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0210 LONGVIEW DRIVE
D4 ACTIVE 0 7hgihz 4 { t rTfP,P RISE ? ,t �txr € t. ak, �L, Division of Thielsch Engineering,Inc. --^E•- '- 4 Fit'F i 1341 Elmwood Avenue ENGINEERING Cranston,Rhode Island 02910 I T r j # _ m �, 1 Tuesday, July 10, 2012 Town of Barnstable Thomas Perry, CBO 200 Main Street Hyannis, MA 02601 NVAIJOTS RE: 210 Longview Drive; Eeftfervii MA 02632 Barnstable Building Permit#: 201203856 Dear Mr. Perry, This affidavit is to certify that all work completed at 210 Longview Drive; Centerville, MA 02632, has been inspected by a certified Building Performance Institute (BPI) inspector. The following weatherization/energy saving measures were completed: ➢ Performed 20 man-hours of air sealing, included all appropriate blower door tests, combustion safety tests and procedures. ➢ Install 2.25" R-10 FSK faced semi-rigid fiberglass board insulation to 120 square feet of kneewall area. Tape all seams and edges with FSK tape. ➢ Install a 6" layer of R-21 Class 1 Cellulose added to 600 square feet of open attic space. . ➢ Install a 10" layer of R-37 dense packed Class 1 Cellulose to 150 square feet of kneewall floor attic space. Drill and plug or lift and replace flooring as appropriate. ➢ Insulate and seal 1 attic hatch by installing 2" rigid foam board that meets the sections R- 316.5.4 and 316.6 requirements of building code. ➢ Install [1] insulated hose(s) and roof mounted vent(s) to exhaust existing bathroom fan(s). Each hose must be securely fastened at both ends with zip ties and screws. The outer vapor barrier must be sealed at both ends with quality air barrier tape so the fiberglass is not exposed. NOT DUCT TAPE. ➢ Install ventilation chutes in(58) rafter bays to maintain air flow. All work performed meets or exceeds Federal and State Requirements. Since , Erik J. Nerstheimer RISE Engineering Residential Installations Department RISE Engineering; A Division of Thielsch Engineering CSL 1004591HIC 120979 401-784-3700 . 800-422-5365 . Fax 401-784-3710 ` 14T4- Page 2 of 2 Village CASE #: 123426 CHECK #: 0 0 e 1 7�-y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 251 Parcel± 080 Application 6 Health Division Date Issued Conservation Division Application Fee $SO:,00 Planning Dept. Permit Fee $35.-00---- ' Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis f Project Street Address 210 LONGVIEW DRIVE; MA 02632 }-}YA,MATc5 Village C� Owner EDWARD G. BEARSE Address 210 LONGVIEW DRIVE; CENTERVILLE, MA Telephone 508-790-0153 Permit Request WEATHERIZATION WORK: PERFORM AIR SEALING MEASURES; INSTALL FIBERGLASS BOARD INSULATION TO KNEE WALL AREA; INSTALL CELLULOSE TO OPEN ATTIC SPACE; INSULATE KNEE WALL FLOG INSULATE ATTIC HATCHES; INSTALL VENTILATION CHUTES AND EXHAUST EXISTING BATH FAN. SEE ATTACHED COPY OF CONTRACT FO MORE INFORMATION. Square feet: 1 st floor: existing propose 2nd floor: existing proposed Total new Zoning District Flood Plain _Groundwater Overlay Project Valuation$3,102.30 Construction Type _ Lot Size Grandfathered: ❑Yes 0 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 b Total Rooml'Count (not including baths): existing _ new First Floor Room Count C k k Heat Type a'nd Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other U_ Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove::-0 Yes_U No Detached garage: ❑ existing ❑ new size--Pool: ❑ existing ❑ new size Barn: ❑ existing ❑ rrew 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 RESIDENTIAL Proposed Use SAME APPLICANT INFORMATION (BUILDER OR HOMEOWNER) RISE ENGINEERING: A DIVISION OF Name THIELSCH ENGINEERING Telephone Number 401-784-3700 EXT. 6133 1341 ELMWOOD AVENUE Address CRANSTON, RI 02910 License # CSSL-IC 100459 EXP. 3/28/14 Home Improvement Contractor# 120979 EXP. 3/25/14 Worker's Compensation # 3730961-01 EXP. 1/1/13 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO YARMOUTH TRANSFER ATION; 50 ORKSHOP ROAD; S. YARMOUTH, MA 02664 SIGNATURE DATE ERIK NERSTHEIMER FOR RISE ENGINEERING FOR OFFICIAL USE ONLY :r t ' APPLICATION# DATE ISSUED t ,MAP/.PARCEL NO. ., c Y P ADDRESS VILLAGE a r OWNER r DATE OF INSPECTION: . FOUNDATION . F FRAME t INSULATION 7 f 10, FIREPLACE k F t • ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:-, ROUGH ;- FINAL AFINALBUILDING << s F i DATE CLOSED OUT t ASSOCIATION PLAN NO. z_ .r t m z The Commonwealth of Massachusetts Print For �-� Department of Industrial Accidents Office of Investigations , 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): RISE ENGINEERING;A DIVISION OF THIELSCH ENGINEERING Address: 1341 ELMWOOD AVENUE City/State/Zip: CRANSTON, RI 02910 Phone #: 401-784-3700 EXT. 6133 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 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑.I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑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#I 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: THE PRESTON AGENCY,INC. Policy#or Self-ins.Lic.#: 3730961-01 Expiration Date: 01/01/13 Job Site Address:210 Longview Drive City/State/Zip:Centerville, MA 02632 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 certfff un r t ains a enalties o er'u that the in ormation provided abo a is true and correct. Signature: ---..._.... ----— --- - - - - Date ..: 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#: RISE ENGINEERING Federal ID#05-0405629 N RI Contractor Registration No 8186 A division of Thielsch Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 %w 1341 Elmwood Avenue,Cranston,RI02910 (401)784-3700 FAX(401)784-3710 CONTRACT +� Page 1 J E PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CLC-RCS ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE CIieM# Edward G Bearse. (508)790-0153 03/20/2012 123426 SERVICE STREET BILLING STREET - 210 Longview Drive 210 Longview Dr f SERVICE CITY,STATE,ZIP - BILLING CITY,STATE,ZIP �„j-:+` ? ?a1/ rry Centerville,MA 02632 Centervil,MA 02632 �'"i Ll U JOB DESCRIPTION Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage._This work will.be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality. Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed) $1,400.00 Provide labor and materials to install 2.25"R-10 FSK faced semi-rigid fiberglass board insulation to 120 square feet of kneewall area. $331.20 Provide labor and materials to install a 6"layer of R-21 Class 1 Cellulose added to 600 square feet of open attic space. $702.00 Provide labor and materials to install a 10"layer of dense packed R-37 Class 1 Cellulose added to 150 square feet of kneewall floor. $313.50 Provide labor and materials to insulate the attic hatch with 2"rigid foam board that meets the sections R-316.5.4 and 316.6 of code. $31.00 Provide labor and materials to insulate the attic hatch with 2"rigid foam board that meets the sections R-316.5.4 and 316.6 of code. $31.00 Provide labor and materials to install 1 insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). $108.00 Provide labor and materials to install ventilation chutes in(58)rafter bays to maintain air flow. $185..60 RISE Engineering will apply all applicable,eligible incentives to this contract. You will be billed only the Net amount. Currently,for eligible measures,the Cape Light Compact offers 75%incentive,not to exceed$2,000 per calander year. $2,676.70 E1 Y Ito FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF h 1 our Hundred Twenty-Five S 60/100 Dollars $425.60 MAR 2 C 2012 J NAL INSPECTION AND APPR ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF/%WILL BE CHARGED MONTHLY ON ANY - NPAI R BE FOR IMP§RTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. T SIGN THIS CONTRACT IF THERE ARE AN7ANK SPACES TH IZED TU •RISE ENGINEERING _ CUSTOMER ACCEPTANCE "1 NO :T S CONTRACT MAYBE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED To DO THE WORK DAYS. - AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE _ . r AeG' CERTIFICATE THIEL-1 OP yy) ATE OF LIABILITY INSURANCE OAT01/-13/12 . 