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TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY 1"ORMATION Address of Project: *I (9 NUMBER STREET VILLAGE Owner's Name: 13_a e i OCo',"o r Phone Number �— Email Address: Cell Phone Number b -77 6-s 6 5 Project cost S_ /, (y 5 — ' Check one Residential Commercial T ® IT'S AUTIIOPJZ.ATI®N As owner of the above property Y I hereby authorize P to make application for a building permit in accordance with 780 CMR Owner Signature: See Mcd,,,-Q Date: TYPE OF WORK t Siding D Windows (no header change)# 0 Insulation/Weatherization Doors (no header change)# 1 Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to w as4 e- n,�� c P ,��-G 1�,mo ,fib, MA CONTRACTOR'S INFORMATION Contractor's name Anzec., I arr+e l y� A Home Improvement Contractors Registration(if applicable)# 112-7 F S (attach copy) Construction Supervisor's License# D (attach copy) Email of Contractor 4-s,,,f Phone number #o /- 7/V- 6 3 3 9 ALL PROPERTIES THAT HAVE STRUCTURE OVER TS YEARS OLD OR IF THE SUBJECT PROPERTY is IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE PERMIT CAN BE ISSUED. i APPLICATIONNUMBER............................................................ *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 attached on Additional tent dimensions can be at 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/COAIJPELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S NER'S LICENSE EX m ME TIOlV 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 CAM 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 applicatlo are subject to a building official's approval prior to issuance. I . L Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improveme%4t..Cantractor Registration Type: Supplement Card HOME DEPOT USA INC _ Registration: 112785 ----, I, u Expiration: 04/22/2021 P O BOX 105451 ATTN: LICENSE MGMT TEAM ATLANTA,GA 30348 Update Address and Return Card. SCA 1 C+ 20M-05/17 A Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only , TYPE.:twolement Card before the expiration date. If found return to: Registltiften Expiration "Office of Consumer Affairs and Business Regulation 04/22/2021 1000 Washington Street Su' 10 HOME DEPOT w Boston,MA 02118 ANDREW SWEET i 2455 PACES FERRY FU. 11 HSC ATLANTA,GA 30339 Undersecretary . NO al itIt ut SI nature .. a ,.• - 'r I , Tlie Commonwealth of Massachusetts 'a Department of IndustrialAccidents �- 1 Congress Street,Suite 100 Boston,MA 02114-2017 • www mass:gov/dia 'Workers'Compensation lusaranee Affidavit:Builders/Contractors(Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORM., ApplicantIaformation Please Print Lesibly Name(Bwiness/Organization/Individual): n a - - t,-t- Address:—010ES r City/State/Zip: S w P M Ot S 4 S' Phone#: -7-7 -Z1 5 - 2- 1 S S' Are you an employer?Check the appropriate boa: Type of project(required): LQ i am a employer with employees(fW1 and/or part-time).* 7. [:]New construction' 2.❑I am a sole proprietor or partnetship and have no employees Awtiriog.for me is S. Remodeling any capacity.[No workers'comp.iM�*��e required.]. 3.[]1 am a homeownerdoing aU workmyselE[No workers'comp.fi manee required.]t 9. ❑Demolition ❑4.❑Iam a homeownerand wdi be hiring ceatxaeton:to eonduntall workoa my property. Iwal 10 Building addition ensure that all contractors either have workers'compensation insurance or are solo 1 Lr j Electrical repairs or additions Proprietors with no employees 12.❑.Plumbing repairs or additions 5.®I am a general conhaotor and I bate hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-eoatractoa have employees and have worlflers'comp insurance.= 6. We arc a corporation and its offices have cx=ised their ' 14:dOt11eI �/t o4` D t�l' ❑ tp right of exemption per o. 152,§1(4).and we have no employees.[No uvrkets'comp.insurance required.) re,014 *Any applicant that checloi box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this a$4davit indicating they are doing of[work and then lure outside contractors must submit a new affidavit indicating such, #Contractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and state whether or notthose 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 Belary is the policy and job site - r information.In ,/ ' Insurance Company NameL /I t_"e laa/ V—A;C l / &_ 1V7. Policy 4 or Self-ins.Lic.#: X l je- S S &5 5 1`7 r Expiration Date: C) Job Site Address: Lf ci plc( h c/'r-, i��'. City/State;14.: 6.1 der✓r•_t 1,e_ �. Attack a copy of the workers'compensation-policy declaration page(showing the policy number and expirhtigp.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 imprisonm as ell as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. py; thus statement may be-forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un an enalaw o information provided above is true and correct Signature:.: ate: Phone : 3`1 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#: The Commonwealth of Massachusetts 1 j Department of Industrial Accidents ` '=MRj" Office of Invesfig ations EJ ° 1 Congress Street,Suite 100 Boston,M4 02114 2017 {'`'- r www.mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le0bly Name (Business/Organization/Individual):_ Address-_ s�&. City/State/Zip: ('�;-, , 13 ;1 - -, �� ,n � �• Phone#: Are you an employer?Check the appropriate box: 4. ❑ I am a general contractor and I Type of project(required): tu i.❑ I n a employer with employees(full,and/or part-time).* . have hired the sub-contractors 6. 0 New construction 2-L7 I am a sole proprietor or partner listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have - $. ❑Demolition Working for me in any capacity. employees and have workers' [No workers' comp. insurance comp-insurance 9. Building addition 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 11.0 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' 11❑ Other _-�- comp.insurance required.] 'Any applicant that checks box C must also fill out the section below showing,their workers'compensation policy information. t Homeowners wha submit this affidavit indicating they are doing all.work and then hire outside contractors must submit a new affidavit indicating such_ tContractors that cheat this box must attached an additional sheet shoving 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 in information. surance for nzy employees Below is the policy and job site Insurance Company Name: Policy#or Self-ins.Lic.