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HomeMy WebLinkAbout0082 SKUNKNET ROAD F wfH' r `� 4�'�I'I-,��I,�1,.�,Il:��,,�II.",�,.,'i�,�I",��I"I-"-i',0..I.�1'-_�I,�-',:P��:I�I�.."�I���:;I,,I"��,I��.-i���':I'"�'�--.��I I r—,I-,��II","—II�.'�I��:�""11 i I�I-v,.,I,,I-',:I,�.,��::.��'I�"I��i—'�'II��,',I.�I.''.I',�'.,"1I�,�;�.,.��:'",",'I,,,I��'i",�'�"-�-.,','.'�����'1,�lI.,�-4"�I,I�—I,,-.I;.I�I I��,�I Ij 1 I,,,I,I,�:I'I,,:;."I',�"�I"I,�:.;I,,'�I�,II-1:�""��'I�,:��,I,��,—���.I.,1".I-:,��I 1 II'v-'�,;1���.I�I����,I,.�,�',-�"--'-�I,-',,.,�4,�;,:";�.'�'I I`,��,I I-I,.",:'I-,'r!I,,I'-�,,I-�I���.�,"��,�,��.��I:.r�.2,�,�-:,.I-'�-,,'1,.:,I,I-�I�,"'1'��,'��'-;I'I r,I'�'I.',-I.1,1��,�'��I�I�7-.,,':..�-.�,��I 1��.,.."I�I''�.I�'I-��,�II i'-I,�II,II'I I I,I.1-'�I Y-0. 3f y �� �rR II I a r'G rn"� +xi? r n�,. a arfr , ��r v:5 r ,.,`+.y;. 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'R y �, ,'R ,Y V r x i; r H _ ':/ 11 F x 1' .r`f •5• ii J . i i e 7. v J 7 �t> i'I "r: �' Y kf` l k R' 9 ,Y R' D AM F S . V e a /:iJ i E i' j .y -� v i! 5 t t a € + v tj 6 y- t , • .n. C' r,r' u n !'j i t it -.p t .AI, n r ) r '-it' i ' - ' 15 ,, } a x e I# s + I x i 1, n. a k � ,r0° ) n F r i 4i 4 G uv P n .J u r r + ¢ s "' �Wii x �' �•u, o .,nr n ' Assessor's map and lot number ......../ 1......:���.... } ` Sewage Permit number ....44.feM .. l.A1. SEPTIC SYSTEM Af1U Q� 7 INSTALLEQ !N M • TABLE. i House number ... :.. W� YITLE b 94p M6 q. .................................................... ENVIRONAMNTAL. CODE Y a� TOWN - OF BARNSTA'DERIATIONS BUILDING INSPECTOR APPLICATION 1 / FOR PERMIT TO .�i!'.. ��JG7•....4 .:.,/,.�o.��..�... . .. Cl:...................................................... TYPE OF CONSTRUCTION ...CoG:.�:/...".. Ce�� yal......"........... ..........�.. ...J� ....................19.a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according*to the following information: Location Aa ..e.o........... „cS !c! = .....led' ... .................. ProposedUse ............................................................................................................................................................................. ................................................Fire District Zoning Districtv.f. Name of Owner 16maAlI '.Address ......... Name of Builder Address .......... ....................25 I,YANOUGH R04D . .................................................................... ...... ...................................... 1 ` RTE 28 Name of Architect .......`'v Address .........(AM9011011sec �IYNW& MASS. 02601 .................................................. "Capoeod $1fi�15.28fl5 Numberof Rooms .........../V C�..............:..........................Foundation .................... ......................................................... Exierior ....................................................................................Roofing �.�.............................................. FloorsN...... ..6/./y/�///./�a' .................................Interior ................................................:.................................... Heating .. ..........................................................Plumbing .................................................................. Fireplace ..................................................................................Approximate Cost .......[o? ?....................................................... Definitive Plan Approved by Planning Board -----------_-------------------19________. Area ..................................:....... Diagram of. Lot and Building with Dimensions Fee / as .................................... SUBJECT TO APPROVAL,OF BOARD OF HEALTH 106 f ,wl Al 36 qy 9 w � t LViJ A;,G.Ne- �lJ� I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... . ,...4,.. ('.. yl rn.Fl . ...... SST. ROMAINE, GEORGE No ..2: 24.5.. Permit for .....Build.,,,,,,,•,•,•.,,,, *Private Swimming Pool,•,,,,,,,,,,,,,• , I Location .Lo.t...#$...82...Skunknet..Road.. Centerville ................. ................. .................................... _- i Owner ...George...St......Rom?.?.Ag.. ............. Typerof Construction .......................................... ............ .........................................I.................... Plot ..:......................... Lot ..:............................. 7 - .. _ , i - { Permit Granted ....3une• •5 19 80 lt�'df TP�s' len ...................jY�1...19 Date Completed ..................... .19 t � , t r { PERMIT REFUSED - , .> rn ..... . .N. .. .