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0329 LAKESIDE DRIVE WEST
e a ) ma : At7 i * o t r,r 4i a r 4 e ' _ r r ' v : 0 � 0 a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map OM Parcel I TOWN' OF BARNSTABLE Application # � C/o Health Division Date Issued 7 PO }3 .. 17 & w E Ikj : t3 Conservation Division Application Fee XX Planning Dept. Permit Fees Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 3 Ct L /-a �fe c: Village Owner SV��� �D<< s� Address gas (,A Ces ,X. Telephone (h)k) -7 ? y 1 Permit Request(;? A� r-- (LNr cep_ O- -1 T FIG iIA4-4-( +o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Va "7, construction Type JI Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family W . Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ 'Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ 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) Names ` �'l � Telephone Number Address �� � Oy_ 1— License # a 7 N\,A 0 I Home Improvement Contractor# / U 1 6 Email+per r.,, (tip`cr G AnI . CO -- Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO /"C /�- S*4�..���� e'er. 6-� SIGNATURE DATE 3 ` 2,2—/ FOR OFFICIAL USE ONLY f r APPLICATION# a , k DATE ISSUED ,I MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ? FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f_ GAS: ROUGH FINAL I; FINAL BUILDING b ' 1 ` t 1 f DATE CLOSED OUT f, ASSOCIATION PLAN NO. I I A f 6tFGlNE891ML - ti OWN ER RATION FORM i J .s.9 V� (Owners Name). owner of the property located at (Property Address) o 6�9 (Property Address) hereby authorize 1 , Y (Subcontractor) an authorized subcontractor for RISE,Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. Owner's Signature date ` RISE Engineering 6 Dupont Avenue South Yarmouth,MA 02664 LIS The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia NVorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians_/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): - Address: 7 b. 1 o.e , o S� City/State/Zip: S L'^lle c Phone#: Are you an a ployer?Check the appropriate box: vJ.77 Type of project(required): 1 employer with employees(full and/or part timt).t 7. Q New construction ?Q I am a sole proprietor or pammship and have no employees working for me in S. Q Remodeling any capacity.(No workers'comp.iruurance required.) 9. 3.Q I am a homeowner doing all work myself(No workers'comp.insurance required.)t 10 Q Demolition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.Q I am a general contractor and I have hired the subcontractors listed on the attached sleet 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance t 6.Q We are a corporation and its officers have arcrcised their right of exemption per MGL c. 14. er L✓ �`� Z d J 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Airy applicant that checla box g1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing aIi work and than hire outside contractors must submit a new affidavit indicating such tContradors 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:- 2 Policy#or Self-ins.Lie.#: (f C- Expiration Date: Job Site Address: 3 Z`i leer Q� . —City/State/Zip:� lie VV 4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration�date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under t1z 4 p and penalties of perjury that the information provided above is true and correct Si ature: ate: �2�?Z 7 Phone#: SZ� r-S Official use only. Do not w)je in this area,to be completed by city or town offudd City or Town: Permit/License# Issuing Autho ' (circle one): 1.Board of Healtlr.Building Department 3.City/Town Clerk 4.Electrical Inspector 3.Plumbing Inspector 6.Other Contact Person: Phone#: office ofC,��A rs a�sdBu. R�� 10 pg*p1m Suite 5170 , t 02116 � 7 "t8s4 jSETIWi`FT ENSiLAMVNt INC. Ell dosEPH ELLY P.O.am SEEIMK,MA OM1 � ,�`►' •, D LW cod WA, a umm dt�e�attC�a C .b a 11*md tior p�,at#IoaNwrQttssrtDwa��► TM PmftColpo Wor mlael�li �>�ts Ott RE�I' FAtl WWM WA ; wit6aeE s iVlassachusetts Denent of Pubic Safety Board of auiiding Regulations and Standards i arise uL:uror�super,'7st Si.�ii"sdii� License: (S.SL-702771 . JDSEM JRER-J,, t` PO Boi 105 . : Sakonk,1VIA,OrIal.... ' Commissiorfer 06)05130'l7'- RETRINS-01 RBLACKI ACORD" DATE(MMMDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 8/1112016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate .holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#'1780862 CONTACT NAME: HUB International New Engiand PHONE 5pg 5T6-1971 F 222 Milliken Boulevard ) AC Nra: 568 678.2156 Fail Rarer;MA 02722-9946 E-MAIL ADDRESS: IMSURER(S)AFFORDINGCOVERAGE NAIC0 INSURER A:Selective Insurance Company of South Carolina 192" INSURED INSURER B:Star Insurance Company 118023 RetroFit Insulation,Inc. INSURER C: PO BOX 105. INSURER D: Seekonk,MA 02771 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS. TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED.OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MMiDDIYY Y LIMITS A X. COMMERCIAL GENERAL LIABRRY EACH OCCURRENCE $ 1,000,000 CLAMS-MADE FK1 OCCUR X S2187653 08115/2016 08/1512017 PREMI •S Ea oxurrence $ 100,000 MED DIP(Any one person) $ 5,060 PERSONAL SADVINJURY $ 1,000,600 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE i S 4000,006 POLICY a JE LOG PRODUCTS•COMP/OP AGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY Co aeaidED SINGLELIM1T $ 1,000,000 A ANYAUTO 10018200 0811112016 08/11/2017 BODILY INJURY lPer person) $ ALL OWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS PeracdZ $ X W IRRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,0001 A EXCESS LIAR HCLAlMSMADE11 S2187653 08M512016 0811512017 AGGREGATE DED I X I RETENTION$ $ 1,060,00 WORKERS COMPENSATION PER OTH' AND EMPLOYERS'LUIBRITY Y/N STATtlTE1, ER B ANY PROPRIETOR/PARTNERiEXECUTNE C0845201 0810212016 0810212017 E.L.EACH ACCIDENT $ 1,0001000 OFFICERIMEMSFREXCWDED? ❑N/A (Mandatory In NH) EL DISEASE-EA EMPLOY $ 1,000,000 oyes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE,POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCA71ONS I VEHICLES(ACORD 101.Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE National Grid THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 50 Washington Street ACCORDANCE WITH THE POLICY PROVISIONS. Westborough,MA 61S81 AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION, All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Town of Barnstable _ � Building entttvsrwe Post,This Card So.That rt is Visible'From the Street 'Approved Plans Must be Retained on Job and'this Card Must be Kept n Posted Until Final Inspection Has Been Made m/4f4• ,.w. .» ^'r aA.:. .� -wK t 'X.a. .r. n. 's ,�y4 [�a F, :,3}§'t ,., ..z, ,.�„ s r is Pernllt ,�a+° Wfiere a Certipfcate of Occ.upancyJi�s Required,`suchBuildmg sHall Not`be Occupied until a Final Inspection has been made.