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HomeMy WebLinkAbout0876 OLD STAGE ROAD ITv fig.......... II1 of IBM IfT Iany V7 K-Y Igummy A II%mip t ft, Lill IlZ ell Ionic Rue "I iI5200101 an malls 1 ENS Not MW IARE, BONN&Jgo mugs M, 44 onto pig,"if Not 1 MIR PRI Iq vvy�=jmw, WNW IIwo It I -some maws Kau_�-N f is N WWI Mg t I—emu out HIM "MEN=MnYW IA man MIXT ISO in-Man g NMI son I'w1g,h A HMO I-Mom IIOUR VMS IElms U98 WOMB _p V4 11LIf, MCMWER, ARN Ioil tIItag IEgg mom All an BUILDING DEPT. T Application Namber.... ..... ..................1..�................ ,►center,►», • AUG 10 2020 /�'A� .NA Permit Fee... .............Zoning District... .......... TOWN OF BARNSTABLE 1J TotalFee Paid../ .................................................. l :- TOWN OF BARNSTABLE Permit Approval by. V. -.:..............on.... .�3/... �'.... BUILDING PERM�bANNED ... .. `1`�. .... .. ...... ..�1 oz...... ..Map. Parcel APPLICATION 21/6 /aD Section I —Owner's Information and Project Location Village 4 tO f L,41 f �.Project Address �t Y Owners Name �a4/ e y\- Owners Legal Address (o City State Zip Owners Cell# E-mail 3 2 91a Section 2 Use of Structure Use Group - ❑ Commercial Structure over 35,000 cubic feet Commercial Structure under 35,000 cubic feet , 2Single/Two Family Dwelling Section 3 . Type of Permit ` ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty. ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System iAddition ❑ 'Retaining wall ❑ Solar ` Renovation ❑ Pool ❑ Foundation Only Other-Specify . Section 4- Work Description GAl Last updated:.1/31/2020 a Application Number......,,.....a,.....:..,:..:............................. Section 5—Detail Cost of Proposed Construction G 60 Square Footage of Project Age of Structure _ Dig Safe Number_ #Of Bedrooms Existing, ` Total#Of Bedrooms (proposed).__ 110-MPH Wind Zone,Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics E Wiring ❑ Oil Tank Storage ❑ Smoke Detectors Plumbing ❑ Gas ❑ Fire Suppression Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal - BOn Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: am using a crane ❑ Yes U�' No Section 7-Flood Zone Flood Zone Designation.,_,. . Within or adjacent to a wetland,coastal bank? Yes ❑ No Section 8-Zoning Information Zoning District J_L�" Proposed Use_... Lot,Area Sq.Ft.,_ . A0.- 0Q - R / Total FrontagePercentage of Lot:Coverage #of Dwelling Units(on site) Setbacks Front Yard Required__,Proposed Z b Rear Yard; Required. . Ib Proposed .r Side Yazd Required.., _1 Proosed /.D� p Has this property had relief from the Zoning Board in the past? ❑ Yes No P P Y g 3 j Last updated: 1/31/2020 i Application Number.......... .......... ................. Section 9—Construction Supervisor Name r" Telephone Number- �(� � Address _ . W W.t&1Pov _l�o`, Ci c lw ,,,/ , ty . .� y ItiState Zip _1 C-090U�G License Type -Expiration License Numbe �� Date 7 7 /-Z t___�____,^ Contractors Email _r k Q'y r,,� t'csc,`�;,�,R, (� c A eo wyCell# 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.Attach a copy of your license. Signature ., _. �✓ Date Section 1 —Home Improvement'Contractor Name c ,l Telephone Number Address ' Zc W c�c.a��_G�fj L City. state* Zip; Registration Number. Expiration Date $O I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR an4 the Town of Barnstable.Attach a copy of your H.I.C... Signature Ch _. a 20 D to c� ....:..... Section 1 —Home Owners License Exemption Home Owners Name:.i� Yl�� /! �60 Telephone Number. c 4 7O�A 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 an he Town of Barnstable. Signature /� Date Z APPLIUA1 ` SIGNATURE Signature a Date 6 Z Print Name M s o ka, Telephone Number. 