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0167 MAIN STREET (CENT.)
y11 to xS ,. , t tai•, �r vyn t,,, t '�' �'Qazx }d �i v �rR t •4Y 41 ML Ill's 7+" _' �.-,: a1C..{'�is�. F.E d� t .( d r M?• ' . (,' .1° a_:... ,rr•".. M Y�.+ �..t,r a .h a H ',;.h 7 � _ i �4Ki�kr 1 :., _ .. ,. ,° .m „ r , a n A u n o � o r ° , x ° : a,. ° o - .: x a a v s ° e , „ ° ° ° ° ° a ° , , ° e . � �, r.• vo° ,, a a a p w ro . n c ° , a e " ° ^ a d e C = e ° ° •. ^ u s' a. .. _ .q .'. � k'^ � w .. vy a c, ° P TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V Parcel Application # �p Health Division Date Issued Conservation Division Application Fee _ Planning Dept. Permit Fee si Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 1 (n 6 M 4 i o S Village Ce.v Owner e lam►. Q e kA," Address Aa P&kA w 1 Telephone Permit Request rIZ P A.0 J P 6 10 L LZ d ' DC Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size� Grandfathered: ❑Yes C No If yes, attach supporting documentation. Dwelling Type: Single Family a' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes L1<6 Basement Type: 1/ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) (J Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z new Half: existing new Number of Bedrooms: ,3 existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: a'Gas ❑ Oil ❑ Electric ❑ Other Central Air: )k Yes C�No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: 'existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: c:7 x Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# � Current Use R-e 5 jn tiT 4- Proposed Use �.a APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /Vl l �\,k Telephone Number Address V3 7 N �v,u Q�1 ) 1 e.�e License # A z 6 (o Home Improvement Contractor# Email AA 1\{ jLeAj Z k CG-tis r V C] /a 6orker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _ V fl1Lz 0 U 1 h SIGNATURE DATE 4 i y � FOR OFFICIAL USE ONLY APPLICATION# a DATE ISSUED MAR/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable Regulatory Services Richard V.Scab,Director �► Buffding Division Tom Perry,Building CommL%joner 200 Main Street Hyannis,MA 02601 www.town.barnstablema_us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Us ing A Builder I, I G T'1t�j�✓ ,as Owner of the subject property- herebyauth i oze—d d► to act on my behalf, in all matters relative to work authorized bythis building permit application for. (Address of Job) "Pool fences and Auii s: are the respons bil 7of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted.owne ; Sr ture of rant" VPN e 3 t �?-r . Isnnt Name Date . QF0P1a.0 WNERPERMISSIONP00L4 LOT 1 �L o . ! i •HSEiii / DO LOT 2' �9 13� w1 AAAAAd, Charles J. MeyerISTC��J y`�,,v Richard A. & L C. # 22082 s��°HEra r s Judith L. Knowles o 4 " WILE i VT FLOOD PANEL- 250001_0006 D FLOOD ZONE- C___ DATER 712192 I hereby certify that this mortgage inspection plan was prepared for.- Plan is For PLYMOUTH SAVINGS BANK Bank Use only The location of the building shown does NOT fall within a special flood hazard zone. PLAN REF. Per taped inspection it appears the location of dwelling does - conform to the local by laws in effect at the time of construction with respect to horizontal dimensional setback requirements Scale 1 = __0Q—'__ +T or is exempt from violation enforcement action under Mass general Laws Ch. 40A -Sea 7 Date.• 4L12104 PLEASE NOM The structures on this inspection were located by tape not instrument and are approximate only. An actual survey is necessary for a precise determination of the building location and encroachments, if any exist either way acre= property lines This inspection must not be used for recording purposes or for use in preparing deed descriptions and must not be used for variance or building plan purposes This inspection must not be used to locate property lines Verification of building locations, property line dimensions, fences or lot configuration can only be accomplished by an accurate instrument survey which may reflect different information than what is shown hereon This inspection is not to be used for any purposes other than mortgage. Yankee Survey accepts no responsibility for damages resulting from said reliance. PHONY 508-428-0055 YANKE1 E/ SURVEY CONSUT T 4NTS FAX 508-420-5553. UNIT 1, 40 INDUSTRY RD, MARSTONS MILLS, MA 02648 36532 RJB 77ze C'ommornvealth of1Vassachusetts Departarzezzt cz,f lirdushial Accidents ems-- O-ce of—hn' esfigatIons 600 Washuzgton Street Baston,I-MA 02111 tl!!{rl1:i mass.ggovIdifl Workers' Campensatian Insurance Affidavit.ButldersiContractursJElectricians/Plumbers Applicant IufGx-ma.t an Please Print Legibly Namo(Business'�OrganizationFL� Anal} /(/l 1 IL( {•✓2. l l� h y c7z y.� Address-�2 I H r�v�PTJ ($�y 4 Clfyl� 3tt'1 Sp= ..✓ S ( Phone< Are you an employer?Check the appropriate box: Type of project(required),:' 1.❑ I am a employer with 4 ❑I am a general contractor and I employees(full andlorpnrt-time). * have hired.the sub-contractors 6- ❑Near construction 2:k2f.am a sole proprietor arparfner- Tisted on the attached sheet. 'I- ❑Remodeling These sub-ccatractars have ship and h-we no emplayees. $. ❑Demolition world for me in any capacity- employees andhave workers' g ❑Building addition [No�uorbers'camp.insurance comp.insurant�t required] 5. ❑ We.are a corporation and its 10-❑Electrical repairs or addition 3.❑ I am a homeoumer doing all work officers have esercised their 11-❑Plumbing repairs or additions myself[No.eorkiers' - fight of exemption per MGL 12.❑Roof repairs c.152 e no imctrranre required..]-1empto §1(4),andwe have o wor.km I13-0 Other D r (,�- comp-insurance required-) 4An.y W1icantthatchecksbox 91 mast also fill out the sectioa.below showing die&wo;kes'compensalian Policy inforouien- #Homeowners who submit¢his af5dacru m&cxt mg they are"doing s11'wat anfl then hire outside contractors nmst submit anew affidavit indicating such- Ic'ontracturs that rhxY this boa must attached an additianat sheet shovdng the nurse of the sub-coatczcto-a and state whether.or not Those enfitieshavp- employees.If the have employees,they=urpmtade their wurken'-comp.polio'number. I am an erripL4vr tleatispr4nidirzg workers'congwcsrrgaii uzstirazzcefor my enrplaj.ees ffetojv it 6i#paltry and joh srtcr it formation Insurance Company iNrame: Policy,41'or-Self--ins.Lic.9: Rkpiratiou Date: Job Site Address: City/Statel .