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HomeMy WebLinkAbout0010 MAGNOLIA AVENUE /�� �.�. . r a . . �� .. 8 t �. . d a _ � c .. ,. � � 6 -"�^�4.. .. -�.�._._...... _..yr...__,�...r., ,.._ y _.- .. ."..«,._,.�_........Y Y..s.!a. t. T.yS� -r .. ..Gt,.�.. _ ;F.,�, tr .''aFtM�EYJ'49 'y7 .. � r mac.- -..,_._-�..w.� iy+ ""��� --..�.4.r._,.._._:.,..LSO..�...a..- �:_.., .., a� -0 '�+�,, .,f .-,A" .f� II� :. m ,..i. Town of Barnstable *� 1RAN=6S31'AAB L°B. " ife=WPPbf"ss;nsreT hiiCsm:a;l,'.t:difi Scoa"tTeh oaft Ortc arc s'u=V`p°'i"a�sinEb cl e:iFsr eoRme t�u:`h�er�e Sdt.rs:e•:u.e'dct s"hd,�BApipld,r om v Ke.sdh`:,P a'l lal,nNfiseo:ItV.'lbu es t^O bcec uR+pae i,tead�i nuBuilding ted Untot M Celt a r Permit ym llOeh Permit No. B-19-1761 Applicant Name: Approvals Date Issued: 06/03/2019 Current Use: Structure Permit Type: Building-Deck Expiration Date: 12/03/2019 Foundation: Location: 10 MAGNOLIA AVENUE,CENTERVILLE Map/Lot 226-145 Zoning District: RD-1 Sheathing: Owner on Record: HYLAND,G ARTHUR JR&SUSAN B Contractor Name- Framing: 1 Contractor License " - Address: PO BOX 538 2 WEST HYANNISPORT,MA 02672 Est Prolct Cost: $7,000.00 Chimney: P Description: add 10 x20 to existing deck - r;ermitj ee: $ 110.00 - A Insulation: Fee Paid $110.00 Project Review Req: Note: May require additional support under�15'dimension to f Date X 6/3/2019 Final: support new section of deck. , � �:�� •�_ Plumbing/Gas, Rough Plumbing: Building Official x Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorizedrby this permit is commenced within six months after�issuance. All work authorized by this permit shall conform to the approved applicatici&i d�the approved construction documents•for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws an'd codes. This permit shall be displayed in a location clearly visible from access street or'road a d shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. ` Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the'Buildi'jand Fire Officials are provided on his permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing ,x 2.Sheathing Inspection '°V - Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed' 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy - Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health ,,.'Perso, ontracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Sy s s a Q co .. ca C*-' V 9DB4 a Q;QD�T4'Il'Il , JQ�'�' QDaT 11.13STQDMMON - RED ODDELINQi - FINISH CARPENTRY 17 CIRCLE DRIVE - HYANNIS,MA 02601 (508) 737-6834 g 1 - Si 43i- i. t ` z :.. ;: . F' NOI5IMC, 69 :6 NV 8Z ON 6101 s-V.SNUO Jo Nmol e Q q. ii R dry( q{/y(�}}F{+jp�4T�(s� �.. I mo, _ NOIS—IAIG .. � .. '� 9IlSHU�g �4 NMUI o v A • F k • X 61 -krl_0 It n fk •+dam"_ 'b.•g.' Y P QIl�a� Q;OM4'Il'IlJQ;'Il' QDDT RESTORATION - II.EMO D➢LING - FINISH Q;AIII'➢?N'I'RY 17 CIRCLE DRIVE • HYANNIS,MA 02601 (508)737-6834 i TOw� �� BARN5T�1B 9-. 5$ .y/ E i � � 1�•��. ��\rYwii��eppwJMw.ifraYni�t�r'y�`'Y4r r.r�:�fu�1 � ' k { �jCA �►���a���aj ®l AOP -- i s n�. :tea Q co " 1 Application Number .. .. .................................... BARNSPABLE, +'' � � Ivl , KAS& Permit Fee........................4...........(Mer Fee........................ 03q. Total Fee Paid...................................................... .... . TOWN OF BARNSTABLE Permit Approval by..... ...... ................on....� .r BUILDING PERMIT Map... ......................PaTeei..... .y�................:........... APPLICATION Section 1 — Owner's Information and Project Location ILI Project Address � Village - 15 fie/ Owners Name ' l Owners Legal Address C) hd City4 State Zip �+y hi Owners Cell# E-mail- ZC ` Section 2 —Use of Structure ` N ' Use Group ❑ Commercial Structure over 35,0)0 cubic et ❑ Commercial Structure under 3 5, 00 cubiofeet m-� 0 ,. , LLYSmgle/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild [ ,-beck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar A ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 - Work Description _ --------- Application Number.................................................... Section 5—Detail Cost of Proposed Construction , cC� Square Footage of Project Age of Structure Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 67 Project Specifics ❑ Wiring ❑ Oil Tank Storage Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom I Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: TwyJ ,0'&Vq\z I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information I C Zoning District Proposed Use Lot Area Sq. Ft. doc Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Si Setbacks Front Yard Required Proposed Rear Yard Required Proposed ' Side Yard Required Proposed Si Has this property had relief from the Zoning Boaid in the past? ❑ Yes ❑ No P. T9Cf11Tli9tPl�• I�GYIn�9 Y CNM Parcels FY2o19 -,e 1 l �t u. ,,,�•. i� �"'� ':.,� 4 .�,, .�. .eta'". . ' k is ... Address Street Numbers �a�•+.*� � �"�a� B�Ps�,� � ax�w- mil,„.;�,, 7�' y � r� �`'L E ■rrWrr■ Town BoundarytGRP',G."\`�`' be ' ' t r3`. -- -^x.'." _. �x�,�..> "�. a, •a� �` ��' Y i . t Approx.Buildinga .• rxv , Buildings a 9 Decks Patios :...,��� ', "^.. � .: +. ` -• � .•.. :...•)•- .f'. - OCR'?� --�z Above Ground Swimming Pools - r - � `�.- �>.�, �� ,.:: •; .: l -- ' - g � O= In Ground Swimming Pools -,?- °e' *• Paved Walkways f +uxx^�4 ' Unpaved Walkways ANNUALt 1 �t+ 226-146-002 Paths r ." �r CHANCE` # 11 a Stairways Paved Roads 1__? •� „), ^a Unpaved Roads -� Paved Driveways w Unpaved Driveways - Painted Lines• .` `�'^i *, ..1 { . 0 Paved Parking Lots a. Unpaved Parking Lots ` L, „'t Nt 15-1 - 1 Bridgesit Railroad —— Fences \\ Ct e s� t i § �, *` �2 '�✓ �--- Guardrails „ an 1 # ^v`#44• `� z,,,n# v ..�y --- Retaining Walls Z ► n �. °�, .. .� 226 146-001 Stone Walls s *- Other Walls Hedges 1..> yL '"'' 't' e ^ 7t"� q �? Q= Sports Areas Golf Areas ` c `•mEi try"; k °" t ,+Ye- 'Ir ".-.e, 1� >. �`+� � �,a, Docks/Piers ` . �� ^`, �~ } ,.r �� '�•`f t Boardwalks �a • "ly -.r ,-v t Jetties *' `}. s� Streams91 1 ,;. -- -- - Drainage Ditches � Marsh Areas Water Bodies Spot Elevations(NAVD88) s " l C,_ Topo 10 ft Contours(NAVD88) �i: ..._Woo(TM%9,fsC rjfrNA Tcet r88s ® Catchbasins x 226 142`. ?gw Monuments - § ''a •% « *, + t r 4 Lamp Posts el --� •#:19 �$.:,;z'* ,� � 1 ��r�s ,3, A��+ * �' J) Sathte Dish - ;•rr _Manholes ® FuelTanks +-vs �; ;' j-.� •SEWY.Utility NV 8Z �F� F.y # 29'..;:',',;iL,:' 0 Water Tanks *,A °` Signs �.. ..� .,- 7Hb �x Flagpoles ,. Town of Barnstable Data SourCC Human-made features, Disclaimer This map is for planning purposes only. It is 1 inch=30 feet N hydrography,topography,and vegetation were parcel lines on this map are only graphic not adequate for legal boundary determination ----- Feet Conservation Division interpreted from 2014&2oo8 aerial photos representations of Assessor's tax parcels.They or regulatory interpretation.This map does no O 5 10 20 30 40 W E httu://w .town.barnstable.ma.us and may have been updated from more current are not true property boundaries and do not represent an on-the-ground survey. oFT Town of Barnstable Conservation Commission B^RNm'ABA� ADMINISTRATIVE REVIEW FORM . ADM19- Fee $25.00 Fee Paid Address/location of proposed Droiect: Street Village: L l Map: Parcel: Owner/Applicant: k Mailing address: i�)� s'�j��( Phone/cell: -Email: Fax: Contractor/Agent: Address: f hone/cell: Email: V1 [ Associated File# Noly Project description: Attach additional she if necessary,along with photos and a site.plan if available(include distance from resource). IQ 1 X �� i �eC� 1. Will the proposed work to a place within any of the following resource areas? (If"yes,"please check the following resource areas). ❑ Town coastal bank; ❑ State coastal bank; 100-year flood plain (land subject to coastal storm flowage); ❑ Salt marsh; ❑ Beach; ❑ Dune; ❑ Vegetated wetland; ❑ Lake; ❑ Pond; ❑ Stream; ❑ Intermittent stream; ❑ Estuary; ❑ Ocean; ❑ Land under said waters. 2. Will the proposed work take place within 50-feet of any of the above resource areas? " 3. Is excavation by machinery required? V 4. Is foundation work proposed? 