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Home My WebLink About3925 MAIN STREET {w . m f _ a e 4 e II • o • t rois Town of Barnstable *Permit# � 7 . eft Q, Expires 6 months from issue date Regulatory Services Fee ,5-� * BARNbTABLE, * v 4/3 �,�� ThomasF.Geiler,Director /�-PRESS PERMIT EDMA't� _ Building Divisionp12- JUL 17 2012. • Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma:us TOWN OF.BARNSTABLE ' Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY �. c Not Valid without Red X-Press Imprint Map/parcel Number { 0 S- Property Address J l pa s m A w st., C AA M p J i►1 3 -] Ob es 2 idential Value of Work SOO— Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address -ee '-t" CJe - it 39 -- /1/41,e1-, 1 S-�-, C u nA MetcEVi o ma o 2.6.97 Contractor's Name ? ee e . �ErVI k_ Telephone Number SO R( 3 6 2- �S�. Home Improvement Contractor License#(if applicable) ' 5 0 ' St) Construction Supervisor's License#(if applicable) 99L/ge _ ❑Workman'sCompensation Insurance Check one: • ❑ I am a sole proprietor g I am the Homeowner ❑ 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) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) KRe-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows 0 Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ; . ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is I equired. ..------- SIGNATURE: . i ?:1WPFILES\FORMS\buildingpermit 8.4,• 4'RESS.doc I ,evised 053012 f _ . :. " The Commonwealth of Massachusetts ,, Department of Industrial Accidents t. '— = Office of Investigations Tag limer=Mauri 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): ?dr-le \I . `t C / Address: 39o)5 Me(.. ✓`— St. Z 'Fax 36 Cuieq p/ City/State/Zip: Phone#: 6-6 g 36 2 ` 3,5 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling Ty, hipand have no employees These sub contractors have ❑ 8. Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. $ 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3 .S. •.I a homeowner doing all work officers have exercised their 11.0Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 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 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. 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 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 hereb ertt under the pains and pIii alties of perjuty that the information provided above is true nd correct. Signature: - Date: 7/ S Phone#: a , J 2 - ,c-,csg` 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#: • - e -ain/mowavaa or,//tacuadigaelts Office of Consumer Affairs&Business Regulation " License or registration valid for individul use only 1 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:HOME Registration:i.:f-'10950 Type: Office of Consumer Affairs and Business Regulation Expiration::VIM DBA 10 Park Plaza-Suite 5170 c:7-t-ti Boston,MA 02116 PETER J.SMITkHDW-1MFROVEIVENT at,g4 - PETER SMITH ST/I1A1( V( CUMMAQUID,MA 0263 :,` Undersecretary Not va ithout signature •- ' Mas-s;husetts - Departm.-ent Pu- Board of Building Regulations and Standard Construction Supervisor Specialty License License: CS SL 99486 • •Restricted to: RF,WS • cP uP0E mTBEmORAXQS3uM6 IT H ''..ji.011;' 77 • ID, MA 02637 Expiration: 11/1/2013 iimmissioner T : 7029 • • • • • i>rl---OT bi 1•91 - * BARNSTABLE, • 7 MASS. Town of Barnstable 44, ion. Pto huith Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,CBO 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, 11 , as Owner of the subject property hereby authoth C- to act on my behalf, in all matters relative to work authorized by this building permit application for: (Ad ess ess of Job) Signature of • s ate ?Q:(`ek Sewik Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. \WPFILESTORMS\building permit forms\EXPRESS.doc Revised 051811 311.1HETown of Barnstable abs 1 Regu atory Services BARNSfAibis) Thomas F.Geiler,Director 9 MASS.......y • \ea Building Division. • Tom Perry,Building Commissioner r 200 Main Street, Hyannis,MA 02601 1 www.town.barnstable.ma.us Office: 508-862-4038\ Fax: 508-790-6230 ti HOMEOWNER LICENSE EXEMPTION I Please Print DATE: -7 i r S ` � i JOB LOCATION: J 72--S \ r l p o'") gr C V 41 vM , tJ umber street vilage ' r-pkJ ! ZP"HOMEOWNER": it)-Pe name home phone# work phone# I CURRENT MAILING ADDRESS:TO b)X 3` ) Cu v rh,iv �'io M d 2 3 7 city/town 1 state zip code The current exemption for"homeo e ers"was extended to include owner-oc. pied dwellings of six units or less and to allow homeowners to engage an individual �Lsr hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOME¶WNER Person(s)who owns a parcel of land on which he/she resides or intends to:eside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached s. ctures accessory to such use an or farm structures. A person who constructs more than one home in a two-year period shall not be c.