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( ! �r 1' I•r ,.9 t f.: ! t ( ,.t' 1 , �1, ! ,I .� (. , It � f� ,) r , ;, ,.{, t 1, t'•.,,, , •i.' r a , 1 r,l j :, i r L,r, } jyj�!{r 1 � �}t!. � �9 �1 r I , t: ,r .r :Y I • , , .,,., dl i,:. _ !�Vl,.r« , 1',(.. r t �. �. t.., M-a j (}, ,. .. d., [ , � S f 1 .1 ` `t a tF, kl��,�b ,�i� , + � � I�� r, ! :?• $ I. ,� , 1 #!!#+•«f �,. � � `, rl r , � � {i j, ' :, - ' 1, ; 1� +r t tl ,r1 .t1. .,+ ,!{ f' � r � ��.,, e.:�; rf � t• (�`�< { ,: #t it ;i a 1 tt ,i!�•,r� rr. . +�� � jj , � �#'f ,, t , 4,1f CEk�rf_r3�Zlt�„ Town of Barnstable *Permit# �.� Building Departme a 6monthsjrom issue date =nxntsTr+st� Brian Florence,CBO AQJP 3S.� MASS, 9. ,� Building Commissioner � a TFc MprA 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us . NOV O 3 2017 Office: 508-862-4038 TOWAJ 0 �p� �o Fax: 508-790-6230 ".A Nth I A. E EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY of Valid without Red X-Press Imprint Map/parcel Number 1412— // — ®®. Property Address�� .'� C -7�c /_� �il� l'. Residential Value of Work$ ® Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �H AJI(IZ i Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑'I have Worker's Compensation Insurance Insurance Company Name /%� �1 U f uh L Workman's Comp.Policy# Li—, C 17' U C) 3.2 a 1 7 . 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_ /1o\ri ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. a ' A copy of the Home Improvement Contractors License&Construction Supervisors License is equired. SIGNATURE: LC QAWPFILESIFORMMEXPRESS2017 T7ie.Commomveakh gfMassad iuseits 1?vartrnezit of 1ndrrslrid Accideu& � - � l�,face a,�1Fnn�tigations . _ 600 Washington Street Boston,MA 02111 ' ft+rvty maxLgov1dui Workers' Compensation Insurance Affidavit Builder-dC.ont ractursM ianslFhimbers ApplicmAlufmmmfian Please Print r Name(13as�eganii�tior>lFnd�v0a1} A ddres Phone 41--- 6 d d 9116 d Are you an employer?Check the appropriate box: ` Type of project(required): I.-U,,I ant a employez.vith 4 ❑I am a general contractor'and I employees(full atfidfor part-time�. s have hiirredthe sub-c=taaators� G-..❑New construction 2.❑ I am a sole proprietor arpartuer- listed on the attached sheet. 7- ❑Remodeling strip and have no.employees These sub-contractors have g_,❑Demolition woricing fnr me in anyo wodoers cfl insurance comp. and �e workers 9. ❑Building addition. required] 5. ❑ We are a corporation and its 10❑Electrical repairs,or additions officers have exercised their 3.El am homeauier doing all worts 1 L❑Plumbing repairs or additions myseM[No workus'comp- fight of exemption per MGL 17 152, have no, ElRoofrepatrs insurance required-]F c. �1(�andwe ha employees-[No workers' 1.3.❑Other comp-insurance required-] . Any appticsrtdat dhedsbos#1—st also M oulthe secuioabelowshovdnj di i vndere caoap—sat; parr-yinf mL Hmnemmem Who submit dais afiidn ft i ucatiog tioey am Horny RU wak sad&ea 1&e Qu=&contmdbom— submit a new sMdatd;t mdfcatk sadL ZCoatzact. ff=check this boot mast atMched sa addili®sd shorn sho tbe3m a of the nab-cauftwAa s.god state whethm ar ant f6ose entities bay empk gees.Iftbe snb-ca=ta=mhave empicyw,Huey=srpmvi&dek worke&camp.porky moaben I ant an ernploy�sr fleatis prQuidireg ivarkets'cotr ensrdiart insrtranca�vr myJ entpTu}�etrs Betoty is flie p:rticy ared jeb site €nforrnafwra. I(A of vA Insurance CompasryNam: A/ S Policy ie'or Self--ins.Lic.;k 4 w c 4(b6 20 !�:// 3a 01,2 J) ExpirationDate: 5 ' Job Site A ddsess_ `f i �— � v ���i��.7�s. /ti/L� cityrstater�p: �� /V7 4 Attach a copy of the workers'compensationpoUcy-declaration page(showing the policy number and expiration date). � Failure to secure coverage as required under Section'25A of MGL c M can lead to the imposition of criminal penalties of a fine up to$UOD OD andl'or one-year imprisonment;,,as well as civil penalties.in the farm 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 maybe forwarded to the Office of. 7avesfigations ofthe DIA for insurance coverage vezification- 1 do heraby e taluter-thepians idpirnaltres ofperjury thatthe informadwi protvidr d abm a is true and correct Sitmatnre: Q� °� vim!