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3060 MAIN STREET
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"I 1A 7� h Town of Barnstable Buildi.ng. hi[V So.That,it is>1/�s�ble°From:theFStreetA rov d Plans Must belie#arced on Job arid':this Card Must be.Ke t' �, arese: 3 Permit' Posted Untl:Finahans action Has Been IVlade F fi�` is A f pr � "3 So ' jai. vi .az' a""1.;; .�. %a: .i .,Y:, r: �,.. .. � 'sin,: :. _ earl `Where >C,ert�ficatexof Occu anc is�Re aired such Buld�n shall Not be�Occu iecJ until a Final,.lns ect�on;has,been,,;made � .,.� ,p,�.,. YQ:�:' `.,.a,.�,�w':r ..��s<�;a�. ;;5s�:' wr..>... ..�-.gip �., p �4. �'.,�'�' : Permit No. B-18-2408 Applicant Name: PAULJ. CAZEAULT&SONS, INC. Approvals Date Issued: 08/01/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 02/01/2019 Foundation: Location: 3060 MAIN ST./RTE 6A(BARN.), BARNSTABLE Map/Lot 279 034 Zoning District: SPLIT Sheathing: Owner on Record: RUETER,SARAH L&MATTHEW C TRS �,_ 'j y, Ctractor Name .PAUL J. CAZEAULT&SONS, INC. Framing: 1 r Contractor;L�cen�se 103714 2 Address: PO BOX 852 3 AR, ,. BARNSTABLE, MA 02630 Est Project Cost: $6,975.00 Chimney: Description: re-roof stripping old Permit Fee: $35.57 Insulation: Project Review Req: Fee Paid $35.57 Final: Date 8/1/2018 1 Y `= Plumbing/Gas YR Rough Plumbing: � . ;: Building Official £ Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized qthis permit is commenced within six J"onths after,..issuance. Rough Gas: All work authorized by this permit shall conform to the approved application antl1the approved construction documents,for which this permit has been granted. All construction,alterations and changes of use of any building and structures ishdll be in compliance with the local zoriirig by lawsand codes. Final Gas: 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. Electrical _ "Y � � The Certificate of Occupancy will not be issued until all applicable signatures by thelBwlding and Fire'Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:` & 5 1.Foundation or Footing =` 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 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT oFtr�ral, Town of Barnstable *Permit#8 (� Ex fires 6 months from issue date (� Building Depart®e , BARNSTABLE Brian Florence,CB e ,MASS;� ���' Building Commissioner , T ArFO MA'I A 200 Main Street,Hyannis,MA 02601 j U L 252018 www.town.b .stable.ma.us Office: 508-862-4038 l`� SOWN O� BAHNST 1_ 8-790-6230 EXPRESS PERMIT APPLICAT N - RESIDENTIAL ONLY Map/parcel Number Z oa� Not Valid without Red X-Press Imprint Property Address 30(,- ) O 1 yl Sifeet A*e-lY S [ti]Residential Value of Work$ Cce1+ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Ga, -c1 H � OmAA� PO aox <�152_ � 3arn5- AbL X M6 02_Ge��o Contractor's Name 6w) � C'��' ec cat So�S Telephone Number Home Improvement Contractor License#(if applicable) J OS"I A Email: 0MCP@Ca%e0 4 C01M Construction Supervisor's License#(if applicable) C-6` O$ S PI a*orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name LM Iv) 5 , C. /o��,(q,., Workman's Comp.Policy# wC_5 S 1� J Oif`�G1 V®214 Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ t(check box) I ) �, ��^ Q Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to�IQ�P(0U+h (�1(1C,+ ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\W indows\INetCache\Content.Outlook\9NNOKXYW\RESIDENTILONLYEXPRESS.doc 09/26/17 Office of Consumer Affairs & Business Regulation- Mass.Gov Page 2 of 2 Click on the registration number to view complaint history. You can also view arbitration and Guaranty Fund history. The list is current as of Tuesday,July 24, 2018. Search Results Reg istrantNamORESPONS I BLWEG I STRATM=RESS EXPIRAT1 ATU INDIVIDUAL NUMBER ®ATE .. .. .............. , PAUL J. CAZEAULTCAZEAULT, 103714 .1031 Main Street 07/08/2020 :Current & SONS, INC. `RUSSELL ? Osterville, MA 02655 Site Policies Contact Us © 2012 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. https:Hservices.oca.state.ma.us/hic/licenseelist.aspx 7/25/2018 E Ell t,I: ::€. .CQ1"• i1? Ll_ `ll l',=/( IIIIca-n 1,l 1 t I(?1111�UG 1 1( aCr 1�111 Lr'4T1 1�' it J I I ,,. 7';t 1 Ci: Ir r 1?_ f I I I �: 1i I'-��llll�� th �l�t. �:ti li.. _."_`• t (_�;, C 7?..li._I�i.1;!:i] rj I ka t.11 I ili).(7 sic t� :IJ? �.-1_" - - ? l,:Jl.: - ill I ll IiJ'Lni ) t ,l'l) l li:iJ_ li li : I1 i171 Alit 'i " Sh c- . sl. 1, ai. " "'i e 71 c 1,1=:1 ees l hr ;t!I,a t.?1 I1'i i_-_ -I C:I l t 1o11 1 1 1 r Jil ,1 V, t_�1ipjo—, s Ili have\ C r-R` is — �I,I -Ul.-eds . � J 11'1dino i LC'[J .onip. 1 u ran ll1'll, 111 Llance.- i 1 requirp-d.] We are a corpc)yaijo:ll m'd l S c11 iel)Fi-s or ilii�l7ilJItiS 1 offices have e`;ercised their' J�_ , iJl rl1'!C.il]GJ1F1� r CU_)711g aD 1a��i:h I I'lunit)in rc.-pa1:G9 oi addil1UilS nJ.�Sclf �l\JO 1t,'011 e1S c.orllTi• Jl�hi U� ..i,.l11pt.],o1 1)e1 114C.1L, 12.❑Roof repairs i11.SllT3i1ce required..] I c' 1 52; 1(4), and we have Do enlp.loyees. [Nio r>;%or.Icers' - comp. insurance:required.] Any appIjcani that checks box stl must also nll out the secti011 belo�x sho'wiu2 their v-orkel.3 c0mpensa Li 011 policy i11 fol131a ti CM. r Tomeov,�nzrs who submit iiiis affidavit indicating are doing ali work and then Lire outside contractors must submit a neva;affidavit indicat'ine such. Co!atraetors That check this box must attached am additional sheet showing i?_le mane of Bet sub-contractors and state whether of not.tLos�entitics.h,.nve employees. If the sub-contractors 11ave zn;ployzzs;they must proVi dz the.ir v onhis'comp.policy number. i .rM Ziff" Grtf�ilC�'BI %illt ;JI^OVIL�Ffip}PJf'jiL'P3 COL7ti7C1P[SL, 7JrE. t is,7" .f2CB O1'Trr t o-rt „ --' ' —r T^—r r j } er,r_Le,�Bs: LB1ol is t`,7:c1.f,Fcj'clr._<.10.J sire Insurance Company Name: /V Folic or sel -ins. Lic. / Expiration Date: Job Site Address:S&DO MGt rt S+ rel&t fat it-,Staie,/ 1 fiZ .,N1 0263o .i): �Y1S b ;rife I-11 a COp'y 0f Lhe vvo rkers' C.021!er1SaCiaii Policy d,ecl._r adore page(sho),-fn th6 Policy T,a,m I i er an d exliTt atiCIn di(e)l. Failure to secure co veragre as required under section 25A of 1MG.L c. 152 can lead to [lie Imposition of criminal penalties of a fine up to$1,500.00 and:/or one-year-Impr.isoluajent; as ,17vell as civil penalties In the forum of a STOP �VORK ORDER and a fine of up to S250.00 a day against.the violator'- Be adivised that a copy of this statelneui 11.1a�% be for��tirarded to the Office of Investl,gai:1011s of the DI a for insurance coverage verLllCat1011. -C` do herBUJ'eer%ij`j%it;ider thepLI_%Zs Cfi2d2Y�3$![.pIGIL':i CT��7Ji..+,Pt%i�iCll i�tB i7Ljui';9'1U_170f`sJ71'E V L/2C C-/.UOpB ,i ti'me CIiidCc?7Tt Ci. �'1 /l Slgnatllle: C / Dal': Phorie 7vsc'C%[h'. 0 nor -tvritte Fr Mis Cilva, to, be r %7 l B '1 I•C 11'o ((,o 7 iCML I ICin, I Enuft/L ice_ls_ — : I ia _ l I'ra e li. 3. , _ .. . ._ °,-r L7,1 LIJb:eT i�'=;_1� I I_o,si3 eCG1' �I s Property Owner Must Complete & Sign This Form i If Using a Roofer / Builder. I (print) as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job 0 Signature of Owner Mailing Address of Ownerc �2-- 24 �64 5-6�L , WtA- J-13 6 Telephone # f 3 L I '1 Date - Please return this form to Paul J. Cazeault Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com 1 1 Il:l�i.:'�:i/ it / - ,. _ ;• /',�, t •'+ 1 I + i i I ��rlr /II1 1k 1aza laztei NO C os�a�1; 1`✓-,Lssacjaustt.cs 0211 Come Zz�zl�l ov���.�_ez� CCzactm,Rcgi strati orl Regisira ion: 103714 I ype: SuPPIemeni'Card PAUL J: C67EAl IL I` c S(Df\IS, II�IC, Expiration: %lq/20,3 RI_1SSE C LL 14"71EAUL JS I ERVILLE; It1A 0-2658 SCAU jJ G'[1t8 rCIdY25S£iil Ci 1'c i.i;r'p ral•d,ls'7_`I,'_1%irascn T of C,hB;`oc. Addres s J 2Ci e1, 1 LI r, ...-7.7 pl D,"aYcrif Lost c,iprl I. =_Of;Tce OI n �ensunzerAffahs .-8usiness1,CLul )^=—'+ -:1CCIPSC or I'Cg7st.ation i+2)id for indipidual use 011.1)7 I=rVn-10_if11PROYE IE_NTCOIV 'A I l: - _+ - ti CIO( befoi.e(-he expiration la%e, If found return to; -'1,i - . Peoistrarion: 103TA TJi OzficeOfConsun_er.,kflirsandBClsiness�2cgu!ation Exxpiratioii: :;/Jgt20S, per' 10) ar'kl': �' Supplement Card a�a-Suite S170 PAULJ•CAZEAULI&'S01'JS, [Wa L°osi-an; MIA 02116 r RUSSELL CAZEAULT 1031 MAIN ST OSTERVILLE, Ib`lA 02658 Un�ersecrefary �i�rntYfali@ sviillouit��naiure i is%Irssachi s i xil Ise-tS �De J parnrien or P!;biic Safety Board of uuiiding Regulations and Standards I Cu:hal•uctir>n 5uperri.ti'nr ��-�—=-__= I License: CS-108157 zTJESlrL Ck7ZAZUp1T 2071I1ZAJY STR . aim ; =;= Brefvsrer 11,E 02631 Fkrulratl,nn r Commtsslnr;ry 111231201E I r I 1 I . I I I i I t I; I; _ I I. -Yj K-1 1) E N,�VDOP,,� _4_j THIS CER-fiFICAIDE' IS ISSUED A,�_ A I'WATTER OF IN:F-ORfViE,.,T;0i ONLY AND -0 FICA-I-E NO FRIGHTS UPON -I HE CERTIJ _,o! CERTIFICATE DOES NOT A'MIRMATIVELY OR NEGATIVELY AIMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLiCiES I BELOW, THIS CERTiFICATE OF INSURANCE DOES NOT CONS IITUTE A CONITR,(�CT BETYAJE-EEN THE ISSUING fl\ISU-ER(3), AUTHORIZED REPRESENTATIVE OR PRODUCER,PN D THE CERTIFICATE HOLDER. I PAPORTANT: If the cer-rLift2te holder is an ADDITIONAL INSUPED, the policy(ies) MUSL be endorsed. if SUBROGATION IS WAIVED, subject to R J"- 1-HE U I HO 2 7- j WAIVED, s �c, the terms and conditions of the policy,cer-cair,policies may rOqUire an andorsemeril. A statement on fnis cerfificace does not confer rights to the terms holder f certificate holder in lieu of such endorsernent(s). uc PRODUCER Linda Sullivan DOVA/LING & OWEIL INSURANCE AGENCY I PHONE 17AX LIA, (508)775-1620 (A [,to): E_N'Afl�ss- lsullivani�r:L)doins.corn ADDR �'I'I'Nio U, 973 J)'ANINOUGH,RD )AFFORDINGCOV7RAGE HYANNIS tk;IA 0 Livi lt\!S CORP33600 INSURED R6' f R_�Ilsulr ER 61 E PAIJL ,jCA.7EAULT& SONS INC INSURER C: 1031 PIAIN ST INSURER E: OSTERVILI F IVIA 02655 F I ri",,'IS U R E R F J GOVE_R,3,GE:S: CERTIF_K;/Q",,TE NUNME—IR: '118,11752 RE:VISION NUPYIB_R: THIS IS TO CERTJF"THAT THE POLICIES OF INSURANCE LISTED BELO'/V HAVE BEEN ISSUED TO—THEINSUR-ED NANIED ABOVE FOP THE POLICY PERIOD OTli,/ITHSTANDING ANY REQUIREMENT, TERM OP CONDITION OF ANY CONTRACT OR OTHER DOCUIVIENT 0j'ITH RESPECT TO iRHICH THIS CERTIFICATE vlAY BE ISSUED OR NIAY P-_RT2Vj\I, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEN!S, AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN IYAY HAVE BEEN REDUCED BY PAID CLA(i\,IS. INSR _FF ,POLICY EXP LTR TYPE OF INSURANCE I lD!IDDL POLICY`UMBER 11�1;011 MLI y Y I Iii-1/0131PYYYY LIMITS CONINIERCIAL GENERAL LIABILITY EACH OCCURRENCE CLAH-AS-NIAIDE Floccup DANIAGE TO RENTED PRE,M11SES E2 occurranceL MED EXP(Any one person) N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIN11T APPLIES PER. GENERAL AGGREGATE POLICY I JECT PRO- r LOC PRODUCTS-COI,IP/OP AGG OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) Is ANY AUTO B INJURY(Per