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M 9a f� G A r A h i p 14, F�.` I tl1. �,. l� r .>R w �, 4��1,`1 1 �I ° `%o,,.L' pup v 6, b f h U.' i. a _ f': Ifll r ¢l M t J p /q��, L r 1' '.'f fi d'. f P p r: ,l r w �,asm tat,t.,J,.,,, , .....M3, r.,.. .n.,:^.d., , ,..•,•, .i„ ,.� '`-;,,. t"=,._ r. ,. k,� � Y. �a 1 .d r .�a. ,�•. i- , k - r It-CRESS P RMOT 6 2s----/C flown of Bhrnstable *Permit# 7 5 2015 Expires 6 mo from fa•ue d Regulatory Services Fee n 1 v u TA B LERichard V.Scali,Interim Director Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www:town.bamstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address 136 esidential Value of Work$ b 60, 06 Minimum fee of$35.00 for work.under$6000.00 Owner's Name&Address Kl( 4J bbZ 44 ' -�7'„ itlf Contractor's Name b Vl 6- S rL U q Telephone Number Home Improvement Contractor License#(if applicable) Email: ' Construction Supervisor's License#(if applicable) D9 <nWorkman's Compensation Insurance , Check one: _`tam a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# �� W UU Copy of Insurance Compliance Certificate must accompany each permit_ I .. Permit quest check box) (=J ""roof(hurricane nailed)(stripping old shingles) All construction,debris will be taken to ttt, WWW ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. •Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Mstork,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of a Home Improvement Contractors License&Construction Supervisors License is t required. SIGNATURE: z/1'I TAKEVIN_.Muilding Ch ges1E CP P RESS.doc Revised 061313 �.. ., ' • ` ` s Sri 3/17A2014 Office of Consterer Affairs&Business Regulation-Mass•Gov The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer-Affairs and Business Regulation) Home Consumer.Rights and Resources Home Inprovement Contracting Home Improvement Contractor Registration Lookup You can search/fIter the'r ig'stration _t by•any of the crtera bebw. Search by Registration Number 134313 =Sears Search by Registrant Name �� Search by City - j pyCode •s,.,, :. ,F i#•, . . �.: . 4 _Search Registrants Click on the registration number to view complaint history.'You can alsowiew arbitration and Guaranty Fund history.` The Est is current as of Sunday, March 16,'2014. -- Search Results REGISTRANT NAME RESPONSIBLE REGISTRATION f fi EXPIRATION hV ADDRESS STATUS INDIVIDUAL. . , : NUMBER DATE w - SAWXI=R, DANID 134313 t 318 ME9GGS BACKUS 10/24/2015 Cunent _.:. CONSTR=" x. , FAD:' .. _ d,. sANDWICH, MA.t32563 ,. ©2012 Cornmonw eaith of Massachusetts. Mass.Gov®is a registered service mark of the Commonw eatth of Massachusetts. Massachusetts -Department of Public Safety Board of Building Regulations-and Standards r, •�. ;' l .1 ��llJtl VItIULL'JUtJt.Z-llUr Speci lltY' ¢s t • —. J. - _ , s .�_ License: CSSL-098859 DAVID R SAWYE 318 MEIGGS BA ("; . SANDWICH MA2025 %, •� Mass nxi efts tpartmen€of Pu c kafety $oard:ot tldmgRegptations Standards Commissioner 01/27/2017 s , ' - ..'Construction._ en isolr Spe 'alto License_ -09 DAVID R `318MEIGG� } SANDWI Expiration dlaJAserWces oc a state ma us/f>;cllicenseetist poc Commissioner- 011;t7f2015 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any'contract of hire, express or im}lied,oral or written." s s j 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 legallrepresentatives 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 anothewho employs persons to do maintenance construction or repair work on such dwelling house or on the grounds or build' appurtenant thereto shall not beca e of such employment be deemed to be an employer." MGL chapter 152,§25C(6)11se states that"every state or to ' licensing agency shall withhold the issuance or renewal of a license or permit operate a business or to c' nstruct buildings in the commoriweaith far any applicant who has not produced cceptable evidence of co pliance with the insurance coverage required." Additionally,MGL chapter 152, §2N (7)states"Neither the ommonwealth nor any of its political subdivisions shall enter into any contract for the perform ce of public work til acceptable evidence of compliance with the insurance requirements of this chapter have been p sented to the co cting authority." . Applicants ,Y Please fill out the workers'compensation affida 't com etely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addre (es and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or L ed 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 vit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. so a sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application forithe permit or license is being requested,not the Department of Industrial Accidents. Should you have any questionjenurnber%isted egardi�g the law or if you are required to obtain a workers' compensation policy,please call the Department at below. Self-insured companies should enter their self-insurance license number on the appropriate lin 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 Of ace of Investigations kas you regarding Y g �to contact re the aPP licant. Please be sure to fill in the permittlicense number w 'ch will be used as a erence number. In addition,an applicant that must submit multiple permit/license applicationin any given year,need `only submit one affidavit indicating current policy information(if necessary) and under"Job Sit Address"the applicant lould write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by th city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A ew affidavit must be filled out each year.Where a home owner or citizen is obtaining a icense or permit not related to y business or commercial venture (i.e.a dog license or permit to burn leaves etc.)saidiperson is NOT required to compl to this affidavit. The Department's address,telephone and fax numb�r: The Com�onwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 . Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax`.# 617-727-7749 Revised 02-23-15 A www.mass.gov/dia WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE .. ,•y AGENT NO 3020 OFFICE NO 3020 s: MARK SYLVIA INSURANCE AGENCY LLC 404 MAIN ST, CENTERVILLE MA.02632-2916 FARM FAMILY CASUALTY INSURANCE COMPANY _ 5087428-0440 NCCI COMPANY NO. 16721 po,UCY NO 2001W6406 INSURED AND MAILING ADDRESS. RENEWAL OF NO. 2001W6406 {` . a".,..EFFECTIVE 3/05/15 ... DAVID SAWYER ' OBA SAWYER CONSTRUCTION 318 MEIGGS BACKUS RD SANDWICH, MA 02563-3131 r THE INSURED IS INDIVIDUAL Workplaces covered by this policy: RTG.BUR N0. INTRASTATE NO. " ST WP NO. ADDRESS OF WORKPLACE 210677 r MA 01 318 MEIGGS BACKUS RD k.; SANDWICH MA [p• ,. << 1 i i . ., T . period 'is from 3/05/15 t0 3/os/1s 12.01 A.M. Standard Time `at the insured's mailing address The policy p , .'.... ....... ... ::::::::::........... Workers Com nsation Insurance: Part One of the policy applies to the Workers Compensation Law of A. R. _ the estate list here: MA Liability Insurance: Part Two of the`policy applies to work in each state listed in item 3.A. B. Employers• under Part Two are: The limits of Our liability under Injury By Disease, Bodily Injury By Disease . - Bodily Injury By Accident $ 100,000 each employee $ 100,000 each accident $ 500,000 policy,limit applies to the states, if any, listed here: All ,states C. Other States Insurance: Part Three of the policy pp a and ND, OHS WA, and WY except the states designated in item 3.A. of-,the information page <, _ - 3 D. This policy includes these endorsements and schedules:WC 00 03 15 WC 00 04 14 We 00 04 22A WC 00 00 018 WC 00 01 14 WC 00 00 OOC WC 20.04 05 g WC 20 06 01A WC 20 03 01 WC 20 03 02A- WC 20 03 03D x ' i t INSURED COPY PROCESSED 01/24/15 Copyright 1987 National COUndl on compensation insurance ti. «:Y, , a . WC 00 00 01 B Issuing Office - PO Box 656 • ALBANY, NEW YORK 12201-0656` " '� N17=14 Office of Consumer Affairs&Business Reg ulaRion-Mass.Gov The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation Home Consumer Rights and Resources Home bprovement Contracting Home Improvement Contractor Registration Lookup i You can search/fiter the registration Ist by any of the criteria bebw. Search by Registration Number 134313 Searc Search by Registrant Name Search by City Zip Code -Search Registrants Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The Fst is current as of Sunday, March 16, 2014. " t Search Results RESPONSIBLE . REGISTRATION EXPIRATION REGISTRANT NAME ' • ' ' ADDRESS STATUS INDIVIDUAL NUMBER DATE ® ► � ySAVIfYER, DAVID 134313 318;.MEIGGS`BACKUS_ 10/2412015 Current 'CONSTRI-JCTION --" . - •t::- � ... SANDWICH; MA.02563 ' _ . ©2012 Commonw ealth of Massachusetts. = - MasS.Gov®is a registered service mark of the Co"wriwealth of Massachusetts. !fit Massachusetts -Department of Public SafetyC—,l f Board of Building Regulations and Standards ��W construciiou Supervisor Saeciail-tv � License: CSSL-098859 .. DAVID R SAWYE r j 318 MEIGGS BA SANDWICH MA47025 - } ass 'sefts 0gpartmenf ftb6cafety `; Expiration .a B_ oard,of tldingReg flint : sand Standards Commissioner 0112712017. ' Gonstructfo vpe iso pecialty License: S 889 r , DAVID R 318 MEIGG AKU. s SkNDWI D7A.-025'_ . Expiration I ftp-l/services.oca state mai slivcAice seelistaspuc ;'Commissioner ; 01/47Q2015 1 l+ i The Commonwealth of M assadiuseits Department of Inrlrrsiraal Accidents - Office of Investigations •600 Washington Street Boston,AfA 02111- 1lavw:J71a5Lgov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ( Please Print Le 'bl Name(B�nenQrgmization&dMdwD: \/I \ A A ill_.A 7V�1 i t� IA,%- city/stat-izip: Imp Are you an employer?Check the appropriate box: - Type of ]project(re 4uir ea)= 1 I a employer with 4- ❑ 1 am a general contractor and I F �P Y 6. ❑New construction employees(full and/or part-time)_" hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees These sub-contractors have. g- ❑Demolition working for me in any capacity. employees and have workers' a q_ ❑Building.addition [No w orloers'comp.insurance comp.insurance.requiref -. d 5. ❑ We are a corporation and its' 10.❑Electrical repairs or additions officers have exercised their : 11. Plumbing 3.❑ I am a homeowner doing all work idh ❑ g repairs or additions myself[No workers'emp. right of exemption per MGL 12.Nhloofrepairs insurance required.]I c.152,,§1(4),and"have no employees.[No workws' 13. ther comp.insurance requirect] *Any apphrant that checks boys#1 nub also fill out the section below showing their v9Aei `amipensation policy iafaam 16M Homeowners who submit this affidavit indicating they an doim;g all'war$sad then here outride contractors mragt submit a new affidavit indicating mdL t ECcnuactors that check this bona must attached an additional sheet showing the name of tie sub-cmMa rs and state whether ar not those entities have employees. If the sub-cantmams have employees,they must gtvvide their n arkeas'rump.policy number. I am an employer that is providing,workers'compensation insurance for my enrployeex Below is the policy acid job site hiformatior6 1, t Insurance Company Name: Policy a or Sew ins.Lic-4: r>? 