5. Is removal of vegetation proposed aUnderstory ❑Groundcover ❑shrubs 6. Is regrading proposed, either the addition or removal of soil? 7. Is tree removal proposed? If so, why? ❑ Water view ❑Aesthetics ❑ Safety issue Are trees: ❑ living ❑dead ❑ dying(please supply photos) 8. Is planting proposed? - If so,please supply a plan which includes species. 9. _Is removal of poison ivy proposed,or other invasive species removal/control proposed? ! If"Yes,"please explain on additional sheet. n 10. Is the use of herbicides proposed? ( v Applicant signature: Date: Reviewed by: Date: Q\regulations\admin policies procedures\adminreviewform 7/1/2017 Office of Consumer Affairs and Business Regulation One Ashburton Place - SuiW 1301 Boston, Massachusetts 02108 Home ImprovementYCon�tractor Registration Type: Individual y ` Registration: 171522 JAMES MCMORROW �� �' " Expiration: 03/26/2020 D/B/A JFM CONSTRUCTION - 17 CIRCLE DRIVE 4V' HYANNIS,MA 02601 Update Address and Return Card. SCA 1 0 20M-05/17 �a, Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registr`ationg Expiration Office of Consumer Affairs and Business Regulation 1715 03/26/2020 One Ashburton 02108 Place-Suite 1301 r JAMES MCMOfO-�� ,t DB/A JFM CONS.,FRL}C�T10N� I: JAMES MCNORRGIW � 17 CIRCLE DRIVE Not valid without signature HYANNIS,MA 02601` p--` Undersecretary , Details Page 1 of 1 Licensee Details Demographic Information Full Name: JAMES F MCMORROW wner Name: License Address Information , ity: Hyannis - tate: MA ipcode: 02601 ount : United States License Information License No: CS-098120 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal 11/15/2017 Issue Date: . 9/10/2011 Expiration Date: 9/10/2019 License Status: Active Today's Date: 5/28/2019 econdary License Type: Doing Business As: tatus Change Reason: License Renewal Prerequisite Information No Prerequisite Information No Available Documents, 1 https://madpl.mylicense.comNerification/Details.aspx?result=eb63e432-40b9-4033-9954-... 5/28/2019 9FE a� CgDi k 'Il'Il��JQ;'IlHON 1117S OIIIVFION — REMODELING — FINISH ("ARPI'sA TRY 17 CIRCLE DRIVE •HYANNIS,MA 02601 (508)737-6834, uo Od �0 n . andfil _ t -- 0' A F Wes#H an.' #UCH S -RATE %kw�_ Exi�ngDeePing :. :, e�o T #id 2'xi- f ..u�g< .Riit ,.aartt �$ arw becwg a fowlb x Raft,kmka t �n mar •tw Wig; os$ bis Aga t"#,,_mA&lhis, 'davof mlj'w JFm ai�rei��ffer�sigrt�Iid`at��us�t`.wit}�.s mailing address:off: t-ao.M-agnona Av .e Wast"yaAmpod MAM6WTfmdjFM �onsc�tton Ott tt�Ci�smme .for eonsiderz6on,:hereiriafW,named are0_as fbit �vsRt,; t:; t ;oint�� #i #t .furnish WWr,.(oas and'pe_rbrm wottas: specified,in the:attached imoice Said::, to. '4wea,custofl%ri k-bgmq'at lo }yofla V I , QUIl�a� Q;QD�T4'Il'Il��JQ;'Il'�QD�T IIi.l?4'II'QDlitMON - IIi.EMO DII LIING - FINISH QAIID PEN'II RY 17 CIRCLE DRIVE • HYANNIS,MA 02601 (508) 737-6834 46f'6e:ih,iwcbrOahoe-grit #le.specF +cM arrduriie�s-o�'eCffted;':a#i:a�i .- , Mefd ofs.good'materia[".gf _ as the:frfaf cei afforfts-in.the.respeCh a, rade ord ri-c uxitf�:ffue 0 ns and.speoif a#is ns matenafs.as ar nariC .pxperi nCed"in Cof#st�:tc#ion-of similar dweiiin_gs � -good M&,ena gra&.a5. r r ce#a#ixds- � fesd# e made C�# t+ st1 bo rr�aeCo€d�OC-e i � ' �foiCc and'.speci#icalions as cCase as{s �` reasofiat t possve,t tolerance- ��aaef�s3st�s- csJ�p af�=��at�e�Fs o aril expe nce6 i t Cuffsof R0L- r t;nar es#o spepffifim6ons h-ft f hed=aoop '.s0otf tip Toads-by,k-m Canstruction at ei6erihe. CRr erwf, I # t of der tryEi w mars-per,, c�U .for ens strttotrevzll 'Wit'.�tr d o o€ds. 9 .. -Also,the pacenoes-nq:66Wr idpfoce Brat t fotGr_inseddamagein,theexisting-stiud re, 'ih 1 t. trb t �tl i" 11t GC i t C#1 = e e#tt# GUsOM00 KeS.af`�Usst,€Qra :i�i�'t�,31=1��ftsh'Ust :�ifs v�Fit '�#�e�st�ed-egs,..aF�shy set�?�_ tfte;cosf,if.any,.of��.Ccing.s .o!'ianges of#der i s signature:Any Vita a-lmw-g:a a : Ustflt <u g-"efpto-f-thg ck a e.o .- e ' 0 Q�Il�a� Q;QD�T4'Il'Il�,�JQ;'Il'�QDa� Ii.D+'.4'1'QDIIMFION — II.D?MOD IMINGi — FINISH Q;AIII'➢?\T'I'RY 17 CIRCLE DRIVE - HYANNIS, MA 02601 (508) 737-6834 .... ART-4 4 ,t s#cucort,soufd tie:work be stflpped L7C�11�[ER{S�#au#.t���a��`�IC:C�nstruc#i�:any .pw,nem-.wk r.se.van.(7).da.s.,WW t is-due vufi en..nofice.to, tE ,.m40to -oT t !#tti d°tZegt recom its stl't3j c#to afii{di6y'S fees B46 -costs ARftCttttl'SttIf Wit, worts wftfAiri rsa W'e.fim from tie.tea#e fi Dorm fa Mort #fetcocrt.er ert3ert#.t work Tita' Builder shalt-not 6ethefid responsmie-for.. s castsrai<tI ate+apt,.� Y, t:har�gesn hod c3m of.#fieu _ uar tsua# Ia rr at�statrer�:o#rr # oafs Ads at ARTICLE& tt i&.hemby a ed bet n_,_ wZ�4�;P#tis�i'sposaT�#:Cos#.$.i _ft�ita� $5te 1 t# s-tiv�t -ram�asl���t�l��4e€t-irr-Sd��ie of WorCc.wig be paid.4ub by f he;i=f d sanemeefc hours:are:comptetem Batance r� tom: -ARTICLE�:1�i1 hum Ctrs, i Est m oumined i #1 Sabi lobe- -tom 4he Dk9T €&. A Y QUIl�a Q;QD�T4' 'IlJQ;'Il'IIQD�T IIIIES'i'QDIIIIM RON - IIi.D:MO DEII ING - FINISH QAIIIIII'II?\T'II RY 17 CIRCLE DRIVE • HYANNIS,MA 02601 (508) 737-6834 ACTJWTY- WY tWM resut of Mis c Erad,AA'.bc nW6d And sub:—tors mjst be, am.--anv -"'Wws-Ab6Ut tewabwr. srli�-ea ° AhgpfO be,dJ'reoW-tq Pf#ic a©f Consumer Affair.and:.Regutafions;•Ten.Park Piaza; 97; g7 Q.:That is a lcae&` lgft#;to A' ' d atonstmction:flemted Perit ;drat it is ttae ebb taf tonfridor to Wain zw pOr-mds;an(T owners viho�5ecm ft.ADrlstfi3C21'an- muted f9ttt�4�r: 'i�i�C�t��f8t�°Gflt�tr��t3t`Sfi3f -sub-con#tac�ts•spat!-be:a�lu�d t�3h� € r�ta�t�S�pi;rvtsc�'s�e�se#�'Sd39��'�4 Home tthpmworneM- t straticin#4 IS22 TOTAL_:-DUE `oil. r Application Number........................................... Section 9- Construction Supervisor Name I n 4rly,c. Telephone Number -7 3 7 9-3V Address j Cc��(=e city State zip License Number PLZ) License Type Uo tY5±rtt4Expiration Date Contractors Email 5 VV\ Cell # �� 37� f I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your license. J Signature Date )0I Section 10—Home Improvement Contractor Name Telephone Number -7 3 ?j, Address City u4c CA n i State Zip Registration Number t Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C....^l Signature - Date Section 11 —Home Owners License Exemption Home Owners Name: s 'elephone Number Cell or Work Number `.iderstand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 R the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and entation required by 780 CMR and the Town of Barnstable. s a Date k . APPLICANT SIGNATURE .mature Date O74 int Name�C����Z Telephone Number -mail permit to: G Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ j Fire Department ❑ Conservation For commercial work,please take your plans directly to the fire department for approval, Section 13 — Owner's Authorization I, , as Owner of the subject property hereby authorize `" °" to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name f 4 w i r } 1' DATE(MMIDDrN") ,,_ CERTIFICATE OF LIABILITY INSURANCE o 11s 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 CUNIACI NAME: Schlegel&Schlegel Ins Brokers,Inc. a/co No Ext, 508-771-8381 /C Ne; 508-771-0663 34 Main Street E-MAIL West Yarmouth,MA 02673 ADDRESS: schlegelinsurance@gmail.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Travelers INSURED INSURER B: ' JAMES MCMORROW INSURER C: DBA JFM CONSTRUCTION 17 CIRCLE DR INSURER D HYANNIS,MA 02601 INSURERE: 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. INSR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGEORENTED- PREMISES CLAIMS-MADE OCCUR Ea occurrence $ MED EXP An one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO ti BODILY INJURY(Per person) $ OWNED SCHEDULED (BODILY INJURY Per accident AUTOS ONLY AUTOS ) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? Y❑ NIA ASSIGH000149586 05/22/19 05/22/20 (Mandatory in NH) E.L.DISEASE-EA 6MPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) James McMorrow has elected not to be covered under his workers comp policy. 