✓v Date: /// 4, Phone is ( G k -(' e,'7 L/�l I' O t3�ciaL ups artFy De trot tsrite in t ib area,fe be coimpletesd by ter ortQs-n offierat City or Town- PertaitJLuense# Issuing Authority(cu cle one): 1.Board of Health 2.Budding Department I City1rown Clerk 4.Electrical Fuspector 3.Plumbing Inspector 6.Other Contact Person: Phone#: formation and Ins ructions Massachusetts C=,= el Lavn chaj E M requires all employers'[n provide vu.&-exs'compensation for their earpIoyem. P -to this sty,an mrployee is defined as`...every persdn in the service of aaoih=IIndes any cobra ct oflurey express or implied,oral or wtiffffi." An employer is defued as"an ink partnersb�,association,corporation or other legal eutiiy, or any tw or more of the foregoing engaged is a joint else,and inchzdmg the legal sepreseofatives of a deceased employer,or the re,ceivea or trustee of an individna,p'mtaeCsbip,association or other legal entity,employing employees. However the owner of a dwelling house having not more t mn three apartments and who residw therein,or the occupant of the - dwmUiag house of another who employs pm-sons to do maintmmi=,conshuction or repair work on such dwelling home or on the grounds or building appur thereinn shall not because of such. loyment be deemed to be an empployer." MGL chapter 152,§25C(6)also.stags that"every state or local gency shall withhold fhe issuance or renewal of a Iicease or pe operate a business or too constru e# dings na the Commonwealth for any applicantwho has notprodU. acceptable evidence of compIian the msurance-coveXragerequired" Additionally.MGI.chapter I §25C(1)':,starts"Neiffim the nor my of its political subdivisions shall eater into any contract for the p ce ofpublic work until table evidence of compliance with the iusmance.- rez gents of fins cbapterhave presenSadto fhe ar�ho ty." s ApPiicamcb l Please fill out the wori='compeasaiio affidavit comp,letel by checlang the boxes.ffiat apply to your situation and,if necessary,supply snb�onEractor(s)name( ,`affi s(es)and ne number(s)along with their certifrcate(s)of h3mm ce. Limited Liability Companies or Limited fljty-Part uesbzps(LIP)withno employees other+than the members or paAaeas,ate not requked to ricers' ensatim insuranm If an LLC or LLP does have employees,a policy is regaftr& Be advised 'ibis affi - maybe submitted to the Department of Industrial Accidents for conformation of msm�ce cov `.%Also a sure to sigxi and datethe affidavit The affidavit should be retamed to the city or town that the application th peunit en or license is being requeted,s not the Department of . Trrh,rt,�a 14 rr;� Sb. onldyou have any questions the law or ifyou are required to obtain a workers' compensafion poIiey,please call the Departm erh at ea listed below. Self-m reed companies should enirar their self-insurance ce license number on the apprapriaiE Ime. City or Town Officials t Please be saL that the affidavit is complete and. Iegmly. The Department has provided a space at the bottom of the affidavit for you to fill.out in the event the cc of Inv has to contact you.regarding the applicant P leas a be s=to fill is the perm"t crose corm which w�be us as a reference number. In addition,an applicant that must submit multple p�llicense app " "ors is any given y ,need only submit one affidavit indicating coirent policy infozmation Cif necessary)and under`moo Site Address"the cant should waii�"all locations in (city or town)."A copy of the-affidavit that has been o ciallp stamped or d by the city or gown maybe provided to the applicant as proof that a valid affidavit is on a for futnre'permi�or li m A new affidavit must be filled out each year.Where a home owner or citizen is o a license or pezmitnot to any business or commercial vdnfras (Le. a to dog license or pennit buoi Ie aves etc said person.is RIOT re uircd e businessgmplete