`" Permit NO. B-18-360 Applicant.Name: JOSEPH J REILLY Approvals Date issued: 03/02/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 09/02/2018 Foundation: Location: 329 LAKESIDE DRIVE WEST,CENTERVILLE Map/Lot 232-051 Zoning District: RD-1 Sheathing: Owner on Record: FALKSON,SUSAN f tontractor`'Nam",,JOSEPH J-REILLY Framing: 1 Address: 329 LAKESIDE DRIVE WEST Contractor License.,CSSL-102771 2 u ° CENTERVILLE, MA 02632 17Est..Project Cost: $2,029.00 Chimney: _ . Description: Insulation in walls and crawl space k Permit Fee: $85.00 Insulation: E Paid: 85.00 Project Review Req: �..Fee a d $ Dater 3/2/2018 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 permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. 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 Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for'pu1 inspection for the entire duration of the work until the completion of the same. Electrical - :' •.. .. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: K. Rough: 1.Foundation or Footing g 2.Sheathing Inspection .. 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation Low Voltage final: 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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 1" TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel DS I Application # , Health Division Date Issued 2 `� Conservation Division Application Fee Planning Dept, Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address .,oZ L �beS 'T- Village 00) C 3 Z Owner S y S A.3 1G (�Q� Address �� 9 /-� (Ge f �� ✓�2 . Telephone 7 9 J-- 7 o C Permit Request (� - \ Ar� er� MQr- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0 7.�'. instruction Type , CD Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup orting dotumRtation. �v Dwelling Type: Single Family �,�"/ Two Family ❑ Multi-Family (# units) � N b Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's ighwa<?Yep ❑ No � rn Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — 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 �3U Sip 1^ `l ri�Gt r �- Telephone Number Address L) , Via K k o S License # �v ._l< V-A A 64 ? # Home Improvement Contractor# l D YG/ Email i pGre_Ak,, G. ,M 1 1 . ev-,\Worker's Compensation # At w C S-U.Z /L U ALL CO STRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO -�- f w�^�{- c� A -j 6 SIGNATURE DATE 113o bj�- FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. 4 ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT I E ASSOCIATION PLAN NO. E i The Commonwealth of Massachusetts Department of Industrial Accidents ` 1 Congress Street,Suite 100 Boston,MA 02114-2017 wwmmass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Li ¢ibly ' Name (Business/Organization/Individual):RetroFit Insulation #. ' Address:PO Box 105 City/State/Zip:Seekonk, MA 02771 Phone#:508-989=6436 Are you an employer?Check the appropriate box: ' Type of project(required): l.❑✓ I am a employer with 10 employees(full and/or part-time).* 7..E]New construction 2. I am a sole proprietor or partnership and have no employees working for me in ❑ 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3T1 I am a homeowner doing all work myself.[No workers comp.insurance required.]t - 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole l l.❑Electrical repairs.or additions proprietors with no employees. 12.n Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6. We are a corporation and its officers have exercised their right of exemption per MGL c.` 14.0✓ OtherWeatherization 152,§1(4),and we have no employees"[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site`. information. Insurance Company Name:STAR Ins. Policy#or Self-ins.Lic.#:V9WC802160 Expiration Date:8-2-18 Job Site Address:329 Lakeside Drive West City/State/Zip:Barnstable, MA 02632 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,.§25A is a criminal violation punishable by a fine up to$1.,500.00 and/or one-year imprisonment,as well as civil g malties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unneepains and penalties of perjury that the information provided above is true and correct Signature: Date:. . 1/30/18 ' Phone#:508-989- 36 Official use only. not wri a in this area,td be completed by city or town official 'City or Town: ' Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector .5.Plumbing Inspector 6.Other Contact Person: Phone#: 'o cif aryl RNST a 2aclia d V. Sca1i;D rect Div. 100,Miiiri street, y�tidis,Nl,1,A 0260 ,,w ww;tt}wn. �rnstable,r�aa�s ;fir must ® Sign , ton. Susan'Falkscn t caper o '"the s5 p property hereby"att2l�ar to ac#.:ow,m beh�� irl rn`atters° elatteo vuork ahortzed y tlts btl�3ng pennt„ pplac�nt ©r 29:Lakes `T�riv '� ;T C,-,ery-1 e; 1 A � 'f 3 .. ro :, ,,. >✓ - .rk 3 F :., t4 xai' Wpm .. w.y Sature:cf iJvner:; Date ' 1 rupvrty,Owner U appl;14g fnr;permikpleaw �l.iowe uinpt*on,. orn. C tJSerse c>li�kPitiit,vcalltyfc rc5at°t1 ?indc� aslllt%Cachel rnt�ri1.C?utitacktt ,'1JC1,121T:J,'P1I;S4w('� :+�Wc: U11251i7'� .. Town of Barnstable Regulatory lato Services , saxes ` Richard V.Scali,Director WAM 039. Building Division" Tom Perry,Building Commissioner 200 Mai Street,Hyannis,MA 02601 .' %ww.town.barnstable_ma.us Office: 508-862-403.8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section f viZ3� A Pu?lder 1, as(?a'ner of the subject ro n 5—'' - - --' 1 P Ex' hereby authorize to act on mvbehalf, in all matters relative to work authorized by this building permit application for: do k v Ille �ffia (Ak_t(Bres of fob) Pool fences and alarms are the responsibt6� applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. S ature of Owner Sign tune of Applic t` Print Name Print Name , Date ; Q:FORMS'0%1#*%RPFRMISSIONK)OLS ` " r� c r u 4 �s �w T. 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Xea.� -,';m� ,y>x..,. - l;�.. ^.< .. .vq,A i� fsC«+< Ne, P" . P , a 2" n �, , €. ry,€ 1 I NA' f i L""P X Y fr f' f Lam' 'h' # .f Jtt �xY. -k a - ,., o '. k N .Y / '.k , r..:.. ", - r .w e c -. ,` 5: ���,, +.'. r u Y 'fly 2 4 r phi s` `' ✓c - �`'k, Y,":" i xx,t k :4 � Sr II J i II .t y" fx•. L ', v a—q,-Wyk`,, ' t-dam•a .. � "i Fr '� .€ E `? f .say° k 5 F_f„"', c ,e „ �'• `....-.—S. ., w,v u•m.. 'll'—.... _—,— .-u...c......_,.._._..- — _.,, . .. - - n ",��Sc ,,.r ' .s..,...e' ro ....:• ,. _�_1;'--- ......z.�*P, ",'—. .....'i �1+, RETRINS-01 DCARVALHO � ./�_=✓ .. DATE(MM/DDIYYYY) . - CERTIFICATE OF LIABILITY INSURANCE 07/27/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#1780862 CONTACT Diane Carvalho NAME: HUB International New England PHONE FAX 222 Milliken Boulevard (A/c,No,E:t): (A/c,No): Fall River,MA 02721 ADDRESS:diane.carvalho@hubinternational.