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" otte.yd;:.:hs x�U?_CairtLlJr'.:tl,;F.ifi Sni`c,a'oa l`t TeI1nh,'ioa'sa.x�pft.<e.Oit.c e t:i:c:si,1ou'Vn?p zi asH'L3�n"ba',c.ls.,ye z`B`:�Fs er oeR,anrneq.M":t u:,1h.ar`:,res�d^m e,.&eSd't;�cSse.,u3ec.t hs,'ABx.0 p,� p"l;kd,r•�omvg,e.,asdh:P.>a.'1.lal'an Nso<'^M t`buess'tr O bxc,.ec•u;,Ra.pe...i�t.e'a.r,d<�`ym,uen„d t iol na JFro.'t•.*n.b�.>a al.nImstls•.t,p''%xhe`i.cs_U':C:'o'a.".n'r.�.dh"x,aMrs u BAiAreA M' tTn Permit os PPs �"C Wheae Permit No. B-18-2097 Applicant Name: DEREK R EVANS Approvals Date Issued: 06/29/2018 Current Use: Structure Permit Type: Building-Smoke Detector-Fire Alarm Dection 'Expiration Date: 12/29/2018 Foundation: System Map/Lot: 230-059 Zoning District: RD-1 Sheathing: Location: 100 POINT OF PINES AVENUE,CENTERVILLE v ContractorWame DEREK R EVANS Framing: 1 Owner on Record: FARWELL,WAYNE LLOYD& PAMELA Contractft Li- ise CS 102315 2 � ..' Address: THE KEITH ALLAN FARWELL FAM TR F Est Protect Cost: $0.00 Chimney: MADISON, MS 29110 `g Permit Fee: $35.00. Description: Smoke detectors/CO Insulation: F Pa ,`< $35.00 ee id. Project Review Req: '. Dates 6/29/2018 Final: Plumbing/Gas Utz Building Official Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized°by this permit is commenced within six months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and struures shall,be in compliance with the local zoning'by 1pW.s6n ct d codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. ` The Certificate of Occupancy will not be issued until all applicable signatures by the Building and,Fire Officials aWbe6vided on this:permit. Electrical Minimum of Five Call Inspections Required for All Construction Work a 1.Foundation or Footing y Service: 2.Sheathing Inspection ! Rough: 3.All Fireplaces must be inspected at the throat level before firest flue Immg is installed, 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: - Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: m Buildingplans are to be available on site p Fire Department '.-7` All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: c S q1 O - Application Number=. ........................ ...................r TOWN OF BARNSTA L ..3icFec.......................................Other Fee........................ KAM hAIN 28 PM 2= 1POW Fee Paz................................................._................ TOWN OF BARNS'. �. —LE g�Approval by..... ......................on.... _. 510N BUILDING PERMIT Map.......................................ParceL....................»............... .� APPLICATION Section 1— Owner's Information and Project.Location Project Address 40 Pa i wr ® . l�,`dl�5 /3✓cam Village C�/� �✓� '/�� I Owners Name LA Y14e farLj ell --- Owners Legal Address City 1q aC—) -s0t1 State ?i.P Owners Cell# s7® ' a E-mail K P �� GJr irh Section 2—Use of Structure' Use Group 0 Commercial Stivetvre over 35,000 cubic feet ❑. Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction C] Move/Relocate ❑ Accessory Structure . '❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Almn Rebuild ❑ Deck Apartment Sprinkler System . ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4-Work Description T jut nndshm&219=19 l ApplicationNumber.................................................... Section 5—Detail Cost of Proposed Construction- ___.-.- .._. --_--Square Footage of Project Age of Structure, Dig Safe Number j #Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing Gas -❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney . ❑Addlrelocate bedroom Water Supply LJ, —Public ❑ Private -- Sewage Disposal ❑ Municipal, "❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am.using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation 1 Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No i.