this affidavit The Of of Investigations would like to you in advance for your coop "on and should you have any,questions, please do not hesitate to give us a call The Department's address,telephone and fax Cr. Tha C O� Wn 81*of M&SachnWEb i Degarhnmt of lridugi dd Aocidents �of�tt�e�ig�fioaa� -Q4lean t BQEan�MA 01 1 I I Fax 9 617` 27'749 Rtvised4-24-07 1 AC R CERTIFICATE OF LIABILITY INSURANCE , : DATE`M"�DD/YYYY' ; 05/19/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,.certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Lori Wong OXFORD INSURANCE AGENCY INC P"c"o (508)987-0333 A/ No E-MAIL ADDRESS: lwong@oxfordinsurance.com 300 MAIN ST INSURERS AFFORDING COVERAGE NAIC# I, OXFORD MA 01540 INSURER A: AIM MUTUAL INS CO 3375S I INSURED INSURER B: LIBERO MOLINARI INSURERC: MOLINARI HOME IMPROVEMENT INSURERD: 11 SHEEP PASTURE WAY INSURERE: [AST SANDWICH MA 02537 INSURER F: COVERAGES CERTIFICATE NUMBER:.156284 REVISION NUMOER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT•TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS ,.TR TYPE OF INSURANCE POLICY NUMBER MM/DD/YY MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE 7 OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&AD INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ I POLICY 0 PRO JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ A COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL Or SCHEDULED BODILY INJURY(Per accident) $ i I AUTOS AUTO S NIA I NON-OWNED" Pe�PER DAMAGE $ i I 1,E]HIRED AUTOS AUTOS - ` -- $ S F--I ! UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 41 , I EXCESS LIAR HCLAIMS-MADE N/A AGGREGATE $ —e_ Il DED RETENTION$ �/ $ WORKERS COMPENSATION X STATUTE ERH —j AND EMPLOYERS'LIABILITY Y/N 1 ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? WA WA WA. AWC40070081132017A 05/21/2017 05/21/2018 - - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 IF yes,describe under' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 1 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. SThis certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. .Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street - AUTHORIZED REPRESENTATIVE Hyannis MA 02601 '`�� ( LL x Daniel M.Crowley,CPCU,Vice'President—Residual Market—WCRIBMA I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(20,14/01) The ACORD name and logo are registered marks of ACORD • i .B MOLINARI HOME IMPROVEMENTS SPECIALISTS IN ROOFING, REROOFING, REPAIRS,WOODSIDiNG&GUTTERS 93 THORN TON DRIVE, HYANNIS, MA.02601 Office 508-771-5266 Cell 508-36m745 Fax 508-888-3750 508-96584435 11/02/17 MR SHANE AUGUSTINE 645 LUMBERTS MILL RD . M A RE—ROOF ENTIRE ROOF #1 STRIP OFF EXISTING ROOFING #2 INSTALL METAL DRIP EDGE WHERER NECESSARY #3 CHECK ALL BOARDS RENAIL .WHERE NECESSARY #4 INSTALL ICE AND WATER SHIELD AND UNDER LAYMENT PAPER #5 CHECK FLASHING #6 INSTALL• 30 YR . ARCHITECT SHINGLES ( COLOR TO BE #7 THOROUGH CLEAN UP OF ALL DEBRIS RELATING TO THE ABOVE WOR,< r!' * TEN YEAR WORKMANSHIP GUARANTEE * THIRTY YEAR WARRANTY ON SHINGLES FULLY INSURED WORKMENS COMPENSATION AND -LIABILITY INSURANCE SEVEN THOUSAND DOLLARS ---- ----------------------- ONE HALF TO BE PAID UPON COMMENCEMENT OF THE ABOVE 4JORK , THE BALANCE TO ?E PAID UPON COMPLETION. tarn Massachusetts Department of Public ndard Board of Building Regulations and Standards UPeNAs°� Use gtic meters)°{ CS-040124 License: Visor tS any 1 Ub ,Construction Supe G° Sir ced to. U\\&� 9s jeet�99 c v�restrr ed 1 cUb`c LIBERO J MOLINARI in \ess tha d pace. 11 SHEEP PASTURE W02537 , e EAST SANDWICH MA ,setts sac'., use. oltoeM Ittbtst�ce Expiration: �ocaC�on OVIDps / Ju✓ /�J� . nt ea�Ua� 0312912019 a`Urre se{or ve tAxss G Com missioner _ t\Urn to posses Gee`5 ta°v,5,t Ea Buy\ding ,nfo�a QPSVice in9 6 . V`ie �pomvnzoauaecclC�d�C�aac`ur eta 71. Office of Consumer..Affairs.