•#: Expiration Date: 9 Job Site Address: City/Site/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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. ' I do hereby certi under the pauis and penalties of perjury that the information provided above is true and correct t ---- - _ - --- - -- - -'T - S i fftiature: � 'A. �.. F � d , ,,;;•>�, :Date:� ._ -— -- Phone#: Official rise only. Do not write in this area,to be completed by city or town.officiat City or Town: Permit/License# Issuing Authority(circle one): - 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspectgr 5.Plumbing Inspector 6.Other Contact Person: Phone#: - Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constract3tti`�4r�isor u ires 04/0412021 CS-074247 PAUL M DOWNING i r 25 ALCOTT CIR. TAUNTON MA 02T80 , � Commissioner I o Home Improvement Agreement: Page 2 Description of Work to be Performed _ A detailed description of the work to be performed is included in the paragraph entitled Scope of Work or Specification which is included in this Agreement. Anticipated Delivery Date / Installation Schedule Approximate Start Date: TBD Approximate Finish Date: TBD All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. i Electronic Records Authorization You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this Agreement. By contacting your Service Provider, you may update your email address,withdraw your consent, or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above,you confirm that you have access to a computer that can receive and open emails and PDF documents. i I do❑do not Q consent to receive only electronic records related to this transaction. Contract Price and Payment Schedule Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 11582.05 Includes all applicable taxes. Excludes finance charges.' Sales Tax: $ 163.32 (If applicable, total amount of taxes included in Contract Price) I i *Maximum deposit ONLY applicable in MD, MA, ME(33%), NJ, Wl(99%) � IDeposit% Deposit Amount $ Remaining Balance $ Finance Charges Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement,to which Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payments made payable to Home Depot. Insurance proceeds will will'not be used to pay some or all of the total amount of sale. Acceptance and Authorization ^� By signing below, you authorize Home Depot to: (a)arrange for Service Provider to perform any Services or(b)order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign if blank or incomplete. (Service Provider's or permitting information may need to be provided to You later.) By signing, you acknowledge that: (i)You have read, understand, and accept this Agreement in I its entirety, including the General Conditions and State Supplement, if any; (ii)You are receiving a complete copy of this s Agreement; (iii)all rights and interests under this Agreement are solely vested in the person listed as"Customer"above; and (iv) Electronic signatures will be deemed originals for all purposes. X I CIL e UL, 1 08/12/2019 Customer's Signature Date X /s/The Home Depot 1 08/12/2019 The Home Depot Digital Signature Date Call The Home Depot at 1-800-466-3337 for help. f ACo CERTIFICATE-OF LIABILITY INSURANCE Dotios2019DIYYYYI THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu`of such endorsement(s). PRODUCER CONTACT - MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHONE FAX Not: 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: _ INSURER(S)AFFORDING COVERAGE NAIC 4 CN 1 01642069-HomeD-GAW-19-20 _ INSURER A:Old Republic Insurance Co 24147 INSURED INSURER B:New Hampshire Ins Co '231341 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD BUILDING C-20 INSURER o ATLANTA.GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439-28 REVISION NUMBER: 21 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. ILT R rypE OF INSURANCE ;AODLiSUBR; POLICY EFF POLICY EXP LIMITS LTR' POLICY NUMBER MMIDDIYYYY I MMIDDIYYYY A X i COMMERCIAL GENERAL LIABILITY MWZY 314574 03101I2019 03/0112022 EACH OCCURRENCE S 1.000,000 DA A O REN D ! X 1.000 000 i CLAIMS-MADE OCCUR PREMISES Ea occurrence !S " X SIR:b1,000.000 MED EXP(Any one person) S EXCLUDED _ PERSONAL&ADV INJURY S 1.000500 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 1,000,000 X POLICY PRO LOC PRODUCTS-COMP/OP AGG S 1,000.000 JECT OTHER: S A :AUTOMOBILE LIABILITY MWTB314573 - - 03101/2019 03101/2022 COMBINED SINGLE LIMIT S- 1.000.000 _ IEa accitlentl X i ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED SELF INSURED AUTO PHY DMG _ AUTOS ONLY i AUTOS BODILY INJURY(Par accidenq S HIRED NON-OWNED PROPERTY DAMAGE S AUTOS ONLY AUTOS ONLY - ! Per accident UMBRELLA LIAR OCCUR r EACH OCCURRENCE s --'EXCESS LIAB I CLAIMS-MADE; AGGREGATE S DED i i RETENTION S S B i WORKERS COMPENSATION WC 012717099(AK,NH.NJ,VT) 03/ul aulg03I0112020 j X STATUTE i ERH B AND EMPLOYERS'LIABILITY YIN ! WC 012717100(WI) 03I0112019 03101I2020 'ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT S 5•(1110,0�� '.OFFICER/MEMBEREXCLUDEDY i N jN/Ai (Mandatory in NH) E.L.DISEASE•EA EMPLOYEES 5.000,000 If yes,describe under Continued on Additional Page 5.000,000 DESCRIPTION OF OPERATIONS below 'E.L.DISEASE•POLICY LIMIT!S C s Excess Auto 297110011002019 0310112019 03/01/2020 1 Limit: I 4.000.000 A Excess General Liability MWZX 314580 03/O1I2019 03101I2022 I Limit: 8,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC ROAD 2455 PACES FERRY ROAD T " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE I of Marsh USA Inc. ManashiMukherjee �CcLuao ��lw[t� e�. ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER fD: CN101642069 ' LOC#: Atlanta ACOIR" ADDITIONAL REMARKS SCHEDULE Page 2 of - 3 AGENCY _ 'NAMED INSURED MARSH USA.INC. THE HOME DEPOT,INC. HOME DEPOT U.S.A..INC. POLICY NUMBER 2455 PACES FERRY ROAD _ BUILDING C-20 _— ATLANTA.GA 30339 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Workers Compensation Continued: Carrier:Indemnity Insurance Company of North America Policy Number.WLR C65890549(AL.AR.FL,ID.IA,KS.KY.LA,MS.MO,NE,NM,ND,OK,SC,SO.TN)NVJNY) Effective Dale:03101019 Expiration Dale:03101/2020 (EL)Limit:$5,000,000 Carrier.New Hampshire Insurance Company Policy Number:WC 012717098 (DC.DE,HLIN.MD.,LIN.MT.NY.RI) Effective Date:03/01019 Expiration Date:03/0112020 ' (EL)Limit:S5,000,000 - Carrier:ACE American Insurance Company i 1 Policy Number.WCU C65890586(OSq (AZ..,r A.IL.NC.OR,/A,NA) Effective Date:03101/2019 ` Expiration Date:03/01/2020 (EL)Limit:34,000,000 SIR:31.000.000 SIR for the Mates of AZ,CA,IL,NC.OR.VA.WA Gamer.National Union Fire Insurance Company Policy Number.XWC 5565596(OSI)(CO,CT,GA,ME,MI,NV.OH,PA.UT) Effective Date:03101019 Expiration Date:03/01/2020 (EL)limit:54,000,000 31,000,000 SIR for the states of COMEAVAI.ORP.A.UT 3750.000 SIR for the state of GA $350,000 SIR for the slate of CT Carrier:National Union Fire Insurance Company Policy Number:XWC 5565597(OSI)(MA) Effective Dale:03101/2019 Expiration Dale:03/01/2020 (EL)Limit:34,500.000 t SIR:3500,000 i TX Employers XS Indemnity: Carriec111inios Union Insurance Company Policy Number.TINS C65221019 iTX) ^a Effective Date:03101019 Expiration Date:03101/2020 (EL)Limit:310,000,000 SIR:31.000,000 t ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD mot , Shed • TOWN OF BARNSTABLE Permit * BARNS "TA • MASS. �.e 1639' ? a Permit Number: . E D MA'S Application Ref: 201307801 20132636 Issue Date: 10/28/13 Applicant: OCONOR, JAMES C & SONJA M Proposed Use: Accessory Structure Permit Type: SHEDS 200 SQ FT &UNDER Permit Fee $ 35.00 Location 49 OLD FARM ROAD Map Parcel 251219 Town CENTERVILLE Zoning District RD-1 Contractor PROPERTY OWNER Remarks 10 X 12 SHED Owner: OCONOR, JAMES C & SONJA M Address: 49 OLD FARM RD CENTERVILLE, MA 02632 ArN cH Issued By: PC POST THIS CARD SO THAY IS VISIBLE FROM THE STREET , Town of Barnstable To or � RBI TA BLE THE to Regulatory Services 20 � 's: 5 Thomas F.Geiler,Director STAB LE. ` Building Division Tom Perry,Building Commissioner — ' ED MP'�A 200 Main Street, Hyannis,MA 02601 Mj I www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# ,—O �5 001 FEE: $ S SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less q47 OLh r 2�( R!> C r;--��.�eyiLc 2 Location of shed(address) Village 3-AH =S 2- 56,--J-T/4 0"Cd JOA J—Qe "7 It 3 7515- Property owner's name Telephone number 1 .2 .257) a � � Size of Shed Map/Parcel# 10 —.29 -13 ignature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 V PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:052813 m N o o•� 0 0 •��� ' mod. . 