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 AUTHORIZED REPRESENTA V ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD F ------ The Commonwealth of Massachusetts Deparhrtent of IndmindAccidents Office of Investigations 600 Washington Street Boston,MA 02111 wwM.massgov/dia Workers' Compensation Insurance Affidavit:Bwlders/Contractors/Electricians/Pinmbers Applicant Information Please Print Legibly. Name(Business/Organization/individual): e 9 C'I tom' Address: (t- City/State/Zip: C Phone#: Are yZm n employer?Ch the appropriate bo . Type of project(required): 1, a employer with 4. F1 I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no-employees These sub-contractors have g, E]Demolition working for mein any capacity. employees and have workers' 9. ❑Building addition - [No.workers'comp.insurance comp.insurance.: 10.❑Electrical required.] 5. -We are a corporation and its repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers'. 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors rust submit a new affidavit indicating such. rContractors that check this box must attached an additional sheet showing the name of the sub-cont actors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the poUcy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: ki I aAo Uo i�j (P Expiration Date: Job Site Address: A 1�4 ka r—)(VA City/State/Zip: Attach a copy of the workers'c pensation policy declaration page(showing the policy numb and egpi tion date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided ab a a ttr�ue correct Si Date: u Phone#• Ojj`icial use only.. Do not write in this area,to be completed by city or town of klaL 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#: L Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person iii the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or budding appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable-evidence of compliance with the insurance coverage required" Additionally,MCIL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public workuntil acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confnmation 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. Self-insured companies should enter their self-insurance license number on the appropriate lime. City or Town Oi3icials 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit mdicatmg current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The COMMOMealth of Masswhusetts . Department of In&mft at Accidents Office of Znvestigatiffles �1 600 Washington Street Boston,MA 02111 Tel.#617-727-49W ext 406 or 1-877-MASSAFB Fax#617-727-7749 Revised 42407 wwwxam.gov/dia �tr+eqk, n Of Barnstable T11 Regulatory Services wee 6 month e • Y # # MASS.BARNSrABLE Richard V.Scali,Director i639• �0 Building Division Paul Roma,Building Commissioner 260 Main Street,Hyannis,MA 02601 www.town.bamstable.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 vZ a U J 9,� Property Address 0 aG nb l V) ye-- [Residential Value of Work$ o� ,SL`U' Minimum fee of$35.00 for work under t6000.00 Owner's Name&Address u r -0" 'S'fitSalll 10-1i d, Contractor's Name S C&H- Pea-E� Telephone Number5-0—q-a 9 r-7&,06 Home Improvement Contractor License#(if applicable) , 5 Email: ��1't..►�2L�� �.��!171�j'1 rIQ�' Construction Supervisor's License#(if applicable) Ls— C)C1 qS 41*orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance +� � Insurance Company Name - y)l e- ' _ -A4­, � SEP / N ofWorkman's Comp.Policy# �C� �,�i_�s�,. ��P r:i�a� _�,. Copy of Insurance Compliance Certificate must accompany each permit. c�iA 01 Permit Request(check box) L i ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ' Re-side ❑ Replacement Windows/doors/sliders.U-Value (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 mus i Property Owner Letter of Permission. A c of the Ho a provement Contractors License&Construction Supervisors License is equired. SIGNATURE: Q:\WPFILES\FORMS\b Iding permit forms\EXPRESS.doc 01/25/17 aco CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DDNY Y) 07/10/2017 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 CONTACT NAME: Germani Insurance Agency PHON o (508)428-9194 F�Ne: (508)428-3068 908 Main Street AIL ADDRESS: certs@germaniinsurance.com INSURERS AFFORDING COVERAGE NAIC# Osterville MA 02655 INSURER A: SAFETY INS CO 39454 INSURED INSURER B: Granite State-A#U Holdings 000000 Scott Peacock Building&Remodeling,Inc. INSURER C: P.O.Box 171 INSURER D: - INSURER E: Osterville MA 02665 INSURERF: 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ A BMA0022118 07/05/2017 07l05/2018 PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 POLICY❑PRO ❑ JECT LOC PRODUCTS-COMP/OPAGG 5 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY eracddent AUTOS ONLY AUTOS ) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S DED I I RETENTIONS $. WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY AT ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT s 500,000 B OFFICER/MEMBEREXCLUDED? ❑ N/A WC005-81-5464 O6/22/2017 O6/22/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT Is 500,000 i DESCRIPTION OF OPERATIONS I LOCATIONS/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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Scott Peacock Building&Remodeling Inc ACCORDANCE WITH THE POLICY PROVISIONS. PO BOX 171 Osterville,MA 02655 AUTHORIZED REPRESENTATIVE Fax: Email: ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Town of Barnstable Regulatory Services ` Riduwd V.Sca%Director Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property . . � P Perty hereby authorize LS ��, to act on my behalf in all matters relative to work authorized by tbis building permit application for. (*ddress of Job) _- **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fen is installed and all final . inspections are performed and accepte S�a��te of OwnerS&nature of Applicant SCE Print Name Print Name q Date Q:F0RMS:0WNE"M?Iv0sI0NP6OIS Massachusetts.Department of Public Safety Board of Building Regulations and Standards License: CS-094500 Construction Supervisor JAMES S PEACOCK PO BOX 171 . OSTERVILLE MA 02655_ Expiration: Commissioner 07/22/2018 n%lc�r•>rr��irirrrnea�/�o/C/'l�tel:Jrrc�rcdc Office of Consumer Affairs&Business Regulation License or registration valid for individual use only <{HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - Office of Consumer Affairs and Business Regulation Registration 151853 Type: eg Expiration:- 7/7/2016 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 SCOTT PEACOCK BUILDING;&=.REMODELING INC JAMES PEACOCK 1046 MAIN STREET SUITE 7 OSTERVILLE,MA 02655 undersecretary Not valid without signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION pp Ma Parcel ` I :"Application p Health Division Date Issued ' Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board _ : O Historic - OKH Preservation / Hyannis U Project Street Address Village 4-cm --<— Owner P uIr t Cl, Address Telephone J v L� ll�, MA 020�- Permit Request �� , X + Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain - 2*" Groundwater Overlay Project Valuation ' s �0 Construction Type b d Y Lot Size V Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: Full ❑ Crawl r �❑Walkout ❑ Other Basement Finished Area(sq.ft.) "I I Basement Unfinished Area (sq.ft) L4 U Number of Baths: Full: existing 2— new Half: existing new Number of Bedrooms: Lf existing -new Total Room Count (not including baths): existing new First Floor Room Count U � > Heat Type and Fuel: ❑ Gas Oil ❑ Electric ❑ Other ' Central Air: ❑Yes 4 No Fireplaces: Existing New Existing w66d/coal stave: ❑des ❑ No c t Detached garage: ❑existing ❑ new size_Pool: ❑existing ❑ new size _ Barn ❑existing` neuu size_ t :Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 5 - �Y "Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes XNo If yes, site plan review# Current Use _�1 ��I e- `1 Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone NumberJ� Address ?10 'Va 1 G 1 _IUq(0tW Sr,A License #�I' '"6`I� 0 "�� le •i �2.� Home Improvement Contractor# 151 � Worker's Compensation # W y ALL CONSTRUCTION D BRIS RESULTING F OM THIS PROJECT WILL BE TAKEN TO \4 aA t SIGNATURE ��"°' DATE h _ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO.:..-:. .: ADDRESS - VILLAGE i OWNER DATE OF INSPECTION: — u,lFOUNDATIONx .,•;qQ 0.' a �LzO 2, FRAME y, -t.