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0003 LI'L LANE
ACTIVE .rz TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION rt ?2 Map Parcel:', Application `� 1 Health Division Date Issued 3 .'I Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive PlanApproved by Planning Board G 3lll�� Historic - OKH _ Preservation/Hyannis Project Street Address 3 Z-( 'L LAI, Village �`--" • /1/tlni�f Owner Address 6- Telephone 9 7 F 7'67 / 9 9 Permit Request ' " 1.S7,0 N / .� C� �r�e4�� �-e n C_� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation/C 06 0 Construction Type Lot Size -59, M6 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family V Two Family ❑ Multi-Family(# units) ck Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's"Highway: L)Yesz LJ 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 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 's ��� � G ' Telephone Number 3_6`d :3 6 1-( Address b 1 tZT6_ F License# ov YA-A Dtis ,/fora o2�e4 Home I provement ontractor# Wor is Compensatio # VrL% (J to d0. ALL CONSTRUCTION EBRIS RES TING FROM THI PR JECT WILL BE TAKE TO 2 11A-oo SIGNATURE DATE I a t �� I t x { FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. b - j 1 i ADDRESS r, VILLAGE OWNER 1. 4 DATE OF INSPECTION: FOUNDATION FRAME INSULATION ';F FIREPLACE s ` ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL a a FINAL BUILDING = DATE CLOSED OUT — Il ASSOCIATION PLAN NO. APPLICANT INFORMATION (BUILDER OR HOMEOWNER)- - Name t�,rk � � �� ���- 5 _—Telephone-Numb Address-----t �=VA R License# C H L-L ! ( L�112 / to D(92 I Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO CSIGNATURE DATE-'j 2=- «-2 0l y ___--- s ppTME ram, Town of Barnstable Regulatory Services • BARNSTABLE, y MASS. Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 February 17, 2011 Juergen Keller .4 Nevada Drive Chelmsford, Ma. 01824 RE: 3 Li'l Lane,Hyannis, MA, Map253 Parcel 013 .002 Dear Mr. Keller: This letter is to follow up on a violation of 780 CMR at the above,referenced address. An existing fence was increased to a height in excess of twelve feet without the benefit of a building permit. You have applied for a permit; however, the construction documents were lacking all of the necessary information needed to issue a permit. I have spoken to „ you about the additional needed details some time ago and have yet to receive the required information. The violation remains and over three months have elapsed since you were first notified. You are hereby ordered to bring the property into compliance immediately by either removing the unpermitted work or obtaining the proper permit and constructing the fence in accordance with 780 CMR. By Order, 06®re�y L Lauzon Local Inspector (508) 862-4034 Q:zoning5 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. 600 Washington Street j Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly riName (Business/Organization/Individual): _J Addres �rU 70 City/State/p G�� �iJt�� c'D� Phone #: / 16— Are you an employer?Check the appropriate ox' Type of project(required): 1.❑ I am a employer with f47`0"I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El 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. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and'its required.] officers have exercised their 10.❑ Electrical repairs or additions M�I am a homeowner doing all work right of exemption.per MGL I LEJ Plumbing repairs or additions E myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ 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 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 f e DIA for insurance cove ra verification. Ido ereby ce i under the pains d p n ies ofperjury that the information provided above is true and correct. [)_u Dates �. Phone#: 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#: 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 service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house '' or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local 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 produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the . k members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications.in any given year,need only submit one affidavit indicating current policy information(if necessary)and 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 or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is,obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office 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. The Department's address,telephone and fak number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 611-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-OS Fax # 617-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts Department of Industrial Accidents 3 Office of Investigations d 600 Washington Street' Boston,MA 02111 www.mass.gov/dia Workers" Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �Af C (f_®® F_E..A C_JF ICY ' Address: I D 9 3 City/State/Zip:, 3 oX AIA bo W Phone.#: Are you an employer? Check the appropriate box: ;Type of project(required):. 4. I am a general contractor and I 1.�I am a employer with�_ ❑ 6. [ New construction . employees(full and/oxpoit listed on the attached sheet. 7. ❑Remodeling -time),* • have hired the sab-contractors 2.❑ I am a'sole proprietor or partner- ship and have no employees These sub-contractors have g. 0 Demolition workingfor me in an capacity.. employees and have workers' y 9. ❑Building addition [No workers' comp.insurance comp, insurance.$ 5. [] We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work . officers have exercised their 11.❑Plumbing 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 13.❑ Other employees. [No workers 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: _ AND (5 6 20 u-p __17"%C . — Policy#or Self-ins.Lic. #: we—% lq (o og L( _ Expiration Date: 1 /it Job Site Address: 3 Li'L L14J City/State/Zip: �✓�T^enfi l�� .A44. 00A le 3 A 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 1 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 4' Investigations of the DIA for insurance coverage verification I do hereby certify under the pains-,and ppenalties of perjury that the information provided above is/true and correct. Signature: �" (" Date: /2-[/3 l v _ Phone#' 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): A.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Pursuant to ----- express or implied,oral or written." An employer is defined as "an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a"deceased employer, or the receiver tr or ustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local 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 produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter..152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of co nplianee with~the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es) and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members*or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their . self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly.-The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple perm.it/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and 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 or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. "A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office 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.- ., The Department's address,telephone-and fax number:. The Commonwealth of Massachusetts cpa xzeut of z�dustrial A..ccxdents Office of luvestlgations 600 Washington Street Boston,-MA 02111 Tel. # 617-727-4 900 ext.406 or 1- 7'7-MASSAFE Fax## 6.17-727-7749 Revised 11-22-06 www.mass.gWdi SEA TZ' h i sT C---P L-A u 2 vry A -ie 11 A L 6-r OF --b�--LA (-T H R tA'Y A� l L -r U)1-7- Fi X/A L I- C�( U(F- 9 OU F5BR, 17 2-011- Itl ,T, C-Ar-Tc--p TO ybut (-EFFRZ -r up- (o -TO C) 'W - eI+Atc- 3 -04cv I u / 11 14 ct+ 20 1,4A( L I /k 173 L To GLT t--O�Ul OP ID EE DATE(MM/DD/YY`yY) AW D' CERTIFICATE OF LIABILITY INSURANCE DAVEN-1 06 14 10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Addis Group, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 2500 Renaissance Blvd. Ste 100 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. King of Prussia PA 19406-2772 Phone: 610-279-8550 Fax:610-279-8543 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: American Zurich Insurance Co. 40142 C pe Cod Fence Co. INSURER B: Zurich American Insurance Co. 16535 c o Davenport Realty INSURER C: S ephen Aschettino 20 North Main St. INSURER D: South Yarmouth, MA 02664 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD EFFECT E DATE MM/DD Y) LIMITS GENERAL LIABILITY EACH OCfO-RE CORREN C $CE $ E— COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) CLAIMS MADE DOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JECOT- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 B ANY AUTO BAP8196256 03/01/10 03/01/11 (Ea accident) X ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) X Comp $250 PROPERTY DAMAGE $ X Coll $500 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND JL I TORY LIMITS ER A EMPLOYERS'LIABILITY WC8196024 03/01/10 03/01/11 E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 Ifyes,describeunder E.L.DISEASE-POLICY LIMIT $1,000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Informational Purposes CERTIFICATE HOLDER CANCELLATION EVIDEN- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Evidence Only IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTH ENTATIV 4 ACORD 25(2001/08) ©ACORD CORPORATION 1988 O Town of Barnstable Regulatory Services " sAx/sTnstE,ss. Thomas F. Geiler, Director tr a Building Division 4 Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 5a8-862-4038 Fax: 508-790-6230 ------------------------- HOMEOWNER LICENSE EXEMPTION Please Print qq DATE: 12— �0Brt:oc_-ATr=10N.3 L 1 rL L=A/Tn� 14.LE number �) street�C (� ,(� / village 01.FIOMEOW7VER" �--J "�'1►L /� 1 / �`- ` �U CJ-(/S3 name home phone N work phone H CURRENT-M:ALCN_G=ADDRESS. EU� A- /L/E �c-+r=r,.r s roe; y l city/town state zip code The current exemption for"homeowners" was extended to include owner-occupied dwellings ofsix units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF FOMEOWNER Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit (Section The undersigned'-'homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. 