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HomeMy WebLinkAbout0725 OLD STAGE ROAD 7U 50,44 t Application number................................................. Fee ;T7fL....................................................� WAS& ' ` AUG 0 ��Cj _ Building Inspectors Initials.. . ............................... 1-7h 0M I�� Date Issued....................I.......................................... Map/Parcel.............:.... !. I .2................. TOWN OF BARNSTABLE EXPEDITED PERMIT'APPLICATION: ROOF/S IDINGAVIND O W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: Oeyt-ie f tillco ER STREET VILLAGE o- Owner's Name: "J)oC)Ke'j Phone Number Email Address: Cell Phone Number Project cost$ 18 006 Check one Residential t/ Commercial OWNER'S AUTHORIZATION As owner of the above pr erty I hereby authorize U l ec to make application B rb 'ldin a in ac r ce with 780 CMR n Owner Signature: Date: ' E OF WORK Siding 0 Windows (no header change) # 0 Insulation/Weatherization 0 Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than I.layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# `t�1 ` 6� (attach copy) Construction Supervisor's License# co Z1 ,( py) Email of Contractor /u f P y 14ck 6w in Mtn G Phone number s'03 67s' 6,5 ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A mgTnR/r nI.CTR1rT_.Vnll MINT nRTA1N H1.STARIr APPRnVAL RFFnRF A PFRMIT rAN RF I. V 1Fn_ 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. Purpose of Event 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 Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes,a gas permit is required. 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 d-J IP C T'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 Please Print Legibly Name (Business/Organization/Individual): l e i�{a 6 U" 1(Ai;A h`C Address: �/ L� Gt�4fy✓1r City/State/Zip:1%¢u-k Qa 6 3 Phone#: 65"6 Aean employer?Check the appropriate box: Type of project(required): l. m a employer with 3 4. ❑ I am a general contractor and I employees(full and/or part-time).* t 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 g, ❑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.❑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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 1yCl% �*yo T CQ� Policy#or Self-ins.Lic.#: �O. .90 ` L?693) 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 im risonment,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 vi tor.'' advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insur a cov age verification. I do hereby certify under ties of perjury that the information provided above its true and correct. Si ature: �� T Date_: (` . Phone# 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#: i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide rkers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the se ice of another under any contract of hire, express or implied;oral or written." An employer is de a ed as"an individual,partnership,association,core ration or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal r presentatives of a deceased employer,or the receiver or trustee of an in 'vidual,partnership,association or other 1 al entity,employing employees. However the owner of a dwelling house ha ' g not more than three apartments an who resides therein,or the occupant of the dwelling house of another who ploys persons to do maintenance, onstruction or repair work on such dwelling house or on the grounds or building app enant thereto shall not because f such employment be deemed to be an employer." MGL chapter 152,.§25C(6)also states at"every state or local li ensing agency shall withhold the issuance or renewal of a license or permit to operate business or to coast uct-buildings in the commonwealth for any applicant who has not produced acceptable vidence of compl• nce with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states either the corn onwealth nor any of its political subdivisions shall enter into any contract for the performance of publ c�work until ceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contract' g authority." Applicants Please fill out the workers' compensation affidavit completel by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and .ne number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Li bility Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'com ensat*-n insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidav' may b ubmitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to si and date the affidavit. The affidavit should be returned to the city or town that the application for the p rmit or lice n a is being requested,not the Department of Industrial Accidents. Should you have any questions reg g the law or if you are required to obtain a workers' compensation policy,please call the Department at the ber listed belo 