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L/0/ 7/ 71 • • • • �� � Y j as a • e • ENE Application number.... I ;141.0.115-c s, 40 4f Fee' �N;$39:4�,• � ��G«� '-� � - �� Building Inspectors Initials��� \ Date IssuedQ ��.�'�� � � 0 Map/Parcel 3 b ® .11 TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 10 to tiff(A) X . C.A3 MMIR IQ ii igo, TREET VILLAG Owner's Name: DoZIR L .1 Phone Number 1'1 L(- `Mg - c)121 Email Address: Cell Phone Number . Project cost$ 3l O® °� Check one Residential Commercial .1 OWNER'S AUTHORIZATION As owner of the above ope I ereby authorize to make application for a build' permi ' accordance with 780 CMR Owner Signature: Date: t5' i /I • TYPE OF WORK 1 Siding 0 Windows(no header change)# El Insulation/Weatherization ® Doors(no header change)# Commercial Doors require an inspector's review El Roof(not applying more than 1 layer of shingl ) Construction Debris will be going to Too)a Ot yMw)Jti. CONTRACTOR'S INFORMATION Contractor's name e Pefek N.1, IV?itk Home Improvement Contractors Registration(if applicable)# 1 rj0 /SS (attach copy) Construction Supervisor's License#C551-01g126 (attach copy) Email of Contractor QiA beMc1 ®LkC tQ, Col Phone number 5O S6 qTd 1 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. The Commonwealth of Massachusetts *�Y Department of Industrial Accidents t- Office of Investigations "ilk= 600 Washington Street iJff I Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): k J, 5 Address:'PO i3DX 3‘ 3 `!-2( itiat ;1i 15kat City/State/Zip: C O v11/144 at J i k 62437 Phone#: J'0 g O — 9 3? Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. [l I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ID New construction 2.1% I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. [] Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp.insurance comp.insurance.; required.] 5. El We are a corporation and its 10.0 Electrical repairs or additions 3.C] I am a homeowner doing all work officers have exercised their 11.0 Plumbing 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 , j employees. [No workers' 13. 5O�1 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 • nder the pains angpenalties of perjury that the information proviil'/1 bis true and correct. Signature: 6fttijik, • Date: F Phone#: 58g c O q [ 37 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#: APPLICATION NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X , X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES * Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature 4P, Date $` 5 g All permit applications ' • subject to a building official's approval prior to issuance. • ure Regulations and Standards Board of Building DCioymismioonnowteparlothfeosf MassachusettssionaiLicens • Con structi 01/2019 5-Apires: 111 CSSL-099486 • 3;;,: 174 f , • : Pp!oT EBRoJx 36SMITH CUMMAQUID ••„1,4,0 • vO/SS=1-_‘0 • C/1., • Commissioner _ AFcvnnacyztheade 6/9../Zer.,Joiadaaetz. . • Office of Consumer Affairs&Business Regulation- . HOME IMPROVEMENT CONTRACTOR TVREIndividual • Registration' 'Expiration 15.096Crit± 05/15/2020 • • T) PETER J.SMITFIFF,4-Z••• Oat • PETER J.SMITH\-;..\ ,q;•/ 3925 MAIN ST. CUMMAQUID,MA 02637 Undersecretary • • • • • Registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation One Ashburton Place-Suite 1301 Boston,MA 02108 Not id without signature e Town of Barnstable *Permit _ I-7__ O to.,,,, . Expires 6 monttrs m is�u e �►, $°: Regulatory Services • Fee (o • Ne1063941 Richard V.Scali Interim DirectorItIO ) , liv) Building Division JAN �- r',PI', ` if `�) Tom Perry,CBO,Building Commissioner 2 6 F� 1" 200 Main Street,Hyannis,MA 02601)!4jj j(tr _ 2®'I - www.town.barnstable.ma.us 4,fk. , Office: 508-862-4038 Fax 50.8 190-6230 1 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 3� �� Not Valid without Red X-Press Imprint Map/parcel Number b Property Address `l o l d 091})&) .T 6LaptntA- qt,,,A Residential Value of Work$ lll 7 ?Li Minimum fee of$35.00 for work under$6000.00 , Owner's Name&Address 7XJPLA L1 TA .di---- diU/O /"Al A) 67 -- 6upilvificattiiI 0{4 o26 3 7 .. Blew) 1 Contractor's NameSO erk) X)E.(13M riawS 4Eyvi1/Soles Telephone Number 4OI-Zzr—TWA Home Improvement Contractor License#(if applicable) / 73zits" Email: Construction Supervisor's License#(if applicable) 0 SW 7 1 .Workriian's Compensation Insurance Check one: - "O-I-am"a sale pfoprietor - e , iiI am the Homeowner ` I have Worker's Compensation Insurance Insurance Company Name A ,a#)A C IIUS . I ntf IN 7 . Workman's Comp.Policy# W 7 a 9.(23 g o2.3 9`9 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 il El Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side '1 �] p Replacement Windows/doors/sliders.U-Value �, 3 V (maximum.35)#of windo s / #of doors: 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 required. SIGNATURE: __-. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc _ Revised 061313 f Iiire Lijnwai :- ° `: RENEWAL BY ANDERSEN "TAWorm " m7s ` Q o°�o/ Cr Worm a 11'32tt ' bY e15e11 '4`,- 26 Albion Road • Lincoht,RI 02865 / — 17—/9 lead Firm M1257 i Miaow u►twawns► re.aro.ww Phone 866.563.2235•Fax 401.633.6602 / I l 0:,7d C .a m a� 5s36cso Southern New England Windows,LLC d/b/a `0 {1'‘�7 r Renewal by Andersen of Southern New England i , I id CUSTOM WINDOW AND DOOR REMODELING AGREEMENT 2 .... swots)Nam ,C)h,,t t) L 1.P 7 9 J,L f Due°Malve-mar�_ 1 y �t�� wyerls)tveetAdams, ty Saae:ard Zip Coda r ao.Ba: L- ...1 1�-1.A.1� C(4 S-�f•/�..,}. t_!1�s..//+�.. 0.-+� ? • &M■t.:n ,-Ts>c 1r sa . hA1 L..�.SFUHameTelephoneNumbeN500 3 �" 7/ WorkTelaphonINumber: J�P Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Southern New England Windows,I LC d/b/a Renewal by Andersen of Southern New England("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this'Agreement"). QF1 Historic 0 Condo 0 HOAT 1 Vd/r''' ' Total Job Amount—��t . ��'y.,"C�[ Estimated Starting Date: Method of Payment 0 Check 0 Cash 0 Financed Deposit Received(33%): 3 a Ain l/`9F of Tin t. Credit Cards are accepted for deposit only—maximum 113 of the Balance at Start of Job(33X): 3 S e_Lit Card Payment Form.)By signing this Estimated Completion Date: Agreement,you acknowledge that the Balance at Start of Job and the i Balance on Substantial Completion of Job cannot be made by credit Balance on Substantial 3 I/ AF7�n Arita. card and must be made by personal check,bank check or cash. Completion of Job(33X): !