4Thedeigned"ho eowner' certifies that he/she understands the Town of Barnstable Building Department minitnitm inspection and requir m. t he/she will comply with said procedures and requirements. owner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section.127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which it building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing ofconstruction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work, that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly whet)the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she'understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. of THE Tp� it 3 • MRNSTA➢LE, ' Ass. � 1619• 1b Town of Barnstable �rfD MA'S A Regulatory Services Thomas F. Geiler, Dire or Building Divis' n Thomas Perry, BO Building Com issioner 200 Main Street, H nnis, MA 02601 www.town. rnstable.mn.us Office: 508-862-4038 r Fax: 508-790-6230 � Pr ert Owner Must Comp ete and n This Section If Using A uilder as Owner of the su 'ect property hereby authorize to act n my behalf, in all matters relative to ork authorized by this building permit application for:. (Address of Job) , Signature of Owner Date Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on'the reverse side. 4 �I 5 00D g�b/L ` q 04 15 (h ADS M, , 411 _ f f r 7 i ' -• r- .Ip I _. - �.;..... ..._( 4"T .: g...MC:�►S'._t-�T,:.._.. ( } �p'p, µ rnp� of..; 2� T _ v 5 H OF q, q0 �o MICHELEu tiG f CUDILO m NO.34774 STRUCTURAL PROPOSED MODIFICATIONS MICHELE CUDILO, P.E. Ait� Consulting Structural Engineer 123 Cottonwood Lane, Centerville, Massachusetts 02632' Keller Residence Fencing Drawn By: MC Date: 12/28/10 814 OLD STRAWBERRY HILL RD. Scale: AS NOTED Rev. o _ Drawing CENTERVILLE, MA S K- 2 File Name: KELLER Project No.:2010-31 t �� ►HOFr 10, lf��Ev�fiO -ro 11. ,147, MAY SOL lb f4-,-t4&r5; CU€3IL3 STRUCTI R A: s''A 010 • .;� FENCE P05T%AST1 A3la r _ l►D ow FENCE r 60TTOM RAIL 11/2"(TYP) 3/4"(TYP.) TENN15 COURT PAVEMENT t4A OR SURFACE 5Y5TEM TOP OF FOOTING TYPICALLY ~ BELOW COURT SYSTEM r -III — OR CONTIGUOU5 TO T—`— E COOING (NJ A) �' ►I �I��IIII�I � C014CRET•:• _ _ v 'Co McAC1-ED CRUSHED Lli —� STONE BA5E COUR5 0tLk .' j cj�u- N I . .. .; I _r_ 4• 1 ' .t 5ET P05T IN SLEEVE(OPTIONAL) 6" (TYP.) �. CONCRETE POT FOOTING ►= _ 2 A FOk p05T T 1p. NOTE #2: , FOUNDATION DEPTH MAY VARY WITH ',OIL TYPE.P05T SIZE,WIND l.0A05, WOOD TYPE,SPACING,HEIGHT, OPENNE55&FA5RIC 5ELECTION. 19 FENGE p05T5'SECTION5 - TYPICAL CL1~ NOT TO SCALE 1"(Inch)=25.4mm 1'(foot) 305mm �C lA c 42FPO5T1.AVL,09 sr 'g ILOM G fi�'1Z.1/�t►1 �-� /�/A r _7AU CLCION Iil ?III PRAWING5 APE ILLU5TRATIVE Gr'dLY ANp A5P,^ANP U5rA �p'1 (hIII�IUt�> A�o,Irlur � ACCEPT NO KWONSNLITY FOK JA USE. , l(p, I l , SJNIll3Ma M3N UOd a3uinC)3d S11W83d l,3NVdn000 r d./r •eNs . odNs� p/ =d Q7 9G'LL�it b'M J/78/)d 03/V/��70N/7 1� Off) 0 - 77/H �C2�2� BMb'�1S s 86 �s/ sho l o , 9S,4S•.a0 f No M O/'riCr .: SS�N1Sng � � oi, r,;'•�.`' ��,���'' ��5 bLlf9/� Z^ 1L'6y 2 d �n 3l� , A n{ 00 z . Nr.op.00ags_ / aooZ _ k: .•'� „ Q�''. .�'.' . pal �A \p 0 _ os'9S - _ by��a� �f � •� ��,S�z�o Q ,L1 .•dF 2e/o$ .• � � Z: 7 O , .. 0 n A� f>DZA tv 3de7s bow 1 8G 60/. _ I�_� _ r' t vq do �a.vov 7 NS a 7 r.d 1 L t; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION uMap 0—53 Parcel__ 0(3 y 06?, Permit# q�&f, Health Division Date Issued Conservation Division 9 Fee �.� Tax Collector - ►� � � � `�`�� � Treasurer �c��t�� /� ���lSl SEPTIC SYSTEM MUST BE Planning Dept. STALLED IN COMPLIANCE ei WITW TITLE 5 Date Definitive Plan Approved by Planning Board PJ I� VIRONMENTAL CODE AND Historic-OKH Preservation/Hyannis TOWN REGULATIONS Project Street Address :Village Owner -�U��(pL—"1V� � T/� �L=LL�:� Address ' GUC(9 �� G H Telephone 2-56 0 0) Permit Request — RA&n Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost l q 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: Cl 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 Al 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 Cl 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 BUILDER INFORMATION Name aq22112 4 Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION-DEBRIS RESULTING TOM THIS PROJECT WILL BE TAKEN TO SIGNATURE'\41 DATE..,, l FOR OFFICIAL USE ONLY PERMIT;NO. _ DATE ISSUED. MAP/PARCEL NO.'* ; i ADDRESS VILLAGE OWNER 'DATE OF INSPECTI FOUNDATION " FRAME - - INSULATION FIREPLACE ELECTRICAL: ROUGH - r FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH f. `f FINAL FINAL BUILDING'DATE CLOSED OUT s , ASSOCIATION PLAN NO. SJNIl13M0 M3N dOH 43uinC)3H S11W83d k3NVdn000 e s v•l 0 dye/, �Z£"9o/ eAWAf 0/78/7d 47;9,V /�O/V/7 1d'Qi> Q� £!S" Z¢'99- r o0 s 77/H CgV2V--7BMb'&.LS .'ems oc£E?,�lc �9� OVA' " JW � a o fi o� z• 2 7,: 9S,[,S.ZO S a 3 r4 -4 t 6 6-01) 00lvg '662 .. ff - o0 Sz . o0 0Z1 y \� 5\ �o OpE v06 - d may.!/N .Oe, 05"gS A 14 1l t • to } 14 � f• `��. �1.r � r . ' �'�' ate', ��` �' f tzeiogveep lz 03 ' V r 4 Naw9s V.7 r 1 y I r —-�� S!f�2 Ahiv arm nso�� a.os 9L 60/ t VZI _ \ ,.x '(y➢ Eat -vt ���- \\\\\\ .\\:- �� +may.. j' ► t. . , -:` a >4 a149P � ` 06 Y� d ; Mp7 esr 367 Main Street;Hyannis MA 02601 t� g �tw►ts' ' Office: 503-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissi: HDMEOWNER LICENSE EXE14 MON / ,/ p• Please Print DATE. JOB LOCATION: �� l �L number sasot village -Homww .w. J UC— V--L Z,f- 2 5^� A-�-3 7 9 7,F—2SG �e home phone h work phone s CURRENT MAiI.ING ADDRESS: jq eityitown state tip code The cm,cat exemption for was extended to include owner led dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, that the owner acts err=gib DEFINMON OF HOMEOVAM Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered, a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that heisheghall be=onsible for nit such work rmfwmedunder the buildinggpermit, (Section I09.