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F . . _ Building ' din 0 BA"srwa'M ; Post'This.Card So That it is Visible From the Street-Approved Plans Must be Retained'on Job and this.Card Must be Kept i iposted Until Final Inspection Has Been,Made. a �� �� .aye. �� _ � 't Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made Permit No. B-19-738 Applicant Name: CAPE COD ALARM CAPE COD ALARM Approvals Date Issued: 03/14/2019 Current Use: Structure Permit Type: Building-Smoke Detector-Fire Alarm Dection Expiration Date: 09/14/2019 Foundation: System Map/Lot: 170-018-004 Zoning District: RC Sheathing: Location: 432 SKUNKNET ROAD,CENTERVILLE a Contractor Name: -GENE A CORMIER Framing: 1 Owner on Record: GIANNELLI,JAMES Contractor License: 1592 2 Address: P O BOX 148 , Est. Project Cost: $ 3,200.00 Chimney: CENTERVILLE, MA 02632 Permit Fee: $ 35.00 Description: REPLACE EXISTING SECURITY AND FIRE ALARM SYSTEM DAMAGED Insulation: BY WATER a Fee Paid e' $ 35.00 Date 3/14/2019 final: Project Review Req: 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-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. a Via` Electrical The Certificate of Occupancy will not be issued until all applicable signtures by the Building and Fire Off cialsare provided on this permit. Minimum of Five Call Inspections Required for All Construction Work:= Service: 1.Foundation or Footing 2.Sheathing Inspection _ _- Rough: installed . 3.All Fireplaces must be inspected at the throat level before firest flue lining is sta ed P P g 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 RECIPIENTS Final: 4 v • TOWN OF BARNSTABLE Permit No. ------------------- Building Inspector Cash ---------------------- °""Y�\ OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Jamas K. Smith Address ' ^ 32 Skunknat Rt- Wiring Inspector ��> ' �'i Inspection date L Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department r., y,.rr, Inspection date 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. ..................................................._, 1s_._._ ..........................................-_............. Building Inspector Assessor's mapl and lot number ......../.�.... SEPTIC S T E Sewage Permit number ...... BABBSTABLE, i House number ................ .......... .`'.........'.. ......: NAMMEN TI nE 5 900 39 \e� 0!e!e } �`OMP9�' TOWN . OF z BARN 1 allo-e s BUILDING I: SPECTO.R APPLICATION FOR PERMIT TO .. x' U e ...cofx. .. ..................................... ...�h TYPE OF CONSTRUCTION :. ...�. .Q.{�:� ........ ....... .............. . 3 K ..... 3. :...:t9. wa , TO THE INSPECTOR,OF,BUILDINGS- The undersigned hereby applies for. a permit-.according to the following'information: Location ....... O 5 �v r1� �.... 1\0. .......... .................................... ..............." ....... ... ...........f�.�.... ...... Propose_d Use .......... \.c) \.e.......N.0. .. \ .................................... ........... Zoning District . .... ...Fire District Q4.u��.. .... .... ............................. ................ Name of Owner .. .� M\• n .............................. r,..... ............s.... .... ................Address .............. ... .�..�.. v , Name of Builder' .... 0-.f yx:�n �`B �M .Address ................................ .. Nameof Architect Address .:..............................:........................................ ,...,........... ........................................ Number of Rooms ....................5..........................................Foundation � .. C`',.�. ... ... .. ...... ..... . Exterior .....C Y...1"QCJ✓1d..... ........................`... ... .+.Roofing.., e .................................. Floors .. ......W (..... .. Int662,r � ........ .. .. ............................ Heating �.�..\. '. ...... Plumbing ` `..�..........:t ....: e Fireplace ...:........... ..:...... ........... ........ Approzimate.Cost ...... ;... Definitive Plan Approved by Planning Board ____ ----------- ----- --------• Area Diagram of Lot and Building with Dimensions Fee .1 e- 0-4 .. SUBJECT TO APPROVAL OF BOARD OF HEALTH kr 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. t Name .....: } ..... 1.('� ...1.� : .......................... SMITH, JAMES K. i4o,...24043. One 1/2 Story .. ........... Permit for .................................... Single Family Dwelling ................................................................................. Lot 4.25 432 Skunknet Read' Location .................................................................. Centerville ............................................................................... Owner ....James K. Smith ............................................................. Type of Construction ............Fr a.m.e...................... .. .............................................................. ................. t, Plot ............ ............... Lot ................................ Permit Granted .......Mav....1.2..................19 Date of Inspection .......19 ..19 Date Completed ...... ..... ....... ... 14 6e, •v W._l, uo •GAIz'ar-S 6tzl Qcjt.L7- 2;&IL% FLAW a tic) K s t '37o G.p•D I.. ! , 5C�''1�IG T"Ao.1K = S3ov iriCO a p • s19r7 F.P.D. USE=- 1000 6/iJ... _. _ _.:.. !�0 i 211sp SAL PIT USE lOoo har_ �• ��. �UcWAI.L AL'E.A► L IcjO :� IC 5F Zs • �.Pt>. 