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of South Carolina 19259 INSURED INSURER B:National Liability&Fire Insurance Company 20052 RetroFit Insulation,Inc. INSURER c: PO BOX 105 INSURER D Seekonk,MA 02771 - INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSy ADDL SUBR POLICY EFF POLICY EXP - LTYPE OF INSURANCE ,IN D POLICY NUMBER MM/DD D LIMITS AMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR. S 2187653 08/15/2017 08/15/2018 DAMAGE TO RENTED 100,000 PREMISE Ea ON $_ MED EXP(Any oneperson) $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO- JECT ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident - $. ANY AUTO A 9100182 108111/2017 08/11/2018 BODILY INJURY Perperson) $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ X HIRED X NON-OWNED PROPERTY DAMAGE - AUTOS ONLY AUTOS ONLY Per accident $ $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE S 2187653 08/15/2017 08/15/2018 AGGREGATE $ 1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION - PER. .OTH- AND EMPLOYERS'LIABILITY STATUTE - I.ER V9WC802160 08/02/2017 08/02/2018 1;000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y� I EACHACCIDENT $ FFICER/MEMBER EXCLUDED? NIA E.L. (OMandatory in NH) I 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE National Grid THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN '40 Sylvan Road ACCORDANCE WITH THE POLICY PROVISIONS. 02451 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Eng}veering Dept. (3rd floor) Map o - Parcel Our/ Permit# �� O House# of Date Issued - - Fee j V/0 ri Pl �{INE Tp;_ D y d 19 ; �. BARNSMIX, ' MASS. t659 lFD N1P. TOWN OF BARNSTABLE 4:,7 Building Permit Application Ireet Address 4 Village Owner f 2 Y, Q,YL Address Telephone !717 C! j 9 Permit Request 0 First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ �/ D, v o n Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Y Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: p Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use � Builder Information Name D�-e't�a.c.c Telephone Number '� 7 / .�aZ 1�4— Address License# 0 Home Improvement Contractor# n 3 Worker's Compensation# lit✓ C- V a U d,,� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONS UCTION DE IS R SULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE, -�Z�«� DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) a °FtME tp� , . � The Town of Barnstable • saxivsTa U& • MASS Department of Health Safety and Environmental Services ArFO Mai" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: `Est.Cost Address of Work: Owner's Name Date of Permit Application: 9 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a per it as the agent of the owner: Maid< ContractoV Nam Registration No. OR l jq� (ko v� Date Owner's Name I �- The Commonwealth of 11'Iassachuse&s Department of IndustrialAccidents 600 Washington Street Boston,Mass. 02111 Workers' Compensation insurance Affidavit lgcatinn• nhfirc it ❑ i am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity TMTM-ntmployer providing workers' compensation for my employees working on this job. �gmpany name city• ' ' (n�one�.; onsura Ce olte # ❑ I mn a sole proprietor,general contract or homeow e one)and have hired the contractors listed below who have the following,workers' compensation to 4n e: - J I:, .. . . :*. ..* . ((��(`� tlr9ri 15���,,``�`,'�� 'lie•. �.T 4QI&{f9C� tpin�ianv n.•ttne: addren Clh•'_ �nsur2nC6 CO. Failure to secure coverage a�regnired Hader Section 15A of MG t.152 caA lead to the imposition of criminal penalties o[a flue up to�),.500.00 and�or i aac years'impri5onmeAt as well as chit penatdea io the form of a STOP l�'ORK ORI)EIt And a I-me o1S100.00 a day against me. i andaretand t1tAt a copy of this ttatcment may be forwarded to the t)t5a of Invcsti�a[inag Of the YJ1A far covernge verificadon- I do keiehy ccrfiJy de.[he pains an penallres ojpr►jary that the iujurmalion provided about is true andwrreU. r Signature Date Print numc Phcnc# :check se only do not write Ai thin area to be completed by city or town otficiet wu: permitAiectme 0 -Building 0cpartnient �t,ieensing Board if immediate respoaac is required OScleetmen's OiTiecQHcaleh Aepartmrnterson: phone A; -Other t � 13 freriaM iros p]A> Information and Instructions Massachusetts General Laws cl•:apter 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 en-aged 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 6r 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. 1 Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers 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 Dcparttment of Industrial Accidents office of hNestiodens 600 Washington Street Bostoa.Ma. 02111 fax N: (617)727-7749. phone#: (617) 727-4900 ext.406,409 or 375 w 1 t s • TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE ' . .. '• :_..:�:�. JOB. LOCATION Number Street address Section of 'town "HOMEOWNER" Name Home phone Work phone PRESENT MAILING ADDRESS City town State Zip cc The current exemption for "homeowners" was extended to include owner-occ: dwellings of six units or less and to allow such homeowners to engage an dividual for hire who does not possess a license, provided that the owne acts as supervisor. DEFINITION OF HOMEOWNER: Person(sj who owns a parcel of land on which he/she resides or intends tc side, on which there is, or is intended to be, a one to six family dwelli attached or detached structures accessory to such use and/or farm structr A person who constructs more than one home in a two-year period shall not considered a homeowner. Such "homeowner"' shall submit to the Building Of on a form acceptable to the Building Official, that he/she shall be respo for all such work performed under the building permit. . (Section 109.1.1) The undersigned "homeowner" assumes ,responsibility for compliance with the Building Code -and other applicable codesJ. , by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and re creme and that he/she will comply with sal �. P Y procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be requir to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which 4- bur:. permit is required shall be exempt from the provisions of this sectioi (Section 109. 1.1 - Licensing of Construction Supervisors) ; provided tl Home Owner engages a persons) for hire to do such work, that such Hot shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are asst the responsibilities of a supervisor (see Appendix Q, Rules and Regula for .licensing Construction Supervisors, Section 2.15) . This lack of often results in serious problems, particularly when the Home Owner hi unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home"Ovine as supervisor is ultimately responsible. :.�. ... To ensure that the Home Owner is fully aware of his/her responsibiliti communities require, as part of the permit application, that the Home certify that he/she understands the responsibilities of a supervisor. last page of this issue is a form currently used by several towns. Yc-, care to amend and adopt such a form/certification for use in your comet,. Dept. (3rd floor) Map � Parcel ermit#Wgineering House# Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30)?]