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HomeMy WebLinkAbout0339 MAIN STREET (CENT.) r / .� ;� i. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee J Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village ��� Owner.M f!!1_ i/� G�h� /''y Address Telephone -Oe ��.�f ,permit Request //V ie Z�4'e'�V Square feet: 1 st floor: existing - proposed 2nd floor: existing propos? dtal nv. Zoning District Flood Plain Groundwater Overlay aT Project Valuation "rJI Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s Upporting ydocuntation. Dwelling.Type: Single Family ;k Two Family ❑ Multi-Family (# units) 14, Kim .ra Age of Existing Structure Historic House: ❑Yes 4�No On Old King's1Highway!-_❑Ye9 '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 size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # - Current Use - _ Proposed Use APPLICANT INFORMATION a (BUILDER OR HOMEOWNER) , Ff � Name.� ly3J1'd �✓ Telephone Number, Address ,�c �/� � lif� License# . /'l,4"e4'A Jz/, � Home Improvement Contractor# / Worker's Compensation # �,�oa ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i ear SIGNATURE DATE 'II s FOR OFFIC4AL-USE ONLY APPLICATION# F -DATE ISSUED MAP/PARCEL-NO. ADDRESS VILLAGE h OWNER DATE-OF INSPECTION: / — ;FRAME — — — — — INSULATION 4r w 4 t. FIREPLACE ELECTRICAL: ROUGH FINAL k. PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUFLDING', : . i DATE CLOSED OUT ASSOCIATION PLAN NO, e lix�srrcl►u.�ctts - Ue n u'tmcot of Public `al'rtN 13uartl 11 liaiiltlin� I:�,ulatinn, :Intl 1L1111iI:4c(Is construnction Supervisor License 4 &' L;cen�--.CSC 100988 r � _ HENRY CASSIDY ` 8 SHED ROwWl . rr1"y. bra, y WESfiF 1JARMOUTH, MA 02673 1' ; —y = — Expiration: 11/11/2013 Trg: 7620 \ ,, ����t-� ����;�l�y��.•a�r.,c��E�e�l��� ��f'C�!��cr;1.�c�c�<.��lc���1 k (\ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/?bl4 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 v _. e Updatc Address rind return card. Mark reason for change, l� Address; Lj.Renewal U'lliploynlent L Lost Card u �('rir�.uu rrrl<:rr.FllC O�C':6'('IJJrtc:'f'l[6.1r1'CJ 0114c nI t ou-sumer Affairs J Business,1,tegulati(in Li*nse or registration valid for individul use.only �w ' htOME IMPROVEMENT CONTRACTOR before the expiration date, if found return to: t e istration: Office of Consumer Affairs and Business Re ufatiou 9 153567 Type: b ',Expiration: 12/15/2014 Private Corporatiati LU furl:Plaza-Suite 5170 Boston,MA 02116 "API.CC)[)1111 cULATION,jINC' Inh[AI\O()NCIRUE .Si) 'f;1RP+10Lfl1-1 NIA 02664 Undersecretary of v;ll' witho I: oat re �`. Tfie Commonwealth of'Massachusetts Print Form Department of'Industrial Accidents Office of Investigations - � 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please .Print L�vibl Name (13uSlnesS/01-gtutization/Individual): f a Adciress: &VA&I ,(;i1y/Stab/l.,ip:____ V U►� ���' Phone #: 0�- 121 --- Are you an employer? Check t e appropriate box: Type of project(required): --- I. I am a employer with �10 4. ❑ I am a general contractor and l employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 3.U listed on the attached sheet. 7. ❑ Remodeling I ,un a sole propric br or partner- ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp: insurance comp. insurance. $ 9. ❑ Building addition required.] 5. 0 We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I ant a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions nt sel1'. No workers' com right of exemption per MG y � P� 12.❑ .Roof re airs insurance required.] .t c. 152, C 1(4), and we have no �j ���rj� l /D employees. [No workers' 13Y Other comp. insurance required.] any applicant that chccU box#I must also till out the section below showing their workers'compensation policy information. I lomcowners who submit th.is affidavit indicating they w-e doing all work and then hire outside contractors must submit a new affidavit indicating such. tCoutractors that check this box must attached an additional sheet showing the name of the sub-conu-actors and state whether or not those entities have cmployecs. I I'the sub-contractors have employees,they must provide their workers'comp.policy number. I atn an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site inf r,rntututn. / /► Insurance Company Name: (�(V l�L au I�l�yGtV GtUI G Pi Policy 9 or Sell=ins. L,ic. #: WCA QDz�2Z' � Expiration Date: Joh Site Address: 3 f,/j�r�i,(/ ��+,� � : ; �� City/State/Zip: ©,? 