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2875 MAIN STREET
, v,7 /75-Aa/4 _S-)(----' 'tb-- . i ,.: . ..,,, ,.., . -.. • - , .: - w...... . . . •„ . , „„... .. • . . . .. _ . . , .. • .. . .. ... . . . . . .. . ., . , , . .. .... • . .... .. . „ . • ... •. .. ..„ • , .„. ...,„„ . • ..... . .. ... .,. ,...„ .„ ..„ ..... „.. . . „. . „ .•; . . . . e..".. , .. , . J . . . . .. . , ., . .„,...„.:,, . „.. . . . .., . , . . , .. „. . ., . ., •.,..... . . .. .., ... . . '-' ..\, , . ., . ... . , ..,..... . . 0..,,,..,•• _ . ,.„, , .., .,..,..... . .. ., ,.. .. „:„.....„..„„, , . .. ... . . . . ...„,.., ... ,...,„ ... . ,, • ... . • . • ,.. .• _. _ ..... , .„. .. ... .. • .. :•„ , . . .. . „ •. ... • .„,, ,..• . „„ .. . 4 . . .. . .„„..J. ..,...,,,,„.„ . .,..., . ..., • . .. .. ..„ . .,, ..., , . . , . . , ,. _.., .. , ..„ . .. ;k , - 5 , ii • . l :x. t,. �,.P ,� _ .'{, y ' y " ,:y • A .? .irN £ .=Y. y!i @ � �1Yf+, � .3':, ,ffd"� ,i4 ,•,,,v 4,4 '';* A •.�• "..» .. F • • � ; v d :� ,d�'� ^y • rk � x' ,.. ii'.r .�. � ,✓�».. °�. y. ry er 4 • p 3� • n,:ofi .,.,dj , � �', r�a +.K} -� d _ 4;tom•x, - x � .g= �'��s, �� c -, g 'd..,. rc • k _ t.av e. ,. A'.y 4` ,;,k. .. -' a Hwy• ,� __ r ,,e "a. • r` , .ky..,! .., ;. "..: . y....aa, ,; ,. .. ': - *, ♦ . l -� '• .y L x • w r ry� • • > "�y� •• <.. " :w d� - �ae. >r;. Hx R - .. t .. : ,,' ,eR _ . . 1 Town of Barnstable 11,5712-0-sy-s-pg.7 , ,... Regulatory:Services tiDate: , -ni Thomas F.Geller,Director 1 , U." . -Vi_ \'6. Will%#40193.M1LE i _1._ likitNiT kBLE.. : tom Perry, Building Commissioner ....,/,ta.C.—f 'i.,,,,--- e' il --,--- •.,,,o, .s,.3. 200 M.Wn.lir 1-ipimi3,,Virfill •• tEr,..,,R0 l. LIU fit;c1 // -'1I • wwwlown.barnstable.ma.u's 1 • Office: 508-862-4038 I Fax: 508-790-6230 . . TOWT4FRARNST-XBLE SOLID FUEL STOVE PERMIT . Owner: th ()aliell:k . one.Ph - - C55-2)v1A/L3556.____. ., ..._--- Install at:_1215._.‘Cfylik5A-. Village: ba(1)51A91e._ Map/Parcel: .. 14 __CILZ___ Date: ____Elik-2 .? - Stove Used - B. "t ype: q.adian /Circulating C. Manufacture . eif4eS& j)c,tch_(1/e 5,r Lab. No. D. Model No.: 7- ,Y A. • -/Existing (if existing, please note date of last cleaning) . • . B. Flue Size • C. Are other appliances attached to Flue? D. Pre-fab Type and Manufacturer das5 -11 • E. Masonry: Lined/Unlined Hearth. A. Materials: Reic k • - B. Sub Floor Construction: Calioni 0.-.1c te-/-e Installer Pi% Name: peizioe? I\cv . Address: ?,0 !ism%)-5020dziA met- ... . Phone:1_5C% OaEtZ Location of Installation: FLLC Registration 4 la1586`t . Construction Supervisor# c5Eptosgssri OR check Homeowner Instaili g, no li- nse required APPLICANTS SIGNATURE APPROVED BY: IU . . Please make cheeks payable to the Town of Barnstable *This constitutes an official stove permit after inspection, photographed, and approved by the Building Inspector • • Q:forms:stove Rev iO3,07 Jfae sumerrco�z Affairs &i nessuogulati n In Massachusetts -Department of Public Safety Office of Consumer Affairs&Buisiness Regulation VV/ fir HOME IMPROVEMENT CONTRACTOR Board of Budding Regulations and Standards Registration 120859 Type: Construction Supervisor 1 & 2 Family r 7 ",,s1 =`ts License: CSFA-058557 [Wiz Expiration 3/12/2014 Private Corporatior SAWICH CHIMNEY SWEFP INC. KEITH A CLIFF ,` `° PO BOX 90 „ �k KEITH CLIFF SANDWICH MA 02563 4 28 EMERALD WAY• 4Q�___�,,,�_ ' 7. FORESTDALE,MA02644 Undersecretary c-' ` } i'y' Expiration J.•�..� �� Commissioner 02/27/2015 COMMONWEALTH OF MASSACHIJSETTS - - . DIVIsco SH�ET METALION OF AWORL NstiRE-BOARDof 3 a N ._ WORKERS:...:-.-.-..:.,., 0 3. r„ Ts AS AMASTER-UNRESTRICTED N giro E'ISSUES THA8OVE'LICENSE TO:: .I o k 4 S , LLZW t KEITH- A OLIFF ._ �_' "" s — 2'8 EMERALD ,WAY . .,i w .o to FORESTDALE MA -02644 1530 _ -,, , _,bm ;�' 3 1`1088 02/28/15 33.009�+ U vCO LICENSE NO.. EXPIRATION DATE SERIAL NO. • License or registration valid for individul use only Restricted -One-and two-family dwellings or any before the expiration date. If found return to: accessory building thereto, irrespective of size. Office of Consumer Affairs and Business Regulation m i 10 Park Plaza-Suite 5170 Boston,MA 02116 1 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Not val. thout signature For DPS Licensing information visit: www.Mass.Gov/DPS CONTROL# H575047 . - N ti tiAti-ao w-i� ��— IMPORTANT a °o a_g-oo__ --a,2, ,a3<_,2 °Q _ �--ate-aye n "d.�'"ao �"m�com o'"a vni'n m'm New Jm Q^.o (n If this license is lost or destroyed, notify your Board at the: _ ii v ill!"a a;Q!<2 z a o i o.a a v, Division of Professional Licensure, 1000 Washington St., _ �s 2 2°^ 2.°_=N .„,-.re;„ _g b v a''.'2, D Suite 710,Boston,MA 02118-6100. :z " a-i O oa"m o2;gaPv-R- -fc�=Na; No va m If your name or address shown is changed, notify your board i_:m N _ N„ a v- r - li i, of correct name or address to insure proper mailing of next =- - a .m _ a _ _ O m mqz 3'c, 7a oociow Nmi N1 Renewal Application. Always refer to your license number. __ _-___.-3 ry m a d cs =.av -Q o s, n- m This license is subject to the provisions of the General Laws rt _ a a m- ,Boa'<g ,Q v O= r« as amended.It is a personal privilege,and must not be loaned y T _- e.v.= U a z y2 0-°o s n -• ` c a = m m o g a_g or assigned to any other person. Keep this license on your '_= _ - _ „a;,7 a N person or posted as required by law. s iTrIE " ;c° Town of Barnstable it.,7 Regulatory Services l as r TilOzras F.Ewe Fier,Director ':_40: � Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Sec on If Using A Builder coa..-goi&A. ,as Owner of the subject property hereby author ze �� ` S1 to act on my behalf, in all matters relative to work authorized by this building permit application fon (Address ress o. job) nature of Ow,<, r ate /Grit tet r !7• l e Ai Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM S:OWNERPE RN!SSlON ..._ . - The Commonwealth of Massachusetts Department oflndustrial Accidents . ' Office of Investigations • • 601)Washington Street • Boston, MA 02111 www.mass.goildia . Workers' Compensation Insurance Affidavit: Bttilders/Contractors/E ectriciaras/Phh bers. Applicant Information Inforz ation Please Print Le b o Name(Bass+essfO adoa dividt=ai):���V J�A ?1 ud\S l(S1n D f ll l� ` Address: TX) . i1 [) _ City/State/Zip:_ak j \ Q SIo,� t hone. l—:_ % 7- IAre ye an employer?Check the appropriate box: Type ofproject required): r" 4. f am a general contractor and I yp 1, i am a employer with g hare hired the sub.-contractors 1New 5. n canst ctaont employees(fu4l and,�or part-time).* .2.0 I am a sole proprietor of part=-. . listed or:the attached sheet. ?-- 0 Remodelrng - ship and have no employees These sub-contractors have g. 0 l?e so±iedan - emalo employees and have workers' working for me a any capacity. y 9. D Building.addition. ' [2slo workers'•comp.-insurance comp.insurance.: required.] 5. 0 We are a corporation and it 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work of ten:have exercised heir $ 11.0 Ph mhi,g repairs or af€ciitions myself.[No workers'cow. right of exemption per MMMGL y 12.[ Roof repairs 1 52; l 4 and we have no I .ItstII2F1f:8.a`E(BtirCd.]t § � }9� �` employees.