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4181 MAIN STREET
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Building Division Paul Roma,Building Commissioner JUN 12 2017 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us TOWN Off' BARNSTABLE Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - 'RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number .,j Y/ -D 1/-7 Property Address ❑Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1� f o4 Contractor's Name ' Telephone Number o 6 17 c Home Improvement Contractor License#(if applicable) 0 Email: Construction Supervisor's License#(if applicable) y y 6 f �/ ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 4Q-I have Worker's Compensation Insurance Insurance Company Name A!M A4 Workman's Comp.Policy# 4 tv C G o ) d o t Copy of Insurance Compliance Certificate must.accompany each permit. Permit Reque 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) ❑ 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: Q:\WPFILESTORMS\building permit forms\EXPRESS.doc 01/25/17 O 1_ 27w ComwomveaftkofA&s3adrusetts Depmrftffmt c�,�'IndusindAccidads fuse af' mtigat�0'rts 600 WashiMfon,9treet Boston,CIA O2I71 t�rv►�mg�v�riin rWw4wrs' Campensafrnn.In ce Afdzvit BwldersdCo-ntracfiamMectrit-ranslPhmlbers APPHcanITnfw-mafi= Please Prim Naffie�Bus'meanirationfindnal v/ Address ti 3Go o � Y,S r'ire you layer?Checkthe appropriafebo ' Type of project(required)- L am a employer w iz 4. ❑I am a general coairactor and I employees(Rdaat;for paztaime). * ]save luredfhe sub-coal 6. ❑Ne�v mnsfi�cLia4 2.❑•I am a sole psnpsietas orpattaer- listed onthe'attached sheet. I ❑Remodeling ship and have no employees These sub-coafract=bee 9. Q Demalifiion wod-ing fnr.n e-in any capacity. employee's and hire wars' 9. Building addition jldo WP&MM! comp.itisun=e comp.t„surarm el a corpoza egcured I 5. �] re ti r m and its la El,e l repasts er a dditions We a I❑ am a hamemrmer dairsg all v�orlc officers have exercised tlseir 1 L Q Plumbingrepaim or additicm. _ z of erfiou per SGLmyself[No 7 insurance rei � a 152,§I{4k andwe have no l-'- flofrepaus . employees.[No workers' l3-❑other comp.insu mce mquired_] •bay apg&c=tdaccbeftbox#lmar#e]suflloatthesec =beIowsbnsdag@ie-s•woxkeecompeasat; upeTrpiafnm 5ML Tffumeowmemwbosub=itffiris iu theyas&h6'RUwc&and&=himoutsidecaatmC=wmstsabmitanewaffidaidtindicadnemcb. fCaatucforsr�td�ecYihisbmtmtrtattad�edsaaddifi�alsiceeisbomiagthen�eoflhesnb-crs�rlst�ewlsethe;arnott3�nseentitieshsee employees.If the empIoFees,gheY pm-I their-orl—'tmnp.paticymmnbet I arrc all srrtper flea!ispratadrrrg n�orkers'coorpeicsaiiart insrir�es 'or�rc1�cmpTQ}�ees d3eladv is fltepaticF area jQb site hiformaitam , hsatance,Company lee: i AA "Policy-or Self-R&I.ia-4&L �/� fiV C 41 'no / dn. F Job Site Address: ,-J 1T Div/_,'�r CiEvIstdaO = Attach a.copy of the warl:ers'compensationpoRcyydedaration page(shoving the policy number as expiration date). Fadme,to sew coverage as requireduncler Section 25A of MGI.c 15-7 can lead to the imposition of ctiminal penalties of a fine up to$1,50a 0G awVor one-gear impdsoament,as well as ci-*iY penalties m the farm of a STOP WORT ORDER and a foe of up to$250-00 a day against the violator. Be adlised iiraf a cape of this sbhment.mag,be faded to thB Office of Investigations ofthe DIAL far coverage yeifca&m.. -I ri'a Fterezy certify Ariper tkts sand vfger cry fiiattJks ihfarm m�prm rTsd abates i g bars arzd arrrect ;�it�aturer Bate= • Phone I ' OJ%did use wily. Do not wrke in flh area,ter be cmxpfeted by city ar tome o,O`rcbL City or Tows: PernatMicense:ff Issuing-kn0wr€ty(drc one): L Board of ffealth BuilEing Deparfm.