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HomeMy WebLinkAbout0015 PINE VALLEY ROAD is I i� # Co (zKon , # 1 N.'ZDkzW'Vk W $ a ipol V 41 11/14/14 Thomas Perry, CBO Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, This affidavit is to certify that all work completed for insulation work at 15 Pine Valley Road (application#201402385) has been inspected by a certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State requirements. C> 0 Sincerely, j:3.ca Conor McInerney ConserVision Energy 376 ROUTE 130,SUITE C SANDWICH,MA 02563 508-833-8384 WWW.CONSERVTODAY.COM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma 1 ,v I V '�' Application p # >> (07 N P Parcel Health Division Date Issued '7 Conservation Division Application Fee J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address _ /4' Village Z&�J j Owner �,1_T�j� C`i�i� �j�.tr Address Telephoned Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new. Zoning District Flood Plain Groundwater Overlay Project Valuation &,0, O Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family A Two Family ❑ Multi-Family (# units) ,'1 Age of Existing Structure Historic House: ❑Yes $No On Old Kiq'g s Highwe&IL: ❑Xe ,i�No { G-•) , Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other =tea Yv14 "^ Basement Finished Area (sq.ft.) Basement Unfinished Area (sq!.ft) Number of Baths: Full: existing new Half: existing 5rjew U Number of Bedrooms: existing _news 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 �'��� l6�f�� �� Telephone Number Address/ i/�i License# �i�i��YJd Ll Home Improvement Contractor# Worker's Compensation #/,Z•�i' ®d,3"2,��a� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 099.1-) _1�/I 1?t/'y4lP SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# —DATE ISSUED MAP/PARCEL NO. :R= ADDRESS VILLAGE s. OWNER DATE OF INSPECTION: FRAME 's A=INS:ULATIONtk,�i-k — :.,_ ,:•t ; FIREPLACE ELECTRICAL: ROUGH FINAL -- - - PLUMBING: ROUGH FINAL A GAS: ROUGH FINAL FINAL BUILDING t. w DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/(>rganizadon/Individual): •��4� ��, J� Address: City/State/Zip: /' T� m. o ,,AAhone #: Are you an employer? Check the appropriate box: 1. I am a employer with� � 4. I am a Type of project(required): ❑ general contractor and I employees (full and/or part-time).* have hired the sub-contractors . 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling slip and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp, insurance comp. insurance) 9. ❑ Building addition required:] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised k their . 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no 12.❑ Roof repairs 3a.❑ I am a homeowner acting as a employees. [No workers' 13.R Other_/,_/'�,� �� igeneral contractor(refer to#4) comp.insurance required.]. 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensatiortpolicy information. It Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContmctors 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. am an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.# Expiration Date: Job Site Address:/� /f�� � City/State/Zip:_ ,!gl A) f 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u,nou the pains and penalties of perjury that the information provided above is true and correct r Si a Date: -- Phon #: 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: r t y CAPECOD-27 KLIGE --' CERTIFICATE OF LIABILITY INSURANCE TT DATE(MMIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO R6/1 3/2RA4 IGHTS 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(les)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 IIetI of such endorsement s). PRODUCER �0gers&Gray Insurance Agency, Inca NAMEncT Barbara DeLawrence S34 Rte 134 /AIUNNo. xt�_ FAX iouth Dennis, MA 02660 EMAIL �A/c Nc; 877� 816.2156 ADD E sj bdelawrence ra ers ray'Corn — INSURER 3 AFFORDING COVERAGE ^- — _ NS Rkp INSURER A:PeerleSS Insurance COmpany NAIC q INSURERe;COMMERCE INSURANCE COMPANY -- Cape Cod Insulation Inc — --ny INSURER EY ii 18 Reardon Circle c, anston Insurance Company South Yarmouth, MA 02664 INSURER o:ATLANTIC CHARTER INSURANCE GROUP INSURER E; %O ERAGES INSURERF; CERTIFICATE NUMBER: INDICT IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED T )THE INSURED NA REVISION D A ABOVE FOR THE POLICY PERIOD ATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT C R;TIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, E Cj USIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WITH RESPECT ALL WHICH THIS R TYPE OF INSURANCE POLIC EFF POLICY EXP X COMMERCIAL GENERAL LIABILITY ICY NUMBER MMIDDIY YY MMI O/Y T LIMITS occuR 7`CBP'8263P06L3CLAIMS-MADE XEACH OCCURRENCE04/01/2014 04/01/2015 Pn�C'ffT0 ' $ —... 