01L13112 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 _ - 401-886-8000 CONTACT The Preston Agency,Inc. NE 1350 Division Rd Suite 303- 401-885-1700 aC No.Ext: A/c No): PO BOX 810 E-MAIL East Greenwich,RI02RI&Q810,, _. ADDRESS: Judith A.Wright CPCU AAI ARM INSURER(S)AFFORDING COVERAGE NAIC A INSURER A:Zurich-American - - INSURED Thielsch Engineering,Inc.Thielsch Group Inc. INSURER 8:American Guarantee&Liability Hi Tech Realty Inc. INSURER c Twin City Fire-Hartford AttTrent Avenue ux 195 Frances INSURER D:North American Capacity 195 .Ave Cranston,RI 02910 INSURER E: -' - INSURER F: - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF'INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS - CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DDLSUBR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER iMMIDDfYYYYI jMM/DDfyYYY`ILIMITS GENERAL LIABILITY ' EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 3730962-01 DAMAGE TO RENTE - 01/01/12 01/01/13 PREMISES Ea occurrence $ 300,00 CLAIMS-MADE a OCCUR MED EXP(Any one Person) $ 5,00 PERSONAL 8 ADV INJURY b ' 1,000,00 GENERALAGGREGATE $ 2,000100 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,00 POLICY X PRO• LOC f Emp Ben. E 1,000,00 AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT . Ea accident $ 2,000,00 A X ANY AUTO 3730963-01 01/01/12 01/01/13 BODILY INJURY(Per person) $ ' ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accdent) s ' HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS I Per accident) $ _ a X UMBRELLA LIAB OCCUR EACH OCCURRENCE b" 10,000,000 g X EXCESS CLAIMS-MADE AUC4857188-01 01/01/12 01/011/13, AGGREGATE, s 10,000,000 __TIDED RETENTION E E WORKERS COMPENSATION T RY UM T OER AND EMPLOYERS'LIABILITY YIN X A ANY PROPRIETOR/PARTNER/EXECUTIVE 3730961-01 01/01/12 01/01/13 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? ❑ NIA _ (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE 5 1,000,00 DESCRIPTION OF OPERATIONS below . E.L.DISEASE-POLICY LIMIT $ 1.000,00 C Property Section 02UUNHE6930 01/01/12 01/01/13 Property see belo D Professional Liab DVL000026802 01/01/12 01/01/13 Prof Liab 2,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Addltlonal Remarks Schedule,If more space Is required) When required by a written contract.. CERTIFICATE HOLDER CANCELLATION TWNHARW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Division ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE _ Hyannis,MA 02601 ©1988-2010 ACORD CORPORATION. All rights.reserved: ACORD 25(2010105) The,ACORD name and logo are registered marks of ACORD .. Details Page 1 of 1 Licensee Details Demographic Information Full Name: ERIK S. NERSTHEIMER Gender: M Owner Name: License Address Information ddress: 228 Gleaner Chapel Rd. Address 2: City: North Scituate State: RI ipcode: 02857 Country: United States License Information License No: CSSL-100459 License Type: CSSL-IC -Insulation Contractor Profession: Building Licenses Date of Last Renewal: 4/24/2012 Issue Date: 5/6/2009 Expiration Date: 3/28/2014 License Status: Active Today's Date: 4/25/2012 Secondary License: Doing Business As: Status Change: 18 . Prerequisite Information Licensee: NERSTHEIMER, ERIK S. Relationship: Attribute Of License No: CSSL-100459 Discipline No Discipline Information Documentum http://elicense.chs.state.ma.Us/Verification/Details.aspx?agency_id=1&license _id... 4/25/2012 y Office of Consumer Affairs d Business Regulation _ - -- 10 Park Plaza - Suite 5170 -03R � Boston,Massachusetts 02116 , Home Improvement Contractor Registration J�N202012 Registration: 120979 Type: Supplement Card THIELSCH ENGINE ♦RING Expiration: 3/25/2014 tKIK 1341 ELMWOOD AVE. CRANSTON, RI 02910 Update Address and return card.Mark reason for change. SCA 1 0 20W05n1 Address 0 Renewal Employment Q.Lost Card �i om�lc �e ir-anLnaa�r�aealf�a�C�la.,s«c�iraelf nice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistrat�on ;.120979 Type: 10 Park Plaza-Suite 5170 Expiration:':3/25/2014 ;:. Supplement Card Boston,MA 02116 THIELSCH ENGINEERING ERIK NERSTHEIMER f 1341 ELMWOOD AVE. g CRANSTON,RI 02910 Undersecretary Not valid without signature e Control No: 3 4 2 4 4 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF LABOR DIVISION OF OCCUPATIONAL SAFETY 4 19 S.TANIFORD STREET, BOSTON,MASSACHUSETTS 02114 LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER RISE Engineering A Division of Thielsch Engineering, Inc. 1341 Elmwood Avenue Cranston, R102910 WAIVER: LW000672 EXPIRES: April 15,2015 IN ACCORDANCE WITH M.G.L'C. 111, § 197(B)(b)AND 454 CMR 22.03(3)(b), THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER IS ISSUED BY THE DIV. OF OCCUPATIONAL SAFETY TO THE CONTRACTOR •_ ABOVE.FOR THE PURPOSE.OF PERFORMING LEAD-SAFE RENOVATION WORK. THIS LEAD-SAFE RENOVATION CONTRACTOR LICENSING WAIVER MUST y BE MAINTAINED BY THE CONTRACTOR IN ACCORDANCE WITH M.G.L. C. 111, § 19713(b)AND 454 CIvIR 22.04 WHEN PERFORMING LEAD-SAFE ry RENOVATION WORK. HEATHER E. ROWE,ACTING COMMISSIONER Printed on Recycled Paper �oFr►+r rod Town of Barnstable *Permit# ti Regulatory Services E-rpires6,nonrhs ran issue dare BaRvs A.13Le, Fee -k � ss. � ,e a ns•- �� Thomas F. Geiler, Director pT�MA-a -PRESS PERMIT Building Division Tom Perry, CBO, Building.Commissioner ( T 3 200 Main Street, Hyannis, MA 02601 1 www.town.barnstable.ma.us TOWN OF BARNSTAKE Off-ice: 508-862-403 8 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Fax: 508-790-6230 Not Valid withorrr Red X-Press Jrnprini Map/par el Nunber�5 Pro rty Address to Residential Value of Work 0 v / -� Minimum fee of$35.00 for work under$6000.00 Owner's Name & Address 110 6-p—Ab Contractor's Narne � lod, T lephone Number �9 ���T . Home Improvement Contractor License #(if applicable) J .3 3W ;on,l ction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I m a sole proprietor ❑ am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Aw //,�, ` .. Workman's Comp. Policy# _ ' `�' Copy of Insurance Compliance Certificate must accompany each permit. Permit Request (check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ RR tde #of doors Replacement Windows/doors/sliders. U-Value_ V; �� (maximum .35)#of window *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. *"Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is requir iIGNATURE: t:1WPFILEST0RMSIbuildin-permit formsTXPRESS.doc revised 0721 10 - L Tize ornnionwealtlt of MassatClt,�SC'tt5 t Department of Industrial Accidents ®ffice ojlnvestigations I _ o00 Nl%itsl;!irlgtosaSt;eet 1 1.14 Workers' Compensation Insurance Affidqvit: $uilders/Cor9trar iorslEl Please Print Lez.bly Applicant Information Name(Businessrorganization/Individual): . { +i.,•s• _ Al l 0. •' T mil. '-�:)"a Address: ' �� City/State/Zip: i�'� ew Phone#: — Ar you an employer?Check the a propriate b Type of pro' t(required): 1. l am a employer with_ni1-� 4. 1 am a general contractor and 1 6 ❑N construction employees(full and/or part-time).* have hired the sub-contractors 7 emodeling listed on the attached sheet. 2.