEVATION SCALE 114" = I '-0" EXTERIOR FIN 15H NOTE5: MATCH ALL EX15TI NG 51 DI NG / ROOF 5H I NGLE5 - CORNER BOARDS - RAKE BOARDS- ' SOFFIT/FASCIA DETAI L5 - WDW.' TRIM - TYPICAL VANDERMIDER RESIDENCE LAKESIDE DRIVE EAST,CENTERVILLE,MA. DEC. 21, 2004 REVI5ED 4!7/05 HOWARD WOOLLARD BUILDER FLOOR PLAN-FOUNDATION PLAN-FRAMING PLANS ELEVATIONS-FRAMING SECTION t 10-0" ADDITION ' 1 VERIFY 5-110 ° VERIFY ' ......... LL=il _ EXIST. HOU5E SET BACK 5" -. PROP05ED LEFT 51DE ELEVATION SCALE 1/4" = I'-0" VANDERMOER RE51DENCE LAKE51DE DRIVE EA5T,CENTERVILLE,MA. DEC. 21, 2004 REVISED 4f7/05 HOWARD WOOLLARD BUILDER r FLOOR PLAN-FOUNDATION PLAN-FRAMING PLANS ELEVATIONS-FRAMING SECTION Ili EXIST. H0U5E FRONT ELEVATION SCALE 1/4" = I'-0" VANDERMOER RESIDENCE LAKESIDE DRIVE EA5T,CENTEKVILLE,MA. DEC. 21, 2004 REVI5ED 4(7/05 HOWARD WOOLLARD BUILDER FLOOR PLAN-FOUNDATION PLAN FRAMING PLANS ELEVATIONS-FRAMING SECTION 4 GI-O" 10'- 1 1 " VERIFY 5'-1" VERIFY 2X 12 RIDGE BD. 0-I O RAFTERS @ I G" O.C. % 12 VERIFY TO W/ 1/2" CDX OR EQ. 5HT'G. V fRIFY TO 12 \� \ MATCH EXIST. MATCH EXI5T. ` 2X5s @ I G" O.C.-R-30 MIN. INSUL. - I/2" GYP. BD. CIEL. EXIST. FRONT - u WALL ____�H..D. R-3 1IN5UL. ON I X3 @ 24 O.C. _--W/PROPOER V_ ENTj ALUM. DRIP EDGE-I X8 FASCIA iv t I BATH F N Ew _ BD. ALUM. GUTTER- i X8 50 F IT I rn wU/ I BD. W/ CONT. VENT- I XG FREEZE BD. i p > 2X45 @ I G' O.C.- 1/2" CDX OR I ►n Lu - E - INGLES _ I 16'-O" 8'-5 7/8" I EQ. SHTG. TYV K W.C.W.0 5 5L7 . �! 3 <,_�I1\15UL. MIN. - 1/2" GYP. BD. BACK5" @ INTER. I EXIST. FIN. GRADE I 3/4" PLY WD. 5U5 FLR.- 2X 1 25 @ I G" O.C.- R=W INSUL. MIN. I T-I I I OR EQ.5HTG.W/ z BRD'G. MID 5PA1 ' I ua'o.VENTS @PA.BAY i 1 BATH ROOM ADDITION TO: Lp 1 2" CONC. 50NO TUBES W/ ( I VANDERMOER RESIDENCE 244 VERT.-51MP50N GALV. 7'-7" 7'-7" LAKESIDE DRIVE EA5T,CENTERVILLE,MA. ANCHOR BA5E- 014, 5" 1 GI-O" 5" - DEC. 21, 2004 REVISED 4/7/05 ATYPICAL FRAMING SECTION t10WARD WOOLLARD BUILDER SCALE I/4" = I '-O" FLOOR PLAN-FOUNDATION PLAN-FRAMING PLANS ELEVATIONS-FRAMING SECTION 6'-O° CID TYP.- P.T. 2-2X 12 Z/ U 1 S - tn O I � � �i O „ fLU C) m i ui N „ NLu = V, o � v� i . cm O �Nuo, N cq ca " 6'-O" FLOOR FLAMING PLAN 5CALE 1/4" = 1'-O" VANDERMOER RE5IDENCE LAKE5IDE DRIVE EA5T,CENTEKVILLE,MA. DEC. 21,2004 REVISED 4/7/05 ' HOWARD WOOLLARD BUILDER FLOOR PLAN-FOUNDATION PLAN-FRAMING PLANS ELEVATIONS-FRAMING SECTION r � GI-O" 01 ol 2X 15 ZCal 16 O. X tu Q u- - N Q O 2 1 R1116 a oC 131 ). O X 1 5 I o.c — O ol ol r - ROOF FRAM I NG PLAN SCALE 1/4" = I'-O" VANDERMOER RE51DENCF LAKE51DE DRIVE EA5T,CENTERVILLE,MA. DEC. 21, 2004 REVI5ED 4/7/05 HOWARD WOOLLARD 13UILDER FLOOR PLAN-FOUNDATION PLAN-FRAMING PLAN5 ELEVATION5-FRAMING 5ECTION I ' TYP.- 12" D. CONC. FILLED 50NO TUBE5 @ ( 3) LOC'5. PROVIDE GALV. 51MP50N ANCHOR BAH5 A5 REQ. VERIY MODEL# ,.�.— ................. 1 1 . i 1 1 1 1 1 1 ' A1 a — 1 1 1 1 1 1 1 1 1 , D 1 1 1 1 1 1 °• 1 1 1 I 1 1 1 1 1 1 1 1 1 , I I 1 D 1 1 I = 1 1 1 ICI 1 1 1 1 1 t I 1 1 I 1 1 PARTIAL EX15T. HOUSE FOUNDATION ,° I 1 e � 1 1 1 , 1 1 1 1 1 I I lTllTllll-lllTll-- D° � �-- a � v a v � � • v 4 v � � v 4 v/ , t c _ e• a o' a t , a 1 a— ------------------------------------------------------- —� 1 1 81-811 C 1—Q" VERIFY HT./TOP OF NEW CONC. 50NO TUBE5 TO PLAN I LAN ALIGN FIN. FLR. FLU5H W/ EX15T.FIN. FLR. 5CALE 114" = I'-0" VERIFY ALL DIMEN51ON5 NOTE: RELOCATE SPRINKLER AND EX15T. CONDITION5 AT 51TE PRIOR TO START EQU I PT. OF ANY WORK TO INSURE VANDERMOER RE51DENCE CORRECT P051TION OF LAKE51DE DRIVE EA5T,CENTERVILLE,MA. ADDITION FTG5. DEC. 21, 2004 REVI5ED 417/05 HOWARD WOOLLARD BUILDER FLOOR PLAN-FOUNDATION PLAN-FRAMING PLAN5 ELEVATION5-FRAMING 5ECTION a • e _i 6l_Ols 3'-0' w WDW.A5 0 5ELEcr. s rn Q MA5TEK BATH ADDITION Q FIXTURE LAYOU BY CONTRACT 6'—O" fLooK PLAN SCALE 1/4" = I'-O" VANDERMOEK RESIDENCE LAKE5IDE DRIVE EA5T,CENTERVILLE,MA. DEC. 21, 2004 REVI5ED 4/7/05 HOWARD WOOLLARD BUILDER FLOOR PLAN-FOUNDATION PLAN-FRAMING PLANS ELEVATION5-FRAMING 5ECTION t f F THE f The Town -of Barnstable BA.AA-q&LE a MASS. . Department of Health Safety and Environmental Services 2659• `04 acre•+` Building Division 367 Main Street,Hyannis,MA 02601 )ffige: 508-8624038 Pax: 508-790-6230 1 . PLAN REVIEW , Owner:l\� �7 c�y� c9 c e�r Map/Parcel: `� _ C) 9 Project Address: l e t J Y^ Builder: _('1. L�)0)C) I Ce The following items were noted on reviewing: 2 )a- C_ C � k Reviewed by: Date:. '��' Frru r Town .of � �� o o1yL of�4rnstable "Permit# Erpires 6 m �t!/rs jrour 1 lale Regulatory Services sv�aysra.»ra. + Fee 16J9- �m� Thomas F.$ Geiter, Director�rcq h1A'l k . Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable,rna.us Offic e: 5 08-8 62-403 8 EXPRESS PERMIT APPLZCATZOIr' - RESIDN Fax: 508-790-6230 TZAL ONLY n iVot Ynlid)PIlhout RedX-Press lrraprin! Map/parcel Number / P XeRestidentialAddresss Value of Work VC) Mini um fee ofS35.00 for work underS6000.00 ` Owner's Name cC Address 6 O.t'}„ Contractor's Narne �7 A� �O Telephone Number Home Improvement Contractor License#(if applicable) Yk ction Supervisor's License#(if applicable) man's Compensation Insurance Check one: �® V11hic a sole proprietor )AR-PRESS ER11Ithe Homeowner Worker's Compensation Insur nce MAY - 7 2012 Insurance Company Name a Workman's Comp. Policy# g30 T TOWN OF BARNSTAQ�.� I 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 ofrooi7 ❑. -side Replacement Windows/doors/sliders. U-Value #of doors �, (maximum .35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,Le. Historic,Conservation,etc; ***Note: Property'Owner must sign Property Owner Letter of Pe rmission. A copy of the Home Improvement Contractors License & Construction Supervisors License is Tequired; NATURE: — �,,�� PFILESTORMS1bui lding}ia„nii for,a,sTXPRESS.doc The Commonwealth of Massachusetts Pnrt Form Department of IndustrialAccidents Iry 0A 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): ��t!t�0 d77 jC(_,14S _ Address: City/State/Zip: o-efi%;o, /(�� - �`� q� Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 6�- 4• ❑ I am a general contractor and I 6. ❑N construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached'sheet. 7. emodeling ship and have no employees These sub-contractors have g„ ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.1 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 ' right of exemption MGL y �o workers.comp. on per 12.❑ 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 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: Lc.G4-70U � s Policy#or Self-ins.Lic.#: J7 �J a Expiration Date: � nn Job Site Address: We's)'o,f- City/State/Zip: , �e e Ce ��J C 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains and enalties o erju that the information provided above is true and correct. Simature: �.._. _ _.-.vim-,,,..-- .:_..__ . ... ;._._. _._._. _..._......:Date• .... .... . �'.... . Phone#: rg - w v Official use only..Do not write,in.this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle.one): 1.Board of Health .2.Builditg Department 3. City/Town Clerk 4.Electrical Inspector 5:Plumbing Inspector 6.Other Contact Person: Phone#: A"C CERTIFICATE �F LIABILITY V INSURANCE ....-r- ND OR ALTER THE COVERAGE AFPORDED BY TM _ THIS CERTIFid- E IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO Rlt'sliTS UPON THE CERTIFICATE HDLDEA.THIS CIES CEFMFr.AtE DOES NOT AF IR INSURANCE DOES NOT CbllS7lTtJT�AEtX RAGT E1ETWffN T?I I UREi3�3} AUTH Minn BELOW. THIS CERTi REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT: N the C"DcWA hokfer Rs an ADDITIONAL INBURi:D.tte polley(ios)toast Aa endohsad. N BUBROOATIOK I8 WAIVED,sh�6ject to the terms and mdftm of the policy.r sfbdn policies nW require an ersdorsamant A daesh w*on this aartf)cate does not confot ril ft to the certificate holder in Hsu of Op h endorsem s lis"aa 401 76"SDC NAM, Ax HunW Insur me,Inc. 401 TO 8502 PMD"� 389 Old River��d,,P.O.Box 1 menvins,RiLOMOMIDIp 02636.0001 MOONA 1 N MUR Awo Mille# tasuMt� Moon Associates Inc. I A:Nationsl Gran Co 14788 {rtiwrance Renewals By Anderson msummt B!9eQcm Mutual lmmnce Co. 1137 Park East Drive ihrsus IlIc: Woonsocket,RI 0=5 mMAM D: uR e C GES CERTiF7CAT'EHUMBEA: REVISiONNUM13ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED$f30Vll HAVE SEEN 13SufD TO T}lE INSURED lfAMkk�ABOVE FOR THE To v* PERIOD INDICATED. NOTWRHSTANDMiG ANY REQUIREMENT,TERM OR CONDmON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO VdFI1CH THIS MRTIFICATE MY T AND BE ISSUED ONS OR MAY PERTAK OF SUCH POLICES. 4 INSURANCE AFORMN REDUCED BY GY THE 95 D Cat RIaE HEREIN IS SUBJECT TO ALL THE TERMS. Lt1AT8 - L TYPLO!UMURANGB uoY NUMER 1,000;0 eatlatrJLL Ausam PACH OCCURRENCE S 09J16l11 D911i3112 s Ik10.0 A X OOMMER(RA WNERALL"ILITY P82861$ >P�E(tg EONP Uar as o «) ss 10,0 cLAs 'D Locu AL&AOVINJURY a 1,000.0" t ALAGORGATE 2100010 PRODUS-COew—AGG 2,0001 M AGGREGATEfUWAPPES PER POLICY AG Gt>MBINt�SINOL>c LIMIT AUTOMOBILE LMLITY Ma scddaM) 1,008.00 A x ANYAUTO 81$26619 09t1�4'i 09d1S112 BODILYIMRtY(Perp—) hl ALL OWNED AUTOS BODILY INJURY(Per&lXkWN a SCHEDULED AUTOS PROPERTY DA 9 a (Persmdmt) HIREDAUTOS a NOMA"EDAUTOS a Wa X OCCUR EMk10tCt1 eNCEVA a 1,000,60 extxss Lush: cLAI aaAaE CUS26619 09mliml 09f16112 AGGREGATE _ A QEQUC716LE S X RETEMON 41Q8� STATIJ- OTN- ptQhlKEttd tEKRATID1t ;g�jOO AhDVMCVI!WUAeirrY