-INS-ULATIONP, I I FIREPLACE s ELECTRICAL: ROUGH _ FINAL T PLUMBING: ROUGH FINAL ROUGH, FINAL 11=INAL BU'I:LD.INGi qj 1311z { -z�;DATE CLO.SED.OUW, .. { ASSOCIATION PLAN NO. ' f i � The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations > 600 Washington Street `x- Boston MA 02111 www.mass.gokdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers' Applicant Information Please Print Legibly Name(Business/Organization/Individual): 8 f 5 I nC Address:IL* �,�,>� •��3 1 ��� &X V City/State/Zip: (11f . A4 A 02,6Z_ Phone #: 5D�"q2g -`(.o co 3 Are you an employer? Check the appropriate box_ Type of project(required):-, l. ,I am a employer with_ 4..❑ I am a general'contractor and 1 employees(full and/or part-time).* have hired the sub-contractors • 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.,.❑ Remodeling These sub-contractors have ship and have no employees . - 8: ❑ Demolition working forme in any.capacity. employees and have workers' 9.' ❑ Building addition [No workers' comp. insurance ' comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑'Electrical repairs or additions: 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions, myself. o workers' com right of exemption per MGL Y p . 121] Roof re airs insurance required.] t c. 152, §1(4),and we have no /w r - employees. [No workers' ]3. ] Other YCi11J 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. ( 1 t I Insurance Company Name:'v G� �� �., .(M l s• Policy#or Self-ins.Lic. #: %J -1 0 Expiration Date: i. 21, I Z Job Site Address City/State/Zip: Gr4w, . M 02D'-32— 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 forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby rtify under-the ins and p nait' of perjury that the information provided above is true and correct. Si nature:. — Date: 2 = - Phone#: 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#: I AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ....�' 07/06/2011 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: German)Insurance Agency PHONE FAX 908 Main Street c o 508 428-9194 Alc No: 508 428-3068 E-MAIL ADDRESS: Osterville,MA 02655 PRODUCER CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: SAFETY INS CO Scott Peacock Building&Remodelling,Inc. INsuRERB: P.O.Box 171 Osterville,MA 02655 INSURER c: INSURER D: National Union Fire Ins.Comp. 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. INSR I ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY) JMMIDDIYYYYJ LIMITS A GENERAL LIABILITY CP00001152 7/5/2011 7/5/2012 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY ' DAMAGE7URERTED PREMISES Ea occurrence $ CLAIMS-MADE OCCUR , MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: y PRODUCTS-COMP/OP AGG $ r POLICY PROJEC- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ 4UysRELLA LIAB HOCCUR EACH OCCURRENCE. $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ D WORKERS COMPENSATION - WC 5815464 6/22/2011 6/22/2012 WC STATU OTH- - AND EMPLOYERS'LIABILITY YIN T R L - E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ _ 100,000 OFFICER/MEMBER EXCLUDED? ❑.N/A - (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 } DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,ff more space is required) CERTIFICATE HOLDER CANCELLATION Scott Peacock Building&Remodeling,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Fax#"508-428-7625 ACCORDANCE WITH THE POLICY PROVISIONS. - ' - AUTHORIZED REPRESENTATIVE ©1988-2069 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) _ The ACORD name and logo are registered marks of ACORD L — Vlassacl;ilsetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 94500 JAMES S PEACOCK PO BOX 171 " OSTEVILLE, MA 02632 Expiration: 7/22/2012' ('oum�isiuiicr Tr#: 29233 " ✓le �arwireaoeu.eaCCLi a�,�Ccz.:reiufiueeLTd ` ' Office of Consumer Affairs&Bdsincss Regulation License or registration valid for individul use only ( HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration 151853 Type: Office of Consumer Affairs and Business Regulation - F Expiration 7/7/2012 Private Corporation 10,Park Plaza-Suite 5170 '~ Boston,MA 02116 SCOTT PEACOCK BOILDING&REMODELING INC JAMES PEACOCK 1046 MAIN STREETSUITE OSTERVILLE,MA 02655 „ Undersecretary Not valid without signature ;• g I : oF�r+e Teti , Town of Barnstable ' BARNSTABLE. 9� 6 9 ,0� Regulatory Services HIED�a�s Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us` Office: 508-862-4038 Fax: 508-790-6230 . Prop riY e Owner Must Complete and Sign This Section If Us in" A Builder ' as Owner of the subject property hereby autho L, h '� iq% o act on my behalf, . 3 in all matters relative to work authorized by this b • g permit application for. " (Address of b) 7. r` Signature of Owner Date • Print Name ;. QAWPFILES\FORMS\building permit fOrmS\EXPRESS.doc :+ Revise020108 f yz 9� _ ; z rd `oF1HE r � own of B arnstable BARNSTABLE ` Regulatory Services ices '.. Building Division plf0 MPy a 200 Main Street,Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Inspection Correction Notice Type of Inspection A c- Location/I U P/A G N o,. & Permit Number Owner Builder One notice to remain on job site, one notice on file in Building Department. The following items need correcting: W-F H-ArU-r_- C.0 m P 1-1 A l i H'AA)Q 1f 4T- L n 0 7--e—)T4 G s 7-;I•+ I TAZW—s G f D� AL-L_o wets r� f Please call: 508-862-403-8 for re-inspection. Inspected by k L- / I Date '1l10)I Y J 2. � T Town of Barnstable �Pe mit# Expires 6 month ron issue d!�_, Regulatory Services Fee + IARNSTABLE, + , Thomas F.Geiler,Director- Building Division r6k 3151iZA Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 Z-62 J Property Address i U ► I trk U.cLO I Residential Value of Work Minimum Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 6') ur S((iYl 4-hi I (,( n ITV 1 Contractor's Name Pe�a r cat �I � ��� �. Telephone Number, Home Improvement Contractor License#(if applicable) S� 3 Construction Supervisor's License#(if applicable) C. y�� .' ®PRESS PERMIT tWorkman's Compensation Insurance Check one: MAR 0 6 2012 ❑ I am a sole proprietor ❑ I am the Homeowner ��� have Worker's Compensation Insurance R.N�JtA P BA Insurance.Company Name Workman's Comp.Policy# ��eL Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over' existing layers of roof) Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows i *Where required: Issuance of this permit does not exempt compliance with other town department regulations,'i.e.Historic,Conservation,etc. ***Note:* Property Owner must sign Property Owner Letter of Permission. A`copy of the.Home I ovement Contractors License&Construction Supervisors License is re e SIGNATURE: / C:\Users\decollik\App to\Local\Microsoft\Windows\Temporary.IntemetFiles\Content.Outlook\QK1H7J6E\E)TRESS.doe Revised 070110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600`Washington Street Boston MA 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/.Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): VIC Address: suac City/State/Zip: 0�r Ul��, .A Phone#: ZY, q ' 7Ceca). Are you an employer? Check the appropriate box: Type of project(required): 1:N-1 I am a employer with 4. ❑ Lam a general contractor and [ . employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- -listed on the attached sheet. 7. ❑ Remodeling ship and have,no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9: ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work' officers have exercised their 11:❑ Plumbing repairs or additions myself. [No workers' comp: right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no � [ . l3.❑ Other 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: I Vl Vr/► a�f. >�1 `�'l/I'�. l�1 S �%(1' Policy#or Self-ins. Lic. #: Vy� (0� Expiration Date: 2Z Job Site Address:' Q I.I l t'A-�1 i'l ll Ci F'1'V�l = City/State/Zip: Attach-a copy of.the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of:up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here certify under the ins and penalties of perjury that the information provided above is true and correct. Si atur . c Date: Phone �`1 Zg • I UN) Official use only. 