❑ I a sole proprietor or partner- These sub-contractors have 8. ❑Demolition shipip and have no employees > employees and have workers 9 ❑Building addition working for in any capacity. comp.insurance? [No workers'comp.insurance 10.[ Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.El I 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 c. 152,p l(4),and we have no l3.❑Other insurance required.] .employees.[No workers' comp.insurance required.] "Any applicant that checks box#t 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. -3 ' Insurance Company Name: Owl D ✓� Policy#or Self-ins.Lic.#: 903 Expiration Date: J dL - Job Site Address: 1/_S e v�/ y'� City/State/Zip:C t Me • Attach a copy of the workers'compensation p Alh olicy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MG L c. 152 can lead to the imposition of criminal penalties of a fine up to$I.SOO.UO and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine 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. 1 do hereby certify u pains and pen ojperjury that the information nrov;ar>.rl.^.4ove is true and correct. Date: ® � J7 Si nature: 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.CityiTown Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r f The Conttnonwealth of Massachusetts Department of Industrial Accidents FfT- -r Office of Investigations 600 Washiugtoti Street Boston, MA 02111 ]vlvly.niass.gov/dia lVorlcers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lel4ibly Name(Business/Organization/Individual): ,�O5e U e Address: Jr' , Si- lql 4. G ;71 City/State/Zip: Phone#: Are you an employer? Check the appropriate box: Type of project(required): I.❑ I at I employer with 4. ❑ I am a general contractor and I ployees (full and/or part-time).* have hired the sub-contractors 6• ❑ New construction 2.T 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' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance p• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 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 lure 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 must provide their workers'comp.policy number. I am an employer that is providing workers.'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: 80 G W44n Expiration Date: d Job Site Address: 1-0-414 City/State/Zip:C t4/�VC, 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.imprisomnent,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 cevti under the pains and pe lti.es of perjury that the information provided above is true and correct. A Si nature: Date: 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#: i ate office of Consumer Affairs do Business Regulation License or registration valid for individut use Dail?' before the expiration date. If found return to; --( OME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business 9teguEafiox: Registration 1261393 Type: 60 Park Plaza-Suite 5170 v � Expiration 8%3t2012 Supplement Card Boston,MA 02116 The Home Depot At-N.qrt a SeMces DARREN DEMERS i i 2690 CUMBERLAND PARKWAYS GA 30339 l Not valid without signature XfL5kM, Undersecretary ® DATE(MMIDD/YYYY) ���'�® _ CERTIFICATE OF LIABILITY INSURANCE �. 02/19/10 PRODUCER, 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. I ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AUI=111D, EXTEND OR homedepot.eertrecruest@marsh.com L :: TER THE COVERAGE AFF0RDED B`!_` P-3 CiES EE C}`'•!. 1`mo Alliance Center, 3560 Lenox Road, Suite 2400 Atlanta, GA 30325 !Fax ( IVSL f<Rn AFFORDING COVE—R* aGE 212) 948-0903 JAIL ) INSURED hvFJJi:ER A.Steadf a a t L^.s,Co { 26 87 Th_ Home Depot Inc. -- - -- r IN-URE,:9:Zurich P_me_i::an .ten_ 16=35 Horne Depot U.S.A„ 'Inc. 2455 Paces Ferry Road NW INSURERC:New Hampshire Ins Co —_ — - 23841 Building C-20 `-- --- -- — Atlanta, GA 30339 INSURERD:NATIONAL UNZON FIRE INS CO OF PIT_T S i19445 INSURERE:Illinois Union ins Co 27960 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. INSR EFF ADD-L POLICY ECTIVE POLICY EXPIRATION LIMITS TR POLICY NUMBER DATEMM IYYY DATE M ID /YY Y A GENERAL LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE $ 4,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES jEa occurrence $ 11000,000 - CLAIMS MADE Fx_]OCCUR MED EXP(Any one person) $EXCLUDED _-_-_ PERSONAL&ADV INJURY $ 4,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS=COMPIOP AGG $4,000,000 . ..._...: PRO•._.: ...� .._._ .._._._:__._ ._..__... _.. --_..�...__. u.:.__ ..._ -.X- OLICY LOC .. B AUTO MOBILE LIABILITY BAP 2938863-07 03/01/10 03/01/11 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS — -_--- _— HIRED AUTOS BODILY INJURY (Per accident) $ NON-OWNED AUTOS X SELF INSURED AUTO PROPERTY DAMAGE (Per accident) $ PHYSICAL DAMAGE GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC __- AUTO ONLY: AGG $ A EXCESS I UMBRELLA LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE $5,000,000 X OCCUR CLAIMS MADE .� AGGREGATE _ $ 51000,000 $ DEDUCTIBLE r $ $ $ C WORKERS COMPENSATION OTH- WCO20342355 (AOS) 03/01/10 03/01/11 X _RYLI�TU- ' _ER_ ---_ _ - AND EMPLOYERS'LIABILITY Y I N D ANY PROPRIETORIPARTNERIEXECUTIVE❑ WCO20342356 (CA) 03/01/10 03/01/11 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEP.EXCLUDED) N E (Mandatory in NH) WCO20342357 (FL) 03/01/10 03/01/11 E.L.DISEASE-EAEMPLOY_E_ $ 1,000,000-- _ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT $ 1,000,000 OTHER E TX Employers Excess TNSC46242373 (TX) 03/01/10 03/01/11 Occurrence/SIR 30M/2M D Workers.Compensation WC0910566 (QSI) 0.3/01/10 03/01/11 C Workers Compensation WCO20342358(XY,MO,NY,WI, ) 03/01/10 1 03/01/11 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS . RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE HOME DEPOT, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN HOME DEPOT U.S.A., INC. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 2455 PACES FERRY ROAD NW BUILDING C-20 REPRESENTATIVES. aTLANTA, GA 30339 AUTHORIZED REPRESENTATIVE USA ACORD 25(2009/01)Jthornton_hd ©1988-2009 ACORD CORPORATION. All rights reserved. 14481889 The ACORD name and logo are registered marks of ACORD ( 4 °•l:t�?:i£ni?.tai� - .:•ti:i:'ii+iEi:t •+i . i4 �*.i+it; � -R✓i;si•t! reC SsaEs!in� !?c%.=t:etia,r..and �t:+;ttxi•t!> �-onstruction Sueerviscr License License: CS 70077 Restricted to: 00 JOSEPH C OUARTE 15 FALL ST T WAREHAM, MA 02571 , Expiration: 12/30/2010 < .muui�.i..nei Tra: 7W2 few do aad`;tsoJsrt> tr.Tetras+g of w,i.L.mon o olid ftw indio�iidua@ uaileV k noenl of flrilel�®�SdmIG 11 f®ufld tcemeea tom: WME twROVEMEW Cr pgACTOst of vNihom pezvIvitirim sud Slawdseds Registration: 13234% tTtte:tshburtne Pbe+t i$st �potatlot►: t11;12(111 tett ??d91 94+»tva. a tt2lUi TIP&: Nadnenflits J a J Reim J�ph Ouartt° ,.. .. Vitore Sl tM1t��Ef�jlfiblYYt ,i�791t•i�IP:^•� arm®m, ma 0267, 5 5082555604 ' � li a r 23 10 0 3: 14 a L i a n a ��Te;Mrr:T�ermvl n CERTIFICATE OF LIABILITY IN 5UO3/15/2010 � - 11 --1F(�FOR�AY ON i 1� OT 6 _,� FAX 50$.?95.S$64 THl9 CERTIFICATE IS ISSUED AS A 7 PIGDUCER 50$.295.440 ` ONLY AND CONt°ER5 NO RFGiiTS l3PON THE CEIRTiFiGATE , Paul B. Sullivan Insurance Agency Inc. HOLDER.THIS CERTIFICATE DOES NOTAIIriEidC,EXTEND OR ALTER T-HE COVERAGE AFFORDED SY THE PQLICVES BELQ`N. 2570 Cranberry Highway P. a. Box 551 E^c?:GE RFFGaDt+VG Cv"v �tA;C ,t -_Rv i =ase Wareham, MA OZ516 Nsli _ trCi Insurance CO. S �en 34754 J F.emodel,a9 ;. ._ ._ ' CamltLerce Tnsuraree Company j 15 Wilson Way I 4A 0234a" � hi c3d1 ebvroLlgh, — i INSURER t k COVERAGES _ rv;TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH CONDITION OF ANY CONTRACT OR OTHER DOCUMEN?I�t1 1 REaP_CT TO L�:T±iCFi THIS CERTIFICATE MAY Bc'J'5NS D