>............................... . --19 cr ......gym. ..... ................................................ an J { t t ... 7(� j 1 �.0.. .. 411 M.. . ..... 1.................... .... � .j ............................................. a- g . .�. . ................................................ ® tt-- M "M Approl ...... ...................................... 19 ,. a . ............................................................................... ............................................................................... J Assessor's map and lot number ....../... � �1r ...... 1 pfTHEtO 1 �r `i Sewage Permit number F ..0.............. . ..... . .... ......... F Z 33AUSTADLL House' number MAB6 r� 9�p 0 :Tt �QG 39• �0 U �E'p MPY a' TOWN OF BARNSTABLE Z oo—acqy zqS BUILDING - INSPECTOR -4..... .......st......2) o./�aualc...................... APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ...... .�....X... ......... ..........:.........:............................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: qa / / _ /Location .......o...............�.....�... .��:.1�.......��............��'.�!i.�l.(1�.C.� M�.�.'.S..S Proposed Use ... ZoningDistrict .X.....C..:.....................................................Fire District .............................................................................. Name of Owner ...`�.kJ/'.. ey?..o7ireCAddress Cf.....S CI:r ....! 2 f f✓/..1 Name of Builder .. :.. ..�&&gdress .... . .,`..,.,,..,,.... ...�..... �:..:.. ,. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ....(..�0............................:...................Foundation .............................................................................. Exlerior ........................................................Roofing ..-Sa. 4P_9........ ...................................................... Floors :... .........................................................Interior .................................................................................... Heating ...../.....................................................................:.......Plumbing ..................................................:............................... Fireplace ..................................................................................Approximate. Cost . ............................................. Definitive Plan Approved by Planning Board -----------_-------------------19________. Area ....... ..... :f.......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �0 O ` ynn Q. v) OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS S72�C% I ,hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name :.��� .. .............. m� .... Construction Supervisor's License Q�................................ ST -RDMAINE,,IGEDRGE & ANN No 26844. permit for ...Bold..storage Bldg. .... .... ... .Accessory to Dwelling.......................... Location ••• 82 Skunknet. ..Road ...... .... ................................. Centerville .......................................................... • Owner ....George & Ann St. Romaine ................................................. Type of Construction ....Frame............. Plot ............... ........ Lot ................................ w Permit -Granted .....Axagust..15 19 84 , Date of Inspection ....................................19 q 1� ' Date Completed ..�),:-.Z z......... -.1.9 f sC , � s s , . t 421 QQ v AssAsor's map and lot number ..... ....!'..�.�i.�.I.a`............'1 1. � y �o �y T�^IgCy�Y SYSTEM M�®U®� �^ p� ' SEPTIC AOs MUST \pF T11E z ? ` Sewage Permit number INSTALLED IN COMPLIANCE g .......:...........................�.. WITH TITLE 5 (rr � >p ,r��t�g;p-pig fig` r� li BABH9TADLE, • " i9Y Cask�7dG si9�s`L0.� c 9p N 9 House number ......................................... .............:'......c........ �! p L NID TOWN 1OF BARNSTABLE BUILDING IHS,PECTOR APPLICATION FOR PERMIT TO t..Ucd.v ' TYPEOF CONSTRUCTION ............y .. ...... ..................................................................................... Y ............... ..J. �. ..............19.. TO THE INSPECTOR'OF BUILDINGS: `` ` The undersigned hereby applies for a permit`according to the following information: Location ........ .��r.......... ....... .>...`.:.............L./�,%���r�.�l..l�.��' .............. ProposedUse ............ .jy !.N.v................................................................................................................................... ZoningDistrict ...........:�.:�......1..............................................Fire District .............................................................................. Name of Owner ..Iy;t.K'e......:5�...... 