� Bayer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings changing any of the terms of this Agreement. Buyer(s)acknowledges that Buyer(s) (1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and(2)was orally informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only)Notice to Buyer:(1)Do not sign this Agreement if any of the spaces intended for the agreed terms to the extent of then available information are left blank.(2)You are entitled to a copy of this Agreement at the time you sign it.(3)You may at any time pay off the full unpaid balance due under this Agreement,and in so doing you may be entitled to receive a partial rebate of the finance and insurance charges.(4)The seller has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement.(5)You may cancel this Agreement if it has not been signed at the main office or a branch office of the seller,provided you notify the seller at his or her main office or branch office shown in the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made.See the accompanying notice of cancellation form for an explanation of buyer's rights. Buyer(s)received the consumer education materials provided by the Rhode Island Contractors Registration Board. (Buyer's Initials) Renewal Andersen of Sou ern New England Bu s) • Buyer(s) By: Signatu Signature ignature of Product Manager LiPr,Qtlk o c.l) Print Name of Product Manager Print Name Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT_ k ?` wnnrr['F ojF CAJyStELLAT1 NOTICE Of CANCELLATION `-1�—/ 7 .You may cancel 1 Date of Transaction .You may cancel Date of Transaction penalty or obligation,within I this transaction,without any penalty or obligation,within this transaction,without any Pe tY y three business days from the above date.If you cancel,an propertyhree businessd days anyrom ye above date.If you°u cancel, the I property traded o,any payments made b you under the traded in, paymentsn made by y or Contract or Sale,and any negotiable instrument executed I Contract Will bearet returned and withinegotiable °ten ibusiness days following d . by youwilly be returneder within ten businessa Lice, owiny 1 receipt bythe Seller`of your cancellation notice and an receipt by the Seller of your of thelattrn notice, and any 1 f? out of the ' will security anele iIfyoust arising must m avaialab a to the Sel er action will be I canceled interest you cancel,you must make available to the Seller bYe at your en cancel,insubstantially condition as when 1 at your residence,in substantially as good condition as when at your residence,in su sued toy as goodgoods delivered to you under this Contract or received,any goods wish, you under this Contract or I received, you may,if you wish,comly with the instructions of Sale;or you may,if you wish,comply with the instructions of I the Seller Y. the Seller regarding the return shipment of tg000gdds av aailable•( Seller's expense and-risk.k.If you do make oods available fyou tip make the within to d,.Seller and the Seller does not pick t m up within )' { v.' . nttt0 pick crab retain I days of the date of may retain,or «, listion,yob may .Ifor twenty f cancellation,you !: /• ;cf}l+teiyou I dispose o the goods without any further obligation If Y°u i (tlrthsr r.obligation.on.If P° !i ` ;' the Seiler,or if you agree I fail to make the goods available to the Seiler,or if you agree 4: h )!err yt fall to do so,then you 1 to return the goods to the Seller and fail to do so,then you �F` z • c obligations under the remain liable for performance of all obligations under.the w, •of Contract.To cancel this transactio mail or deliver a signet# A:; s {lee mail or deliver a signed n, x. ,t of this cancellation notice or any other and dated copy of this cancellation notice or any others , seals to Renewal byAndersen of I written notice,or send a telegram to Renewal byAndersen o �'a A.. . . at 2 IUbion Road,Lincoln,RI 02865, I Southern New England at 26 Albion Road,Lincoln,R102865F �� NDO�LATER THAN MIDNIGHT OF u' � y' r MIDNIGHT OF )'�Z' / I . 1 '' `'1 ' }�t BY CANCELTHiSTRANSACTION, K HEREBY CANCELTHISTRANSACTION. Print Marne Data •uyar'e fiputura Print warns Date c Massachusetts Department of Public Safety eBoard of Building Regulations and Standards License: CS-095707 „t Construction: Supervisor s`t BRIAN D DENNISON fir ;''? 7 LAMBS POND CIRC` I\{4 '";« y CHARLTON MA 01507 r ,,,h , `, r,,,:, .. �' h F P4 tsi.....dv,k, C_ Expiration: Commissioner 09/08/2018 _.1 9Lie Vo n a4 ;rce U o % ! trir. 'g' _4; F Office of Consumer Affairs d Business Regulation r 10 Park Plaza-Suite 5170 l - Boston,Massachusetts 02116 Home Improvenio contractor Registration —i,_ Registration: 173245 k � ^t ,---_' 'ik Type: Supplement Card w Expiration: 9/19/2018 SOUTHERN'NEW ENGLAND WIND L4 {i~ BRIAN DENNISON ! P Tv 26 ALBION RD v LINCOLN,RI 02865 V ,_k„__ /,5 cam-- /' Update Address mid return card.Mark reason lor change. —�J ❑Address ❑Renewal ❑Employment 0 Lost Card SCAa Ca 20M-05/71 l:52C er,, ,,,.said ty(G :W(/Cltue6 — s flee-of Consumer Affairs&Business Regulation Registration valid for individual use only before the expiration date.If found return to: OME.IMPROVEMENT CONTRACTOR .Office of Consumer Affairs and Business Regulation �? Registiation�15kss, T➢Pe: 10 ParkPlaze•Suite 5170 Expirattoq_9(1812018: :Supplement Card Boston,. MA 02116 GL SOUTHERN NEW EIJGLANOININDOW S LLC. RENEWAL BY ANDEEi50lJ F 2, BRIAN DENNISON '�.s 26 ALBION RD t :C' • LINCOLN,RI 02865 L116d Not valid without e • The Commonwealth of Massachusetts 1,4 F.?