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HomeMy WebLinkAbout0057 CAPTAIN LORING LANE e" a U 4 { d t" v i, - c r a . . ,: - r ,. .. .,:, -w,: ...j - '� ,: r ._ ,�{..: 11.. .-r, ..•` ri` �.1., ,. =z' ,�. ., r. - .. ,, ,r; ' 4e f/ xs N.' f', �,. f i a' : _ .._ r_ r . . i - ' - • -r - V p , _ . { i - - .; .. .: .. F r .-. , - ' e a y p . �, 1 r r' ,n I '- F d ,... > , x -- ..-. -.n _ _ -.. - -.-_- {...a.r+ Application number.... ... ....... ....................... � _ l �► Fee ............ ::. ......Y's............... ...................'.. s�Rt An Building Inspectors Initials...(,�a... Date Issued.............r3.......~..t II ..7............................... MAY Map/Parcel........... 7-1..........�t�.. . ........... O T O � °A' IVP 04NSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: NUMBER STREET VILLAGE Owner's Name: �bc,9.mp Phone Number Email Address: Cell Phone Number �$cost Project ProJj Check one Residential V Commercial_ OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK E-1 Siding 0 Windows (no header change) # ED Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review 0—Roof(not applying more than I layer of shingles) Construction Debris will be going to T'l °a �``� CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable) #_U'N .S ] (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor t er 6p s 6ao 4 6 ALL`PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. �- 1 APPLICATION NUMBER `Y..1 k.... *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes No____, if yes, a gas permit is required. Natural Gas Yes No , if yes,a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer 4 Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature � Date All permit applications are subject to a bull ing official's approval prior to issuance. Application number................................................ QaFee ....................................:......................................... MAW ` Building Inspectors Initials....................................... DateIssued:................................................................ Map/Parcel.............:................................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: NUMBER STREET VILLAGE Owner's Name: Phone Number Email Address: Cell Phone Number Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK © Siding 0 Windows (no header change)# E3 Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review 13 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# -- - (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. ;r {ki 1 . Town of Barnstable " Building Department Services nines Brian Florence,CBO yh,� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstableana.us i Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder i i 1. h 6 ,as.Owner of the subject property hereby authorize )uj to act on my behalf, in all matters relative to work authorized by this building permit application for: K Sr C 7 ✓1 r I �MA 45L�L't� t JLr (Address of Jnoi.) I i *Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. f TC Signature of Owner Signature of Applicant I-awCe4 r� L-Liy c Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 Town of Barnstable Building r. ; ,_,Ca n Job.and this ar Mus b K t Post This Card So That it isMisible'Fromthe Street-Approved Plans Must be Retained o C- d t e;,ept Posted Until Final-inspection Has Been Made. ) e yam'it Where a Certificate of Occupancy:is Required,such Building shall Not be Occupied until a Final Inspection has been made ? �j� Permit No. B-19-1352 Applicant Name: David Anderson Approvals Date Issued: 04/24/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/24/2019 Foundation: Location: 57 CAPTAIN LORING LANE, BARNSTABLE _M _ Map/Lot 279-077 Zoning District: RF-2 Sheathing: Owner on Record: LYNCH, EDWARD& MAUREEN Contractor Name DAVID C ANDERSON Framing: 1 Address: 57 CAPTAIN LORING LN Contractor License:.