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HomeMy WebLinkAbout0037 HARVARD STREET 11 `� try 1 �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �� Parcel Applications . Health Division Date Issued 6-/SX ©� Conservation Division -J) Application Fee A0 Planning Dept. Permit Fee--P � Date Definitive.Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address �+A rve.n�A Village a i/ Owner � V-,Anrj v Address q1 An6J(y— Telephone 6v r- 13 Permit Request ���� n�d' t 2,AA�,-)A 4�✓_5Q Ve b an -(� �e��lc�S'S -f�- �- G� ��hS.�-l'1'1z>1i- 1''�'�� �'<����' �►'�S��n,�--� -�' Ir �c�.��.e,�j�►-�"� �6,�e�u1.�,�- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 206 ' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure '$® Historic House: ❑','es ❑ No On Old Kings JHighway-n❑Yet ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ,i Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new K M Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 0'No If yes, site plan review# Current Use ��`� G�-� ✓�� `e� Proposed Use I S 1 /L Cam— APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) � 1/1 C - Name krd^_hNe r ti/VZCU.'`1 �0��'�ro✓�5, Telephone Number l-l''( 'Z� �® Lt Address Sol k-A r u, i G� �-o a� , License # 16 Srk:w ,� �r, kA 2 6 Home Improvement Contractor# I Worker's Compensation #V y -100 L Gf S IF = �;A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 2� i FOR OFFICIAL USE ONLY :Y. APPLICATION# DATE ISSUED d V; MAP/PARCEL NO. �r z ADDRESS VILLAGE OWNER �Y DATE OF INSPECTION: ` FRAME ;,I.NSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ti PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING'' __DATE CLOSED OUT ASSOCIATION PLAN NO. t. Y OWNER AUTHORIZATION'FORM L T. h, (Owner's Name) owner of the property located at e er (Property Address) n '•S d o� roperty,Address) hereby authorize e` (Subco tractor) 1 -- — --- - an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit adds to perform work on my props Owner' re • kDate i f 3/ 16/2015. 12 : 35 : 39 .PM 8626 21, 02,/02 CE TIFICAT OF LIA ILI I SU NCB; 7 fa DATE(MMIDDrYfYY) 03M 612015 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 00509-001 ' aoT Jeffrey.Fora L— E - Rogers&Gray Insurance Agency AH No.Ext: ('800)553-1801 -- FAX No: f508 9 3 98-024 6 434 Route 134 �ooIRESS: f South Dennis,MA 02660 - -- _ INSURER(S AFFORDING COVERAGE NAIC# INSURER A: A.I.M.Mutual Insurance Company 3 758 INSURED INSURER B Frontier Energy Solutions Inc INSURER C, 502 Harwich Road y Brewster, MA 02631 INSURERD: lNSURERE: �. 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, TERRA 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, '.k POLICY NUMBER� POLICY EFF POLICY EXP -. -LIMITS LTR i IusR:VW�_ (f mmolYYYY) (MMIDOIYYYYi GENERAL LIABILITY I EACM CCORPEN t . CctrttEn^fLbENERALLIABILITY ° DA.MA ETOPE TE $- PREMISES(Ea n c recce CLAIMS-MADE C OCOUR M.ED Df.P(Any one person) PERSONAL v ADV INJURY GENERAL AGGREGATE $ 41,VILAGGREGATE LIMIT—APPLIES PER. �. PRODUCTS'- OMP/oP i I AUTOMOBILE LIABILITY Gr M3 htp SIN LE LIMIT } Ea c ArYAJTO BODILY,-INJUR (Pe person) 1:r, PLL OWNEu �-HED,JL4D BODLY INJURY{P accident)�y L AUTOS AUTOS -ac — -- 'NON-OWNED. � PROPERTY RAlAA:; r C'AUTO. AUTOS ipera.C.cznt J UMBRELLA LIAR I vccuR-` _ — I EACH OCCU:4-r EN-CE .EXCESS LIAB" 'I CEAiM�:v,`sDE AG=RELATE 1 b - _I DDED �RETENI'IOhd $ — I — — — � Tr- � :- ADMPQA�tT �h -`-I,AYg L A,i\YPKGFPIETCR/ ARTPJER,ECUTIVP, f.L EACH ACCIDENT $ 1,000,000.00 =CE NtAA 0r L VWC400-6015315-2015A 311412015 3114/2016 (Mandatory in NH) EL `A SE EA EMPLOD v cE $ 1,000,QOti.QQ Gvc �-nt>Eun�'ur byELDi�cASE.