1droP E-mail permit to: ►�1— C ®� o • Last updated-1/31/2020 Section 12-Department Sign-Offs Health Department ❑ Zoning Board(if required) El Historic District ❑ Site Plan Review(if required) `❑ Fire Department El ` Conservation ❑ For commercial work,please take your plans directly to the fire.department for approval Section 13 Owner's Authorization I as Owner of the subject property hereby - auth rize .,�,. rwc`1 icy e, .. ,_to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of j ob) Signa r of Ter 4 date Print Name , ': Last updated: 1/3 U2020 Town of Barnstable Building Department Services ' ELAFNWMM Brian Florence,CBO M 039. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-79076230 Property Owner Must Complete and Sign This Section - If Using A Builder I 'tie Wefi/4 c ,as Owner of the subject ro erty � � 1 property hereby authorize Yr ' L � ���c o v�C. to act on my behalf, in all matters relative to work authorized by this building permit application for: 6�76 01W#--qc- Rd q7�, rof /6�= (Addy ss of Job) **Pool fences and alarms are the.responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. -7 - lG S ature of Owner Signature of Applicant Print Name Print Name r Z© �® Da Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17• r CPfnmon Vealth ct,"4assacnusetts Division of Profe�slonal Licensure B oard of Building Regulations-and Standards Cons c ' ,;i�(t ,rvisor ' CJ 0SO38Fi F fires C�I77f2021' MICHAEL P LOARY'j r 206 WORCEOEll CT S A Ta2B'" ( FALMOUTH IfA 021i40 ' I Commissioner ' ' �e cpamvnza�rusea�l/z a���a�tac/uuselt 0"We of consumer Affairs&Business Regulation '_` HOME IMPROVEMENT CONTRACTOR a .TYPE C.onmration . ' . . � x', Reyistratior Ex it o :� ,} :• . . ` 1�79588�" OI3/19/2020 '- h 3.,� M.L CONSTRUCTION Ail GQMPANY,INC �. i' MICHAELP.LEARY /4 651 RIVER RD ' ` MARSTONMILLS,�0 Undersecretary The Commonwealth of Massachusetts Department.of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): M.L. Construction Co, Inc. Address: 21 Wildwood Cicle City/State/Zip: East Falmouth MA 02365 Phone#. 774-836-8950 Are you an employer?Check the appropriate box: Type of project(required): . 1. ✓ 1 am a employer with 1 4. .I am a general contractor and I _ employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8• Demolition workingfor me in an capacity. employees and have workers' y p �'• ,. 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. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below,is the policy and job site information. Insurance Company Name: Associated Employers Ins. Co. Policy#or Self-ins.Lic.#:WCC50050216142020A N Expiration Date: 3/19/21 Job Site Address: 876 Old stage rd City/State/Zip: Centerville Ma Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine . of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA-for insurance coverage verification. I do hereby certify under the pai nd enalties of perjury that the information provided above is true and correct' Si atur . Date:8/5/2020 ' Phone#: 774-836-8950 Official use only. Do not write in this area,to be completed by city or town of)tciaL, 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#: ' ACC CERTIFICATE OF LIABILITY INSURANCE ' FDATE(MWDDNYYY) 05/15/2020 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 pollcy(les)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 CNAM� Ronda Laventure RSC Insurance Brokerage,Inc. PHONE (781)98"Q0 - - AAIC No: (781)963 4420 15 Patella Park Drive ADDRESS: RLaventure@rlsk-stmtegies.com Suite 240 INSURER(S)AFFORDING COVERAGE NAIC d' Randolph MA 02368 INSURERA: Ohio Security Insurance Co. 24082, INSURED INSURERS: Safety insurance Company 33618 M L Construction Co.Inc. INSURER C: Associated Employers Ins.Co. 205 Worcester Ct B2 INSURER D INSURER E: Falmouth MA 02540 INSURER P COVERAGES CERTIFICATE NUMBER: CL2051559988 REVISION NUMBER:' THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABO'vc Fr Av 1 i L INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICI4 Tliw CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, - EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADVIL OU13RI POLICYEFF Ml�E)tP V LTR TYPE OF INSURANCE POLICY NUMBER COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE ®OCCUR DAMAGE TO MMITEff-PREMISES Ea occuna E 300,000 erro MED EXP(Any are ) $ 15,000 A BKS61236924 - 04/01/2020 04/01/2021 PERSONALBADVINJURY $ 1,000,000 GEN'LAGGREGATE UMITAPPUES PER: GENERALAGGREGATE $ 2,000,000 POLICY ECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: LEXE $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT g 1,000,000 accident ANY AUTO . - - BODILY INJURY(Per pawn) $ B OWNED SCHEDULED" 6212142 t 01127/2020 01/27/2021 BODILYINJURY(Peracciderd) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per aaiderd Uninsured motorist BI ' $ 500,000 UMBRELLA LIAR OCCUR • _ EACH OCCURRENCE 5 EXCESS LWB CLAIMS IME AGGREGATE $ DED RETENTION$ _. $ .. WORKERS COMPENSATION - - PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETOWPARTNERIEXECUT(VE EL EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBEREXCLUDED7 N/A WCC50050216142020A 03/19/2020 03119/2021 (Mandatory in NH) E.L.DLSEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 1o1;Additional Remarks schedule,maybe attached K more space Is required): , RE Property Address:53 Dale.Drive.Falmouth,MA02540 a CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE J� THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - LUTHORSM�DD/jREPRE4ENTA7IVE `l 01988 2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Op 1Hf r� y Town of Barnstable BA"STABLE � M m 200 Main Street,Hyannis,MA Tel.(508)862-4644 f639. �0 prfOMA�e INSPECTION REPORT Permit: Building -Addition/Alteration - Residential Use: Date: 8/10/2020 9:07 AM Inspector : barrowsd Permit Number: TB-20-2146 Name: WALLACE, KATHLEEN M Address: 876 OLD STAGE ROAD, CENTERVILLE Unit No. Inspection Type Inspection Item Status Comment Building Admin - BA-Site Plan showing NIC need plot plan attached Construction location of proposed work. (If required) Inspection Overall Comment: Overall Inspection Status: FAILED Re-Inspection Date: Inspector Signature Owner Signature Total Score: 100 'TOWN OF BARNSTABLE BUILDING PERMIT APPLICAT ION Map C1Z ParcelI Application #, l 'V Health Division Date Issued I �' o� tv,0 Conservation Division �� Application Fee dL v Planning Dept. � �T Permit Fee Date Definitive Plan Approved by Planning Board 4 =ev Historic - OKH _ Preservation/ Hyannis �~ Project Street Address 76 SE Village C-QAXkW1 L Owner 11kA, WiVtd CZ-- Address Telephone Permit Request V V V'[[ 4> W *.i [t07ti.. ku �(,ey-m va k -eq -X� - lz4o ow Wl� W. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation'00 "D1 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ 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 Telephone Number 1 7� [ Address vG�� License # bd r I'�V A Home Improvement Contractor# Email Worker's Compensation # w e,Coo 31 . off- ALL CONSTRUCTION DEBRIS RESULTIN ROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE l l FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL = PLUMBING: ROUGH FINAL GAS: ROUGH FINAL � z FINAL BUILDING S i DATE CLOSED OUT ASSOCIATION PLAN NO. o� IVIE T Town of Barnstable Regulatory Services r u • BARNSTABLE, Richard V.Scali,Director MASS. 900 1639. Building Division Paul Roma Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office:508-8624038 Fax:508-790-6230 Property Owner Must Complete and Sign This Section I, KATHLEEN WALLACE as Owner of the subject property hereby authorize CAN p n QdAj10'VI to act on my behalf; in all matters relative to work authorized by this building permit application for: 876 Old Stage Road Centerville, MA 02632 (Address of Job) Y Wa Signature of Owner _—_— Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. C.