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0148 WEST MAIN STREET
�L s D ��'E In tJL 7�� - �Q�� ��/ / __ —_ ! � _ _ ;. , ' �� .�_ � � s i, I;r 11f n 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map :� Parcel 7 - D� Application # 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 1�(y �G Village Owner Address AW �/,z2&4 ri Telephone 0 Permit Request S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 9 V Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) ✓ Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ c Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:: ` Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ `� y Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION a (BUILDER OR HOMEOWNER) Name l�L � l� (7 elephone Number ZZ6`8 qS:-4 §(66 Address License # (; 1.~ /D 7 2 &xdxLJ_ //%1 D Home Improvement Contractor# ` 0 Worker's Compensation # /,UU61- 610-4 11 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 'Id —15 FOR OFFICIAL USE ONLY 1 APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ± OWNER 1 C` DATE OF INSPECTION: x.,FOUNDATION,i. . . j FRAME INSULATION ,f FIREPLACE r ELECTRICAL: ROUGH FINAL T' 1 Y PLUMBING: ROUGH FINAL t R. GAS: ROUGH FINAL 2 FINAL BUILDING ' 'r i 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/Organization/Individual): KTM Properties, LLC Address: 25 Spaulding Rd - Suite 17-2 City/State/zip: Fremont, NH 03044 Phone#: 603-895-0400 Are you an employer?Check the appropriate box: Type of project(required): 1. x❑ I am a employer with 25 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. [D Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself o workers' com right of exemption per MGL Y <N p• 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 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 and job site information. Insurance Company Name: Union Insurance Company _ Policy#or Self-ins.Lic. #: WCA51 5231 6-1 0 Expiration Date: 6/16/2016 148 WEST MAIN ST. HYANNIS, MA 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ang turd_ Date: 10/9/2015 Phone#: 603-895-0400 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: tax W,saNr C1 s2Cti tCAY tiK7ERl€!�aU Filtl�ApY OR1Eti�llYlzk� �IYdK#i �tt KEFt tli t:CNEf&1$� K� A � � t5£KtdS f34Vti1FkT1fiiCATf t�F 1#SUEKp.�11 #9K7 �NC}T Ct1Nltil GN �a / EN liE::13S1fK #jK{ ¢{$ JSKtq 1; � sErr cup 4tJct o gNE cEisrr s� �t K1N1P60A T N the aerttFica# Kta ko� K K ckte g9tu! ) lita##k4 »d�taad Kf.SKR+t�Ql �; #o t�«ns e�,m ctrerdititrns otf�+s���a�rea#r;tt t�tt�¢tas+�trair�ors w?a>srabgm�at���#a€ ahe r�r+�,ts a�1t +��ns��r+��} ��a�i� cea#zRai+te hral�ar lit figU ofsG;2h anr#i+�s0atr&n s x Or, Hsawrt 8 brown{Mrlrriln�k� .' .y y��py {t qq{{u�. � �49 ta#e►Wei#C&#K1g11V+ � w-.� �- �— AGec�zr#ack.NW 03RCxi �n ... �,-� r--.• ,.�..-- � G1i�Ks NSeP#zali zlar�l�ln ds#trartae Cclettl,;pa 25 SgU1di ldo C RA $ TYk1 Hfl8 }$ sitR1! 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Massachusetts-departmeri#of Public SafL4y s' Board of Building Regulations and Standards f instruction Sunemkor License C8471077 camLiS Fr�noont NH.030i4 "� Y fff t J.�.+r..d�.cst�c.: Expiration Conmussioner 07125=17 l 3 S 5 3y� F p 3 j t i , l .F/ (`Jt f �ri4ll7t h3t4^ta� 'E'� Cf .° � GyA+GtSt'Gafi? t1 s; cif Co :�ur � pees Regd, fi 4 40 Mk p1. � Uftt- 70 o 1ct€a ,Idcu��tt�Abu TapeQut)p'ea'} tt"rard KTM PROPS RTIE� LL £xp,mtlan :e3 5 }�s 25 SF3Al1t7i. tt3 RU iJ9TE 17 Z FiPtt)t�f, di Q3 —41 _ flpelatrrAddi°e��uad r�cl,rn eatct 159er}t reosoti far ebarg M':! tlddicrs� `.,;Reue�'rai "��mpluKn�tB 'r f�isE'��trd '`",� ���ConaamaF�4'Fuirs;k3tuasunssi��whea p.}maffsusrMte�tstrfft�onvaa}id f+�C';jndlvf�tu},Xt;3cnnl� ElMPl2E�+5NtEi+t�Gt)!tTlfACT9R trefirxttbr9x'p�xatavn.datc�}ffu+ndretuc�`ta ss:: Q#fLce afi�"unyuxnes;z�i}i��ra a�i4tj�iusiaess:kegcL}�t�en e egfstraua z t OM1 a YAe. }p `arkf'}Sxa Ssi}W,174 w: E�prattont:.fi12©f5 sUPtii6sttf£�etd }}pston,At12}#6; K fi}PR€3?Ek�TIcS,€:EG CHARDS fl�k;�SALtj ... � UftQeruarepiry ..:;\f}t d Nsithvut 3i nature . .tTIN • f '+iS14mk."fAt:YA56.d 1.6,IIYtl`w"�7'6146YPYi f'iGflG9d1fi0k1 i 25 6PAUI._.DINq R.D • 5UITC 17-2 • fGZEMONT. Ni-1V 4J4MP-- .J9zC-- 05044 PIJ 6o5-895-0400 • FAx 60_:�-895-0445 September 28, 2015 Corcoran Jennison Management Attn:Tim Pacheco 150 Mt. Vernon Street Suite #500 Boston, MA 02125 Re:The Village at Fawcett's Pond C-108 Dear Tim, As per your request and our site visit we are pleased to provide you a proposal for work at the above referenced address. Scope of Work This proposal includes the removal of existing 12 windows, 12 a/c sleeves, clapboards, trim and sheathing on back of buildings C-108, and back of the shop building excluding all upper and lower deck areas on C-108 building. The existing sheathing will be removed & replaced with new / plywood and / PT plywood at lowest building level to ground. • The addition ofTyvek building wrap. • New pre-primed Hardi Plank (exposure to match existing) per request. • The new siding will receive 2 coats of finish latex paint; color TBD by others. • All existing down spouts will be removed and replaced as needed for siding. • The 12 new Harvey White Classic 2- Lite RW Double Slider w/screen no grills (5'x4' units) to be installed as new construction windows. Windows to be flashed with 9" Vycor plus after installation and made ready.for new 3/4"1x4 Azek (or equal) trim window surround secured w/SS nails exposed • Also new a/c casings (supplied by others) to be removed and.re-installed will receive new W Azek trim on-the.,exterior to best match existing Sizes secured w/SS nails exposed. • Supply& install new interior trim to best match existin size..& style) around newt installed windows & 6c's, in by others. • Any exterior/interior rot found or exposed will be considered an extra and notification given prior to any repairs. • Any insulation that may be needed will be considered an extra and notification given prior to any installation. • Includes permits as needed &trash removal for listed work. Labor& Materials$ 64,998.00 25% Deposit due at contract/proposal signing. Balance due at completion. Acceptance Date If you have any questions, please feel free to contact me at 603-895-0400. Sincerely, Charles Minasalli k r 25 SPLIULDIN( RD - .5ulT1_ 17-2 • FREMONT. N11W .04MP- iRE o5o44 Plj 6o3-895-o400 • FAx 6o3-895-o445 September 28, 2015 Corcoran Jennison Management Attn:Tim Pacheco 150 Mt.Vernon Street Suite #500 Boston, MA 02125 Re:The Village at Fawcett's Pond - C108 C115'and gable at'C108 Dear Tim, As per your request and our site visit we are pleased to:p;rov.Of you a proposal for work at the above referenced address. Scope of Work This proposal includes the removal of existing 37 windows, 33 a/c sleeves, clapboards,trim and sheathing on buildings C-108-C-115 and the gable at C-108. • The existing sheathing will be removed & replaced with new%z" plywood and ''/z" PT plywood at lowest building level to ground. • The addition of Tyvek building wrap. • New pre-primed Hardi Plank(exposure to match existing) per request. • The new siding will receive 2 coats of finish latex paint; color TBD by others. • All existing down spouts will be removed and replaced as needed for siding. • The 37 new Harvey White Classic 2- Lite RW Double.Slider w/screen no grills(5'x4' units)to be installed as new construction windows:Windows to be flashed with 9"Vycor plus after installation and made ready for new 3/4"lx4 Azek.(or equal)trim window surround secured w/SS nails exposed `.* Also new a/c casings(supplied by others)to be removed and re-installed will receive new Azek trim on the exterior to best match existing sizes secured w/SS nails exposed. Supply& install new interior trim around windows and ac units to receive new pre-primed 3%z" ..z pjf casing, interior painting of new trim by others: • New Azek for rake boards and corner boards where it hits new side walls and water table where it now exists on lower level of both buildings and applied w/stainless steel nail exposed. • Any exterior/interior rot found or exposed will be considered an extra and notification given prior to any repairs. • Any insulation that may be needed will be considered an extra and notification given prior to any installation • Includes permits as needed &--trash removal for listed work \v\v\v 1,TMPrzoP �2 r , Labor&Materials$147,000.00 25% Deposit due at contract/proposal signing. Balance due at completion. Acceptance: Date: If you have any questions, please feel free to contact me at 603-234.9213. Sincerely, Charles Minasalli . .Town of Barnstable Regulatory Services r RiRNCILRT]t- + MAS& g, Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner . 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder I YYl ym—,� as Owner of the subject'Property lP Pert9 . 1 hereby authorize o 1 e�, �V��S9��� to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to. be filled or utilized before fence is installed and all final inspections are performed and accepted.' �ozm Zogq ignature o Owner Signace f .. cant Print N Print Name Date Q:PORMS:OWNERPERMISSIONPOOLS 6/2012 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a 50 ��� oo� - Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee �3S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address 14 P— t0e_S�McLkhn S�'c�L VQnYI is Village n Owner 11 CI A0G/d TU417l3 Address a 0X Telephone (_�-Za,) 771 -7 0.)__ .,Permit Request 1h Ss'�C;� �7S 6��_l�G cam, �)ni'PSI� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation $01, 000 , Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) JS JT30( Age of Existing Structure 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count 4� Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yeses❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ e fisting L4,r�ew _"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 01- 7 9-6 Address /,) on n C(a c/ License # C S C 3 }y d 6u L a. &C y Home Improvement Contractor# Worker's Compensation #uue t �- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE CL• c1vl� DATE pppp- FOR OFFICIAL USE ONLY `APPLICATION# DATE ISSUED MAP PARCEL NO. t J` ADDRESS VILLAGE OWNER t DATE OF INSPECTION: L_FOUNDATION FRAME INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL E GAS: ROUGH FINAL ° FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1ne E ommonweaitn uJ triiw•acccr&&"vtia Department of IndustHal Accidents Office of Inveyfigations 600 Washington Street. Boston,MA 02111 www.mass goy/dig Workers'.Compensation_Insurance Affidavit:Builders/Contractors/Electricians/Pinmbers Applicant Information /I Please Print Legibly Name(Business/Organization/Individual): �S O(y4-•t G!0 irl C r�U (1C - -Address:, 4 (Jv d MFl 64,S3�-Phone.#: CSC ) �" 17� 0 City/State/Zip: l�U Z�t.��S� . Are yo4.qg employer?Check.the appropriate bog: :Type of project(required);. 1. I am a employer with_ L 4 [j I am a general contractor and I 6 New construction . employees full and/or art tinge).* have hired the sub-contractors ( p listed•on the-attached sheet: 7. ❑Remodeling 2.❑ I am a•sole proprietor or partner- These stub-contractors have •8• F1 Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. ❑Building addition o workers' co insurance comp.insurance.# [N mp• •10.❑Electrical repairs or additions 5. [� We are a corporation and its required.] officers have exercised their 11.❑Plumbing repairs or additions 3. I am i homeowner-doing all work• right of exemption per MGL myself.[No workers comp. 12:❑Ro repairs insurance requrred]t C. 152,§1(4),and we have no , to ees. o workers' 13. thedxc = . � y . [N comp.msuranee 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 uame of the sub-contractors and slate whether or not those entities have employees. If the sub-contractors have er*ioyees,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 Co- Policy#or self-ins.Lic.