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Home My WebLink About0568 SHOOTFLYING HILL RD PP7 - ", --I I —-,..f,, . "Ota" i�,,),.p.,�:. � -.. P,:1',W,71`1 Uri Ar W *jA, p All o"'g,+ -1 W, 7174 T Ilk n�li A Om t4!ION e0q I"'A� -114," 5 Y I j��11 hxO!�1 A- -,v Uwa pf 'i g,4jw'yupj N Iml v W U Et Aji-,WA wn, ,WT,?MYP4�`� fp. $4. "It �`R` mt W5 I'M W ill t, I-pf m;I 91, WO-41.%1 .P1, WG�6� "Al gi P3 Vin TR, it .41-11 1--I j W,7m, '!-wpo� -- ft , KIM ''fall -tff,tj,; , a g p'p Ws AIR wr,�."j 4, J j-,��, ;eoi I ., , .4 , ;� , 1,f!T),; .pj RI. 'o, F�,La,I N-w, Ji`�Y,�.l V, Z, .15 m v IW1 ®R Mg) PAR, Ryli i�I �'I, �V wlg.q,�A igi l � w I �t4, ,) 1- .1 'Fa 'M ii A�, �� - "i ,�i . i R Ig 1 1011", 'rev 31 S ip)jenu , I , 11" W-)'A,�* 'g, 1ki, , , I T) 1-1 Vi� -NiA �Abl®r-!YWN� i MY en 16A VT Zwil ON ANIVIAW - 7r FTf'Z-- ,�,TT rqe; 1�f 14111 -00.4 1 i"I ra T s 7W ff ii T TP�-7R, 7-7 --wl Wiig�)MR �o TIT 4 gilt WE`BrITNIVY-M 11 77, T r p In �R �""TT M 11 UR?!, MaN Z VirMlli'l I. 441,vlS 3 -qp! �'��il��i!� A-1-F'Arl A A '5.. 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(1 14 A �,4,e l l, 'm A ip, ,I '61. 05AMR, um N I I y--a 6 ` SIR IWIV.114—q SONA, ORNAIPNLA I NVY115 Rim 3 R.1y, op A I 'RIP, e,M NWIJI,h� ftj NFA M4 Rif ljlf��, jj f rypi "WhIll RAIA um,� P1 -,11 1-, " I(� g 11 V)iW"A v�.,�Imfmm Fill M140"'(Pa"� 4 f vumiq A AW A (DWR 4 AM ii�, .g lip i�� T IT IDEA, rmg �t WRVIM�HAM Jig `14 fp 41 I�f -t, it 4 IiV M-1 'I, J,1,j , 0;�, W,WITM1`6 Rfff�-" M, mA - I t ii t . . - 7 M M 111-1,Y1 , 1�U,.� I ;wi4i M, ON— ortol-11 R IMP, Wj H111,1161 irt E, gn -4 1— AP F T Owl 3,j �,A 11� �1' t J�jp wi IF9, AIN N iml �JW; I I J-v— V 'klj 4J N f10�4 3-11.11 " ", q,4� � ;�,k, 1-1,` A�I I�,--1� r INi Rip" 1 K�'k J V�1 t N, t�764 �p _ Town_ of_Barnstable _ _ Building iPost'This Card So That itis Visible From the Stre t Approved,Plans Must be'Retaine`d o'n 7ob and;this Card Must be Kept SARNSi`AHLLT,. - - MASK R� 1Posted�Until Final Inspectioh-"Has Been Made: it t (Where a Certificate of Occupancy is^Required,such Building shall Not be Occupied untilha Final Inspection.has be erm .. ._. .,� en made.. Permit NO. B-19-525 Applicant Name: ROBERTJ MUSTO Approvals Date Issued: 03/04/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: '09/04/2019 foundation: Ma Lot: 193-032 ZoningDistrict:` RD-1 Sheathing: Location: 568 SHOOTFLYING HILL RD,CENTERVILLE � _ , ,_ _p/ •q � --� g Owner on Record: HARRINGTON,JAMES C&CYNTHIA L,TRS Contractor Name:` ROBERT J M.USTO Framing: 1 t .,q Address: 196 DOW ROAD Contractor License: CS-039693 2 HOLLIS, NH 03049 x _ Est Project Cost: $20,000.00 Chimney: Description: Remodel Downstairs Bath, Relocate Fixtures,Expand Area into Permit Fee: $ 152.00 3 i Insulation: Adjacent Previous closet. Existing windows and doors stay as is. No Fee Paid:! 5152.00 structural changes. Date: 3/4/2019 Final: Project Review Req: INTERIOR.ONLY. NO STRUCTURAL WORK Plumbing/Gas Rough Plumbing: -- —....._ Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after:issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which.this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by)aws and codes. 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. ` Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and_Fire Officials are providedon,this„permit. Minimum of Five Call Inspections Required for All Construction Work: r Service: 1.Foundation or Footing Rough`. 2.Sheathing Inspection (n ..� .ro . _. _.n 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy _ Low Voltage Final: . Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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 All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: o� Application Numbe .... .................... BAWWABLE, MAS& Permit Fee.......................................Other Fee........................ 1639. FD�a Total Fee Paid..:......... . . ................................. ...... TOWN OF BARNSTABLE Permit Approval by..: . ..................On.....3/..Y..I..9........ BUILDING PERMIT Map........q�.......................Parcel....... .0 .................. APPLICATIONT Section I — Owner's Information and Project Location Project Address ,tea g Sfi�a aT�L Y�.S/6 G-ram, Village Owners Name �jt/� G,�� Owners Legal Address 2wk City A/111 State Zip. O 3a 9� Owners Cell# So8-8 l3— 3433 E-mail iru C4��G �.GNI •C�M Section 2 —Use of Structure Use Group /0 /O ❑ Commercial Structure over 35, cubic f(* ❑ Commercial Structure under 3 5,006 1 cubic fit ®. Single/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 ❑ Addition ❑ Retaining wall ❑ Solar „Renovation ❑ Pool ❑ Insulation Other—Specify ��7`t 12ex 9 P i L f F ' Section 4 - Work Description ?'I �QN/nd DGG Docv c.S TJ4.%*l S A'o*7''M 0t e oco xe X e x Met 4e,A4 Ag e d /iv Ta 19»iyCeA Sill,ys ��e�e�� ,�>�rTi�,e Cu�,uDows t Pdt7?Jr u GTU rt L c, giy4iEs_ Last updated: 11/15/2018 Application Number.................................................... Section 5—Detail Cost of Proposed Construction 20, a 6c- Square Footage of Project '76 Age of Structure 40 y4f.. 6f q S't3) Dig Safe Number /y Tit #Of Bedrooms Existing 3 { ^ ' Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics Wiring ❑ Oil Tank Storage Y ❑ Smoke Detectors ® Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Waxer Supply Public ❑ Private Sewage Disposal ❑ Municipal On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: L,* I am using a crane ❑ Yes ® No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information i Zoning District Proposed Use A% Lot Area Sq. Ft. y Total Frontage 1& t/Percentage of Lot Coverage f d 4 6#of Dwelling Units (on site) Setbacks Front Yard. Required Proposed amg /FS &1. is Rear Yard Required Proposed !5 TS Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated. 11/15/2018 Office of Consumer Affairs 8 Business Regulation HOME IMPROMEMENT CONTRACTOR TOE Individual � ReaiM-ra tion Expiration I f a 1b$ 39r� 08/19/2020 ROBERT J.IV,-_ TO F/� ; ROBERT J.MUSTO (1� I 105 BONNIE BRIAF2-RRJVE" k OSTERVILLE,MA 02655 Undersecretary commonwealth of Massachusetts� I Division of Professional Licensure i., `.• Board of Building Regulations and Standards Const\ dill* -'�bp .rvisor .j CS-039693 - i ' , ires: 12/06/2019 { ROBERT J 1.1— '� yI C 105-BONNIE BRIAR OSTERVILLE MA�02655✓ T . _ S� Commissioner p�J t is Registration valid for individual use only before.the expiration date. If found return to: Office of Consumer Affairs and Business Regulation I ' 1000 Washington Street-Suite 710 f Boston,MA 02118 ti I L fd LIA&I Not valicrwithout signature li Construction Supervisor Unrestricted-Buildings of any use group which contain less than 36,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl p - y I DIME Town of Barnstable Building Department Services ' eart MASS. Brian' Brian Florence,CBO 1639. 1,�� Building Commissioner EO MA'S 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, James Harrington , as Owner of the subject property hereby authorize Robert J Musto, Builder to act on my behalf, in all matters relative to work authorized by this building permit application for: 568 Shootflying Hill Road, Centerville, MA (Address 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. lJxv J �J Si ature of Owner Signature of Applicant �s - �R,y,N� ►� Robert J Msto Print Name Print Name Da e Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 t e The Commonwealth of Massachusetts . Department of IndustrialA.ccidents 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): �4 t</l 7" 7 y'S'ro Address: /O S Q��rti�� B.Cii�tt -D�e�diEt City/State/Zip: GZ6 Ss— Phone#: 77�"2 3 8 293z Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with" 4. 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.F,I am a sole proprietor or partner- listed on the attached sheet. 7. 0 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.] S. 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 isproviding workers'compensation insurance for my employees. Below is the pokey and job site information. Insurance Company Name: ; Policy#or Self-ins.Lie.