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 print d legibly. The Department \1nn ided a space at the bottom of the affidavit for you to fill out in the event the O ce of Investigations has to coou regarding the applicant. Please be sure to fill in the permit/license number which will be used as a referenceer. In addition,an applicant that must submit multiple permit/license applicatio s in any given year,need only one affidavit indicating current policy information(if necessary)and under"Job S to Address"the applicant shoul "all locations in (city or town)."A copy of the affidavit that has been offic ally stamped or marked by the co may be provided to the applicant as proof that a valid affidavit is on file f I r future permits or licenses. A nda 't must be filled out each year.Where a home owner or citizen is obtaining license or permit not related to sines or commercial venture (i.e.a dog license or permit to burn leaves etc.)sad person is NOT required to comhis affi vit.The Office of Investigations would like to thank y u m advance for your cooperati should you ave any questions, please do not hesitate to give us a call. ' .�'' <-= x;. The Department's address,telephone and fax num r: \M '>4 The Commonwealth of Massachusetts,R Department of Industrial Accidents office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-7274900 ext 406 or 1-877-MASSAFF.� Revised 4-24-07 Fax#61.7-727-7749 vvww.mass.gov/dia Comrnonwealth of Massachusetts Division of Professional Licensure x hoard of BuJ ding Regulations and Standards rvis ConstmOtfil 6 " , Up" or Vlk x E ' VIKTAR V TUEIKA .f 4 EAT41U CT .� ~ YA Av COT!!IT A ()ZS�J ` Co11imissio e " 3 r w y � w af y„ "°B mw r TULEtA E3t/3+FL3t(VGi�C�# tVIF'N yam. D .CC?TUIT;$MA t3263a� y + r 20tR sotta� ��� %/!q)✓fJ1{/I.I�t%t N"fT bld � of y ns Two , £s affice 6t Coumer AHahs Bsinese Hegu(mtiort-,�z=4�.� s� r . tieg#strgtiond Insf�+r�d#�8 F#OA9E IM FR. OMENT GO1d7R�ACTpit v ; ay�betor6�thb�xpi�iotf d3t8 at� i ��� : Car aeon � Offi eaiConst qcA s n s t]uauQ �•i �'' ';da �(78117/20�#9„��,w r err' iJ1 E#KA BUIL[%tOWPA 1NC ##STAR Tt1LE#� M , -44 EATON CT t.✓. ��� tf F x£ 111tC3CTS2Ct8t8t+� �'r >cr � a ACORO® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 03/25/2019 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 Robert Monahan - - NAME: C&S Insurance Agency,Inc. PHONE (508)339-2951 1 FAX (508)339-4811 A/C No Ext: A/C No 190 Chauncy StreeVP.O Box 406 F'MAIL s: -ADDRE INSURER(S)AFFORDING COVERAGE NAIC p Mansfield MA 02048 INSURER A: National Liability&Fire Insurance Co INSURED INSURER B: Tuleika Building Company,Inc. INSURER c: 44 Eaton Ct. INSURER D: INSURER E: Cotult MA 02635 INSURERF: COVERAGES CERTIFICATE NUMBER: Workers Comp 19-20 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF.ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AIJULISUbM POLICY F POLICY EXP - LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY - LIMITS COMMERCIAL GENERAL LIABILITY - EACH OCCURRENCE $ CLAIMS-MADE DOCCUR - - DAMAGE To RENTED PREMISES Ea occurrence $ - - .. - MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: - - GENERALAGGREGATE $ POLICY 1 JECDT- LOC - PRODUCTS-COMP/OPAGG $ OTHER: - . . $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident) ccident - ANYAUTO. BODILY INJURY(Per person) $ OWNED SCHEDULED - BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS - - HIRED NON-OWNED - PROPERTY-DAMAGE - $ AUTOS ONLY AUTOS ONLY - Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE _ AGGREGATE $ DED RETENTION$ - $ WORKERS COMPENSATION - - - - PER STATUTE ER AND EMPLOYERS'LIABILITY Y/N 7 1,000,000 - ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ A OFFICER/MEMBER EXCLUDED? NIA V9WC092060 02/16/2019 02/16/2020 / (Mandatory in NH) - E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes;describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 Barnstable MA 02601 � .�• a.,�_ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03). The ACORD name and logo are registered marks of ACORD ' �IKE Town of Barnstable *Permit#06 156 7�8 Expires 6 months from issue date °7 Regulatory Services Fee snuvsrasr.E �✓ I �A I_ I�' 16.39 MASS, Richard V.Scali,Director Building Division Tom Perry,CBO,Building Commissioner OCT 9 200 Main Street,Hyannis,MA 0260 �/�®� www.town.bamstable.ma.us Office: 508-862-4038 R�r e -790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY q( _ (� Not Valid without Red X-Press Imprint Map/parcel Number II Property Address 'Residential Value of Work$ "ZI Minimum fee of$35.00'for work under$6000.00 Owner's Name&Address �� "5- Contractor's Name Telephone Number 126`- — Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) drp� eworkman's Compensation Insurance M . Check one: ❑ I am a sole proprietor { ❑ I am the Homeowner kZ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# /j ."x Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ t(check box) [DRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows r#of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. -! Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.' u ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is realired. - SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 . S !.a �T61E Town of Barnstable Regulatory Services Richard V.Scal4 Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 vrww:town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder as Owner of the subject property hereby authorize_ ���1 ®� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:IWPFILES1f0RMSlbuUding permit fbr=\EY?RESS.doc Revised 040215 n " � • y .� TTie ComnioYriveakh of Massachusetts . Departowtni't of litdustrial Accidents : - Of re of'1mw-stigations 600 Washington Street =y Boston,AL4 02111 ivrvrs:mass_govIdir: Mrarkers' Carnpensaf an Insmrance Affidavit-Bgilders/Cantractars/EIecfricians rPlumbers APPEcaut Infiar mafiau Please Print Le gib Name(Busiae=/0.rganiz&onadiw&a1) Address: CityfStatelig: Phone Are you an employer?Check the appropriate bom Type of project(required): 1-0I am a employer-%ith: 4. ❑I am a general contractor and I t employees(full andlor part-time).* have hired.the sub-contractors 6- ❑New construction 2.El I am a sale proprietor or partner- listed on the attached sheet. 7_ VZReznodeling strip and hm�e no employees. These sub-cgntrac#ors have 8: ❑Demolition w o for sere in an c ci employees and have workers' °�'nb �' 1 9. ❑Building addition. [No tyorl<ets'comp.insurance comp_insurance required-] 5- ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am.a homeoum-er doing all work officers have exercised their 11-❑Plumbingrepairs or•additioms' ' right:of exemption per MGL �'�€�o workers �F- 12-❑Roafrepairs . . imsuranre required.]F c.152, §1(41 and we have no employees-[No workers' .13.0 Other comp-insurance required-) 'Amy appticmt&ar checks box iTl Est also fM cut the section below showing their workere compensatiou policy infornration- I homeowners who submit this affidavit indicating they are doing all wa*and then ham aut d&contractors amct mkmit a new affidavit indicating sucIL :Contractors that check this box mast attached sa additional sheet showing the name of the sub-contract m and state whether.or not those entities have eaployees. Ifthesuh-cuntoictarsbave employees,theymorst pm4-ide their workers'comp.poRU number- lam ark Betoty is the policy and jab site information Insurance Company Name: ��iL'�1/.J7..r�Y�._L_ Policy 44"or Self-ins.Uc_9:�f/ 9 ' 1 Expiration Date: Job Site Address: �7Z:5—e�,t7 c�Tir?�y-�3'/ ice? City/Statel2 g: 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 imrposition of criminal penalties of a fine up to$1,50D:00 and'or one-year imprisonment,as well as civil penalties.im the form of a STOP WORK ORDER'and a fine of up to$F250.00 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 verifxcatiaa I do hereby certify uA crr tha paints andponaldes ofpetj'utp thatthe infon nation prmzded abuiv is true and correct Sio attire: Bate: Officiall use only. ,Do not write in this area,to be campleted by city ortown ofJiciat City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of wealth 2.Budding Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone it: Information and Instructions v f Massachusetts Geneaal Laws chapter 152 requires all employers to provide workers'compensation for their employees. ,s PmsSuant-to this stye,an.emplvyee is defined as-- -every person in the seavice of another ender any contract of hire, express or hnplied,I oral or An EmPj�J'� deffiied as"an individual,partnership,association,corporation or."other legal entity, or any two or more of the foregoitengaged in a Joint enterprise,and including tha legal representatives of a deceased employer,or the receiver or trust Hof an individual,parunmship,association or other legal entity,A employing employe w es. However the owner of a dwellnig house having not more i3aa three apartments and who resides thcrem,or the oc apant of the - d nwelling house of another who employs persons to do mah±Ez ce,constriction or repay work on such dwelling house or on.the grounds or bi ildmg appurtenant thereto shall not because of such c4loyment be deemed to be an employer" MGL ter 152,§25C( also states that"every state or Iou licensing agency shall withh'Qld the issuance or renewal a license or pe \. to operate a business or to construct bn�gs in the commonwealth for any applicant who has not prod acceptable evidence of compliance with the insurance.coverage required_" Additionally,MCrL chapter 152, §25CM states"Neither the commga nor nay of its political subdivisions shall enter into any contract for the pert ice ofpublic woik nntl acceptab e evidence of compliance with the ins ran CO. requirements of this chapter have been p�ented in the contacting uty" A-PPIicaais , , Please fill out the