# t O d—S 3`( S... 3-7 6 a 3 O S Expiration Date: Job Site Address: w- Ql,� 9—r P City/statelzip: 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 e. 152 can lead to the imposition of criminal penalties of a fine tip 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 Investi lions of the DIA for rasurance Coverage verification. I do hereby certify under,the pains-and penalties of perjury that the information provided above is true and correct Date: Phone# Official use only. Do not write in this area,to be completed by.cit 0 town offuiaL - City or Town: Permit/License# Issuing Authority(cirde one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: t/J.s i V. G V� J/ nrl rnv c r vvo r ar. oci c_ • ^ " DATE(hT6VC!'WYV) AC'C>VirJ CERTIFICATE OF LIABILITY INSURANCE 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 terns and conditions of the policy,certain policies may require an endorsement. A statement on this certlficate does not confer rights to the certificate holder in lieu of such endorsement(s). i PROOUC61 SMALL BUSINESS INS AGCY INC CONTACT NAME ----- AG 542 MAIN STREET PrtoN=_ ac r�.�ay(5081:9 0635 �-L tWORCESTF_P,, MA 016150022 6MNL ADDRESS — _—.—___•____ _•.__._.- . I INSUREPJI-]S AFFORaNGCOVERAGE I Nia!C^ I INSURER A_Libgn1'MS?L'� .-. .. .... ....---..........._...._._..._' c INSURED RESOLUTION ENERGY INCORPORATED INSURERc: I I 49 HERRING POND ROAD — -.-- _—•----..___--..__.-..._._. I ' BUZZARDS BAY MA 02532 INSURERD: — -----------.-.._.•... INSURER E: COVERAGES CERTIFICATE NUMBER: 13 97741 REVISION NUMBER: THIS IS TO CERTIFY THAT TFIE PC UCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE Pa ICY P;Rli:G j INDICATED. nK71lroITHSTANDING ANY REO(J)R&AF\Fr,TERM OR CONDITIOJ OF ANY aWrRACT CR OTHER DCY;tyt IEINIT WITH RESPECT TO kMAICH THIS CERTIFICATE I.W BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFCRDED BY THE POLICIES DESCRIBED HERElld LS SU2 F(-, TG A!I THE T=RPfi; j EXCLUSIONS AND CONDITIONS OF SUCH P�7UCIE&LIMITS SI-IOVVN MAY HAVE BEEN r EDUCETD�BY PAID CLLAIM& - ----JAtstS�svBw rPri'Y�^rt' �Dpl1, r_----____..__....._ i Iris 1 TYPE OF POLICYMIMBERItJi!° V4 I Uts:5 I_r: I I i GENERAL LIABILITY Rue? _ — i ((XSmtEF (AL!;ENCft�L.JFRNJ7Y , --._—._ -- ........ —.._.. _- -1 --- j jr x, . ' YY„r ...__.._... E L ' 111rd"rAflAL!E _�CK J.R ! I i I ^�cD EYP_Pr - t P :ADv iw�uFly I•_-- I _ -- ---- - I —---------- ---- - L ATE PrC)OLr'r5•G!7+IG/G'A.��i 4 !u_ENLAI�f'+ECATEi1F:ATPF1yJE:inEF.: ? — --- ... { I R")U(;V j —I PRO (--t Jx' I - S —I I �1 I i � � _ u— AUiOMOSILEUA87UTY 30>!LY INJURY(Pe immra)) 1 S j -- PLL p A/'_�rrO cti, c J Y..!'�®I�J:D , I ! I �EODi:Y!t`Ln1RY(Per�- "r 4 �.�AtIR'SIEPn:rtR-YTJ'SIvT�iC� FUFEDP1JTCb I_— AUrO� I 1 ' I I iC — ! I U SRELLA UAS ..1 I rxr,1 IEc l=in.HCr.JCURP•E VIE - LFXCESS UA6 �tRwj ( !�-. !---'DED _- -`RE!EV71CNS ; I I I ! - •—r- _ !WORKERS-MVE'a.SAnON I WCS-31 S-370523-052 1 3/1212012 13i12/2013 I ,/1 Tc�u(TS I I r I A!m evPLOYEPS LIABILITY ! - kNY PRCIPRI'TCRiFARTEPI::Y.Efdrt(vE Y/N i i E L.EPCH ACGD6uT ._ a __700f.10(I , ;)=;:ICL-i-u6t1vL•ERc'JCCd_UJEC� iN/A1 I I I 'E.LD'SE0.;E•FJ•.6U�LOYEE?S � _ 10�Q(11A ! (Nandamry in Pigs.degribe urdrr i I ! i E.L DISEASE-POUCY LJ!;Afr i S —5i0(r"A o�IPTIDN�cflERATlr�lsrs!rn. '• ( DESO`Zi"0N OF OPERA n0;\6:LCZATI0P Sr vE-60LES(Attach ACORD 101,Additional Remarks Schedde,If rrcxe Spam ig regUlr&d) Workers como2nsation inwrR!tre CO%ftga(Ie applies Only to the workers compensation of the state I••AA.. �CERT.IFICaTE.HOLDER s CANCELLATION s 1 SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. ) THIm EXPIRATION DATE THEREOF, NuncE WSLL eE DEUVERED ir•! HOUSING ASSISTANCE CORPORATION ! 460 WEST MAIN STREET ACCORDANCE IArITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTF10'nIZm REPRESENfATiVc � ) - 'r. .'1'r.l'�"=-E..C�Ir FJ •-ram•�r/. e } Je8 Eldridae cS)1988-2010 ACORD CORPORATION. All rights reserved!. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD -r:- ,yc'; i •:Jw r ,:r.e: Ir. •. ,.-.�.,.. � a iJt2 t2:i' -. Ev,exe �.:u` . '•'11I. _.._._._.'.9L�~'t•)-4:U•-•ate .'+�--cS'_-'E:ardo-..}>r1".;us 1, �i��:+>:J_c.•rL iiicaces. _ of " - v - w -. �i:r••at hu,crr• Dep:trlttunr n( Pultlir �:IICIt Bnartl nl' i3uil{lin_ Rc;:ulatinn. :ttl(Ii:ulrl;irti� Construction Supervisor License License: CS 53202 j- JEFFREY R TONELLO �i PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( „nmiisi,urr Trg: 21481 c � �am.»zaruuea�C/z a�✓l� �a�{"� License or registration valid for individul use only office' of Consumer Affairs&Business Regulation before the expiration (late. If found return to: HOME IMPROVEMENT CONTRACTOR Type: office of Consumer Affairs and Business Regulation Registration:.:==171991 10 Parlt Plaza-Suite 5170 .' Corporation Boston,MA 02116 �Y Expiration;. 5/9/2014 RESOLUTION ENERGYfNG,;':,,- JEFFREY TONELL-O`"... 43 FIELDWOOD ORIVE i lid w' oui signature SAGAMORE BEACH,MA�02562 Undcrsccretary �Py��ram, • - • - - a 1ARNGrABLE + g. 39 16 - Town.of B�.rnsiAble ��� • prED NiPt�' - Regula ory �erv�ices Thomas K Geiler,Director Building Division Thomas Perry,.CBO. Building Commissioner - 200 Main Street,-Hyannis,MA 02601 www.town.barnstable.ma.us Office: A8462-4038 Fax: 508-790-6230 Property Owner' Must Complete and Sign This Section If Using A Builder T •���� o. � � ;as Owner of the subject property hereby authorize I€:— to act-on my-behaH, U U,. in all matters relative to work authorized by this building permit application for: (Address of Job) It ,�' hh / e Signature of Owner >f} Date tt j,.. 1. i�.. C.. G Print Name if Property Owner is applying foe permit,please complete the'Homeowners.License Exemption Form on:the reverse-side. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 0.1-7 Parcel Application #� Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 3 S Date Definitive Plan Approved by Planning Board ! _7 Historic - OKH _ Preservation/Hyannis Project Street Address �► pmt ayaiiti S Village Owner - UJW c LA Po/-cl fq jQ21-oL i Cn h Address PQ &A /6� -79 dP Irv, 0 Telephone ,) 7 / ?0 Permit Request 1h s /-u_,(.(_ ��S S z R '3O (»resknlC"�Cl '5C 11e_d Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay c. _{ Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting dbtumen ation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) 3'w -a . A'I'1 Age of Existing Structure 9iP 3 Historic House: ❑Yes ❑ No On Old King's f ighway:0 Yes'❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other m. Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION -. -- —-=JBUILDER OR HOMEOWNER) Name COA0 LO Telephone Numbe� Address i!5 v4d c License# �* S S3 &v L,4._ quil�" 61,*;L-a 3 .L Home Improvement Contractor# Worker's Compensation # We S31 3 W--)-3od d' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO (2 C/ 8u QG.* a� SIGNATURE C l DATE E FOR OFFICIAL USE ONLY x APPLICATION# <i DATE ISSUED MAP/PARCEL NO. 4 ' t =` ADDRESS i VILLAGE 4ti OWNER DATE OF INSPECTION: a i �;°:�FOUNDATION; _ G FRAME INSULATION t FIREPLACE A ELECTRICAL: ROUGH FINAL . F PLUMBING: ROUGH FINAL E GAS: ROUGH FINAL `r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. y DAMS 13 a 47 i639• 10�` Town of Ra>rnstable ATEb MPS�' Regulatory 8�1z"'6riCe3 Thomas F.Geiler,Director Building Division Thomas Perry,CBO- p Building Commissioner 200 Main Street,-Hyannis,MA 02601 www.town.barnstable.ma.us Office: A8-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �rw ya c as Owner of the subject property hereby authorize d ` '�. � y t ems' to act on my behalf, U U in all matters relative to work authorized by this building permit application for: (Address of Job) 1 rt l x 9 $$ .^car EFr.. Signature of Owner -' -` j Date I � �� - Print Name If Property Owner is applying foe permit,please complete the Homeowners License Exemption Form on.the reverse.side. ,✓,.,� ;,, 4zr r.vt[. 1v, GV JI nrt rnvc .?r vV17 r cLn JGt vci DATIF CERTIFICATE OF LIABILITY INSURANCM �, � THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS N0 RIGHTS UPON THE CERTIFCATE HOLDER. THIS CER71RCATE 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. i IMPORTANT: It the certificate holder is an AD5IT10NAL INSURED,the policy(ies)must be endorsed. It SUBROGATION IS WAIVED,subject to i the terms and conditions of the policy,certain policies may require an endorsement_ A statement on this certificate does not confer rights to the 1 certificate holder in lieu of such endorsement(s)- a SMALL BUSINESS INS AGCY INC CCNTACT NAME: —_ -------•--.-_ I 542 MAIN STREET1_F9x-LC1:-_l` LZI+$_COI? .+ WORCESTF_R, P/tA 016150022 &MAIL AOD, REs3 — --------•----_-.-- -._.. . i INSUREPg AFFORDNGCOVERAGE L_W?rCX INSUREFA: h-s�1i r,Mylt:�gl .......... ........... ....._..._._.--__.-_ .-- - u•SURF3J INSURER a__-- RESOLUTION ENERGY INCORPORATED I j InsD 1 49 HERRING POND ROAD INSURER_—_ _.__._......... -- _,..__......... BUZZARDS BAY MA 02532 astJRERD: INSURER E_------•-----.--- COVERAGES CERTIFICATE NUMBER- 138g7741 REVISION NUMBER: THIS iS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE E POLICY F II T INDICATED. Nrj-RtiITHSTANDIRG ANY REQUIREhr,NT,TERM OR CONDIT104 OF ANY(XYv7RACT CR OTHER DOCUMENa'T VATH R.-E PECT TQ kAfriCH THIS tERTIFICAT: NrAv BE ISSUED CR mAY PERTAIN, THE INSURANCE AFFCROED BY THE POLICIES DE_RIBED HEREIN IS SUBJECT TO ALL HE T=A,pn j EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.UMBTS S!-'.OWN MAY HAVE BEEN F ED�SLL�GCEZD�BFY PAID C�LLAIIMS�_ iI sR IAMMSR MVIDDYYWI—��CDN Y1 -- - UrtIs 7F: TYPE OF WSLJRAN„'E I POUCV htbVIBER i r IMPA' YY I GENERAI-UABIUTY i !tx7m+tR tnu:EN LTwLUcRe J ,' !PRf rt59(Er i�iiau I - -- ! I_� R✓'rM1N+L1E ! !U•XJ.fi. I j I ! i I��rD EXP;Arse:YJ;J61) _Pcfw'�VA:�ADV IN.<UAV I S I a;Ac4_f�-cr.- TE is .... .. ! I !Pk-�DLCT I uENLAL-fOREG1TEUhJIT?FpJ_SPEP: ----- r--I FnUCY I -I PP.O. r--j AIJTOr,/OBILEUABIUTY I ! I LY INiUn'y(Per perrriJ 1 g ...I i ANY WrO Q,� I _ -- I P'L NBJ i.YJiEDLr�p I I I 16OD Y 11AR TRY(Pw a-dch n; ! A`UTC 5 I--I lull- IS6VF11 I f _g_.It HT, g I WPEDP11TOS t-- AlrrO,_ ! I ---'*--------- I i$.. i i C LMZRELLA LIAB 1 , ( ! !Eix,H Gr...Cl1RnEV^E 5 J EXCESSUAB 1-J_CL"v.S4.ODE ACi3RECJt•I>= --Ire'--•-- _.. i LIED ..I RErDJT10`$ ' h IWORKERS CC1Y23sAT10N I WC5-315-370523-052 1 3/1212012 13i1212013 ! ✓!TLv—>>'Ur rSl I c�__._,_- f_ APID EMPLOYERS LIABILITY Vi N j I I ! 5 _-- PNYPROPRI?.4=iPAR,-WP(=Y.r.QrrIVEaiNlAj, i_E.L.EA.CHAcCosw - . - —__--1000OL"j (Fund-Dr.i L'ER EXI I_UJEC i 1 i I E.L O:SEASE-E4 61nPLOYE�s 100001E +I;•// .deIlx�ruder I ) 1 E.L DISEASE_POLICY LIt,AfT i S 50000� - DESCAIF'TICN0 C•PERATI(>rSM_nw ! . OF-SCfnPTICYv OF OPERATia S.LOCATCNSr VE"CLES(Arad+ACOR0101,Additional Rarr aft Sdredufa,if more space is required) I t�/pfker5 GOmpansation in•Stirance coverage appligs Only tothe workers compensation la%%s of the state MA., I t i �ERTfFICAT-NO[DER i CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE EXPIRATION DATE THEREOF, N011cE WELL BE DELIVERED iN HOUSING ASSISTANCE CORPORATION i 460 WEST MAIN STREET ACCORDANCEVAgTH THE POLICY PROVISIONS. HYANNIS MA 02601 ALrr.-+OaZID REPRc-SENATE VE j l ;'11 C � t 1i • Jeff Eldridoe Ip 1988-2010 ACORD CORPORATION. All rights reserved, -CORD 25(2010/05) The ACORD name and logo are registered marks of ACORD -+ �4�T 7 •:1..0 •�'r�: Ir•:^•. t;x 7a-.1F,t c:�l-ri:•pl: t�:i' '. P3 pa_^te .os. _ ':i•t. _____._:hL'-•'l-"�7_i_• .�� ...r=i�`='la:.��..r.,-F,- -::,rsl/-•i.5s,.>.-:J�e.+rL-ii ic.ce_. v -�. �iaz�aChti<Cttc - f)CII:I I't lli l'Ill nl ��II ll�ll �airil a Boar(l nl' Bi,IIdIw-! Rc;tul;l(inn. ;ut{I �I:nill;lrtl� Construction Supervisor License License: CS 53202 JEFFREY R TONELLO PO BOX 1516 SAGAMORE BEACH, MA 02562 '-?%:� , Expiration: 7/14/2013 { „nuni<si„nri' Trg: 21481 92. �o,,,,,naruuea�C/ a�✓1 � { a'- License or registration valid for individul use only `�\ Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: _ HOME IMPROVEMENT CONTRACTOR office of Consumer Affairs and Business Regulation Registration:. 1171991 Type' 10 Park Plaza-Suite 5170 Expiration:.. 5/9/2014 Corporation Boston,MA 02116 RESOLUTION j� JEFFREY TONEL`LO ..,�- 43 FIELDWOOD DRIVE :" �- t�— Wjtj lid w out Signature SAGAMORE BEACH,MA 02562 UndcrsecrctRry i v 1t1e C,oxnmon>veatttz u�1r1uJucrsuat r� Department of Industrial Accidents Office.of Investigations 600 Washington Street. Boston,MA 02111 www.mass.gov/dia Workers'Compensation-Insurance Affidavit:Builders/Contractors/Electricians/Plu fibers Applicant Inforniation Please Print Le�ib� Name(Business/Organization/lndividual): �'Sc7 Address: 4R• rr-(n,5 City/State/Zip: l�U Zt.r-trc�S 64 S 3�-Phone.