[No workers' 13. Other comp.insurance required.] - J `My applicant that checks box#1 mast also tMk out the section below showing their workers'corsx;,wasator,policy information. t Homeowners who submit this affidavit indicting they are doing all work gild tray hire=side contractors must submit a new affidavit indicating such. 1Coniracters that check this box nnist attached an additional sheet showing the name of the sub-cont+zntors and state w hethr or not those cmt tics have employers. If the sub-contractors have emplo;ems,they rust IAovide their workers'camp-policy mor'M T am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site • information. insurance Company Nrame:__+ } i C. �++ l ajtale_esn . Policy#or Self ins.Liu.#: obi 0 1 0? J j Expiration Jane:_Aalka015._ Job Site Address t f -a s#aole.-.TJ a. 30_Gi?'StatelZip: 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 25 A.of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 ar_dior one-year imrrprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of.up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Lnvess cations of the bIA for insurance coverage verification. I do hereby ce ,fy a,r -i�e pains and penalties of perjury that the information provided above is true and correct Signature: •0P G - Date: 2.-X3-a()13 . Phonetf: (60%):$g-5[I`4 Official use only. Do not write ate this area,to be completed by city or town officiaL . E • I .City or Town: Permit/License Issuing Authority(circle one): \ 1.Board of Health 2.Building DepartDepartment 3.C=ity/Town Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other l Contact Person: -Phone It: ._.______LA . 1 r AUG. 23. 2013 10: 15AM HART INSURANCE NO. 061 P. 1 C'Al oar(a�DCIYYYYj CERTIFICATE OF LIABILITY INSURANCE oaroi 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 tarms 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 Laura J Murphy HART INSURANCE AGENCY,INC. JAM; • 243 MAIN STREET PHONE rice. (508)759-7326 PATS 908 759 736E PO BOX 700 m. Imu h hertinsuranoed eri (ArO,Nbi: ) tootseSs: rp y� g cy.com BUZZARDS BAY,MA 025320700 INSURER(S)AFFORDING COVERAGE rdAICi INSURER A: MAX SPECIALTY INSURANCE 20079 INSURED Sandwich Chimney Sweep INSURER B: ATLANTIC CHARTER INSURANCE COMPANY 44326 PO Box 90 -- Sandwich,MA 02563 DISURERC INSURER D: INSURER E: :AVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS Ls TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVI"fHSTANDING 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 CONDPfIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. dSR ROM SLIER POuOY EFF POLICY EXP - -TL} TYPE OP INSURANCE JAM wYD POLICY NUMBER (MMronlrYYY) , MJDDIYYYY) LIMITS A GENERAL.LIAea.ITY MAX013100005253 10/09/2012 1 of09/2013 EACHoccunneme S 1,000,000 OAMAGE TO RENTED COMMERCIAL GENERAL UABIUTY PREMISES Ma mew a 1 OO,pOO CWMS•MADE OCCUR MED EXP(Any efts pawn) 5,000 - PERSONAL&ADV INJURY S 1,13OD,O00 GENERAL AGGREGATE S 2,000,000 GEM AGGREGATE LUArr APPLIES PER: PRODUCTS-COIP/OPAGG S 1,000,000 G —1 POLICY I ITei n LOC g AUTOMOBILE 643B]UTY F a IN INGLE UNIT $ ANY AUTO BODILY INJURY(Per person) S _ ALLGOWNED AUTOS -SCHEDULED BODILY INJURY(Pc,sadder l 3 HIRED AUTOS ^NO E0 Tgralr�iY Y DAMAGE $ AuTOS tPe( ktenll 3 UMBRELIA LOB _I EACH OCCURRENCE S — EXCESS LIAR Ck.AINIS-MADE AGGREGATE $ DEO RETENTION S 3 WORKERS COMPENSASTON I WCV01032500 08/28/2012 OB/28/2013 YSTATkIt _ OYH- $ AND EMPLOYERS'LIABILITY Yd N UNITE V/1IER ANY PROPRIETOkmARTNER/EXIBCUTNE 08/28/2013 08/28/2014 EL EACH ACCIDENT S 500,000 OFFlDEPJMEMBER EXCLUDE N NIA _ (Mandatory In NW • EL DISEASE.EA EMPLOYEE E b 500,000 IPras desaae wider — nE RtP')'ION OF OPERATIONS below - EL.DISEASE-POLICY uurr I$ 500,000 ISCRIP11ON OF OPERATIONS I LOCATIONS I VEHICLES(Meth AMMO 101,AdWtIAnal Remarts Schedule,If meta space Is gqub d) aerations as performed by Terms&Conditions in the policy. ERTIFICATE HOLDER CANCELLATION - I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL, BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,Ma.02601 AUTHORIZED REPRESENTATIVE _— I ________ 7-4("4‘- 01988.2010 ACORD CORPORATION. AD rights reserved. CORD 25(2010/05) The ACORD name and logo are registered marks of ACORD T4:4-71,7, own of Barnstable BU11C1111 Post This Card" o,"That�t s 1/�sible From the Street °A , coved Plans Must be=Retamedon,Joband this Card M.ust,be;Ke t , •`;., g wuvir�eax • ix I' ;�: PP P • b" iPosted Unti Fir,al inspection Has Been'Madet e All"):.La p yamu . e red such Build�n""shallNotbe O I s action has•-, ' - beenWmade 1 el mit pYeq ' ". gamt � .y p� _�,k_"_h to Permit No. B-18-869 869 Applicant Name:: RICHARD SOARES Approvals Date Issued: 03/30/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 09/30/2018 Foundation: Residential Map/Lot: 279-072 Zoning District: RF-2 Sheathing: /�G� Location: 2875 MAIN ST./RTE 6A(BARN.), BARNSTABLE 'il t �, " Contractor Name ' RICHARD SOARES Framing: 1�G�` ` ���c� Owner on Record: BEAUSANG,JEFFREY&ERLA 1-- :ContractorLicense 164040 2 Address: 2875 MAIN STREET f� "" Est Project Cost: $40,000.00 Chimney: BARNSTABLE,MA 02630 $254.00 Permit Fee: Description: Kitchen Remodel, New Cabinets,new drywall,newfloonng insulate Insulation: � � Fee Paid' $254.00 upgrade t 4- Final: 1_ Date ' 3/30/2018 Project Review Req: i : � 7/ Plumbing/Gas Rough Plumbing: ''' ,A., - .. Id Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the,approved construction documents for which this permit has been granted. ' * Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws aril codes. This permit shall be displayed in a location clearly visible from access street ar:'road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. �, li- , Y N Electrical F The Certificate of Occupancy will not be issued until all applicable signatures by the Building and'Fire Ofcials are prowdeed on this"permit. Service: t ;� Y Minimum of Five Call Inspections Required for All Construction Work:! w , 1.Foundation or Footing ,,, fix,• Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: ..2ki--e" All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT The Commonwealth of Massachusetts --- Department of Industrial Accidents r. ,� 1•"_ • Office of Investigations =. = v • 600 Washington Street D l =l Boston,MA 02111 -at www.mass.gov/dia - Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plurabers Applicant Informa tion Please Print Legibly 7 Name(Business/Organization/Individual): X,G / �e_,4 . Address: / c� ic,o. S,7"-- /A,- ®2t 6 q City/State/Zip: Gtie. p�z. a Phone#: i 3/o oee 2? Are you an employer?Check the appropriate bow Type o project(required): - f t 1.0 I am a employer with 4. a general contractor and I 6. 0 19w construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. elmodeling ship and have no employees These sub-contractors have g. 0 Demolition working for me in any capacity. . employees and have workers' 9. El Building addition [No workers'comp.insurance comp.insuranCe.t required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work . officers have exercised their 11.0 Plumbing repairs or additions myself workers' right of exemption per MGL [No comp. ,and we have no 12.0 Roof repairs insurance required.]t c. 152,§1(4) 13.0 Other employees.[No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. -\ t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. lithe 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.Lic.