Loading...
HomeMy WebLinkAbout0749 SHOOTFLYING HILL RD ...� �' f Town of Barnstable Building Department Brian Florence, CB Building Commissioner MUST COMPLY WITH HOME OCCUPATION 200 Main Street, I4yannis,MA 02601 RULES AND REGULATIONS. FAILURE TO www.toymbainstable.ma- s COMPLY MAY RESULT IN FINES.. Pre-application for Business Certificate 01 Date Map _Parcel Applicant Information Applicants Name -,d►�►-cx C'tT'' Applicants Address. '749 Email Address ,Cam-c�Nam. �~e �L A V_CkA 1 • C V�-. J Telephone Number S a�—q,01 1�), Listed❑ Unlisted ❑ Business Information New Business? No. ------ --------- ---- Y Business is a registered corporation? ___________________ ----_. Yes If yes Name of Corporation Does business operate under the registered corporate name? -Yes F No Is the business a sole proprietorship or home occupation? ___- _Dye;s No If yes then aHome Occupation Registration is req rad—See Building Division Staff Name of Business YES rc d � Q E Business.Address YA Type of Business • Y--kk%.Ct SAG�J t �1 uikiiig Commission pr Office se Only C ndido tio -� t �Pil �S Building Commission `� rate Clerk Office Use Only Pa-0 i tLot 5O t�-ak cam-, but --cse 1 dp b� a, Vs � =s�.;p -� Ntl �•hl�c Gldvc--c-�i��,� Town of Barnstable �"E Building,Department MUST COMPLY WITH HOME OCCUPATIOf rOicy Brian Florence,CBO RULES AND REGULATIONS. FAILURE TO Building Commissioner COMPLY MAY RESULT IN FINES. BARNSTABLE, « 200 Main Street,Hyannis,MA 02601 Mass ,0$ vyww.toFgn.barnstable.ma.us pTED MAi a Office: 508-862-403 8 Fax: 508-790-6230 Approved: Fee: Permit#: O HOME OCCUPATION REGISTRATION �C Phone#: qr — �4lb Name: c Address: ` SX ,A- Village: Name of Business: rMOA ` Type of Business: pC-..�. . Map/Lot: SO`C � INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside'the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. subject to the After registration with the Building Inspector,a customary home occupation shall be permitted as of right ) following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. The use does not involve the production of offensive noise,vibration,smoke,dust or other particular .matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,h ead and agree with the above restrictions for my home occupation I am registering. Date: Applicant: Homeoc.doc Rev.10/17 Application number-......... .................................. Fee .................................................... ........ . ........ HAM Building Inspectors nitials....... ....... ....... ........... Sf-? 24 2013 Date Issued........... . aa (0101 (k 1JAHNS)ABLE Map/Parcel........,.... .) ................................. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION P Address of Project: _ 7�'9 S4od i-J (< s- 4r7 ff ip NUMBER , ST ET v VILLAGE Owner's Name: a Phone Number Email Address: Cell Phone Number Project cost$ Check one Residential Zl-�Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK E-1 Siding 0 Windows (no header change) #_ED Insulation/Weatherization D Doors (no header change) #- Commercial Doors require an inspector's review Roof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name W- 12 Home Improvement Contractors Registration (if applicable) # , (attach copy) Construction Supervisor's License# Aov� w (attach copy) C Email of Contractor -7 Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES * Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or,Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are su ject to a building official's approval prior to issuance. a i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 62-t•ay Q a Address: r COT City/State/Zip: �t Yd(t'"� /�k Phone#: ��l-1-6 `mac ;` Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. W 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 g, ❑Demolition working for me in any capacity. employees and have workers' comp. insurance.# 9. ❑Building addition [No workers comp.insurance p• 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 C O>3 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: Policy#or Self-ins.Lic.