�c�a�v9rzois a84D D�1 01840 Dq Washer/Dryer a1060 DR Dm� , a,o3p ps! 1 76 x cm.Fbr�TZD14Cdd i Sc rn2U Gta s p1� - s02 ae 6069 Frc x 91 O O111 t kAr-6aVn la'K IS 3o30 D� L.MY,eA Tw,n Elcla al 6n Od ( ctie�ib # 068 FL 3050 nN a65o off — 1 K E y a1oEa D11 rt O- 91,PIW rurp+ucli BIZ ;if lu-53 LED SMOKE DETECTORS 'REVIEWED rpora alo6o DO 4 dab feral loca4 U I F;JA A — L E p 14 x la 10 X 1a �6/ �_ �itiavSr FAa�['91+r ' 0 Do ST B BUILD I G DEPT, E 6•o � QS - sa+oeer.dace+,r 6ui 11060 DN sao,cc 0 cARgon dc�ccr»I' '# 9z FIR DE ARTMENT ATE cuuon,omna"�� ,.s�a ,r sI BOTH SIGNATURES ARE REQUIRED FOR PERMITTING s'wmisn 8040 Drl a mop bq at{' Foranll Io0 �i a.h oC :�e� A+t Cenkrr�lle rho. F ucinz - - u� The Commonwealth of Massachusetts Department of IndustridAccidznts Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Le gib Name(Business/OrganizadonadividuaD: -�re k �Vrl {A' S Adaress: 1 F_ea+► \e rb cot L 1J city/stawzip: J -a(Al o V+11X r0- Phone#: Or—?e 7 ��� Are you an employer?Check the appropriate box a of project(req uired): 1.0 I am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2 XI 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' [No workers'comp.insurance comp.insurance• $ 9. ❑Building addition required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repass or additions myself [No workers'comp. right of exemption per MGL 12.0 Roof repair -------licit once Tequired]t'--� —---- --c.-1-52,-§1(4),-and-we-have no----- --- employees.[No workers' 13.0 Other comp,insur-ance required.] *'Any applicant that checks box#1 must also fin out the scetion 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. �Contraetors that check this box must attached an additional sheet showing the name of the sub-cDnt actors and state Ytbether or notthose entities have employces. If the sub-conhractDrs 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. ho=ce Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/St wzip: 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 incrrrance coverage verification. I do hereby c under the pains and penalties of perjury that the information provided above is true and correct Si attrre: Date: v2 Phone#• Q 9 7 3 7 official use only. Do not write in this area,to he completed by city or town official City or Town: PermiMcense# Issuing Authority,.(circle one): 1.Board of Health 2PBBuildmg Department.3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any % of hits, oral or written." express or implied, An employer is define as"an individual,partnership,association,corporation or other legal entity,or two or more o' in a joint rise,and including the legal representatives of a deceased loyer,or the of the fore ] � P foregoing�� receiver or trustee of an dividual,partnership,association or other legal entity,employing employ es. However the owner of a dwelling hoes having not more than three apartments and who resides therein,or the upmt of the ell' house of another o employs persons to do maintenance,construction or repair work such dwelling house dwelling P " or on the grounds or buuil ' utrtenant thereto shall not because of such employment be ed to be an employer. MGL chapter 152, §25C(6)also that"every state or local licensing agency shaIl old the issuance or renewal of a license or permit operate a business or to constrict building in the co onwealth for any applicant who has hot produced' ceptable evidence of compliance with tfie uisaran coverage required." Additionally,MGL chapter 152,§25 7 states"Neither the commonwealth nor any of' political subdivisions shall enter into any contract for the perform ce of public work until acceptable evidence o compliance with the insurance requirements of this chapter have been esented to the contracting authority." Applicants Please fill out the workers'compensation affi completely,by ch a boxes that apply to your situation and,if nessary,supply sub-co�ractor(s)name(s) ec ,addresses)and phone nun s)along with their oerlfficate(s)of insurance. Limited Liability Companies or Liability P erships(LU)with no employees other than the members or partners,are not required to cony work 'compensati insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this vit may a submitted to the Department of Industrial Accidents for confirmation of insurance coverage, o be ear to sign and date the affidavit: The affidavit should be returned to the city or town that the application for e p or license is being requested,not the Department of Industrial Accidents. Should you have any questions re the law or if you are