#: CSC } �- (-1�I Are yputn employer?Check the appropriate-box: :Type of project(required);. 4. ❑ I am a general contractor and I employer with.' 6. ❑New construction - employees(full and/or part- :Lime).* 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 Tie slit-contractors have •8. ❑Demolition employees and have workers' working forme many.capacity. $- 9. ❑Building addition [No wo*crs'comp.insurance comp.insurance. - 10. Electrical airs or additions ;5. ❑ We are a corporation audits � ❑' � required.] officers have exercised their 11.❑Plumbing repairs or additions -3.0 I am a homeowner.doing all work - - myself [No workers'co>IIp. right of exemption per MGL 12:❑Ro repairs -. c.152 §1(4),and we have no •insurance ret�tnred.]t �. , 13. mer�eGt �LaJ{ employees.4[No workers comp.insurance required.] . •-Any applicant that checks box#1 most also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing aU work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box.must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: �/ n1 U�'iJ t^c-Q Ins. co- - Policy#or Self-ins.Lic.# (� �° S 3 "(J-- 3=7 S d 3 y$ Expiration Date: . Job Site Address: City/State/Zip:4 i/GCr2m f J ,691' i (00 Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required tinder Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine rip to S 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 WA for insurance coverage verification. I do hereby Gertz fy under the pains and penalties of perjury that the information provided above is true and correct Si Date:' Id- 3 4 Pl>nne#k J ��J�-0 Q , Official use only..Do-not write in this area,tb be completed by co-or town official City or,Town: Permit/License# Issuing Authority.(circle one): Y.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map --)90 ? Parcel 0 O d pA plicatioonn # 1 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �1 Historic - OKH Preservation/Hyannis Project Street Address krX__e_ Vann as Village Owner and Address Po 6cK t W. P' lr n Telephone c/_5D -D d" 70a Permit Request !/)J kJA S P 30 U/7reSI-rn-C Sr_N-kC1 J_zc Lt •n a Q A S c2V a_Z4 4 eca,c..r-, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay P 1 ,Project Valuation 006 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attachRMs porting documntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure �' 3 Historic House: ❑Yes ❑ No On Old King's�Highwaym ❑Yet ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name d O Telephone Number6zk pit- - Address 4 S C'Clo/lS (✓evid &C/ License # o �- Home Improvement Contractor# /7f 9 1 Worker's Compensation # Oe S-7 76A-A 30 �- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO aiOCZ &Ct '3 LILL OCA i SIGNATURE J DATE / dd- t FOR OFFICIAL USE ONLY APPLICATION# A DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER I . DATE OF INSPECTION: } e .FOUNDATION. t FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 4' PLUMBING: ROUGH FINAL t w GAS: ROUGH FINAL G .. FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r Py r J e IARM rABL E e s639• Town of Barnstable ��� .. Regulaiolry Services Thomas F.-Geiler,Director Building Division Thomas Perry,CEO. Building Commissioner 200 Main Street,,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8Q-403 8 Fax: 508-790-6230 Property Owneir Must Complete and Sign This Section If Using A Builder - 6 I e k:tLi7 - it . i ;as Owner of the subject-property hereby authorize 40 �y .a � ls'. �° 6 W k.� -4/L-` to act on my•behalf, U in all matters relative to work authorized by this building permit application for: (Address of Job) Y y r li C Signature of Oven r j� ,�l Date Print Name if Property Owner is applying foe permit,please complete the-Homeowners.License Exemption Form on.the reverse-side. J-iv ;�i �zl LJ1L 1VGV Jr r1l'1 L'!-fuC. VVO rd�� oci vci na DATE_ CERTIFICATE OF LIABILITY INSURANCM THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFCATE HOLDER. THIS '- CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES O LI ED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S). REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. It SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this cerMicate does not confer rights to the certificate holder in lieu of such endorsement(s). j PRoouc� SMALL BUSINESS INS AGCY INC CONrACTNPN!E 542 MAIN STREET PHONEac___I�ogt 150&1 7.3�4 J_F3Z-LC�J:._.l50_ F WORCESTER, MA 016150022 EMAIL aaDREss -.---- -- I - -----'-- - i INSURgP AFF ADM--qpgRAGE .IIvSUREFA_LihemiMut�a,�llrs�lra_rcQ.._-_..._....__.--.....___. �.... RESOLUTION ENERGY INCORPORATED IMSURERC: 19 H[RRING POND ROAD _— _.__._.._.--•--•---._.._-._.....__._.__......... BUZZARDS SAY MA 02532 1_SLStR D: ( INSURERE: -•--------•----.._.......__._._. . t INSURER F: .- :OVERAGES CERTIFICATE NUMBER: 13 97741 REVISION NUMBER: THIS IS TO CERTIFY THAT THE PC)UCAES OF INSURANCE LISTED BELOW HAVE BEEN ISSIJED TO THE INSURED NAMED ABOVE FOR T F-E POLICY PERK INDICATED. Wj-RtvITH5TAN0Hw ANY REQUJREhJFNT, TERM OR CONDMa l OF ANY CX',NTnACT CR OTHER DOCtAv1EIJT VATH RESPECT TO 11HICH THIS CER'IRCATE P.A4Y BE ISSUED CR VAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN ISSUBJECT T Vl!A THE TERM: IO I D(CIU90NS AND CONDITIONS OF SUCIA POLICIES.LIMITS SI)WN MAY HAVE BEENF-OucED BY PAID CGL�AIMS. — — — 1-1 TS 1 a5R t7 TR i TYPE .--Irt5L1RAtJ.'-E —'�ATf6L�5Ut�R POUCV M.MBER I itJ�Y Y If& YY I UP L i GENEP,AI_UAB(UTY — -- _. lX7 tEFLIALGENL�WLJAPF T I I _—.__--'- r- I I ��rr I L L .—I -i J 1 � PcFi�VftL:ADV IAL�URV I-c I j _ Pr-)0t1?S•COJG/C?AC i+ I uE7N_A EC�iTEi/haITAP�E5PER: -- - 1 ti=L ALJr0MOSILEUABJUTY i°.J:?DI_Y INJURY(Per Ier...:,11 ;g I ANY Au 1 I I A L N� aU LIED I I I I I �1_Y 1t LA JRYq ED wPEDP1UTC6 ;_—;4(1703 II L__._..._- --...--...._..... .. t ' 5V RELLA UAa 1 I r i i !EACH C CURr^MV�E S EXCESSUA6 j�•CtRiNSf�1ALEi i i I!ALr ?CJ+CJ+-fE —'-- !_- J LIED i_. REIL-Vit(7vE I ! -----.........._. WOMERSCONVa'SAT10N I 1{ WC5:315-370523-052 13/1212012 ,311212013 ! /':Tc LFir`TTSI ILc i A I AN o ENPLOYER5 LIABILITY I ! -}} c Y/N 1 i_Ei.EP.CH AC JONT —I 5 1001101 !fiNY PRDPRIR'.d-7•ARTCP%EY•EfdtilV,. ! I j i .—. _. I OFrICL UI.S rvL•Efi c�cG_UJeC: FN N'W I i ! E.L DaFA E•EA 6V'Pi- EE�S 1000C1�. J {Mariramry m fJi i) I i _ —.—_ _ h�r desaibJ w'dm I ! ) ) E' 1-DISEASE•POLICY JkAR 1 S —50t)C0 DI':..—cZ5WTION I-FCf ERAT1(>G Wow � DES*Mpr 1Oy OF OPERATIONS%LOCATIONS!VEI-06S(Atooti AOORD 101,Additional%marks Schedde,if more space is regirirt-d) I I Y-forkers compensation.insomr-ce coverage applies Only to the Workers r.Ompensat ion lays of the state 111R.., ! 1 . I I PE -rifICATr-HOLDER. F CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. HOUSING ASSISTANCE CORPORATION Trim EXPIRATION DATE THEREOF, NOTICE LULL EE DELIVERED ir•! 460 WEST MAIN STREET ACCORDANCEIARTHTHE POLICY PROVISIONS. i HYANNIS MA 02601 AU640.RIZ©REPRr-s.EMATiVE t Jetf Eidridoe t)1988-2010 ACORD CORPORATION. All rights resereed ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ..... - 7.•.1r c.�N11 f L:e I'.y rncI- ,�r. . 7bi.r :.�L'~°:�c�-eie. •:�i .•.a�:n-s�-:b:_�` 1>. _;us D; i.:=:•:�9- rtiiic..:es k Y �. �iassachu<ctt• - Ot•Itarlmt••n1 ul Pu11�iC `;tlCl� Board iil• Builtlin_ Rciittlatinti. :111t1 �tantlartl� Construction Superviso, License License: CS 53202 JEFFREY R TONELLO �••Yam.t�.f. PO BOX 1516 SAGAMORE BEACH, MA 02562 cJ�� iyiJyc� Expiration: 7/14/2013 ( .unmisi.iirr Trm: 21481 e'ovmuzolmmaN. a�✓ ���t a' License or registration valid for individul use only \ Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Rehulation Registration:..' Type'171991 IO part<Plaza-Suite 5170 Corporation Boston,MA 03I I6 `• _� Expiration;- 5/9/2014 • RESOLUTION ENERGY; INt—...— JEFFREY TONEIIO 43 FIELDWOOD DRIVE lia�Y out signt�nt-'ure SAGAMORE BEACH,MA=02562 Ltndcrsccretary i 1 � , Ine uommonweatm-ai LrAUA--t&Ga" e4a Department of Industrial Accidents Office.of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation In. Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / -Please Print Legibly Name(BusinessfQtgauization/Individual): '�[�SC7 t�1 i`� Oil l—r1 e �►�-1 �1C - -Address:, 4R.. rrtn,,- City/SWe/Zip: 1�U LLA,-CfS t`nA 64 53--Plione.#: CSC I^?� Are yo4.tn employer?Check.the appropriate-box: :Type of project(required);. 1. I am a employer with.' L 4 [i I am a general contractor and I 6. El construction . employees(full and/oi paZt rime).* have hired the sub-contractors 2:El I am a"sole proprietor or partner- listed•on the-attached sheet 7. ❑Remodeling ship and have no employees These stib-contractors have g- ❑Demolition employees and have workers' working for me in any capacity. 9. ❑Budding addition [NO workelS'comp.insn*ancp comp.lncnrance$ - 5. Q We are a corporation and its - 10.❑Electrical repairs or additions required] . = . . I I am a homeowner-doing all work• - officers have exercised their 1 LFJ Plumbing repairs or additions ` right of exemption per MGL myself [No workers comp. 12.❑R39f repairs insurance required-]t c. 152, §1(4),and we have no , e - - , 13. er 1���•�'l��l l `Gt.�. employees.4[N6 workers comp,insurance regairedJ Any applicant that checks box#1 most 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 employee& Below is the policy and job site information Insurance Company Name: 01 d l U CLI Ms, Cy- Policy#or Self-ins.Lic.# IAJ S 3`( 3:7 Q J d 3 5 Expiration Date: Job Site Address: W-.V71 aC '.-) S t—rpQ-1 City/State/Zip: VLar j,i',3 ,n4)� Attach a copy of the workers'compensation policy declaration pap(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 31'500.00 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 thaf a copy of this statement may be forwarded to the Office of Investigations of the DIA for insuaance coyerate verification. I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct Si 3 Phone# Official use only. Do not write in this area,tb be completed.bv city or town offzciaL City of,Town: Permit/License# Issuing Authority.(circle one): -1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ap c7 C) Parcel d` Application # w Health Division Date Issued 1 Conservation Division Application Fee Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis �T Project Street Address -�4 C,U e off-()')�c.,7 �i�r e�L H yao n I Village Owner f Address �C 1�7�c d' �l�✓rr'l� Telephone 7 ? Permit Request'] J'a_.2 t 5 7.S ,�'�. (,(�. /� 30 U/)re-S t' 'C h Cr �2 ff/-CCU l h a�h C_: (P-4'1 ra Cam- aJA ..LLZC_U;1 S .Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay :; Co Project Valuation ,000 Construction Type 1 CD Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. '4'�3 0 `f Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) �s _.. F..t� Age of Existing Structure q 3 Historic House: ❑Yes ❑ No On Old King's Hi hway: 0 Yes NZ® No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name //0 Telephone Numbe�_�� �� -o Qb Address Q J �f[rr/ T, 4 Cl I d License # OS S 3 U�- 4&1, MA 3 d- Home Improvement Contractor# J��95>l f Worker's Compensation # 10e E3If 3 -W-4-36 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 45 rrrn� Nc 1Cl Q��, (Q y SIGNATURE A vVIA I(o DATE ��— r FOR OFFICIAL USE ONLY LL APPLICATION# k DATE ISSUED 14 A MAP/PARCEL NO, b , ADDRESS VILLAGE OWNER A i DATE OF INSPECTION: „FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 4. PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL r FINAL BUILDING S DATE CLOSED OUT ASSOCIATION PLAN NO. s f t _ • BARNSTABLE. + 'down of Rarnstable AlEQ MA'S B. -. Regulatory Services. Thomas K Geiler,Director Building Division Thomas Perry,.CEO. 