0 LAI( 40 (n Expintion hate: Job Site Address: 3P ltl�t- City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 t1#DIA far insymce coverage verification. I do herebyleender the 'ns acid pen s of perjury that the information proWded aboye is p7w and correct Si tune: Date: �. Phone#c f Official mse only. Do not wMe in this area,to be completed by city or town of cial City or Town: PermitUcense Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Y f Property Owner Aiust ~ Complete and Sign This s Section If Usm* ` A Buil er as Own of the subject property hereby authorize N r to act on my behalf, i { in all matters relative to work�authorized by this building ermit application for: } (A ess•of Job) Signature of Owner Date r Print Name If Property Owner is applying for permit,please com lete the Homeowners License Exemption Form on the F reverse side. b l • 1 • }! r Property Owner Must Complete and Sign This Section if Using A Builder . Cal L yj e kh� ✓ _,as Owner of the subject ' (/'W z to action my behalf; hereby authorize ' in all matters relative to work authorized by this building permit application for: (Address of Job) 12 j -Signature of Owner ateY i eP t Name ,u 5;`u+: � . ➢.r f s �.. 1xv. ♦L 4� � r� ,x +• .++ � �,"` -.._ ;.�., ., ,•.u r': `{ a �' `p`:;�i4r..x'�+...s"�� ." - rt '.:a � •3 S.' i if Property Owner is applying for permit;please complete the Homeowners License Exemption Form on the reverse side. - - -'-* - TAKEVIN D\Building ChangeslEXPRESS PERMIIIEXPRESS.dco h �' Revised 061313 David Sawyer Construction 318 Meiggs Backus Road Sandwich.MA 0256-3 508-539-1992 Proposal Submitted To: Work Address: Dr.Eric Webber 508-7370425 wife-508-737-5238 364 Main St Centerville,MA 0266 Worked to be Performed: . *Strip Roof House Only-Replace with CertainTeed AR Landmark Architect Shingles a Color-customer to choose *Nail Plywood as;needed *Clean Gutters as needed *Install: White Aluminum Drip Edge as needed Ice&Water barrier on all edges of roof,valleys and velux Underlayment Paper System. Pipe Flange Ridge Vent Hurricane nail shingles _ *Remove and replace trim as needed with pre prime pine trim *Recommend to replace skylights *Clean&Remove all debris from workplace,take to landfill Total Labor&Investment• $11,625 00 eleven thousand'siz hundred twenty five dollars Payment due at completion of job. All materials guaranteed to be as specific,and work to'be performed as stated above in-a workmanlike manner: Please remove and/or secure-anyvfragile honsebbld items.Not responsible for broken or damage to household items. Five year Labor Warranty/Plus Manufactures Lifetime warranty. Contract may be withdrawn if not accepted within 30 days., lease see back for additional terms. Respectfully Submitted i' Date Acceptance of Proposal The above prices,specifications and conditions are satisfactory and hereby accepted. You are y authorized to do the work. Payment d t completioq.of job, Owner.sigiaturc r77 F 1 T O Town � �,. of Barnstable ti ble Permit# 0 ' Regulatory Services`* �atvsrwaLa, + Eapires6onthsfro US Fee m MASS �! 039. ,b� Thomas F..Geiler,Director - rFD AAA'l A ' r . :j . Building Division j d16 J�] Tom Perry, CBO, Building Commissioner ' 200 Main Street,Hyannis,MA 02601Q1;^�,l\, u" i✓ � aA � www.town.barnstab le.ma.us Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTL4L ONI,yax: 508-790-6230 Not Pana without Red X.--Press Imprint Map/parcel Number `[L Property Address jV0 /722in ST Residential Value of Work // Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name !�//ChRE�f ;�cnti1 Telephone Number Home Improvement Contractor License#(if applicable) IC� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [f I have Worker's Compensation Insurance Insurance Company Name OCLca; Workman's Comp. Policy# , Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going'over - existing layers of roof] Re-side 404it" e7eeclaj [� Replacement Windows/doors/sliders. U-Value #of doors (maximum .44)#of windows *Where required; Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. IGNATURE: 1WPFILE81F0R_Ms\building permit formsMORESS.doC .vised 070110 The Commonwealth of Massachusetts ITDepartment of Industrial Accidents JOffice of Investigations 600 Washington Street Boston, MA 02111 www.mass:gov/dia Workers Compensation 'p Insurance Affidavit: Builders/Contractors/Electl'icians/Plumbers Applicant Information _ Please Print Le 'bl Name (Business/Organization/Individual): Address: 0973� /✓�rS�ytm�7� City/State/Zip: . �/n /1- Phone#: 42;rrdV2) 92_:�, Are you an employer? Check the appropriate box: F2. I am a employer with� 4. ❑ 1 am a general contractor and I Type of project(required):employees (full and/ part-tim * have hired the sub-contractors 6• ❑New construction ❑ I am a sole proprietor or partner- listed on the attached sheet. 7.'_,EkRemodeling 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.t 9: ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.El am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no 12.❑Roof repairs employees: [No workers' 13.0 Other lLInp�r� comp.insurance required.] 'Any applicant that checks box#] 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: Policy#or Self-ins,Lic.#: � ��j/Z Expiration Date Job Site Address: c /4q"; so(, / City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL.c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ns and penalties of perjury that the information provided above is true and correct Signature: Date: —5 Phone#: W FAPV �F7-2-1 Official use only. Do not write in this area, to be completed by city or town officiat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: �tHE Town of Barnstable �.