requi ed to obtain a workers' compensation policy,please call the Department at the ber listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete printed legrb y . The Department has provided a space at the bottom of the affidavit for you to fill out in the ev the Office of lnv 'gations has to contact you regarding the applicant. Please be sure to fill in the permitllicens umber which will be ed as a reference number. In addition,an applicant ions in an 'vein �az need only submit one affidavit indicatingcurrent that must submit multiple permrt/]i applications y g �� , Y policy information(if necessary) under"Job Site Address"the ior Him. cant should write"all locations in (city or ' town)."A copy of the affidavit has been officially stamped or y the city or town may be provided to the applicant as roof that a valid davit is on file for ft re permits A new affidavit must be filled out each aPP P , year,Where a home owner o itizsn is obtaining a license or permit not re to any business or commercial venture (i.e.a dog license or permit bum leaves etc.)said person is NOT required complete this affidavit The Office of Inve ins would like to thank you in advance for your coop an and should you have any questions, please do not hesitate give us a call The Departinaaf s ess,telephone and fax number. The Comma wealth of 11 assadhusetts ' Dgmtnent of Indlast Aeddents office of Itvesta�atla 600'Wad ngtan t Boston,MA 02111 Tel.#617-727-4M ext 4.06 or 1-M-MASSAFJ Fax#617-727-7749 Revised 4-24-07 V gDV/dia III ApplicationNumber....................:...................... Section 9—.Construction Supervisor Name Defi,- 7/Q�, _S. Telephone Number ®,�- 7� 7 Y�2 Aaress , 01 stde N I—zip- �2_ 7 License NumberL�lD23l License Type 09 r0rl'��°�Expiration Date � Contractors Email .60n Cell# 09-7 7- 2;,2 j - I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 E` CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation by 780 CMR and the Town of Bamsfable.Attach a copy of your Iicanse. Signature Date Section-10—Home Improvement Contractor I-Name ✓ Telephone Number • - �- Address a f 2g fi��6�Y �_ YC/AA Q 1 S)t_�State�zip-6102(0 7 j- . Registration Numb Expira#ion Date I understand my responsibilities under the rules and regulations for H=e Improvement Contractors in accordance with 780 CMR the Massachusetts State BmWng Code. I umderstand the conssfzucti In inspection procedures,specific inspections and domnneatation required by 780 CMR and the Town ofBanzstable.Afmch a copy ofyour H.LC... Signature Date Section 11-Home Owners License Exemption Home Owners 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 Btuldmg Code. I understand the construction inspection procedures,specific inspections and doc unemation required by 780 CMR and the Town of Banstable. Sim Date APPLICANT SIGNATURE. K Signature Dated Print Name a� Telephone Number ,j�D� 7� Ly E-mail permit to: I K4_, S� C C . 6 a r� e Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required ❑ Historic District ❑ Site Plan Review Cif r 0 Fire Department ❑ Conservation g ❑ For commercial work,please take your plans directly to the f re department for approval Section 13—.Owner's Authorization` as Owner of the-subject property hereby authorize , to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of job) �99 - 1 Signature of Owner date Print Name 4 { Last=date&2192018 Town of Barnstable Building g� lldiJIJI g "M Pos` Th Card rThatSit, s. d Plans.F, _ust e.ltetamed on,••lob,and this Card Must be Kept ► HA1Ch'3C- ► � ,-`. xo��",.a' .�b r r ✓i""'g;� 3 .#,:" ,z ,'`3s'� �l x.; -� - 2 ' y .�.�✓x� Permit ." �Posted�Uai i ��a�s ect�on Has�Been ,acts r � � ;� � � �� �� � � � • � �,.. ��� �'� .� R �� -' `� "" ild� all No beOccu ied antes final-lns ect�on.has beerr:mad�e .. � .: Where a.Certe scats of Occupancy s Requsred,such Bu ng �p � ... � -�,�<2:t<....ca., :- .rH �,.5.�a �„,:.� »�c.:,,,.�. � t,� *t,• .:�"�`,..�d'o:��.; s'�!x? ^,z ��3,"Cs..,., „�._: .. ....M..•�a ... ,f�, <, z. �,.