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 'Phis Section If Using A Builder I, T ' ' 6 � ;as Owner,of the subject property r hereby authorize `% max .L 'j-eul'1 to act on my behalf, t3 U in all tatters relative to work authorized by this building permit application for: _ I - J to'Yo �yrC��`.FI�°' t3'-� �M- ii '. /�'-•`-rj�� tr'� -�..1�';. .. L•`'(� ¢'•l��"� (Address of Job) Signature of Ovvt•er ;fl �l ,/ Date F —= Print Name if Property Owner is applying foe permit,please complete the Homeowners.License Exemption #orm on..the reverse side. J-,� ;,, ,z.Lvic iv. av, �r nI-r rnv�c r vwo rd1: Jct •�ci =0A 7 F,(W.10 09 Y Y N) CERTIFICATE OF LIABiLITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE 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. i IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject Io 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). N aroOuc� SMALL BUSINESS INS AGCY INC CONTACrNAME i 542 MAIN STREET a-�=_ AC- E,ar r50817 .0635 I WORCESTER, MA 016150022 t E-MAIL ADDRESS -. -----'- - ItJSi1RE�AFFORgt�C(�VERAGE tJAlC� i INSURER A: Libg-a M�t,Le'�I 11.�ira_reg...._ ......__. �._.. _ _......._...._._...___.__ .^ - j trSURm INSURE-R S__-- RESOLUTION ENERGY INCORPORATED 11SUPERC: ! sy HERRING POND ROAD — ---•—.—.-_._—..—_._....-_.....__.....i._-- . BUZZARDS SAY MA 02532 WSURERD: INSURERE: COVERAGES CERTIFICATE NUMBER: 13B97741 REVISION NUMBER: IC THIS IS TO(:ERTIFY THAT TFIE Pa-IDES OF INSURANCE LISTED BELCrA HAVE BEEN ISSUED TO THE INSURED NAmED ABOVE FOR THE POLICY PER INDICATED. Wj7Yv1THS7ANDJNG ANY REQUIREr Ir , TERh9 OR CONDMCN OF ANY Cphrrr,ACT OR OTHER DCX:tJLIENvT VATH RESPECT TO Vvr;ICH PHIS CERTIFICATE NIAY BE ISSUED CR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DEwRIBED HEREIN IS SUBJE�T O AL HE T_P.PA'-.) EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.UWTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- - --lAl7DC+5D6R �•�SI�EV� ��G�'�s-r---__..-._.- riasai My1N' YVY1F ` DIN- Yl Un'S LTR: TYPE OF INSSURANCE POUCV hLbNBER �( . v :InTA° V� I i GENERAL UABIUTY I t IXY+�sER:,iAL!;ENL-fi�L�JaRi!JiV -------- --- -._.-_-._---•-_ i i I �lCD=_><'P,Al�[+_7,Y..CI, ___.__._•__._-._......... C`?J0.i"`rWNLIE L -'--- PER_'-1"`�VAL 4 ADV if VURY i S r .:..------_-._..__.._... I Pk -.'3 i uf: AGWEGATEU11ATAPryjE9PEP. ( - i---I R uc,I -I FRO I EtX: wu. AUTON48ILE Ua&ury I ! I _L I ecodiri ! ----i +X JY AlFO - `t'AIL � amLc�J D• 1 I t E+�i_Y IhUURY(r'w 7-i:ci?rT);.: - �. I -� r , )U•v"M!T i tr y=& _-.Vic '---._..__.... HRED PUTOS ; ;ALfrC3 UMBRELLA UAS I EACH C{CUR EV;E 5 ! I -—j------ 1 1-'EXCESSAB ' I U I f i i A(rREGATE S l L-;...CtAt ' nGrwtA[tE. i +_ - -_ _..----.._.... .—., LIED ;_. ,'• RErE�rtt(`rnrE` ? I i I i...- '� .I A Iw0FxERs MvPaSA'n0N I I WC5-31 S-370523-052 3112/2012 +ail 2/2013 i';Tc Lrir�TS I I Lc Ar`O EMPLOYERS'LIABILITY I , ! I ANYPROPRIcTOPC PARtNER,_yr.'QlnVE YIN i ' EJ~EP.CHAGJD�1T - .�_,---_- j J=FICXwIttvPEROCra_UDEC; N NrA- j j ^E.LDGEJuE-EASVPLOYEE�S • 100�(Y' i (Nanraroryin NH) ! ! I -.—_M_ - li•, .de fftlar urt r j I ! E' L pIS=ASE-PC)UCYi9�Atr 1 S0f .D�SCRIPTIC N CF C.f'ERATIC G Wr" I - l I 1 • I i i -- DESCfvPTION OF OPERATIONS.LOCAMONSr Vi7•aCLES(Attach ACOR0101,Additional Remarks Sr}tedule,11 rove space rs required) V./orkers rompansation insurance coverage applies,only to the workers compensation la,%s of the state I-AA., ! CERTIFICATE.HOLDER. F CANCELLATION + , SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ) THE EXPIRATION DATE THEREOF, NONCE WILL EE DEUVERED it-! HOUSING ASSISTANCE CORPORATION i 460 WEST MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 ALIT:io;zizEDREP'ai rsarrATvE j i j ��:�.•('h..;.� ICJ-�! <.r_:t.�:L Jeft Eldridge :D 1988-2010 ACORD CORPORATION. Ali rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD . -•- - ,yy?; `aw--: r ,'I8': t�:^ �:vi a�,-,.:m "-:3112 12: '. +s pn.?^ ..oi: . .*..i�r. -____._st:�rr_cr_±ic• •:,-a+.. lrs4:fr.'ALL i� ..:a-I}• ice...>��e.rl i?iea___. Y ' `�n��:IC IIII�CttF - f�C11:111111C I11 ��l 1311111 is a Bnartl nl (iuilllin_ Rt•;'ulalilllt� :uttl �tanll:lrll> Construction Supervisor License License: CS 53202 JEFFREY R TONELLO r PO BOX 1516 r, . SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( nnmi..im•r Tr-9: 21481 r �ja�,e }�vrxoyceuea� o- '✓ � ' License or reo gistration valid for individul use only \ OCGcc of Consumer Affairs&Business Regulation c before the expiration date. If found return to: _ HOME IMPROVEMENT CONTRACTOR Type. office of Consumer Affairs and Business Regulation . Registration: 10 Parlt Plaza-Suite 5170 Corporation Boston,MA UPI Iti Expiration;,' ,'5/9/2014 RESOLUTION ENERGY"_;1NC JEFFREY TONEL`LG'_m:- L 43 FIELDWOOD DRIVE: ���`—'?B"'�- t lid w' out signature SAGAMORE BEACH,MA�02562" Undersecretary 1ne C:orrzmonweacsn uj irccc� uca 2uaCt a Department of Industrial Accidents 01 pff�ce.of Investigations 600 Washington Street Boston,lVlA 02111 3vww.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plnmbers Applicant Information Please Print Leif Name(Business/Organization/Individual): r�1 L4 I1C -- -Address: 41 rr't City/State/Zip: Phone.#: CS�� - (�? Areyo_utn employer?Check.the appropriate-box: :Type of project(required);• 1. I am a em�Ioyer with� L Q 4. Q I am a general contractor and I 6. New cons6rnction . employees(full and/oi parE-time).* have hired the sub-contcactvrs listed-on the-attached 2:❑ I am a sole proprietor or partner- These sheet: 7.-[]Remodeling • ship and.have no employees These srib-contractors have g- ❑Demolition employees and have workers' worldug for me in any capacity. 9. ❑Blinding addition [NO workers' comp.insm'ance comp.incurance.i 5. We are k corporation and its ' 10.❑Electrical repairs or additions required.] - officers have exercised their 11.❑Plumbing repairs or additions 3.0 I am i homeowner-doing all work - myself [No workers'conk. right of exemption per MOM12.❑Ro repairs c. 152,§1(4),and we have no , insurance,rimed-]fi employees.[No workers' comp.mcnrance required.] . Any applicant that eheaks box#1 mast also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing aA work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this bo'must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Tthe sub-coahactms have employees,they must provide their workers'comp.policy number. ' I am an employer that is pro yiding.workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ;b er/-�7 010j-u Cz_t !/1 S Policy##or Self-ins.Lic.P. iO d-S-3 1 J-3 7 Q S- d 30 Expiration Date: lob Site Address: I 0 w-.M Qt 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 Sne up to S 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 ina,.rance coverage verification. I do hereby certify under the pains-and penalties of perjury that the information provided above is true and correct Si Date: .Id, Phone# Of use only. Do not write in this area,to be completed by.city.or town offzc&L 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#: • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ply plication # - f Health Division Date Issued � . s Conservation Division Application Fee Planning Dept. Permit Fee 3`s' Date Definitive Plan Approved by Planning Board r' Historic - OKH _Preservation/ Hyannis Project Street Address I9 C(�•s t G2:c �� S�i'��a 1/0/1 o iS Village Owner LW JI S Oil Cl A z7fi,--J-M cn4S Address PO 6ox 7 �� �l�r/�'�S J k Telephone �? � -D / - F -70� .Permit Request h73 iz%-U S 7 S � S , ( 1 f _ 230 (_Y)reSr;c+ c !-Cc/ �0 Yin Q.t� Ci.A Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay _ �7 Project Valuation OUO Construction Type ) Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting Qocumentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) O , Age of Existing Structure /��.3 Historic House: ❑Yes ❑ No On Old King'sHighway ❑Yet ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use - - APPLICANT INFORMATION (BUILDER OR HOMEOWNER)Name rdAl-AQ Telephone Number(ok Address l crrin and na! ad License# Ci S C3 v . Q U)-4-a Home Improvement Contractor# 12 M/ Worker's Compensation # 14jC4 r,3/S 3705 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO g 5 rlins Attic/ /Ld u Qct_y SIGNATURE /(,• 1 d !D DATE / .pl - 3 "/ i' !i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. Ik ADDRESS VILLAGE t OWNER DATE OF INSPECTION: ti _FOUNDATION_- FRAME R 'k INSULATION b FIREPLACE ELECTRICAL: ROUGH FINAL F I, PLUMBING: ROUGH FINAL GAS: ROUGH FINAL C FINAL.BUILDING DATE CLOSED OUT s ASSOCIATION PLAN NO. ` f i c BARNSPABLE e - �$ ,�� Town of Barnstable Regulaiolry Services Thomas F.-Geiler,Director Building Division Thomas Perry,CBO_ 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 as Owner of the subject property hereby authorize 4 ik't to act on mp"behalf U in all matters relative to work authorized by this building permit application for: (Address of Job) Ltr Signature of Owner 1�- �l��ta �; Date F f + fi Print Name if Property Owner is applying foe permit,please complete the Homeowners License Exemption Form on..the' reverse-side. : : " i.:.i�r ;�r 47.r LV2G 1VGV Jr Arl 1"AUG t VVJ rdl: Jct vG1 DATF_(h'MWYYYY) , � A CERTIFICATE OF LIABILITY INSU ANCM P.:�iT1�(,T THIS CERTIFICATE ES ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE 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. i IMPORTANT: It 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 1 certificate holder in lieu of such endorsement(s). PRODUCE". SMALL BUSINESS INS AGCY INC C:CNTACTNM9E: .___._—... .; 542 MAIN STREET Prix=_ acro•oar(50g);.B5�9 3 ---___1_FAX_LC1:._15�7!7S_�iQgZ J yVORCESTF_P., MA 016750022 EMAIL ADDRESS. _ __---.--___-_-- ....... I 1 it�SLIREPS AFFORGhkCRAGE INSURER INSURED RESOLUTION ENERGY INCORPORATED INSJRERc: I ag HERRING POND ROAD .--- — -.--•—. .._._—..—_._..._._-....__...__......- - BUZZARDS BAY MA 02532 I RtED: i 1 ' INSURER E: --•-----._�------ :. j IM1SYJnEF F: _.—� _ CERTIFICATE NUMBER: 13 9774t REVISION NUMBER: COVERAGES 8 — THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOA'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE E POLICY PF TIC;G INDICATED. N`gnrvlTH.S37ANDIRG ANY REOIJIREMENT. TERM OR CONDMOJ OF ANY CX)NTr,ACT OR OTHER DOCIJI IEiJT V•ATH FESPECT TO VP iCH THIS i CERTIFICATE MAY BE ISSUED CR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POL'CIES DESCRIBED HE'EII•J IS SUBJECT TO ALL I-Hc-T=RVE, j D:CLUS!ONS AND CONDITIONS OF SI.1c I POLICIES.LIMITS Si AWN MAY HAVE BEEN PEDUCED BY PAID CLAIMS. _.. . —lAUt3C508H _ r-.—___--..—.....UKT I iaSR! TYPE OF 1rtStJRIV> E I POUCYMAVIBER ilNrbDDVYYY) ih DDJIYVYII UrtiS �r: I j i GENERAL LIABILITY EsY'H OyCl1RRR•�Y'E ': I I '-- —--- -y ---- i ' lu�EXP(AI'- ute ir�sc�i I j �v,}llr�hr1ADE ! I Gt7a.E: 1 i I � --L.�--....._--------- ..j _-�-- i i I G'-'•IERAi Pti�RE{.CT'c I F j aFLNDU_TS•M\IP/CP AC-I S 11 1 GEN_A +EG3TEJIva1TAFr��_ESPEP. "--------...... r-- '- PPD. j I i 's5 I r XT I NTUCY I S v wt WGzfN Fi AUTOMDBILE LIABILITY i ' I -- odriri __ .-----'-'.•-•- . ]LY INJURY(Per per-M, '•` r '• �PLi.(����� r-^4„IiEUi!:.ED � i I .EG17r_YlhtIIJRY(Pwa-ottmrT I AUTG=S �—i AIIfC.S 1 I I �.r—``l—tR1J'J7 `1v1Ai. i i AJfrC3+6VEP I I I ' �JI HPED P11TC6 A11T0= 1 C LWSRELLA LAB 1 I { (i !E w H CY CURE EN;E S i EXCESSUA6 iCtl1PlF,±IADEi I ' j AG3RECA� fE ---J DED _. ._ RE'Ilrvnrrl: - I , I j i— —i----•---.._.___.. WORKERSCeev-asAn0N I ` lWCS-31S-370523-052 I3112/2012 I3N212013 j /!T(�i�UrvItTSI I e�`: r, I Apo ENfi3LOYERS LIABILITY I ---- - ViNi ANY PROPRIcTCd-7PARTIT�Ar'YMfrlV£ E1.EP.CHAC;.,IDENT .—' !'.-.-------_1(ln7(:n(_"57�: J: ICLwt L'-IvLER ECG U!JFCT a I N:A I I I 'E.L DaEASE-EA 6_PLOYEf.a 100ocic,� . (NandamryinNM i _ r',tt .dewibgLr:dat 1 ! t E�E-POUCYUPArr i S —50000 r DE4CRIP'nCNOFOPERATIONSwow �+ OESC RIFTILYtl OF OPERATIONS.LOCAmONS1 VE•6CLES(71ki i 6—M 101,Additional Renmrks Schedule,If more space is reciorcd) I Y-forkers rompensation insurance coverage applies or.ly to the workers compensation lay%s of the state MA. I _ C'ERTIFICATE.HOLDER CANCELLATION _ : t SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. ; HOUSING ASSISTANCE CORPORATION Trr EXPIRATION DATE THEREOF, NOSICE WI.1 SE DEUVERED iN 460 WEST MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. I HYANNIS MA 02601 i • Alr640'IZED REP;Ic-SE7YiATiVc i Jeff.Eldridoe :D 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and Iogo are registered marks of ACORD - - 7. i Ew r-.?.= o.*. ` .Y.i[. ___._._.-hL=eta:?.i:-+:��'..r_•,.�[-:b,.�r,.�.�.irt�-•[4���l irc�.