8o►r-rt7�c� yam. 3C TOTAL_ P/T Vmec.oL&TIO LJ 04-M : E"11.1 Sm I tj 02 LASS. x a�s r RIc AL 7-4 Tor Fao •41�3 • �f \�I///.lC i� 11.fi11C�. t tsN+ s!'Oiae l o0o Iu� ': Suoyo►�.r _ _ 4 ' -box SEvnc n 1►tv l "f"Q�tK ! ' tW GAO 8g�4 INV 1 / •f' 1 4 FIT Ir G %VA0 aD CCG'TlF1ED PLOT' �L ( L bCAT l Ck4mjLV14L4 (I!41,6 / I 1 CGtZTIF,4 T"A'r. TI•IG. FOV NDQTtoh� 5"0-Q .I pL,l.�IJ R r-_l;c RE►mil c E. �•1t::�LoI.1 Cc trt,P1.�lS W I-rA TN:; 51�E.t_t►-lam .' .L 2� AWo 5C--rV-AC4 lVG4IUIREMC:WTS OG 'I' 7oww OIr - , tZ rYA �� Auto Is TT A+J Ro>1�7L. 6�JvN Lo TEb w l-n-u 1,4 . •T"t-4 t.,or�c� PL.AW. ' TAD C.A RGGIStt_RCD t.Awo SU2v�=YoQ T1415 VLAw IS t.dOT t'�ASC�` oN Ate! ®aTp-r v%L-Lr-- ® IW';rCcJMGwr �,ut�e/�=Y y YIJL- U6=6. ,ii_T. ,Idce�w APPL-tGA.1-_DT ,-- rti r-. _, Ir-r r. Uf+1'[ C/1�{144C LOT ` l_1N�:.•.'i �1t11� 1 Town of Barnstable . �., Building 1rn s Post This Card So That it is Visible�From the Street Approved Plans.Must be Retained on Job and this Card Must be.Kept 10osted Until'Final Inspection Has Been Made I r 1639 I Permit gnatWhere a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made Permit No. B-18-3846 Applicant Name: DANA A WARD Approvals Date Issued: 12/12/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 06/12/2019 Foundation: Location: 432SKUNKNET ROAD,CENTERVILLE Map/Lot: 170-018 004 Zoning District: RC Sheathing: I ContractorName:�,,DANA A WARD Framing: r1 Owner on Record: GIANNELLI,DAMES , _ r � Address: P O BOX 148 _ Contractor License; CS-096349 2 CENTERVILLE, MA 02632 - �� Est Project Cost: $57,100.00 Chimney: Description: REMODEL BATHROOMS KITCHEN. DEMO CURRENT KITCHEN, Permit,Fee: $341.21 REFRAMETO NEW LAYOUT FOR KITCHEN AND BATHROOM I Insulation: �/�`(�jpL r i° Fee Paid.' $341.21 REPLACE ALL WINDOWS WITH VINYL REPLACEMENT IN CURRENT Final: OPENINCHAN:GE KITCHEN WINDOW t Date. 1€ 12/12/2018 G ( Project Review Req: KITCHEN AND BATH REMODEL. Plumbing/Gas i = ' Rough Plumbing: r e; Building Official71 Final Plumbing: �^ � Rough Gas: Final Gas: 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'approyedconstruction documnt es for which-this permit has been granted. Electrical All construction,alterations and changes of use of any building and structures,shall be in compliance with the local zoning 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 Service: work until the completion of the same. 3 Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of five Call Inspections Required for All Construction Work: Final' 1.foundation or Footing Low Voltage Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: 5.Prior to Covering Structural Members(Frame Inspection) Health 6.Insulation 7.Final Inspection before Occupancy Final: Wlere applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department 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). HcationN=ber.... .. .1. -............... . . 31JILDING rjEP 6. _ - . NOV21 2018 Pelt Fee...... ............Oder Fee.................:...... Mld TOWNOF BAFtNS!AuLc Total Fee Paid..................................................................... TOWN OF BARNSTABLE Permit vy::. . ......................on..1. .1... .Al.— BUILDING PERMIT Mp ........... .. .......Ps el... .6 �.-.....i APPLICATIONA � s � Section I— Owner's Information and Project Location Project Address ��Z S �''� ✓l�� �-c� . V71� age�f r44 r�(r �' l�' Owners Name j u vo e.S (n 4 n LLi Owners Legal Address M City w it4 J( J State C^ zip D E-mail1•, '�' 6 r. wl _ A n vC � � l a k • YY� /}-�!io���'✓( Owners Cell# �0 8 6 '� q Section 2—Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structare) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar = Renovation ❑ Pool ❑ Insulation Other—Specify �Lwt o oLL L i��T rl ado wt 4 T�,�cN ` Section 4-Work Description o� e� 0, 4 rc>o UA QCe T.Rst Tmdate&-219=19 Application Number.................................................... Section 5—Detail Cost of Proposed Construction 3 7,I bn, --Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing 2 Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics S . Wiring ❑ Oil Tank Storage Smoke Detectors 3 Plumbing ] Gas ❑ Fire Suppression Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply —43'Public ❑ Private Sewage Disposal ❑ Municipal On Site _ Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility. I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation MY Within or adjacent to a wetland, coastal bank? Yes ❑ No Section S—Zoning Information I Zoning District ®, 1r fevJ`f Proposed Use e • Lot Area Sq.Ft. Total Frontage ' v Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed ' { Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last imddedh 2J9rz018 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): �/,Y/I/� 44,--d Address t/ b U1q—L'A of City/State/Zip: 1 Phone#: - o "'7 Are u an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or p tune).* have hired the sub-contractors 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' 9. ❑Buulding 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.❑ repairs Roof r airs 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: D /,,A66 —rW !AI S• CO ljey4lee S Policy#or Self-ins.Lic.