OR THE?OLIGIES O> INSURANCE LISTED BtLOVJ nP.VE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY F CERTIFICATE I A E MAY N iSS1-''SD O ANY REQUIREMENT.TERM OR CO MAY PERTAIN,THE INSURANCE AFFORDED BY Ti IG POLICIES DESCRIBED HEREIN PS SUBJ POLICIES.AGGREGATE LIMITS SHOVJN WN HAVE BEEN REDUCED BY PAID CLAIMS. LInIITs N TYPE OF INSURANCE POLICY NUMBER DATE MMlDD1WYY GATE MM/DLD II Z,OOO,(?00 LTR NSR BP11020520 03/22/2010 103/2Z/Z011 EACH OCCURRENCE ; $ _ 50,00 GENERAL LIABILITY i 1'I'ZEM15E5(Ee a= naveell 51000 X COMMERCIAL GENERAL LIABILITY NtED EXP(Any ore.person) S CLAIMS MADE I OCCUR; 1,000,00 ii PERSONAL 8 AOV INJURY S A GENERAL AGGREGATE S ,000,000 l PRODUCTS-GOMPIOP AGG 'a 2,000,00.0 CEV'L ACCREGATE LIMIT APPLIES PER: PRO- LOC i POLICY, JECT QVZ276 11/26/2009 11/26/2010 (EaaccVEOSINGLELIMiT $ AUTOMOBILE LIABILITY (Ea acaCent}ANY AUTO BODILY 111jURY S 100,00 ALL OWNED AUTOS I (Per Person) X 6 edotLY NJLJRv SCHEDULED AUTOS S 300,000 HIRED AUTCS ! (Per accident) NON 0 NNED AU-0 5 PROPERTY DAMAGE S 104 000 (Per acadanl) r { - AUTO ONLY-EA ACCIDENT S I GARAGE LIABILITY EA ACC S OTHER THAN 1 ANY AUTO ` AUTO ONLY: AGG S # EaCH OCCCRRENCE S REGAT£ g j EXCESS!UMBRELLA LIABILITY AUG_ _ I r_ b OCCUR CLAIMS MACE 4 ---;--�— I i t j ( ;$ I Dc'OUGfiOLE -RcTE rNT!ON $ TOI2Y LIMITS ER I WORKERS COMPENSATION E.L.EACH ACCIDENT g __------ I AND EMPLOYERS'LIABILITY YIN I ANY PROPRIETOWPARTNER EXECUTtVE(-�T !E.L.DISEASE-EA EM?LOYEF S dFFIGERlMEMBER EXGW05=? :_L.DISEASE-POLICY LIMIT 5 (Mandatory in NH) If vas.da_crbe under SPECIAL PROVIS!QNS be!aw OTHER I ,l � I I i DESCRIPTIONOFOPERATION51LOCATIONSlVEHICLESI EXCLUSIONS ADDED BACEO'B��lu�e�EaSL Additional Ins with reSpeOtS tO HD AT Home Services, Inc and The Home Depot erneral Liability Insurance CANCELLATION THE CERTIFICATE HOLDER SHOULD ANY OF THE ABOV DESCRIBED POLICIES BE CANCELLED BEFORE10 DAYS Y4RITTEN DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL THD At Home Services, InC NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHAL i ENTS OR DBA The Home Depot At Home Services INIDOSE NO OBLIGATION OR LIABILITY OF ANY KING UPON SHE INSURER,ITS AG 2690 Cunberl and Parkway REPRESENTATIVES. 1 Suite 34Q AUTHORIZED RePRESENTAIWE Atlanta; GA 30333 Edward Sullivan/ANNE 1988-Z009 ACORD CORPORATION. At!rights reserve d t�i rks of ACORD ACORD 25(2009101) The ACORD nasa�e and logo are sag+stare a' PE.EASE RiAdi 38iS. ranch Sold,Ftunished.audlledtiy �• Name:'Roston', Date: :Tk13h At H optic Services;Inc: Bran Numbe _. ::.::.:_:,..:.. :•r ,34 d!b/a''T'lt�.flome:DepbtAtrHome•Scrvices S A orcestar k-01607 . Crt etmwood'St ioet;Unit 2;W' �..-.. ^ . .. _..:• Toll: 657=5 2 fFasc(S08);ZS6 8823 ' QNorth.33.,., 31..._:: :••:''::: ,::: :,�::=::�;�,:..:.::::..:.:..::"�:.:, 1•rce( 1.8 � ,.... _;Federtil=IDS#75-2695!164;;2vf$EiG#.C:OZ439;121:Cont I,ici116L27. • _ .;•::': ... CL,Lie#56554;iYfA,Nomgiprprove eot;ContrnctorReg.:#_.126>i93• Tzstallxiion,Address: 16 'G, ctzy true zip Ja J_e Pu Work Phone: Home.Phoria Cell Phone:' Ay Home Address: J (lfdifferentfrominstal]ationAddness)=' City:- .E-moil Addres.(to Moelive:projeoteotnmtmrcattons and Hoitte Dc 0f dates).,. ❑.I DO NOT.wish fo receive any marketing c-marls'from The tome Depot Proiect Information; Undersigned("Customer"),the.owners oftha-property located at an = the:abov d THD At-Home Sevices,Inc.> ( The Rome Depo")agrees to£tmtch, n e tih all nateriaJe desciiion the>-below snd on rte..zeferoncod SSb ticsi,ampsat�silolaati;oidhd r(e"sIsn sata`llea tico")bf Spec a.Owhiehare•incorporated•into:this'Coatactby,6is reference,along with•any'applllbablc State Supplcment and Payment Summaryattached,hereto'nnd any-Chavge:prders.(coliectivrly, ••Contract"): •, ... : .. - , P oducm:. Roofiu&. Sidin Windows. ;Insulation. Amount' S Shoe s-#:. • .Pro'ect []Gutters/Ccivas C]Entr - R'oofiitgr.-.S.id B--:• ,Windo., Gutters!Covert �)✓iitiy boors ] _hoofing Siding Windows insalatioti []Gutters/Coversr©Entry Doors❑ _. _ $: Doting Siding Windows. InsulWion. - Gquttcts-/Col-cC s [DEnt{y poors:,a $ . . Minimum 25%'Dc�osito£CoutractAinouatdi►a•upooCaecotionnfthigconfraCK'' .' '.'' �,..' ', � ;:'., :, TOtal Contract Ainonnt $ Ms,;nc Purchasers may not daposit mole than one third ordteContMctAmount ' Custotiier agrees due,iromediaieby upon:completion of the.work-for,each:Produce.Custoi`r,ei W,-i)1 execufe a<Completion,:Gcttificate (one-for each-product as de€tned by.aw'individua-SpecSheet):and:pay;.any balance;•due.,;A�,APplzcablc;,each Customer udder this Contrset ages to;be jointly aud:3everatly obligates;and•iiablc_heLenpder,.;;�::_.. :. ,-`.... ,..: .. : , The.Home Depatreserves rite right to.issue a Chsuigo'Ordee or'tcituinste this'Conttgeror arty individual PTo<lucc(s)-included herein at its discretion,if The Homc Depot or its authoii>.ed•service provider determines that it.cannot-perform its obligations due to a structural -problem*with-the h6iiic,;envi1Conmeota1liawds such as:mold,'asbestos or lcad.paiut,otlicr satfety,conecros;pr(oiagcrrorsior!beeause word:.reVired to:complete tha job-was:notancluded m the Payment Sui iimar ,The'?4ay neat i, ::. .. .., t. . :.r _. .:.: :.:...;•..f..,: .` ....,. .: Summtuy # neli:ded as part_of'this Contract;set,4 forth the total Contract amount and p"aymeiits raqutred for tfie deposhfand Iinal paymen44 by Prodtict.(as. - NUTICE;TO CUSTOMER You are entitled to a comp) tally filled-in copy of-the COB tr^act,at.th� u time.yo sign-.Do-.not..sigri a GompTetiou Ce��cate(note: there is one Completion CCrtrficate for each listed Product as dcfined'by individual Spec Sll¢eYs)"IiBfp[e.work on that 'roduct is complete. In the event of termination of this Contract,.Customer agrees to pay The Home Depot the costs of materials,.labor,expenses and services provided by The home Depot or Authorized.Service Provider.through the date of termination,plus any other amounts set forth in this-Agreement or allowed under applicable law. THE HOME DEPOT MAY WTIM•IOLD AMOUNTS . OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER-PAYMENTS MADE, WITHOUT LIMTMG THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. .acceptance and Authorization: Customer agrees and understands that this Agreement is the entire-agreement between Custom r and The Home Depot with regard to the Products and Installation services and supersedes all prior discuwsions and-agreements,either oral or written,relating to said Products and In stailatiom.Thi�t Agecment•cannot be assigned or amended except by a.writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read;understands,voluntarily accepts the terms of and has received a copy of this Agreement. e Yr Custom s ip�„atutc Date Sales o sultsnt's X Telephone No. Customer's Signature Date Sales ContiTiltamt License No.. CANCELLATION: CUSTOMER MAY CANCEL.THIS (scapplicablo) h AGREEMENT WITHOUT PENALTY OR.OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE, THIRD BUSINESS DAY AFTER SIGNING TMS. AGREEMENT. THE , STATE SUPP.LENfM" A TTAC HED HERETO CONTAINS A FORM TO,. USE IF ONE: IS SPECIFICALLY ' PRESCRIBED BY LAW IN ' CUSTOMER'S STATE.. NOTICE:ADDI7TONAL TERM$ANDCONDITIONS ARC 1rrATEW0NTNS•REVERSE SIDE AND AItE.