� eertiiiea�?5� � ;�la••achu<ctt: - f)t•Itarttrtt•nt f PuitliC �:II•CI( � Bn;trrl nl' [3uiirlin� Rc:ul;ttinn. :ultl �tan�l;trtl� Construction Supervisor License License: CS 53202 JEFFREY R TONELLO .i PO BOX 1516 SAGAMORE BEACH, MA 02562 .:.�,,t,--.•��:1. ._._ Expiration: 7/14/2013 ( .unniisi.nrr Trg: 21481 �,� ,�a„7„no,uuea�C/z a�✓fit ' License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. if found return to: . HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation — Registration:.:-`171991 Type' 10 Parl'Plaza-Suite 5170 ` Expiration:_ ,-5/9/2014 Corporation Boston,MA 02116 RESOLUTION ENERGYING;::_:= JEFFREY TONEL` O 43 FIELDWOOD DRIVE.`':;;.: �� ��' � i lid w' out signature SAGAMORE BEACH.MA-,02562 Undersecretary - r 1ne t;ommoicweaiin uJ tricc�aucaic�etea Department of Industrial Accidents Office..of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/diet Workers' Compensation_Insurance Affidavit:Builders/Contractors/Electricians/plumbers Applicant Information Please Print LegiblY Name(Business/Organization/Individnal): �SC7 �1�—i C9rl irkC �1�-i oC- -Address:- 4-9- r w d City/Sta e/Zip: l� Zt�i�ctS 1 mil C,4 S 3.X Phone.#: CSC - F �I 0 Are yo employer?Check.the appropriate box: :Type of project(required);. 4. [j I am a general contractor and I 1- I am a emplo ' 6. ❑New construction yer with - employees(fun and/orr part have hired the sub-contractors listed.on the-attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have ship and have no employees 8. ❑Demoli tion working forme in any capacity. employees and have workers' 9. ❑Bu ld addition [NO workers' comp.hmiance Comp.insurance.* - 5. [] We are k corporation and its 10.❑Electrical repairs or additions required.] � -. . 3.0 I am a homeowner•doing all work - offctas have exercised their 11.[]Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12:❑Ro repairs insurance required.]t c. 152,§1(4),and we have noLIC � ) o workers' 13. ther �pto ees.[N y . comp.Msurance required-] . Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information f 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 prrnide their workers'comp.policy number. ' I ant an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: ;6,r l� n'l c1i I►1 S. �rJ- Policy#or Self-ins.Lic.#: tk) d° S 3 ( J- 3=7 0 S d 3 y Expiration Date: Job Site Address: I w.m Ga(,,) S-Y• Q-�- City/StatelZip: *14 i/oton+.5 � Attach a copy of the workers'compensation policy declaration page•(showing the policy number and expiration date). Failure,to secure coverage as required=der Section 25A of MGL c. 1.52 can lead to the imposition of criminal penalties of a 4 to S 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 thaf a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains-and penalties of perjury that the informatdon provided above is true and totted Signature; Date: id, Official use only. Do not write in this area,to be completed by city-or town offuiaL City or Town: Permit/License# Issuing Authority.(circle one): .J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map: 50 ParcelC a' Application Health Division Date Issued b Conservation Division Application Fee S� ✓ Planning Dept. Permit Fee �3 r Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis iT Project Street Address Village Owner Y� A311 Cl e9,Qg4- A1,*i Address ` 0 6&�, Aa 7%J dC— Telephone _ 77 — F 704, ' Permit Request 42 S/2UL:2 s S� k O-/L /Z 30 Uar'2S ho'ct—E d� kCl Square feet: 1 st floor: existing proposed 2nd floor: existing :proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation VdrUOU Construction Type z Lot Size Grandfathered: ❑Yes ❑ No If yes, attacrE� pportinVdocLOentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 30 � <D Age of Existing Structure / 3 Historic House: ❑Yes ❑ No On Old King'r Highway: ❑Y%s ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other " '13 Basement Finished Area (sq.ft.) Basement Unfinished Area (s .ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use - — APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameC'nsd/0 Telephone Number Address 49 � li n S �n/1C� /1 U License # e 5 � -U l Home Improvement Contractor# 1 9 S Worker's Compensation # Lb Q 15 3 7 09-436 �a- ALL CONSTRUCTION DEBRIS /RESULTING FROM THIS PROJECT WILL BE TAKEN TO :9 (�C.r�r�11�/8)nc/ 2 cJ (3U SIGNATURE o DATEd— P 'M g K, FOR OFFICIAL USE ONLY t APPLICATION# DATE ISSUED MAP/PARCEL NO. r Y ADDRESS VILLAGE OWNER y r , -; DATE OF INSPECTION: x yrFOUNDATION . . FRAME INSULATION FIREPLACE 4 ELECTRICAL: ROUGH FINAL 4 ti PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f. ' DATE CLOSED OUT ASSOCIATION PLAN NO. f lne t,ommonweatur QJ Lf1RaJ"t{cnuaetea Deportment of industrial Accidents Office.of Investigations 600 Washington Street Boston,MA 02111 ' www.mass.govIdia Workers' Compensation_Insurance Affidavit_Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Leeibly " Name(Businesslorganization/individual): 1C r - -Address: 4.9- r- 0 City/State/Zip: L�u Zui''eIS f t'n A 64 5 3?-Phone.#: CSC ) ' I^1�1 Are you.,eil employer?Check.the appropriate-box: :Type of project(required);. 4. [j I am a general contractor and I 1. I am a employer with' ( 6.' ❑New construction " employees(full and/oi part time).* Have hired the sub-contractors listed-on the-attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- These sub-confracEors have ship and have no employees 8. ❑.Demolition working for me in any capacity. employees and have workers' 9 El Building addition ncnransp [No wo&ep' Comp. i comp.m a SUrcean *- - 5. ❑ We are corporation and its lo.❑Electrical repairs or additions 3. I am a homeowner-doing all work required - officers have exercised their 11.❑Plumbing repairs- or additions myself: [No workers comp. ' 0• - right of exemption per MGL 12.❑Roqf repairs - •" insurance re t+d t c. 152,§1(4),and we have no , ] �to e. C1`I es. o workers' 13. ther toe_aj- �- . - Y . comp.insurance required.] Any applicant that checks box#1 most 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-coammtors and st&whether or not those entities have employees. If the sub-coz pact=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: ! 01 y�U - --J Policy#or Self-ins.Lic.# �—S 3`( J-- 3 7 Q 5� a 3 y Expiration Date: Job Site Address: Pe. w-.frjaL ,,7 Citylstatelzip: 14 Va�_T 4)14 Attach a copy of the workers'compensation.policy declaration page'(showing the policy number and expiration date). Failure"to secure coverage as regtured=&r Section 25A of MGL-c. 1.52 can lead to the imposition of criminal penalties of a fine iip 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 slat-=it maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under,the pains-and penalties of perjury that the information provided above is true and correct Date: .id, -"3 i -�L_ Phone;�: C s l -ebb-( 7 4-0 Official use only..Do not write in this area,tb be completed by.city.or town offuiaL " City or,Town: Permit/License# L uingAuthority.(circle one): Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other ntact Person: Plane#: �rr� vi �Zt tV1G 1VGVJ[ [1l'1 I-AUG J[ vvo rd1L Oct vG1 s DATF(h iVayI'YY) CERTIFICATE OF LIABILITY INSURANCE Zannn THIS CERTIFICATE is ISSUED AS A MATTER OF INFORMA-tON ONLY AND CONFERS NO RIGHTS UPON THE CER71RCA TE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICES _ BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADYMNAL 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 Ji certificate holder in lieu of such endorsement(s). PtiOQUCER SMALL BUSINESS INS AGCY ING CONrAC ?NWE: 1 542 MAIN STREET Ps3ONe wa-r�.og}:f5081i.D`�9 3 ___.__.-LFAx_(aGJ:._l _7i�_SQQa .M WORCESTF_P,, hAA 016t5(1027_ &MAILACDRESS - __-- _--.-_._ ....... I 1 INSURE AFFCRDhk RAGE IIUSURERa: Lib f� Mkt!��Ins��ra_rct:.-._.._.___-----•.....-._._ �--.. I INSURm INSURERS___ �.-----• ---__-_',,_._....-. ... ' RESOLUTION ENERGY INCORPORATED INSURERC: I ( sy IiCRRING POND ROAD --- -- ----......... - - .._._....- j BUZZARDS BAY MA 02532 ID' .. INSURER E: COVERAGES CERTIFICATE NUMBER: 13 A7741 REVISION NUMBER: TWS IS TO CERTIFY THAT 71 IE POLICIES OF INSURUVVCE LISTED BELOVN AVE BEEN ISSUED TO THE INSURED nL4I tED ABOVE FOR THE PG ICY PERK- INDICATED. Wj-RpvITHSTANOING ANY REOUIREPAEJNT, TERM OR CONDITION OF ANY CXaNTRACT OR OTHER DCX:IJI.1EIvT tuATH.-SPECT TO V•A-ITCH 7HIS CERTFICATE PJIAY BE ISSUED CP tJWY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HMEIN IS SUBJECT TO ALL HE T_RIA E):CLUSIONS AND CONDITIONS OF SIJO-I ROUCIES.UMTS Sl'-0 (MAY HAVE BEEN REDUCED BY PAD CLAIfJSr_y -_...._.-__._..__._.... . �plsR '-1ATSCSCSOSFI- P V�H�F PC"SuLY- UrsiS LTR: TYPE 0=fr1AJRMk:E PoUCY"_WBER !It�'YYYY) trfrA'aCuyyVVl j . i GB•IEP,AI_UABNTY EACH=RREACE i I l;rr7A,dEt•Z;tALi;FJQLT'iALJ6R1!JTY { ! --.__--- ---------_._.. j ! L t, EXP(ar;f(3}e:ry:;oti i v ADE - { --�.._._._—•-------------- I f � I S GE"1ERALFC�R-C.STE_..._IS. _" - - j GF.'LmG"+EC-s},i P'h17p1 'E:i i I ----5• ,A - t S ._,-----•---__.-- ! !PFL\DLr-T PIC2 A LiY AUTOMOBILE UAB1UTv i ! - i I ta2cIN od`YI'i ,-------•--..._ . .( BODILY IhUURY(Per pers:lil f X\TY AUTO- i P p�NETJ Y IiEDLc�D , j I I r_�r_v trin lRYv,P a ddar}t::-- ----- _ ALLUrLa i--! kV iivh tEP I -tR1'M�IuCt --I�..__•._...__.... ' J HIPED AIRC6 y_ At/f0= f- LMB LLA UAB 1 !E,-H CCCURREN;E S ( • � ! i L------ - 11 ! i Af3GFEC�-TE -S r-J I EXCESS UAB 1.__i.Ct�tvS rtA[>E t ! s I --!— •----.._.. __ -y _-�_. -_- ._._._. — ! LIED i REiL-VnCN°.i � I i I i - •--- 1 VVORKERS-coN%P ,nON I WC5f31S-370523-052 i311212012 ,3i1212013 ! /!T(,�?YLHI TSI ILc91 A �w�t7uPLOYERS UAOIUTY YIN! I aN1'PROFRITCFirAFTEP, Y.t:<dRNE t j I E.L.EP.CI-t AC;105UT - -i 3_------t OtI.UOfJ� O=rICL-R 1,C-NLER cXCLUE)Er a!N/A I I I I ^E.L DSEASE•EA 6V�LOYEE S 1000n} I (Nana vey,inNH) ...-._.. �y i II-e-dewib o uidrr E' L DISEASE•POLICY Jl�1ff50t).^0!7 D�SCRIPTICN(]�CflERA71CN;Mnv T OESCF'nPtIC1'a(y OPERATIO;'I6+LC)CATIONS[vp_-acLfiS(Attach ACORD 101,Additional Rerrerks Schedule,If more space is required) I }P•lorkers romp2nsation insurance coverage applias Orly to the V+'orkcrs conqpensation la�tis of the state IAA.._ f I CERT.INCATE-HOLDER. CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. I HOUSING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NONCE WILL EE DELIVERED Ire " 460-WEST MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 .. q;., •- AUTH0:dZlSJ REPRc'SpViATiVc .. .� } • � � .. • � fir '�:r•�`'�=�••(Ji.4J�<•-r_ %�L s 4 Jeff Eldridoe J J t- :p 1988-2010 ACORD CORPORATION. All rights reserved ACORD 25 (2010/05) The ACORD name and logo arer'egistered marks of ACORD -�.- - ,u:;�7;} •:}.,.: ;. ..,'Ih': 1 ^'. ;:,r 2.::1�,[ =:+ 'i0t: t2:t' '' PA r-aae ;-:I.f . .bis ___._. -ste r_:�=is��:'.> .. �.^rs=-:b:_�`�.,.,.}:ram-•.::ue.ly i��,- :I-=.^rt iiiuces� , r r d �. �{a..at•ht�<ctt• - Ocltarlincnl nl Pltl)IiC �ail'I� ' a Bn;trtl nl (3uililin_ Rc;tul:ttinn• :uttl titantl;irtl> Construction Supervisor License License: CS 53202 JEFFREY R TONELLO " 4. i PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 Trg: 21481 A ��e _e1,1. 411A uea&X a�✓1 ���f License or registration valid for individul use only \ office of Consumer Affairs&Business Regulation before the expiration date. If found return to: l and Business Regulation HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs FJ _ Registration:. =171991 Type" Ip park plaza-Suite 5170 l� corporation 5/9/201 Boston,MA Ul 116 `3 -- Expiration:_ 4 RESOLUTION ENERGYrING: :..;_ JEFFREY TONELL' ...`.