person) ALL OWNED SCHEDULED AUTO, AUTOS N/A JURY(Per accident, S5 P, WOWNED HIRED AUTOS P,�,IOTOS Ip ROPERTY UANIAUE (Per accident) IS UMBRELLA LIAB R EACH OCCURRENCE S EXCESS LIAB M AGGREGATE $ HCOLCACINUIS- ACE N/A DED RETENTION$ 1 k WORKERS COMPENSATION ,X, PER OTH- AND EMPLOYERS'LIABILITY YINJ STATUTE ER ANYPROPRIETOPJPARTN-RIE"ECUTIVE S D _E RENTED '0 E P F occu"enceL_ ,�n . fE� - n _" ,P(Any '-n' ED e pairs J'NJU PERSONAL A,"7 P GENERAL AGGREGATE ,R U, D "",lpj"AGG B 1, ODy'BODILY III �TIVE E.L.EACH ACCIDENT S 1,000,000 N A N/A -IIA WC531S386670027 11/11 VI/C531-38667,0027 A OFFICER/MEMBEREXCL�116ED? t 08/10/2017 08/10/20,18 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE1 S 1,000,000 DESCRIPTION OF OPERATIONS 1 000,000 S E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization �s given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired-those employees outside of Massachusetts.'given to pay This certificate of insurance shows the policy in force oil the date that this cerificate was issued(unless the expiration date on the above policy precedes the I_ issue data of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification] Search tool at i/:,iA,vi/.mass.gov/lwd/,iiorl<ei-s-compeiisatioii/inves-Ligations/. CERTIFICATE HOLDER CANCEI LATfON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE kNILL BE DELIVERED IN Paul Cazeal-Ilt ACCORDANCE VVITH THE POLICY PROVISIONS. 1031 Main Street AUTHORIZED REPRESENTATIVE 3sterville NIA 02655 A— I Daniel fvl.CrqD('�'!'ey,CPCU,Vice President-Residual Mat Ifet-VVCRIBMA @ 19'.8-2014 ACORD CORPORATION. All rights reserved. .CORD 25(2014/0-1) The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map D� Parcel 03Y Application # 0 6 i L)b Co Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 4�3 1�) Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Q 6 p �► Village � ( C Owner `L rL4_11Kv '— Address �q "u S d C Telephone (—Y-d 8 ) 36 a so), & 1 .1 Permit Request i ...SC C< VIL etp, alf to e"k�v KN Square feet: 1 st floor: existing proposed 2nd floor: existing proposed . °; Total nevv Zoning District Flood Plain Groundwater Overlay .ry Project Valuation � 8O O Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach suppoiting documenta ion. Dwelling Type: Single Family W/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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 ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# .Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name OM � � �� C Telephone Number Address C If License# 3 8 �WHome Improvement Contractor# b �l Email Worker's Compensation #� 5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ` �✓ (�� . SIGNATURE DATE - 1311'� k FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED c MAP/PARCEL NO. i t ADDRESS VILLAGE I OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT } ASSOCIATION PLAN NO. Building Permit Authorization I, Matthew/ arah Rueter as owner hereby give my permission to Cape Save, Inc. ' 7-D Huntington Avenue South Yarmouth, MA 02664 Office:508-398-0398 .to take all necessary steps to obtain a building permit to perform work at my property located at 3060 Main St Barnstable, MA 02630 t Signed ?I A. Date / A f '#��"Fnnt Forme The Commonwealth of Massachusetts . `` F Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Cape Save,Inc. Address: 7D Huntington Avenue City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-398-0398 Are you an employer?Check the appropriate box: 7Nemw oject(required): 1.❑✓ I am a employer with 17 4. ❑ I am a general contractor and I construction employees(full and/or part-time).* have hired the sub-contractorslisted on the attached sheet. odeling 2.❑ I am a sole proprietor or partner- These sub-contractors have g, ❑ Demolition ship and have no employees working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers comp: comp. insurance.'insurance10.[] Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3. I am a homeowner doing all work officers have exercised their I I.[]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 13. ✓❑ Other Insulation employees. [No workers' comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Technology Insurance Company Insurance Company Name: Policy#or Self-ins.Lic. TWC 3353968 Expiration Date: 04/09/2014 #: � �� �� �0 �✓� � o city/State/Zip�V� 115 Job Site Address: 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 t at the information provided above is true and correct. Si ature: - -- — — -- - - Date Phone#: 508-398-0398 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#: :�co CERTIFICATE OF LIABILITY INSURANCE DATE(PAMIDD 10/22/2013013 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(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONT NAME: Colleen Crowley Risk Strategies Company PHONE . (781)986-4400 FAC No):(781)963-4420 15 Pacella Park Drive nnigss- Suite 240 INSURER(S)AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:Selective Ins. , of America INSURED INSURER B:Safety Insurance CcWany 33618 Cape Save, Inc INSURER C:Technology Insurance Company 7 D Huntington Ave INSURERD: INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL13102268490 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. �TRR TYPE OF INSURANCE SR D POLICY NUMBER POLICY MIDD EFF MWDD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISE Ea oc