3 2— 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 line up to$1,500.00 and/or one-year imprisonment,as wel I as civil penalties in the.form of a STOP WORK ORDER and a tine 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 ofthe DIA for insurance coverage verification. I do hereby certi .,'rifler the rains-OW penalties of er'ury that the information provided above is true and correct. Sin;utlre: r ' ' Date:de 7 i Oflicial use only. Do not write in this area, to be completed by city or town official. I ('ity 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#: CAPECOD-27 MYOUNG DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 7/812013 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). CONTAPRODUCER License#PC-5514062 NAME: Margaret Young Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte,134 A c No E t: (A/C,No South Dennis,MA 02660 AI DRESS:myoung@rogersgray.com. INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:PEERLESS INSURANCE COMPANY INSURED INSURER 13:COMMERCE INSURANCE COMPANY Cape Cod Insulation,Inc. INSURER C:Evanston Insurance Company 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,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 B POLICY EFF POLICY EXP LTR R POLICY NUMBER MMIDONYYY) (MMIDDNYYYI I LIMITS GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CBP8263063, 4/1/2013 411/2014 PREMISES Eaocaarence $ 100,000 CLAIMS-MADE F OCCUR MED EXP(Any one person) $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY Ee accciden ED SINGLE LIMIT $ 1,000,000 B ANY AUTO 13MMBCKVMK 4/1/2013 411/2014 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per ac ident) $ AUTOS AUTOS NON-OWNED NED PROPERTY DAMAGE $X HIRED AUTOS AUTOS ACIT)X X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 + C EXCESS LIAB CLAIMS-MADE XONJ453512 4/1/2013 4/1/2014 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION - VVC STATU- OTN• - AND EMPLOYERS'LIABILITY TO .LIMITS E D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN _NIA. WCA00525904 6/30/2013 6130/2014- E.L.EACH ACCIDENT -$ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) - E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1 000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ,. , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101;Additional Remarks Schedule,if more space is required) Workers Compensation includes Officers or Proprietors. Addtional Insured status is provided under the General Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Cod Insulation,Inc ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD . OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at 331 (Property Address) (Property Address) ' D , hereby authorize Can (Subc tractor) ' an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. k Owner's Signatu t x Date D .2013 ,ems CAPE COD -TO.WN OF SARNSTABtE INSULATION Z.? p26 3' ® 23 rl Fq® /Ie GArts 5 St U", '"U-CAM 9""'N" 1 BA01 6U- WSA'AT10N CLP—t 1-800-696-6611 Town of Barnstable 8ic's `l 12ra)13 axns able Regulatory Services Building Division 200 Main St Hyannis, MA 02601 a Date: d / 3: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds Federal &State Requirements. Property Owner Property Address. Villa e Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted , Ceilings ( ) (X ) 31 ) ( ) . Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls Sincerely kCod y Jr, President ulation; Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION BUILDING to Map e y Parcel I ZS Application.# Health Division APR2 7 2017 Date Issued (�- - r tat-- Conservation Division OF19AR , T SL Application Fee Planning Dept. ermit:Fee °- 00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 33cl N J4 t' 0 Village 0_.LAeX_0 I Ike-, Owner_M 1 P� P 14 )1 'Address IUA k)!Sl Telephone "�7S ' ��C! UXXI AkC MA 0 3a Permit Request,900 S C")S QQ DA1:9 r4iC, Q_Q�, Q Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Q0. 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 Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: . ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/co.al stove: ❑Yes ❑ No Detached garage:`❑existing ❑ new size_Pool: ❑ existing ❑ new size = Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes @-1`15­ If yes, site plan review # v � n Current Use Proposed Use t APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Namfi��EEFQ l Q%�c� &Telephone Number 729 Address RMAA9 License# V d � QQ A -_ 1 Home Improvement Contractor# &S III " � (1 EmaMM01I-I ` p�--�Q,if611� ,W& - LO►'VArker's Compensation 400—(00t5315'QpI-/a+ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 09 QJ� MU -1y 0 ILL pht"Ag M na �(6 SIGNATURE DATE �t FOR OFFICIAL USE ONLY w. APPLICATION # s DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE r. OWNER DATE OF INSPECTION: 4 FOUNDATION Y FRAME ' INSULATION t 'r FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING � DATE CLOSED OUT ASSOCIATION PLAN NO. Y The Comniontvedith of Yassachusettv PF •� De ii€rtnieid Ittrltrsttitil ccirtetlts l Congress Street, Srtite.1011 RJR Bvstonr t't 4 02114-20.1? 