- 43 FIELDWOOD DRIVE.::::�. SAGAMORE BEACH,MA:02562 Undersecretary , ' t lid w' out si�nnture RARNSrimr.E a 9. Town of Rarnstable Regulatory Serymes Thomas F.Geiler,Director Building Division Thomas Perry,_CBO_ Building Commissioner - 200 Main Street,-Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508462-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A wilder I n' -" 1 " t Z k : ;as Owner of the subject property hereby authorize '= ,: `�L•i�.. to act-on my.beh4 U U in all matters relative to work authorized by this building permit application for: (Address of Job) r� �, ��•`y sa a 'j' f ihoo Signature of Ovver y- � �''/, />��' Dates � tt 0 Print Name if Property Owner is applying foe permit,please complete the Homeowners.License Exemption Form_ on..the reverse side. _ � I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 9d C 7 Qd r"30 0 l Map Parcel application # Health Division Date Issued l s ' Conservation Division Application Fee Planning Dept. Permit Fee �-3s _ Date Definitive Plan Approved by Planning Board 3 Historic - OKH Preservation / Hyannis Project Street Address l/I anjj,s Village Owner c'1t q t0onc/ A'Qc,arv- �Af Address D d x l 79 l rr�i'1S J �C Telephone CSDb-) -7�� -8�Dc� Permit Request /h 5 hL U 5_7S 81,U.L pZ_ R 2O Ulire S k-rl 0_-t2_c/ Se 61kC� 1k-) ate_ ,Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay :Project Valuation )A)0 Construction Type. Lot Size Grandfathered: ❑Yes ❑ No If yes, attach SUDDOr.ting Ogcumeqntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 07 Age of Existing Structure /9�3 Historic House: ❑Yes ❑ No On Old King.`s fflighway:`�U Ye ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft F� Number of Baths: Full: existing new Half: existing new v� Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ■Yes ■ No. Fireplaces: Existing New Existing wood/coal stove: ■Yes ■ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - - -- (BUILDER OR HOMEOWNER) Name Telephone Number Address rl'l n$ lw/10 t1d License # e S S"3 ✓L I- Home Improvement Contractor# Worker's Compensation # AJC S-3/S-3?Oct ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 9 S n!!� Av/Icl '�&( ,t3vL t-. SIGNATURL r6��& DATEd— FOR OFFICIAL USE ONLY 4 r APPLICATION# E` DATE ISSUED MAP/PARCEL NO. } ADDRESS VILLAGE x OWNER r F - DATE OF INSPECTION: A.-FOUNDATION, s t FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. t 7 E oCUM row SARNMELF- Town of Barust ble _ - Regu #Ory Seryices Thomas F.Geiler,Director Building Division . Thomas Perry,.CBO. Building Commissioner . 200 Main Street,'Hyannis,MA 02601 www.town.barnstable.ma..us Office: 50MQ-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �`'�`� � � r' �.� ;as Owner of the subject property hereby authorize =mot- .a: :� @� ¢ �_-#' E' i, . to act-on my behalf {� U in all matters relative to work authorized by this building permit application for: (Address of Job) , F , r Signature of Os 1 J07 6 >�� Date � )A ILA Print Name if Property Owner is applying for permit,please complete the Homeowners.License Exemption Form on,the reverseside. �..r-ev - v, r�e L.v1G tv. GV Jr nrt rnv e. or vvo reaA a •,ei DATE(ncI44. Yyyy) CERTIFICATE OF LIABILITY INSURANCE ,0 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 T E POLL IIES BELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. It 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). i PRODUCER SMALL BUSINESS INS AGCY INC CONTAG T NAME — --------- ( 542 MAIN STREET a}qN=_ wC ruo.F,gr.1508)7g 0 3�5 E .LC _Za -TsD4' .I WORCESTER, NIA 016150022 EMAIL ADDRE55 1 iNSUREP�]S PFFCRDNGCQfEIR/+GE r INSURE;A: -ry—m!!LLd(IrsuMao:....._._._.. i ----- INSURt1� INSURER B_ RESOLUTION ENERGY INCORPORATED INSJF,ERc: 49 HERRING POND ROAD — -----.—.-.--'--.—_.__.__.___....._......... I BUZZARDS BAY MA 02532 IISJRERD: — ...-'- ---- - 1 INSURERE: COVERAGES CERTIFICATE NUMBER: 13$g7741 REVISION NUMBER: THIS IS TO CERTIFY THAT TFIE POLIC IES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE-E PO-ICY P:1 li:f INDICATED. WjM1v'tTH_STA(Dlha ANY REC JIREfra-E fr,TEFihq OR CONDMO(-J OF ANY(XWTRACT OR OTHER,D(X:UMEN VAII 1 RESPECT T!)V P'IC I it{IS I CE-nFICATE NIAY BE ISSUED OR 61WY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SU JECT TiD ALL THE TERWA, j EY.CLUSIONS AND CONDITIONS OF SUCH POLICIES.UMITS SHOVvN MAY HAVE BEEN PEOL10EED BY PAID CLAIM . __._ _—__.....___....-•---------._.... . I d5731 --J�P.I SDSFI ' Fll�t 't' 1—puUl —VYl I U!'XTS j tT-.. TYPE OF InSURAW-E POLICY huViBE^ GENEP,ALLIABILITY I i j cACH..YJCIIRRc�r-'E `: _, .1 L_ CG6`3•PAPLIE L_�Q?7.Jn. ! I I '- j FER^,�VAL`ADV IN;URy I j (PFL) LAc�R_=crTE IS I GFN AG0SEr:ATEUlATAPiyJ_E_:ir'EA: : _ ----- ------------... 1-- P V. I— troutw LIM I I. AU7OVOBILEUABIUTY ° j �LocSrrYi --- '_ ---._••- . .-� I I 13C?71_Y I V;URY(Per mmrt) .q ANY AUrTO _ ALL RNED ;Y'tiEDL.I:Fp Altr P.Ures I 3 EF�J�JwCt I i HREDA1T06 ;_ ;AtITDi i - I I LMBRELLAUAs J m I !EACH C CURREN;E - 'S xrl -L----- -- ..� �— FYCESSU IS j t(fJNSFtADE ( I I?f���CAfE �iS _ j bED J_. _i t1ETC-•VT1rNff I i I i —i----- j A IworacERs'ceev2 rsAnoN I ` IWCS-31S-370523-052 3f1J2012 i 3i1212013 ✓!.T.._UTATsl I `"f_—_---_._._ -, At�EN8L0YER5UABIUTy � VlNj I iEL.EACHACGOB,rr ?5 1Q0`.1Qt%I I P,NYPROPRIETr J rICL j CNL'Ek c�f!_U7F07 a E.L D!SEASE-EA 6,,PLOYE�S ,- 1000c, ( ry — j H-rv,de�tls3 urdg I ! — Dgq'RIPT10VoFc.fERA-nc-Ni fsirn� I E.LDISEASE-FOUCYLPAfT;5 50W.0 f)! 0ESCRPT10N OF OPERA- +'LO^ATICrrSr VES•aCLES(Arms,ACORD 101,Additional Rerrnrks Schedule,It more STace required) I I INorkers compensation,insurance covarage applies onlyto the Workers compensation la«s of the state 10A., I l i •CERTIFICATE.HOLDER CANCELLATION i} SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1 rrfE EXPIRATION DATE THEREC'F, N0710E WLL BE DELIVERED iN HOUSING ASSISTANCE CORPORATION 460 WEST"MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. ! HYANNIS MA''02601 - AUTi-t0'nIZID REPReSOYfATeVi: ff j Jeff Eldridoe *1 988-2010 ACORD CORPORATIOP9. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD _ - ,uC?; •71w--;r r,E: I ,<, r•-.�. _-' Ci'2e)l e. 12:17 -. 'EM r•.a-,e -'.•.L[. ..____._:hL�••�•[�-_.i..-•:,� .>aretiss'H:_.`,.e...t:r•'�•!;e:s l'Vr..m•.a::J�e.rL-iiiea_•<� - n v �. �laszat•hu<ctt: - Ocltar[titcnt ul �1ult�tC `:tlfl� a Board rtl* Builtlirt_ Re"tilminn• :uttl stantl;trl>t Construction Supervisor License License: CS 53202 JEFFREY R TONELLO ,i p0 BOX 1516 ; SAGAMORE BEACH, MA 02562 ;kJ� Expiration: 7/14/2013 t , nnuixzimrr Trg: 21481 liae (7007WJ:aruuea�� a ✓l ea "`� License or registration valid for individul use only \ Office or Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR office of Consumer Affairs and Business Regulation t. Type: Registration: 10 Parli Plaza-Suite 5170 ,l-• _;� ,; Expiration,._,5/9/2014 Corporation Boston,MA 02116 RESOLUTION ENERG,Y;ING:::: JEFFREY TONEL'LO`. `: 43 FIELDWOOD DRIVE �4`--��°� SAGAMORE BEACH.MA 02562 Cindcrsecrctary t t lid w out signnturc f 4 111e (:ommonitieacan u1 cracwscc�auaetra Department of Industrial Accidents 0 ce..of Investigations 600 Washington Street. Boston;MA 02111 mminass.govldia Workers'Compensation_Iinsurance AffirlaYit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le�ib� Name(Business/aganizationadividual): ti e—so 10+1 C9rl l—f'1 C r�1 t-i 1(1C - -Address: rr _ 3u LA,-C(S Q& City/State/Zip: L .. , Are yoRan 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 . (furl and/or part- employees time).* have lamed the sub-contractors listed•on the-attached sheet 7. ❑Remodeling 2:❑ I am a sole proprietor orpartner-. These sub-contraciors have •8. El Demolition ship and have no employees , working for me in'any-capacity. employees and have workers 9. Building addition o workers' co msurance comp.insurance t '[N �• 14.❑Electrical repairs or additions .-. • _ _ 5. [I We area corporation and its ' required-] - officers have exercised their 1 LEI Plumbing repairs or additions 3.El- I am a homeowner-doing all work, - right bf exemption per MGL myself: [No workers camp. 12.❑Ro repairs in�erequired]t c. IS2,§1(4),and we have no 0- to o workers' 13. ther f1��2G�'�'LMI LGh yam•[N comp.insurance required.] _ *Any applicant that checks box#1 must also fin 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 xConhactors that check this box.mt>st attached an additional sheet showing the name of the sub-cmt actors and state whdher 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. Insumuce Company Name: f1 S. C� Policy#or Self-ins.Lic.M � C—IS-3`( J.. 3 7 O _F d 3 v Expiration Date: Job Site Address: I �V- �Q[,7 S�YP Q Cm'istaate/Zip: 1-t /a0il �.3 Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date). Failure•to secure coverage as required under Section 25A of MGL-c. 152 can lead to the imposition of criminal penalties of • 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 till to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigz4ons of the DIA for ins ranee coverage verification. I do hereby certify cinder the pains-and penalties of perjury that the information provided above is true acid correct. Date: Signature: t9� .�d� - 3 - % d, jF 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): J.Board of Health 2.Building Departinent 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mae c1 D y ' Parcel �O Application. �400 p1 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 3 is Date Definitive Plan Approved by Planning Board p j --7 —a 3 Historic - OKH Preservation /Hyannis i Project Street Address Village Owner In-cuc2.,iV3 1061d OpCc/d,11-LLnFS Address 6'06 6dA, (07S l�rr✓t� 1k Telephone 77 I -c37 D.)_ Permit Request ll�S�u_�Q ._7SSG �,�• Bi,- Al 30 UnreJkr;C kcl _�fAkcl ate,, _L.eO.��e-y,S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 9�,DUD Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) __Zy->- 3 O E- Age of Existing Structure 14f.3 Historic House: ❑Yes ❑ No On Old King's H.ig,hway: o,Yes o No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Uw.ip Q Basement Finished Area (sq.ft.) Basement Unfinished Area Number of Baths: Full: existing new Half: existing new -„ •-tip .;� Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor RoomlCount tl: 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 ._Jai, Telephone Numbers Address 4q C License # L1 s 3 �- 8 `L.. 6coy 61(�-3 Home Improvement Contractor# / 9 If Worker's Compensation # 3 15 3ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4 g JLll r n s and 2c.( 5V I l i, SIGNATURE (�� .. 2� / jd DATE I - 3 - a- c` r FOR OFFICIAL USE ONLY ''. APPLICATION# �. DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE f OWNER DATE OF INSPECTION: i r_FOUNDATION . 1 ' FRAME 4 INSULATION FIREPLACE 6 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. oF�ram, • . - - sARNSresMAM- cs. Town.of Barnstable prED MA'S�' Regulatory Services Thomas K Geiler,Director Building Division Thomas Perry,.CBO. Building Commissioner - 200 Main Street,- Hyannis,MA 02601 www.town.barnstable.ma.us Office: 5084V-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 4_ as Owner of the subject property to act on my behalf, hereby authorize in all matters relative to work authorized by this building permit application for: - 1.�.� -� � e �. a �^C''-C i A 64 J f 1! (Address of Job) \ f Signature of Owner Date Print Name �! if Property Owner is applying for permit,please complete the-Homeowners.License Exemption Form on,the reverse-side. L.r.,V V, /Z, G.V1G 1V GV V! [1l'f ['All C• Jr V VJ r Jcl •,cl n DATE(R'8h'DO'YYYV) ACC>RV CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE HOLDER. THlS 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)r AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. f IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED.subject e ! the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the `I certificate holder in lieu of such endorsement(s). PRODUCER SMALL BUSINESS INS AGCY INC i 542 MAIN STREET PraN�aG No�P�a) 1508)7 35-0635 __.__J_F�x_Lc 1:._.(508)Z_43-.K?r WORCESTER, MA 016150027 _ INSUREPKS AFFORDNGCOVER/GE INSURED RESOLUTION ENERGY INCORPORATED —""---_--- 49 1-IER.RING POND ROAD INSURER C: I I BUZZARDS BAY MA 02532 LNSU f D' { i INSURERE: INSURER F: !COVAGES CERTIFICATE NUMBER 13$g7741 REVISION NUMBER: _ THISER IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TFE POLICY PF�ICG j INDICATED. N:311MTHSTANDII�V,ANY REQI.1IREPAENf,TERhI OR(XAVDIT10tJ OF ANY(7-kn TACT OR OTHER DCX U�1Ei�T WTH cSPECT TO V'f�ilC.rl Tl IIS CER-nFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERfC� j EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UM!TS SHOVMf MAY HAVE BEEN FEDUCED BY PAID CLAIMS. p�T��p-�- II•ISR 1 •rypE OF tr15l.IRAM:E Iq I yyyp —POLICY M1,VIBER —i(tDD'Y F 'Iril A�fY`IYVYI I U L _• I-I---- 'S rr TA: {GENERAL UABIUTYEA- -•'---'-.'-_'...__..._.. ! 1h.tER:"IAL C;EiJLF74L_JG.RI!.IT\' ; G. ..'