rr nce $ 100,000 A CLAIMS MADE a OCCUR 1994480 0/16/2013 0/16/2014 MED EXP{Any one person} $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PROPOLICY X JEC FX1 LOC $ AUTOMOBILE LIABILITY COMBINED N LIMIT Ea accident 1 000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 6208200 1/6/2013 1/6/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PRO PERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ $ X UMBRELLA LIAR I X I OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB 19 CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ sit 1994480 O/16/2013 0/16/2014 $ C WORKERS COMPENSATION Officers Included for X WC STATU- OTH- ANDEMPLOYERS'LIABILITY YIN Y IT ANY PROPRIETORIPARTNERIEXECUTIVE Coverage E.L.EACH ACCIDENT $ 500 000 OFRCEPJMEMBEREXCLUDED? a NIA (Mandatory in NH) 3353968 /9/2013 /9/2014 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) Weatherization Specialists GL: Blnkt AI, Blnkt PNC,, Blnkt WOS, Per Proj Agg, Per Loc Agg / GL Exclusions: Snow & Ice Removal/OCIP/Wrap Ups CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE chael Christian/CLC �' ACORD 25(2010105) O 1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD . 4r `r12S5%C=tt Board. 0- icy.. CSSL-102776 WILLL4, M J MC'--LUSXEY 3714AUSET ROAD West Yarmouth NA 02673 06/28/2015/ 1 e L 1gt11qgi,---, I _ Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 !` Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 " Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM MCCLUSKEY = 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. Address 71 Renewal ;; Employment ; host Card OP&-CAI-0 =-oiA,0zW04-G101216 — �+. ✓fie VF91id1tG7lGGeQG�41 c%��•llasac/r�..lise� Office of Consumer Affairs&Bd`ssiness Regulation License or registration valid for individul use only = —HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: .s Registration: 171380 Type: Office of Consumer Affairs and Business Regulation '_ _' Expiration: -3/14/2014 Corporation 10 Park Plaza-Suite 5170 71= Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY.-= 7-D HUNTINGTON AVENUE,",:. i��� SOUTH YARMOUTH.MA'.02664 Undersecretary Not valid wild signs% , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �4AI, P H.j A� Map Parcel 0 o . Q; 1PAR S TABLE- Application # I Health Division 7013 15 PM 2. 38 Date Issued �� l } Conservation Division Application Fee S Planning Dept. Permit Fee " Date Definitive Plan Approved by Planning Boar r Historic - OKH _ Preservation/Hyannis Project Street Address 3 CF 6 0 Village 3 I-et,L /e Owner *Y q, e(,y � u c, Address Telephone Su 6 — 3 6- )- Permit Request Add le-1 '( C-C 6 c wCOS ( I-Lsu, 4 ft 'J i-1 1-0 ah, /t q, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �06© Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family t Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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 0 Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION / (BUILDER OR HOMEOWNER) p q Name �rG`l '� �' `� / � C2 P ���e Telephone Number Address 1 �`� G� �� � License # loa D V'q V;44 0 1t 44 0, Home Improvement Contractor# ` 3 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN'TO SIGNATURE DATE d• I�� 3 'r ' FOR OFFICIAL USE ONLY APPLICATION# t DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER V 'Y DATE OF INSPECTION: FOUNDATION FRAME r INSULATION a a FIREPLACE f ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT 1 - ASSOCIATION PLAN NO. i 1 4 � - •- Massachusetts- Department of Public SafctY Board of Building Regulations and -Standards Cons+ruction Supervisor Specialty License License: CS SL 102776 Restricted to: ICE WILLIAM MC CLUSKY Vil 37 NAUSET ROAD WEST YARMOUTH, MA 02673 Expiration: 6/28/2013 Tr#: 102776 �fg Q la^ A Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 17138C Type: Corporation - = Expiration: 3/14/2014 Trtf 222184 CAPE SAVE INC. WILLIAM McCLUSKEY - - 7-D HUNTINGTON AVENUE - - SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. - = Address 71, Renewal Employment _ Lost Card PS-CA1 a 50M-0404-G101216 J1e fTla�xo�zaurcea cl:.lj�:�clzuret License or registration valid for individul use onl Office of Consumer affairs&Bddness Regulation a Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business R laticn a Re istration: . 171380 Type: �' o 10 Park Plaza-Suite 5170 �w;g _= Expiration: 3/14/2014 Corporation Boston,NL&02116 CAPE SAVE INC. WILLIAM McCLUSKEY-' 7-D HUNTINGTON AVENUE=.: SOUTH YARMOUTH,MA 02664 end— Not valid wi 6 signa� f Building Permit Authorization I, Matthew Rueter.? , as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 3060 Main St Barnstable, MA Signed Date ' The Con2nlon Pealilz of illassaclzusetts Department of hzdirstrial Accidents Office of Investigations 600 R'asizin;ton Street Boston, _1tI4 02111 ivjv nms.g ov1dza Workers' Compensation Insurance Affidavit: guilders/Contractors/Electricians/Plumbers Applicant Information C Please Print Legibly Name(Business/Organization/Individual): C l a�,Y n ,, Address: D HtA,ntinO-on Nve11H,P. City/State/Zip:50tk*', YOSMOVA MR 0A64 phone#: 508-- 3 q $ - 0 3 9 ? Are you an employer?Chec•the appropriate box: 1.9 I am a employer with O 4. 0 I am a general contractor and I Type of project(required): 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 working for me imany capacity. employees and have workers' S. ❑Demolition [No workers'comp.insurance comp.insurance.