ViN 10l01i11 10t01h2 L°L.EACHAC91DRE s g AN'r PiLOPRIETORlPARTNERM=Curnre N rA WC+!7 731 1330A27 rS80.00 t ULLUDED9 FA.W8EASE-EAEMPLOYE t n dasedbe LAW E.L.Dist-POUCYLmT SOO,d10 IPTiON F OPERATION below pTlDN O!t�EidLTiONs!tOO1hTIDp81 vl (tLSfeelt AOORD 901.AiMl�ei RittglrlelJ�ii�:M,9enoroa�tee k regdre� CERTIF& iD CANC Th3N DEPARTM SHOULD ANY#THE ASOV6 DESOiMED MJCIES�CA1�B gACCCpFM�E tMTN THE POLL PCY OFROVISIOM Wild Be DELIVERED IN AUTMORIZIM fumWAIINTATIVE Q 1968-2009 ACORD CORPORATION. All rights rleSerVed. ACORD 25(2009109) The ACORD name and login are m9is66red marks of ACORD , office of Consumer Affairs and usiness Fte�tilation g 10 Park Plaza- Suite 5170 Bosion,M fssi chusetts 02116 Hofrie Improvement G�ant ^ araetnc Registration '�IrA ReAlatrsii": 11953E Type Orfwate tafpordtion Ex�kiicm 7%24t2Q13 Tt* 2081t MOON ASSOC INC JAMES PAOQ''N �� } 1137 PARK LAST DR. WOONSOCKET,.Ri 02895 n; :y• 4pdaie Atldresi and rrinro tasd ¢lar1:reasau ror ebsn�e; CI Addr6� i j Reaemyl C) Em m plovcal LA,si Card va !tcense or re�istrntiur!timed t»rindisldn!u5egntp o HOME toPRUVEMENT COtITRACTOR bero►e the rxpli o dnfc, it ruunit'retura to Registration: 119533 Trig Office ar con I. . . ArfiirY aad Bu`n`ess'ltcguta#inn g4iratioA, -fklobo private 06tpora wn f4:1'ail.Pt1?a-Suite gt'?0 ��.a Boston„h1A 01118 MtfO, ASSOC{tVC r D 1, PARic Eq$1c- 1ivO0oS&KE7 Rf C1ZasSff r , + t'pdrrsctr<iary iYoi 4411ii1 wilhool signature { 4�t '- ` :_± . ,�`•- t f +� IF Wit" soft, i CC ' J, n 2 - ,the =— * 3.. +jw C Olnl*rl '01 -"OfU 41 w �100-0 { E� r, T cur Par,*Eau Orfve �1f�yeTxrt - atprc•u:5'umsaa woonucket.Reude Ws'd 0299ier,.x asa)r_s {alturyT)•Da22 ,J� ` !Ie. .<.,��•xtur�ur ..rr.• Wo Win t3m!k purcheser(s)Name, ?:(��lt�s�v^�'�(t_...cY�./n1�•►QQ]I�n <le. t,a��. J Qf= +y/ .-. l"fafl.ftra Addrrxs: (1 -.,.......7^qt,•�`�,i; 5 o D—Ave t'r .®.. �M l,,,�y►�}C qA- sa MaltingAddresss!el�a T� �ecsA`�'fit�Q _vetgC� O„r#,r�- G'ff+r�4l a�1�F�T_,,._lbt4,..,_. Homephone,[Jo•��+}r� �Q{� C'S rlr —1,, �B �'�y�_ E-mail: wort(mrlmrs):- '®"r— Cali(mr/mrst: Taxes Paid in: /4 � f1We,the above putchasetts)i'Pu,cftaser(s)'I and the owned;)of the property located AT the:sndve installafton address.hereby Sorntty ono)cvcrsny agrue to contract with Moon Associates,Inc•dba Renewai by Andersen t'Contrdow')to turnrik deliver,and Install of all malwmis as described n erns agreement('Agrnement'1,the attached Spec Sheel(s),Sales Agrww.rit Summary and diagrams)whith are incorporated herein by reference and made a aart hereof.A CatrtpWtfon Certificate will be ecrcuhd for all jobs O fhe nd of the rTt;tai+at o& F ct Type: C[,rtNoetil. DEPOSIT/PAYMENT OPTIONS W tSuR4gttta lufed re,iGeatiore antler t,redi2 apararefl. , AgrQMmnt Amount S I�1 ��� - 1.Cheti6 Cashier's Check or Money Order Ck a`_•_ Lost Deposit$' f _ 1Q$,L�� IMaoe uayaDle to Rerfewsl by Andersen) WNante Due On Completionssf 1Credit Card'(neck-) yea Mastercard Dttcover. Actt a Eap Date Security Code 1 lj 00 (seaa,mm�n ig�rarmrvn A+nosurr a.aa ui»nemtano!�. .Fittansing f.'Ms:,I�,�Ifes�►. �. indicate Payment Method for gafame tr` Duo at Time of IInstallation: Acct Apprgvai Cade L S/�l1� G j 1MYAWK At"a Anryrnvel Lr>rfe I.. Tst S ta rt Date'. I Ets CnInDiption Deane '1lyrr cfyre to Wkm rtmaxra to dwea tat m(dreerra mda vt d fm tea dryota amount ' 12 �w.�t +Z MaIDatCO k.lJSrttCE]lP tfiJ e•4 to critic Ca/E Jian canWrrnon 6r lrutr4t%'ma,Wi,ht ab.e. Ito agrted by and tfrr e n the parties that that,R61�001w,it unglltute,arse Rduc t dr"Zintura.between me genies,and there are no vetai;undN WAAgs rnansfina Of rnodltyinE an e Nr y of the taint of this Agreement.PuRhafrl hMeby acknowleoe"that Vurnfastvisi I I has,cod:foe Iron and rery c of this Agreement and Rae,rnta«Rst a - Completed,signed.and dated copy of this Agreement,hrth lift.she rw0 aczmnoa"PIR Notice Of CanceFadee tam►,an the date first wnnrn ahrno ant 2)was wsUy Infetiree of hhlner fight to came tNa transfuuon.Ycu and Renewal agree that rhos aliteRment(including the Sales Ailteement Summay,Wk cow SDR'cDflGtm Sheet,and.as - attarWnentsl is the fmaf e[aression of our attement,11,the a mplatn and egtusm statement of the terms and it#sdfxans of our agreement and supeneft"ail agreeme(lts, ` vrgrntandings or trisoauWrr,wRerner over or wraten ZatCred rove Nw to ar tantampo.aneoen)y.vxR rate a$mCTs.rat lilts agreee»stn[may not t17 roddnrled pr aman0ed - . earept In writing flirted try vGv end Renewal you may anal this transactittrt any time prior to midnight of the third business day at indicated below in the terms of the Notice of Cancellation,Thera will be a stance Marge equal to 10%of the