#: I'�t/' :2,�g Expiration Date: Job Site Address: 7 �6��`� f% �' City/State/Zip: lee t/i 11�),1,74 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 certi der the pains and penalties of perjury that the information provided above is true and correct Signafore: �'- Date: Phone# Official use only. Do not write in this area,to be completed by city or town official 7 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 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 certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cant'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 permitllicense 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. would like to thank you in advance for our cooperation and should you have an questions, The Office of Investigations w y y p y y q , please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Dgwtment of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAM Revised 4-24-07 Fax#617-727-7749 www.maw.gov/dia WARDD-1 ACORO DATE(MMIDD/YYYV) CERTIFICATE OF LIABILITY INSURANCE 1111912018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT,BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. 508-564-7200 CONTACT JAMES W.RI-- DER PRODUCER PHONE vFAX 508-564-7272 Rider Risk Specialists (A/C,No,Ext):508-564 7200 (qIC.No): Insurance Agency,Inc. E-MAIL' " " PO BOX 115 ADDRESS: "T Cataumet,MA 02534 INSURER(S)AFFORDING COVERAGE NAIC#_ _ JAMES W.RIDER INSURER A:ACCEPTANCE INDEMNITY INS CO INSURED DANA WARD I INSURER,B:_TRAVELERS ------- ! 198 CLUB VALLEY DRIVE #INSURER c EAST FALMOUTH,MA 02536 { I.INSURER D: `{ {INSURER E: _ +. INSURER F COVERAGES "CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION D BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS: ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSF2 �-ADDL SUBR POLICY NUMBER .� POLICY EFF M. POLICY EXP I .LIMITS — I TYPE OF INSURANCE I r FF - 1,000,000 LTR A X COMMERCIAL GENERAL LIABILITY ' t EACH OCCURRENCE �a$ __, i DAMAGE TO RENTED 1 OO,000 �J CLAIMS-MADE OCCUR CL00251995 03/07/2018,03/07/20194.pREMtSES,l Ea occurrence) `` 5,000 t MED EXP(any one person)_.S _ t - 1,000,000 in PERSONAL 8 ADV INJURY`;�,S {{ GENERAL AGGREGATE 2,000,000!-,S .'GEN'L AGGREGATE LIMIT APPLIES PER -Q�QQQ�QQQ -X Pot-icy j PRO (( LOC PRODUCTS-COMPIOP AGG S EJECT t Is OTHER. 1 COMBINED SINGLE LIMIT j S AUTOMOBILE LIABILITY 1.,(Ea accident). - ANY AUTO - BODII Y rso INJURY(Per pen} O)A SCHEDULED ! i �NED ( + f BODILY INJURY(Per acdtlenn�5 I _ AUTOS ONLY ! _ AUTOS `` t PROPERTY DAMAGE S HIRED �NON-p`NNED F,(Per acatleMj _.._ ,. - (� AUTOS ONLY AUTOS ONLY UMBRELLA LIAR '` J OCCUR !EACH OCCURRENCE rt EXCESS LIAB �. CLAIMS-MADE + AGGREGATE *S_ I RETENTIONS I )S CEO - � +t PER y X OTN B 3 WORKERS COMPENSATION i�,L$TATUTE + ...ER IDESCAND EMPLOYERS'LIABILITY YIN UB1 K228996 03/0612018°0310612019 j }s 1,000,000 ANY PROPWETOR;PARTNER;EXECUTNE I Y L{ i 1 E.L EHCH ACCIDENT _ OFFICERWEMBER EXCLUOED� (� NIA { �1 1,000,000 (Mandatory in NH) 111EA EMPLOYEEi_S If yes.describe under 1,000,000 , IPTION OF OPERATIONS below E L.DISEASE-POI ICY LIMIT M S r I ` DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) THE SOLE PROPRIETOR HAS NOT ELECTED TO BE COVERED BY WORKERS'COMPENSATION CERTIFICATE HOLDER CANCELLATI N SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, JAMES GIANNELLI 432 SKUNKNET RAD AUTHORIZED REPRESENTATIVE r CENTERVILLE,MA 02632 JAMES W. RIDER . { yr✓ � .r YC ,���" ,?':'r;�" ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD �I T� irrinciiiocaoGairutJel/. office of consumer Affairs&ausiness Regulation. HOME IMPROVEMENT coNTRACTOR. TYPE:,Individual Registriltion\ iration __ 7(! OW20/2020 'DANAWARD DANA WARD z, i z 198 CWBVALLEY E:FALMOUTH,MA 0253E Undersecretary. 1 Commonwealth of Massachusetts s Division of Professional Licensure Board of Building Regulations and Standards Cons 'UfiSiipef isor E�Ires: O`1111I2020 CS-096349 4, .'# DANA A WARD 198 CLUB VALLEY DRNE,. EAST FALMOUT,H MA 0253E `. i COnrriliS510neF. Application Number................................:........... Section 9-:Construction Supervisor Name h_fit co 04_/gC Telephone Number Address 6 l V!T II - / lw City e g df(.iJ/,State PW—�p 402-/31V License Numberf D% 3 4 � License TypetAite-s4ici Expiration Date- / I t ;;Lo Zo Contractors Email_ �- G(��vLA �) '�/�9-�oU,L)w Cell# _56 4` 'Flo ,21©7 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' �...780 CMR and the Town of Barnstable.Attach a copy of your license. Signature � LJ Date Section-10-Home Improvement Contractor Name Telephone Number -YDk sz 6 < Z8'0 Address 1T_?U,t-& V4-l1e_Z&City PVL1W State d0ll- Tjip D 2.5--3 4 Registration Number 19'0 70 q Expiration Date ;2 0 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 re 780 CMR and the Town of Barnstable.Attach a copy of your IUC... Signature Date.