♦ 9. ❑ Building addition required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their myself. I I.❑Plumbing repairs or additions Y [No workers comp. . right of exemption per MGL - insurance required.]t c. 152, §1(4),and we have no 12.0 Roof repairs employees.[No workers' I3•(4 Other_' Pomp.insurance required.] ;Any applicant that checks box RI most also fill out the section below showing their workers'compensation policy information. 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 shonring 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 isproviding workers,compensation insurance for my employees. Below is thepolicy andjob site information. Insurance Company Name: _Teo�not otl V Tn S w,1-an c,e C f1 Policy f or Self-ins.Lie.',-': _r W C 3 31 g 0 ,; y / a i Expiration Date: J ,�7 Job Site Address:���� ��✓l �� City/State/Zip: 9��'4S!q'Lfe � ON 6� Attach a copy of the workers'compensation Policydeclarati Q /%' on pate(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 S 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 S250.00 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. 1 do hereby certifi.-under the paints and penalties of perjurh that the information provided above is true and correct. Signature: (� ( b 13 Date: (7` l J _ Phone 9: . 0$ ' 3 g Official use onrll-. Do not Waite in this area,to be completed by city,or town offncial 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 Ins '. Other Inspector p Contact Person: Phone 1; A oC CERTIFICATE OF DATE(MM/DD/YYYY) LIABILITY INSURANCE 11/9/2012 DAIS 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()es)must be endorsed. If SUBROGATION IS WAED, subject to certificate holder in lieu of such endorsement(s). the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate Ne does not confer rights to the PRODUCER NAMEA�Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 FAX 981)963-4920 15 Pacella Park Drive E-MAIL No): ss errazza ri - Suite 240 DR ss. P @ sk strategies.com IZandol h INSURERS AFFORDING COVERAGE NAIC# P MA 02368 INSURED INSURERA:Selective Insurance INSURMB:Safet Insurance Co an 3618 Cape Save, Inc Ave 7 D Huntington INSURERC:Technolo Insurance Company g INSURER 0. South Yarmouth MA 02644 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER CL1211954576 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD S BR LTR TYPE OF INSURANCE POLICY NUMBER M CDY EFF MMND EXP LIMBS GENERAL LIABILITY WVD EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY -PREMISESDAMAGE O occurrence $ 100,000 A CLAIMS-MADE F OCCUR 199448001 0/16/2012 0/16/2013 MED EXP(Any one person) S 10,000 PERSONAL&PDVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 PRO 7X POLICYPRODUCTS-COMP/OP AGG S 2,000,000 LOC AUTOMOBILE LIABILITY $COMBINED SINGLE OMIT Ea accident S 1 000 000 ALL B ANY AUTO BODILY INJURY(Per person) S AUTOS OWNED NON-OWNED 6208200 1/6/2012 11/6/2013 BODILY INJURY'(Per accident) S X HIRED AUTOS X ON-0WNED AUTOS PROPERTY DARMGE $ X Per,aaident X UMBRELLA LIAR CCUR Underinsured motorist BI split S 100,000 O A EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ 1,000,000 AGGREGATE S 1,000,000 DED RETEPITtONS 199448001 0/16/2012 0/16/2013 S C WORKERS COMPENSATION fficers excluded X WC STATU OER TH- AND EMPLOYERS'LIABILITY ANY PROPRIETOWPARTNER/EXECUTIVE Y/N MIR coverage ��� OFFICERIMEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) C3318007 /9/2012 /9/2013 If yes,describe under E.L.DISEASE-FA EMPLOYE9 S 500,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT I S 500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Issued as evidence of insurance. Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a/ National Grid, Action Inc. , Colonial Gas Company and NStar Electric are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 427/SCH 3195 Main Street AUTHORIZED REPRESENTATIVE Barnstable, MA 02630 Michael Christian/SMS �"� ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INRD29 r7mnnsi m The ArnPn name enrl Inn^ern renic+arerl_..k.^f Af`ARr1 f:. CO o13�iY g� Cape Save Inc. 7-D Huntington Avenuez"Lgjq, CrT .. . - South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 9/29/14 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 3060 Main St. has been inspected by a certified Building Performance Institute (BPI) Inspector. Walls: R13 Dense Pack Cellulose All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Town of Barnstable *Permit# '7 7 6 S Expires 6 nrorstlss from issue date O•^ , srAsr.>E; Regulatory Services Fee ' .r Xass: Thomas F.Geller,Director sbg9•` �m 4''°'Eo►++p�°' Building Division Tom Perry, Building Commissioner X-PRESS PERMY�R 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 SUN 7 2004 Fax; 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDE NTTQWbKj ARNST'ABLE Not Valid without Red X-Press Imprint Map/parcel Number R 7 !q 6 Property Address sy' /3L �.: /�9 o l 34 []'Residential Value of Work l/ J Owner's Name&Address ��n S' .. Contractors Na ' me �i►� L% Telephone Number �� Home Improvement Contractor License#(if applicable) /� �S 2 9 Construction Supervisor's License#(if applicable) � 2G3G/ [RWorkman's Compensation Insurance Check one: Fj I am a sole proprietor [] I am the Homeowner `] I have Worker's Compensation Insurance Insurance Company Name //MASS �i4'.S'l/�LT -1'/Y`[- Worlanan's Comp-Policy Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) [] Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) (/Re-side [] Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. Signature Q:Forms:expmtrg Revise053003 i p�SHEfoy, Town of Barnstable Regulatory Services STABM Thomas F.Geiler,Director 9cb s6g9- Building Division pTfD�"A�a Tom Perry, Building commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Fay:: 508-790-6230 office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property to act on my behalf, hereby authorize in all matters relative to work authorized bythis building permit application for: At kt (Address of Job) Signs of Owner Da Print Name d i Massachusetts Casualty ® 0 155 Federal Street,7th Floor � •. 