carrrW amount if jab Is cnncotlad by purchaser AFTER the third business day,bur Wore materish were ordered.Thera will be a service charge equal to 0%of the contract amount If the job is cartceitecl by Purchaser AFTER materials are ordered, DO NOT SWN TMS CONTRACT IF THERI ARE ANY BLANK SPACES.SEE REVERSE 110E FOR TERMS AND CONDIRONS OF SAtF, s $(Initial) PUruaaser(s)give the Contractor permission totontact me by telephone about future promotions and special offers, Initial, Purchasers)adanowledges having read'Notice of Possible Mechantes Lion"on the reverse, Pu ate PurGt ter SiontratttarReprese tam azure tore S;gn dad - P,nt Name Print Name Print Name YOU,THE BUYERIS),MAY CANCEL THtS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF 114E THIRD BUSINESS DAY AFTER THE DAM OF THIS TRANSACTION.SEF THE NOT la OF CANCELLATION FORM BELOW FUR AN EXPLANATION OF THIS RKsHT.* i O IG _ T1M Sib Date of Trortsactidn (Z. I Date of TranSaCtlan You fWY CAMI this transaction,without any penalty or obligation, You may cdmef ffth transaction, without day penalty at dbllgatldn, within three business days from the above date,If you c irreei,any t within three business days fret,the above date. if you cancel, any property traded in,any payments made by you under the Contract or property traded In,any payrnents made by you under the Contract or Sale,and any negutlable Instrument executed by you will be retumed Sake,and any negotlabto Instrument executed by you will be returned within 10 days foEwving receipt by the Saner of Your r:anceilation within 10 days following receipt by the Seller of ~- cancellation notice,and any security Interest arising out o1 the transaction will be notice,and any sMur4ty interest arising out of the transaction will be canceled.If you cancel,you must make available to the Seller at your•cancaled.1t you camel,you must make available to the Setter at your residence,In substantially as good condition at when received,any residence, In substantially at good condition as when received; any good4 delivered to you under this Contract or Sate;or you may.It you goads delivered to you under this Contract or Sale;or you may,if you wish,comply with the Instructions of thin Seiler regarding the return Wish,comply VIM*0 Instructions of the Seller regarding the term shipment of the goods at the Sellers eaponse and risk.if you do retake shipment of the goods at the Sof lert expense and risk it you do make the goods available to the Seller and the Seller does not pick them up the gaodt available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation,you may. within 20 days of the date of your Notice of Cancellation,you may retain or dispose of the goods without any further obligation.If you retain or dispose of Die goods without any further abllgatlon,If you fag to make the goods available to the Seller,of It you agree to rohfm fag to mate the goods available to the Seller,at It If"agree to return the goods to the Seller and fall to do so,then you remain liable tar the goods to the Seller and fall to do so,then you[remain Mote for performance of a0 obtigatiorts under ttm Contract, To cancel this parNumana of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and dated copy of this transaction, mail or deliver a signed acid dated ropy of this cancellation ftatice or any curer written notice,or send a telegram to camilatfon notice Or any other written notice,at send a telegram to Renewal by Andonen,1139 Park E Dr oonsosket,RI 02i95,NOT Renewal by Andersen, 1137 Park Woonsocket,RI OMS,NOT LATER THAN MIDNIGHT OF s motel. LATER THAN MIDNIGHT pF 1 NEREBY CANCEL THIS TRANSACTION, z I IRRISY CANCEL THIS TRANSACTION. . f ConsuntePs Signature Date Conitimet's Slgstature N'hnattq+! Nua�tn L. .l Vol-t>nvr.-4uv..7— .. Perk cur,,ltuf iSr+u:iahw . r T'� ISbgi�yLit�t'1:fj1 -�:trl'rt:�trt>I1"r7:� h"1tiJlnl�.,�. �13�£2 'I3ti1�•LT-.-.9•i l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z Parcel 7b� �''} 14 Permit# Health Division Date Issued 2--2`6 Conservation Division S Fee Tax Collector f14 � ®� IE TIC ISYSTEPA MUST EE Treasurer ®� I T ILLED EN COP L1A8 %0i.X:,. Planning Dept. 5� 5 OR TAL CCOE:rr-D Date Definitive Plan Approved by Planning Board 'MIN R GU TIan Historic-OKH Preservation/Hyannis Project Street Address "Ic6S l-Le )by�, CAS 1 Village �C ��'LLB it JN Owner/UlC`�WaL-AS t 5V6AN VAN6MQFNr'-- Address °¢9 L I,r�S►DEw2.., e-f)sr Telephone ] Permit Request REPLAUc 4c41STIA/G �E� ��1(7`a Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new I Valuation 00 fbo.Cc) Zoning District gV1 Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: Cl