#: Expiration Date: Job Site Address: City/State/Zip: — Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties blithe 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 epains penalties of perjury that the information provided above is true and correct. Signature: Date: 2,��1 Phone#: , z7 340 e' 2-•w7 Official use only. Do not write in this area,to be completed by city or town official City or Town: Perinit/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#: r • ,, '- ' .. - .. ._� fiy1am Massachusetts Oepartm.ent clt-Puer 5sfc;;y • . Board of Building Regulations and Standards .-.' , ,.- -g,�-- 3: Construction Supervisor � � t License: CS-085267 _ (Restricted to: Construction Supervisor - +Unrestricted-Buildings of any use group which contain "1 ' less than 35,000 cubic feet(991 cubic meters)of I `RICHARD D.SOARES i ,� '' enclosed space. t +-�. 18 SPRUCE STREET, � , ' � 'WEST BARNSTABLE MA 02668 -' + r 1 ., I 5 . Y witcat ")/21t�r.�. Expiration; k (Commissioner 02/22/2019 • 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 C, ,,, ,.� - - . , ` C-nic T'arrainrvuacuiC,o 0/74 Jr-rArrieffj Office of Consumer Affairs&Business Regulation "-0" - - - �. 1. 5,1�� '•ME IMPROVEMENT CONTRACTOR ; . . ._ .- 1 i egistration �64040 ; Type: ' •License.or registration valid for individul use only ' . "I. xpiration: 8/14/20171, Individual before the expiration date. If found return to: 1 `` r r Office of Consumer Affairs and Business+Regulation RICHARD SOARES1I4 10 - Plaza-Suite 5170 t: i _K N I Bos MA 02116 RICHARD SOARES`y � lri _ 18 SPRUCE ST 'k. � _/,' W. BARNSTABLE,MA 02668 gj-- , Undersecretary. , 9}. . 4 tNot valid without signature ' =�' ' ' . �oF1HEIN, Town of Barnstable . 's� °� Building Department ''E' ` Brian Florence,CBO • �� 6 a``� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must • Complete and Sign This.Section • If Using A Builder • I, lefi-- (� ,as Owner of the subject property hereby authorize . clet..-�'�� to act on my behalf, in all matters relative to work authorized by this building permit application for: )._e7-5 444,111 sY Farivilii,ot Pit , -1 • (Address of Job) **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. S' a of Ow Signature o pplicant • IEFF SkiN0— "". .ie-4.q.407.1 4,e—I Print Name • Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:10/17 . 1VvvU lJl _vat ual.aUic tHE rp Building Department Brian Florence CBO sAnNsrABLE. • Building Commissioner M"Too_ $ 200 Main Street, Hyannis,MA 02601 1°t6;q. �� Mp' www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION' Please Print DATE: JOB LOCATION: '4number street village • "HOMEOWNER": . name home phone# • work phone# • CURRENT MAILING •'DRESS: • city/town state zip code The current exemption or"homeowners"was extended to include o •er-occupied dwellings of six units or less and to allow homeowners t. engage an individual for hire who does no I.ossess a,license,provided that the owner acts as supervisor. • • DEFINITION OF HO 1 OWNER Person(s)who owns a p• ?•el of land on which he/she resides •r intends to reside,on which there is,or is intended to be,a one or two-family d lung,attached or detached stru' •es accessory to such use and/or farm structures. A person who constructs mo it than one home in a two-year.eriod shall not be considered a homeowner. Such "homeowner"shall submit,• the Building Official on orm acceptable to the Building Official,that he/she shall be responsible for all such wo' erformed under the b ding permit. (Section 109.1.1) The undersigned"homeowne : sumes responsi• ity for compliance with the State Building Code and other applicable codes,bylaws,rule• d regulations. • The undersigned"homeowner"c- 'fies that e/she understands the Town of Bamstable Building Department minimum inspection procedures • requ' meats and that he/she will comply with said procedures and requirements. Signature of Homeowner • • Approval of Building Official Note: Three-family wellings co • •.g 35,000 cubic feet or larger will be required to comply with the State Building Code Sectio, 127.0 Construe Control. e I I OWNER'S EXEMPTION The Code stat• that: "Any home' I •r performing work for which a building permit is required shall be exempt from t e provisions of this s,c in(Section 109.1.1-Licensing of construction Supervisors); provided that if the h meowner engages a pe o'(s)for hire to do such work,that such Homeowner shall act as supervisor." Many hom owners who use this exemp In •re unaware that they are assuming the responsibilities of a supervisor(see A pendix Q,Rules&Regulatio i r Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious probe s,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed aga t the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is mately responsible. To ensure that the homeowner is fully aware o is/her responsibilities,many communities require, as part of the permit application,that the homeowner c. 'fy that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form curre\ly used by several towns. You may care to amend and adopt such a form/certification for use in your comm i i:sty. r . .*THE,rois4, o': 0 0 - 4 :A Application blim3ber... 4' -ib b(P61 Permit Fee Other Fee ragti 9 • Total Fee Paid....................- TOWN OF BARNSTABLE Permit Approval by-it/04V On. 5/317/4) BUILDING PERMIT Map . il' .pare. - 0'1 9 . APPLICATION . Section 1— Owner's Information and Project Location Project Address c›2-15. 75 / .17,,, ,c;, -- Vi11age/7.- 40, Owners Name . .q.e -z.3- 7-,-;,,,,,7 j j 12-P Owners Legal Address QV-5- atiTh 51 6(4/Kiii 'M 6 114/1 "." / City , e.40 State :er0; , Zip O ,2‘ 3 0 Owners Cell# '9:21 -7-3 I ;I)b6 3 E_mo i b.e.,4..cAso.. n Section 2—Use of Structure i I Use Group 0 Commercial Structure over 35,000 cubic feet 0 .n.lomercial Structure under 35,000 cubic feet , Pringle/Two Family Dwelling Section 3 —Type of Permit 0 New Construction 0 Move/Relocate El Accessory Structure 0 Change of use O Demo/(entire structure) El Finish Basement 11 Fprnily/Amnesty El Fire Alarm Rebuild 12 Deck Apartment El Sprinkler System O Addition El Retaining wall 0 Solar EPlenovation 0 Pool 0 Insulation Other-Specify ISection 4 -Work Description I Z ' I ' tr .:.. .OSIIIIM:.-*71-/POZAt.r_; 1 - .' , ...... - 04 . ,... , :gasieJ57,,, PIT .,,7,9PJ f [ , fr' -A-711'4 r ;' ‘'Z1 ") .11--- 9/ rr2 '‘f a I T 51 Ct undxted!2/9/201 8 1 Application Number Section 5—Detail Cost of Proposed Construction ` 0 Square Footage of Project s D Age of Structure �_.3 a_:_zi) , . Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) v f_ 110 MPH Wind Zone Compliance Method p'lc heckhst ❑ WFCM Checklist 0 Design Section 6 Project Specifics a Firing ❑ Oil Tank Storage ❑ Smoke Detectors lumbin ,,_,/Gas Fire Suppression g �" ❑ uPP 'Heating System. ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ElPublic r . 0 Private Sewage Disposal Runicipal -❑ On Site a nn Historic District i Ini s storic District ❑ HYd Kings g Highway Debris Disposal Facility: ❑ Yes��Cp�� � „�9�,�/�� I am using a crane Section 7—Flood Zone Flood Zone Designation , Within or adjacent to a wetland, coastal blink? Yes 0 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 past? ❑ Yes •1;]-' No LastimdatPri•2/92018 e _ • Application Number Section 9—.Construction Supervisor Name /(1114 4,079 YOcon-0Telephone Number ov' Address ytlLa.-. 