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0153 OCEAN AVENUE
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Tgg�E Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number(Y Property Address 45 3 GE eA Au Residential Value of Work �d�� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address F1t^ P &j Z_a L 153 OcQ;io-, 4,jP OrA-qi y i L L Contractor's Name dWV_1Le44'1q_7 �N 1;51� C /©AZ Telephone Number ,� r�� .E Home Improvement Contractor License# (if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance/ Insurance Company Name a u� f C to / Workman's Comp, Policy.# 6'7u (3—Q 7 ,9 9(f��—� CJ 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 Dom n ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License.is required. S I GNA TUBE: (;�4 14, 1!�V,4,1 — 1-7 n:\WPFIi.F.S\FnRMS\huild.ina nermit forms\EXPRESS.doc - �\ ✓/ze �om�rcarzulea:� n��,/�/faaacic`ucaeJ,ta Board of Build►ng:Regulations and�landarjds j FIOME IMPROVEMENT CONTRACTOR Regstrat€on''137139 / [y E�iPiM-.ion 1D/1f0/2008-. CUNNINGHAM CbhIST ,, PHILLIP CUNNINGI AIGt �`r 314 QUAKERMEETINGHO SE RD E SANbyJiGH MA 02537 Depgty olmfiki f ' a ,.. . ' 9`i.Board of Bu►►ding Regulations -Aft idads • Construction Superirisor License zt' Li-en a CS 34280 Tr# 21976 E�Ftn�io �/ 010 I 6 $ }€ . { t f r PHILLIP A'CUNNI,G�HAIA l �� t 3.14 QUAKER MEETINCi1� �� ;€ CommissIoner. I E.SANDWICH M . 02537 t , 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/Plumberr. Applicant Information Please Print Legibly NaII2e(Busintss/orkanin on/lndividuaI): U w4e, Address � �Y� City/5tate/Zip:,551 Phone.#:_ Are you an employer?Check the appropriate bwc Type of praiect(required): 1.PkI am a er oployrr with 4. [] I am a general contractor and I 6 New construction croployccs (full and/or part-time).* have hired the sbbrconiiactors 2.❑ I am a'sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-con tea-ctors have g. Demolition employees and have workers' worlang far mein any capacity. 9. ❑Building addition. No workers' camp.i ns„anr_e comp.insurance.* 5. [] We are a corporation and its 10.[]Eltctrical repairs or addition rtqulr�] officers have exercised their 1 L❑Plumbing repairs or addition 3.El I am a homeowner doing all work i myself [No workers' comp. right of exemption per MGL 12 ❑goof repairs incrrrance r t c. 152, §1(4), and we bout no - egtured-] employees. [No workers" 13.0 Other corop,insurancc required_] Any applicant that cl=lm box#1 must also fill out the section balcrw showing their wmirs'eomPco-ration policy information Homeowner%who submit this affidavit indicating fbcy an doing all work and then hire outride contrnetom must submit anew affidavit indicating such tContractnrs that check this box ussst attached as additional ahrzt showing the narne of the suh�antracturs and slain whctha or not thost entities have crployces. if the sub-contntctoas havecioployccs,theynnutpxvvi&then avrkcas'comp-Policy number. lam an employer that is providing worl.ers'compensation insurance for rrzy employees 3elaw is the paltry and job site information. Ild Insurance Company Name= 2Q (t' I A)S Policy#or Self-ins.Lic.#:lc�y 6 "O 7'9 UAI�L—& 07 Expiration Date: 1 fob Site Address: /56 LI 'Ie 9�v :5 r 0U AQ U i`/V City/Statdzip: � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date, Failure to secure coverage as requncd under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of: finer up to$1,500.00 and/or one-year imprisonment, as wcU as civil penalti'cs in the form of a STOP WORK ORDER and a I of up to$250.00 a day against the violator. Be advised that a copy of this statcmcrit may be forwarded to the Office of Investi-gatims of the DIA for insurance coym&9c vcri_fication. I do hereby certi&under the afns- d penalties erjwy thal the information provided ave'ts true and correct Si Datc: - Phone# 2 Official use only. Do not write in this area, to be completed by city or town offrciaL City or Town: Permit/License# Issuing Authority(circle one); 1 Board of Health 2.Building Department 3. City/Topn Clerk k 4.LIecirical Inspector ector S.Plumbing Inspector or 6. Other i . PROPOSAL I C I Sheet No.,_..... ._... Proposal Submitted To: Work To Be Perforrned,At: _ City:.__ ._., . .r_: r 4.____. __._ _, _, __w.,:.., City __._... State _.. State _..».e S l Date of Plans Phone.__ Architect_.__......._ We hereby propose to furnish the materials and.perform the labor necessary for the completion of T ...-!»ft If .._._ "__.......,,..__.,.-.1, ..t__._•__�,.�._.e�...""_f�.S?. ....,�..^ ..__,..(...,«.. ,,...,.�j. _pig,.f....... .,.._...,_. ....._,_.. .._.. _.... .._,,.»........ ............ ...»:.r..._,. .__......... ...»._.,:. ... ...,,...._._ .......... .. f / r � � aTtl ( I �(t Gp n �nL 5. _ All material Is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work and completed in a substantial workmanlike manner for the sum of U �7 �C`/i nC, Dollars ($ 6 36 C ). with payments to be made as follows .,._ ... _._ .,_ .D�pQa I 30300 7 Any alteration or deviation from above specifications involving extra �, i costs,will be executed only upon written orders,and will become an Respectfully sub.mltted/x�/ j.w.'?extra charge over and above the estimate..All agreements contingent upon strikes,accidents or delays beyond our control.Owner to carry fire,tornado and other necessary insurance upon above work..Work- Per ...._ __ _...__ ..... .__. _. men's Compensation and Public Liability.lnsurance on above work to be taken out by Note—This proposal may be withdrawn by us if not accepted within _ days. ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted.You.are authorized to do the work as specified. Payment will be made as outlined_above. Signature Q ` Date_.__._ _.... . ..®(J __-___...__ _:____.n_.._. Signature __ _. ..... , ., ..._. ..,,.:.. TOPS FORM 31350 )U RP C A 7- urHo IN U.S.A. A1iVH-QTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM;°°,YYY,). PRODUCER (508)540-4555 - FAX (508)540-9255 07/24/2008 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DFM Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. BOX 565 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND"OR 668 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Falmouth, MA 02541-0565 INSURERS AFFORDING COVERAGE INSURED CUNNINGHAM CONSTRUCTION, INC. NAIC# - C DBA: Phil Cunningham, dba INSURERA: Zurich Ins. O. 314 QUAKER MEETINGHOUSE ROAD INSURER B: INSURER G: EAST SANDWICH, MA 02537 INSURER D: INSURER E: COVERAGES THE.POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE IC 0 NDICA D.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS T FLA OF INSURANCE - POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION ILITY LIMITS CIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED $ IMS MADE ❑OCCUR. is(Ea ocnirerice) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ ATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ECO-- LOC PRODUCTS-COMP/OP AGG $ IABILITY COMBINED SINGLE LIMIT ( ALL OWNED AUTOS Ea accident) $ SCHEDULED AUTOS BODILY INJURY (Per person) $ HIRED AUTOS NON-OWNED AUTOS BODILY INJURY. (Per accident) $ PROPERTY DAMAGE GARAGE LIABILITY (Per accident) $ i ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ EXCESS/UMBRELLA LIABILITY AUTO ONLY: AGG $ - EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND 6ZZUB-0729C44-A-07 08/.1.9/2007 08/L19/2008 $ EMPLOYERS'LIABILITY WC STATU- OTH- v c A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT 100,00( OFFICER/MEMBER EXCLUDED? $ If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 100,00C SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $ 500,OOO DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES /EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN.NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,. Jamie c f n l 11 O BU RE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 6 Prince ett, M Circle OF NY KIN UPON THE INSURER,ITS-AG S OR REPRES ES Mattapoisett, MA 02739- AUTHO EDRE ESENTATIV ACORD 25(2001/08) FAX: (781)575-1575 ©A RD R30RATION 1988 Engineering Dept.(3rd floor) Map . �� Parcel J,,Q/�F�ti Permit# - House# /�j� G `'""' Date•Issued ,�-- Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30). t✓.1_g� Fee o�S �C. od ; Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) THE Definitive Plan Approved by Planning Board 19 BARNSTABLE. ` SEPTI MASS TONS OF BARNSTAELE INSTALL® ����ppz� CORIPLDA�r CE Building Permit Application WITH TITLES Project Street Address 53 WAR4 OC� p�U�7 ENVIRON14ENTAL CODE AND Village Owner A-k)GvS L-A VV—r_- Address S A+A2 Telephone oZ g Permit Request 1E— ®©-F I t,�, G— C` First Floor square feet Second Floor 9C� square feet Construction Type Lk_)o O _ib T—B,A>I.E . Estimated Project Cost $ f ��, a a Zoning District Flood Plain Water Protection Lot Size C Grandfathered ®Yes ❑No Dwelling Type: Single Family a Two Family Ll Multi-Family(#units) Age of Existing Structure /� S Historic House ❑Yes ®No On Old King's Highway ❑Yes ®No Basement Type: ❑Full ❑Crawl ❑Walkout ®Other ?_A a S t&sement Finished Area(sq.ft.) �./* Basement Unfinished Area(sq.ft) /114- Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing k_New Total Room Count(not including baths): Existing_ New First Floor Room Count 15 Heat Type and Fuel: 5 Gas 0 Oil ❑Electric ❑Other Central Air ❑Yes ZINo Fireplaces: Existing / New Existing wood/coal stove ❑Yes No - Garage: p Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) WNone ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization p Appeal# Recorded❑ Commercial ❑Yes N No If yes, site plan review# - Current Use r`S I D -z^i r Proposed Use f�'j S 1 b C,u C E Builder Information Name t4 A-) D i4 U iS Telephone Number /21? —_1f 4- G Address 3 ¢¢ L /ZA License# GEC FJ ! 6-L) Q ZC 3 Home Improvement Contractor# ��$ Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1�4 S iPdl F\LL SIGNATURE DATE —7 BUILDING PERM ENIED FOR THE FOLLOWING REASON(S) t FOR OFFICIAL USE ONLY M. PERMIT NO: DATE ISSUED MAP/PARCEL NO. ; ADDRESS VILLAGE ".'. . OWNER DATE OF INSPECTION: tit_ FOUNDATION FRAME a INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL �. GAS: ROUGH- ra n - FINAL FINAL BUILDING ` DATE CLOSED OUT ASSOCIATION PLAN NO.