Yes 0 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: 0 Yes ❑No ' �d Basement Type: ❑Full 0 Crawl ❑Walkout ❑Other I Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new _�",, ber 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: 0 Yes ❑ No Detached garage: 0 existing ❑new size Pool:0 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 0 Yes 0 No If yes, site plan review# Current_Use _ __ _ _ Proposed Use n BUILDER INFORMATION �i� / p Name W� L O A VOV Telephone Number Address ZS -Bp 1 Z-1-- kj�> License# 00539�_ 1_�T1h,S LIE M A Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO p�m 1'STL SIGNATURE DATE b�-- a FOR OFFICIAL USE ONLY PERMjT-NO. DATE ISSUED - 4 MAP/PARCEL NO. ' ADDRESS' VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME j INSULATION FIREPLACE t ELECTRICAL: ROUGH FINALc--. PLUMBING: ROUGH FINAL GAS: ROUGH FINAL + FINAL BUILDING, DATE CLOSED OUT r ASSOCIATION PLAN NO. P`oFVE,°�� ` The Town of Barnstable ^R ASS. E.P Department of Health Safety and Environmental Services MASS. i639. `00 pTFo Mp{ Building Division 367 Main Street,Hyannis,MA 02601 Office:1 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: 0 L gK Map/Parcel: /0 Project Address: 4c F/1 ki 51D r AF, Builder: e 1414 ye-41 The following items were noted on reviewing: r f /� 5� 3 015Ta�1� 2 s ?> Tea Thi Fj�r �S Y' ZZe LON , r Reviewed by:,. Date /f /QZ `.�/f2 q:building:forms:review 4' q The Town of Barnstable Regulatory Services Thomas F. Geiler, Director .Building Division Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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 adj acent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. � p Type.of Work: q Z(- r LAC(= A61 ST_l,AJ L b9CAC Estimated Cost 106 Address of Work: Owner's Name: N �c albs .SUsAtJ AN�6 bE� Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded bylaw ❑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 a ent of a owner: Date Contractor Name Registration No. OR q:forms:Affidav :rev-122001 r _ -_— The Commonwea&th of Massachusetts Department of Industrial Accidm& ,a _ -, , _� , • Onlcroflarar�atloas � • 600 Washington Street Boston,Mass 02111 workers' Com ensaiion lh ramie Affitiavit ffamsm i %fin lccatioa 6� cityehone� �l�Z 0011>94 ❑ I am a homeowner pcd=niag all wmk nMrZ I am a sole givpaetor and bave.no oae wmld=in aav c m)i,ty - - -- ��! 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BOARD OF BUILDING REGULATIONS ` License: CONSTRUCTION SUPERVISOR Number.'.CS 005392 Expires: 10/1.9/2003 Tr.no: 6902 I-_.,- -- -- Rest ded'- '60 BRADFORD K HAVEN 25'BARNHILL RD G•f �i i W BARNSTABLE, MA 02668 Administrator bl e Pavx�no9emezllst�.�laakza�uivell3 HOME INPROVEHENT.CONTRACTOR Registrat ioo: lO4Sl3 Expiration; 7/14/02 µ Type: Individual ti BRADFORD L HAVEN CARPEHTR Bradford Havenf ZO'" O 25 Barnhill Road k a ADMWISTFIAToa Y. BaiostaD HA o2668 u z i N The Town of Barnstable P`pF THE Tp�� BAR E.ASS. A 1 Department of Health Safety and Environmental Services MASS. ATFDM s Building Division 367 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 6 � PLAN REVIEW ,j„V Qwner: 0 L Jy q X 14e e Map/Parcel: �S e2 'l a?p Project Address: Builder: /LI171'D/Za �4 y9-Y The f Rowing items were noted on reviewing:,, 'G� �U�'n� Y�Ti4 /dam �Ir'✓LA LL�9-� ///�55-i.v� �`�" Cfl � Ib 3 F'y(Fb� 004-J2bs Aid7- S�6�k" D 22> $HOC, S/��/ �4N D �v ✓�D fY'Y?/G S r� v� � Teo Q&k - �Yl�, 369' 6015- A Reviewed by: 4*1,z Date: q:building:forms:revi6v tL '4wn:Jre t;jladlera 502-S62.-6007 To:Brad Haven Date:3i1912002 Time: 1:1&24 PM Page 1 of 2 WAY k 0 ce 7 5 2�0 E P a r a La m 0 PS L fMS PRODUcT MEET$ OR EXCEEDS IME SET DESOGN CONTROLS FOR THE APPUCAPON AND LOADS LMYED Ovprail Dirrienslon zz;48' -A 21 Product Cljtqrjirrj is ('0rlC(3P9:uaj. An�ily"':IL for Ije@tl" fAernbef UPPQQingFLOOR-RES.ApplKlon. Thbutaq Loaj WN 13' Lo2d.3(psf): (-,,o Ljvj:.�qt '100%duration: 12 Dcticid- 0 F-1�2nitinn INKJT WIDTH L P-N C.;TH t-I V E)D L-A,E T 0 P L',,' DEPTF, DETAIL OTHER 1 CoWn 150' 2 87T 356 649 3925 to" 2 r;oiLjrl 3.�,0,, Dad 12 1 W LS L 07 T741" a 132 1835 10586 1 1 oesh B3 I Colmn &50 7.134" 8 222, 5 97,.)7 1 4 QwMn Detail B'- T74 V 8732 18*"S5 Lletai!&3 5 Colmm r, :1875" 3270 649 ,'3P2�� I.P" Dc-tq;l A2 Lc',l Rim 'Elee IJ SPF -CIFIE 513!SUIDERT (30DE4 hy VIOMWq:A W. "M9 le'll"Wrameill exceeds Trip at suppno(a) 1, 2, 3, 4, SPenan2r. dWarF jE MAXIMUM DES ION C(-')[qTQCl 5337 4552 4902 PasaWYQ RE eA Span -1 under Fldr)j:-;A'[-) sn.qn 12282 12282 14333 Pmsed;86%) RI ,d SQ !_OS De4jr,) Fiaor�6J!4CENT. p,, 7 '3 al-; a3N W-) Spun, I ur-ler F-l*0rALTERN/,'Tj= sp@tl los,TOM oewyj) aW PawsadajWl MID Sparl 'i undef g 8.dTlq&lAh AP bMWQ nWW oe bracad kit 28 'Vc t'nJes's d9failed othetvvise. 