#: F 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 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 c u der�thp p ' nd• enalties of perjury that the information provided above is true and correct Signature: </ 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#: 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 contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance'or renewal of a license or permit to operates business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number 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 and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: t The Commonwealth of Massachusetts Department of In&strial Accidents (Jffiee of Investipti m 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.maw.gov/dia Application Number........................................... Section 9-.Construction Supervisor N Telephone Number 7 7-f'Z 3 8 -Z 9 3 2- Address 10S' 8a.u,.1,jr9ti.� �t City ash✓i�� State Zip OZG S.g' License Number - License Type es' Expiration Date J 2/°G(I q CS-o 39693 Contractors Email R��ryS�'o Cell # ?74^Z3 8-Z Q3z 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 requir y 0 C d Town of Barnstable.Attach a copy of your license. Si ature . Date AM' 7114117 Section 10-Home Improvement Contractor ! Name A'6,3E,,tT J', iGl vs ra Telephone Number 7 7!% -Z 38- 2 932 Address /6S,Qomai6&ox r C ity e3 S rFe State &A_Zip n Z C. SS'' Registration Number.f0 g6 3 p Expiration Date S// Q f 2 a z 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 ed by 78 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signa J`b Date ±V41 It y Section 11 -Home Owners License Exemption Home Owners Name: - >,f ..tA te/ti 7V t/ Telephone Number as.?- 21 O?_ Cell or Work Number SOO -8 I3- 3 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 APPLICANT SIGNATURE Signature �, r� Date 2 -/ 4- P Print Name ?0 362 Z /f(/ S r6 Telephone Number E-mail permit to: f, ZT M u S M ArejOiai&, tii6T Last updated: 11/15/2018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ • ' Conservation _ .. For commercial work,please take your plans directly 6 the fire department for approval, Section 13— Owner's Authorization i L , 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) Signature of Owner date Print Name 4 1 " ._..,�, . .... Last updated: 11/15/2018 75" PRIOR 32"x 48" NOTE: CLOSET SHOWER AREA EXISTING 3 1/2"EXTERIOR EXISTING WALLS SHALL BE WINDOWS 22"CLEARANCE INSULATED USING R-15 (2) (REO'D MIN=21") FIBER GLASS BATTS W./6 MIL POLY VAPOR BARRIER. 0 — WALLS ARE CURRRENTLY UNINSULATED. z a > 11'-5 1/2" N 0 34" o X N V Edge of jamb m ,.v a a rt • ro _, 15" X 20" .2 LINEN CLOSET HARRINGTON B77H PLAN Scale = 1/2" = 1 '-0" Drawn: 12-17-18 Baaznstable Bldg.Dept. Apprmd � permit I 75" PRIOR 32"x 48" NOTE: CLOSET SHOWER AREA EXISTING 3 1/2" EXTERIOR EXISTING .,-*' WALLS SHALL BE WINDOWS 22"CLEARANCE INSULATED USING R-15 (2) (REO'D MIN=21") FIBER GLASS BATTS W./6 MIL POLY VAPOR BARRIER. 0 - WALLS ARE CURRRENTLY >- 1UNINSULATED. z Q 11 '-5 1/2" N 34" X 0 N 11 V Edge of jamb 15" X 20" LINEN CLOSET HARRINGTON BATHPLAN Scale = 1/2" = 1 '-0" Drawn: 12-17-18 Barnstable Bldg.Dept. Approved by: Permit#• �lg'.SZs 7511 PRIOR 32"x 48" NOTE: CLOSET SHOWER AREA EXISTING 3 1/2" EXTERIOR EXISTING ,,-*' WALLS SHALL BE WINDOWS 22"CLEARANCE INSULATED USING R-15 (2) (REQ'D MIN=21") FIBER GLASS BATTS W./6 MIL POLY VAPOR BARRIER. 0 — — — — — WALLS ARE CURRRENTLY UNINSULATED. z ' 11'-5 1/2" N 34" m X 0 N 'a. Edge of jamb cn �, o �++ .40 15"X 20" LINEN tta CLOSET HARRINGT01TRATH PLAN Scale = 1/2" = 1 '-0" Drawn: 12-17-18 Barnstable Bldg.Dept P,pp, by: � permit#: /..._. —�---- _ . I Q I 7513 PRIOR 32"x 48" NOTE: CLOSET SHOWER AREA EXISTING 3 1/2"EXTERIOR EXISTING WALLS SHALL BE WINDOWS 22"CLEARANCE INSULATED USING R-15 (2) (REQ'D MIN=21") FIBER GLASS BATTS W./6 Lu 0 MIL POLY VAPOR BARRIER. WALLS ARE CURRRENTLY } JUNINSULATED. z Q 11 '-5 1/2" N (D . 