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Home My WebLink About0065 FERNWOOD AVENUE �� E�P/1/Gvooc� �vC�-- i� �,� _ _ ____ i FAD rnA�lQ.d Town of BarnstableECEIP6 f 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-16-3398 Date Recieved: 11/17/2016 Job Location: 65 FERNWOOD AVENUE,HYANNIS Permit For: Building-Solar Panel-Residential Contractor's Name: SOLAR CITY CORPORATION State Lic. No: 168572 Address: 24 ST MARTIN STREET BLD 2UNIT 11, Applicant Phone: (508)640-5397 MARLBOROUGH, MA 01762 (Home)Owner's Name: ETIENNE,EVENS& MARIE C Phone: (508)904-4333 (Home)Owner's Address: 65 FERNWOOD AVE, HYANNIS,MA 02601 Work Description: Install solar panels on roof of existing house,with any upgrades, if applicable,as specified by PE in Design; To be connected with home electrical system. 5.355 kW 21 Panels JB-0263433 M =Z s Total Value Of Work To Be Performed: $7,600.00 Structure Size: 0.00 0.00 0.00 a Width Depth Total Area`' I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work.on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Cheryl Gruenstern 11/17/2016 (508)640-5397 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $7,600.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $90.00 11/17/2016 $90.00 XXXX XXXX XXXX j Credit Card 1 8975 i Total Permit Fee Paid: $90.00 ram,., F" '�". su ..._...s .a��'..•. � �. vw> b .,�...`�.. �xB_...... ,.,�..u...��z¢\a.... i� �3� o r i 13 �� Town of Barnstable.'' Approved Regulatory Services App g Y Fee Thomas F.Geiler,Director Building Division Peter F.DiMatteo,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Home Occupation Registration Date: )19/ �1 G �/ Name:L2c j P l/ E O—I l d- Phone#:—,`J2 Address:� Village: Ci7 l!1 /S Name of Business: TA L ce" Type of Business: W yl k Map/Lot: O9 1014, INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no " increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector, a customary home occupation shall be permitted as of right subject to the following conditions: The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. No traffic will be generated in excess of normal residential volumes. The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter, odors, electrical disturbance,heat,glare,humidity or other objectionable effects. There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess of normal household quantities. Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation, and not within the required front yard. There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. e Applicant: Date: Homeoc.doc TO ALL NEW BUSINESS OWNERS Fill in please: APPLICANT'S YOUR NAME: (�qrme_2 At if I BUSINESS YOUR HOME ADDRESS: TELEPHONE Telephone Number (Home) ti Uk - 7 2k NAME OF NEW BUSINESS T'A L A - s TYPEOF BUSINESS IS THIS A HOME OCCUPATION? yPs 1 ADDRESS OF BUSINESS 6 .F MAP/PARCEL NUM 5 BER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor- Town Hall). 1. GO TO BUILDI2G �lISE CTOR OFFICE (4TH FLOOR TOWN HALL) This individual hasrme o n re uirements that pertain to this type of business. A rized Signature COMMENTS: A Aj 2. GO TO BOARD OF HEALTH (3RD FLOOR TOWN HALL) This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature COMMENTS: 3. GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY) - (3RD FLOOR SCHOOL ADMINISTRATION BUILDING) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS: he required d signatures you must return to the Town Clerk's Office to obtain your business certificate (cost $20.00 After obtaining t q g Y . g s do b es not roe you ME i h own which you must M.G.L. - it do 9 Y SYOURNA nt et for 4 years). A business certificate ONLY REGISTER ( Y Y permission to operate -you must get that through completion of the processes from the various departments involved. f C 7.3d Assessor's map and lot number .........�.�� ,(/. �i FTM Et 0 Sewage Permit 'number .............. 33AH39T4DLE, i Houselnumber ......................................................................... 9 rues �p 16}9. \0� o MAI a' TOWN OF BARNSTABLE BUILDING INSPECTOR CLjzj - APPLICATION FOR PERMIT TO ..................................................... . .................:...................................................... TYPEOF CONSTRUCTION ..................................................................................................................................... ..... ...................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...."...................:................ ............................................;.,....................................:........:.....:.................................... ProposedUse ........&,,hr�r e� a......!c ..<-. ....................................................................................................................... Zoning District .....................................Fire District 1 v Name of Owner .......�Am.es..... �jJc f�i !�!��,! Address � E 4/,lxr ?w,s' Name of Builder .................Address j r Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..........1 �'�........................................................Foundation ... 'G.....................' ...//......................................... Exierior S�ir��*�.t.... ...Roofing .......� .............. Floors C.