3 Insurance Company Boston,MA 01110 Incorporated 1926 (617)718-0000 PREMIUM NOTICE STEPHEN WHITNEY HAZARD n t;� PO BOX 52 6 C ", BARNSTABLE, MA 02630-0526 i v �> c,m DISABILITY INCOME POLICY n ; � zt:, Notice Printed: ---- -------C 03 18 04 MCO 7o Policy Number Mode of Payment Amount Due Due Date 0600023 TA# 15706 QUARTERLY $ 218.85 20 APR 04 Er , �r a D s � -OUR BILLING NOTICE 8A3 ANEW LOOR." OUR MAILING ADDRESS FOR PAYMENTS HAS CHANGED. o x rt �1 1 i a Q PLEASE MAIL THE L., BILLING STUB IN THE RETURN ENVELOPE C I�� ��i i� M rIr r'O'r TO ENSURE PROMPT AND PROPER CREDIT. ALL 7� OTHER INQUIRIES SHOULD BE SENT TO THE ADDRESS ON THE TOP OF THE BILL. THANK YOU. PROMPT PAYMENT PROTECTS YOUR FINANCIAL SECURITY ' PLEASE RETURN BOTTOM PORTION OF PREMIUM NOTICE WITH YOUR P�� , � AYMENT oFTME t Town of Barnstable *Permit# 55 _2-�;,_3 Q„ Expires 6 months from issue date ,AMszASI : Regulatory Services Fee ?6/ � KAM �0 rhomas F.Geiler,Director �FD MA'S Building Division Elbert C Ulshoeffer,Jr. Building Commissioner n 367 Main Street, Hyannis,MA 02601w Office: 508-862-4038 w Fax: 508-790-6230 X_PRE.SS PEi EXPRESS PERMIT APPLICATION Not Valid without Red X-Press Imprint A U G 1 6 2001 [r Map/parcel Number ig TOWN OF BARNSTABLE Property Address 30 O m/91 AJ S la cv�tv S /YI✓� b [.Residential OR F1 Commercial Value of Work 6000 Owner's Name&Address rytelo :; OOA O o"Z — Contractor's Name QQC4A� Telephone Number �S`Zl�—ya� 'b�$a Home Improvement Contractor License#(if applicable) �l'o2S3 6 Construction Supervisor's License#(if appli ble) �,�Workman's Compensation Insurance No ChR►iceo s'w►-n -e C Sg e 0)19 k-t�i Check one: a [] I am a sole proprietor I am the Homeowner R I have Worker's Compensation Insurance Insurance Company Name d �l4JS1J��'!t1 C,� Co Workman's Comp.Policy# 3 W C, / 7 Q / Y 0 040 Permit Request(check box) �Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) Re-side Replacement Windows. U-Value (maximum.44) Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature -rLh-- expmtrg TME Town of Barnstable Regulatory Services vq aruuvsr"si.e. ass. Thomas F.Geiler,Director 9�j0rf1 39. � � Building Division Peter F.DiMatteo,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $ o SHED REGISTRATION 120 square feet or less 3a (06 MAIN s - ba:vr� S���� Location of shed(address) Village Property owner's name Telephone number j n t7g a �� Size of Shed Map/Parcel# Signs ure Q Sr� - � � Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) Z AI 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:083001 �t r Town of Barnstable Regulatory Services BARNSTAB. � g rY i'E' ' Thomas F.Geiler,Director 9� i°39' Building Division QED MA'1� Peter F.DiMatteo,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# FEE: $ SHED REGISTRATION 120 square feet or less 3� �6 M0,1 J Tk- ScQ�op�. Location of shed(address) Village Property owner's name Telephone number Size of Shed Map/Parcel# Signs ure _ I1 Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature required) Z 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 I Q-forms-shedreg . REV:083001 0—®CA-TOC)IN ® F RRC3RER-FY IN ES M^Y NC)-r [BE ACCUR^- ' STANDARDIEGEND NOTE:not all symbols will nppaan a t a . nugt # 44 15 AC GOLF COARSE FAIRWAY MAPf 279 EDlar:of Dl:cluuous Tkffs 1 O AP 2 { EDGE Of BRUSH 212 3026 N ORCHARD OR NURSERY 180'AC / . . :50 AC ��/�,' ' . / ;'" `� �..�\ / ,� U -•--� i V—V—f"'V LOGE OF CONIFEROUS[RL•ES -C MARSH AREA EDGE OF WATER A' DIRT ROAD `� ; DRIVEWAY PARKING LOT PAVED ROAD — - - — DRAINAGE DI ICH PAl'll/TRAIL. I, y # 3NAP 219 1 PnkcEl LINE E 0 5 ASP lla MAP k 3b0 421 E- - PARCi.NUMBER lR I. 41860 HOUSE:NIIMOER AP 279 2.42 AC ❑1 7 ---- 2 FOOT CONTOUR LINE AC tee— 10 FOOr CONTOUR LINT: Flavation hosed oilNGVD29 /4.9 . SPOT ELEVATION c ., . STONE WALL. • �� © � C, fln \ / _�... .►. RE MINING WALL. RAIL ROAD TRACK / . , ' STONE IETIY C) SWIMMING,POOL PORCH/DECK f �✓ c. � v MAP 2l / ® IO a 0 BUILDING/STRUCTURE: c; HOCK/PIER 07 _ 42 HYDRANT © VALVE 0 MANH011: fO POST 0 FIAG POI.E T O W N O F '6 A R N S'T A B L E G E O G R A P N I G I N F O R M A T 1 O N S Y S T E M S lD N 1 T o SIGN \\\ SIORPA[[RAIN N PRIk1E0 SCAl[:III HET *r101F.: [his amp is an onlmgeinrnl al o **NOIE: [Ile puaal lines are only graphic iaptesemalions DATA SOURCES: I'l0nimanics(man-made reotuies)were inlmpieted horn 1995 aeiinl phalogugths by 1110 Jollies a t� _ _ o WILRYPOLE. r POWER i — I"=100'scale mop and may NOT nice[ of ptopeity boundaries.They me not title locations,and W.Sowall Company. TapoBmphy and vegololion wmo holopieted how 1989 oetial pI Mup Am by G lan w -x 0 40 60 National Map Aawncy Standmds at this do not teptesenl actual telolionships to physical objeels (otpotolion. Plmtimeltics,lopogtaphy,oral vagelalion Ovate mnpped to meal Nulionul Map Accumry Snmdmds i 11001=80 FEE* indulged scalo. on the.mop. at a settle of 1"=100'.Parcel lines wmo digitized hom 2001 Town of Dmnstable Assessor's lax coups, O IIGIIT P01[ ELEi7Rlf.ISOX ROPE RTV ADDRESS I I ZONING I DISTRICT CODE SP-DIETS.I DATE PRINTED I CSTATE LASS(PCS i NBHD KEY NO. 0163 ROUTE 6-A 04 RF-2 100 04BA 07/09/95 1091 00 76AA R279 034. 