�. idered a homeowner. Such".omeowner"shall submit to the Building Official on a form acceptable to the Building Official,that h-she shall be responsible for :11 such work performed under the building permit. (Section 1 109.1.1) 1 The undersigned"homeowner"assumes resp nsibility for compli ;e with the State Building Code and other applicable codes, bylaws,rules and regulations. . eh.-rsigned"homeowner"ceaifi<s that he/s s- understands e Town of Barnstable Building Department minimum inspection .I aced ,-s ..d requireme• < and that he she will c omply with s d procedures and requirements. ..rf. A Signature of Horn: ii / If Approval of Building Official Note: Three-family dwellings containing c ..c feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HO19O' ,•'S EXEMPTION - ` The Code states that: "Any homeowner perfoijming . s rk for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Lige-nsing o' onstruction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that suchiHomeown. shall act as'supervisor." Many homeowners who use this exemption are unaware tha they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing.Construction Su i ervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires an.'censed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a�`licensed Supe ,'son The homeowner acting as Supervisor is ultimately responsible. ; To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she'understands th4 responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You May care t amend and adopt such a form/certification for use in your community. ;., Q:\WPFIT.FS\FORMSbuilding permit forms\EXPRESS.doc '``'� \ Revised.0518.11 Message Page 1 of 1 o ►a` Anderson, Robin To: Smith, Tracey Subject: Dismiss Ticket Hi Tracey, Please dismiss the for Peter J Smith , BAR#74214. He has maintained compliance since I spoke to him a few months ago. Thank you. Wp6in Robin C. Anderson Zoning Enforcement Officer Town of Barnstable 200 .Wlain Street Hyannis, M.4. o26oi 508-862-4027 3/20/2013 U.S.POSTAGE>>PITNEY BOWES ..,,—:n 4..04,,,ip,e; 4 ^r.".. - AgiMmyruir gezmapiagnamy, firMAGIWO, ETASEMAMISMO c%. 0b 0161,00 - . Kele i ---aialiSSW'"PrW.atizazammcr camgalms,Asirocaur 02601 $ 000.45° -- % z.:-. .• 02 'IVY '. .,7"••• 4 ': 0001361475 JAN 15 2013 k........„ 1 \_,L.......S (A63 0 - * = _.: • • '3d013AN3 1V3S 013dd1133d 3SV31d ezzr J v•--1 A, tl . , ,,. . (L`vJ ¢ mUaN Li O TO / Y O�E�. off • U X 2 •s..." W O` Q N 0 w. CC o GOa0 W e c - P.=-• --a ›, LST-----' c. . . 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LL. z W p � �� (`�02 air 1�0112 122LI2tU2p YlEEdi p UCD Z `p ✓ O `=1 W ~ Q 1. `p ' 508.428.8700•fax 508.428.8524 0 �� =�` U p o = (6'�1' www.Iujeanprinting.com 4507 Route 28•Cotuit, MA 02635 F= ►- 0O m 'fir n p p u: cc cc W z > p p p cc ' iipfd-- ,r• • 4:2:7 u s Imstable POSTAGE)>PITNEY BOWES 1 /tirseieotn , ';'' IA 02601 . i - I 3:0. ...."4:; -.Ai• ..1240•..ams,....„ :1..a. Lig 1,1..7 ZIP 02001 t Arte •re 7012 1010 0000 2843 2393 - 0001361475 DEC 20 2012 \.) q to Le \ • 1 , uk0,.--- Peter J Smith L ) 3925 Main Street ) ..)/ 7 I 7- Barnstable, MA 02630 f A NT Y.T 0 7 0 OF 1 RETURN TO SENDER 1.2 f%1 1 Ai M'.- E/ d TN 1-1 15 L C i KJ r 3.)IN Yr il ii i) R C : 07 6 0 1 400?0 0 *0(464—WI 7 444—:,Y0-1.1iq 6t67kiftlIt6lABb? ar.5.-POstal ServiceT'm , '.'' - ‘, CERTIFIED MAIL, RECEIPT ,, . rip ;,,(Domestic Mail Only;No In rancq Coverage Provided) 9 . m i't For delivery information visit our website at www.usps.come 4 -1 ru m 0 F F 1 C I ii,gi E . Postage $ ru • Certified Fee CI Postmark C3 Return Receipt Fee Here O (Endorsement Required) 0 Restricted Delivery Fee e3 (Endorsement Required) r1 O.