��IM2. oe�_W.`"................Interior .......l s�� ./!.j .C.............. .................................. Heating Plumbing Fireplace ......../i�1. .. ..........................................................Approximate Cost ......... . o.e......... ................... Definitive Plan Approved by Planning Board --------------------------------19________. Area /02 Diagram of Lot and Building with Dimensions Fee a —7, SUBJECT TO APPROVAL OF BOARD OF HEALTH I y � i I hereby agree to conform to all the Rules and Regulations of the Town of-Barnstable regarding the above construction. }} Nam(e/ .. ....... �.r,/ �� ......................... McNally, James P.' A=289-164 No .... Permit for ....lds�.!n..porch...ta ...........................................................dwelIlng.. Location ...........6.5..Fe=WQ.Q.d..A.va.................... ....................................Hyannis........................... Owner ......J4WA$.. ......................... Type of Construction ..........frame..................... ............................................................................... UPlot ............................ Lot ............ Permit Granted/................j-ul.y.....30.......19 , 79 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................ ............................... 19 X ............................................................. .....� ...... W ............... . ....................// (1 ................................... ... ....... ....................... ............................................................................... Approved ................................................ 19 ............................................................................... ............. . ........................................................... V THE THE Sewage Permit numb�er .... .. SEPTIC SYSTEM MU 7' TABLE. : TOWN 'OF BARNSTWO BUILDING N �� . ��NN N 0-�� N �� N �� =� � �� mw PfX-T 0 R ( ' � APPLICATION FOR PERMIT TO ................... I.......................... ..................................................... TYPE OF CONSTRUCTION -----------------_-_________~~_.__.___.________. -- .. -! --l��. \ / / TO THE INSPECTOR OF RV|LD|NG5. The undersigned hereby applies for o permit according to the following information: �� Loco�on ---.wx.°^ ........... ---- -----..-.---------.------.. _ Proposed Use --' -- � � �/ � ------.--------------------------------.. | Zoning District ------..--....------.-----.�ve District -----.-------_~______.____.. | � � Nome of Owner -- -..�,�. --A66reu -./�.1�--- ��.��--.. ' , ' y, /x Nome of 8oi|6e, ----��-------------A66�ao ------_--------.--.---------.. Nome of Architect ----------------------A66res ------------------------____ � Nvm6o, of Rooms ........ .------------------Foun6ohun - ...... .................................... Exterior --' -----------------'Roofing -- 6�-�\�� ' . ~�. Floors --- '�!��. ��-.---.|nn,,io, --��r��*��---___---�r---� --v---- �' ' ----------. HeHeating --'. t�.........................................................Plumbing ........&��^^o .......................................................... �u ��^ � �7 --- Fireplace '—'��.x. .........................................................Approximate Cost --- .................................... Definitive Plan Approved by Planning Board lg . An*o ...... ...................... � -7�^' \ Diagram of Lot and Building with Dimensions Fee .......... /=.................... SUBJECT TO APPROVAL OF BOARD OF HEALTH � [ I hereby agree to conform to all the Rules and ` � � , Regulations of the Town of Barnstable regarding the above N-- ----z~-'--'—''`---'' -------''~ - - -- James P McNally, . . ` . ^ - No -.2152D '.FArmh for ...Add.!zz....Poroh''�m . ~ � ...................................................dwelling.......... , Location ..... F#KCXV.9QcL.Ave°........................ ' ................................... ............................ . . � Owner ...--..J��. .......................... | ' ' Type of Construction ----.�caoua-----.. . ^ ° ----.---------------------- ' ' 1 ^ Mc� ,--------- Lot ----------.. ' � ' / ' � 'parmk'G,on*�6 Jg�� @8 lV ' ' ' ---- . —' ---' ?g ' note of Inspection --------��=—.^}A , . Date Completed --- �.�!�.��-----]q ' \ ` . . _ � PERMIT REFUSED . . ' 19 . ~ ' ---- cl .................... 'r--'.' - � ' �� . -.. .-`�----------.. 19 . '''�� ' --------------..-----.—..—.-- ' ------------------~----^^—^' ' ^ ��--- Assessor's map and lot number t✓..'...................... Q��F THE T0� Se age Permit number g ........ � ..,.�.r>.✓r.�. ...��..�!.(::�rc./�.,_(��,+.-,.� rep' � °� BARNSTABLE, i 1-louse number ......................................................................... 90o rb a \0 Q mix a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO � ....................................... TYPE OF CONSTRUCTION � �/7 f;1 I j/ Gj ............................. .7...................................................................... ... ...... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The- undersigned hereby applies for a permit according to the /following information: .Location .............G ....... �.......-�py....... ....... 1f�f>/l s......� .1�s:5........