-),f b Q !tciV Conservation Office(4th floor)(8:30- 9:30/1:00-2:00)C ;` c�� _y ;� -�t av nn P n 1st floor S ool �b p�� �aQ�J �1*46 i 19 TOWN OF BARNSTARMomEkTA E AND /3-�7' Building Permit Application T OM REGULATE0144.8 Tfustreoddress Village Owner & ez►h SI5SAAG Address Telephone Permit Request i9AAR©Otil e D e z l First Floor square feet Second Floor square feet Construction Type L d g vn Ae g l4 r Estimated Project Cost $ 000, cry Zoning District /?7 Flood Plain Water Protection Lot Size 1 .3 j� Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes I ko On Old King's Highway ❑Yes flo Basement Type: ull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 1 �. Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing 3 New p Total Room Count(not including baths): Existing y 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 `Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use i/ Builder Information Name gnu"*Gn 0E- ��/E Telephone Number 36D IY Address ?_(_ RoX License# 06 JSS 144 &4 & _ Home Improvement Contractor# I D 9 7,::')",l Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PER T DENIED FOR THE 0/LLOWING REASON(S) `� h i "(7/KJ �p ., nnr. � /'/ / _ .+..w.:a.,.>,r.•wr.^k....w.w..e»t..as:+,eenr�•rrw yr :,.,.�,.�,w..v,wa-.+�w.,.y;, .....»-'. _„ _,.�Na•raj uw.a�..,+C 5....,,.s+i ,' � + ,wj' / .. _ r; _ . i �, � � ; , - _ -. • .�t .i . . ,, .. .. _ ... .. _ �".. r ! 1 i � ° - � i �: a ,i r - � -� 1 - d y ,, e , r l • .` � i r �� d � 3')( 3b/I w,AJOvws NI %N CA& ENS w�/l �p0 I t �0 L °FZMIE tp� The Town of Barnstable , ABLV. ? MAM ��� Department of Health Safety and Environmental Services r1659. Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. G� Type of Work: g.�' Est.Cost L© D Address of Work: Owner's Name Date of Permit Application: 7� -/ply I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MffROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: L-)J Date Contractor Name Registration No. OR Date Owner's Name �'- The Commonwealth of Massachusetts Department of Industrial Accidents Office 01//l=1192110/!s 600 Washing-ton Street Boston, Alas. 02111 Workers' Compensation Insurance Affidavit • b ipj ant tf`ormation: '^ Please PRINTle :..w..._. name: 1_) A) 13,n 1) location: l Nam! Ae y v city o �s-� 1� Z� phone# I am a homeowner performing all work myself. 1 am a sole proprietor and have no one working in any capacity e ...,taswn� x�•-;'�'arx• "A .z a>, "'�5*tia!#'�'+r' `SS7 un,7+.±^¢�'4��`P A�,,,�",.:i`s9T7T.;::�'.. �!IS",vt.awaT,"�°""""�,,r;T.'."';"!'.at'� '� r.:gn•1-er•-,•+....« sx...ap;,. ..... -"-.�+x.x,i+=':. .:::r...»..wxsa�x:.•r�iY,:...s�.•.s�a ,q:.,y�,i.y,...,, .t�a;r..E'•�"�����se.l•xa.� yiCld,�63......�: -•wi:sw"�:fi..�.i ..rt.:,,r�...........r:...._._.::•..�... I am an employer providing workers' compensation for my employees working on this job. company name: 4 6� address: /na< city � //t S• /�� !` h lei 7 o: �� D /% � 107 � r noc#• 1�r9f c>tiJ �� t�t� olic) �60Q 0 insurance co p t.. r- �. .. A ,.•pr.y.v^..�i"7A' ww.: Wjgl7rq�"^J'.._+"'m"M'^!sYiY 'vM• T'7kn �y # _ �py,a�-..... _ _ -.w...�'.," 'iwr,.sv..7XNT• ,:+-. .. rw.>'r.w..r.• 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 ciLv: phone#• insurance co. police# ! p VR:Fi'i. '.¢Y-�':'Y,•Y;•. ••Tr J'iT. -�'.tT, T[r,^,. Y w+++• 1x :x:;R. '�C�s...,.,,.�,� .y ."'T•_Z""k •9-!"• `t •C�• �!V-Fa`7.> ar'Cyr•:7"+t` era` i4 'F�wa`,. "T3'?'^..3.'. ^-..�.�_.......r�•. _.;.:i�a-... .:a:4lsax,►i. '1�'�• -'�•` '+ia"'ra�.•a..r�LWaF :aa:itix:,e4 company name- address: city phone#• insurance co. policy.# .Attach additt n o al sheet if necessary,"�>�;:..: ,.� �: a';..sr_-r�,:; ;,�_ � •r �a ���/ •. •�- .� .. - ��ar''" Failure to secure coverage as required under Section 25A of DIGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one)•cars'imprisonment as well as civil penalties in the form of a STOP AVORK 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 herehr ce rfj run +r the pair n td p tallies of perjure'that the information provided above is true and correct. Signature Date 7 0-2 r L `� Print name ` I z) )A) LJ ()U l)C Phone# G��7 :r oflcial use only do not write in this area to be completed by city or town official ° city or town: permit/license# nl3uilding7Department[3Liccnsin check if immediate response is required 0Sclectmen's Office i" C]Ilealth Department contact person: phone#; r jOther ' -•..._ z.,... "„' a..>v,. y... .+.:;-4Srt�n'!.TRr+,A+P=.,... ,-. .;,... .., ,.�4+,�nv,,,,e*, ^•e+G--+r„ (revised 3,95 PJAi Information and Instructions y Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an empinree is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An enrpl(►ver is defined as an individual, partnership, association, corporation or other legal entity, or:any two or more of the fore-oing engaged in a joint enterprise, and including the legal representatives of a deceased emplover, or the receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwel,lin�g house having not more than three apartments and who resides therein, or the occupant of the dwcllin�(, house of another who employs persons to do maintenance , construction or repair work on such dwelling house or on the ��rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. L MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or rencival 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. ._.. . ...T - -- i .. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers 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. 77 77, .. y Cit-v 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 t 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. t-.�,v.,:..y.... ...,.,..,. ,........:e., .... .---r .�-,-rw ...-,...[.�^c+.w ..,+-s'•..,.nw r7C4��+•..-ue,.y,_sTervr,:'.��'sm"^—T""'•"'�"'r�X' Y.y�t�rrs.•na^+vrs�+S3.rrm�'"m-•v.v+.•�+nq+wrr-+•.-,.•Pa.4• The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations _ 600 «'ashington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 Assessor's' offio Nst floor): ; 'I CF TM E Assessor's map and lot number ..ew.-".!!A'..�/......... Board of Health (3rd floor); Sewage 'Permit number` .....................'...V............................... 2 BAHd9TODLE, Engineering Department (3rd floor): rb o• House number ................... :........... .................... 1.:...............-� .ego YaY APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only M ) "TOWN OF BARNSTABLE bUILDING INSPECTOR ` APPLICATIONi OR PERMIT TO ' Alter,, repair, and extend ....I...... ... ..................... • ...................................... TYPE OF CONSTRUCTION ...........'.....Conventional — Residential . ........................................................................................................... June 11 .........