+es Regulatory Servic es Thomas F. Geiler,Director EDP' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 'www:town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the p subject to e l P . tty hereby authorize /h117 to act on my behalf, in all•shatters relative to work authorized by this building permit (Address of Job) Pool fences and alarms are the responsibili of the e applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant M a r, 'fir Print acne print Name dL51 Date Q:FORMS:O WNERPERMIS SIONPOOLS THE Town of Barnstable Regulatory Services aARNMB , ► Thomas F. Geller,Director p hIA99. Building Division Tom Perry,Building Commissioner , 200 Main Street, Hyannis,MA 02601 f www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 L. HOMEOWNER LICENSE EXEMPTIO Please Print DATE: JOB LOCATION: o number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was xtended to includ/owner-occ upred dwellings of six units or less and to allow homeowners to engage an individual fo hire who does ,of possess a license,provided that the owner acts as supervisor. DEFIM ON OF HO OWNER Person(s)who owns a parcel of land on which he/sh resides.o intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detache structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-ye period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a orm acceptable to the Building Official, that he/she shall be res onsible for all such work erformed under the build' !ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for c pliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she and rstands e Town of Barnstable Building Department minimum inspection procedures and requirements and tat he/she comply with said procedures and requirements. l] Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 5,000 cubic feet or larger will required to comply with the State Building Code Section 127.0 Construction Control. HOMAOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1.-Licensing of construction upervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are Lware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisots,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this cash,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue.is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt f Date: 10/5/2011 Time: 1:10 PM To. Eric Cooper® 9,1508-258-2144 Rogers & Gray Ins. Page: 001 • Client*42555 PIMEMICI ACORD,. CERTIFICATE OF LIABILITY INSURANCE F DATE(MMIDDIYYY`r) 10/05/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(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 certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER UUNIAGI NAME: Mina Vaughan Rogers&Gray Ins.-So.Dennis PHONE O No Exq:508 398-7980 rc,No 434 Route 134 E-MAIL P.0. BOX 1 601 - ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC I South Dennis, MA 02660-1601 INSURERA:Peerless Insurance 18333 INSURED INSURER B:Associated Employers Insurance Michael L.Pimental , 275 West Yarmouth Road INSURER C: West Yarmouth, MA 02673 INSURERD: 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 CONTRACTOR 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 ADDLSUBR POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDNYYY MMIDDIYYY LIMITS A GENERAL LIABILITY CBP3312093 0612312011 0612312012 EEACH OCCURRENCE $500,000 X COMMERCIAL GENERAL LIABILITY PR MISES Ea oNcu nce1 $1 OO,000 CLAIMS-MADE 5XI OCCUR _MED EXP(Any one person) $15,000 PERSONAL&ADV INJURY $500,000 GENERAL AGGREGATE $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 POLICY PRO-JE LOC $ AUTOMOBILE LIABILITY CO Ea aBINcid D SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED tid P BODILY INJURY(Per accident) $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DIED RETENTION$ $. B WORKERS COMPENSATION WCC5009507012010 9/2712011 09/27/201 X WC STATU. oTH- AND EMPLOYERS'LIABILITY YIN TO LIMITS ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $1 OO,000 OFFICERIMEMBER EXCLUDED? � N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) **Workers Comp Information** Included Proprietors-Michael Pimental Terrorism Coverage Included CERTIFICATE HOLDER CANCELLATION Eric Cooper SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Pleasant St. ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE Jill ©198 -2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S72308/M698880 MEE `//'e �ani� o�✓liCaoaaT,lzuaeCCa License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g y HOME IMPROVEMENT CONTRACTOR before the expiration date.-If found return to: Registration: a.'15T639 Type: Office of Consumer Affairs and Business Regulation 6/20l2012 DBA 10 Park Plaza-Suite 5170 Expiration: _' Boston,MA 02116 MI AEL L PIMEN�ALCONSTRUC.TION&REMODE M I C H A E L PIMENTALt 275 WEST YARMOUTH?RC� \ W.YARMOUTH, MA 02673 k Undersecretary. Not valid with signature " • (Massachusetts- Department of Public S ttct� .. Board ut"`Building Rct;ul.ltions"and Stantlilr�lti , ConstructiomSupervisor License License: CS 98881 MICHAEL PIMENTAC ; 275 WEST YARMOUTH.RQ WEST YARMOUTH, MA 02673 �-- - -�! Expiration: 11/9/2013' ('unnnissiuncr Tr#: 6619 Y Town of Barnstable *Permit# �C, Expires 6 months from i ue date Regulatory Services Fee Thomas F.Geiler,Director Building Division ®PRESS PERMIT Tom Perry,CBO, Building Commissioner MAY 2007 200 Main Street,Hyannis,MA.02601 www.town.barnstable.ma.us �'� ;�� �4,�KFpRESS Fax: 508-790-6230 PERMIT APPLICATION - RESIIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ) Property Address h ^a q 1�� \.i y �LSN e,_ C L) 1Y1� Residential Value of Work�`-f 0V().,D 0 Minimum fee of$25.00 for work under$6000.00 i Owner's Name&Address ' Contractor's Name Telephone Number,�-OQ Home Improvement Contractor License#(if applicable) /,S' Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance GG Insurance Company Name A;> C� Workman's Comp.Policy# L✓C_`a 9 >Z 3 / Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: roperty Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: C/ Q:Forms:expmtrg . Revise061306 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,M4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anulicant Information Please Print Legibly Name(Business/Organization/Individual): Address: A-7,, F m tit 0 City/State/Zip: 04�� n- ��f(`� t M 1-Y Do1.�9SS Phone#: Are y an employer?Check the appropriate box: 1. I am a employer with— -ll�— 4. TYI�of project(required): ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. [No.workers' comp.insurance 5• El We are a corporation and its 9' ilding addition required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I ❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp, insurance required.] 13.R Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this-box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers compensation insurance for my employees. Below is thepolicy and job site information- Insurance Company Name: Policy#or Self-ins.Lic.#:_ �� p `�j f— Expiration Date: as / �/, e �c(�/I, 1Gfe.�(,q Job Site Address: t ��'1 f 1'ASt' City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenaldes of perjury that the information provided ab ve is true and correct Si afore: p Date: . Phone#: �J� b eW— (,DC)() Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 11/15/2UU6 14:58 YAX 5UU426UUUO (LXMAN1 1NbLIXAN(L II wiUVI `3 A...CORD„ n DATE 1RAM/DD/YYI...r'. �;=1'I� ! +:.n:r.:wvuwmwuamlawvct.,m,:,:c. h I N�;47• 1 : Sia-.,irS '�{ ;�'(I ,t; 6 11/1 ZOO6 i� .. PRODUCER- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE GERMANI INSURANCE AGENCY ROL-DER.. THIS CERMELCATF—DOES-NOT AMEND6.EXTEND-OR,.... 908 MAIN STREET ALTER THE COVERAGE AFFORDED 8Y THE POLICIES BELOW. OSTERVILLE,MA 02955 COMPAKIES AFFORDING.COVERAGE-- COMPANY _ ESSEX INSURANCE COMPANY . A - INSUREa COMPANY SCOTT E.CROSBY.BUILDER, INC. g AIG AMERICAN INTERNATIONAL GROUP 6-2-CROSBY-C1RCLE.. _.___ _......_._.__.. —..._.,_...... ..,....__�.._ OSTERVILLE,MA 02855 "coaiPAbr C 'COMPANY D :.. ...ri •,..:�; 'r:'t 1 • 1 � { riih•u 9.r•.r•. :. � : :�y�:l•w 1 n r. ,;,.,,.. 4 1 .11. •.h: .r'i•,.,.I;i:..L.n��j..•.I'I. �1,.(t.: ,l,(I•A., :"IF . ra U{Ire',.,?Gi:�I.. ':nF;:•,>;rif Il� 1'�:ati:l+:'r�'�•'.''.-,�';.•_�•,. i,.:.11n..r.l11.,.11�{,, � '�h. „7,,.,:•. „ v'.u:,}8,. ,:1.. ..! . ,A. n.lcJ.: ,1., rl.••: ..C. •e'.h.: ..i .F. .1. .v. ,.J. d 1. ,6�.•: :'!'i� ''.iiJ!,, ,`I�. :•.. 1 I�Ix„•.at,�h+aa:r,w.,:.,.t.,.l.•.,L:�t••.5il�,:l:,o,:r.G.�.h1a1r..�at::;a... ...li�:h:•nla�.l.,{.:ic�C...,�lJ.�._r ,...W:i uGiVil,ar ':uw:uu!s`•:w,.._,_,....�ii'l:LLaitiGi_ioi�_L___a.-.,.I:Loi:":I;����i-::.,...'r., THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHS-TANDINGAN_Y REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY'BETSSUED OR MAY PERTAIN,THE INSURANCEAFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TQ ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ...— -..... _........._.... CO•! POLICY EFFECTIVE POLICY EXPIRATION LTR I. TYPE OF INSURANCE POLICY NUMBER LIMITS DATE(RAM/DOIYYI DATE(MMJDDlYV) GENERAL LIABILITY OOO-- - 07/05/06- O7/05/0T A �( COMMERCIAL GENERAL LIADII�TV 3CU943O PRODUCTS•COMPfOP AGO. a CLAWMADE 1. OCCUR RERSGNALS JNJLULY.. JL... . . OWNERS CONTRACTOR'S PROT EACH OCCURRENCE .I . 1 tOOO,OOO FIRE DAMAGE thqYa fl[e). $ MED EXP(Any one petaon) S AUIOMOBILF-LIABILITY ANYAUTO CCMBINEDS�NGCEUMIT t A l-OWNED AUTOS.. . .. 'BODILY MPiURY-... ... •a".. SCHEDULED AUTOS (Per person) HIREDAUTOS NON-OWNED AUTOS a Per aceaenldom)I*JL Y ' ._ .... ..___...__..._.. .. PPOPERT•Y'OAMA6E T. GARAGE LIABILITY AI/TO ONLY-EA ACCIDENT a ANY AUTO OTHER THAN AUTO ONLY; T�- EACHACCIDENT S , AGGREGATE 6 EXCESS LIABILITY EACH OCCURRENCE a UM8RELLAFORM AGGREGATE a OTHER THAN UMBRELLA FORM a B WORKER'S COMPENSATION AND TORr u WC 898-31-13 06/22/06 06/22/07 rLMlTa.,;tF o>M —, ER . EMPLOYERS LIABILITY • EL EACH ACCIDENT�.- a- 1 OO O0O r,{E vROJ1aE*Oa net EL OBEASE'POUCVrLIMIT• f • PARTNlRSIIETM - OFFICERB ARE: HEACL EL DISEASE-EA EMPLOYEE a 100,000 OTHER DESCRIPTIOWOP OPEMTIONSlLOCATIONSfVENtCLESISPECIALUVMS...- 'M:. !. a ..iA'„!=.:.•.w.. 1Qi al>Itl•I;u.:,�I r 1° u.0_ItlR gilt•1 :. ' .Y l-•;,.,,I�'`' ra`�"', '"a I«s In ,n,J IJ•h�ru' u t:c c Fs� i..s::��(:uri:r,:•,.,>�`�:�.�:_�":'�'..�.,:�. � ROME— SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATWN-OATC TMCRfOF-SHE-IWU*J4.COMPANY-"Iv- NDEAVOit TO•�AAIL-. .. 11 U DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, , 11AM FALLURETO MALLAIJOL NQTICESgALLY0PC5E!(O _._. OF ANY KIND UPON THE-COMPANY ITS AGENTS OR REPRESENTATIVES. AU7HO2QIFD REPRESENTATIV eu' -.... .��� ���I• I ,fir• ;m�k�a'q'Hlr Irlyil u pr,p ! ^,.,j,{��" ,.r,,„�-.,•.,.,., , � - :'A>�R►'l ,l4LIA�!TM '1' 111A'!:1 `,'1'• ik)Ih�f�lk:rr!i.i4�ll4�k' Irl III�i.Y�k'l,r-I �I'• nl(.��8:• f- ' r- ��`� �oard of Building Regulations and Standards r Const�uctioi�''pervisor License • j License ,CS 43556 i "x BYrhdate2 3111962 �` Tr#' 6,886 � � , � �xplration� 12/a1�120,08 . tri 1013 0 , �., SCOTT E CROSBY�� �'` `..... ��1 I:. 62?CROSBY CIR '=� ��-==• � - a OSTERU IL LE, k.62655 Com►rii's's�oner" 1 ��ie -�an�rreoouuea,�C� ���aQaac�uaeCZa Board of Building Regulationsaand Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before.the expiration date. If found return to: ,t Board of Building Regulations and Standards Registratron�:`J 51882 One Ashburton Place Rm 1301. Expiration 7/13/2008 Boston,Ma.02108 I i� Type Pnvate Corporation I. riz SCOTT E CROSBY BUILD'.ER INC SCOTT CROSBY i F 1112 MAIN ST UNIT#7 ' \� ��!