1,000,000 PREMISES(Ea occurrence) 100,000 MEp EXP(Any one parson) — $ 6,000 G N'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY'_ $ 1,000,000 1pICY l PRO- I� GENERAL AGGREGATE $_ 2,00.0,000 L_:..I JECT t�J LOC ER PRODUCTS-COMPIOP AGG $ 2,000,000 AUTOMOBILE LIABILITY $ '—'-- _r COMBINED SINGLE LIMIT ANY AUTO 14MMBCKVMK Ea accident $ 11000,000 ALL OWNED X SCHEDULED 04/01/2014 04/01/2016 BODILY INJURY(Per person) $ :- AUTOS AUTOS HIRED AUTOS X NON-OWNED. BODILY INJURY(Par accident) $ AUTOS PROPERTY DAMAGE Per accidanl $ X UMBRELLA LIAR X OCCUR $ EXCESS LIAB CLAIMS•MADE XONJ453514 EACH OCCURRENCE $ 11000,000 DED X RETENTION 10,000 04101/2014 04/01/2015 AGGREGATE WORKERS COMPENSATION Aggregate $ 000 AND EMPLOYERS'LIABILITY ER.— ( H 4NY�PROPRIEI.OR/PARTNERIEXECUTIVE YIN WCA00525904 SEA TE OFFICERIMEMSER EXCLUDED? - NIA 06/30/2014 06/30/2015 �--- — Mandatory In NH) E.L.^EACH ACCIDENT $ 11000,000 II qos,describe under 0 SCRIPTION OF OPERATIONS below E.L.DISEASE•EA EMPLOYEE $ 11000,00 E.L.DISEASE-POLICY LIMIT $ 11000,000 t IRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Serq'Compensation includes Officers or Proprietors. �to al Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, tTIFiCATE HOLDER — CANCFI I ATIr1W _ i i Massachusetts -Depattnita'nt of Ppbtic Safety r ia2rd of Building Regula#•ions Intl Standards Constnlction Supen•isorc,ti..., License: CS-100988 11, HENRY E CASSII)V 8 SHED ROW WEST YAWAOL�-I- >.2. Expiration Commissioner 11/1112015 ja ^ Office, of Consumer Affairs and BusiZsegulafiion 10 Park Plaza - Suite 5170 Boston, MassachLIsetts 02116 I Iome Improvement Cggtraqtor Registration Registration: 153567 i t , Type: Private Corporation "Fr_..c._: .• ` �.:.- Expiration; '12/15/201 h TO 233831 CAPE COD INSULATION, INC ,,; :::: :,.:._- HENRY CASSIDY `kt. _._ 18 REARDON CIRCLE ----- SO. YARMOUTH, MA 02664 Update Address and return card. Murk reason for change, i t; surd u;✓i i Address ❑ Renewal ❑ Employment LostCnrd � I �il r: �t(�L.7R.7Il.C.ILCOF:R.(l{'C G�C7i"(�'�C:1JCt0/I CGJIiCt �}., 1)1)iec ufConsumcr Affairs& Business Regulation License or registration valid for individul use only �l;iOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: euistration: 153.567 Type; Office of Consumer Affairs and Business Regulation _ 1 xpiration: 12/1'5/2014 Private Corparati�n lU Parlc Plaza-Suite 5170 Boston,MA 02116 �t c UD INSULATION,;;I�JC, .. VI?l' CASSIDY ,ILA 'f)ON CIRCLE YA I NIOUI i i, MA 02664 Undersecretary Aotvalr* witho t nat re i OWNER AUTHORIZATION FORM (Owners Name) owner of the property located at (Property Address) (Property Address) hereby authorize Co ThsAi,,,j (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Owner' Signature L (L IL4 Date TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map .Zy'g Parcel box— Application 4a (d f CCO Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Q Village Owner sa Address \ ?. E ♦� A ��.., a.\ Telephone Permit Request yZ o+�'. �,„ �.-�8 �o ., A-t-e♦ e� �w5�'Cq�` G �. ♦.` ♦�♦.OJ� ♦ .� 4� ♦L ♦�-3S Z `rSY ♦ v GO O� _W A♦.♦� \ vaTW .._. -LZ C.C. V`��d i til f��AZ Af�6 G.6L.\1v� . Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tott-Pew 6 Zoning District Flood Plain Groundwater Overlay — `-5 Project Valuation Construction Type ? . Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documena iion. / - _4 Dwelling Type: Single Family 9 Two Family ❑ Multi-Family(# units) Age of Existing Structure \"N%W Historic House: ❑Yes ❑ No On Old King's Highway: ❑lies LPNo Basement Type: ErFull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing Z new Half: existing l new Number of Bedrooms: -2- existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas Lff'O it ❑ 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 Telephone Number s c:) Address \3o License# Home Improvement Contractor# Z S Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY t' APPLICATION# DATE ISSUED MAP/PARCEL NO. , E ADDRESS VILLAGE OWNER 1 , DATE OF.INSPECTION: FOUNDATION FRAME t - r INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT f ASSOCIATION PLAN NO. I rf -^_1_R `-.