\Users\decollik\AppData\Local\Microsoft\windows\1NetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 r The Co rrrmonwealth o 1i�assacltus f efts Department of Xnduslrlal Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017, www,mass,gov/dla Workers, Compensation Insurance Affidavits Bullders/Contractors/Electrlcfans/Plumbers, TO BE FILED WITH TUE PERMI71ING AUTHORITY, Applicant Information Please Print Legibly Name (Business/Orgmization/Indlvidual); Cape Cod Insulation Address; 18 Reardon Circle City/State/Zip: South Yarmouth,MA 02664 phone#; 508-775-1214 Are you an employer?Check the appropriate boxt 1.211 am a employer with 48 employees(full,and/or part-time),* , Type of project(required): 2,01 am a sole proprietor or partnership and have no employees working for me In 7' New Construction any capacity,(No workers'oomp,Insumnoe required,] 81 [] Remodeling 3.[]1 am a homeowner doing all work myself-(No workers'comp,insurance required,)t 91 ❑Demolition a,[]I am a homeowner and will be hiring contractors to conduct all work on my property, I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees, 111 Electrical repairs or additions S,Q I am a general contractor and I have hirod the sub•oontractors listed on the attached shoot, 12,�]Plumbing repairs or additions These sub•contraotors have employees and have workers'comp,insuranee,t 13,[�Roof repairs ' 6.[]we are a Corporation and its offloem have exercised their right of exemption per MOL c, . 141 Other Weatherization 152,11(4),and we have no employees, [No workers'comp,Insurance required.) *Any applicant that checks box#1 must also fill out the section below showing their workers'c t Homeowners who submit thff ompensation policy Information davIt indicating they ere doing all work and then hire outside contractors must submit a new affidavit Indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state'whether or not those entities have employoes, If the sub-contraotors have employees,they must provide their workers'oomp,Policy numbers 1 am an employer'that is providing workers'compensation Insurance information. jor my employees, Below is the policy and Job site Insurance Company Name: Atlantic Charter WCE00431902 Policy#or Self ins,Llo,#: Expiration Date, 06/30/2018 Job Site Address: CI /State/zi :C� V- Attach a copy of the workers':compensat n Policydeclaration a e s p tl�si on - p g (,bowing the policy number and expiration date), Failure to secure coverage as required under MQL c, 152, §25A is a criminal violation punishable by 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, A copy of this statement may be forwarded to the,Office of Invest{gations of tha DIA for insurance coverage verification, 1 dohereby cert y under the pales and penalties ojperjury that the Utformadon provided above is true and correct: .Unguro1 Henry Cassidy �w. `"rMWMYMW YyiIWAMw�WM rIM 1 ////gg11 _ by 111I1 1 INW V n/ � L� 508.775-1214 Of lclal use only, Do not write In this area, to be completed by city or town oJylclal City or Townt Permit/License# Issuing Authority(circle one); 1. Board of Health 2, Building Department 31 City/Town Clerk 41 Electrical Inspector,5► Plumbing Inspector 6,Other Contact Persons Phone#s f CAPECOD-27 KDOYLE ACORO" DATE M E M/DD/YYYY CERTIFICATE OF LIAB . - ' ' `.� LIABILITY INSURANCE 06/30/2017 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(lesj must have ADDITIONALJNSURED 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 endorsements. PRODUCER C ACT " Rogers&Gray Insurance Agency,Inc. PHONE ) ac,No):(877)816-2156 434 Rte 134 A/C,No,Ext South Dennis,MA 02660 E-MAIL .mail@rogersgray.com r INSURERS AFFORDING COVERAGE NAIC k INSURER A:Peerless Insurance Company 24198 INSURED INSURER B:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C,Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company 44326 ' South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. ` ILTR NSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER LIMITS POLICY EFF POLICY EXP - A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE [�]OCCUR CBP8263063 O4/O1/2017 04/01/2018 DAMAGE TO RENTED 100,000 MED EXP(Any one erson 5,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY Jeer LOC 2,000,000 , PRODUCTS-COMP/OPAGG OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 11000,000 ANY AUTO 6232707COM02 04/01/2017 04/01/2018 :BODILY INJURY Perperson)OWNED SCHEDULED AUTOS ONLY X AUTOS ' BODILY INJURY Per accident $ X A�T O ONLY X NO - (PROF OPERTY AMAGE S ON N AUT OWNED R OS ONLY Per accident $ C r UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE EXCl 0006635002 04/0112017 04/0112018 AGGREGATE $ 2,000,000 OED RETENTION$ D WORKERS COMPENSATION PERTLITE OTH- AND EMPLOYERS'LIABILITY Y/N - X ANY PROPRIETOR/PARTNER/EXECUTIVE R/O WCE00431902 06/30/2017 O6/30/2018 E.L.EACH ACCIDENT 1,000,000 �FFIC.tor EMBER EXCLUDED9 a N I A /landatory In NH) 1,000,000 If yes,describe under E.L.DISEASE-EA EMPLOYEE DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE -- THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C:_2)_ ACORD 25(2016/031 0 4QAa_,)naa Arnon rn00n0ATinki An Commonwealth of Massachusetts Division of Professional Licensure .Board of Building Regulations and Standards Cons Gtrlisp�•rvisor CS-100988 u ; r it tr f�� 1ires: 11/11/201.9 t HENRY ECASSIDy` { ' 8 SHED ROW WESTYARMOGTiM026,73 ?C J. Commissioner lam z 8 Office of Consumer Affairs,and Business Regulation 10 Park Plaza - Suite 5170 Boston, MZ::(t.'-.0,0,jracto 6010,usetts 02116 Home Im rovemr Registration ( � i) Type: Corporation Registration: 153567 Cape Cod Insulation Inc Expiration: 12/14/2018 18 Reardo "Circle So, Yarmouth M A 02664 I N 1 t/ L.. y �• l Update Address and return card. Mark reason for change, --------------- •--..__.____-------------.._._:__._.._..._.___-........:_._...,.�.(�.:�1d�:s.^.�,-.I-'.-f?.�.~,.r,.�;za._I �•s:plo:�mb.rt Cl�.-os±-^.�.r�+.,..: . . �e�omzmtaruucm�C�o�C�/tilrcaarcc�cWetlJ Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only Type; Corporation before the expiration date..If fours urn to: S' `•aealstretlon Ex Iratlon Office of Consumer Affairs and si as Regulation = E?67 12/14/2018 10 Park Plaza• e 5170 Cape Cod Insu atli' cr- Boston,MA. 11 I it.1 0. i.�' HenryCassidy 18 Reardon Circ' '� ''" So.Yarmouth,MAg2i�%' C� C�ry'� ^ z":5 Undersecretary t al hout si atu CAPE COD INSULATION fI511t OSASI IIAMSISi IPA AT?OAM SUSPIf1010 BASIS OUTTIOS INSULATION CIIIINOS 1-8007696-661.1 l Town of Barnstable Regulatory Services Building Division 200 Main St ��� 1711, Hyannis, MA- 02601 Date: Dear Building Inspector . .. d Please accept this Affidavit as,documentatior>,that Cape Cod Insulation, Inc. performed & completed the insulation-and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application, All work has been inspected�by a certified Building Performance:Institute (BPI) inspector. All work preformed meets or exceeds Federal &.State Requirements, Property Owner Property Address Village Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( V� ( ?v ) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ) ( ) ( ) ( ) ( ) Walls ( ) ( V-1 0-1 ( ) �Ntr°l X (Vor k 17ee*fgr,*1�d Sincerely A ssi r, President Ins ation, Inc, , �t r Town of Barnstable *Permi d Expires 6 months r m'sue e K Regulatory Services Fee ' • IARNSUBM • 9c6 erns. Richard V.Scali,Interim Director . prED MA't� 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 Map/parcel Number qc9l Not Valid without Red X-Press Imprint � LProperty Address 1 ❑Residential Value of Work$ �19d< Minimum fee of$35.00 for work under$6000.00 n Owner's Name&Address �ptA c L' o�(de rm. ®,LV 2x-��Bh e-0-0 57f—?4 LLE- Contractor's Name LF Telephone Number q 9., 44a44 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance MIT Check one: ❑ I am a sole proprietor APR - 4 2014 CKI am the Homeowner I have Worker's Compensation Insurance TOWN .Insurance Company Name ®F BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany.each permit. Permit Request(check box) ❑ Re-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.