&.,..au«1��. ,'; ^�:._.. . Permit No. B-17-2986 Applicant Name: JEFF BARONI Approvals Date Issued: 09/28/2017 Current Use: Structure -Permit Type: Building-Addition/Alteration-Residential Expiration Date: 03/28/2018 foundation: I Location: 100 POINT OF PINES AVENUE,CENTERVILLE Map/Lot 230-059 Zoning District: 'RD-1 Sheathing: Owner Record- FAREWELL,WAYNE LLOYD&KEITH ALLAN � ontractor Name ,DEREK R EVANS Framing: 1 Address: 137 BURNE RUN $Contractor) tense CS`102315 2 4s -- MADISON,MS 29110 w. st. Pr�oiectCost: $175,000.00 - Chimney: Description: reframe window opening accomodate larger w ndows reroof. Permit Fe'e: $942:50 �✓ecd . s o /�P �v new siding. move front door. r Insulation: x wee Paid -$942.50 Project Review Req: Plan shows kitchen,bath,and interior remodel with cathedral tee 9/28/2017 Final: 1. ceiling 5 um i as PI b ng/G . k _ ... .. Rough Plumbing: Building Official .Final Plumbing: 2st3r Sc%S � SAKrz TU&� 2� �V t M07SHM No iswt This permit shall be deemed a ndoned and invalid unless the work authorized�by.ihis permit is commenced within six mon i aftepssuance. rfp 68 Rough Gas: All work authorized by this permit shall conform to the approved application',an tl a approved construction documeA&MVwhic this permit`has been gr nte� r ! , N� final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by lawsand codes. This permit shall be displayed in a location clearly visible from access&, or road'and shall be maintained open for public�inspect�on for the entire duration of the i" 1 Electrical work until the completion of the same. �z s � The Certificate of Occupancy will not be issued until all applicable signaturesby theBui dmgand Fire Offiic�als�re providzed on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work i � Rough: 1.Foundation or Footing .... 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to.Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund"{as set forth in MGL c.142A), Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ' 'TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � s Map- ^J.?DU Parcel `O Application # 7 `off 1 0tv Health Division Date IssuedConservation Division Division Application Fee . d Planning Dept. Permit Fee •'� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 0 0 �®1(1`� Village ►��Q_ Owner Tc� ,a90 Address 31 i c�C!�� �U Cy"o'dIson Telephone 5 0k 10& -A 09 rrl\ 0 Permit Request CC\cAk Uj © ���� C r\,\O A t of r 2� Wkn'do(AA . 2 , C� 41 w `C� o C\ Square feet: 1 st floor: existing nkroposed I1 2nd floor: existing proposed Total new l Zoning District Flood Plain Groundwater Overlay. Project Valuation 5gOOO Construction Type Lot Size l Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-,Family (# units) Age of Existing Structure 10 Historic House: ❑Yes �a o On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full J'C rawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing' 1 new a Half: existing new Number of Bedrooms: Q, existing -0 new Total Room Count (not including baths): existing I new C3 First Floor Room Count Heat Type and Fuel: O/Gas ❑ Oil ❑ ElectricT❑ Other Central Air: ❑Yes o Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: 0 existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: O Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# v� Current Use Proposed Use --� APPLICANT INFORMATION 1 ` (BUILDER-OR HOMEOWNER) _._. Name c oS um C t� �ecl �iG nes Telephone Number SOB Address 9 go ko� � ���� � - �U License # S• 0Ae.(\J\l5 C'MR 00Z 0 Home Improvement Contractor# 1 U Email ( 40JPC U " e� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO C MD k 0��M� SIGNATURE DATE 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 FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1 3 i f 4 I. Custom Crafted.:Homes 90O.Rte 134,Suite 3=30 South Dennis, MA.-026.60. (508) 619 3057 Y info@customcraftedcc::com rI M wlauW.71 R 9172 zM t i { ESTIMATE E E. ADDRESS ESTIMATE-#1239°. i Allan&Wayne Farwell DATE 08l14/201 T l` 100. Point of Pines:Rcl .Centerville,MA 02632 f C RA i= Ai4tiflE3fWT Waste removal 2,a00.00 2,800.00 remove debris from property Demalrtion` 1.20 65:00 T BOOM Demo partitions walls,cancrete.sI b and exte�igr,.deck. k Foundation 1` 2000 00 2,000:00 Form and pour-hew foundation Framing 246 65.06 15,600.0T 1 Frame:new partition walls as well as new window:and door openings' Frame;n:ew. exterior walls at bathroom.. Framing 1 12,626 06 12,62600 Truss system from,Timber Creek Post and Beam i door 1: 431.80` 43.130 i Kitchen entry door x windows/doors` 1: 9,4`45..00: 9,445.:00. Integntywindows.and liding door priced by Mid` Gape windows/doors. 