^.:/.�C [r4'i!!li[f•'i/I/:nllff/I(j� �7/i)I//'1f{/:P�5 = Office of Consumer Affairs d Business Regulation Licinse or registration valid for individul use only kWME IMPROVEMENT CONTRACTOR before the expiration date- Iffound return to: gistration: 171251 Type:. Office of Consumer Affairs and Business Regulation piration: 3/1/2016 Partnership10 Park Plaza-Suite 51.70 _ Boston,lt1A 021.16 CON-SERVE ENERGY CONOR MCINERNEY 376 ROUTE 130 SUITE C SANDWICH,MA 02563 Undersecretary N4ot valid without signature � ? CSSL-102778 f CONOR D MCMRNEY, 39 SIASCONSET.URINE SAGAMORE BEACH MA 02562 08/19/2014 Ate` 03/1N 712014Y) CERTIFICATE OF LIABILITY INSURANCE DATE / 014 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: H the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT CS&S/WORKCOMPONE NAME: PO BOX 946580 PHONE FAX (A/C,No,Ext): FAX No): MAITLAND, FL 32794-6580 E-MAIL Phone-877-724-2669 ADDRESS: Fax-877-763-5122 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Continental Casualty Company 20443 INSURED INSURER B: CONSERVISION ENERGY 376 ROUTE 130 INSURER C: SUITE C INSURERD:Continental Casualty Company, 1 20443 SANDWICH,MA 02563 1 INSURERE:Continental Casualty Company 20443 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 ADDL SUER - POUCYEFF POUCYEXP LT'R TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300,000 CLAIMS-MADE OCCUR I A ® PREMISES(Ea occurrence) Y N 6011316335 03/1112014 0111/2015 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 17 POLICY JE TPRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) A AUTOS AUTOS N N 6011316335 03/11/2014 03/11/2015 HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE 1,000,000 D EXCESS LIAB CLAIMS-MADE N N 6011316352 03/11/2014 03/11/2015 AGGREGATE 1,000,000 DED RETENTIONS 10,000 WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY >1 TOR V LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $100,000 E OFFICER/MEMBER EXCLUDED? N N 6011316349 03/11/2014 03/11/2015 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 OO,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder is added as an additional insured as provided in the blanket additional insured endorsement. CERTIFICATE HOLDER CANCELLATION Ise Engineering SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1341 Elmwood Ave THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Cranston,RI 02910 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD cac4865 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ConserVision Energy Address: 376 Route 130 Suite C City/State/Zip: Sandwich, MA 02563 Phone #: 508-833-8384 Are you an employer?Check the appropriate box: Type of project(required): 1.E4 I am a employer with 8 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 8. [:],Demolition workingfor me in an capacity. workers' comp. insurance. Y p tY• 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' c 13.® Other Weatherization comp. insurance required.] *Any applicant that checks box#1 must also till 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: CS&S/WORKCOMPONE Policy#or Self-ins.Lie. #: 6011316349 Expiration Date: 03/11/2015 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 of the DIA for insurance coverage verification. I do hereb tify der th p 'ns nd penalties of perjury that the information provided above is true and correct. Sio.ature: Date: N 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#: OWNER AUTHORIZATION FORM eej�A j NE E4. Cv a vti.,P �-�\ (Owner's Name) owner of the property located at IS P,jL v,&ktx4.j P'0" (Property Address) � �S L 6 0 l (Property Address) hereby authorize lorj (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Owner' Signature CCI. a lt4 Date 020 ( 6b1_0 35- �oFt r Town of ]Barnstable *Permit# SS PERMIT Expires 6 months from issue date MIl 1 Regulatory Services Fee r + 1 y BArtNSTAB - 9� Mnss. 2010 Thomas F. Geiler,Director A i639. A�0 � OF BARN-STABLE Building Division Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 Www.town.barn stab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Z�� •��� ��11 111willow Red X-less Imprint Map/parcel Number Property Address �J� flvt V"t ❑Residential Value of Work y d�e� Minimum fee of$25.00 for wor under$6000.00 Owner's Name&Address Contractor's Name /� r�� .1 r"�'` Telephone Number Home Improvement Contractor License#(if applicable) ,7 Construction Supervisor's License#(if applicable) 9 L/ S f/ ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name j- ■ Workman's Comp.Policy# �v '3 ejo '"l d 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) -}^ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit for doc Revised 090809 -• '•- ivlassachu_setts=Department of Public Safco i Board of Building Re�-ulations and Sfandards Construction Supervisor License ` License:.CS 94302 Restricted to:.00 ADAM HOSTETTER. _ 770 SUITE A°MAIN ST ' t? OSTERVILLE,MA 02655 `` a AAN"! Expiration: 12/22/2011 ('Doan issiuner Tr#: 13857 4 f e f _ I • The Commonwealth of Massachusetts Department f Industrial Accidents .,_ tment o Office of Investigations I°F 600 Washington Street r Boston, MA 02111 - sr www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Address: City/State/Zip: a5 fi & AAa. Phone Are you an employer? Check th appropriate box: Type of project(required): 1, I am a employer with 4. ❑ I am a general contractor and 1 6. []New construction employees(full and/or part-hme),* have hired the sub-contractors \ 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 workingfor me in an capacity. employees and have workers' Y9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions right of exemption per MGL i = myself._[No_workers'.rcoznp 152-- _...,. ave no e --.- z. ___.12.❑Roof.repatrs.._ ._ insurance required.] t c. ,§1(4), and w h 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. lContractors 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 andjob site information. Insurance Company Name: dcti t "P e'".' Policy#or Self-ins. Lic. #: 00 ) 6 yExpiration Date: / �1 fit. City/State/Zip: !�.`✓.✓/5 Job Site Address: f Attach a copy of the workers' compensation poll y declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead io 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 f insurance coverage verification. I do hereby certify uxt er a pains and penalties of perjury that the information provided above is true and correct. Si nature: Date: beg Phone# Z ��b~36161 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): z 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 _ --• - -- members or partners,are not required to carry workers'compensation insurance. If an'I I C or l✓LP 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.rnass.gov/dia I a 5 oFVE T Town of Barnstable Regulatory Services BARNSTABLE, Thomas F. Geiler,Director y Mesa $ Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder J t I Gl SL , as Owner of the subject property hereby authorize � 5 to act on my behalf, ' in all matters relative to work authorized by this building permit application for: (Address of job) / 9no 0 Si er Date . Vl Print Name 71 3 If Property Owner is applying for permit please complete`the Homeowners License Exemption Form on the reverse side; Q:FORMS:OWNERPERMISSION Town of Barnstable �0FZHE o� regulatory Services =nxxsrnBLE, ; Thomas F.Geiler,Director Mns& �� 1639. ��� Building Division AT fp�,l p Tom Petry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": p name home hone# work phone# CURRENT MAILING ADDRESS: 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,provided 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 undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner 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 a building permit is required shall be exempt from the provisions of this section(Section I09.1.1 -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 us'e 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. QAWPFILES\FORM SUromeexempt.DOC 0fticc of C:onsumcr Affairs& Business Rc„uhIion —t j� °j ;.HOME IMPROVEMENT CONTRACTOR Registration: 152124 Type: +!:�`,l Expiration: 8/2/2012 Individual W:: ADAM HOSTETTER ADAM HOSTETTER 770 A MAIN ST. OSTERVILLE, MA 02655 lhidcrsccrcl:u•� License or registration valid for individul use only before the expiration date. If found return to: Qfrice of Consumer;lffairs:urcl Business ReLulation 10 Park Plaza-Suite 5170 1"1011, iIMA 02116 Not valid without sihnature f . CERTIFICATE ®F LIABILITY INSURANCE DgTC 12/0 ,DD,YYYY, 12/07/2009 c SylJla Insuranc®Agency (506)426-0440 " THIS CERTIFICATE; IS ISSUED AS A MATTER OF INFORMATION / ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE /1 Main Street HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. o~ Ostervilla MA 02655 -' INSURERS AFFORDING COVERAGE West Bay.Property Management Trust IN8uRr;13 Montpelier Adam Hostetter,Trustee - ----------- -- ; INSURER 0 NJasco Insurance 770A Main Street -_----- --- Co----...... ...... .. . OstcrVllle;MA 02855 INSURER C INSURER D 'ERAGES INsuPER E E POLICIES OF INSURANCE LISTED BELOW HAVE GL:CN ISSUED TO THE INSURCO NAMED AOOVL FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING Y RP_QUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CCRTIFICATC MAY BE- ISSUCO OR .Y PERTAIN, THE INSURANCE AFFORDED 6Y THE POLICIFS DESCRIBED HEREIN IS SUBJECT TO ALL THC TCRMS,EXCLUSIONG AND CONDITIONS OF SUCH UCIES_AGGREGATE LIMITS SHOWN MAY HAVE SEEN 14CDUCCD BY PAID CLAIMS POLICY NIJMnfiR !'041CY1'hHLI'IIVC P LIrY_XPIRATIO ..._...'.�— —...... ...._— , ,N GLNCRAL LIABILITY 1 r LIMITS MP0009001002077 GACHOCCURRENCE 6 1,000,000 C��dr,InRr,(nl.anNI HAI.LIAmLrrY 12/4/2009 12/4/2010 D�!:rAZ1 FraTels-- 100 000 GIAIMS MADE ( , OCCUR I lil tdl@L'fi-((I[>9 f�1411 91_._...0- MCD CXp qn one araan 5 5,000 PERSONAL B ADV INJURY G 1,000,000 - --- 2,000,000 OCNP AL AGGRGGATF, 6 GEN'L AGGPE_G_ATE LIMIT APPLInti PER. - --- - ! PRODUCTS-COMPIOPAGO S 2,000,000 POLICY I P.O' I LOC --- _... — AUTOMOMLO LIANI.I'(Y t ANY AU'I'0 CCL Oh1DINE D BINGLL�LIMIT A1,1.owrNrD ALI'rOB ?' ©CHI!DULCO AU'roa IIOon,Y IN,I0RY 8 (Par Potion) HIRED AUTOG ---......_.._... ----.-- NON•OWNnD AUTOS noDILY INJURY 6 fPa Gccidnnq _....- I'ROPL'R1Y DAMAGE 116 (Par acCIdanl) 6 -GARAGE LIABILITY C� AUTO ANY AUTO --- ONLY-LA ACCIDENT 6 -- — EA aCC G OTHER TITAN --._...._ .... ._................... ........_ AUTO ONLY AGO S CXCLGC/UMDRI;LLA I�IA011.1'IY -•� OCCUR CLAJfA8MAOEf AChI QGCURRCNCF p • AGCRCOATB p .rl R6TCNT10N IRKQRG COMPCNCATION AND 6 PLOYER6' LIABILITY VVWC3004610 30/2009 3/23/2010 "`' N IN U- x OTH_ u r-oH.Y.�lnitr.3- UrL—_. Y PROPRIL�TORIPAR'rNpN/CXCCLI't'IVIl "�--�'-."�"'"" " r`ICFR.lMCMOER UXCLUD1-1 F_L EACH ACrIr1nNT 6 500,000 na,doocriho under .-__E L.n16EA61a-IlA I'MpI.OYCC S 500,000 rICIAI.PROV1610N9 nalow _..._._.....__._... _ ..,.-.---.....----------.---._-. `c tiI;R G L DISH, -POLICY LIMIT 16 500,000 ° i Ord 0 .CPCnATiONS/LOCATIONS/VCH',CI-C9/nXC'LU610N6 ADDED BY CNDORBrMCN"r/6PCCIAL PROVIBIONB Ipe gardening, painting,carpentry C: C,` ICATE HOLDER CANCELLATION (506)790.6230 SHOULD ANY OF TH[ABOVE OC60RIDC0 pC LICIES nE CANCELLED BCFOR THE EXRIRATION )wn 0'Bamslsble Building Deportment DATE THCP20F,THC ISSUIN3 ENSURER VdGL f:WNCAVOA T r-. )0 Mcln St.'0©t 0 MA(.- :-DAYS WRITTEN NOTICC TO TI•IG CERTIFICA7C HDL DER RAL'ED TO i'HC L(:F1'.N.IT FAILURO TO DO 60$HALL yennis,MA 02801 IMPOSE NO OBLIGATION OR LIABILITY OP ANY K!KO UPON THE INSURER, ITS'AOCNTC On RGPR!?tiCNTATIVI.',q a ' AU'rHOR11CU R1iNRI:SIiNTA'I'I'll: 25(2001/08)" S ®ACORD CORPORATION 1988 t SUBDIVISION PLAN OF LAND IN BARNSTABLE (Hyannis) ��®�� All Cape Engineering, Surveyors June 1, 1989 . W Z.. 3 it's PINE VWLeY I (40.00 k7de f 00 0.1'OS'50 h' Q9 Al f70.00 CIO o LIM � 0 � 1 r h OR N O_7- I ,� CB.733 F� - '�.9 /4.0/ 0 170. 00 N 46'qB-f VAQ . .00 ode J .go &/0rF P3Z3 Subdivision of Land Shown on Plan 33064-A ' Filed with Cert . of Title No . 33834 Registry District of Barnstable County Abutters are shown as Separate certificates of title may to issued for land on original decree plan . Show,? hereon _as is 1_a _ _2 By the Court. ' / Copy of part of plan filed in LAND REGISTRATION OFFICE ti AUG-_91 1989 — — — — — — — — AUG. 9, 1989—Aecor Scale of this plan 40 feet to an inch. � AW✓✓D•-39 Louis A. Moore, Engineer for Court i jw Assessor's office(1st Floor): �� �®�; � SEPTIC Sy'STEM MUST,BE Cf TM E TO Assessor's map and lot number ��-, INSTALLED IN COMPLIANCE Board of Health(3rd floor): _ 5 3 C. _" WITH TITLE 5 d w Sewage Permit number � � r ._ Engineering Department(3r8 floor): �S^ ENVIRONMENTAL(s'OI�E AND o Grua LL . House number T ` �t$ .�E,. "�tS ' Definitive Plan Approved by Planning Board 19 ��� APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ei✓� i �V`�� `�. TYPE OF CONSTRUCTION w19 TO THE INSPECTOR OF BUILDINGS: eenJ`k'e b`UL << � The undersigned hereby applies for a permit according to the following information: Location i `Q T Proposed Use SCE, e �A Zoning District Fire District Name of Owner A2/jots MQI 2bL Address 5 m4—,-V RXL6 Name of Builder AALAQ62 2ee—lro Ale- Address 7i VC17 zY1, Name of Architect Address I ; Number of Rooms l Foundation �JO(/1 A -FV65 II Exterior C��Tr 2 SoL4 Roofing P��-hV VNI rt i J. Floors Interior s 2 Heating C) Plumbing d Fireplace o Approximate Cost !. a00 Area _ 4V Diagram of Lot and Building with Dimensions Fee 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 � (0 71 MURPHY, ARN07UD Ct P W,�.33987y Permit For Addition Single Family Dwelling Location 15 Pine Valley Road ' Hyannis `t ,y Arnold Murphy - 1 Owner-'�', Type gf,Construction Frame _ �' • ' it , Plot j Lot Permit Granted September •24 , 19 90 i n Date of Inspection - 19 } Date Completed 19 .� M ; ' C- - m c; -w C II 5 - • • , , i ' ,1 r � .� ,.' r �.i.�i �;' � - aSr t�-iT'/� :•{r. � to � ,.:4 ., -.1' " Assessor's office(1st Floor): Assessor's map and lot number /7 �lv 6OeZ "yoi�wE to` Board of Health(3rd floor): e�P #10 Sa age.Permit number Z i Engineering Departmen BL"37AILL t(3rd floor): // rrua House number tS �Js °0,.�1639•����' Definitive Plan Approved by Planning Board 19 c rrr APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR �c..,APPLICATION FOR PERMIT TO Sc '2't� 111` TYPE OF CONSTRUCTION (tiJC�d(7 9 � Z � 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: \` Location r 7— .Proposed Use 5-C.r P-e,✓ r it Zoning District Fire District Name of Owner A2AJOO MQRR i' Address , I'E R)cL6 Name of Builder {� d Address T r✓. 2 V�7 /?/-Y,- 1/ ' , Name of Architect Address Number of Rooms Foundation Jyi�A yt✓IP5 Exterior ��� ��' Roofing `S�� Floors y Interior Heating Plumbing O Fireplace Approximate Cost aU© I Area d Diagram of Lot and Building with Dimensions Fee \ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS i 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License 0 ro C MURPHY, ARNOLD - A=248-067 . 002 ay Nm 33987 Permit For Addition Single Family Dwelling Location .15 Pine Valley Road Hyannis Owner1. Arnold Murphy Type of Construction Frame Plot Lot Permit Granted September 24, 19 90 Date of Inspection 19 Date Completed 19 { f 1111-1 �x Assessor's office (1st floor):. T N E LLI-11 T�� Assessor's map'and lot number .................�......................... WQ o Board of Health (3rd floor): <0fO Sewage Permit number ......... 0.'" lry.. .... • -i •••••••••• Z ELUSfAXLE, •� Ehgineering Department (3rd floor): 9 'oo rb39• \0� House number ....................................../..<......?!(..?4...,�-........... ',F0mo Definitive Plan Approved by Planning Board --------------------------------19 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only - TOWN OF BARNSTABLE BUILDING INSPECTOR cb,jsT APPLICATION FOR PERMIT TO ........................ ........................{............... ......�. . ....... ............................... TYPEOF CONSTRUCTION ....... .................................................................................................... .. -.......1 ---------------19e TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location . `- .1 . ./...........<..'.!1J�`...Vf�Gl /. �?!......... !�N/d/S ��......4...,�.2,4/................................. f....................... . Proposed Use ...L .eJ6L ... �/yl/LV.............................................................................................................:............ .. ........ Zoning District ....... .. T-. ....................Fire District ............... Name of Owner .f'lJ./ �1/ ....../ /�fi���..........Address ..11.J... G���jD /�. � ��l/s/S r Name of Builder �! �)�1CL��G�����s� � .............Address ..,1.1...?`... lK00 i!U��/�.131 0.......... Nameof Architect .................................................'................Address .................................................................................... Numberof Rooms ...................1-41..........................................Foundation ......;.. !' CGrct........................................ ...............Roofing /.. ... . . Floors ......Interior ..... i� / G� ..................................................... ................................................................................ Heating .......PA) (/......f/<.-.C.:.............................Plumbing ........................................................ Fireplace ........;!.t1.o....................................................Approximate Cost ........ � T' ............. Area -.�........................... Diagram of Lot and Building with Dimensions Fee ...........J........'s�. .......................... V�JLLEy �CY r� -- - ----- -� U + v1 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 �/ --A MURPHY, LORRAINE A=248-067 No ... Permit for .... Qr Y Un.gle...FAMily...Dwelling........ Location ...Lot...#17.........15...Pi-ne...VaLley Road ..................Hy.annis........................................... Owner ..Loxralne...Mu-rp-hy........................ Type of Construction .....Frame......................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ....Q.Q.tQl:?.er..20..........19 88 Date,"of Inspection ....................................19 Date Completed .......................................19 00 R .,y.,,:rw„ r.. lxa'... .i,,.,.s+,�,r.. ....n . :�i,.w •y�r _-'rFr. s.°^. ` ,}s+ff'} r:x+..,k... : . Y t C ` „ o TOWN OF BARNSTABLE Permit NoA. ?74 l Din I BUILDING DEPARTMENT Cash .$. Q.P.©�? wa TOWN OFFICE BUILDING HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Lorraine Murphy Address Lot #17, 15 Pine Valley Road 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. ` January. 10. 19 89 �..., .,�.. . ........... .......... ,Or....r Building Inspector i 7 , DATES J,410 9. CONTINUATION OF ROAD BOND BUILDING PERMIT # -�3, 3 The undersigned owner/contractor hereby agree to maintain their road bond in force until the following work items are completed to the satisfaction of the Engineering Section of the Department of Public Works. loam and seedshoulders as soon as / weather permits. (/ other (explain) SUc3 Jj �cIS AJ' LOCATION l S Y P-""Ahv /-S GNED Owner/Contractor gNGINEER,,?' G AUTHORIZATION NO ell 0� a� / K | �-yN U AR NSTABLE, MASSACHUSETTS u 1v lu' ) I 19. } PE r ANT ' .Gtllirl E.'S +ti11i:Cile11 A�DRESSa,rnfatc�ZG' RUa > t 3T121 (S REET1. Build Dwulliru t RMLT TO__ ( ) STORY 11Ig11� r anvil, DwE2113."n�UM8ER OF ,ITYPE OF IMPROVEMENT), WELLING-UNITS u N0. '(PROPOSED USE) AT (LOCATION) Lut #17,' lr5. pihe, Valle" 12U. ? ZONING r yarllti.s fi (No.) OISTR ID.T +: ... (STREET) � .- BETWEEN AND t r (Cg OS STREET), SUBDIVISION L >,- L• X LOT BLOCK 1 r BUILDING IS TO BE FT, WIDE BY LONG BY „ F> ---- — FT, IN HEIGg)AND SHALL CONFORM IN ! TO TYPE USE GROUP BASEMENT WALLS OR POUNDATION r $ a. i TYP E).. 5 3 9 � REMARKS: Cllurlc:;, ti�tchell 71115R, a .0�� sw 5 84' i3arrlstablc TZ 4?ad, vIiyai�nx� k VOLU ESTIMATED COST 67/U©Q OO i' t PERMIT Q� 4 1 (CUBIC/SQUARE FEET) OWNER LOrra 4 11£: j .iC;ct Uc1xY1 ��C il' flyda1l1A.S BUILDING DEPT.. � r ADDRESS � I 1 f t" pit, n BY THIS PERMIT NVEYS NO RIGHT TO OCCUPY ANY LEY 'PERMANENTLY�ENCROgCHMENTS ON PUBLIC PROPERTYc.NOTLSPECIFRCAIDEWALK OR ANY-LLY PERMITTED:UNDERTTHE BUI'1;DING CODEM'S�B�.'; 'P ,Tt> PROVED BY THE JURISDICTION. STREET OR ALLEY- GRADES AS.WELL AS DEPTH AND LOCATION R THE BUILIC SEWERS�MAY BE�!OBTAIN FROM THE DEPARTMENT OF PUBLIC WORKS.,THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE''APPLICANT FROM THE•tSONQ 2 OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. ,; MINIMUM�OF ,THREE CALL INSPECTIONS`REQUIREo FOR APPROVED PLANS MUST BE RETAINED ON JO)El AND THIS ;WHERE APPLICABLEISEPARAJ ALL CONSTRUCTLON WORK: CARD KEPT POSTED UNTIL FINAL INSPECTIr7N HAS BEEN -PERMITS ARE,-REOUIRED FDA' s' j OUNOATIONS`OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUHANCY.IS RE- 'MECHANI•CAL INPLUM STALLIAT'O�NN k 2."PRIOR.TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL I (READY TO LATH). ; v- 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE, `OCCUPANCY. L POST THI CARD. SO ITFROM' �.. ; S VISIBLE FR f $ ILDING INSPECTION PROVALS OM S T R E E T f ►`r PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS. .I' r v VPP 1{ �l ..r. 2 HEATING INSPECTION APPROVALS ENEEAINGDEPARTMENTs OTHtR ` t- BOARD OF HEALTH 5! �31,Lf+Y� l� HE TOR SHALL NOT PROCEEDTHE IS STAG SPEC- PERMIT WILL BECOME NULL AND VQID IF 'CONSTRUCTION INSPECTIONS iNDICATEDrONTHIS CARP 70R HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CONSTRUCTION. I ARRANGED FOR BY-TELEPt10NE OR W I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. I�� 1 i `, • F I lot 16 I-ot 15 it 5Z•5 114.99 53.t 1-6 --< #4571 p - � � s�•fir !:'l/2 'd tone- L _ rPZ_z 392_ d I cot 17 _ 9.9 D R I v Pine700 f1cr,GCey i ! t.MiJ �bvLG I •rP, 10' 2 9 o oad' , J! 2 ioh ound, 4 � Y4 4 I t -.