1 C.B. i 26.3';;; tK LOT 4 IV moo. I 26.3' 1 w kph 25 r era ,kp � LOT 3` o •h RES. ZONE.- 'RDI" This MORTGAGE INSPECTION Blau issForO FLOOD ZONE.- "C" . TOWN: _ ---------- REGISTRY OWNER: jqm J.emm cAST/// & Q9fCA . PENDBRCAST-RAASDORP DEED REF: _ �82,��--- -----BUYER: ------------- DATE: _10Z(29�97----------- pLAN REF: _237 117--------__SC ALE:I"= 30___FT. I HEREBY CERTIFY TO 5'ALVD_LCH-C-QQP�-AZY-vE'6BNlf_ YANKEE SURVEY __-THAT THE BUILDING } SHOWN ON THIS PLAN IS. LOCATED ON THE GROUND AS o�� PAUL � CONSULTANTS SHOWN AND THAT ITS POSITION DOES _ __ CONFORM A. 40B (SUITE 1) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE 3 IIERRHm H TOWN OF -__6ARNS��BLE___-----------AND THAT Na 3m INDUSTRY ROAD IT DOES--2&t_ LIE WITHIN THE SPECIAL FLOOD HAZARD MARSTONS MILLS, MA 02s48 AREA AS SHOWN ON THE H.U.D. MAP DATED$f-L9/Q,� TEL 428-0055 Lc- o _ it ane 250001 0005 C FAX: 420-5553 ________ THIS PLAN- NOT MADE FROM AN INSTRUMENT ZI?42 DCB AUL A. ME 1TF�E SURVEY. NOT TO BE USED FOR FENCES ETC. . i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel / Application #- - Health Division Date Issued -7 Conservation Division Application Fee G. Planning Dept.: Permit Fee US . Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis ^ Project Street Address '�/ Dl01 rm I Ccl. Village Owner ���wl O 'e-0mo 2 Address Telephone Permit Request E4—U) L &_ G I-,) J-?—X �z a /<'7V'FAv i�A_) '�►��yw �v , CCU a?xS) Lu '4k x Square feet: 1 st floor: existing proposed 2nd floor: existing proposed. . _ _ Total new POdLl.�li' O DEPT, Zoning District Flood Plain Groundwater Overlay Project Valuation �3�5� Construction Type AUG 15 2017 Lot:Size Grandfathered: ❑Yes ❑ No If yes, attach?,suppo- r gAocumentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑.No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use T APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ICJ `�i�-� w� Telephone Number S � ?�1—631e7 Address License# O -76 S-:�L/ ,Lo, 2&­2 � wl 4, 3( Home Improvement Contractor# Email Z:2-71 Q iFiVS CUw) Worker's Compensation # wC S3/S3�'WOY0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C co SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME ��.t 3�t 7 INSULATION � -7 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING�(�3//1��K DATE CLOSED OUT ASSOCIATION PLAN NO. f Canr�►ea#3t��x�� . i �t��Ac�iaT • Basw t,MA 02HI wwmmasLgvr/dw Wmkern' Cwnpens c Iusm-= a Affdzvit UMWAM&rZCtMMfE1eCbidaUSThM1her3 Avp c znt kfmmLition P.e252 Print 71 -{ mif 0.442 -w sod- SYF'-y Arc you an e=pbyer?tbwktbe appragriate ban Type of project(reguked}: L 0 I am a anplo,ywwi& /,')— _ 4..❑I am a geuetal c fmctur and I 6 ❑lde� emplagees Pcd awLbr part-ime s have hin d$e� . 2-❑ I am a safe grvp orp�srtaer- listed rmlhe attached sheet; 7- ❑ Pr BaBeHng sly and have no a mptrP s Mese smb-c .I�e g. C]Demolition VMddng fo�rMd is asrg capacifg. exzj�andhave vas' 9 ❑B.uilffng addition [No wodmw camp.;uma camp- � 1 5.❑ We are a cmpozafion and its 10-❑Elec f repairs ar ad&fum 3-❑I ama bomw=er doing all wmk affm=bm used tlmk 1L❑Pam 6ingnTairs or adcbi cm coup - Tiot of perAMM ❑ d j M iIwe lne as ❑ empluyem[Na ` Otbar c=zp-iwmam=require&] ;Amy cl ma pgTug7M �naiev�nga�m sat�t des�aaea`la g pep ao= g sg taa�a�Bu=ak�o atsideco�scrosmast s35mit a new2Txdaet mdiav0a =dL rC�ffiatck 3c9�ctmsmaw =sadisrnsl Shed sbosriagftn�of&ausedstoma mcffaotticasaemiueshx� e24&7YE s.I€1b,--M e-coa bavemoglvy�tfieY=x5rP=M1&&ek aMke'aUMp FGIL-Y saz lam an arripIar tFtr�is prauidurg�var&ets'avian itsnrcr$cs jer a�I $eFoev fs riffs ptr&cp ar�d jab s Fx,jormat�a ' P y oz .sLi�/. /,c>C S3/ 3���'oyva-�- D U,z- )3�/8 Job Site address: / / Cb3,/SEafxF25p: l�� �.rq/�• A bwh a copy of the worriers'compensation poles declaratina Pie'(showmg the palicY number and ezph-Awn Jzte). Failstre to serum coverage as re under Sects 25A of MM c-M can Lead to ate ixoposifi=of criminal penalises of a fine np to$L54D 00 aadfor ane`yexrinq iso as weA as dv2 peudti=..in the foam of a STOP WORK CERand a fne of up to$250M a dug agatusf the violaimr. Be mhised that a cW oftis s statemed maybe ceded to 9fe Offim of IWedig& oss oft3ie DIA.for" -CoveMN v Ida harby &a and ofyerjwy thatfits hVernzati provi&dabam is true and mrect T Phone 90 a,�at tts� 33a urst esarits fet�axa�€a 5e ra�rfet�by ter ar�u�r�irerrtl Cay or Taws: Fermiffiiceme,;g Issuing And (circk ow): L sand of MI Bug&o,.-Depot 3.C1t3Yruvm Clerk 4.Electrical FnVecxar S.gibing for 5.other duct Pia: P 6 1 i li 11 1 / ! i li lI:K. ..1.1.�1R - ■ ...tf.� �•a.l:•. -I �nlr •' R t. ■1 . •- ••.1.1i+R ►■/ntr�t6:.t•1. 1.1 t.iiI �!.■!■ ••>:. •[l •Ynl .• 1■ i. r(t.1\ _/■ I•rr• • •i)■I■�■ : - .ifR.■ !t ■fi ti� • :a.•.•� It••� :t■ ►•.■1. :r •I ■tt is ■ �• I. 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W •n r..•� :u m a•. I.. • •.• /_ • .n ■.�•m �■- P.a In-..• :.•1 k ■- -a Isis .2210 G• ■nnl r t.l t_- •a.r��.�_. • �._ It. • �:moo+% r .�a16 fail ■.- J . :-.y>r.= - ■ . a 30-9 �• 1 f O A+CORO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/17/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Christine Davies DOWLING &O'NEIL INSURANCE AGENCY PHCN; Eidl: (508)775-1620 1 FA Alt,x No ADDRESS: Cdavies@doins.com 973 IYANNOUGH RD INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURERA: LM INS CORP 33600 INSURED INSURER B CAPE& ISLANDS KITCHEN &BATH REMODELING INC INSURERC: DBA C&I KITCHENS INC INSURERD: 99 STATE ROAD ROUTE 3A -INSURER E: SAGAMORE BEACH MA 02562 INSURER F: COVERAGES CERTIFICATE NUMBER: 173797 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRR TYPE OF INSURANCE ADDL SUER POLICPOLICY NUMBER MM/DY EFF MM POLICY1 EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PROECT ❑LOC PRODUCTS-COMP/OP AGG $ J OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED - - PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accdent $ UMBRELLA LU\B H OCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER TH- AND EMPLOYERS'LIABILITY Y/N A OFFICER/MEMBER EXCLUDED?ECUTIVE NIA NIA NIA WC531S369904027 07/03/2017 07/03/2018 E.L.EACH ACCIDENT $ 500,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensationfnvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Daniel M.C y,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD _........... ....... vrrx.ol;,,wee, '_Office of Consumer Affairs&Business Regulation License or-registration valid for individual use only 1A=H.OME IMPROVEMENT CONTRACTOR before the expiration date. if found return tw, f 160266. Office of Consumer Affairs and Business Regulation R�,=Re ist 9. ration Type: 10 Park Plaza-Suite 5170 Expiration 7/7�2018 Supplement Card Cape&Islands Kitchen&Bath Remodeling Inc Boston,MA 02116 i WILLIAM SCHMITZ 99 State St. -• _... Sagamore Beach,MA 02562 Underecretary Notrvalid without signature Massachusetts Department of Public Safetdys ' Board of Building Regulations and Standards License: CS-076571 = ' Construction Supervisor #; WILLIAM L SCHMITZ 66 CARAVEL OF HATCHVILLE MA 02536+w s gi Expiration: Commissioner 0910912017 1 Town of Barnstable . Regulatory Services KAM Richard V.Scab,Director Mea► Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder i. CJ l�►/�� as Owner of the.subject property > S a hereby authorize �/ I G vyt , to act on my behalf in all matters relative to work authorized by this building permit application for. (Address of Job) A **Pool fences and alarms'are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed final inspections are performed and accepted. Signatur of Owner Signature of Applicant ° �I (J CD BUD►2 (.