—fz_ Deparinrent of industrial Accidents `(`_ :- ;_1 1 Con• gress Street. Suite 700 • w `JBoston, MA 02714-2017 wlvw.massgov/ala t of leers' Compensation insurance Affidavit:iiuiiders/Contractors/EIecnicians/Plumbers. TO BE FILED WITH THE PER.eliT [NO AUTHORITY. applicant Information Please Print Le,ibiv Name ;BusinessiOraanization;individual): Ltd td Ae r l v ' -.ft.) ✓ 36/ iUI l tU 4:i..)AD ID �l f i.,; .) 5 0 r C i l�ti S i3 (Zip: �i'�-t l-' �.� ;� T�k -��- Pore - �� - L/ Are you an employer'Check the appropriate box: • Type of project((required): ' i am a--inn with w�J'amthopers!lull and/or par-ihnej. etv construction i-1 2.1!sin a sdle proprietor or par ership and have no employees„orkir.g-far ine in S. El R emodelinc any capacity.[No worker-come.insurance required I 9. L-i Demolition I ;.1!I am a homeowner aoaia all mirk myself.i�lo:vor 'G'camp.insurance restored.]' 1 10 ❑Buildins addition ' am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that oil contractors either hove workers'compensation irsurarce or arc sot-. 1 1.El Electrical repairs or aaodittors I proprietors with no employees. P 12.0P1L*mb1ng repairs or audIt:OnS li ".Li am a genia contracor a i l nds have hired the sub-contractors th ctors listed on e at-oohed sheet 1�.E ROOT-repairs These suo-cons actors have emplcvees and have workers'comp.insurance." I p(i Other W/�i3O W5 1 6.0 Dr::are a eomoration and ie;officers have.e ereised their HEM.of exemption per?v(t:.c. ` __ 1r1j,and we have no enl.ay_a.[No workers'_o!tp_insurancerequired." • i ''-°r applicant that checks box=l must also'rill out the section bolo,.showing their workers'coinpensation 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 additionai sheer showing the name of the sub-conractors and state whether or not those entities have employees. lithe sub-contractors have einploy ..they must provide their workers'comp.policy number. ii 1 tun an employer rhet is providing workers'compensation instira,zce for lily employees. Below is the policy and lob site- . r '�'Ol'117aI±On__ i surance Company Name: '_ ;iJ ;l.7 /l! 7?_ IA./-eS f jZ U i‘iJ . (10 . - c; ;� ] • f r l Policy=or Self-ins.Lic.=: q.),',�j 4. 1.3 0 'S 1 Expiration Date- 7 i i /1 77 3eb Site Address: /-/O/D #11Z G/ City/State/Zip 6: t !/t J PlAilf Attach a copy of the ,vorke;s1 compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MCIL c. 152,§25A is.a criminal :'iolation-punishable by a fine up to S1,500-00 and'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S25 0-00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverane verification. �'t f do hereby cer tndsr the phi zs and penalties of perjury that the information provided ab .e is triteT'7 lad correct. Ciunature. Date: / ZI%p Phone : 0 f Zif — 7 f Official use.only. Do not write in this area, to be completed by city or torn official. 11 • 1 C ice:or Town: I . Permit/License= i issuing Authority(circle one): I_ Board of Health 2.Building Department 3.Ci y:Town Clerk 4.Electrical Inspector 5.Plumbing Inspector o_Other • Iff Contact erson: Phone=: 1` • .-----"1 SOUTNEW-01 CZOLLINGER ACORU' DATE(M ONY'!Y) `� CERTIFICATE. OF LIABILITY INSURANCE_ 6129/2016 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 BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE.ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE:OR.PRODUCER,AND THECERTIFICATE HOLDER. IMPORTANT: If the.certificate holder is an ADDITIONAL INSURED,the policy(ies)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 endorsement(s). • CONTACT PRODUCER 821 17th St CoBiz Insurance,Inc.-CO PHONEO.No.E:H:(303)988,0446 (ac,No):(303)988-0804 Denver,CO 80202 a DRESS CoBizinsurance@cobainsurance.corn INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Western Insurance Company 10804 INSURED INSURER B: ' Southern New England Windows LLC INSURER C: DIBIA Renewal by Andersen INSURER D: 26 Albion Road I Lincoln,RI 02865 INSURER.E: INSURER:F: I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED-ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING.ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER'DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN;THE INSURANCE AFFORDED.BY THE.POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDrONS OF SUCH POLICIES:LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LsR POUCY EFF •POLICY EXP ADDL SUBR POLICY NUMBER (MMIDDIYYYY) (MWDD►YYYY)I ' LIMITS TR TYPE OF INSURANCE INSD'WUD A i X COMMERCIAL GENERAL LIABILITY 1,000 000 j I EACH OCCURRENCE j$ ,. CPA3136080 107/01/2016 07/01/2017 PREMI EIOREMED i$ 100,000 CLAIMSMADE � X OCCUR i PREMISES(Ea ocamence) MED EXP(My one person) S 10,000 I PERSONAL P.ADV INJURY $ 1,000,000 I I GEN•L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE I$ 2,000,000 2,000,000 PRODUCTS-COMP/OP AGG $X POLICY JE a LOC i OTHER: I EMPLOYEE BENEFI I$ 2;000,000 COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY ` •(Ea accident). CPA3136080 . 07101/2016 07I011201 T _BODILY INJURY(Per person)_..1.$__ .- A �X ANY AUTO _ . ALL OWNED SCHEDULED I I BODILY INJURY(Per accident)I$ AUTOS I PROPERTY DAMAGE !$ i—I AUTOS ED i ' i I(Per accident) I $ HIRED AUTOS AUTOS EACH OCCURRENCE $ 5,000,000 XUMBRELLA LIAR � X •OCCUR A EXCESS UAB II— CLAIMS-MADE CPA3136080 07/01/2016 07/01/2017 AGGREGATE $ Aggregate $ 5;000,000 OED I X I RETENTION$ 0 • WORKERS COMPENSATION I PER STATUTE I 1 OTH 0T ER AND EMPLOYERS'LABILITY WCA3136081 OTlOt/2016 07I01l201T EL EACH ACCIDENT s 1,OOQ000 A ANY PROPRIETOR/PARTNER/EXECUTIVE [ /N N/A 1,000,000 (MandatoryIn OFFICER/MEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE S (Mandaroryin NH) 1 000,000 M yes• IPTIOe tOrder EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks maybe emas Schedule, attached ti i space Ie rerod ed) CERTIFICATE.HOLDER CANCELLATION SHOULD•ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE- EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE _—.. - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -� Z(�I3 b �� ) I' Maps` Parcel Application # Health Division Date Issued 7 27"6-- �� Conservation Division Application Fee 50_ CO Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 427/Z /' aof c / ( (pA) Village 1L J P 07 4 a (A /_ Owner D O PEE /A tl O / dC Address Off 0.3 aernim au l Telephone 7 7 7 9$ ' p? 7,-. / Permit Request Tj / l'7 // K"3P (INGC e,/dacC b&i7 ins/-c 1/ s " My e_4 ,,7rJ eau / cg/l /o �`/7,f7/ / V la7`-)`o{7 Ok-el S /r) t&/Ye R 6471 . Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District ���� Flood Plain Groundwater Overlay Project Valuation2aY'`J;8(J Construction Type Lot Size Grandfathered: U Yes U No If yes, attach supporting documentation. Dwelling Type: Single Family U Two Family ❑ Multi-Family (# units) Age of Existing Structure /y9 7 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) 7-0 Basement Unfinished Area (sq.ft) /DSY Number of Baths: Full: existing -- new Half: existing , new Number of Bedrooms:-) existing _new Total Room Count (not including baths): existing 7 new First Floor Room Count Heat Type and Fuel: Ias ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes Er Jo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: U existing ❑ new size Barn: U existing 0 news size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other. r Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ x I =L Commercial ❑Yes U No If yes, site plan review# Current Use Proposed Use ,:,f -' APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /Cf ' C 21� ) (,(f PQ _. Telephone Number �0 7 70 —Wit Address 4 4 1 ! 9 I AJ UItJL /"�C�License # C V&2 9U L (/rL,� (/ ti ) o��� Home Improvement Contractor# / 7 Emaila( Vf»/ d7(0 /7/2Pi �,B �kr) Worker's Compensation e -6 5b 7. /��/1!`l A LL STRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO / /aw [pra/ SIGNATURE DATE 1//&7/5--- 1 r. FOR OFFICIAL USE ONLY 'APPLICATION# DATE ISSUED M�4P/PARCEL NO. f t ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH• FINAL FINAL BUILDING DATE CLOSED OUT ASSQ_CIATION PLAN NO. . .i ..; .• . , . . , ) Town. of Barnstable . .. Regulatory Services ft santaranarc Richard V.Scan,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,' MA.02601 www.town.barnstableanams Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section ILIJ.._ 13 ,. Ali3 "Mgr (.4 L 1)frifC1( ,as°Mier of the.subiect Property kJhe-retTautholize Tu f edIAe -/41/\..10 act on raybehalf, in Amours relative to work authorized by this building permit application for: if 0/0 P"Vi-A/dr: Ct4P'AfiutfakAt4 (Address tif JO* Pool fences anti alarms are the respausiailityof the aipliamt. Pools are norto be filed or ualited-before fence iS installed and all final • inspections performed and accepted. _ _ _ _ Signature - Signature- • - — — • D a A6444 ti-,774,k --6-4.4.(..4 cd)074,A__Pint Name -Pnnt Name COORMS:OWNERPERMISSONFOOLS _. .._ __. 1 "� �RTiFICA' E' OF` LIp fLItY}1 °A'E'A""O°'"^", } r�lulATloN:oNLv a i�SURANCE �ola9/�o4. t. THIS CERTIFICATE-IS ISSUED AS'A MAtlER'OF INFO ND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER;THIS CERTIFICATE DOES NOT.•AFFIRMATIVELY OR NEGATIVELY AMEND.;EXTEND OR UTERINE COVERAGE,,AFFORDED-BY THE POLICI 'SELOW;',THIS CEi TIFICATE OP INSURANCE O0E9.,'NOT CONSTITUTE A',CONTRACT BETWEEN THE ISSUING;INSURERS), AUTWORIZEP REPRESENTATIVE OR-PRODUCER;AND THE CERTIFICATE HOLDER. imPONTANT:J1 0.to eorHf rode holder I!an A DI 0 LANS ,th®poI oy(Ini must be en er! .11.8U ROGATION f9 WAIVED;oubj+ect to the terms And conditions of;the 0011eV;certelnpolteies;mmj require en endorsement A t ment.on<tis be►titicate doss not:confer.rights to.the .04,11f eatw'heiiter initouof such ondoraomen A - _ _= t?RA6UCOR- �1 �,ei�1 E�.$9iiCd _ Stfut saat ri ' sulr icc Agatntiy• ' ii°.itl todii )SOS)04, GDi1, ,Nil::use9)090414 . 439 E .to; Rd tT1J9i3ectasu. ta�rrLna:tem p.O. 3*x 7g39D _ t4 ! ee60 N . INOrtY'par outl . 1d4 ., 2747 N ro1 ; 4l : *'*.644� -0 N Wfia ... 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LLw - v..�._. e fi � t . p y• _ 10171 gk1Mc 14104.p �imootreihrookfookoetito 1 -NIAi , to ( a_ I iiii iit IV!I •,C- — - , '10/5/4014 10/41,/40t5- :p i. pip— o I:,' E i t- i 01 , Intlr;1ilf4itfNI tit iitrgrJhlieidAi4UCeili1i►i0l Uhl U�1;1€!itili9P.NAtat1Ni;'ltlirAiifitilEilai,FtiriiNWtdaiifltiduifUYihlNWsai0i?ii ilk RiltiiSlt��) • • �^€�:r +'°�,, � writti°wear ..:,--_• , otf_dIPiek i�i0LNRR __OA q tIiIDULD ANY OF MO ABOVE OEICWIREb POLI0{00 DE nANOELN.@d N0130gR INN EXPIRATION OAT 7H514E0k, NDYtCd WILL. .Ng .051.11044t0 IN . t# '£3i3I �'TOZ� � N AC3 DRtiANt WITH?At tit3LIL'v•HNitiVlbIt�1iN, • - tOtittlEt t 3 'R 31'C'',L'xdm di) Ltd 546 A tivortm dR Tt ik .AU111p{iiig..0 PRE;ENTATIVE , totbt h litut mit 02673 • • i1C©RU Zli(Z090i05) ...v.�_..,,—.- ti 10884610 A eitii COFIPOI LTION, AM-irNNhtt tot§tai id:' 11062ti r iiiMAiit - this amen iiriwta anti 1MA 6r8 ittiHiniiiSigsfi 0w644en fiats At`etn i si The Commonwealth of Massachusetts Department of Industrial Accidents �rj ®141 Office of Investigations ti. =^ 600 Washington Street • —.:;, Boston MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. . Applicant Information Please Print Legibly Name(PusinessWOrganization/individual): Tupper Construct ion Co LLC Address: 546A Higgins Crowell Rd City/Mate/Zip: West Yarmouth, MA 02673 Phone#: 508-778-0111 Are you an employer?Check the appropriate box: Type of project(required): i.Cf l am a employer.with 4. El l am a general contractor and 1 6. ( New construction employees(full and/or part-time).* have hired the sub-contractors 2.[].1 am a sole.proprietor or partner- listed on the attached sheet. t 7. ®Remodeling ship and have no emploYees These sub-contractors have 8: :[] Demolition working for mein any capacity, workers'comp.insurance' 9. f:Building addition [No workers'comp:insurance. 5. [l We area corporation and is required,] officers have exercised th it MU Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per M L 11.0 Plumbing repairs or additions myself[No workers'comp. c. 152, §1(4),and we hav I no 12.0 Roof repairs insurance required.]t employees, [No workers' comp. insurance required,, 13.