2n ,dgF2s posTaning of latar�r bractr- ,.e i�i to cj jjiE:vq. "lembar tkttdbi!ity T f'e i(.'j c'id condittons ccr�sit;.ered in thie desi-p Ad we ohmat and adj'accint rnenib�—.qkip 'L 'L1!Lq-q!L NOT? 14L - !'PIAHORTA[,IT The anoiysis p i«,enleci !S MqPut Wn solaw develope, by Truls W(Tly Tj wauant Me&4, No ,&,I b,W, saftware kivflI t.,e ac.ccmy*Qd M 0W,M,Q yd,Tj ,,d,,, awe*a(i -)n 0131100tiorl tout desin 420 and shWd dimersun We been pinvied by we sopwam user TQ OWPW has 9W been nvnwed q a T.1 Asswht�'i THIS ANAYMS FOR TRUS JQ�S'T pRCr) -FS 6j,�-Lyf PRODUCT SUBSTAPON 0661 AS ANMYSO. Alkwj3ble Stress D, _tjC ,�g'gr' 1185 us,2d kh CHO NER w=109 the TJ Resid'enlial producj ijlted CmmWWMh, OCAN 2 A510VE GRCPUND EXPOSURE t,'TREA',ED). 281�,',, MA'XiMlim fvjo Mnmber vaysw jcappFopriatf-.�cnl'y fL)r Q11latt-;rial T;al i:*I prouery tramea hl accoManne vAU, orocedu!'Es aLlfileFize-d oy Tj,GCA P=WmS rigNigil hakg Me Thber Product lnspscljOil, 1111, Wality Inert{i3 w rrarlt-')ql undo Clint aglree,-nenFs by TJ arlc� 9PIRAW WWQRMAnQNL MH PMa R(j, Wswoh MA 02001 edi cgi�t�recf 8cj6ri= :of 7ru,JNST raqlsl°ri!d lr-306ll15r�of Vle �Plorr:: Joe Kladera 508-352.6007 To:E?rad Haven Date:3/19/2002 Time:1:18:24 PIM Paga 2 of 2 The piev T• ° &n V a I hJuT!)Bt'.-iCUi'•ll;c` THIts EETS OR E1 CSF-08 1'H SET DESIGN CONTROLS rOR THE AF PL,ICAT!0N AND LOADS LUSTEED I q. 'rodUc1.Ll,a qrijjTn PS i":oY9c8latLittl. f,r1al}s`s irir beam PCemb ,.Cuppertir7ra r LOOR-RE,z?.Appliratloni. T 61331Jtgry Lo �Wir+til 1r''.' Lodfa"-+(pt): b�Live at 1"0 1' C{Lir`3tir t` ' L)e!8Yr' iJ(�_91ti'Ilfa1 -flu7ri L i V rCE DrTC) PLY DEPTH C1 (r;IUm;t Q" .E764" :3 Ors �� 9"i 1 JT,f'" JF 31iA:', :Sig L: L.fdr'il 2`.V4Pi9t> -Crr3 a;}ri' �_f5� l;vL?Jt�,- rr. Liet IB `t:-_ 622 +f'j C: .i i-i.'�' F5et-d A3 '' ?r_` C"P T'J SPECIFIER';,. FttILLt_ ( VIL)IES ,Jr 9'17 A( ,fct' rs1: F"7 -C)r=i8.1'Ii1cT left(Jfll requirelllL'r,t r,. C8ECl5 inpt It yI 1, 2, 3. utitlfci "ental tl:rif::!�^tF',fe I�t .C11ir.�d t0 (elESiC3N CONTROLS: - 49r'XIMUA+I ;)h ir,N CC N"!POL CO,J ROIL LI +r 1 TI0N 4602 ,fir 0,2 Ft }M r'°,-_ , i Ir Mcn erittft.-b) 12813E7 jc 8OF 141.3 3+' P,:Sv',.I'(J(7°1nj F.1.em-j Sp;ptll 'I under Floor it'actinc Tot. i DFfLI,r}, "rLive Diif i'!) 10,2 4 cd(Ut81 M!!D an2 un,-` FIcnfJ1LTi 0,32: 0, 2 Pas.ad(1,1435) PvHD !;rl r I IturF Trn ATE SJ] II or::fininy. C�Etieclrci 1";tE:riw. S-TkiaD!-RD(L1_: Li 6C, i. I_ ,'._•.1i i i'ac!n�{Lu) All!ompresSino edges(top an(+ r Dj�c:il) t7;J£i bi b t`:rid it r." 8c/c ulllqs> r_; f�tiied nttt!4ry ise Prnl;r r tf ,ci,r'�erlt af'ca po ittion nq of lateral bra- 'tq i= j'equi,ed to �..1i 19('Etrlhbr t yt>t�lf td. -�I ilZ iodil�:Ll(1C+1i14115 CCit-i: IfTPrer it?l.r,l�ti r+w?-;ICt1 i:'1r,;i"_IG�:f'tl'rr�rrl`i;'r�'"f}t:�;?}ht-�r I's-<:,Cflflr:l. ADDITIONAL NOTES- __.—IfeM1P!:eKTAfdTI Tilt!c r)c�IYSlS pres211ten IS outpLit frori'7 colftkvurt dc-Velf7ped by T rus J(iiet(I f) T,)lmarr 3nt8 the sizitl(t r%+It 3 i7r' Jt;C:S !;' ,;ii5 Soft ial'e will be 21CCnft1T,11'lied in 2CCcrUEri e AIM l i I ^du:'t design nhte'da and cod,?. ,fir epter) TIIN ct} r ITIr l_•r7 ! I Ct applicaticr, nPut dlle;igll IC)i?d•;, yl':J 4t tE�1�tlr•IB" Ib':" i):-wa been pr•oviff�.-Q by the sclfty] r�! '-i ., 1 his ou!nl.lt has. QT'bpS ". 't.VIF..,:ec; tDy T J AysoriatW. Vf)t at, pfexiuct6 arp vead'ly eVnilable. Check with txial"SUPfAie:-I:)r TJ t;t 4nics!I—eprrSSet1tativefor prodi.JL't clVBllnblllt;^ TH18 AWA.I YSi3 FOR"FRUS J018T `�-ruiIJL;VrGtirilt-'ft� PRCli�ji1% CNj 't r � TI I a L T(CPT "`11r" fHl S Ah h,LLI°1_�n15 .% }I2 Stfcr� Design me�hoLiolf)gy NE elVng le . R 8identl,product I tsc above,{�CI1rijQ _ r 10 A-S".. : (Ir I!C 2� n),ABOVE PQI �`Lrl c"X CSJFGTP�, TCD .'�vS 11��•IA.,t• , 1,/IrrlltlE'i dtlaly tlq 15 0p`gfU?fl1.P Gtlljr Jf I l?I;; .I r._.i:IS l'I'n(JPIIV trezted Ili�3(.;.h?d;,)ce1/It11 til'0^E3 llfWS r UtGI,':"I CQ I?) T.J. ;/!fnlli'Inr'gtr=:'a'i CCA r'arc7llclitl3i t'1�t!'fi�i beal,r.c>tho Ili ib r rQd!r.,, Inan CilOri: Inc.0,Ljaii:V 1111f(+, 1"erl?eL1 lJf`: c+P'jCei(lt;i^7":e?t"}i)t )V ?•) ?.l t' HICFSvI (,CarT.77ra`.16 H'Ve:1 00tion ' 11`ev�rl nLrca; c'nil,:n ia_t�r f�rut�S-11 1 WIJ:Pori 7 Rd xi". iai.C,le. MA 0206" 7Or++-��rifl-)1u(7f) Copyrl'1nt,i:7 21,00 h Trva.1�mi,5 VJe,;.,, :,a,ar, i Y 1f1 r E u5,ness. und'r;I-�rJEi1 1 1'�^ate.tr2diI.. o-r n, s'.:2 I.