'Po.not write in this area,to be completed by city or town official. ' City or Town: Permit/License# Issuing Authority(circle one): L-Board of Health 2. Building Department 3. City/Town Clerk' 4. Electrical Inspector5. Plumbing Inspector Other Contact Person: Phone#: F SHE Tp� 4 µ Town of Barnstable " BARNSCABLE, MASS.9. Regulatory Services _ *� AIFo Thomas F.Geiler;Director Building Division , Thomas Perry,CBO ;. Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 r Fax: 508-790-6230 {,. . Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the sub'ect property. ` { c , � - f - hereby autho • �, l' '� ' �ic' 4L o act on my behalf,f ' in all matters relative to work authorized by this b • ,ing permit application for (Address of. b) . , 0 Signature of Owner i s Date f ,a - s usA N, JL Print'Name QA0r-'ILES\FORMS\building permit formS\EXPRESS.doc Revise020108` j 1 Aco" 07/06/06/2011 CERTIFICATE OF LIABILITY INSURANCE DATE Y) �'. 011 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: German)Insurance Agency ' - PHONE FAX 908 Main Street ruC No E • 508 428-9194 A/c No: 508 428 3068 E-MAIL ADDRESS: Osterville,MA 02655 PRODUCER CUSTOMER ID M INSURERS AFFORDING COVERAGE NAIC p INSURED ':" INSURERA: SAFETY INS CO - Scott Peacock Building&Remodelling, Inc. P.O.BOX 171 INSURER e Osterville,MA 02655 _ = INSURER C:. INSURER D: National Union Fire Ins.Comp. a .z 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MM/DD/YYYY A GENERAL LIABILITY CP00001152 7/5/2011 7/5/2012 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence $ CLAIMS-MADE a OCCUR MED EXP(Any one person) $ ` PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICYEI PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS - BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS A' r (Per accident) NON-OWNED AUTOS r 4 _ $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIARH CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $` RETENTION. $ _ - 1 - ' $ D WORKERS COMPENSATION WC 5815464 - 6,22/2011 6,22/2012 WCSTATU- I OEH' AND EMPLOYERS'LIABILITY Y/N. - ANY PROPRIETOR/PARTNER/EXECUTIVE .. $ l 00,000 OFFICER/MEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT` (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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER �' CANCELLATION Scott Peacock Building&Remodeling,Inc , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE _ THE EXPIRATION DATE'THEREOF, NOTICE WILL! BE DELIVERED IN Fax#"508-428-7625 + . ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE } ©1988-2009 ACORD CORPORATION. All rights reserved. "'ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD f Massachusetts-.Department of Public Safety . Board of Building Regulations and Standards LL , Construction Supervisor License , License: CS 94500 a A=x JAMES S PEACOCK PO BOX 171t OSTEVILLE, MA 02632 Expiration: 7/22/2012 ('unimi„iuncr Tr#: 29233 92. �arrviruyzu eaLC�i �Gl��� - Office of Consumer Affairs& Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: + = Registration 451853 Type: Office of Consumer Affairs and Business Regulation i Expiration: 717l2012 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 SC TT PEACOCK BUILDING-& REMODELING INC JAMES PEACOCK .1046 MAIN STREET`8UITE 7` OSTERVILLE,MA 02655 Undersecretary of valid without signature L. a 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel j� j� Application`# Health Division Date Issued c Conservation Division Application F Tax Collector Permit Fee Treasurer ���• Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 90 Ot AA- j� AM Village etia-y. Owner Addresses Wim,n ll-k Z �e Telephone Permit Request Vve-VAM, i 40 t W d e 4 IN top Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District 1��— Flood Plain Groundwater Overlay Project Valuation 0� Construction Type Lot Size 6,7d PC re, Grandfathered:•''❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family �d Two Family ❑ Multi-Family(#units) Age of Existing Structure .O Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: A 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 l I new First Floor Room Count Heat Type and Fuel: ❑Gas *Oil ❑ Electric ❑Other Central Air: ❑Yes 'X No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes M No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 14? Telephone Number L Off'I 1 0--&] Address ;! e- License# � Q C-Urcb��`' --�f`-� G-Z A Home Improvement Contractor# 'Worker's Compensation# czl� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Q 'A' MDak h r ? DATE SIGNATURE ' / C� K FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION t 56 0' (093)( 616T.44e, o FRAME 1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 5(rw3 t 4*,jr- s owir dil l I*- o DATE CLOSED OUT :; ASSOCIATION PLAN NO. ' I � ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _ d 600 Washington Street Boston,MA 02111' wltiw.mass.gov/dia Workers}Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEribly Name(Business/Organizationadividual):. cv`• •Address• \C1 -i� City/State/Zip: Ce n _ Phone.#: 0 - ' 4 Are you an employer?Check the appropriate bog: :Type of project(required):. 1 I am a employer with 4. [] I am a general contractor and I mPto Y 6. ❑New construction . employees(full and/or part time).*' have hired the sub-contractors2.❑ I am a'sole proprietor or partner- listed on the'attached sheet 7. ❑Remodeling ship and have no employees ' These sub-contractors have g, []Demolition '*orkin for me in an capacity. employee$and have workers' g Y P tY• $• - 9. ❑Building addition comp.insurance.t., e s comp.insurance p o work r , p 5. We are a corporation and its t 10.❑Electrical repairs or additions required.] '3.❑ I am a homeowner doing ill-work . officers have exercised their 11.[]Plumbing.repairs or additions ' myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance. required.]t c. 152, §1(4),and we have no employees. [No workers' 13 Other comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating'such. ' tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site' information. Insurance Company Name: > Policy#or Self-ins.Lic.#: Expiration Date: ' 4 lab Site Address: . J h/1 -2 �, C,31, &..A.. �li City/State/Zip: Attach a copy of the workers' compensation policy declaration page-(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 thq 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'doherebX certi&under the pains F-Fenidi e o ry that the information provided above is true and correct Signafore: Date: I _ Phone#: Official use only. Do not write in this area, to be completed by.city or town off ciaL City or Town: ' Termit/License# Issuing Authority(circle one): A.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6. Other Contact Person: Phone#: Town of Barnstable Geographic Information System February 12,2008 PGA��pD X1 15 72 X� 11.04 • t r X 13.53 .f r, X 1,. 85 Z X 12.44 X 17.74 X500 � pa and itCDORD 19 Feet X 6.83 DISCLAIMERS:This map is for planning purposes only. it Is not adequate for legal Map:226 Parcel:145 boundary determination or regulatory Interpretation. Enlargements beyond a scale of Owner:HYLAND,G ARTHUR JR Total Assessed Value:$1249900 Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:SUSAN B HYLAND Acreage:0.72 acres Abutters B' boundaries and do not represent accurate relationships to physical features on the map Location:10 MAGNOLIA AVENUE such as building locations. Buffer 'F!' �C� e � s sto Oltas oxfoxib CYC /q � I _ , -Timer 111UU AM 'lot W Cl ie nt#:9580 2KP RE' ACORD. CERTIFICATE OF LIABILITY INSURANCE 09/10/07 DlYYYYI PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS.UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyanough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: Associated Employers Insurance Compa Kenneth Perry D/B/A INSURER B: K.P. Remodeling&Construction INSURER c: 19 Guildford Road iNsulaER D Centerville, MA 02632 INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS'SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADO' - POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MIDDIYY E'DAT MM/DD/YY " GENERAL LIABILITY EACHO,CCURRENCE $ DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY .- PREMISES occurrence) CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMPIOP AGG $ POLICY PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident), - ALLOWNEDAUTOS - BODILY INJURY $ SCHEDULED AUTOS (Per person) HIREDJAUTOS A - BODILY INJURY- $ NON-6WNED*AUTOS - (Per accident) PROPERTY DAMAGE - $ (Par accident)" I GARAGE LIABILITY:: AUTO ONLY-EA ACCIDENT $ ANY AUTO _ _ - OTHERTHAN EA ACC $ " AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY(, - EACH OCCURRENCE $ OCCUR GEI CLAIMS MADE AGGREGATE . $ t - $ DEDUCTIBL6�� $ RETENTION $ • $ A WORKERS COMPENSATION AND WCC500545001,2007 06/13/07 06/13108 X WC STATU- OFIL TH- EMPLOYERS'LIABILITY - - E.L.EACH ACCIDENT $100 000 ANY PROPRIETORIPARTNER/EXECUTIVE t OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100 000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $5OO O00 OTHER - - - ADDED BY ENDORSEMENT/SPECIAL PRO VISIONS DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS **Workers Comp Information** Voluntary Compensation Massachusetts Limits of Liability Endorsement Form#WC200301 Edt Date: 04/01/84 (.See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable Bldg Div. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVORTO MAIL In DAYS WRITTEN Attn:Tom Perry, Commissioner NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 200 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis, MA 02601 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) 1 of 3 #49038 JMH © ACORD CORPORATION 1988 f . -- '�' ✓lie •t�arrr�io�ruoealCfi a� �ude�4 Board of Building Regulations and Standards s j Construction Supervisor or License License CS 76820 { Birthdate� 8/,28/1965 , Expirraation 8/28t2009 Tr# 2373 -3t Fu I _ /Restriction UOt � N 1 KENNETH O PERRY 1f 19 GU FORD ROAD`S CENTERVILLE,MA 02632'} Commissioner I Board of Building Regulations and Standards >7 HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use'Oil ly Registration n before the expiration date. If found re• :13228 turn.[ 2 Board of Building Regulations and Standards f Ezpiration 12/21/2008 Tr# 124628 One Ashburton Place Rm 1301 f1r J Type::DBA; Boston,Ma.02108 !' K.P,REMODELING . ' I I+ _ KENNETH;PERRY� 1 ,19 GUILDFORD RD.X,� Centerville,MA 62632 - Administrator Not valid witi, t - -- e e r s Q V A 3 r Let ON ob C or CA--t- � x NZ 4 ` .` I Town of Barnstable Regulatory Services a WMM LM ` Thomas F.Geiler,Director Mass. 6. A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790.6230 Property Owner Must , Complete and Sign This Section If Using A Builder L, I 1 R 7 . �L � ,as Owner of the subject"property hereby authorize`Y P 1 ' 1OPEL1&)(I C �L S. T00 to act on my behalf, . in all matters.relative to work authorized by this building permit application for: Av-6Z A4 vim, Signature of Owner Oate r � Print Name If Prolerty Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Ma r. 5. 2008 8:40AM No. 6533, P. 2 t "P , �.. a. irown, of Barnstable *rertnit# oI (�12 AIA kxpir6�4 morxths from Issue date TOWS 2008 Regulatory Services � 7� �F�qR Thomas IF,Geiler,Director NSTABL,j� ' ]Building Division cal -5/7/0 g-e Tom Perry,C790, Building Comtnissioner 200 Main Srrect,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 FaIx: 508-790-6230 EXPRESS PEItMT APPLICATION - RESI]DENTiAL ONLY Not Valid without Red X press Imprint Map/parcel Number e9s 6 7-6 Property Addressi &esidential 'Value of Work Q 10 t/-) Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address ' a Contractor's Name . a a arc, Telephone Number•54 Home Improvement Contractor License#(if applicable) E - Construction Supervisor's License#(if applicable) If.71- (o (p [ 'orlonan's Compensation Insurance Checl one: ❑ I am a sole proprietor d I am the Homeowner 04 have Worker's Compensation Insurance Insurance Company Name workman's Comp.policy# t�' J p L..3 5 cS en Copy of Insurance Compliance Certificate must be on file. Pwnr t Request(check box) :woof(stripping old shingles) All construction debris will be taken to aN -o-, 7 C,t�k ❑Re-roof(not stripping, Going over existing layers of roof) Ito-side [J Replacement Windows/doors/sliders. U-Value (maximum.44) '"Where regt,ired: Issuance of this permit does not ettcmpt compliance with other town dcparlmcnt regulations,i.e,historic,Conservation,ere, Property Owner nrast sign Property Owner.Letter of Permission. A copy of the Home Improvement Contractors Liomse is requircd SIGNATURE: Q:Fon=:c)4pmtrg Revisc061306 - I Ma r, 5. 2008 8:40AM - No. 6533 P. 3 The Commonwealth of Masgachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston, MA 02111 www.nmssgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/individual): r—KF SS F V, t'-6/0 LCLC ( (0 /LJ Address: 2 26Y / �, Lj-s City/State/Zip: -� / 'll� �o�o . Phone #: v�� — yo� _o�a�g Are you an employer? Check the appropriate box: Type of project(required): 1.M am a emptoyer with� � 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).' have hired the sub-contractors ❑ 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.. ❑Remodeling ship and have no employees These sub-contractors have g_ [] Demolition workingfor me in an capacity. employees and have workers' y � tY comp.insurance.x ° 9• ❑ Building addition [No workers' comp.insurance p' 10. required.] 5. We are a corporation and its ❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.[I Plumbing repairs or additions right of exemption per MGL myself [No workers comp. right repairs , insurance required.] t c. 152, §1(4), and we have no employees. [No workers' l3. Other comp. insurance required.] 'My applicant that chocks 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, tContractors that check this box must attached an additional sheet showing the name of the sub-oontractors and state whether or not those entities have employees. if the sub-conxtractors 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. '' In Insurance Company Name: =Ea 7 �^P D g- Policy#or Self-ins_Lie.#: �,� j Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up.to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby earl er the aims and ties of perjury that the information provided above is true and correct Si nature. - Date: S Of)kkd use.only. Do not write In this area, to be completed by city or town ofciad City or Town: Permit/License.# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: - 4 0 z ®� zell _ ®eta A3•hRuU�� ��Od�,Q �� �� jMo l � �c ds . o Boston. � ROOM 1301 r awe � 0 � 2 tratio G O 7Yve: pS C®Tl.D17'X 1,846 ��ra�arL 3�231�Do� MA 02635 12792o • . aaaca, ,� �� _ update d return HOJMiE ,- ruts "W,clo � �t Q cardi? g od• � beftm�� for date � �T� 127820 � dl�g if fte QD�' �e 'alsifn,�$ CbTUtr.MA B35' sia 00 It Lx_; _ Ma r. 5. 2008 8:40AM No. 6533 P. 6 1 l . d POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards, Plywood Sheathing or Other Carpentry Needing Replacement will be Bone and charged for As an Extra at the Rate of S50.00 per Dour Plus Materials Plus 201/0 Overhead Mark-up on The Total Extras. Any alteration or deviation from above specifications will be executed only upon written orders and will become an extra charge over and above the estimate.All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado, and other necessary insurance upon the above work. FRASER CONSTRUCTION carries Workman's Compensation and Public Liability.Insurance on the above work, certificate_ available upon request. This proposal may be withdrawn by us if not accepted within thirty days. DATE OF ACCEPTANCE: � HOMEOWAR FRASER CON UCT N, LLC Ma r. 5. 