( chhervveatherizetion 'Arty 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 subwontraetors and their workers'comp.policy information. I am an employer that is providing workers'compensation Murano for my employees. Below is the policy and job she in iirmation. Insurance Company Nate: AEIC Policy#or Self ins.Lie.#: WCC 50055 93 0,1,2,01.411_.._.. ..,.,... Expiration Date: 10/3/15 Job Site Address: 4010.Main. St City/State/Zip:Cummaquid MA:02637 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 ofMCL,e. 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 wider the pains>ti ti'penalties of perjury that the information provided above it true and correct. r _ Signature: ,.. _ 7/16/15 j - _ _.mate;_ Phone..#:...:(508) 778 0111 Official use only. Do not write to this area,to be completed rrpleted by city or town official City or Town:- Pernit/License# Issuing Authority(circle one): 1,Board of Health 2.Building Department 3.CIty/Town Clerk 4.Electrical Inspector S.Plumbing Inspector b:Other Contact Person: � ..� - Phone#: . e • &if tf, 0A 1 it Office of Consumer Affairs f :d� 111088:Regulation '' =;r 10 Park Plata . Suite 5170 .BOSton,MdB8achosetis 02116 Home Improvement Contractor l eg1 tr t on RO01§tfatiipOO i17��Mg4• 5 -• - . ., � Ty LW - : • • Ennifillont i9 W2918 try 29'1979 •TU �EI C+ NTCT1N , Im RI HARic TUP R . 708MICNr I=Ibf , • utithiteAddhi§§mid rennin earth. aen nation to ehel:ang atn-iiatf rj Addf eal• 0 ttttttdwtil I i ntpleyttif tit �� ,aat Card .,.,A, . op wiiillopoofirosfytapdaoastmem afet eft-ammo tfltiPs&fltt§lntst to aletiau Lieeflge.er eegi§tratieli valid far htdividui uae only 'tif = �l>n If�pi;l�ll i iJ1 h1Yt 1 � ileloee the effiti ,.data 1f bind HUH H tat edistmtlfiet 1fltk 'Aim Office of q ffaii^s and'hight ti§Regulation ttttiratitata 4ifif O1t1 LLB 10 Par "'`°to d l�u' st5d � �, 1ltArl�t' TUPPE 661181 Llet1 �l.00i lid, RICkAkib TUtiOfri 9 8 Miti45881.1Il • VV,VAI1Mbtl1Wt MA 0261S ' undet ebratet Y ,r.thout signature %s. i agtOlief46tta g i Opaitfneftt e,t 13u13110 6ataty ;BUILDING:PERFORMANCE INW`tITUTlt, IN . .• 88afd of buildiije lognlatif nft and 8lond.ord§ 197 HfteftfOfa pftaO,.btiltft 2.19 t'nttttruttlfrn titper 1 or mono,NV it®pii a'a . L 16efign' 077)gYd71274 4. _ANC t)''''sa. .."; ', WWW♦Ipi�atg . .tY. , �y,'N , .'. ,c*J4 Nip l itttlttttwi§'l�ti�lt�Ws v � �, ���� +r, r'� Wen`ifirtg6tlttt AlA � � aw 6�'"p 4 i Ri�hC � r• 0 'rsd 4..•pt � y, ' t,VA. 4$ '"" Go Ieation bafnmtssioner 1 112018 ''fix°n '' E ts��� €��si� f n€�dtfar�aia ne tat ��, =a • Uniestei d-Burr of any use lotto which 6%611in icss Sinn 35,000 cubic tint(99110 nt etkom PatirtaglaNst frtSiaNAil6N_ __ListEiilI rIaM dAf cnic)oe d-esp1ace;- : Buii ig Astelstt Pit t`eg�lanul 5i"iir eli- • ailure to possess a cutisent edition of the Massachusetts . state Building Cade Is cause for revocation of this Ditto, For Des itcensirig tnfotrttation visits www.Matt:00/01)8 , , • ;, BUILDING PERFORMANCE INSTITUTE; INC • 2815 07:05a Tupper Com / i - 15087785010 p.1 TlJPPER CONSTRUCTION CO.LLC' 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 WAlA W.TUPPEF1CP.CE]M Date: 27 d/ / Town of Barnstable Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application # fie)/. . o 51s Issued on 77. 745' has been inspected by a certified Building Performance Institute(BPI) inspector. All work performed me; is or exceeds Federal and State requirements. g ) m--- /77/ Sincerely, 0/0 /'Y) i r1 Richard Tupper License # CS-69058 I4 r— ,s • • • �oF �� Town of Barnstable 16��(`{�; *Permit# �►y�f' Regulatory Services t��ires6mont/rs om issue date � . . BARNSTAB E Fee • 1639. ,$$ Thomas F. Geiler Director r ira'- d)473 We Building g Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 _ • www.town.bamstable.ma.us Office: 508-862-4038 Fax: EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 508 790-6230 2 Q Not Valid without Red X--Press Imprint Map/parcel Number 336 .bs Q Property Address qolo vot $, . , • , CO [Xesidential Value of Work 4000 Minimum fee of S35.00 for work under S6001).00 Owner's Name&Address boAJMlp d Li t4L1( /P,:tiquo Contractor's Name ?ee k cm tlx Telephone Number 5-6 ge j Z- S 12 Home Improvement Contractor License#(if applicable) ISO 9'S0 • Construction Supervisor's License#(if applicable) siq 476, ����" r��.�... a Wit: ❑Workman's Compensation Insurance • • Ch ck one: U IN 6 .I ( I am a sole proprietor ❑ I am the Homeowner • TOWN OF BARNS T ABLE . 1 ❑ I have Worker's Compensation Insurance I Insurance Company Name s Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. • Permit Request(check box) • ❑ Re roof(stripping old shingles) All construction debris will be taken to ❑R -roof(not stripping. Going over existing layers of roof) DiRe-si-cle\K.J\iA(., 9_, .\0%,\I"--\-D_ ttkAktiL , 0- IL. 60cora_. . #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows • *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 re uired. IGNATURE :\WPFILEs\FORMSIbuildina nerrni'f r,,,�irvnnrcc.7.... ^t k fN The Commonwealth of Massachusetts E n 1 I Department of Industrial Accidents t 4., , ; - Office of Investigations i ;ir"ia i ;l41: 600 Washington Street �` j ' Boston, MA 02111 r s' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �-e�eik J. ,c®Yl ;1-4 Address: 37,0)c ilia(() t /kt Cici City/State/Zip: CJ✓ 1 (J1'Q` (1I O..(437 Phone #: So $ . 3C 2. - c—pg Are you an employer?Check the appropriate box: Type of project(required): 1. ❑ I am a employer with 4. [1,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. t 7 ❑ 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 corporation and its required.] officers have exercised their MD Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs . insurance required.] t employees. [No workers' 13.fit Other RPSl,f �t't1 comp. insurance required.] *Any applicant that checks box III 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. tContractors 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. 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 hereby c6.__ ' under the pains and,penalties of perjury that the information provided above is true and correct. Signature: Date: 6 1 it . .. Phone#: SO'? 