�/' /�t�1 sz— Print Name s Print Name Date QXORM&OWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services p�Et Richard V.Scali,Director Building Division su►sNsrescs, Paul Roma,Building Commissioner 059. 200 Main Street, Hyannis,MA 02601 . A www.town.barnstablema.us 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXE ON Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was nded to include wner-occu ied dwellings of six units or less.and to allow homeowners to engage an individual for hire wh does not posI a license,provided that the owner acts as supervisor. DEFINITIOF HOMEOWNER Person(s)who,owns a parcel of land on which he/ a resides orends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures ac ssory to suuse and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a omeowneuch"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall b re onsfor all such work erformed under the buildin ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for o pliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she undetstaz the Town of Barnstable.Building Department minimum inspection procedures and requirements and that he/she will comply th id procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35, 00 cubic feet or arger will be required to comply with the State Building Code Section 127.0 Construction Control. OMEOWNER'S EXE ON The Code states that: "Any homeowner erforming work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1 1-Licensing of const ction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,th�t such Homeowner shal act as supervisor." Many homeowners who use this exemption are unaware that the are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Lice sing Construction Supervi rs,Section 2.15) This lack of awareness often results in serious problems,particularly when he homeowner hires unlicen d persons. In this case,our Board cannot res y P P proceed against the unlicensed person as,it w ld with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fu y aware of his/her responsibilities, any communities require,as part of the permit application,that the homeowner cer if that he/she understands the respo sibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and a,opt such a form/certification for use in your community. Q:'%WPFILES\FORMS\building permit fomis\EXPRESS.doc ` 06/20/16 1I1,i1P1 ii lo, 11I11.1 11l�l14 1111/IP V 131n1 .` 'I fi lrp".... (a7n) (u)�111 ',(IF1,I,�j (It�llSj s; (LGU7 125/ri" I61/11" 19 i/1" 24" 27 1/1" (321) 61(l) (502) (610) .'f 2815/16" 351J/16" 433/16" 5121/16" (735) (913) (1097) (1313) 1 I'/11i/16 TR2910 CTR3410 CTR4010 CTR4810 h --= CTR5210 OO OO DO y CTR21810 CTR22010 CTR22410 CTR2281( CN22 C22 CW22• CN225 C225 CW225' IL CR73 _ C23 CW23• CX23 II IL._wlf,�l �� 00 ,. 11IIIII CR2.15 CN C235 CW2350' "—= CX2.350 CR'l.4 CN24 C24 CW240' �4I ii 6240 fI� CR2/15 CN245 C245 CW2450' ill CX2450 C1125 CN25 C25 GWl.1 I:X'l,!id CII;'b!1 CN:'!Pfi 1+'NIP ldkl) iPri ' 7 i i i i 19241„ -- - 3 1 9 ; /, 24,-2" !v 36� ,,; 75 2 ,I I 777-7 1 0 1 'DW302424C1� l W3330' r) GI =' LO - I SLS36R SB27 i DISHW24 B21 RTR j 'I 2 i --2 ,; _ _21„-_�, _- 84.511 - t f f All dimensions size designations F This is an original design and must Designed:5I5t2017 given are subject to verification on �® not be released,or co ied.unless Printed-.7/72017 ti 1ECMNOlOG1ES' P � job,site and adjustEnent to fit job applicable fee has been paid or job conditions. order placed_(C)Mark Dupont=2014 O'Conor Kitchen I EI I j I)ranving#: I No Scale. 10 "' t -- 33Be— 30" 12�e 2411 � 00; I Y� 1/V3012 COw33®;f 1230 �uv0 � U ►� -HOO of a� IIII i 3DB33 MANGE GAS. 0 2 SLS36R CY) j IZ 41 30 3 ®° , 36�° i_ 5 ea —51 ea it 8 / --..�— .- ----- ---r— _ All dimensions.size designations 2� 3" E This rs an original design n and must Designed 5/5/201 7 d. green are subject to verification on i , cHnataG,ts� not be released or copied unless Printed 7/7/2017 job site and adjustment to fit job I applicable fee has been paid or job conditions. ; I order placed.(C)NA ark`Dupont-2014 —- -- ` G'Conor I:itchcn 1 El 1 Drakm,;t i No Sc11c - _ - o 10 2 O V. 20 00 rQ Q•(p � ti tl n a . N:" r, .5 M - v c A l� v O. � J V) O i O ..N m V O m J n TOWN OF BARNSTABLE BUILDINGPERMIT APPLICATION Map Parcel T01N I Application # I Health Division ;'�(�, i ? .'� ? Date Issued /Q Conservation Division Application Fee Q y� Planning Dept: s, rvma Permit FeeDIVISION (�•y Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address �9 Q& 12/0-M /•Z al Village �,, &7,)/�i/, Ile Owner e.i r o/ Address e Telephone J7D Permit Request IA��7 g/l ,/D ,l l,—Z ,i2 20- e2 /j�f�J' / Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation .014 a ze>; ,;Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Q�1' Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes -a'No On Old King's Highway: ❑Yes EYNo Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) - Name (_ o�& .4 Telephone Number �h�✓ " �4- Address /� n ��,p License # 14,,2 Z s--f Home Improvement Contractor# Email&iZ11ed SaWe_III c�J&442Zllf_ �ol�f Worker's Compensation #d&_lea 6 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 4M A DATE 'e FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. :r k� ADDRESS VILLAGE t OWNER DATE OF INSPECTION: FOUNDATION ' F F FRAME INSULATION 'a FIREPLACE F ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i 'j FINAL BUILDING DATE CLOSED OUT. ASSOCIATION PLAN NO. f , The Co»smorsaversltls of Mressrschusetts .i DeJ�rsrtm.enl of lnrlscstrircl Accidents 6 1 Congress Street, Suite 100 Boston, MA 021M-2017 • l VIM,m.=g o 011 a VYw—kers' Compensation Insuraace Affldavlt; Builders/Contra011*0WEl TO BE FILET)WITH THE PERMITTING AUTHORITycfricians/Plumbers, cant Inf ma I n Name(Business/Oroonizalion/Individual)'. PI ase Print Le Ibly Address, City/State/Zip: b 2� :�. . //�/ M___�__ Phone Arc you nn employer? ack the appropriate box; ant a ontployor with _ZZ-- om ployoos(full and/or part,llmo),1 Type of project (required) �~ 2, I am a$ole proprietor or pamnorship and havo no employees working for mo in anycapaoity,(No workers'comp, insuranco (equlred,) �' 0 New construction ).Q I am a homeowner doing all work myself $'"(] Remodeling Y (No workers'comp, insurance required,)I o I am a hom00%vnor and will be hiring contractors to conduct all work 9' Demolition ensure That all contractors tither have workors'compensation insuranco or are$01 0 1 will 1 (� Building addition proprietors with no employoes, ama general contractor a»d I havo hired the sub contraolors listed on the atta 1 I'Q Ele0tl'ical repairs or addittnr, These sub,conrra,olors havo employees and havo workers'comp, lny,uanco.l ched Sheol, l2,[ Plumbing repairs or addtl��,r 6"We are a corpornllon and its of freers havo exercised their right of exemption ar 13'CQ Roof repairs I52,f 1(4),and we havo no omp10yeos (No workors'comp,Inswanco required,) __ P MGI.o, 14,(rOther /G/✓yJ/ Any applicant that ohack�box ri must nlso fill out rho section below,11 s t ' Homeowners who submir1his affidavli indicating they are doing all work and Than hire outside contra " iContraclors Ilia[chock this box must agachod an additional shoot showing slid ten flrkors compansal r,$ policy Information. amployaes. If the sub contractors havo employees,they must provide Ihoir workors'pomp, olio olors must submit a now affidavit indicating such he sub contraolors and slate whether or not Ihosa ontilics I�avc ' /«nr«n employer t/r«l is provlr/t�l� ►vorkers'eorrrpensntton lrrsrrr«nce or y number, lnfornrndon, _ ' f my employees, Below is tl:e polley rrrrrl/vb srre�� . • Insurance Company Hama' Policy#or Self ins. Job Site-Ad re Expiration Date:.' Attach a copy of the workers' compnn�n tlon policy declaration fty/State/Zip; ' �� 3� Failure to secure coverage as required under MQL p, i S2, §2SA is a criminal violati P ge (sbowing the policy numb•er•and czplratio�)�Ici: and/or ono-year imprisonment, as tivell as civil penalties in the form of a STOP OP-K day agalrist the violator. A cony d'f,ti;is statement may be forwarded to the Office on punishable by a fine up to$1,500 0f- coverage verification, ORDER and a fine of up to x250 Uri of investigations of the DiA for insurance .. /rlo/fereby cert�y rurrler(Ire prrlrrs nrrrl pennitles o fPerf►cty thnt t le • t a u , � lt/orttrxon provlrle!