•eut I CiLyLTown Clerk 4.Electrical Impector S.Pl unbmg Inspector 6.other Coact Person: phone#: -- — -- 6 L"Z-i�Pa �I IYZ3 VRr MO?4 Poe=°jI-4�P8 s�a�daQ arli, -aE3 E snag q zit[}o'a op asaald `saa�rnb�aa-EgnoLpinogs zadoaa mo:izo�aa�apea<nod� a�a�r[Pln°� nlg° O I. . eP�e s� I (4 P ?ZOl�t s?nos�ad F-M(-3 sa&Eal=g c4 791 ad zo as=zl f op E•a-c] � �b won zn ss a=.q 1�Ile boa mad Io asuaarj E 2m[me;go Sc zo Ia�o aacoq E azaq& rasa Ito palCg aq pP -sasuaatl zo sjlrn7ad.ax ?off a do sc} pt�e prat oozd se ,rjddE aq}o�papt�ozd aq 1�Eur r�o�zo a pa�em zo padmgs dIIe?n o aq sue[ q}}uEP a J01SrIoa (ae�cq io,fro) at s� a?oI 1p.q=A TOT rldde aq}Q FP b q°lam�F�P�(' 31� n�?I°d aao Imiqns�Iao u`z�a� s¢odda asuand aj�gnazgos = ;u=Hdfi ae`ao4, oagm as E se pasn aq ILA : agaTza asoaaP,�t =d atp o4 azns aq aseald �aearlddB azppre�aino.s}o�°o° saq - - dam°= as alas�o o4noLL zapEP�atp zo °q ate,p a n&E papraaid szq;tmu;xe atjb �I�I P�alaI�Oa sr��?��a tos aq aszajd sfWO troy xo SM jau.I clip XXF=aso=lnzam'mc,4gas � �a u�aseajd`6�goaaores�adazoa IIagi PIno sa�d�paa�snz 3faS PIIIQgS - -�T `q sia xo& E qo o4 pa mmb=cm n04F M AI aqg saorsaoh Lm abEq nod ° d� ou anb= aq si asuaorj zo d 1-T aotParldde aq} waa�}zo a aF Paulas a4 a ate} `ems PInOq ? 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If found return to: 102322 Type: Office of Consumer Affairs and Business Regulation Expiration==7ZOtg DBA 10 Park Plaza-Suite 5170 MOLINARI ROOFING Boston,MA 02116 f Libero Molinari 11 SHEEP PA STUR /J EAST SANDWICH, r Undersecretary . Not valid without signature I I, Construction Supervisor Restricted to. Unrestricted- less than 35 000 ildings of any use group enclosed s cubic feet(9g1 cubic p Which contain Space. meters)of Failure to possess a current Massachusetts Department of Public Safety State Building Code is cause for'trevoO cionf the Massachusionetts Board of Building Regulations and Standards DPS Licensing information visit: of this license. WWW.MASS License: CS-040124 this Construction Supervisor LIBERO J MOLINARI 11 SHEEP PASTURE WAY::•.:; EAST SANDWICH MA 02 537}» �rx Expiration: Commissioner 03/29/2019 r' I t i DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 05/19/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Lori Wong OXFORD INSURANCE AGENCY INC PHONE 508 987-0333 FAX No): E-MAIL ADDRESS: lwong@oxfordinsurance.com 300 MAIN ST INSURERS AFFORDING COVERAGE NAIC# OXFORD MA 01540 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: LIBERO MOLINARI INSURERC: MOLINARI HOME IMPROVEMENT INSURERD: 11 SHEEP PASTURE WAY INSURER E: EAST SANDWICH MA 02537 INSURER F: COVERAGES CERTIFICATE NUMBER: 156284 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DD EFF POLICY EXP LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTE CLAIMS-MADE OCCUR PREMISES Ea occur