34" X CV V Edge of jamb too .., a a Z � w m �v 15"X 20" � a LINEN ;Q CLOSET ,c O+ HARRINGTON BTTH PLAN Scale = 1/2" = 1 '-0" Drawn: 12-17-18 Baug,ble Bldg.Dept AppYoved b9 Permit#: N ROp,O LE GE D CENTERVILLE PROPO SED ED CONTOUR TOV �. OR . - � 7' - IAKEVIEW Z4 t9 € o I�H] PROPOSED SPOT \� GRADE � Q" �ONF Q4 EL=4C2 1` 3 FT: SOIL REMOVAL + 96.52 EXISTING SPOT GRADE OCVS EARSE mm GU �c32 �0 uP. --W EXISTING WATER SERVICE NY$ POND' et)IJ TEST PiT WEpUAQUET EOK y� ID: 0 LAKE. INE;G( 2.5DOG 2—COMP SEPTIC ^' � �h 7 W SS TANK PUMP CHAMBER 1.93/031 �q:B9S Sf) SPO �P�� c� DINT EL=42.3' /Q, LONG .. _ �LY . Rp�•••• T�k POINT FULLER C _ 3, \�t<7 �� Q.✓'• POINT 0. B.M.: STEP LOCUS MAP Hr �_ EL=38.1 (N4Vp) P/�� . ......... �qy —� LOCUS INFORMATION, ti�UPOIE_ '(V\ +�•' .ru ^ h PLAN REF: 126/33 F-2 EA 143/133 T171;E REF 117a3/239 1• PARCEL ID''MAP 193 LOT 32 ZdNINC: '. ZONE: K GOId.UNIT,PANEL: 2WOlC056IJ DAIED:07/16/14 SEPTIC SYSTEM' • 9 sse P' _ I# PAR CEL I D• _ REPAIR PLAN PARCEL ID: w <y9 - r+ 193/032 193/034 �g _ OF JaRES LOCATED AT: O _ an ' ,S 568 SHOOTELYING HILL ROAD - .••',:� CENTERVILLE, MA. SOIL LOG PIS: 15166 - •• M PREPARED FOR DATE: SE— PT EMBER 21, 2016 -��e'' P�``�'• M BARBARA SCHWARTZ SOIL EVALUATOR: DARREN M. MEYER, R.S., WITNESS: DAVID STANTON, BARNSTABLE HEALTH 16 QF.y `. OCTOBER 1:2, 2016 0 / \0��ti� OQ ESN �f �1fy , � Do, TP-1 p TP—.2 p;� PARCEL ID: -°Y DARREN M. 40.80 0' 40.ea o,. 193./033 P MEYER 40.13 FILL 8. 40.13 P9,L -8" _ . 'No; 11.40 `^ . L 1p 0�1_'A 4 t� LOAMY.6UID 1 tOYR'4J1 Q 1 _ 39.3a 17" 39.38 17" Qp� �NI:iAR1Pa LOAMY SANG I,py,(y_yJ1p ! P 1DYR a%e 1�..a/8 J . 37.80 C 3tS" 37:80 C 38". AERC 6 38,30 MEDIUM SAND NEU111 IA �V�U M.EYER. 8C SOIY.Sy INC. 2.aY 7/4 2:5Y 77/4 - GRAPHIC SCALE P.O. BOX 981 31.47 11z 31:47 -112 D is 30 40 12O EAST SANDWICH, M . 02537� ' w PERC RATE<2 MIN/1N..("C"HORIZON)a.' PERO RATE<2 MINAN. (-C-HORIZON) "GROUWR 09SERVO.AT 106" 380 Gfwww,, 093 o AT 103 EL 380 PH:. (5O$)3SO-3311 FAX: , . 11 WEIL SOW-262.ZONE C,.UIVEI.47.8.ADJ 3,4' WELL:SOW-252,ZONE 0.IEYEL 47.8..,ASA — ORARPISTAAPRAAD)&4' / W. ). tT1Ey@rvndSon stitle50maU.Com USE TOWN OF 6AR AT0t1E EV,33.E0 USE TOWN R MWAnM EV.33 cu 1 1 Inch ® 30` ft" . _ADJUSTED OROUNOWATER ELEV.33.b ApJUSTW ORDUNDWATpt P.LEY.33A I SHEET 1 OF 2 J 1864 Town of Barnstable it • Post This�Catd So That'itas Visible From the Street A , ;ro�etl Plans MustxbeRetamed onJob and'.this Card Must betKe t 6^ ,PostedUntil Final tnspectionHas Been IVlatle te. h i Permit :""' �: >.'::'^� -€r•.,:� °�'�,,.'? ,<« 9 ,:_ r. � �»�' .. �.r � - ,�-- .,H. ,+J.,z�$-��.,> r _ .., ...� a.�,a` zy Where a Certificate ofgOccupancy is Requredsuzch Buildi�ng�shall Not be Occup fed until a'Final Inspectionhas been made y Permit No. B-19-525 Applicant Name: ROBERTJ MUSTO Approvals Date Issued: 03/04/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration_Date: 09/04/2019 Foundation: Location: 568 SHOOTFLYING HILL RD,CENTERVILLE Map/Lot 193-032 Zoning District: RD-1 Sheathing: Owner on Record: HARRINGTON,JAMES C&CYNTHIA L,TRS Contractor Name ROBERT J MUSTO FramingKl � Address: 196 DOW ROAD Contractor License, CS 039693 2 HOLLIS,NH 03049 Est "Project Cost: $20,000.00 Chimney: Description: Remodel Downstairs Bath, Relocate Fixtures, Expand-Area into. ,P'ermit Fee: $ 152.00 u: Insulation: 0 Adjacent Previous closet. Existing windows and doors stay as is. No �t7�.1�1 Fee Paid; $152.00 structural changes. , Date 3/4/2019 Final: Project Review Req: INTERIOR ONLY. NO STRUCTURAL WORK _ - Plumbing/Gas Rough Plumbing: < __.._ ,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months afterissuance. All work authorized by this permit shall conform to the approved application and the=approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures'shall be in compliance with the local zonmg by=laws and codes. 