1 7,350.00: 71350:00. Windows and.exterior door/slider installed and trimmed inside and out: Siding 12 750.00 9,000.00 Remove and replace q ar shakes with Grade` f A cigar shingles: i 4 Roofing 24.10 450.00 9,495;00 l Strip shingles,tar paper'whi n:eeded;.Ice and'. water to code, drip edge,ridge cap all included Trim 1 3,250.00 3-250,00 Replace;pine with Azek on all rake boards;. t } 3 i i r F . i ACTIVITY C2TY RATE ML3UPiT i EleCtriCal 1 8,371 00 8 37-1 00 labor cost Plumbing 1 59500.00 5 500.0.0` plumbing':as shown on plans. Estimate to be reviised,and updated upon receipt of fixtures PlumI.binghvac 1 8 800 OQ 8,800.00 Forced air heating/AC System Goodman gmss96060 High effici6ncv furnace, coil,Goodman gsx'13 seer conden5e.r l Insulation 1 14,275.00, 1;4,275.00; f. See estimate provided l i Blue Board. 1 5,1'Z0.00. 5;17000: Blue Board and:plaster:: Flooring 1,089 8.31 9,049;:59 Install flooring in.kitchen;living area and porch,. I $450 allowance'for flooring product::. is Flooring 1,3.76 2.25 3,09600; ' sand and finish floors.with.water based:poly.: Millwork 1,877 11.0. 24064.701 Materials for shipiap 42"up.walis and all ceilings Millwork 99`6 4.00 3,984:00` { Installalion:of s.hiplap as shown.on plans:: kitchen cabinets 1 1,850.00 1,850.00 Installation:of cabinets . ;. kitchen cabinets 1 6578<00: 6,578 00' Mid Cape to provide quote Carpentry 1 -5,250.00' S,250:00 Build in shop 1 kitchen Island-work table 36" high,36"wide '727 long Counter Top 1 3,080:68 3,080.69: Purchase-and Install granite/stone as;shown;on kitchen.Dian; paint 1 5,500 00 5,500.00_ } Prime and`paint alls,stain window and`base :board.trim': building materials 1 6,000.00: 6 000 00 Interior and Exterior trim materials, fasteners: and day`to day job.supplies profit and overhead 1 174500.00 17,50000 Contractor profit,and overhead { supervision 1 3,500.00 :8 500.00 Supervision of job;town7homeowner consultations, inspections;permitting, reports` and administration. `TOTAL I $189,366 77 l i t' i F Accented,By Accepted Dafe 04 . i, i. 1 1' t P. E i i p } a E- t t F. jFt# r ? 3 t f- i 1. 1 I i F 1 t i t i i E f f r 3 i I 07w Wow���� alcAwadm4affs Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, MasCachusetts 02116 Home Improveme4k tractor Registration Type: Individual tag Registration: 169552 JEFF BARONI JAI Expiration: 07/04/2019 DB/A CUSTOM CRAFTED HOMES 's 900 ROUTE 134 SUITE 3-30 f t# i S.DENNIS,MA 02660 f: " Update Address and return card. Mark reason for change. SCA 1 0 20K 05(11 _._..... . ..:... ._.. ...... ___.. __ l �tayer#.❑ Lost.Card.ll .. ._. ��e�mnz�rrc�zwe�cfl�.a!r?��x.ia�cc�c�;re Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only n TYPE:Individual before the expiration date. if found return to: ( i 9eaiitrj$lon Expiration Office of Consumer Affairs and Business Regulation �� �169552 07/04/2019 10 Park Plaza-Suite 5170 JEFF BARONI Boston,MA 02116 DB/A CUSTOM CRPATED HOMES JEFF BARONI ' 900 ROUTE 134 SUITE-3-30.:, S.DENNIS,MA 02660 Undersecretary Not valid without signature 11/9/2096 IdAG 34#DR..IPC 2 P1X N ¢ ¢ a �T Zvi, 7 » L .a Vol Rl� r a� asums 8* R M emuslid ¢a5 Vies c" ^? WAS 0- 212. '. - n.�tu„ l• ` OWN WE � I fs' '`-.,'#zor : y 2' � J/ma#.Ooogie.comlmai}luaWmboxfl SU94bc74e340gq njec WmI 1/9 ACb& CERTIFICATE®FtLIABILITY INSURANCE 05/15/2017 rd.r .. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON 1HE O�i'IFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMON% 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: .9 the certificate holder b an ADDITIONAL INSURED;the paNCy(ies)must be endorsed. If SUBROGATION 13 WAIVED,subject to the terms and conditions of the policy,Certain policies may requiten endonswnenL A statement on this certficate does not Conf$r rights to:the CeRifiCBta holds(to Neu of.such endorseme s. Pu Rogers and Gray Processing ROGERS&GRAY INSURANCE AGENCY INC ''' 50a 3W7980 FOX No: I L MaH@rog"ray.com z ). 