&Business Regulation HOME IMPROVEMENT CONTRACTOR o Registration: :"102322; Type:• Expiration- 1 t�2Elf8 DBA MOLINAR[ROOFING— , i< Libero Molinari 11 SHEEP PASTURE EAST SANDWICH MA 0253r .:-. Undersecretary .' � 6 �tMME r Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee BAPAMABM MASS. Richard V.Scali,Interim Director 9� s639. Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �� Not Valid without Red X Press Imprint Map/parcel Number 1 Property Address v M�'�fY M i i R-6 a Residential Value of Work$ 26(cC2- 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address f�L iSSj� l�3�5 64A,� 1-U s tll 2� ,•y ;ten �� Contractor's Name �;�y1 1 Ji1N _Telephone Number 'Gy�' Home Improvement Contractor License#(if applicable) k to i l Qk Email: )C)t 31j V w (owASS 11� Construction Supervisor's License#(if applicable) L of � _ -r []Workman's Compensation Insurance Check one: MAY 19 2014 &I am a sole proprietor ❑ I am the Homeowner �. I have Worker's Compensation Insurance � ®F BARNSTABLE Insurance Company Name Nr S QJ Workman's Comp.Policy# k .JCGS !M-0 1a(31 3 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 � 3t►`D� ❑Re-roof(hurricane nailed)(not stripping. Going over, existing layers of roof) IN Re-side ® Replacement Windows/doors/sliders.U.-Value o U (maximum.35)# d windows �o #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 other4own department regulations;i.e.Historic,Conservation etc. ***Note: Property Owner must sign Property Owner Letter of Permission. e, A copy of the Home Improvement Contractors License& Construction Supervisors License is required. \ f, SIGNATURE: Q:\WPFILES\FO S\build g permit formsUTRESS.doC Revised 061313 1 a z 4 . The Commonwealth of Massachusetts Department of Industrial Accidents -- � '` Office of Investigations ti 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): -C) - Gk Address: a�d`-t t"1A2, City/State/Zip: �� t—((�. V Phone #: 114 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4• ❑ I am a general contractor.and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑ New construction 2.[►l am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand 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.ElI am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.[]-Other comp. insurance required.] U,-,. A *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors.and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: gC'e,t YN_� ;--� t (L2E" �_ Policy#or Self-ins. Lic.#:A�t-Q)o q C P_0'10(i ( ? Expiration Date: Job Site Address: Cn�_f7 L.Jr7r_AC,12 >1', City/State/Zip: �(�t s'cGit.ut�1� �� CA 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 herek certify under the pains and penalties of perjury that the information provided above is true and correct. Si nature: 6_,PJ� Date: Z Phone#: �-a �`l 1 Official use only. Do not write in this area,to be.completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: v C Massachusetts Department of Public_ Safety _ Board of Building Regulations and Standar(js fv��r.�s�m�i.r,.iA/, ( 1-111t 1 11,hm) 'rup%-r r� i \ OCfice of l onsumer Affairs&Business Reeulation t 'Cense CS-014007 �6HOMEIMPROVEMENTCONTRACTOR tI Registration: 101149 Type: JOHN P DUNN Expiration: e/25f2014 Individual BOX 924/80 MARIE 4y - j JOHNHN P. DUNN Centenille MA 02632 John Dunn 92 —01-' ration 80 MARIE ANN TERR. :.�nuru»um.•� - 05/25/2014 CENTERVILLE,MA 02632 Undersecretary Unrestricted - Buildings of any use group which contain less than i5,000 cubic feet (991m`)of License or registration valid for individul use only enclosed space. before the expiration date. 1f found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS N valid without signature � E r Town of Barnstable Regulatory Services BARNST"M ` Richard V.Scali,Interim Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder 1 C � U 007 as Owner of the subject property hereby authorize '�J C�re� vy�J�'J to act on my behalf, in all matters relative to work authorized by this building permit xa l :. eaI Address of job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and-all final inspections are performed and accepted. t Signature of