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0254 MAIN STREET (CENT.)
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Fa. t. i:;:6`,. <,.'n,,,r l� /P,. r V e., :,. t , ._, a ., F �' V_ ,. ..'M1M il Y r , u,, {;, 9 u". _G 4 � - e.y. lw �� r , Town of Barnstable ` Building i ' Post This Card SoThat at;is Uis�ble;From the Street :A ' rouedSPlans Must be�Retamed on Job antl this Card Must be Ke t * �AiZ1V3TA>3I.E: ' �". - .N ;.. �:�a • � ;� k � :,� .� � ,p `"����g�'" �s :� p � p M" Posted Until Final Inspection HaBeenIVlade Wherea3Certificate:of Occu anc is_Re aired,•such Buldin shall Not be�Occu ied until a F�nallnspeetion has been made Permit ,< Permit No. B-18-1693 Applicant Name: HENRY E CASSIDY Approvals Date Issued: 06/13/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 12/13/2018 Foundation: Location: 251 MAIN STREET(CENT.),CENTERVILLE Map/Lot 208-102 Zoning District: RC Sheathing: Owner on Record: ALLEN,WILLIAM H IV&CORLEY; Contractor Name ` CAPE COD INSULATION, INC Framing: 1 Address: 251 MAIN STREET t Contractor'License 153567 2 CENTERVILLE,MA 02632 roect Cost: $ 1,800..00P Chimney: Description: weatherization Permit Fee: $85.00 Insulation: Project Review Req: _ Fie Paid $85.00 Date 6/13/2018 Final: Plumbing/Gas u Rough Plumbing: r c - Building Official Final Plumbing: .."� � This permit shall be deemed abandoned and invalid unless the work authonzedby this permit is commenced within six•months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which#his permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street-or,road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. r a Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures.by the Butltling andaFire OfficJAI.re provided on-his permit. Minimum of Five Call Inspections Required for All Construction Work: Rou h: u., ,. g 1.Foundation or Footing ..�, �n „ .,_-�. �.,. �• � . . -'� J, 2.Sheathing Inspection Final: 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 Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7..Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with"unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). Fire Department Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # U"/ Y Health Division Date Issued .(� l d C9 Conservation Division Application Fee Planning Dept. Permit Fee �� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Af'l_19,114141 fot Village��IZ01��Z1/i 11W Owners Address ,o Telephone fi OY 70 Permit Request f_�/�S�i�/� ! /� IA4' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation «'Id , 4) 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 )il No On Old King's Highway: ❑Yes WNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/costove: ❑Ys ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing new size_ C? c Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: � LL m Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 5 Commercial ❑Yes ❑ No If yes, site plan review# 49 Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Z �' %��sId/.4 ;-� e A_�o Telephone Number 77S,2z Address ✓� ,/'�� �-c✓i��e License# Home Improvement Contractor# �� Email Worker's Compensation #f�,_'Z.'®Z� fly ! 9e 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER y DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. DocuSign Envelopd ID:94410E82-79F1-43AE-9E97-2D9ABFAF2A19 of INE To Town of Barnstable wk Regulatory Services BANN- STABLE, + Richard V. Scali,Director MASS. m 9�pA 1639. ,,00 Building Division rED M(►�A' Paul Roma 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 I, JACQUELINE L CORLEY as Owner of the subject property hereby authorize zc� Cc a �'�1So �t�� to act on my behalf, in all matters relative to work authorized by this building permit application for: 251 Main Street Centerville, MA 02632 (Address of Job) DocuSignodby: � - - 5/15/2018 1 7:43 PM EDT 26168FA5767F4F2 Signature of Owner Date Jacqueline Allen Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. C:\Users\decollik\AppData\Local\Microsoft\Windows\(NetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 0l/25/1.7 The Commonwealth of Massachusetts r Department of lndustrlalAccldents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dla Workers' Compensation Insurance Affidavit;Builders/Contractors/Electricians/Plumbers, TO BE FILED WITH THE PERMITTIM AUTHORI'C'Y. Applicant Information , � ; Please Print Legibly Name (Business/Organization/individuai); Cape Cod Insulation Address; 18 Reardon Circle City/State/Zip; South Yarmouth,MA 02664 phone#; 508-775-1214 Are you an employer?Cbeck the appropriate boxt 'type of protect(required); lQ l am s employer with 48 employees(full and/or part-time),* 7. ❑Now construction 2,[7 I am a sole proprietor or partnership and have no employees working forme In $, ❑ Remodeling any oapaoity,(No workers'oomp.Insurance required,) 371 am a homeowner doing nil work myself,-(No workers'comp,Insurance required,)t 9, ❑ Demolition 4,[D I am a homeowner and will be hiring contractors to conduct all work on my property, l will 10 Building addition ensure that III contractors either have workers'compensation insurance or are sole I,❑ Eloct Ical repairs or additions proprietors with no employees, [] S,[]!am a general contractor and I have hired the sub•oontrsetora listed on the attached shoot. 