3C2 ` J 5 O O 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 I M . V. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the servic- of another under any contract of hire, express or imp led, oral or written." An employer is d- ed as "an individual,partnership, association, corpor. ion or other legal entity, or any two or more of the foregoing en_<ged in a joint enterprise, and including the legal re. esentatives of a deceased employer, or the receiver or trustee of individual,partnership,association or other let-1 entity, employing employees. However the owner of a dwelling ho se having not more than three apartments an who resides therein, or the occupant of the dwelling house of anoth who employs persons to do maintenanc:, construction or repair work on such dwelling house or on the grounds or buil.' g appurtenant thereto shall not beca .e of such employment be deemed to be an employer." MGL chapter 152, §25C(6) :iso states that"every state or to al licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or,to construct buildings in the commonwealth for any applicant who has not produ -d acceptable evidence o compliance with the insurance coverage required." Additionally,MGL chapter.152, :,25C(7)states"Neither is commonwealth nor any of its political subdivisions shall enter into any contract for the pe ':.rmance of public w. k until acceptable evidence of compliance with the insurance requirements of this chapter have b=,-n presented to th, contracting authority." Applicants Please fill out the workers' compensation .ffida/t completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s', ado ess(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LL ,or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry\ orkers' compensation insurance. If an LLC or LLP does have employees,a policy isTequired. Be advised,i a this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance co Brag: Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the ap.,ication or the permit or license is being requested, not the Department of Industrial Accidents. Should you have questio regarding the law or if you are required to obtain a workers' compensation policy,please call the De utrnent at r,.- number listed below. Self-insured companies should enter their self-insurance license number on the ap ropriate line. - City or Town Officials Please be sure that the affidavit is co plete and printed le_Ily. The Department has provided a space at the bottom of the affidavit for you to fill out in a event the Office of 1 Ivestigations has to contact you regarding the applicant. Please be sure to fill in the permi cense number which will e used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any gi -n year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" ,e applicant should write"all locations in (city or town)."A copy of the affidavit at has been officially stamped or arked by the city or town may be provided to the applicant as proof that a valid at davit is on file for future permits . licenses. A new affidavit must be filled out each year. Where a home owner orpitizen is obtaining a license or permit t related to any business or commercial venture (i.e. a dog license or permit to/burn leaves etc.)said person is NOT requ' ed to complete this affidavit. The Office of Investigations/vould like to thank you in advance for your co eration and should you have any questions, • please do not hesitate to give us a call. - The Department's address,tEelephone and fax number: . , {, The Commonwealth 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 1-1 . Fax # 617-727-7749 II co,zi-tE T Town of Barnstable 's;. Regulatory Services • • $ Thomas F. Geiler,Director • =639- �m Building Division Tom Perry, Building Commissioner • 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862 '1038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder • I, Donaid , as Owner of the subject property hereby authorize I4r c.i44, to act on my behalf, in all matters relative to work authorized by this building permit application for: 4/0% main/ S'7 ll&T CGIrukvt t i,L • (Address of Job) • - I da-/eA„, Signature of Date Print Na MP =' • • If Property Owner is applying for permit please complete. the Homeowners License Exemption Fo1ii! on :the reverse side. a IL! F., • Town of Barnstable Q Og THE rp• �y Ls'' ,wss, Regulatory Services a lRrisust� Thomas F. Geller, Director / - • " i� Building Division -- ab39-D MAC Tom Perry, Building Commissioner ' - 200 Main.Sfreet,_FIy?nnis,MA 02601 vs-ww.to wn_b arnsta b 1 e_ma_us Office: 508-862-4038 Fax: 508-790-6230 • • HOMEOWNER LICENSE EXE t ON • Please Print DATE: - 1 JOB LOCATION: - number street village "HOMEOWNER": name • horn phone - work phone# CURRENT MAILING ADDRESS: - cityhown state zip code ` The current exemption for"homeowners"was extend . to in,lude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire • does not possess a license, provided.thst the owner acts as supervisor. .. • - DEFINITION OF':'OMEOWi'11'ER . Personfs)who owns a parcel of land on which he/she resi• s intends,,to'reside•on which.there is, or is intended to' be, a one or two-family dwelling, attached or detached s• ;ctur : accessory to such use and/or farm structures. A person who constructs more than One home in a two-year .eriod s',. not be considered a homeowner, Such "homeowner"shall submit to the Building Official on a corm acccp:.hie to the Building Official, that he/she shall be 1 responsible for all such work performed under the buildrtg permit. ection 109.1.1) The undersigned "homeowner"assumes responsibility or compliance t •i the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that•be/she,ynderstantis the Town of amstable Building Department _ minimum inspection procedures and requirements d that he/she will comply ',•+'th said procedures and �.,,requirements. N s • r . Signature of Homeowner Approval of Building-Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be,required\to comply with.the State Builrlitng Codc Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION • .The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section,(Section 109.].1 -Licensing of construction Supervisors);provided that if the homeowner engages a person() for hire to do such work,that such Homeowner shall act as supervisor." \ }rfany homeowners who use this exemption arc unaware that they are assuming the responsibilities of a super-visor(se Appendix Q, Rules&Reg-Watkins for Licensing Construction Supervisors,Section 2.15) This lack of awareness Often results in serious problems,particularly - when the homeowner hires unlicensed persons- In this case,our Board cannot proceed against the unlicensed person as it would with i licensed Supervisor. The horircowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, . that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a,form currently used by several ou ma care t amend and adopt such a form/certification for use in your connnunity. towns. Y Y ICI tssachusetts Department of Public S.itets Board of Bui!dingRegulations and Standards ConstFuctbn Supervisor Specialty License License: CS SL 99486, 1k`°',; Restricted to: RF,VVS t t• , PETER SMITH 3925 MAIN STREET ,' CUMMAQUID, MA 02637 .+'' 3 Expiration: 11/1/2011 (' 'ssil ner Tr#: 99486 ✓1e a/./�aaaacki� tetia Office of Consumer Affairs&Business Regulation License or registration valid for individul use only P - before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR p Registration -5, 150950 Type ! Office of Consumer Affairs and Business Regulation 1_1— Expiration:' 5/8/2012 DBA` 10 Park Plaza-Suite 5170 ,� x Boston,MA 02116. PE ER J.SMITH(-I¢ME ItVIPROVEMENT I PETER SMITH ‘ V—et - 2 3925 MAIN ST. r 1 ��orlr— ,63_,p4C4/444"\- CUMMAOUID, MA 02637.a_-e: ; Undersecretary Not v. ithout signature i r Assessor's offioe (1st floor): / G 4 THET Assessor's-map-and lot number �3�7 "� De-a 'h -`�." $`}NTEM UST Q 0, off♦ ,. I, ..-LiED 9N ;,-,. as. .: el -Board of Health (3rd floor):, COMPLI P :, Sewage Permit number—��� wiTH TITLE 5 99d3T..DLE. ; v Engineering Department (3rd floor): D -yam j(i "..:` �..:,� �. IRONMENTAL CODE ‘e�� House number ��� TOWN RE E ' - 1 . REGULATIONS APPLICATIONS PROCESSED 8:30-9:30 'A.M. and 1:00-2:00' P.M. only. OF .BAR T B TOWN NS A LE BUILDING INSPECTOR a--sr4y . . APPLICATION FOR PERMIT TO e0A* uC"T S/,u44 E FAir'/gt/ /.)yELL04 TYPE OF CONSTRUCTION 2-X6 WOOL) reeimg. /70,e61/ a2 3 19.87 TO THE INSPECTOR OF BUILDINGS: 1 The undersigned hereby applies for a permit according to the following information: /�1/T/�1/° Sr/S7�A%y 2 //VT/�0®4b L°G/r/ ,t14//A /1A Location ..,..0.QT........2..� i i Proposed Use (?FS/AE/L77AG .3//liaL4E 74+4!79/Ly" Zoning District Fire District eN164r6 Name of Owner .e°2Q 4, W�.',,ee Z4 Address 42- 44/7 4'7 ZM//e, el/7074 /1 Name of Builder iqV/ .....<..f��., . aeg Address RD, AdX g// ,1,1-0/ji/!i/S, Name of Architect 1P� 7647 6 Address ,!eri 13.1:›A 613-1 i 'e / 15Y-E Number of Rooms 7 Foundation S''?Ov/?Eb CO/lifek/& Exterior 4' ► :cm 4")Sry/,tf ES , Roofing C6 O7E.1` F/,BF.P641CSWL"fi/T 2.4L Floors 01)1j Interior 1/71(64/s 774eavaioncr, 5 ai/,eecaAc e Heating /9/41//6/45 Plumbing 2 1/2- 447?/ r.. . Fireplace 2011 1 ///v06,eo 1. 1 FW/dy Approximate Cost 00i ODO , Definitive Plan Approved by Planning Board 19 Area / �o APPRo'uigC.Alai,eea'D ) Si&NEZ) S/S/7S— ;. / Diagram of Lot and Building with Dimensions a Fee .../.�j..l. . SU JTO APPROL OFOARD OF - go2, -; i.; ,0,0O25t vcii v.; �)30-Tr, 161T� r. 18 �4 to___.4.,,, ,;: .. 14,.{ 0*- S � 14 1+ 1 I6/../g A/i i STeEET (, Tom'6A ' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. /.' �, ' Construction Supervisor's License •- . ' . . Parrella, David A. ..,.7 . - .... . --.2 i ... . . ..L , 30724 two story . .- —I '''.,<,'• . -• 0 Na i Permit for -1. -4). ..,... % . _ .4 single family dwelling .. el .44 .. -e,-- . ....., • •;:.. .. . , • _ •,.....,... 11. ..'t .. . , ..9 • . rf .'; . . . ...- 4010 Main Street ..1 • 3 Location,... e • C- ,.., ., • "•,. i..i• 3.. ' *,. !t •1 ..t.-+ . •Cummaquid ) 1I..• - ,,,.- - --• -, '.;-, ,,.-- ---' .1. . '.-_-• . •.• .-- Gr. "0" + ei ... P i . David A. Parrella 1 c . 15 -4, 1,,- , "3. • • , ' Owner ,- .., (--, _,„,.......-..41 -•-•--: ... ' - ,.• • -." _4. .. ---, . .---- i frame • ,•, .1 ...'r, I . , ...."rn. ...,''''''. , Type of Construction -zi•-• to.'" ,,, . _ ....-1 •-, ..." ^ t.•/' ',„.......7,-----4 „-- ,- • , .--, i ,,,•07 . ---,,,, --; • ' r i 4.. : .#.• 41. ,%., •-- ....., • , ' 's?' 0""' te=., =•,,, t - ':-... . -.- , f,',# ...".. +.''',. .." 1.- ...; . ._.. _ . ..-----...,C.".^.rn i 1 '. .1..., 7 '. ` ' 41 .._ _....-- ,- 1 .41; ,.., 1. "4 ocelp 4 #32 i'' i':" 4 , '... .."‘` ... Plot - Lot ,--' `-"," .-.. ... ••• ---- , , ,:, i.. ..., ..).-. I t ...... ..1 ,.„- ,<•".„, ; .•••••• i ! I . • , --.-? Y' 4-,-. •-- ...- , fr* ..o.'. i 4 1/4, 1 V .---', < 7s . ..-- ., —OM. --sic-- • . Permit Granted May 11 .' 19 87 ,......- / -,, . ' -7.7..xr--1 - , • / 4 .., t • 3-''' _.., . ,,,.1 I 4•J . _ • - .." '- Date of Inspection .1... -19 "." ,- .-.•-•-• , i 1 . &• E?S--- ?)'-- .-' - i1i . . . (.‘ r 1.....-:..Date Completed . - / t- .. - ,.....gm........-4 4.0-.i.....7„. __..... .19 . .. 6 • : i,- 0 1,7 .0" , - . ,,,, 1 .:, • +N.-i , to '''''''''''''''"-.I"-....".."'" -1 ' 1 '. :Ae ..„.... r't -.1, •-• 7- • ,-e' . , 4.4 -;‘ :',..",,....-. :<I . . . ., .., , ,., t - -, . L .,,.., ..f • -%; 0''' 0 C., ....T. /1 ,1) A .- C. .4 y , 4'. r ,E?, -• .......... *t L- 4.- r, -4 -r..1 , I ...,--- . . A, /' - ../ / ..,.: ., ..,- . , t \ 1 it ..- • ,• 7 • ..- ti6J . .... .... 1 '•..,1 r: oe %., 0', e. 5 15 i• e ....0- . % . .... ., g"' ::-.• w' .- ..- ‘.... -A 1:. cc en ...- -, .....:- ,.., 7'? • t % .... . ; . .., .. ...,..- -.,,t:., . . . I .. - ill k" / •1.,: Ne . . ..; if `';., It' I .......„........ _ \ • .A.. t i I ..`r.1 .." •'.. ,,.. 1 ..ft ,./ - <,, LA .„. ,,,i,• ‘'''. - .. . - ' e*. 1 _...... ,,..„.„ . r ,,. . ...,.. , ,. 4` . . •n . 1 ....1 -. />... ..: 'e...6 ,...5 . # ..*/) .....' -• i • #. 5- „... .1. .4 ^' 1 i _/•z i4- .. P". .