'R w v inass.gav dilt: Wu'ker '{'rim;ictifiatizealzastic�asice Afftttiwi#: ,x�it+ke`rsff�Vcl tract r,r lr.Gtrician tl'te naIbers. I'0 BE FILITH`THE.�PER SII"CT FILED tit` ING ' tUTKOlti n,� : .. Sp icanl`Information � f'ivasc Prenk Lelyibtw Miniv i7�us!eaSIL}r anlca;.or T,i�t a �tlwi`E � 1 f t 1t-1G i t1 C I�G n C Address:.,,I. Ci 2� �:ty/5tate/Zip, (; �A" t _t, � t Phone #i �­7 Are youan ernplover Chcck tilt dpprnpreatt izrox t 0 Type of project frequireeij, 1 1amsCn7p ,rrviti nplw;.`t'fItIi,altL'urp},.tite�.' 7r Nvvvconstructi.on 2 i nm a sake pitlFne m Ur 1 irttec-Inu art i+.4c no rmaio,t'-5 twor ul_ f'r ring u _ J ker-niodeling anv U dcit,,, No wt>rkrrl Exim .ulsu. nc, required �"''� - L tl DetT1;JUU01t a ho+a7 ownerdvEtag all aini'r v,el#.('vo ua.k.e; ur rI rti�aran t t;�:�tn,red i ¢ tL© ( uilit�g<sdJ€ttc�. 1 h' 0riC an��r)-_prs>pt:ry_€wr€E cnssre that aN conkrac prs vtftte$'iuv vr>rk.s cc mp xv akrr,n,ns sa cc rr sre 4 to .I..E3 Electltc3# rCoai or additions p optett>irs cwrrPz ntt;em royees: ??...0 r'Iunibiili�rt ratrs or additirans . 3,M t.0 t a ce:,trat contra::e,zr arn'i have hrresj 'a at b cadtre rota Irtrw on the a urnerf slis', t suk�<rtne ut<srr , 3,� d r5tcTuha n 4�fllcicccr,rrtapl a i p r i El 152 a t°4 and wt' zv ,w c iplivecs [No workcra'tarnit.;ttsura!cc r iiinc 'Any checks Lzt ,Al.nit6 ilsa tell out*hesectioll he'10 k huwirtg rlteie ur.ee€"=ttz tt[,ea; on paircv-infne nakio j t Humeuwner wh ubmlt d s ar l t+ii ineicjTine,they r!ors n a l wok and lter,'here ow iJe tun&actor m,st stibrtta at new x€ €1 iv.t tit rtatin s rh.. {a t r ,tin=t Era ce�k rl,i,bat.n st atirsr ttcJ W%,addirkmai she tt,tovtia ng tlit uan:c uE,hy Flii ccinzr,i4tdrs.mc 3Lake.ttitsether r7c:n at Chas enktties iiaq'e �motr4y'er Ititlz->ab soria cbr�3izt cl t,iav t ;'t[P rnu st,prr~6de^,fit wofket ur cr•numbe, nY �r. ..P-p� 5. s,. 1 ant an<etiililnyer tlidt'fs proviitinr;workers'compensation insitrance:.for iiiy eirrpinyees.-Below is the policy land job<3tte information. { 4nskirance ©tnp is yaame wL ii t I fl / j Polley Or jr it tn3 L c r.t �. 7c * �) t 33 f C i 431t�ti1)t7 b ttr /� { I ! Job Sae t'ttdre j 1: UlviState/r�ynum Attacha ciipy of thew,zriters comp nsatiiio ti(iev tl claratirfi p tit.(shoyy:In t#tcttnla er and expir,tloiiidatc): Failure to Sec lle cclvvage aa'i.equire:l tinder€NI(_�fr 152,§'25 A is-a cr o On v 100,x a � e a , {t and/or one-year ae wdl as Liv � o Ca { iT )' ) f2C} t . arr � }= 3 ' -day`:teainstthe viiifator 1 crspv o Fthis statl€?tent ma be:tb ;d to the(`) fsc.r~I nveI aticrs oft heDIA C;�i 1_ crr irut:ruzci ce,ver�e v�rificatictn, I do hetetry reridj jtr under the pains at of I e;rjiary drat-the info r.n:rttiirri pruniilr t''qjiti Are rs r.e nriiC,rirrect: na �I 13ttJrt ,. t�ltt Y'tone Of Jicinl it.ie. l7irnot write in this cireci;tri be erimfrleterl by eity or tuxdn nffriaty +`ify or`fotivtt:w aW... I'etmitiLiettse #' . N%uin Authority{tattle tlnc l f.Board of Health Z.Buildii Dpartnient 3 f iiyIlfowh IIe k 4.3iettrio) In-spectt in, nspe for? t 6.Other i C:outact t'ersou.. f'#tone V: i ® DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 03/16/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). NT PRODUCER NAME:c Rogers and Gray Processing _.._._--._._.._..... ----._...._...._..........._.._..._...__. —._._.....__....__._........_._._..........._..._....._..._............. ROGERS & GRAY INSURANCE AGENCY INC _mac"N,E... (5os)398-7980 „ ._........__.___.__._.__.___"_..._.__� aooResS, mail rogers ra .com 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIC# SOUTH DENNIS MA 02660 INSURER A: AIM MUTUAL INS CO 33758 INSURED - INSURER B: .-----"._.."---............. _.._._._...—_...---------------------._.......__..__.._..---- FRONTIER ENERGY SOLUTIONS INC INSURERC: INSURER0: 502 HARWICH ROAD INSURER E BREWSTER MA 02631 INSURERF: COVERAGES CERTIFICATE NUMBER: 134675 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE �RT ADDL INSD SUBRi POLICY NUMBER i MMIDDYKYYY MM EFF I C Y xP LIMITS COMMERCIAL GENERAL LIABILITY [PREMISES EACHOCCURRENCE $— ETd FtEi1TE9--CLAIMS•MADE OCCUR (Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY S" GEN'L AGGREGATE LIMIT APPLIES PER: ' GENERAL AGGREGATE $ POLICY❑PRO- JECT EI LOC I I PRODUCTS-COMP/OP AGG $- OTHER: i (. ----------.._..