$¢RT OF PHIS COAi7 RACE 10.1-08 rev 8-06-08 C-SG Whyte-Branch Pla von .. -- Tnn•,r SIlI@lTfAH d,OdHG SWOH 89:ZT OTOZ-EZ-DIIV r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4Map Parcel d Permit# Health Division �"' Date Issued 4 9— 0 Conservation Division Fee Tax Collector % ®,. Treasurer g l zr IS EP"nC SYST tintelT Planning Dept. /1_/ A— WITH T➢TO* 5 Date Definitive Plan Approved by Planning Board TOWN REGULM� Historic-OKH Preservation/Hyannis Project Street Address /)C�Ll lad s Village U 1Ai S Owner ,J W l GSA PS E Address _S rmVV `r Telephone 1 b 0 -- d 3 Permit Request k2`X b S� & CgA Square feet: 1st floor: existing proposed ZI i� 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Typei' W Lot Size (� s t� Grandfathered: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure "13n Historic House: ❑Yes �gNo On Old King's Highway: ❑Yes No Basement Type: Full ❑Crawl ❑Walkout ❑Other ®, i Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) c3 "FL Number of Baths: Full: existing 1 new Half: existing new Number of Bedrooms: existing new ,Total Room Count (not including baths): existing new First Floor Room Count fleat Type and Fuel: XGas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing V/.' New Existing wood/coal stove: ❑Yes ❑No Detached garage:Clexisting ❑new size Pool: M existing ❑new size l,�)rf Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed: ❑existing Cl new size Othe . FrF`72 U i Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ S E P 2 1 20 01 Commercial ❑Yes XNo If yes, site plan review# Current Use �� yt> �`-- Proposed Use By BUILDER INFORMATION Name ��y�'„�.�,I Telephone Number Address License# f)t Kpzk_� STk-e) t ri L Zk_-'S-0 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _'�, SIGNATURE I DATE 1 f7 of i - FOR OFFICIAL USE ONLY " • i PERMIT NO. t DATE,ISSUED ! MAP/PARCEL NG. R•` <� ADDRESS VILLAGE 1 t OWNER p DATE OF INSPECTION: 1 FOUNDATION FRAME INSULATION y' FIREPLACE a ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL z GAS: ROUGH FINAL FINAL BUILDING { DATE CLOSED"OUT k ASSOCIATION PLAN NO. f , f 2 — _-- The ommonwea o U _`= Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers,Coln ensation Insurance Affidavit XXXX name: � location 1 ("' 6 r ' city �.\ -trN '-)Vi x� �]�b d phone# ❑ I am a homeowner Performing all W01k myself: I am a sole Droofictor and have no one in aav on tWs job:. �•^^workers easatron for mp a waziang::..:::::::.:.? }::<:_ crop�.................... :......................::.}-::::::::...::::... .:.:.:::.:......:::::..........:.....................::::::.:.. ,.:...................-...,.. 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WxwY4:...,..xx{M:•• .. ......-... ............. ........v...-..........:::::............. v., .;lvi .. .x.`%,+•.v.••.:vrtt2'} ...n....., .{v:nv::nv:• ,n.}:i<.:iY:•.::•}i::n::... ............ .......... ............ ....n.......... ............ .-..a.....,..r....-....... ............. ....n, �::w:n.-. n::w:.:}:•}}i::i}:•i%-}`;>.:r::;j}:�{::"i',v';i�:•irk.:.::.,;;::: .......:v.:v:::.....:.:::.::n..........vv. ... ...w::n,v:.v.n..........x..:t.. ,..h...:L ....•.{ynx..;... ry .... ::.:::..........::.,........::,.... ...w�z� s. under Seen=2U of MGL=cm iead to the ingmxdd n of crhwnai peoaida of a Hoe up to Sr.'�00.00 mdlor onaFafl y a to seems onM=te well ASred a ape years'lmprbonmeot as well as eivH penal of a tT0 u�liS ORDER DU for �EHO1s° 0 a day against me. I copy of thb statement may be forwarded to Mee r fPQI�' the infomto ioitpro�above is tru.mid ward I do hrrrby certify P� Dffit �/ �1 �/ �0 Sigaatlut . name s �� • Phone# 49 6 2 - y oiHdal use only do not write in this area to be completed by city or town oMdat ❑Bnildin4 Dep'r�t dty or town,.— —- Pe a ❑LIcaudn;Board ❑Selectmen's Offl= ❑checkif Immediate response is required C3gealth Departmr"t . ri: _ ❑Other contact person: - phone (tevuaa 9/95 P1N Information and Instructions ' J Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers compensation for their lovees. As quoted from the"law", an employee is defined as every person in the service of another under any co= emp of hire. express or implied, oral or written. An emplover is defined as an individual partnership, association, corporation or other legal entity, or any two or more the foregoing engaged in a joint enterprise,and.including the legal representatives of a deceased emplover, or the re=ve 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 or the occupant of the dwelling house of another who einploys.persons to do maintenance, construction or repair w°rk M such dwelling house or on the grounes building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or rent buildings in t of a license or permit to operate a business or to construct he commonwealth for any applicant who the not produced acceptable evidence of compliance with the insurance cove ragrequireTd� cdtttel �bhr commonwealth nor any of its political subdivisions shall enter into any contract havethe been presented to the c o raezr: rk acceptable evidence of compliance with the insurance required ofthis.chapter authority. /. Applicants t the box that applies to your sitaatlon and Please fill in the worker's' compensation affidayt completely,by chwldng supplying company names,address and phone numbers along with a certificate of insurance as all affidavits maybe aruneat of Industrial Jcideuts for cam of insurance coverage• Also be sure to sign an submitted to the Dep city or town that the application for the permit or license is date the affidavit. The affidavit should be returned to theShould y�have�Y questions regarding the"law"or iz big requested,not the Department of Industrial Accidents• atthe member listed below. are required to obtain a workers'compensation policy,Please call the Department City or Towns legibly. The Department has provided a space at the bottom of Please be sure that the affidavit is complete and primed sti has to contact you regarding the applicant. Please affidavit for you to fill out in the event the Office of bivestigations be returned?� be sure to fill in the permitllicease number which will be used as a reference number. The affidavits may the Department by mail or FAX unless other arrmgemeats have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questi= 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 lavesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 y .;A • �W' Y i 4 _ - .F... r.h-.`.�;'�`FM ^-:z['�. ^R s - :G+i:.t•�•.t.n.. -.. j t 'L166 C(5N OCTIOI . 185Q 7 E Tr,no `1714 To: 00 a W3372 �i7AktNSTABLE MA Administr W,",- • b � '��,a '� <r �-7 ��voonare4 ooucers�Qf e� { �I V-, _ HQIIEINP�RpEflENTRCONTRAC10Rr ±' Registration .10039 ¢* A Expiration Q6� /200ejndi 2 Jr y k ark "•'' s}raa� i:StUrQlS{':St Peter `i t Box 37,'. AOMINfSTRATOR: Barnsta6le 0263Q; • �T... L 4 � }E n* d fi s, c - W LOT yZ N Lor 4 9- 1jj o 0 0 2 1 Z864-' 0 J co r 4(- I ss�\ ;p V41LLIAP,1 C. =;t" _r=' CERTIFIED PLOT PLAN LOCATIONS 7L-TZvi t:( �: , 1�J. I CERTIFY THAT THE Fov�J DATi�I� SHOWN HEREON COMPLYS WITH SCALE DATE THE SIDELINE AND SETBACK REQUIREMENTS OF THE . TOWN OF PLAN REFERENCE S'TA\3LC- AND is LOCATED WITHIN I�THE n FLOOOPLAIN, : LCr 2874 DATE : `}-I�-�� �`-�U� -ti�1 •BAXTER t NYE INC . THIS PLAN IS NOT BASED ON A REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OSTERVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES, APPLICANT K - f c * A A 71, y. t ri-4 4 r 71 x; d , W { z � � IL 2 X- 223 �0 Lo V\ \7 cw ` v- - cjavyv-Cl r---4j I CA,C-- �A 1 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE rr Z l (o square feet x$96/sq.foot= Z6, L x.0031= b plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq. foot= x.0031= plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft.l >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot.= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) r Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) ! IaL Permit Fee L� projcost F 1HE l°� The Town of Barnstable + WRNSTABLE. • 9 M Regulatory Services �A 1659. aim Thomas F. Geiler, Director Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 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. Type of Work: �.. �� , ,� Estimated Cost . Address of Work: Z-Ip Owner's Name: Date of Application: `O 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 as the agent of the owner ` iOZ 3 6 Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav:rev-070601 t Assessor's offioe (1st floor): Assessos's map and lot number ...... � ... .... .d�. .®............. �oFTaE o r ` 9vard of Health (3rd floor): < Sewage Permit number .............. H ........................ Z BAMST&BLL, Engineering Department (3rd floor): �o N 9, House number ............................... v./D /%��. a�0 ........................... a gar APPLICATIONS PROCESSED 8:30'-9:30 A.M. and 1:00-2:00 P.M. only _ n _r TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......p Vj. tA.. rU 5Qb'*..L 11%41.� ......... �....o..�...l.......................................... TYPE OF CONSTRUCTION ........ Q!tv..... ....+ UI n�` +1 A e'- .............. ............. :/.,f.l. ...............19.96. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: lke Location .............Z�.d........... or`'1y ....Vf a!^�.......r✓r��j'Fr � .............................CLO ........lS ........... ............... ; cam•,ti A o � /6 )( T b .......................................................................................................................................... Proposed Use .............. 1 ZoningDistrict ....................... ................................................Fire District .............................................................................. Name of Owner .... )"Vel IJe�vS zfU L—O ' .. ow Address ............ ............. .......... ......... ........ .. ......... 'eA"/ • Name of Builder' .....f.................................... ..........Address `f' / ` ��,� a f(3�3 ,/ Nameof Architect .... f .....................................................Address ................ .'.... ......................................................... Numberof Rooms ..................................................................Foundation ..........................................t'................................... Exterior .......................................... :....................................'.R,00fing .................................................................................... Floors ..................................................... .................................Interior ......................................................:.............................. .....Plumbin "Heating 9 +,. ............... ....... ! ......... y ........................... /® dv,) Fireplace ..................................................................................Approximate Cost ..............d................................................... Definitive Plan Approved by Planning Board -------------------------- ,�• 19 Area . . . ........ Diagram of Lot and Building with Dimensions Fee ee / ....�._......... ........__................. SUBJECT TO APPROVAL OF BOARD OF HEALTH } OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agreek conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. !� /�'�.... Name .............. ... .................... , Construction Supervisor's License d 7D O ................... ............ BEARSE, EDWARD A=251-080 ' Z S1 �� No s 1810. Permit for ...Bu...... Swi tiri .rig Pool Ac ce s sory,...to,,,Dwe 11 ing............ Location .....Lot....#.4 5 , 210 Longview Dr ive _. ....... . X.................................................... . ... Owner ,.....Edward Bearse ....................................................... Type of Construction ,Frame............................... ............................................................................... Plot ............................ Lot ................................ Permit Granted .....April 14 , 19 88 Date of Inspection ....................................19 Date Completed ......................................19 File No: 3 1908 e 1 _c. & P r.i n c i. , P C= _ Dead Book: _ Page: ern uc Ghent: — 28749B Lots : 4_5_---- Owner: Esta ee of Arthur C . Young Plan No. Page: ( ) 84436 Applicant: Edward G . Bearse , III Certoftitle: None Available As sessor's Plan: Lot(s)._ Census Tract No:_ --- ORTG ti GL INSPECTION PLOT PLAN M IN B A R N S T A B L E . d 100.00' d� --------------- ` Bulk ead be.u I ,r 16'+ 1-1k story Dwelling Lot 42 No. 210 Lot 46 N I � j 100.00' Date: 5/6/87 L 0 N . G V I E W D R .I. V E. Scale: 111=3 0 ' I CERTIFY TO GARNICK & PRINCI , P .C . , NEWORLD BANK FOR SAVINGS. AND ITS TITLE ARE . NO VISIBLE EASEMENTS OR ENCROACHMENTS INSURANCE COMPANY, THAT THERE EXCEPT AS SHOWN AND THAT THIS PLAN WAS PREPARED UNDER MY IMMEDIATE SUPERVI— SION THE LOCATION OF THE DWELLING AS SHOWN HEREON IS IN COMPLIANCE WITH THE LOCAL APPLICABLE ZONING BYE-LAWS IN EFFECT WHEN CONSTRUCTED WITH RESPECT TO HORIZONTAL DIMENSIONAL REQUIREMENTS . [DES LAURIERS& ASSOCI ES, INC. THE DWELLING SHOWN HEREON DOES NOT MA02012 AT i FA L WJTHIN A SPECIAL FL..00D HAZARD 1256 Park Street,Sulle202,Slougtton.Jzo 7_OPdt ;a � SHUN:Iv UiJ_ MAP OF (,UMMU it i " ;,— INUMBER 250001C LIATED 8/19/85 BY THE `t�aF F .E .M . A , tioa�� t` 1 r #• NAME DETAILS FOR RECTANGULA'i POOLS 3. ADDRESS 'Snap Strip"Coping CITY/STATE -rEL. NO. '1 i Wall Panel 5/8" Hex.Nuts and POOL TYPE SIZE Cement Pad See"Typical Wall 11/16" I.D.Washers Cy 0 i d Tek Screw Joint-Detail: \ BACKFILLING NOTES 23"Stake f/4 - 21 . " Short j Brace t. Backfilling should proceed at the -- - Adjustable"A" same rate and time as filling ------ Frame Clip the pool wi!h water.Do not let --"Holiday"Rim Coping water get ahead of backfill or vice-versa. Drainage gravel is preferred for Tek Screw r backfill.Never place rocks,large Long x Member ber Adjustable( 1 Long (41-5/8" Long) .• ✓ ! ��(,r 1-1/2"x 1-1/2"Adjustable k. boulders or debris near the poo! w i' Long-Member(41-5/B" Long) walls as part of backfill. To minimize settling around the pool gradually backfill approximately Wall Pane 12"at-a time and firmly P hand tamp. - Never use sand or clay so ADJUSTABLE A-FRAME n against pool wall. COPING CEMENT PAD LONG MEMBER ASSEMBLY Tek Screws— Concrete Deck - See"Adjustable A-Frame Wall Panel Long Member Assembly"Detail 3/8"- 16 x 1- Wall Panel Hex Bolt Wall Panel _ i See"Typical Wall Joint"Detail CC 1-1/2" x1-1/2" Adjustable I / � Long Member(41-5/8" Long) o� . i Wall Corner (2 pieces) If Undisturbed Earth - ' fi, -- 7 o 42„ f // / Concrete Collar o 3/8"-16 Hex Nut Wall Panel _ See"Cement o `-- Pad" Detail - ' R -e bar ' 7/16" I.D.Washers Tek ScrewConcrete Collar Note:This Wall Corner CemenE Pad Assembly Not Required 23" Stake t For Grecian and Octagon Pools. 21-3/4"Short Brace TYPICAL WALL JOINT OPTIONAL CONCRETE WALL CORNER ADJUSTABLE A-FRAME DECK BRACE SYSTEM f _ a g 6' 9 .3e' r-WORK AREA 12 A G A �ca'r?'-•, u 20' 6 /6 C / I 0.. III .. ...-. POOL LOCATION Safety Line Use Adjustable A-Frame o"4 \�o- Braces At Wall Joints "b�'� + I � ac ��. ; pus = - b o Indicated uy A. Digging Layout tp A I i I t .-� NSP! !' See "Wall Corner Detail" I (Typical Ail Corners) TYPE-I1 DIMENSIONAL m — '\ �a;���;;�, SPECIFICATIONS AS APPLIED TO # 20713 I ! Q� j WEATHERKING POOLS --1— 1. Overhang of diving board from edge "'F....