«hove i true «nr!correct Offlctal use only, Dogtrot Ivrtte lit t/10 area, to be oornpletecl by ct or�' lovers City or Totvn- ll Issuing Autbority(circle one)- PermIt/Licensa W,� I, Board o•f Heaith 2, Bulldla De nrtmeaf 3 CI 6, Other ,� ^�� City/TOM Clerk 4, Electrical Inspector 5, Plumbing Ins pector Ij Contact Person.; I Phone#1 i Massachusetts Department of Public Safety Board of Building Regulations and Standards License; CS•100988 Construction Supervisor HENRY E CASSIDY +. 8 SHED ROW WEST YARMOU;fH 16 Expiration: Commissioner 11/11/2017 Office of Consumer Affairs and Bustness Regulation ` 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C�:ntxactor Registration Registratlon: 153567 Type: Private Corporation 6mn" Expiration: 12/15/2010 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY - 18 REARDON CIRCLE 30. YARMOUTH, MA 02664 .' Upda,te,Address and return card, Mark reason for change. $CA 1 !'+ 20*0/11 - [] Address Renewal I­_� Employment Lost Ca,•cl dee Tow ncomoea•&1i 01GAI-kidr+.c/udozo •01'ke of.Consumor Arrairs& Ruslnoss Regulntlon License or registration vRIld for Indlvldul use only OME IMPROVEMENT'CONTRACTOR before the exptratlon date,'If found return to: eglstratlon: <1:53567 Type: Office of Consumer Affairs and Business Regulation ;j xplratl•on;-:;1.21;4:5l20:1.6 Private Corporation 10 PRrk PiazR •Sulte.5170 Boston,MA 02116 CAPE COD INSULAT:I'QN;:,ING'... HENRY CASSIDY 18 REARDON CIRCLE` . - Z � � 50. YARMOUTH,MA 02664 �Undersoorew,y--- N• valid wl lit sign e CAPECOD•27 CLEDDUKE ACORO° CERTIFICATE OF LIABILITY INSURANCE [:!7/1(M1201 E YYY) 6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Ileu of such endorsement(s), PRODUCER CONTACT NAME: Barbara DeLawrence Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/C No): South Dennis,MA 02680 noDRess:bdelawrence ro ers ra .com INSURERS AFFORDING COVERAGE NAIC q INSURER A:Peerless Insurance Company INSURED INSURER B:Saf9ty Insurance Company 39464 Cape Cod Insulation,Inc.. INSURER c:Endurance American Specialty Insurance Company 41718 16 Reardon.Clrcle INSURERD:Atlantle Charter Insurance Comp an 44326 South Yarmouth,MA;02684:.' INsulteR E INSURER F: COVERAGES Cl~f371FIC.. NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF.JN$URANCE';LI.$TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 7AIN INDICATED. NOTWITHSTANDING ANY'.REQUIREMENT,•Y9R1 bA,CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY.:J?E} , THfti,:(NSUI�INCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUO.HiPOLICIES,LIMITS'SHOWN•MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EXP LTR TYPE OF INSURANCEAV— OLICY NU' BER MMIDDIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $. 1,000,00 CLAIMS-MADE OCCUR CBP826:3A83 04I01/2016 04/01/2017 PDAMAGE TQ REMISES RENT occurrence) $ 100,00 MED EXP(Any one person) $ 5,00, PERSONAL aADVINJURY $ 1,000,00, GEN'LAGGREGATELIMIT:.?PG PER.,. . GENERAL AGGREGATE $ 2,000,00 X POLICYQ•:j 0 LOC PRODUCTS•COMP/OP AGO $ 2,000,00, OTHER: $ AUTOMOBILE LIABILITY COMBI Ea a cld Dt E LIMIT $ 1,000,00 B ANY AUTO . 6232707 COM 0.4(01;(2018 ''04/,O:il2017 BODILY INJURY(Per person) $ ALL OWNED'`: SCHEDULED AUTOS X :AUTOS "' BODILY INJURY(Per accident) $ yy X HIRED AUTOS x. 'AUIOSED ED $ ;. R Pere Ident X UMBRELLA LIAO X OCCUR.? ;BAC.F{O,000RRENCE $ 2,000,001 C• EXCESS LIAB CiLA1MS.MADE EX 1:0006835001 04/01/2p16 04101/2Q1�'1' -qGG $ DED I X I RETENTION$ 10., 00 " WORKERS COMPENSATION cAggregartA• $ 2,000,00 ..•... PER;.. AND EMPLOYERS'LIABILITY TAT 7f3' 0 Y .N.;•..., D ANY PROPRIETORIPARTNER/EXECUTIVE WCEO,G.431802 08130I2016' 0.6/30/2017 'E is •CHACCIOENT�.t; $ 1,000,OOI OFFICER/MEMBER EXCLUDED? N I A (Mandatory In and E.L.DISEASE•EQi�.ti.Mp�OYE $ 1,000,00, If yes,descdba under DESCRIPTION OF OPERATIONS below E.L.OISEA E£sp,,, L'ICY LIMIT::? 1,000,00I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICL'Ifb (ACORD 101,Addltlonal Remarks Schedu(a,may,be:atfadRB'd;lr.rnore space is required) ' Workers Compensation Includes Officers or Proprietors. •: `: ,:'., Additional Insured status Is provided under the General Liability and Auto LIB !..ty,W bn required by written contract or agte6mert4'with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE h {({A. U) THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 94A Co erce Park SOLI(�h ACCORDANCE WITH THE POLICY PROVISIONS, Sou hatham,MA 0285 1" ,". AUTHORIZED REPRESENTATIVE c:_0— ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD f °4 l ti Town of Barnstable )regulatory Services Richard V.Seati,Director Building Division Torn Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towu.barnstable-ma.us Office: 508-8624038 Fax: 508-790-6230. Property Owner Must Complete and Sign This Section If:Us ilia A Builder M/=•S Q+�ti ep, ,as Cheer of the subject property hereby authorize._GAPr C N to act on mybehalf, in all matters relative to work authorized by this building permit application for. qq 014farnit. Nk, �►dl�, (Address oflob) "Pool fences and alarms are the responsiblLyof i ie applicant. fools are not to be filled or utilized before.fence iS installed and.all final inspections are performed and accepted mnature of Owner Signature of Applicant Print Name Print Natx�e Date Q:FORMSi01VNFRPEn.iJSS10NPC?ULS Town of Barnstable *Permit# � � 61,(D Expires 6 months from issue date Regulatory Services Fee %-- r BARNSTABLE r MASS. $ Thomas F.Geiler,Director 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 Vaud without Red X-Press Imprint Map/parcel NumberI Property Address Gw)(.t/\v ed 6 Zesidential Value of Work Cv 0 Minimum fee of$25.00 for work under$6000.00 , C _ Owner's Name&Address `�) .�,t/1v�d%(IBC Contractor's Name f—r�_Ser �nS-Fr'uc-��c1�, L.L C y Telephone Number (SO Home Improvement Contractor License#(if applicable) Construction Supervisor's License#,(if.applicable) (�fWorkman's Compensation Insurance r Check one: ❑ I am a sole proprietor . I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name �ATI on& U n i o Y� E'i f e L n S U rc n C e ,O • Workman's Comp.Policy# N C O b R 9 I40 b 0 Copy-of'Insurance Compliance Certificate must accompany each.permit. Permit Request(check box) MRe-roof(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. Going over existing layers of roof) ❑.Re-side :. #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: PropertyOwner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is quire . SIGNATURE: . Q:\WPFI1LE3\F0RMS\building permit form,;TXPRESS. Revised 090809 f i The Commonwealth of Massachusetts I Department oflndustrialAccidents Office of'Investigadons 600 Washington Sheet Boston,MA 02111 www.mass.