% Not valid without signatur OSTERVILLE, MA 02655 -_�'` Deputy Administrator Mls� 01 07 02:56p 5oat crosb�;. (50®1429-9080 P. N Town of Barnstable Regulatory Services 9 anpR R 3 MOMU F.Ctiter,Director MAn i�g9•�a� Building Division Tom-Perry, Banding Com12tssi0ner 200 Main Street, Hyannis,MA 02601 Fax: 508•�90�230 offic®: 508-862.4038 Propery Owner Must Complete and Sign This Section __._.If-Using-A-$der as Owner of the subject property hereby authotizc to act on my behalf, in all matters relative to wotli authorized by this banding permit applicadon fox: (Addxesa ofj Si�tx a t♦ Vnei print NnmP Q:FDI MS:OWNtRPBRMWI0tF - --- - k _ Y TOWN OF BARNSTABLE BUILDING PERMIT�APPLICATION Map_ AUS Parcel U 44 .. Permit#, ,.,, 3coq a-i{ Health Division rs Date Issued 3 Conservation Division 3 I dl Fee. s :x Tax Collector ' Treasurer lqyTIC SYSTEM FAUST BE INSTALLS®IN COMPLIANCE �a Planning Dept. '- EI�9�/IWITH TITLE " Date Definitive Plan Approved by Planning Board ':' FT<<, � ta Historic'-OKH Preservation/Hyannis i Project Street Address 3 04 /Lt S➢�� Owner 4 11e, !r� 34— y Address Telephone Permit Request n vt. fi-P, I 9elo)Ocl Square feet: 1 st floor: existing -'' ' proposed 2nd floor:existing -� ` proposed Total new Estimated Project Cost � G8 Zoning District Flood Plain Groundwater,Overlay - Construction Type Lot Size Grandfathered: ❑Yes ❑No Ii yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure D Historic House: ❑Yes O No . On Old King's Highway: ❑Yes V No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other, Basement Finished Area(sq.ft.) 0 Basement Unfinished Area(sq.ft) -- Number of Baths: Full: existing new 0 Half:existing new Number of Bedrooms: existing _ new p® ` Total Room,Count(not including baths):existing A new First Floor Room Count' Heat Type and Fuel: I'Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes tWNo Fireplaces: Existing . O New Existing wood/coal stove: O Yes ®'No Detached garage:existing 0 new size Pool:U existing ❑new size Barn:❑existing•• ❑new size Attached garage:❑existing ❑new size Shed:O existing ❑'new size Other: Zoning Board of Appeals Authorization ❑ Appeal# 'Recorded 0 .Commercial ❑Yes .X'No If yes,site plan review# ; Current UsegT� f—�t �/y LS.//.exee___Proposed Used y ' BUILDER INFORMATION Name . Telephone Number '3 27J' ,. Address Y License# D � Z 317Home Improvement Contractor#' /h Worker's Compensation# ab 2 0& . ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO -SIGNATURE DATE '3 S' a' 4 FOR OFFICIAL USE ONLY kERMIT NO. DATE ISSUED r MAP/PARCEL NO. ADDRESS 't i � ` VILLAGE OWNER ► t _ r: a DATE OF INSPECTION FOUNDATION FRAME _ .•3 INSULATION }, FIREPLACE _ ELECTRICAL: ROUGH , FINAL PLUMBING: ROUGH} '! FINAL GAS: ROUGH,, FINAL FINAL BUILDING • t r N • • ' ' i 6�w Y A• t F t ' � - 1ti x r , ., f , 1 6 • f . ` ..v� . V, - .. DATE CLOSED'OUT ASSOCIATION PLAN NO. "' NSAL A. PRATT CUSTOM BUILDER 42 Ca!ABE ROAD E. SANDWICH, (VIA 02537 13' - Fg �- Ub 0 Rai o Claw Tulo 0 0 New 10' F71 ExI 'st n Lin Bath g Bath Shower e Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 ; Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: � Zimated Cost_ Address of Work: 3 Owner's Name: a, Date of Application: 3��� � I hereby certify that: Registration is not required for the following reason(s): Work excluded by law []Job Under S1,000 Building not owner-occupied Downer pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNETS UNDER PENALTIES 0 ERJURY I hereby apply for a permit as the agent of the owner. 3 00 Date Contractor ame Registration No. OR Date Owner's Name q:fbmis:Affidav .'� . <' :.: :.:.;:.;:.B ILDIN SE 042 .. R :BZUZZMAN STR EET ,.. S EET :::..:........ ....:..:.:::::................................................ ..NEIGHBOR .... .............................................. ............................................................................. ...............................:.>::.:::::::::............................... ......:::::::. .... ........................ .... ....... .... ........ .. ................ ... GOING TO RUN BED AND BREAKFAST- IS aaaa G . . .E AL. . .RES CH- --PLA ED C CALL TO OWNER S.WILL WAIT FOR RET URN TU CALL.LL. > . `: `; :« :a.^,rt �'Sr. �• 'FRa yQ, .Y r ? s .-� "' ,APPLICATION FOR PERMIT fi0-INSTALL AND,:REQUEST Y FOR ELEC�'R'TC� SERVICE a _ } Inspector of Wire in. Permit# COJ. M/Electric# Town off r -SQssachusetts _Building Permit.# Customer G ��S Cot# in the vilia a of tility pole numbe rand :round `umber y 4 Customers billing.address P �. f Temporary. w inst Ilation ange of service Job descriptionP .✓ f` t r+�(/ � %`-lpe /"'"' y3 f i . , - Service entrance voltage lob O oZ V Amperage' Phase Wire size(cu or al T Conductor per phase j 3 Water heater Off.peak:Yes No - Number of meters ate eat p L s ':Estimated load:Electric heat kw, li hts kw Range dryer Motors N &Phase Read for inspection Read for final ins ectlon`_ x /r 73 Lic.# TTele hone# S r ctor p.Electrical C t a Address Additional Remarks:.'Remarks: _ G Do.Not Write ReloW This.Line ELECTRICAL WIRING INSPECTION CERTIFICATE INSPECTOR OF WIRES INSPECTIONS y pATE ��r FEE CHARGE -Temporary Service y - Roughing in Service and.Meter ' Off Peak Meter • Final Approval- - T-y£ . � Disapproved *Fort a following reasons -noY buildingpermit on site future use'a' 9 o bath is for use a Bed & "Breakfast ? :Refer :ta ,Gloria CERTIFICATE OF INSPECTION BATE To the COMMONWEALTH ELECTRIC COMPANY.The installation described above has been comple'ted.and has this day been inspected and approval granted for connection to your service. Ins- ector of Wires - P WIRING INSPECTOR TO:BE NOTIFIED WHEN WORK IS READY FOR INSPECTION ` Permit Good For One Year From Date Of Issue s` = i� ea as ,z White COM/Electric Green inspector Canarx Town Receipt Pink InspeegtoE dopy ^t aotdenrod r Electrical Contractor to C W lectnc DAM i numn la OMSiON BY Engineering Dept.