2008 8:40AM No. 6533 P. 1 WISE & OUI THIS PlI CERTIFICATE ($ ISSUED A8 A Ary�q t0�15-0~7 ' QUINN INS AGCV ONLY AND CONFERS MO RIGHTS UPON THEICF R77FICATE '^ 449 PLEASANT ST HOLDER. THIS CERTIFICATE DOES NOT AMEND ALTER THE COVERAGE AFFORDED BY THI=pOWCIEa BELOW. OR BROCKTON 2 W MA 02301 COMPANY COMPANIES AFFORDING COVEfiACM • INSURED A AR Mom 11kift—.1 TE I Y ERASER CbNSTRUCTION LLC COMPANY CE Co p Po BOX 1845 e COTUIT MA 02635 COMPANY C COMPANY 9. - R N R, <• u THIS IS O .. s r T CERTIF Y THAT THE POLICIES Of INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED INDICATED, NOTWITHSTANDING ANY REQUIREMENT' TERM OR CONDITION <s EXCLUSIONSCATE MAY 9E ISSUED OR MAy pERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN Is SUBJECT TO ALL THE EXCLUSIONS AND CONDRIONS OF SUCH pOLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED CONTgy pAID IMF TOR OTHER DOCUMEPERIOD NT WITH RE pE TETO WHICH THIS TR TERMS, LTr9 TYPE OF IN9URANce POLICY NUMBER POLICY EFP EC"VE POLICY EIIPIRATIO GENERAL LIABIlJ,ry: DATE(MEg1DD1Y11) DA-11(MIM DM" - uwm COMMERCIAL GENERAL LIABILITY GENERAL"AGGREGATE CLAIMS MADE[D OCCUR, PRODUCTS-COMP/OP A(IG. OWNER'S A OO NTRACTOR'9 PRD7: PERSONAL A AOy,INJURY 4; i FACH OOOURRENOE $ FIRE DAMAGE(Arty ane FlroI AUTOIAODU.E LIABIUTY MED.EXPENSE(Any one pereoly g ANY AUTO ALL OWNED AUTOS COMBINED SINGLELIMIT E SCHEDULED AUTOS DODILY INJURY HIRED AUTOS (Par Pelson) 6 NON-OWNED AUToB BODILY INJURY (ParAuuIdenV a GARAGE LIABILITY PROPERTY DAMAGE A ANY AUTO AUTO ONLY-EA ACCIDENT & OTHER THAN AUTO ONLY: EACH ACCIDENT bXCES6 LIA�UTY AGGREGATE 6 UMBRELLA FORM EACH OCCURRENCE OTHER THAN UMSREL(A FORM- AO(IREOATE S A WCAKER'S COMPENSATION AND F-NIPLOyEWS LIARILI hr (6560UB�0850L35^5-07 THEPRoPRIEroFV 09-26-07 09-26-08 'W'ATUTORYUWFS PARTWERBMECUTNE INCL EACH ACCIDENT oFFTOERBARE X EXCL DRTEASE-POLICYLIMIT 011tEA S DI6EA8E-EACH EMPLOYEE ® 5 i )ESCRIPTION oP oPERAT)ON - !�/IOCATYON@/VENICLES/R69TRIcnOP16/SP$CLAL ITE19s 4 THIS REPLACES AM' PRII]R CERTIFICATE ISSUEb TD THE CERTIFICATE HDLD COVERAGE, . SNOUTA ANY OF THE ABOVE DESCRI®� POLICIES BE,CANep�p� t� L3�IAATIOR DATA TN�TEOP, THE ISSUING COMP/UryYALL ENLIEgV�OR TO MAIL ERASER ENTERPRISES LL C 10 DAYS WRITTEN NOTICE Ib TIIEc PO BOX 1845 LEFY, NUT FANURE ERTIFICATEI/OLDEA llplaa To ME I�OTUIT TO atI suck NOTICE SMALL IMPoBE NO OBLICdNTION oR RNA 02635 LIABILITY OP ANIV Vjt#D UPON IN,!CONFANY,ITS AGENTS OR REPAESL NPATIVES. I AUTe40Rl7en RL'P6tlC91ENTAT) — aAls.r Y - ,.a iyl:oi .' b x.. 'rb�;.".f`N .1•N :3??o'ii7iiY:?'.'l.,dS:R?6�'.`3i7'„.4ZiidWaY.:.. .r..................... 1 �OFIKE roh1� Town of Barnstable *Permit# ,4 0� Expires 6 months from issue date y7 Regulatory Services Fee w + � BARNSfABLFw • 9� MAM s63 9. ' Thomas F.Geiler Director �0 p'EDN'0�� Building Division Tom Perry, Building Commissioner X-PRESS PERMIT 200 Main Street, Hyannis,MA 02601 OCT 3 0 2003 Office: 508-862-4038 Fax: 508-790-6230 g11STABLE EXPRESS PERMIT APPLICATION - RESIDERM HN,Y Not Valid without Red%Press Imprint Map/parcel Number Property Address n1 I J N (Residential Value of Work Owner's Name&Address Contractor's Name ®�M �✓�-U'�-�' Telephone Number- Home Improvement Contractor License#(if applicable) I S Construction Supervisor's License#(if applicable) ®Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner LO I have Worker's Compensation Insurance Insurance Company Name Workmen's Comp.Policy# x 6 Permit Request(check box) W Re-roof(stripping g.old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) a ❑ Re-side _ ❑'Replacement Windows. U-Value (maximum.44) *Where required Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc._ r ***Note: operty Owne sign Property Owner Letter of Permission H eme Contractors License is required. Signiture f Q:Forms:expmtrg Revise053003 Fraser Construction Roofing & Siding Specialists TOTAL INVESTMENT HATTERAS AR-40/EPDM - $10,l Ob.00 Payable Immediately upon Completion y' NO MONEY DOWN- NO Payment at the start or part way thru Payments accepted are: CASH - CHECK- MASTERCARD -VISA -AMERICAN EXPRESS Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as a n extra at the rate of$40.00 per hour, plus materials,plus 20% overhead mark-up on total extras. Proper ventilation panels, $4.00 each, if needed. FRASER CONSTRUCTION Warranties the shingles and labor for 10 years. FRASER CONSTRUCTION Warranties the shingles against B1ow0Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100%for the first 10 years, and then on a pro rated basis for 40 years total if the shingles become defective. y CERTAINTEED Warranties the shingles to be ALGAE Resistant for a full 10 years. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Workman's Compensation and Public Liability Insurance on the above work. Date of Acceptance: Submitted By: Home Wner a ruct'iora &""xvwwea1M1' Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston.-Mast sal usetts 02108 .� v,� Home ImprovemenkWhtractor Registration - Registration: 112536 c t Type: DBA 'f _ Expiration: 3/23/2005 FRASER CONSTRUCTION co DEAN FRASER {�`; r = �= 71 TARRAGON CI R r r tx,F At COTUIT, MA 02635 ti/. Update Address and return card.Mark reason for change. (� Address Cj Renewal ❑ Employment Lost Card ✓fie �amznzoowsea� a��,cwaac�ivaeCla 19Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Regisl:41 ton` 142536 Board of Building Regulations and Standards r = One A,�hburton Place Rm 1301 TE cpiratton 3l23/2005 } Boston,Ma.02108 p',O S'BA^ k �f= FRASER CONSTRijCTIONco DEAN FRASER 71 TARRAGON CIR � �,,� COTUIT,MA 02635 Administrator Not valid without signature �FVET Town of Barnstable *Permit# LS C Expires 6►months from issue date N Regulatory Services Fee izrt d BASrABLL v MASS. Thomas F.Geiler,Director �'ATf1639. p X-PRESS PERMIT . Building Division Peter F.DiMatteo, Building Commissioner AUG 2 0 2001 367 Main Street, Hyannis,MA 02601w Office: 508-862=4038 TOWN OF BARNSTABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 99 rr Not Valid without Red X-Press Imprint Map/parcel Number Property Address 10 cz. of n o r^�t rl V Residential Value of Work 000 - __� Owner's Name&Address R rtj1,r a,,,rL S c,e� I.d —rIuctn�ti-t /Tt/e- 1 . O 'JV Jt �� � h/ l?tia..��cUcr!► Contractor's Name c�cX�c� pt�Skzj�� 40 r,►,L,2 c,TelephoneNumber�5��� Home Improvement Contractor License#(if applicable) f O J Construction Supervisor's License#(if applicable) C i C!rWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name L e 1, .� S u ro-,�c-� C a ►1 4 Workman's Comp.Policy# ki C 6 " ! oZ / ) x 0 Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maxjimum.44) j Other s eci e I- a,Ct ctiSS l tc��: �'c { e -3� *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.. Signature Q:Forms:expmtrg:rev-070601 mn eeng Dept(3 rrrd floor) Map.: 02 b Parcel Permit# 73 5,CQ 6 4'— House# I Date Issued tBoard of Health(3rd floor)-(8:15 -9:30/1:00-4:30) Fee - Y -9 �p Conservation Office.(4th%floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) 0{111E Definitive Plan Approved by Planning Board 19 - - BARNSTABLE. ` MASS �rFD MAC� TOWN OF BARNSTABLE Building Permit Application Project Street Address 10 M f Village �.��,Q C YI o r'�' ►-l a Owner G. A, 4 y/a 1' S r Address f 0 Q o,c�o l.`w �,✓ �� h[�r7 d nt Telephone T 7 7 l —•S Permit Request rep jg ee.. w '.\A C;w S First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ - ( S-QG o Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family p/ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: EfFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing Dl- New Half: Existing 1 New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count s Heat Type and Fuel: Utias ❑Oil ❑Electric ❑Other Central Air ❑Yes Ejflo Fireplaces: Existing ( New Existing wood/coal stove ❑Yes UkNo 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 Builder Information Name Q;Gl^a�r�pl. A-ct 57, Telephone Number Address �.�' f v,rA-S A e. License#_(�O O C, 0 S Home Improvement Contractor# t 0 IS-:5-1 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 w ram. SIGNATURE DATE 5-1t!VfJJ1 BUILDING PERMIT DENIED FORTH 0 LOWING REASON �.�,. , ; 1 f ,. FOR OFFICIAL USE ONLY ~' PERtMIT NO. ' D;\TE ISSUED p MAP/PARCEL NO. ' ADDRESS VILLAGE ' 'OWNER DATE OF-INSPECTION: FOUNDATION FRAME , • INSULATION FIREPLACE - ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL , f GAS: ROUGH FINAL _ FINAL BUILDING - r DATE CLOSED OUT ASSOCIATION PLAN NO. r F The Town of Barnstable '� ,e$ Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossrn Fax: 508-790-6230 Building Commissior For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL a 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. T e of Work: lr�h� L- r t.Cost 6 YP � Address of Work: r Owner's Name Date of Permit Application:_ I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. 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 EMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL G 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date Contractor Name Registration No. OR TOWN-OF BARNSTABLE BUILDING PERMIT•APPLICATION `f r� Map .