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HomeMy WebLinkAbout0377 MAIN STREET (CENT.) 7 n -r r. : , , r n y • t f L : � v r 0 , > , , a i V • i/ IU . . . v ., .� � - - a ,. k •� .. k Application nurnbL�)-.1-15�-3)3�.. Date Issued........1.��3�� ........................................ STAB . b Building Inspectors Initials... 9........................... FD My`l A 49 , � . SEP 1 3 201� Map/Parcel......ZO 9.... 12.0 n1A!N �- fO" OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 377 t1,f,-n Sf NUMBER STREET VILLAGE Owner's Name: c l( T; Phone Number 15 ( - C) I Email Address: - Cell Phone Number Project cost$ cI I Z '-( Check one Residential ✓ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: 4\4ac�4 cawtm,-� Date: TYPE OF WOE a Siding 1 Windows (no header change)# /S Q Insulation/Weatherization Doors (no header change)#' ' Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to t,JcS�P CONTRACTOR'S INFORMATION Contractor's name -�' Sfiee(e — G,l�i.��„l Wor 0 ,ac ,3oStun Home Improvement Contractors Registration(if applicable)# 7 0,2 S (attach copy) Construction Supervisor's License# 0Z Z? 7 2- (attach copy) Email of Contractor Q'Sld)eel 9 ff- a)G AA-)L - c-o r✓l Phone number 7 91 J - 7 3 Z- q?o 5 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. r APPLICATION NUMBER............................................................ "Foil° 'Vents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X I X I X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pHL Commercial events may require Fire Department approval X V'%®®DlC®AL/PEL ET STOVES Y Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S LICENSE EXEMTTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 Clot the Massachusetts State Building Code-* I understand the construction inspection proeedura s,specific inspections and documentation required by 780 CMIt and the Town of Barnstable. Signature Date LAC 9 S SIGNATURE flJ RE Signature _ Date 1-/Z - / 8 All perms a 'ons are subject to a building official's approval prior to issuance. Customer declines exterior wrap and understands painting and/or repair may be required Initial Customer declines grids on windows/doors Initial DISCLAIMER:Customer is responsible for the following in connection with this contract:Painting,Staining,Alarm System disconnecVreconnect Building Permit fees in excess of$25.00,Homeowner and or Condo Association Approval,Historic District Approval.City of Boston parking&sidewalk Permit fees in connection with instailation. NO EXTRA WORK IF NOT IN WRITING! Customer agrees to the terms of payment as follows: Extra Labor&Materials $ Site Set Up, Permit, Disposal&Delivery Fees$ $389.00 ft�C 'v Total Amount $ / Custom Order Deposit 33% Ck#_ ®/ S/S�Irrl.� ���.5 �� Balance Start Payment 33'/0 $34�Z alance Due Day of Installation $.306,1/ AmountV�nanced $ Window World of Boston anticipates starting this work on ® and being substantially completed ia/- ays.Security Interest:Yes =No:/ Any deposit required in advance of the start of the work SHALL NOT exceed 33113%of the total contract price or the actual cost of any material or equipment of a special order br custom made nature,which must be ordered In advance of the start of the work to assure that the project will proceed on schedule.No final payment shall be demanded until the contract is completed to the satisfaction of both parties. All home improvement contractors and subcontractors shall be registered and that any inquires about a contract or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170 Boston,MA 02116.Phone: 617 973-8700 No work shall begin prior to the signing of the contract and transmittal to the owner of a copy.of such contract. Window World of Boston under provision of Chapter 142A of the general laws is required to apply for and obtain all construction-related permits.Window World of Boston shall not be deemed responsible for delays in the work described in this agreement caused by regulatory,permit granting agencies,authorities or individuals. Notice:If the PURCHASER(S)obtains his own construction related'permits for the work described under this agreement or deals with unregistered contractors, the PURCHASER(S) is hereby advised that in the event of a dispute,judgement and nonpayment,the PURCHASER(S)will not be entitled to make a claim or collection from the guaranty fund established by chapter 142A,M.G.L. You the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Notice at cancellation must be in writing postmarked no later than midnight of the following third business day. TIJI§ IS A CUSTOM O ER NOT E0_JREAALg1 This Window World®Franchise is independently owned and o erated by L&P Bost O eratin , .under ilcen a from Window World,Inc. Owner:Do not sign if there are any blank spaces. Dat Salesman:Do not si ere are any blank spaces. ate Owner:Do not sign if there are any blank spaces. Date Boston 06.18 White Copy-Original Yellow Copy-File Pink Copy-Customer Hayes Printing 336-667-1118 Commonwealth of Massachusetts Division of Professional Licensure ~ Board of Building Regulations and Standards Construelbn'Supervisor CS-072772 Ej!cpires 0410712020 JEFF C STEELE 24 SHERWOOD AVE r DANVERS MA 09823 . Commissioner Cis— A&-1 - <''�fiHr�rir�nna+�r�l�t�/'''lfti�vcxt�rrts�Ilt Office of CommerAffairs&.8usir►ess Eiogulatlon HOME IMPROVEMENT"CONTRACTOR TYPE-u c 1 04/11r2W WINDOW WORLD OR K'LLC. ,. , � 1 JEFF C.STEELE2�C ---- 1 SA CUMMINGS PARK W OBURN,MA 01801 WndBf Crg f r e The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 021144017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders!Contractors/Electricians/Plumbers. TO BE FILED V1M THE PERMITTING ALTMORITY. Applicant Information / Please Print Levibly a Name (BusinesslOrganiration/IndMdual): JAZhC ,J I��f-l /p� �StM L L C Address: 15- A C K City:/State/Zip: 14,)oburA oieo i Phone#: -78 1 -19 S 2 - qo s- Are you an employer?Cbeck the appropriate box: Type of project(required): a employer with _employees(full and/or part-time).; 7. New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in" B. J Remodeling any capacity.[No workers'comp.insurance required.] °. ❑Demolition i 3.D I am a homeowner doing all work myself 1vo workers'comp.insurance required.; 10 Q Building addition 4.O 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions _r7 I am a general contractor and I have hired the sub-contractors listed on the attached sheet li.[i}�oof IEpairs 1 These sub-contractors have employees and have workers'comp.insurance.= — - 1 ither G�\n I we are a corporation,and its officers have exercised their right of exemption;per 14. G MGL c. ( : i>"t;§1(4),and we have no employees.i vo workers comp.insurance required ���t ac Fnt L"f`S *Any applicant that checks box 41 must also fill out the section below showing their worker:'compensation policy information `Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. (Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for mV entploVees. Below is thepolicy and lob site information r Insurance Company Name: (4 CiT �0!'G+ Fie Tn s J RFl fJ C'E C—e-D Policy#or Self-ins.Lic.#: Z Z WC C L ,�� S Expiration Date: /" Z 7=- /1 Job Site Address: ,S71 /`�k t�l Sk City/State/Zip: Ce�t4,ey yi e-. �✓� Attach a copy of the workers' compensation policy declaration page(sbowing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonrnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this s tement may be forwarded to the Office of Investigations of the DIA for insurance coverage verifi -on. I do hereby car under a pai erjury that the information provided above is true and correct. Date: Si azure: C Phone# - -3 2-'' 0, .. a 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#: '4C�7►i�,V CERTIFICATE OF LIABILITY INSURANCE DA'rEQ1JMUfY" F . sr�sr�ola THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION QNL Y AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER.THIS CEIMFICATE DOES NOT AFFIRMATIVELY OR NEGATIveLY AMEND, EXTEND OR ALTER THE COVERAGE AFFMED BY THE POUCIES BELOW, THIS CEIMPICATE OF INSURANCE DOES NOT CONSTITVM A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRMNTATIVE OR PRODUCER,AND TIME CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL.INSURED the o!i P cyl;es)must have ADDITIONAL INSURED prpvisiow or be endorsed. If SUBROGATION IS WAAIEQ,subject to the teirms and cowj t10ns•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 endorse4nerd(s). PRODUCER co, ac7 Marsh&McLennan Agency LLC IJAMI Carp Wnctssr CIC,CISR,CBIA S625 N.Elm St. PJlar o .336-544-6850 rj.:212-607-6516 Greensboro NC 27455 AAn AID: Carli.Mic marshmma.com INSURMMAFFORD946 CDVERAC-E I NArro INSUR4INSURE2A:Alllllerica Financial Benefit 1 31� Window LARWDO.2 insuitim B:Hartford Fire LAStirmce C a 19682 V+nncfow World of Boston,LLC 118 Shaver S6 eet I1JsuRm c:Massachuseft ft,Insurance CompW 22306 Borth%Nrlkesboro NC 28659 rNsttReRnz t+rsJrRr:sza: fNSlBtER F: . COVERAGES CERTIFICATE NUMS ;1016015772 REVISI0Ir1 NU►18BEP THIS IS TO CEP nFY THAT THE POUCIES OF iNSURANCE'LIST'ED'BEL&R HAVI_BEEN ISSUED TO•TIME INSURED NAMED ABOVE FOR THE POLICY PER(OA INDICATED" NOTVMSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OLD OTHER.D000MENT VWTH P.ESPECT 70 VIB 1J.^,H THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFOP.DED BY THE POLICIES DESCRIBED HERMJ IS SUBJECT TO ALL THE TERMS, S. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CIAII L A. TYPEQPS7SURAMCE A�LJ POLICYNUMBEP ( POpnnn F PM�rlffSp if1s41T5 C i( I COMMERCtALGEMERALLSA6Rl7Y ` } 9U67-°tt2x""7 i W1+2J18 4PF20�9 EACHOCCURRENCE $1.MQ000 CLAWS-RAM a OCCUR ANN5 o 7ED EF R =u i c $5coaoo r ED FAP(Any oral&us' oN $6.000 ' I �PERSONALE i nV omupy $S.00ROW GEMA.GGP,CGATE L idf ApPUEES Pm. POLICY PR0. 1 GENMALAGGREGXE $20040M L_a JeCT 'OC i ; ---- s PRODUCTS-CCCAMPABG 32.M.OW i OTHER ; $ A AUTDNIOBILELJABILrrY. f AVWa75M6 _ t 6MM017 ens=a J't�.TlEJ INGLEUMrr ! :�ANYAUTO f I CRffiC ODO RODILYIN,JURV(Perper ) ; OWNED 77 S HEDULED AUTOS ONLY NAUTOS OA!-OWNED {If BOD'eLYINJURY;Peraedden1) E AUTOS ONLY i AUTOS ONLY 1 1 ARTY DANAGE y c X--� A1.tA>3 X CE-53L ' /+ FX OCCUR I , 0�'��7 j 4M7 4�e EACHOCCURViENCE FJ(CES9 LIAR CLAIAifSI4— t AGGREGATE 000.000 =' ON$ G I rJORItl;RS COIVIPENSAS10p! i 22b4 J32$9 i 112711018 1127J,e"C'19 j R, i ER _ AItuEMPCDYERS'1/A8)LM i ANYPPOPRIETOMPARTNEM R UTJVE YtN i I OFfICEPJMEMREXCLU0E0? PIJA ELErACHAOCIDENT 5500000 (Mandat ory in NH) i If yyes,desCriba wider I E.L.DISEASE-EA EMPLO11EE 55MOOD i � DESCRIPTION OFOPERATI SJgam ! E.L.IASEASE-POLICYIJMIT S57R000 i DESCRR�7rO JaFOPPRF{TIONSfLOCAT{ONSJVEFJ(C6ES(ACORD 1II1_Add7iM21Regrarl--SCft9t i1e,miVbeAtldched Winne Spam isregyirod) CERTIFICATE HOLDER CANCELLAMOM SROULD ANY OF THE ABOVE•DESCRIBEV POLICIES BE CANCELLED 8EFoRE THE EXPIRATION DATE MRECF, NOTICE WILL BE DELIVERED IN ACCORDANCE W)TH THE POLICY PROVISIONS. REPRF,SPffA71V5 ( ©1988-2016ACORD CORPORATION. All rights reseried. ACORD 26(2016103) The ACORD name and logo am registered marks of ACORD C ' a . .Ao hcation number� Date Issued. . ......?./ '• OF Building Inspectors Initials ............ p/Parcel. � ..... JUL 24 201 TOM% TOWN .� u SABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION , PROPERTYINFORMATION Address of Project: 11 1"iaA by S� U I ER STREET ` VILLAGE Owner's Name: N(C (� QS ( � , Phone Number ���9 Email Address: Ah IJ 6ty- we o t,oo smp Cell Phone Number Project cost $ - Check one Residential X Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK, , 0 Siding Windows (no header change)# E Insulation/Weatherization: Doors (no header change) # Commercial Doors require an inspector's review"" Roof(not applying more than 1 layer o£shin les) Cons ction Debris will be going to �1 F7CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy). Email of Contractor � ® Phone number s6a'z/ ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent (s) will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X , X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I.understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A Pleas Print /Legibly Name (Business/Organization/Individual): Address: 6,tOmsk G44- City/State/Zip: wjm f Phone#: Are you an employer?Checkthe appropria a box: Type of project(required): L p I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or art-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its I0.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are'doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: ' / Policy#or Self-ins.Lie.#: RZ,�L� Expiration Date: Job Site Address: 311 Ra, 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. Ido hereby certify u 50ep t le pains andpenalties ofperjury that the information provided ab ve is tru and correct. Signature: Date: Phone#: � 30 U�� Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions E Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax##617-727-7749 www.mass.gov/dia t y (91je &.?n won.wea`1,oy kol.&r XweC7a Office of Consumer Affairs&Business Regulation Registration valid for individual use only HOME IMPROVEMENT COiv+RACTOR before the expiration date. if found return to: TYPE:LLC Re4istration Expiration Office of Consumer Affairs and Business Regulation 170787`- 12/18/2019 10 Park Plaza-Suite 5170 ROOFING AND SIDING OF CAPE COD,LLC. Boston,MA 02116 DZ�i11TRY LABKOVICH �,k CGS 268 ��U WINSLOW GRAY RD ; Not valid witholYt signature W.YARMOUTH,MA 02673 Undersecretary Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-102600 Construction Supervisor DZMITRY LABKOVICH 68 NNSLOW GRAY RD WEST YARMOUTH MA 02673 Expiration: Commissioner 03/27/2019 Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to Possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DIPS Licensing information visit: ��. WWW.MASS.GOV/DPS who secure their own construction-related permits or deal with unregistered contractors will be excluded from access to the guaranty fund. This Contract not valid unless signed by Corporate Officer: Acceptance of Estimate The above prices, specifications and conditions are satisfactory and are hereby accepted. ROOFING AND SIDING OF CAPE COD,LLC is authorized to do the work as specified. Payment will be made as such: 1/5 Deposit 1/3 Beginning of work 1/3 upon completion Date: Signatures: Note: No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. You, the buyer may cancel this transaction at any time prior to midnight of the third business day after the day of this transaction. Ems: �x I ' +c 4 "r' � :.u*w•.:s��r�r�W�¢wuynr a:s' I .; 3F�7II IIIII � 111 . ss x z wv" iW. gill �w saw r�vl 1611 Y a' N dry I j ROOM "'- "�'. v: :. # i "- 7" r IME EXMATWNN 1 MLAIIZME j Cape tms -q.:11-.. S` -Road : PG- G df - n SM .� .- .,.. #+e� ,; ,��w✓ .. d#z y: � �h �'# �':� h!e 7r +'*'1: « ^"+:Ynv r y *��.„: rynN nr;;l��«:r ;:'�. Y:«r' •'qn '�" - .�:;#'r "' "1;.1;:,z,.„: #`#.CFIy ha4p1 .' 4 a.-�. ':.. "&;�'i""" ps!b:�I � a .n ara wu,w;� I '!:.: 1 I;.a t .r ,.I."�::#k" .."�a = w y � ..m. �E E> ��, >r' M• + ,.��#w::, uwu � 'h .Cy:n� u'. y ,, "I n 7 a ��,' ''�' X #I « aG F1'�v�r{ ..::.«""9: :.;n OW S . .r•.: " - k �.. r,nc�:.:N -�, w �' ,. '�-° .>k an W "sax °r": " r xr�:��� r:;a i OF" Q Application number....,�.......g.................. 'late Issued .... ..... KAM �tiBuilding Inspectors Initials... IVSTABL _..... Map/Parcel........s ..':...a O..................... 3 TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 3 IY24 a r1 Sid ee rt t e C V; t o i NUMBER STREET VILLAGE Owner's Name: /-Qo 1 Phone Number Email Address: Cell Phone Number Project cost $ / Check one Residential Commercial 1Q OWNER'S AUTHORIZATION As owner of the above property I hereby authorize / U lei a 2v, 1�1 n c to make application for building p t in accordance with 780 CMR Owner Signature: ,Qx D. Date: 5 Q l TYP F WORK Siding a Windows ( change)header e)# 0 Insulation/Weatherization 0 Doors (no header change) # Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shin les) Construction Debris will be going to oa -e p4 eri I CONTRACTOR'S INFORMATION Contractor's name lea 14 6u, Home Improvement Contractors Registration(if applicable) # (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor y r��i� `� �0 I � + Phone number SO$ GAS ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. r APPLICATION NUMBER ............................................................ - *For Tents Only* , Date Tent(s) will.be erected Removed on number of tents total Does the terit have sides? Yes No (If yes please attach floor plan with exits marked) 1 ' Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date - T',S"SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. .M r. 4 The Commonwealth of Massachusetts Department of IndustrialAccidents - Office of Investigations 600 Washington-Street - Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: �� La&on Cifi City/State/Zip s !!/Ia 096� Phone 4�E6 Are. an employer?Check the appropriate box: Type of project(required): 1. I am a with employer 4. I am a general contractor and I �* have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. El Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp.insurance comp.insmance.t required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other S i 4 Al comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their worker;'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. n Insurance Company Name: /'1 C t? 44Qrs GQ d1 Policy#or Self-ins.Lic.#: fj 5� /��7 �f Expiration Date: Job Site Address: 371 .ncil n 61- City/State/Zip:6werv, l enp, 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 ffi4ce coverage verification. I do hereby c1vpi u der the 'es of perjury that the information provided above is true and correct Si jznafore: / Date: Phone#: S-OR Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions ;1 Massachusetts General Laws chapter 152 requires all employers to provide workers'comoe'ation for their employees. Pursuant to this statute,an employee is defined as"...every person iri the service of another umda any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives o 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 ij!more than three apartments and who resides�lherein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(O also states that"every state or local licensing a ency shall withhold the issuance or renewal of.a license or permit to operate a,business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage'regnired:' Additionally,MGL chapter 152,§25CM states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofipublic work until acceptable evidence of compliance with the insurance requirements of this chapter have been presen&d to the contractin&authority." Applicants Please fill out the workers'compensation affidavut completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)narne(s),addres (es)and�phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limit4f lability PartQerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of ins ran_ce coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for he permit or license is being requested,not the Department of Industrial Accidents. Should you have any questioryegardmg the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate live. City or Town Officials 1 Please be sure that the affidavit is complete and1prmted legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Inestigations has to contact you regarding the applicant. Please be sure to fill in the permit(license number which will be used as a reference number. In addition,an applicant that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address' the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or'town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to bum leav�s etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lilt�to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephon and fax number: The Commonwealth of lassachuseUs . Department of InduustriA Accidents Office of l uveslagWom 600 Washington met Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-8'�7-1�lASSAFE Fax#61' 727,4749 Revised 4-24-07 wwwmass.gov/dia � T \ \\\\ \ \ \ a Y N E ` TLE11�A BL1 � u A �! I LL t71 1 ce er an ;trld*,po' c , el dtrxsed ihff SU AT10t1 the telms:and conditions 0f:ft policy;certain paGcies maY"Ire an erdo,x:eme�A statBrtterrt onth soerhfiiate Qoec certibCatei holder in 6eu al such endorsemen s. PRODUCER JTP4 HTNaMAN Schlegel S Schlegel Ins Brakder E Of3 772—t3381�� 34 Main, Street Eaa A s: schlegelinsuranceftbg*IL West Yarmouth, MA 02673 INSURERMAFFDRDING -- :I RERAa.II :insurance goo MSURED INsu ERa'ACE AMERICAN Tuleika Building ;Company Inc >? , IN§uRERc:2�(,�i ::44 Eaton Ct Cotui.t, MA 02635 : e uRERe i::: ..... COVERAGES CERTIFICATE NUAABER. RE'ViSiON NWIN THIS.IS:TO:CERTIFY:THAT:THE:POLICIES.OF:INSURANCE USTED:BELOW:HAVE:BEEN ISSUED TO THE INSURED NAMED ABOVE FI INDICATED.: NOTWITHSTANDING ANY REQUIREMENT:TE2M OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RE .::CERTFICATE MAY BE ISSUED OR MAY PERTAIN:THE INSURANC.£;AFFOFDED.:BY THE POLM$:DESCRISM HEREIN IS SUB: ! EXCLUSIONS AND CONOITIONS OF.SUCH POUCIES.LWRTS SHOWN mAY HAVE F EN REDUCED BY PAID CLAM: ... _. _ . TYPE OFINSURANLE. ...A POUGY MBER :: AN/M _ ID EXP. A GENERAullsluTY MPi65:93Q sJ3olii 9J30/ie'' EACidocculadEldcE X CdYMERCt4LGE►2ERALLtA6RITY DAW CVitMSh1ADE ®"OCCUR NEC)EXP ale. I PERSONAL&ADV INJU: . GENERAL AGGREGATE :!GENT AGGREGATE LIMIT APPLIES PER `. ... :: . PRODUCTS-COM OP POLICY PRO LQC AUTDMOBILELIABUN. M1T94358 6J14/1f 6/14/18 ash Lin $ "ANYAU60 ;; $ODtlY1NJURY{P�.pa ALLOWNED SCHEDULED AUTOS .AUTOS 80DILY !NJ URY(PtrBa HIREDAUTOS _: OPERrY Ad44 UNBREtLA UA6:. OCCUR .': .:' .. .i i i ;i i L'EACH OCCURRENCE: EXCESSLIAB cLAmss WoE E AGGREGATE DED RETWIO B VMKE2S.COMPENSATION 6S62LTB7H92292318 2X16J28 :2I15/19 v TATu AND EMPLOYERS'LIAERLny ' YIN: ANY PROPRIETORMAKMEMXECUTNE S S N!A OFFICE RVEMBER E)(O.LOED? ( `f pAandabry in NH) : E E1_ IS 1 SdRN)�n6 RATIONS 6ezow _... .. .., :: .:I M .. :: :i .i r>E rnoa iiF OPalAnoras/LOW# Hs rv>� (naiaal acaRb 1o1;Aa*eol;d imr,�n�s Iv;u rom;K pua m m raa) Corporate officers.have. elected:to be:covered under their,worrkrs caiap policy .::. .. .. .. ... ..... .... .. ... .. CERTIFICATE HOLDER CANCELLATION_ SHOULD.ANY OF THE ASOVE DESCRIBWO POLICIES TOWN: OF-::F%12 OUTH:::: ACCORDANCE MTN 1HE POLICY PROVISIONS. TOW,It= SQ'U31RE ..: :.; '. ... " .` :AUTNOR2ED.RBPRLSEIiTY1TN@ ffAIWT1T8 MA :02540:: ATTN: U'EW'ING DEFT, 198.$40 1p:.C CORPORA71 ACORD 25(2010i00) The CORD Elaine and logo are re j[SWred marks a. 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I s- SO � wl .- I. . . 14-1 111. - . .. ­ 21 , I : . .-A Town of Barnstable Building /ass ,n , l n Iry �"' •. ost ,;his rc)Sa at�at�s 1/.is�ble, rom the Street ApproyecjPlans3ust be,Retair'ed onJob and#his Card Must;�be�Kept M ` * Poste until, final spe9O "'IR Has Been Made; Au-' r s. s Permit �:'' Whher ~Certificate # ccu, an �s Re utred-such 13u�ldm sh�Il�Not bea®ccupied-u,� �I a H»al Inspefct�oii has;been made. Permit NO. B-17-2862 Applicant Name: VIKTAR V TULEIKA Approvals Date Issued: 09/13/2017 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration.Date: 03/13/2018 Foundation: Residential Map/Lot 208-120 � Zoning District: SPLIT Sheathing: Location: 377 MAIN STREET(CENT.),CENTERVILLE 7r1Contractor Name: VIKTAR V TULEIKA framing: 1' Owner on Record:; REED,STUART MALCOLM&JOAN A , Contractor,License CS-091854 2 Address: 209 N.FT.LAUDERDALE BEACH BLVD fst Project Cost: $10,000.00 Chimney: FT LAUDERDALE,FL 33304 j F y Permit Fee: . $101.00 Description: renovate bathroom on first floor remove a non i}earmg wall on 2nd �, Insulation: floor support joists in basement rot repair Fee Paid $101.00 9/13/2017 final: Project Review Req: renovate bathroom on first floor remove anon beartngwall on s 2nd floor support joists in basement rot repair t — Plumbing/Gas Rough Plumbing: w„ Building Official FinalPlumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within s z months after`issuance. g All work authorized by this permit shall conform to the approved applcatn nod the approved construction documents forwhic th permit has been granted. All construction,alterations and changes of use of any building and structure Rough Gas: s shall be in compliance with the local zomng`by taws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access A eetor road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ' t k Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the 13uildmg and Fire®fflcials areprovided on`this permit. Service: Minimum of Five Call Inspections Required for All Construction Work Rough: 1.Foundation or Footing ' i 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low'Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final' Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical:Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , Map Parcel ?f `. Application # 117 Health Division p �{ Date Issued !3X 7 XWcA-- Conservation Division � Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic -`OKH _ Preservation/ Hyannis Project Street Address Z Village Owner T0-6ll0 111C4 Address 1 Telephone Permit Request 49v Ilay L&a# 2fcor Square feet: 1 st floor: existing proposed 2nd floor: existing prop e � Total new Zoning District pe 2 ilk' O— Flood Plain Groundwater Overlay Project Valuation 40 000. ` 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 ❑ awl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) P Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new N Half: existing new Number of Bedrooms: 03 xisting� ew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes /WNo 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 o If yes, site plan review# Current Use ` 2� Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name .Telephone Number LaE ram& Address Y � J'�` C,d`' License# �� ofl/ffl�� Home Improvement Contractor# r 66 Email 1111CMLel aJ Yu,. LDO e0,-,-r Worker's Compensation #�zrJ�������JJ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO DATE SIGNATURE /` FOR OFFICIAL USE ONLY APPCICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL .PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I I be CE# TI`F C TE QF OATE(N11m-.D .. . _LIABILITY INS U ANCE. 9 1 17. iWS CE..R11FtCA..TE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RtGtTS tJFK}N THECERTIFiGATE WLDERs:Tt�5 CERTIFICATE DOFF NOT AFF,IRMATIYELY OR NEGATt\/ELY AMEND,.EXTEND,-OR-AL.TE TWE G01' RAGE AFFORDED BY TMtE POLICIES ::. : I I BELOW: TW1S;CERTIFICATE`OF INSURANCE 130ES IVOT CONSTITUTE A CONTRACT BETWEEN'fWE'ISSUING INSURER(S).. AUTHC?FSZED.:;. : REPRESENTATIVE Oit`PRODUCER,AND.'THE CERTIFICATE HOIDER. IMPORTANT f'the ce ficate holder an ADDITION .L INSURED,the'.pbUc esj must t o endorsed. If SUER OATi N IS WAtUED,subject to the terms and conditions:ofthe:policy,canalnv policies may require an endorsement, A 13emerrt:on fhis.certtiicate does not confe rights;to the ce . ca e a _er,in leu a suc ,;e orsnen s .:: PRocucER, : INDMAN NAME �1IM':H Schlegel &�:Schlegel Ins Broker : ririE max;; 34 Main Street a 50., 771 8381' t5t)8f 7.. .-1- 3 : oDa ss schte el nsurance@GMA ,L COM West YaratOuthr MA 02673 ... . .. ..''. . INSURE S`A40,RDING COVERAGE NA►C.A . .. .: �- g CGIIt an Z _. ,.,_._._ LNSURERA:NGH ZNSt TCE 14788 INSURED ttaURER a:AIM:.MUTUAL Tuleika Buildsn p y nc. INsuRERc II 48 Eaton Ct IBA Cotultr Iv1X 026.35 INStIRERE. I. . .. . it1RER E. COVERAGES, " CERTIFICATE NUMBER REVISION.NUMt3ER THIS IS TO CERTIFY THAT:THE POLICIES OF INSURANCE U TED BELOW HAVE BEEN:ISSUED TO THE INSUREP,NAMED ABOVE FOR THE'ROLICY PERIOD INDICATED NOl1MTNSTANDWG ANY REQUIREMENT,TERMxOR CONDITION_EF ANY CONTRAGl OR.OTHER DOCUMENT WRFi,RESPECT:T(7 WHICFTHI$ GERTICATE;MAIf BE ISSUED OR MAY RERTAW THE INSURANCE AEFOf�17ED BY THE POLICIES DESCRIBED k{EREW-IS-;SUBJECT TO Ail:THE ERMS t':-I..I1I1:--.EXCL6 rONVrAMDQONOITIiS OF SUCH POUCIES L�vIIT3 SHOWN MAY HAVE,BEEN REDUCED BY PAS CLAIMS ____ . INSR AOD S .: .. POtJLY EFF.:; Pi�tJCY LTR TYPEOFINSURANCE POt7CYNUMBER . MlODlYYW MMlDLY UkA1TS. GENERALLIAB►LITY 9/3Q/16 A MP165:93Q : /3oh7 EAt;H.occURRENCE . $ -1 000 000;` X COMMERCIALGEPERALLWBILITY ENTER ' oceurreneel $ Q OOO CLALS fi1ADE OOCUR: O.R DANtAGE T . " hip E%t'Ipry.ore person) S 510 OOQ . . PER$0M. ADVIN,AIRY $ :::'I , . . 4 000 ::: . . .. ;, GEIVERALRG.GREGATE. $, ::2 000:"00.0' :::.: GENL:AGGREGA7ELWUTAPBUESRER. PRODUCES.COMPIOPAGG $ 2 000:,000 PRO. POLICY, .. . LOG I4UTOM09ILE I IEl91UTY . >. ... I. , : . $ Es:aaade � .5:.: :: ANYAUTO. ; .. . . . BODILY INJURY(Per peBon) $ ' ALLOWDED ;SCHEDULED . AUTOS AUTOS - BODILY INJURY(Per accident) $ : PROPS $ . ... RaT�YY HIEiEDA�JTOS AUTOSWED .. er,IMerrt `: . Ub1BaELLA LiA9 OOQ.UR " EACHOCCUMENCE $ EXCESS tJAB ,, - :CLAIMSimkct :0. .. :: ... 1 AGGt2EGATE:: $ DFD RETENTIO $ 8; vwRKEt:scoalPEnlsgnoN , 6S62UB2E�33341315; /6/iT a/d/18 X' w srAru 4TH C ANDEA9Pt0YERSLIA6ILITY. YtN ANY"PR OPRIEmRmARTNER/EXECUTiVE . OI*,m RUEEMBEREXCLLOEO? N'/A EL:E HACCIDENt 1OO> QQO Qula1.MaloryinNH? 1. Et.DISEASE+FJltA4P YEE 1OO' OOO :i tf a,.damIW under .yy aa _ - DESCRtPTIO OF:OPEWtTIONSbebw. E,L:OISEASE=POLICYIrrIIMIT $ 5OO' QOQ:: .;, I I I [, ....... r r 9 91 .. ... I . � I . r .. 9 . I 4 :: 9 . r r 9 .... -: t...:. '. ... . .... . Dr. E$CRIPTI4NOP OPERATIONS/LOCATION$.fiVEtUCLEB>(Att ►ACOR610i:J4tl�dmlal Rsrrarks&ieduis,if more spseaf raper adi. Corparatefoffscera hav91.e elec..ted to be covered under thenr,.warkrs: ccmp polseY . , : . . . ,: . . .. . CERTIFICATE;NOt.DER BAN.CEtLATiON. .. SHOULD ANY OF.:THE AI30VE DIrrr.ESCRIBED P()LIC�S BE CANCELLED$:SPORE I THE EXPIRATION DATE;THEREOF, NOTICE WILL =$E DEUVEREQ tN TOWN OE BARNSTABLE,,.. ACCORDANCE1NtTH THE.t?OUCY RROVISIOMS . . . . . .:' BUILDZNG DEPA 2TMSNT.: . .:: F7 M1ZN;; STREET r .. . vr . AUTH0mm REPF T HYANNXS MA 02fi01 . - - ::,..:.�.,r�, . . . .+. - -- -- .1 - .. f. .:. .: .L.... .. - -::- .... . ®1 89-2 ', 99 CORD CORPORATION .AO rights reserved AC.ORD 25r. {201 fl!I)5) The ACt7FiD name and;iogo at 'regtstered marls RD Phone . . .Fax: f Mall. SALL:;3HEABTOWN BARNSTABLE MA.US.. . . I .. .. _ _ The CmnmarrYwah*,qfMaRqadi=ettv. Departiffeut of ru mY&idAcdderd g — orwe a Isa gatEti7lS Baston,MA 02111 kV me rnaSs g-orldia Warkers' Campens.3fcanInsm-mceAfHaviffi 13,Eitdex-r./Cianfrac.tars1EIectd ians1Plombers cZnt IufM=tEalot P� ase rat Nam '.+rtFsrai,��`'lrba��ha Ad&ess: �N Phone' ✓��.��S'��S�S_ Are you an employer?Check the appr6gria-teb= Type of project(reTzircd): L am a employer ti 4 ❑I am a general contractor and feemployew(fall anVor part-time)-* Ii awe lamed$se sir-caadFacfors New a=txuctiba 2.❑ I am a sole propriexo>r orpartne s Tisfed onihe attached sheet 7. ❑Rersodesing Mew sob-cadractars hafie lop and have as e�sloyees. • 9-,❑Demolition - fCd�in employees andhave workers' 4. ❑Building addition Web �Y��`- . LNn vuPdoft y,' comp.fasu 3nce comp_%nenranrr required] 5. ❑ We are a corporafirn and its l a❑Electrcal repairs or additions 3_❑ I am a homeouner doing alT wodc officers have eYm-dsed their 1 L❑P1m�nbingrepaim or additiona Myse£�o wcckers' p right of esmpion per M(M �L.❑Roof a 2,� (�andwehavenafnen e1e?ix+d�[ r 7 employees.LNG woAcess' 13_W'O&C, comp.msuranw regu aA] •Anyapp datchedulaoxiFl alsnSIla thcsec aabeTAwshmdag ieocwo3cea'mmpevsatiaupoTscpi�fformaQ� amF�wn¢zs vrhn saki dti s�dae s ig tLvy ug dffing alFcva�c age tfimLaz aumde eoatmcm�samst saFrmit a new affid� t indiae sacfi rCa actosr ch�3ril z boot most stlsrhed eaadditiffial sheet sI�atc�gti►enam�of the sib-c a and sfle�rlrether arnotrl�nse enaties]>M Empkye;.Ifthesalr•camtUtDesIxqe empIvfee.%tbeymustpm i&thek warken'tontp.palm¢iaaisen I atr[ara 8rrrpb�r tlerrt is pr�ttadria�u�arl€ers'caa�resrdiat[irrsriranoa�'vr m}*empl��ees $alvty is 2Y��ga£iry�rrad jala�a ` Flr�OrRIQtfOlL /� Inoxan.ce Company Name: Ro-ficy 4 or Setf-ins-I ic_ V� �k/ �� Y�� `9 ��F�hauDate: Job siteAa. ti Xitylsra Attach a mpy of the warkere compensationpolicydeciaration page(showkg the policy number and•ezpir-ation date). Fadnre to sew coverage as sequiredunder Section 25A of MGL c. 15-7 can lead to the iffiposition of rdMET1al penalties of a ' fine up to$L50a0a anNor one-yea oa . — as well as civil penalties is the faan of a STOP WORK ORDER and a sae of up to�(Ha a day against o . Be adcdsed that a copy of this z teme^t sway,be forwarded to the Office of Inestrgations ofthe DIA.far' =covens a y on. , .I'rl'a Ieere6y cc�rtr �r r t rurc and psrla s afFer ct�?faaiatf7Es irrfar>ncdiozr prmzrT dab is bar arzd wffr.Lt S+ aturer Bate Z Fame iF Oiid d t50 wiry. Do not writs in th&=ea,to be wwpTetesd by city arton-11 official City or Town: PermitUcewe� Issuing Anihorify(c rde one).: L Board of llmdth j.BuTding Departramt 3.#iiy1rown Clerk 4.Electrical Inspector S.Fbumbrg Inspector 6.Other Coact P'ersaa: Phone#: ormatxon and Instructions Massacliase#f�GenPaA Laws ffiVU:r 152 ream.all boy={°ode wolkE& won for their elployees. gto this sty,an emplaye�is defined as.