�l Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Contraction Supervisor in accordance with 780 CMR the Massachusetts State Bolding 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 7Zo�, Date 41 Print Name //k'�cI ��,�� Telephone Number b�'�5^� 207 E-mail permit to: CQ 0 g" IIQ ,/,14-Aoo ' a a1-1 Section 12—Department Sign-Offs Health Department © Zoning Board(if required) El Historic District ❑ Site Plan Review(if required Fire Department ❑ Conservation ' For commercial work,please take your plans directly to the fire deparbnent for approval Section 13—Owner's Authorization as Owner of the-subject property roPe�."J}�hereby I, j Y authorize A-AJ d- A $-`2 I to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of job) ' Si/ a of Ownei / r �—daze �GoviP t a �dle__ G � Print Name Last undated:2/9/2018 MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (6171723-3800 Ma Oniv(800)392-6108,FAX(8001851-8424 3/912017 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.313 CENTERVILLE BUILDING DEPT 200 MAIN ST HYANNIS MA 02601 Re: Insured: JAMES E GIANNELLI Property Address: 432 SKUNKNET RD,CENTERVILLE,MA 02632 Policy Number: 1279485 Type Loss: Water Damage: Plumbing Systems Date of Loss: 03/07/2017 Claim Number: 412715 Claim has been made involving loss,damage or destruction of the above captioned property,which may either. exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. MPIUA Claims Division CD 3 CMA00021 4 Town.of Barnstable *Permit# C�01solow Expires 6 months om issue at �7 Regulatory Services Fee r r r r BARNSTABLE, « v� Mass. Richard V.Scali,Director 1639. �0 AtFD��p Building Division . Tom Perry,CBO,Building Commissioner z 200 Main Street,Hyannis,MA 02601 / www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY w f Not Valid without Red X-Press Imprint Map/parcel Number Property Address �� L)1.4 h-A2 yl/i//` Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 /Owner's Name&Address ) Contractor's Name 2 Z,.,:;i! Telephone Number 7 V1 Home Improvement Contractor License#(if applicable) l qr67 Email: Construction Supervisor's License#(if applicable) LS - (� ���S 3 ❑Workman's Compensation Insurance ®PRESS PERMIT Check one: ❑ I am a sole proprietor MAR 0 3 2015 ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance TOWN OF BA R N S rA6 LE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Valu6 � z(maximum.35)#of windows—7— 3 #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home prove t Contractors License&Construction Supervisors License is fired SIGNATURE: Q:\WPFILES\FORMAig forms\EXPRESS.doc Revised 061313 i r+7�ri,rnrnrnrorrr�l/r r/C EiJ.JrrC�INr//J ' frice of Consumer Affairs&Business Regulation_ g License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - Registration: 148688 Office of Consumer Affairs and Business Regulation r Type 10 Park Plaza-Suite 5170 Expiration: 10/18/2015 Supplement':and Boston,MA 02116 LOWE'S HOMES CENTERS INC ROBERT ABBOTT 7 *7 136 TURNPIKE RD.SUITE 100 49; SOUTHBOROUGH,MA 01772 Undersecretary Not vali w' out signature h<4".� '"r;F,4 '+ '<'0� ✓.'.ir .r c .ye°v�cr^-�r>��"�'g4M fr`+ PS T"Rvf�t�§`�1'{dyYY3+ 7#�,�,+r7 f' `� � �� 'r p� rv��'^�/- 5✓ r-', �r{��, ;t 1 s Y ..7 i %t �, r�S„%d ti��F� i 3��'''-y� ".va�E�,�*+^�'wr``'�'♦'�{zx�,,�t���'"f,+"��t}��5�/'W `"`�.`�.>�f-c$ 7�13t i�I:�yf` �� v,..� 1�:. � <: � ; =fr} f +, xx r`t �- d:2,3• '� w•t d� "? "� rtt _3b� 2 `W`r 'd�'�(�.�. ;} .y v''�. •n of 1.i r "'�','�m'`"`ske,.n 't`�'.+ry a.. s7 f + ssx '? s `Sa'uwGv s e: 1 ,r,�a,,yV'rl d'..5 it'r fn,ate .[ 1 d J hn.J MASSACHUSETTS SER1/ICESSOL'UTIONSITALLED SALES CONTRACT Y rt r `+ { LOWE S AUTHORIZED REPRESENTATIVE CUSTOMER + t STORE NO STREET ADDRESS }�' CITYf rf ( Jcl ._...�_,..;�{IP.. � a zh'rt STET ADDRESS Cl of C.-S. �! y f CITYSTATE TELEPHOJ`!E e r. N. ,7 c t f E, t/` ^' r ♦ /i i� "�'_.� 4; TELEPHONE•..._ da} DATE LOWE S HOME CENTERS LLC S MA HIC NO 148688 cnsH s"aa1 aANxG REG 4 kr LCC r t- FEIN 56-0748368 fiM r�4&y-{, tip .,r CHARGE ,a'w ._ F�,, .a• ""4i ';L.' . r`m�is Doty a quote for themerchandise:a'M seMces pnmetl below This mmes an a r emenf, n merit"`r r<-upo,pap a ilpon pay ent the en8re agreement J2cluding Ne specifically completed pages of Is! ref document;Uie Terms and;;Gond�Uons`inGuAed mth tliia."d ment,_and:any other adQenila,and adactong�ts'heretg.shall bexeferred to herein,as?(his a yy��PLEASE�R�AD ALL TERMS AND CO�DITIONS�ON THREVERSES�DE�OF THIS PAGE�AND FO�OWING#P`AGE.3;S.tBEF�OREr51GNING{�,`�' Y;vyr.�,-+.,r h�.Tryj ��" �q 3 "s'`�'at T`�-t„*k' - , r.Wx. ..._-,.�: ,:i�: .a,�cfi:�.W�-s'�'rv.� r.�°;'u-.�.f'���=�"b.4`.,���;�`��"+is"s� >� „`���,3�'aC`xrrr 'F=e�:✓ � �_.��.��,�C•.� � � u._ 3 INSTALLATION STREET ADDRESS CITY STATE ZIP A11; f.a ,.`�/f�"-( F :.;// J&+ ♦ f; u t f'•;. v 'r - NOTICE TO CUSTOMER—PRICE CALCULATIONS:In order to ro erl p p y perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calculated upon both the value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which may be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. Contract Total Are permits required for this installation?::[ Yes [ j No *applicable tax included v NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began Informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. NOTE:If rotted wood is discovered during installation additional charges will app7 You will be given a"quote and a change order must be completed and signed by the customer for any additional charges Customer Customer must initial. 