187906 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T,, UNIT 'ADJ'D.UNIT Lano By/Dale Sze D_mens�on ACRES/UNITS VALUE Deaori t E DWA R DS. J A M E S..K LOC./V R.SPEC.CLASS ADJ. COND. P PRICE PRICE piO" MAP- CD. FF.De m,Apres #LAND 1 76,9200 CARDS IN ACCOUNT - 10 1BLO6.SIT 1 X 11 =10 100 59999.95 59999.9! 1.00 60000 #BLDG(S)-CARDr.1 1 128.900 01 OF OZ a 11 .1RESIDUAL 1 X 1.4d =10 95 12000.0 11400.00 1.42 16200 #SLDG(S)-CARD-2 1 '17,400 COST "J #PL 3060 MAIN ST ARKET 208800 �_, wo S 2.0 U X 8= 100 8800.0 8800.0 1.00 8300 B #DL LOT UNNUMB INCOME _ BSMT S x I B= 100 6.5C 8.1S 1110 91OU-8 #RR 1387 3060 1364 C USE A FIREPLACE U X B= 100 3900.0 3900.0 2.00 7890 d #SR RENDEZVOUS LANE APPRAISED'VAtOE D J A 222.500 PARCEL SUMMARY F S AND 76200 S T LDGS 14630C -IMPS M E TOTAL 222500 - CNST N DEED REFERENCE1 f I Tvpe DATE SR.lea Pd R I O R YEAR VALUE T M Yr D AND 76200 S 00/0Q PLDGS 146300 OTAL 222500 BUILDING PERMIT Numpe Amount 3 LAND LAND-ADJ INC ME I SE SP-BLDS FEATURES SLD-ADDS UAITS Dale Type 76200 I 7500 Class I Unlias Base Rale Ad,Rate A e r B I' Age Depr. CDonO. CND I L., %R G Repl Cost New A°I Repl Value Stones Heighl Rooms Rms 9.tha 1 I Fia. I P.r oll F. f 000 110 110 68.70 75.57 06 60 34 56 100 56 230200 128900 2.2 9 5 2.0 7.0 Description Rale Souare Feel Repl.Cost MKT.INDEX: 1�QO IMP.BY/DATE. LK 6/91 SCALE: 1/00.33 ELEMENTS CODE CONSTRUCTION DETAIL BAS 100 75.57 1110 83883 , FSF 90 66.01 40 2720 I *-16-* STYLE 05 OLONIAL OLD 0.0 FOP 35 26.45 219 5793 110P 16 D ESrGN ADJMT -02 DY.TIGN--A6]UUT--I_U 0 FWD 85 8.50 296 2516 ! ± EXTER.WA-ILS-- -12 lAPBOA9b -U 0 2SF 150 113.36 400 45344 *-16-* EAT/AC-TYPE -04 IL --------U.O ' 10P 125 94.46 256 24182 !2SF ! hT-ER.FI-NISH- -00 ------------------U:O FEP 65 49.12 42 2063 25 25 INT-ER=CAYOQT -02 ------------------�=0 822 67 .50.63 1110 56199 ! ! NT-ER.WUALTY- -02 AM'E-AM' -EXT-rlt.- U=O *--*25--*-12* . FCOJi2 ST-AUCT- -00 ------------------U.O ` ! 822 9 E LOUR-COVER-- -00 ---------'-------- Q W I -0-=D E Total Areas , 557 Base- 1806 ! *-* OOF-TYPE---- `Jt A3LE=WS`FR-�9---U'.0 BUILDING DIMENSIONS 3 Q BASE *-* T CEZTRItAL--- -GO ---------ZT.O BAS W14 FSF SO4 W10 N04 E10 .. ! FEP OUVDATIUN- -" -J ----------------O -9v.9 A SAS W23 FOP S07 FWD S08 E37 NO8 ± 1 -------------- - --- ---------------------- I W37 .. FOP E37 N07 W14 SO4 W10 * 13* 10* 14X -----NEI -KOORH OD ?6AA_lFNRNSTABLE-- L N04 W13 .. BAS N30 E25 2SF N25 7 *FSF* 7 LAND TOTAL MARKET W16 1OP N16 E16 S16 W16 .. 2SF *----FOP----* PARCEL 76200 222500 S25 E16 .. BAS E12 S09 FEP E07 *----FWD----* AREA 3 674 S06 W07 N06 .. BAS S21 .. 822 VARIANCE +p 1673 N30 W37 S30 E37 .. r STANDARD 25 R OPERTV ADDRESS I I ZONING DISTRICT CODE SP-DISTS.1.DATE PRINTED'STATE I pCS I NBHD CLASS KEY NO. 0163 ROUTE 6-A 04 RF-2 l00 048A .07/09/95 1091 00 76AA R279 034. 1879C6 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T LOC./V R.SPEC ,, UNIT ADJ D.UNIT/ Lantl BylDate size Dim ens�on ACRES/UNITS VALUE Description E D4A R DS P J A ME S K MAP- .CLASS FFDe mlAcres ADJ. COND. PE PRICE PRICE BATHS 1 .0 U X j 0= 100 2700.00 2700.00 1.00 2700 B I— CAOR2DSINACCa NT — 1 ft NO BS t4T S X i o= 100 7.8 6.1 2 342 21 UO-B biOF 222SOC-- NEAT S X D= 100 2.35 1.83 342 1 600-3 ARKET 208$00 NCOME SE D PPRAISED VALUE J 222.500 U ARCEL SUMMARY S AND 76200 T LOGS 14630C m -IMPS - E IOTAL 222500 N CNST DEED REFERENCEI Type DATE Rxwtlstl . R I O R YEAR VALUE T Book Page 'nsl. MO. Yr.D Sales Prico A N D 7 6 2 C O S LOGS 146300 OTAL 22250C i BUILDING PERMIT STIMATED-83 ' LAND LAND-ADJ INCtJME St SP-bLDS FEATURES BLD-ADJSI UN NVmber Dale Type Amount ITS i Const. Total ge Norm Obsv. CND Loc %R.G Repl Cost New Ao Re Valve Stories Hei nl Ropms Rms Bathe I Fis. PMywaN Foc. Cia Base Rale AOI Rate r B II A Units l.'n its A 1. I Depr. Contl. I Pt 9 000 100 100 53.45 53.45 50 50 44 38 100 38 45701 17400 2.0 4 2 1.0 4.0 Descnpnon Rate Square Feet Repl.Cost MKT.INDEX: 1 1 OD IMP.BV/DATE: LK 6/91 LT, SCALE: 1/01.DO ESLEMENTS CODE CONSTRUCTION DETAIL BAS 100 53.45 342 182801� : OPO 60 32.07 216 6927 *-----12----*--------19--------*----11----* TYLE OS OLONIAL OLD 0.0 G20 90 48.11 198 9526 ! OPO ! 820 ! ESTGN-A-DJMT- -OG. ------ ------ ' U=0 Ii20 60 32.U7 342 10968 ! ! ! ! XTFR.GAtCS- -Tt WUUD-SNTNGL_ES--- a-0 1 � ! ! ! EAT/AC-TYPE- -Ut NONE--------------1r.0 ! ! ! I NTFR:FINISH- -00 ------------U.O 18 18 BASE 18 18 NTE-R:LA?OUT- -01 ------------------or_O ! ! ! ! N TER:DU-ALTY- V2 AWE--AY-EXT-EW---n-.0 ! ! LOUR STRUCT- 'JO ------------------Jr-0 yr ! ! ! ! E LOOIR-COVER- 00---------- --------- D E Tplat Areas Au. _ 216 Base e 342 ! ! ! G 2 0 ! O Of--T Y P�--- -U 3 1F=A S"-S HTN G--1r=0 BUILDING DIMENSIONS *-----12----*--------19--------X----11----* L E7C-T RI rA-L___ _00--------------------0-=0 T ST—S—W-T9 NIS OPO WI 2 S18 E N 0U-N-DATI DIN- - -05 TO-NE-ICALLS-----9�.-99 A .. 13AS E19 G20 S18 E11 N18 M11 --------------- ----- .. BAS S13 .. 