Owner S' ture of Applicant Print Name Print Name Date n•L'nA A.fC•nWT.TFA PCRrATC CinT7UnnT Q in/11 - f Details ' Page 1 of 1 Licensee Details Demographic Information Full Name: John P Dunn Gender: Owner Name: License Address Information ddress: Address 2: Marie Ann Terrace City: Centerville State: MA Zipcode: 02632 Country: United States License Information License No: CS-014007 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 5/9/2014 Issue Date: Expiration Date: 5/25/2016 License Status: Active Today's Date: 5/28/2014 Secondary License: Doing Business As: Status Change: Prerequisite Information No Prerequisite Information Discipline No Discipline Information , Documentum T• } v s .t http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=210684&• 5/28/2014 TOWN OF BARNSTABLE Permit No. 27936----------------- IMSTAn Building Inspector Cash -------- x .,0CCUPANCY PERMIT Bond ------------ issued to' Address Larry Nickulas Lot 69A 645 Taimhprt Mill R nAd- Centprville Wiring Inspector �7Inspection date ..... Plumbing Inspector Inspection date X Gas Inspector c j Inspection date X E ngineering Department, Inspection date Board of Health Inspection date THIS PERMIT WILL NO T BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. azel ................. ........ .................. ..._..,. _ ... ,.:. .. rF yt' , y,. .I� '..�t � - .. k _.a:;: n - - - '1�.. =r sJ�.- h- ♦ .k. ,,,, _ -_ y ,ry TOWN OF BARNSTABLE BUILDING DEPARTMENT . out 2 sasasr TOWN OFFICE BUILDING ' 1639. HYANNIS� MASS. 02601 I �OIUCI M� 1 i MEMO TO: Town Clerk FROM: Building Department DATE: (Y.(. An Occupancy Permit has been issued for the building authorized by BuildingPermit #........._.. r�.� .2.......... .......................... ....... ................. .... issuedto ..............................�/ ��/ �' 9„ �� �"G �' ....................................M...................................... ^, `ti Please release the performance bond. Assessor's map-and lot number ... ....... .......... .... THE Sewage Permit number .... • BARNSTABLE, House number ..... ..................... ............................. MASIL ... ........... t639- vlk,(It, TOWN OF -BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........... ......................................Z:7 ... ........................................ TYPEOF CONSTRUCTION ....................................... . ..... ........................................................................... ........... ...........19... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .............../.......C......r....... ............................................................. Proposed Use ..... .. .......................................................................................... ....................................................... .......... .....................................................Fire District .................................................. Zoning District .... Name of Owner ........ K ............... ................ 4 A�_s...Address A"'I Nameof Builder ............... ..................... ......................Address ............................... ................................................... Nameof Architect ............... ........................... ...................Address ..................................................................................... Numberof Rooms ..................................................................Foundation ............... ........................................................... Exierior .................�v .....................................................................................................Roofing ................. / �"C.&- C < Floors ........................... X..............................................interior ...............