12, Plumbing repairs or additions These sub•contracton have omployam and have workers'comp,insurance,= 13, Roof repairs 6.C]We are a corporation and its officers have exercised their right of exemption per MOIL o, 14, Other W eatherization 152,ri1(4),and we have no employees, [No workers'oomp.Insurance required,] $Any applicant that oheeks box 4l must also fill out the section below showing their workers'oompensatlon policy information. t Homeowners who submit WsVddavit indicating they are doing all work and then hire outside contractors must submit a new affidavit Indicating such, tContr•aotors that check this box must attached an additional sheet showing the name bf the sub-contractors and state whether or not those entitles have employees, if the sub-contractor: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 " tr{/ormatton. insurance Company Name, Atlantic Charter " Policy#or Self-ins,Llo;#; WCE00431902 Expiration Date- 06/30/2018 ` Job Site Address;_ 57 fY/�1,r1 S �� p, ✓�1�� City/State/Zip; Attach a copy of the workers eoinpensatlon policy declaration page(showing the policy number and explratlon date), Failure to secure coverage as required under MOL o, 152, §25A Is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator,A copy of this statement may be forwarded to the Office of Investigations of the DIA for Insurance coverage vodfioati n, 1 do her=.,�'en e /s and penaltles owf�perjury that the lVormadon provided above is true and correct, "" °".;.WfMYWMMWMWWYYMIsMM.411M 4 (� VIV , 508 75-12Phone# 4 Official use only, Do not write In this area, to be completed by city or town officla4 City or To Permit/License# Issuing Authority(circle one); 1, Board of Health 2, Building Department 3, City/Town Clerk 4. Electrical Inspector-S► Plumbing Inspector 6,Other Contact ersont Phone#i r a t Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Ma ,Ulsetts 02116 Home Improve ma :� 'e tractor Registration TYpe;-- Corporation Re0.6f tblli 1535e7 Cape Cod Insulation, Inc Expiration; 12/14/2018 18 Reardon Circle n So, Yarmouth, MA 02664 _ a • 'SCA 1 0 20M•06/11 Update Address and return card, Mark reason for change, nat•pxr �aaavracancuealt�a Gd�aaeao/ttWetlb• OHIO$or OonsumerAffalre&Business Regulation 19HOME IMPROVEMENTCONTRACTOR Registration valid for Individual use only TTytq Corporation before the ex Iratlon date, 1 urc�{`n.�.e""ls.t,ration x Iratlon Office of ConsumerAftalra andun sl sa Regulation ;l'z.. `fi u 12/14/2018 10 Park Plaza• e 8i70 .)i�" t11.1 Boston MA Cape Cod Insu I `F f t511 t'!, 11 Henry Cassldy ' .,,y � s•:' 18 Reardon Clro Sol Yarmouth, Underseoretary t al hout sl at 1 n�• C . I 1 , ' I ' Commonwealth of Massachusetts Dlvision of Professlon'al Llcensurs .Board of Bullding Re ulallons and standards ` 1 Cons�!Q-0 ' �I� rvisor • CS•100988 ytiS; •,err,•• o �' HENRY 9OW IDy' 8 SHED WEST YARMO>j,T;bt�r�,��; �1� �•, ' Commissloner 1 CAPECOD-27 KDOYLE CERTIFICATE OF LIABILITY INSURANCE DATE 0 4/0 312 0 1 YY) 04/03/2018 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(les)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 Ileu of such endorsements. PRODUCER CT Rogers&Gray Insurance Agency,Inc. PHQNE FAX No; 877 816-2156 43 Rte 134 A/ No Ezt South Dennis,MA 02660 .mall ro ers ra .com INSURER AFFORDING COVERAGE NAIC# INSURER 'Peerless Insurance Company 24198 INSURED INSURER B:Wety Indernnily Insurance Company 33618 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon CirclINSURER D;Atlantic Charter Insurance Company 44326 •, South Yarmouthuth,,MA 02664 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 ADD L SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,��0,0�0 CLAIMS-MADE a OCCUR 3 BKW63328281 04/01/2018 04/01/2019 DAMAGE TO RENTEDEBEMISFS ire occurrence) 1001000 MED EXP(Any one erson 5,000 ERS NAL& DV IN RY 11000,000 EN'L AGGRE ATE LIMIT APPLIES PER: ENERAL AGGREGATE 2,000,000 X POLICY jE LOC PRODUCTS-COMP/ PA 2,000,000 OTHER; B AUTOMOBILE LIABILITY d COMBINED SINGLE LIMIT 1,000,000 ANY AUTO 6232707 04/01/2018 04/01/2019 OWNED RTU NESDONLY X SCHEDULED BODILYBODILY INJURY Per person) X AUTOS ONLY X AUTOS ONLY BROOPED'LYRTTNY AMAGParE ccldenl 1,000,000 Per accltlent C UMBRELLA LIAR X OCCUR EACH OCCURRENCE 2,000,000 X EXCESS LIAR CLAIMS-MADE R/O EXC10006635002 04/01/2018 04/01/2019 A REGA E $ DED RETENTION$ Aggregate 2000,000 D WORKERS COMPENSATION , AND EMPLOYERS'LIABILITY X7 PER OTH• :.ANY PROPRIETOR/PARTNER/EXECUTIVE WCE00431903 06/30/2017 08/30/2018 1,000 i 00QaFnICER/MEMNH NIA E. .EACH ACCIDENT IfEa story n 1,00000 0 Gdescribe under E. I EASE• A EMPLOYEE ORIPTION OFOPERATIONS below E.L,DISEASE•P LICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101TAddltlonal Remarks Schedule,may be attached If more apace Is requlred) Workers Compensation Includes Officers or Proprietors. Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CERTIFICATE HQLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ACORD 25(2018103) 01988.2016 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD F y .if TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # i 2z-i 7 Health Division Date Issued �� P Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis ��t� Project Street Address �! /� Village Ae Owner ,�%C�l' U�� /,�z° l� f�,� Address Sr. � Telephone Permit Request ,/ 9f,��� /� •C�11� ��1'��1s l L�//y�b�� a� � .1'o S� ,�r� � 5� � ir�/ llea ,f4 )T' g7Zi Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District. Flood Plain Groundwater Overlay Project Valuation e., f Construction Type /.��2,i Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family C-,K Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes UKlo On Old King's Highway: ❑Yes s No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new sizo_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ JU Commercial ❑Yes ❑ No If yes, site plan review # 1V20 2017 UWC Current Use Proposed Use N®B SA un- APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name �',�9Ae Cd� ,:04� 7 l�� Telephone Number Address z&%e,,e1 License # ,/Def)1/4:�f Home Improvement Contractor# Email� Z/✓ z fW� 16p ; 404 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/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. J l y �tiss a'� IticliArd;4t St CIE;:I�ir�clAr Wpi � - a_ ��� �az�g.J�ivas�am. `1'O'M errl' BUJ'l iina.Comnuss asu�r U0'.Nfaxot S tit, utu�ni ,a :,g260.. ti���E�ftri�n:l�a�•nsl�f>lc:nia�ras., FTC Rr C .i:er?Must: t Js7 : ' 7aacr a .. 30CA 0 ereb all6iolim: in zJ Lrz y 4�arkvr.rc,WO k mu±-�1�eG b- t[ i i>flailz pemilto l c.ati n for- ree .� e e�- i l of ssrc d hias a L the' s;ts�c zisir,�E���u�.t�; bi .f)l I()r*li ile '6�f-�r�'h�ne,-is ;xz�e�.trGra.�s �z� �4 :�rax1���arlci:.�c�eZ�tr_c3.. . Q;C�.I�Itt°i-a\'r1��.''r�Nfi'•S1C;�'I�YC:{7d S �'' The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 _ .• ' www mass.gov%dia 11rot-kers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrganizatiorAndividual): Cape Cod Insulation Address: 18 Reardon Circle City/State/Zip: South Yarmouth,MA 02664 Phone#: . 508-775-1214 Are you an employer?Check the appropriate box: Type of project(required): 1.Z I am a employer with 48 employees(full and/or part-time).* 7. New construction 2.0 I am a sole proprietor or partnership and have no employees working for in 8. Remodeling any capacity.[No workers'comp.insurance required.) 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 ❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions S.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.�We are a corporation and its officers have exercised their right of exemption per MGL c. 14. ✓�Other Weatherization 152,§1(4),and we have no employees.[No workers'comp.insurance required.] Any applicant that cheeks box it l 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 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: Atlantic Charter Policy#or Self-ins.Lie.#: WCE00431902 Expiration Date: 6/30/2017 Job Site Address:-IJ% i Alw .�� r�w���o��� City/State/Zip: I" Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Henry Cassidy Signature' Date: Phone#: 508-775-1214 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town CIerk 4. Electrical Inspector 54 Plumbing Inspector 6.Other Contact Person: Phone#: Gi- Massachusetts Department of Publlo Safety Board ohf.Bullding Regulatlons and Standards Lioense; 08•100988 Construotlon Supervisor, HENRY E CASSIOY;� :N., 8 SHED ROW WEST YARMOUrHol tl E x p l r at t o n; .' Cornmissloner 11/1112017 Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Ma ,� b.lLUSettS 02116 Home Im roveme::::,.�Co t raptor Registration Typed Corporation Cape Cod insulation InC ��! " �i Registration; 153587 �'� "' w Expiration; 12/14/2018 18 Reardd Circle So, Yarmouth, MA 026e4 8CA1 d3 20M�06/I1 Update Address and return card, Mark reason for change, ..,. .!.,.�._...__...._._.�s�oa!tmca�acuar��t/oyo _....___.....,....._.... .. .�,........,._....,.... ,(7��1�1�:ras,,tR...(�..ft,xn•r1.it:tt._��z;plolYrr�9t7t_Cl-1.o,�.±.0.ax�+... C��«4a�ra/rwatL'v Offloe of Consumer.Alfalrs&Business Regulation 1 HOME IMPROVEMENT CONTRACTOR ,�;• Registration valid for individual use only Ty. e.r Corporation before the explratlon date, If foun urn tol lixafretlon OHIO$of Consumer Affairs and si as Re v. tt.tititk } .. sJ 12/14/2018 10 Park Plaza• e 8170 9ulatlon '"•` B Cape Cod Ins0it Boston,M 11 He 18 Reardon Ciro bv, . r R cG So,Yarmouth,M11C, Underseoretary t 01 hout sl atu ACOR ` CAPECOD-27 KDOY CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/30/2017 THIS CERTIFICATE 13 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 polloy(les)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 Ileu of such endorsements , PRODUCER ADT 34 ore&Gray insurance Agency,Inc, o Eztt South Dennis,MA 02000 ma ro ere way—,Com No 1877 816.2156 4—PAIR(s)AP O D O 0 WERACIE NAIC# iNsumEnAiP2erless Insurance com an 24198 INSURED INSURER Safety u an a Com an 39454 1 Reardon Circle Cape Cod Insulation,n,Inc, u Endurance American 8 eclalt Insurance Company 41718 South Yarmouthh,,MA 02884 iNsynEsDiAtlentlo In urance C m an 44326 INSURER F 1 gOVERAGES CERTI13 ,. 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 CONTRAOT OR OTHER DOCUMENT WITH RESPECT TO WHICH'PHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE IN8URANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITION$OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED SR TYPE OF INSURANCE ADDL ovum BY PAID CLAIMS, PO IC eFP POLICY NUMBER LIC eXP A X COMMERCIAL GENERAL LIABILITY LIMITS CLAIM;•MADE �X OCCUR R/O 09P8263063 H U 1,000,0 04/01/2017 04/01/201a DAMAGE RENTED 100,Oi M P one r h 5,01 LAOOR LIMIT AP ;PER; A I J Y 1,000,01 X POLICY�I*' "L03"'D 2,000101 OTHER! OMP/OPA00 2,000,0( AUTOMOBILE LIABILITY CO BINED;I 0 E IMIT ANY AUTO 6232707 COM 01: 04/O1/2017 04/01/2018 R�R7E0�8 ONLY X ULEppp a OIL INJ Y Per Person) _s X AUTOS ONLY X AVT09 Op7[Y ODI U Per uidenl 1,000,0� �ieOPER� AMAOE r+ 1 UMBRELVA LIAR X OCCUREXCESSLIAO CLAIM;.MADE R/0 EXCIOOO8635001 04/01/2017 04/01/2018OCCURRENCE $ 2,000,OC P�' DED RETENTIONS 0 R 0 D �"r�� �to°>9rPsNla�j(Q F Agf�regate 2,000,OC �A yPR�O�PRlE Q�R�/PpRTNER(EXE CUTIVE WCE00431902 OT eri0deforyFln�H)'ExCLV0ED7 � NIA 08/30/2018 08/30/2017 X PE IDE 1,000,00 .. II YYee deeorlbevnder DRIP ON E96OF 0 ERATI Iow E, DISEASE•E MP EE 1,000,00 E,L•DISEASE•POLI Y LIMIT 1,000,00 D%RIPTION OF OPERAATION8! OOATIONB/VEHICLES cACPRO 101,Addlllonel Remarks Schedule,may be attached II more space le regvlred) orkore Compense►lon Inofudes OHIcere or Proprietors, Iddltlonal Insured statue Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, 9HQLD ANY OF For Informational Purposes THE U EXPIRATION THE ATEV THEREOF,e NOTICEDsCR 190 POeWIIBE LLC82 DEL VEREDORE ACCORDANCE WITH THE:POLICY PROVISION$, IN AUTHORIZED REPREBENTATIVe ACORD 25 2010/03 01988.2015 ACORD CORPORATION, All rights reserved, The ACORD name and logo are registered marks of ac:nRn Town of Barnstable `Permit# Expires 6 months from issue date Regulatory Services Fee h,. 2 MAW* s,►atasrns�. � N . �� Thomas F.Geiler;Director 1639. 1 b161�0 Fa nto'+" Building Division . Tom Perry,CBO, Building Commissioner 01 " '� PERMIT 200 Main Street,Hyannis,MA 026 www.town.barnstable.ma.us O C T � ,0 10 Office: 508-862-4038 Fax: 508-74-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAI3',Q�?T,i�I'�F BARNTABLE Not Valid without Red X-Press Imprint Map/parcel Number Ol d(� Property Address Residential Value of Work . U V Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address AYW ' t� WP i &.Y-n e PA 1 76-1 Contractor's Name I � Q � ��/J(y 1 Telephone Numbe'r6 �'/r� `L Home Improvement Contractor License#(if applicable) ' Construction Supervisor's License#(if applicable) PWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name —LIJIA khAj Workman's Comp.Policy# ( Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) PRe-roof(hurricane ailed)(stripping old shingles) All construction debris will be taken to 17e i ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-sideV�t� r #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: pe Owner musts n ro erty Ow er Letter of Permission. A co f r-ov_ment Co tractors License& Construction Supervisors License is r SIGNATURE: C:\Users\decollik\AppData\LocaiNicrosoft\Windows\Temporary IntemetFiles\ContentOudook\DDV87AAZ\EXPRESS.doc Revised 072110 ti s�veras�. • . MASS.s63P :Town of Barnstable A�� - , Regulatory Services Thomas F.Geileri 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 Property Owner Must Complete and Sign This Section If Using A Builder rnQy X] �C�1Cao ,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) 4tature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOudook\DDV87AAZ\EXPRESS.doc Revised 072110 is oar• �� HOW CSSL low T dp. loam c� {•� -� �� OMke of Cowmr &B'35- CONTRACTOR �pROVEMENT Type: ' Win: 143074 p N- , won: 6115=12 DBA _ e GARDNER CONST . RICt114RD GARDNER - , 92 PARK PLACE WAYMAS)f EE.ma 02649 Undersecretary $ tmasua� a 1o�ur0 � , • cam Guam r - The Commonwealth of Massachusetts r---- Department of Industrial Accidenfs 1'- Office of Investigations 600 Washington Street Boston, MA 02111 y www,mass.go.v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Pie , e Pt L ibl Name Business/Organization/Individual): 1. Address: City/State/Zip: l� f :� �� }'hone #: zV `V, Are you an employer?-Che the appropriate box: Type of project(required): 4. I am a general contractor and I 1.[1 I am a employer with ❑ h 6. ❑ New construction employees(full and/of part-time).* have hired the sub-contractors., _ 2.El 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.$ .] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required 3.❑ I am a homeowner.doing all work officers have exercised their I Lo Plumbing repairs or additions myself. [No workers' comp. right of exemption per MOL 12.0 Roof repairs insurance required.] t c. 152,§1(4), and we have no q 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 arc 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 or not those entities have employccs. If the sub-contractors have employees,they must provide their workers'comp,policy number. f 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.#: h �1 7�� Expiration Date: Job Site Address: �� City/State/Zip: f~ b Y 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 MOL 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 tl IA for insurance erage verific'tion. Ldo hereby cerd tub r ie .14 the information provided above pis,trzip an correct.' Si natur Date: 149/,V ` Phone#: Official use only. Do not write in this area, to be completed by city or town offlciaL City or Town: Permit/License# Issuing Authority (circle one); 1. Board of Health 2, Building Department 3, Cite/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person; Phone#: a 06230 P.1 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYYI 10/25/2010 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(les) 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 certiRcate does not confer rights to the certificate holder in lieu of such endorsoment(s). PRODUCER _ .NAME: - Schlegel 6 Schlegel Insurance Brokers Inc PHONE FAW (A/C,No,Ext: (A)C,No): 34 MAIN STREET -1:-MAIL . ADDRESS: PRODUCER CUSTOMER B)0: West Yarmouth, MA 02673 - INSURER(S)AFFORDINO COVERAGE - NAICN _ INSURED INSURER A PHENIX MUTUAL Richard Gardner Dba Gardner Construction wsuacR DLZBERTY MOTIIAL 92 Park Place INSURERC: - INSURER D: Mashpee, MA 02649 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. IN POLICY EFF POLICY EXP TR TYPE OF INSURANCE INSR WVD - POLICY NUMBER (NM/OD/WW) (MMIDDIYYW) LIMITS GENERAL LIABILITY A CPP0709341 FacrloccuRRENCE _51,000,000 COMMERCIAL GENERAL LIABILITY "DANIAGETURENTEIT X 08/20/2010 09/20/2011 PREMISES(Ea occurrence) 150,000 CLAIMS-MADE FxD OCCUR _ MED EXP(Any one parson) 55,000 PERSONAL 8-AOV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEWL AGGREGATE LIMIT APPLIES PER; PRODUCTS•COMPIOP AGG s2,000,000 POLICY JECT LOC - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 3 -- (Ee,accldonl) ANY AUTO - BODILY INJURY(Per Person) $ ALL OWNED AUTOS , BODILY INJURY(Per accident) 3 SCHEDULEDAUTOS PROPERTY DAMAGE 3 HIRED AUTOS - (Per acUdom) NON-OWNED AUTOS 3 3 UMBRELLA UAB OCCUR - EACH OCCURRENCE 3 EXCES3L1Ae HCLAIMS-MADE - - AGGREGATE- 3 DEDUCTIBLE $ RETENTION 3 $ WORKERS COMPENSATION WC2-31S-37635E-010 02/27/201002/27/2011 X AND EMPLOYERS'LIABILITY /N - E.LEACH ACCIDENT ER. B ANY PROPRIETOR/PARTNERIEXECUTIVE Y� CIDENT 3 lOO,000 OFFICEPJMEMB£R EXCLUDED? I X I N 1 A - (MandatorylnNH) 1- E.L.DISEASE-PA EMPLOYEE a 100,000 If yes,describe under - - DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMIT 3 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Atlech ACORD 101,Additional Remarke Schedule,a mom space to required) - - THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR RICHARD GARDNER CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLF 200 MAIN STREET SHOULD ANY'OF THE ABOVE DESCRIBED- POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN HYANNIS, MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RESENTA FAX$508-790-6230 01981MM9 ACORDICORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are reglstered marks of ACORD _ �i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel b Application# lV Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee ll Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address e725i— Village C-eVeYy_L k-e_ Owner TOV1- tA VVQ V 4l Address Telephone (s (1 —,������o a7 Permit Request c o V\_ Q0 ov- Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new -Zoning District Flood Plain Groundwater Overlay roject Valuation 0 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 ❑No On Old King's H{ghway: �W Yes_.. ❑No Basement Type: ❑ Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq fto- N Number of Baths: Full:existing new Half:existing c ' ew z Number of Bedrooms: existing new , Total Room Count(not including baths):existing new First Floor Ro m Coun 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 0 new size Barn:❑existing ❑new size Attached garage:0 existing ❑new size Shed:0 existing ❑new size Other: oning Board of Appeals Authorization_-O__Appeal# ommercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name- .ei.c �f4(Q `C�` Telephone Number L5 Or Address License# d Home Improvement Contractor Worker's Compensation# W(L Co ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO S tsJ✓l.. i/?4oti i�cTZ � A. SIGNATURE ce- cQJ DATE C? a f 7 + FOR OFFICIAL USE ONLY r- r • k PERMIT NO. DATE ISSUED MAP/PARCEL NO. ~ ADDRESS VILLAGE OWNER DATE OF INSPECTION: a FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH FINAL 0 GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111' www.mass,govIdia Workers}. Compensation Insurance Affidavit: Builders/Coiitractors/Electricians/�'lumbers A,pplicant information .Please Print Ee ibl ` �` LL: Name(Business/Organization/Individual): . ( U �� Address:_ e Woa& X, City/State/Zip: 0,-YA9�� O oGOI Phone.#: SOS'•' a-C �q / Are you an employer? Ch ekthe appropriate bog: :Type of pioject(required).. ; 1. I am a employer with 2- 4. ❑ I am a general contractor and I * , have hired the sub-contractors 6, ❑New construction . •erQployees (full ar�d/oz part-time), • 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. employee's and have workers' [No workers' comp,insurance insurance,$' 9. ❑Building addition required.] 5• ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their '3.❑ lam a homeowner doing ill-work . 11.❑Plumbing repairs or additions • myself. [No workers'comp,- right of exemption per MGL 12.❑Roof repairs inane.required.]t c. 152, §1(4), and we have no employees, [No workers' 13.❑ Other_ comp,insurance regiiired,] *Any applicant that checks boz ftl 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 anew affidavit indicating such. :Ccntractors that check this box must attached an additional sheet showing the name of the$ub-contractors and state whether ornotthose.entities have employees, Ifthe 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 Comp any Name; � ✓��„ --t. `�-e— Policy#or Self-ins.Lic,#; W G s -(_0 Expiration Date; Job Site Address: ohs[ ac i h 3T G`ity/State/Zip ��VCr�2yy Xe M Aoo� 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 penair_es 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 ire of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the O:EE,-ce of Lvestigations of the DLA for inst,=once coverage verification, I do hereby certify u r the pains and penalties of perjury that the in provided above is true and correct. Sim'Mature: Date: Ji ofZcial use only. Do not wrire in this area, to.be completed by.city or town officiab City or Town: .Perrr�t/TLicense# i Issuing Authority(circle onEj: '{ :1,Board ofHealth 2.Bull rrgDepartment 3. City/Town Clerk 4.Electrical Inspector 5,Ph nbinQ Inspector 6,Other Contact Person: Phone#: lvlassachuset�s General Laws chapter 152 requires all employers to provide workers' compensation for their employees- Mass to+ems sta te, an employee is defined as"...e'rery person is 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 conu-nonwealth 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 cornmonwealth nor any of tts political subdivi sions shall enter into any contract for.the performance of public-work untii acceptable evidenee•af•conzpl auce with flue instance' 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-conti actor(s)name(s),address(es)and phone number(s)along with their certificates)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 fhe 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-ii=ance 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 necessity)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. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo 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 CommonwWi t of Ma=bus ds Dt partmi ezzt of ladusWal A.cd&mts .'Offict of 6..00 Wa"a_toii S1'ee . B•oE�on,.MA 02111 • ` TO.#61 7-'-.7-49Q.0 ext 406 or 1-8.77 MASS.AFB Fax 4 6.17-727-7749 Revised 11-22.06 wwCiF.I}2aSS.gov/dia From:Al2-(508)945-4048 To: Bldg Dept. Date:9/23/2008 Time:8:43:24 AM Page 2 of 3 MMIDDNYM ACORD CERTIFICATE OF LIABILITY INSURANCE DATE23/20 8 PRODUCER (508)945-0393 FAX (508)945-4048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eldredge & Lumpki n Ins. Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 697 Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chatham, MA 02633 INSURERS AFFORDING COVERAGE NAIC# INSURED Caliber Building and.Remodeling LLC, Steven Whi INSURER A: National Grange Mutual Ins Co 14788 INSURERB: Granite State Ins. Co.-ARWC 13102 147 Ridgewood Ave INSURER C .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. INSR ADDT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSR DATE MMIDD DATE MMIOD GENERAL LIABILITY MP027360 09/15/2008 09/15/2009 EACH OCCURRENCE $ - 500 OOO. X COMMERCIAL GENERAL LIABILITY" DAMAGE TO RENTED $ 500,000 CLAIMS MADE Fx] OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 500,000 GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY JPE0. LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ ` AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE -$ - OCCUR ❑ CLAIMS MADE - AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND - - WC8266485 03/02/2008 03/02/2009 WCSTATU- OTH- EMPLOYERS'LIABILITY ORY LIMITS R $ B ANY PROPRIETOR/PARTNER/EXECUTIVE - � � _E.L.EACH ACCIDENT 100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS]VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpentry , CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIF !'_E CANCELLED BEFORTHE EXPIRATION DATE THEREOF,THE ISSUING INSUR$ ILL ENDEAY/OR TO MAID . 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE- OLDER NAUS TO TFIE LEFT, Town of Barnstable Att: Bldg Dept. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE N OBLIGATIOWOR LIAO-Ty 200 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REP ESENTATIVg,S' m Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Alan R. Long, President ACORD 25(2001/08) FAX: (508)790-6230 ©ACORD CORPORATION 1988. Board of Building Regulations and Standards Construction Supervisor License ' License, CS 95038 , B�rtgdate 2/29/1964 ExpIratIon 2/28%2010 Tr# 95038 1 '` � Jtestnctiorr -0(l�, I STEVEN WHITE` 147 RIDGE WOOD AVENUE HYANNIS,MA 02601 Commissioner ✓JZ2 \ Board of Building Regulations and Standards �' ! HOME IIiAPROVEMENT CONTRACTOR egiStratl= 15,4359 Explri t" 2 8/2009 Tr# 254412 Ltd Liability Corporation CALIBER BUILDING AND;REMODELING,LLC. ,i STEVEN WHITE ;5 147 RIDGEWOOD AVE ` HYANNIS,MA 02601 Administrator i jw j t'"y �p�,t�yNt`� ^'��Ms z� r`a� wc� �.{S`�•4:'.�`r'6 f� a�. +'a$'� . .iS i^` K` +•L ' ` •"27 ,,etF Pit Y _#+ 14$ .. }{v �� gat "K € : T a pr kMa y� s � # ri �., ,$'� iYf. ,1 c^-x� • Allowances: ❑ Bathroom door ❑ Pedestal sink ❑ Water Closet ❑ Faucet ❑ Tile ❑ Total $700.00 General: Drawings provided by contractor. Layout to be approved by customer. All work and materials supplied to conform to MA building codes. Contractor to supply building permit. Removal of all debris included. As stated in the above specification we propose to furnish material and labor for the sum of: Seven thousand, Four hundred dollars ($7,400.00). Payment schedule as follows: $2,500.00 deposit and $2,500.00 upon completion of rough framing, rough electrical and rough plumbing and $2,400.00 upon job completion. All workmanship guaranteed for 2 years. Materials guaranteed by manufacturer. Any alteration or deviation from the above specifications involving extra costs will be executed only upon a written order and will become an extra charge over and above the proposed estimate. All agreements are subject to any accidents or delays beyond the contractor's control. Submitted by: Steven C. White, member Caliber Building &Remodeling LLC Acceptance of Proposal As stated in the above specification. The costs, materials, and specifications are satisfactory and are hereby accepted. I authorize the contractor to perform the work as specified and payments will be made as summarized above. Customer Signature: � K� Date: Customer Signature: Date: www.socrates.00m Page 2 of 2 PKI13-2•Rev.osroa taw. Ga v Lw FIXTURES : T ❑ ILET & PEDESTAL SINK 3 112 EXTERI❑R WALL --\, O ` KITCHEN LIVING ROOM EXTERI❑R WALL PR❑P❑SED PARTITI❑N WALLS EXISTING WALLS 251 MAIN ST , CENTERVILLE HALE BATH PROPOSAL The Town of Barnstable Department of Health, Safety and Environmental Services Building Division NAM 039. ��� 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: Name: CO /✓!MOLL P13k k A72-a--5 &5/P/0� Address: . � 0'6)J)-6;e VI LJ-L' Village: ems'( ""q Type of Business: Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance, provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit, located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. l � � Applicant: Date: /7 �S dssessor's office(1st Floor): Assessor's map and lot number Board of Health(3rdJloor):�-} g- Sewage Permit number Ar � `%4 i �f24X't�! +"✓!