� i 'o•t 18 1 G I i 1000 49 c10 wide � Gtit � � t 2 oh 100 0 cep. 4 3 �9tt Cape C'��'2� -- b-- ----- ------ _.._ _—. S0.0M. 49 /da%boti Road (C :I /jgant ice., Ilia. 02601 D ea.i c�.n Data No. b ed'rco onto. `2 Sccd-r-. 1 "-70 ' ; J no Jute- 9-7-88 fat c<.0 , g-tow 220 aP' 54:o P,coi;-tp- No jcate -Peach ante 204 41 i 1?e�eJuJ e " 204 Ca aaibi 392 gcpc l000 E /-6 '>C 4 1 it I<<•; 4 z.o �.4, z' Z . .........-- _-- r Sketch /''.Lan o j- Xand in Ryanx i s., (Ia. l)eJinc tot 17 aa, shown on a ptan o f Vak Clt.�" r eco td ecl in bk 1,u pq�. 87. fteuationa. sae baa.ed on an a44urced da-t t. feat ;' i,t�t`/�-706 3 Slhe Jobuula t ion Frown on � ii4 p� i i locoed on - a r toured ay shown hereon and we t i the,-30-88 (;U i t. �e�J�aeh. �rzc;wi�er�n t�s o -tjl o gown o 4' I_?c%,m tabze. No watet encorurte"-d bate 10-20-88 49,9 t&ti 47.9 4s.3 :ed. 47 3 �. � d�tOnPiJ. i2ei3. - - A�k Of coatle I c; I O pl46��4:_i t.LINE No.3249p Q 'K IP, - `p Sao 4 �q\• s /STER pQI IAWD QN -5TQ0a . TMR ' t-1. (/A 4 , ��i�, �� � I!a or -TL WA Tc: I Cie IZ OF 7 W=47C') 1 z (0100 t y IbVfrARq GN 1. �s i D 1 G o KEARN"j y - - 5�12606 ti, loco F410NAt. 17) G 1-4 r-G � � z � 7z , 5 � 3 X 30S0 $�to 110 2 / PpLcL Fib Oro Asses' ors office Nst floor): Assessor's,map and lot number .................. ...................... �� °� EPrC SYSTENt MUST BE e�Q�♦� Board ofHealth (3rd floor): c p �(►" Sewagee Permit number .......J••�•^� �••�i�.•�• •-•• •••• ,.r~y s1,COMPLIANCE T� TITLES �BN�a LE,O s'Engineering, Department Ord floor): 039 House number �5...:h�.?C�.�- ...E M ENTAL CODE ..AND °�0 MAI a�e0 Definitive Plan Approved by Planning Board _________________________TOly REGULATIONS APPLICATIONS PROCESSED, 8:30 9:30>A.M. and 1:00-2:00 P.M. only k TOWN-- OF BARNSTABLE t BUILDING INSPECTOR �O� ) S���L� dq [L, �L we�c�✓ APPLICATION FOR PERMIT TO ......................... ..................... ............... ................Y..............................C/ TYPE OF CONSTRUCTION ....... 9......F / . ...-.. /..�..................................................... ........................... .......... 4�% TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies'for a permit according to the following information: r A Location .1`rG. . ".... .Y`/!1JE...Vf�L . .. ....... y! /✓/1�/5.... .......O.Z6 / ............................. . Proposed Use ... ot16LF ,j,�jTlIL45e 0•. :............ Zoning District :...:.................�C.�./�?......................................Fire District :............ ;...........L !�. ' Name of Owner .f�G. �7I ......�.✓�1 ! � y..:........Address ..II..J........ j� / l�,l ' �5 Name of Builder /7fL � � 11. 1-�-..............Address ..Lj.. Z..,../� Name. of Architect ..................................................................Address ................................................................. Number of Rooms ...................('0...........................................Foundation ...... Exterior ...............0M. ..................: Roofing .. .../0.................................. /Y�!f`...........:...........:........................ ...... . .. ....�.�l Floors ..............................................................Interior ..... ........ Heating • ....... r!.. ...... ......a4..............................Plumbing .... / C............. Fireplace •.................... Q....................................................Approximate Cost ..�.y/ .. ............ ............. Area a .., ............. Diagram of Lot and Building with Dimensions. Fee S7 ,5 ..................................... "VK Al Z) bo it 2g _ 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 ����G �p ///� Construction Supervisor's License ...6.. 1,,:.3.t��.......... V MURPHY, LORRAINE 1 - ' o 3 3.7 4.. -Permit for ...QxU�...S .R ,y.......... ........S.a.x g,],e..k:=Uy...D.w.1.J.ing....... Location .. Valley.ot....U.7..........1.5...P.ixle.. Road - ....�.. ............................................ t t S Owner .... .OX.1, a.n.!..M.Ur. kl M Type of Construction Xxame........... '''' � _ •. � w ter'. i 'F •--^-- ''�: �,'�- � -�. . / f' 'Plot .... Lot ................................. - .^ Permit Granted ....:OCootober .........19 88 /Date of Inspection .F.� � f .....19�� DciterCo pleted:.y........... .�. �:19� T ....� ;dig;` 'N- _ •,, .. 3♦ 1- 0 M A, CD in ti - - / 7-7 in Y-S NeNell, r w, i f i i ,6 wTay 7?z&rboze, /y