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. c 4 a Electrical The Certificate of Occupancy will not be issued until all applicable signatures by�the Bu�ldmg and Fire Officals are provided on permit.this; Minimum of Five Call Inspections Required for All Construction Work Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection �,v 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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 Engineering Dept. (3r&floor) Map I% 3 Parcel O Permit#*" ' 3 Cp S_ House#- ��' at Issued' 2 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) • 0 Conservation Office(4th floor)(8:30-9:30/ 1:00=.2:00) L Pic, % ' 'e(� TEM MUST Be igSabnol Admin. Bldg_) ED i CE Defini 19 _ ENVIRQ M Towly RE AND TOWN OF BARNSTABLE! Builldin Permit Application Project Street Address J��tq S� n a� P21U 1 Ala 211 L ' Village �C ru�P� ✓i �-P i Owner 1 Q A( T�V4 �(T (�� (Z' Address Sla Telephone 3 7 S - 03.1 Permit Request tg d� 12 C 19-(' JP-TA c ZFirst Floor square feet Second Floor _Tl-oel4s2e� 20 square feet Construction Type_/)moo r- Estimated Project Cost $ 0120 pap Zoning District Flood Plain Water Protection Lot Size f 7 U00 .39 f7 Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure :VO Historic House ❑Yes Rl o On Old King's Highway ❑Yes �lo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other .NO/v,e_ Basement Finished Area(sq.ft.) I Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other N1.4 Central Air ❑Yes 214 o Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No • Garage: gr6etached(size) )(620 Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use /� Proposed Use /l!L�4.710 C a•vS� Builder Information Name a ti Telephone Number SO Address �f e 0:�7/J License# Ord 17 3 q Home Improvement Contractor# Worker's Compensation# Y 7 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTIO DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO GA7 /� T/o'G iP SIGNATURE DATE BU LOLLOWING REASON(S) C-_b//ter i . FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO yy f ADDRESS } VILLAGE' OWNER } *; ; • , DATE OF INSPECTION: FOUNDATION q T " ,i FRAME i • , INSULATION' FIREPLACE ELECTRICAL;• ROUGH ,i FINAL PLUMBING 2 .RG�H `' k FINAL. GAS: FINAL FINAL BUILDI c . a DATE CLOSED',__ tn ASSOCIATION PLC,%NCO, s ' tri in �7 , t i N hh A.M. FOR DATE TIM'/- v 'P:M. I'M OF f�fTt,1RNED` PHONE YD11R CAL{ ARE ODE. - NUMBER XTE'NSION MESSAGE PLEASE CALL W�Ll CALL � 1 � .AGAIN �Aflf7p SfE YOtJ v�Afuxs�a SEE"You : SIGNED 7niversal' aeoo3 NOTES dpThe The Town of Barnstable NAM Department of Health Safety and Environmental Services 9.► Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissionc For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any preexisting owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est. Cost gL 00r>' Address of Work:. V Owner's Name /6V Date of Permit Application: 9'.2 - 9 7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME MOROVEMENT WORK DO 'NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL G 142A SIGNED UNDER PENALTIES OF PERJURY I hereb apply for a permit as the agent of the o7/////R of a Contract a e V Registration No. OR The Conrmonivet11111 of Atassachuseas =1;_:- Deparniz nt of Industrial Accidents t ;;,, _ office 91"llyestiyatlons ' \ "' 6110 11 a.0ittrton Street i4- i Bostutr. A1u�s. 02111 Workers' Compensation Insurance Affidavit ApnIi -a"it tnforntahon': Please PRI1VT lebi6jy _....... ca i n• city -_.Pi� .per�Gi�Zo nhone# 3�S- 0 3 i y I am a homeowner performing all work myself. 1 am a sole proprietor and have no one workinra, in any capacity ..�_— :.....r. �. ..r••......i.rr..n�—arch _.__ 1... '(!_....—_�-..-..._ �.- '..._ ,. '�'�•.�_'.•• - __ --.�J ._. _ � [J 1 am an emplover providing workers' compensation for my emplovees working on this job. cunt tam• name: a city: �Icz . ahnne#: L50 aPl insurance cn. Ze A' .) 00-2 yl V 7 [� I am a sole proprietor. general contractor, or homeowner(circle ate) and have hired the contractors listed below who have the following workers compensation polices: company name: aticiress• Rhone#• insurance ro. nolicv tl - .t�:•.-.. v� - _ '�'.;t.•.::•-•S:•-- -� -ram:n:r��iT••r�nws. —�'*.•i._. _ .e-r.....�_...-... _ .-..__._.... .._ ...__-....._. _bG-..may..._._ ._.._ye._....n�-__- - - �— ___ - __ .1�7�- - __ -__ ..��.