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: v Q:\WPFILES\FORMS\b din it forms\E SS.doc Revised 061313 -7,e Cammmyreah*qfMassachusetfs Deparftnent offulas&ial Accidents - 0, tee trf i iiiorrs 600 Washington,Skreet Dorton.MA 02111 wm nass gov/dur Workers' Compensafiuu suranceAffidavit:BuildersfContractorslF ectricianMumbers plicant Information Please Print I&Obly C---Name CA -ss.- Sle (�2 '5cPe-,z9- v rg—ity/Stat&Zip �� V��cL ���©z��zPhone K6 Are you an employer?Check the appropriate box: Type of 1uo]ect(regt dred): P Ycontractor and I 6_ New suction I_❑ I am a employer er with 4_ I am a general employees{full andlorpatt-time}* have hired the sub-contracfors 2_❑ I am a sole proprietor or partner listed on the attached sheet 7. ❑Remodeling ship and have no employees These sob-contractors have 8. Demolition working for me in capacity employees and have workers' �c� �` 9_ ❑Building addition [No workers'caiup_inamanre comp.insurances regniied] 5. ❑ We area corporation and its 10-0 Electrical repairs or additions t 3_ I am a homeowner doing all work offimrs have exercised their 1li_.Q Plumbing repairs or additions, myself.[No workers'comp. right of ememptionper MGL 12-0 Rnof repairs insivancerequired.]1 c-152,§1(4),and wehave.na employees_[No uwmkeis' 1340 Other comp.insurance required:f *Aiiy$ppHamr that checks boa#1 mast also fill out the section below showing Their vraa$ets'eotupensatiaa policy ite£umation tHnmeorwnersWhosubmit this affidavitindarstmg they.Rdoingallwaalkmdthenhire outside contractorsmastsobmitaaewafdauhmtricatirt Mra tCantiRctors that check this ba K must attached sa additional sheet showhg the nme of dm smb-eomRtsctoa and stazle Whether ornot those efities have employees- If the mbh ontmctam hope employees,they must pimride their workers'comp.policy aurnber I am an employer thatisgrmidAig workers'compensation im airance far my angA peas Below fs the policy and job site informatfram Insurance Compmy-Name: Policy or Self-ins-Ile- Expiration Date: Job Site Address: cityfState P: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Seetiba 25A of MGL c. 152 can lead to the imposition of'rr i inal penalties of a fine up to$1,500.Oa an&or o=-yeariraprisorrment,as well as civil penalties in the form of a STOP WORK ORDEPaad a fine oftip to$250.Ofl a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of . Investigations of the DIA fDr insurance coverage verification - I do her certi it. tke pafilse(nrl penatiies ofpedwy tkatthe information provided above fs hire and correct © ctal use only. Do not write in this area,tabs completed by city or town gfi'ciat City or Town: PermitUcense if Issuing Autharity(circle one): 1.Board of Health 2.BurT'ding Department 3.CitylTowu Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Town of Barnstable Regulatory Services Richard V.Scali,Interim Director ti °-� Building Division a AARNAM F - Tom Perry,Building Commissioner 9 ��� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6250 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB.LOCATION: 07(O ©� 5? c ram f,' �1�1.