. � s -_-_ , 1 I Y7,F PERSONAL F.ADV IPL_URY--!S I i ! --_-_- - _-__- { GENE.FAL ACCRECATE j S GEN_AuGREC aTE Uhr1T 'PER: i i i PF DLl TS CAP _ AC is da-- i I I i , j I fl7UCY 1 PR T � LL.bwX AUTOMOBILEUABIUTY ! I't-2tO Hfl .i ! I ! I BMI:Y IiWURY(Per Ixrs.'.rll S I ANY AU FFO _Y�UURY(Pw a-oti�t�¢ .`...._.- .. I PLLNED ' ' 1FiEDL!ED I I I fa7D1 I i:..__ lfF' c7e-� - `�HREDP11TOS I AUTO: B:� 177 EPCH OCCURREN':E S ( rIAVIBRELLAUAB I �, �, { ----I----.-----..__. OCE�UA6 L (;LPJA' 1ALEi i I I IA(rRECATE 1 DIED 1 I v �IAI cx1 A IwoRfcERscceua�sAnoN I ` WC5-315-370523 052 311212012 3i1 J201 / ;T( LIMITS I I c . o ENFLOYER5 UAOWTY VIN j 1 ! ---1-..-.-------..._.._...... ANY PROPRIETC'dPARTCi+T'Y.EOtrrIVE 1. I ' I � l E i.EACH AC;IDENT - 1:S10000Ca I� i1C_LER D(CI_UDED i F i N'A I I I ' E.L.DDGEASE-EA EMPLOYEE S 10000 bri in" t•/e,.ditx lvder E' L.DISEASE-POUCY LII',AIT j S---~` 500.^=0 ' l DE ScRIP71CNOFCPERATIC_NSW_mv UESCRPTICIJ OF OPERA"111 i LC�ATIOttS/VE!eCL6(Atra�+A�tD 101,Additional Rerrerlcs Sd�edWe if rtme mace is requlrcd) L l Y-lorkers compensation insurance coverage applies only to the workers compensation laws of the state MA... ; t f 1 LCERTIFICATE.HOLDER CA rCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOUSING ASSISTANCE CORPORATION 4(30 WEST MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 ALJrFnPyZm REPRESENTATIVE Jeff Eldridoe cg)1988-2010 ACORD CORPORATION. All rights reserved ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD -i c iuy?� i :1.-= •'i!'.f:: 1°-" i 2„'.5-i mill: 1['t? ., C.N 1'?n_,e ,.:�i. Ai.; I' ..•ae•L, i;_,.;.xJ-crrL.i s-ieaces. i *=. �f;i••,�chu:ctt• - fh•ltaruru•n( nl Pu111iC �,t11't� Board nl Builtlin_ Rc;tul;t(inn. ;trt(I `t;tntl;tr(I> Construction Supervisor License License: CS 53202 JEFFREY R TONELLO i PO BOX 1516 ' SAGAMORE BEACH, MA 02562 4 Expiration: 7/14/2013 ( nin,is�iuiri. Trz: 21481 z /,� 1�omvrzaruuea a�✓r! sacu/z"� License or registration valid for individul use only \ Office otConsumerAffairs&Business Regulation before the expiration (late. If found return to: —�, and Business Regulation HOME IMPROVEMENT CONTRACTOR office of Consumer Affairs Registration: . =171991 Type' 10 Parl<Plaaa-Suite 5170 Expiration:. 5/9/2014 Corporation Boston,MA 02116 RESOLUTION ENERGY',INC JEFFREY TONECL0'.. 43 FIELDWOOD DRIVE: .:..- out signature SAGAMORE BEACH, MA;02562 Undersecretary i 1 ine uommonweaim.uj 1r1aJ�'ttc c s�eE�a Departmentof Industrial Accidents 0 i.ofInvestigations 600 Washington Street Boston;MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plnmber� Applicant Information Please Pi Leib v Name(BusinesslOrganization/Individual) 5C7 I Qi-1 On ..kddress: 49 r f 4n City/State/Zip: a 0 7-L irdS A m A (AS 3�-Phone A: CS`� Are yogwl employer?Check-the appropriate-box: ,Type of project(required).. 4. I am a general contractor.and I 1. I am a employer with' : 6. New construction . :employees(fan and/oz part time).* have hired the sub-contractors listed-on the-attached sheet. 7. Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have ship and have no employees -8. ❑Demolition employees and have workers' working for me m.any capacity. 9. 0 Building addition [No workers' comp,insurance, comp•inrance, - 5. F] We area corporation and its 10.❑Electrical repairs or additions zequired] = officers have exercised their 11.❑Plumbing repairs or additions 3.0• I am a homeowner-doing all work right Of exemption per MGL myself. [No workers comp. 12.❑Ro repairs , ed c. 152,§1(4),and we have no insurance r m ]t. 13. err�P �1 i.Cth employees:[No workers comp.ms rance 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 anew 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. Tf the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for employees Below is the policy and job site information. Insurance'Company Name: !,r b e�-b 01 bl S. (!�O- — Policy#or Self-ins.Lic.#: w L°-S 3 ( S. 3 7 0 .S- d 30.-a Expiration Date: 3- I.)- Job Site Address: / W= �'1 cti, Shr P _City/State/zip. 1� am y,3 n91 U a-CoO. Attach a copy of the workers'compensation policy declaration page'(sliowing 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 lavestigaiions of the DIA for instiranee coverage verification. -and penalties of perjury that the information provided above is true and correct I do hereby certify under-the pains Si •e t DateOr : Phone# ' Official use only. Do not write in this area,io be campteted.by.city or town offu iaL _ City or Town: Permit/License# , Issuing Authority(circle one): :1.Board of Health 2.Building Department 3.City/TovPn Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other ; w Contact Person: Phone.#•. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # 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 Village Owner - iWwc`Lbi- t'ditc� Aocm J-,I�k Address PO 13ox 6'791 P- Inli o!� k Telephone C SZs ) 7-? - -� Permit Request /e-)S� ,a 9 7S LLk Off_;6-30 Un/'nkr)'Ic 7-c cl SCJ�kd C r`` 7 Q�� ' a 6<--- CIAc Square feet: 1 st floor: existing proposed 2nd floor: existing . proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation $d,U 00 Construction Type • � r�7 ,Gj Lot Size Grandfathered: ❑Yes ❑ No If yes, attach su�"pl1orting ddcum tation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) . ED = 0 97 Age of Existing Structure 90-3 Historic House: ❑Yes ❑ No On Old King's Highway:-Lb Yes;❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Lxl � Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft �. Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name v Telephone Number F I �w Address License# 2A,L m/-4 O 44-3 4- Home Improvement Contractor# 7 / Worker's Compensation # bLJ b�3 /S 3 b 5J 30&-4- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 19 &,1_r�T10-611d /1 d 1. &A.i, SIGNATURE DATE f d - �' a- r, t r' FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED MAP/PARCEL NO. Y ADDRESS VILLAGE �E x OWNER I'k 'Y ;M1 DATE OF INSPECTION: g • ,-FOUNDATION 'F FRAME 9 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL k PLUMBING: ROUGH FINAL GAS: ROUGH FINAL w FINAL BUILDING F DATE CLOSED OUT ASSOCIATION PLAN NO. EARNSrABLE m"i639. 'gown of Barnstable Epp `�� Reg�la$ory Se>�ces Thomas F.-Geiler,Director Building Division Thomas Perry,CBO_ Building Commissioner 200 Main Street,-Hyannis,Mk 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.' as Owner of the subject property hereby authorize to act-on my behalf U U in all matters relative to work authorized by this building permit application for: ! � :r �`O.� ���C:'�-1`��.' i��� \'�j�\✓� E' t b'j C;R✓3����^� '1����-�� ��t 1�'��':4 (Address of Job) 'J Signature of Owner �yf F , ['#/ i i� Date PLnt Name if Property Owner is applying for permit,please complete the Homeowners.License Exemption Form on:the reverse side. : - 1V,e-V If Al'1 C-AIfG Jr VV.7 rC.l: JGl `/G1 .`P'� DAT WYt') CERTIFICATE OF LIABILITY INSURANCE THIS CERT11716ATE 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), AUTHOREZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. i IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject 10 i the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the i certificate holder in lieu of such endorsement(s)- PRODUCER SMALL BUSINESS INS AGCY IN_C COWAGTNAME: _, .--.--.--._---._-•-. 1 542 MAIN STREET PHmE 7vSL�.E41;_L`aQ$1%.9.`�0635 LF6X.Lc^�-Y:._15 L7(if �Qn W G ORCESTER, I+AA 016150022 MNL aDDR IIJSURE AFFC UNGCOVERAGE IPSUR�AyLihet){-fV1s11unl 1115LVnt C(.....-.._.-.,.__�___............ IIxSURm INSURER9_ ___'---.- -` ! RESOLUTION ENERGY INCORPORATED IILSU ERC: 49 HERRING POND ROAD — _— -_-•—.__.._._—..—_._....-._._..___..._._..:.. 1 BUZZARDS BAY MA 02532 t-COVERAGES CERTIFICATE NUMBER: 13 g7741 REVISION NUMBER.: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOVV HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PS;Ii:C INDICATED. NjRry TH,STAND)NG ANY REQ(.JIREIA3\rr, TERM OR CONDITION OF ANY M r-r ACT OR_ETHER 0W.0 TENT WITH-^E;PECT TO tNHIC`ri THIS ! CER iIRCATE to V BE ISSUED CR MAY PERTAIN, THE INSURANCE AFFCRDED BY THE POLICIES DESCRIBED HEREIN IS SU.3JEC1 T_1 ALL THE TEP.M EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UWTS SI-0WN MAY HAVE BEEN PFOIJCED BY PAID CLAIMIS- TV, — � POLICY nsneER p ^r FI r�"rr° yr U!V5 TYPE v1SURAMc I GENERAL LIABILITY I EACFi.XX;IiRR=•WE ''_: _. ' i IlxT�tEFrvIALt;ENETi4L�J4Rl!J-+Y i � i 1;�It,�eaoLlE !___�Gh:J.lr'. ! ) I ! ^�;cU EXP;,1'�e:r•rsa,l �� ,--1 • i _ ' � I PcRMVAL:ADV INURY IS '• . j i _ • c_:..,_.�:,.:A>;•�FL=car x i r._. .. __-_.__-_ -•--'-'--_ I PFL-)C-L--7S- � ,F.W;AGGRECATE UNIT APFMJESPEP: P/C'A"j x r- POD' I 1 roucy I-!.Iy, six AurOrw�BILEuaslury ! I " 777 �w" �'_-_ _ _ i ANYALrfO _ I +I aDDI'_YI�IURY(Pe Ue�itl f ALL l•7J�NBj - y FiEDLr J D I I I I I I E�Dr Y It LIl1RY(Pw v,:dcl�iT: i�AUTGSS P1JfG5 j I Y FY? N YJ{ir6JEP HR.EO PUTOS I_—!AUE'Qi i c t- ,Urear•1ELLA uAe J rxr.t w ! 1 E'a,H CCCURREN;E EXCESSUAB I� rlrinrF,r�v+UE i i I , (arr r� TE —_i, rC-\ ! DED ... ;itEtL-vtt(N? _.J i i A I WORKERS"t."COVPEI'sAT1ON I ` �WC5-31 S-370523-052 1 3l1212012 1 3i1212013 AI,0 evPL0YERS'UABIUTV Vi N' i ANY PROPRIETCPiPART:WP/TY.Cra MVE . --j--'---- iJFrIC'L:t•TL-'NLER CXG.UDEDt N iN;A ' E.L EACH ACCIDENT - !3 �' (ft/anrf ry'in NI lJ j I 1 1 I E.L DISEASEf v•EA PLOYEE S y.,r��de�i6e I mde � I D�St74)PT1C7Jt C•PERAT r-'c,stnw ( ! E.L DISEASE•PGWCYLA411'I S ~50WO I T-1 I i l OESCRPTI N OF OPERATIOI6 s LOCAMMSr VEHO-ES(Arad,ACORD 101,Addtional Reffaft Sdadde,if more space is required) 1 V-1arkers rompansation instlranr:e Coverage applies Only to the,Workers compensation of the,late i I i (s'efiTlrlcATe.rtoLoeR CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HOUSING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE 4tiRLL BE DELIVERED iE•: aso wEsr MAIN STREET ( ACCORDANCE61'!T•HTHE POLICY PROVISIONS. HYANNIS MA 02601 I ALm-to;azED REPRc'Se rrA-n VE + �Jet!EEdridoe J o :�196tI-2010 ACORD CORPOR4:TION. All rights reser•vaL'. ;CORD 25(2010/05) The ACORD name and logo are registered marks of ACORD -c - 1�9q? Rt •a.a ".:fm.: I-:° - : r5--�r c:+ ;,:h11.". l<:?7 -- ,�14 r-a:-w sf �r. _._._._.:.L± ,j�,±.i:, .•.:+.=+r,.,+rs<_-:V:�..x.. 1-�.- vsl•,• i.w•.Icj erx-t ificaces� ' 4 V i �= �I:t�snchu<CII� - f)CIY,U'11Y11'n) nl ��III)�Il' �:Ill'I� a Bra;lrtl nl fiuil<lin� RcLul:ttinn. :uul titanilarti� Construction Supervisor License License: C5 53202 „ JEFFREY R TONELLO �, �. i PO BOX 1516 fr SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 Tr-g: 21481 � (l . omvn�ru uecz i 4 ✓ 9CtC�tuJe s � -� � License or registration valid for individul use only \ Office of Consumer Affairs&Business Regulation before the expiration date. If found return to HOME IMPROVEMENT CONTRACTOR Type' Office of Consumer Affairs and Business Reoulatior, Registration:. 171991 10 Parit Plaza-Suite 5170 Expiration:. 5/9/2014 Corporation Boston,MA 02116 RESOLUTION ENERGY..".NG:: JEF REY TONEClO`:.`:= 43 FIELDWOOD DRIVE` lid ��' out signature SAGAMORE BEACH,MA'02562 Undersecretary Inc (,ommonweatrn uJ rccw�ucnuaetio Department-of Industrial Accidents pffice of Investigations" 600. Washington Street Boston;MA 02111 W".mass.gov/dia UTWorkers'.Compensation.Insurance' Affidavit:Buz,lders/Contractors/Electricians�umb bI Applicant Inforl�ation Pleas Name(Businessiogmizationftdividual):_ (lam -Address: �1A C9S3�Phone.#: City/State/Zip: L, U Z-LardS 8 , Are yo employer?Check-the appropriate box: :Type of project(required):. 4. [� I am a general contractor and I 6 New-construction . 1. I am a employer with L _ have hied the,sub-contractors employees(full and/or part )-* U'ted•on the-attached sheet 7. ❑Remodeling 2.❑ I am a'sole proprietor or partner- ,fie stib-contraciurs have -g• Demolition ship and have no employees employees and have workers' working for mein any capacity- 9. ❑Building addition comp.insurance.$• . [No workers' comp.instusnce 10.❑Electrical repairs or additions 5. ❑ We are a corporation and its ' required] = of have exercised their 11.❑Plumbing repairs or additions '3.El I am a homeowner-doing all work right of exemption per MGL: 12 repairs myself. [No workers'COMP. 0 insurance required_]t c. 152,§1(4),and we have no , 13. t�p o workers' ther�>t?Cl � .. employees.