5 City f,✓ , iVIAState i Zip d 2(0,& g License Number 01041 License Type jAr 9h j,k Expiration Date 2/I-2/20/q l Contractors Finail Pti vtnil 0-0 hoe,k ,1. cam Cell# Siv6 -36 0 , o /'z-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 required by 780 d the Town of Bamstable.Attach a copy of your license. Signature Date 5/2 3A S Section.10—Home Improvement Contractor Name ///l4'/ JiLte4 Telephone Number,rig ''t/2 7 Address/t ,s0/ ee y ( City tr4)'Pefrili4 E' State/9 Zip &,2/4 Registration Number/6 liotio Expiration Date 1 , 3/ 20 / 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 and Town of Barnstable.Attach a copy of your H.LC... Signature Date 3.2 3 • 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 3 23/ Print Name RI.61 . f4r-e$ Telephone Number3 P .�� �0 ®yZ 7 E-mail permit to: kh_III/ro1-1 �`1' `7 , eePh T innnio - f Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) El Historic District ❑ Site Plan Review(if required) • ❑ Fire Department ❑ • Conservation ❑ • For commercial work,please take your plans directly to the fore department for approvaL Section 13-Owner's Authorization I, ae-FF f AU.s as Owner of the-subject propertyhereby authorize Gi o to act on my behalf, in all matters relative to work authorize this • ding permit application for: 'Yvvt,ix A 4.4t, A1A- Address of job) -).6 -16 p� Si a e of r date Print Name • Last undated:2/92018 :,;'° . Town of Barnstable i i,-1lri } ;': . .,.- ; ' �: - .,r-: . _ . . . : _ , ,.. :a' 11 i s Post This Card So.Tht itas,Visible`From theStreet�A roved PlanMastSbe ,taIrled oIIIInd&this Gar - ust be Ke t ' ' + anruvan'was.& - �.? C ". s ' DPP z �. a ..�yr :*.`�P 3 , °�, 17 M" Pos.#ed Until Flnalltns ectton Haast.';BeenMade k I .' `' MeceR Where a.Certificate:of OCcu a,f4t lks,Re u=re `such B �ldm` �ahalIkNot be Occu ie,i until a`Final--Ins ection'haszbeen made , ,, Permit `� ° ;:r :_� . .- �"r.; d+`�`xp �� i...4...�.,Q ��u.;,.,...�:�s°�.:_�..g.._.�Yak�: � '�,�'��,3 .xi�a _�[��spa.�.,�',. __: •a,�a-;,;,6._ .,.... Permit No. B-18-868 Applicant Name: RICHARD SOARES Approvals Date Issued: 03/30/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 09/30/2018 Foundation: Location: 2875 MAIN ST./RTE 6A(BARN.), BARNSTABLE Map/Lot 279 072 Zoning District: RF-2 Sheathing: Owner on Record: BEAUSANG,JEFFREY&ERLA ContractorName RICHARD SOARES Framing: 1 Address: 2875 MAIN STREET - Contractor L eri e,1164040 2 BARNSTABLE,MA 02630 � „" :. Est Protect Cost: $ 15,000.00 Chimney: Description: Reroof £zg rt PerrnitFee: $76.50 Replacement Windows(4) ' Insulation: F,ee Paid;F $76.50 = Final: Date 3/30/2018 Project Review Req: tt , 2 Plumbing/Gas 1 x 1. Rough Plumbing: . Building Official �, � � Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authonze,Any this permit is commenced within six months aft r issuance. g All work authorized by this permit shall conform to the approved application and tl a approved construction documents for whichtthis permit has been granted. All construction,alterations and changes of use of any building and st0Fris_shall be in compliance with the local zoning by taws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street�or road and shall bei maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatureslby theBwldmg and F re,lOfficials are prowded onthis permit. Service: Minimum of Five Call Inspections Required for All Construction Work: A� 1.Foundation or Footing , r g' - � �r..' - . Rough: 2.Sheathing Inspection Final: 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 Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department -"?‘ Building plans are to be available on site Final: •.,; 1-<( / All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT y 01.THE h� Town of Barnstable *Permit;16 -6&� '�V�' rres 6 months from issue date Building Department wee 9�, � �� �`� Brian • Florence,CBp cb i639; 45 Building Commissioner ji(tO 5.0 '°rEo °' �� 200 Main Street,Hyannis,MA 02601 t AR 2 www.town.barnstable.ma.us Office: 508-8 6f,t2 40338U - � �I�S TABLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ,7�� _ D Not Valid without Red X-Press Imprint Map/parcel Number Property Address ,79 S-7 S /72 r'' ��2.� ' : dt� ®-Residential Value of Work$ e-T.3 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name,,�' .�J� Set.et_ Telephone Number .'?? ' D 'Oct�T Home Improvement Contractor License#(if applicable) /b io"ft Email: 'es-L47 fps,& kpw /,cepti Construction Supervisor's License#(if applicable) C S` - Z2 g S.T b 7 ❑Workman's Compensation Insurance Check one: ®-4-am a sole proprietor 0 I am the Homeowner 0 I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) [ —R -roof(hurricane nailed)(stripping old shingles) All construction debris will be taken t // �( ��� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) jJ�j ❑re-side eplacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ' *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Cs!rvation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Th-`""- Q:\WPFILES\FORMS\EXPRESS2017 r • 1 N. The Commonwealth of Massachusetts -- ___,_ Department a, Industrial Accidents .f w Office of'In tigations 4 ry= -6 600 Washington Street 4 Boston,MA 02111 T"%•14, ia`-' wrvwu masgovcdia Workers' Compensation Insurance Affidavit Bt derslContractursiElectricians/Plumbers A&plicant Information Please Print Leah Name(EinsiaesstOigan oafFn 3na1} di,,,,4,3 Address: cf`77-- ,-,, i9 1,-/r . . ,,4 -�ce . City/Stater /77 4 ee Phone i.S'7' :3G 6 CI C✓2 Are you an employer?Check the appropriate box: ' Type of project(required): 4. I am a contractor.and I I.❑ I am a eaaployes. g� 6- 0 New construction 9yfoyees(fall and/or part-time).* 'have hired the sub-compactors 2.g-t am a sole proprietor or partner- listed on the attached sheet 7. 0 Remodeling chap and have no.emplayees. . These sub-contractors have S.-0 Demolition working forme in any capacity. employees and have worms' 9. 0 Building addition • [No yv�g'comp.insurancecomp.insurance-1 I ' reared.] 5. 0 We are a corporation and its 1 0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L Q Plumbing repairs or additions. ,,rysg o workers'comp_ right of won per MGL insurance required.]a a 152,§1(4),and we haveua 12_Q-Boe€2ep • employees.[No wok's' L3.0'Otter comp_insurance required.] *Any apylicarrebat chedsbox 01 cast also Moot the section.below thawing diet-workers'compensation poky ud-ormafion_ • I Homeowners Who sabot this aifida[ir i f,they axe doing rig wn&and then/sire outside contmcmrsmnst submit anew affidavit irv>;rg*q;sack tCoutcac1ors that check this box mast attached an additional sheet showing tlrename of the sab-ccatractorsamd state whether or not those eatitieshave . employees.Ifthe su cat actoss Lave employees,they met provide their workers'camp.policy number. . Ian[an employer that is providing workers'compensation insurance for nay enrployees Below is the policy and job site information. . Insurance Company Name: . 'Policy#or Self-ins_Lk_g • Expiration Date: . Job Site Address City/State/Ty: Attach a copy of the workers'cotupensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage as requi eedunder Section 25A of MGL r 152 can lead la the imposition of criminal penalties of a fine up to$1,500_O0 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDERand a time of up to$$250_00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations ofthe DIA.for insurance coverage v-erif on_ - . Ida hereby certify under the pains , , ,-* ,ri7- ofperjalythatthe information.provided above is tr ue and correct Sitmature: �� Date: f' Phone!: S15 -51 o gV-2--7 . • Official use only. Do iwt write in this area,to be completed by city or town official City or Town: Per tlLicense# I�*rid•g Authority(circle one): • • L Board of Health 2.