------ $ it AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT $ ' Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS _—J AUTOS _—.......... ..._._._._ NON-OWNED PROPERTY DAMAGE $ _ HIRED AUTOS —__ AUTOS I $ UMBRELLALIAB " _ OCCUR EACH OCCURRENCE $ li EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ -----_--. —_....--FT ....----.._........---'- '-'--'----....._....—.— DED I I RETENTION$ $ WORKERS COMPENSATION PERX STATUTE OETH AND EMPLOYERS'LIABILI Y Y I N ANYPROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? N/A N/A NIA VWC10060153152017A 03/14/2017 03/14/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 " If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S 1,000,000 I i N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER 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. Frontier Energy SOlUt1011S Inc. 502 Harwich Road AUTHORIZED REPRESENTATIVE Brewster MA 02631 Daniel M.Crowley,CPCU,Vice President-Residual Market—WCRIBMA i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD � / , acl If or registration valid for individual use only License Office.of Consumer_affairs do B11siness Rigulanun before the expiration date. If found return to: z HOME IMPROVEMENT CONTRACTOR t Type• Office of Consumer Affairs and Business Regulation X' Registration: 160854 10 Park:Plaza-Suite 5170 3 f Expiration 9%812018 LLC Boston,NIA 01116 FRONTIER ENERGY SOLUTIONS F FRANCIS SHEEHAN r, f 502 HARWICH RD _ 5 z. __. ... BREWSTER;MA 02631 Undersecrct try N t gat` ithou signature t I Construction Supervisor Specialty Restricted to: `�8assachuse�.s Department of Pobfiv Safety GSSL-IC-Insulation Contractor ? Board of Building Regulations and.Stand rds L�icer7se_ CSSL-10.5941, 4FrIl J - construction .`_e j1�"3�'L'{sor p£'c i�.Wi} FRANCIS S SHEEHAN 502 HARWICH RD. BREWSTER MA 02631, Failure to possess a current edition of the Massachusetts r State Building Code is cause for revocation of this license. Faun- DIPS Licensing information visit:WWW.MASS.GOV/DPS 0 illm;ss°otter 02117/2018 i � E I� I rrow n of BarusOblc R�Mdlq Division �� xnir�rai�.n Y2�rktar�l�.Seali,�i�-ec:ttir 'Lam Periy,BuA ing,Cunums'ioner 200 Maki Str�t,'L'lywi it,NhA 0L601 s�-s�.na;vu.t�ar'nstal�Ie_na.r�s . Of'fiee: 508-862-4038 Ax-4 508-790-6230 prop�rty Owwr Alwt lnplc-tc.,axld`$ig Tl ins Sectioll. i since Bu lder , .... r ref t11ect - l�`� ' exe i au h� ze ;�} .( L I �uku} o^.s to as da n--iy bebZ- u zssarcez5 r�Ia vt'to �c� k:authmizedl t� is bu�tiin;petit appEcat�=gin for_ 3 a ` fr,()A n jj eO C C al NnjAk_m C,,4 '3�, .YC •' 'oc�l fmices and alj,= are t'he resp6-Tis l t,,�To the apphcaut. Pool: ire zzc r0'`be.fl1ed car urd bee fzce is iralletl and A-, fixw �.zzsp�rti�zz$ are-pet=�rirrnc�anc�� ce��t�t�.: Si,�natuz .of.Qwner. S:-rn nre of Appkani tk not Name Prime Nam De Q:�CJR?+�1S:C�1'��'.F'�'.k'wR1.r S51�hPP4X23:s s RISE Engineering I .. 5 Dupont:lveo tic.Soul hYal•Inoat It,,NLAi12(ifi4 EN CONTRACT ENGINEERING � � O 508-568-1926 FAX 508-568-1933 Page 1 . PROGRAM THIS CONTRACT ENTERED INTO BETWEEN RISE CLC-1-ILS ENGINEERING O TI4E CUSTOMER FOR WORK AS DESCRIBED LOW CUSTOMER - PHONE DATE CLIENT 0 WORK ORDER MA(t'[HA CHA!'It.UT - (5OK.)775-6091 _73;1/2017 146983 24505 _.,._ ._ ..... - .' SERVICE STREET BILLING STREET ....... . • •..., ._........ .... ....._ 339 Minn Street 339 Main Street _ ._. __......_........ .. ................. _�....__.... .. ....__..... SERVICE CITY,STATE,ZIP BILLING CITY,STATE, ' Centerville,MA 02632 Centervill . 1A 02632 JOB DESC I TION l It At f-i&SAFUYi A Blower Door Test will not be onducted at your ho I. due to the presense cif ashestos. A'1"1'IC'I'LA'f:Provide labor and materials to install an 8"la'ur of 1t-2 "lsLes I Cellulose added to(300)square feet of floored attic $600.00 Space. S%i'O12R(Ili tiAd7ltlLdt:I tonlcownLr is responsible for the rent al I'the stored items blocking the installation of fI kl (Initial") weadtenrttion work in the attic: Removal must occur prior )the se -duled work.tart. COMMON WALLS:Provide-tabor and materials to it a11:2"rigid both with the required fire rating to(Intl)square feet ofcommon � $385.00 wall,aria. 1NC'1 MCIVf3:I2ItiT.1 Engineering will appl,�tell pplicablc,Eligible incentives toXd.,,, ract. You will be billed only the Net amount, iti5.00 Currently,for eligible measures,the Cape l.',ht C;gNapact r>tyers 75�4f"incentirB,noexceed$ ,tlTlfl per calendar year,and an incentive of 100%for tlm Air/nuiures. For the safety and health of yodoor stir quality,we might be conduc �er door diagnostic ofthe availableair flow in your home both belbre the wond alley the lveatlicrizallon work is (it to be conducted iiasbestos is present).Wewill Also conduct a diagnosticfthe combustiontumcs inthe exhafwou TE�uin��sya value of$90 and is at no co- `file Permit will he secure y the insulation contractor 1T is has t e<alue of$?5t no cost to mu,tt is dw homco)wner's resi-Amsihihty to close oIicrnof Epic work. i Total: $1,150.00 Pro ram Incentive: $903.75 Cus Me Total: $246.25 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR E SUM OF 'Two Hundred Forty-Six&25/100 Dollars $246.25 UPON FINAL.INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT A14OUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 00 DAYS.SEE REVERSE FOR IMPORTANT INFOR).aAT1ON ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,,AND CONTRACTOR REGISTRATION. .,....,... ............. ,...,...__...... .....,..,......_........... ._.�......__.:_ ._...__......., ............. ....,...._ .. .._..... ............. ......,...,...._.. .... .. _._._ "1�"���.�.'" _,._,w_ .__ .. ... _ __._ _... .. .. ._.__._ _.._. AUTHORIZED SIGNATURE•RISE£ngtlslNrinOr" CUSTOMER ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ��� �.�....� .�._.t. ...... ......_,.„.,...w...�..._.___.._..____.___. ACCEPTANCE.OF CONTRACT THE ABOVE PRICES,SPECIFICATION$AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED,PAYMENT WILL BE MAD£AS OUTLINED ABOVE. ate: .✓ E h ��6 v '.c3;'i���, j 13 S S' .. y 1f �M i c r x `f !ff '1 ;a2b iY u - hyanrns')v,IA 0/-bu i RE: Insulation Permits Dear Mr. Perry, This affidavi is to certify th t all work completed at: Street: Ct J Village: 7-t7 has been inspected by a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds federal and state requirements. Permit application umber: IaJ-1 /Z3� L Issue date: Sincerely, Francis Sheehan President Frontier Energy Solutions, Inc. 502 Harwich Road Brewster, MA 02631 Office: 774-237-0410 Email: fssfrontierenergy@gmail.com SJI4 MEW Town of Barnstable Final Inspection Affidavit f Date: . Building Division 200 Main-Street Hyannis, MA 02601 RE: Insulation Permits Dear This affid Jt§' to certifX that all work completed at: Street: Village: has been inspected by—a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds federal and state requirements. Permit appli tin um er — I � Issue date: Sincerely, a Francis Sheehan President Frontier Energy Solutions, Inc. 502 Harwich Road Brewster, MA 02631 Office: 774-237-0410 Email: fssfrontierenergy@gmail.comGw nAr� °J� Assessor's map and lot number ... f 77- ='Li�w Sl=�Gr`r- 5 v ��� y Sr— O� kr0 IcGL Sewage Permit number ............. ............. � IGu.`r ........`'... ............ _ rioR s �v v' ��P�oFTHEto�yo� TOWN OF BARNSTABLE f 1 .4 e_oee f6,Az- T �/ Z EARNSTME. • ,639.E JulY BUILDING INSPECTOR Or• a APPLICATION FOR PERMIT TO .... �?'� `�f r.`?.C .... f'..r. E'�. ,a c�a f...... nl ✓!1nl�I.... ...... TYPEOF CONSTRUCTION ................................... ..... ..............................`.......................................................... ............ .. ...................19... ? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: /lr Location ...... .��...,.... Sf.cw.rr............. ........... .r'r✓:............................................................................................... ProposedUse .....X%a�.........�tiJ a..r!O...!!-?c... ............................................................................................................... -Zoning District ....... ... ... ..'2::............................................Fire District .......:................................................................ Name of Owner . ....................Address ..... Bti ! . Sf... .. .. 1 .......... Name of Builder .�!�!�?.% /a�" ............Address +� - '�f�^1A, � /�/ n��+� � . .........�. ..... ... .�. ............ ................... ........................ Nameof Architect ............. !` .............................:.........Address .................................................................................... Numberof Rooms ..........F�............................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Interior ............Floors ........ ........................................................................ U / /,) Heating ..................................................................................Plumbing .................................................................................. Fireplace ........................................Approximate Cost .............. 'J OCR Definitive Plan Approved by Planning Board ________________________________19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee __. .. �.... ........................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Ai I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. -,-7 / Name ... ..cl�n . .......................................... 19399 Kenneth Salimeno No ..193.99.... Permit for ...Swjj mmlng...P-oo-1..... ............................................................................... Location ....339...Ma.in..S.t...,... .................................. ............................................ .1 Kennet Salimeno Owner ........YM I q1V(�i V... ...S:afooa.................... Type of Construction .... .. Alum........... ............................ Plot ....208-118 L*N............................ at Jul4 j........ ....1977 Permit Grante .......... . ....... .. ..... Date of Inspect on ....................................19.....................................19 Date Complete . PE IT REFUSED .................................. ................. ....... ... 19 P..E... ..I. .R..........I ..................... .. ....... ....... ...... .......... .......... ................. ................................ .............................................. ............................................ .................................. Approved ................................................ 19 ............................................................................... ............................................................................... Assessor's mc1' and lot'number �P �-l��.. 77- .. 6�.#..... rCIT ST�wC 11 ^!v UST. i/ /f� ��!`e e- Ov A-c/ Sewa.g Permit number A'Ow� { T i :............ .. �G �f�./pL rGi [= ,� ���°`�"��°��o TOWN: OF BARNSTABLE SeS Iv sr 6 i EAEBSTAEL$; 1639. � BUILDING INSPECTOR 900�0MPYOr•e� r11 . APPLICATION:.-FOR PERMIT TO 1... .4?¢P.`�.G...........................�' . v ....... ....;.......... TYPE OF CONSTRUCTION ... .Y...................19..77 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... .a.7.. ...... . Y..........�.`......1...P!�.f...l�°�.:�`t ............................... ..... ......................................... ProposedUse ....:Y.....®�. ........./... r.•.!..`�N�......................................................... ................................................... ZoningDistrict ..............................+..........................................Fire District .....L....� � ..��.1. ..................................... Name of Owner .IlrewwE',A.J'�/�.t'!!.57.:....................Address Name of Builder ./.?`P.!�1. .... 1�0�..... .�"4r-...........Address ... 611V/ NN'..S...... Name of Architect ,! .fj U i ................ . ........................................Address ..................:................................................................. Numberof Rooms ........ 1 ..........................................Foundation ................................................................:............. Exierior ....................................................................................Roofing .................................................................................... Floors ........................... ..... ...`..................................Interior .......... Heating ........................................................... .............Plumbing :.-..-- .......... .. .-. .......... ........ .................... ........................... -- Fireplace L,U' p ..................................................................................Approximate Cost .......................,.............s.............................. Definitive Plan Approved by Planning Board -----------_______-----------19________. Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH y` I hereby agree to conform to all the Rules and Regulations of the Town of Barnstalble regarding the above construction. J Name ...ve...l< n...:.... .�4 .. ...... 19399 Kenneth Salimeno No .... Permit f or .....Swi Ag..P...o..o..l.... Location .*.a...CgrAtgx.v. ......... j A ............. ................................................................ Owner .............R@4n.e.th..s9.11mvp................. Type of Construction y. *.. ...............................Coaaxeltp.................. .......... Plot ........2A8 r.118. . Lot ................................ . . j Permit Granted .................... uly 1.4 2.19 77 Date of Inspection ................................... 19 Date Completed .........19 PERMIT REFUSED _ .................................. .. 19 y r ..................... ........... .................................... ................................... ...................................... M ` .. ................F. ...................................................... tit' Approved .` .... 19 ................................. ............................................ s Assessor's map and lot number *, /c ; rt!- 7 i y�S j-...... C'...L.... ..�.r.. Sewage Permit number ....... ................................... ..... �. �!f>C/�lhe- f r��Tif-�t r� ��e k•! �uff/C.h�,l�Pc 4 fTNEro�°� TOWN OF BARNSTABLE i EARNSTALLE, i ° a M BUILDING INSPECTOR nv a APPLICATION FOR PERMIT TO 'I•!.....A��It o................................................ TYPE OF CONSTRUCTION ..........IAU! l�.4 m .............................. ........... .:.. .`?�.....................19...%7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .. .:��.5'... �'?'� ..?....Sf...... ....?..ram........&......................................................................................................... ProposedUse ....A!4!r{ �/ /l/1�? ................................................................................................I......................... *Zoning District ........ :... �...............................................Fire District r;;..J,r e. Name of Owner ....................../. . / �s'?�e)....................Address :�;3�„/�1.,a.^^........................................................... Name of Builder +.k,, 1�wa��,a +}+p._}7� irr,rt/,C!'�S...Addressus� � �A ciN ................. r, ... Y. ............. .. .�. P Nameof Architect ' ......................................Address............................ .................................................................................... ,r Number of Rooms Foundation 5 //( !' n 4 Aj{ t .. ........... l..... ......... ..... ................................. •�! !`. //! .CAL.A,.................................. 4 I7 f'� S,� !A���I Exterior ..................... .............................Roofing ........�... ..._�_,..... ................................................... ., ✓J S�� uru� J � Floors �`� ' ! '�' .Interior r O c q/J�! ............................. ............................... ................. .,. ................................................... Heating I:.... :..............................................................Plumbing /U N� .............. ................................................................ A ' i Fireplace ........ v C) .........................................................Approximate Cost .... ..��U U.:............................................. Definitive Plan Approved by Planning Board -----------_______-----------19________. Area .... �...`� ..: !..�.... Diagram of Lot and Building with Dimensions f�?mil Fees ' d SUBJECT TO APPROVAL OF BOARD OF HEALTH r A C I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......................... .:................ Kenneth -Ssllmeno 9 98 \ J �9��8 No ---.--. Permit for Ad. ition--.-.----- -..��-..--..---.--.-..-.---.-.---.. � � Location ... ...... Owner U.4rQqAQ..................... . pe of Construction ........(Eriame..................... Plot 19.u98. Lotz........................ �Permit ~_...- uo/e or / ' � Date p .......... l9 --- ................................... V-----'---- ' V '---'-'— --'---_-'_ ---�.][.-~- .................... ' -'-~^-'-^----^^^^^'^^~^'~`~~`^-^^^^^^'' , � Approved ---------------- lA ^ '----------------^'`---'-'--`- -------'--------'--'^^'-'^^~~^^^'` H � Assessor's map and lot-mumber 7 7. ._... 0..._..... �. r..p Se"wage Permit number .......`./�:.../ ,...>` _ 6j J d w TNET��♦o TOWN` OF BARNSTABLE Di BASHSTAALE, i } "AB` i639 r,1 BUILDING � INSPECTOR 9�0 APPLICATION FOR PERMIT TO r sz �. .. ............. .... .. ...... ........................................... TYPE OF CONSTRUCTION ..........`. . ............... .......................................................... ci t sY W ' ...........7.`.................................19.2 TO THE INSPECTOR-OF*BUILDINGS: The undersigned hereby applies for a�permit - according to the following information: Location .. .�... .�'l�c ! ......C,,F! l ��I e ��Fr..o.................... ........................................ ................................ ProposedUse ....F1�1.°.y../Ioc)./K.•...........................................................................................................I......................... ZoningDistrict te '........ ..... ........................................................Fire District ... ................................... Name of Owner .....................Address .... .. ....,............. .....1. .... .................. Name of Builder/y4! .k. /yfQ/r?.t��i.Q .