--• Total Postage&Fees $ rg i _. Sent-T4 --T- :5.110.J.7IA • Street,Apt No.; Si IN_ or PO Box No. (36. )51.222_aiiii .L.... City,State,ZIP+ ,v. i i . PS Form 3800,Atigust 2006 ,i317W11,,,r tr,00,ii See Reverse for Instructions Town of Barnstable C af Regulatory Services �� Thomas F. Geiler,Director .04. Building Division ° �' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 20, 2013 Barnstable First District Court Attn: Clerk Magistrate PO Box 427 Barnstable,Ma 02630 Re: Peter J Smith 1 — 3925 Main St,Barnstable, Ma Bar No. 74214 Dear Magistrate: I, respectfully request the immediate dismissal of the aforementioned matter. Mr. Smith has maintained compliance in accordance with an agreement arranged a few months ago and therefore the pending enforcement action is no longer necessary. Sincerely, C--qt: Robin C. Anderson Zoning Enforcement Officer TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION (12211N Map 335 . Parcel 050 Application # O Health Division Date Issued .Ct t Conservation Division Application Fee Planning Dept. Permit Fee t r Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address 392'� /�/Ct+'N j�(eiel-/P -e 6 X1 Village C;� yv,v✓r a v., et- Owner 9g fee Address 3Q26- a.►'vl ��- I'�✓v�S�Q�i1 Ain Telephone sag- 3C 2 3 58 8 Permit Request Air , c) 3-Oo e ou n GQ��'+ or ro m i;n re C c ' ( C rai\ cs.) +4-4 oar/) to •Cectoce ( i-+'or► F.64 $reiin01 rovect nil R-11 eel/u hjiS' -t-d a cox 4-OO eei) ,')1Jett ,er 4- 4- ex+, orS Square feet: 1st floor: existing'4')(proposed 2nd floor: existing 1026 proposed — Total new Zoning District Flood Plain Groundwater Overlay oo Project Valuation , 2300 Construction Type Lot Size •(� ri Grandfathered: ❑Yes ❑ No If yes, attach supporting tation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) w r Age of Existing Structure )900 Historic House: ❑Yes ❑ No On Old King's ighway:=' U No Basement Type: WiFull IICrawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) 209 Number of Baths: Full: existing 3 new — Ri If: existing i' new — Number of Bedrooms: existing =new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: O'Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes "o Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing 0 new size Pool: ❑ existing U 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 VVV ,'/1,i►j7 eeir4e/fiar L' 3 Je Telephone Number 6O8-345 .Ogq/9 Address 7-C }Iv ylf ' +o r Ave. License # )O Z 776 Z _ Ya y-wo utk) M r4 og664- Home Improvement Contractor# )4.4 4'3Z Worker's Compensation # K SG b+u R - 9958111 c7 3-O9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Yr,sr mn a SIGNATURE DATE g - -)0 -F_ FOR.OFFICIAL USE-ONLY -'APPLICATION# , DATE ISSUED . _ MAP/PARCEL NO. . - t ADDRESS VILLAGE f 1 OWNER .- kjj ' 1 it DATE OF INSPECTION: ` t FOUNDATION - / , FRAME .INSULATION r" . FIREPLACE -- - ELECTRICAL: ROUGH FINAL - "= �m PLUMBING: ROUGH FINAL GAS: ROUGH FINAL . FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO. i I The Commonwealth of Massachusetts * Department of Industrial Accidents ►*— =►.(. / Office of Investigations _ er�„ 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): «,�� y3, Ait ee)osk Ack. Oae e Address: 7-C /T ritl`hni^ph E pie w e City/State/Zip: v Phone #:�o �- ya�rm •F oc� �►l /y1�4 026�4 SDS 4_19B Are xou an employer?Check the appropriate box: Type of project(required): 1.[V I am a employer with 4. ❑ I 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. I ❑ 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. ❑ We are a corioration and its required.] , officers have exercised their MO Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. . c. 152, §1(4),and we have no 12.❑ 9.00f repairs insurance required.] t employees. [No workers' comp. insurance required.] 13. Other ,,s iz l��-C a� *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 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. n Insurance Company Name: )a1'j-•Lock �)YI�►XBCWri t-es S a—yts (ay)L'e e rrrQdy Policy#or Self-ins. Lic. #: 5 00 B 4458 hi -3-D 9 Expiration Date: )p - ,21-)0 Job Site Address: 3g,2�' R tz. 6 A. City/State/Zip: a c,ns 4-a��el 4414 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 penaltiesti of erjury tha he information provided above is true and correct. Signature: Date: .: Phone#: Soo-3g8-0398 '.'' 