`�;eYeiY person ih.the service of anotier ceder any coxftarlt of hues orimplie-oral orwr>it=-7 oration or other Legal may, mY two or m= AaIoper is defined as"aninl,Pm ►m ,associafian,corp �, the oftheforegoing a3onit ,andinchIdmgfm legal represefa&esofadwzasd=0p However ho recurs[or trastes of an P�1P,associatirFa or o$ie�Legal may,�oy�MV y�- own=of a dveIlmgh=ehavmg not 3n=than tler=aparlmeots andwho resi-destfi=i a,orthe;occ¢paot°ftba- dweIImg house of am$icr who ploys P=S=to do maw,ca3s uLt on or repair Wrlc on shah dwe7lmg house mfenar�iheretn shaHnotbmanse of sash emplaymcdbe&emedto be.an employer." or on_the gratmtTs ar bni7dmg app - MGL I5'Z,§25C(6]also states thataevexysiafe nr lo=l r'ce�g agency sFralEwiibliold ffie fiance or renewal of a Tcen e-or permit to operat=a business or to construct bwIdmgs za the comma-nwealth for any applicanttrho has notprodnc ed acceptable:evidenam of compfian�with tTze i,«rrrance rAve -agez eQ� -� 2S states=Teifher the c =O-a�• m nor any of's political•snbdrnisions shall AdrlitiBnaIIY,MOLD ISZ,§ =fMr i 0 o any contract far the;pe�anm ofpnblir:veo�ic�acceptable,evidence of compIian cewith the msmaned• rCq:===fS of this cbapirahave been P=Cmted-b fTie cauftacdng-anf mI ity-7 ,4.gPHraats - affidavt co I ,by�g�boxes that apply to your soon and,if Please fiIL o� the wow' compeasai�nn mg,�y necessary, PPly��s)name(s), address(CS)andph Dammber(s)aIongwiathar=t•�cate(s Othec)of than the=u,Emce. L=dtedLmb94 Compame5(LLC)or Li�tedLiabilityParfneialliFs(IIP) thno eaupIoyees members or parfncas,are not rid to carry w❑dm-e compensatian insrrtanca- If an LLC or I.L P does have To ees a olicyisrequired. Beadvisedfhst this affidxyit maybe snhml�dta the,Depa-fineutof rod ntrial - y , P ATso -a sure 1 o and daf--the affidavit. The affidavit should Accidejs for confirmation of insnx-ance coverage not the D eparfm•enf of heretnm ed to$e city or town that the application for ffie pe�E or license is being rec�esi�,Sh to obtain a wot rs' �s i�,�s nnldyou bavc may regarding the law or ifyon a�retd e call.l3>e;Deparime�at the�.be2lisi�d beIflu* Self-insured��es sllonld eater their. _ compensationpohey,P� ' self-a��ce license n�ber on i$e alssprcl¢iafe line, Cry or Town Officials f _ e a$dav>f is Ieia and pried Ieg�ly_'The Departmenthas provided a space a±fha bottom. Pleasebe sore that fit has to coAfacty regardzmgthe licant of$ie affidavt for yo'Q to JM o�in fhe event the Office of"V=d tio= °n � �� Please be sure to fM in the pen iLWHce me rtmnber which wM be used as a reface�bcy In addition,�; �cnn�t Ie e�lrcease Irceiions in any gmmyear,need only submit one a$tday t'T' i that mast snbn�t m� p aPP policv imlromaiion(if nec Y)and ceder`Tob�e Q—dese tie applicant shone wry"an Iocaidens. (�`r „A copy of the affidavitthathas ben offida-UY stomp ed ormarkedbythe city ortovmmay be provided to the town) applicant as prooftbat a valid affidavit is on fee far 531M PM itv or licenses_ Anew aff davitnnrst be f71ed out esa eh emitnotTzedia=iyb„s;n=orcommercialy� year.W]ie2e abome owner or chino-is ob�ing a liceose or P @t� �this affidavit . (ie.a dog license orpe�ittobnmleaves etc.)saidpesson is NOT 'P1ie Office ofInvcsdgad= wovldlix to thank yon>n adv-mce for your cooperaiim a2d should you have nay qacslims. lease do nothesitate to gimms a cal II Z1ze 1?eparim�s address,i�lephone andd fax comber: h . - .. . m�cif 1sid�,ialA�d�n� • • Bwtoa,YA 0�111 617-727-TM gevised¢24-07 ag�dia • . . . mo i ��axa<, fit, � �A�� $ xx� „�A�4�4,.ys ��V�• \W�g ��apy"Ica` �C RV ..ot �. ...'�'�i.. .�R� ..IA, a f t �5 0 �R3 h r 5r� . A {*�V Si.•S tT• E,y • � t,Y J ::y5 7 •.� i Cony l�:in, .`Struc;tw En-g •r 123 Cottonwood Lane•Centerville, Massnh.Osetts 02632.10,9* (508) 71-7601.- mcudIIo@conccast,net SYRUCTUTtALREPOF( EXt5TING itESIOENCE AT 377 MAN ST.;.CE1NTEAVILLE,MA. r, _ 'FAR , N HoLASTRlELtO�fRAdVK i Fil7LEY`. .'.. , .� x � p Ect St 1.23 Cottonwood Lane ,Centerville,Mlasskhhosettstl2632-1 79*4sfl8)771=7Sn1 n cudilo come st.net July,2017 NICHOLAS TRIELLO/FRANK:MCCAULEY via email RE: STRUCTURAL REPORT EXISTING RESIDENCE AT 377 IVlein St.,CenterviIIe,MA Dear Ivls.Coca-Siena, At your prior request,I met frith you at the shove captizaned location on.luly 11,2017€o the purpose of addressing:the structural integrity of the residential.structure,in particulAr as related to the 6.bse'rve e�lsting+". conditions in the foundation,walls and framing and,observed:undulating In the f166rs. The purpose:of this report is to list the structural isssues'bf;concern with regard, the observed conditions. Other . .' isstr'eswe not covered herein. " 1.0 Background Th"e site is Iotated on an inland"lot,which is relatively flat at the,lrt use,siting and dopes sII htly,toward the stye .. : at the front,,pri.Cape Cod M.Osteruille;MA.,it is understood feorri the Assessors;t atahase attached,ghat tile" original residence fotttpr nt,was constructed around 1R23..;1 was idfornted that if as hose lifted a»d` rved tca' this loiatio Thereis a detached gara8e"at tl e rear of<the property,not.;part of,thls report" e,rear laulkheaiJ entrance to-tie full'laserrrent,which appears as a concrete"block 7'wall vvrt ancrete eovred sort buttress,and ,4.. slab-ran-grade. You informed me ihat"the existing residential'strwcture'ls,un ler;reviewldr the,p rpps erf-evaluating tkae,exastlitg conditions in lrght,of a harrie rnspectron.iepdrt irYntly przivrded:, t 2.0"FOUNDAT oN AN.D FRAMING ONQf lON.S ' It appears hat.the,rear entrance into a kitchen'was a later shed roofed addition,,15'xl4`,:to the original.L shaped. footprint,18'x23'€rpnt:tb rear With attached right srdey25' 22' Ti e sited oofed,area"appears in generally gocltl'; condition"with-ceiling heights fra 10'1".to€'E"w"itl in the rear bur p pui. erltrrg.i etgitts vwttl lrt:the ortglnalr' footprint are 7'R'first€Izsorrrd"6'7y'rnaxlrrarrt secrrd€loar,constraeted uitltarr tits galale roo€; 13afte ,€rarntrrg,Carr be o served<in a closed behirid,the7! floor stairs, x8,in eneraliy good,;randWon The front and rear.6 droitms have e v all sepa'rating them;I waiinforrrred this wall is intended to be removed" This:fall appears.parallel to rafters and"to be a non be ring wall,and there€ore may lac emt v d corid floes are Hidden. tits rncist:part and rraust have surface dernolation f c'onftrrn Grin Iiions " .A aoset,Wall"has 4 :degree pIaster,:cra;ks,which is indicative o€vsettlement 'Of riate isthat the.floor€ramie rs"at Conti ued s STRUCTURAL REPORT 377 Main St. Centerville..MA Page 2 the intersection between the.L-shape. The presence of..a'sufficient bearti7;to receive°the prpendlcular:frrriang is bidden,but due to the 45 degree cra..cks this beam..rriust be'reinforced The beam;size carp be calculated based:on: existing conditions.orice surface finish is:removed,:and 2' .floor frai•riing is,exposed, The frame requires.remediation,main#y from below to correct the excessive spans in the continuous wood beams; and lack of double framing below'pprtition wal#s iincluding., elow stair walls and around,tl3e center firep#ace hearths,causing undulation:throughout the;structure firsffloor level This requires work.froiri under the.first fib-of joist level:in'.order to reinforce the beams.and provide adequate beams below all bearing;and partitlon walls Of .. note is the inside flush girt is 8x8 spanning 2 1'9"wlth onlyone timber.post cord- an. Eng'ne ring calculations are: required to.be performed and the u iderp nning beam sized,'once:upper.level Hidden conditions are exposed Th'6, timber`posts are tabe changed to concrete il#ed.stee#pipe"!ally"columns. The foundation,walls of the.main building are 8"ibicic concrete block approximately 2'tall;most likely on no footings just concrete setting beds,below,these are banked sand.berms,i ,buttresses,xwith a thin concretes ' d <. :topping, l observed:thi.fourioation:wali with an active runoff water leak;dUriog the rain on the date of observation. Prom the exterior we noticed that the gutter system dol n.n poutwas poueing rainwaier,just above. .. .. a f .. that.corner location. , 4.0 Conclusions and RecoMmendations The above information provides your with the inadegraacies in the structural conditions'of:the above captioned structure. The structure is in.need bf the following'repairs, 1. Re ovi'the front gutter,downspout,frarn the front corner to alleviate basemen.