•gov/dut Workers' Compensation Insulr•ance Affidavit:Builders/CA IicantInformation ontractors/Electri cians/Plumbers Name Please Print L 'b FBas'ness/Organiiation/Individual): r�S2 Y Address: S' —t City/State/Zip (�c>rf- >q Q3 b 3 Are ou an employer?Check the appropriate box: Phone#.- a �^ y'28 �� 90-7 1•E71amaemployer. � with 4 (]I am a general contractor and I Type of'projeet(r:equired): i 2 ❑ employees(full and/orpart-time)* have hued the sub-cogs 6.. E]New construction i I am a sole proprietor or partner- listed on,the attached sheet ship and have no employees These sub-contractors have 7. ❑Remodeling working for me in any capacity employees and have workers' 8ElDemolition' j [No workers'camp insurance comp insurance t 9• ❑:Building addition required.] 5. Lj We are a corporation and its 10•0 Electrical r i 3•Q I am a homeowner doing all work officers have exercised their repairs or additions myself.[No workers'comp. right of exemption per MGL 11..0 Plumbing repairs or.additions insurance required:]t c 152,§1(4),and we have no 12-0 Roof repairs i employees-[No workers' 13.[]Other, comp.insurance required.] { 'Arty applicant that checks box#1 must also 0 out the section below showing their workers'compensation li t Homeowners who submit this affidavit indicating they doing all work and then hire outside mPo cY information tContractors that check this box must attacbpd an additional sheet sb contractorsmust submit a new affidavit indicating such. employees If the subcontractors have employees,they must ° name of the sub-contractors and state whether or not those emit es have ey provide their workers`comp policy number. I am an emploper that is provrdrng workers'compensation nrsurance or i utlnrmu7ron f my employees, Below the policy and job site Insurance CompanyJ Name: Policy#or Self-ins-L ic..#: VV.0 OQ� Expiration ( Date: Og 2-6 � o'2oY( i. .lob Site Address: yh Attach a copy of the workers'compensation policy declaration City/StateJZip: ✓���� page(showing the policy number and expiration date), Failure to secure coverage as required under Section 25A ofMGL c 152 can lead to the imposition of criminal penalties of'a fire up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP o W01�ORDER and o 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. • 1,o hereby eerti ' s d penalties o e fP that the information provided above is true anal correct Si turn; Date: hone#• Official use only. Do not write in this area to be completed by city or town OSWal City or-Town: Permit/License# Issuing Author ity(circle one, L Board of•Health 2.,Building Department 3.•City/Iowa Clerk 4.•Electrical Inspector- 5..Plumbing Ins ' 6..Other' g pector ------------ Contact Person: Phone#: ACC>MEr FRASC �.� CERTIFICATE OF LIABILITY INSURANCE ON-o1 MOSU DATE(MM/bO/YYYY) rr PRODUCER (508)676-0309 10/21/2010 IV Insurance Agency,Inca THIS CERTIFICATE ISSUED AS A MATTER OF INFORMATION rport Road ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ver,MA 02720 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Fraser Construction LLC INSURERS AFFORDING COVERAGE NAIL# P.O.Box 1845 INSURER/l National Union Fire Insurance Company Cotuit,MA 02635- INSURER B. INSURER C. INSURER D COVERAGES INSURER E. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D' POLICY NUMBER POLICY LICY EXPIRATION GENERAL LIABILITY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR PREMISES Ea occurence $ MED EXP(Any one person) $ PERSONAL&ADVINJURY $ GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ POLICY PRO LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILnY ANY AUTO CO BIKED SINGLE LIMIT(Ea $ ALL OWNED AUTOS SCHEDULED AUTOS (BOODILp�INJURY $ HIRED AUTOS NON-OWNEDAUTOS BODILY INJ(Peraccide RY $ (Pea DAMAGE $ GARAGE LJABRJIY ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN EA ACC $ AGG EXCESS/UMBRELLA LU181Ln AUTO ONLY: $ Y - OCCUR F-ICLAIMS MADE' EAG`H OCCURRENCE $ AGGREGATE $ DEDUCTIBLE $ RETENTION . $ $ WORKERS COMPENSATION $ AND EMPLOYERS'LIANLnY X WC STATU OTH. A ANY PROPRIETORIPARTNEIVIDSCUTrVE YIN C009930601 91=2010 9/26/2011LIMOB OFFICERIMEMBER EXCLUDED? EL EACH ACCIDENT $ 500�00 (Mandatory In NH) rcyes,describe under E.L.DISEASE-EA EMPLOYE S 500100 SPECIAL PROVISIONS below OTHER EL DISEASE-POUCY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS i CERTIFICATE HOLDER` CANCELLATION t SHOULDANYOF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Fraser Construction,LLC PO Box DATE THEREOF,THE ISSUING INSURER VIIILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Cotuit,MA A 02635- NOTICE To THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO Do So SHALL i IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVE$, AUTHOR®REPRESENTATIVE I ACORD 25(2009101) ©I OW2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i e i Board ofBnildingitegnletioheend License or regkbvdon valid for individul us HOME IMPROVEMENT CQNTRACTOR e only I2egisG befvro the expiration date. If found return to:. 912536 Board 0BuildingRegulations and Standards 011 Tr# 281021 One Ashburton Place Rm 1301 Type: 00 Boston,Ma.M108 FRASER CONSTRU-n' N CEO. DEAN ERASER > 114 104 7NNN VIEW"E E FAWIOUT 4,MA t)2d36 , Admitdsdm rot rot Not e 07-7 hoar o ual e ns an s .e Ashburton Plwe m Room 1301 BostorL Mmsaphusetts 02108 Horne ha.-provement-C6n for Reposer ors Rellist u lon: 112536 TYpe: DBA FRASER CONSTRUCTIOR! CO. , Expiradon: 3/23=11 Tr# '281021 DEAN FRASER P.O. SOX 1845 COTUIT, IAA 02635 Update Address and return card.Mark reason for change. Al 0 40n4-M&ossu rA1oaLh2= ❑A.ddrm Renew! ]employment host Cal, MOM 4 owl , _ -. :, li ,j •.Via- :. .b�y .4�� $-�atc:` TM8. I '� .� 7 •• •�L�P ,}•may-�•--�'.�'�., j 1 _ ,� �.e I -Any deviation or alteration from above.s ecification 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: r Homeowner Fraser Cons tion, LLC For com an use on1 Date Received Date Started: Date Completed Job estimate: Dean/Mike # of squares: Billed . Material ordered Extras Paid Available Discounts 4 { g EVE The Town of Barnstable Department of Health Safety and Environmental Services '�FG Mop' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner SHED REGISTRATION Location of shed(address) Village Property owner's name Telephone number Size of Shed Map/Parcel# i L11ce hq S' ature Date Hyannis Main Street Waterfront Historic District? � Old King's Highway Historic District Commission jurisdiction? �V xConservation Commission(signature required) THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg J N o Q C.R LOT 4 moo. I 26.3' LOT 3 RES. ZONE- "RDI" This ' MORTGAGE INSPECTION Plan is For FLOOD ZONE- "C" . Use Only TO WN: _ ___—___- REGISTRY OWNER: JiL& J PENDERCAST 111 & ERICA J PENDERCAST=WAASDORP . DEED REF: _802-1 Q___------BUYER: �I�ME,���c�SOLNIAM Q'�QJY01 _______--- --- DATE: _10�09 97—_—_—_—__-- PLAN REF: _237 117—_----____ SCALE.1" _30____FT. I HEREBY CERTIFY TO 5ALVD�' _CO2PE94TVE ___THAT THE BUILDING 0i FYANKEIE SURVEY SHOWNONTH15PLANISLOCATED ON THE GROUND AS �� A� � ULTANTS SHOWN AND THAT ITS POSITION DOES ____ CONFORM (SUITE I) TO THE ZONING LAW SETBACK REQUIREMENTS OF THE MERtTHPW H TOWN OF ___ TH BARNSTABLE__________ -_AND THAT No. 320M INDUSTRY ROAD IT DOES_ 1VOT_ LIE WITHIN E SPECIAL FLOOD HAZARD �f E MARSTONS MILLS, MA. 02648 { 'Ff G�tE� TEL. 428-0055 AREA AS SHOWN ON THE H.U.D. MAP DATED_��9 ,�_ � os Co it ane 250001 0005 C '�'k FAX: 420-5553 THIS PLAN NOT MADE FROM AN INSTRUMENT 21742 DCB AOL A. ME 1THE SURVEY NOT TO BE USED FOR FENCES ETC. ��_�....'' j1— CA jnd 0 1 2 I 0:S8 ac:. to o 0 /is•; "' Otd 1 wndatc o o , i h r ( I•. I I � !