434 ROUTE 134 j a APFORonEc coVERACE NALc s SOUTH DENNIS MA 02660 INSURER A.. TRAVELERS PROPERTY CAS CO OF AM 25674 RMRED VMRER 6: HCCC INC DBA CUSTOM CRAFTF:b H6ME6 mac: tINS IlRERD 900 ROUTE 134 BLDG 3 5UITE 30 # rHSURER E o SOUTH DENNIS MA 02660 v INSURER F: COVERAGES CERTIFICATE NUMBER: 15427$ 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 INpiCATEp:, NOTWITHSTANDING ANY REQUIREMENT,TERM OR C0 DI'T10N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS C1=R IIFICATt: MAY BE"ISSUED:.OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES t3t- TERMS, SRIBea HEREIN 19 SUBJEG t TO ALL THE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYIHAVE BEEN REDUCED BY PAID CLAIMS. SIM LTR TYPEOFINSURANCE; POL�YHUa1IER iJNEfB COMMERCIAL GENERALLIJABAM EACH OCCURRENCES WRIT �I a OCCUR M ED EXP am ) $ NIA PERSDNAL&APV INJURY $ GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ RPOLICY❑SECT F.L.00 PrtODUCTS-CO1biPrCrPAGG $ OTHEFtS SINGLE AUTONOSILE LIASILITY s (Es aocklerdl $ ANY AUTO BODILY INJURY(Par Person) t: ALL OV IED SC�ULED BODILY INJURY(PerAUTOS NIA NoraowNED 4 8 HIRED AUTOS AUTOS $ U WH EACHOCCiRREHCEN MEXCESS LAB A $ AGGREGATE $ OED p b $ IWIFIMERV820M PENSATM X 5TAMPLR$.LIABO fYY/NOPWPARTNERr�C11�E NIA NA WA 7PJUBTH91544317 021241MI-r02I24/2018El EACHACCroENT $ 1�'�A ERExcLUDEm 3. E.L.DISEASE-EAt�LOY $ 100,000 (Atiy<&Hb tory In NH) t I f MbNe under OFF 0 TION4 below`� � El.DISEASE-POLICY LItAIT s 500,000 NIA ;F )I DESCRtPTtG1 OR OPERATMS I LOCAT�IS I VEHICLES(ACORD I OI.Addltl MW IFI a,:s ScbedWe maybe aid g more a is required) Workers'L'o7iipenSaban benefits Wdl be paid to Massachusetts employes only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for berjOiits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of9hsyranoe shears the policy in force on the data that this certificate was issued(unless the expiration date on the above policy precedes the issue date of thus Cer�fic 4trsurance). The status of this coverage`oan be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.massgW4i wd/workers�ompansetioMnvestlgaUons/` p, k CERTIFICATE HOLDER _' CANCELLATION t. SHOULD ANY OF THE ABOVE DESCRIBED POLCIES BE CANCELLED BEFORE a' THE EvIRATION DATE THEREOF, NOTICE WILL RE DELIVERED IN Town of Yarmouth ACCORDANCE WITH THE POLICY PROVISIONS.9 B s4Y I'piflt E AUTROFAZEDREPRESISIffATME South Yarmouth MA 0264 Daniel M.Cm(*y,CPCU.Vice President—Residual Marker—WCRIBMA ' C 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and jogo are registered marks of ACORD r r r 5 1 The Commoweaft,of Owlew Delvarimeni o LedusbW Accident Qflki of Inmitigataons 600 Washington Sired BoiioFa,M4 02111 govItod Workers' Compensation Insurance ' :BnldonIContraeforwyjeetaiciandPlumben Aualicant Information Please Print Lftwbl Name(Business/or oo/Iravifiu : kc f�D r ;-X C=40 � Address: I L i S!� C' /Stst#tr/Z :5 Phone#: CI h; Are pfat employer?Check the app priate bone I Type of projed.(requh*: amp with y 4. 01 arty a general contractor and I I. I am a * have; the sub-contractors 6• New construction employees(full td/or p�t-xime), a t the attached sheet 1. 0 modeling. 2.❑ 1 am a sole proprietor or gamer T�e have S. ❑Demolition ship and have no ezapioye� �„� ees and have wags' . working for me in anycapacity. `""ri 9. 0 Building addition [No workers'comp.insurance comp•Insurance., required.] 5. 0 Wetar'a corporation and its 10•❑ or additions A offi loyhave exercised their 11.Q plumbing repairs or additions 3.0.1 am a homeowner dad5 all.work exemption per 1vIGL Myself.[No workers crimp• ° 12.E Roof repairs hwm=.r��j t c. 152,§I(4k and we have no 13.0 Odor em eres.[No workers' . %urance required.} •Any appC>met met checks box#R1 laud also 8n out dw iection b"Aidf iq mar waken'capon ter Ito t Homeowtte 9 who snbmittilis d&javitiodicaftStIn ate dontg A and then him outside mast submit a=w d&kvk iAdu�ing such fCowouton.dw tdwk this box nuen atedwd an edd�oed sheet me oao>a of the�and smm whedter or eat those have emp�� tfttte mb4oaaacmn bm mtpITY=4 may tent paovae wishes'comp.Polity MM*W. I am an emiployer,jhjV h prvwdbtg worker`congmnsa bk brsuaoxce for my errrloyeex Below h the potato and job site htfomaoft insurance Company Naae�l� tj Policy#or Self-its.Litt.