�. ......... ... ProposedUse ........... ............................................................................................................................................ ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ...... ....... Address /(� i�i�1'/�i�>�J -,411 #�, ... Name of Builder ........Address .................................................................................... .Name of Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation ....................................................:.......................... Exierior ....................................................................................Roofing .............................................................._...................... Floors ............................................................Interior .................................................................................... Heating ...................................................................................Plumbing .................................................................................. Fireplace .................. ..............................................................Approximate Cost ....... . bra' .................................. Definitive Plan Approved by Planning Board ---------------____-----------19 . Area �r................:...............:... r v ........i , f Diagram of Lot and Building with Dimensions Fee ...............................j. .,....... SUBJECT TO APPROVAL OF BOARD OF HEALTH IR l r f I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... rr �1...!!! ,,/1l � . . .. /. ...................... ' t A=289-164 ' McNally, James P. No ...2220...........7. Permit for .................Swm .>l�g..Po07............................. Location .65 „Fernwood Avenge.............. Hyannis ............................................................................... Owner ....JAMQ.�i...P......UQK4.11y..................... Type of Construction .......................................... ............................................ ................................... Plot ............................ ot ................................ ' Permit Granted ......... .May...21............19 80 Date of Inspection ....................................19 Date Completed ......................................19 PERMI REFUSED ................................ ..... ..... 19 ..... .J. . . ..................... Approved ................................................ 19 ............................................................................... ............................................................................... Assessors map' and lot number .................................... C THE t _ P o Sewage Permit number l/I.U... r`�tc. L SEPTIC SYSTEM MUST INSTALLED IN COMPLIA MSTAMLE, i HP WITH TITLE 5 °o 1b 9. 0� use number ......................................................................... 9 ENVIRONNIENTA► r w:, ��,'�au,",Ar TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO d�?.5.. `!l S :........................ . ............................................................ ......... TYPE OF:CONSTRUCTION S � u. ........... . I F-X 3d / l n ........ ........... �......... ... ...................................�........ ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............. ...... /2/VL//©®..r...,.........�vE........... .......�J..........s S......... ............................ ... ProposedUse ..........FX1.A-A2g....................................................... ............................................................................... ZoningDistrict ............//....................... ........................:............Fire District .............................................................................. Name of Owner ..........14. .e4: ...Address Ag....... `ml : Nameof Builder ............ %7?/..1 ........................../...........Address .................................................................................... .Name of Architect ................ .Address................................................. .................................................................................... Number of Rooms ..Foundation .......................................................... .................................................................... Exierior ....................................................................................Roofing ...................................................................................... Floors ......................................................................................Interior .................................................................................... -Heating..::..... .............. .. ............. g .................................................... ... ..Plumbin .... .... .............. ............ .............................. //�� O d Fireplace ..:...............................................:...............................Approximate Cost ........... ...44v.................................. Definitive Plan Approved by Planning Board ---------------—__—-----------19_______. Area XO.. t . .. Diagram of Lot and Building with Dimensions Fee .......1...0................. . SUBJECT TO APPROVAL OF BOARD OF HEALTH sePJ4 e I w,h I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . ...✓. '.....��..:� ........ ....................... ^ ' MCNA � L L No ——P—a—r—m'--h--for ——'^'—I— —m--i—l---l---P-- ----. .---------- Swimming Pool -------------''T7---' Locoon 5_ . ____ �ao�io �ueo I . McNally Type,"of Construction ........................................... / . . . . . . ' ^ ' ' '.. _-_ ~ --------------------------. . _� P|c* —� -------. �t ----�------. ' - - �— - ' Permit.' --J�ron�y� Aa-y...2J�'----...]q 80 � ~^^ . . � 'note �f Inspection ------------lq Date' Completed ------`�v-- Jr 9PERMIT REFUSED \ ^ l� ^ \ --'' ��-----------------� ~ �� ^ ' . | '. — �-----------------'' �� ` 4.1 Y � . LS . ..--... ~' \ ........................................................... . . � | � . Approvein�--------------'�.. lg ' . � ' ---^----------`------'--'^—^—'' -----------------~----.—...— ^ i a i i ,� � � O � i Ci �c� .. 1 o`3 f" �°G � ��7� Assessor's map and lot number ..... ................................. bEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Sewage Permit number `-`� S WITH ARTICLE II STATE SANITARY CODE AND TOWN yoFTHE.TO� TOWN OF BAR I `II bLE b�Q� you B9HHSTODLE, S Mb MpY BUILDING INSPECTOR a• APPLICATIONFOR PERMIT TO .................. ' ....................................................................................................... TYPEOF CONSTRUCTION .............................................................................................................:..:.................... ................................................19........ • TO THE INSPECTOR OF BUILDINGS: i The undersigned hereby applies for a permit according to the following information: Location s.�.....y. ....................e Jj....�:.�!:.'h► w� 0 �� .. .............14t/. .11.21� ...L...:`,/.......)S.S...:............. ProposedUse ............�.� ....�.�.}.... ........................................................................................................I......................... ZoningDistrict ..............1. .. ..............................................Fire District ............................................................... V Name of Owner ...� F.��..:f1 �' ." .��.�°� I -E ��1 ui.... ...... Address t;....... ... ). J Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .....................................�.............................................. q �vY e�` C o��C Number of Rooms .....p..........................................................Foundation ............. .........:................................r .................. Exterior 'aJ ..Roofing ......, s. .l.�.� ............ .r. .:?..Y..................................................... c I� �4t+�'./.?1.3 ........... .....Interior ....... ./.r). °. (.�J.. Floors ...........O a........-..... . .. . ..... .t5.a�. .. ............................... .............................................. .........Plumbin Fireplace ....... ..5........................................... ...............Approximate Cost ................yq.................................... :^ . Definitive Plan Approved by Planning Board ________________________________19________. Area .......................................... 06 Diagram of Lot and Building with Dimensions' -:�� Fee ...... ?..�.. .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH t et 39 3 ► / 0 w� ' 13 I t I 1 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......�'"1 :C�?.? ?` ..�...... ................... � Henry, ^~°^"=°°= ` ^ - No .................. Permit" for .........single fami2y � ----��...��.. _--�~~�.=^ ---- Locoho` —. .Ane�..\ �_____.. ~ ' ^ Hannis -------..-��.--...----------. . Kenneth Owner ------_—_.��______.,_.. Type of Construction ----.. ___—_ ---..��--------------------. . ' ^ —. �Pk ^~Plot .�-------_. Lot ................................ � ' 8 , Permit E;,onu*6 --.�u��...---.—.]g ��` ^ x r uota of Inspection /o/~7 � "".= Completed ' � [ ' - ^~ 7V, m 2 PER REFUIEE? � -----_--------------.. �V ' .�.------------------------. ''' ^—~`------------~`----------' —.------------.—.---..—.--~-- '----^---''—^---.----.--..---.... � > -- i — Approved ................................................. lg -------------..--------~---. . . . `- ^ ` ----------------------.---.. Yy �ttte rq Town of Barnstable *Permit# :20 1100 J Expires 6 month ji 7 'ssne date F F Regulatory Services Fee Thomas F.Geiler,Director Building DivisionD. P �� 3`Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address esidential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number, ! � Home Improvement Contractor License#(if applicable) l! / Construction Supervisor's License#(if applicable) ��I orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner VI have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# /� `� go ) Copy of Insurance Compliance Ce ifieate must accomp ny eac permit. Permit Request check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will.be taken to f ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ ftlacemcnt Windows/doors/sliders.U-tlalua (MaSci-mum.39)Ji ofwindows '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. copy;L� Improvement Contractors License&Construction Supervisors License is Vequ' SIGNATURE: C:\Users\decollik\AppD ocal';Microsoft\Win ws\Temporary.Internet Files\Content:Outlook\DDV87AAZ\EXPRESS.doc I Revised 072110 r, Me oC'amm'on wi th ofMassachusaft D prat ref lndunoial Accid Qftc of li►rvstigs 600 Washington Shwef Boston,AL4 02111 www.massgovIdia Workers'Compensation Insurance Affidavit Buiklers/CGntractws/Flechicians/Plumbers A►ppiicant Information Tlease Print Lezilb Dame City/stat&Zip- Z2� � Are an foyer'c h tht:apppropria to boa: 1_ lama to . ❑I seas a contractor and I Tye of project(reread): employ (full as ar part-rye)-* have hiredt 6. 