_,._ _t �-. .:..! �—_t 1 .i.__:.-.._ � I ! .,'1_�,..f... 1._�..-- - ' I - � �- - - _ ...._1_ , j I iL.�t'i�_•__ i + • wale - P8rB 1— Xo 3 r o►i. F.P— � � _ � ounila-#.t,orc. shown' .Cart -v : O! qs .._. dhows eon � i her - t t , yyAA � CcCk; � k` /Z2 �u1rE 10 l� cep r -s i t gr-- IT, I i site rim O Wand e, rye tot 4 ad. ahown on -'.C.#35892 A a Scat l"-4 0 3/ ate 4-2 3=9 AU Cap a Fno-4 Rgc4ut i.4:, Mq 02601 . ddd .1),. t t...., A.:., � S 7 6 I..:- •—.� {' �— L� -_J-T `- a "' f._ 1-_ i .-_' � ! �� t�J i _ �_ , �) �•� �e'•� i ' ) � T, i r , Assessor's office(1st Floor):. _ / /� . = Asssessor's map and lot number . �L �����{ � ��Pip fN f t0`1 Conservation(4th Floor): PLI + Board of`Health(3rd floor):��jj „ r ��I TH TITL M t seassrantc .Sewage Permit number p '� �a OIb�p. Engineering Department(3rd floor):- House number Definitive Plan Approved by Planning Board 19 . APPLICATIONS PROCESSED_8:30-9:36 A.M.and 1:00-2:00 P.M.only ► TOWN , OF BARNNSTABLE BUILDING ' . INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION -;7 19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location L6 T LA G LQ VT � `XAD CL^N tlsj�uG Proposed Use Zoning District T Fire District C G tV Name of Owner 3046J 1W:' Address SSI�7- moll v SCR \ VV-hww�g /'ame of Builder Address * i �c Name of Architect � Address Number of Rooms A Foundation Exterior Sy11 n Roofing S ICI Ng /gspa jt Floors hardwood carrot Interior Shed roGle- Heating Cec, gaL + Wood kof6 Plumbing .2) Fireplace Y710 Approximate Cost 4ATA M- Area 4.01 Diagram of Lot and Building with Dimensions Fee �c ''i Y 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. Na 4 on uction iipervis 's se19t— PE#DERGAST, JOHN J. III No 2-- Permit For 1 z Story t Single Family Dwelling - Location Lot '#4, 49 Old Farm Road t Centerville _ Owner John -J. Pendergast III ` r Type of Construction Frame - Piot Lot r . Permit Granted.- April 26 , 1 g 94 Date of Inspection: r Frame /� 1p/�'T 19 Insulation 19 Fireplace ✓ 19? _ Date Completed 19 r f TOWN OF BARNSTABLE . Permit No................. BUILDING DEPARTMENT I '�0- I TOWN OFFICE BUILDING Cash X "► ` HYANNIS,MASS.02601 Bond ................. CERTIFICATE OF USE AND OCCUPANCY Issued to JOHN J. PENDERGAST, III Address lot #4 49 Old Farm Road, Centerville USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID..AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING .INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. July 7 19.g4............ Build ing Inspector............. TOWN OF BARNSTABLE BUILDING DEPARTMENT = rsaiSTAIM TOWN OFFICE BUILDING rua t6J9• HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit # �7 ,J 2........................................................................................................... ......»................. . .......» issued to ........ ,1.�.:.�»... .»..» ................ '!» ! ». c G.. F..»......».». .... �.. Please release the performance bond. THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) - .- 11 �- I I M AG(�� L DATA .�cNSTABLE, MASSACHUSETTS BUILDING PERMIT ` r94 NQDATE �ICANT ` �a :H -f!ADDRESS _� I INO.) (STREET) ( ,t IZ`EIJSET JUiiQ �.'Ld( 11 itsu 1 .C:'i.is S.'2i�T:ii i1G: .J..•_i. t*NUMBER OF PERMIT TO ( ) STORY - :1 DWELLING UNITS (TYPE OF IMPROVEMENT)) NO. (PROPOSED USE) AT Lot #4 49 Old Farm Roud Centerville ZONING _ DISTRICT `� -1.(LOCATION) (N0.) � (STREET) - a BETWEEN AND (CROSS STREET) (CROSS STREET) " LOT SUBDIVISION - LOT BLOCK SIZE ' BUILDING IS TO BE FT. WIDE BY - FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: it93--3E5 . 13ollii AREA OR 930" s j. --t. 75, 000. 00 PERMIT '���-� �� VOLUME ESTIMATED COST .� FEE $ !• (CUBIC/SQUARE FEET) OWNER ADDRESS ,J�::j ::'_Ut. :�.tli .7L:�.c.:i`. ?i1•u_(;iii.` BUILDING DEP-.BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP-PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL IN (RE INSPECTION TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. +- POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 � 2 2 2 HEATING INSPECTION APPROVALS S J ENGINEERING DEPARTMENT,�` BOARD VHEALTH OVtR SITE PLAN REVIEW APPROVAL b ( 7� WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. PERMIT iS ISSUED AS NOTED ABOVE. NOTIFICATION. Bn6084 PAGE 301 QUITCLAIM DEED We, JOHN J. PENDERGAST, JR. and ANN D. PENDERGAST, husband and wife, as tenants by the entirety, both of P.O. Box 576, Centerville, Massachusetts for consideration of love and affection and as a gift , grant to JOHN E. PENDERGAST, III/', individually, of P.O. Box 2325, W. Hyannis Port , Massachusetts with QUITCLAIM COVENANTS, a one-half undivided interest in that certain parcel of land in Barnstable (Centerville) , Barnstable County, Massachusetts , together with any buildings thereon, bounded and described as follows: NORTHEASTERLY by Old Farm Road as shown on hereinafter-mentioned plan, one hundred thirty and 00/100 (130.00) feet ; SOUTHEASTERLY by a portion of Lot 3 as shown on said plan, one hundred eighty-eight and 76/100 (188. 76) feet ; SOUTHWESTERLY by land of Karl T. Dussik et al as shown on said plan , one hundred twenty-five and 00/100 (125.00) feet ; NORTHWESTERLY by land of Donald P. McKeag as shown on said plan, two hundred fourteen and 56/100 (214.56) feet . Being shown as LOT 4 on Confirmation Plan No. 35892-A, which said plan is duly filed with Barnstable County Registry of Deeds in Plan Book 237, Page 117. So much of said land as lies within the limits of Old Farm Road, as shown on said plan, is subject to the rights of all those lawfully entitled thereto, in and over the same. There is appurtenant to the land hereby conveyed a right of way over Old Farm Road from locus to Phinney ' s Lane, in common with all those lawfully entitled thereto. There is also appurtenant to said land a right of way in common with others legally entitled thereto in Parcel "G" on Wequaquet Lake and the ways shown on said plan, for all purposes for which ways are commonly used in the Town of Barnstable, as set forth in a grant made by Harold E. Wilson et ux to Frederick 0. Sarkinen et ux, dated September 18, 1963, duly recorded with said Deeds in Book 1221, Page 385. For title, see deed recorded with Barnstable County Registry of Deeds in Book 1540, Page 156 . :0. BOOK60-84 MUE 302 For title, see deed recorded with Barnstable County Registry of Deeds in Book 1540, Page 156. WITNESS our hands and seals this �` day of embP� , 1987. l jJOH J. P E ; AST, JR. G� ANN D. PENDERGA&T COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. �''� 3 1987 Then personally appeared the above-named John J. Pendergast , Jr. and Ann D. Pendergast and acknowledged the foregoing instrument to be their free act and deed, before me N6-taky Public My commission expires: RECORDED DEC 30 87 x�5t'f�q e pRl�/ATE x T3 1 ZL J / O L,- n,-,-,••„•• ,.,,,•,... - ,,....,'T' j r-r' "'fit."C'•r,T,• ,T,; ,..••y r>41;"':,,, --'"' fi'..' g ,.. r r, ,Crfta•.,,, i i t ••�',it' C' T"1 t`��^`-- w 'mot: .r' �, u l,x�. 'y '6 ti'+.k } •� ( �+t,+1. 