#: 'PM "3' Exp. : '- tration Date. Job Site Address. i City/State/Zip: _ Attach a copy of the vrorttcers'compennuon poncy ' uoa page Esaowittg the gooey anmt�er t.nn ezptrataon aate7. Failure to sin rovterege as required under Section 25 cif MGL c. 152 can lad to the imposition of criminal penalties of a fine tip`tb S1,5oo.00 and/or one-year imprisoament,as ll as civil penalties in she farm of a MP WORK ORDER end a fine. of up to.$250.00 a day itpinst the violator. Be advised a copy of this statement may be forwarded to the Office of $ations of tote DIA for ins mcc coverage vt Y 4 hereby eer*wdff thepabes andpersaMa of duo the l ennaden provided above is true and correct o t , cried wo only. Do not write in Ah area,to be cc 41ded by city or town offlcial City or Town: . i Permit/License Lwaing Authority(eirele one)! ; 1.Board of Health 2.Buiilding Department 3.Ci gmro aerk 4.Elech iral Inspector 5.Plumbing aspector 6.Other Contact Perm: Phone#: ti I f j • i DEED RESTRICTION , WHEREAS Wayne Lloyd Farwell&Keith Allan Farwell,Trs.of Lloyd S.Farwell Of (owner's name) 137 Burne Run,Madison,MS and 3777 Lajolla Village Drive,San Diego,CA MA (address) is the owner of 100 Point of pines located (address) at Centerville MA(hereinafter referred to as and being shown on a plan entitled "Subdivision of Land in' MA, Property of et al, duly recorded in Barnstable County Registry of Deeds in Plan Book 122 , Page 99 F1 Or on Land Court Plan Number WHEREAS, Wayne Lloyd Farwell&Keith Allan Farwell as the owner of said lot has (owner's name) agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit incompliance with 310 CMR 15.000 State Environmental Code, Title.V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage;. WHEREAS, the Town of Barnstable Board of Health;as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR.15.200, State Environmental Code,Title V, Minimum• Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing 'the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the' Barnstable County Registry of Deeds by recording this document, E deedr i i j 1 • f NOW,THEREFOREwayne"oydr—d &KdthAuanFanv& does hereby place the } (owner's name) f following restriction on his above-referenced land1n accordance with his agreement with the Town of Barnstable Board of Health-,which restriction shall run with the land and be binding upon all successors in title: ; 100 Point of Pines Avenue,Centerville MA may have constructed (address) upon the lot a house`eontaining no more than three (,s)bedrooms. wayne Lloyd Fu weu&Keith Man Puwell agrees that this shall be permanent deed (owner's name) restriction affecting located on MA, and being shown on the plat!recorded in Plan Book 122 Paged 99 Fl Or on Land Court Plan For title of see the following deed: Book 28162 , Page 184 Or Land Court Certificate of Title Number Execute as a sealed instrument 2 day of Owner's at • / 4 1 Owner's signature • i IOwner's signature COMMONWEALTH OF WM AMUSEM Mid+ ,ss 41, 20LI I Then personally appeareo the above-named QMcA nrygjt known to me be the rson who executed the foregoing instrument and acknowledged , the same to be free act anfleAd, before e, •n eucu< • •< Public My co IS 1 M D p,o ' p. a �l•� ,� m t_.x.isil•as Ct. s deedr If � f` f California All-Purpose Certificate of Acknowledgment A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached,and not the truthfulness,accuracy,or validity of that document. State of California County of San Diego S.S. On 2017 before me, Kncheol Noh, Notary Public , Name of Notary Public,Title _ personally appeared Name of Signer(1) `i Name of Signer(2) who proved to me on the basis of satisfactory evidence to be the person whose name(sf = is/ay,6 subscribed to the within instrument and acknowledged to me that heh^lthey executed the same in his/vr/th r authorized ca acit s , and that b his/ r/tWr signature(4)nature on the � P Y(l� ) Y � 9 ((� instrument the person), or the entity upon behalf of which the person) acted, executed the instrument: i certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. KNCHEOL NOH WITNESS my hand and official seal. Notary Public-California