- Attach a copy of the workers'compensation policy declaration page(showing the policy number andexpiration date). Failure to secure coverage as required.under Section 25A of MGL c 15-7 c-aa lead to the imposition of criminal penalties of a fine up to$1,50D 00 and/or one-year itnprisonmmt as we11 as civil penalties.in the farm of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement maybe forwarded to t1m Office of h ;estigatiom of the DLA for iusurmee coverage verification. I do here-by certzfi,under thapauis rued penalties ofgelury that the uzfartvra6n prin-v'W abmv ig true and correct Signature: C c Bate: Phone 0joicial&w only. Do not write in this area,to be cornpietced by city artown official City or Tom'n: Pernriff Sense if Iss.IIing Authority(circle one): 1.Board of Health 2.Buff ing Department 3.City1rown Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Mane it: Lnformation and Instructions , hfa ssarhusctts Gezezal Laws chapter 152 req imz all employem to provide worker'compensation for their employees. parMjzntm this ,an eng7[L yee is defined as."-.every pers61L in the service of another under auy corfract of hire, express or implied,oral or writinn.." An e7np[z yer is defined as"an individual,partnesbip,association,corporation or other legal entity,or any two or more of the foregoing engaged m a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,pmtamsbip,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 occapant of the - dwelling house of another who employs persons to do mafilfim nce,construction or repay work on such dwelling house or oa the grounds or building appuntenaatthemtn shall not because ofsach employment be deemed to be an employer." MGL chapter 152,§25C(6�also states tlizt'everysf2te or local licensing agency shall withhold the issuance or renewal of a Neese or permit to operate a business or to construct burZdings in the counmonwe-alth for any applicant who has not produced.acceptable evidence of compliance with the insurance_coverage requited." ub ions shall either the commonwealth nor of its political s divusi . 152 25 st',if'PS aN �y Additionally,MCrL chapter > § C(7) _ enter min any contract for the performance ofpnbhc woiic u atil acceptable evidence,of compliance with the in�c8 requurements of this chapter have been presented to the contracting authority_" Applicants Please El.oit the workers' compensation affidavit completely,by checiciag�e boxes that apply to your situation and,if, necessary,supply sob-contractors)name(S), addresses)and phone numhber(s) along with their cc-rtcEcate(s)of insurance. Limited Liability Companies(LLC)or Limited Li.abflity Partnerships(LLP)wino employees other than tht members or partners,ate not required to caizy workers' compensation fiim=ce- If an LLC or LLP does hate employees,a policy is r-,quir . B e advised that this affidayitmay be subm th--d to the Department of Industrial Accidents for confnmation of insmmmce cove h rage. Also be sure to sign and date;the afIIdavi- The affidavit should be retrmmed to the city or town that the application for the permit or license is being requested,not the Departmem of Tn Ly trig Accidents. Should you have any questions regarding the law or if you are rr qu td to obtain a workers' compensation policy,please call the.Dep tnent at the nummber listed below. pelf-insrued companies should enter tbeir self-in� c,6 license n=ber on the appropriate Ime. City or Town Officials f _ Please be sure that the affidavit is completB and pried legibly_ The Department has provided a.space at the bottom of the affidavit for you to till out in the event the;Office of Investigations has to contact you regarding the applicant Please be sure to fill is the pm iit/license number which will be used as a reference number. In addition, an applicant that must submit murtiiple pmnit/license,applications in any given year,need only submit one affidavit indicaiithg current submit policy, inrbrination(if necessary)and under"Job Site_address"the applicant should write"al]locatiLns n (�'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 f[tnre permit's or licenses_ A new affidavit must be ti1]ed oit each business or commercial venire eo es or citizen is obtaining a license or ermit not related to any busm year.Where a hour wn tag P (i e_ a dog license or permit to bum leaves etc-)said person is NOT regahied to complete this affidavit The Office of Investigations would like to thank you m advance for your cooperation and should you.have,any questions, please do not hesitate to give us a call The Department's address,telephone and fax number_ -Ul �a> n t of Massach�fts . I�ega�n�nt c�xud�zzal Acckde�ts ,., � `• �, ; ;, - Bostou�MA(2111 T(-,L 4 617 7-4.( Qxt 4€D6 or 1-9 MA,'39AFE Fax 9 617-727-7M Revised 4-24-07 w -mas, gQgidia F Massachusetts De`partme nt of_P` Board of A�58266 Public Safety gulations and Stan License:, 66. lards Construction r 1 8.2 Fa MICHAEL J R 387 PHINNEY CENTERVILL h iCommiExpiration:01/30 2018 a - F . ,. SOt . slsv Go t�o� vse s¢, l ��ta on v't¢nsele BPS' Q0 oa¢�s aeon o 0 nf • static ,per ✓fze Uianvnzaou�sea/,C� o�✓�Zaoac�uitetT6 - - - - b - _- \ 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::;-1.11859 Type: Office of Consumer Affairs and Business Regulation Expiration:_ 2/4/2017 DBA 10 Park Plaza-Suite 5170 - Boston,MA 02116 MICHAEL RENZI W STRUCTION MICHAEL RENZA� - 387 PHINNEY'S CENTERVILLE, MA 02637 Undersecretary Not v 1 it)(out signature u • A I rm I • -- - ---- ------ ' --- -- - - , - -- - --- - r-- 3 1 3 • V i , = -- __- --- - - --- - - --- - - -- -- - - - ._ .- - - - - € : • yA\ 3 , s - a F --- 3-V, _ ---17�� - - -- - ---- ---- - , --- - 2 s __ - --- ---d�-Cry--�-- --� -�� ------ ---- - ----, - ;_-__ fpr x t I . I . , I e v • I v a , � r S : - - r - 3 - P i I , 1 — _ , r _ F Town of Barnstable ' Regulatory Services Fthe rqk, �y�o do Richard V. Scali,Director ELAM9rASIX Building Division BARNSTABLE MAss saws*a"E•sm m uc.cnw" ".is 9c� 39, Thomas Perry, CBO �°"`""� 16 0� 1639-2014 AIED �a Building Commissioner 575 , 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 .,..Fax: 508-790-6230 March 14;2016 Michael Renzi 387 Phinne s Lane � 7 Centerville Ma. 02632 b-0 RE: 167 Main St., Centerville, Map: 208 Parcel: 096 Dear Mr. Renzi, This letter is in response to application 13-16-336 submitted to remove a deck and construct a larger deck at the above referenced address.Unfortunately,the application can not be approved at this time because of the following: 1) The application is incomplete. A certified plot plan is required showing compliance with setbacks. Please do not hesitate to contact this office.with any questions. e Respectfully, AyTIWAMn— Local Inspector jeffre .lauzon e,town.barnstable.ma.us (508) 862-4034 rr' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued to Conservation Division Application Fee Planning Dept. Permit Feeo�rS i.y Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address A—A y S� Village v k L l Owner 1\ k C,A-N K n t-Adayr14An_e (-e-C AryAddress l to 7 C—C/M-f Telephone Permit Request D1 ,a,&0 0 e 11f (0CA- Ao v{0- y bi e .I..,, k-< Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size V z kc-K.( Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 3 Two Family ❑ Multi-Family(# units) Age of Existing Structure ) O 1 Historic House: ❑Yes ;lo On Old King's Highway: ❑Yes O'llo Basement Type: 2 rull ❑'Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) r Basement Unfinished Area(sq.ft) l Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: _ existing 0 new Total Room Count (not including baths): existing new 4 First Floor Room_ Count Heat Type and Fuel: ohs ❑ Oil ❑ Electric ❑ Other Central Air: �'es ❑ No Fireplaces: Existing�S New Existing wood/coal stove: ❑Yes dMo Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ exiting ❑ w Ze_ Attached garage: sting ❑ new size _Shed: ❑ existing ❑ new size _ Other: a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ at Commercial ❑Yes ❑ No If yes, site plan review # sr, Current Use - = 'Proposed Use_ t�! rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) cue // Name �j_Iti e 12 n .�L y Telephone Number Address ] 2�t 4,,A AeV J ftry C License # r Z(a l -V, Home Improvement Contractor# 1/! S TnI Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 71-6 (f-,-,o �11 SIGNATURE ��!ll��.f/ILG/ l ' DATE �� ���I x b FOR OFFICIAL USE ONLY ,. , APPLICATION# DATE ISSUED MAP%PARCEL N0. ~ ADDRESS VILLAGE.,- OWNER - 1 DATE OF INSPECTION: FOUNDATION FRAME Y , INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL-',. - GAS: ROUGH FINAL FINAL BUILDING i • f DATE CLOSED OUT ASSOCIATION PLAN NO. µ The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street f Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/OrganizationAndividual): /1A , l—t L, A_ Address:—3 ?Hwtie7 ) City/State/Zip: K Ut We Phone #: S- Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑l am a general contractor and I 6 ❑New construction have employees(full and/or part-time).* hired the sub-contractors ` 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑4emodeling 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 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other 5TAg oo/" 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic,#:. 1 Expiration Date: ` Job Site Address: ( V) A6(a) 5��.✓�Crl✓t ` City/State/Zip: 4,4 J i 6 l (o Z Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains-and penalties of perjury that the information provided above is true and correct. Signature: Date: 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#: 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 in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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 indicating 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia bA 4:11 PM To: Sally @ 9,150879ubL3U .wy `�4•`cam Client#: 4597 CCINSUL CERTIFICATE OF LIABILITY INSURANCE 10/2/09/DDmYr> ,JCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION togers 8 Gray Ins. -So. Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 434 Route 134 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 1601 South Dennis, MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA: Peerless Insurance 34754 Cape Cod Insulation Inc INSURER B: Atlantic Charter Insurance 455 Yarmouth Road INSURER C: Commerce Insurance Company Hyannis, MA 02601 INSURER D: 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-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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MMIDD/YY DATE MMIDD/YY A GENERAL LIABILITY CBP8263063 04101/09 04/01/10 EACH OCCURRENCE $1 000 000 DAMAGE TO RENTED $1 OO OOO X COMMERCIAL GENERAL LIABILITY - - - PREMISES Ea occurrence CLAIMS MADE rxi OCCUR - - - _ MED EXP(Any one parson) $5 000 PERSONAL&ADV INJURY $1 00O 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $2 00O 000 POLICY PJECTRO- LOC _ C AUTOMOBILE LIABILITY _ 09MMBCKVMK 04/01/09 04/01/10 . . COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS - BODILY INJURY $ - (Peraccidenl) X NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) - GARAGE LIABILITY AUTO ONLY,-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCE55/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE - AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ STATU- OT $ B WORKERS COMPENSATION AND WCA00525900 06/30109 .06/30/10 X OR - _ EMPLOYERS'LIABILITY - E.L.EACH ACCIDENT $500,000 ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 It yes,describe under - - - E.L.DISEASE-POLICY LIMIT $500,000 SPECIAL PROVISIONS below _ - OTHER - - - - DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES l EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Mike Renzi - DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 3B7 Phiriney's Lane NOTICE TOTHE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Centerville, MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S46393/M46044 CBR ©-ACORD CORPORATION 1988 • I • , I i Board oBu/ding aguul ns • n StandardsConstruction a {t Supervisor License I License. C 58266 I $ + : . Expiration ' J - 3032010 - Tr# 13630 Restriction. -,t MICHAEL J RENZ ' 387P \ HINNEYS LN. c : CENTERVILLE,MA 02632c I Boro m mg egU a`nd Stan a . HOME IMPROVEMENT CONTRACTOR f License or registration valid for individul use only l before the expiration date. If found return to: Registration 111 859 Board of Building Regulations and Standards lugExpiration a 214/2011 Tr# 279440 One Ashburton Place Rm 1301 Ype DBAj Boston,Ma.02108 MICHAEL REN4CON:STRUCTIO�N MICHAEL RENZI�'� y a f 387 PHINNEY'S LN ' f ; CENTERVILLE,MA 02632„---•''- ���V,� Administrator Not vali -----= th t signature ' f e 'THE r, . Tawn of Barastab4e Regulatory Services i Y Y Thomas F_Geiler,Director n 16 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using_ABuilder as Owner of the subject.property hereby authorize I y` `Z C �-FN Z 1 to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of job AatureOwner I ate Print Naive If ProperU Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Hof T�ray Town of Barnstable yrL � Regulatory Services Thomas F. Geiler,Director 1639. �,�� Building Division rEo lust Tom Perry,Building Commissioner 200 Mairi.Street, Hyannis,MA 026.01 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCAT70N: number street village name home phone# work phone# CURRENT MAILING ADDRESS: city/town state rip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such 'homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that_he/sbe understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/sbe will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner performing work for which a building perrrrit is required shall be exempt from the provisions of this scction.