•.' Pere;lER1;F�iv B rgrj l:aY«;5❑tf8�!gIT%ri(p'TrUc:!ilst .TIWr.." 1._ `.r;+ iiY,dni7r„!il:IJ 9 rcplslAr@ty lr8d?n13fk u`ttte Hick..':C^C:r_,rr,p/2 lim. # f *Permit _3 l down of Barnstable Expires 6 months from issue date ti Regulatory Services Fee • a�nrtsr�st.t:. b v� ass. g' Thomas F.Geiler,Director U7101 16s9. �Eo►may'' Building Division Elbert C Ulshoeffer,Jr. Building Commissioner_P©E S S PERMIT 367 Main Street, Hyannis,MA 02601 w X 1� Office: 508-862-4038 ,JUN 6 2001 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION-,OWN OF BARNSTABLE Not Valid without Red X-Press l►npnnt Map/parcel Number a �7 Property Address Value of Work Residential OR ❑Commerc/ial Q Owner's Name&Address Telephone Number Contractor's Name Home Improvement Contractor License#(if applicable) l i aS 6 Construction Supervisor's License#(if applicable) MWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance CAS Insurance Company Name Workman's Comp.Policy# 2zC 70 Permit Request(check box) P,Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side r Replacement Windows. U-Value (maximum.44) b ❑ Other(specify) *Where required: issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic.Conservation.etc. I Signature expmtrg Assessor's map and lot number ..:..... � l •:� ( �� i ' Sewage Permit numbers,.. 9...... .............::.........f sTME CQ g BARNSTADLE, itj 2639 QED 4fAY 0' r APPLICATION FOR PERMIT JO .............................. ................................................. . TYPEOF CONSTRUCTION `nn ..........:.......................... ..................... ................................ ..................... .....:........ J .... .`�5 ........... TO THE INSPECTOR OF BUILDINGS:--- The undersigned hereby applies for a permit according to -the following information: / Location ....................1.,Y / 13 �G'•1.1 CJ'T2�' 1: :...:_.......:.......\`....:............................. ............. _ . _ ... . ProposedUse ......................�%7 l� ...0 . ..>..A... ................................... . ............................... t s ,cam,T „ r T :. Zoning District ................................Fire District ........,. ................................... _ .. ............................ Name of Owner .................... . .,BJ...�7••�"AJ_• '.✓. ......Address ......s'� /jZ........................................t / 1. Nomeof Builder' ....................................................................Address ..................::........:.......:...................:..;.................:...... Name of Architect ..... Gsw ......... �� c> !''.Address ............ ✓G1 ' . .............44.%� �' 1' ' - .........:.........Foundation ...r. . ./ ............. ti ....... ....................................... 2 ... �I .Number of Rooms J....:.,...../ �n /1�'YJ.c-�---C- Exterior ..................:........... !T'1•//s...........:..................Roofing .......... L:r:............ :...:............ Floors ................:..................r' ll:r .....,..............Interior ........ . �i�l .........:........................ a Heating__�:: :::.................:`... f'"' ............. ::Plumbing ......... ... ,� � � Fireplace .......................................`f..,...... .....:.:.......:.............Approximate. Cost .....................:..... ..,................................... Definitive Plan Approved by Planning Board ________ � _ __1-9 A la . Area Diagram of Lot and Building with Dimensions �T6 7 Fee ....... .................................... SUBJECT' TO APPROVAL OF BOARD OF HEALTH Y`71 Ile N +y I hereby agree to'conform to all the Rules and Regulations of the .Town of Barnstable regarding-the, above construction. ' 4 Name ✓7i2 �, .................. ............ 4'a..s 74o h x �,a. mar �� �� ����al�� _� ^��7 . ~ ^ro � Dwelling , No - .^. Perm for — 4l�i---. —'--~-----^—^'------'`---'---- Locohon .....4q..lakamida..Dr..... ...... � ~eoterv1llm � —^—'-^^---^---~^^'—^----------'' Owner Mar ..Realty...... .......................................................... Wood .''~ of Construction ----'---'---'—'' ''"' - �Permit Granted . � CompletedDate PERMIT REFUSED � � . � .'� .............. ............................. ...... / : .., .-----. 7*"** � —.— ' | ' ' � )\pprova6 ................................................ lA ^ --------------'~^^`^---^---'—~' --------.--_---.—.—.—..—.--.~~.- ' � opef Rt .� t M i3.� Y .• v ar. R. S t 1 �o Z f'L.4N .SHOW I Nc � 'El LL to x (n o < a sy Z A/avSE ZDC,9i 1oA/ cl: s � o ;� �- � v6c. 1977 Q J tt;MAN \\�; JVQkgMA/V emossm 4N P.L. S. � z. => q C: UNu' /''IAQ. ,Qa'.44 LS/ COIZ P. V TOWN OF BARNSTABLE Permit No. ___ �` 84 5 12/?