- POLiCYLIMIT 4 1,00Q000.00 DE�rRIPTIONO. OPEPATQNShe4w, -- ____-- _--- _-- _ -- r DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space it required) Y , CERTIFICATE HOLDER CANCELLATION Tovm of Sandvactr ° 16 Jan Sebastian Drive SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sandwich,MA 02563 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN i ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a 19M2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 2630 The calu tw:ItWcarth o t rrsssze-sisals 13�t�a�ixe�sB o,�"I�rlrs���rl.r�ccu3'e�s�s , Offire of-IfIvesag4 a is 600 Waskin on 'tom Bosion,MA 0 111 Workers'Compensataau hsarance .davit:B ei-s ContractorsfMee-trzr-xaiis/Plurnbers. ADDUcant hl or tion- Please Print LesLi�v Team:-p "viduaQ.- �Ae_ J.�O tt,s IA 4. C;`ifyfstawzip- . ei..,3 . r,MA 0213 1 Phone Are eu an employer?Check Me app6p late how of project r ` 7 4 T am a gen�l oontmctos and l Type f eg ret): _ l_ 3 a�n a ex�3oy�e wz� �6 �New sE .ctioai ezeployees(fun.=dkr pax"i=): have ev_-rdb-contact. 2.0 1 am.a sede pr etm.ofp=ftcr listed tsn tbr-2'tacW Sheet y. R=pd dkg ship and havem zm r+ploy= Tles-_sdh-coxit=t=have S_ 0 Detctolit%an w fa€rtie:ih.atiyeapacz� alloy and:�z�e`woz ' °� 9; 0Build addiG is zv(No eil;C&comp-imuraac c uaauce: _ S_n Ne am a corporatim and its 14,O:Electdcal=pairs or additions � 313 I aizt alaamevrv=tloiv-g al work cocas haw exe cd �11,Q Pimnimiug'repaiis or sdrMam myself{Na wa&ems'camp Tight eexemptimt per�U'� 12: Roof ails iaasura ace:requ retl t c.iSZ§1(4),.and have no ti=sberks box.#j wim alsa fill the sxfiaah kw 9mving their wa mx salion peliry;-afbM2dw_ � uraeaviu svIno:submW&iss avuz ugt ysrP.#osmgarl and bkt-miside t cMmmv m&m&a:aewAME&Vifinaicalm9i4l. j �Czr�a�as�'iatc�irckTats iio�ro-st a#tr�.�i�u �vn�s�3 sh, i3ui�aFne c� ss�u3 s��e.v �rnxt�:aas.es�i�Es bavc ' E emp o} s. Ti the;sub—o ha a 4rr s,.tia r larevs e a c s'ctnnp.,p92i n A'=rug eMPlo� elvta is.Owpa&cy,gn&T jA*sib } z�cfarmation. �( f�f�� t JMSManreCA7mr�E ATazre '+ ✓' t tl1 �-{f G�a.A 3'rb Site Addr=. Aftaeh a copy of thevorkeis t mperasafiamt poh d S�c� P {lists ei s €he pn3te re mh x anti e ma atr�n da Fm"bm to somm ooverage as rvjukcd andcr Socdm 25A of 1.40L c..152 cm lead to the bnp6sifkm of cam.genaWC&of a fineupto$1,SfU.t�C3antllci nneyear sxi .as"si+eilam vIgets iltf be fb=ofaSTDF WORK ORDE md a;fie €fup to 250.00 a day zgabast.tbr violatm. Vie advised thri a,capy of faij sue#may be fozwa ded tD Once of �vestigatioas e�f.*die�Z�for comae�ez�c�io�. - � - I do heznFry pins andP afp tFiat flee ix�cirn oaprvvi ed u8nus is#tee a carry i 2 Mne OLro `usd We orb Zia not reft.44 thisamm�to be rmptet=a 4.e&Y or toe Offhe4urZ. (X orTowm Permitucmse4 Undag Ardhority(drde one), L Board of Realth 2.BadbaggDepr`IT umf 3.City/Town Qerk 4.Elat 1cal bTeetDF 3.Flmaabtarl- ,TMspedDz 6.Other. �OIIf3C1�et"S4II: ��Ita[de.,'�: L......._... F > •���", '��.�� � � � Rod OT Oz or 0 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map J O-e7 Parcel Application # �)e I S p 7�� Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee �® Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address �`�O+(�l a.r,�, `�/�.� puk Village (�1 yA-AA z S OwnerO�VJv ' Address Telephone $(96` (" u' r�`� �)'e_W+oVJ n cr Permit Request 11'eGik_�r`2_44-Qn -T k e_ 'J► g1-7C r,"r,\"�`�n��s��A_A)rl aCZ k S O m.�1 2.0ty e-7v 2 w c9- d (' �� dt "nS�s pi a�1 CC\J�r r 4Jlwl� �J SfZ A_ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation S (0 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Q Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes Ao Basement Type: ❑ Full 2Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Dejached garage: ❑existing ❑ new size Pool: ❑ existing ❑ new size _ BarntO existind�❑ nev size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other" LL Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ , Commercial ❑Yes L1 No If yes, site plan review# ,a Current Use �Q-� //vCO�C� Proposed Use Q_�� 49— T' APPLICANT INFORMATION �^ (BUILDER OR HOMEOWNER) Name t�n�'�( �AatAy 501u,�'d^5 ,Lnc, Telephone Number -7 2 d Address O 2 (4l(W c Gk RA License # D fl Home Improvement Contractor# I ® —I Worker's Compensation #V WIC l bU `G(S 3 i s'-lilf ALL CONSTRUCTION DEBRIS R�ES�pULTING FROM THIS I PROJECT WILL BE TAKEN TO Anaa ` � 1 SIGNATURE I DATE 12411 FOR OFFICIAL USE ONLY i APPLICATION# DATE ISSUED '4 MAP/PARCEL NO. t ADDRESS VILLAGE OWNER t DATE OF INSPECTION: t+FFOU:NDATIONk FRAME INSULATION.+ :- i, FIREPLACE ELECTRICAL::-- .ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUYLDING ` DATE CLOSED OUT ASSOCIATION PLAN NO. .{ a 1 -1CL z 1 m ... t _ =L c o + 21 J ' �f�e�e�n»ixelrrrRavl�f��,f nrl��rrz;Frc�r�rsel� " t>flfke d&.r umer A$airs Basic Reg a€anon License oa registration valid for iii idui uSe 0 t NPRdifE:ENT'CONFRACTOR before the expir2tima date.If found return tw a istralivu: q pg 'Type-.' oirme areenwmer r+.ffaM and Business Ltegubdon ration: 18 rark:P#aza-Suite 5I7@ Boston,MA 02116 FRO"ER ENERGY SflLt#i fift]S FRPM13. 4:MLEt AN BREWSTER,mA o2631 UndersuTdwy ' l r �rts%zPatiare j Resricted Ta:CM-W--insulWnn cAntrattar . _ SoAard of�B satIding iegula�t�€dnls and Standards: FaBurep�iis Code 'e edirmn OF thef sachm-tis , State Ba g Code is cause mmocation of tift Ncem., J.e�+. �a_; ' — �4FcrfiPStte�sin�infaraian unvu� ssGoVJDS. Al e f • The Commonwealth qfMassachusefts { D an*ent oflnduslhaal Accidents Office o,f Invesfigadons 64#9 Nfasit soon creel Boston,MA 02111 wwm9.wass govldia Workers' Compensation Insurance AMdavie B ders/ContractorslElect ncean 'lu era Au�ticant ImffraatiQ�a ilea #Ee `bty Name(Bw row # sib): e- :. � `Rt .sd ^,_ T Address:SO QA Ci 1StatelZi .' P1ne : sire y_ou as employer?Check the apprapijate boy T project raj ( am a_employer With 4 0 I am a general contractor and 1 ` New commctida employees(full and/or part-time).* haxe.hired the suh-caut�ctorm 2, I am a Sole progrmetor or laar#mer- listed on time attache sheet:. . . 7. Iterrtodeling } ship and have no employees These sub-contractors#mane. . $ : Demolition ; working for me in any capacity, employees and have urkers' 9. �$uiltling addition {No workeas'comp_insure mee comp.insmmrarice. Tom- 5.0 we are a corporation and its l d.0 Electrical repairs or ad"ons � 3.,0 lam a hci�wner doing,all work:; officals have e7cercised them 11.0 Ph=birrg.repairs or additions. myself;[Nis workers'.coanp. tight of exemption pet i4fCtl� 12. oof izrstmmamxt:e requmr }1 c 152,§,l(41=and we hage no 0 . repairs 3a,.0 I oat a hcrmotswnec acting.ass einptayees(No vvvrlceas' gecterat'Contractor(refer to##) camp,:r uauce requnrs d-j t: ?.. -Any appIiesnt&a checks boa#I cos aiso:m out to smdon below.showiug ihi rronccts compowdofi0oficy infmmaitan. Hcmeownets Whasabi nt this affidavit intttmftg dWam doing ailwoelk and thenbav outside cronnactow must submit a new affidavit ind`iea g;etch. � tcon uctom*at cheek this box most atwhed au additional sheet showing thensaw o€ths sab-conttactors and state whedw or not*on caddes have ee� ifc salacx�atractoas have e emgiuy TApiayt�s.theiramastymi+ide;dsesr woe$crs enm¢:.poUsp:nnmber lam an employer t Bedew.is pei* jQb site in ornatiom _ Policy#or Self-ins.Lic,#: ir' L " " f (a E S raiion Date: Job Site Address: >� �y ':�`�r:c c l itytState zip. `l �.%�15 Attack a copy otthe workers eobmpeasntlon paUcy decf radon page( h.06N. ng.t .pokey numb4r and expiration date). : Failure to secure coverage:as required=der Section 25A of MGL c_152 can lead to tke.knposition of criminal penalties of a fine up t©$.1,500.00 and/or€xne:year imprison i2ent,as well as civil penalties in the form of a.STOP WORK ORDER.and a fine t of up to SM00a day against the violator.Be advised.that a_copy of this statement may be.Forwarded:to.the Ilffce of Investigations of the.DIA for insurance Coverage verification. 1 den hereby etrdr&vndTT a aloes is pen d ?o jperjury t the lnfbrrr q&n provided above is om d convcl 2� h - 0 4 t tl' ` oflr d rase orrly. Do nr t write in this arreti,to be torampdeterd by city or town af,fciat City or Town: Per mitUcense# Issuing Authority(eitle one): I.Board of Health 2.Buildiug Dejartment 3.CitytTown Clerk. 4.Electrical Inspector 5.Plumbing Inspector ti.Qther Conbet Person: Phone M 3/ 1,§/2015 12 : 35 : 39 PM 8626 2 02/02 i ® DATE(MMIDDIYYYY) A CERTIFICATE OF LIABILITY INSURANCE E/16/2015 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()es)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 00509-001 NAMEACT Jeffrey Ford. Rogers A Gray Insurance Agency AICNNo.Ext: (800)553-1801 Fiic.No.: (508)398-0246 434 Route 134 EMAIL South Dennis,MA 02660 ADUREss: NS RE S AFFORDING COVERAGE NAIC i INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B Frontier Energy Solutions Inc SU C: 502 Harwich Road Brewster, MA 02631 INSURER E: INSURER - 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. ItdSR TYPE OF INSURANCE tNS POLICY NUMBER � j FF) NOP )- LIMBS LTR GENERAL LIABILITY EACH OCCURRENCE., $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence t CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER:', �` PRODUCTS-COMP/OP AGG $ OLICY R� OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ - Ea accident ANY AUTO BODILY INJURY(Per person) - $ ALL OWNED SCHEDULED,AUTOS AUTOS BODILY INJURY(Per accident) $ . HIRED AUTOS NON-OWNED': PROPERTY DAMAGE $ AUTOS Peraccident - $ f UMBRELLA LIAB OCCUR- EACH OCCURRENCE $ EXCESS LIAB CLAIMSMADE ' AGGREGATE $ DEERDg C RETENTION $ 1 C g L� 7 $ Ai (dIPLc)YERPs�`LSABI�1 fY ; X TORY LIMITS I R AN PVRPRIETp RIPARTN€@1 CUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000.00 . A of ICt JMEEMBERExcLUuuttD ❑y JNIa VWC-100-6015315-2015A 3114/2015 311412016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 DSCF21eP5TI0t4 OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) � I , CERTIFICATE HOLDER CANCELLATION Town of Sandwich 16 Jan Sebastian Drive SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE - Sandwich,MA 02563 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED; IN/ ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD I 2630 �r �•�"7'` � �"' Ste` t� '� _ IRM v _ s r Town of Barnstable Final Inspection Affidavit Date: a Thomas Perry, CBO Building Division . - 200 Main Street Hyannis, MA 02601 d la a pia i0o RE: Insulation Permits Dear Mr. Perry, This affid3vA is to certify that all.work completed at: Street: : i5 I w Village has been inspected by a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds federal and state requirements. r s Permit application number: 2-6 GL0 6 2 Issue date: Sincerely, Francis`Sheehan President Frontier Energy.Solutions, Inc. 502 Harwich Road fey p. £ Brewster, MA 02631 k Office: 774-237-0410 Email: fssfrontierener mail.com ■ _ _ _ HH _ - _ - _ _ _ g _ ■ ■ 00000000000000;00000..000=00a0aooao0o0o000. �o . ■ 0a` 00000000000- 00U0o0000o00aU0a000-00000.-000 0 ■ ■ 0. a.00o0a0o00oa00000000000- 00U- 0a0000, 00a- 000 0' ■ 0 ° 00. 0000 '00000000.000000000000000000000000 0 ■ ■ 0 00000 VD ] 000 .0000000000 -00,,000000000000000 0 ■ - _ - - - - _ _ _ - - - = = _ _ _ _ - _ - eN Scan this sheet to align•cartridges. ' - O Numerisez cette feuille pour aligner les cartouches. 1 R Eseguire la scansions del foglio per allineare le cartucce J ■ ►I►fl�: � of Zum Ausrichten der Patronen these Seite scannen. 1111111= Escapee es to p6gina pars alinear los cartuchos. �� Nl Scan dit vel am de cartridges uit to liinen. of ozlz _`tH tFoj zlzlz iMtl- Ir-f. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION OF AARNSTAp.Le Map 3o I _ Parcel )`TS Application Nb(-aast Date Issued Health Division All 10- 06 top Conservation Division Application Fe Planning Dept: Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 3-? cal a(_ Village 4-4(A\rWN'\ T J Owner Address 9 J Api l -Ly) Raikurv.� CST ow 3 Telephone Permit Request Y\ os�c L�4 \r,// R-4a1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation .03 Construction Type -� Lot Size oaf .rz%S Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 1930 Historic House: ❑Yes 5k No On Old King's Highway: ❑Yes -9 No Basement Type: IUFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name `n�� S 56J(y) Telephone Number 7��' �3�7 - 4 � Address 9 J License # 10 59q 1 M A Oa- I Home Improvement Contractor# ( (OA 5LI Worker's Compensation # 00 2(5315--a0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PRO EST WILL BE TAKEN TO SIGNATURE DATE i' r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED F�• MAP/PARCEL NO. ADDRESS VILLAGE i OWNER DATE OF INSPECTION: hf 'F �'� ;�wFOIJNDATION��r-rs;:a.: alc..rr, z �,+aurr�s� FRAME INSULA(TIO.N, o, `Y F FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL k FINAL BUILDING" n DATE CLOSED OUT ASSOCIATION PLAN NO. y e The Comm I onwealth of Massachusetts , Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auolicant Information Please Print Legibly Name(Business/Organization4ndividual): 5 Address:- City/State/Zip: �6Zi�..r c'�a,631 Phone#: �?7 - a�j� - C-)q 10 Are you an employer?Check the appropriate box: . I am a general contractor and I Type of project(required): 4 1.a am a employer with L6 ❑ g employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' ! 9• [No workers' comp.insurance comp. insurance.= ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. officers have exercised their I am a homeowner doing all work 11.0Plumbing repairs or additions � myself. [No workers'comp. right of exemption per MGL 12 ❑ Roof repairs insurance required . ]t c. 152, §1(4),and we have no 3a.❑ I am a homeowner acting as a employees. [No workers' 13.12 Other 4�) A\hQ f 1 J\ general contractor(refer to#4) comp.insurance required.] ;Any applicant that checks box#1 must also fill out the section below showing their workers'compensatiod l)olicy information_ 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 state whether or not those entities have employees. If the sub-contractors have employees,.they magi provide their workers'comp.policy number. j I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: G\ ��j`/ (�Y-\u, Co Policy#or Self-ins. Lic.#: 10 0- pl 3 � — Expiration Date: 3 1 y S Job Site Address: 3� r4��v��d 3�e , ,n,(} 1 5 j�/ 0��c7 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 S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct i s 4 11 jib l la Da Phone#: a- F l use only. Do not write in this area,to be completed by city or town official City Town: Permit/License# Authority(circle one): d of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector r t Person: Phone#: 1z Information and Instructions 3 Massachusetts Cenral Lawn chapter 152 require all employers to provider worker'compensation for their employees. pursuant to this statute,an usp1e)w is defied as"...every person in the service of another under any contract of hire, express of implied,oral or written." An a xplow is defined as"an individuat psrtoash*association,corpofatiaa or other legal entity,of any two of more of the foregoing engaged in a joint enkggis%and,including the legal of a deceased emploM or the receiver or ttmstee of an individual,partoershipr association or other kgal entity,enVloying employees. However des owner of a dwelling boat having not mere than three apartments and who reside thereita,or the occupant of the dwelling house of another who eapbys pawns to do maintenance,construction or repair wait on such dwelling house of on the grounds of building appurtenant dordo shall not because of such employment be deemed to be sa employe:" iMaL chsptw l52,f 2 q6)also states that"t►ery stab w heal lkuWsg agrney shale wlthholti the lssaaaa er renewal tf a Henn w prank to opmb s bvdaess or to contract buddlap In this esssaoawtsith for any a ho w bse not satable evidence of compHana with the lasnraaa eoversge regdreV Addid=Wly,MGL chspw 1522,¢ ap2SC(7)states"Neitha the coasaonweahh na am of its political subdivisions shall eater into any contract for.tbt paformance of public wak until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Appffmts Please till out.the wrorirars'compensation affidavit eomplelely,by checking the bores that apply to your situad w and,if necessary,supply s)name(s),addresa(es)and phone number(s)along with their cati8cate(s)of j insurance► Limited Liability Convania(LLC)or Limited Liability Pa waships(LLP)with no enwloym other than the members or paumM are not required to carry worlters'compensation insurance. 1f an LLC a LLP does have erployeea,a policy is repaired. Be advised that this affidavit maybe submitted to the Department of Dial Accidents for confirmation of iumance cove:age. Aloe be aura to sty and date the alfldsvtL The affidavit should be rearmed to the city or town that the application for the permit or license is being requested.net the Department of industrial Accidents. Should you have any que:<ioo-regarding the law or if you are required to obtain a wcakets' corms policy,please call the Department at the member listed below. Self-insured coma should enter their self-imsuaaect license number on the appaopfiatt lint. i i City or Tewn Onkfab i Please be sure that the affidavit is complete and printed legibly. TU Department has provided a space at the bottars of the affidavit for you to fill out in the event the Offce of Investigations has to contact you regarding the applicant Please be we to fII in the perimNlicem number which will be used as a refame member. In addition,an applicant that mast submit multiple pamigliceme applications in any given year,need only submit one affidavit indicating current policy khrundoa(if necessary)aid under"Job Site Address"the applicant should write"all locations in (city or town"A copy of the affidavit that has been officially stamped or marked by the city at town maybe provided to the j applicant as proof that a valid affidavit is on.fie Loa Batas permits or licenses. A new aidevit must be filled out each year.Where a home owner at citizen is obtaining a license at pamit not related to any business or commercial venture (i.e.a dog license or permit to burs leans etc.)said person is NOT requited to complete this affidavit The Off cs of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call Rae Department's address,telephone and fax numbest: Commonwealth of Massachuse The C tb Department of Industrial Accidents Oaf ee of Investipatlons 600 Washington Street Boston,MA 02111 Tel. l#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised I1-224)6 www.mvs. gov/dia '3/ 18/2014 1 : 10 : 10 PM 8740 ® 03/06' .NCO vR CERTIFICATE OF LIABILITY INSURANCE 03,18 12014 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), AUTHORED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:H the certificate holder is an ADDITIONAL INSURED,the poficy(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 endorsemerrt(sj j PRODUCER 00509-001 CT Jeffrey Ford ' Rogers 8 Gray Insurance Agency PEA�/CA.`No : (80015534801 Fax_No (S0a)39a-024e 434 Route 134 ADDRESS: South Dennis,MA 02660 INSURR(S) COVERAGE INSURERA..A.I.M.Mutual Insurance Company 33768 INGWRED _ Frontier Energy Solutions Inc INSURER C 602 Harwich Road INSURER Brewster,MA 02831INSURER 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 NTH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERON IS SUBJECT TO ALL THE TERMS, ' EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN R TYPE OF INSURANCE I S°R POLICY NUMBER pPO p �jjlj� K LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY DAMAGETOFMED PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S LICY E� OC -1 AUTOMOBILE LIABILITY / (Eaa $ ANY AUTO BODILY INJURY(Per person) $ ALL OV&RIED SCHEDULED BODILY INJURY(Per acadmQ S AUTOS AUTOS _ HIRED AUTOS NON VMM PROPERTY DAMACE $ AUTOS Rar aed i $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS MADE r. AGGREGATE $ ' DED RETE(TION S S x N EL.EACH ACCIDENT $ 1,000,000.00 A WM�M� Y NIA VWC-100-6015315-20UA 311412014 3/14/2016 �(�Myaanndatory in tNf i)) EL DISEASE-EA EMPLOYEE S 1,000,000.0000 C1�OF OPERATroNs bHow EL DISEASE POLICY LIMIT S 1,0 ,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 1(H;Additional Remarks Schedule,If more space Is required) v - ) CERTIFICATE HOLDER CANCELLATION ' Town of Sandwich l 130 Main Street SHOULD ANY OF THE ABOVE DESCRBED POLICIES BE CANCELLED BEFORE Sandwich,MA 02563 THE EXPIRATION DATE THEREOF, NOTICE WILL BE,DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORS REPREsmATiVE 01988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2018105) The ACORD name and logo are registered marks of ACORD 3201 i 71 &Iirwollwealflj o/-n�i�aur�c�i�se/tc Office of Consumer Affairs&Businfiss Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ istration: 160854 Type- Office of Consumer Affairs and Business Regulation piralion 9I8IP01li . LLC-._-- .. 101•ark Plaza-Suite 5170 _ FRONTIER Boston,hU 02116 ENERGY SOIUTfONS_- -_ t ppp FRANCIS SHEEHAN a 502 HARWICH RD BREINSTER,AAA 02631 Undersecretary t va' with t signature J 1 Massachusetts-Depaebnenz of Public Saidty Restricted To:CSSL_IC-Insulation Contractor Board of Building i3egulations and Standards Con-structi{n.Suawrt isor Speck t_irose'CSSL 105941 .: FRANN�CIISSWE - 11RWSr ATi . fir, d Birms erMA :OZ631 Fa�1ure to possess a current edition of the Massaohuse State Building Code is cause for revocation of ttus tioerse. �e til;Z ExpirationForDtKGcevainginfam,ationvisit wwwMassGov/Df►S - Commissioner 02J17W16- y _ 1 r , r 1 - OWNER AUTHORIZATION FORM Wu-j u,r (Owner's Name) r owner of the property located at 3-7 ' f�a-'r'ycLrJ S+rr-e C:+ r (Properly Address) • S as (Property Address) hereby authorize �`f! (Suboo ) an authorized subcontractor for RISE Engineering,to ad on my behalf to obtain a budding permit and to perform work on my pr - Owner' 1 t. r- - TOWN OF BARNSTABLE,*BUILDING PERMIT APPLICATION Map 3L2 Parcel /��'�6 J3� Permit# Health Division Date Issued — �^ Conservation xDivision ` , - Fees d a Y Tax Collecto ti Treasurer L2 1 Planning Dept. , Date Definitive Plan'Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address'Village - Owner ,� Address Telephone / `7Z 3 ,,� l Permit Request .Q Square feet: 1st floor: existing '1 proposed 2nd floor:existing ' proposed Total new Estimated Project Cost Zoning District Flood Plain' Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes,attach,supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic'House: ❑Yes ❑No , On Old King's Highway:, ❑Yes ❑No - Basement Type: ❑ Full- ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing : new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No' Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new soze. Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ -Appeal# Recorded❑" ,Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use- - 6 BUILDER INFORMATION ,sy Name Telephone Number ' J1 a/) Address (J r License# (l��;3� i Home Improvement Contractor# Worker's Compensation# 4A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 919 r a _ FOR OFFICIAL USE ONLY r PERMIT NO. DATE ISSUED MAP/PARCEL NO. ' • -i .. • •/ , ' i� , , . } C- , - . •'. .. .. "•'y ,1 i - ,yam { ADDRESS � - P. VILLAGE OWNER i - ..J * ''"£ �„- _ • . - , . .i a ;:,y j _ ." . DATE OF INSPECTION: - - - FOUNDATION FRAME INSULATION } .FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINALt GAS: ROUGH FINAL: FINAL BUILDING•. ' - z ; '_-, __ ,• .•. _ �.�' • =• �! ' DATE CLOSED OUT ASSOCIATION PLAN NO. ± ;- �TMe . . °: The Town of Barnstable • i3AitNtsrABU& • MAM Department of Health Safety and Environmental Services '°rFo Me't" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ed Type of Work — Estimated Cost - D 10 Address of Work: Owner's Name: / Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law []Job Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit the agent of the owner: 1JI(IIQ 9 Date ontractor Name Registration No. OR Date Owner's Name q:for►ns:Affidav iiic Luminuitweaiin uj iviassacituseus w' = Department of Industrial Accidents ?� Office O/iffres oollaOS 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location- city hone# ❑ I am a home+ er performing all work myself. ❑ I am a sole r rietor and have no one workin in anv ca acity FE W �am an emplo er providing workers' compensation for my employees workin on this 'ob. g J om andname.' address. c } "i A i tt insurance G. r ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices comvanv name.. address: :.::.:::::................ i .;:;::...:..........::::.:. � _.;....... :; .:::. »; ,. oircv# lx' �. .. ..:..:..... c, anv:name :;>: omp :.;:;::.;:.::.;:.; :;•;:.;::.;;:.;:;.::.;:.:...... address. ' dtv :bhbne#: ................... ........... .................................... n�nrance:co: - T .>.... w �i Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crinrhW penalties of a tine up to 51 imoo and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understnud_thd a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. 1 do hereby certify the p penalties of perjury that the information provided above is tr�u/an eorre Signatures . V Date Tg Print name t100 t I Phone# official use only do not write in this area to be completed by city or town oincial city or town perndt/license# ❑Bufiding Department ❑check if immediate response is required ❑Licensing Board ❑Selectmen's Office contact person hone#; ❑Health Department P ❑Other Oevaed 9/95 PUU � fie �a�;►�r�ovuueIz�C�i o��.G�Qcx�;`ucae�• i. HOME IMPROVEMENT CONTRACTORS REGISTRATION j Board of Building Regulations and Standards i One Ashburton Place — Room 1301 I Boston , Massachusetts 02108 I I HOME IMPROVEMENT CONTRACTOR Registration 103714 Expiration 07/09/00 I Type — PARTNERSHIP _67L HOME IMPROVEMENT CONTRACTOR I Registration 103714 PAUL J . CAZEAULT & SONS ROOFING Type - PARTNERSHIP Paul J . Cazeault I Expiration 07/09/00 22 Giddialt Rd . P .O.. Box 2781 ! Orleans MA 02653 PAUL J. CAZEAULT & SONS ROOFI Paul J. Cazeault G� �o 7f � iddialt Rd. P.O. Box 278 I ADMINISTRATOR Orleans MA 02653 Oi'•!1: ;';.`.:;IIE::UI 1011 1'1 A(T, 10i ).;;4' '1 Et U`il'( fxl:. ''f4f1 4) .4?.3 :l.0 l..:; i'Ui'.I ;I;:IJi1I(Jhd .;111'C:1t�✓:I::iUli L.f.t:l'IWO' - f X pi r i :,: I,iS I� ki+ef►aka. 27 x t a F x f kF t LII 1 — I?:;I Iz'•J I I,L.I;, i1r1 VJ<'.(i.'S5 ... lift.'O i.,o1) 1QI' !"^C::' .f)1; i_)j floi.l 11.c,:I1...I. -' 411 9/3C -V/tYpt4lt09tIIMQ�� Of a.!(lIJJ(Lf.�(IJC�IJ P.rr DEPARTMENT OF PU01.1f. SAfFTY CONSTRUCTIAH SUPERVISOR LJCENSE F Number: Fxoile<: fil!hil,ae: CS 026325 10j10J;�)S i�l.:Pl.�Sy ') Reskricl'ed To: 00 I "''frOL J CAZEAULT i ISBS MAIN ST i OSTERVILI.E_ MA 011655 ��