--16ks Replacothe corner. downspout t©another'location by,p.AI:h#ng the gutter system toward well draining portigns of the site Have a mason re point thexoncrete bloc ,work and berm concrete topping to prevent water frorri entering the building,all around the perimeter Provide contiriucaus drainage ail around the house foundation by providing,ppsitive pitch with minimiii 8"ctearance between tfie wood trailing tsi#ij and. grade 2.1, Add First'floor beans below existing beams or beating°shad wails,with walk thrrsigh openings,on continuous footings;belowtearns :Doul3l foists be#ow partitions✓or add bit"ekarig l etweeri foists 3. Provide 2 . f#oor beam reinforcement below the closet waft at the intersecticiri of the t fi ai#hg F 4. Future,firstfloor roaster bathroom:new a',occess;to living roorri stile piari an a beaixt to;carry the>rall Y above,if it is to rerriain;and framir►g. l trust the contents of this reportraaet your.'needs,at this time Shr3uid you have ariy�questions Qtr any of tyre above,plme do nbt,hesitate to call; Sincerely Q poi s ti � 7 lViichele Cuijilo .P. Oulu , . k. .:•.:. . �'. � .: ., :.. `, .. , ::`. dai?z'��.o.h.. ° . 't3g �'. o +T - ' . ENERAL r US :,(Res eMint IRC Cgnstruction) K 1 , FOVNI ATfOINIS 1.:111 vvarkmanship ta.canfarm tit the requirements af'the�lassachtasetts State'Btialding;Code,latest edifiari, 2: Far site location Nand gradm&mfor navb'n,.sze Site Plan,hyothcra:. : 3: Assurrred net alltav able soil bearing capacitj,q-3000 psf,.foi a medium sand.Igravel.composition. Other soiIs encounterY d, contact the Engrner:af Record. 4: Concrete: Minimurn?g.day strength;fc-:3000 psi.3f4"aggregate,designed per American.Conerete In tatute Code,latest issue,maxirnutn.slurna=4 a.) tlnchor.bolts ASTNI A307 galvttriiied,rain 51$"diameter, 12"long :wl 2-1 r2"haok spaced per.Cane Checklist,,or in: concrete piers w, .irrrpson B'U-series base;SPACED—2'o/c frig slab-anWgr�tde:i tanstruct on(i.e, ar e Brtsetneni.t�alkcsuty etc.). b.) All walls to have min 24 top horizontal,2"clear,to prevent shrinkage cracks c.) Ali walls ling;r_.thait 25''slrall:ha;e vertical cantrol:iaintwith wlaterstoppir7 .betweun wrap faint: : FRAMING 1.A11 workmanship to conform to the requirements of;the.Massachusetts'State Building t~;azlt;sates}edition 2.Structural Deg Load De s:. ad:i aads-Actual Veight of Building Components Lived oad,5 Snow Load —3.0 psf(plus:drifr)with applicable reduction ATTIC Storaae-=20 p§f Li vtag Flo =40'psf Sleeping I loan=30.pst'. Decks and'13alconies.: 4.0 psf Wind Load Crrteria used.for l 10 Exposure f3 or C as;noted per.,,pl.ans 3. ;Stntctural:Steel: (as required) a AS 11t A572 Grade 0;shop paint with,rust inh.ioitive paint.Thru iioits:.F+S\4 A307 tl'2':diameter pvnelted tittles; 9116 diameter.. : b Melds Shop weld'sap and base plates to columns,shop weld bearing,,plates to beams:usc.E'flxx electrodes: Atternativrrl�y ircld weld b��erutreu:y�.lders. c. DcJlutron�riterra: Li360 total:load:deJlectan. �I 4.;Prmber F'rami ` a All new tirnber framing Spruce:-Pine Fir:lva 2 with Eb-l066psi,E*t]300Ob0 psi.,.:or better: b Presure treated trrnber5;(P T) Sauthern':l7rne witltl`Iz I��10 psi C=1 b00,i7t):4 psi,or briter:: c.Laminated' ereer l'uirsber AII;L V ie..slall be 1.9) L V: vvrth pb9� psi, 1900 itsr�t v 2$ p =,Rc_per 7a0,psr, I<c par 3033 psi Par4t3am tPSI.) All PSL shall b:rears i 9)?ES with F'b`-29fl0 psi,l=T 900 ksr,;Fv 2�5 psi 3 c pe�750 psi' 1 opar=29U psi * 'die thatlacrallam anti Parailam may,:be aanterchanaeabl�; 1,..I�eflectran•Crrterra..::Lt480 Live lo'a'a,L13b0'I'at,a,I L"aii ` 2. .ptaonal F'ravide>sliop draw,no subiii�ttal of engrtae�red lamb ,}sterlis jar approval peer to atrra4>p�arzhastng,.. , . . 5.11'y_letal Connectors: As maiulacturetl by Simpson Strong Tie Co shall Abel-and ler3 and installe6,p er manufacturer r;.quircpjents,with atl rt�il., holes filled;with the'size nail' 3peci ed by tntgr,or laerern, a. Rafter to R dr~r:8earq Sir:,ip do LSSta;seraer.or Sampsgn Straps.over tap of plywaosl spac ed i6"n?c,, Rafter to Ride Pl,tc Collar,;'ies mua :i x& = l ' olc at top or Sr son. aps ayes top of lv wood rpapgd:l i' cab b Rafter ends to top plate Simpson Ii215=1 c Band Jar�t >,S=mpsari straps at`4 oPc `.CS MR-4g',c,e d-at bared joist -6:_Bolts Bolts i.n kood?framing shall be standard machine bolts unliesn noted otherwisel''Bolt holes in wood shall.be irs2"larger than.i bait drarneter.Bo.Jt headstand nuts shall bear an standard•malicable.irrin vvasliers,•ar'square plan washi rs All,ntats sEtatl'o ;. retightened atmspletior of jcb. '..''Blocking- a. Blocking st all"be,solid block in rriiniftm;and full;depth ofmcniber , b.Stud l�;ails:prov rde 9cattng:at 8'0'otc maYiirrum height Canners tb 6e;blocked;at 4$'.olc with°?lvwaod;edge nailsng to this blocking.ar•the f1 t148'of these building earners.' c.Naili,I Schetlulep : Solid Bltacking to Bearing. 2 8d..toenails;ea side.. Blockrn g Betvieen Studs ' l`t)d taenarls:ea end:ar? Ibi.enrl-nails ea:End. d 'l tlJ BLt3rl l G.l ravine 2:blocl;:itag for?.jarsvr�tl pr bays and spaced-18 tote n j!5,j nd raftei plane at all edges,, . . .° attach plv wood e I to this blocking g.Nailing S.,.: .chr3re.:.; Alt naating,shatl-be in accordance with the'W CM t ab3e :l Hess noted hergjn,, pecificall3. �ultrple S�itds.. ilbd,(; •l2 `staggi�reaM�� a.ill ndils shall be:pomrno wire:nuals. b:;m-bare when;nails tend to spiit,wood:. 9. Header: less than-'- 1 use 2 2x5;all others,pq-MA State,:BuiWing Codc. OF f o� "MiCNEIE �, .�� 3 ���✓ � t313T&P q{{ Fr }1 C f a: } 1 QJ J. wk - .: .. j `51 777,77 PR( 't}S VIA IFICATI��N / �1 Mlc���� �� I��� "Ur7 n' 1 1 fit" x 5 377IiN ST 41- '06idt6rV�1I�, cql NO v S1S .fyr,. nx�,G�L s ,�/.3 Fii t+iprrta:TRI L Pfoje TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Health Division Date Issued 5 ( Conservation Division Application Fee k Planning Dept. Permit Fee". Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address 3 -71 M k n !aa I 0 Village—6211:m K 10 r Owner .5 7V OY-1 M A-I C61 M, i J®AII R ddress 3-7 ti ST e1hr Telephone 57S_ —)7 1 d 04-7 l Permit Request _io-t�gA):e tvegx ✓&f .ft 5. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed ® Total new Zoning District &0. Flood Plain_ U Groundwater Overlay Project Valuation Z�Pj "Ll Construction Type dr 7 A g Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sur porting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# uni � Age of Existing Structure I®P9 Historic House: VYes ❑ No n Old King's Highway: ❑Yes ❑ No Basement Type: 0 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 r Total Room Count (not including baths): existing new 49 First Floor Room Count Heat Type and Fuel: $Gas ❑Oil ❑ Electric ❑ Other Cenfral Air: XYes ❑ No Fireplaces: Existing l New 6 Existing wood/coal stove: ❑Yes kfNo 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 # 4 Recorded ❑ Commercial ❑Yes C�No If yes, site plan review# / rZ3 O Current Use Proposed Use fti 7-_ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) rn a Name p Tele hone Number 36- 7513 t Address � �J � l7V License # T7 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM T IS PROJECT WILL BE TAKEN TO SIGNATURE DATE r !i. 1 FOR OFFICIAL USE ONLY APPLICATION# t DATE ISSUED '-- — MAP/PARCEL NO. u. ADDRESS VILLAGE, OWNER DATE OF INSPECTION: , a. FOUNDATION FRAME kG UI ILI)i3 .t INSULATION FIREPLACE 4 s ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL r r - FINAL BUILDING � I IG�IK 0 11� r _ DATE CLOSED OUT ( ff } - - s�14c1 ;L j�.L�rl •.i�ii4 � . ASSOCIATION PLAN NO. i - The Commonwealth of Massachusetts 1' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA.02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluinbers Applicant Information Please Print Le 'bl Name(Business%Organization/Lndividual): Ll Address: `' City/State/ZiP: a Phone#: J 6� . FAre you an employer? Check the appropriate box; ❑ Type of project(required); I am a employer with 4. I am a general contractor and I employees(full and/or part-time),* have hired the sub-contractors 6• ❑New construction 2 T I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees These sub-contractors have 8, El Demolition working for me in any capacity, employees and have workers' comp.inmrance.t 9. ❑Building addition [No workers' comp.insurance P• required.] 5. ❑ We are a corporation and its ` 10.❑Electrical'repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their ❑ g pairs or additions 11. Plumbing re myself. [No workers' comp. right of exemption per MGL 12,❑Roof repairs insurance required]t, C. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp.insurance required:] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees.. Below is thepolicy andjob site information Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy 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 InvestigationtoDIA for insurance coverage verificationI do hereby cthe p enalfies of perjury that the information provided above is true and correct' Si ature: Date: 5 � l Phone#: Official use only. Do not write in this area, to be completed by city or town official City or.Town: Permit/I,icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department,3. City/Town Clerk 4.Electrical Inspector. 5.Plumbing Inspector 6. Other Contgct Person: Phone#: 4 ' Y ��e �P���aooacuea��o� aaoa�cv�eCt�, Office of Consumer Affairs&Busi ess Regulation License or registration valid for ind►vidul use only OME IMPROVEMENT CONTRACTOR. . before the expiration date. If found return to: egistration: 103928 Type: Office of Consumer Affairs and Business Regulation. xp!ratio n:._7/10/2014. Individual 10 Park Plaza-Suite 5170 y ® e PETER E. KELLY ti } _ j i t;> os MA 02116 Peter Kelly 50 RUSTIC AVE. g HYANNIS, MA 02601 � . Undersecretary Not valid without signature - _ I i .. I i I ' Massachusetts- Department of Public Safety Board of Buildi.na Regulations and Standards Construction Supervisor License License: CS 15044 £ ,: -- -- z;- 1 — rim PETER E KELLY ' 50 RUSTIC LANE ,t4 r HYANNISPORT, MA 02647 Expiration: 8/15/2013 Comm i."ioller Tr#: 1601 )1 a' ■■■■■■■■■■■■MIME■■■■■■■■■ ON MEN SEEN MOMMEMOMMISOMME NEESE ■ a : OE■S N■■■■■■■■■■■■■ ■ ■ ■ ■ ■■■■ ■ No M■■■MME■ ■■■■ ISOOM■N■M 0 - E M k ■■■■■■■■■■E■■■■■■■ MEMM EMO�ME■■■M■■■MEN■■■■E ■ NONE MENNEN MOMMEM mom ■ ENEM ■E ■NON M . ME MI■■■■ MONOS■NNE MENEM■ No ■E■■N ■ ■EMMON■M NENn■ ■ ■ ONE ■ = =�_ MEN NEE NE No mm- NMOSE moos EMOMME■N■MN = ME■O■NEEM■ ■MEN M■■MEMENONE EI EMOMM■MMEM■M■EM MENNEN MEN MENNEN moms IMMEMIN■ MEN ■■slims ■SOME■ NEON MN ■ m MEN ME MEMMEM EEEM■OOEM M M MOMM■MEMEMEMEM MEN N�■M MEM■MMEMEMMEMEM MEIMMEMEME SOMEONE ME MEMMEMEMMEME■■ ■■MMEN moms MOMM■MMEMMEMEO ■NOOSE ME■■ ■■ MEMMEME■MEMO No ENE M NEEMEMSEEM ON MEN 0 MEMEMME ME so IMMISMEMOMMEM ONE ME u MEEMEM■M■E so , 1 ■ MM ■MNO■MIME ■ M ■■N■ ■■■ M■ Mmm■ ■mM _ -- _ SEEN MEN ■■ MMMMM ME ■ NEN■■M MEN ■ MENEM■■ENO■SEEM ■ ■NMEMMEM ME i R 4 f i• �� _., rr..�, ./I `�� �.- f ,, ,. r s �_ � .i I� 1 t � i'] � � �' t _ _ ... r ��, �`. ! t ` r i t� J r t i � 4 � � *� a 4. S! (ftt )) A d i s�/�' i1t ' ry as C}tcu=ot the zubjoct�ro[cxtn hcrch?an dapzL•;e (o xcE on n;v bcnw,`, :o all in;ittrn_eLtivc to mnrkat:dioaze3 by t tis nuldiat pq—Wt -(address of job) **Pon]fc;nccs:and alarms qrc the responsibility of Yfte,jppl cant. Tool. :ace xtot to be filled or utilized before fence is installed and all Real inspections are performed atld acccp d. .� Iflnf4t'e Gi.`.7R1C:r-i P.`UL N=e I?rite+:Naais, y �� t Q-)%vti:(VAN-rl3:,9}•tiss:On:00LZ 6.20:2 Town, of "Barnstailble E• -i1Lti'iTStSIJs., 1 Ittaais:4- 1 d 0.4-r. Vsi-edor 163� r� Bui cum Perry: Bu'iild i ts'i9iN�"ew f9tjs;;r . ...,, �:c���z ,c•f , d d,, Sign SCE LlOri Jf Us BuR der - �- P Town of Barnstable 3� *Permit wK 91� Expires 6 months from issue date Regulatory Services Fee � C� Thomas F.Geiler,Director Building Division 10A109 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 - IRSI]DENTIAL ONLY. Not Valid without Red X-Press Imprint Map/parcel Number �( Property Address 3 : S 00esidential Value of Work �c 1 t0 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address l C�l ► a,��. il, C a 77-0 661 Contractor's Name F/� a_&� Telephone Number-50�1— Home Improvement Contractor License#(if applicable) R�3(e Construction Supervisor's License#(if applicable) S C 9 r. npp2c RAIT [AWorkman's Compensation Insurance OCT Ched one: ❑ I am a sole proprietor ❑ I am the Homeowner OWN OF BARN STA�L� have Worker's Compensation Insurance Insurance Company Name � E Workman's Comp.Policy# _ LL 2 — 0 3 g I m S5� Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) aRe-roof(stripping old shingles) All construction debris will be taken to, c�L ❑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 pemvt 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 is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /Please Print Legibly Name(Business/Organization/Individual): LG Address: �P O 1 ox City/State/Zip: d6 MPr 0a63s Phone#: 9 s 42 o?- QOR Are you an employer?Check the appropriate box: Type of project(required): 1,AJ am a employer with 4. ❑ 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. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are,doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1 / Insurance Company Name: �'L�¢ 6� �T7 Policy#or Self-ins. Lic.#:U 13 d 3 Ll ( M EAP "09 - Expiration Date: Job Site Address: v�- )qat^- ST City/State/Zip: LVL.� /'t' 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 certi he d pe ties of perjury that the information provided above is true and correctSi ature: Date: ,d'C6, Phone#: =5"_ Yoe e. 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#: ,r -Tfze Uarrunwnurea o�✓vLuaaae/ Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. Tf found return to: Registr_ LOt P 112536 Board of Building Regulations and Standards ir�tin� Y23/2011 TrIE 281021 One Ashburton Place Rm 1301 Type: D144 Boston,Ma.02108 FRASER CONSTRUCTION C.O. DEAN FRASER y� s 104 TWINN VIEW IS.ANE ,hI E FALMOUTH,MA 02536 Administrator Not re uil TegulagBo 4 s an tan ar s One Ashburton Place e Room 1301 Boston. Massachusetts 02108 Horne Improvement-Contractor Registration Registration: 112536 Type: DBA Expiration: 3/23/2011 Tr# 281021 FRASER CONSTRUCTION CO. DEAN FRASER P.O. BO)(1845 COTUIT, MA 02635 Update Address and return card.Marls reason for change. Address Renewal Employment Lost Card Al 0 40M-08/08-DBSLIFORMC/�108212008 I ,r. andWd Owl • '�r-f�',9"91• Ted 9�6.6`8 DEAN FRASft ap EST MUML-l H.IIt 02-ass 5�seon�r RightFax C2-2 9/29/2009 5 : 35 : 22 AM PAGE 2/002 Fax Server AC®R®o CERTIFICATE OF INSURANCE DATE(MM\DD\YY) 09-29-09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE WISE&QUINN INS AGCY IN HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 449 PLEASANT ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE BROCKTON,MA 02301 COMPANY 24WCB A HARTFORD GROUP INSURED COMPANY B FRASER CONSTRUCTION LLC COMPANY P.O.BOX 1845 C COTUIT,MA 02635 COMPANY D COVERAGE 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. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MWDMYY) DATE LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL PRODUCTS-COMP/OP AGO. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0341M556-09 09-26-09 09-26-10 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 500,000 PARTNERS/EXECUTIVE INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: X EXCL DISEASE-EACH EMPLOYEE $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFEC MG WORKERS COMP COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FRASER CONSTRUCTION LLC EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUT PO BOX 1845 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. COTUIT,MA 02635 AUTHORIZED REPRESENTATIVE ACORD 25-5(3193) Ramani Ayer E: d CERTAINTEED Warranties the shingles and labor 100% through the Sure Start Warranty duration. CERTAINTEED Warranties the shingles to be ALGAE resistant for the duration of the Sure Start Warranty depending on the shingle that was purchased. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION, LLC: Carries Workman's Compensation and Public Liability Insurance on the above work, certificate available upon request. DATE OF ACCEPTANCE: /"00�- Homeowner Fraser Const tion, LLC oFt r *Permit# Town of Barnstable 2 �016z Expires' onths from issue date _ Regulatory Services Fee IARNSrABLE, : Thomas F. Geiler,Director 16 96a Building Division 3/14169 L& TFD MA't Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 62601 www.town.bamstable.ma.us Office: 508-862-4039 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint � Map/parcel Number ( 0 , 1 1 Z-0 Property Address G 1 Mal()1al() 51 ve-&-i , L� r(.