workers'compensation afli completely,by ecI®g the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addr (es)and phone ex(s)along with their certificat (s)of mmarance. LiusitEd Liability Companies(LLC)or Liab - Partnerships(LLP)witbno employees other than the members or partners,are not rued to cagy wow. ' comperes on insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this davit m be submitted to the Depaiimnent of Industrial Accidents for confirmation of msun-ance coverage. Also e sure sign and date the affidavit The affidavit should be rstzned to the city or town that the application for the p r license is being requested,not the Department:of LnAh,atrial A ccidents. Should you have any questions regar e law or if you are required to obtain a workers' compensation policy,please call the Department at the numb below. self insured companies should enter their self-iT, ce license number on the appropriate line. City or Town Officials . Please be sine that the affidavit is complete and printed legIly. The apartment has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Inv tigatio•.` has to contact you regarding the applicant Please be sure to fill in the pennitllicense ntunber which will be used as reference number. In addition,an applicant that must submit muhiple pennit/license applit5tions in any given year,ri.� only submit one'affidavit indicating current policy info ation(if necessary)and under"Job Site Address'the applicant onld'Frl -"all to cations in (city or town)_"A copy of the affidavit that has been officially stamp or mar$ed by throe city or town may be provided to the applicant as proofthat a valid affidavit is on file for firtnre Pr Ii A•p„¢es A new affidavit must be,filled out each year.Where a home owner,or citizen is obtaining a license fir° permit not rehated to`any business or commercial venture (i.e. a dog license or permit to bum leaves eta.)said per4ce NOT reginzed to c m\ late this affidavit The Office of Investigations would like to thank you in. for your cocperati , and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number - Depacl mtat of lndu&tzal AOCZent-, Gf fice Qf kvesf ti an Sint Bceco�lMA f12111 Tf,-L 4 617-727 4WO 4fl6 or 1-977-MASSS-� Revised 4-24-07 Fax 9 61T727-77� v, .masgo�f dza DAVID-2 OP ID: KG ACORN DATE 0rrdm0rrYYYI CERTIFICATE OF LIABILITY INSURANCE 07N4II2015 THIS CERTIFICATE 13 133UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH13 CERTIFICATE DOES NOT AFPIRMATIVELY;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 ►NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It 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), COWAPRODUCER NAME: Kathy Geddis Northwood Ins.Agency,Inc. tHU-540 Main Street Suite 9 Arc E •508-771-1S32 A) 4o;808-393-29M _ Hyannis,MA 02W ADDRESS: _ INSURER 3 AFf•ORDINO COVMAGE NAiC I INSURER A:Travelers Insurance Corn pany INGUREEI David Cox,Ina: INSURER8: P.0.Box 401 INSURER 0: S Yarmouth,MA 02664 INSURER 0: INSURER 6: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L13TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. N OTWrrH STANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT wrM 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 SY PAID CLAIMS. POLICY�— EFFFDLICY OXF TVpr.OF INSLIRANCE ;%%M NUMBER (M mckn= M Y LIMITS AIM ( MMERCIAL GENERAL IIA3ILITV I I EACt+ Jt�EV-_ 1,000,00 CLAIMSMADE GOCCUR 88014VIM796 03A412015I0 311412 016 pREA11SESLEao•c:rranca: 300,00 elnses Ownsm I I �' - r I I McU E%iF(Any one prwn)--1 f---� $,OD i I I I PERSONAL S AG'J INJLRY ^t 1,000,00 ^^^^tttt��� 'L AGREGA-E_IIW AP(F�LI�=SPER I { I I GENERAL aGC?SLATE S 2,000, POLIO'Q JEC. IJ L i f PROCJCTS•'.OM�;OP A53 S 2,000,OOC OTHER: S AUfOMDEIL3 LIA6ILIMIT TY COMBINE)•t r .I I{Ei wddent) ANY AV-0 BOCk_Y IN.UP,Y(Pet pertorl ALLOLVNED SCHEDULEL i t �@nC:I_Y)N.I,'PY(Par acciaantll S AUTOS NOWC _ HIRSDAUTO, R O N•CwNED I r A. .v, AUTOS Par xcid5ntl 15 UMSRSLLA LIAS OCCUR I J EAi,M O: J4RE JC.c S EXCESSLIAB CLApe:.MAG= I i AG3REG.ATE S LIED .BTEN '13N t I S WORKERS 0 FIN AT10N I I 3 ATUTE ER 'AND EMKOYeR8'LIA9L1TY A IANY PROPRI:TOR,PAR*PaERi_','<ECU1VE Y�INJA� 'CERTIFICATEWILLFOLLOW 074612015 07/1612016 E.L.EACt•AC ICeIT_ s 100,00 OFFICEt NCV4:RE>C_uUEU7 WITHIN 9 DAYS FROM CO. 104, Ilendatery In INN)) I E.L.DI SEASE-EA Ertel GYEE ^o _ U 66 deSOIt*41491 D suie rlCN OF OPERATI Qd5 aalaw ;E L.DISE43E•POLI:Y LIMIT S g00, i I I i DG?CRPrION OF OPERATION®I LOCATION®I VEHICLE® (ACORD 1a1,Addtlenal Remarks Ochedule,may be attached F more apse is requl.ed) CERTIFICATE HOLDER CANCELLATION TOWNSAR SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE; WILL re DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIORti. 230 Main Strut Hyannis,MA 02601 AWHOIRIZED REPRESONTAWS 01069.