-CS-049405 2 BARNSTABLE, MA 02630 Est. Project Cost: $ 13,238.00 Chimney: Description: Replace 10, 2nd floor windows with new construction energy star Permit Fee: $67.51 certified Harvey Windows. All sizes and configurations to be like for Insulation: like, as existing ) Fee Paid; $67.51 Final: in size,color,exterior trim,and grid patterns.1 Six 2446 double hung _,. - Date: 4/24/2019 12/12 . Four 24310 double hung 8/8. One new bathroom awning ` window,AWN 31 with 6 lite grid, located on the rear corner Plumbing/Gas elevation, not visible from a public way to add natural light to the " Rough Plumbing: master bath. - — Building Official Final Plumbing 1 This application is in addition to the currant fire-damage interior restoration work/permit. Rough Gas: Project Review Req: ; Final Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Electrical All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Service: This permit shall be displayed in a location clearly visible from access street or;road.and shall be maintained open--for public inspection for the entire duration of the work until the completion of the same. Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Final: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Low Voltage Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Health 6.Insulation 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. S / Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). � (� Town of Barnstable Building a Post MAM This Card'So That;�tas Visible;From the Street A ,coved Plans>;Must be,Retaed on.Job and this Card:Must,be Ke t , , f> .�- iAaxt3�'ABIF. • sa rr�� ...;w� .,4�. .E �;.q. ,§-y�r �r�p.� �,�� Posted UntilFinal Inspect�onHas,.Been Made ° ea,, a�Cert�ficete,.of Occu anc �s Re wired such Bwldm shall Not:be Occu ied until°a Final Inspection has.been rnao>e, Permit Permit NO. B-19-1019 Applicant Name: David Anderson Approvals Date Issued: 04/08/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 10/08/2019 Foundation: Residential Map/Lot 279-077 Zoning District: RF-2 Sheathing: Location: 57 CAPTAIN LORING LANE'BARNSTABLE Cortractor'Name: DAVID C ANDERSON Framing: 1 Owner on Record: LYNCH,EDWARD&MAUREEN x Con.tractor License: CS-049405 2 Address: 57 CAPTAIN LORING LN s Est Project Cost: $ 100,000.00 Chimney: BARNSTABLE, MA 02630 r Permit Fee: $560.00 Insulation: Description: Second floor interior finish restorations,due to fire damage. Project Fee Paid. $560.00 to include plumbing and electrical improvements Final: and code upgrades. Minor no load framing alteration and sub floor Date: 4/8/2019 rot damage repair,new wall and attic floor insulation Interior finish trim and bath fixtures. = L Tcrn Plumbing/Gas `. Rough Plumbing: Project Review Req: y y f Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed,by,this permit is commenced within six`monthsafter:issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents,for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structuresshall,be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road'and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Mel M, Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Buildiri&andFire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: ` ', ` r Service: 1.Foundation or Footing •; " 2.Sheathing Inspection ' Rough: x. 3.All Fireplaces must be inspected at the throat level before firest flue lining'is installed' 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 1. Town of Barnstable g it 1 , �:.` 'a .''. ..... '� ,� -:xa , .,.. , '�` i .!> ,�:- . } -- ,; s, r Post This=Card SoThat it VisibleFromahe Street ;A , rovedPlansMustbeRetaine°d�on�Job,and this Card.IVlust SARN'S['Aet.R p p, • MAC Posted Until Final Ins ection Has Been Made ,k ° Where a Certificate;of Occupancyr ,Required,"such•Buildmg sh'all Not be.Occupied`u,ntil a FOal'Inspection hasbeeri made Permit �,u,�c�.. :..._.. .. :m. a�:�t� Permit NO. B-19-144 Applicant Name: MULTISTATE RESTORATION CAPE COD DIVISION INC. Approvals Date Issued: 01/17/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/17/2019 Foundation: Residential Map/Lot: 279-077 Zoning District: RF-2 Sheathing: Location: 57 CAPTAIN LORING LANE, BARNSTABLE ' ' Contractor Name:` MULTISTATE RESTORATION CAPE Framing: 1 Owner on Record: LYNCH, EDWARD& MAUREEN COD DIVISION INC. Address: 57 CAPTAIN LORING LN % Contractor License 14Q427 2 1 Chimney: BARNSTABLE, MA 02630 Est Project Cost: $ 16,200.00 Description: Remove sheetrock and Insulation and floorrnh'on entire 2nd floor Insulation: Permit Fee: $ 132.62 due to fire/smoke damage �g Fee Paid $ 132.62 Final: Project Review Req: Demo only New permit will be requiredto; econstru Date 1/17/2019 well as Upgrading smoke detectors to current code �,A Plumbing/Gas % Rough Plumbing: Building Official Final Plumbing: e 't Rough Gas: Final