#: 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 certify under thepains dpenalties ofperjury that the information provided above is true and correct/G Signature: Date: '2AK / 4 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#: le y; 1 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 operate a 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 s.__ye-rzct�i-�IeG-t�.uYe-Cn..,rx8'dr'•a-'erzaru'3 �,�6n-�".�:-.' �,.v.-�..— T_-a� _ Industrial Accidents. ould you have all the Departmentyqu' at the number listed below. Self-insured are companieso nshould s' compensation policy,please 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 0211.1 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax##617-727-7749 Revised 4-24-07 www.mass.gov/dia REPRESENTATNE OR PRODIJ;,AND THE CERnFRCATE HOLDER. IMPORTANT. Wthe cerffm ate holder is an ADDIIONAL.INSURED,the policy(es)mist be endorsed. N SUBROGATION-IS WAIVED,subject to the terms and conditions oftbe policy,certain policies may require an endorsenimst A stalmerd on this certificate does not omfer rights tD the Certilicate holder in neu ofstich endorsernent{si. PROWCat c 2.' JABS HIMIDmx Schlegel & Schlegel. Ins Broker PHONE 508 771-8381 ICU NA. (508) 771-0663 34 Main Street PhT, schl e ;�+c•,ranee@ .com West Yarmouth, MA 026i3 a+SUREMAFFORIUM CadEPAGE NAIC„. INSURERA•TRAVELERS PROPERTY AMID CAS INSURED INSURER 3: Jn4TAM CAHOON INSURM C. DRA CAHOON CONSTRUCTION It�I1rJ�a 16 NEQUAQUET AVE IrsltR e: CENTERVI=, MA6 026323 INSURERF: COVERAGES CERTIFICATE NUMBER. REVISION NUMBER: THIS 18 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 OTHFR DOCUMENT WITH RESPECT TO WHICH THIS CERTFIC4TE MAY 6E ISSUED OR MAY PER:TAw.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH PQUCIES.LI ITS MOWN MAY HAVE BEEN REDUCED BY PAID CLAW& CYW LTR TYPEOFINSURANCE A� POLICY NUMBER Fm= NMDW UWIITs 'MERA LIABILITY EACHOCCURRENCE S cORNERCW.GENER4LLiA811I DAMAGE TO RENTEDTY s CLAW-MADE OCCUR AED EXP ompersm) 3 PERSONAL&ADVI=RY 3 GENERAL AGGREGATE 5 GEN'LAGGREGA7ELMTAPPUESPER: PRODUCES-COAAPIOPAGG S POLICY PRO. LOC S AUTDrA091LEUABiUTY Ce�rtSINGLELrNIT S ANYAUM BODILY tNJURY(Perpelson) 3 AUTOS ALLOWNED AUTOS SCHE BODILY INJURY(Per aoddent) 3 NON-OWNIED, PA HIRED AUTOS AUTOS IOaodderdDAII � $ UtEMLLAL= OCCUR EACHOCCURRENCE $ EXCESS UAB CLAIMS MADE AGGREGATE $ DED RETIENTIONS S A 1NORKERSCaRPENSATiON1165040 2/13/38 2/13/19 1 WCSTATU- I 10a- YIN ANY: u0 NIA M-EACHAcaDEUr $ .100,000 OFFICER&FWanda"MBER in NH) E L Dls-Eass-Se. OY s 100,000 eyy��,aemibevnder EI LDISFILSE_Po cvuanlr 500 000 DESCRIPTION OF OPERATIONS below DESCRIPTIONOFOPERAFIONS/LO(ATIO111.SIViNC1ES(AttachACORDlM.Aditonalibvedo:SchedWe.ErtasesinceisIegdred) JINTANA CAHOON HAS ELECTED NOT TO BE COVERED MWER HER CURRENT WORKERS CadPENSATION POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLIGnn-S. BE CANCELLED BEFORE THE EXPIRATION DA-FE THEREOF, NOTICE WILL BE DELIVERED IN RICHARD W EADLT ACCORDANCE WITH THE POLICY PROVISIONS. MA 02632 AWHOt6M SSYTr171VE 1 -2010 ACORD CORPORATION. All rights reserved. ACORD 25(201010% The ACORD name and logo are registered of ACORD Phone: Fac E-Mail: CAMULT7 @COMCAST.NET f PROPOSAL Proposal No. 18-9418 September 4,2018 To: Nancy Cassano Work to be performed at 749 Shoot Flying Hill Centerville MA We hereby propose to furnish the materials and perform the labor necessary for the completion of: NEW ROOF l. Remove existing roof 2. Install aluminum drip edge 3. Ice&Water barrier first 2ft, all skylights and penetrations 4. Cover roof with 15 lb felt , C —�- 5. Re-roof with 30 yr architectural shingle 6. Install ridge vent 7. Flash all pipes and penetrations Labor and Materials$8,000 All materials is guaranteed to be as specified,and the above work to be performed in accordance with the specifications and completed in a substantial workmanlike manner for the sum of Eight Thousand Dollars $8,000 with payment as follows: Four Thousand Dollars$4,000 with signed proposal and Four Thousand Dollars$4,000 due upon Completion Respectfully submitted, -------------------------------- Richard P. Cazeault,Jk HIC# 168607 CSL#100393 198 Five Corners Road Workmans Comp and Liability with Centerville,MA 02632 Leonard Ins of Ost (508) 420-5482 Acceptance of Proposal No. 18-9418 The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment is outlined above. - -------------------------------- Signature - Date Commonwealth of Massachusetts Division of Professional t-icensure Board of Building Regulations and Standards a Con str-uct or1'Sli rvisor CS-100393 Expires: 02/03/2020 RICHARD P CAZEAUIT,JR � 198 FIVE CORNERS ROAD: ' CENTERVILLE MA 02632 ' n Commissioner .. _._ Office of ConsumerAffairs&Business Regulation , r HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only T TYPE:Individual befo a the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston;MA 02116 RICHARD P CAZEAULT JR D/B/A R Cazeault Roofing&Repairs RICHARD CAZEAULT JR . _ ... 1 98 Five Comers Rd-. Centerville,MA 02632 Undersecretary Not valid without signature pgS Qepartmept ohL�ahOr upati0[ l Safety nd H�eall!th AdmiNstrationo, r �� �'s'rri1JOG� eu� e rr 44 utass�tullycomplesed alllhou�rlOpcupati �T pal Safety�andte�ifh sn: Iry �� Assessor's map and lot number F...1. ..2...PL.O.T...11..Ah ` ypF THE T0� ..Sewage Permit number ... ..4 ` �.....::. #7 4 9 2 BAW STADLE, ( ,,,,House number ......................................................................... v ■AOM f �O 039. \00 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........C© STR!!C. 5 I NGLE I'AM I LY HOME .................................................................................................. TYPE OF CONSTRUCTION` .................WOOD. .....F...R.AME ....... .. ................................................................................................. •................................................19 :?.. #. �1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locations. :.......F�sM #� �ml.,..R "OADMCEN ERV I A� .................................................................... ........,............................ Proposed Use ..........................................SINGLE FAMILY RESIDENCE ................................................................................................................................... Zoning District � I.........................................Fire District .......� N.TE RV I LLE/OSTE RV I LLE Name of Owner ?&!J/....TX.Address .. r�t��.. U. ........0 :�.... ..... Name of Builder ......C.L. I•.F.T..{� ••. ;-QQIM1�s.M-R.?...............Address .... ..?TZ..�!��.I At...STRE.E.T,..OSTERAI.i i t F y Nth r t` Name of )ArcQteat+ ...' ':°:...........................................Address Number of Rooms ....::.", s xr .... .".:......Foundationf... ...................... Exterior ....CLA-•PBQA.I?D..AN.D..+,C QAR... .........Roofing ...r..........A-.S.+,5?UAL I`..........................:......................... 4AI( AN>a CARi� T Interior .............. ?Yt^FAF L Floors T........................................... ........................................ Fa�CFD WARM AIRHeating ...................................:............. . Plumbing .................................................................................. Fireplace .......DNE............................................. ...: ....Approximato Cost ................... D. Definitive Plan Approved by Planning Board _______________________________19 ` __. Area "' .. ............... r ....... Diagram of Lot and Building with Dimensions Fee ..........0..-, . SUBJECT TO APPROVAL OF BOARD OF HEALTH #148 �ALFRED..W.+w.CH #16 #18 EUGENE H. KE/N lOOD H. MILLER #17 LAWSON 2-4 i �OCCUPANCY PERMITS 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. Construction Supervisor's License .................... .' CLIFFOM REALTY TRUST A=192-17 No ....2$$.0 Permit for .......One...........Story........:......... � Single Family Dwelling .................... Location ...Lot ��1, 749 Shoot Flying„Hill Road Centerville ............................................................................... `, .. . Owner ......Cliffward Realty, Trust ....... ............ ' Type of Construction Frame j .....................................a......................................... i Plot ............................ Lot ................................ Permit Granted ....,,,January..27,.........19 86 Date of Inspection ....................................19 Date Completed ......................................19 1 . oftNc,� TOWN OF BARNSTABLE Permit No. .?888$ BUILDING DEPARTMENT : TOWN OFFICE BUILDING Cash HYANNIS,MASS.02601 Bond ........ j CERTIFICATE OF USE AND OCCUPANCY Issued to Cli f fward Realty Trust Address Lot #1, . 749 Shoot Flyinci Mill Roach Centerville, Massachusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. N ar h 8 7 -P Building Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT aaaa°T ' M TOWN OFFICE BUILDING ,"a g .639. HYANNIS, MASS. 02601 'fie cur r. fl MEMO TO: Town Clerk FROM: Building Department DATE: An 'Occupancy Permit has been issued for the building authorized by BuildingPermit $ ........�� Q O ...... ........................................................................_............................... . ... issued .�,.. �.. Please release the performance bond. I THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) IM ^ACC DATA BUILDINU :4RNSTABLE, MASSACHUSETTS PERMIT. JOB WEATHER CARD 19 2�8 II 8 DATE PERMIT ..APPLICANT L 11'i UYii y ADDRESS :i i '+' '• 1 I IN0.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO -X'u�i:i L:Glr:•-.•-?r`.= (_) STORY '�� DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) _C L L'1 i i / DISTRICT (N0.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE r BUILDING'IS TO.-BE FT. WIDE BY FT. LONG BY :FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE %;+wuypgo+7 USE GROUP BASEMENT WALLS OR FOUNDATION L_.. • (TYPE) REMARKS' AREA OR PERMIT VOLUME ESTIMATED COST .$ FEE (CUBIC/SQUARE FEET) OWNER BUILDING DEPT. ADDRESS BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR i ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH).3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET : BUILDING INSPECTION S PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS z z z If 3 HEATING :NSPEC ING 44PPROVALS ,REFRIGERATION INSPECTION APPROVALS OTHER , I. « z 2 �"'7r I � j WORK SnA.LL NCT PROCEED UNT L THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION iNSRECTIONS iNDICATED ON TH!S CAPINSPECTOR SAS :.PPROVcO 74E WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR By TELEPHON STAGES OF CO'i�5TRUCTiON• OR WRITTEN NOTIFICATION. }� PERMIT IS ISSUED AS NOTEp ABOVE. ter. .W_.. Z. .. t ' I l , 2.0 0 o ' 46,E 4 29ZooCs S, �, Z r ! ) ! /" ti ;5r14o67FLVI N G N ► LL 2.oA R104ARD F. RO�'2104$ i y . � Ull } CERTIFIED PLOT PLAN p F_R.V1L _e "I ,CERTIFY. THAT THE Fou1uD;ATio LOCATION CGQr tJ SHOWN HEREON .COMPLYS WITH SCALE 4a DATE1 -z4 THE; ':SI.DELINE . AND ' SETBACK ' RE'QULREMENTS . OF THE` TOWN OF PLAN REFERENCE P t�sTA a LG-, ' AN.D .IS. N Ir 'LOCATED ' WITHIN THE FLOODPLAIN. P�-�!U of L.o-rs t�R, S.A. Mc leAki DATE : II-'2 vr�rGo UEc.EMtt. 8, 1964 BAXTER NYE, INC. :THIS°PLAN IS NOT BASED. ON AN fREGISTERED LAND SURVEYORS 1NSTRU.MENT SURVEY-'AND THE -- ; - '- - OSTERVILLE^- MASS. " II OFFSETS SHOWN -SHOULD -NOT BE f I USED TO DETERMINE LOT LINES APPLICANT CLlFFtJ 2 A a i =� l0Y i— 2. i I zw r 4 , � �wiG� 3►�Cj.�Z4���me�vU, G�?v. Z 5,2 � � - } *ter ►�.41. .�a, ra4 � c�► � : T A24 ;4,tC.44_-v ' l�3. �.� 83 •S ' �j. R,E J �-� ats?✓. 7'= J".f/.` Mks/ ez .� 94 1 Q a �StILUVARf ' t. s �' ONCHA�iQt.. h FQ; :'�asp.,�. �2aoas : ..t ., 22'� ` ' � e � ,�•�1 , �� STE F•, e'. 'A f'•1 .f` , � J4• ' '�M '�41�p c= ,re � � 6• .4 �q.� ' - 1 �� ! '/ r�7 ram, ' •,.� fL/Y c�c. AOJ hL 40 Div✓ 7-A.v.� .., , • •. �E.2T/F/EO FAGOT oOPAA �1� c• � � LocQriav .." � �: 14e. r?- g/•/, ' oar-../ Tom► 'GE�e?/FY Tf/.QT T•y€'� ,,.; '� ��t+�►.� o F �� �0�.S>wA.�l cl.�.,�,i�. ,. SAID - 2F3 �9 GGL�l�l,Y.S Wes/ 'Si ,c✓,vE BsX7�.e ' ,�/!' ;/woem c. CX 0 QSr�.eY/Ld /CId�t7_C _ T//!f�vL•eN IX •shbryv yE,Pv s.