(Scction 109.1.1 -Licensing of construction Supervisors);provided that if the homcowncr engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they art assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awamtncss often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it Would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/hq rrsponnbilitics,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns.'You may care t amend and adopt such a fora/certification for use in your community. Q:forrns:homccxcmpt f V. e)cvP �,g n �/C/ �oFYtt t Town ®f��r��t�aJ�� e;% .e OErpires 6 nronths from issue date Regulatory Services Fee �� 9�jibJ9 ,�� Thomas F. Geiler,Director OQ . . ` Building Division �i i� I�6 Tom Perry,CBO, Building Commissioner To1N`� 200 Main Street,Hyannis,MA 02601 www.town.barns table.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid fvithout Red X-Press Imprint Map/parcel Number Z Property Address [?Residential Value of Work l �° �f Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address A61 Contractor's Name—AN,h It 7 � Telephone Number—JAY—))1—7?16 f Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) d S 2 le ❑Workman's Compensation Insurance Check one: L" 1 am a sole proprietor 01 am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name U 1 UJ Workman's Comp.Policy#. . Copy of Insurance Compliance Certificate must accompany each permit, Permit Request(check box) 0 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 ,3 (maximum.44)#of windows �( *Where required: Issuance of.this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation;etc: ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement.Contractors License & Construction Supervisors License is required. SIGNATURE: _ Q:\WPFILES\FORMS\building permit forms EXPRESS.doC Revised 090809 The Commonwealth ofNlassachusetts Department of XndustrialAccidents l;� 1 — ;' Office of Investigations I' 600 TYashington Street L� Boston, MA 02111 Zwyvw,ntass.gov/dia. _ Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): \�\_R Address: 7I S!7 ti° — 3z City/State/Zip: , v`V 1 �t AA(5 n77Phone #: 7 t 11 .S_ Are you an employer? Check the appropriate box: Type ofproject(required): 1.❑ I am a employer with . 41 ❑ I'am a general contractor and I e loyees (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 sttb-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ wilding addition [No workers' comp. insurance comp. insurance.# required.) 5. ❑ We are a corporation and its 10:❑ Electrical repairs or addition 3.❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or addition 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. =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 andjob site information. Insurance Company Name: Policy# or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy numberand 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 fin 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 thepains andpenalties ofperjury that the information provided above is trice and correct. Si nature: rW Date: I Z 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): I. Board.ofBealth 2. Building Department 3. City/Town Clerk d. Electrical Inspector S. Plumbing Inspector b. Other Contact Person: Phone 4: 7. r Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an eniplo},ee is defined as ".-every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appuftenant 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, MGL chapter 152, §25C(7)states "Neither,the conunonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill 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 confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the pen-nit 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 line. City.or Town Officials 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 indicating 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia ppIHErofy Town of Barnstable Regulatory -Services `E Thomas B. Geiler,Director o 9. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, C 'Jy)aD as Ownersof the subject property hereby authorize AA k 1,•_C I to act on mybehalf, in all matters relative to work authorized by this building permit application for. ( _ A kJ E l 60"JTP1" 1 ',t (Address of Job) 12, Signature of Owner D f CH a' it Tint Name If PropeM Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. a. Town of Barnstable Regulatory Services * * Thomas F. Geiler,Director rinrtr�srwsr.e, hrnss. TC� i67g. ,�� Building Division, . PrFD � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnsfable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 10B LOCATION: number street �` village "HOMEOWNER": name home phone#i work phone tt CURRENT MAILING ADDRESS: — city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such. "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all"such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: .Three.-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to dQ such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2,15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC BoAo umgguCatioan tan a "l License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR i before the expiration date. If found return to: Registration: 111859 Board of Building Regulations and Standards Expi4ti6n2/4/2011 Tr# 279440 One Ashburton Place Rm 1301 W—Wkp DBA', Boston,Ma.02108 MICHAEL RENZh+CONSTRUCTION I MICHAEL RENZhy _. 1 l 387 PHINNEY'S 1 CENTERVILLE,MA 02 32 Administrator Not vali th�t signature 4i, fie�om�inaoiecue o�./�ao�uc�i%�oeltG P }JI Board of Building Regulations and Standards Construction Supervisor License LiF se CS 58266 _ Ex ir._a lion 1.- 2010 Tr# 13630 WE (�2estn tion =1G • MICHAEL J RENZI ` 387 PHINNEYS LN 0 ez- r; e i'. CENTERVILLE,MA 02632 Commissioner - �V Town of Barns able *Permaz, 3 Regulatory Services EL 6�' o�iss� * ansrts ABM 163 Richard V.S i639, ♦� Call,Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Q 0 Not Vabd without Red X-Press Imprw Number f-v l� nn Property Address�� fl?,4- (! sw , C vw7- ;Q yT LF , 01 ht Residential Value of Work$ i t;. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address kMH19kD F9EH41V , -167 MWV ST, 0,EVTk'P_V`TLJ_E Contractor's Name,A LEX Y Le_b t=D Eire Telephone Number 714 -i08�-56 Home Improvement Contractor License#(if applicable) Y-"�617 7 Email: Construction Supervisor's License#(if applicable) C S A N- 1001ii ❑Workman's Compensation Insurance ,Cb&k one: I am a sole proprietor ❑ I am the Homeowner jt.pj? ❑ I have Worker's Compensation Insurance Insurance Company Name FRAN Workman's Comp.Policy# To WAIn r 2015 Copy of Insurance Compliance Certificate must accompany each permit. V RA St E IS Req 4(check box) S�� ` Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to f ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property OwnVtsign operty Owner Letter of Permission. A copy of theement Contractors License&Construction Supervisors License is req 'red.SIGNATURE:C:\Users\Decollik*pData\Local\licrosoft\WindornetFiles\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 f ,l TOTAL INVESTMENT ------$ 11 ,250.00 PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is Normally Scheduled for Completion Within 45 Days of Acceptance and Receipt of Deposit Providing the Materials are Available. Please make Checks Payable to: ALEXEY LEBEDEV DREAM HOME IMPROVEMENT Warranties the Shingles and Labor for 10 Years. CERTAINTEED Warranties the shingles and labor 100% for the first 10 years and the shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the shingles up to CATEGORY III HURRICANR-130 MPH WIND WARRANT. .. CERTAINTEED Warrants the Shingles to be Algae resistant for a Full 10 Years. DREAM HOME IMPROVEMENT Carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: 10/12/15 ACCEPTED BY: RICHARD FEEHAN ALEXEY LEBE V HOMEOWNER DREAM HOME I PROVEMENT f�ee�ia� t. ! Massachusetts -Department of public Safety Board of Building Regulations and Standards Construction SuperA Nm- License:CS-108208 ALEXEY LEBEDEV 60 FRANKLIN AVENUE Hyannis MA 02601 f, .,G,.. Expiration Commissioner 11/27/2018 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 X Home Improvement Contractor Registration " — Registration: 176777 Type: LLC Expiration: 9/25/2017 Tr# 270447 DREAM HOME IMPROVEMENT LLCd 8{ram* , ALEXEY LEBEDEV - 60 FRANKLIN AVE. -- HYANNIS, MA 02601 ---- `c_ Update Address and return card.Mark reason for change. sCA 1 0 20M-0en 1 D Address D Renewal ❑ Employment Lost Card tJl�>rrynz�no�urea/!f a�'P�flzdscrf•/r��rll 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 176777 Type: Office of Consumer Affairs and Business Regulation Expiration 9/25/2017 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 DREAM HOME IMPROVEMENT LLC:' ALEXEY LEBEDEV 60 FRANKLIN AVE. HYANNIS,MA 02601 Undersecretary Not valid without signature _ The Commonwealth of Massachusetts Department of IndustrialAccidents u Office of Investigations hd d l Congress Street,Suite 100 a a Boston,MA 02114-2017 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly • Name (Business/Organization/Individual): Alexey Lebedev Address:60 Franklin ave City/State/Zip: Hyannis, MA, 02601 Phone #:7742083589 Are you an employer? Check the appropriate box: Type of project(required): 1.® J am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling kohip and.have no employees These sub-contractors have g, ® Demolition workingfor me in an capacity. employees and have workers' y p �'• 9. ® Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ® We are a corporation and its 10.® Electrical repairs or additions officers have exercised their I I. Plumbing repairs or additions 3.® I am a homeowner doing all work p myself. [No workers' comp. right of exemption per MGL 12.® Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: _ Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.-Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for' surance coverage verification. 1 do hereby cer5 under th p ins and penalties of perjury that the information provided above is true and correct. 12/18/201.5 Sip-nature: Date: Phone#: 7742083589 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#: f AC RO " CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 16. � 12/15/2015 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 NAME: Ashley Paiva Southeastern Insurance Agency, Inc. PHONE (508)997-6061 FAX A/C No Ext: A/C No:f508)990-2731 439 State Rd. E-MAIL a aiva@southeasternins.com RE P.O. BOR-7 9398 INSURERS)AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURERAArbella Protection Insurance 41360 INSURED INSURER B AEIC Armen Safaryan, DBA: Corey and Corey INSURERC: 67 Sea Street INSURER D: INSURER E: Hyannis MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER:2015 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 ADDL S BR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER 1MMfDDIYYYYI IMMIDDIYYYYI, LIMITS R COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 CLANS-ME Fx PREMIS Fa occurrence) $ 9520046441 9/18/2015 9/18/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 B POLICY❑JECT PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ I,accident ANY AUTO BODILY INJURY(Pet person) $ ALL OWNED AUTOSSCHED BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ _ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LJAB CLAMIS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION IPER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNE OFFICERIMEMBER EXCLUDR/EXECED? IlTIVE N I A E.L.EACH ACCIDENT $ 1,000,000 B (Mandatory in NH) WCC-500-5015091-2015A 9/18/2015 9/18/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached if more space is required) .CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Display Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORrLED REPRESENTATIVE Ashley Paiva/AMP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(2ol4o1) TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map A06 Parcel ~. 9� 'JS Permit# Health Division Date Issued - Conservation Division Fee Tax Collector Treasurer :s SEPTIC SYSTEM MUST BE � INSTALLED 6N COMPLIANCE Planning Dept. WITH TITLE 5 ViR0N MENTAL CO '' LAy.w ) Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address G Village r �Q� Amy► , Owner -e /� r LC ktv Address t i C'Wc- Telephone r Permit Request F WI+ & Z00.44 to A 2 ' Square feet: 1 st floor:existing proposed 3sa 0 2nd floor: existing Sad proposed -6- Total new Estimated Project Cost 3o c,6a. Zoning District Flood Plain Groundwater Overlay Construction Type 1.4/ooaP ,j_ot Size" m 95-- C� 'S Grandfathered: ❑Yes O No If yes, attach supporting.documentation. Dwelling Type: Single Family dle, Two Family ❑ Multi-Family(#units) Age of Existing Structure y1 virs 4— Historic House: .❑Yes O No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full 2 rC"r"awl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing I new Half:existing new Number ti of Bedrooms: existing 7 new ` T Total Room Count(not including baths):'existing . (e new ( First Floor Room Count Heat Type and Fuel: Gas O Oil ❑Electric ❑Other Central Air: ❑Yes O'No Fireplaces: Existing 4 New Existing wood/coal stove: O Yes ❑No Detached garage:❑existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size M� Attached garage:O existing ❑new size Shed:O existing U new size, `Other: P • Zoning Board of Appeals Authorization' ❑ Appeal# Recorded❑ Commercial ❑Yes . ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name e"We-rie.) ��1 S�©� Telephone Number ( o8 221 //G Address Ig.?a ica1Gl Ul�ct) I�,^ License# 00 6o 6 6 Home Improvement Contractor# Worker's Compensation•# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE '�� FOR OFFICIAL USE ONLY - PERMIT-NO. i s ,' x t - � . •+ rr 1 4.. - - 4, , E- R� 1. * r� 'Y'i t �� •�� : „- } DATE ISSUED � MAP/PARCELF NO -�' "`• 6 � r, .^ ► _' -.. -> _ '" ,,��_ 1 , . .� f`� _ ! +' ADDRESS VILLAGE _ ,; w r'' OWNER . 4 - ...•.k f � - r _.. k s ; - 0. _ foe DATE OF INSPECTION• y �. ri k, -r:. r FOUNDATION --ZZ- 7 . 'ELP { $ , - V .4w , FRAME f 3 _ ' INSULATION FIREPLACE Y• ELECTRICAL: " ROUGH FINAL w PLUMBING: ROUGH^ ! FINAL. St r �• r 1 a 0. n -+e GAS: ROUGH.. FINAL FINAL BUILDING - ,• t .fi DATE CLOSED OUT• ` _ _ -` # + ASSOCIATION PLAN NO. ` • _ _ , t � ,e+'r a .. i } !» a. F x • The Commonwealth of Massachusetts �s= = Department of Industrial Accidents ,� -- = ; Olflce offm�estigatfons - e t 600 Washington Street -- Boston,Mass. 02111 Workers' Com ensation Insurance davit name: i location city hone# ❑ ,Iam,a homeowner performing all work myself a soll ro prietor and have no one worki>ig in anv capacity 1 rovidin workers' compensation for my employees worlQng on this job.:::> I am an em sdaress-: h : ># .. . ?i�iYii::isii:isvi::ii: ::;:;:i_:j;:;::;:�i:::}j;:+.:i::':<:::i:Xi'<:ii::f:4:iiYi:::�i::fi::i:i:ii:?+:iiii:'::r':i:::+:iiiii:(:`iii:+::{•;}i::• insurance cG.- :..::...::::>:.... 0/0000/00/04 ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have ' compensation polices: the following �yorkers ::....................................................... ............... ::::.::. . X. .......................................... ....... .........: ::::.::::..........................::::::..............:::::::.:............::.:::::::::.....................:::::::::::_............ hone:#.......::..:..:.:<::,:.:.::,::::,,:<;;:.<.,. >..:.., :!� w ........... ..................................................w::::v:::::::::•:::::::::::::•.�:::::::::::::v::::.vrrv:r:.:::�r:�.::r:.v:.::r:r..�:::..•r::.v::.v:rii:ir:�::::irr::i. ..................................::v.�::::..................... .............:•:.::::::.:::::::::.�::::w:::::,�.w::::::::::::::.�:::{{•:iii:•;}ivii:{{•iiiii:C:{:4ii:..........................rw:::::::•::::::::{?:i"r'•:::. :::::�................................. ...-,•:.�.i: insurance ca c an n ............................................ OII :............. Ct .. ...,..........:. .................................:.:.:........................:...... . ... ......... :....:::::..r................ :... NX wMa Fafiare to seem a coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Sae up to S1, M90 and/or one years'imprisonment as weII�ip am to the�m�f Investigations form of a STOP WORK ORDER and a DIA for coverage fine ofation00 a day against me. I understand that a copy of this statement may be I do hereby certify air d pen es of perjury that the information provided above is true and coned signature Date I — Print name i a s: i z ���TS/ S Phone#�5'09/ 77� — official use only do not write in this area to be completed by city or town official city or town* pernORcense# OBuiiding Department OLIcrnsing hoard ❑S 'a Office ❑checkif immediate response is required en _ Health Depst�tmt contact person: phone#; �Ottter (wined 9/95 PJA) The Town of Barnstable MAM• s�►arier,�s�, • �m Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-862-4038 Building Commissioner Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost_ Cam,� �— Address of Work: 1(g7 ,4Ai Yl 37, � Owner's Name: S k c Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 OBuilding not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORSHHEF.a RBITTRPATIION PROGRAICABLE HOMEM RROVEMENT WORK DO NOT GUARANTY FUND UNDER MGLc. 142A. ACCESS SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: C� Contractor Name Registration NO. Date OR -------------- Date Owner's Name ghmis:Affidav ILE # C1263 CENSUS TRACT # CLIENT : &nryL. Murphy DEED BOOK. 1021 PAGE 6 OWNER : H. Costello PLAN BOOK 0 PAGE L APPLICANT: E. ' hamm ASSESSORS PLAN PLOT MORTGAGE INSPECTION PLAN OF LAND I . N SCALE: 1"= 40 ' B A R N S T A B L E AUGUST 2, 1984 LOT 97 90 , ' (S) LOT 146 LOT ACRES± Q 38 - 167 O° w oCD 101± +1 M , ^ MAIN STREET I CERTIFY TO ATTORNEY HENRY L . MURPHY , NEWORLD BANK. FOR. SAVINGS AND ITS TITLE INSURANCE COMPANY , THAT THERE ARE . NO VISIBLE ENCROACHMENTS OR EASEMENTS EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVISION . THE LOCATION OF THE DWELLING AS SHOWN HEREON IS IN COMPLIANCE WITH THE LOCAL APPL ICA);+C ZONING BY—LAWS 1!ITH RESPECT -_ _e =_:.•`'` ' ��_ TO HORIZONTAL DIMENSIONAL REQUIREMENTS . KENNF:T14 (:* R. ` THE DWELLING SHOWN HERE DOES NOT FALL �er.izc irzn SPECIAL AL FLOOD HAZARD ZONE AS WITHIN A S DELINEATED 014 A MAP OF COMMUNITY #250001 DATED 10/1/83 BY THE F , I , A @. -T; 'r"'''. �}`' �,. NOTE', LOT CONFIGURATION TAKENFROMASSESS — ORS MAPS OF RECORD AND IS NOT NECESSARILY ACCURATE , Lend SurveyorsCivll Engineers Abe �oston Pna Surl eq (go., �nr_ 261 ;finion ESL c(v cafara, A 027,10 GENERAL NOTES: (1) The declarations made above are on the basis of my knowledge, information, and belief as the result of a mortgage plot plan tape survey inspection made to the normal standard of care of registered land surveyors practicing in Nassar•husetts. (2) Declarations are made to the above named client only as of this date. (3) This .plan was not made for rer.ording purposes, for use in preparing deed descriptions or for con— structions. (4) Verifications of property line dimensions, building offsets, fences, or lot cop.figuration may be accomplished only by an acr•urat.e instrument survev, t MAScheck COMPLIANCE REPORT I I Massachusetts Energy Code I Permit # I MAScheck Software Version 2.01 h I I I I I Checked by/Date.1 I CITY: Barnstable STATE: Massachusetts HDD: 6137 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non-Electric Resistance) DATE: 7-8-1999 DATE OF PLANS: 6-11-99 TITLE: New Addition PROJECT INFORMATION: Helen McCluskey 767 Main Street Centerville Ma. 02632 COMPANY INFORMATION: " C. Paltsios & Son Building and Remodeling 183 Longview Drive Centerville Ma. 02632 NOTES: MaCheck by Cape Cod Insulation INC: # 856 COMPLIANCE: PASSES + Required UA = 97 Your Home = 97 Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value UA CEILINGS 376 30.0 0.0 13 WALLS: Wood Frame, 16" O.C. 481 13.0 0.0 40 , GLAZING: Windows or Doors 59 0.330 19 GLAZING: Skylights . 