ence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY1:1 JECT PRO ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE $ r DED RETENTION$ $ WORKERS COMPENSATION X I STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBER EXCLUDED? WA WA' WA AWC40070081132017A 05/21/2017 05/21/2018 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A 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 is 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. This rtificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date 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 www.mass.gov/lwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Daniel M.CroWy,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ' Page No. of Pages. 4 y 1. MOLINARI HOME IMPROVEMENTS 93 THORNTON DRIVE ' HYANNIS, MASsAGHUcETTS 02601 PnOPOSAIL Phone/Fax (508) 888-3750 Sandwich Phone/F�x_,% 771.5266 Hyannis PHONE DATE TO S08-472-53 0 05/2 1;7 MRS MAGIE' CROWLEY_ JOB NAME LOCATION 4181 RT 6 A CUMLQUTD ,MA JOB NUMBER JOB PHONE I We hereby submit specifications and estimates for: RE-ROOF ENTIRE ROOF AREA red cedar ##1 STRIP OFF EXISTING ROOFING 2 INS?Af_!_ METAL_ GRIP EDGE WHERE NECESSARY #3 INSTALL VENT PIPE FLASHING ##4 CHIMNEY CHECK ALL FLASHING AND COUTER FLASH WHERE NECESSARY ##S INSTALL TCE AND klATER, SHIE.L_D AND SHINGLE uNDER LAYMENT WHE-RE.: N`=C;ESSARY ##6 INSTAL.L. RED CEDAR PERFECTIONS 7 TH(;ROU'GiH C:LEAN UP OF ALL. DEf"3R.I RE'.LAT'ING Try i"?-!E ABOVE, WORK � ; FULl: Y INS�UREG WbRKMENS COMP f�!SATT'ON''AND LIABaL LTY TrNSU`2ANCr r r NQ 1PIPOJP®Z(B hereby to furnish material and labor—complete in accordance with the above specifications,for the sum of: TWENTY SIX THOUSAND SEVEN HUNDRED - --'- dollars($ ). Payment to be made as follows: ONE HALF TO BE PAID UPON 'COMMENCEMENT OF THE ABOVE WORK , THE; BALANCE TO BE. RAID UPON COMPLETION . . All material is guaranteed to be as specified. All work to be completed in a professional manner according to standard practices. Any alteration or deviation from above specifics- Authorized tions involving extra costs will be executed only upon written orders, and will become an Signature f� extra charge over and afsove the estimate. All agreements contingent upon strikes,accidents or delays beyond our control. Owner to carry fire,tornado,and other necessary insurance.Our Note:This proposal may be workers are fully covered by Worker's Compensation Insurance. withdrawn by us if not accepted within days. Ac�ccalplamlc a ®4 IPTT@0Zd1a —The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized Signature r r e to do the work as specified. Payment will be made as outlined above. Signature _�7 Date of Acceptance: 44,1 y 1 r 35i I L-%1-577 /G / Cal7/16 E 0 � 0 ry Zqi!!.4 1 / wcr I Ivor- SN6WN CPA.* 71/�S �ZG•� UND�'X C'aNS.�7�1/�'Tlra.v 1 � I Dior S� S/YjRGL 'y%o�vs, M ^a o a;i,'`''�r� CTC. 1.0 �4, ��` 7 A i 1 I � 1 C, ,e- 2�c,��y =H� I certify that this property is located in Flood Hazard Zone. C ( out- side the 500 year flood) as identified by the Department of Housing and Urban Development (HUD) . Date CERTIFIED PLOT PLAN '' LOCATION . .... .sT�.ez. T P1`9D �.�ti ;4 " _ i3 �t _ SCALE . .�.��:�oo. . .... DATE S? :.�Z /9:� . �� I `NIA PLAN REFERENCEi�'G Lea Reg �` +� .53�1 .S,[10 PL, /��C, 7 /0 3 : ,moo ��.