Gas: This permit shall be deemed abandoned and invalid unless the work authonzeoby�this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved applicator and the�approved construction documents for which this permit has been granted. K � Electrical All construction,alterations and changes of use of any building and structures�shall be in compliance with thello�caf zoning by-laws and codes. '• f This permit shall be displayed in a location clearly visible from access streetor road andIshall b mamt' d open for public inspection for the entire duration of the Service: work until the completion of the same. 3 �' m Rough: The Certificate of Occupancy will not be issued until all applicable signatures b he Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Health 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work'shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Application Number... .................................... .... Permit Fee...........MASIL .....Other Fee........................ iiL65 Total Fee Paid.................................... ................ ...... P0 W/V op 019 a- SAPA,- TOWN OF BARNSTA. -B. E Permit Approval by. . ..............On... BUILDING PERMIT mv......2....j..."al ..............P.,.......Q.73..................... APPLICATION Section 1 — Owner's Information and Project Location Project Address 3-7 n3FII-AiAl 1-oi jXg SAP Village Owners Name �LVA-RJ Owners Legal Address <5'7 CAT-A-7�J 4otl Jul_q 1.A) City 1Siq-" 5 1-6 be State /41h ' zip Owners Cell# SUb q -7 7- 3=3 3 3 E-mail Section 2 —Use of Structure Use Group_ ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling F Section 3 —Type of Permit Fj New Construction E] Move/Relocate [:] Accessory Structure E] Change of use ❑ Demo/(entire structure) El Finish Basement El Family/Amnesty El Fire Alarm Rebuild El Deck Apartment Sprinkler System Fj Addition E] Retaining wall E] Solar 0 Renovation ❑ Pool El Insulation Other—Specify PP-vLr-i (4 J, N-re&i d,& '06-t 0 Section 4 - Work Description ov-c- coffee-12ock t+7-;�D/ 1A)s Af etA)r-ife'e 2-P4 FLz,ofL-- Du *L r-b 2e Last updated. 11/15/2018 i Application Number.................................................... Section 5—Detail Cost of Proposed Construction'#4,a&o Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics j Wiring Oil Tank Storage ❑ Smoke Detectors D Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom J Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage # of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the post? ❑ Yes ❑ No Last updated: 11/15/2018 a Application Number........................................... Section 9- Construction Supervisor Name_ (C P A(L-d 1 A rU R t A Telephone Number al 6 ' Address f LC-Aq p(c City [Rbc-(GLAD l State 414 Zip 6 a37a License NumberCS 0)-05(-7-8y License Type I t-2&/m Expiration Date Contractors.Email L k i'Z i A �L(7{P C'OyPI Cell # -79 y-`�6 7-7 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation requir d by 780 CMR and the Town of Barnstable.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor Name l Cry PR R-J Z A U VLi yq Telephone Number S 6 -7-7 Address A-t- e&Qu o z FJ City I t i.qS4 Stated Zip b a h Registration Number Expiration Date /v-/q-/9 I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR d the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date /-I V ly Print Name Z( Ct4 ktz j LA u(z(A Telephone Number E-mail permit to: 7 NSN 1re,P? Last updated: 11/152018 Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) Historic District ❑ Site Plan Review(if required) El Fire Department ❑ i Conservation. ❑ For commercial work,please take your plans directly to the fire department for approval Section 13-Owner's Authorization I, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date Print Name Last updated. 