3' e�)�Sk�y , G, 1Y1, 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):I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 1 ,rr,... G Information end Instructions Massachusetts General Laws chapter 152 requires all ployers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as".. very person in the service of another under any contract of hire, express or impli\ed, oral or written." An employer is defined as 'an individual,partn ship,association,corporation ther legal entity,or any two or more of the foregoing engaged in a joint enterprise, nd including the legal representati es of a deceased employer,or the receiver or trustee of ail individual,partners ip,association or other legal entity, mploying employees. However the owner of a dwelling h. se having not mo .- than three apartments and who resi es therein, or the occupant of the dwelling house of ant her ho employs .ersons to do maintenance,constructs n or repair work on such dwelling house or on the grounds or .uildin appurten, t thereto shall not because of such e ployment be deemed to be an employer." 1 MGL chapter 152 §25C(6)also stars that"every state or local licensing gency shall withhold the issuance or renewal of a lic• se or permit i.operate a business or to construct b !dings in the commonwealth for any applicant who I as not produced . ceptable evidence of compliance ith the insurance coverage required." Additionally, , GL chapter 15 , §25 7)states"Neither the common alth nor any of its political subdivisions shall enter into any contract for the ierforma e of public work until acce able evidence of compliance with the insurance requirement of this chapter ,.ve been pre nted to the contracting .uthority." Applicant,/ r> Please fil/out the worker.' compensation affidavit on letel ,by checking the boxes that apply to your situation and,if necessaryj, supply sub-cs tractor(s)name(s),address(es)an. shone number(s)along with their certificate(s)of insurance. Limited Lia,Jility Companies(LLC)or Limited iability Partnerships(LLP)with no employees other than the members or partners, . e not required to carry workers(c. pensation insurance. If an LLC or LLP does have employees, a policy i s required. Be advised that this of'4 avit may be submitted to the Department of Industrial _. Accidents for conf ation of insurance coverage. Al . .a sure to sign and date the affidavit. The affidavit should"` be returned to the ci or town that the application for e a-rmit or license is being requested,not the Department of Industrial Accident/. Should you have any question..regard 44g the law or if you are required to obtain a workers' . compensation policy,please call the Department at he numbe listed below. Self-insured companies should enter their self-insurance license number on the appropriate e. City or Town Officials » Please be sure that the affidavit is complete ano�t printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations .as to contact you regarding the applicant. Please be sure tof fill in the permit/license nuncber which will be used as a re -rence number. In addition,an applicant that must submit multiple permit/license applications in any given year,need o ly submit one affidavit indicating current policy information(if necessary)and under!`Job Site Address"the applicant sho d write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the ci; or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A ne affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any 'usiness or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete his affidavit. The Office of Investigations would like to/thank you in advance for your cooperation and sho ld you have any questions, please do not hesitate to give us a call. The Depai tinent's address,telephone andjfax number: . . ti The..Qommonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax#6f7-727-7749 Revised 5-26-05 www.mass.gov/dia A From: 04/0&I2O10 16:46 EMS P.001i004 . VDAC WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INPORMAIION PAGE WC 00 00 01 ( A) PoUCY NUMBER (GS6OUS-91WSIMT-3-09) NEW-OS INSURER: HAR1PORO UNDERWRITERS INSURANCE COMPANY 1. NCC1 CO CODE:80411 I� ENSURED: PRODUCER: MCCLUSKEy. 