'Any work or material not specified is not included in this contract.Any changes or additions vkill-errattf' an additional arge for the material and labor. PHOTO,RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will be performed and.all work performed at the Premises related to this Contract,and irrevocably grants,to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpp In ding,but not limited to,marketing, advertising,publicity,illustration,training and Web content.By initialing here,Customer agrees to the foregoijtg Customer to initial to the left]. Work is to commence upon reasonable availability of Contractor and/or any special order or custQmef a_de Goods)which is"anticipated to be [fill in date].Estimated completion date Is [fill in date]. Said estimated substantial completion date is not of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: 1 >:- (if applicable,insert a statement of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [;,J,Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: (1)Deposit $ to be paid upon signing contract.Deposit should be 113 the total contract price;,and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation,I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT Enrs riIAIMS COVERED BY M C L 14�n LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,THAT LOWE'S MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M G L--:c 142A BY ; Date: Lowe s Home Centers,LLC f ,♦ By: a. j �'d.�� Y`✓1=1 Date: s Owner& natdref- ' THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIESTO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M'G:L.c.142A.THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTIONI'ABOVE IS NOT SEPARATELY SIGNED BY THE PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ,UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT.AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS .f,✓ DAY OF 1" t"" Lowe's Home Centers;LLC Lowe s Authorized Representative "Otyrrer ` Co-owner or Witness Customer acknowledges receipt of a true copy of this corytr'act which was completely filled in prior to Customer's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction.See the attached notice of cancellation form for an explanation of this right. 55102 REV. 12/13 FILE COPY ®2004 by Lowe's.®.Lowe's and the gable design are registered trademarks of LF Coryoraaon. Back to Quote LOWE'S HOME CENTERS,LLC#2376 2421 CRANBERRY HWY,STE. 100 s a �~ WAREHAM,MA 02571-5022 USA Date:02/20/2015 (774)678-6000 Project#: 433161677 Description: 250 pellas Customer Name: JOE NICOLOSI Customer Phone: (508)775-1014 Customer Address: 423 SKUNKNET RD ' 4 CENTERVILLE,MA 02632 USA Line Item Product Code Frame Size Description Unit Price Quantity Total Price 0001 Manufacturer.Pella(R)250 Series Windows Size=27 3/4-in W x 45 1/2-inDivision:Millwork H Product:Windows Type:Double Hungs Manufacturer:Pella(R)250 Series Windows i i Energy Star(R)Qualified Products Only: Yes-I would like to view only the units that are qualified for Energy Star(R). Energy Star(R)Zone:Northern Room Location:Bath 1 onfiguration: 1 Wide Frame Type:Block Actual Frame Width:27 3/4-in Actual Frame Height:45 1/2-in its Opening Width: 28-in ( ` Fits Opening Height:45 3/4-in Venting Height:Equal Unit Type: Complete Unit Performance Option: Standard Exterior Material Type:Vinyl Foam Insulated: No Foam Insulated Actual Base Frame Depth: 3 1/4-in Actual Base Wall Depth: 3 1/4-in { Sill Adapter: Sill Adapter Included Head Expander: Head Expander Included 'Exterior Color:White nterior Color:White Glazing Type:Insulated Insulated Type:Dual Glass Strength:Annealed i nsulated Glass Option:Low E ow E Glass Style:Advanced j $199.69 6 $1,198.14 f t - - - Gas Filled:Argon High Altitude:Non High Altitude i Sash Lock: Standard Lock i Limited Opening Hardware:No Limited Opening Hardware Hardware Finish:White Screen Option:Full Screen Screen Shipping Option: Shipped In Unit j Grille Type:No Grille 3 ' Will This Product Be Installed By Lowe's(R)?:Installed By Lowe's(R) s This A Remake?:No Lead Time: 21 tem Number: 530802 0002 Manufacturer:Pella(R)250 Series Windows Size=27 3/4-in W x 37 1/2-inDivision:Millwork H Product:Windows Type:Double Hungs { Manufacturer: Pella(R)250 Series Windows Energy Star(R)Qualified Products Only: Yes-I would like to view only the units that are qualified for Energy Star(R). 1 1 Energy Star(R)Zone:Northern Room Location:Other 1 Configuration: 1 Wide Frame Type:Block Actual Frame Width:27 3/4-in Actual Frame Height: 37 1/2-in Fits Opening Width:28-in j Fits Opening Height: 37 3/4-in i Venting Height:Equal Unit Type:Complete Unit t }- erformance Option: Standard xterior Material Type:Vinyl 3 :Foam Insulated:No Foam Insulated ctual Base Frame Depth: 3 1/4-in ctual Base Wall Depth: 3 1/4-in Sill Adapter: Sill Adapter Included Head Expander: Head Expander Included Exterior Color: White I IInterior Color:White Glazing Type:Insulated j Insulated Type:Dual Glass Strength:Annealed Insulated Glass Option:Low E Low E Glass Style:Advanced Gas Filled:Argon j High Altitude:Non High Altitude ash Lock: Standard Lock Limited Opening Hardware:No Limited Opening Hardware i Hardware Finish:White._ iScreen Option:Full Screen creen Shipping Option: Shipped In Unit Grille Type:No Grille i ill This Product Be Installed By Lowe's(R)?:Installed By $186.00 1 $186.0 owe's(R) s This A Remake?:No Lead Time:21 Item Number:530802 Project Total: $1,384.14 Salesperson: CRAIG STOUT(52376CS 1) Accepted by: Date:02/20/2015 Print thiSPage I' This Millwork Quote is valid until 2/23/2015.This is an estimate only.This estimate does not include tax or delivery charges.Delivery, of all materials contained in this estimate are subject to availability from the manufacturer or supplier.All the above quantities, dimensions,specifications and accessories have been verified and accepted. f 2015-03-03 15:02 isoprt75.2376 0 >> 7746786001 P 1/1 Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.maus Off4:..50$4014038 • Fax: 508-790-6230. Property Owner Must :. . COrnplete and Sign This Section •If Using A Builder .e t l G 6 S/ subject h as Owner of the subj r. . . . • l P operty . h6e y.authorize Q _—• to act on my behalf, : in,24 matters:te]a tive to*work authorized by this building permit application for. ? ZL :• (Addr6ss of job) ona�ure ez Date Pritit•N=e T� Operty(3wider is.applykm for permit,please complete the Homeowners License Exemption Form on the reverse Sidi, C:\usasw �k�ApgDatalT.econ mpmwy lutmiet PIIes\ConteatoedookY)Dva7nazlEXPREss.doc ocallMicrosoRlWindowslTe Revi ec1072110 The Commonweallh of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Businesss/Organization/Individual): L Address: /Po po Z-C'yz,e City/State/Zip: iZe- hone Are you an employer?Check the appropria*^box: Type of project(required): 1.El am a employer with 4. I am a general contractor and I employees(full and/or part-time).* �have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g_ EJ Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.: 9. ❑Building addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs-or additions myself. [No workers comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[-1 Other r 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: G r:✓ 14-10 l' Policy#or Self-ins.Lic.#: a� ! 1,31el _ Expiration Date: Job Site Address: City/State/Zip:_Cpl- ?67 t// 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ipsurance coverage a 'ficatio I do hereby certify un er aims nd p of ' ry that the information provided above is t e and correct Si ature: Date: 3 �J Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M I Tke COMMn wed&o Man f achuseits Dqarhitent of IrA 1Acdd.& Orke OfIfivadgavow 600 was*rtou mom Boston,MA 02111 Workers' Compensation Insurance Affidavit:$g1�A licant Information denslContractors/Elechicians/Plumbers Name(By Please Print I Address: ee C�Gi City/State/Zip ry— Are you asem to I p * Check the appropriate box: ❑ I am a employer Wilh 2�employees(full and/or`# 4- ❑I am a gear ,.and I TYpe of project(repaired): 1 am a sole p�� r PWUW), have hired die subconlractors 6. ❑New cow ship and have no employees listed on the sheet 1 7. []Remo&rmg working for have [Nworkers-�in any sty. workers, wanm 8• ❑��n 3.[] �r Comp.fiance S. El we a ctiparaticM and its 9- ❑�dbg adder am a homeowner doing all work have exei,� 1013 Electrir�ti Workers.comp ❑ repass or addmons �Ce[NO negnireq t ��$1( have no I 1_ Pi�b1°g s or additions employees.[No wo*as' IZ❑Roof repairs t ` tl�az boot COmI Mp I3.[ ether Mare halstawzoarSaaVt. o5it� 1 oa the tConaactorsdat check ,� �mdcawe doing an w �� OOP i°°poric�' spa kjfo" � .Der that is proyidarg xorker, 'co�r3Pexs�n �rce oMmddwWVWbW=MqLPQS�9a f MY Below a d*epeliry mrd job sire lnsmance Company Name: Policy#or Self-ins_Lac-#: Job Site Address: lxsnation Date: Arch a copy of the workers'compensation �� s��,� secure coverageY eclaratim page(4, aihzre to polio d fine up to S1,500.00 as req�d under lion 25A of MGL c.I52 wmg a poBcY",be aW a ii ration date).-00ad and/or one- imprisonment, can lead to the imposition of mina( of up to p p�a day agar the 'ovr as well as civil penaltiesm�e form of a Pe�lties of a %Investigations of the DI for e e csed thata copy of this statement may be f��to of a fine I do hereby pahv and-patalt"a Sr Store: f of Pell y thatthe or8zation provided above it trove endCWre% Phone#: s Daft- Ilse only. Do not wr&e in area to be CUY or Town• coarpl by c&y or town official LURB tag Authority(circle one): Permwacease# Hoard of Ifealth 2.Build. 6.Other Department 3.City/Towa Clerk 4, Nectrical Inspector Plumbing Uspector - Contact Person: Massachusetts -Department of Public Safety Board of Building Regulations and Standards l"INtr uctiii11 Supeni-i.sor License: CS-075153 I Is Kenneth D Kendall= 5•Weeden Place gt Fairhaven MA OY/19 .4ra� 57-2•� Expiration Commissioner 01/12/2017 OEMEof Coasamer Affairs&Basing k �aeba License or r IMPROVEMENT Cp bon valid for individul use only NTRACTOR before the expirationdate. If found return to: on: 168d17 Type: Office of Consumer Affairs and Busiuess Regulation tion: I;W/201fi , DRA 10 Park Plaza-Suite 5170 KENNETH KENDALL Boston,MA 02116 KENNETH KENDALL 5 WELDEN PL FAIRHAVEN.MA 02719 Undersecretary �� � • otvalyd with Out sign re * ZWAIVZG A" r, S, rE ExprraI - . 1A ' f Y 23,6- Wwehm,Ma 02571 Iq05� 941- Assessor's map and lot number ...../� ��........................... �p*THETO�r , �? SEP i Sewage Permit number 02� .. .......................::..... 'N �, e`SV'STEM MUST ALLED.IN C®MP`+�� House number— ......:.................................: ��� T9T� o aea L$ y, ��� asa S b1��/� � � O 639• MENAt* TAL TOWN OF ! BARNST "DLIEJS BUILDING INS:P CTOR 'APPLICATION FOR PERMIT TO ................ .`.. .1..... l �C;?L� , s TYPE OF CONSTRUCTION ..... ....:............ .. . ..`.`'�.................. 1 c- �� �..........19....A..� l 94 r •t .,.. ...., .�.. ..,_.....