••'4 ,q .4 A - � of pool is 2'-8 7/8" (±3 inches) _ PdavD...,< et co°je 34 (— 1 2. Water depth under tip of diving board is a minimum of 72" at Point"A". ; Plan Note: 3. Maximum board length is 8 0". Stainless Steel Wall 2' 8 7/8 (f 3") Overhang Distance anels 41" High. All 4. Maximum board height over water is �-� 20 inches. Others 42" High. e �Y�. ANGllO P.fFA1UR1 1 120"Maximum Height Above Water j'— I 5. Diving board must be centered in width of pool. a wus LSee Safety Line N.3247 6. Refer to manufacturers' specificationsmum Water Level for fulcrum locations.elow Top Of Liner7. 5afety,!;nes must be mechanically at-Undisturbed Earthtached on one side supported .by .2 `Jinvl Liner Over buoys. 2" C:,n:pacted Sand 8. A step or ladder or other approved • 10,-0' means shall be provided at both the a' 0- 6' 0" 14'-o shallow and deep ends. _ Profile FOLLOW ALL APPLICABLE SAFETY AND BUILDING CODES, AS WELL AS INSTALLA- TION INSTRUCTIONS FOR THE POOL AND ALL EQUIPMENT AND ACCESSORIES. 16, 16' .-. 16112, 16112 CAUTION: DIVE-FROM DIVING BOARD ONLY. 16x34 RECT 16x34 RECL s�' ! e�Q p �+�c 2- 14' SECTIONS 14, 2-15' SECTIONS YV EQTHERKING PR®DUC 1 S1 IN l4 4- 16� SECTIONS l5 -4-X w SECTIONS l5 p ^u . 4- /PG 90°ROLL CORNERS /0-COPING CLIPS CORNERS EAST G R E E N W E C H,- R.I. ' l0- COPING CL lPS DRAWN: APP' "I.p.P: 16, 16' 16tl2 16112' 16 x 34 x 8 BGT 11 AF[H DATE: 12-82 Holiday Coping Layout Snap Strip Coping Layout y RECTANGLE Assessor's offioe (1st floor); listm STEM MUST Be Assessorr's map and lot number .....v........d.g.�....... TALLY '' %C0MP'LIt.NCE �Q�pFTMET��O Board of Health (3rd floor): fO Q/ r. �`I�'LE 5 Sewage Permit number .....1?P... .. S.a-..�.r�.............. �, � i BASd9TABLE. ! ENVIROU',o .ITAL CODE AND Engineering Department (3rd floor): '°o 2639• 0� House number ................................ .....:...... � .. TOWN REGIUI.A"+9'14I�S ,� a. 0 ypV APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M.. only, p TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......6t j P..... ......I....j�. /. .. :............................................... TYPE OF CONSTRUCTION ........�'�I.U..... .(...... �...v1`!�`......�k�!�....................................................... . r .................... ...............,9.. d_ TO THEINSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: D J `b Location ..............2 .......... 'a ............................ S Proposed Use r�1glF v�+ �``�k� �oo 6 b ZoningDistrict ....... ................................................................Fire District .............................................................................. ,/ �• ' Name of Owner ....F GI!!! .... 1� 5 z to Lcs �/1 ew lJr �e !� -e ...........................................Address .............................. .....................................77 Name of Builder �-�+'�!"`�`JAO-.. Address ....X :ctKo � /: J we►� ... � sf� y` ..... .......�.. -........................�................Name of Architect ....... .... .........Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating. ........................ ..............Plumbing L ................................. ............ ........ Fireplace ..Approximate Cost .......... f................................................ Definitive Plan Approved by Planning Board ------------------------.-------19________ . Area .. . . �... Diagram of Lot and Building with Dimensions Fee eQ.a .. ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH ..;OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1.hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction: Name,.; �. �..r........................... Construction Supervisor's License v� . BEARSE, EDWARD .4 Permit for ....Build....Swimming Pool .... ....... .. .....A.c.c.e.s.s.or.v...t.o...Dwelling,,,,,,,,,,,,, Location .Lot .......210 Longview...Drive ................Hy.an.n.i.s............................................. . Owner .....E........dwa.rd............Be...a...r..s...e............................. Construction Frame Type .......................................... .......................................................... r. 'Plot ... 'Lot ................................ Permit Granted .....tpr 14,............19 88 Dc#,e- of 4. spection ....................................19 IdNe Co-mrt9led ................ .....................19 36 0 TOWN OF BARNSTABLE Permit No. ...29237...... �p { i. BUILDING DEPARTMENT Cash ($400.00) TOWN OFFICE BUILDING ho�uv�� HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to Arthur Young Address . ,Cat #45, 210 Z,ansvieca Dxive.- Centerville Masaaehuset=t,-, USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. � .� �'............... 19................. `..-...-...... Buildini Inspector As"ssor's ffice (1st floor): ' 0.0 SEPTIC SYSTEM MUST EE f INE Toy Assessor's map and lot number .......... . :....... .............. �' INSTALLED IN COMPLIANC Q �� Board of Health Ord floor): WITH Sewage Permit number ..................... H TITLE 5 Z BAgg9TODLE 'ENVIRONMENTAL Engineering Department (3rd floor): CODE A oo r°' 2639. House number ........................�..% ...�.�6.:.. ....... TOWN REGULATIONS `'EaYAv� APPLICATIONS PROCESSED 8:3019:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .................. ..................................................................... .........:..... ... TYPE OF CONSTRUCTION ..........PVPQ.2)....: .......................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: r v v; ,r Location ......rt<.G.r"....S�S:. '�:. ...��.�......�...-"" .��'1..�..........4P��.-.^.'.h`.': v�L-[� ..:................................... ........... ............ .................... ProposedUse .................. .......................................................................................................................................................... ZoningDistrict ...... V..........................................................Fire District .............T............................................................. Name of Owner sni� 7 v plc'u^',� O�LIS"? -s"f ......................Address .... .. ................ Name of Builder ��Vxz) �� Sf v,�� a ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms `�K ...........................Foundation ..�0�✓G/ O/ �0.�(.' Fi' ........y............. Exierior .... '` ..�5�>/M '-5........................:.......Roofing ...... 5 iJ�9GT......................................................................... Floors �G ; .................................................Interior .....� ........................ ........ :. -a' Heating .. . �.... .:..............Plumbing ..... .8 ................................................ Fireplace .. ....f%�,�. C! LC('lC......................................Approximate Cost ..... ©iOC/U............................................ Definitive Plan Approved. by Planning Board --------------------------------19________ . Area ......... ......�... . ......... Diagram of Lot and Building with Dimensions Fee t. SUBJECT TO APPROVAL OF BOARD OF HEALTH s�erlj �d yD Q� 23-4 � r 2G y Z Da 0 a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... ............. .. ................. Construction Supervisor's License . ?�.jr�.F`5............. YOUNG, ARTHUR s Rlo .. .`..237.... Permit for .....Zi...S.tor.y.............. - f !t....Single Famly... ...................... t. Location #4 Lot .5 210 .v7 Rxzve = n ::............a................ , Centerville f Owner Arthur Youn ti .......................... g.................................. Type of Construction ..FKAIRP.....................•.