(3rd floor) Map ;2—&9'_ Parcel 04 2_ Permit# House#_ ,lC 1x` �i .a Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) 7 -3�� Fee �b Conservation Office (4th floor)(8:30- 9:30/1:00=2:00) � C�® loN , ���d TOWN OF BARNSTABE MD OWN REGULATIONS Building Permit Application Project Street Address 3&p l /WW S 7% Village Owner Address .Sq i4l � 4Teone Z eques eeByi,�O_ s: ��✓®�iz� ��- e,CJ First Floor ; • square feet Second Floor ��S,/�, square feet Construction Type FYGI Xhc__- Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure OW Historic House ❑Yes °?`No On Old King's Highway ❑Yes No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) ©yp.� � Basement Unfinished Area(sq.ft) /V1 A Number of Baths: Full: Existing ZA, New Half: Existing ® New No. of Bedrooms: Existing —3 New 0 Total Room Count(not including baths): Existing_ New First Floor Room Count Heat Type and Fuel: ❑Gas 2f Oil ❑Electric ❑Other Central Air ❑Yes 4 No Fireplaces: Existing ® New Existing wood/coal stove ❑Yes )j No Garage: tj 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 XNo If yes, site plan review# Current Use S��/ =gyp �� y. Proposed Use Ce 221ne Builder Information Name Telephone Number Address License# 030 F9 a Home Improvement Contractor# l03 761) O� Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ��^ ww" BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY - PERMIT NO. I ' DATE ISSUED MAP/PARCEL NO ADDRESS VILLAGE ; OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION I ' FIREPLACE f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGHP FINAL GAS: .ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - EXISTING CROSS SECTI❑N -a� EXISTING EL❑❑R PLAN 12'-5' _ 5' 2.4 studs Existing 4'x6' rafter and ceiling joists 42' O.C. R13 fiberglass 'outside kneewalls' Blown ;n ins ulat;on R30 ex;sts R19 insula Yo 4' Shower Closet Closet - 6 7 7' Ceiling break BATH \ 5' Ceiling height \`---� Kneewall PROPOSED BATH CROSS SECTI❑N PROPOSED BATH FLOOR PLAN NEAL A. PRATT SULZMAN RESIDENCE DATE: 10-1-96 PAGE:1 of 1 BUILDER/DESIGNER SCALE: None t 42 CHASE ROAD PROPOSED 2ND FLOOR BATH E. SANDWICH, MA 02537 BY NAPI A III PHONE: (508) 888-3206 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I -A, m �C&-, DATA -s office st Floor): s's map and lot number 2f �I i �P�o`tNf toy` w�;t✓ation y loff Health(3rd floor): 1 DASIST&D6t: age Permit number � rua r..:ngineering Department(3rd floor): �o �a79. \�d° ;'douse number �o NO Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 4-z TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location a(o y ��/�S �c.(l yi Proposed Use Zoning District Fire District Name of Owner �� L1,469 , Address 36 y !� AJ Name of Builder ; iC,WpCQ I • Address Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost 00 Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License 70 Q 51 Permit For Re—ROOF/ GARAGE - Accessory to Dwelling x Location 364 Main Street Centerville _ w Owner Job Lippincott Type of Construction Frame Plot Lot ' Permit Granted December 1 , 1g- 91 Date of Inspection 19 Date Completed 19 - F r 1 r' 5F Assessor's map and lot number ..... ................................ THE O Sewage Permit number ......421.. ..az./. ... .. . . ..... MTALM IN House number ... .....I&I.......................................... WITH 1639- ENVIRONMENTAL COC TOWN OF BARNSTADLOEGUIAMNS BUILDING INSPECTOR . ................................................................ APPLICATION FOR PERMIT TO ............. TYPEOF CONSTRUCTION ................................................... ........... ............................................................... ...............................................19........ TO THE-INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the f wing information: f AO ..........Location ......... ..........M�......................................... . .................................... ProposedUse ...... ..(zAaLf.....(_1....................................................................................................... ......................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ..... . .. .. . ....... .....Address ..... ...................................... Name of Builder ...... Address .................................................................................... Name of Archite ... lne<�,--�.maz.,r. .................Address ..................................................................................... Number of Rooms .......................a.....................................Foundation ........021p.. ... .......................... Exterior . ..........................................................Roofing ...... ..................................................... Floors .......... ..........................................Interior ...... ....................... Heating ......... ......................Plumbing .................................................................................. Fireplace ........... .............................................Approximate Cost ........... ........................e........................ Definitive Plan Approved by Planning Board ---------------------------------19--------- Area ...................................... ... Qa Diagram of Lot and Building with Dimensions Fee ................. ........................... 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 .................. . .. ............... ...................... McLaughtin, K. Do A=208-42 Sewage none Aeqw I wed No P�!�.... Permit for ..,QoAagp..................... fi Location A04A4&n..,S.t..................................... ................ ...................................... Owner ........K,..�,...Makaug........................ ti Type of Construction ..........Acme..................... .............................................................................. Plot ............................ Lot ................................ Permit Granted ..........!A49C41 �......I.......19 79 Date of Inspection ....................................19 Date Completed 19 PERMIT REFUSED ........................................................... .... 19 fro ........ ......S.. ............................ ........ ...... .................................................... ........ ................................................... to 0. z Appr .... 0 ................................. 19 rh mm .......... ............................................................................... J� j f_so Assessor's map and lot num ..�.. :(,�. � / �`'` Cf?NE TO ` � Ir Sewage Permit number ...................:......�..............,. SEPTIC SYSTEM MUST BE . INSTALLED IN COMPLIANCE = BaHasTnnrs, House (number ...................................... WITH APTICLE II STATEmum 9 1639 �> r SANITARY CODE AND TOWN G� i639. \0� :ry a Nix `-TOWN OF 'BARNS A�'LE I� ,- 'BUILDING -INSPECTOR APPLICATION FOR PERMIT TO .......r�v. Zo.k:�..4.......: '.... !. &`..................�........."""///.// :. I ` 4 / ... TYPE OF CONSTRUCTION ..........:.......: /i ....................................................................... 00 ..... � V.��`. �...... .......19.:�� TO THE INSPECTOR OF-BUILDINGS: The undersigned hereby applies for a permit according to the following information: ' Location ........ ....... ..i.. fir:. ! 1..�1 /G� ..............................::........:.......................................... ProposedUse .... .........1. ..................................................................... ................................................ Zonin District ... f ..G......................Fire District�G�'!�R. �LLZ,,,,,, 5'?F'�ELL 'i g Name of Owner .1..�.cLl....r L. l` .�I4.��'Z....................Address y� ...lc.`^dc:R4°'k.....?�� Name of Builder .... .�`.� !....... J. :.l �l.�i!<}.(I...............Address .5.1�lrn.Th.Az. ........(��..^!'!t`t......... .................. Nameof Architect ................... ..............................Address .................................................................................... Number of Rooms .........................................................Foundation ........ ......................... Exierior ..W.0.D.4....... 13-l. Z f !10... Roofing. .. ....... Flo.ors .......L!?QO.L6.................................................................Interior .... Heating C�........./t{.12.i.......!kr.t.T ..2................. ......Plumbing ................................ r Fireplace ......T40.................................................................Approximate Cost ........ .................. Definitive Plan Approved by Planning Board __---------____---------------19________. Area ........ ..... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH / f, hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. pp Name `(�. ` .. �ti C� ter......... ......... . McLaughlin, R. D. 20356 add to frame No ................. Permit for .................................... dwe 11 ing ............................................................................... 364 Main Street Location ................................................................ Centerville r ............................................................................... R. D. McLaughlin Owner .................................................................. frame Type of Construction .......................................... ; ............................................................................... Plot ............................ Lot ................................ - Permit Granted ..........June 30 . .19 78 Date of Inspection ... 7...........19 Date Completed .... , 1!�1..!..��.........:19 PERMIT REFUSED ................................................................ 19 ........................................:.................................. ................................................................................ ............................................................................... ............................................................................... , Approved ................................................ 19 .......................................................................... r ..................•............................................................. z 7 , y� r • i j `q, r 1 34 f i IV y % Y r" f a t , v _ . a yr { p 1 f i " r t , r Y 4 f `r , ` - .. .. ... .. _ ,.....-...._...-_,,.-ram ......._._ ` ` i 14-0 i ;`} is X �,`A •'� � � r' �� ..�. _ , .. _, .. .. { g � ?tea j J,✓;.{-. JJ':.. ! }. x*�.'�'; l b .f 1 i ,• t _ / 33 , t i i L S +v. : _ P r t EY , 'o � � Ctittu"m,a„, }�A�,f•1°'�-4' N.f�,:r.�pa c.� h i:. I v i 4: t ILI b y r '•rC.. r`J.•W /��+. 44 �} [gyp r t E" 1 ' y{ u n A N a r {{ q /> i / war �� v :` 'J . Lo t , U h4 Y� 4y. B l.. J