20 0.240 5 ' DOORS 20 0.180 4 FLOORS: Over Unconditioned Space 352 19.0 0.0 17 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the Massachusetts Energy Code. The heating load for this building, and°the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building, shall be no greater than 125% of- the- design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date r , E MAScheck INSPECTION CHECKLIST ' Massachusetts Energy Code MAScheck Software Version 2.01 New Addition DATE: 7-8-1999 r Bldg. 1 Dept. 1 Use 1 I 1 CEILINGS: [ ] I 1. R-30 I Comments/Location I WALLS: [ ] 1 1. Wood Frame, 16" O.C., R-13 1 Comments/Location I _ WINDOWS AND GLASS DOORS: [ ] 1 1. U-value: 0.33 I For windows without labeled U-values, describe features:. I # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments/Location I I SKYLIGHTS: [ ] I 1. U-value: 0.24 I For skylights without labeled U-values, describe features: I # Panes Frame Type. Thermal Break? [ ] Yes [ ] No I Comments/Location I , 1 DOORS: [ ] 1 1. U-value: 0.18 Comments/Location FLOORS: [ J 1 1. Over Unconditioned Space, R-19 I Comments/Location I AIR LEAKAGE: [ ] I Joints, penetrations, and all other such openings in the building 1 envelope that are sources of air leakage must be sealed. When 1 installed in the building envelope, recessed lighting fixtures I shall meet one of the following requirements: 1 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or 1 gasketed to prevent air leakage into the unconditioned space. 1 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the 1 conditioned space to the ceiling cavity. The lighting fixture 1 shall have been tested at-75 PA or 1.57 lbs/ft2 pressure 1 difference and shall be labeled. VAPOR RETARDER: [ ] ] Required on the warm-in-winter side of all non-vented framed 1 ceilings, walls, and floors. 19 y r I MATERIALS IDENTIFICATION: [ ] I Materials and equipment must be identified so that compliance can I be determined. Manufacturer manuals for all installed heating I and cooling equipment and service water heating equipment must be I provided. Insulation R-values and glazing U-values must be clearly marked on the building plans or specifications. I I} DUCT INSULATION: [ ] I Ducts shall be insulated per Table J4.4.7.1. I DUCT CONSTRUCTION: [ ] I All accessible joints, seams, and connections of supply and return I ductwork located outside conditioned space, including stud bays or I joist cavities/spaces used to transport air, shall be sealed I using mastic and fibrous backing tape installed according to the I manufacturer's installation instructions. Mesh tape may be I omitted where gaps are less than 1/8 inch. Duct tape is not I permitted. The HVAC system must provide a means for balancing I air and water systems. I TEMPERATURE CONTROLS: [ ] I Thermostats are required for each separate HVAC system. A manual I or automatic means to partially restrict or shut off the heating I and/or cooling input to each zone or floor shall be provided. I I HVAC EQUIPMENT SIZING: [ ] I Rated output capacity of the heating/cooling system is I not greater than 125o.of the design load as specified I in Sections 780CMR 1310 and J4.4. [ ] I SWIMMING POOLS: I All heated swimming pools must have an on/off heater switch and I require a cover unless over 20%'of the heating energy is from I non-depletable sources. Pool pumps require a time clock. [ ] I HVAC PIPING INSULATION: I HVAC piping conveying fluids above 120 F or chilled fluids I below 55 F must be insulated to the following levels (in.) : I PIPE SIZES (in.) I HEATING SYSTEMS: TEMP (F) 2" RUNOUTS 0-1" 1.25-2" 2.5-4" I Low pressure/temp.. 201-25C 1.0 1.5 1.5 2.0 I Low temperature 120-200 0.5 1.0 1.0 1.5 I Steam condensate any ,' 1.0 1.0 1.5 2.0 I COOLING SYSTEMS: I Chilled water or 40-55 0.5 0.5 0.75 1.0 I refrigerant below 40 1.0 1.0 1.5 1.5 I [ ] I CIRCULATING HOT WATER SYSTEMS: I Insulate circulating hot water. pipes to the following levels (in.) : I I PIPE SIZES (in.) I NON-CIRCULATING CIRCULATING MAINS &�RUNOUTS HEATED WATER TEMP (F) : RUNOUTS 0-1" I 0-1.25" 1.5-2.0" 2.0+" 170-180 0.5 I „ 1.0 1.5 2.0 I 140-160 0.5 I 0.5 1.0 1.5 100-130 0.5, I 0.5 0.5 1.0 ----NOTES TO FIELD (Building Department Use Only)-----------------=------ l i I ^ - -r ram'1`r'-r- r. i 183 LONGVIEW DRIVE N E<E y /l!'latKsy C. PAUSIOS E SON CENTERVILLE, MA. 02632 °•" „^'°°'°'•° �xo"' ona: 771-1410 f<wr cy BUILDING & REMODELING LICENSE # 006653 �F��tzio,rs °A.WiNO/MaE i Cif __ - a-nrc r6 c�ro+u.ff NAct �h - r tutu.tww oaw� tom of aww" Poftm ►�pr�YnU*Aft MM enueMn /Y`,'A.l N'l![uJA'cY . . � �ON183 LONGVIEW DRIVE .�7 �A.N rrC. PAUSIOSCENTERVILLE, MA. 02632 ..�Ko 771-1410 BUILDING & REMODELING LICENSE # 006653 ,rwerww.o w.orw+nts•wrarm TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION SST"EM �sraP A'r,fi E ( 3 7 Map Parcel S PTIC Z. � 'e�r�it# V INSTALLED IN COM,I�LIANC Health Division - 9 "WITH H TITLE @ate Issued _ Conservation Division ENVIn-ONPOEMITAL CgP,.E AED. Tax Collector q)�`�'I Y Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address /6 7 Village Owner 41Y&n ./lt�� QSI��w �� Address Telephone Permit Request —7-496 Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new S ✓ Estimated Project Cost An,a 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 76 YJf5 -t— Historic House: ❑Yes 11 o On Old King's Highway: ❑Yes eIQo Basement Type: O Full ❑Crawl ❑Walkout ❑Other �'` I.t��lr © �2e � ✓L 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 C new First Floor Room Count Heat Type and Fuel: &Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes o Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size-XX-J `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 