�.�. 3�.6. ..��: 7 s. . . . . . . ApprNOVED . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . I certify to its title insurance company that there are no visible encroachments I CERTIFY THAT THE . .. . ... or easements except as shown and that this SHOWN ON THIS PLAN IS LOCATED ON THE GROUND plan was prepared under my immediate AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF supervision. WHEN CONSTRUCTED. DATE /Z 7 T. C~-VC.'A/ P677- REGISTERED LAND SURVEYOR Assess0r's4mce(1st Fbor): / � LL�J Assessor's map and lot num �s` / SEPTIC SYSTEM fiV �E Conservation(ath Floor): INSTALLED IN ODPAPLId`N,d C�' Board of Health(3rd floor WITH e gTLI- 5 = DAS77T 6c : r Sewage Permit number rua ENVIRONMENTAL Engineering Department(3rd floor)::' �0-Z "CiD °°�; ►`�� House number TOWN REGULATIONS Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO C1 d I t-(bh TYPE OF CONSTRUCTION CJ a a 19 / TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: //11 Location ( "" `l �C V 1 C' {Yl 4 Proposed Use ? c td k!, i/u Zoning District ` 1 Fire District 69AW-2 r_ Name of Owner �14 r a,P--� Co w e Address-. �// 2 k-t a t� O U41 u U U,,� b a Name of Builder Address ' Name of Architect 4v II��a � 4Pt<, Po Address Ua;- h, v u4-� Pot- a1 Number of Rooms / Foundation it C Exterior �. C ,S n 1 MCI Y S Roofing w' C Floors oo d Interior flu Heating o r ` y Plumbing Fireplace l A• Approximate Cost O b 0 Area S �� Diagram of Lot and Building with Dimensions Fee �a < 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 Siipervisoes License CROWD'EY, MARGARET e 418Y MAIN STREET, CUM14AQUID I o' 44"J4 Permit For ADDITION S. F. D. Location Owner - Type of Construction r Plot Lot - Permit Granted Sept 1 ti r 19 94 'Date of Inspection: Frame 19 — Insulation 19 ! e Fireplace 19 Date:CompIgied 19— S. i # Cl 1 _ w N ,s r x' V . iz � ' ( cr �77 '1 4i id, 771,1 t - . Assessor's office(1st Floor): Assessor's map and lot number v o�TM It Conservation(4th Floor): Board of Health(3rd floor): { BAR13TLDLZ S Sewage Permit number rua Engineering Department(3rd floor): i619 Ito Oil House number Definitive Plan Approved by Planning Board < 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only �1 1 TOWN OF B:ARN,STABLE BTIC ING INSPECTOR APPLICATION FOR PERMIT TO 4 / TYPE OF CONSTRUCTION 612 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 7 I �'YI l 54 - Proposed Use �1- Zoning District / ► / Fire District Name of Owner y t4 C © U) e Address C1! C f I Ir Name of Builder 62 h-e SO h S Address 6rah 1C I, ulrbLl/ Name of Architect �S1-a� um i' (�d` �✓� Address Number of Rooms Foundation Exterior Roofing ` Floors Interior Heating Plumbing Fireplace Approximate Cost S O O D Area C !� � Diagram of Lot and Building with Dimensions Fee 60, i i 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 constructio Name Construction Siipervisor's License ntFj , CROWLEY, MARGARET No Permit For REPLACE WINDOWS, SINGLE FAMILY DWELLING - Location 4 18 1 Main St, �f ' d Owner Margaret Crowley Type of Construction Plot Lot ' Permit Granted June 22 , 19 94 Date of Inspection: ' Frame / `" Ul 19 Insulation 19 _ Fireplace 19 � { Date Completed - 19—' 9 { tt { ' z - p j:. 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