�o�ri•• .a._-� cnmpnn• name: address city: phone#: insurance co. roiicv# Attach additional sheet if necessary ;r^- t • +� •« - _ _"""""`"�"'�`*� -�• _ Failure to secure coverage as required under Section ttion 25A of NIGL 15Z n lead to the imposition of criminal penalties of a line up to S1.500.00 andiur one cars' imprisonment as well as civil penalties in the form of a STOP AVORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. do herebt•cerrifi•t tier the pains•and pet /tics of perjury that the information prodded above is true and correct. Signature --.�- Date ",/� 7 Pri name -�0 8 Phone# — 73.2 6 3 eJ official use univ do not write in this arcs to be completed by city or town ofDciai city or town: permit/license# riBuilding Department C3Liccnsing Board [� C]check if immediate response is required oSelectmen•s Office 1 C]llcalth Department contact person: phone#• r JOther �y;� �._.. ...� ...-.�� .ter-�+�r�-.+,.� _ •-•»-+-� ' Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers" compensation for tltc employees. As quoted 1rom the "ta��' an cmplgree is defined as every person in the service of :rnut cr under any contract of hire, express or implied. oral or written. e An einplurer is defined as an individual, partnership, association. corporation or`other legal entity.'or. ahy two or mo: • rise and iricludinc the lei al re rescmati��cs of a deceased em lover, or the iint ente P . . P the foregoing engaged in a lc rP receiver or tnistee of gn individual , partnership. association or other legal entity, etnPloying employees. However tl. owner of a dwellin�a, house haying not more than three apartments and who resides'tlierein.'or"the occupant of the dwcllim, house of another who employs persons to do maintenance , construction or repair work on such dwelling_ he or on the ;,,rounds or building appurtenant thereto shall not because of such employment be deemed to be an empio\•e MGL chapter 152 section 25 also states that even• stater local licensing agency shall withhold the issuance of- renewal of a license or permit to operate a business or to construct buildings in�the commonwealth for an applicant who fins not Produced acceptable evidence of compliance with the insurance.coverabe required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the perfor►nance of public work until acceptable evidence of compliance with the insurance requirements'of this chapter been presented',o the contracting authority. '• 77. Applicants Please fill in tite workers' compensation affidavit completely, by checking the box that applies to your situation and supplying_ company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law"or if you are require: to obtain a workers* compensation policy. please call the Department at the number listed below. , City or,towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Ple be sure to fill in tite permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. The Office of investi=ations would like to thank you in advance for you cooperation and should you have any questic please do not hesitate to give us a call. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts €` Department of Industrial Accidents Office of investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 n6nnn P-• (AV7) 727-490n P.t_ 406. 409 or 37S STANDARD LEGEND 5 note.not all symbols will appear on a map 77 , , t 149^ "+ f \\ �� -��/_ ).. .. ...\ GOLF COURSE FAIRWAY ,la. x., DECIDUOUSTREES 5 67 •�\ \ _ / „ R �Y EDGE OF BRUSH f t = ."�', ORCHARD OR NURSERY ' - CONIFEROUS TREES � 'AC'_. 027 QC .. ._...... 1. �� - MARSH AREA EDGE OF WATER DIRT ROAD 1 54 i a, — ' � lJ PAVED R D DAD r DITCHES DRIVEWAYS . .. T ,<— � PATH TRAIL ...- PROPERTY LINES LOT ACREAGE /// ..... �;•mil ��. \ ..u• / %' .-c—" 2i��E PAR ELNUMBER N �.. ,� ..... .:66 A HOUSE NUMBER +7 (%\ i. /;, / / \ - \ •.. ' % > 'J 2 FOOT CONTOUR LINE 10 FOOT CONTOUR LINE 40. �• / /--/ / .* \-\ 0.45 ACK x`.' SPOT ELEVATION % '� „ 7 !