13ICJ4AEL USA RISK STRATEGIES C0 CAPE SAVE 1 S PACELLA PARK OR T C HUNTINGTON AVE RANDOLPH 116t 02388 scum YARMOUTH 4I* 02844 Insured lO AN I NDI VZOUAL Other work places and Iden1Mostion numbers are shown M the schediie(e)attached. R. The policy period is from 10-21-O9 to. 10.31-10 1E:01 A.M,et the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers - Campensatlon Law of the abate(s)listed here 43111 S. EMPLOYERS LIABILITY INSURANCE:.Part Two of the policy applies to work in each state listed In Item 3.A. The irr,s of our liaablky udder Pan Two aars: Sadly Injury by Accident $ s0oG00 Each Accident Badly iniury by : $ $00000 Policy Link Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states.If any,listed here: C0VERAaR REPLACED SY ENDORSEMENT WC 20 03 08A O. This policy Mdudes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION Of INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules,Ckleaffications,Rates and Rating Plans. AN required Information is subject to verEicetlon and change by audit to be made ANNUALLY. GATE OF ISSUE: 11-10-os ILL ST ASSIGN: lIA OBE: ORL.ANDO DA NTPD 060 PRODUCER: RISK STRATEGIES CCNP 76211P Department of Pubiic tct 7 Bitartl �i#'Building '�� , �r�telj:Cri+►t,; and `�tan��litril� Construction Supervisor Speciaity License License: CS SL 102776 Restricted to: IC • WILLIAM MC CLUSKY 37 NAUSET ROAD • WEST YARMOUTH, MA 02673 Expiration: 6/ 2812013 "7;}1111NsitDfk'V Tr=: 102776 , „,,,,.„-_,---.4„.„, J.., ea- f."1- O' e.. V .../Ax,' # I;, ;{ M�ktv;, Office of Consumer Affai s and Business Regulation U ,'ir 10 Park Plaza - Suite 5170 _; - .. Boston, Massachusetts 0211 E Home Improvement Contractor Registration. Registration: 164432 Type: Supplement Card Expiration: 10/6/2011 CAPE SAVE WILLIAM MUCCLUSLEY 8201 S. HOURD CT CHAPEL HILL, NC 2751E Update Address and return card.Mark reason for change. aps cAI CA soM•uaioa-G:072a6 __ Address j"J1 Renewal ril Employment L I Lost Card �-/A em,mon. «l1., ty/',,gc,54ache443,14 «- "e- Office of Consumer Affairs&Business Regulation License or registration valid for individul use only w *. l `'VI HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ,i Office of Consumer Affairs and Business Regulation p Registration: 164432 Type: 10 Park Plaza-Suite 5170 ,,, •::fps;., . .•. Expiration 10/6/2011 Supplement Card Boston,MA 0211E CAPE SAVE . WILLIAM MUCCLUSLEY , 7C HUNTING AVE. --,,,t9A.6„--- S.YARMOUTH,MA 02664 Undersecretary Not valid wi ou signature • 's • �o�tr£r T own of Barnstable ' RegulatoryServices • ant es, Thomas F. Geiler,Director ED . 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 Section If Using A Builder as Owner of the sub property I, 9ei-e-C subject� Y✓! l �� . J P P S hereby authorize (,�;j�,'� /rt e e) y� ( e __<?,ie to act on my behalf, in all matters relative to-work authorized by this building permit application for: IY100‘4Sh YD yo ma -) Address of ob t 7- ZQ-)0 Signature of Owner Date Print Name If Property (wrier is applying for permit please complete the Homeowners License Exemption Fortis on the reverse side. . Q:FORMS:OWNERPERMISSION C SAVE 1:1 La a 1E9 e eatherization 508-398-0398 October 14,2011 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 permit application #201003981, Status A, Parcel 335050 at 3925 Main Street,Barnstable, MA,Permit type: RADD , and issued on 6/03/2010 has been inspected by a certified Building Performance Institute (BPI) Inspector. R-10 Cellulose insulation was added to the attic.All work performed meets or exceeds Federal and State Requirements. Sincerely, \\\\\\I / William McCluskey Cape Save 7 Huntington Avenue Suite C, South Yarmouth,p gMA 02664 Town of Barnstable Permit: O06 3(ocl5 �OFVIE T Regulatory Services Date: /D`glo P ' /wS/, Thomas F.Geiler,Director ** BARNSTABLE, Building Division Fee a5 QQ 9 747MASS. ` .. `�� Tom Perry, Building Commissioner ,elFo0 200 Main Street, Hyannis,MA 02601 www.town.barnstable:ma.us /0 1' Office: 508-862-4038 • Fax:.'508-790-6230 TOWN OF BARNSTABLE 1 SOLID FUEL STOVE PERMIT Owner: Fefedcv t I - "'J`h�� CG!�'lCale 561,t4Phone: 5a k 3(a 2 35�� •• r Install at: 3 7c .5 4Gt Village: CUmmipttU1v� Map/Parcel: 3 3 5 So Date: Stove A. 10101 Used B. Type: Radiant/ • C. Manufacturer: 3-Cyt u L, Lab. No. D. Model No.: - P 3 Chimney A. New/ xistin (If existing,please note date of last cleaning) I WeeK B. Flue Size U j 1 - New 6 `� .;",v 5 64 lie d C. Are other appliances attached to Flue? AJ o D. Pre-fab Type and Manufacturer 5611A)/eSS See E. Masonry: y�5 dtrik nlined Hearth A. Materials: / �ef�,� B. Sub Floor.Construction: — "S-foioe Installer Name: rj c(7.4 t. - � Address: /'il6FRS'(o4/5. r(/S' Phone: 56E' - y20.. 6I Location of Installation: 3/.25 AAA; ;fit. u N,,;0, APPROVED BY: Please make checks 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 122801 54- 362_ 311?