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD t r , _ ��e cpoo�a»aaircuecclt�'o�P%l/�cc�oac�cueGl Office of Consumer Affairs&Business Regulation ME IMP.ROVEIMENT CONTRACTOR Registration: 100497 Type:: 4, xpiration 3/25/2016, Private Corporati DAVID COX, INC: David Cox 19 LAVENDER LN g �� W.YARMOUTH, MA 02673 Undersecretary ' i Massachusetts Department of Public Safety �= Board of Building Regulations and Standards.. License: CS-063537 Construction Supervisor • DAVID R COX PO BOX 401 A - 90 SOUTH YARMOUTH M" 2664 - 7. �4 Expiration: Commissioner 10/15/2017 sIRE r 'down of Barnstable *Permit# � Fxpires 6 months from date t - Regulatory Services Feepe s sn�srwat�, rsnna $ Thomas F.Geiler'Director � ►�'�` 0� ® ' uilding Division ®K 2��6 /BTom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstabie.ma.us Office: 508-862-4038 �F Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint p/parcel Number perry Address i Residential Value of Work �?� _ Minimum fee of$25.00 for work under$6000.00 ,ner's Name&Address (U tie I' ztractor's Name P 11— t'_'��(�a� Telephone Number 629 � &01? me Improvement Contractor License#(if applicable) istruction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner �ave Worker's Compensation Insurance 1 arance Company Name i on r 1 t �VA-- / ,rkman's Comp.Policy# 0 c9joo 10 py of Insurance Compliance Certificate must be on file. mit Request(check box) [�Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Prope Owner ust s' n P perty Owner Letter of Permission. Ho Im rov ent n ors License is required. :NATURE: xms:expmtrg ise071405 n 8 �tLP U/O�I7/rIt07ZUJ 'f - • . Board of Building Regulations and Standards License or registration valid for individuq u9e Only HOME IM +EMENT CONTRACTOR before the expiration date. If found return to: �, Board of Building Regulations and Standards Registratr 6480 One Ashburton Place Rm 1301 /T 08 Boston,Ma.02108 dual n MARK HERBST MARK HERBSTAV 35 PEEP TOAD RD. CENTERVUE,MA 02632 Deputy Administrator Not valiawitho , r V�I Ifl nJJVt,1Hl CU I-IN�UKMt NU. 291d r. 212 CERTIFICATE OF INSURANCE`PRODUCER ISSUE DATE(MM/DD/YY) THIS CERNO RI E 1S I33 AS A MATTER OF INFORMATION ONLY AND Leonard Insurance Ag�ncy I11c CONFERS NO RI IV UPON THE CERTIFICATIC HOLb$R, THIS CERTIFICATE P 0 Box 494 ' P�p�1C B NOTEL W,EXTEND OR ALTER THE COVERAGE AFFORDED NV THE Osterville, MA 0265� COMpANIES AFFORDING COVERAGE I eI INSURED i Mark Herbs[ 35 Peep Toad Toad LETTER Y A A.I.M. Mutual Insurance Co Centerville, MA 02J2 I� 1 OVERAGES j IND LS TO CERTIFY TFIIAT NDI POLICIES OF 1NSUItANCE LISTED BELOW KiAVE K1EEN ISSUED TO THE INSURED NAKr(FO ABpvE FOR INDICATED,NOTWi'fH8'rANDINGANY I2EQL1JTtEMBNT,TERM OR CONbrTIpt1 Op ploy CONTP ACT OR OTHER b CERTIFICATE MAY 13B ISSUED O MAY PERTAIN,THE INSURANCE AFFORDED By THE POLICIES bI9SCRIBEb HEREEQ TrrHRA F ALL THE TERMS EXCLUSIONS AND cpNnfrloNs Of SucK POLICIES. LIMITS SHOWN IvKAY HAVE BEEN REDUCED BY SCRPAID DESCRIBED H CLArMSMENI K SUBJECT I TO ALL WHICH THIS ) TVT%OrllQsf INS H 1'ULICY NUAIDIiIt POLICY BtEFCT1VS POLICY BXPMATIO GENERAL LInkII.ITY DATE( POLICY DATE(MM/DD/YY) LIINITS COMMCRCIAL(iGNr{KAL LIARII,ITY GENERAL AGGREGATE s �C1dIMS MAD� �CCUR PRODUCTS•COMP/OP AGG, S OWNER'S&CONI'I(A4TOR'S PROT. PERSONAL&ADV,1NlURY S i OnCH OCCURR8NC6 S 1 FIRE DAMAGE(Any ow fire) s i AUfTOD10L1I-91AA11ILITY MED.EXP5NSG(Ariy person) ANY A VI'0 I COMAINED SINGLE twrr I' All OWNGD A(p'OS f CNBr)IILEDAUTO.S I ODJLYINIURY 1 HIRGD A IITOS (Per person) S NON-OWNED AUTOS BODILY IN)URY GARAGE LIABILITY INN`Wddent) S i S EXCESS f,(AIIILITY ' ROPERTY DAMAGE �MRRCLLA FORy I _ _ EACH OCCURRmCG S TIICKTIIANUMHKJLAr,0k?A, - WURkI;k S COMPCNSATION AND [MNLOYINIS'LIARILITY I X WCSTnTU_ OTH- ! 7UIb2I5012006 01/10/2006 01/10/2007 IMrr r11F Pxorkl[r(n(r CCiDI:1AR'rNCRs/sxr-.cuTlvy � rucL S )M-CCRS AI(b: Irin[t LL DISEAa-} x ( LICY LIMIT S 500 000 IL DI SrrEA HMPI YSE S 100 �QQ I - i ;Il'f1U�01'01!IiRnT'IONSR,QICAI'IUNSNf)hfCUiS/SPECIAL 11'JiM5 I i flrlCn'I E 110LUI( CANCEL AAON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED gIrOR EXPIRATION DATE THEREOF; THE ISSUO E TO I MAIL 15 DAYS TEN NOTICE TO THEING COMPAK1y WWILLgNDE P THE YVRYT CERTIFICATE HOLDER NAMED TO THE vn Of Barnstable LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPO Bldg beet. LIABILITY SE NO OBLIGATION OR OF ANY KIND UPON THE COMPANY, Oft St j REPRESENTATIVES. ITS' AGENTS OR 1111LI1s, MA 02601i AIPI I;ORIZED REPREbTNTATiV$ x� Y MARK -'M"ST ,hr s 35 Peep Toad Rd. Centerville MA 02632 3 (508)420-6216 Y' Y Cell phone 774-238-2938 * S 9 PROPOSAL SUBMITTED T0: WORK PERFORIVIED ' :AT• Bob OW/ C 725 Old Stage Road SAME ` Centerville MA 02632 � 978-884-8800 A£ We herby propose to furnish the materials and perform the labor necessary, or the Completion of the following; `sNew Roof: breeze w gara om &shed g sunro Remove 1 laver of existing shingles Install 8"dry edge c Install ice&water shield at:edge &in valley areas n� d 4 4 Install IS lb.felt paler Ly Install IKO 3 Tab shingle color earth tone y. ' w Cut ridge&install cobra vent