�cv��,smear- A,= vsEv h� MAP 1 2 Assessor's map and lot number ..............9......PLOT ...........:.1..:7 : h �+ MUST SvEPTIC SYSTEM MUST F!' O F THE T0� Sewage Permit number ... `..1.11.5 0............... INSTALLED IN COMPLIAC e�P ♦°^ WITH TITLE 5 #749 ENVIRONMENTAL CODE A = BAflH9TODLE, i usenumber ...............................................................:.......... r rasa tttrrrr"'' o TOWN REGULATION: °'"�1639 �rPY TOWN -.OF BARNSTABLE BUILDING INSPECTOR CONSTRUCT SINGLE FAMILY HOME APPLICATION FOR PERMIT TO ............................................................................................................................. TYPE OF CONSTRUCTION WOOD F...RA...ME :............... ............................................................................................ .. 3 ................................................19 8.5.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location...?.... HOOT•„FLYING H I I,L,.R4AD ICERTERV•I,L•LE MA.$ ....................... ..... ................ SINGLE FAMILY RESIDENCE ProposedUse ......................................................................................................................................................................... �� �.........................................Fire District ..... CENTE RV I LLE/OSTERV I LLE Zoning District .................... ry f� Name of Owner .�, , .(.( .f%/L�/ . ....� 11 7........1. ..Address ....I .yF1.../, , :............... Name of Builder ......CL.I FFORD. W.DOW�.JRi...............Address ......7.72..MA.I.N...S.T.REE.T.�ASTERV-1.LLE.�NA. Nameof)" ..................................................................Address .................................................................................... Number of Rooms .......6..........................................................Foundation ..........PQURED CONCRETE .............................................................. Exterior ....CLA.P. OA.RD..AND...C.E.O.AR....$.HINGLE.........Roofing .............. 5RUAL.T.................................................... Floors WARD...CARPIET..........................................Interior ..............DRYWALL —in -FORCED-WARM-AIR Heating ........:..........................................................................Plumbing .................................................................................. Fireplace ONE .................................Approximate. Cost 70 000 u / r Definitive Plan Approved by Planning Board --------------------------_-----19_f _. Area .....f.�1.......... .�........ Diagram of Lot and Building with Dimensions Fee j SUBJECT TO APPROVAL OF BOARD OF HEALTH #148 ALFRED W. CHILDS JR #16 1324 #18 EUGENE H. KENWOOD H. MILLER ' a #17 LAWSON 24 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS S�qar Tky.,41;_•//L I hereby agree to 'conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. { Name ........... ..!.. . ........................ Construction Supervisor's License ....................:009...34 CLIFFWARD REALTY TRUST 1• � , q No ..... Permit for ....On.e...S.tor ......... ............. ............$. t?gle FanlY..Dwelling................... t 1 749 Shoot F1 in Hill Road Location ...�v....��...�..................... Y...... ...... i .........................Gggtervi11e.............................. Owner ffward Realt rust ` ' 4 e rt Type of Construction ......Fr.aye......................... • - • r} f , Plot ......................... Lot ................................ Permit Granted ,,.,.,..January 27`,R 86 ............... l 9 Date of Inspection ........................ r .19 Date Comple ec ..�...�-�. ~... r'.19.3� l r ir • M1 h r . Ye Y t • � .... i J i i i .�; i'l ~�• TOWN OF BARNSTABLE BUILDING PERMIT,APPLICATION Map �l�, Parcel Application Health Division Date Issued. 1 Conservation Division Application Fee Tax Collector Permit Fee, (J� Treasurer Planning Dept. � �� Date Definitive Plan Approved by Planning Board , r Historic-OKH Preservation/Hyannis vv Project Street Address '-1� —���'�4 t IQ.cQ Village l'r QT_f &J (�p Owner 1ZDbOMT" 0ASS&tW0_ Address icy (Zd aimy__ L6; AA Telephone o(;CA it-) 02O 3 Permit Request Square feet: 1 st floor:existing oot proposed 6 2nd floor:existing proposed Total new Zoning District Flood Plain �', Groundwater Overlay Project Valuation 101 ODO 00 Construction Type D Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family t21( Two Family ❑ Multi-Family(#units) Age of Existing Structure P-�4 Historic House: ❑Yes 2-1go On Old King's Highway: ❑Yes U/N o Basement