• +x L .............. ............................................................... •' .Fr 1' ' ~`y S - Plot ......... ..... Lot................................. Permit Gra April ,24, 86 nted ......... ............................... . Date of;Inspec`tion .. .. .." . - 19 a PO j .+ Date Completed IM t � ` t l' 04 7,jD oTH 4o'f -1 Lo T 3S't , • AND 38't p 2 Ig �. „ f - LoT' T IS 1610 S-F. 48'± Z RtCHARD- �r+t- IMTER . . `•_ Na 24048 CERTIFIED PLOT PLAN LOCATION CC —c-j2_vi �.LC I CERTIFY THAT THE C=ov�1nAT"� a � SHOWN HEREON COMPLYS WITH SCALE DATE THE SIDELINE AND SETBACK �c°�' �a�aa t - 'r.�► SG REQUIREMENTS OF THE TOWN OF PLAN REFERENCE F`AizaJ�Ai3l lr AND. IS NoT LoT \"t LOCATED WITHIN THE FLOODPLAIN. 13�G 3" "c— z7 DATE : (0-7`96 IraBAXTER e NYE INC. THIS PLAN IS NOT BASED ON AN REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OSTERVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES, APPLICANT c 1pcu ,- LOT A IZ7. _4 N L-o r 4 5' o o 7 p GI O o qj v► 0 p : a � o J , Co T 4 C WILLIAM yin\�z �v CERTIFIED PLOT PLAN LOCATION /v ViC,CL , CERTIFY THAT THE �ov�J DATi�s� SHOWN HEREON COMPLYS WITH SCALE DATE THE SIDELINE AND SETBACK REQUIREMENTS OF THE . TOWN OF PLAN REFERENCE gA�ZrJsTP:��l.l AND IS i�o T- U T- 4 5 LOCATED WITHIN THE FLOODPLAIN. Lc.. 2 '674 � "-- z DATE '. `4"IG4�(. `� � �16�4r' •BAXTER $ NYE INC. THIS PLAN IS NOT BASED ON Ak-) REGISTERED LAND SURVEYORS INSTRUMENT SURVEY AND THE OSTERVILLE^- MASS. OFFSETS SHOWN SHOULD NOT BE USED TO DETERMINE LOT LINES. APPLICANT BUILD • ,fI N G TOWN OF BARNSTABLE, MASSACHUSETTS PERMIT , JOB WEATHER CARD • DATE 19 PERMIT NO. 29237 APPLICANT ADDRESS (NO.) (STREET) .(CONTR'S LICENSE) 7 i U d ..9:..:.':;, _,r<;1.t' _... iV LrV:d'.<_i iiL NUMBER OF PERMIT TO ( �l: STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) "J1....`w' II:':'t.'t:.; T (:i_:';�'i r..'.1•V.11.1-... ZONING AT (LOCATION) DISTRICT (N0.) (STREET) ' BETWEEN AND - (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS:' AREA OR 1.3(;4 4t;. i C.. ii'.sJijl�),lii.r PERMIT VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) - t11 OWNER 1')U BUILDING DEPT. ADDRESS. . ;:'�.L':;Ct'i': ;iLYL>r�:� .•..ii:•.'._: BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR ® PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS _OF_ANY::9P_P_LLC_k0LE_SLL5DIYLSION RESTRI-CTIONS MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION. BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET J BUILDING INSPECTION kPPROVALS PLUMBINg INSPECTION APPROVALS ELECTRICAL INSPECTION' A RO`:ALS Ll 2 2 2 3 HEATING 'NSPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS OTHER- '2 2 � . _ :CT uNT PF. 7N1'"+'ILL BECAME NULL ANi?.VGIO I° CONSTRUCTION ra FCT!cr.�. a r'. r_n ON rAL.EJ .HE :.^,! i !'It3RK I5 N97 STARTED Wl'rHIN SIN'MONTHS OF 'DATE THE � ;ti ARRi:�� rOA BY . i. ''FRm; iS 1SSUED A; NOT"ED ABOVE. ! `v0. Y!'4 .'EN �" ay JOHN F. THIBBITTS ATTORNEY AND COUNSELLOR AT LAW 255 MAIN STREET- POST OFFICE BOX 276 HYANNIS, MASSACHUSETTS 02601 (617) 771-2690 March 12 , 1986 Mr. Joseph Daluz Building Commission Town of Barnstable South Street Kyanni.s, :Massachuse.tts: 02601 Re Land of Arthur C . Young 2.10 Longview= Drive, Centerville, Ma. Lot 45- Certificate of Title. It 844.3.6 Dear Mr, Daluz : f The. above parcel consists, ' according to the assessors office in the Town of Barnstable. of . 29 acres or approximately 12, 600 square. feet and is shown on the Asse.as-ors, Map 25.1-80. According to records- at Barnstable Registry of Deeds Lot 45 and Lot 42,C shown as Parcel' 2.51-144 were held in cQ,,mmon ownership by Adelard Carbonneau et ux from 19.66 to 19669 when Lot 42 was- sold to Paltsiss.) In 1972 Lot 45 was sold to Ernest Kapatoes, Trustee- date 'of sale Octob.e.r 16, 1972 , this .property passed tharu a :foreclosure from Guaranty First Trust Company ` and waa sold to Mr. Young on January 29 , 1981- I Certificate: .of Title I6 84436, Prior to th.e upzoning to lA whach took place on Feh- ruarr 28, 1985 this area was zoned RC C 15 ,000 'square feet minimum) which_ zoning commenced in 1965 . Prior to that .thz:.s property vras located in zone RA which. called for a mirikrRu-m lot ai:ze :of 7 ,500 'square. feet . At th .p> .time Mr. Young owns no th_ex lots abutting this property., T'hi,s information sh-ould enable_ .YQu. to issue a building p erzg t for th.i.s p r o.p'e=r tr, 'Very, truly yours, John F . Thibbitts JFT/apt_ As§.-ssorAs office (1st floor): _ g+ F THE T Assessor's map and lot number Q o Board of Health Ord floor): S;,G- -;)-s- Sewage Permit number ........................................................ 2 EAMSTAnLE. : Engineering Department (3rd floor): j b A, K9 � o 1639• House number ........................................................................ �Fo YpY a' e - � APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............................................................................................................................. TYPE OF CONSTRUCTION GvOGZ .�'�� _.......... ...ch......otr' ..........19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: v�.C`o Location ..............................................................................................:................. . . ... ................................... ProposedUse .........c`>i v9(°.... ''' ...V........................................................................................................................ ZoningDistrict ..........................................................Fire District .............................................................................. Nameof Owner ................................:.....................................Address .................................................J�.,.f............P............ Name of Builder .....:�v/� � .:"��v�G ............ .............................Address ......................................... Name of Architect .......Address Number of Rooms ....... ..Foundation .. U�o.I Exterior ................. ............................................Roofing ..................... ....................................... .................. /� Floors ..... �...�1 r`...�......................................................Interior ..... G��9L....................................................... - efin .............................................................................ra Plumbing frg ............................................... ............................... Fireplace .. �.C.k.4../3CG�/�......................................Approximate Cost .....�O�c?G.G............ Definitive Plan Approved by Planning Board _______________________________19-------- . Area Diagram of"Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH --L.4 i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .......................... ....................................... c0c9c) S Construction Supervisor's License .................................... t YOUNG, ARTHUR A=251-80 i No 29237 Permit for 12' Story ................ .................................... 4 Single Family Dwelling Location Lot #.45.......210 Longview Drive Centerville ............................................................................... + Owner .. Arthur Young s ................................................................ Type of Construction .....Frame. ` ...... ............................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ApK l:.24............19 86 Date of Inspection ....................................19 Date Completed ..............:....:..................19 11007