Remove antenna om main house All.shingles will be stormed-nailed ` 4 All debris cleaned daily Shingle over existing shed Price includes material labor&dumb fees ,, emu All material is guaranteed to be as specified, and.above work to performed in accordance with specifications submitted for above, and completed in a substantial 4 r "tom workmanlike manner for the sum:of; Two-Thousand Seven-hundred&Fifty ` F Dollars($2,750:00)with payments as follow;fill amount due upon complefion * Any alterations)from ove involving extra,costs will be added underwritten tit agreement, and becom n e a ge over and above signed estimate/agreement rt s »� s RESPECTFU Y S Signature 10-18 06 CCEPTANCE OF.PROPOSAL '' The above prices specifi ion'& conditions are satisfactory, we herby accept r You are author' t he ork, and payments will be as specified;above. K '. Signatures . k Date:�w1 * This proposal may be withdrawn by said compa' ny if not accepted with'n,30 days : f Frt"iWi k s f TiN a , f��*,; � a�Fi'� x�vars6r .. Yf . --. , n :3::n.. t'� The Commonwealth of Massachusetts zr 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 �rn A Please Print Legibly Name(Business/Organization/Individual): V l ►Q1�1� `���1>\J� c—� Address:_ City/State/Zip: Phone#: � � �� C5 10 (D) lre you an employer? Check the appropriate box: Type of project(required): ❑ I am a employer with 3 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the'sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions ❑.I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.0-oof repairs insurance required.]t employees. [No workers' 13.❑Other comp.insurance required.] .ny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. iomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. zm an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. (� surance Company Name: )licy#or Self-ins.Lie.#: © 1 0] 16 1 10 Expiration Date: 1` 1`t � b Site Address: c� U C l�C� P t� ll`IC C! - City/State/Zip: ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ie 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of .vestigations of the DIA for insuranc coveTape ve ' at c ' n.. Jo hereby certify under t ains td pe lt'es f 'ury that the information provided above is true and correct. ature: Date: Zone# J (ba l b 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#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Pr Map` �'9l Parcel / 72 Permit# 61py Health Division Date Issued Conservation Division Feed S D Tax Collec r Treasurer Planning De Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 7,,2 .S DoZ /J Village , — /i� Owner Address Sri',I r '43e), Telephone Permit Request_AE WOO/- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost DPI Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family IIIXTwo Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes . ❑No On Old King's Highway: ❑Yes 416 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 O. Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name , IcA6f' o?- Telephone Number 'dL) k7 Address License# Home Improvement Contractor# Worker's Compensation# &IC 9'//— 63 " -� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO )167f�D U r// SIGNATURE DATE _3� 7 4 61) - FOR OFFICIAL USE ONLY PERMIT,NO. ^ _` DATE ISSUED , r MAP/PARCEL NO. r, ADDRESS r`VILLAGE OWNER of DATE OF INSPECTION FOUNDATION r .Q f ; L , FRAME - - INSULATION ' FIREPLACE $ ELECTRICAL: ROUGH FINAL- PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 4 - • - FINAL BUILDING ILA DATE CLOSED OUT ASSOCIATION PLAN NO. Assessor's map and lot number �._.,_ ., ........,.• �TIiiS��71TE1Y1 MUST,9E, �FTNETO Sewage' Permit' number ���� ��- INSTALLED IN C®MPLIANC� g .......................... . ..... .../...:........ ., WITH TITLE 5 ' J f'' Z 31UNSTADLE, i House number '7�S r�L ENADINMENTAL CODE Af�I MAO& t639- TOWN REGULATION c°�cYaYilk. TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..l{. . ..:.... p, j..�YI.C.?.17. �?fi?!'!')y: k1.S1.�1� A✓ �iG: raj TYPE OF CONSTRUCTION ............W.O.C).Z:)......... r „m. ......................................................................... ...........1.1...-..�. ....:.......,9. .�-- TO THE INSPECTOR OF BUILDINGS: The undersigned htereby. applies for a permit according to the following information: Location .....9-23••••......C2.L.D.........S.TGS.� . .......RD.........1.... .Y1/..r°1 (. .iZ.. .,., ,, ............................... Proposed Use .(TG�Ir4ti�. }......... .................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner . a)—a 1...... ................Address ... ..Q Name of Builder1/l�.Ga -T.Address .6!'c. .. .0.x Nameof Architect ..................................................................Address .........................................................................)