�t �6 Residential Value of Work t� " Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address (��(�f� � � Q_ee 0 Contractor's Name (1�(A AM-2 Telephone Number C) Home Improvement Contractor License#(if applicable) 14Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ® ❑ I am the Homeowner -A" ®, RESS PERMIT I have Worker's Compensation Insurance Insurance Company Name l 6M r)r\ Ua 1 {n5. LIAR 2009 TOWN OF BARNSTABLE Workman's Comp.Policy# I CU g q Q _30�ngcC)� 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 �j Replacement Windows/doors/sliders.U-Value (maximum.44) 5 �,uv Ste. *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 is required. SIGNATURE: �--� Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston,MA 02111 www.massgov%dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elee'tricians/Plumbers Applicant Information Please Print Lezibly Name(Businessiorganization/Individual):ai36in Lie bkfA 0 TM in Address: City/State/Zip: J-�Jopn�t) MCA Phone#: &77 Are y an employer?Ze the appropriate box: Type of project(required): 1. am a employer w 4. I am a general contractor and I 6. ❑New construction employees(full and/or p -time).* have hired the sub-contractors ..2:0 I am a sole proprietor or partner-' listed on the attached sheet 7. .�Remodeling ship and have no employees These sub.contractors have g,'0 Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers'..comp.'insurance comp.insurance.# required-] 5. [�.We are a corporation and its . . 10. 'Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12. Roof repairs insurance required.]t C. 152, §1(4),and we have no employees.[No workers' 13. tfier comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have erryloyces. If the subcontractors 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. j Insurance Company Name: �� ( Policy#or Self-ins.Lic.M oclq Girl--Z)m ;9U().9 Expiration Date: I l I O Job Site-Address: M 1 ► 1(X(n 5 � . l -PiA,tuai�6 _City/State/Zip: IM-(,L Attach a copy of the workers' compensation policy declaration page(showing the.policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00'and/or one-year imprisonment,as well as civil penalties in the form of a-STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy'of this statement may be forwarded to the Office of Investigations of the WA for ins a covera a verification I do hereby c ' under a -and penalties of perjury that the information provided above is true and correct .Si ature:= G -Date: _ Phone# ��n Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health '2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: } f ��* :- �iI�I:��:�E�������:�in:��a:nlulsiul�:u► Y T �..- #'12/31/2008 14: 18 Bryden & Sullivan Insurance Donna Seviour-*Margo 1/2 ACORD. CERTIFICATE OF LIABILITY INSURANCE OF'ID DS DATE(MWOD/YYYY) SPRIN-1 12/31/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 62601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED . INSURER Assoelated Industries of S!A ` a, INSURER 8: - S rinkle Home Improvement Inc. INSURERC: 1�9 Barnstable Rd INSURER0: Hyannis MA 02601 INSURER E: - - COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEENREDUCED BY PAID CLAIMS. I POLICY EFFECTIVE POLICY EXPIRATION LTR INSRO TYPE OF INSURANCE POUCY NUMBER DATE(MM/OD{YY) DATE(MWDD(YY) - LIMITS GENERAL LIABILITY - - EACH OCCURRENCE Y COMMERCIAL GENERAL LIABILITY PREMISES Ea bccurence f CLAIMS MADE E-1 OCCUR - MEO EXP(Airy one person) f• PERSONAL&ADV INJURY S GENERAL AGGREGATE f GEN•L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POUCV PER& LOC - AUTOMOBILE LIABILITY - - - COMBINED SINGLE LIMIT f ANYAUTO (Ea accident) - ALL OWNED AUTOS BODILY INJURY - f SCHEDULED AUTOS (Per person) HIRED AUTOS - . _ BODILY INJURY f - NON-OWNED AUTOS (Per acdbent) PROPERTY DAMAGE f • (Per accident) - GARAGE LIABILITY - AUTO ONLY•FA ACCIDENT f ANYAUTO OTHER THAN EA ACC S - AUTOONLY. AGG f _ EXCESS/UMBRELLA LIABILITY _ - EACH OCCURRENCE S .f OCCUR r-1 CLAIMS MADE - AGGREGATE f S DEDUCTIBLE RETENTION - - - WC STATLL OTH- WORKERSCOMPENSATIONANO - TORYUMTS - ER EMPLOYERS'LIABILITY A ANY PROGRIETOR/PARTNER/EXECUTNE AWC7004943012009 01/01/09 Ol/Ol/lO E.L.EACH ACCIDENT f 500000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE f 500000 s yes,Describe under - SPECIAL PROVISIONS below E.L.DISEASE-POLICY UMIT S 500000 OTHER - - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDEO BY ENDORSEMENT I SPECIAL PROVISIOAS - CERTIFICATE HOLDER - CANCELLATION SPRNKH0 SHOULD ANY OF THE ABOVE DESC RIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Sprinkle Home improvement, Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Fax 0508-775-1350 IMPOSE NO OSUOATIONOR LIABIUTY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Margo Mack 199 Barnstable Rd. REPRESENTATIVES. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE - IKelley A.Sullivan ACORD 25(2001/08) 0 ACORD CORPORATION 1988 lio ss ti ot.[3!usitlusl R'egui ttiUis and Sfn;ixlaiaris :Gonstrue'tion Siipervisor',Licens':e= Lic'ense:.C'S 6643 Exuir'ation' 1:078/2009 Tr#' 942:7 t, Restr.:'ction: 00 BRAD:K SPRINKLI 190 LO HROPS LANE . W BARNSTABILE MA 02668 CiYnunsssioi'er 0:0 3S,QO;O cf enclosed sp ice lA Masonry onay i k.G-1'..2;P'amily�Ionres r; .F:ailure to poisess:•a eurrett ediGso,rt of"t<Fi`e moso..l'usetts State Building Code t is cause for revo'cattonof:E+hts hceitse: '�� �' fr;,•:,rsrart�:crea�(.t: +:f.:lfrc`;tdrr;fia:ar.'�G , Board`of:Ilm ing Regulations an :Stan:ifarils kai iNOW 4' HOME IMPROVEMENT CONTRACTOR Registration: 103757 Ez.'piration. 7/9/201`0 Tri 271:033 tv, Type:.:Private Corporation SPRINKLE HOME QPA0 EMENT 1NC. Brad: Sp.rinkie ;. 199^Barnstable R.d: ..n�;t` Hyannis MA`02601 Admen'sstrator s License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,.Ma.02108 Not valid it out sig ture zT � Town of Barnstable Regulatory Services rMAM Thomas F.Geiler,Director 16596. a� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 73 -(2 � *J-0po &&A�' ,as Owner of the subject property Q^ r hereby authorize ) (; (MI-Q- M(JIfLY'k C�'1— to act on my behalf, in all matters relative to work authorized by this building permit application for. V 3Z7 VY\" 3hz_LA:, Gent eluyk. Mck '(Address of Job) 31009 Signature of Owner Vate To a I �! Print Name If Property'Owner is applying for permit please Complete theµ Homeowners License Exemption Form on the reverse side. 'a o-izn R M C-nVJNF.R PFR MT.QSinN Asse4or's.oide(1 st Floor): ' Assessor's map and lot numbqrp2 O 1 oZ yy\C, <3EPTIC SYSTEM MUSTBE ��THE Tp Conservation ``f ;..!STALLED IN COMPLIANCE Board of Health( rd f ): " ` WITH TITLE 5 • Sewage Permit number. , 2> l ` "- IRONMENTAL CODE AND MASK t sea �o rua Engineering Department(3rd floor): �77 jk TOWN REGULATIONS o �e�o. House number '� Ito Y1'r r Definitive Plan Approved by Planning Board 1g, APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING AWSPECTOR APPLICATION FOR PERMIT TO \`A TYPE OF CONSTRUCTION 12 AZCU 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 7 r (n Proposed Use �,o\ 0 G—rvk--�e's Zoning District Fire District ��l�`� Name of Owner,325� 5\��\ Address Name of Builder Q C � lit \ Address Name of Architect 0C �DWE�� _ Address_ Number of Rooms Foundation Exterior Roofing Floors w D� Interior Heating Plumbing Fireplace Approximate Cost CD Area �ZD 2 Diagram of Lot and Building with Dimensions Fee n rY 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 � �\I Construction Supervisor's License Reed, Joan & Stuart 35603`, remodel & r ,_ Permit For , � Ladd deck' 3,77 .Main Street - Location # Centerville Owner ' Joan & Stuart Type of'Construction frame Plot ` Lot t 'Permit Granted January 15 19 9 3 'into�t Inspection l /9 19, _ Date Coted Y , i i s i r +fit� •,, � � _� i � ! � I I�ii) I ," - �i t I i-- `—t_• ,.. i L� JK ire F= L-_rZj:j-".t\I .1 ��'�LI �.I'Jr :�3 �.�,l:y`��.+°^K�!...:::w"�.1��-��1 � ��t t!i., i•-�^� t' ��`J/ i� I f��.�-•--�-s,..=-h` �.� �a+w..�.ti ..- � �Ac,_'r .� ,�.�.>:,y:�sti..° s -°'t^ensae.•" _ G i \ _ 4--- E G u 1.114 Fr N+.TGH�C7 __1C1 {_.� G� FE �H - - r;U i —zi i r,,t 5- Gi_A?_i h l t I it I . n ov ci i�/�D Ca6ht�J 7 t I �ct� • New E I I W I I�iDJ.Y�/S I