// �i .. STONECE WALL RETAINING WALL j/ 5` :� y/� 1 `• ..f\ '— `.. , -:` / RAIL ROAD TRACKS \ j/ TELEPHONE POLE STONE JETTY SWIMMING POOL PORCH DECK "` ... -_/ y1\ t(�0 5 _. \�`\•"\°\ \ 7�..._-.' �^,.'a BUILDINGS/STRUCTURES \l,/ - µl+L DOCK/PIER/JETTY ,� 7 ASSE55OR'S MAP BOUNDARY 582 t ;, -� SITE MAP �% yso;' 3 9 G O U 7.0.B.GEOGRAPHIC INFORMATION SYSTEMS UNIT SCALE: in feet 07 0 30 60 i\ ,• \ 1.....A( 1 INCH = 60 FEET #6.Q2 s , THE PARCEL ONES AAF ONLY GAAPIIIG RFPAfSTNTATI0N5 OF PROPERTY 8a0NDARIES,THEY ARENGTTRUE LOCATIONS<aili 939A , , VEGETATION,IDEOGRAPH Y ANO PLANIMETRI(DATA INTERPRETED FROM�• Z i MPPED989 AT IAERI L OVE FLIGHTS,100''.PARCEL DATA DIGITIZED Y AT I 00 ROM I"=1 ' TWITTERING ASSESSORS MAPS 1995 \ R }ni -�s":",,35�� _. ___—,_ .__—._..__—. � Y +y� •. � '^ iNS� t6 ^` $��,y �T'S f.'y-r 4v'r V. V. iM gs rT , �f� x S �t ��}r �•�. 11 i 11)) ,i w2'V' y�5✓{. � f.. 1_� �.:, .. i �� 11. _ I - •' 1.• 7,y' Al t IkK' ;u. i -C i - 3 Psxl M. . �"'�t ��ax�-' � .,� .- _ _ -- — —. .— _ —, _ .1..' .1 . . �— q � _— —-- t' � L L—� k• I +h' y .S-�� r fl qg $ � �'2_§Y ; - - a -'— ---------- .. � !`„si r h I',/. �a ,�+'.r ti`'�•.rises. � �,xz`r �� -,t y.. ��_ ♦s' t � /A�'-s � a�I1hn.Sjt; N"if`�/��'�`�'Pr�'�P''�. 1�-.gWZ __ �R�� ;:it f—f/ -��_�. I — I-. . I Y .,1', I" �n..IrF,i`,',•�..� -I z;.i r :.ad� '�`�.r � _:� i e yy t. ^fi>. �'-�'�,�c�+�•G°�J:C/,/%1/G � 2_ -:�. 4 �� SIG �{ - r'+�• � t � , =: yE, ��.,�r�'l'�« —_ _ _ ..—. •��,f'I *) 4 I --.— _'_ •_1 � L. � �Y,,I�..f �^ r i• tj-. t + 4�+ X , s cam' i• °+ 26� t d _ i � / �� ` y. t r• '� `'ram �- '� �i � � / (n�?i�'. �fir, .� � `• '��,�w}" I tI i v s I'.' -III-�C'- -_. �• �_ F� ---'I- � _ �`,—_`�_ �•�,� +..*. �\ /.. ..� ,,h z/,�'J:�- vQd- /� V/d9J7AYNNZI!/62I,CIG d�ii 1�/.Q.J:JCI,'(,/2LCQP.�d t. a DEPARTMENT OF PUBLIC SAFETY Restricted To: 80 42240 CONSTRUCTION SUPERVISOR LICENSE 00 - None Number: Expires: 16 - 1 6 2 Family Homes Restricted To: 00 Failure to possess a current edition of the .X Massachusetts State Buiilding Code JOSEPH H LANGWAY is cause for r ocation of this licens . E 3 MCCRACKEN RD HARWICH, MA 02645 y!v Registration 101 85 t . Type- OBA. ' i Expiration 06/26/98 LANGWAY CONSTRUCTION Joseph H. Langway 3 McCracken Road 2 rich MA 02645 ADMINISTRATOR a1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INIFORMATION PAGE NCCI Co. No Policy No. 10901 WC2-0024147 �I 1. INSURED: JOSEPH H LANGWAY _ RenewalofPolicyNo.A egion- The Insured/Mailing address: 3 MCCRACKEN ROAD INSURANCE COMPANY ®Individual ❑Partnership HARWICH,MA 02645 ❑Corporation or Other workplaces not shown above: Insured's I.D.No(s). (if applicable) See WC 00 00 01 F.E.I.N.# 010325916 Risk ID# 2. POLICY PERIOD: The policy period is from 02/14/1997 to 02/14/1998 12:01 A.M.Standard Time, at the Insured's mailing address. 3. COVERAGE: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: Massachusetts B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident$ 100000 each accident Bodily Injury by Disease$ 500000 policy limit Bodily Injury by Disease$ 100000 each employee C. Ot her States Insurance: Part Three of the policy applies to the states,if any,listed here: D. This ppolicyy includes these endorsements and schedules: WCOOOOOOA,WC000001,W0000414,WC00031 IA,WC200301,WC200302, WC2003D3,WC200306,WC200601, 4. PRENRUM: The premium for this policy will be determined by our Manuals of Rules,Classifications,Rates and Rating Plans. All information required below is subject to verification and chage by audit. Code Premium Basis Rate Per Estimated Annual Classifications No Total Estimated $100 of premium Annual Remuneration Remuneration See WC 00 00 01 w interim adjustments of premium Premium for Increased Limits Part Two,if applicable $ If indicated below, J shall be made-- Total Premium Subject to the Experience Modification $ Premium Modified to Reflect experience Mod.of $ ❑ Semiannually; ❑Quarterly; ❑ Monthly $ Total Estimated Standard Premium $ MA - DIA Assessment $14 Premium Discount,if applicable $ Expense Constant Charge $ Total Estimated Annual Premium $ Minimum Premium$ 500.00 De osit Premium$ 539 Total un ted Annual Premium $ 525.00 Name of Producer: CHASE INS AGCY INC Servicing Office: MASBU Program Countersigned B 02/19/97 2517 HWY 35,MANASQUAN,N.J. 08736 Authorized Representative Date THIS INFORMATION PAGE WITH THE WORKERS COMPENSATION D PLOVERS LIABILITY INSURANCE POLICY AND ENDORSEMENTS, IF ANY, ISSUED TO FORM A PART THEREOF, COMPLETES THE ABOVE NUMBERED POLICY. 