Type: Full ❑Crawl ©'(Nalkout ❑Other Basement Finished Area(sq.ft.) U) Basement Unfinished Area(sq.ft) (�O Number of Baths: Full:existing . new O Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new ® First Floor Room Count 3 Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air: a/yes ❑No Fireplaces: Existing 1 New Existing wood/coal stove: ❑Yes ❑No Detached garage:L existing ❑new size Pool:❑existing ❑new size Barn:❑existing 1,0 nevi, size Attached garage:Ufexisting ❑new size Shed:❑'existing ❑new size Other:, r _ - '{ ry —; co Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ �-. z Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION - 'Name yx Telephone Number ,s7,— I Address Y, License# C6 V�IIr�S�1(}P� C37j o � Home Improvement Contractor# 13 9.)C�S � I Worker's Compensation# We DZQ0(07 'ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t.c o+ (�C OJAJ-2_ d SIGNATURELJCDATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED - MAP/PARCEL N0. ADDRESS r VILLAGE OWNER DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING ?As- DATE CLOSED OUT I } ASSOCIATION PLAN NO. ' The Commonwealth of Massachusetts Department of Industrial Accidents i 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 DI,�Q�S (� Name(Business/Organization/Individual): Q U CC 1.p Address: I'.O. aC))( V4tkS W, ©7L L�qI IL -- City/State/Zip: Phone.#: 06 Are you an employer?Check the appropriate b x: Type of project(required): 1. I am a employer with `0 4. ?I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling. ship and have no employees .These sub-contractors have g. ❑Demolition workingfor mein an capacity.* employees and have workers' Y � 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.❑ of repairs insurance required.]t c. 152, §1(4),and we have no p employees. [No workers' 13. Other Ild pJ�1 l� Yowl V1G�o 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: Policy#or Self-ins.Lic.#: �, 010 0 0 Expiration Date: A 1101- Job Site Address: City/State/Zip: f v�3Z Attach a copy of the workers' compensation policy declaration page(s owing 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 hereb certify nde e p cn enalties of perjury that the information provided above is true and correct Si a e: 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 Persons 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 representative's 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 operate a'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-contractor(s)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 n and date the affidavit. c nfrhiaiion of insurance coverage. Also be sure to sign fidavit. The affidavit should Accidents for o g g 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617--727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Name: Site Address: print Town: Applicant Phone: Applicant Signature: Date of Application: NEW CONSTRUCTION: choose ONE-0 the followin '`two optionsy. 780 CMR TABLE 6107.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab II--II Option 1: Basement l—1 p Fenestration;.. exposed Wall Floor a Perimeter Wall AFUE HSPF SEER U-factor floors R-Value R-Value R-Value R-Value'; R-Value and Depth " National.Appliance Energy R-10, Conservation Act(NAECA)of R-38 R-19 �R-l� R-103 5 4 ft . 11987 as amended,minimums or greater as applicable Note: This form is not required if you choose,either of the two versions of REScheck as listed below. ❑ Option 2: REScheck Version 4.1.2 or later variant software analysis must be completed (780 CMR 6107.3.2) h REScheck—Web which can be accessed at http://www.energycodes. >,ov/rescheck/ ADDITI0NS OR ALTERATIONS TO EXISTING,BUILDINGS-:OVER 5.YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the'% of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b a) Sti SF . 100 x Jt -- S2 f Z .1 R % of glazing (b) Glazing area equals SF •, b a :N If` lazing is'<40%use the chart;below If.glazin 'is >:40.%..proceed to".