%Ming Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person Phone#: • 4 8, 21. c.1 r, 8 rc RI ji V . • .-. �' q g i! a 0o Fa � tr CPC' s :t�"` �•� .' i * pIP � ' '1.-dm Gil 44MR 1.1B; g• glitclii :pli iVa,g,,, gBE.... U1H Qkrh o °, N4. IAVg. PP ` sy �'g �0 -� 1 • , . 4 i I-h ��y�.y�iy' ,- L,p' Evrf i' Et . I, 'A ;1', `P ',00. 2 'it R.: u .`-.5: 1.. i w E ° g a 1 4AP lrR R @.R. pi ti, 11: ri. g. gl 11 I t( u: J !tIj 2 �Ly�•E u, 44 ,.1 0 TA , si .N , . .54 5. rii I . .0 15 I -5 f 6 r -- --Er-44 ' 0-- -1,1,__4_ s, at g-A P.IP .-- ri, , 11 R ,, r; 1 al gill HI pa .1z,,..tt 0) 2 - N.,- : ---, ilni 81.: rot .1i 0,1 'Itei R. R.ilLlit'" 1 E g'..-1. R Ris,IH g 1I1Hll � �.(W �y+ �A �p A. 0.,, „9 aHI1 D1,1 H, . . pi 8 >-.... ."- r 8 • X'tj 01. 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I .: 0 S � , 4 DPS Licensing information.visit WWW.MASS.GOV/DPS -_ r//..i;one, ,,,,efeold./l/4,4elcAte.;a1; :i .r fi, ,//s/I/"/i/efli�/A I/(`:./4/3�./f�I/1.'��i °-_ Office of Consumer Affairs B Business Regulation � Office of Consumer Affairs 8,Business Regulation - �� HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only -:••i -rg HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only -,', TYPE:Individual before the expiration date. If found return to: "'t 4 TYPE:Individual before the expiration date. If found return to: N Registration Expiration. Office of Consumer Affairs and Business Regulation Registration Expiration Office of Consumer Affairs and Business Regulation , 1164040 08/13/2019 10 Park Plaza-Suite 5170 °r 3 1164040 . 08/13/2019. 10 Park Plaza-Suite 5170 RICHARD SOARES ` Boston,MA 02116 R 1-IARD •SOARES Boston,MA 02116 • RICHARD SOARES j� IL.0. EJ--' RICHARD SOARES r R„C p,,,� -. -.� .�C_.� 18 SPRUCE ST ., .. . 18 SPRUCE ST _ /. W.BARNSTABLE,MA 02668 - Not valid W hout signature W.BARNSTABLE,MA 02668 Not valid W f pout signature Undersecretary Undersecretary R TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ri d'-.1v ,�G �7 Map C\ Parcel /f Application # c OV C.1� ` 56 Health Division Date Issued 230 PI Conservation Division Application Fee S Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address Ds'7C )7,41St. Village !•7`r"S hgIt- Owner })cl Iv'- Address s.,,� Telephone cay-71C--.Th i Permit Request cL ,-.7_ .., cci( Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ) Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attaclz1 pporting-4ocunientation. Dwelling Type: Single Family GY Two Family ❑ Multi-Family (# units) tZa 2 ` ' Age of Existing Structure Historic House: ❑Yes ❑ No On Old King' Highway: ❑ s ❑ No Basement Type: ❑ Full ❑ Crawl U Walkout ❑ Other C0' Basement Finished Area (sq.ft.) Basement Unfinished Area (s .ft) Ira 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: U existing ❑ new size Barn: ❑ existing ❑ new size_ Attached garage: U existing ❑ new size _Shed: ❑ existing Cl new size Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Comrrie,rcial Cl Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike Mccal,thy Construction Telephone Number PO Box 52 Address West Dennis, MA 02670 License # Cell (508) 280-6964 Home Improvement Contractor# CSL-58633 HIC-169393 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 11 SIGNATURE - DATE )2-) 11 y FOR OFFICIAL USE ONLY -APPLICATION# • DATE ISSUED MAP/PARCEL NO. • ADDRESS • VILLAGE OWNER DATE OF INSPECTION: • FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _ _ -,. - 1 DATEaCLOSED.Q.UI • C1- ASSOCIATION.PLAN NO, )CN" OWNER AUTHORIZATION FORM • (Owner's Name) • owner of the property located at 7c /144.i (Property Address) ILLCiA5Ltblei 4i4 . • oa63O (Property Address) hereby authorize fr-Q---CR4 �4Y1c roc" • /t/ (Subcontractor) an authorized subcontractor for RISE Engineering, to act on'my behalf to obtain a building permit and to perform work on my property. Owner's""=Signature Date Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 ft `\ 1 11 /, MICHAEL J MCC,J . -,. PO BOX 52 * ' W'DENNIS MA O267 '4.�; • 'r/ •40,raa \\ ��^ � ' "� Expiration Commissioner 04/10/2016 Cl/be eat% o C�G Camackr�ea,i, i— Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tr# 238121 'MICHAEL MCCARTHY MICHAEL MCCARTHY - -- P.O. BOX 52• — — ---- - WEST DENNIS MA 02670 --- — - -- _ Update Address and return card.Mark reason for change. Address Renewal Et'Employment Lost Card SCA 1 Co 20M-05/11 7..-, El j,. • The Commonwealth of Massachusetts Department of Industrial Accidents '1114—�f Office of Investigations • Eiifir== 600 Washington Street Boston,MA 02111 www pass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Mike McCarthy Construction Name(Business/Organization/Individual): PO Box 52 West Dennis, MA 02670 Address: Cell (508) 280-6964 • City/State/Zip: CSI §A3 HIC-169393 Are y u an employer?Check the appropriate box: Type of project(required): 1.&I am a employer with I 4, El 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7. 0 Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. 0 We area corporation and its 10.0Electrical repairs or additions required.] officers have exercised their 3.[] I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. 0.152,§1(4),'and we have no 12.0 R f repairs insurance required.]t employees.[No workers' - comp.insurance required.] ]3. they *Any applicant that checks box 111 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 or the subcontractors and their workers'comp.policy Information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and Job site information. Insurance Company Name: P A•4.1 //Li Policy#or Self-ins.Lic,I1: V W1 C. 1 i-6 C, � � Expiration Date: Job Site Address: Its /?e' -51/ City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500,00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a 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 cent)"tt d p pa a males of pedury Mat the information provided above is true and correct, Signature: Date: )0)i Sl I�� Phone#: • Official use only. Do not write in his area,to be completed by city or town official Clty 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#: • • Acc•RD CERTIFICATE OF LIABILITY INSURANCE • DATE(MMIDDIYYYY) 07/10/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER 01962-001 CN.QOCT Bryden&Sullivan Ins Agcy of Dennis Inc W M EA: (508)398-6060 rd.No.: (508)394-2267 PO Box 1497 iNgtEss: So Dennis,MA 02660 INSURER(S)AFFORDING COVERAGE _ _NAIC# _ INSURERA: A.I.M.Mutual Insurance Company 26158 INSURED INSURER B: Michael McCarthy Construction Inc -- INSURER C: P 0 Box 52 INSURER D West Dennis,MA 02670 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 WTI-IICH 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. ILTR TYPE OF INSURANCE I yp in POLICY NUMBER ;NSW)_I M) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea occurrence) _ L— CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 3EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ - OLICY PELT F—rOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS MADE AGGREGATE $ oRKDEERDg pM RETENTION�gE $ yy�gT 7U TH $ • ANNyD ERM�PPLRO�YEErRpSR€LIABILITY X TORY LAMITS OER A AOFFICER/MEM'BER/P ��IjRECUTIVE Y( N/A VWC-100-6017656-2014A 7/17/2014 7/17/2015 E.L EACH ACCIDENT $ 500,000.00 (Mandatory{{ a In NH) tU? I I EL DISEASE-EA EMPLOYEE $ 500,000.00 VEITI ON OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ 500,060.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space Is required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thielsch Engineering 195 Francis Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cranston,RI 02910 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE frLC2? ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD TOWN OF B• ;`1),jej. E BUILDING PERMIT APPLICATION ryllt ` 1 Map `_ Parcel ; % I ' `'? -: t Application # 20 ` V� Health Division Date Issued A ,'" /..e(Conservation Division Application Fe ° Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 8 7 c 11'la IN 57" Village bk/' c* 4/e Owner�`��tice G�cz i o- dziltetr 7 A Address,�g74l1z/; 5 &E,WAgi4 Telephone SOg — — 3 6-Ty Permit Request /Vecv Ch wvle7- Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation/S: O,0Q Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: 0 Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 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 0 No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 10t4ct 0 if. f Cali Telephone Number 508- -c - 3 Scc Address (94;1/7 Hain St License # gams/t7 /0 70 C ?O Home Improvement Contractor# 31i+h yfa 69&1 Cz i/•CD v r Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ate_.„lc 4 C 41 e Se /9 SIGNATURE DATE �/l f FOR OFFICIAL USE ONLY APPLICATION# ._.DATE ISSUED_ MAP/PARCEL NO. • li r c ADDRESS VILLAGE OWNER DATE OF INSPECTION: FRAME tINS.ULATION. • *-LA_ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i FINAL BUILDING- 47. - Y� -DATE CLOSED OUT ASSOCIATION PLAN NO. � tl. yI. -.: a - /t- The Commonwealth of Massachusetts . . _ - Departznert of industrial Accidents , N Office of Invest4 ations w 600 Washington Street Boston,MA 0II1I x " Ivwwsw.massgov/dia Workers' Compensation Insurance Affidavit: Builders/CoritractO.r§/leetricians/PIarr-ther"s. Applicant lnfarnathr ,�� � , rt� _ - , �" Please Print Legibly Name Bjsines/O anizatioarndividuz�: �_ llf d).1 foleJ \ l' \lri)ne 1C e' • Address: •46ox90 . :0 � . City/State/Zip: Phan.e.: _ } Are yo- an employer? Check the appropriate box: Type of project(required): 4. 1 am a general contractor and I 1.l— i am a employer with "'1 fl t. -- 5. [ Neva.corn uc on employees(fail and or pa t ti:ee).* htaae hZ-ed the s`�eb-congactt�_s 2.0 I am a sale proprietor or pares hstea on to arched sheet, 7- [ iZeitndeling Th sub-contractors have ship and have no employeesS.•roj DemoIt'd;in - working forme in aay capacity. employees and have workers' 9. Q Building addition comp.insurance_= — [No workers'cif .irsln-ance required.) 5. Q We are a corporation and it -10-U Electrical repairs or additions ' 3.0 I am a homeowner dciaa all work ef`:cena have exercised their I 1 11.0 Pltrrrhi g repair,or or additions myself.[No workers'cow. :ght of exemption per MGL f _ - 12.D Roof.epaus irrsr arequired.]t c. 152,§1(4),and we have no .-, :3.`!Other employees.[No workers' 1 comp.insurance required.] 1 i `fury applicant that checks box 41 mist a sc fin out the sxuen below showing t air workme eompnisatia-:policy fo nia im_ 'Homeowners who submit this affidavit indicating they arc doing all work and ten hire outside coetcactors roast submit a new affidavit indicating such. =Contractors that check ohs box mutt attached as additional sheet showing rlte name of the sob-couese rs and state w ctr` or not those cu*.'des have employees. If the sub-contractors have empla ,they roust provide their workers'comp.poIicY renob Ion an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site • information. Insurance Company Name: ptkkantLejjacilikani .2tion6e ec . • Pokey#or St. -ins.Lic.#: tOe NIy 010 3 Expiration Date:_02,\a 3' Job Site Mdresc: 1 ) •Jali 1 V 1 ybacA e_lMt O( 80_City/Sfiate/Zite: 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 o,:MGL c. 152 can lead to the imposition of crinirial penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a S T OP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investraations of the DIA for insura ice coverage veri:caton. I do hereby ce y u ' e pains and penalties of perjury that the information providedt above is true and correct. Signature: 2.."a3-ao 13 _ 1 Phone n: (6o) 251N-5«k-c Official use only. Do not write/5 this area,to be corn lvtorlby '� jf 7n csty:or town official il City or Town: Permit/License# :I Issuing Authority(circle one): • t 1.Board of Health 2.Building Depart men t 3_City/Town Clerk 4.Dentinal Inspector 5.Plumbing Inspector i5.®titer . Contact Person: . Phone#: II f JI l _ • ' The Commonwealth of Massachusetts • Departme of Industr al Accidents r1.7 +woman � Office of Investigations -44111...... 600 Washington Street r Boston,MA 02111 • www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information • Please Print Legibly Name(Business/Organization/Individual): 'Tam.t 4-6.14 _ ©- [ Address: g s -t1 /4 [�► Cj City/State/Zip: Fclif vistabie 74- 0, C 5O Phone#: 17 7o2 ✓ Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4.(.Lam a general contractor and I employees(full and/or part-time).* have•hired the sub-contractors 6. ❑New construction 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling Ship and have no employees These sub-contractors have 8. El Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.: • ram] 5. ID We are a corporation and its 10.❑Electrical repairs or additions 3.E. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp, right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers 13.❑Other • comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating suck $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: /� Job Site Address: / �1(Lim �7 City/State/Zip: ��tS �t%!� /,#0.46 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 and penalties of perjury that the information provided above iis is true and correct. Signature: � Date: 7 4�[/3 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 l R Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as."an individual,partnership,association,corporation or other Iegal 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 horse having not more than three apartments and who resides therein,or the occupant of the dwelling house of another"who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building�appurtenant thereto shall not because of such employment be deemed to be an employer." \ • MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to\n erate a business or to construct buildings in the commonwealth for any applicant who has not produced a eptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25 7)states"Neither the commonwealth nor any of its ;olitical subdivisions shall enter into any contract for the perform ce of public work until acceptable evidence of co..pliance with the insurance requirements of this chapter have been p ented to the contracting authority." Applicants . Please fill out the workers'compensation affi.'svit completely,by checkin: o e boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),aria-ss(es)and phone numb, s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or ►i..'ted Liability P. '•erships(LLP)with no employees other than the members or partners,are not required to carry worke compensation,i. ' ••ce. If an LLC or LLP does have - employees, a policy is required. Be advised that this . ' -vit may b submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also b. sure t sign and date the affidavit. The affidavit should be returned to the city or town that the application for the p- r licEtnse is being requested,not the Department of Industrial Accidents. Should you have any questions regarding y.- law or if you are required to obtain a workers' • compensation policy,please call the Department at the numbeir ' -, below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials I Please be sure that the affidavit is complete and printed/legibly. The Departmen .as provided a space at the bottom of the affidavit for you to fill out in the event the Of e of Investigations has to co. t you regarding the applicant Please be sure to fill in the permit/license number A}n'ch will be used as a reference n ber. In addition,an applicant that must submit multiple permit/license application's in any given year,need only sub.. one affidavit indicating current policy information(if necessary)and under"Job S pe Address"the applicant should write 'all locations in (city or town)."A copy of the affidavit that has been offi ally stamped or marked by the city or to . may be provided to the applicant as proof that a valid affidavit is on file or future permits or licenses. A new affida 't must be filled out each ' year.Where a home owner or citizen is ob ' ' g a license or permit not related to any busines or commercial venture (i.e.a dog license or permit to bum leaves etc, said person is NOT required to complete this affidavit. The Office of Investigations would lice to ark 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 andifax number: /e Commonwealth of Massachusetts partrnent of Industrial Accidents Office of Investigations • 60Q Washington Street • Boston=MA 02111 Tel.#617-727-49W ext 406 or 1-877-MAS.SAFE Revised 4-24-07 Fax#617-727-7749 • - www.nlasS,gov/dia o► CERTIFICATE OF LIABILITY INSURANCE nmousarirm ='HIS CERTIFICATE IS.ISSUED:AS AMATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS BELOWC THIS DCERTIFICATE- INSURANCEDOES NOT CONSTITUTE A CONTRACT BETWEEN THE D OR ALTER THE EIISSUING GE FNSURER(S), AUTHORIZED RDED BY'THE POLICIES �= BELOW. THISendorsed. WAIVED,F REPRESENTATIVE OR.PRODUCER.AND THE CERTIFICATE HOLDER. 'A tM n c nthed io rs of h holderh Is rt ADDITIONAL INSURED,the an endorsement statement must be on this certificate does not confer rights to the the terms and conditions of the policy,certain policies may require certificate holder in lieu of such'eridorsemunt(s). oDNtA6 Laura J Murphy PRooucF�e HART INSURANCE AGENCY,INC. Meer (50B)759-7926 508 7587386 3 I(Ara,ao):( ) 243 MAIN STREET A&MAILnnr,r>7s•, ImurphyehartiasUranceageftCY.com i PO BOX 700 INSURERLSIAFFORDING COVERAGE MCI BUZZARDS BAY,MA 025320700 (SPECIALTY INSURANCE 20079 r — I MIRED Sandwich Chimney Sweep INSURER A:INSURER s: ATLANTIC CHARTER INSURANCE COMPANY 44326 7 PO Box 90 INSURER Sandwich,MA 02563 INSURER D_ _ INSURERS: .orsulmzF- —" j TV IS GES TO CERTIFICATE NUMBER: REVISION NUMBER: _ ' THISS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PO WHICH THIS LICY PERIOD , IICANYBESeES OR DFYPOACT 4R OTHER CINSUL CERTIFCATEMAA ISSUEDUED OR MAY RTAIN,THE INSURANCE AFFORDED B THE POLICIES DESCRIBEDHER S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDrriONS OF SUCH POLICIES.LIER LIMITS SHOWN MAY HAVE BEEN REDUCEDPAID CLAIMS. RSR TYPE OP INSURrwCE IN'.SR PM POLICY NUMBER. IMINnorr rtrudi F IMINDO YYYYI 1 i LIMITS MAX013100005253 10/09/2012 10/0912013 EAcH OCCURRENCE $A GENERAL WIeaTIY OAW1dE TO RENTElS S 100,000 000,000 PREMISES fEQ s>c ur 1 VcoMtas3tC:AL GENERAL LY�6ILITY MED EXP(ANY one paea i) $ 5,000 cLAIMs.MADs OCCUR1 00D,000 y . PERSONAL 6 ADY INJURY S i GENERAL AGGREGATE S 2,000,000 —' 1,000,000 -3 PRODUCTS•COMPIOPAGO $ OEN7 AGGREG�AT"E�WAIT APPLIES PER S 7 POLICY I 1 Ira- l I LoC (Ea IN SINdLE L1MR $ ' { ALIYOrrNY AU LIABMY BODILY INJURY(Per pawn) S ANY AUTO BODILY INJURY(Pa anddmQ 3 1 —A OOIgMhINNED SCHEDULED WEE Peoedilorr nAMAGE f ! AUTOS ....— NM/AWNED 1Ea[Aeyeeek, - T� HiR�]AVrQS AUTOS S 1EACH OCCURRENCE S rlMRRilA LIAR OCCUR AGGREGATE $ EXCESS LIAR CLAIMS-MADE CED I I RETENTION$ $ 3 WORKERS COMPENSATION WCVOi02500 08( N1LtOg + ERVs 500,000 AND EMPLOYERS'LIABILITY V I N QQ1 B 08128I2014 EL EACI7 ACpoENT s ANY AER ry In NH AR rNERJF3�CUTNEFi NIA E L DISEASE•EA EMPLOYYEE $ 500,000 OFFICER MEMBER EXCLunaT/ 500,000 (Mandatory In ) EL DISEASE-POLICYLMR $ M ePTIOe weer DES�RIP710N OF OPERATIONS balm/ - FSCWP'110NOF OPERATIONS/LOCATIONS!VEHICLES(Attach ACORD tot AdmfrBHlRomuts Somme,N mom space Is mquln0) eratlons as performed by Terms&Conditions in the policy. ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILD, BE DELIVERED IN 200 ofmain 13Street a ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street . Hyannis,Ma.02601 'AUTHORIZED REPRESENTATIVE I 01988-2010 ACORD CORPORATION. AU rights reserved.CORD 25(2010/05) The ACORD name and logo are registered marks of ACORD J UNREGISTERED LAND 54106 DEED BOOK: 2374 PAGE: 202 1 E. CROWELL. JR. PLAN/DEED BOOK• 276 PAGE: 45 LOT(SI I •°fCOD CO-OPERATIVE BANK PLAN NUMBER: OF AVERT F. & CAROLYN E. ECK REGISTERED LAND • -ANT SAME SCALE 06/17/92 1'•80. . REGISTRATION BOOK: PAGE: E; : CERTIFICATE OF TITLE: FLOOD HAZARD INFORMATION PLAN NUMBER: LOT(s) FLOOD MAP COMMUNITY NO.: 250001 ZONE: C ASSESSORS MAP PANEL. 0003 C DATED. 8/19/85 MAP: BLOCK: PARCEL: MORTGAGE INSPECTION PLAN IN BARNSTABLE c • cl Lot 3 ....) o, 134.421 _ I ( O . r I - W Lot 1 oo,1 .00 Acres -'\I 01 cV if -. WI: cv N Lot 3 M 3. � Sheds �,.3 C) • *-5& 6S'--). 3 •s r e Ne.2875p arch 126.01 ' -; . MAIN S T R E E T (ROUTE 6A STATE HIGHWAY) THIS IS THE RESULT OF TAPE MEASUREMENT. NOT THE RESULT OF AN INSTRUMENT SURVEY AND IS CERTIFIED TO THE TITLE INSURANCE COMPANY AND ABOVE LISTED ATTORNEY AND LENDER. THERE ARE NO DEEDED EASEMENTS OR ENCROACHMENTS WITH + + K USE ONLY RESPECT TO BUILDINGS SITUATED ON THIS LOT EXCEPT AS DES LAURIERS & ASSOCIATES. INC. SHOWN. 110 WEST STREET THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN WA ) 287-; MA 02081 f800) 287�-:800 (508) 668-5010 A SPECIAL FLOOD HAZARD ZONE. ,lM af`M;� THE LOCATION OF THE DWELLING AS SHOWN HEREON EITHER WAS STEPHEN sir`. IN COMPLIANCE WITH THE 'LOCAL ZONING BY-LAWS IN EFFECT a P• N CONVERSE 2 WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL SETBACK A No.33565 v .4 REQUIREMENTS ONLY) . OR I S EXEMPT FROM VIOLATION EN- �tiloFFss�°�,�ot FORCEMENT ACTION UNDER MASS. G.L. TITLE VII . CHAPTER s-.yt, 40A. SECTION 7. ._ GENERAL NOTES: (I) The declarations made above are on the basis of my knoviedge, info motion, and belief as the result of a mortgage plot plan tape survey inspection made to the normal standard of care of registered land surveyors practicing in Massachusetts. l21 Declarations are made to the above named client only as of this date. (3) This plan vas not made.f or record- ing purposes. for use in preparing deed descriptions or for constructions. (4) Verifications of property line dimensions. building offsets. fences, or lot configuration may be accomplished only by:an accurate instrument survey. e. et �-i Shed * - '� TOWN OF BA�STABLE Permit * BARNSTABLE, MASS. 9�Ar�� �Al Permit Number: Application Ref: 20062744 20061010 Issue Date: 08/29/06 Applicant: ECK, CALVERT F Proposed Use: RESIDENTIAL Permit Type: SHEDS 120 SQ FT &UNDER Permit Fee $ 25.00 Location 2875 MAIN ST./RTE 6A(BARN.) Map Parcel 279072 Town BARNSTABLE Zoning District RF-2 Contractor HOMEOWNER Remarks SHED 10'X10' Owner: ECK, CALVERT F Address: BOX 512 BARNSTABLE, MA 02630 ip Issued By: LB fa POST THIS CARD SO THAT IS VISIBLE FROM THE STREET r-°'' Town of Barnstable PLO sf � Regulatory Services Thomas F. Geiler,Director F + BARNSfABLE. • 4 t W 9� b 9 �0� Building Division ,�� . ter,w►AS° Tom Perry,Building Commissioner �`'� i f; 3: 14 0 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us --_.. Office: 508-862-4038 ,OO (P 7 `t" Fax: 508-790-623( Eel r\(o21� 3-542:3 PERMIT# ,6 U FEE: $ SHED REGISTRATION 120 square feet or less oZ 7C /)I1/ / S/' Z1,60(1,7' 6 Lb— Location of shed(address) Village 5LV e 5© _ Property owner's name Telephone number l40 X /0 2"1 q— o 7 `Z.r Size of Shed Map/Parcel#di:46464.7 / 3)2.616 Signature Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:042506 L__ UNREGISTERED LAND FIDE NIIMBFR 54106 DEED BOOK: 2374 PAGE: 202 ATTORNEY: WILLIAM E. CROWELL. JR. PLAN/DEED BOOK• 276 PAGE: 45 LOTtS) I LENDER: CAPE COD CO-OPERATIVE BANK PLAN NUMBER: OF OWNER: CALVERT F. & CAROLYN E. ECK REGISTERED LAND APPLICANT' SAME DATE: 06/17/92 SCALE: 1 ,80' • REGISTRATION BOOK: PAGE: CERTIFICATE OF TITLE: • FLOOD HAZARD INFORMATION PLAN NUMBER: LOT(S)• FLOOD MAP COMMUNITY NO.: 25000I ZONE: C ASSESSORS MAP PANEL. 0003 C DATED. 8/19/85 MAP: BLOCK: PARCEL: MORTGAGE INSPECTION PLAN IN BARNSTABLE Lot 3 o, 134.42' N -�i r 0 r- . 1 S Lot 1 0,1 .00 Acres --\1 M r\ N N/F Stark N w Lot 3 �6�-6S® Sheds M Q ±50 •-6 '—� 4\ ) 2 r \ e No.2875Porch I -- 126.01 ' • MAIN S T R E E T (ROUTE 6A STATE HIGHWAY) THIS IS THE RESULT OF TAPE MEASUREMENT, NOT THE RESULT OF AN INSTRUMENT SURVEY AND IS CERTIFIED TO THE TITLE INSURANCE COMPANY AND ABOVE LISTED ATTORNEY AND LENDER. THERE ARE NO DEEDED EASEMENTS OR ENCROACHMENTS WITH t : K USE OLLTY RESPECT TO BUILDINGS SITUATED ON THIS LOT EXCEPT AS DES LAURIERS & ASSOCIATES. INC. SHOWN. 130 WEST STREET THE LOCATION OF THE DWELLING SHOWN DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE. WALPOLE . MA 02081 (800) 287-4500 (508) 668-5010 fitof ..THE LOCATION OF THE DWELLING AS SHOWN HEREON EITHER WAS 4STEPHEN ctles IN COMPLIANCE WITH THE 'LOCAL ZONING BY-LAWS IN EFFECT ` )J7 P. r WHEN CONSTRUCTED (WITH RESPECT TO STRUCTURAL SETBACK ' a CONVERSE No.90565 0i REQUIREMENTS ONLY) . OR IS EXEMPT FROM VIOLATION EN- FORCEMENT ACTION UNDER MASS. G.L. TITLE VII . CHAPTER 1° — E4 - 4OA. SECTION 7. _ c-‘._I r GENERAL NOTES: tl) The declarations node above are on the basis of my knowledge. info nation, and belief as the result of a mortgage plot plan tape survey inspection made to the normal standard of care of registered land surveyors ors practicing in Massachusetts. (21 Declarations are made to the above named client only as of this date. (3) This plan vas not made for record- ing purposes. for use in preparing deed descriptions or for constructions. (4) Vorif ications of property line dimensions. building offsets. fences, or lot configuration may be accomplished only by an accurate instrument survey. t)FTH fE Tp� Town of Barnstable *Permit# c3 2 2 2-_ ti Expires 6 months from issue date ai' �►��,)t ► BARNSTABLE. Regulatory Services Fee /a1C V BI.E IP MASS/2' Thomas F. Geiler,Director 4004 i639. .o rep mg Buildin g.Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w PR w �„ Office: 508-862-4038 9� `� Fax: 508-790-6230 MAY 4 2001 EXPRESS PERMIT APPLICATION Not Valid without Red X-Press Imprint TOWN OF BARNSTABLE ` / Map/parcel Number -79— v7Z �v C c_ h� _ %� q2 yyl� 6 z , .3 Q Property Address 2 O .J /�`4 �N .c / ✓ARA15 �1 '�`J� Residential OR 0 Commrcial Value of Work ` CO C Owner's Name&Address (,, 2-P / �%aLy� 2/ G Z k__ Z-7 %-# 5)Z 1 h,eNs7 B L&I M O ci3a Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) DWorkman's Compensation Insurance Check one: 0 I am a sole proprietor • I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name , f4,e.,o S(/9-6 Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side 0 Replacement Windows. U-Value (maximum.44) !/ ❑ Other(specify) )moU6 fL1ry Clf///1/ 7 I /roof- D-(JZ72. I/o LN *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. / . 76-C:74- Signature expmtrg r GI f- p Assessor's map and lot number m- �� ''"~� �1 � _ . ! '"/' 7� v �l ` Q���7HET��� Sewage-7Permit number — '�� � � SEPTIC SYSTEM MUST Irt: r� A; o„ ./e, '7; INSTALLED IN CDMPLIANC'i i 2 ;Luz House number WITH ARTICLE II STATE .1.," bums. SANITARY CODE AND Tt� it 4:°42 0, 4 TOWN OF BARNS1 f E 1 • BUILDING INSPECTOR APPLICATION FOR PERMIT TO C.0 522e !C.i....../.9 .f' 14i 6/2 s/h&/4.e." TYPE OF CONSTRUCTION .00-1) .II'. 419. .4" ' 4k?/...T/./'....6" .0 4G vof w vAi Seirerneor . .1sri 2 - 1 19 i.e. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...., 2 7J�..../.l'1!/!a!✓......5f. . ,C4/4.d' :4.4 LOLL Proposed Use 6/ 4 ie 90. Zoning District /1 f/N t Fire District al/Zicallear 044-1? -er �' F a' d i n/14,,v sr- Box-5/2 ,, Fae.�s ,.., Name of Owner41y��i � ���..�� Address Name of Builder Wa►iv'Hax- efiA �YY7Address ..1. isliat diler# F 4 0n'9j M Name of Architect f, Address 1 r Number of Rooms / Foundation g.Q4'er atiCe403---' Exierior SI-465 , Roofing .eleS°30447- 16(5 /2$ rd' ZS' Floors 7 *4 4410,0 Interior 0/1/`//t/r5hio: Heating /7�'707`l,Vc Plumbing '" A/ON ` Fireplace A/OA/'S' Approximate Cost 'i S®® Definitive Plan Approved by Planning Board 19 Area /Zed 50 FT 1 Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH / 77 (//b . t.r...-._:_=._:__.... 6�1. /7'sfioP.iC eo, m Tl 6% -,._ _ . A. Delwizziv Per p_. d .4-2e 44,01... i.ji . f9DpeD 20, I 0.. 1 , I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name a‘teill7f1�—a . i — , Eck, Calvert F. & Carolyn E. . i t * P. 20548 add greenhouse to ; • - • „ No Permit for t . . , - . .. dwelaing .,:. . ., , • -,, - , • -. -;, 1 i:• - .4,,, • i • . - 2875 Main Street Location I . - ..,‘ i :: , ,,•, ; -; •- ' ,, Barnstable 1 ' ' , . .-* **;, .. ., . - -..., - ' i • •.. ; ...: ,., ....7.*' :* ., • 1 .., • i "•: .,.. I Calvert F. & Carolyn E. Eck _ ' -- -; ....- --- -"** •••4 „7, Owner • i ,-.., i 11 ,. , •,., ,-, . • .•:- t • I -Type of Construction .., .;' , , - ...., k , -Tr , ' • . ,;''' r, 11„...- n ' . , i • .,'J't I , ,,,"" " :' \ . ......- - .. ., . . - , ....... . ' 1, . ,,, , ,f Plot - 1 Lot - . • -•--- , .„,.• • , - -, , •. o .•.? - ,,,•. . , •-). -,, 1 , . •• - - , . .;- .., . . . ., September.:l -.19 78 I - ..." , . ' . • Permit Granted , I ,, • - , . . •/ ' •_ '-; ' — Date of Inspection - :19 I ..„, • , ...._ .- . . . ,\ . • ••--Date 'Completed ... ........... ..... ...... ...... ... $ ,. ' - gllse/ :7/ge,Ab, S)/454 ---' '• . . . • • . 1 . 1 1 i I • is' s ... . . ‘ '• ,V '1 i ,.PERMIT REFUSED , -'' , 's --,„ - > -s ..- ‘14 „ • , ..--p , 4 , 4-- — ,-, , 4.- •-• , - . \ '.t.,: t,..-,/•,'.-,, . *. . . ,, ‘,-t.Nt\x. Is,I\it -'-•--.•''''-i'''. '.-„,, 11 9 _ -• .. --/--'•.-..",,1._ . et:•,.•,,.-:.-•1.. (/.._,.,'.-/-.-., _•..,.i • . . ••.•.; . .• • .;•','' - a•7,• ... ... .„ 1 , • , ., I ' * • r"..t, •/ . I; • • J, , ,. ..• J... 1 .•• '.) .'I. • . \' ' '. Or. 'I 4 ' .. t.' • 0 1 I /e'' . • . • . ••.„.1 ',.;:- .•-i .. , m ,• , 1.. • _ , „.. • - . Approved •--' 19 --- .. ,:-. t. • • :1 , . f • . . • . , .1. . , • • . • I +i . ••' 1 - r^ 1...". • • ...,1 . , . Ai• .1 . ., • - • . . ,., 6... ..-._-