��O�'G.fA�F ...Address .a7J� L.1/Ffi�Ov � ° fS................ • Name of Architect ...............~. .....................................Address .................................................................................... Number of Rooms ......./.......6.................................................FoundationS'!a c ...Qh.. ..Q®. 4.............................. Exierior4. 11�c5. N. KX*...............................................................Roofing ...A S.. .SRO..�vF� ................................................. Floors �.cd �..... 1..�' Urt o/t� ...............................Interior .... ...................................... Heating Plumbing Fireplace ....... �. `9 .......6..............................................Approximate Cost .... d..4: 00.:. Definitive Plan Approved by Planning Board ________________________________19________. Area .y� 7 Diagram of Lot and Building with Dimensions Fee A SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..:.,�/� R.. .. .. ................ - Kenneth 0al 8 � No ..-- Permit for Addi.tiooK........... � � ^ —.—.��—..---^.—.—...----..--..—..~—.. ' � � Location '...3���'D�ai n.8t��.. 11la....... | � | � ` --,..----,--..—~—..—..—..—.-----. ~ Kenneth 8a12zueno ~^ � ~_.~. ....../........................................................... . . ��aou� Type of Construction --—----------'. .� . � -^''`--'—''—~----^—'--~'----'^'---'' ' ` . ^ plot .j9�98.............. Lot -----.-----. ' ^ - � � � | � . . Joly 14 ^! ' 77 Permit Granted .............................. ---lg Date of Inspection .—.lg � ^ - . Dote Completed .. 77 l/ ^� ^^ ' l� . ��..� — , ..y.----. .. , ' � L ' | ~ / ` - PERMIT REFUSED ' ' [ .~.---._—..—.—.----.—..--. 19 ..—..'....—...._,..—..-,....,—..�^,—.�..—.. ' / .......................................--.'-..-.. . ......,.—. — } ` �- .��� � '`-`^'~'---^`c'_^^^^'`^~^`~^—^^—_-----'. .—.—~.,..--..,..�--.-----'—.. �.---.-���. � — , 'r l� '° ~`~~ ------------_—`' . . ` . ' ---------~----.—.—....~...'--.—.— ' ---------------.----.......—..�^.. . . � K ' - ' ze Engineering Dept. (3rd floor) Map =�2d,f Parcel '// Permit#`_ S 2 S_Fs� House# !j Z'a •. D to Is ued $' Board of Health(3rd floor)(8:15 -9:30/1:00---4:30) Conservation Office(4th floor)(8:30- 9:30/1:00='2.00) Plannin Dep (1&1 floor/School Admin. Bldg.) d C 1. IANCE Definiti an pr ved by Planning Board 19 INSTALLE _ WIC DE AND TOWN OF BARN TABLDNVIRONM S TOWN REG TIONS Building Permit Application Project Street Address Village -, .�r Owner �� _ . Address `U . Telephone Permit Request ,r 000.0, { First Floor 1, e:7 square feet Second Floor square feet Construction Type r Estimated Project Cost $ TO,® o Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 2 Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing�_ New Half: Existing New No.of Bedrooms: Existing New i 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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) - ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name (_,.c f Telephone Number 4 `f l 7 Address License# 0,0 L12 '7,eC Home Improvement Contractor# Worker's Compensation# 16J<—' eeat2l ;2 7 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJE&WILL BE TAKEN TO E' SIGNATURE A� DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) *A r FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. F f�E •� ADDRESS rrf VILLAGE OWNER DATE OF INSPECTION: - FOUNDATION �'` •. + ,r FRAME ®' 2'3&Z _ ' INSULATION FIREPLACE ,. ELECTRICAL: ROUGH FINAL' ` PLUMBING: ROUGH FINAL- GAS: ROQ_GH € FINAL t FINAL BUILDING , DATE CLOSED OUT ASSOCIATION PLAN T0. rri © f t 1 I '� dFtHe�a . The Town of Barnstable IM& �0�' Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissions For office use only ' Permit no.__ Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW a SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, improvement,conversion, 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: Lt���1:L/.L�.s� '�'/� i Est.Cost_ Address of Work: 3 77 -OW' - '' Owner's Name Date of Permit Application: KZi 7 Z9 7 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 G 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: 0*4:za 4�ne / ,0 C/ Dalfi Contractor Name Registration No. OR PROJECT NAME: ADDRESS: 63 PERMIT# PERMIT DATE: O M/P: LARGE ROLLED PLANS ARE IN: BOX `D SLOT �r Data entered in MAPS program on: BY: . q/wpfiles/forms/archive I Y-j��t ---- - --- 6;e Cr or V t4t L Z4 -'71 1 i� 4Zi 17% c 1,4 47, 7/j ...... ... J' t 4� All 4L Xk.r2 77 IT 1 44 �J,'77 ® y o . f . ,oj � At pool 00 , o ctf v �d a �4,e*� 8