i @My San Diego County iCommission#t 2164905 Comm.Expires Oct 14,2020 Signature of N -4 F&Ixfe' OPTIONAL INFORMATION Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unauthorized document and may prove useful to persons relying on the attached document. Description of Attached Document The preceding Certificate of Acknowledgment is attached to a Method of Signer Identification document titled/for the purpose of Proved to me on the basis of satisfactory evidence: - ❑form(s)of identification ❑credible witness(es) containing pages, and dated Notarial event is detailed in notaryjournal on: Page# Entry# r The signer(s) capacity or authority is/are as: ❑ Individual(s) Notary contact: _ ❑ Attorney-in-fact ❑ Corporate Officer(s) other Titles) ❑ Additional Signer ❑ Signer(s)Thumbprints(s) = ❑ GuardianlConservator _ ❑ Partner-Limited/General _ ❑ Trustee(s) ❑ Other: representing: _ Name(s)of Personls)Entity(ies)Signer is Represen tin q - - - z - - z 'n:l:v.n.Ll:nc. _'•1.tcl... .t.r.uc. l..�r.\rl...'utu.l.ln:.t ..•r.t�'1...;..c:Iiul:�u:x9L.\C'1;nl nl l.l.nuvl:n•ncu.vut..;n1:.n:.T.\t'R Wtl l.hl.r:.t n;vinc:�..,..m:tn..-1'.a'L.otn.l:nl:>ns.,' 2009-2015 Notary Learning Center-All Rights Reserved You can purchase copies of this form from our web site at www.TheNotarySSLot,e.com BARNSTABLE REGISTRY OF DEEDS irPt John F. Meade, Register c 3�l?l�E2 �t►,F r� Town of Barnstable *Permit# 009013 D '40 Expires 6 monthsfi ' u d to Regulatory Serv><ces Fee lid IARNsrASLE, : Thomas F.Geiler,Director 1639. A.�� Building Division rED MA'I Tom Perry,CBO, Building Commissiongg,gV1SN1d8 200 Main Street,Hyannis,MA 02601 O NAA01 www.town.bamstable.ma.us go�Z Office: 508-862-4038 fF008-790-6230 EXPRESS PERMIT APPLICATION - RESI ,' Not Valid without Red X-Press Imprint Nd Map/parcel Number y 5 Property Address 10O Li -� 4�'') iY-,Q_S f �� [residential Value of Work t.( Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �'—y� k.�yu®�; ,r0�4 �`� ►I 1 r717 vontractor's Name Telephone Number `zt-( -S2)�. Home Improvement Contractor License#(if applicable) j fS ❑Workman's Compensation Insurance Check one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name d,(n J�Ws 01 P 1 <y � Workman's Comp.Policy# "3rL i� y�. 1 -T Copy of Insurance Compliance.Certificate must be on file. Permit Request(check box) E�4e-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/doors/sliders.U-Value (maximum.35) *Where required: Issuance of this permit does not exempt compliance with other town department regulations;i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is required. SIGNATURE: \WPFILES\FORMS\building permit forms\EXPRESS.doC `,ise020108 oF1H�►w,, Town of Barnstable Regulatory Services �BA BLK �& Thomas F.Geiler,Director Fo;s,rA�` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 :....--^' Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, g=asOwn2er065 e subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Jo ) Una e o Owner Date not Nanie If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side Q,FORMS:OWNERPERMISSION Town of Barnstable �Op THE Tp�� Regulatory Services saexsTwatE Thomas F. Geiler,Director 9 MA. �p 1639. A Building Division lfo � Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: e city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units of 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 procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval 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 fora✓certification for use in your community. Q:forms:homeexempt r� a W m J 2 m O O� 2 W = N 3�• Q W Q O 2 O a i0n _ m 04 g � vo J 73 M" r � o D o� -- -- W 00 3 O i I t i O � � I e = I 3 i a i L O Q O m .� i i J � o _—y L i y C} 00 0 T CD" t i a O r i 1 - a E p U z p o_ U 119 Cf I V I � JJ O Z Ul S \\ UO Ci Lr Cie 1.0 o r c� J o � , v v N � o 0 =o � a A �+ n x CK _o d C- 01 T z .� 3 � c � Li O A �'6 c� �1 a � m Z m u z m z a O C p v � f i o lLIJ 4 s W � 1 � o 0 I 00 id -a c� h ' III a9�t0 DPI a8�D� clotiei- o I�a�►er/Dryer dtow DH Der 1�a ►�ce�M Y a�o3o Del 76 x WC c�cntbrATwOpen Yoi'C�IA Hcte. i n 8'KAd %ow1 aa� �,�+� a uSb `\6O6A FrenO. 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