320 N18 W19 S18 ------------------ L E19 .. LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD vRESIDENTIAL', PROPERTY MAP NO. i LOT NO. STREET3OCO Main St• FIRE DISTRICT SUMMARY _ & Rendevous Lane Parnstable 279. 34 _ 73 LAND kit., �w OWNER B 01 BLDGS. '/7 9 0 TOTAL G 0 U RECORD OF TRANSFER DATE eK PG I.R.S. REMARKS: unnumb. LAND BLDGS. TOTAL Edwards, James K _ _ 1 0 _� LAND 3415 90 O BLDGS. ��/�•�` E/Z ST lP2uy� E �1 Qa a -- - r� ;2 - 4f.J 3 o p TOTAL LAND A/7 9 u rn BLDGS. TOTAL Cr „F ! J / \ LAND BLDGS; TOTAL LAND BLDGS. TOTAL LAND 0) BLDGS. TOTAL LAND INTERIOR INSPECTED: ✓ �_ % 1 f `j] �t T C_��!_:`+...✓ BLDGS. DATE: / v J ✓ Y' J 1" TOTAL ACREAGE COMPUTATIONS LAND LAND TYPE # of ACRES PRICE TOTAL DEPR. VALUE 0) BLDGS. HOUSE LOT O ZQ O - TOTAL CLEARED FRONT 0000 OQ p o I LAND REAR 6 1 R 49O BLDGS. WOODS OUT FRONT TOTAL REAR .S 3/ O LAND_ WASTE FRONT / D U BLDGS. REAR TOTAL LAND . O BLDGS. � T'OTAi Z.S LAND � 3/ UU LOT COMPUTATIONS v- „ FROIIT DEITN STREET PRICE DEPTH%I FRONT FT.PRICE TOTAL l.A DEPR. COR. INi. .+ ,c. Blk.Walls Bsmt.Rec. Room St. Shower Bath 1 Bsmt. (� _ PURCH. DATE /I. ✓f ,ic. Slab Bsmt.Garage St. Shower Ext. Walls PURCH. PRICE. ick Walls Attic FI. &Stairs Toilet Room Roof RENT /l. one Walls Fin.Attic D Two Fixt. Bath Floors .rs INTERIOR FINISH Lavatory Extra , Fit/ 'f 2 3 Sink / i ✓ Attic G ay 1/2 y4 Plaster Water Clo. Extra .. XTERIOR WALLS Knotty Pine Water Only hle Siding ✓ Plywood No Plumbing Bsmt.Fin. ' Int.Fin. .ogle Siding Plasterboard Shingles TILING IV 0 r, Blk. G F P Bath Fl. Heat ..,.e Brk.On Int.Layout jhF Wains. Auto Ht.Unit Veneer Int.Cond. Walls Fireplace ,,m. Brk.On HEATING . FI. Plumbing ,,lid Com. Brk. Hot Air ✓ .FI. &Wains. Tiling Steam .FI. &Walls.;lanket Ins. i/LHot Water r Total y.roof Ins. Air Cond. �� 1 •. -- Floor Furn. ROOFING COMPUTATIONS \sph. Shingle Pipeless Furn. S. F. .;'cod Shingle —-- No Heat S. F. -;sbs. Shingle Oil Burner (/ / S.F. slate Coal Stoker S.F. j Li. D 10 Gas S F 1 21 - ' OUTBUILDINGS ROOF TYPE Electric �f S.F. Q 1 2 3 14 15 16 7 8 91101 1 2 3 4 5 6 7 8 9 10 MEAS D •.�ahle Flat Floor dip Mansard FIREPLACES S. F. Pier Found. Wall Found. 0.H.Door LIST +,ambrel Fireplace Stack / t/ FLOORS Fireplace Sgle. Sdg. Roll Roofing t:unc. LIGHTING Dble.Sdg. Shingle Roof DATE L aith No Elect. Shingle Walls Plumbing ,line ✓ _ Cement Blk. Electric Hardwood ROOMS Brick Int. Finish PRICED Asph.Tile Bsmt. 1st SB TOTAL J 3 Jingle 2nd �j 3rd FACTOR 7— 13 3 4 REPLACEMENT (,71 f. OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. :�wt c. .��.r':r oZs�i> fie �� / ov G'QaJ G 7 V6 3 d / G V Q 'fo 30/ -- --2 5 —6 7 8 9 10 _- ^.,.. ..... .. - TOTAL II RESIDENTIAL PROPERTY MAP NO.,/ LOT NO. FIRE DISTRICT SUMMARY STREET Main St. Barnstable B 73 qLAND _ pf 79 34 OWNER rn _ RECORD OF TRANSFER DATE e.K PG I.R.S. REMARKS: OI - B TOTAL LAND ' Edwardsi James K, 12-31-813415 333 90 0 . BLDGS. TOTAL a� ., LAND BLDGS. d TOTAL LAND BLDGS. TOTAL LAND BLDGS. Ol _ TOTAL LAND BLDGS. TOTAL r LAND INTERIOR INSPECTED: BLDGS. .\ f _ �= i+i ZXXY`J '� DATE: S,f/'� TOTAL LAND ACREAGE COMPUTATIONS 01 BLDGS. LAND TYPE # OF ACRES PRICE TOTAL DEPR. VALUE TOTAL HOU T LAND CLEAR FRONT - BLDGS. REAR - TOTAL WOODS&SPROUT FRONT LAND REAR f 2- BLDGS. WASTE FRONT TOTAL REAR LAND 0) BLDGS. TOTAL LAND BLDGS. LOT COMPUTATIONS LAND FACTORS iOTAI FRONTLDEjPTH .S7REE7 PRICE DEPTH% FRONT FT. PRICE TOTAL DEPR. COR. IMF. VALUETOWN SEWER HILLY LAND —_ ROUGH TOWN WATER BLD 4GS. � ± as -HIGH GRAVEL RD. TOMI LOW DIRT RD. lAMO _ SWAMPY BLOCS. 7 I-UU1VUMaIk-j - - - -ni"" LAND COST ' one.Walls Fin. Bsmt.Area Alp Bath Room / Base / /t{U BLOG. COST onc.Blk.Walls Bsmt. Rec. Room , St. Shower Bath I Gl� Bsmt. PURCH. DATE )nc.Slab Bsmt.Garage St. Shower Ext. Walls PURCH. PRICE rick Walls Attic Fl.&Stairs Toilet Room . Roof RENT tone Walls Fin.Attic Two Fixt. Bath Floors — L iers. INTERIOR FINISH Lavatory Extra smt. F II 1' 1 2 3 Sink /4 y2 r/4 Plaster Water Clo. Extra Attic EXTERIOR WALLS Knotty Pine P/1 Water Only rouble Siding Plywood No Plumbing Bsmt. Fin. tingle-$$}}(ding Plasterboard Int. Fin. .. Wei Shingles 1/ U --- �. I iLING :onc. Blk. G F P Bath Fl. Heat Face Brk.On Int.Layout Bath Fl.&Wains. Auto Ht.Unit Veneer Int.Cond. Bath Fl. &Walls Fireplace Com.Brk.On HEATING Toilet Rm. Fl. Plumbing D Solid Com.Brk. Hot Air Toilet Rm.Fl.&Wains. - --_- - Tiling Steam Toilet Rm.Fl.&Walls �02 .� Blanket Ina. p Hot Water St. Shower — Roof Ins. Air Cond. Tub Area Total OP ' Floor Furn. p� ' ROOFING COMPUTATIONS ' Asph.,Shingle v'_ Pipeless Furn. S.F. !Wood Shingle No Hest S.F. DO 'AsboiShingle _Oil Burner S. F. Slate { Cod Stoker S.F. A.,e,?,d NI S I a� ;r .Tile Gas S.F. OUTBUILDINGS ROOF TYPE Electric - Gable Flat S.F. 112 3 4 5 6 7 8 9 10 1 2 1 3 1 4 1 5 6 7 8 9 10 MEASURED cGlp ' Mansard FIREPLACES S.F. Pier Found. Floor 'Oambret Fireplace Stack Wall Found. 0.H. Door - _LIST�ED\ " FLOORS Fireplace / Sgle.Sdg. Roll Roofing ;,Cone: LIGHTING Dble.Sdg. Shingle Roof !J Earth No Elect. DATE Shingle Walls Plumbing - -'Pine ;Hardwood. ROOMS Cement Blk. Electric RAMLn 'Asph.Tile Bsmt. 1st TOTAL / ,yU Brick Int.Finish —P ;Single 2nd 1/-ld 3rd FACTOR REPLACEMENT i �(p a �YS,4 r Ifas.aJla OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.D p. ACTUAL VAL. DWLG.� T 5 or&<!3� 5!r `/��iC /(0 3� .�JS U 3 5 2S (� UU `f. ,3, t TI 2 3 4 6 . 1 6 :ar 7 8 9 10 v TOTAL