� P rcel Permit# Health Division sDate Issued /�- /cl~" 9 f TIM Conservation Division Fee Tax Collecto ' ,� SEPTIC SYSTEM M ,DST BfE Treasure �1 ' Flk INSTALLE®IN COMIPLIANCE MtH TITLE 5 t Planning Dept. E4Q�I �t PM 'TtiL CAE AND Date Definitive Plan Approved by Planning Board W4� Historic-OKH ' Preservation/Hyannis k Project Street Address t-0 14 102 �4 • Village garb 'Owner d U_r'a Address M h:c f'�,q A V'�. Telephone (SOS) 771 r Is- y k Permit Request T e r- 5 i rIQ Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost 9, o o 0. Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family ;Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes WIN o On Old King's Highway: ❑Yes 2(No Basement Type: dFull ❑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 3 Heat Type and Fuel: M Gas ❑Oil O Electric ❑Other Central Air: ❑Yes U'No Fireplaces: Existing i New Existing wood/coal stove:. ❑Yes dNo 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 El Appeal# Recorded❑ All , Commercial -❑Yes ❑No If yes, site plan review# , Current Use Proposed Use- BUILDER INFORMATION Name -C_/n a r av-_n r i- Telephone Number 7 7% 5).S-3 Address :� dart S o�_e_ License# 0 0 •�o (n% Zn :c _ M (N 0.1 P„o l Home Improvement Contractor# t 0 S S;,.1 . Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO T o � o SIGNATURE DATE FOR OFFICIAL USE ONLY • . .. _- PERMIT NO. DATE ISSUED _ MAP/PARCEL'NO. s ADDRESS i VILLAGE ` ate` ,,,... 1 �g r '•-,r _ ' 1, • .,i `' i ,t, { 6Y" •;� _ . i •I ., t' i • � Y 4 � > e. OWNER'.) DATE OF INSPECTIONc FOUNDATION * F 1 FRAME INSULATION FIREPLACE k ' ELECTRICAL: ROUGH - - FINAL PLUMBING: ROUGH} FINAL GAS: ROUGH i f : FINAL}} s , FINAL BUILDING T DATE CLOSED,OUT # ASSOCIATION PLAN NO. f The Town of Barnstable 9 &659. Department of Health Safety and Environmental Services. Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair;modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied- building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: ire—s ,c J e L.,a- Estimated Cost � 6 0 d, Address of Work: {tt/4!�— �✓. f� „� .-�.,;s o o r�t Owner's Name: G. A,.4-1. L4 y I cv,.,,( . 'T,-. Date of Application: it t i 6 I I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav Assessor's map and lot number ............. . cF THE to a ,Sewage Permit number .......�' .-..t`.�... .l.:. _�.... d� y� Z B9BBSTAIBLE, i ' House number ,4', ' r M0. & a.......................................... �p 1639. \00 D MAY A' TOWN , OF BARNSTABLE BUILDING INSPECTOR �3ur 6x APPLICATION FOR PERMIT TO .............. ....... ....... .. N.. ........................................... TYPE OF CONSTRUCTION --5�(JL .....�-�.!�!L13 ................. ........... ............2.......19--45.6 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby ,appplies for a permit according�lto the following information: Location .....�.�.10{`lN�, �,�T.... Uc ...........4N.�..J�a�l / /� 6/. .r ........ ................................... ProposedUse ............................................................................................................................................................................. ZoningDistrict /.......................................................................Fire District .......................................................................... Name of Owner ./ ....�i�l` 1............Address . :..... t... .: ... Name of Builder ...1... !!!. 7..5....=,yrr:��12< .........Address cna.j.�.� Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation ............................:............. Exterior ...... .............................................................................Roofing ............................... Floors ."""""" .....Interior ..................................:............................................... .................................................................................... Heating ......::....Plumbing ........ ............................................. ` . "`.... ...................... ... Fireplace ...................Approximate. Cost ..l�.... soo .............................................................. ....... Definitive Plan Approved by Planning Board ________________________________19________. Area k P S il` Diagram of Lot and Building with Dimensions Fee ..............1.. .. ""77" , SUBJECT TO APPROVAL OF BOARD OF HEALTH v 30 OCCUPANCY PERMITS R QUIRED FOR NEW DWELLINGS f � I hereby agree to conf, rm to all the Rules and Regulations'of the Town of Bar le r garding the above construction. Name ...... .r...._............... ............. .. ........................ Construction Supervisor's Licens .........Io. ' -y�, HYLAND, G. ARTHUR JR. A=226-145 No ...2962$... Permit for ...Build Deck Single Family...Dwelling..................... Location ......1,0,•Magnolia••Ayenue••.. ......••• i I ^az�r.�M. M,a r�r icss + ... ......... r--.t..................... Owner G. Arthur Hyland, Jr•...••...• Type of Construction ..........Frame,.,•,,,,,,,,,,,,,,,•. . ................................................................................ Plot ............................. Lot ................................ Permit Granted July 10, 19 86 Date of Inspection ....................................19 ' i` Date Completed ......................................19 97 , 1 J 1 A - SEPTIC SYSTEM DAUST 1 CE ssessor's map and lot number a�....,�17� .............. INSTALLED IN COO WITH TITLE 5 Quo f t Sewage Permit number ......... . ..:-.1.�... .i. ENVIROMMENTeA�Lee COD .................. .. Fk 9.��........ B9flH9T1►DLE, i House number � lR9 -r 90 rasa Qefs O s63q.�0 YAY a.- TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... 6x TYPE OF CONSTRUCTION ............:.. � ` ..f'7Z9- ... .?yl .......................... ........... .. ............2.......19..& TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....t.6./4&A)04,4....✓.441.6............a....f.. 7 ............................................... ProposedUse ................... . ....................... '. ...................................................................... . ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owne,6,,* cl .... l�?�� .............Address .. E - lr l� ...... Name of Builder .. ....C.. '�rJ� 2�.........Address .e..�.. Nameof Architect .........Address :.............................:......................:.................................. ..................................................... Numberof Rooms ..................................................................Foundation ........................................ Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing ....................... .......................y•••......................... Fireplace .................................................................... .............Approximate Cost .......... ................................... Definitive Plan Approved by Planning Board ________________________________19________ . Area ...........S..........'.......... do Diagram of Lot and Building with Dimensions Fee -� SUBJECT TO APPROVAL OF BO `RD OF HEALTH 60 v Dg-r— µpvsE 30 1 OCCUPANCY PERMI S R QUIRED FOR NEW DWELLINGS I hereby agree to Ionform to all the Rules and Regulations of the Town of4Licenoq.7�' Bove construction. Name ..... . ................ Construction Super �f. HYLAND, G. ARTHUR JR.- _ 29§2. . Permit for ..wild `;.'ck Single Family Dwelling ................... Location ....10..Magnolia Avenue• ............. . ................. 1 e �._.. i+ rrr 1 � ............•.....7P..........J............ .�.............................. Owner G.........Arthur. ...Hy1a .r Jr.......__ ... . ...... .. Type of Construction Frame ............................................................................... k i Plot ....................... ; ..... Lot ................................ Permit Granted ..........1u1.y...10..................19 B6 i w Date of Inspection .........:...............`........19 " Date Completed ......................................19 -17 • r .. t 5 e a � , t •