11/152018 K 1L' ellx 7 e { �r 13rZ / . Bp CL T4,00en r r MULTI-STATE RESTORATION, INC. FIRE* FLOOD*WIND* SMOKE*HURRICANE*VANDALISM Fed ID#050515889 CONTRACTORS REGISTRATION#140427 AUTHORIZATION TO PERFORM SERVICES AND DIRECTION OF PAYMENT E&4,f"l %IAJC6 ,herein referred to as "Customer",authorizes MULTI-STATE kESTORATION,INC.,herein referred to as "MULTI-STATE",to perform any and all necessary c and construction services on Customers'property at: leaning— k,4-V 2 Telephone: and with respect to items that need to be cleaned at a remote location,to remove and clean such items as necessary. Customer authorizes / tr Insurance Company,herein referred to as "Insurance Company", o dir ctly and solely pay MULTI-STATE. If for any reason the check should come to be or be made payable to the Customer, Customer then agrees to pay MULTI-STATE immediately upon receipt of the check from the insurance company. In order to expedite payment to MULTI-STATE, Customer hereby appoints MULTI-STATE as attorney-in-fact,authorizing MULTI- STATE,to endorse Customers' name,and to deposit Insurance Company checks or drafts for MULTI-STATE services. Customer agrees to pay Customers' deductible in the amount of$ that applies to this claim. If the loss is not covered by insurance,Customer a ees to pay the total amount to MULTI-STATE upon receipt of the invoice. Signature of Owner It is my understanding that the services to be performed by MULTI-STATE will be limited to those,which are authorized by my Insurance Co ny. Insurance dompany Name Policy Number Customer agrees that MULTI-STATE is working for the Customer and not the Insurance Company or agent/adjuster. r Additional remarks: I have read this document and completely understand and agree to same. /J.la I r,G . Signature ( Date Printed Name P.O. BOX 2210•MASHPEE, MA 02649 .866-921-9111 •FAX 774-238-4422 ,� vhe tPar�vnzareuseallfi a�U�a.�aac/iueelld ' � h Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR 1 TYPE:SrioolementCard. ReoistrafioW' Expiration 14U 10/!,:.. 019 MULTISTATE RESTQ 1_4 RPE COD DIVISION,INC. RICHARD LAURIA.� 21 PEQUOT RD. MASPHEE,MA 02649 Undersecretary 1 f Massachusetts Department of Public Safe Board of Building Regulations and Standards.;;; License: CSFA-051784 Cons,ruction Supervisor 1 & 2 Family RICHARD D LAURIA 1 LEAH DR ROCKLAND MA 02370 ' �rGcr�-- Expiration: Cornmissio er 04/Oy/.2 19 ' Regrstratro d be f.r e the eXpadoor individual .; Office of Co er n date. use onl 10 Pack PI Su Affairs t t found retur ns Boston,Mq 02.S ste.gy.70 and Busijje�R 9ulation ! Not si 1 9nature 9 Construction Supervisor 1 &2 Family Restricted to: Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS:GOV/DPS ,, ,acoRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDYYYY) `.� 1 01/09/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: STARKWEATHER&SHEPLEY INSURANCE BROKERAGE INC. PHONE FAX 60 CATAMORE BLVD AIC Ext: AIC No: E-MAIL East Providence, RI 02914 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: AnnGUARD Insurance Company 42390 INSURED INSURER B: MULTI STATE RESTORATION CAPE COD DIVISION INC INSURER C PO BOX 2210 INSURERD: Mashpee, MA 02649 INSURERE: 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. IN SR ADDLITYPE OF INSURANCE INSD SWVDR POLICY NUMBER MM POLICY DDIYYYY MM DD YEFF POLICY YY LTR Y LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 0 CLAIMS-MADE OCCUR DAMAGE TO RENT PREMISES Ea occurED rence $ 0 MED EXP(Any one person) $ 0 PERSONAL&ADV INJURY $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 0 POLICY F PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 0 OTHER $ AUTOMOBILE LIABILITY COMBINE DSINGLELIMIT $ _{Ea accident)_ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS LIABILITY YIN STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE R2WC942723 �r 07/16/2018 07/16/2019 E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? � NIA _ (Mandatory in NH) - - E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DES�RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Description of operations/Job: 57 Captain Loring Lane, Barnstable Village, MA 02601 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main St Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE /7 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachuselft Department of Industrial Accidents Office of Investigations IV 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letsibly Name(Business/Organization/Individual) H 4( -T-1 - S A F e ( C�5 ,i� Address: T FA `s G)d- j f City/State/Zip: AS (��e A G Phone#: 5Pg' q:7:F- 33.33 Are you an employer?Check the appropriate box: Type of project(required): 1.9I am a employer with- 3 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' [No workers' comp.insurance sance comp.inanranCe t 9. Building addition required.] . 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11-[1 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required]t c. 152,§1(4),and we have no employees. (No workers' 13.