---•...................................1987...• TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: e Location ...................51 Lakeside Drive D Centerville, Mass. ................................................................................................................................................................... Proposed Use Summer Occupancy ............................................................................................................................................................................ Zoning District RD-1 ................................................Fire District Centervi.lle. . ./OSterville. . . . . . . ................... .. .. . .. ....... .... .. .. . .. . .. Name of Owner Joseph .............................Falkson..............................Address ............50..:Briar Lane Westwood , Mass. ..................................................................... Name of Builder Donald Dodson PO Box 64. East Orleans, Mass. ...........................................................Address .......... ..:..............:...................................... Emil S. Gallik PO BOX 611 East Harwich" Mass. Nameof Architect ..........:........................... ..........................Address ............................................................ Number of Rooms 3 8" x 7 ' 6" with footing ...................I.............................................Foundation .............................................................................. White Cedar Red Cedar Exterior ...........................................................Roofing .................................................................................... Carpet/Wood Sheetrock Floors .....................................................................................Interior ............................................................ Heating ............ ...Hot....`.ir.........................................Plumbing .....Copp@r............................................................. Fireplace p _ 'Red Brick Fire 2 flue $10,000 00 z .R ......... Approximate Cost Definitive Plan Approved by Planning Board _________ ________________19-------- . Area .. !� �... Diagram of Lot and Building with Dimensions Fee �/ /..'.v.Y................... i SUBJECT TO APPROVAL OF BOARD OF HEALTH 664 . 1c� � � r 3Z j,� • a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 'I I hereby agree, to conform to all the Rules and Regulations of the Town of Barnstable regarding the above 'I construction. Name . .._. Construction Supervisor's License ' FALKSON, JOSEPH A=232-05L 30900 No Permit for .Alter Repair,. Extend ................. ..................... Gp -e av - '. X.onal Residence �tj ocati Lakeside Drive e ........................C.entervill...................................................... Owner ...Joseph Falkson ............................. Type of Construction F.rame. ... .... .. ......................� ............................................................................... Plot ............................ Lot ................................ r Permit Granted June 23 , 8 Date of Inspection ....................................19 Date Completed ......................................19 I 7 G J , Assessor's offioe (1st floor): s ' SEPTIC SYSTEM MUSTS OF THE TOE Assessors map and lot number ... �TW�.LED IN (i©I�IPLI� o Board of Health (3rd floor): /� ��°� o� jj�� � ( + Sewage Permit number ....0.............101L.......... r�" �!� WITH TITLE 5 Z EAHd9TABLE, Engineering Department (3rd floor): —``,,'��flRONMENTAL CODS °o' N & House number �a �. .. �i`[�1 ',N EG r�%�' °?Foray a�0 J APPLICATIONS ` PROCES� E Epp 30,=9:30 A.M, and 1:00 2:00 P.M. only1� AP PRO1� st le Conserv2tio N ®F B A R N S T A B L E 1>�►e4 1 LD ING INSPECTOR r Alter, repair , and extend APPLICATIONFOR PERMIT TO ............................................................................................................................. TYPE OF CONSTRUCTION Conventional — Residential ..................................................................................................................................... June ...............11..................................19$7---- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 51 Lakeside Drive G Centerville, Mass . ....................................................................................................................................................................................... Proposed Use Summer Occupancy ............................................................................................................................................................................. Zoning Distri t .. RD-1 Centerville/Osterville ....................................................................Fire District .............................................................................. 4Name r ...._ Joseph Fal kson 50 Briar Lane Westwood , Mass . .......... ..........................................Address .......................................... .... amBuilder .....................................I..............................Address ................ ....... .. . .. . . . ... ....... ....... Name of Architect .......Emil S Gallik PO Box 811 East Harwich Mass . .........................................................Address ................................ ........................:..............!........... Number of Rooms .......3 8 X 7 6 g .........................................................Foundation ............ . ....with.....footin.................................... White Cedar Red Cedar Exterior ...................................................................................Roofing .................................................................................... Carpet/Wood Sheetrock Floors .....................................................................................Interior .................................................................................... Heating - } Hot Air g Copper ......,..........................................................................Plumbin ................................................. r.' Fireplace ......... c fl pp . .............. .Red.....Bri..... k 2 �- .ue.....................Approximate Cost ................$10.........'....000 00........................ ............. Definitive Plan Approved by Planning Board --------------------------------19_______ . Area .1.�. .... . ............. Diagram of Lot and Building with Dimensions Fee ........ �`.V ".... ... .......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH 60 3� F i' OCCUPANCY PERMITS REQUIRED FOR NEW D ELLINGS I hereby agree to conform to all the Rul an Regulations of the Town of Barnstable regarding the above construction. Name . . L/ Coralwctio S. e v' Licen a ......... . .. .... ... 