4.!! /.....Address ....lJ..Z...... v A6�.r . ......... Name of. Builder . ....................Address ...r�. ....�1/��1✓ 1 ...��..�.:... of?Zi L.S Nameof Architect ........../�!/ ............................................Address .................................................................................... i Number of Rooms Foundation ........................................................G . ...................... R.......�..y......... Exterior ...GC ..`.. ....r 4!:.7. /QI ....5&�&.61 5Roofing ........ �/ `a. lY.h�!%.. ......f�%.. /.................... Floors ..... Q..............................................................Interior ........�1 L� ', .�GGh�.............. Heating ....Ao ... R. .......` ........ � .............................................................. Fireplace .lfJ )(j........................................................Approximate. Cost Definitive Plan Approved by Planning Board _______________________________19________. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 AL I o00 CAL, (o(O Y AL I oc�a c>u►��L='L�t�f,� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. .. . ............V..�4297 ............... ConStr on Supervisor's License ....... .. .. ST. ROMAIN, ANN 27614 111g, ................. Permit for .�...........ldUi .................Addition.............S.ing.l.e..Family Dwelling. . . ...................... .... . .. ............. ......... . . Location .....8.2..Skunknet..Rc.)ad......................... .. .................. ... ..... Centerville ............................................................................... Owner ....An.n..St. Remain .... .. ..................................................... Type of Construction .... ........................... ................................................................................ Plot ............................ Lot ................................. Permit Granted March 19, ....... .19 85 ............................... Date of.Inspection ....................................19 Date Completed A&142,4--.,........�&..19 SA 6 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/4/16 .-. Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permit TO: Building Inspector(s), • 9 , This affidavit is to certify that all work completed for 82 Skunknet Rd,Centerville has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey I f oFSHE ro,,, Town of Barnstable *Permit# Expires 6 months from issue date y n ,CAB , : Regulatory Services Fee BAR939MASs � i6;q�- Thomas F.Geiler,Director A 10 Building Division Tom Perry, Building Commissioner X-PRESS PERMIT 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 MAY 2 3 Z003 Fax: 508-790-6230 ,�T EXPRESS PERMIT APPLICATION - RESIDENTIAL IPF 13ARNSTA13LE Not Valid fvitltout Red X-Press Imprint Map/parcel Number U Property Address �"' P ELge'sidential. Value of Work C�- Owner's Name&Address ao r-r 5& S "n)p, Contractor's Name a Telephone Number l Home Improvement Contractor License#(if applicable)- toj%_4�6, Construction Supervisor's License#(if applicable) 5 D ❑Workman's Compensation Insurance t Check one: ❑ I am a sole proprietor ❑ I armthe Homeowner Save Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of rood Re-side RfP1a_cement Windows. U-Value (maximurn.44) ❑ Other(specify) *Where require • ssuance f this pe it do not e t compliance.with other town department regulations,i.e.Historic,Conservation,etc. Asti Signature Q;Forms:expmtrg Revised121901 P�°'THETof� Town of Barnstable Regulatory Services * sa�vsznaLe. ' Thomas F.Geiler,Director y Mass. g' $plfDMA�A1� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1 t �U 1� , 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) 9 Signature of'Owner Date Tint Name Q:FORM&O WNERPERMISSION N � 1 � r i I ' - .�.. .-.. .. __-..�_....__._. _— .,._.-*•---" �-.�-^-^4^'s��.^'� III 7 } Nu�pbe 072276 ' 14 � I.no: iris k4APEE, iiA4 02fi4 Ac3inmistrator M1.. � � :♦ �nr.LaR}b Rai 2' � ��� Y 1( '4 �. t *� �� arc *'� ¢ � •C����' t� c nd Board of Building Regulations and Standacds �� rr ` NHOME IMPROVEMENT CONTRACTOR C t V�04 Ian: ENT 1 - x - .� ; iris, .,pX_. � .y-+z. � - r t,S '✓ z is Ek,raK r n 3,- 4 $ 1 . .n���s ,g ik FFi �W, t.,a.v.o- � K7,� F.iva �TMt ram, The Town of Barnstable J&. Department of Health, Safety and Environmental Services • ��B . ` Building Division MAM ,0�' 367 Main Street,Hyannis MA 02601 TEb MA'S R Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: _ 0 Name: c XV � .,;-is�Sj — n 3 Address e: L"Ilv�=2 Type of Business: Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operat*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. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the 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 is 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,have read and agree with the above restrictions for my home occupation I am registering. Applicant: �` ` Date: -q--- Homcoe.doc �* Town of Barnstable r *Permit# rS�-,T/ R Expires 6 months from issue date Regulatory Services Fee , D.b Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner •P 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us NOV Office: 508-862-4038 �-O� faR: 790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL0&A N,3 I j� qq Not Valid without Red X-Press Imprint TABLE Map/parcel Number Property Address 2 6 1-�,y n IC n P+ 114 s residential Value of Work J D,ODO Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address -red Gr e- St- 9. O YVI Y�@ 92 -S k UV1 he.+ Contractor's Name P I�.tD A*4- ri f H"73YVI e `Gw l ty- Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) [�Vorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 211 have Worker's Compensation Insurance Insurance Company Name = 103 66- D IC 0 h Workman's Comp.Policy# 5 -! 2— Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) eRe-roof(stripping old shingles) All co struction debris will be taken to e-roof(not.stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must'sign Property Owner Letter of Permission. Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 Town of Barnstable Regulatory Services r 1$MA • asks. Thomas F.Geiler,Director 9`� 0 ►4�$ 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 Ommer Must Complete and Sign This Section If Using A Builder S4-Poy"yi&i E- ,as Owner of the subject property hereby authorize fix iL to act on my behal f in all matters relative to work authorized by this building permit application for: 2 cS )�-yn 16lie �d (Address of Job) 7--O-f Signature f Owner Date C� L Sf Print Name QTORMS:0WNERPER YOSION ffiOf ammm TOW. SUM%WANMC" THE�y� HOM 32WpA Cp�Xp® GA A WEsT9'VI11 ,GA 1 v romC' a > s ' Y . q f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION el Map Parcel QUITI NG ©EP Application Health Division OCT T pp Date Issued 0 6 2U16 A Conservation Division TOW Application Fee C� Planning Dept. N OF egRNSTABLIEF Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Cen+tr fill Ie Owner Georr Qa�fi. o rr�-0,;�Q. Address or e, Telephone �6 74 1 Permit Request R- k e, kW �r e � eJ►� �c W ti To Al � 1, J ;N11A L11 on +20 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 15M Construction Type It Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure -Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )(No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) q4 NameiI�iLC h r nG Telephone NumberSOB g g 0 3 l o Address �-•�t1�,n+��r�n ytei License # C 1 y_r4,,L4,4 k Home Improvement Contractor# l �3g b Email Worker's Compensation # ���/� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 a�!'n►ay�� SIGNATURE DATE `6 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f HOME OWNER WEATHERIZATION WORK PERMIT: ' PLEASE COMPLETE AND SIGN THIS FORM AS c THE APPLICANT HOMEOWNER. I � 01& �t S�, K om�igP� hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: 0 a U 0�l The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping;air sealing; attic&basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the. following: 1. 1 give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement and give my consent. Home Owner(signature)x Horne Owner email: Date: f � . Agent:(signature Date: Weatherizatio Contractors: Adam T Inc 4ron�fie�rEnergy 'All Cape Energy Solutions Alternative Weatherization Lohr Home Improvement Building Science Construction Resolution Energy Cape Cod Insulation Tupper Construction DATE(MM1DD)YYYY) A�v CERTIFICATE.OF LIABILITY INSURANCE 4/12/20l6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE. OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE;OR PRODUCER;AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holderIs an ADDITIONAL INSURED, the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A:statement on this.certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACT OOT Risk Strategies Company NAME:Risk Strategies Company AH,C E (781)986-4400 IFAX No.(781)963-4420 15 Pacella Park Drive EMAIL randol held@risk-strata ies.com AooREss: P 9 Suite 240 INSURER(S)AFFORDING COVERAGE NAIC S. Randolph MA 02368 INSURERA:Selective Ins of America INSURED iNsuRERB Allmerica Financial Alliance Ins Co .10212 Cape Save, Inc INSURERC:Star Insurance Cc 7 D Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02664 )ruuRER F COVERAGES CERTIFICATE NUMBER:CL1641211375 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED:ABOVE FOR THE POLICY PERIOD INDICATED. NOtWrrHSTANolNG ANY,REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE:INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONS AND.CONDITIONS OF.SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �TR. TYPE OF INSURANCE POLICY NUMBER. MOMIDD EFF POOL 1 EXP LIMITS X COMMERCIAL GENERALLIABILnY EACH OCCURRENCE _ $ 1,600,000 A CLAIMSdv1ADE OCCUR DAMAGE TO 100,Oo0 ENTEU PREMISES R occurrence) $ X 01994460 10/16`/2015 10/16/.26i6 MEDEXP(Any one arson $ 10,000 PERSONAL&ADV INJURY $ - 1,000.,-00D GEN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $ 2 0..00,000 POLICY a.JE� �LOC Y PRODUCTS-COMP/OP AGG $.. 2,O:Oo,000: OTHER $ AUTOMOBILE LIABILITY COMBINED $ 1,060,000 SINGLELIMIT - - -Ea.acciderrl - B ANY AUTO BODILY INJURY(Perperson) SMEDX. TULED AUSA46796600 11/6/2015 11/6J016 BODILY INJURY(Peraccident)�TO SCHEDULED $ X HIREDAUTOS X AUTOSVtitJED PeraccidentERTY DAMAGE $ $ X UMBRELLA LIAB X _ OCCUR -EACH OCCURRENCE $ 1 000 0:00 A EXCESS LIAB CLAIMS-MADE , 1 , AGGREGATE $ 1 000 AO'0 DED I X I RETENTION$. VIL �019944180 10/16/2015,1011612016 $ WORKERS COMPENSATION r,- - ;. off iceia incl uQed for / ` „�:. X -, , 'PER :OTW W. - AND.EMPLOYERS'-LIABILITY '.• YIN •- ;'i STATUTE OR ANY PROFRIETORIPARTNERIEXECUTIVE coverage - E.L.FJ+CHACCIDENT $ 50000. 0 C OFFICER/MEMBER EXCLUDED? ®NIA- (mandatory inNH) dt(.$,- 1 VC005540700 4/9/2016 419/2017. E.L.DISEASE-EAEMPLOY $ 500..000 scribe Under - e M .- - - - -- -- - DESCRIPTION OF OPERATIONS below. E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS 1.LOCATIONS I VEHICLES(ACORD 101,Additional Remarks.Schedule,may be,attached If more:space[a required) National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included'as Additional Insureds with respects to the General Liability coverage of named insured as required by written contract. ' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES SE CANCELLED BEFORE: r Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE.WILL WILL 'SE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Barnstable County 460 Vest H6.in Street - - AIUTHORIZED.REPRESENTA7IVE -' HyaAnis, Ida 026:0.1, � r M chael Christian/CLC 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 2&(26,14101) ' The ACORD name and logo are registered marks of ACORD INSO25(2O141)1.) a 4 The Commonwealth of Massachusetts Department of Industrial Accidents. f - 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.massgovldia Nfiarkers'Compensation Insurance Affidavit:Builders/Contractors/Electrcians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Legibly Name (Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue - City/State/Zip:South Yarmouth, MA 02664 Phone# .508-398-0398 Are you an employer?Cbeck.the appropriate box: Type of project(required): l: ✓ 1 am a employer with .15 employees:(full and/or part-time).° 7. New construction 2. I am'a sole.proprietor or partnership'and have no employees working for me in ❑ 8: ❑Remodeling. any capacity.[No workers'comp.insurance required.] 3.a 9. ❑Demolition I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10'E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 L M Electrical repairs or additions Proprietors with.no employees. 12.❑Plumbing repairs or additions 5.❑.I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13;❑Roof repairs These sub-contractors have employees,and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other Insulation 1.52,§1(4),and we have no employees..[No workers'comp.insurance required:] "Any applicant that checks box#1 must also:fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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,theyurust 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 sate information. Insurance Company Name: Star Insurance Co. Policy#or Self-ins.Lic:# WC085540700 Expiration.Date: 4/9/2017 Job Site Address: R2 Rkunknet Road City/State%Zip:Centerville Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,425A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations.of the.DIA for insurance coverage verification. , I do hereby certify under the pains and penalties of perjury that the information provided:above is true and correct Si mature: Date: 10/5/16 Phdne#:508-398-0398 Official use only. Do not write4n this area,to be completed by city or town official _ i City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector $..Plumbing Inspector 6.Other Contact Persons Phone#: fil Office,of Consumer Affairs and:Business Regul:atlori. 