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0024 SOUNDVIEW ROAD
ecv 0 c A d i . � Town of Barnstable Building ' Post"ThisWAS& Card So That it is VrsibleeFrdm thStreetA roved Plans Mus be.Retamed on Job,and this GardMwst..be Ke t J pP p wet r dd z r s t a e is PosteUntilFinal, nspecti4on Has:Been Made z ,a ` 9 yam W.here,.a Certificate of Occu ec is Re "iced such:Buildm s all Notwbe Occu ied un#il a Final ans ection.hasFbe`en made.. '' a mit Permit No. B-18-877 Applicant Name: PAUL J. CAZEAULT&SONS, INC. Approvals Date Issued: 04/09/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/09/2018 Foundation: Location: 24 SOUND VIEW ROAD,CENTERVILLE Map/Lot 247-042 Zoning District: RB Sheathing: Z y �• a ,�.y, . Owner on Record: CLERGY, MARY-JANE TR "`, ContractoraN e:` PAUL J. CAZEAULT&SONS, INC. Framing: 1 A Address: 24 SOUND VIEW ROAD � A ContractorLicense� 103714 2 CENTERVILLE,MA 02632 Est Project Cost: $4,500.00 Chimney: Description: reroof(stripping old shingles) �Per mitFee: $35.00 k _ Insulation: Project Review Req: Fee Paid:' $35.00 Date 4/9/2018 Final: Plumbing/Gas ° z ' Rough Plumbing: > � '� - - Building Official • Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorrced by this permit is commenced within six months aft&.issuance. Rough Gas: All work authorized b this permit shall conform to the approved a licatio and t ea roved construction documents for which this permit has been ranted. All construction,alterations and changes of use of any building andptructures shall fje npcompliance with the local zoning 15 laws=arid odes. g Final Gas: This permit shall be displayed in a location clearly visible from access streetibr road and shall be maintained open for p&lic nspectlon for the entire duration of the work until the completion of the same. Electrical i The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:k � '' Rou h: 1.Foundation or Footing j' ZSJ g 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department c Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ��SEC Fit„ T®wlll? of Barnstable ,,Permit# z' Expir2— es 6 nrorztlzs fi onr issue dote Regulatory Services Fee * BA MASS. LE, 169; 1° Richard V.Scali,Director. ® �� lFB phA�A Building Division ' Tom berry,CDO,Building Commissioner 200 Main Street,Hyannis,MA 02601 � '�� www.town.barnstableana.us Office: 508-862-4038 Fa ''' -7 0 EXPRESS PERMIT APPLICATION RESIDENTIAL 0%� 117 . IVot Valid rvitlzoutRedX-Pi Map/parcel Number �,� �i Property Address O�7 Sri e.-1W VII.-W 'Le-U. �.•2 y�`��. `� o4esidential Value of Work$ y-r�� Minimum fee of$35.00.for work under$6000.00 Owner's Name&Address 1�/4Y e ✓ll+e ��re��i y y� ��®[i � illew /�W Contractor's Name P A U L-,- CA Z�A U isi -i- Sc%,j - 1-+_Telephone Number ` � Home Improvement Contractor License#(if applicable) 0 3'� ( Email: 0 -z-ec,L� { • Cc� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner �ve Worker's Compensation Insurance Insurance Company Name Lr i P1 I 'Workman's Comp.Policy 4 (/1/G S - i S 3 CO) (b 6 -4- 6- 0`Z S Copy of Insurance Compliance Certificate must accompany each perinit. Permit Request heck box) e-roof(hurricane nailed)(stripping old shingles) All const-action debris will be taken to �t�f'� 40U ❑Re-roof(hurricane nailed) (not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&fire Permits requited. "'AkIere required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\DecolliklAppDataUcal\Microsoft\Windows\Temporary Internet Fires\Content.outloolcLPIOiDHRIEXPRESS.doc Revised 040215 !'it of 1ppa�l IISJ/u/4 %?y %y t .. '< {t _rJ �i�i��b'$'LG�.�YG� l'r 48�,�+i•� /In.y LU GdrJ B'r14.Y.^.J.0 uu.'Ju Lib. . ', +pi �a�,I hip t:��' Lf�rd�ry''elf l(S�l�,itCSftrbdjLG4'PG'�s 60 T�ersG�2tr¢�lav� ��L%7 peC a � w w.rylass.govId is Workers' Compensation insurance Affidavit: Builders/C on,tract,on/'i lec>ricians/Plumy ers Applicant information Please 11'r hit--Legibll Name (Business/Oraanization/Individual): ' :''-i 1 -> s Address: amity/ gate/Zip: ,. , ! = 'h©ne#: 'T i •.T } A-e you an e_nipjoyer? Check tle appropriate Type ofpboject(rreg1ti-ired : . � �I am a general contractor and I 1.�'�I am a employer with 4 t3 � New constnlction employees (fiill and/or part-time).'` have hired the sub-contractors 6. 2.[] I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand have no employees These sub-contractors have -t 8. ❑ Demolition working for me in any capacity. employees and have workers' Buildin g addition kers' ' [No workers' comp. insurance comp. insurance.{- 9. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their •11.❑ Plumbing repairs or additions myself. [No workers' comp. - right of exemption per MGL 12 Roof repairs insurance required.] t c. 152, S 1(4), and we have no employees. [No workers' 13.E]f . thencomp. insurance insurance required.] "'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infoimation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. rContractors 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 anz an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: �r / , J 6) 6 U'V Expiration Date: G ,�'it� ✓; Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a tine 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. Ido hereby certify /f under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: �`� ��� � L- �� � Date: Phone#: Z —i'. - l i 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 1. Contact Person: Phone#: I -fir-7 '3''F?•v .'�'a'y ' �: ').:'•: .J,i 7il I%1,�.