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building De eat minimum insp 'on procedures and requirements and that he/she will comply with said and o meowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEA'IPTION 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 109.1.1-l icensing of consuucdcn Supervisors);provided that if the homeowner engages a person(s)for hire to do such wort that such Homeowner shalt act as supervisor." Many homeowners who use this exemption ace urtimm that they arc attuning the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for L3ceruing Construction Supervisors.Section 115) This lack of awareness often results in serious problems.paaiculariy whey the homeowner hires unlicc and persons. In this case.our Board cannot proceed against the unlicensed person as itwouid with a licensed Supervisor. The homeowner acting as Supervisor is uldmateiy responsible. To cum that the homeowner is fully aware of his/her responsibilities.manY communities zequ=as pen of the permit application.that the homeowner certify that he/she undetstaads the responsibilities of a Supervisor. On the last page of this issue is a form curr=suly used by several towns. You may care to amend and adopt such a formlcemfrta;tion for use in your community. Q:FORMS--lD<EMFIN �IOV, �s od 'f Application number Fee.............. 1.... ... .............................................. Sit�s'ri►s[Z'. �, Kgg Building Inspectors Initials....................................... ��� Date Issued................................................................. 9 2019 To SII`i ® � RNpD Map/Parcel... ... �.3, .04 .,�..... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project ! _La rL. - --- NUMBER STREE K VILLAGE R Owner's Name: So r, Phone Number Email Address: }j±q 1 66'►V\ ;N3S7 @ 9 O/-Co," Cell Phone Number Project cost$ f�,000, f'� Check one Residential�� Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize �l`� r� . Vt.�, to make application for a building nermit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK © Siding 0 Windows (no header change)# 0 Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to rmo� 1 CONTRACTOR'S INFORMATION Contractor's name_ t C►' L r0/ K le— Home Improvement Contractors Registration(if applicable)# y ��3 (attach copy) t Construction Supervisor's License# CS (DF-6 (2 (attach copy) Email of Contractor&i`e-d row ne �,� � cox-i Phone numbe ALL PROPERTIES THAT HAVE STRUCTURES O R 5 YEARS OLD OR IF THE SUBJECT PROPERTY-IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. 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 Fuel source being used LP tank 201bs. or>Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. 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 � 4 Date All permit applications are subject to a building official's approval prior to issuance. rL Commonwealth af-Massachusetts 5 ' Division of Professional Lic ensure Board of Building Regulations and Standards Constvpj�ti'bz Sb'pervisor CS-086694 _ � E� Tres 10/0912019- e� sW iq , ERIC J ARONNE `� = , Cort§truction Supervisor , which contain 14 CYGNET ROAD': � ) " f , 22 � 4 UnrestrictedL-Bdildings of any use group WEST YARMOUTH`MA 02673 a rr less than 35,000 cubic feet(991 cubic meters)of enclosed ETC>> O�S v r space. Commissioner l/^'"'. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this massSeovld I Call(617)727-3200 or visit www. g p ackoe office of Consumer Affairs&Business Regulat i.n Registration valid for Individual use only HOME iMPROJEMENT CONTRACTOR before the expiration date. If found return to: - .. TYPE:Individual Office of Consumer Affairs and Business Regulation Registration Elation 10 Park Plaza-Suite 5170 _ L8233 09/13/2019 �' , � Boston;MA 02116 ERIC ARONNE-I_=` J.ARONNE ERIC 't,. "; { r � Not valid without signature .14 CYGNET RD. _ 1'.. W YA.RMOUTH,N1A 02673 Undersecretary ;. s ¢ ., �- The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,ALL 02111 www.mass.gov/dia t Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /)Please Print Legibly Name(Business/Organizadon/Individual): I' �_CO_yl Address: f' City/State/Zip: rlvilLd5)ct T GIX W,40J61 J Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. -1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working forme in any capacity. employees and have workers' r # 9. ❑Building addition [No workers' comp.insurance comp.insurance. El required.] 5. ❑ We are a corporation and its 10.❑ ectrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing 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 employees. [No workers' 13.❑ 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 providi workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: I ✓1�l C- Policy#or Self-ins.Lic.#:� V y 7 cOO y Expiration Date: Job Site Address: 0 J 011r Sira z berf,/ d A J tJ City/State/Zip&ALery 1 09-6 3 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: /1�51Sz i Phone#: 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#: 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 service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local 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 produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and 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 or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office 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. The Department's address,telephone 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 Fax#617-727-7749 Revised 4-24-07 www.maSS.gov/dia . Vo To r �� � � �) ear �2 !� ��► : °� Y q � ►v!�- ()v7 lb i A-ve- o;—u J 13,E� � e to 0 A-6z-H o'�,I & THE C16,A CV w� / Ci44 PROPERTY INFORMATION y Mns4 �a $Atf1 MA'S 0�0 Town of Barnstable, MA Property Information: Owner Name: GIBSON, JOHN E & HOLLY T Address: 3 LI'L LANE, HYANNIS Parcel ID: 18840 Zoning: SPLIT Property Use: 1010 Taxes are Due: Please consult the Tax Office before applying for this permit . Town Hall 367 Main Street, Hyannis, MA 8:30 am - 4:30.pm 508-862-4054 �„ ► I MICHELE CUDILO , P.E. Consulting Structural Engineer Centerville, Massachusetts 02632-1979 1 Town of Barnstable Building Department 200 Main St. Hyannis, MA 02601 j 1 i �jEi I � ' II _ _ --- _.-._. � f t i 1 _ i � If 4 4 1 f 1 ., � kN ' ��. �/ �.. ry D .�: i Oct ,3� 29.9e0 4�3�6 M r1 70 5 74 1949 P, 2f8(MM1DONY)A Li_;'. - - FIC i',.:wF LIABILITY INSURANC% VEN-1 10 30 00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Addis Group, Inc. HOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 2300 Renaissance Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Xing Of Prussia PA 19406-2772 INSURERS AFFORDING COVERAGE 8hone1610-279-9550 5sxa610-279-✓�543 INSURED- INSUFIERA: American Zurich Cqpe Code Fence C INSURER B; c/o Davenport Re¢¢Tty F Mr. George >9aldwia wsuRERC: 20 North m,"T' St. INSURERD: South Yarmouth, MA 02664 INSURER E: COVERAGES THE POLICIES OF INSURANCE L18TE0 BELOW HAVE BEEN ISSUED TO THE INSURED NAMED A80VE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY SE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGATE LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS, LTR TYPE OP INSURANCE PCLICY NUMBER D TE Mh1lDp 1 DAPOLTE MM1DplYY ! LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE ❑OCCUR MED EXP(Any One person) 11 PERSONAL&ADV INJURY $ GENERALA93OREGATE It GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGG $ POLICY jE� f�LOC AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT $ ANY AUTO (Es accident) ALL OWNED AUTOS BODILY INJURY $ SCHEOUL'cD AUTOS I (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT 9 ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG $ EXCESS LIABILITY i EACH OCCURRENCE $ r OCCUR CLAIMS MADE I { AGGREGATE $ DEDUCTIBLE g i RETENTION I$ , $ WORKERS COMPENSATION AND R TORY LIMIT8 ER A EMPLOYERS'LIABILITY WC819 6 0 2 4 0 3 03/01/00 I 03/01/01 E,L,EACH ACCIDENT IS1,000,000 I E.L.DISEASE,-EAEMPLOYEE $ 1,DOG,000 E.L.DISEASE-POLfCYLIMIT a1,000,000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSJVEHICLBSJaXCLIJSIONS ADDED BY ENDCRGEMENT/SPECIAL PROVISIONS CERTIFICATE MOLDER N ADDITIONAL INSURED;INSURER LETTER: CANCELLATION KE:, 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL iLTTN I LorrrBiriE! Mr., Keller IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 614 Old strawberry Bill Road REPRESENTATIVES. Centerville, INA 02632 I Pamela 8.*Xlocko r ACORD 25-8(7197) CACORD CORPORATION 1966 k t -30 . 2000 4:36PM r'102798F78 No- 1949 P. 1 THE ADDIS GROUP 2300 RENAISSANCE BLVD, KING OF FRUSSIA,PA 19406-854,3 (610)279-5550 FAX (610)279-8543 Fax Date: October 30, 2000 To: Mr. Keller From: jean Sells Attn: Lorraine Fax#: 508-790-6230 No, of pages including cover sheet: 2 Re: Certificate of Insurance for Davenport Realty Trust PLEASE CALL(610)832-2XOO X..F YOU DO NOT RECEIVE THIS COMPLETE FAX In accordance with your request, I am pleased to forward the certificate of insurance that you requested for Cape Cod Fence. If you have any questions,please call. CC: Ann Millett,Davenport/508-394-6765 Insurance Brokers and Risk Management Consultants Assessor's office(1st Floor): /, Assessor's map and lot number 1 3- K)13 - G L Q�oi taE ♦ Board of Health(3rd floor): Q d� Sewage Permit number n �- /IT • . (,f' � Z BABd9TGDLL, i Engineering Department.(3rd floor). House number �� f! !W °•�i639. Definitive Plan Approved by Planning Board �. 19 r�r APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE ILDING INSPECTOR APPLICATION FOR PERMIT TO J 1 TYPE OF CONSTRUCTION [,-) )Q 1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: b Location J� Proposed Use T-A VY,) r � R Zoning District Fire District Name of Owner Address dY-i-P y NameofBuiIder�A.t �c�`'a�C�I� Address Name of Architect Address ` t � / Number of Rooms Foundation .D '-11 4 c�!YC) Exterior A k__ Roofing Floors Interior Heating �aC `(�� t,�,A(4°d 1U �i 1 Plumbing Fireplace Approximate Cost P VDU UG Area -J J C f Diagram of Lot and Building with Dimensions Fee fi • OCCUPANCY PERMITS REQUIRED FOR-NEW DWELLINGS hereby agree to conform to all the Rules and Regulations of the Town.of.Barnstabte,regarding the:abov a construction., - ------«� Name: 1�1 -= " Construction Supervisor'sLicense ' KELLER, JUERGREN A=253-013 . 002 w o953-®l3, nxoa No 33354 Permit For Build Addition Single Family Dwelling Location .3X Li ' 1 Lane Hyannis Owner Juergren Keller Type of Construction . Frame I. Plot Lot Permit Granted November 13 , 19 89 Date of Inspection 19 Date Completed 19 PERMIT COMPLETED 1/1/� 0) As'essor's dffice(1st Floor): � FMC SYSM Assessor's map and lot number 013 - 06� INSTALL D I"COMPUANCE PROF THE TOE` Board of Health(3rd floor): Wrffl y=rJ Sewage Permit number— CODE Engineering Department(3rd floor): V t/ n� TOWN uLAMOKS aeaMAB& c p� rasa House number °° i6}9' Definitive Plan Approved by Planning Board 190 YpY d' APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only A p 4 R 0 VON - OF BARNSTABLE VSrn able or.per anon Commis$ �� I L D I H G INSPECTOR fJ�ATION FOR PERMIEe TYPE OF CONSTRUCTION [,hoc L 19 � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use � �� --� �' azc,tn Zoning District Fire District Name of Owner ,@� � �-e� Address S-0,uv►n-e, Name of Builde 56 Address �(A "Ps eA Name of Architect Address i t Number of Rooms Foundation c�G Exterior 15Nf)AJ!51eS, A�. Roofing S "g � \ Floors. Interior Heating�UdV\Q� w4D(`Cl' N �Lt Plumbing �� 1 P Fireplace C) Approximate Cost 0aV•0c Area 4 Diagram of Lot and Building with Dimensions Fe �Z 9 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Bar le regarding the above construction. L4Name i Construction Supervisor's License l` PPPP-KELLER, - JUERGREN ! No 33354 Permit For BUILD ADDIT N Single Fami,ly� Dwelltllinq m Location Li ' 1 Lane Hyannisc Owner Keller '' r Type of Construction game a � Plot Lot #5 Permit Granted November 13 , 19 89 _ Date of Inspection 19 Date Completed 19 r Cz CU tit ra + F.Y t ..__...._..._....._........_._......- ., 1. ,• .. 1 imlN , t1PssA�Nus .nS I , i i j 1"nl.P..hINi� SQFFIT.. .. .... I r ' __ \N\SIdSFO Si�RrL� i Ull _........: - I . 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A i I r j Q�A� " r t `"n ' r ,�i ,title""f \yLtEM t 1 s> M Lacm7 ;.f • x Fs . W J , apt+rg� J�„tpN { tlry�r��s �" ah �� .'� •, � `��.� $ •"`� F ct-5 17, 1, 'sue}!. i-_J ALE 01 ilf'W P MICHELE CUDILO, P.E. Consulting Structural Engineer Centerville,Mass-'akfiuidti"02632-1979•(508)771-7601 •Fax(508)771-7163 mcudilo@comcast.net November 29,2010 Town of Barnstable Building Department 200 Main St. Hyannis,MA 02601 Attention: Mr. Thomas Perry/Jeff Lauzon ADVANCE COPY VIA FAX: 508-790-6230 Building Commissioner/Inspector RE: PROPOSED FENCE ADDITION 814 Old Strawberry Hill Rd.,Centerville,MA Dear Mr.Perry,Mr.Lauzon, At the prior request of my client,Jurgen Keller,Owner,I went to the above captioned Site on November 19,2010, for the purpose of addressing the structural requirements of the above captioned project,in particular as related to the additional construction work since original fence construction. I was informed that the Town of Barnstable requires that the Massachusetts State Building Code 7th edition needs to be adhered to for this structure. This would include analysis for Wind gust of 110 MPH,Exposure C for solid (stockade)fencing. Therefore,I submitted this information,including load requirements to Bill Ultrich,Certified Fence Professional,CFP,Link Consulting,LLC,Annapolis,MD,and we reviewed supplemental items as follows. 1. Fence posts 6.625"O.D. Schedule 40 spaced 4.25 feet on center,24"dia.concrete pier,min.4' deep. 2. Fence posts 8.625"O.D. Schedule 40 spaced 8.51 feet on center,26"dia.concrete pier,min.4' deep. See attached SK-1. Please call should you wish to discuss any aspect of this project. Sipcerely, is ele Cudilo,P.E. /2010-162 cc: J.Keller 0 CUI)ILD NO- 34774 STRUC-rij 17 :V* bf J HU iu J0 0i op r 5T6�gt, C0D/A oil a� D/A, /I FENCEPU5T'%A5TH A3co !' 5oU P A FENCE 60TTOM RAIL r TENNIS COURT PAVEMENT, 1A 0. J OR SURFACE 5Y5TEM M TOP OF FOOTING TYPICALLY Id 5ELOW COURT SYSTEM r OR coNTlGuous TO CONCRETE CDOwG (I4l►A) _ ~ w �I "r1 I I= COMPACTED CRUSHED uw y* _, I STONE 13A5E COU»5F (CPTIOAAL) • I I oG Lu 4 l 5ET f 05r IN SLEEVE OPTIONAL _ CONCRETE POST FOOTING ` —T' 77_ _ 24 DIA.FOR (a , a ��W POST �4 �°,� _�_ I I—` N PIA.TOR 6 DIAi � I ICI , lI_I, III OF MA �'4! o@sRICt9EL NOTE#2: E z CUDILO FOUNDATION DEPTH MAY VARY WITH `=U ^. No 3477� ,SOIL TYPO,POST SIZE,WIND LOADS; STRUCTURAL WOOD TYPE,SPACING,HEIGHT, OPENNE.55&FABRIC SELECTION. ` / a • Ilio FENCE-F05T5 5FCT'ION5 - TYFICAL CLF <N07 TO SCALE 1"(Inch)=Z5.4mm t'(foot) 305nam 42FP05TI.AVL:09 _7;WS"WiOrq DRAWING5 ARE ILLUSTFATIVE ONLY AND A50A AND 115TA !� fMrt®3UUst�Aa�aol� ACCEPT NO RWONSIBILITY FOR THEIR USE. I•- .I vv"��� `�° � � FIRE Top, Town of Barnstable * Regulatory Services * BA"STABLE, Mass. Thomas F.Geiler,Director iOrFn r6' Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 November 5, 2010 Juergen Keller 814 Old Strawberry Hill Rd. Centerville, Ma. 02632 RE: 3 Li'l Lane,Hyannis, MA, Map253 Parcel 013 002 Dear Mr. Keller: Upon a recent inspection at the above referenced address it was observed by this office that a fence eight foot in height has been increased further in height without the benefit of a building permit. You are hereby ordered to obtain the proper permit for work done or remove the unpermitted work. Failure to comply by November 26, 2010 will result in further action taken by this office. Thank you for your immediate attention in this matter. Please call (508) 862-4034 with any questions. By Order, hfr e L Lauzon Local Inspector (508) 862-4034 Q:zoning5 Bldg. Dept. a 200 Main St. +*' '- U.S.POSTAGE>>PITNEYso Hyannis, Ma. 02601 .; /��✓� .ZIP 02601 $ 000.4 0001361475 NOV 05 20 Juergen Keller 814 Old Strawberry Hill Rd. Centers/iil?_.Ma_02632 _ NIXIE 029 5E 1 ---'—`00 11/17/10 RETURN TO SENDER NOT DELaVE .;E A,s. ADDRES QED UNABLE TO FORWARD {{ _ = 0 i e r r i i F 3 i i i i pFIME rqw Town of Barnstable ti* M Regulatory Services ♦ t BARNSTABLE, MASS. �, Thomas F.Geiler,Director �p i6gq. �0 rFc,,,orA Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 November 5, 2010 Juergen Keller -` 814 Old Strawberry Hill Rd. Centerville, Ma. 02632 1 RE: 3 Li'l Lane,Hyannis, MA, Map253 Parcel 013 002 Dear Mr. Keller. Upon a recent inspection at the above referenced address it was observed by this office that a fence eight foot in height has been increased further in height without the benefit of a building permit. You are hereby ordered to obtain the proper permit for work done or remove the unpermitted work. Failure to comply by November 26, 2010 will result in further action taken by this office. Thank you for your immediate attention in this matter. Please call (508) 862-4034 with any questions. . B r y Order, jhe L Lauz� Local Inspector (508) 862-4034 iK 4n I a+ Q:zoning5 �pTNE r Town of Barnstable Regulatory Services x BARNSTABLE, MASS. Thomas F. Geiler,Director �A 039. �0 rEo,,,p+A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 November 5, 2010 Juergen Keller 4 Nevada Drive Chelmsford, Ma. 01824 RE: 3 Li'l Lane,Hyannis, MA, Map253 Parcel 013 002 Dear Mr. Keller: Upon a recent inspection at the above referenced address it was observed by this office that a fence eight foot in height has been increased further in height without the benefit of a building permit. You are hereby ordered to obtain the proper permit for work done or remove the unpermitted work. Failure to comply by December 3, 2010 will result in further action taken by this office. Thank you for your immediate attention in this matter. Please call (508) 862-4034 with any questions. By Order, dre7r Lauzon Local Inspector (508) 862-4034 Q:zoning5 Citizen Web Request Page 1 of 3 Wf le �.° Logged In As: Citizen Request Management Monday, Novernber.l 2010 TOWN\lauzonj Route to Users Search Requests. Create Rcauests Request Information Request ID: 32637 Created: 10/29/2010 2:40:46 PM Status: Assigned To Staff Assigned To: Lauzon,Jeffrey Building.Dept Anonymous: No Request Category: Work with out permit edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 11/15/2010 Change Estimated Oct November 2010 Dec Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 .22 23 24 25 26 27 28 29 301 1 2 3 4 5 61 7 81 9 IL0111 Created.By: Shea, Sally Priority: Medium edit Building Dept Citation Numbers: edit Requestor Information Requestor COLLEEN MEDEIROS Request DETAILS: 5 LIT LANE LOCATION: 3 LIT LANE Hyannis Ma 02601 Hyannis, Ma'02601 508-790-0438 Request Parcel Number CALLER REPORTS AN EXISTING Map: 253 Block: 013 Lot: 002 FENCE HAS BEEN ADDED TO IT'S OVER 8'TALL. THIS WAS DONE Parcel Lookup WITHIN THE LAST COUPLE DAYS. Email: CCARRIGAN28@YAHOO.COM Edit Requestor Information http://issgl2/Internal WRS/WRequest.aspx?I,D=3263 7 11/1/2010 Citizen Web Request Page 2 of 3 Track Request Progress •Request Work History: •Internal Note History: Entered on 10/29/2010 2:40:46 PM by Shea, Sally CALLER REPORTS THAT YOU CAN SEETHE PROPERTY BETTER FROM 5 LI'LANE (THE CALLER'S MOTHER'S PROPERTY) System entry on 10/29/2010 2:40:46 PM: Assigned to Lauzon,Jeffrey Enter work progress: Enter internal note: (Viewed by everybody)- (Viewed internally only) f?si ilr: Spell Check , Spell Check Add document or image link: " Browse... * You can also type in a folder name to see everything in the folder Current Links: Time worked on request: 19 Response time: P . .. * Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. . Do not include nights, weekends, and holidays in response time for most departments. 0 Save changes r Check to notify town employee below to review this request. r Save changes and notify Building Dept citizen* _- r Close request Amara, William r.Close request and notify citizen* Brief message to reviewer: *notify works if email address was given ;Update . SpelLCtieck http://issgl2/Internal WRS/WRequest.aspx?ID=3263 7 11/1/2010 t TOWN OF BARNSTABLE BUILDINGPERMIT APPLICATION Map es 3 Parcel 4016 Permit# r; -� Health Division �oS- �9 /� 2( Z°�L'O�C Date Issued Z r �Conservation Division /® ` G Fee., Tax Collector,-, Q2 S -/I/P� Treasurer S PTIC SYSTEM MUST Vv' INSTALLED IN COMPLIAN.U. Planning Dept. IWITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL.CO®E A TOWN REGO S Historic-OKH Preservation/Hyannis f 'Project Street Address Village Owner J 0 JL6r 1 L6: Address PEVAPlt NIDE CAFI V-WJ p Telephone 05-37 l3l�z Permit Request { Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation 1l`�i �)O 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 )Q'N-6 On Old King's Highway: ❑Yes ,4No 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 Z new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: 14fGas ❑Oil ❑Electric ❑Other Central Air: es ❑No Fire laces: Existin �.SPew Existin wood/coal stove: ❑Yes ❑ No p 9 g 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 BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUC ION DEBRIS RES LTING F OM THIS PROJECT WILL BETAKEN TO �GNATURE DATE 012•wZ60 l FOR OFFICIAL USE ONLY PERMIT NO. _ 4 DATE ISSUED 7 i £ MAP/PARCEL NO. ADDRESS L. VILLAGE OWNER / � r DATE OF INSPECTION . FOUNDATION FRAME } INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH : FINAL 40. GAS_: ROUGH FINAL FINAL BUILDING _7 L .. �. I'm Z. DATE CLOSED OUT _ C ASSOCIATION PLAN NO. t 11� --. _. ��nQ� ��� N/ �s oa/ �° ,� �x� �,�� r ��1 7C. f4i�� > �__ � I t .. '} SJN1113Ma M N SOd a38im3d SiME3d },DN`ddn000 3 ect�M o/send o�ni/.��o/Vn . o Q70 77/H yCb�2�/�9Mb'�1S / /. r..�rf9z �'l �,Zo6.:z , JW ire ns� ' -e s .'.8�• oE'EE/ �°�'ro '" . o z• i2 5',. 9S,LS.ZOS r7� r a � AIL N h• ,Of ' "' .',c.`: .00'662 �b �/l S-' M.OppOsgs bA3'1� DbrJ�l OopO "Poo //N h°13✓ K�.dAPAW OW Q= OS 9S �A 1' 04 of y\ ry ca TO-Z A"71V i7tr r7507J — �� O'9 S I Y t f S±9R2� r n So *r `' y s ,:'t'y'r k7�',„a�m� iJi1. '. 4,r s v!' fi- I• .M. 'L /1�0 7 ,r.r °F IKE The Town of Barnstable sMxsTnai.E, 9 M'E g Regulatory Services 16.39. 