10 Park P1aza - Surte 51'70 B"oston, Massachusetts 02116!,, Home Improvement Contractor Registration Registration 1;71380 . :Type Gorporafion Expirabon '3L1412018 T:r# 419291 CAPE SAVE INC. . WILLIAM 'MCCLUSKEY 7-D HUNTING TON AVENUE, _ SOUTH'YARMOUTH,'MA 02664: t, - :" r U.pdate Address and return card:Mar k,reason for:change. .. ✓ Address Renewal Employment Lost Card SCA 1 26WD5111 _ Office of Consumer AffairsrBc Busibess Regulation License or registration valid for mdiv,dut use only HOME>IMPROVEMENT CONTRACTOR before the expiration d ate If found return for Registration ' IM80 Type: Office of Consumer Affa►rs`and Business;Regulation. Expiration 3/1412018 Corporation: 10 Park Plaza Suite 5170: Boston,MA 02116 CAPE SAVE INC. } WILLIAM McCLUSKEY `r 77D HUNTINGTON AVENUE- ` SOUTHYARMOUTH,MA'02664 Undersecretary -Not valid IV i signature: . Massachusetts -Department of Public Safety i Board of.Building Regulations anti Standards r < au.,.IrnuriiCl:�fiu /i;l�rlu,/ ane..la,._..- License CSSL IOZ776 V J WILLIAMJ`MC 0U 37 NAUSET ROAD .!I IF West Yarmouth NIA V%7 Expiration Commissioner 0672812017 i - 3 73 I E.r TOWN OF BARNSTABLE E9HB9TABLE. i 9� 0 pY �e BUILDING INSPECTOR APPLICATION FOR PERMIT TO ... .�. .......... .... 1 .............................. TYPE OF CONSTRUCTION ..k640..FA., !YA................................................................................................... ............................ .!••:•• ......19.Z TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Al ..`"�'.r.... � ........ f1 v .................. ?...... F . vILL�=....................:........:... ProposedUse .e cIS............................................................................................................. .................................... ZoningDistrict ......................... ..............................................Fire District .............................................................................. Name of Owner ...C-�ML....f.Q U491&0..............................Address Name of Builder .... 4.r/�!`6,6j...........................Address ..). C.....................................:............................. y� plrit ....Address .... ..'`'�`�� Name of Architect ..... �.�.'.�?.L.......!7.`.�.............................. � ......................................................................... Number of Rooms ........ ..................................Foundation C'r-lT' Exterior ",of% S`, f. c- ........Roofing ...1?��!G/7✓/fi%.......................................................... ....... ......................:............ .... FloorsrL0.. 00/,.............................................................Interior ... d..!r��.. . :../........................................... Heating .1-7!! ..A4 ..................................................Plumbing ..Cgi®.9iriQ ` 1 - •? . Fireplace .....4<.....................................................................Approximate Cost .A5.O0.U................................... Definitive Plan,Approved by Planning Board ------------------------------� Diagram of Lot and Building with Dimensions _�1 �/ 'Z✓ SUBJECT TO APPROVAL OF BOARD OF HEALTH w fi ! Q' -a Ld (� � LO N p� 0 m z —' - Ld I\ cr w > d = LL LU CL , O � 0 (f) Z 0 0 — - - - 0 ?:>- a U, J J �}— CL X Q-.Q LLI � _ U)-{~!) Z" Q. CL' U Z IN () < 0 V) " CL �C z 1p W !�- / 0 } Z U ,( CLLJ Q -� Lj 1°0 < d M I hereby agree to conform'to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ' AUDZNJ^ CA8L � 2�n� Story ^ , No -������— Permit for —.-- -----. farailv residence Location . ..Roa�l.______. , —^'—^----^^—^----'--^-----'--''' Owner ...C�J�,. ....................................... Type of Construction —..�r ......................... —~--.—^..~—.--.---...—_,------- - ^ Plot ............................ Lot ... ........................... � . ' / PermitI8 ��� � � �� �� � uo/a of Inspection =�� � uoe Completed .ON ..A � . PERMIT REFUSED . -----~—..--...--...------.. 19 ----'^^--`--^'`—'-------^~—'--'' | \ —'~—`--^--'^`^^^^'---'^`'~~^--^'—^^^—' ' , '--~-----~----~~^^—'~--^'-`^^'—' | / —.--..--.-....—_.—...—.-------^... . � Approved ................................................. lA � � ^ � —.-----------.--.--..,—..—...--, � � - —'---------^^---^^'----^'^^^--^` � �