}I t, SAMS. ALL Engineering Department(3rd floor) �� � , �o yy House number o ,aye, -Definitive`Plan Approved by Planning Board -i19 �F - APPLICATIONS PROCESSED'8:30--9:30 A.M.and.1:00-2:00 M only .' c_ y TOWN OFF BAR�NST.A � , BUILDING "INSPECTOR APPLICATION FOR PERMIT,TO ��, S �CjV 1 00 G U O r \� TYPE OF CONSTRUCTION , Wp01�> Z19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Cam_ Location C45 / C'2y LLB Proposed Use - Zoning District Fire District Name of Owner � �` �• �QNINOLI_ Address Name of Builder s W 6 _ Address 15,Z-3 Name of Architect Address Number;of Rooms roL Foundation��OCaG,' Exterior CEgps�z Q�1 Roofing Floors�(�1�Pan"\ Interior t !— li.� 3`1����e Plumbing Heating_� 5 � Fireplace Approximate Cost , ^—" - Area 1 /ya"dre p Qn 1 Diagram of Lot and Building with Dimensions Fee 5 . M A OCCUPANCY PERMITS REQUIRED FOR-NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardi g.the above construction. F 5 � Name +)A )l,'_ "Construction Supervisor's;License Otto • CONNOLLY, KERRY A. A=208-102 (:9-0 No 34662 Permit For Remove Rehuild Roof r Single Family Dwellincr Location 2 51 Main -r et Centerville, Owner Kerry A_ 117 Type of Construction , Frame e Plot Lot Permit Granted C)ctnher 24 , 19 01 Date of Inspection 19 Date Completed 19 y. r 6 PERMIT COMPLETED 1/1/ :� 07 I ` Assessor's office(1st Floor): p 4 _��� Assessor's map and lot number ��Q ' f' SEPTIC SYSTEM >f INSTALLED IN! CO `` Board of Health(3rd floor),nn 4 � / ! yn Sewage Permit number /"/iS' i✓(f'%4 � ��j1 V k1h, - tr. WPTH TIT L t t E.• �«, .�i EtNF.rtr^�a�•e� DITAA LL Engineering Department(3rd floor): S /, �a j - House number. Definitive Plan Approved by Planning Board APPLICATIONS PROCESSED 8:30=9:30 A.M.and 1:00'-2 00 P.M.only chse R 0 D r1$tior TOWN OF BARNSTA I BUILDING INSPECTOR \� APPLICATION FOR PERMIT TOF p�(E '4 ��jU\1�j O0� � C�t�{� �i ice•/� ' I � �eT✓ti.��.�j TYPE OF CONSTRUCTION •W QOt] �^ Z G,19 _ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location l_ tL.try Proposed Use Zoning District Fire District C^ Name of Owner ��-� �• COQW Ll- Address a� ` Name of Builder W �a Address I Name of Architect Address Number of Rooms =CA_A�- Foundation1_;L9 Exterior C - � � Roofing Floors l 2�� 1�l,' Interior lZ �t' a�ZIC�L `C rA��-L1N Heating y 1c �— Plumbing Fireplace Approximate Cost 5-0a 01 Area /Uo l'e (2ApAl',e_ Diagram of Lot and Building with Dimensions Fee CIO OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ti 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regqrdiqg the above construction. t -- O)A Name Construction Supervisor's License nuu� u� `i —LLY, KERRY A. r -34662 REMOVE & REBUILD ROOF No' Permit For r, Single 'Family Dwelling � 1� _- - • Location- 25.1 Main Street Centerville Owner'—Kerry-'A'. Connolly Type of Construction' Frame a f ; r' ., I .a.. ,�...r .7t �. '.. ! j-1 1 r•—'.t --«; 'i(.: 1� ` . .,• ` Plot Lot f r� 21 Permit Granted! October-4 -=19 91 - } ��� Date of%Inspection - '':19 , .. Date Completed; 19 , ' S - `fa -+�r�'~ i_ •� � � � � , ,' ;.' r ,�5 ; - �,, ,` ;rat U .i PHILBROOK -- ENGINEERING 156 MAIN STREET YARMOUTH PORT, MASS.02675 1-508-362-9577 ENGINEERING DESIGN • CONSTRUCTION MANAGEMENT& INSPECTIONS • ECONOMICS OF CONSTRUCTION 30 April 1991 Reference: Foundation Inspection A #251 Main Street Cen terville, r - ille, Massachusetts ' 02632 For: Ms. Kerry Connolley c/o Mr. Peter Kelley Robert Wenger Builders To Whom It May Concern: I conducted an on-site inspection of the in-place foundation construc- tion at the above residence on 26 April 1991. This ;inspection was con- ducted at the request of the builders after their discussions with the Barnstable Building Department. The purpose of the inspection was to determine the existing failure and to recommend a method~of repairs. Background: The present structure is a small 15 ' x 24'„1 story wing used`"as--live-in quarters. The addition is a combination -of old and" new.% wood frame construction with a poorly framed roof structure . The wing is very close to the wetlands located in the rear. Current plans call for the replacement of the entire roof framing with a new,- more fully insulated ceiling_. Before any new construction is begun the existing foundation needs to be repaired as directed by the Building Department,. Observations: The foundation is in poor condition. The footing for tie 8 nCasonry block wall consists of a standard 8" CMU laid core down. The height of the wall is only one block. The wall was laid dry with- out mortared joints. The block work has settled, conforming to the lot slope, allowing the wing to assume a dropped rear posture. Plumbing for a bathroom has been dug under the right rear corner. The gutters --- are ,not functioning, overtoppping the low points near the downspouts at both rear corners. This action further saturates and