7 , , 1 � I''+, ,I Y �•�.. ('� t,! .1. 'I t ,, ,,t,w r�"';.$,�, +...t«�.,� r a..l t �... :.� 1 1', '�F� [[1 r. d r ,.. .p l I � '�� �i. l d' f: � ,•, i�� r,� t;g.�``!$$ � �i<.d:. 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M ' } Specs, page.1 `>David Carse' iV e 1. `February!1.,T 1991ti 4 w ibncoln Hill` Cottage a x ECIFICAT:IONS?. \ 'Foundation r�x 1) poured concrete footings;,k8"a x 20 2) poured 3000psi concrete 8"'foundation walls and frost wall , reinforced w/2 #4 bars`at`-top of wall. , ;3) poured concrete slab basement floor, minimum 4" n 4) poured concrete piers for"entry,.way porch'and deck supports. { 4 continuous perforated' 4" foun'dation curtain drain at footings: exit ; ,f y non-perforated pipe to .daylighf asphalt waterproofing on exterior of foundation wall Framing' is a) 2 'x' 8 PT.'mud sill overhang foundation wall 1-1/2" ,rt' ' a sill seal: x > t basement 'center beam ;laminated of 2x10`s; 3 thick. =41 conc. filled tally column at oenter span. tt " r c) 2x10 floor joists 16" oc and:;2x10 rim joist. a s+ double' or triple joists &,headers as needed at floor rough openings: k ' double joists as needed in joist overhang areas. �i LVL beam by TJC as noted..on 1st floor plan. 2 x .ib`window & door lieaders gt d 3/4" fir`T&G plywood CDX for,subfloor glued and nailed to joists PY 9 A` PL400 or similar construction adhesive. e) 2x6 studs exterior walls 24" oc. 2x6 double plates pine plywood CDX wall sheathing I,9)'Typar house wrap ', °',. „• {, studs interior partitions;424" oc. I) #2 pine: exterior trim (5/4" "x`4 corner boards tx10 facia). Exterior latex i trim paint. �! .,,, deck 4x4. PT posts,. 5/4' PT decking, 2x8. PT joists deckJoists 24" o.c Galvanized fasteners. =' buyer's choice; * 4 ("B" grade) white'cedar shingles; 5" exposed, galvanized # } y mails. - ( fr' - + - tRoof a),2x12 rafters 16 oc 2-pitch on main house=roof .1/2";cdx 'Fir plywood CDX roof sheathing. f15#. felt on roof. Bird Jet 80�asphalt shingles, "Woodblende" 8" galv`tlrip edge. z oontinuous Core-vent ridge vents �12"` overhang, 3/8' AC plywood, soffits 9 - - .4 ) YContInUOUs soffit vent, i { r {2x6 co.11ar,•ties (ceiling foists) 2x8`porch roof rafters B a ' 6/12 pitch on porch roofs 2x6 po ch ceiling joists gs 4 a r t rr t - ,5. , i Specs, page 2 , .1 +Window$ ix i.. .} . Marvin clad"windows and terr6c6Ao6'r. Double hung and 'n -window units. (See window schedule.) :k clnsulation i '1/2': 'Dow,,;'Blue Board" insulations on foundation. ; R-19 fiberglass batts in walls , ¢ 6 mil poly,vapor barrier on interior°side of exterior walls. R-38 :blown'cellulose insulation in" attic and in roof slopes. +` Proper-Vent channel venting, ni roofalopes: r °F Bay window `and stairway overhangs insulated minimum R-30 " # fiberglass batts or rigid foam' insulation. xlnterid )finish r a < % a „ 1/2" drywall'.throughout: Taped and#finished. Paint-grade,pine trim (casings and :baseboard) throughout., �tr` .Handmade -custom cherry kitchen-,and bath cabinets, and cherry cap board on railing walls 1Laminate counter tops. g ` Masonite interior doors. � .Hardwood floors: maple grade,"C' 1x4 T&G flooring. "? Ceramic the at hearth, entry,`and bathrooms. Capet bedrooms, fr stairway; and studio. Utilities A , `, 'irM � t,;,' 4 1) Electncal.y 150 amp entry ,Breaker box in basement. r �. F ;{ 15 amp circuits for lights�'wired 14AWG, 20 amp circuits for outlets wired 12AWG `' Dedicated circuits for installed r 7 equipment (water pump, boiler',.etc.) as needed. y 2) Water pump and pressure tank with pressure switch• installed. Copper hot & cold •supply lines to all fixtures 'shown ,r, IY on plans. PVC waste and'::vent lines. µ ' Gas:`buried 350 gal. propane an Gas lines installed to gas range , and to propane fired boiler and hot water heater. ' w a:w. 4 � t�arSrom 4,) Heat Boiler and hot water�b'aseboard radiators -installed :according: to heating subcontractors specs. , ; -� Masonry 7 Concrete block chimney with the flue liners. Two 8" diam. round flues.' One "flue with thimble for;,boiler in basement, second flue r, S "y `IK , y #} # with thimble at location for wood'stove on first floor. Cleanouts s�3 ; �r ry S � e � =for rboth flues in basement Faced .with fieldstone on first floor.' :tw; 56rick `chimney above roofline` 4 IA �a f Ad l ?PPyI Mces, Built-in. is gas,range and hood; and refrigerator provided S � . builder � a� x i• r,e• � - t dj tl iq p .�(.a lie d : r,I . '- t% t ' -4 eE� D y r '•z t a,`l f,d Ie is do s # , t -4? i3„;B � 7 - E>+ 1G,ar1a+,� '�xZnr r 3 3 V r ,.•,1 # '.i Pk .tj�� tt �"�p,�x 1 v �j " 1 4�. ., v w r.r. - ' • �• 7l 4 �SY.. a a a • } 3 Y{.J t �.xi1�1 i.t •ti i §p �" � k ti�r�.,{ i�7 t9'7�PR C + ,ei e e ,. "-y y 4 Window and door schedule: Lincoln Hill Cottage KEY QUANTITY MAKER CAT NO DESCRIPTION T ROUGH OPENING LOCATION A 8 Marvin :CDH3224 "EZ tilt" double hung, clad ext., 6-9/16 jambs, 1/2" insul. glass, screens. 3' 2-3/8" x 4' 8-7/8" basement, first floor, second floor B 1 masonite colonist interior door unit, 3' 0"x 6' 8",,LHI 3' 3"x 6' 10" front entry C 1 Velux €VS-304 ventilating skylight, screen, type EDL flashing. 30-1/2" x 39" second floor bathroom D 1 Marvin CAWN3636 awning, clad exterior, 6-9/16 jambs, 1/2" insul. glass, screen. 3' 1" x 2' 11- 5/8" kitchen E 3 Marvin 2-CDH3224 twin units of"A"above, same specs. 6' 3-3/4" x 4' 8 -7/8" 2 first floor, 1 basement ..................:..........................................................:.......................................................................................................................................................................................................................................................................... ........................................................................................... F 1 Marvin CTDR6068 XO RHI terrace doors, clad exterior, 6-9/16 jambs, 3/4 insul. glass, screen. 5' 11-5/8" x 6' 7-9/16" basement ....................a G 5 bi-fold masonite colonist interior door unit, 4' 0" x 6' 8" 4' 3"x 6' 10 first and second floor closets H € 5 masonite colonist interior door unit, 2' 6" x 6' 8" : 2 LHI, 3 RHI 2' 6"x 6' 8" first and second floors , I 1 masonite colonist interior door unit, 2' 0" x 6' 6", LHI - 2' 3"x 6' 8" second floor bathroom linen closet J 1 Peachtree €A31A ext. insulated steel door unit, 3' 0" x 6' 8"; 6-9/16 jambs, single light, LHI 3' 3"x 6' 10" front entry door M 1 Marvin 42" stationary octagon, clad exterior, 6-9/16 jambs, 1/2" insul. glass. stairway N 1Y Marvin €CDH3218 "EZ tilt" double hung, clad exterior, 6-9/16 jambs, 1/2" insul. glass,.screen 3' 2-3/8" x 3' 8-7/8" second floor studio N 1 Marvin ':CRT3716DH roundtop for "N", clad exterior, 6-9/16 jambs, 1/2" insul. glass. 3' 2-3/8" x 1' 7-3/16" second floor studio :.........,;.............................. ..........................;..............:...................................................................................................................................................................................................................................................................................................................................................... P 1 Peachtree €A31A ext. insulated steel door unit, 2' 6" x 6' 8", 6-9/16 jambs„single light, RHI 2' 9"x 6' 10" kitchen door Q 1 _ exterior wood screen door only, 2' 6"x 6' 8" 2' 9".x 6' 10" screened porch door