•. f f+...a j ir- ...._<....._._.__...�.._ ...... ........................ TO THE INSPECTOR OF'BUIL,DINGS: { The: undersigned hereby applies for a permit according to ,the``following information Location .................. ...... 5�'.....................................................� ....... �. �':. � J► \� f Proposed Use ..................... ............ M.`." .......... ... .................................. ............ Zoning District 1...... ............... Fire District .(1 ►. Address �A �'"� Name of Owner ...... .arn ...... :... � ^.... ...............�............ �`......... .............. Name of Builder ....e.l .... ....Address ................................................................................ ... ' Name of Architect .......................:.....................Address ...........................: :......:................................................ 4• Number of Rooms ... ... ............ ..... .......Foundation ...... . .:.r4r�l� .C. ... ........... Exterior ��!!� l�s-.....<Y ....:... � �.. .� .... ......Roofing .............. Floors :..�1�. . . '..• vJ c�9La--.:: ......................Interior ... ... ...0 ... jHeating .........O -. ............................................Plumbing ............ .�. �. ^4 ... Fireplace -- .............................Approximate Cost s Definitive Plan Approved by Planning Board ___ -________________________19 __. Area ............ ,. ............. Diagram of Lot and Building with Dimensions Fee .................... ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH z, ju 4) ev it .. ..._ ....._. _ ... 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 ....... .`.'..'........... SMITH, JAMES K. 24163... 1;2- Story...... >�No .............. Permit for ................... -...Single...Family.... . . Dwell i.ng. ................. .. ....... .... ..... .. .... .......... .... .. Location ...... Road Centerville ............................................................................... Owner ....James.....K.....Smith ............. . ....................................... N-1 Type of Construction ...9r4n!Q.......................... .............................. ................................................. Plot ............................ Lot ................................ June 24. Permit Granted ........................................19 8 2 Date of Inspection .....................................19 Date Completed .................19 clec, 62er 17-110 A _ : *Assessor's map,and lot'number ....................................... . . �>7 cF 7ME ro Sewage Permit number .: .............................. d``Q °+►............ Z 33AUSTABLE, i House number ......... 9 NAB& w p s639. E VA a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............. �? �? C��c �'i eAk of TYPE OF CONSTRUCTION .....................,: 1 � .` ......: rt'. !! '.' .........................f...................................... 1 �,„��.. 19.... „ ,a ........ ............ , TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ly--o k'�- ax() r\\,,%,t-\iz \z. . ,,& Gn ,( I Location ............................................................... ...................................................................................................................... Proposed Use W`' -a�v� C9 ry : .............................................:................................................................ ,........�...................�.. Zoning District ' ....................... ? � c. ..............Fire District ...................!�? " ... .:.......................... Name of Owner ...... :.! r l Pl?a b :...� .:Y1`... )......Address ........................................�. ......�� . .. �. ............................... Nomeof Builder. .. ... ....... *........ !....Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms 1 ..............................................Foundation .....:40 " .c_ an c �Q ................ ................................................ Exterior .. ' t ...Roofing Cs _kz�, 6j A Floors ........• ,1C ._..5 CO , �iV� v ........ ..................................................................Interior ........................,............................................................ { :.s - '.Heating `1 T � ulc--,...................................Plumbing ................rf,�:. .:..........4.'...... `.. ...................... Fireplace ..Approximate Cost .k—s 0 0CD ................................................ Definitive Plan Approved by Planning Board ________________________________19________. Area ........... .................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 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 ....... .... ...........1 "..�.."..' SMITH, JAMES K. A=170-120 /?0 -- /0?a No ...24163 Permit for ...1 i Story ................ Single Family.•Dwelling........... Location ..Lot...#. 0 432 Sly, ]� •••Rd.......................... .................Center.„il le................................. James K. Smith Owner .................................................................. Type of Construction Frame 5 r Plot ......................... .. Lot ................................ June 24, Permit Granted 19 8 2 Date of Inspection ....................................19 Date Completed ......................................19 100 -1/0 y3 i p1^SIGN DATA. :� t �j1►JG�C:. FAMIt_Y - � BEOtiZaoM ` W0 GAP-BAGS �j2t►�1DEGZ DA1h�( FLOW IIOX 3 = 33oG.P¢ 219 SEPTIG TAtiK = 33Ox15O% =�97rG.P. R ZZ9 y5E- la�o GAS.•. Q.- o15Po5AL PIT v56 1 vo0 GAL, q� 9 'Z _+I •o _ x BOTTOM AP - 5O S,F. eXP Tr �20� �1 <<� _. f 5jo $.F x 1• o -- 5 O �P G? ZZ. 8` p n��N ; IJ . 5 .F. PD Q -roT�.L lOA 1�Y F>✓o>r! - 33o G. . 7 ftzoP .p ` PERGOLATt0�1 RATE: t'.'iN 2MIN O2LE55 .. ,. :. : � .. Per._ ... r 7 , .,• L O': Z 1Z010 SQ.F , ; i RICHARD titA. t - QAXTER rlU t TEST . . .F4s 7 1. P To FND q-q-a:." IN\/. 1 Dte,T. INV. GAL. �G sua ao►L.- Bc>�C SSPITIC- ZIIL tdoQ INJ Q�.L TANK . _ , I s..N a w l,-u WASNCD 6TONE .. C1;SZTl SIC- D P►-oT P1-A.t.l �# , � _ l..oCA-tloN GeNT.ERvI�.LC� NO SCALE �jCALE N s _.... �.1 . FT.. A{'1 ZI FSZ PL-At�I RE�E2ENc,E- �i. GE [zTIFY 'CNA'v 'TNT �oUh1'�aTl0{�5y{ovvN NE2COtt GOMC't^�(� anl.lT.N�T 1-iE Sj pEt_�tJ 1✓. _ �T ZZb A.wo tizr--MEN`i"5 F -cµE- pLAN FOB. A,%-ANc.SM INC. p Ca F i 7 W N QN`�'j'/ 2C3 ,b.N D 1 s . . LOGP.TE-D •W lT 1 tJ 1r1 E G pC7 P�A l t�I P'1 A R.GH GATE(c'11-$Z .1 $/VCTE� titYE { h1tG, i1 8AATEi2e IJ`(E FNC. s REG 15 �QEU't-AN O y u 2Y P;YCD TM:5 PL&Kl 16 WCT BAS1 D 40d A KI vSTEE2;V.lLLE v MASS. I W'STP-V.tME,W-r S V 2V.5�r y �--T.NE: q.FF JETS; -$WOULS> !�. ►.loT 1'.E VyE.DTb QET. uM1�E l.r�'T; t-IB.�j f�PPLtGA►-1T V AMEN „o�*�'.• TOWN OF B.ARNSTABLE Permit No. ----- ---- - } SAW9TAX Building inspector Cash - - -- — -- /YL ”' OCCUPANCY PERMIT Bond -------_________—_______ L� Isfsued to f.'lops TK Sint Address iIC1t:i' (74 Wiring Inspector Inspection date Plumbing Inspector Inspection date t'? !•? Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date 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. 9 Al 19.. ...................n :..:.`:. ::............................................................ Building Inspector Assessor's map and lot number '............................... y0*THE tO P �y Sewage Permit number ....... .......:'..../�....,.7.......................... Z BARNS MILE, i House number ............................ `1.3.� ............................. 9p� N 9 00 is/d t A�,O YPY a�9 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �' e (} TYPE OF CONSTRUCTION ................. 1,� .....�........:: :xA.1�:?.�':............................................................... - t' . (...� � ... .. .....................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following information: Location ....... ?............. ..e...............i,1�un�(�.�'.�...........�(�,C.� ................1:.�?11�� d ��\��- ................... ProposedUse ..........1 An A: .........0.im�.:•k-4 ........................................................................................................... Zoning District ......�` � �` Fire District ��� � ........ . .....�........................ ........o-.(................................................................ Name of Owner `k� ��� t-` �� �'"`.............Address � s � �'-- . ........�................... ..``................ ............. .................................................................. Ic Nameof Builder' ��.. .e^... �....�?.m. .............Address .................................................................................... tl� Nameof Architect ..................................................................Address .......................................tt............................................. Number of Rooms ...........................................Foundation ..(1rt...G'; 1 n•� ..................... ` . ........ pCC1..1� ...Roofing t" !�? �n f Exierior ................ ...................................................... ..,....:...:.............................................. Floors . ff � t�........` ..........Interior .C.1a - ,•!;) 3. ✓`^- ...... . 1.................. .................. - :,..� ^ Heating ....................:.:.'.,...:................................Plumbing ....................1.... .... '"........................................... HS b Fireplace .........................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 �14k � 4 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 . \ G t! 4. . .C:...... ........................... I _ • i SMITH, JAMES K. =17U-18-4 24043 e 1/2 Story No Permit for Single Family Dwelling ............................................................................... Location ..Lot. ##25...4W Skunknet Rd. ... ..... ................................... ................. entervi11e ......................................... Owner ....�.ameS K. Smith .............................................. Type of Construction ,Frame ........................... Plot ............................. Lot ................................ Permit Granted MaV 12 , 19 2 Date of Inspection ....................................19 Date Completed ......................................19 T _ I_-, ! 7-1 f 'I -�—�_: �I —I,1 I I i I— ! I i •. ! � 1 i � � � _-- __I __ -- I I .-_ � I .___—__ ' i _I __I _ - -� h I---)---I-----�; ! I, {--E-�---- ----'!-'--.- ��-_ __�_•.--I---I i i �- f _�_`� I_"'I----fl ---r---�-- I i i i i l l I ,I I r I U I i2 L�lLL I • ; i ! I I ! 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