1 -F—ALIKSON, JOSEPH ti 309 1er Repair Extend ..t........................... No ...........0.... ".. PermitDor .. L 4* . ' . conventiZnal A e faen c e . .................. I......... -W............................. Cr 1e DriveLocation ..... ............ ................................. Centervi1e ......................... . .... . ................... ......... Owner .... ......................... Type of Construction. ....... oam.Q...................... r. ta ................... ........... .................................. Plot ...................... Lot ................................ June 87 Permit Granted ........................................19 Date of Inspection ....................................19 ...........19 Date Completed ........................... W, t e, ra U* ro 47 I THE E NEIGHBORHOOD CARPENTER — Licensed in Massachusetts — C YLS,Q- Lrxv t.-1 �A �5-5 US4 o� VL v� Edmund D. Sullivan 428 Great Marsh Road Centerville,Massachusetts 02632 617-771-2128 Assessor's map and lot number .....�Z��jj//J� ... 7 9 V.�Sv.�........... . F THE g .......11aZGi2� .... !t,Qr ..:� SEPTiC SYSTEM Sewage Permit number / INSTALLED IN CO B6HH9TADLE, i House number ........................................................................ MTN ENVIRONMENTAL rb a A TOWN OF BARNSTAftV "` ' BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............. 7.....e.7-0elf ........ TYPEOF CONSTRUCTION ........................................................................................................................................ ................... �, ......19..1../.. N TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ' Location ...........................................ZAID:4SX W.Jr.....�O.......4e,........C. Proposed Use ......... ...................... �r.........GZ�G�N.. ............................................................................ Zoning District .......A; :P—..1............................................Fire District ...CE07-OoC4oe/..44,67.-..04'TE.tLAV,4, � Name of Owner .....rAZJGSQ.A/................Address4l!!�'7' J..IYiQSi.�' Name of Builder )q0,f6......................Address ............. Name of Architect .........................................Address ...... Number of Rooms ...........9—V.46........................................Foundation ...... Exlerior ...........W..0.0-0, .....XW../W4Z4..dr........................Roofing ...........A11119Ad.42P...J'.iC/./..J-X1,--WXP1—.4r.................... Floors ....................C.RI... ....O..r.....................................Interior ..............VI}V..41*4 i .4. HeatingX74-1....4.........................................Plumbing ............ ,��ii( ............................................. Fireplace ................... AA1<2. d.r.........................................Approximate Cost .........aka............................... ........... Definitive Plan Approved by Planning Board ____�&-,Z3-----------19,11C . Area Diagram of Lot and Building with Dimensions Fee 7J�_ r....................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..... �C .. ~°Vm.°Falkaoo, JoaePb � No —.2�.4g3.. Permit for ...zimglm-famijy'— . ' .dweJ.1in��«xnw:---... Locohod.........Lak"Ide..Dr°—.������.S.l— � . ' . ..........................~°a~e^ °"""le.---------. Owner ...............JosePh..F.alksou.................... ' Type ofConstruction .......fmmiR�-------- . - ----.------..--.------------.. ' Plot ............................ Lot ................................ ` ' . . | | Permit Granted ---.—_. ........ Tg � . Date of Inspection ------------lg Dote Completed —.-���.—.�.��—.. .....—lA � ` PERMIT REFUSED / ________^________---,—. lA ' 1 ' / ^ ` . am � ' . ,rj lg—���� m�� --l�� —.. .�-----------^----- ` ^" �� | mm U � -----------'--------'----'-- - /cam. � — 7-�,5 -- 7 j Assessor's map and lot number ..... �.. ,... �/�,�" THE ewage Permit number ....... �rl!✓gin ...... . . ./.1. f.!�.: ;,fG�,yy • • h. � V Z BAHBSTADLE, i • ,1House number ..................................................................v:.' Va 39• • om TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO s .x!.,:C . 's:.ti.IR"'' ......:' ...1!. ............?.r, .?.............................. TYPEOF CONSTRUCTION ........................................................................................:............................................ .............. ......19.. 'C� r' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............................................:>..�/fr... t`� l'::�......7�. ....................... ProposedUse .........!........................... 7!.:..:'` �t� !=.......+'.:e?.•.^...:a� ............................................................................. Zoning District ......... '�...............................................................' -7) Fire District .. f' ',+�T"'..''.',! Name of Owner ......0 ...............Add i:e''.; -v"f: " .......................... Name of Builder ..'.:' ,��.5r 'r r.Jr. Address . �`^- ..�•.... �r r ' 7....... ... ................ ................. xt .r..........<.. X ' ..................Name of Architect Z_ i ..................Addres .......Number of Rooms /t`.........................................Foundation ..... . ' -'.. ::r.:.:..:............. Exterior .....• � " ' ...Roofing Floors r, ...................:. ...........:..................................................Interior .............. rl, %r,� '�,. .�'.,'. .; .. Heating .`................. _'........................................Plumbing ..? . . , Fireplace s,. ..Approximate Cost %'.............................. .......... Definitive Plan Approved by Planning Board _____:___�_ ___________19_______. Area . Diagram of Lot and Building with Dimensions Fee `.... SUBJECT TO APPROVAL OF BOARD OF HEALTH 1 � r r \ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......................................... .................................... i � r Falkson, Joseph ' A=23 -51 No ..2a49.1.... Permit for �. i .................... .........dw�dw�&lli.ng.................. ... A. �j a Location.... ........'�"� ...................Cen�e �t331e ................................... Owner ........JQaap1-i••Rai.kson........................... Type of Construction ........... Frame.................... Plot ................................................................................... :.....Lot.... .! . ............. Permit Granted .........J y.....25.............19 79 Date of Inspection .. .................................19 Date Completed . ....................................19 PERMIT REF . ED .................................... ..... 19 ........ ... ...� .............................. i ..................................... .................................... I Approved ................................................ 