❑Other comp.insurance required.] --- *Any applicant that checks box 91 must also till 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 sbeet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: a `� a 3 Expiration Date: 7-4 9 Job Site Address: �' P �� Ln iL N5' W'N'l City/State/Zip: ✓��°n�5 131� , 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 am's and penalties of perjury that the information provided above is true and correct Signature: Date: 1�� Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds`or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(17 also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out,the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should 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 submiCniultiple 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 hike 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 CommonwWth of M&mchusetts Aepartmcnt of IndusttW Aeaidents Office of Investigations 600 Washingtoa met Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFB Fax#617-727-7749 Revised 424-07 wWvW.mass.go-v/dia MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392.6108,FAX(800)851-8424 12/29/2018 Form of Notice of Casualty Loss to Building Under Mass.Gen. Laws,Ch.139,Sec.36 BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET DO HYANNIS MA 02601 -_�- C13 Co Re: Insured: EDWARD F.X.&MAUREEN FLYNN LYNCH ' r Property Address: 57 CAPTAIN LORING LANE,BARNSTABLE,MA 02630 Policy Number: 0870966 Type Loss: Fire(including Fire caused by Lightning Date of Loss: 12/27/2018 Claim Number: 434709 Claim has been made,involving loss,damage or destruction of the above captioned property,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 313 is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. MPIUA Claims Division CMA00021 _9 TOWN OF BARNSTABLE Permit No. .g0, .Q7...... BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash �toiuv►� HYANNIS,MASS.02601 Bond ....X.... � � CERTIFICATE OF USE AND OCCUPANCY Issued to AIdT'i Tysol.i Address Lot: #7 , 57 l;antaJ;s; �,oriricr Lane USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL- SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ............ 19.......R.7...... ................. Building Inspector '� �• ' ray cak,.lj,�,,,y� TOWN OFt BARNSTABLE>'MASSACHUSETTS, �' �, ® I(— t ~f Y A "+��t ti:. t DATE Mcil^C11 �,�f 19_m � ' PERMIT � �'�����\ ` • APPLICANT - T�(pfpy `.�T MriiTl' - �+-. t11n ADDRESS e '� t ,:� � 1 (NO.),. (STREE T) C N.•R S IC N t :': '.t ' NUMBER OF c � T�•• T 7 �+ WELLING UNITS (TYPE;OF IMPROVEME NTI' NO .� tw v'cz�Q AT."(LOCATION) T,nf fi 7 �,7 ('ary{-a i n T nr� nrr 1 , ZONING (NO ) .: , 6. '` —� S e �*e. DISTRICT_. (STREET) FL BETWEEN AND' (CROSS STREET), (CROSS-STREET).. - -. .. SUBDIVISION ' LOT BLOCK j. SIZE BUILDING IS TO BE FT WIDE BY FT. LONG BY FT IN HEIGHT AND SHALL CONFORM IPt`CONSYRUCTION 7 TO TYPE USE GROUP BASEMENT WALLS.OR.FOUNDATION. (TYPE) Town Sewers REMARKS. .,, r`. .1.. Bond VOLUME 1712 .SACr• f lrPERM ( IT Y EST�MATEDvCOST 120000 OO FEE:;. C U BIC/SO DARE FEET). owNER: MT7 & Mrs Alan T. son' ADDRESS BOX 65 $BrnS i3b�r�i "��A BUILDING DEPT BY � � n �.5 �?j.yam�"a�`. ',7 .. ,I sT f•. r> , .. .r r r v :. a �;, r Y._n, :., � , THIS',PERMIT ..CONVEYS NOLRIGHT TO OCCUPY ANY STREET, ALLEY OR:SIDEWALK OR ANY PART',THEREOF. EITHER TEMPORARILY OR` PERMANENTLY:ENCROACHMENTS ON PUBLIC>PROPER7Y, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST'BE AP-*," PROVED BY',:THE''JURISDICTION. STREET OR ALLEY GRADES AS.WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED.;}r ;r,FROM THE:DEPARTMESU OF PUBLIC STRIC IONS ISSUANCE OF THIS PERMIT DOES NOT RELEASE.THE APPLICANT FROM THE.CONDITIONS i.OF ANY;APPLICABLE SUBDIVISION RESTRICTIONS.. . MINIMUM INSPECTIONS' FOR CALL APPROVED PLANS MLIST'BE RETAINED ON JOB'AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUfREI FOR ALL coNSTRUCTION WORK .>, CARD KEPT POSTED UNTIL FINAL.INSPECTION HAS BEEN PERMITS .:ARE REQUIRED FOR 1: FOUNDATIONS.OR-FOOTINGS MADE,•, WHERE, A CERTLFICATE OF, OCCUPANCY `IS' RE- MLECTRICAL,INST.ALLIAG AND f 2. PRIOR TO'COVERING STRUCTURAL MEMBERS(READY TO LATH) QUIREb,SUCH BUILDING SHALL NOT BE OCCUPIED'UNTIL �3 :FIWAL INSPECTION BEFORE FINAL INSPECTION.HAS BEEN MADE OCCUPANCY POST THIS CAR®. S0 IT IS VISIBLE FROM' StREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS ' �1 l3v'/i� J ✓� t } Z .. I 2 y:6 2 1' 9 HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS. db GI 1NG, L' I OTHER .' _ t. BOAR OF HEALTH , VOR K SHALL NO PROCEED UNT,I THE _ • ` I PERMIT. WILL BECOME NULL-'AND VOID IF CONSTRUCTION' INSPECTIONS. I{JDICATED`oN,7H15CARD NspECTOR HAS PPROVON THE-vARloUS : ' ..WORK IS NOT STARTED WITHIN SIX MONTHS OF:DATE,THE >TAGES'OF CONSTRUCTION CAN-BE• ARRANGED FOR 1BY TELEPHONE• - K PERMIT IS ISSUED AS NOTED.ABOVE. EN,NO•TIFaCATION 1 OR WRIdT cowI M( c rT�', / j 1 Ezy4s or Of xolr � 4 � t ' � I £L•�60. r 2 �: ', �-Z�•q3' ATE p� L 4ic) I of 41, ARNE ti nOJALA Rvr N` a n HLA i, 426348 - ��E N. C�JAI.A N�j.l..h•, R�• DATE -IOU A-7 fir- -- v> e9.d2 tih V pP 0° / - 202• v V sZ \1 � 3 4�.�' -4- 21 ,, e v I c¢ JOB. # 84-106A CERTIFIED PLOT PLAN PREPARED FDR: LOCATION: CAPT LORING LANE BARNSTABLE , .SCALE: 1=60 DATE. 3/6/1987 REFERENCE.- LOT 7 PL BK 276 PG 45 ALAN TYSON I HEREBY CERTIFY THAT THE BUILDINGS SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON, BUILDINGS CONFORM TO SETBACK" REQUIREMENTS OF THE TOWN'WHEN CONSTRUCTED. g ARNE yG�, g H. down cape engineering oiALA y #26348 / CIVIL ENGINEERS �'"Fss�lp ERA LAND SURVEYORS ROUTE 6A YARMOUTH MA DATE U REG. LAND S VEYOR Assessor's ofrioe (1st floor): oitNEto Assessor's map Arid lot number :.. ..�.�.... .�./....,.... + ��n►t ., Board of Health (3rd floor): MUST CONNECT TO TOWN SEWER Sewage Permit number :........,........:..............................:..... 2 Basa9T/1DLE, i Engineering Department (3rd floor): r --� f " 2 \0� House number .................................................S Op 1639• CEO YAY a. APPLICATIONS PROCESSED 8:30 9:30 A.M. and 1:00 2:00 P. onIV��-9 TOWN OF 'BA'RNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO aC....••••5�� �Q,, r�ti l5`�rZi1C lJl TYPE 'OF CONSTRUCTION �O:.GCJ.\. .................`.M�-................ a..: .2..0.......................19. .? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: , Location ...... pkz.�kV.-,.�C'���:..�Qr1Q.,....... ��tCC���`�)Q�..................... ProposedUse .. ........................................:.................................................................................................... ZoningDistrict r 1 ....................................................Fire District ................. ... ....................................................... 1 Name of Owner s>..}:.Mt`�:.., .` `!� .y.��?. ......Address v M. ...........�.... .....s .......... ................ Name of Builder r...l'` .'.. f� ` Q ..............Address M(,JC�C..�c ...44m.-.051's . Name of Architect ......�`1. ` .....Address ......................:. Number of Rooms .... ........................................................Foundation .........:........................ Exterior .i" r CJ� ... .. 1.T ..0 ...............Roofing ..QS.�1� � ........................... .... Floors `�Qf �t" !!I�f. ...1����LJ...��1!LQ ,...........................:Interior �J.)Z��!` ..Cod. ...�.I�. Y4 ................ Heating .....................Plumbing .. ... .... 4 • Fireplace `' W�..........................................................:.......Approximate Cost ...�.. ......................... Definitive Plan Approved by Planning-Board Area ......... Diagram of Lot and Building with Dimensions Q ®� Fee ............1.......... ................... SUBJECT TO APPR VAL OF BOARD OF HEALTH c.*r- ..rX- OCCUPANCY. PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tpwn of Barnstable regarding the above construction. Name ................................... Construction Supervisor's_ License .P.1..©PVIJ. .......... YSION, ALAN Mr. & Mrs . o ....�9.5.E'Permit for ....Two...Story............. .. .. .... .. �-incfle Fami." y..Dwelling . ....... ........................ .............................. (4 Location i ... .n...L.o?�i--,-ig Ln.-, . Barnstable s. table .................... ................................ T Alan - F Qwner .....................T...Y.���................................ Type of Construction ........F..A�Te............. ............................................................................... Plot ............................. Lot .................... Permit Granted ...... March 1- 87 .................... .............19 Date of Inspection ............?77.....�19 Date Completed', 2......- 9 .......... ........ g A