--n•.� /.v r: i' V i.U�=_gin; e-r.-,.•,.-vf�.... (:1 office of�"onsu�ner �_fraxrs any Business regulation ?� 0 Park Plaza Suite 5170 � Boston, Massachusetts 02116 Home tnaprovement Contractor Registration I' Registration: 103714 Type: Supplement Card PAUL J. CAZEAULT & SONS, INC. Expiration: 7/9/2D18 RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change, scs i :;: zoM.osn i Address Renewal ❑ Eimploymeat Lost Card I - r -^fiOffice of Cons nmerAftnirs Business I egula6on l+`.,icehse of registration linlid for individual use only r, a;I-�� before the expiration date, If found return to: -�_°..��OME IMPROVEMENT CONTRACTOR p� 1,�;�Fi j•— =i''Re istration: - a. Type: Office of Consumer Affairs and Business Regulation 9 1t)371. 10 Park Plaza-Suite 5170 - Expiratioii; :7%97201.8,- Supplement Card Boston,MA 02116 PAUL J.CAZEAULT&-SONS,INC. RUSSELL CAZEAULT 1031 MAINST , r __•.t_,. •: OSTERVILLE, MA 02658 � Undersecrctnry Not valid svitlrout 'nature 1 ( h/lassachusetts ,Oepariment of Public Safety Soard of Building Regulations and Staneards I Cunstructioo Supervisor =' License:_ = `< CS-108'I57 Fly i RTJSSELL CAZEAULT,.,,,;;v ,/•r•. � ; 2071 141AIN 8TRE-T Brewster MA 02631 = ✓mow ��G` ,• - i<:" expiration Commissioner 11(23/2016 '' °j i I f I i ` I 1 Property Owner Must Complete & Sign This Form If Using a Roofer 1 Builder. 1 rna„r� Q�I'tSL as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job S �' V 1 CL eik - Signature of Owner ovu Mailing Address of Owner Telephone # 'I Z q— Date aukP4 10 4- Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com Town of Barnstable '-R. *Permit# 7 - 3, Regulatory Services ogee ires 6 months from issue date 3 BARN rnat.E. MASS. g Richard V.Scali,Director1639. [� A'ED1iA�`A�� Building Division aPRESS 1 " Paul Roma,Building Commissioner FEB 13 2017 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 !� www.town.barnstable.ma.us TOWNS vv(`jF � EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number i Property Address �'j� �ruu t� q( V i W I� C1 �e� ]�eC y o^ll Residential Value of Work$ 4 0 o t0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address /% P Li oz Cle-roq Contractor's Name Core 4 g2n C p re u Telephone Number sO,? 7 7 C-P <7 O Home Improvement Contractor License#(if applicable) �_� Q d a Email: Co re je t- r* yh @./-� Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Xr ee-& find lec 711'o n C e Workman's Comp.Policy# W cc ——YO 0 —so/Y0 9 f _ a 0 GX Copy of Insurance Compliance Certificate must accompany each permit. Permit Req st(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to yc2a"AA a �i, em P ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *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 ofth om ovement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 co --, 0,, & R�E vv v ea T Roofer s 1672 FALMOUTH RD #117, CENTERVILLE, MA 02632 i PRQKE 1, 75;.8,Z40 i. CERTAhHTEE. LARD ARK LIIF`ET1K ALGAE RASIS,TA1T S -- RE ® R 0TI G PROPOIS44 -- January 28, 2017 MARY-JANE CLERGY 24 SOUND VIEW RD Tel: 617-6954317 CENTERVILLE,MA EM: mjclergy@aol.com COREY& COREY hereby propose to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away All of the Old Rolled Roofing(One Layer) on the Shallow Pitched Rear Roofing Areas of the House. Re Nail All Plywood Sheathing as needed. Supply and Install CERTAINTEED LANDMARK : 'LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION,CLASS AFIRE RATED,COPPER/CERAMIC STONES for a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT,240 POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,CATEGORY III HURRICANE,STORM/HURICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED,LAMINATED ---ARCItTEC-TURAI:STYLE,FIBERGLASS-BA SRD-ASPI"L1SHINGLES. --_—_ _ COLOR:' BIRCH WOOD Supply and Install HICK'S VENTED ALUMINUNM DRIP EDGE After Cutting an Opening at the Top of the Fascia Boards or Supply and Install 8" WHITE ALUMINUM DRIP EDGE on Both of the Eaves. Supply and Install CERTAINTEED WINTER-GUARD(Ice&Water Shield)WATERPROOF UNDERLAYMENT SYSTEM on the Entire Area to be Re-Roofed. Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on Both of the Main Ridges. Supply and Install ALUMINUM&NEOPRENE SOIL PIPE FLASHINGS Clean and Remove Debris from work area after job is completed. TOTAL INVESTMENT ------------- $ 4850.00 r y 7A 0 E y f Y t � ev, t v.o: 'I've: Roofer s. POSSIBLE EXTRA CARPENTRY:Any Rotted or Otherwise Deteriorated Trim Boards,Plywood ood Sheathing,Missing Metal Flashing,Side Walling or Any Other Carpentry Needing Replacement will be done and charged for as an Extra:Materials Plus Labor at the Rate of S 40.00 per Hour. PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All Roof Work is-Scheduled-for Completion Within 60 Days of Acceptance and Receipt of Deposit providing the Materials are Available.Therefore Deposits Received are Non-Refundable After a Three Day Cooling Off Period from the Date of signing. This Proposal May Be Withdrawn By Us If Not Accepted&Deposited Received. . Within Thirty Days Or Before The Next Price Increase hi Materials Please Make Checks Payable to: COREY & COREY COREY & COREY Warranties the Shingles and Labor for 5 years. CERTAINTEED Warranties the shingles and labor 100%for the First 10 Years and the Shingles your LIFETIME if the shingles becomes defective. CERTAINTEED Warrants the Shingles up to a CATEGORY III HURRICANE-130 MPH WIND WARRANTY. CERTAINTEED Warrants the Shingles to be Algae Resistant for a Fu1110 Years. COREY & COREY carries Workman's Compensation and Public Liability Insurance on the above work DATE OF ACCEPTANCE:(. ACCEPTED BY: " / SUBMITTED BY: e , t,/Vj� t y'1 YfJANE,CLEAQY CHARLES COREY,CONSULTANT HOMEOWNER COREY& COREY 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' AuDlicant Information Please Print LegAly Name(Business/Organization/Individual):4 S C�rLCa r e Wd ,01, Address: .�;� �I l'� a�V ILI ®".7GO City/State/Zip: Phone#: -S-0 c7 702 ARY, on an employer?Check the appropriate box: Type of project(required): 1. am a employer with C 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, ❑Demolition working for me in any capacity, employees and have workers' 9. Building addition [No workers'comp.insurance comp.insurance. g 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 insurance required.]t c. 152,§1(4),and we have no 12.❑Roof repairs 13.❑Other 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 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. J/^� 7- Insurance Company Name:ff,be-/�G, Pro le c 1. U n ,.�1 rt-'tom r Qf7 Policy#or Self-ins.Lic.#:—WCC ._o 0 --F p/S® e,f a p(('A Expiration Date: V Job Site Address: �y Se)LO n a/ (I Rot City/State/Zip: Ce r??�eP-y,° l� 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' ance coverage verification. I do hereby certify de th p ' n penalties of perjury that the information provided above is true and correct Signature: i Date: U�, I f Phone#: —7'7C 2 cf.D 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#: n ACORV CERTIFICATE OF LIABILITY INSURANCE DATE(MMMD/YYYY) IL.� 9/16/2016 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 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 endorsement(s). PRODUCER CONTACT Ashley Paiva Southeastern Insurance Agency, Inc. PHONE (508)997-6061 FAX, (508)990-2731 A/CNo 439 State Rd. E-MAIL ADDRESS: P a aiva@southeasternins.com P.O. BOX 79398 INSURERS AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURER AArbella Protection Insurance 41360 INSURED INSURER B AEIC Armen Safaryan, DBA: Corey and Corey INSURERC: 67 Sea Street INSURERD: Unit A4 INSURERE: Hyannis MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER:2016-17 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 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DDNYYY) (MM/DDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ A CLAIMS-MADE a OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ 9520046441 9/18/2016 9/18/2017 MED EXP(Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEM13ER EXCLUDED? N/A B (Mandatory in NH) WCC-500-5015091-2016A 9/18/2016 9/18/2017 E.L.DISEASE-EA EMPLOYE $ 1 000 000 IF yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Display Purpose Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ashley Paiva/AMP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INSn25 t9n14n n T SOD _ -' - nLl �rr+3aa �e' '=x�a�it►r� ��c Tianz��ca�rcaerc�f�af'C�/flrc;::ac�ccact�� ` - Office of Consumer Affairs&Business Regulation +� HOME-IMPROVEMENT CONTRACTOR Registration valid for individual use only i TYPE:Supplement Card before the expiration date. If found return to: ---Registration Expiration Office of Consumer Affairs and Business Regulation � � r i83202?? 09/13/2017 10 Park Plaza-Suite 5170 Boston,MA 02116 ARMEN SAFARYAN '; DB/A COREYANQ'GOREY. EVGENY SUSHKO 67 Sea St Apt A4'-,-,� Hyannis,MA 02601 Undersecretary with ut signature t1 — / �f Y Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Mas a husetts 02116 Home ImprovemenVOontractor Registration Type: Supplement Card m w Registration: 183202 ARMEN SAFARYAN Expiration: 09/13/2017 67 Sea St Apt A4 G Hyannis, MA 02601 q Update Address and return card. Mark reason for change. SCA 1 e. 20M-05/11 _.... -- --. -. ... ............---.... ---- --- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2H 7 Parcel byZ Application # a I g 6 2 '1 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee � 0 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address L q Stead 64_tw Village C d'ti-y'��Z Owner 141 Al �wNti G l to A, Address Telephone Permit Request r kc4�y �i aaf /L l� r'. vrM�`.s OC c H ��-�I Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay, Project Valuation P� `'Construction Type G Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Er' Two Family ❑ ' Multi-Family (# units) Age of Existing Structure �� Historic House: ❑Yes ErNo On Old Kings Highways ❑1_ 1E Basement Type: ❑ Full C16rawl ❑ Walkout ❑ Other °= Basement Finished Area (sq.ft.) Basement Unfinished Area (sq:� Number of Baths: Full: existing 2 new a Half: existing ne,, Number of Bedrooms: 2 existing& new tP Total Room Count (not including baths): existing new First Floor Roo Count c �" 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: r n ` Zoning Board of Appeals Authorization ❑. Appeal # Recorded ❑ Commercial ❑Yes 61N�o If yes, site plan review# Current Use •"t�` l�."4-64 b1iw� Proposed Use JC �l5 avfL APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� !�( L_ S �� Telephone Numbers Address P 0, x3a r 13 License # OMIL OS 4 Home Improvement Contractor# Mao Z.S Email S�� ��' S� e-L°Y/yr a�,� � ' C Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO dl C4 r f4 e4,144 0ywc/i:7 SIGNATURE DATE < - `y FOR OFFICIAL USE ONLY ". APPLICATION# y DATE ISSUED MAP/PARCEL NO. ` ADDRESS VILLAGE E f OWNER DATE OF INSPECTION: { FOUNDATION r: FRAME €a i INSULATION r. s FIREPLACE E ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL + FINAL BUILDING ��� $ { f DATE-CLOSED OUT ` qSS® -ION PLAN NO. f The C:olIM1011 wealth ofMassachusetts Department Of I11411.51 al ACV-de-de .- •� Office of Inlw4a ions ` � . 600 Washinglcrlt Street BJosion,1U4 02111 ivsvt1Lr71tF55.g[;l'i1II[� � . •, . NN"orl;.ers' Compensation Insurance dat t:Buildelt s.0 out,•tctors/E.I".t'zciaii iPItimbers .Pplicant Information Please Print Led`b1�- Name. Businesy�Orgmiizadmtbdi-rduai l: �3 +l ceyS/4rc .address: Cityi'Sta#e`Zip: t c�J�'L'^cdcf /!c�. �'?.GS^�' Phone �'�'✓ ,1 �� . Are you an employer;`Check the appropriate box: `Ine of projezt(recurred): 1. .�a emplmwr-with 241 ❑ I am a Seneril and I 6. n New con',tsuction employees(611 andlor part-time),*. hax-e hit-.4 sub-contractofs 3 ® I aryl a sole proprietor or garfner- listed on the attached street:• '�- ❑Rernodeue slip and have no employees These sub-contractor,have - . S. ❑.Demolition working -far one to airr c3 acit;r. employees and have��orkera'" t7 + - n 9. ®Buildikg addition [No work-m- I comp.insurance comp,insuraace.= required.] ® We are a corporation and its ME]Electrical repairs or additions � - 3.❑ I am a homeo vraer doing all work, officers have exercised their ILF1 Plumbing repairs or additions imy e.lf. No workers c.�iW. risght of exemption per MGL. 1_: c. IP,§1(4).and have no ❑Roof reaim p ursurance:yepited:j� ,' a em plQyee..:!f do worker,' 13.❑Othei. comp.insurance req d.] •may op p inmt that checks boo=1=0 also£A our tan se`coa below shouiag ibeir wo*en'coatpmsahon polies infortraisoa i Emeownn w ha submit€his afi33s5c i,4inting t_>�y are doing aA Worts and t1na him outside 2araa:ror;nse t sub u a r R aid s^t iaidicatias sn�6 cssntTacsors that c Eck this box must atta&ed=addtaoaal sheet the a s3 of she sttb CC+L+ttattoTs and state RheCttar 4r get iho3e gadtie:ha;E empIoyecs. l the sub c a am,cior Ln,e em ICY e--s,€hs• u�st provide their wmkas'tome.policy numb FT. - I ant n77 rinployr?that i.Fproidding 9t*oJ it@1S'COJidp&Jt381trfl7i jilpl-pallcefor 717i'ewpkyees. Below h the polio`and job site Ut�171'f17riPIfl1& .�`+c, _ � • Itrsurance CompanyName: to t�.• '/41 t�1 :Len 6 P;A4.n , r Policy r or Self-ins.L-ic.:::� ��Yd _7Fil 3 q I I— ;44 J9'E—%rativrrl3aten Job Site Adore.. Ztf -Say-d o"W l�r� Y pity?State?Zip: C 4•vh-wv 1�'l.,law &iZG S 2. Attach a copy-of the Workers`compens.ltion policy declaration page(shoeing the policy number and expiration date). Failure to secure coverage as required grader Section 2.5A of la3GL c, 15a can lead to the impo:�fioa of xi Mina penalties of a fine up to$1'500M and[or one-Year imprisonment,as well as civil penalties in the form of a STOP IW ORK ORDER and a fine ' of up to$250.00 a day against the violator. Be advised brat a espy of#hi,statement may be fon«ded to the Office of Investigations of the DIA for insurance coverage verification.. I do hereby col rift' idol'rJJapttir 1:d Iiies of pednq lot t1w inforulatioi7 pros i.d"nb a is a and c-orruct Si �srg bate: - Phone g: Offlricil use on(y. Do not wfite-ilt ibis apra,,#o be compldied bt'r iti oe toliw o " City or Town: Per•mit:1License 9 --- Isssiing Authority(cie rle one): 1.Board of Health b.Btritding:l7epArtt3eni 3.,Cits'fa �r Cler1; .Electrical Irrspectisr .Plumbing Inspector - 6.Other a Contact Per-son. Phone ii.s - 6 TE AC ® CERTIFICATE ®F LIABILITY INSURANCE DA10/M112013 Y, � 10l31/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is 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 endorsement(s). PRODUCER 04740-001 •C,l)I JAcT Miller McCartin dba Dowling&O'Neil Ins Agcy wl�acmto.Ext: (608)776-1620 roc.No.: 973 lyannough Road Hyannis,MA 02601 ggAtss: kbolton@doins,com ` INSU S)AFFORDING COVERAGEC INSURER A.I.M.Mutual insurance Company 33758 (NSURED William IN Croston u INsuRERB: William W Croston BuildingContractor s P O Box 138 INSURER Osterville,MA 02666 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 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 DDyyBY PAID CLAIMS. ILT TYPE OF INSURANCE INSE2 SUBR POLICY NUMBER' M�MIDDIY LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED occuABILITY rfen cel S CLAIMS-MADE OCCUR MED EXP(Any one person) S PERSONAL S ADV INJURY S ' GENERAL AGGREGATE S EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S OLICY EE° DO AUTOMOBILE LIABILITY E BII G IT S - accident) ANY AUTO . BODILY INJURY(Per person) S ALL OVVNED SCHEDULED ''r AUTOS I AUTOS BODILY INJURY(PET accident) S HIRED AUTOS NON-OVVNED PROPERTY DAMAGE S AUTOS (Per accident) s UMBRELLA LIAR OCCUR' EACH OCCURRENCE S EXCESS LIAR HCLAIMS MADE AGGREGATE ' S DEC RETENTION S ~ $ 'b$PHOMM6#1r x TsY LIM TS 50- A A P P ECUTIVE E.L.EACH ACCIDENT - S.: 1,000,000.00 PicWF'AVER�t���' [N NIA AWC-400.7013416-2013A 9/8/2013`� 9/8/2014 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 1,000,000.00 DEWWTl N 6MERATIONS below- E.L.DISEASE-POLICY LIMIT S 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it mote space Is required) r CERTIFICATE HOLDER CANCELLATION ' 'Mercantile Property Management 18 Waterhouse Road SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE' Buzzards Bay,MA 02532 ' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010/06) , The ACORD name and logo are registered marks of ACORD Details Page 1 of 1 Licensee Details Demogra hic Information Full Name: WILLIAM W CROSTON JR Gender: Owner Name: License Address Information Address: Address 2: City: HYANNIS State: MA ipcode: 02601 Country: United States License Information License No: CS-014112 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 5/12/2014 Issue Date: Expiration Date: 4/25/2016 License Status: Active Today's Date: 5/14/2014 Secondary License: Doing Business As: Status Change: License Renewal Prerequisite Information No Prerequisite Information Discipline No Discipline Information Documentum http://elicense.chs.state,ma.us/Verification/Details.aspx?agency_id=1&license_id=210759& 5/14/2014 r _DPraartmen# 7177 0f Public Safe#y Mi15�G��lESe S' :. - ��•ttra�(vv f�,e. t�t: iLiif;�3ECjlSl.9te0ila 3'L• 3: r {.-.. 'i �i 6rgse:C"i4112 - RR+ ; $ w® i � ti �11Y � , � tner 04120'� rz ,/�uaaac�u�aelta. �lze �aar�norua? ,+ i License or"registration valid for individui use'onl Office of Consumer Affairs fairs 12egulahon before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR `F S Office of Consumer Affairs and Business Regulation — Registration: y100023 Type `t i 10 Park Plaza-Suite 5170 E ; Expiration: 6/ 2044 DBA Boston,MA 02116 8/ BIL CROSTON gU �i`I 0 TRACTOR ICD witff. f' t ,, t •' �WILLIAM CROSTON 'r -, �' 5 55 SUOMI y 3i-HYANNIS,MA 02601 ! Undersecretarc � ; Not valid without signature Town of Barnstable Regulatory Services e s �� ". Thomas F.Geiler,Director QED�9. Building Division Tom Perry, Building Commissioner.. 200 Main Street, Hyannis,MA 02601 . Office: 508-862-4038 Fax: 50&1790-6230. Property Owner ,lust} Complete and Sign This Section If Using A Builder s M t' 4Ah'L p as"Owner of the subject property hereb authorize5� /IV,64 to act on Amy behalf, y in all matters relative to work authorized by this building permit application for: 1 (Address of Job) qIltbPIZ Ilk- S4a4xe 6f Owner Date �.t NJme Q:FORM&MMERPERMISSION r -ql1-7 y TkW i\Jli A 1 O1�I V®s x �s "-'6 and CommerclIirII older ' ,�°�n� t °N PI` �, �'cp��iv 11 ' W „ r March 15, 2014 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Street Hyannis, MA 02601 RE:insulation Permits Dear Mr. Perry, This affidavit is to certify that all work.completed for permit application#201309040;Status A; Parcel 247042 at 24 Sound View Road, Centerville, MA; Permit Type RADD and issued on 12:00:00 AM has been inspected by a certified Building Performance Institute(BPI) inspector. All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction Town of Barnstable �t Regulatory Services Richard V. Scali,Director a • a a • ,,�„s,,.AB� , Building Division BARNSTABLE 9 MAS g' cb 1639. �• Thomas Perry, CBO 1639-2014 '°tom fir► Building Commissioner. 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 March 23, 2015 Bill Croston ' 55 Suomi Rd. Hyannis, Ma. 02601 RE: 24 Sound View Rd., Centerville, Map: 247 Parcel: 042 Dear Mr. Croston, ' This letter is to inquire on the status of building permit application number 201402489 issued to remodel the above referenced property. As you may recall;this office issued a ` building permit on or about May 14, 2014 and to date the only inspection has been a rough electric inspection. Please contact this office to arrange for inspection or provide an update as to the progress of the work. Thank you for your anticipated cooperation in this matter. Respectfully, 1-912 jJde7 L. L Local Inspector jeff-rey.lauzon@town.bamstable.ma.us (508) 862-4034 a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -72 M � Parcel Mapppli ion # Health Division Date Issued Conservation Division Application Fee Planning Dept. - Permit Fee Date Definitive Plan Approved by Planning Board /zJc►�J'3 f1 Historic- OKH _ Preservation / Hyannis Project Street Address ^ Village �e�a cfr•Il� Owner ��f�l C 1,h/ Address Telephones —7�rq- 757y Permit Request Square feet: 1 st floor: existing ro osed 2nd floor: existing ro osed Total new, q 9—proposed 9—proposed Zoning District Flood Plain Groundwater Overlay Project.Valuation Construction Type 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 Ki W. Highway: ❑ s ❑'No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ;' c o i Basement Finished Area (sq.ft.) Basement Unfinished Area AAft) Number of Baths: Full: existing new - Half: existing Number fBedrooms: xitin •• cs� ube oexisting g —new I �o 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 0 Y Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION '(BUILDER OR-HOMEOWNER) Name Milo mccafths CANSwIletion Telephone Number 0 ft*. $2 Address License# Celt Z80-6964 C9r _58633 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE f^ t h E FOR OFFICIAL USE ONLY ,Y ARPLICATION# , r e' --PATE ISSUED MAP/PARCEL N0. t ADDRESS VILLAGE •� F< yd' y+3 J4 me ti �a y OWNER r ° DATE OF INSPECTION: LvFOUNDATION<E,," ,�£: it ru NuPr"'l— s° FRAME E ' INSULATION,. FIREPLACE ELECTRICAL: ROUGH FINAL ;{ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT I : •T Lt ASSOCIATION PLAN NO. i a the Commomste kh of Massachusetts Deparonent of 1'yulmstrid Accidents OKwe Of invesfigations z 600 Washington Street Boston,AfA 02111 wtvmmassgo,ldia Workers' CompensatianInmmuce Affidavit:BugdersfContractorsMectricianstMambers Applicant Information Please Print Legibly Mike McCa»cny,CO3UW i. Name(EusinesgrOtgani-a ionMAividnaq: .!o Um 52 West Denuis MA 026_70 Address: P�. ran 98 496d CSL-586 AJC-169AO CitylStat�elZip: o Are Jr an employer? Check the appropriate box; Tyre of project(rewired)_ 4. am a contractor and I ❑ 1.�am a employer vritlt�_ ❑� $ ti_ New construction .oyees(full andlor paart4ime).* -have hired the sub-contractors. 2_ am a sole proprietor or partner- wed on the attached sheet. Y- ❑Remodeling ship and have no employees -contractors have g- ❑Demolition w for me in an c ct employees and have workers' orktng y ape. t5 $ 9_ ❑Building addition [No workers' comp.insurance comp.insurance. required] 5. ❑ Vote are a corporation and its 10-�Electoral repairs or additions required] 3.❑ I am a homeommer doing all work officers have exercised their 11-0 Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12_.❑Roof insurance required]F c.152,§1(4),and we have no employees-[Na workers' 13.. ther comp-insurance required], *Any appfi+caat that checks boa-1 mast also fill out the section belaw shouting their woadken'compensation pokey information_ T Homeowners who submit this affidavit indicating they are doing all work amd then hire outside contractors moss submit a new si�davit indira�n�such- tCautmcturs that check this boot must attached an additional sheet showing the name of the sub-coutracton and state whether or not those entities have employees. If the stab-cont rants have employees,they must provide their workers'comp.policy number. I am an smpdoysr that is prmdr&ng workers'comperrsrrtion insurance for my employees. Beloty is Ste policy and,job site information. Insurance Company Name: Policy#or Self-ins.Lic.;1: Expiration Date: Job Site Address:' Cott.. City'State/7.ip: CFI Attach a copy of the workers'compensation policy declaration page(showing the policy number Anal expiration date). Failure to secure coy eiage 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 andlor one-year itnprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fi= of up.to$250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification_ I do hereby certify is a n andpenalties ofpetfury that the information primidedabm�e-is true and correct :. 5i tore: Date: a 4. 43 Phone 9: QjZcial use only. Do not sprite fn this area,to be completed by city or town official City or Town: PerrniVUcense# Issuing Authority(circle one): 1.Board of Health. 2.Building Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person; Phone#- 6 Information and Instructions Y �. Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 apptten be deemed to be an employer." MGL chapter 152, §25C(6)also stage'seat+�ee 'sa ,Iallirsing agency shall withhold the issuance or renewal of a ficense or permit to open-9£e%''NOWts Jed ; '�cQnstrFzct buildings in the commonwealth for airy applicant who has not produced deee�tagle esdd.nce,ofr bo nglia ice with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certi ficatc(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required- Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insumce coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Depaitnent of Industrial Accidents Office of kvestigations 600 Washington Street Boston,MA 02111 Tel.9-617-727-4900 W 406 or 1-877-MASWE Fax## 617-727-7749 Revised 4-24-07 - www.mass�gov/dia e,ie C4209aow"Ve Office of Consumer Affairs&Business Regulation License or registration valid for individul use only - OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ` i •egistration: ,<1'69393 Type: Office of Consumer Affairs and Business Regulation xpiration 6/16/2015 Individual 10 Park Plaza-Suite 5170 - ®, Boston,MA 02116 MICHAEL MCCARTHY s �~ MICHAEL MCCARTHY 6 RANGLEY.LN. SOUTH DENNIS, MA 02660-r Undersecretary ANot valid without signature I , Massachusetts -Department of Public Safety Board of Buildin Re g gulations and Standards Cunstructior, Supers isor License: CS-058633 ^' MICHAEL J MACARTHY ni PO BOX 52 W DENNIS NA 02670 •� ;-7 Co Expiration mmissioner 04/10/2014 -v l° OWNER AUTHORIZATION FORM } (Owner's me) owner of the property located at a 2 41 A014 (Property Address) (Property Address) hereby authorize C- A LJC OFfj (Subcontractor) an authorized subcontractor for RISE Engineerin o act on my behalf to obtain a building permit and to perform work on my property. Owhe gnature Date 5 TE ACC? 10116/20 CERTIFICATE OF LIABILITY INSURANCE °A10/16120'YYYY' 13 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 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 endorsement(s). PRODUCER !CpNTACT 01962-001 NAME: Bryden&Sullivan Ins Agcy of Dennis Inc �r��. fo_Ext);.-(508)398-6060 i _No.: (508)394-2267 PO Box 1497 - - ----- - _.. - ---- -2267 --- EMAIL So Dennis,MA 02660 1 ADDRESS: __11SIS RLS)AFFDRDJNG COVERAGE _NAIC q INSURER A A.I.M.Mutual Insurance Company _ 33758 INSURED INSURER B Michael McCarthy Construction Inc - INSURER C:_____ P O Box 52 West Dennis,.MA 02670 iNsuRER _____— INSURER F: i 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 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 CLAWS. ---- .. - Cy Epp p C - —-- - - ILTR! - TYPE OFINSURANCE - - I INSR f WVBD------ --- --- -- MM( IDD/YYW) (MM/DDYI t------ - -y POLICY NUMBER LIMITS GENERAL LIABILITY I EACH OCCURRENCE -- $ - -_ COMMERCIAL GENERAL LIABILITY j I DAMAGE TO RENTED ----, ----, 1 I I I PREMISES Ea occurrence)____-,.-- _-___,-_,_ 1 I CLAIMS-MADE I OCCUR ! j MED EXP(Any one person) 1$ I- L_..-._, - - ------ f PERSONAL&ADV INJURY j$ j GENERAL AGGREGATE _-L$— ,GEN'L AGGREGATE LIMIT APPLIES PER: 1 PRODUCTS-COMP/OP AGG !$ PRO- 1 i - - - — - - _,..�OLICY ,_. JECT... _. LOC —...L i._....... --- -...- --:..._ i_.. -:.... _ Li AUTOMOBILE LIABILITY i rCOMBINED SINGLE LIMIT ;$ - i-(Eaaccidenti -_- - 1 ANY AUTO ; I BODILY INJURY(Per person) $ _ALL OWNED SCHEDULED 1 ~ . BODILY INJURY Per acc!denaccident) $AUTOS AUTOS ! 'PROPERTY DAMAGE HIRED AUTOS ; :NON-OWNEDis 1 AUTOS I ! ! �(Peraccidentl $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ i -- - - EXCESS LIAB I---i CLAIMS MADE I I I l AGGREGATE- --- $ -- --- i DED RETENTION $ 1 $ ADEPLYMSN ION --- I ------ XI OYL MTS NPMO A AN yP3QQRIELQR/PARTNER/EXECUTIVE YIN i I E L EACH ACCIDENT $ 500,000.00 A oFFIc MEM R EXCLUDED? rY I N/A l ! VWC-100-6017656-2013A 7/17/2013 7/17/2014 r ------ -------- --- -- - (Mandatory in NH) 1 ;E_L_DISEASE_FA EMPLOYEE $ 500,000.00 If s ddescribe unddEE�r I F.L.DISEASE-POLICY LIMIT $ 5OO 000.00 DESCRIPTION OF OPERATIONS below i ----- ---. _.-L.------ —.-- ------- -- --- IT ------ , --- i ! I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF SANDWICH Attention:.BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN HALL ANNEX THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sandwich,MA 02563 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _ ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD � Assessor's map and lot'-numb 7 r .. ................ P�OfTNETO�♦ Sewage Permit number /. .�..... � . .... Z BABH9TODLS i House .number ................. .............. ................`............... 'o MASK .; O i639• MIN a� .TOWN : OF BARNSTABLE -BUILDING INSPECTOR APPLICATION FOR PERMIT TO . ..........( 12 4v .............................................:.. TYPE OF COfdSTRUCTION ........... .... ... ............................................................................. .................3. .1.Z ..............19.. F TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ ........il��.�... .................{111.'....... ........................................... Proposed Use ................... .l.V... .......9t7P141. ./*&-rp.........: �k�.r .A,). ....6&� ....... ?i� l�✓ ZoningDistrict .. ..... ......... .................. ....... .Fire District ...... ........ ..................................................... Name of Owner PO1� �... . f N.K. ....... ...Address .... .'4....�1a1'i �P .l1 ..... p: Name of Builder' !.?> l �Z!?!��a?'Yl .!,7 . .`�.?g('ir.Address 9.,*p.......G�. R Nameof Architect ...�V f A........................I.. ................Address ................................................... ............... .......... , Number of Rooms ....................Foundation Exterior .......' ..1 ,k�... R �.. I- . Roofing ....... ..!.... . J. ......... Floors .�6...... ..�...� ....SLt.�. .r4... ,��..G!!Uterior ....::.... sC'r' f%C ,r..r Heating ................................................. ..............................Plumbing .........C.A�... ......fl4jej........................ ....... Fireplace{............... ............................... ..................Approximate Cost .......... �/../y7r`�00... ..... .. Definitive Plan Approved by Planning Board`____:______-______-----------19_______. Area ...........'�L. ... .........:..... Diagram of Lot and. Building with Dimensions _ Fee ........... . .. ................... SUBJECT TO APPROVAL OF BOARD OF HEALTH lei 71 4 � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the 'Rules and Regulations of the Town of Barnstable egording the -above construction. Name .......... r t CANNY, MARIE 25315 ADDITION No ............. Permit for `................................... Sin le Family Dwelling � LocationS.ou dview Road ....*......:... ' : t r t.... .............. T �. Marie Canny rf Owner ............... .............................. ......•.... ^` Type of Construction Frame .... .................. ......... ... ..... ......... ' ' Plot :....................... Lot ............................... 4 y. `Permit Granted .......Jul......15...............19 8 3 �� 3Date of-Inspectio, '�e�```�:...� ....... ....19 -Date' Completed -A) .. .........19 (eO '1ry � 3. Assessor's map and lot number ` .�' Sewage Permit number /(�?... ,� �rs'��!, ,,,...!��r? .... .. House number ................:; THE t0�♦� B>S3J LLB .... ................................................. �� t63q. " CEO ypY a' TOWN OF BARNSTABLE I�. BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............ n!�.{�..1.r`�TIa ......t!. f f'f(. ................................................ TYPE OF CONSTRUCTION ................ .........4 ± ... .. .....' ............... ................................. ....:. ..: �1 t..::..............19... � /.. TO THE INSPECTOR OF BUILDINGS: , The undersigned hereby applies for a permit according to the following information: Location .......k``t`....�r�1V..11JF.. .V.l.t: .(ru......... ... . .......d-o- ........................................ Proposed Use ...................L.!. ...... —Qc�L f?"� .......... j �';)17...:�% f`� i...... �1 ndlr�r?iy, ZoningDistrict ........................................................................Fire District ................................................................................ Name of Owner 1. r1.F�''.......4./A.0.f�I..d�....................Address .....�.�+..���t�h?�:�.I�1t1.....�Y�:...................... Name of Builder' l t?t�1 ;. .. 1 .!?, J• Ylt .�7. ,`�. . .,`AddressI:.. .jT �.`" f / Name of Architect ........ f-A................................................Address ................. .A. .......��..�. i�......................................... . r Number of Rooms .....................S. .......................................Foundation ....... ........ �✓ /` r...........�t r�l,C..:�,� Exterior ....... ...R:it 1`..�.....�•�-�:��.. ....4<�. Ro fng ....... ::.). �!T. . . J A.l. '...... it Floors .. ......z 1 . ... .... .{z.t :. 5 f....U!tJNr erior .........: �. -L�. :t X.L.... /.��.I..:;.. .� ,! ...... .� A. I Heating ..................................................................................Plumbing ......... T......� �j................................... Fireplace ....................IV. .....................................................Approximate Cost ..........�f'./.,1?J��}C,....pG......... t ,.. / t�.... Definitive Plan Approved by Planning Board ---------------____---------- 9_______. Area �Y��'.../................ _ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH C p i I 1 f 0 i 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 4 construction. Name , ,, .. ...�- {,� F. �. ..... . .... CANNY, MARIE A=247-42 25315 permit for ADDITI Single Family Dwel], Z.g............. Location ... ..S.Qunduiew.. iad................ ...............[a spor-t...................... Owner .Mkt'.-Me....Caany.................................... Type of Construction ....Fxaxw......................... ................................................................................ Plot ............................ Lot ................................ Permit Granted .....July 15 .....19 83 Date of Inspection ....................................19 Date Completed ......................................19 '--Assessor's office(1st Floor): �� . Assessor's map and lot number •�� � � �o� °j����� ���li�ail� ������ "F�°TALLED IN COMPLIANCE �PyoT Tut>o�i Conservation - `� �u WITH TITLE 5 Board of Health..(3rd floor): ENVIRONMENTAL CODE AND DABllrLOc6 i `?ewage Permitt-nUmber �' TOWN REGULATIONIS rum Engineering Department(3rd floor): �o 0639. House number Rio Y1r C Definitive Plan Approved by Planning Board 19' f APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 1 A QL I E E. C A 4 4 Y TYPE OF CONSTRUCTION _ =CX q�- A 'I— p 12,5 19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following in/formation: Location 18 So lA Wn VIEW R6. _ AIYAAIA/5PDAr- Al4 400f6'V7 Proposed Use LAg�'b(zy (ROOM Zoning District Fire District 0 Name of Owner �ltj r{\ C_ CA Address 50u I c W Kb- Name of Builder S 1EV19 13RUt4E Address `3 �0WUAQi7 lAl C 5i4�� 1,OCa Name of Architect Address Number of Rooms o1�E' ��1 Foundation _ M&SoMP--I &F QoLl-OLU LA Exterior Co N't'f t V t N-4 t, S -b ld to Roofing A 5 P HALT H rJ C,LE Floors VI 41 Ft_c oR Interior CK.ITAPEb 4 p b Lift N TE 1) Heating 0-T 14',6Z Plumbing / Fireplace Approximate Cost Area 22 Diagram of Lot and Building with Dimensions Fee 1mO�rfl�o ` a o o ao � o I _ OW ADDdt i 1 o 4=rid h t 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 . Construction Supervisor's License 0 5?L� I (y�- CANNY, MARIE E. No 35157 permit For ADDITION 'Single Family Dwell ; n� Location: Sound V• e ri1'1�� exvann i ort ' Owner Marie E. Canny Type of Construction Frame .r' Plot ' Lot - - - Permit Granted June 25, 19 92 Date of Inspection 19: Date Completed 19-- O R .7 • \� DEPARTMENT OF PUBUC SAFETY COMMONWE(LTH -) \\\\\\ 1010 C 0MM0N,Y'EA'T.H`AVE OF BOSTON,MASS.02215 MASSACHUSETTS LICENSE EXPIRATION DATE , CONSTR. :SUP.ERVISOR. RES�RIMONS 9 3 6 EFFECTIVE DATE" LIC-NO. NONE 02If01/199U '053.164 STEPHEN S BUtiE 3 -HOWLAND LANE S5 '039-24.5054 . E :SANDWICH •*.FA 102537 r PHOTO(BLASTING OPR ONLY) FEE; 0000 HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE AND"OFFICIALLY z OR SIGNATURE OF THE COMMISSIONER DOB: 07/31/1939 (. THIS-DOCUMENT--MUST BE SIGNATUFlE OF IICENSF CARRIED ON THE PERSON OF w - THE HOLDER WHEN ENGAG. /' ffffff OTHERS„RIGHT THUMB PRINT ED .IN THIS OCCU PATIQ N; �/! . GOM MISSIONEI r iu.,�' cj"•.Vn 200M 2-87 81429 RESTRICTIONS 01 OTHER 18 HIGH PRE SSURE AND LOW PRESSURE 35 FROM END LOADER 07 SPECIAL LIMITED .19 HIGH PR E SSURE AND ROTARY_ 38 CAICH BASIN.SEWER %EANING MAG%IN .03 AUTOMATIC PUSH BUTTON 20 LOW PRESSURE AND ROTARY t Cl FRE`GHT 21 ASSISTANT . 37 SIGNEXTENSIONNLIFTS 05 HAT 39 SIGN HANGER 0E SCOTCH 22 TUNNEL 39 LOLICE GIVE,SELF PRC.P!:L 23 TUNNEL AO PO COI,LICE BOMB SOVAO 07 VFi.VT 24 MARINE (UNDER WATER) Al TRENCH M STRAIGHT 25 RESEARCH AND DEVELOPMENT 42 PORTABLE COMPANY 09- RANGE -," 28 BLACK PONDER ONLYy,., 43 ENGINEERED(COMPAN/) 27 SEISMOGRAPHIC A T1 y, O7 _ 28 ELECTRIC _ 44 PH E•ENGINEERED(COMPANY) 12 hIIGH:PRESSURE 29 CRANES 45 H Y OROSTATIC(COMF�ANY) 13 LOW PRESSURE -30 SHOVELS 46 PORTABLE(INDIWDU.LI� IA ROTARY 31 SACKHOES 47 ENGINEEREO(INDIVIDUAL) t5 POWER (LIGHT OIL). 32 DRAG LINES 48 PRE-ENGINEERED(INDlYIDUAL) 16 POWER (HEAVY OIL) - 33 CLAM SHELL 49 HY DROSTATIC(INDIVIDUAL) 17 RANGE AND POT 34 CABLEWAY DO b1 NO. STREET' ' CITY OR TOWN STATE ZIP CODE PRINT CHANGE OF ADDRESS AND NOTIFY THE COMMISSIONER OF PUBLIC SAFETY IN WRITING. a kA a� ��' UC T LA kA-C 1voAT H TES C I T� d {{ C Ac. G Aj T _0 L V N ,r 3 /t , Coo �- C - g . ` ,STALL.dk � �F Cavc s2A Lt Z Cb�C AAsP14ALAW J rl '. l- lZ E s t Ao GLS.6. n t iv a7J .� k 12,a c r n A(Y l) r � . - � ► � __ R dl!l� �� t /t/,%:� � � Ili'. C�a� 1 0 �' w A5 MA R D'RYE t� .t L �1 i �f 5 /Lj % �s'L t>�C'. *OA ;A1 t ..pper� ,,..} � • ' ` I "IMF i lAfG r2.irt/j. 4 b FRS M�RIe `-E_ tA'NNN/. SCALE: 1 2r�= ("O APPROVED BY DRAWN BY DATE: G 1 t 2 DRAW ;Nr, NUMBER 1rT SM"E POST 18AB-08 -11 x,17 €' - „ , � _ {• - ::, ,fir yy� .. .... "... .... .. ..:..: -•'�•..a's, ,.. ., .f. � ice{ , ,...' :: , s, 777 r i Y IJ yy +A� yy ....._ .- '..-'_. `\.. 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