-, F'• , . . i 1,) r) ' I Ft •4'...4 1^, ,.. '''' t,) " ,.. '''', .ff.' f,>-.‹. . .. ' ..; 4 1.. r`,..• 'I::, - "" - •f ,. • -,.. • . . . v ‘... • - - f, • 44', " -:" -, . , . et ..... ,r' A : A .. . - eN 4,f '' 1.. e.: •. . . -: ••,?.' -., :. ..,... , , . . ,. ;;;- ,..., •.-..,. .. -: -,, V.• '''-' '-c: • . .,. . 1'4.. ...),.. .! _. . . / ,, ...", ,, .7 „. ".. • . . , .- , .. A ' o�tNE TOWN OF BARNSTABLE Permit No. 30724 BUILDING DEPARTMENT imam TOWN OFFICE BUILDING Cash o ��°�r r HYANNIS,MASS.02601 Bond X,/ il CERTIFICATE OF USE AND OCCUPANCY Issued to David A, Par'.ro.11a. Address 4010 1,47i i n Sirr���t USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. a/AilfhiA, September 3, 19 87 Building Inspector °: TOWN OF BARNSTABLE ` . BUILDING DEPARTMENT t IMOSTABL ' TOWN OFFICE BUILDING YYl jb 039. Or HYANNIS, MASS. 02601 MEMO TO: Town Clerk . FROM: Building Department DATE: 4 / 1%. 3// An Occupancy Permit has beenissued for>-;the building authorized by Building Permits$# Sa176;21} issued to f // r ; Please release the performance bond. .r' .,^tom'. c s a rt..:. .. TOWN OF BARNSTABLE, MASSACHUSETTS BUIL i G v} PERMIT A-3:36—O88 11�,� DATE 19 u� PERMIT N Y., 30724 APPLICANT Wile.r • T.UDRESS 040300 • (NO.) t (STREET) (CONTR'S LICENSE) PERMIT TO Build dwes.LJ,i,i. _ ,;L'� . .Gaily dwt,'L�..Lm NUMBER OF 1 ( 1 S1OIt'+_ DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) ZONING AT (LOCATION) lei. �'` •i....... C. ('.J..'t.;:.C...... DISTRICT RF (NO.) IS II,I-I.:1 BETWEEN AND (CROSS STREET) (CROSS STREET) LOT i SUBDIVISION LOT BLOCK SIZE 'BUILDING IS TO BE FT. WIDE BY F I. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: • BOND AREA OR 156(; (i• 1.�. 1.0 :):_, PERMIT I VOLUME . ESTIMATED COST s FEE `4t '�� (CUBIC/SQUARE FEET) - - t David A. 1 L 1 t t .h ,; OWNER .� x' BUILDING DEPT. ` r! ADDRESS .klL �b l v+;t JL Lq .:f:Jt:: .' ,:4 t1G (Jllt''.3,liit:: ./f-.CVt t ,.) ------ .,,., �i -•; ITHIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY SIRES"I ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR ' .PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPE..I r -V- SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY OR<ADIr.SAS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSU ANC: HF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE - CALL APPROVED PLAh;S I,1UST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POST BD t.�rITIL FINAL INSPECTION HAS BEEN ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CI_.RTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERSIREADY TO LATH).3. FINAL INSECTION BEFORE FINAL INSPECTION h-i A.S BEEN MADE. OCCUPANCY. POST THIS CARD SC IT IS VISIBLE FROM STREET , BUILDING NSPECTION APPROVALS �/ PLLt 1,,it9'it^_;PE:CTION APPROVALS ELECTRICAL INSPECTION APPROVALS ly--- 0 1 fp:.::', /;• • " ZiX C cPP- 1 iri//1(79 r ),...„/ 2 z 2 2 3 l�t __'WW ,,,r-LCIIur•I APPROVAL S j ENGINEERING DEPARTMENT •9-11..c.i.--/......V.2„„d“.14", OTHER 4 ,6, V. BOARD OF HEALTH ft . 1 PERMIT WILL NULL AND VOID IF CONSTRUCTION WORK SHALL NOT PROCEED UNTIL THE INSPEC- ''`' � INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIOUUS STAGES OF I WORK IS NOT S;,,,, :...•A)i HlH 51,', MON TWS OF DATE THE ARRANGED FOR BY TELEPHONE O0WRITTEN CONSTRUCTION. • PERMIT IS ISSUE,.' H.L I) ASOVE. NOTIFICATION. • > • Iii . 5��.�9 20E 'r . � 472 .t /C'Q 0d 42+ 25" • /00% 'j (I 6'" 6 ' pi t £,y�. di ?•/I :Stone rP® 201 4.I• -- o, i00tuu�,s. 4777 . =427 qt0 CIS/.o . • .e0t I n:CX ontj •1-- ---f/s' • / c, I J . n 1 :-�j�' 49.9 I ScaLe. I"-410 f \ I So • v, bate 3-17-87 N. 0 9R z o'.'ot 2 ' \ '\-1�' Stoney i i \26,083 S9 ' . ,c I 1 0�, Pow t ,a,'t i yu I o ' ', o 4 ;found. ' 1500 i !_I 1 gig , •8 > ' '11 k(r/r,iu.) 1 • 5 13 i ^' I 7 Rd,L Cape £n9.tr1P- n , o L19 l�a/cbo4 road 81 4s�' I waste% m IdyafniA., Ma. 02601 C.'S.i�t i I I nw.teh ,� 50.0 • 31 1 I I -i t° • i , 50.20 161./l I I 1 5/.2 c We --3T'.r de —0 —wail s84-oZ- 40v../ po.Le5a9 3/195 / e.I..L 's.y's.tenc 1• 49.6 route 6 R 401 wide 51.41- ' Sz, • R.I,L ,,,n4v,Ltad Le ma-te2t a.L -La • ?/to f-i,Le No Sca.l e to be tempt)ed 101 around -�'�'� ,e k'C41,4 /s i. p-4t and 2ep.f aced with _. _ 1 S00 GN/.�'•t/ //T. '---� ��" - I/aF 4ei©� Nr • 9 S 9 .�- o .0-r I,. ;,., I-6 /)c 6 l •p4.t r ;: -c v- P I�1, Ui/1 ' ,S.to ne ��91 Tle, is1 I'.,f• it,,,' Al.c i,;. tr.., .j�p� !J oW ep1. I' •/' .ahbarl;e cl.i4- t'zo • ' go-tat eat. ?•Cow 330 gpcl • .('eack.n9 area. 201 's.¢ Sketch /).Can og land in. ga't'i tab.Le, (Curt tu1.d)Na, Pe,letue tt 20I a? 904 auuL R. pahice l ta. Capac 427 c/pd lae ne'. .Lot 2 as 'shown on. a plan. 4ecWLed in t'a tni,tab.Le t 4L. t 4 Lilt. 294 pry. 60. • &Leuat iona. 'shown ate on. an a i.tus.ed datum. Sate: i .en t: 7a rmztal ze i o—aitZ o? T ec2,tT - `7e4.t p-i t #1)402 3 9h i i. .Cot -i i, not wi,tbt r n the $.Lood hapitd lone.' Made 10-8-8 S , Lt. s. C'onCon 9hefoundation 'shown on this p Ccn •L� Located • No wa-tet encounte .ed • on the v.ourui a's, 'shown he/ceon, and nree vs. the' Pete. gate 2 n0.in. •eh I " a.et-baclz a.ecywi,t nten t,. of the gown of l5'aicn'stabLe. 0.7 49.7 -top & top date 5-9-87 15.9 44•z _ me Ilte1Z , /land to . coar.A.e. 0A Of M . • eN 90•9 , /. 41.t22 1.G1 3y 4 $ i• �J •Fi 44,1 ?. 1�} meri�t'sort a 1 MtLNE } 0 y -and No.32490 a?/.. 6I Z to �ss�oN4c ` 10 .''' ' �; P4' ' marc F•� 37.4 37.z 'I"'fALSH 0 LAW OFFICES OF PHILIP M. BOUDREAU 396 NORTH STREET HYANNIS,MASSAGHUSETTS 02601 (617)775-1085 PHILIP M. BOUDREAU April 10, 1987 PHILIP MICHAEL BOUDREAU MARK H. BOUDREAU Joseph Daluz, Building Inspector Town Hall Main Street Hyannis , MA 02601 RE: Lot 2, Route 6A Cummaquid, MA Dear Mr. Daluz: Please be advised that I have examined the title to the above mentioned Lot 2 , which is more particularly described on a plan of land recorded with Barnstable County Registry of Deeds in Plan Book 294 Page 60. I find that said lot has been held in ownership, separate for all other adjoining lots, since April 11, 1975. If you have any further questions in this regard, please do not hesitate to call this office. Sincerely , ilip Michael Boudreau PMB/hcg