........... ................... Number of Rooms ...............................................Foundation .Pow.I.ed....CO.Y.1.C,ZC;7�'......5.L..4�h)3, Exterior ...:................................................Roofing .....aa .Flct...l.,.�....................................... Floors .....................Interior .............,...................... Heating 66x..S....L i....&vx-Z*"4 ... (✓•�-1��. C Plumbing ................ ...�...h-G.�l ....... .. Fireplace ............................................... Approximate. Cost .......�2.0f.�(P. ..... Definitive Plan Approved by Planning Board -----------_-------------------19--------. Area ......71 Z. ............ Diagram of Lot and Building with Dimensions Fee ��C) _ SUBJECT TO APPROVAL OF BOARD OF HEALTH q 4 777 �a 43 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of 5aMstable re arding the above�� construction. • Nam . . . ........... Construction Supervisor's License ,�. :..7..�..... O'-NEALL, JOHN 11 No .. $652 Permit for ,Addition f, S 4 1P..Family„Dwelling•...................... g _ Location ...7.2.5. Old Stage„Road ................... ..................................... A_4 f Owner John„0................................................. f f �• Type of Constryction ......k.raMP.......................... R ............................................................................... 'h Plot ............................. Lot ............................... November' 12,R 1.q 85 Permit Granted ................. ...... Date of Inspection .................................i.19 Date Completed .... . ....... ... .... .190 110 f l , Y r a, ;� Assessors and lot number, .. l. l:: ........7.... 6iA - eewage /L � � ...I: 'nit number � 413 � �] �. - Z BJH.Hn9ETADLE, i HIL House number .........•/•zz• ...... �.... Z ................ 'ooe,i639 \e0a CEO MAI a' TOWN ' OF, fBARNSTABLE BUILDING +: INSPECTOR 6.L,?,4 .Ld s ,..X.1 .......... ..1,�11....R®C)/n..................... APPLICATION FOR PERMIT TO .... ....,.... .... ... TYPEOF CONSTRUCTION ....... .............................................................................................................................. ~� '.. ......................194p ,.57 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: o2..0 .......Q.. ,c.C. s�l'�..5 e. :.Rd. rt,T �' .�.�L., �..nra. ..... Location ........ .. .... Proposed Use .......�.u.N.:1....R.O.C?.A")...on...�.1.1�.�.��....:. ..G4, �'4�.�...�...... .WaLL-1d1/'. .�................ Zoning District ............. ..Y..................................................Fire District ........ '`:.` ....................... Name of Owner mh1•A6......Z-0. .....0..1.t.1'.i.QAddress ....� ..Q.�.C...�..�T4�.�. � ....t�•G{i t..Ep1�L4 4LC' fQ��y Name of Builder a t.j.p... k. �C,,f�1•C„Q� Address .X`a�. lJ` .�. .�a. C,,✓n'ldl#3 •.... 1. .�. Nameof Architect ..................................................................Address ...:................................................................................ Number of Rooms ....... ..f'.............................................Foundation;._�. ,.!:E'_.,)...t..f�/1.G�e/...... �.�G��, f . � r Exierior !�`t`e.... ''�. .o�,,. ,...................................Roofing :./�1.�+. /3G��...t.....c�. .o..i!l5.l.,�'.5..,........ Floors 4-0..�'L.L^r.(t'!= / Interior ...T...l. ..... ............................... .......................... /..N1. beating ........... U' .,1'1...?.................................................Plumbing ......A/C' /.9,.,c......................................................... Fireplace ..................................................................................Approximate. Cost .......�.�e�^C.l... .................................... Definitive Plan Approved by Planning Board --------------------------------19--------. Area ....� ....sSG ./.... Diagram of Lot and Building with Dimensions �',0�� Fee ....................... ..............o..... SUBJECT TO APPROVAL OF BOARD OF HEALTH hD �� �3 100 see 5 . \M OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . . ......... Construction Supervisor's License ... Q..7. ........ O'NEIL, JOHN No ....28 278.. Permit for ADDITIOIJ.............. �f ... .................... —q-inale Famil ..Dwell�ki.&.................. .................Y. ........... . Location ....725...Old...S.t.agg...Road...................... ...... Centerville ............................................................................... -J. Owner ........ohn.....O.'.....Ne..i.11........................................ .... Frame Type of Construction .......................................... ................................... ............ .................. Plot ............. .............. Lot ................... ........... August 1 . 85 Permit Granted ......................... ..............19 Date of Inspection ....................19 Date Completed .......... ...........A [.A t ' //?/~Plan bk#22 Pe 8 5 oo7a # Assesso_.rs'map and lot number ....Ma..... ? i#..... 7..........t..