``SUNRQOM"`'section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE.COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE.RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Fenestration = Ceiling and Wall Floor Basement Wall Slab Perimeter Exposed floors R-Value U-factor R-Value .' R-Value R-value R-Value and Depth _ .39 R-37• a R-13 R-19 R-.10 R-105 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(Le.not,com ressed over exterior walls,and including any access openings). SUNROOM—An addition or alteration to an existing building/dwelling unit where the total glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: ,Owner to fill out Consumer Information Form (found in Appendix-120.P) oFtHEr�, Town of Barnstable Regulatory Services vMASS. $ Thomas F.Geiler,Director �A .s63q �� TF1639 Building Division Tom Perry,Building Commissioner 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 as Owner of the subject property hereby authorize as � De-UgL y--�) to act on my behalf, in all matters relative,to work authorized by this building permit application for (q mi—R V/0)� 6T&V, (Address offob) nature of Owner bak Print Name ` If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS:O WNERPERMISSION pTHE Town of Barnstable Tp�� Regulatory Services BARNSrABLE, Thomas F.Geiler,Director 9q, b 9 .`0�* Building Division ArED its Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623.0 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was 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 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 caret amend and adopt such a for✓certification for use in your community. Q:forms:homeexempt Bonrd.of,Bwldin"g Regulatio s and,Standartls Construction Supervisor License Lic-nl;e CS 6'5891 F�xp:irdtion 11/9/2009 Tr# 9350 4 . Rest3r3iction 9 °` MICHAELA DEDECk,0(� PO BOX.2384/CARLTON DR.-,,, f MASHPEE,'MA,02649 _^'5 Comin ssioner _:__.. _�M_. ---___._ ._.. ---- .--.,.:,ate.= •.;av-.�.�a,�...�. ✓/xe �anv7zoryuupa/,l/ o�✓�,aaa��ivae%la _ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. If found return to: Registration:-`138653 Board of Building Regulations and Standards Expiration;: 5/1/20.09 Tr# 129940 One Ashburton Place Rm 1301 ' Type: Pri�fafe'Corporation Boston,Ma.02108 COMPASS REALTYDEVELOPMENT CORP MICHAEL DEDECKO 3 x 25 CARLETON DR. MASHPEE,MA 02649 Administrator Not valid without signature 7 r 1 2 L( IU .22-, 0-7a � � rn bu 24 � T 3Z IZ.�.�v����ti c, s�¢,c_T Svc lL ar....�. �ax��-t 1� o•�.� lk0 t7c-k.e.,Q i�rLr PT,lrt _v �VL too c"ftlef-e-S i Mar ' 1 08 05: 45p Nancy 5085419644 p. 1 ASS � p r-J a yl f ooTEt-Y � ALL 2� l �[_-J 1� Mar 11 08 05: 4Gp Nancy 508541SG44 p. 2 Jr 11 PL u -law 4 I edalists Sr t�IIlOi We Make Disasters Disappear DISASTER SPECIALISTS PROFESSIONAL RESTORATION ASSIGNMENT AND AUTHORIZATION TO PAY The undersigned, herein,called claimant, has authorized and ordered from Disaster Specialists, the materials and/or services as agreed upon. This agreement shall not be considered a release and/or proof,of,loss. Claimant hereby assigns.to Disaster Specialists any unpaid proceeds due or to become due, under the claimant's policy with the insurance company to pay direct to Disaster Specialists or to include Disaster Specialists' name.on check or draft. . In the event that Disaster Specialists'claim herein is not.covered by, or paid'by, insurance company, claimant agrees to pay Disaster Specialists within sixty(60)days after work has been completed. Claimant understand that Disaster Specialists is working for them and not the insurance company or the adjuster. . , Payments remaining due and payable after claimant has y ' ' g p y received payment from the insurance, company shall bear interest at a rate of one and one-half(1-1/2%) percent per month. In the event of breach by claimant of any of the conditions of this agreement, Disaster Specialists shall be entitled to recover, as additional damages, attorneys'fees, costs and any,other collection expenses reasonably attributable to said breach. If payment is not received within60 days, collection action will commence without further notice to.Claimant. �.hzk2 Date Claimads Sitinature Disaster Specialists • Post Office Box 4804 Sandwich, Massachusetts 02563 508-883-,1113'-800-675-3622 • FAX: 508-888-2951 • info@disasterspecialists.com; ' >'