consolidates the ,0 " soil under the block cores at these locations . The floor sits on a partial length girt of unknown make-upp The interior cross wall has also settled along its ' support joist. The soil appears free draining with no evidence of puddling. Conclusions: The existing foundation -is not a foundation. Any point Toads merely push the block into the soil as they do not have enough. ground bearing area. This could be seen at a jacking point under the bathroom. As the roof is going to be replaced installation of a new block foundation under the remaining structure will not be difficult: Once the roof is off three needle beams passed through the walls will be sufficient to lift the entire wing. Where the beams support the wall some " additional K' bracing should be installed thereby stiffen- ing the sidewalls so that they can act as spanning beams during the ppick. Incl. 1 provides the details for a new 6, reinforced concrete block 'foundation doweled to a continuous concrete footing. Respectfully submitted,. 1 . r2.Jv"'Pill,,tea% T. VARNUM PHILBROOK P.E. Massachusetts Registration:430690 as : 1- incl. - Foundation Plan ' PHILBROOK ` ENGINEERING FIELD REPORTIWORKSHE Project No: P9 .1 -L3 153 MATH STREET Sheet NO: Z Of YARMOUTH PORT,MASS.02875 1f0&332-9577 65 77 3 coV,t.)t) c «< 4 �o,sf �--�'� oaa al 77 1`E •1311T G1 \� 2CZ.lV-,.'2 r— —Z J Z:K(- . . 4 /0 � GJROP ��L pip -7 ,I �. Al �.IUC' u 's... U.U-1 -(} 1i0 ( — a T EPn C— -rz, OF MASsq(y/ �x ,s 7114 C-N T. ARNUM "J� Ul�lt)pTlOaf g R: :f'�'OK \ r Mr: aL v of I 7?�h 3i;oS0 �. Ado EG1 R�� �Q 3 Anrr n 1191- 00oDEF - ( ►�T S y P 5,► W d►d�L LS1 fl�.1 O Li tiri, C�un,:I III-a==.11l�- �uNDe���l w� 1)auLEI, W Do Q-EL- a Grzx� T -D iloll �- �',3'n*w v 5 O rat— WN t l E)51 n vuvs T'o,2> P82-FRW-7 ��QyoFTNETo�y� TOWN OF BARNSTABLE i BAWST"LE, i D pYa` BUILDING INSPECTOR r APPLICATION FOR PERMIT TO ..................... e.........`. Z .l14............................................ TYPE OF CONSTRUCTION ......................Vie. ...! ."...... 9.q TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: n fl Location .................. .. . ...... .1.Yi.....,?../,yy ........ ........................................................................... ProposedUse .......................... ...�.N. 'G' ....,l�.K .u. .¢ 7.le..................................................................................... Zoning District ........................................................................Fire District ..��.�, �T�lrkl/.aP�.Q.d �� 1�< 1 ................. Name of Owner .... ....Address ....!k5l... ................. Name of Builder O /�,e / ...�Z.1�...S"dl+f�•ln.e.r..�..................Address .....tjQ.1.u?.je.n. .r llie"el-zIle..................... Nameof Architect ..................................................................Address ..................................................................................... Number of Rooms .............,........ .........................................Foundation � Gl'.Pr � ..�lfXtrtr> 1. F�' Exterior ....�.��..1�....J.dI..I.Q.........................................Roofing ........... ' . ? .[. ............................................... Floors ..............co.xe"P.Qi�:............................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ... 1�..6.4�. ................................................. Difinitive Plan Approved by Planning Board -------------------------- Diagram of Lot and Building with Dimensions I-V c.49 �3 tv I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .N!.... ` �.'�O.fC .................... r Chaurette, Elizabeth H. No ...10.9.46... Permit for ......garage................. •_ Location .......�51 fain Stree. .t ........ . ......................... i Centerville ............................................................................... j Owner Elizabeth H. Chaurette { ...................................................... Type of Construction frame t ................................ r ................................................................................ ...........................Plot Lot ................................ i Permit Granted Decemb.er..15. ...........19 66 ............ .... .. .. Date of Inspection .........19 C, Date Completed PERMIT REFUSED I ................................................................ 19 , .................................................. ......................... ............................................................................... Approved ................................................ 19 .......................................................................a....... i .................... ......................................................... { l � T A AD 50 � - If Locus 11'711: El 0, C , 5CA L-F- CC)C) A-<5G-5'50Z MAY' H Ti E 211f 0 ne -ToA/k-) AIJAJ C LL I 'F%LL-(:D Qt rrt CAD tit L W.6 M 4'D4A vrac�oftac) \AjtT" A- MAPLe- :K.4 'v4t-Ri ? el 'J% 4 T� *�o(/� -'fit{- y� � #,v y ,. 'NOC/A L L lea 4pp, • v,/ T L A U AT 7-�4 0 4 A Tt-A VJAL(- 00 C tx 9,V o% + A CA 1A \�114 lot# 1AV, LA k AID 1 7C \ ") '\ i - 0 Z(, IN, C LAWN 9 1 ZI-7 A A -001 CT A� T C7 ? LA IQ 'eukc-e C-01'ace,em j-6 %Cin kk &S 2S 4-c-ti�-k :S-r-)5erH \//ALAR-16-T-i 13k- A okvJ oU-y 99 I PCr- 278 aeVAu(�, 1-51 t3Ay-TaL K Vv n 1 C-U-z MA !S S. PL M- 14o T--)Q---=- P-c7F:-'- -F,, 00IC- 3-?4-4 Pz)c--,C=. 14-/o IQ F r� AoK) N TER SULLIVAN Mo. 29733 LO AOC., t s' tog p �V1 61 C) '4'Oz>