_0/. ' _ �Jy °. Y�E1W= : Building Inspector a Cash9. ___-- ru9. OCCUPANCY PERMIT Bond N/A "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 Mar Realty Address 49 Lek)eside Drive, CentervJLlle Wiring Inspector ! E'T�`_ � ^ � Inspection date P Plumbing Insp&tor f/ j\ Inspection date Gas Inspector " C,� C% / ,"^' Inspection date Engineering Department N/A Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE, OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ..................�..._.............._.........._ 19.....� ..............................Bizilding..Inspector ...... ........._. v. ;` TOWN OF BARNSTABLE Permit No. __19843 12/20/V 1 »n.0 Building Inspector Cash --_—__ 7 YYL OCCUPANCY PERMIT Bond NIA A "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 Mar Realty Address 49 Laoside Drive, Centerville Wiring Inspector ! � ., .� Inspection date � ` � Plumbing Inspect r Inspection date Gas Inspector -,l .... f c .+.. %r�ir�a Inspection date Engineering Department Xf A Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. Af /" Building Inspector "As'se.for's map and lot.,number SEPTIC SYSTEM MUST 8E 77INSTALLED IN COMPLIANCE Q Sewage Permit number ........(p.....<......:......................... ''' I!,- STATE x� :., _ -WITH ARTICLE.II c` r ty SANITARY CODE AND TOWN o�TNEro -1 TOWN' OF BA R � r _ �Qy '�� . 1 • � ,� RNA-TA-B L E . y MAM ft { oypY r, BUILDING. _,INSPECTOR 0 „ oQ Y; APPLICATION F6R PERMIT TO ................ .�?Z ........................................... : ................... ........ TYPE OF CONSTRUCTION ...'...................... .................... ................. + ................ : ...` ...........19. TU' THE'INSPECTOR OF'BUILDINGS: The undersigned hereby applies for a permit according to the following information: I eld Location .................... —,e� ......................... 14c, ^Ul.—L76............. .................................................. ProposedUse ...................... /.+ .1"AZ. ..................................................... .............................................. Zoning District .................... .. .1 ...... ....................Fire District ......G y............................... ) Name of Owner ...........:.. ,, ads,%.. i�y!� T ......Address ... ., .aa<.*...r3��5...."...... c..�!42G�......... Nameof Builder ....................................................................Address .................................................................................... Name of Architect ..... Address .......... X/.�4,ioea e. ........ .......... Number of Rooms ........................ ......................:. .Foundation .........�i ,�C1G ,,ET ................. .. . ...................... Exterior ..................�„{ �'�L.l.�t ..................Roofing ............�!`7J%4P/1.sr�4.�.......................................... Floors ...... .....................Interior ...............;�—dV, ....CAJ.&�...................:................ Heating g o4,.,..G .7.�:`%..i .... Fireplace ......................................1j�✓1.,1. ............................Approximate Cost ...............xlf. .... ..................... .......... Definitive Plan Approved by Planning Board ---------- �---------19 Area f '.... . . // . . ................. Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 'it, d ` e �Gv I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding .the above construction. Name � ....1 .. . �t� ............... r. Mar Realty Dwelling -No ...... Permit for........................ ........ ............................................ ............... L6cation'_.49..1.&kesJAe-.Dx................................ Centerville ............. ................................................................ Mar Realty Owner .................................................................. W00a Type of Construction .............................. ................................................................................ j / Y �Plot ....................... Lot ........... ................ December 20 77 Permit Granted ........................................19 Date of Inspection 7 ........19 Date Completed.'. ...... ............19 .PERMIT-REFUSED ................................................................. 19 .........................................i..................................... ............................................................................... I-AI ............................................................................... ................................................................................: Approved ................................................. 19 ................................................................... ........... ................. .......................................................... L