810001(Ed.7-93)(1) COPYRIGHT 1987, NATIONAL COUNCIL ON COMPENSATION INSURANCE WC 00 00 01 A 3433 :.►.µ..;t:::::':::: .y/'�::{.; ��.�//;�::. :' .:::....... :y:,.j:y.;,.. .;:<..,.,.;:.. **.;�,,:.q.:++:l�yyCC.;��:yy.;;;:::`'::<::::::''►�:+r,..::t;:::;::::::<:':2::::: ..:.//.++:..:►►.**://.�:s++.++.:.>::..:..;:++.,II.tt.jy.:�:�:::yy.:;:;::::;'::::`��'::::':::'':<:::::: '::':: :w;;:��:y�.:.:yy�:.....I:.............. ;IM .. F�WM :#M!V11r1471'.;R:.:.: W ...:>.. �skV4lI ,NWF}Il"ir> '1, ..:. ..:. .:. .>:..l1VF!,l,l.. »>..; ; D SCP 31301071 1 02327716 1 150 0005519889-001-00001 ANNUAL BRANCH 19 MD INS GRP - HARTFORD NEW BUSINESS EFF 05/02/1997 ASSURANCE COMPANY OF AMERICA SPECIALTY CONTRACTORS POLICYs- COMMON DECLARATIONS TRADE CONTRACTORS PROGRAM This policy consists of the declarations as well as the coverage forms and endorsements listed on the Forms and Endorsements Applicable List. ::::....................................................................................................: NAMED INSURED AND MAILING ADDRESS AGENCY NAME AND MAILING ADDRESS ....................................... JOSEPH H LANGWAY HBIS/BENSON, YOUNG & DOWNS INSURANCE AGENCY, 3 MCCRACKEN ROAD P.O. BOX 559, 32 HOWLAND STREET HARWICH MA 02645-3000 PROVINCETOWN MA 02657-1607 (508) 487-0500 BRANCH NAME AND ADDRESS POLICY PERIOD MD INS GRP - HARTFORD FROM TO P 0 BOX 5084 HARTFORD CT 06102 05/02/1997 05/02/1998 (860) 257-6500 12:01 am 12:01 am BUSINESS ENTITY: INDIVIDUAL POLICY PREMIUMS In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. This policy consists of the following coverage parts. This premium may be subject to adjustment. PREMIUM COMMERCIAL GENERAL LIABILITY COVERAGE PART $ 350.00 MINIMUM PREMIUM CONTRACTORS EQUIPMENT COVERAGE PART $ 120.00 TOTAL POLICY PREMIUM $ 470.00 Countersigned by Authorized Representative Date Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright, Insurance Services Office, Inc., 1984. COMMON Copyright, Maryland Casualty Company, 1993. 760006 Ed. 10-93 INSURED'S COPY 05/19/1997 3437 � :::7:iA.R::::'::;::j;:%F' >::.:::.;.:.::...:.:...::^:::: :::::::::::::.tf.1:E�.>:�:::.:;.::: �.;.;..:.::::..::. y.::::'::::: *::::::::::::::::::::::::::iY:_.»+y:.*:r�:::.;.:A.> ::.:.;/.>:.:�t.•.:�:y.�::y.;:::k:::: ::::::::::isi::::::::::::i::::i::i.::}::'�::y;�:y.�`::i:::::i .....:.....:::t: .......... :... ..: f.M I.,.. !;s\.'�,.,,� GII.::: :':::a 4e::::::i::.'...::::. {A�*�r.V 1?l i'a?I!MI}IS7F;rTi.:.i:'i.: ::. :::::::::.i:::::;:::::.ii Vt✓i':I..:: ::..::: :':: . D SCP 31301071 0232771E 150 0005519889-001-00001 ANNUAL BRANCH 19 MD INS GRP - HARTFORD NEW BUSINESS EFF 05/02/1997 SPECIALTY CONTRACTORS POLICYsM COMMERCIAL GENERAL LIABILITY DECLARATIONS TRADE CONTRACTORS PROGRAM This coverage part consists of this declarations form, the common policy conditions, and the coverage forms and endorsements indicated as applicable on the forms list. $ itilltl l:El `S..t .::1NSIAIiC > ;; .:::::..:;:.::.:;:::::;:;» ............................... Some of these coverages are sublimits or are subject to aggregate limits. Refer to your policy to determine how they apply. GENERAL AGGREGATE $ 600,000 PRODUCTS/COMPLETED OPERATIONS AGGREGATE $ 600,000 EACH OCCURRENCE $ 300,000 MEDICAL EXPENSES - EACH PERSON $ 10,000 PERSONAL INJURY AND ADVERTISING INJURY $ 300,000 LIMITED CARE, CUSTODY OR CONTROL (EACH LOSS) $ 1,500 LIMITED CARE, CUSTODY OR CONTROL (POLICY AGGREGATE) $ 3,000 "SPECIFIC PERILS" LIABILITY $ 300,000 THE FOLLOWING ADDITIONAL EXCLUSIONS AND LIMITATIONS APPLY EXCLUSION - DESIGNATED WORK ABSOLUTE ASBESTOS EXCLUSION LIMITED CARE, CUSTODY OR CONTROL DEDUCTIBLE - PER CLAIM $ 250 COMMERCIAL GENERAL LIABILITY 760201 Ed. 10-93 INSURED'S COPY 05/19/1997 3.1.1