�c ti' (t I LLF— nummber,1 ( street village "HOMEOWNER":._-r:- C)Q%4 �. v� �.t lZ e o0—tr G e ^44` ( , \- name (� home phone# work phone# CURRENT MAILING ADDRESS: city/town r state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection edures and requirements and that he/she will comply with said procedures and requirements. r ign a of Ho eo Appioval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities'of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness.often results in serious problems,.particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFIIES\FORMS\bm7ding permit formslEXPRESS.doc �TME T Town of Barnstable i Regulatory Services * areas�IE Richard V.Scal' Interim Direct f Building Division Tom Perry,Building Commis ioner 200 Main Street,Hyannis, 02601 t www.town.barnstabl a.us i Office: 508-862-4038 Fax: 508-790-6230 Property O er Must Complete. and Si This Section ' If Using Builder' as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized b this�b i, ding permit (Address f Job) Pool fences and alarms are e responsibility of the applicant. Pools are not to be filled or.utilized before fence is installed and all final inspections are performed and Iaccepted. Signature of Owner 1 Signature of Applicant Print Name Print Name Date Assessor's office(tst Floor): I Assessor's map and lot number .��J / _ ��� mot:TH E Toy Conservation(4th Floor): i 1.3 '9 y WP e Board of}Health(3rd floor): is ' INSTALLED Its ® p� w Sewage Permit number �" y► � B 9��`� � ti ��� �4E� o tr�ct e O s63q. Engineering Department(3rd floor)` ®��: = - E14VIR �e�. p Y House number ,. 3 �(v .� . � �•,,C®!� Definitive Plan Approved by Planning Board ' s • - 19 T®Wly REGULATIONS APPLICATIONS PROCESSED'810-9:30 A.M.'and 1:00-2:00 P.M.only k TOWN . OF BARNSTABLE R BBIL0IHG INSPECTOR •APPLICATION FOR PERMIT TO of 1 t 1 I TYPE OF,CONSTRUCTION J 19 L TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location O L rw Proposed Use d/ Zoning District Fire District Name of Owner J 014 AJ O>C.01vry0Y2- Address � 76 OLa 2� A0 C.V Name of Builder A(�/ -� /d/J ���lUiLZ� Address_ Name of Architect Address Address ,��✓ Number of Rooms / Foundation Exterior C— 677 Jl '/? 57//.9ilV 4!'_�-7 Roofing Floors �� l 0 Interior � '�y Zt,1,0�7 L-1.., Heating Plumbing z 914 Fireplace Approximate Cost / �z � Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Si ipervisor's License - 066 3%o a5-6 3 yo O'CONNOR, JOHN c-:7 No - 440 - Permit For Build Addition i Y Single Family Dwelling Location- Lot #1 876 Old Stage Road Centerville Owner' John O.'Connor , Type'of Construction Frame Plot Lot F Permit Granted January 13 , 19 94 Date of Inspection: Frame 19, I • Insulation 19— Fireplace 19 Date Completed `� -�/S 19 r K� z , gU1LDING ID . � •Y..: . AUG 10 2020 . _ � � - WN OF BARNSTABI�E SCANNE 10'-11 ° J Half watt granite counter ` Bed 1 d Berl 2 CN . 0 Bath 1 00 Kitchen' Living room Screen porch V Al lst FL 1 WaUace Renovations door Plan M.L.CONSTRUCTION.CO,INC. soe-nee-a�eo MICHAEL,LEARY ' I Layover 2x8 rafters on 2x10 ledger Proposed bathr:OOm with H2,5s at top and bottom. 5/8 plywood roof: addition Ice and water a all cheeks and..eves.. Roof paper in the field. Lamented roof shingles, 1/2 inch plywood, typar building wrap. . ice and water at all Sill. sealer on concrete appropriate trim 2x6 double PT plate t. locations, 2x8 KD.. floor framing ALL new trim to be 3/4 Advantec T&G stub f boring, k existing home PVC, 2x5 wall studs and 'white cedar shingles to match 'exist.ing' plates, home. } A2 EtevoLtlons Wallace Renovations Elevations from M.L.CONSTRUCTION.00,I1NIC. Patriot way 508-42e-3380 MICHAEUEARY x8 (edger bof'c d to _ - - ,.. � tr �r1 tee, butted tc:� �t �w 8` X310 the existingc�.a.�E i c3ir r, W, with ,.�/f; E _ er 1pot cl te ;c�: 1 ;t5, r _ � �� t�F'i � .�.-� 1 f• x �en£-4 to 1l ...... _ S\ ~�, 2x8 JcDr<_>t __ ;isi Png F Jilk hangers ---- n 12, X 5 "8 J �f: � xls-tinq r t� Ci t Inc n Damp proof aR rtew work, - i I A 3 T1,`_ a E l S tiJat�ac E2 rovai D('tails M.L,CONSTRUCTION.00451C. 508-4ae_3aeo _~ �MICHAEL,LEAR � ; w, 3 — f 7.3'- ---- t ,. 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