� T 6l ................................................... _HeUfl_rfg ..................................................................................Plumbing .............. ................................................................... Fireplace ......................01/zlle� ...........:.................................................Approximate. Cost .................................................................... Definitive Plan Approved by Planning Board q ---------19---11 Area .......................................... Diagram of Lot and Building with Dimensions. Fee ........................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Jr .A. fi OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnst6ble regarding the,above construction. /,�� Name ... 00 ......................................... Construction Supervisor's License ............................ VS -�No —37.936. Permit {or .................................... ^ ` ___S . ..]�h���lino___, ' ' | Location ..... 69x...G45...AMdlP?�t...MjlI Road | ' ------.. ��---------- [ Owner 14 a_________ ' . ~~ Type of [onstruchon .9KAMe----.----.. ---------'^----------------'' Plot ............................ Lot ................................ . ` �ka� 3O 5 Permit Granted -----..�----. o Do�e�f Inspection ---------.\�,—lg ^ Dote Completed ...................................... � / 6 '� / /0 ' - ' ' | ` | ' sINE Sewage Perm ..��71AA 163 WITH TITLES CODE AND TOWN OF BARN It"OAT 10 N S na BUILDING INS'PECTOWRNISTABLE CXjG"XJATi'0,14 .................................... > TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �'y Zoning District .... Fire District ........ z>6 7 Nome of Architect ----- ........................... .......... ........Address -----------'----------------' Number of Rooms ------'�� ..........................................Foundation ............. .............................................................. Exterior ................. ---------------RooGng ................../... ----------.— F|oo,� -------�1����..��`---------------|nte,ior -----!��?�����.—���.�����-------_. ' Heating -----'....—��.=�.----------------P1umbing .............. Fireplace -------���4��.-------' —' . Approximate Cost ........ . Definitive Plan � Planning 8�� lV�� . �� _.�� ' ' ' / � �7-- -- '���----- Diagram of Lot and Building with Dimensions Fee ........... � SUBJECT TO APPROVAL OF BOARD OF HEALTH 5'le � ` —�» All, � = \ �� ��� ' � ' ' / . . ~ | ^~__ . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' ' I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the`o6ove construction." . Name . .. ......................................... Construction Supervisor u License ' �� N CKULAS, LARRY No 2 7 9 3 6... Permit for V2... .............. ....... ...Welling.............. Location ..,L.Qf-..6.9.........GA5...Lumbert--Mi-ll Road ...................center.V.11.lp................................. OwnerLarry Nickulas .......:.......................................................... Type of Construction Frame .......................................... clip ................................................................................ Plot ...................... Lot ................................ Permit Granted ...May...2.8.1....................19 85 Date of Inspection.....................................19 Date Completed .46....................1 gsz,5, op A i . r , s 3 -3 N � yr,9/S Zz S9 r Q / -r 97 i d ,1 � y IDS / / / /! _•-• \ 0.0 46 fz- 166 . i r _ Jam 'oC) 3z 0 y w 2o,�c:"� �- �I AI- . y3, S-vo s,F, CERTIFIED PLOT PLAN 20/(o/id SC�773�a S �� 6F bfAsp'�y L a 7- uM a ROBE- T F CC—/VTE /c'f//LLB Ssu.,. c6r r' z B. � ELDREDGE IN /�1n-T. TT, 5E'4 � C., F! � No. 19367 �+ AAA�1+$ +y� A V'�AL J4 AASSq •' �cJ�r C3y�gz./s Fss�oEcrsT�n�°oe�`` f SCALE, / "-4 a' DATE+ S NIGKUu1 s 1 CERTIFY THAT THE T9 d!✓G.q riu ' -� r 4�1[NT • SHOWN ON THIS PLAN IS LOCATED 9818TERED REGISTERED JOE NO Bg iv¢ ON THE GROUND AS INDICATED AND CIVIL LAND '` ' '�" �^' ENGINEER SURVEYOR >;; Oft.dY, � ,,I- CONFORMS TO THE ZONING LAW.11 R OF IIARNSTAi E MA8 . " 712' MAIN STREET CM.GY6 .._.�. tATE �HYANAIS, MASS. 8NEETL.Of RES. LAND SURVEYOR