19 t . ...... ................................................................... ............ ......................................................... � ti 1A 1A,G,6' tcl E�'u�4�uET r V a_7 y Ae.c.,rd,vr4: M .ems" OF � (10RMA GROSS . y 6 • ��� ��'o� E/!�l►-,/.�V'E��= .NO�?�1A/Y G,p.��S1'�.�IIiY .�.L.S. r , ra0 r IN s •/1�t!�'.{'-4'}v lam' ,'"'"r.s""..�f�i.^�t✓+�A� �"�"•�"',..,J. - � � ^` '' _}�'r s4 �_. . 1, rsr^..- -�-----r........-�y.._-•.�.� •a-�-.,r.-.-•.-..-�.,,vv--r`r�4.+.,...,-r�,..-.....rw..•-•,.,,�"'...r--...,.r+.--"�,y"`. ."'O"`+"'•`"'"'*�'v''"'^'..........._.......--w---...�.-,t Asse5sor's map and lot'number ... SEPT[C SYV211, KIM 138 NSTA ! E D lei f'0r;,,�,,'LI; NCI= WITH ,��w��� II 4 TAC Sewage Permit number ................. ........................... SA P_.IT Y Cr RQ WWN Q THE r TOWN OF BARNSTABLE Z BABBSTABLE, i "6 0 Y BUILDING INSPECTOR PY�`' APPLICATION FOR PERMIT TO ...... . . . .......................................................................................... TYPE OF CONSTRUCTION . . .....F ...... ' , ........1� 'VI ....................................... I?�`"•'"r•:•.........7..?�...............19.1. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...././........ ... f.............................................................................................................................. ProposedUse .. � ............................................... .................................................................................................. Zoning District ........ ...................................................:Fire District ...i�� ........... k Name of Owner ...:.... .......................Address ...r.4�..�s.......21.La 't........................................ Name of Builder ., .. .... ............Address ..... ........�.a.e.T�....f� O •�' . Name of Architect ..............................Address .... ................ !:�............................... Numberof Rooms ....7...........................................................Foundation ....... ................................................... Exterior ...2f!l z.....q,../. s-......................................................Roofing .......:/?Ao�...... ....................................................... Interior ... ..�.....:. Floors .... .................................................................. ..... .................................................. Heating ....a,^.�..............................................Plumbing ...2a....arz&........................................................ Fireplace ...4 �...................................................................Approximate Cost ....� 0.0.0 Definitive Plan Approved by Planning Board -------------------__-__ 916 - -19 ---• /2 Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 0 &,A Q E JR poitr - <-3 °' I_ _ ti w ere y agree to con orm to a t e Rules and Regu ations of t"�e`Town of arnsta leiregarding the above construction. Name ..... ....Qua.... .... ................................. � Falkson, Joseph | . 17708 l 1y2 -� �. ---._- Permit.. for single� � family dwelling , ' y A%VLakeoidm Drive Location -------,---.-.--------. ' Centerville . --------'---------'^-------' ' ` . Owner ..............Ip .Falkomo_______ ' ' frmme / Type of [nnx�ucdon -------------- � ^ ^ ` Plot ............................ ^.. ................... � . . | May 23 75 � ^ Permit Granted ........................................lV ' ' Dote of Inspection Dote Completed i?��...........lA ' / PERMIT REFUSED ' - \ -----_'-------------- 19 ' . , . ' ......................................... ' -'----~---'--^-'----^-----~--' . . ' ''--^---^^^----'''^-^---^'------'' ` '~'----^-----^~---^^^---'-^--^^ ` Approved ................................................ lV --'-------------^----^~----' . ` -------'---.---------~...--... . � � Assessor's map and lot number Sewage Permit number .................. ................................... N *THETo�o TOWN OF BARNSTABLE i BARNSTABLE, "039. BUILDING - INSPECTOR nwara' ' . APPLICATION FOR PERMIT TO ...... ^^ :_.�^a .. .............:.......................:...................:.................................................... TYPE OF CONSTRUCTION ....: ,: .......!C :.... „ ... �:.. ........... .: �. :`. • .................................' '..............19......... E TO THE INSPECTOR OF BUILDINGS: .,The undersigned hereby applies for a permit according to the following information: Location ..... .... :-. : -'....1 �.r: :'... .. ............ .................................................... Proposed Use ..,� 1 r. .1 ........................ :............................................................................ p �. ................ , Zoning District ........ ..►..................................................................` f Fire. District ...�::^ r... . � Name of Owner 1h ...... r.. ?....... ....................Address .... ?rA. '- ....................................... Name of Builder .. ...........Address ..t':ry.......��, v. ....... Name of Architect ... fro„tip ....Address -�^: .�:................ .. .---- Numberof Rooms ....7...........................................................Foundation .......! :. ................................................... Exterior ....?°4!A !7�r Roofing ....... Floors ....f .Interior ......*:...........c...!!:. V 4 ..:.?:'?.� .................................................................. �. .................................................. Heating (.,»a 4� ....Plumbing ...: .......... Fireplace 7�,. ? ..................................................Approximate Cost ... .:Ss o v ................................ ...................................................... Definitive Plan Approved by Planning Board ______________________---------19--------. l ,� el Area .../. f'� ' . . . ................................ Diagram of Lot and Building with Dimensions / i Fee f ' If . tr' SUBJECT TO APPROVAL OF BOARD OF HEALTH -., �...: _..rraa r..v..�..r 1.�.�... ..._ �� ri��-+.r� ....��..+-..�.�.a•�..n �.r �-..n ...ten..—.. - — W F (,I deb 1 J eN Uj tt, • r� w t I ""I`hereby agree to conform-to alf`th- Rules and-Regulations of'the Town of'Barnstable regarding the above r construction. 1 Name ...: ... -�•. ..'zJ�.... � :.'................................. Falkson, Joseph A=232-51 No ...17708.... Permit for ......1 1/2 story, ................... single family dwelling 32�1 ...... es.........D..ve....WR Location -�'rLakeside Drive Centerville .................................................... Owner Joseph Falkson ............................ ..... ....... Type of Construction ........frame ............./*** ........................................................... . Plot ............................ Lot ................................ ,t Permit Granted May 75 .................j..............19 Date of Inspection ............/...................19 Date Completed ...... 19.... ........................... PE MIT REFUSED ........................ ................................... 19 ....................... ....................................................... .................... ........................................................... Approved ................................................ 19 ............................................................................... ............................................................................... FEE ap cs cc TOWN OF BARNSTABLE, MASS. )fib m ab 19 3 0 M p N D " •� THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO cc oA CD 0 7 .'� V _............................................................................_............._..... ._....._....................._..._.�_.._... :...........- -� ................................................._.�.............._..__. O 1 ROPERTY O ERI (ADDRESS) 6D O b I.a TO ....................................................................................... .... ._. ....... _......... pp .............. ......................................................................................................................__._ 'd (BUILD) IALTE ) (REPAIR) �Y...................._.................._...............................«...... __..../. .................... _....._....... ... (T P OF BUIL4ING (APPROXIMATE SIZE) V M M LOCATION ................._................ ........__._..................................................._ ..._............................................................................................................ V O (STR T AND NUMBER) .(VILLAGE) NAMEOF BUILDER OR CONTRACTOR _ ..._ ...._......._...................__.__..........._........ ......._........_......._._._..................._............�._._ CD APPROXIMATE COST _.._. _....._........ kN t]oCQ I HEREBY AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN 2 OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. (u oA >4 0 . 0= aca _._.__._........_............._......................._......_................................................................ ........................_...................._................................................................................................._._ h ce CO (OWNER) (CONTRACTOR) it Ej m 0 O U BUILDING INSPECTOR Subject to Approval of Board of Health. oak.. . '70 �y a d wr 5�. .. � � 0 � ram•. � ._- t _fit• 4 - r" . 1 .;2/�7/7-T Assessor's map and lot number ..........'3.....-� "" "�1 ' ' " """"" `SEPTIC.,SYSTEM MUST BE INSTALLED IN COMPLIANCE Sewage Permit number ........1 7� ..................... WITH ARTICLE II STATE SANITARY CODE AND TOWN �QyO`TNE.TO�o TOWN N O u A R N S 13T E rio i BARNSTABLE. i1 9�C rb 9 �•� �� � �® � W� OS����® ®r tlPy�'' APPLICATION FOR PERMIT TO...............................................................'............................................................. TYPEOF CONSTRUCTION ......................................:............................................................................................. ............. C.....f. ..........19.,7 TO THE.INSPECTOR-OF, BUILDINGS: v aF w The undersigned hereby applies for ci permit according to the following information: Location ......... d?�1......... !4> rS e?7'IF....... .?Z....................G N..T..e11,' 4, e,A E......./ r9., J':............... ProposedUse ........................ ......................................................................................................................... �.........................................Fire District �'.6rc1. 'e Z r/tGt -¢�S`TE/L......... Zoning District ............................. ....... ...... ...... Name of Owner .........• o .c� ... ?, v...... ........Address ............ ......... y........... Name of Builder ........�U�a��y...7!,C4 ....... ..........Address a,-"a..4-fX...dZ.s............&.,v 4A.W.ar Name of Architect ..6� . ' T �r...........Address ... FjA� .F�L `! G„ aI41 f .................... .... .... ........ ......... Number of Rooms Foundation cO'vG ............. ................. .............................................................................. .Vi,MExterior ..................S........ .G-4.e.............................................Roofing ......... 7............................................... Floors ................... 'iS?, pfir............................................Interior ..............,�J.,I2�, AV&fA1,............................................. Heating ......................................................Plumbing .......................... !Q'r .................................. Fireplace ....................O..�l...0....................................................Approximate Cost ............... ...................../.....p...... - Definitive Plan Approved by Planning Board --------X--42.f-------------I9-A___. Area ...... ..0..... 1 S� ............... S° Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH /oa-ov — ", s�arc ak. V, 3Z-O P^ Sz-a ist b i I \ /o A :t I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........, ........ ... . I ............... ............. ............. Holly Development Corp. 16801 one story No ................. Permit for .................................. single family dwelling ............. .................................................... .... ...... '�al..q Lakeside Drive Location Centerville Owner ..........Ho.11y..Development..Corp........ .... ...... ......................... ........ . Type of Construction ............frame i c�. .............................. � ............................................................... 4 I. Plot ............................ Lot .........#11................ Permit Granted ........ ece. mber 18 . 19 73 . . ... .. ....... .. .... . i Date of Inspection ....................................19 t Date Completed ..... .......�....... /f......19 t 't PERMIT REFUSED ............... ........ .....` , .................. 19 ........................................................... .................... y - ' ................................................................................ i . ............................................................................... ............................................................................... 1 Approved ................................................ 19 ............................................................................... f............................................................................... ,J I_ - w a 1 } Aj OM�l f' `".4. g ,,� •, e � �,} �'.� Po h d i -__ r_ C. 1sm Al - x 4' + - Air 7 s. R �' } � .}` "� ' �.., s; t,•��r� rf' ,t- r,a,4, �-,._ _;_� �.;_. � .. 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