e°f Wles t7AI-7—,SI yj Telephone Number Address /83 ,�oxlwiece/ OP. License# . OGC C S3 Home Improvement Contractor# IlW yq Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO � o SIGNATURE DATE ,ti — FOR OFFICIAL USE ONLY - f PERMITkNO: DATE ISSUED 't - MAP/PARCEL NO. ADDRESS , VILLAGE : .3 OWNER. ' t DATE OF;INSPECTION: 4 r FOUNDATION ., FRAME P INSULATION FIREPLACE ` ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL iAj GAS: ROUGH FINAL ��, • FINAL BUILDING DATE CLOSED OUT , - A - ram.. f'• ; # i t. ASSOCIATION PLAN'NO. . t The Town of.Barnstable BARE. Department of Health Safety and Environmental Services MASS. �E163 Building Division `` 367 Main Street,Hyannis,MA 02601 f' Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection Location crJ , U Permit Number Owner Builder One notice to remain on jobsite, one notice on"file in Building Department. The following items need correcting: Q E6�j Please call: 508-790-6227 for re-inspection. Inspected by _ Date / t1� The Town of Barnstable Department of Health Safety and Environmental Services ; Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 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: �cV 4ey` t5;¢Vt4 Estimated Cost-490 Cco. -- Address of Work: /C �f &S 7 ("1ev% Owner's Name: ,hrele4' Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law []Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. sz/6 yy Date Contractor Name Registration No. OR Date Owner's Name q:fbnns:Affidav z.a,,r vr„ Ile"Jr<rr✓oGK y. — e err j TL7'ovc,Gv<no�e r.--. gv7'avEeR�D ynrL — r . ry N NpprJ RB= 0" SON 183 LONGVIEW DRIVE' 67IV4C. PAUS OS ,�R.K -Sr CENTERVILLE MA. 02632 x.- 1alf^ vvROVED BY: R-wRBv:g j/ DATE: .1 9 REvi9E0 -BUILDING & REMODELING LICENSE#400 o �a� R"Gc 6653 DRAW IRO NUMBER NtW fHGIA�PlPROGRAFIx4fB SUPPLY CO. - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map —Parcel-0 Permit# Health Division 7 Zi� ,� ��7��,h Date Issued Conservation Division � � Fee Tax Collector Treasurer b----- , SEP T IC SY INSTALLED @ Planning Dept. X Vll`� a Date Definitive Plan Approved by Planning Board CODE AND n_""ULATIONS Historic-OKH Preservation/Hyannis r =' Project Street Address MA-11f 9F, Village Ce,4 T—er y e AA 4 Owner HeLe A C [®S K ev -,h4�m CaAdd ess ^• .31.am e Telephone Permit Request �0M -F0 2xo'M r LL .� f `�- X4116 r Square feet: 1st floor: existing_ proposed- 2nd floor:existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size oLi &S — Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure G /S 4— Historic House: ❑Yes trNo On Old King's Highway: ❑Yes J<o Basement Type: ❑Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing 1 `7 new First Floor Room Count Heat Type and Fuel: ❑Gas Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size - Shed:O 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 01- 4Aeke.5 �,AG.%SioS Telephone Number 77/—/%fO Address z&3 .,1-o y6-i/i-e(e) yil License# 00 ef,0rl—'/'t/1 s ®�to✓�-2— Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 2ce 94 r2' SIGNATURE DATE _ L'1,2��� FOR OFFICIAL USE ONLY 14' PERMIT NO. DATE ISSUED MAP/PARCEL NO. - .. ADDRESS a —VILLAGE -,•! OWNER .! DATE OF INSPECTION'S FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH ' �„ ' FINAL GAS: ROUGH FINAL :. , FINAL BUILDING.r DATE CLOSED OUT ASSOCIATION PLAN NO. `' The Town o f Barnstable : . . : Department of Health Safety and Environmental Services Eo► ' Building Division .• i 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 s ` Ralph`Crosse•n 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: /,/U//y1-r Estimated Cost / , Address of Work: /�7 �Q/✓1 $']; c'P-1%e1xj&4 j,4. Owner's Name:17P,L m ✓l ��1,OS Lesi Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job Under$1,000 OBuilding 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. �� r les ��Li 3los f/y�rr� Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav RESIDENTIAL ADDITIONS OR ALTERATIONS If located: North of Ro e 6 - any work visible from outside- needs approval from OKH In Hya 's -If work visible from outside- Check to see if it's included in the Hyannis Historic Waterfront District-if so it needs approval from them APPLI ATION PACKAGE MUST INCLUDE: Map/parcel number v Sign-offs fr m Health Conservation(if exterior work) [� Tax.Collector Treasurer Street address Owner's name & address Permit request-full description of proposed project ._ ESquare footage -proposed project Estimated project cost . �omplete Dwelling information for Assessor's Office B��' :ignature uilder's information 9>-Iot plan L� 2 sets of reduced (8.5" x 11: or-8.5"x 14")plans with cross section& framing schedule Home Improvement Contractor's Affidavit Worker's Comp form must include: Insurance company's name&Worker's Comp policy ° number Energy Compliance Form ` �opy of Construction Supervisor's License & Home Improvement Specialist's License OR Homeowner's ❑ `"License Exemption Form. Fee NOTES: CHIMNEYS Need Home Improvement License . No plot plan required PIERS & DOCKS nNeed Construction Super license AND Home Improvement License Owner cannot pull own permit q-forms-PERMITS 1 Rev 8/12/98 ALLM IIPv ijQuty L JjjUjpjjy uL.L0-,IJUUK. lull PAbE b OW�Peter � _ - & Gvn� hia �} Costello PLA OOK PAGE . L 'APPL.ICANT : r� A & ('hristi �� � •���amin ASSESSORS PLAN PLOT MORTGAGE INSPECTION PLAN OF LAND I N CALE : 1 "= 40 BARNSTA8Le , AUGUST 1 , 1984 LOT \r� �01 ( S ) LOT 146 LOT gg Z ACRES!* Q 1167 r° �- .� d i1 - y 1 MA I N S_.TRE [= T CERTIFY TO ATTORNEY HENRY L , MURPHY, NEWORLD BANK FOR. SAVINGS AND IT ITLE INSURANCE COMPANY , THAT J-HERE ARE : NO VISIBLE ENCROACHMENTS 0 �SEMENTS EXCEPT AS SHOWN AND THAT T I-11 S PLAN WAS PREPARED UNDER M u i 1 1 j Fp kmo hk� » 4Al _ t �vws,AY,evaaa,.�ru�o;; i Y P i ; • I t 4� t�i Y h C i I 'i J �I "^j r% i I I � N a h � '' � � i .EX�sTi•Y� �.: a � .► � � � ; --------------._....._�._____�_.i �i �;/S r' sI-6e-s+cCr, W .............. I I I I - o f V . N . I i i i i i l i 1 Ss�e2�2 •`� >s s 0 C Q• tip ,�, � ,..4 �.� o a st Q= INC a �a a t0 M 04 'Ali 1 Ak �` r ola v t�4titi 4d.#f�elio O�� ! -CO. N •by -Q ♦ G� WE. TE I `I l' bra rCi , ;..!►.• •::.. '� iT A AN _ BA411'.•<STAi:L£ Lv.: ::1 Or SJ4VZY � ti � fir"�Y 1 � 1�:,•�, 0 c D. :p0 e p� lby PLAN OF LA ND I N ��° CENT YI��E R E,L.4RNST,46iCE,MAS►S. ' dr.7/ in sion~ ���Iyn ERE N fV t3 LOG! TO CypwrH i A W. C05TELLO SCALE i IN s QO FT. APRIL Z7. 1959. NeLSOM B Ansm �RIcNAtty LAW. Suavr-YOR9 b E' OF ,tas� IN O V I ki NELSON BEAM k_ RECORDED.... . ... ..... •� 4Q/sTE��"o�. SUR"�`i Y Ta--v 51 cl r 5309