2"0 I am a sale proprietor or Partner listed an ihe:attached sheet "I- ❑Remodeling ship and have no employees These sub-c rs l e 8_ ❑Demolition woddng for me in any capacity, employees and have, g- ❑Building addition [No workers',cam,- e cam-- required] 5-❑ We a ontian and its 1t}. Electrical re ins or additions 3.0 lamahGmeowner,doing all wa k officers have exercised their 11.0 Pl repay-additions myself[No work eas'cramp. rat of exemption per MGL 12eofirtstu se re d j 1 c. 152,§1(4) snit we have 'emplo .(Noems' 11hen cam-msurance ram. �A eB�cBss #I ma3a�tsee till apt��cti�ra bezoxa sh�rimg �' - pelicy• - submit this affulsixitimikatingfty are dM3g all WM ad&M hire autwMcoamsums mmstsubmit&new sfdwit mchcalmg ssdL ff Mrs that aea this box.must,attadmi=M&Um&Am showmg the ns=of the sub-canummm smd s=whadier or zat tbase Eatti s have _ .. If tie sub-t)ntmc1kt cb— —,tbey ➢1-;t pr—j&t r wakers'comp.]loll$-IDiim&u I am an employer thatisprovong workers'compensation insurance for stay emptaioee& Bakwis thepolicy and job site irnformatiam ks u.ancm many Name: / Policy*or Self-ins.Lie.#i Expiration Date: — Job Site Addiess E'tA- , e/l/l /7 f/ City/state/25p_ Attach.a copy of the worhere compensation polky declaration page(showing the policy HIM ben and motion date). Failure to sere coverage as required under Section 25A of MGL,c-152:can lead to the intposition of criminal genes of a fine up to$1,500.0}and/or one-year unprisonment as well as Zvi penalties in the form.of a STOP WORK ORDER and.a fine ofup to V50_M a day aft the visalator. Be advised that a copy of this statement may be fbiwarded,tD the Office of Investigations of the DIA for' coverage'verification. I drr hereby u tha . an, ofpelpfy d w the informanonpron&d above is h3le and correct S" Die: Phrme i€: _ - Of}icial use onnly Do not write in this erred,b be caonph4ed bye*err tin of feW City.or Town. Permitucense Inning Authority(circle ore). 1.Board of Health 2.Bawling Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Persona Phone#: 6 �ttisxchusett� Dep trtment of Public Satct� Board of Buildin R r r �. e-ulations and Stand a d5 Construction Supervisor License 1, License:-Cs 8267 rc� Restrigted to: 00 a a p ,; ;:yw,i ?' DAMES D,:pANFORTH u ", rPO BOX 973 r COTUIT :MA 02635 }� n r Expiration: si1olx12- G'-n,in,esi�.,ner 011,ccpreonsa°'uae / r b merAffa,rsc"f�l,sirics.Tr f s FiOIV►E fltrPROVERriEM1t7 CO!!, ` icens�or registration uaLd for i RACT, Ccr� i r�qy< � �efote the erpiratton �tv,dl,tse Q,SFS�s r Registrat -late If found retnrit tQ cTxp,�ti 11ti8 t s� y fifti�e of 01�� !<011 •, s ConsumerAfa►r Ty jradlual � `O earl,Plaza Sti,te 517 and Business:Fie'gut�tiQ JiaMfnS D DX1NF0 r RMYT M � � ( a FS itt iLTIi�EMCD +7 1 c iM T . Ofi� � fr JttAq DAB-0Rl`t, � � La)POST �� i s 4 �f(750 RD 4 CGTu T M,A 02635 K, � ' Lietlerce�r r ": 7 4. ....max. - - V 0 UN lu: b(; ,a �Ro� CERTIFICATE OF LIABILITY INSURANCE 702/17/11 YY) 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 endorsements . CNTAPRODUCER 617-350-5511 NAME: _ Child-Genovese Ins.Agency Inc 617-350-5522 A/c,No,Ext: A/c No): 60 Temple Place E-MAIL Boston, MA 02111-1306 ADDRESS: PRODUCER William Genovese -CUSTOMER ID#:DANFO-1 INSURERS AFFORDING COVERAGE NAIC# INSURED James Danforth dba INSURER A:NORFOLK&DEDHAM 23965 James Danforth Remodeling INSURERB:TRAVELERS INSURANCE CO P.O. Box 973 INSURER C: Cotult, MA 02635 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 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. 1LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/D//YYYY MM/DfYYVY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 500,00 A X COMMERCIAL GENERAL LIABILITY R1049644A 09/02/10 09/02/11 DAMAGE (RENTED PREMISESS Ea occurrence) $ 50,00 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,00 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO' BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS , PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAB OCCUR CH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TFR B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/❑N N/A 6KUB8027A05110. 08/28/10 08/28/11 E.L.EACH ACCIDENT $ 100,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) WORK BEING DONE FOR JOHN PECK,3800 FALMOUTH ROAD,MARSTON MILLS,MA THE WORKERS COMPENSATION POLICYDOES NOT INCLUDE COVERAGE FOR THE SOLE PROPRIETOR,JAMES DANFORTH. CERTIFICATE HOLDER CANCELLATION 1000C-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT FAX#508-790-6230 AUTHORIZED REPRESENTATIVE BARNSTABLE, MA ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD