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I. ,,:_i�. ,r i'. @ a^ rr,j,f t ( .,r:. sl'7i,' r' ,G !u•t it Y t 1 ft tft ;Y,-.. r I`'�r �'('t:k! } qq 'ti _. ! , r : 'tt '. i.: I 'r,i 1} !1 nl ,t't ;Ir vk�e.IIi11Jr I"itt'{,t �fiI !:3"' t : r I yi r k t - ,. , �.,,-:_ _..'. + - -n:r, ,i"-.`_':1L,,,.u... i'"} ti>..1.r,S.—t..- . �i_.i.. .-a:.�a,..,i�jj��r liti�lt!��vf I Y� i,7+f,JJ.r�,.�.p.'....,:..r �,!S d;�ra' •.t� l<}G>' y �- �VUE t Town of Barnstable *Permit# Expires 6 months from issue date rT Regulatory Services Fee 111 3 3— snxxszA11M v� ,MASS. Richard V.Scali,Director ®PRESS PERMIT �fD MA't A Building Division JUL 0ZOO Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 0260 1 TOWN OF SA R N STABLE www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY /f 22 60 2 �A NQt Vglid without Red X-Press Imprint Map/parcel Number (� //1 e- Ale iF IA4 Property Address G V /�! /,e C/ �ez7 f er yi �lLe, /V 426,T21 D<Residential Value of Work S 2/l 22& DO Minimum fee of$35.00,for work under$6000.00 Owner's Name&Address y50i G�i R i'614z01� /y /7— / f 0 C L. ' 2q V 6, .e Ale- Contractor's Name ZdX f dip V4//194.3 Gt tC C/— 014w i 4 Telephone Number �,Y` 921 od i(d Home Improvement Contractor License#(if applicable) / 7? Email: Construction Supervisor's License#(if applicable)_ CS 07 9� ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance_ Insurance Company Name -C4p ue17 C e C�� �' Workman's Comp.Policy# {��Z71�� Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box). ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value 0 2 (maximum:32)#of windows < #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Acy the Ho Im rovement Contractors License&Construction Supervisors Licenseis SIGNATURE: 0 Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 am W ' .'�� Tern-•�sr�s.t��rr�a�F- Erst� 'uu�t����—=��IPFsr�;c�iv,t , h3:Fam zEiEn Pipe- Nm=Oaia _ did V:,f / 6,0 �� : Cc1,10 11,9 020 2/ Phone 781 Q 2l 00 6'(9 Are =347f r � = L amaeu�Iayer t 4.❑Is=$gmdczmfa=fcr=cf1 E El Raw mad=:Fma esasFf apees{�II3.an�p�e�� ���€he ❑ I a sole props arpazfuer listed an the e3 s 7- ❑ sbig ami ba�*e na earplrs�ees T3 sab o S =4&U ees andhave u�ogs` V uU i forme im any aTac� � $ Q_ ❑$ add�on [No .`comp-k=== S. ❑ W6mamzgxafimaudits It-❑matsepaasuraddiH s s'_❑ I�a a doing aiI wori` °f=lxve CM=i&bd ffick ILD Pl=bmg=pzC=ar adzlili= rr�Ff �a '�P- �� Fer I��zL 1��$naf • i�s �>ae�I l zsz,$Its.zcdweliavr,2D flH 1 _71b�fizxf chedcsb=41=S t am fib o�f��rmbr7Owd_mz arn�r c� ay d eII f oatri cu�coas�si snhc�aum + <s Est�-ct�i bazma;t s�r�mu3di5ffisI sb��u�gthea�af��-a�a�-s m3� ��s 5�•-a` �¢tcp�s_�fbe�h-c. h�ve��PnEg�st�nuide 9t�- erg.pe�xcp amabes xbli•aa 4m�,kyer i}rvfisgri -VurkrM"egiq�tt==M=fOr My=Tr-yesr. Kelm is ffiepaFiq ar d}o6 sfs r�_ `s CO=cPaQy• ;mT._ J�GQf' 14 G/'�l &Iach cagy o-f w=ke s`contpcnaffi palmy decmraiim page(sTt�fim pouzy mer msa Sa#aoa }: Fa>hue i:o QeMM co v-erage asxeViMC1va6es SecfkxD-SA ofh!DM r-152 c=lead to•fife imposifi=arcrsiaraal peBMI&S of a fa;e:up to 00 OD aadfor oae- r as vr1 as cif pmmaliim m tm f—of a 5TCFF WORK t]$I-wand a fnr- cdmp.to S250JMadap-agarffieviobd r Seabiscd tit a.copyaffisiss nr33rbef3rwardodtatheOfEi=of F %J of ffie DU fr msm-a=cov=mge v I da e ss r urn ffc en hug curt carm.t - Si f L Bo2raifHex1th z.BmAfing I CRf «�ac�sT� . - � � � �Caat I.�-ws I52 regrsEres sIl to pLVQide woz�as'��on�ii��Ioyexs ' per „this stdzte,an erVP&Tee is drdZned as -ZMT PMSM in fge �s of a-- Cd=girt MLy DM&Mt ofhae> exp=m m iccP&ed, Drat orwritt� • An=TIapM-is defieci as"M =DCi�bnn CM_Pond=or other Ie921 Or any tyro or mare of�e f nmgoing engagsd in a3c�mt Vie,and in the Ieg-a1 r::p=mbfrv=of a dew emplcyc; to the • receaYes r�r trvst�of an p ,��-;atrsn ctr o#bes Iegal ea�iY>eo�l.opiag emF�S'e� Ho���.e ov�ner of a�weffmghanse haviugnotmore fizan iirree aPatiln�and who resides$e io,i$$re occupant of the dweYMg house �of MXI± whO eMplays PMs to do nmmA=mm mn&actI n.or repair worm on SUCK dweiimg house or on the grcumds or building agpminnar±f3rrrefn shall not because of smh m0ployme�be d=med to be-an.employ rr." 2YM rhapfn<r L52, §250( also slams fhd revery staff-or local li=mbag agency shmU withhold ffie issrzance or rea.e wal cif a use or permit to operah-_a burs�mess or to mnsti�c t buildings in the commonwealth for any applicant Trho has not Pzi,duced accceptable evitlence of coup cs:with�e one e coverage regtm ed' . Ad�aRy,�chapter I52,§250(7 std s Nf:if$c Ihm commnnwealthnorany ofitspolifical subd"tviszons shall enter into any fin'the p���e of purb&o nn acceptable evidence of compliance with the;,, retpxn==d:s of jigs cater have bean p==±rd to the cog ard c ty.' _ A.pphran,`s Please fill ourt the woldiess'mnopeasaiion affidavit complebtly,by slit g flue boxes that apply to your sitnz on and,if n==ajY, SPPIy svb-contar`nr(s)name(s), addres (es)and Phone m mbea(s)along with their ce_L'ficxte(s).of m�ance_ limited I iabr-Idy Compamrs(LLC)at I.im�dLiab�y Partnerships(LLP)wino employees other�the members ear posers,are not mquhed to cant'wozke2s'compems-ion mS**mmC:— If an LLC or LLP does have employees;a policy is r•egu?uex Bc advised that this affidavitmay be submitted to the Department of Industiial Accid=Lts for confumation ofmm=Tex bovwage Also be sure to sign and date the affidavit The affidavit should be retuned to the city or tow th n at tbE application for the pcm it or Iicemse is being regwzted,not fire Departs ezlt of Ind ntCia2 Accidents. Should your have any gncsfdoas regarding the law Or if you me reg-i f- to obtain a v*oil el5' co= p=saidon policy,Please call the Departmezi±at the nmabex Fisted below. Self filmn'd companies should eater their license n=Bcr on the sgpropriafr liar~ - CIty or Town Officials Please be sure 1$e affidavit is con�Iete and prim Ieg�Iy ISe Deparmeat has provided a space at the brsaim*, of the affidavit for you in fill ourt in.the event the Office ofTnvmfigsti=has to contar t.you regaFdmg the zpplie t Please be sure to El is the P_h a,rr=number which-, lM be,us,d'as EL=frrmce nrmiber. In addldon,an aPPlii=ant that must submit multiple peEIficeose applizafinns in.any given year,need only sohmif one affiuiavit indicating cunmt policy infu mnation(if n=msary)and under'Tob Site Address"the:applicant should wrif�,'an locations is (city or town).-A copy of the affidavit that has been officially stamped nr maziced by Ihe city or town may be provided to the applicant as proof that a-; Iid affidavit is con file fur futore pmmits or licenses Anew affidavit must be faed.o•±each year_Where a home owner or citizen is obtaining a license or permit notrela to any bursmess en eommeacial Ycnture Cl-ft.a dog license or peanit to burn le Ves eto.)said person is NOT rimed to complete this affidaYZt The;O Eco of.hms6gafmns would hketo fb2k you ia advance foryou'coopegation and should you have auy.questims, please do not hmita to give uis a call_ TheDeparfm. s add,telephone andfmxnombe r. gala OfMam- ach Depaiclm=t ElawtialA tz _ Rrvised 4-24-O7 _ CONTRACT TO INSTALL SOLACE REPLACEMENT WINDOWS Solace Windows of New England(the contractor)hereby submits this proposal to sell and install the Solace Replacement Window and,. ; related items as described herein at the residential premises set forth below.This proposal shall not become a binding commitment unless" znd until it has been signed by the Contractor and the Customer. - Contractor: Solace Windows of New England a adivision of LUX Ren v i o atons LLC. S LACE 60 Shawmut Road,Canto W I N D O W S Telephone#(781)821-0060 of NEW ENGLAND.. Facsimile#.(781)821-8552 Federal Tax ID#14-1855297.. I Mass.Home Improvement Contractor Reg.#137943 t Date Customer: Customer Name 1\l C_�G.y, 1.: laAj� .1`�'u�.�� rd•c-g0 Street Address j- :w City,State,Zip_ �nf�.w I I z i'Y)>�. •C> 'z 4 +. Telephone z/—SS,/Y This is a contract between the Contractor and the above named Customer to sell and install the Solace Replacement Window and related items specified herein at the Customer's residential premises identified below: Installation Premises: Street Address City,State,Zip ITEMS PURCHASED TOTAL SCREENS WINDOW COLOR CASING COVERS MULLS ..NEW _ UNITS Half Full # Color # - Color �� REMOVED - STOOLS Double Hungs :�� -22- 7. C�i1.('•i'C � Lai 1+t T'` Picture Windows ITEMS PURCHASED TOTAL UNITS STYLE - INTERIOR WOOD #"PANELS Single Panel Casements Bay Windows 0 Double Hung ❑Oak ❑Casement I❑Birch 1 3 , 2 Panel Casements Bow Windows ❑Double Hung 0 Oak - 0 Casement 0 Birch 3 Panel Casements DOOR MODEL #UNITS COLOR IN COLOR OUT LOCK TYPE ` 2 Lite Sliders - 3 Lite Sliders Colonial Grids N 7 Grid Type S L �-,r•l d 5 0J C �t- !ii'►Other. It Frosted Sashes - 5 vL C°i r3c� �v "�•C�1 -t 'WE ARE NOT RESPONSIBLE FOR CONDITIONS BEYOND OUR CONTROL INCLUDING CONDENSATION RESULTING FROM PRE-EXISTING CONDITIONS. 'ALL UNITS WILL BE GLAZED WITH SOLACE 366 HIGH PERFORMANCE DOUBLE PANE GLASS UNLESS OTHERWISE NOTED - PAINTING,STAINING OR DECORATING IS NOT PART OF OUR CONTRACT. r { Work Schedule": 1I Approximate Commencement Date: Approximate Completion Date: ?he proposed work schedule is approximate and subject to change Contract Price: , Total Contract Price: $ Deposit with order: $ 7 ,Z•,2 G,oO. o Cash (Check Balance Due: Terms: Cash o Finance % ' (Cash terms are deposit,33%on commencement;33%on completion) $ n C2 Due on Commencement $ 7 2 7 6 _. CQ Due on Completion j DO NOT SIGN THIS CONTRACT UNTIL ALL APPLICABLE BLANKS ARE COMPLETELY FILLED IN AND UNTIL YOU FIRST READ AND UNDERSTAND THE ENTIRE CONTRACT,INCLUDING ANY ADDENDUM ATTACHED HERETO;AS WELL AS`ANY ATTACHED SKETCHES,MATERIAL LISTS OR THE LIKE,AND THE TERMS AND CONDITIONS ON THE-BACK OF THIS CONTRACT DOCUMENT.' + YOU ARE ENTITLED TO'A COMPLETE,FULLY EXECUTED COPY OF THIS CONTRACT AT THE TIME OF EXECUTION. j Witness our hand(s)and seal(s)below on this y:�.Z_ day of L4 ZU j C LUX Renovations,LLC./Authorized Representative: , r . Signature and Title. - - - - _ • _ ' Pnnt Name •..: - •,. .. .. .. - ,... ..... :I DO NOT SIGN THIS C7A, ACT IF THERE ARE ANY BLANK SPACES .Cus/KBE J'l Print Na e ,t�.jfa 6 C tomer Si h�tu(rr��e � ,,,, z-,h dl�-e/tcS' L I r2,1 l Print Name. Contractor may have certain lien rights in the premises until the price is paid.in full.You have the right to cancel this contract,without any penally or obligation,at any time prior to midnight of the third business day after the date you.signed this contract.See the notice of cancellation below for an explanation of this right. "'Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to customer's execution hereof. Office of Consumer Affairs d Business Re ulation g 10 Park Plaza'- Suite 5170 Boston, M achusetts'02116 Dome Improvem`` ntractor Registration Registration: 137943 Type: Supplement Card LUX RENOVATIONS, LLC. .� y Expiration: 1/29/2017' DANIEL WALSH , ;} 60 SHAWMUT RD �i �- {c� CANTON, MA 02021 Update Address and return card.Mark reason for change. SCA i." 20rn-05/11 Address [-],Renewal 'F� Employment E] Lost Card fie tpanvneanc�e o�C?�i�suc�is�el�a • 'y ►ce of Consumer Affairs&Business Regulation License or registration valid for individul use only ' E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: a Office of Consumer Affairs and Business.Regulation Registration7gg3 Type:' ' 10 Park Plaza-Suite 5170 Expiration 1--: SupplementCard Boston,MA 02116 LUX RENOVATIONS L`L ` OWENS CORNING 'SHING SYSTEMS DANIEL WALSH 60 SHAWMUT RD CANTON,MA 02021 Undersecretary. Not valid without signature i Massachusetts -Departrpent of Public Spfety- Board of Building Regulations and andards y Construction Supervisor. License:.CS4079;93 i 1 DANIEL F WALSIt 488 KENDALL Rif' TEWKSBURY 11FA 0 ir Expirafibn.. I _ t commissioner: R 10/05/2G1' a Solace LaSUw—K t 00256 Oi1001 — — —Solace Window- - I ,, i Frame:Vinyl Extruded w/UltraCore I National Fenestration 1 Foam fill Glass: Dual Glaze LowE 366 i Rating CouncilOO I I Product Type:Vertical Slider Window I' ENERGY PERFORMANCE RATINGS U—Factor(U.S.A—P) Solar Heal Gain Coefficient 0 ,28 00' 21 INS ADDITIONAL PERFORMANCE RATINGS .Visible Transmittance Air Leakage 0 ,50 10 . 1 idanufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance. NFRC ratings are determined for a fixed set of environmental conditions and a specific product size. NFRC does not recommend any product and does not warrant the suitability of any product for any specific use. Consult manutacturer's literature for other product performance Information. www.nire.org ENERGY • e ` In A1150 States rM1 CORO CERTIFICATE OF LIABILITYDATE- INSURANCE `"M/DD"'''r'r' 5/28/2015 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 requlre7an endorsement.'A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jane Logan Andrew G. Gordon, Inc. PHONE (7B1)659-Z26Z FAX (781)659-4725 306 Washington Street •MAIL. A!C NO ADDRESS:]ane@agordOn.COm INSURERS AFFORDING COVERAGE NAIC# Norwell MA 02061 INSURED INSURERA-Libert Mutual A ncy INSURER B:Pi1 rim Insurance Company 21750 Lux Renovations, LLC, DBA: Owens Corning of New INSURERC:Peerless Insurance'Co. 24198 60 Shawmut Road INSURERD:Star Insurance Company 18023 INSURER E Canton MA 02021 INSURER : COVERAGES CERTIFICATE NUMBER�Saster JL 2/6/15- 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. INSADDLSUBRI R LTR TYPE OF INSURANCE POLICY EFF POLICY EXP WVDPOLICY NUMBER M/DD POLICY L1AAnS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A I CLAIMS-MADE Fx]OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 CBP8512851 9/5/2014 9/5/2015 MED EXP(Any one person) $ 5,000 • m -. PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 0 PRO- El - ' JECT LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: § AUTOMOBILE LIABILITY , CTI.1 NED SINGLE LIMIT $ 1,000,000 B ANY AUTO - BODILY INJURY(Per person) S 20,000 ALL AUTOSNED X AUUTTOSCHESDULED PGC10007161409 1/17/2015 1/17/2016 BODILY INJURY(Per accident) $ 40,000 NON-OX HIRED AUTOS X AUTOS wNED PROPERTY D $ Unirsraed motorist ru sorft limit $ 250,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB H CLAIMS-MADE e AGGREGATE $ 1 000 000 DED I X I RETENTION$ 10,000 CU8511953 �9/5/2014 9/5/2015. $ WORKERS COMPENSATION PER OTH.. - _ AND EMPLOYERS'UABILITY YIN STATUTE ER ANY PROPRIETORIPARTNEOFFICERIMR/EXECUTNE E.L.EACH ACCIDENT $ 1,000,000 D (Mandatory In H)EXCLUDED? N/A (Mandatory In NH) irC0428715 5/24/2015. 5/24/2016 E.L'.DISEASE=EA EMPLOYE $ 1,000- 000 If yea,descrlbe under DESCRIPTION OF OPERATIONS below E:L..DISEASE-POLICY LIMIT $ i 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACGRO 101,Additional Remarks Schedule,maybe attached if more apace Is req%dred) Carpentry/Basement finishing/Window'Replacement CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE.DESCRIBED POLICIES BE CANCELLED BEFORE Insured r s copy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Geoffrey Gordon/LEE ���t �— ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD " INS025 rgnt4ntl F6-0 3i �s� I l I - 7,6- g� MAY/24/2013/FRI 12: 50 PM COMM Water Dept FAX No. 5084283508 P. 002 Cente e-Osterville-Marstons AMS Water Department' P.O.BOAC 369-1138 MAIN STREET OSTERVIL LE,MA,SSA,CHUSETTS 02655 www.commwater.com yaa� • O P OFYXC&OF BOARD O�WATF-R COIVMSSIONERS WATER WATER SUPERINTENDBNT DEPT. TEL.No.508-428-6691 ��NS FAX.No.508-428-3508 May 22, 2013 w Mr.Richard B. Trull 23 High Ridge Road BOXford,MA 01921-2103 M Re: Account#512 29 Vine Avenue Centerville,MA Dear Mr_ Trull: I This letter is to inform you that this Water Department appreciates your assistance in connection with the backflow preventer between the supply valve and the feed valve to the boiler being installed on May 14, 2013 by your plumber. Again, we greatly appreciate your cooperation in this matter, thank you. Sincerely, Herbert L. Mc Sorley Assistant Superintendent HLMCS/jw Cc: Town of Barnstable Plumbing Juspector "1937 to 2012 Celebrating 75 Years of Service" ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel. .Application Health Division Date Issued Conservation Division Application Fee Planning Dept, Permit Fee , Date Definitive Plan Approved by Planning Board GK 10� 11� Historic - OKH _ Preservation/Hyannis Project Street Address 7 C% %h nr_ Ave- Village A V�I le. Owner AAn -TV-L., �1 Address Ave , Gegv.111� Telephone 606- 775- 2 b 8`Y Permit Request a► 9=iP\txea- t ►b Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay o O Project Valuation &I ? o Construction Type z Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting�Plcumen'tation. 0�0 Dwelling Type: Single Family,•2r Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 2rNo On Old King's Hi wad ❑Yes, INo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other _ c o r- Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft)w M. Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) -Name - L�%ae-O Gf!!�sPart Telephone Number Address 225- License # 77 8Ll ®2-6® 0 Home Improvement Contractor# d 36,SZ 2- Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 13 SIGNATURE A DATE G O 114 B 10 4 FOR OFFICIAL USE ONLY 1 APPLICATION# t 1 .-DATE ISSUED MAP/PARCEL NO. T ADDRESS VILLAGE n i OWNER s . ; r t DATE OF INSPECTION: j FRAME f r k-INSULATION_ ' FIREPLACE t I > ELECTRICAL: ROUGH FINAL i . PLUMBING: ROUGH FINAL is t G'AS zv—.-- -ROUGH FINAL .r ;4NAL_BUILDIN_G � ;!G, ^ h DATE_CLOS.EDOUT w F ASSOCIATION.PLAN NO. I t 1 1 The Commonwealth of Massachusetts ' v Department of lndustrial Accidents 0-ce of Investigations 600 Washington Street t Boston, MA OZXIX y www.mass.gov/dia Workers' Compensation Insurance Affidavit'..Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/0rganizati on/Ind ividual) e 6//10.., Address: City/State/Zip: t�26o i Phone # jJ�3 `l 51 "�`-1 `0 g Are you an employer?Check the appropriate box: -Type of project(required): r-� 4. ❑.I a dlm a general contractor an 1.LJ I am a employer with 6: ❑New construction employees­(full and/of part-time).* have'hiredthe sub-contractors..: . _ - Iisted'on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor.or partner- , ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition comp. insura.nce.1 [No workers comp. insurance 10.0 Electrical repairs or additions required.] 5• ❑ .We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their l l.❑ Plumbing repairs or additions ' right of exemption per MGL` 12•❑ Ro myself. [No workers comp. .of repairs insurance required.] t 'c. 152, §1(4), and we have no employees.[No workers ]3.[jOther E comp.insurance required.] *Any applicant that checks box 41 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 fo'r my employees._ Below is the'poligy'and job site information Insurance Company.Name: dF D Policy#or Self-ins, Lic.#: VULG Twl Rq0 12.010 Expiration Dater 3 1 6 1 it - Policy Site Address: Z9 1!i xL Ave- Cyk►► 0, 1e City/State/Zip: dY)A Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the-violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains anIdpenalties ofp.erjury that the info rmationprovided above is true and correct. Signature � - tt 4 Phone#: LY51 -11-1y g Official use only. Do not write in this.area to be completed by city or,town.offciaL City or Town; f' % 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 Phone#: Contact Person: f' x information and. truCiX® comn for their Ces- rcrs' Massachusetts General Laws chapter 152 requires all employers toprlheisery ocekof an th P under oany contract f hire, Pursuant to this statute, an emploYee is defined as ".,.every person In express or implied, oral or written." " association, Corporation or other legal entity, or any two or more An employer is defined as an individual, partnership, asso rP t e legal re senlalives of a deceased employer, or the re of the foregoing engaged in aloint enterprise, and including h g p receiver or trustee of an individual partnership,'associah6n or,other legal entity, employing employees. However the owner of a dwelling house having not more than three apartmen is and who resides therein, or the occupant of the dwelling house of another who employs persons to do.maintenance, constnuction 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 slates 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 lvho has not produced acceptable evidence of compliance with the insurance coverage required." ll Additionally, MGL chapter 152, §25C(7) states "Neither the common tevidence of comph nor any Of its liance witical bh lhre ionsuUanns ace enter into any contract for the performance of public.-Work unt�1 acceptable uthority." requiremets of this chapter have beenpresented to the contracting a n 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), addresses)and phone numbers)along with their certificate(s) of insurance, Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have of IDdLIStria equired. Be advised that this affidavit may be submitted to the employees, e policy is r and o the affidavit ntThe affidaviilshould Accidents for confirmation of insurance coverage. also be sure to sign, be returned to the city or town Lhat�the application for the permit or license is.being requested,not the Department of Industrial Accidents. Should 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• S elf-ins ured 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.permiUlicense number which will be used as a.reference number. In.addition, an applica nt that muss submit multiple prrmiV1jcensr applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicanbt s hoeuldt writeown mocations in y be provided to the(cily or town).-A copy of the affidavit that has been officially stamped or marked y y applicant as proof that a valid affidavit is on file for future permits or licenses. A business affidavit mustiness or comm l venture mercia filed out each year. Where a home owner or citizen is obtaining a license.or permit not related to any (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigation -d-like to Lh�nkyoro-in--'adva-nee-for-y-0ur c-ooP-eratinn and should you have any questions, please do not hesitate to give us a call, The Department's•address, telephone and fax number: The.Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 nt 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.lnass.gov/dia z r ti Town of Barn,-stable k Regulatory Services' swaxsresc v MA&q. Thomas F. Geiler,Director Eo Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 veww,towri.b arnstabl e.ma.us Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, tC"Y1 I1 �i tat as Owner of the subject property hereby authorize i, to act on my behalf, in all matters relative to work authorized by this building permit application for t (Address of Job) Y Signature of Owner • Date Print mirile Y If Propeiu Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RMS:O WNERPERMISSION e . Town of Barnstable a ,v P��p�tiE rp�y ' 0 Regulatory Services Thomas F. Geiler,Director t LIRNSI'ABI-E. MA9.9. Building Division v �rfeD " Tom Perry, Building Commissioner 200 Main.Street, Hyannis,MA.02601 _.. www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as Supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a bomeowner. Such "homeowner"shall submit tothe Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies thathe/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION :The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section lD9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption an unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible.. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. You may care t amend and adopt such a form/certif ration for use in your community. Q:forms:homcexcmpt f Massachusetts-Boar(J of Del)itrtment of Public Safet, Building Rea Construction Su ''ul<ttions and Standards pervisor License License: Cs , 77846 Restricted to: 00 MICHAEL B ,.• + `3y '+ �� GASPARD I 225 GOSNOLD ST ,y HYANNIS, MA 02601 ('unmiissiuner Expiration: 3Q312012 Tr# 22435 0 fiiceAoh's'GCfwYi4'W"i 6wdk a License or registration valid for individul use only I HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to Registration: �136522 Type: Office of Consumer Affairs and Business Regulation IFL Expiration 8� 012 Individual 10 Park Plaza-Suite 5170 ' "� Boston,MA 02116 BENJAMINA- /1 PARt7 MICHAEL GASPAR -j 225 Gosnold sty' Hyannis,MA 02601 i�? Undersecretary Not valid with t s nature K Client#: 51796 GASPMIC1 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DAo(MMIDD 0 THJS'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 CONE: Mina Vaughan Rogers&Gray Ins.-So.Dennis . PHONE 508 398-7980 . 434 Route 134 ��°E>n` A/c "° P.O.Box 1601 ADDRESS: CUSTOMER ID#: South Dennis,MA 02660-1601 INSURER(S)AFFORDING COVERAGE NAIC# INSURED Michael Gaspard LLC INSURER A:Nat'l Grange Mutual Insurance C INSURER B:Associated Employers Insurance 0b6'Renovation Socialists INSURER C 225-Gosnold Street Hyannis,MA 02601 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 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 POLICY EFF POLICY EXP POLICY NUMBER MM/DD MM/DDNYYY LIMITS A GENERAL LIABILITY MPP66726 5/17/2010 05/17/2011 EACH OCCURRENCE $1 000 OOO X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100 000 CLAIMS MADE OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS (Per accident) $ NON-OWNED AUTOS $ $ UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ B WORKERS COMPENSATION WCC500799901201 O 3/06/2010 03/06/2011 WC STATu- OTH- AND EMPLOYERS'LIABILITY Y/N r ANY PROPRIETOR/PARTNER/EXECUTIV E.L.EACH ACCIDENT $50O 000 OFFICER/MEMBER EXCLUDED? wP — ' (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $50000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L:DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) **Workers Comp Information-Excluded Officers or Proprietors-Michael Gaspard,sole proprietor CERTIFICATE HOLDER CANCELLATION 10 Da s for Non-Pa ment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town of Barnstable' ACCORDANCE WITH THE POLICY PROVISIONS. attn: Bldg Dept,200 Main St. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ` @198 2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S58532/M58531 MLV f II �se�sor's Office(1st floor) Map ^4� Lot v� ermit# os46 /Conservation Office(4th floor) 1 �� Date Issuu�edi /Board of Health(3rdd floor)(8:30-9:30/1:00- 2:00) ENC AAG �1 -t` � ee yp J1 0 r �En ineerin Dept. 3rd floor House �fNr�1D 2oO+m g g P ( � � ) ��� Planning Dept.(1st floor/School Admin.Bldg.) �pQ��P@ E2Ef€7ALL1fn • iB�ARN3fA�LEf�• L91A SCE Definitive P by Planning Board rat - 19 I (��� TOWN OF,BARNSTABLE ` "�, � Building Permit Application ---Project Stre t Addres o2 /l�� ✓� *`' ;/Village l�J7�a�11(l Lam' MA. 1/1'Owner XO Address 93 — , /Telephone s a C)\`\9-\ a ' ,Permit RequestC�Ui��A�t4..� Total 1 Story Area(include 1 story garages&decks) A(D square feet Total 2 Story Area(total of 1st&2nd stories) 5�,��. square feet ✓ Esfimated Project Cost $ pp 0 . Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction-Type. ` •Commercial., Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder information Name p,\pe\\ �,-Telephone Number �SQ8- /Address , ✓ �•�• �X ��LA License# 0�1,9 iN6N POK7 Q a(P ___, Home Improvement Contractor# \O S to S A Worker's Compensation# r"'N\�J _ , )-©o(SLL 3 "03• 9q NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PRO CT WILL BE TAKEN TO SIGNATURE LV4�DATE,,� BUILDING PERNJ(/DE' NIE9 FOR E FOLLOWING REASON(S) �� r FOR OFFICIAL USE ONLY 4 ' PERMIT NO. 10510 _ DATEISSUED -.Sept 21, 1995 226.028 MAP/PARCEL NO. ADDRESS 29 Vine Avenue VILLAGE Centerville, MA 02632 OWNER Ann-C. Trull DATE OF INSPECTION: r j FOUNDATLON Z<A120 FRAME L X�� 0, Z `'t LpK INSULATION Y 4 rr f Y FIREPLACE ELECTRICAL ROUGH FINAL PLUMBING: ROUGH FINAL R' GAS: ROUGH FINAL FINAL BUILDING �. DATE CLOSED OUT ASSOCIATION PLAN NO. f ' v . The Town Of Barnstable . Kum Department Department of Health Safeq and Environmental Servt 0 Building Division f f 367 Main SIrm.Hyannis MA 02601 Ralph C Office: 508-790-6227 HWtZdias F= 508 775 33" For ace use only Permit now Date AFFMAVIT HOME IMPROVEMENT CONTRACTORLAW SUPPLEMENT TO PEMMTAPPUCATWN MGL c 142A requires that the" tstrnaron,aitezaions rrnoradM °II+ooavc rc=%L demolitim or c==md n of an addition to =Y P Owner ace bniIding containing at least one but not more than fear dwelling units or 10 stta"+a which are to such residence or building be done by registered contract= with ce:taia ins,along wrth Rgniremcuts 'type of work—,eu ?` -;- /- Est.Cost d O address of work: c A tl-"' /Oa-ner.Na= C,d z1 /V Date of Pe: M Application: I herebr coey that: Registration is not required for the following r=s=(s): Work=bdcdby law Job under SI,000 Wilding oat awnawocapied Owner Pulling am permit Notice is hereby gi%vn that: OWNERS PULLING THEIR OWN PERIvQI'OR DEALING Do NOT BAGI G TO Y01t ppPLiCABLE HOME II�ROVEMEi�TI' ARBrrRATION PROGRAM OR GUARANTY FUND UNDER MGL c 142A SIGNED UNDER PENALTIES OF PERJUR7t I h 'apply for a permit as the agent of the , No. R,egrsuauoa ate OR { The Cotllntomvealtlt of Alassachusctts j*;_ Dc pnrtnunt of Ittdttstrial Accidctrts MCI?of INFOSM92118fts 600 {i<ashingtonStreet �Vi: Boston, Ma.v . 02111 Workers' Compensation Insurance Affidavit A licant information: Please PRI1�1T l lebtbT , name: location: City 12hone# :Sa- c4 q q- 1 am a homeowner erforming all work myself. 1 am a sole proprietor and have no one working in any capacity Y."i;, rood'. a-•^ nv',*'tP �:..yy S lie�'ym+tz.g F39 ,yw'T r'dPPJaY '.F*°'AL"A'} .2„ Y,M"`'nyyrh.T^. a••v,,,.,r-tr•y. �. it t..,.,r• .,.. ..twve'�'�,u�.n.'Se�ss.°^ �E'�, ". •:��`�n� t..�y rozn•':e'u�'3`' .x:.z.;v:.G,¢'�•�,tf �, �! ,z��°' ,az ->v-wee.::.a.a.S:.`•Z......r.:�...:rv"�r am an employer providing workers' compensation for my employees working on this lob. company name: 7S . — '� ' 1 address: �' JcJX SL9'1 city: 02U'6 phone#: insurance co. \C ����C �J��CdS Tpolicy# Q qsLA v CIC k......iJw. wa..4s,i4..x»....w.rd »i _. ., ..., ✓ .. : ,. :.+ ... '.frh2h,�WEZT kL �nw�f s.. S,.wsr N .r"3t..:fi1..�':t:� ..s am a sole proprieto eneral contractor r homeowner(circle one) and have hired the contractors listed below who have the following workers compensation polices: --- company name: C1.I.4., address: O . �X 0L phone#: C�`�' CASs i insurance co. COMM e(Z.-C. )L�S. policy# -.,.�., -- sn*ro m.V r^�i ^•y: -rr;+-• x�r..rm:..,, n•x,�-'�a4Lf�S�.l,1 •�' •�.+a�: '��y`°��'�` ',�y" ..ts-.--•-..:._;�.� •� »ram .[c":.s:h�..,,,c.,n.^b. .x,.sai. '„,._:..a84_A.�SYa:r..�:;tisSA�i:Swki.::�.bi�XLi xi:id,�n`b avt`iaiLX"-.�&37'�.L`2���Y T—.,_�_:•� ..__ 'r�i+�p-.s — :si-i�l�„u� company name: address ��C� \{ i1� ��\C.ya�� b� Q- city• phone#• insurance co. _ policy# Atihc_h additional sheet if necessaryry r. W '""•f��tt� /y"�`�{ ["'tl"' �, s� ' .»....�»...»....k,.,,,. .„..,,............��tta:sxkiifl..<.s.r5it-•'bq �"wq�d• Y' d � ✓.R'�s 'sGr�s[M+� `3Li?�Si.�L'�P'ItfA���aa�Riia.'$G�^.zwM ..S ,S•4x.;'.n:»ws#f �:�'AC`fAJYiC. Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjun that the information provided above is true and correct Sienature pate /Print name /Phone# 7official do not write in this area to be completed by city or town official permitAicense# r-IBuilding Department [:)LicensingBoard ❑check if immediate response is required ❑Selectmen's Office l4calth Department ' - #• lher contact person: phone U p n ' �.:wtiis'3fw6r Ira ised 3/95 P1A) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an enfpinvee is defined as every person in the service of another under-any contract of hire, express or implied, oral or written. An enrplover is defined as all,individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing enga�tled in a jint 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 section 25 also states that every state or local licensing agency shall withhold the issuance or rene,*val of a license or permit to operate a business or to construct buildinbs in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, 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. .....,.,H,. ' — «., ..a� Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure,to sibn 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. a¢-, •e.:.flt rx �, J✓ waC"^"a""�.r-^.a. .;er.ran+•._v- ' ' �.. . 5t .r Citv or Tos%,ns 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. The affidavits may be returned to the Department* mail or FAX unless other arrangements have been made. The Office of investi(,ations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. �.^. m..u-r,•'.. ;.. v,- 's-sear !r:a .R.-.+r ��•., '�".+ne...s+xaa:tea,.�.+ +a<aa� � ^-s+-r��i�'°. '�w;^�t•.�•�aa�nts .r.� rs ✓-+ew.t�y'+ars The Department's address, telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 CERTIFICATE OF INSURANCEt CSR CC 02/03/951 i PRODUCER I. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND 1 1 Paul `Pdters Agency, Inc•. ( CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 1 I ( DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE 1 P O BOX 669 i POLICIES BELOW. I Falmouth, MA 1I --------- - -- = - ------ ""------ ---------------- ------ ---02541-0669 I - OM- AFFORDING -AFFORDING -COVERAGE--- --. PHoNE508-548-2500 I 1 -----------------------------------= _ INSURED --r ---- ------I-COMPANY-LETTER A -----AETNA------------------------------------------- I I COMPANY LETTER B I P & R Construction Company I--- -- --------------- --- ------------------------------- ------ I P.O. BOX 3634 1 COMPANY LETTER C WaoitMA 1-7-=-------------------------------------------=-------------------------- I 0 2 7 J 6 I COMPANY LETTER D I--- ---------------- ---------- - --- - I COMPANY LETTER E -- __ -- _ I 1> COVERAGES <................ r I THIS IS TO CERTIFY THAT POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY 1 PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF-ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 1 it WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY.PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO 1 k I ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE.BEEN REDUCED BY PAID CLAIMS. ---------------------------------- ------------ - --- ------------------------ - I CO' TYPE OF INSURANCE i POLICY NUMBER I POLDICY ATBEFF i . POLICY EXP I LIMITS 1 LTR I I DATE - -------------------- ----- I--- 1----- --------I-----------` - I -- I t a: GENERAL LIABILITY j I I IGENERAL AGGREGATE-- ----- ---- I I I i A 1 I I 1-------------------I---- 1 z. IIf ) COMMERCIAL GEN LIABILITY I ( I (PROD-COMP/OP AGG. I } i = CLAIMS s MADE I ) .00C. I 1 I 1PERS. & ADV. INJURYI I-------=---- OWNERS II ) PROTECTIVE & CONTRACTOR'S ----------- I ----------- 1 ) I 1 PROTECTIT VE I I (EACH OCCURRENCE IFIRE DAMAGE 1 I I(ANY-ONE_FIRE) __ I [,1 I I - I IMED. EXPENSE ---I a 1 1 1 I I i(ANY ONE PERSON) , I I� I --1------------------------- =1 - 1---------------1--------------I—, -- ----- -----=I------ --v I { I 1 AUTOMOBILE LIAR I I I ICorB. siNGi.fi LIMIT 1 I 1 I I [ ] � I I I 1-------------------I------ - --- - ANY AUTO IL 1 ALL OWNED AUTOS I I (BODILY INJURY I N II ) SCHEDULED AUTOS ((PER PERSON) 1 i----- ---------- -I ------ HIRED AUTOS II ? I 1 1 (BODILY INJURY NON-OWNED AUTOS II 1 GARAGE LIABILITY I I I ((PER ACCIDENT) 1---- ------ ------I --- - I 1PROPERTY DAMAGE I---1--------------- - I ------------------ ,----i----- ----i------ -------1----- - I ---- ----= 1 EXCESS LIABILITY TEACH OCCURRENCE ' 1 I ]'UMBRELLA FORM I( ) OTHER THAN UMBRELLA FORM (AGGREGATE _ _ -- _ . I' 1 I •u* I- --I----------------------- 1-7---------=---------------1-------------- 1--=-----------I- --------=--------i ----- I X I WORKERS' COMP I 1 1 IX (STATUTORY LIMITS 1 °` i N I I I 006 C 24474863 1 01/04/95 101/04/96 IEACH ACCIDENT 1100 1 ANDI I IDISEASE POL: LIMIT 1500, 1 XI EMPLOYERS' LIAB I 006 C 24474863 1 01/04/95 101/04/96 (DISEASE-EACH EMP., 1100 ws�1x ---I----------------=--=----- -=--1 ------------=------------=I------------ 1-- --- --- I----- ------ -- --- --- - OTHER E ent F OPERAtatched:.. PECIA --------------------- -------- ---------------=- -- -- --------- ----------- - 1� 011 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS I rp_ ry- private residences 14 °I , Fr I4 pM -1> CERTIFICATE HOLDER <------------------------------ > CANCELLATION <.................. .e...o.......m...aa. ee.a. 1 I. SHOULD ANY OF THE:ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE-THEFEX I PIRATION DATE THEREOF, THE ISSUING`MMPANY WILL ENDEAVOR TO MAIL 301, '- 1k I DAYS WRITTEN NOTICE TO THE CBRTIFICATE'HOLDER NAMED TO THE:LEFT,'BUT I FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE .NO OBLIGATION OR LIABILITY OF: 1 ( J Tarrabelli , Inc• ANY KIND UPON THE COMPANY ITS AGENTS OR REPRESENTATIVES. I � 1 PO 'Box 564 _ ---------------------------------------------------- 1 Mashp@@, MA AUTHORIZED REPRESENTATIVE I 1 0.2649 _ i 1_AcoRn zs-s ( /9o) Robert N. Lynch Jr I rn? . rat` �t J-ti1• I I H0_ Ui_I.j}1 r AI:III�i�e IG�ATE OF INSURANCE -- ISSUE DATE(MM,00m) +f PRODUCER THIS CERTIFICATE 18"ISM AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON INS. AGENCY OF CAPE COD, INC. DOES NOT AMEND EXTEND THE CERTIFICATE HOLDER.THIS CERTIFICATE OR ALTER THE COVE p. RAPE.AFFORDED BY 0. BOX $3 8 Pou s EL THE EAST SANbW I CH, MA 0 2 5 3 7 COMPANIES AFFORDING COVERAGE LETTGA Y A AETNA CASUAL,rY R SURETY CO. InsuREO COMPANY AMERICAN POLICY.HOL,DERS INS. CO. C J BtSSCO CO. COMPANY C i P. 0. BOX 658 SANDWICH, MA 02563 COMPANY I.ETTER D COMPANY LETTER E OOVIRAb@S THIS 18 TO CtRTIFY 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 14EREIN IS SUBJECT TO.ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITR SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. } CO 7VPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDDIYY) LIMITS f GeNIIRAL LIABILITY A 'XX COMMERCIAL GENERAL LIABILITY GENERAL AOGRHOATE t 1 ,000,000 006MP0024257946 7/9/94 7/9/95 P040DUCTS-COMPIOPAGO. t 1 ,000, CLAIMS MADE ,ODOUR. OO4 x PERSONAL 6 ADV.INJURY t 506,400 OWNER'S A CONTRACTOR'S PROT. EACH OCCURRENCE t. 500,000 FIRE DAMAG6IMY one are) t 50 oQ4 AUTOMOBILE(:IABIUTv MED.EAP04SE(My One Perron) ffi '000 ANY AUTO COMBINED SINGLE t s LIMIT ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY t (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY t (Per eccldem) ? GARAGE LIABILITY ' PROPERTY DAMAGE t S 1 Excess LIABILITY UMBRELLA FORM EACH OCCURRENCE t .. .: . AGGREGATE t OTHER THAN UMBRELLA FORM' k B WORKERBCOMPQNSATION IWCC182969-02-94 9/26/94 9/26/95 STATUTORY LIMITS � AND EACH ACCIDENT f ,,100 1 EMPL01AW LIABILITY DISEASE—POLICY LIMIT 't S.OQ,OOQ _•,. DISEASE—EACH EMPLOYEE S - ` OTHER DESCRIPTION OF OPERATIONS/LOCATIONAIVRMICLES/SPECIAL ITEMS CONCRETE WORK 'CER 11=ICATE MWER CANCELLATION J. TARAB) LLI, INC. pw SHOULD ANY OF THE ABOVE DESCRIBED-POLICIES BE CANCELLED BEFORE THE P. O. BOX 564, MASHPEE, HA 02649 ';`I EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO :F I'l MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE T �i LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY, ITS-AGENTS OR REPRESENTATIVES AUTH RIZZO R HT y DECONTO ... - ..-. .. - - � .. _ - . . 1v�F S�;~ Y�� fir.av •� - -- t .�•{, r� ACORD CERTI 'F I C .ATE O F I N S U R A N C E' ISSUE DATE 12f27/94 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER Of INFDRMATIOMI ONLY a®'O�IPBRS BOYNTON INSURANCE AGENCY NO RIGHTS UPON THB CERTIFICATE SOLDER, THIS CBRTIFICan DOGS NO?'AI®,` 72 RIVER PARR STREET BXTSt1D OR ALTER TMMB OOVBRAGB AFFORDED BY THE POLICIES BBIAW. NBBDHAN, MMA. COMPANIES AFFORDING COVERAGE 02194 COMPANY LETTER a 001918ACB INSURANCE CD. COMPANY LETTER B BASTSRN CASUALTY INS, CO. 3 ' INSURED COMPANY Peter J Hassett Plab & Rtg LETTER C P.O. Box 2825 COMPANY Brewster, NA LETTER D ' 02631 COMPANY LETTER B xy =� C0VE.RAG9S THIS IS TO CERTIFY THAT:THE POI,ICIBS OF INSURANCE LISTED BELOW HAVE BBBN.ISSOBD TO THE INSURED NAM ABOVE FOR THE POLICY PERIOD , {� INDICATED, NOTWITHSTANDING ANY REQUIRENENT .TERM-OR CONDITION OF.ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO..WHICH-THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE'AFPORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THB.TBRNS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHQWN M11Y HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY BFF. POLICY EXP. In TYPE OF INSURANCE POLICY NUMBER DATE DATE LIMITS GENERAL LIABILITY GENERAL AGGREGATE S ji 000 000~ (1] Conercial General Liability PRODUCPS-COMP/OP AGGREGATE S • 500 000 yw A [ ] Claim Made [X] Occur. U2631 01/11/94 01/11/95 PRBSONAL 6 ADV, INJURY S5colim ` [I] Owner's & Contractor's Prot. EACH OCCURRB11C13 S 500 QQ f ( ] FIRE DANAGB`(AU one fire) S 50,0001 [ ) MED• EXPENSE (Any one on) -S 5i000?, ,- AUTOMOBILE LIABILITY.. COMBINED SINGLE $< a ( j Any Auto LIMIT . [ ] All Owned Autos BODILY INJURY $ x {3 ( j Scheduled Autos (Per person) ( ] Hired Autos BODILY INJURY $ ( ] Non-Owned Autos (Per accident) F [ ] Garage Liability PROPERTY DAMAGE ( ] - EXCESS LIABILITY EACH OCCORRBIiCE S ': l i [ ] UMBRELLA FORM AGGREGATE S Other Than Uobrella Fors ` [ 1 „III STATUTORY LIMITS a } ` WORKER'S COMPENSATION EACH ACCIDENT B AHD NBN. °T A 12/07/94 12/07/95 DISEASE-POLICY LIMIT S " " a m /sI EMPLOYERS' LIABILITY . '. DISEASE-EACH BMPIAYBB` S' '1%`000°t ,* ` OTHER -�DESCRIPTION OF OPERATIONS/LOCATIONS/,VEHICLES/SPECIAL ITEMSt� m-'CI TIF. ICATB "B0LDB'R CAN.C9LLATION = - #4 Apo SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANC11='BBPORB THE ter; J. TARABILLI INC. EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR P.O. BOX,%4 MAIL 10_ DAYS WRITTEN NOTICMi;TO JR CERTIFICATE,HOLDER-NAM TO THB ' NbSNPBB,>NA LEFT, BUT.FAI Ta MAIL NOTICE SHALL,IMPOSB'NOOBLIGATION`OR 02649 LIAM� IVE' 'k x• mow;✓. .. . . . .. _ . ACORD qC `i 3 a../lei �/�jti/(///'�1��(GLLI '/_-J/�o�- '`'(�!►o�.it�� / e4 ARMS HOME IMPROVEMENT .CONTRACT`URS REGISTRATION Boa-rd- of. Building Regulations and Standards One Ashburton .Place - Room 1301 Boston, Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Registration 109652 Expiration 09/21/96 Type - PRIVATE CORPORATION HOME IMPROVEMENT CONTRACTOR J,. TARABELLI , INC . Registration 109652 JOSEPH R . TARABELL I Type:- PRIVATE:CORPORATION PO BOX 564/6. SLIC Expiration E WAY ration 0 9/2 1l96 MASHPEE. MA 02.649 J. TARABELLI, INC. JOSEPH R. TARABELII G� Q o uni r� BOX 56�'6 SLICE WAY ADMINISTRATOR :MASHPEE°MA 02649 f 'T v •'•.•.. Remember Lujean Printing for all your printing needs! 428-8700 •4507 Falmouth Road (Route 28), Cotuit - lifiPt71�'!Y ►�!"�'`�fillE'..�sS.A►�E ' A.M. FOR OAT TIME�d j�P.M. M � PHf3NEt7 OF v PHONE _ AREA CO• E NUMBER EX-TENSION ' MESSAGE SIGNED TOPS FORM 4006 4 r • p. f t E, �. •4 1 `OptHE f0j,� The Town of Barnstable BARNSTABLE.g! Department of Health Safety and Environmental Services MASS. �Eoy° Building Division 367 Main Street,Hyannis, MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection :�aVA Location �� �� r\.-PC 1r�1� Permit Number Cal O Owner , ,C ��, Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: Please call: 508-790-6c227 for reeinspection. Inspected by Date 1 — ae The Town of Barnstable rqy� � o� BARNSTABLE.$ Department of Health Safety and Environmental Services MASS. 1679.�FOMP�N. Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection Location Z--� WTV-Q Permit Number - �t6k C) Owner .._ �� t V`.,, Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: Please call: 508-790-6227 for reeinspection. Inspected by Date r Assessors Map 226, Parcels 26 & 33 Flood Zone A10, Elev. 11.0 NGVD D.E.P. File #SE 3-2843 A ♦ ,q� i-n:li F FLOW V ♦ CENTERVILLE RIVER (TIDAL) EDGE OF SALT MARSH µ µ d - —70P OF COASTAL BANG 0 O O ' 10*1 OCEAN AVE. p / ' Z (40' WIDE. NOT BUILT) - $ $ - 12.8' S E py�_� 10.8 b �zo• 27.12- N 44'30'00' E ALL OFFSETS SHOWN ARE TO '' • �eLDr, 17. i THE PROPOSED ADDITION b u 0 3 w m .D O O b Y J Z 84.00' S 44'30'00' W VINE (25' Private) A 1 . 2 9 19 95 Shorten Deck Width SAW 1 9 15 95 INITIAL ISSUE SAW THIS PLAN IS NEITHER INTENDED NO. DATE DESCRIPTION RY FOR, NOR SHALL IT BE USED FOR PLOT PLAN MORTGAGE LOAN PURPOSES. 29 VINE AVENUE IN CRAIGVILLE, MASSACHUSETTS s, RICHARD B. &FOR ANN C. TRULL SCALE; 1 = 40'1 JOB N0. 1767/1767 I CERTIFY THAT THE HOUSE SHOWN ON-THIS PLAN IS LJJCA ED ' 0 40 eo E ON THE 0 S I IC TE17 9/19/95 /�, LEVY, ELDREDGE & WAGNER ASSOCIATES INC. DATE STERED LAND SURVE YOR EGINS NCAPE ARNE CNN LAND SURV ERS 586 STRAWBERRY HILL RD. CENTERVILLE MA 02632 310 CMR 10.99 ' Form 5 OECE`FileNo. SE 3-2848 F THE TO (To tie proviaed by OEOEi a Craigville F-72111— Commonwealth City.Townof Massachusetts = »sT ApplicantTrull s639. `� Order of Conditions Massachusetts Wetlands Protection Act G.L. c. 131, §40 TOWN OF BARNSTABLE ORDINANCES, ARTICLE XXVII From Barnstable Conservation Commission To Richard and Ann Trull Same (Name of Applicant) (Name of property owner) 23 High Ridge Rd. Address Boxford, MA 01921 Address Map Number 226 Parcel Number 28 & 33 This Order is issued and delivered as follows: ❑ by hand delivery to applicant or representative on (date) ® by certified mail. return receipt requested on March 22, 1995 (date) - This project is located at 29 Vine Ave. , Craigville The property is recorded at the Registry of Deeds in Barnstable Book 7102 Page 83 Certificate(if registered) • February 2, 1995 The Notice of Intent for this project was filed on (date) March 14, 1995 The public hearing was closed on (date) Findings The Barnstable Conservation cni m i as;on has reviewed.the above-referenced Notice of Intent and plans and has held a public hearing on the project. Based on the information available to the Commission at this time. the Commission has determined that the area on which the proposed work is to be done is significant to the following interests in accordance with the Presumptions of Significance set forth in the regulations for each Area Subject to Protection Under the Act(check as appropriate): ❑ Public water supply 2r Flood control ❑ land containing shellfish ❑ Private water supply Storm damage prevention ❑ Fisheries ❑ Ground water supply C-Prevention of pollution 2' Protection of wildlife habitat � Total Fling Fee Submitted $55.00 State Share $15.00 City/Tcwn Share $40.00 fee in excess of S25) Total Refund Due S City/Town Portion S State Portion S ARTICLE 27 Only: (t/z total) ('h total) ❑ Public Trust Rights ❑ Agriculture Q."Erosion Control ❑ Aquaculture ❑ Recreational ❑ Historic [r Aesthetic Therefore, the Barnstable Conservation Commission hereby finds that the following conditions are necessary, in accordance with the Performance standards set forth in the regulations, to protect these interests checked above. The Commission orders that all,work shall be performed in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent, the conditions shall control. General Conditions: 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this order. 2. This order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this order unless either of the following apply: a) The work is a maintenance dredging project as provided for in the Act; or b) The time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance and both that date and the special circumstances warranting the extended time period are set forth in this order. 5. This Order may be extended by the issuing authority for one or more .periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of . the Order. 6. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or debris, including but not limited to lumber, bricks, plaster, wire, lath,- paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles or parts of any• of the foregoing. 7. No work shall be undertaken until all. administrative appeal periods from this order have elapsed or, if such an appeal has been filed, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final order shall also be noted in the Registry's Grantor index under the name of the owner of the land upon which the proposed work is to be done. The recording information shall be submitted to the commission on the form at the end of this order prior to commencement of the work. 9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection, File Number SE 3-2848 " 10. Where the Department of Environmental Protection is requested to make a determination and to issue a superseding order, the conservation commission- shall- be a party to all agency-proceedings and hearings before the Department. 11. Upon completion of the work described herein, the applicant shall forthwith request in writing that a Certificate of compliance be issued stating that the work has been satisfactorily completed. 12. The work shall conform to the following plans and special conditions. SE 3-2848 — Trull Approved Plan: Jan. 30, 1995 Revision, Stephen Wilson,PE Finding: • The coastal bank was not an eroding bank at the time of this review. Special Conditions of Approval: 1. General Conditions 1-12 on the preceeding page are binding,and demand both your attention and compliance. 2. Within one month of receipt of this Order of Conditions and prior to the commencement of any work approved herein, General Condition number 8(preceding page) shall be complied with. 3. The applicant shall pay for their legal advertisement as invoiced. 4. The work limit for the project as shown on the approved plan shall be strictly observed. 5. Prior to the start of work,staked haybales backed by siltation fencing shall be set along the work limit line. Proper placement shall be verified by the project engineer. Effective sediment controls shall remain until the site is stabilized with vegetation. 6. There shall be no disturbance of the site, including cutting of vegetation, beyond the work limit. This restriction shall continue over time. 7. All areas disturbed during construction shall be revegetated immediately following completion of work at the site. No areas shall be left unvegetated or unmulched for more than 30 days. 8. Heavy equipment shall not access the rear of the house except for foundation excavation,in which case a"Bobcat"or small tractor may be used. 9. The abandoned cesspools shall be pumped dry and filled with clean sand. 10. This approval is contingent upon the approval by the Board of Health of the subsurface sewage disposal system. 11. Drywells or french drains shall be installed to accommodate roof runoff. 12. All proposed lawn areas shall be underlain with a minimum of 6 inches of organic loam. 13. It is the responsibility of the applicant, owner and/or successor(s) to ensure that all conditions of this Order are complied with. . The project engineer and contractors are to be provided with a copy of this Order and referenced documents before the commencement of construction. The foregoing condition shall not be construed to exempt project contractors from responsibility for any work performed in deviation with provisions of the Order of Conditions or with the detail of , the plans of record. 14. The Conservation Commission,its employees,and its agents shall have a right of entry to inspect for compliance with the provisions of this Order of Conditions. L 15. At the completion of work,or by the expiration of the present permit,the applicant shall request in writing a Certificate of Compliance for the work herein permitted. Where a project has been completed in accordance with,plans stamped by a'registered professional engineer, architect, landscape architect or land surveyor, a written statement by such a professional person certifying substantial compliance with the plans and setting forth what deviation, if any, exists with the record plans approved in the.Order shall accompany the request for a Certificate of Compliance. Issued By Barnstable Conservation Commission Signature(s) This Order must be signed by a majority of the'Conservation Commission. On this 22nd day of March 19 95 before me personally appeared Eric Strauss to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/ free act and deed. November 6, 1998 , tary lic My commission expires The applicant,the owner,any person aggrieved by this Order,any owner of land abutting the land upon which the proposed work is to be done or any ten residents of the city or town in which such land is located are hereby notified of their right *to request the Department of Environmental Quality Engineering to issue a Superseding Order, providing the request is made by certified mail or hand delivery to the Department within ten days from the date of issuance of this Order. A copy . of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and the applicant. Detach on Dotted Line and Submit to the Issuer of this Order Prior to Commencement'of Work. To Barnstable Conservation Commission(Issuing Authority) PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT AT 29 Vine Ave. , Craigville FILE NUMBER SE 3-2848 HAS BEEN RECORDED AT THE REGISTRY OF Deeds in Barnstable ON (DATE) If recorded land, the instrument number which identifies this transaction is If registered land, the document number which identifies this transaction is Signed Applicant ------------ Detach on Dotted Line and Submit to the Issuer of this Order Prior to Commencement of Work. �—`•� 17�JI] #11,,3�.r,.r�..r BAP,hitifiH IL t;i IIJt�fi'r ��EI�7ST r Or (JE�D3 To Barnstable Conservation Commission(Issuing Authority) PLEASE BE ADVISED THAT THE ORDER OF CONDITIONS FOR THE PROJECT.AT 29 Vine Ave. , Craigville , FILE NUMBER SE 3-2848 HAS BEEN RECORDED AT THE REGISTRY OF Deeds in Barnstable ON (DATE) 4V9.2QY—T li<fff If recorded land, the instrument number which identifies this transaction is / If registered land. the document number which identifies this transaction is Signed Applicant REGISTER RECEIPT # : 1995 6660 BARNSTABLE COUNTY REGISTRY OF . DEEDS RG170R PRINTED : THU 3/23/95 12 : 53 : 09 BATCH : 2657 CUSTOMER : N/A PAGE : 1 BOOK-PAGE 9597 325 RECORDING FEE : 12 . 00 INSTRUMENT # : 13.595 POSTAGE : . 32 RECORDING DATE : THU 1995-03-23 12 : 50 MARGINAL REF FEE : . 00 ADDRESS : 29 VINE AVENUE COPY FEE : . 00 CONSIDERATION : . 00 COUNTY EXCISE : . 00 TOTAL AMOUNT DUE : 12 . 32 STATE EXCISE : . 00 PAID BY : CHECK 1570 - GTEF_/GTOR GROUP : 001 TOWN : BARN BARNSTABLE INSTRUMENT: 0 ORDER GRANTOR : GRANTEE : DESCRIPTION : VINE AV CRAIGVILLE MARGINAL REF BOOK-PAGE :, GRANTORS : BARN_c�TA(:;L. F TOWN OF (CONSERVA-I' 10N) ("IiiJI..L Ii ICii/aI D (&0) ANN (&0) GRANfFI:S : NONE RECORDED RETURN ADDRESS : LEVY ELDREDGE & WAGNER 586 STRAWBERRY HILL ROAD CENTERVILLE MA 02632 -- . .. . ---------------------------------------------------------------------- X .01/24/1995 '16:50 50b5644577 SABATIA, INC. PAGE 01 d &AHATIA. .._ ¢1 t7be�w�►Ivr� L�n�, qb � Pocimdol, IAA 02860 (gulf gin PAX (sao) 8044811 - �Az m�AN�Ntg�toN bAfiN IZ-5/ .5 tl Al/ ,yam► - .. _�i op PAM t tNcLUbtUd T9ANbHf rtAb) , Y a z z r/i�r .1`� ��..�,fV,/�G vy�•o•J� fr1 eye A,i /,Ion A ��11 v� °5 T� `i' e Ih ow' x 1 r, x f O . SABATIA 21 Observatory lane, RD 1 Poaamt,MA 02559 ROBERT M.GRAY, P.W.B., R.S. (508)583-GUO MARIO DIQREOORIO(508)584-8122. FU(508)584.45" Wetland Delineation and Wildlife Habitat Assessment MGL Chapter 131 s. 40 b Barnstable Wetland By-law Article 27 29 Vine Avenue; Richard S. Trull. Applicant 1.0 Wetland Delineations On 21 December 1994, wetland botanist Mario DiGregorio conducted a wetland delineation and ggeneral wildlife habitat assessment on a small residential parcel with ,frontage on the Centerv.ille'River. Two resources areas were flagged using criteria mandated under state and local wetlands law: 1. Coastal Bank- (310 CbR 10.30)- seven stations were established using a visual estimate of the first break in contour less than 18% in slope gradient above the one hundred year flood elevation. The break In the top of the bank was quite evident, roughly paralleling the 12 foot contour (Levy. Eldredge Waggner Associates .site plan labeled 'Wetlands Permit Plan' #1767/1767). All stations were established uppgradient of the 12 contour, ,with the one hundred flood elevation at 5 elevation 11-NGYD,. The coastal bank delineation conforms to both DEP Policy Guideline 92-1, (Figure. 2 c.b.) and the Barnstable Coastal Bank Delineation Policy (Figure 3 c.b.). The coastal bank is. a heavily vegetated, non-eroding 'vertical buffer' presumed significant-to storm damage and flood control interests. Invasive, non-native shrub species have created a nearly impenetrable thicket on the seaward face of the coastal bank. No erosion, gullying or other elements,'of de-stabilization was evident on the day of field `= studY, thouggh one downspout from the existing house had created a small rill down the bank from the northwest corner of the house. ; 2. Salt Marsh (310,06 10 32)• A total of nine stations were , t�N established at a point where at least 501 of the total floral } community-consisted of halo ; highest spring tide wrack line was(evidentadapypi plants and where the Typical salt (and s brackish)-marsh species included marsh elder (Iva frutescens var. ; oraria); spikegrass (Distichlis splcata), saltmarsh bulrush (Scirpus validus), narrow-leaved cattail (T"ha angustifolia) and freshwater cordgrass (Spartina pectinata). 