�........ g „(ter Lot# 6 Qy�i?H F t��f Sewage .Permit number 16..? .......................::..... SEPTIC SYSTEM 701 INSTALLED IN CO LE, i Housenumber ......... ....... .......... .. .. ........:............................ WITH TITLE °° 039. ENVIR TAL C0 v a• TOWN OF BARNSTAT '�u�.ATlols BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... .0.............:............................................................................... y Wood frame TYPEOF CONSTRUCTION ..................................................................................................................................... .............. arch...12...-........j9..81. TO THE INSPECTORYOF BUILDINGS: The undersigned hereby applies for a permit according to+'the "fallowing information: Location ....Lo.t#.b...House...#::...17.,2...0.1d...Stage...Road....rn-Centerville.,...Mass...................................... ProposedUse.............................Dwelling............................................................................................................................... Zoning District ....................... :.......:.................:...................Fire District ....................::................: Name of Owner ..........J.ossph..W.....&...Li.11i.an...M.....Address :P...O...... ...C.umniaqui.d......A-4-a--.n2637 • Ginno �...�k...� �_�)7 n ,�...Ha 1?..Px ,....C.umm.�....P.a.o. 026 r Name of Builder cT h'S'2pI1 �d: 2;iYfi1 Address �( Name of Architect. ....Address Number of Rooms ...........5... �........................................Foundation ...fj.s...aonc.ne e........................................... Exierior ..........Sh pL e.2c- ..&...ft.......9.id.?ne..................Roofing ..........b s.pha.It..:................................................ Floors pX kP P.e t i n Interior .......�.az t.:G.Lt G...n. .Y1C........................................ ..................... ........Plumbing ............Grp ..:: :.:,. h ........................................ Fireplace .............Y.0, ..............................................................Approximate Cost ....$ I.n.Q . .................................... Definitive Plan Approved by Planning Board ________________________________19________. Area � Diagram of Lot and,Building with Dimensions Fee ......... .....3 ..;... ................. . ...... SUBJECT TO APPROVAL OF BOARD OF HEALTH { I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....... ... .................................. ZINNO, JOSEPH W. & LILLIAN M. �0, 22961 One Story ................. Permit for .................................... Single Family Dwelling ............................................................................. Lot #6 725 Old St��cje Road Location ................................................ Centerville ............................................................................... Owner ...........................................................Yq. & Lil li an M. Zin o Type of Construction ..........Frame..................... .... .. .. .......... .................................................... Plot ............................ Lot ................................ .....March...30, 81 Permit Granted ...... .. ...... :..19 • 19 E Date of Inspection ..... 'oro ..........W. Date Co mplet3 .. ..........19 1W, PERMIT REFUSED ............ ....... ........................................ 19 i . . I .............................................. .......... .;............................................... .... .. ... .. .. ......... ....... n zz .......... ............... 4 Approved ............................................... 19 4 . ............................. .................................................. . . ........................................................................... THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A , m / IL DAT A TOWN OF BARNSTABLE Permit No. -------------- t ��7T.0 Building Inspector cash rua -----------'—"-'--- �O Curl" OCCUPANCY PERMIT Bond ------- -- "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to lnr:np'r! 1,4. (& Lj1jiJWr Zinrn Address r Wiring Inspector .' � i -- � Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date 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. ....................................................1 19...... ......................................................................................................_.._._._ Building Inspector r 1 14 t OT- 7s� 'rC-E---R L O C.AT! ON: � . SC..AL E: / "=30' DATE /179QGH z3 /98/ Rt-F E RE N C E: B.E/A-�.e E 0,F-o G A T E R I HEREBY CERTIFY THAT THE ° B;UILDING • R G. LAND SURVE OR SHOWN ON THIS PLAN 15 ' LOCATED ON , THE GROUND AS SHOWN , H £ R £ ON, ' 144 v� JOSEPai K mo • o NmAK i° 13666 J.- M . MONAHAN, JR. & ASSOtfATES -REGISTERED, LAND SURVE.YO-RS,A 'ENGINE..ERS 651, MAIN ST1# EE.T DENNISPORT MASS,. 0T2"639- , , f