61 Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please-P-rint DATE: JOB LOCATION: number / street p village 2 «HOMEOWNER":,j U C6 1 6 t[V 1".l �(-C-C/ti q 7a—2 57 --D5 37 y 7,�Z 5- -- J Q G name + home phone# work-phone# CURRENT MAILING ADDRESS: C_t (_l� �� city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provide d that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The un rsigned"homeowner"certifies that he/she understands the Town of Barnstable Building D ent minimp ins tion procedures and requirements and that he/she will comply with said pro£ -ores and Teq igna re of meowner Approva f Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code 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 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations 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 a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPTN SALES AGREEMENT Cape Cod Fence, Co. 32774 ROUTE 28 - SO. YARMOUTH, MA. 02664 DATE TEL. 508-398-6041 HYANNIS �I MASS. ONLY 1-800-352-7785 TEL:775-3030•FAX: 398-0091 NAME I f SHIP TO / STREET STREET � CITY STATE ZIP CODE CITY /� - STATE ZIP CODE INSTALLATION HOME PHONE BUSINESS PHONE TELEPHONE NOTIFICATION J 76 +J Q Q �✓!� 1 STYIE FURNISH AND INSTALL NO.OF RAILS HEIGH T r A CAPE COD FENCEft '� F { \ 2 J ON YOUR PROPERTY IN ACCORDANCE WITH QUANTITIES AND LAYOUT SHOWN BELOW QUANTITY DESC RIPT ION UNIT TOTAL S DEPOSIT TOTAL SALE U 9a,�— BALANCE TAX TERMS 3 T �) TOTAL ONE HALF WITH ORDER BALANCE ON COMPLETION J LAYOUT - INDICATE ON LAYOUT PICKET FACING ON EACH LINE OF FENCE. CHECK LIST t t t I - d `, f t j _ NSTALL OR 0 DEL.ONLY I STOMER HOME { �,I, LJ NO KE D OWN FE NCE YES NO jQKE AWAY D FENCE LJYES O I �}EAR BRUSJ„ R TREES �...,,.....�....- _.._.._ _._ �.. .. ,.... ',,.,.-._...........- w..:......... LI YES *•JQNO CE FINISHaDE LIN OUT P F FENC�TO FOLLOW GRC'YuU YES U NO r _ CqFC NOT NESPONSIBLE f f DIG SAFE H - ! POST SIZE POST STYLE PICKET OR BOARD STYLI' RAIL STYLE RAIL SIZE GALV.OR VINYL MAIL BILL TO ON OR OFF CGP' SIGN LOCATION All quotations subject to conditions beyond our control.CUSTOMER IS RESPONSIBLE FOR ESTABLISHING PROPERTY LINES AND FENCE LINES,and for conforming with local zoning cy-a:.s This quotation does not include costs met in extraordinary conditions--striking ledge which may require the cementing of posts or the use of a compressor for drilling and pinning posts.or cl-., ; trees,brush or other obstructions from the working area.This contract embodies the entire understanding between the parties,and there are no verbal agreements or representations in conn==::- therewith.It is understood that the title to all materials shall remain with Cape Cod Fence Co.until all payments have been made:If customer fails to make said payment it is agreed that Cap= Fence Co.may remove said material from whatever premises it is located and customer shall pay for both installation and removal. CAPE COD FENCE C A/k,Ey DEPT. j r BY '//�c-'' ACCEPTED BY On accounts over 30 days, finance charges are computed at a periodic rate of 1'h % per month- AnrwW rote 18%. ��. CERTIFICATE OF LIABILITY INSURANC IVED AAira- DA 10/26TE(MMIDD/ °CJ► I /00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE The Addis Group, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 2300 Renaissance Boulevard ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. King of Prussia PA 19406-2772 Phone: 610-279-8550 Fax:610-279-8543 INSURER$AFFQROINGCOVERAGE INSURED !NSURERA. American Zurich C Pe Code Fence Co. INSURER B: c70 Davon ort Roalty I Georg Baldwin INBUPERG: V,tgrth Main St, INSURERD: South Yarmouth, MA 02664 {'NSIIRER E: COVERAGE$ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOLIACMLNY,TERM OR CONdITION OF ANY CONTRACTOR OTHER 60CUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 8UBJECT TO ALL THE TERMA,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS BKOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS: ION LTR TYPE OF INSURANCE POLICY NUMBER DATE MM/DDlY"ECTY VE PDATB MMlCY DO/ri LIMI78 OENERALLIABILITY EACH OCCURRENCE $ COMMERCIAL.GENERAL LIABILITYI i FIRE DAMAGE(Any One fire) $ CLAIMS MADE 1___J OCCUR I VIED EXP(Any ona parson) $ I PERSONAL&AOV INJURY $ I GENERAL AGGREGATE $ GEN'L AOORLOATL LIMIT APPLfEA PER 1 rPRODUCTS•COMP?OP AGO I POLICY M. =LOC I AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Perperacn) $ HIRED AUTOS i BODILY INJURY NON•OWNEDAUTOS (Peraeelaant) $ j PROPERTY DANIA09 I (Pete001danq = GARAGE LIABILITY j AUTO ONLY•EA ACCIDENT $ ANY AUTO A. OTHER THAN CC ZAA00 $ EXCESS LIABILITY EACH OCCURRENCE OCCUR CLAIMS MADE I AGGREGATE $ r--7 DEDUCTIBLE $ RETENTION $ I $ TO OTIN WORKERS COMPENSATION AND X,TORY LIMIT8: I ER A EMPLOYERS'LIABILITY 'WC819602403 03/01/00 03/01/01 E.L.EACHACC;QFNT $l 000,000 j E.L,DISRASP.FA EMPLOYE $ 1 000 000 E.L.DISEASE•POLICY LIMIT $ 1 000 00 0 j DESCRIPTION OF OPERATIONSlLOCATIONSNEHICLEB/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Re: Mr. Keller, 814 old strawberry Hill Road, Centerville, MA 02632 CERTIFICATE HOLDER N ADDITIONAL INSURED;INSURER LETTER:_ CANCELLATION CE14TERV SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TI!RRECP,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Town of Centerville NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 80$HALL Building Dept. IMPOSE NO OBLIOATION OR LIABILITY OF ANY KIND UPON THE INSURER;IT AGENTS OR Attn: Lorraine REPRESENTATIVES. it Pamela S. Klock V1 ACORD 25-8 t?197) CACORD CORPORATION 1960 8L'986L(H [9 NNIb:6 DON.