0 -Ark • --------------_ rt r? r'i* nr 2.0 Wfldlffe Habitat Assessment The project site is not within an Estimated Habitat zone as mapped by Mass Natural Heritage (Exhibit 1.) or within hin an ACEC or Ocean The Centerville River is an important'tidal' estuary system which provides a breeding run for anadromous fish swimming upstream from Centerville Harbor north to Long Pond and Wequaquet Lake (APCC Critical Habitats Atlas-Hyannis Quad). The salt marshes bordering the river have a high value for breeding, migratory ,and overwintering avifauna: many individuals were noted on;the day of the assessment. Such marsh dependent birds as black ducks', great blue herons and greater yellowlegs were recorded feeding in the marshes and exposed land under the tidal river. Also evident was a well -defin ed game trail with fox scat para lleling p Jelin the sal Obvious', an 9 t marsh line and toe of coastal -bank. Y. y potential project impacts to marsh veg9etation or water quality would be unacceptable in the interests of wildlife habitat protection. . The coastal bank itself is a heavily vegetated landform with a largely alien (non-native) invasive thicket community consisting of multiflora rose (Rosa multfflora). Morrow's bush-honeysuckle (Lbnicera m�orrowl)1 t- Japanese honeysuckle U. Japonica), common privet (Ligustrum vulgare), Japanese bittersweet Welastrus orbfculatus), greenbrier (50f1ax _ rotundffolfa) and poison ivy '(Toxfcodendron radfcans) . .These taxa are adapted to disturbed sites where human influence is pronounced. The site's location in a heavily residential section where natural topography and elevations have been so altered. historically lends itself to a proliferation of these aggressive shrub species.pec es. The faunal species which breed, feed and overwinter in this thicket community are species well knovm to suburban residents: song sparrows, northern cardinals, blue Jays, chickadees and Carolina wrens were noted ' during the on-site. A single nest, probablyy of a northern -cardinal , was found in a privet'shrub- on the coastal bank, All of these species area l adapted to edge ecotone sites particularly in residential shrub thickets and fencerows. 3.0 Assessment oVPotential Adverse Impacts to Habitat It appears that the closest point of the proposed addition is. 72 feet from salt marsh station #8 to the northwest M corner of the proposed addition: the coastal bank is twelve feet from the northwest corner of . the new addition. However this portion of the bank was created by the excavation for a arage and retaining wall : the 'natural ' coastal bank landform facing t9e Centerville River actually begins at station #3 ' which is 30 feet from the addition. The-proposed work itself will be entirely within :a level lawn area �t9 21 r y- -------- ------- ,1 t : - --------'. $fit V 01/24/1995 16:50 5085644577 SABATIA, INC. PAGE 03 y The standard threshold from 310 CMR 10.60(1)(a) for 'adverse effects on wildlife habitat is: "insofar as such alteration will, following 2 growing seasons of project completion or thereafter, substantially reduce its capacity to provide important wildlife habitat functions listed" . These functions include "important food, shelter, migratory, or overwintering areas, or breeding areas for wildlife" (MGL chapter 131 s. A0). My opinion is that important wildlife habitat exists in the marshes r bordering the Centerville River. The project is quite distant from these marshes and with an extremely dense and thorny thicket protecting the marsh fauna from human disturbance landward of the top of coastal bank, there should be negligible impacts on wildlife habitat by the proposed addition. Coastal bank wilds fe habitat is of a lower quality due to a lack of natural diversity and native flora. However, these shrubs do provide habitat for a variety of: passerine birds. The project as.depicted . should have no impacts, to the birds or small mammals which lives in the thicket as long as`,the vegetation is allowed to stay intact. It does not appear to be-close enough to effect the stability of the bank landform itself. The one small mitiInto.- drywells ation measure I would recommend is to infiltrate stormwater runoff or stone drains before any flow runs down the coastal bank, possibly causing gully erosion. There is one such rill forming at.the northwest corner of the existing house Fu 1 d,. DiGregor o; Principal d. Botanist: Environmental Planner Sabatia. Inc. xc: Richard B. Trull Levi , Eldredge &`Wagner Associates J. Tarabe111. 3. ;4 3 NYANNIS ' MA/ OF 1ISTIMAT90 HABITATS ' OF sTATI-LISTID RARE W91LANDS WILDLIit Ilea ONIY if, nlgr011cO to the WOIIaNdS Natural Marliess 4 trdenjerad Species N� raa. -Md• RGMjSNIS DIVISION of /IaMat1OS i Wildlife 1 - . . . . . . ..T,.•i^. •.r. •`+1. . ,-�. r. .—.�.•.yr Ex. vine 1 3gt4'.'•'•'•'.••'::• • . • • • • . . . . . . . . . . . • . . . . . . • . • MNHESP Locus-29 • • • • • • ••• • • • •�•i•♦•� IL .••i•••••�••••••••�••• • • • • • • •.• • • • • • • • • • • • • • • • • • •�•�••••••••••••• • • •• • • • a • • • • • • t Le. • • a • • • • • • • • • • • • • • • • • • • • • • • • �f��!•g••••••••••••••• • • • • • • • • • • • • • • • • • • • • • • • • ti • ••••.•.•+•••80 • • • goose ♦ • ••• •.• •••••••• • • NIP .• •••�'� _ '� �• ••• •�••♦•�• • • • to • •• •• • •�•••••g • • • •I~ •. •:: • • • • • • • • • • • • •• ILIND ROCK • • • • • • • • • • • • • • • • • a TOMOW�w11/D�IQ�IIttt ROCK •o'. • • • *so*** •• • • • •• • • •fees tIl•$Act • • r • • G/ **go* �• •••� •••••• - LLAG . . Ha s! • �_ . . .•.•.•.•. A/i 11 ~ t. .•.•.• •• • • ✓� ILLAGA YA st .M- 1Lt' �� .. 'mat AT 11 ay it ' .•' .•.•. � ••.• A•i '1 / , Is ee I '[:jtr�nl••;IV �� t :.i� �' Ir' egg• •�Pd • • • •••i i ' `• • ...ri' .I•' 1 �T^• s yi. •� ••• ,,Fib' ,.'� lipf,•"• �+• •. � i S 4dp. stAea goal 3 /IMOl1 aoQt .:,.w 01/24/1995 16:50 5085644577 SABATIA. IIC. PAGE 05 ! LLU8TRATIONS .► FEMA- 100 YEAR - R COASTAL F1000 PLAIN TOP OF COASTAL BANK ' NO COASTAL BANK PRESENT Figure 1. Figure 2 > 18t �,�tt Figure 3 > 180 001 4 AL r " Figure 4 S 18t > ,at Figure 5 ' S 18t > lAt �'� TrullvSite C.B. t � Fil 1 i� . � I EE:O I O aouer - I j CLOUT LIVING Roots eeDRpoM CaAIzAC .�a -PH I i rt •� �TRULL RESIDENCE, CRAIGVILLE, MASSACHUSETTS TERRY C. KENYON, A.I.A. EXISTING FIRST FLOOR PLAN 45 APPLETON STREET SCALE: 1/4°=P-0° BOSTON, MA 02116 15-Dec-94 (617) 451-6990 EBB C,ENTERVILLE RIVER c- (TIDAL) FLOW u ? " I It (---1 PINE ; STREET EDGE SALT MARSH 2 Z 1 ( c� , , , -� /i J _'1/7 4Q 4 CENTERVILLE, v �� g /,-- -_ � J, RIVER / o #8 TOP OF COASTAL BANK � -------- ---- - #9 // I /12� �' I — ?ra�uvsed �i.,1.E of BEACH --- ' ROAD __ - - - --- .- LAKE ' 5 /' /�, 4b��c S,/E F�,,cc - - - - ELIZABETH DR. - ' -CRA�----- CRAIGVILLE HARBOR _ ---- ------- -- — — — — Ln 0 44 /� 1/ �' 40' WIDE. NOT BUILT \ ( o to I / lop �,,-�o ( ) LOCATION MAP o �O ' � COASTAL � - ----- ---------------- -- - 10 �0 0 1 EDGE OF LAWN O O l o tee, \\BANK I ' O �� Assessors Map 226, Parcels 26 & 33 -r - ---- —�_ _ ----- CONC �K� _ , - �o it CB SK I FLOOR i I �3 5 � i kN W ABANDON ~-� 10 i RETAINING WALL �.�WALLON\ 'Q #2 CESSPOOL i EL TOP � `' *. � � . �ICD Edge of Salt Marsh and Top of Coastal s 2 WALL=14.56 2 �, : , z 22 Bank Flagged by Sabatia, Inc on 12 21 94 # ��gg ' 7 tav s tin, .you s c CB DH ----- FNDH1 ; P: h 27.12 \ „r 20 D I 1 N 44'30'D 0� \� 18 N\F HOWARD HUBBELL WRIGHT � a�c�•s.s by ceti:.�^uc f►or) --� \� � 401 RIVERVIEW LN, BRIELLE o.. y+rlris side. - -- \\\ ` \ \\, I z NEW JERSEY All Elevations Based on NGVD \,� CRY'\ I , BK. 3920 PG.210 16 F BIDC I ,co a c,+\ m � \-� - Flood Zone All", Elev. 11 .0 NGVD j m .., -2O N\F UNITED CHURCH BOARD \\ I oo FOR WORLD MINISTRIES o ` O FEN I Z� BK. 1252 PG. 400 N CE \ 1 w RETAIN O FLAGSTONE---_ I o -- - - I WALL 5 by , �t O �,jp./c/, isr,rs' WALK � I � 5� /`rc � sh•n ,.rsra //cc1 k,,.(!. 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