[N• comp.instance regitirred.] *Any applicant mat checks box#1 must also fiIl out the section below showing their workers'compensation Policy informsriOn- f Homeowners who submit this affidavit indicating theY are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that cheek this box.must attached an additional sheet showing the name of the sub contractors and state whether or not those entities have employees. Xthe sub-contractors have omliloyem,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensadon insurance for my employees Below is the policy and job site information Insurance Company Name: r 6.ei' U ��S �v Policy#or Self-ins.Lic.P. t l.� 6—S 3'( J-- 3`7 O .- d 3 y 5-a Expiration Date: .� Job Site Address: I w- �1 Qc�� S j YP Q 1— :City/state/Zip:��ri/Li! i'i 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 canlead to the imposition of criminal penalties of a fine tip to$1' 00.00 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 statnmerit maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1-do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct Signature: 01 Phone# Official use only. Do not write in this area,to be completed by-cify.or town official City or,Town: Permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone.#: t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map pp Parcel licat on # Health Division Date Issued 4 Conservation Division Application Fee Planning Dept. Permit Fee3S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address 14,f OeS 1-- 016 ;'l Cc van 1 J Village Owner & ZC�13oi1(y Iq loci 4-r')onkS Address Po /(o-9a /ri/;n 1 x Telephone C5-P& -72/— 7 0a Permit Request /6,5J -U 5 7S 3! l� ol— R 2 rPS Pn' C f--c C/ (L;::� Vic_: P_JJA0 bK, Q_L4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay. Project Valuation .a,0 0 D Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach suppipring documenflion. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) J= Age of Existing Structure R 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑-Yes "[ No 1) Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other r � Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) a 7 Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) l - - Name Telephone Number� F 7 4i) Address n C1 License # �a 2. d)A Ua o S �1- Home Improvement Contractor# Worker's Compensation # LQJ L° Y3! 5 3 6 5 4-3yS'�- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �v DATE _ 3 " FOR OFFICIAL USE ONLY Y x APPLICATION# F DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: FOUNDATION= FRAME INSULATION R FIREPLACE t ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 5 t' F# f I DATE CLOSED OUT p ASSOCIATION PLAN NO. i P 4 a DAWSrnBLE. a 9 $ Town.of Barnst ble Regul4io' ry Serviees Thomas F.-Geiler,Director Building Division Thomas Perry,CBO_ Building Commissioner 200 Main Street;Hyannis,MA 02601 ' www.town.ba_rnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder , as Owner of the subject property hereb auth � °' '� ' y orize hQr) t✓= ;` a 3- = r - 1� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) /- j Signa.ture,of OwP eer f' ` I/ i kil. . Date tL Print Name if Property Owner is applying foe permit,please complete the Homeowners.License Exemption Form on..the reverse side. o ' V �. �l;n•ach��:ctt� - fhltarimt•nI ��f Pu111iC �,IICI+ a Bo;1rd nl' Buii(lin_ Rc:'ulnlinn. ;uttl `Ianil;ir�l> Construction Supervisor License License: CS 53202 JEFFREY R TONELLO i PO BOX 1516 'y..Sri.. SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( „nuifs,i,ncr T r•9: 21481 c 92. 0�1✓wj zcx{Maj, License or registration valid for individui use only Office of Consumer AM &Business Regulation before the expiration (late. if found return to: HOME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation Registration: .:=171991 10 Park Plaza-Suite 5170 Expiration:_ 519/2014 Corporation Boston,MA 02116 RESOLUTION ENERG.r,,INC n JEFFREY TONELLO .. `. `. . _ — 43 FIELDWOOD DRIVE".'::= Wj �_,j, out signature SAGAMORE BEACH.MAA2562 Undersecretary e " I 1VGV Vr nrr YnVG VVJ TGJ: Jcl vci .io DATE(AT•M^'VYH) CERTIFICATE OF LIABILITY INSURIANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER'TIF)CATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES TITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S)r AUTHORIZED BELOW_ THIS CERTIFICAIE OF INSURANCE DOES NOT CONS 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 certliicate does not confer rights to the certificate holder in lieu of such endorsement(s). r PROLL'UCEP SMALL BUSiNES5 INS AGCY INC COhtrAGT NAME: --_ I — •-___--. .� i 542 MAIN STREET PHONE ac tb Egl• 72L-N35 _—._-._I FM Afq"a _fSOS)7!LR_-Jpc I WORCESTER, MA 016150022 t—t I INSURERS AFFORDt -COVERAGE --- IPbUFED I INSURERS_- RESOLUTION ENERGY INCORPORATED II'SURERC: i +9 HERRING POND ROAD — -'-- —--- -'--- ..-_.... BUZZARDS BAY MA 02532 i INSURER E__ —------ ----- - -- ._.. . I � , COVERAGES CERTIFICATE NUMBER: 13 97741 REVISION NUMBER: THIS IS TO CERTIFY THAT 7FIE POUCIES OF INSURANCE LISTED BELOW HAVE PEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PCLICY PE,!C O INDICATED. N,r-TWTN,STAfVDIN5 ANY REOI.IIREMENT, TERM OR CONDITI(YJ OF ANY(rNrrRACT OR OTHER,DCXWtYv1ENdT VATH FECPFCT TO V•f'ICra THIS I CEFIIIRCATE NIAY BE ISSUED CR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUGES DER3RIBED HEREIN I.S SUPJ=,T TO—Al THE TcRPli EXCLUSIONS AND CONDITIONS OF Sl.) H KJUCIEt.U"TS SHOWN MAY HAVE BEEN FEDUCED BY PAID CLAIMS T�15FfI - ---�A � POLICY ASMEER F Y Y I UPCT.S •�: TYPE O=INSURANCE I GENERALUABIUTY # I I EACHOxL'IRRcV'E 1 i I it C Lam- I i tX'D.F.L�;IALl;EiVLTIAL:JFAI!J il' { I I ;•-' .I':-t A/' z�Iirrlloe! __..__._____ i ILSt EXP!,�'y :r_Y—�atj I .I L..—__.— a.__._. • i ?FcRSDVAL F.ADV IN;URY_IS i ' '• ': _, .. .. I I PFL�DL'•7S•COJP/O''Ai~,J $ GENA(X;REC�TEUUAITAPP�_SPEP' i I ------ -- - I---I 117UCY i-I PPD S AUiOMOBILEUABILITY I __—=.-•----•-'-•._ . . .� I, zaattr�ri I ( ! ! i 3ODt_Y INJURY(Pe-L'emrjj' i S —i ANYALrrD Nl3J `Y IiEDI!S ED I I I I I EflDP_Y IMIl1RY(Pa as th tT, ALL( 'PUfGS L4%cR-Y'jTfvT :}V � I bVELt J.HPED A1JTC5 , AtfiO �- 1txABRELLAUAB J t'XY.:(A? ' EnHCr,.,CURRE�!,^,E _._'LS-----.__.._-, EXCESSLIAB Cvilvcrt�A(lEi l i j j !Pl�REC1 fF —_IY=_...----_ j[JED Vljc !A I I ' . i Ic� w0FXERS-MVPBsATI0N IWC5-31 S-370523-052 311J2012 13i122013 � /• 7 -.I t 7g Aim evipLOYER5 UAMUTY YIN' (ANYPRCPRF.TCRi}'ART r,--Yr.-AMVE I I S i E-EACHACCIDEIT j 0=>ICL-i-tw7.LEl"Ce EXC.!_UDi:D? I N I A 1 I R ! (Nalda�ry in M i) i E.L OaEC E EA WPi OYES-S—— 100000_ t•Ls.describe tads I I ( •_ / E-L DISEASE•FL�tlCY LP.Atr 1 S DE_`X-'AIPTICNO<C•PERATIOV wmw I i i DF-SCf aP71LlJ CF OPERA71aN6+LO:ATOrtSI VE:-OCLES(rGa;ACOR0101,Additional Ramarks SchedUfe,If More space is required) it-IQrkers rorinpansatior•insurlrre rovarags EIRA✓s only to the workers compensation laws of the state 111A.., i i j CEfiiTir-ICATE.HO_lQ_EP. C 'CELIATION SHOULD ANY OF THE ABOVE DESCRIBED POLIO ES BE CANCELLED BEFORE. ! THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED it HOUSING ASSISTANCE CORPORATION •! 460 WEST MAIN STREET ACCORDANCE AlITH7HE POLICY PROVISIONS. I HYANNIS MA 02601 - AU7'r10.3ZED REPRc-SEMATIVE — —j Jeff Eldridge ' :0 1 988-201 0 ACORD CORPORATION. All rights reserved_ 'CORD 25(2010/05) The ACORD name and logo are registered marks of ACORD -< - +aq?7 •:1.-- r•�f•F.: 1;_": :..2err _u?a?l' li !' EY RI-le of - 'S'',t� _.___._:.it-+rp:-a:- •'ri. F:•'is'�:i-:-`..•...1� usly i.�:Grd-e.rCiti[•a.N_ - l ne uommonweaun u)&AUAW u c ns�ett� Department of Industrial Accidents y07, Office of Investigations 600 Washington Street Boston;MA 02111 - www.mass govldia Workers'_Compensation_Insurance Affidavit: Builders/Conti•actors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organiza.don/fndividnal): _?rSc7 CEn e t-► (1C - Address:- 4.� r t!(lA (A53 Phone.#: City/State/Zip: l� Ztli ctS Wit, Are yo employer?Check theappropriate box: :Type of project(required);. 1- I am a employer with - . 4. [] I am a general contractor and I 6. ❑New construction . employees(fun and/or part iinie}.* Dave hired the sub contractors listed-on the-attached sheet 7. ❑Remodeling 2.E I am a'sole proprietor or partaer- These sub-contractors have _ -8. ❑Demolition. ship and have no employees employees and have workers' addition working for me in any.capacity. - g, ❑B�,;1 ;na $ comp.;T,c,,,-once. • [No workers'comp.insurance 10.❑Electrical repairs or additions 5. Q We are a corporation and its ' required'] - officers have exercised their 11.❑Plumbing repairs or additions '3.El- I am a homeowner-doing all work t of ere lion er MGL myself[No workers'comp. right mP p 12.[]Ro repairs . . insurance required.]t c. 152,§1(4),and we have no , fD o workers' 13. Other I� AJ11 ' employees.� comp.insurance recpiired.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. ` t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box.must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have ernployecs. If tics sub--ontract Dn have employees,they must providt their workers'camp.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: I C/ fl M 5 (!� - Policy#or Self-ins.Lic.#: J 3 7 0 •- 3 3v 5-n)— Expiration Date: .S'— I aZ Di 3 Job Site Address: �- �1 Q i,� l'YP Q City/State/Zip: �� Attach a copy of the Workers'compensation policy declaration page'(showing the policy number and expiration date). Failure tosecure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine Zip 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 Be advised that a copy of this statamerit maybe forwarded to the Office of of up to$250.00 a day against the violator. Investigations of the DIA for insurance coverage verification. I do hereby certify under,the pains-and penalties of perjury that the in provided above is true and correct Si= (L id- — Phone#- SZ Official use only. Do not write in this area,tb be completed by.city-or town nfficiaL Cite or Town, PermitlLicense# '�_ Issuing Authority(circle one): :1.Board of Health 2.Building Department 3.City/Tow,n Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person. Phone#: w TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 90. 0a. (foQ � Map - Parcel Application # Health Division Date Issued , Z Conservation Division Application Fee Planning Dept Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address We S ILffla f J SI72¢3- fl U,etan I S Village 1 nn Owner �?WC� S� pb/)C� 19;go/Lin G/7 As Address 2066c>e Telephone 7 7/ 8.7 0 a „Permit Request 11,gk&.Qt �757`6.Lt4- n;� a30 onre-.SJ-t-,'c1rc/ ,S-effkW Lxc n a:tt rl�c•S K"�,l - QLAA Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain `Groundwater Overlay Project Valuation L,000 - Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting dgcume tation.. Dwelling Type: Single Familyy ❑ Two Family ❑ Multi-Family (# units) 6 Age of Existing Structure /4,3 Historic House: ❑Yes ❑ No On Old King's Highway:,,p Yes¢❑ No Basement Type: ❑ Full 0 Crawl ❑Walkout ❑Other , Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address _49 oc/ Q c( License # CS 5- 3 6v L. (3�v /Yl/9- Ul S3 -a. Home Improvement Contractor# Worker's Compensation # (41 WJ- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO g9 1'- rri j 10o1\d IL C( 3C."17 SIGNATURE DATE 11- r FOR OFFICIAL USE ONLY APPLICATION# j DATE ISSUED 1 MAP/PARCEL NO. I`r ADDRESS VILLAGE OWNER c DATE OF INSPECTION: y s -FOUNDATION FRAME I INSULATION FIREPLACE ti ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 1,4 GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT N ASSOCIATION PLAN NO. 7 , BAMSrABLFw MAS&.1639. Town.of Bans, ble 10 Regulatory Se'rvice3 Thomas F.Geiler,Director Building Divisidn Thomas Perry,.CBO. 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,, I, `6dJ=4 d as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of Job) . i tT Signature of Owner g. Date I ► tt - ; Print Name if Property Owner is applying for permit,please complete the*Homeowners.License Exemption Form on:the reverse-side.' Gv �/r nrl tnt1G ,�, �,•VJ rGl: JG1 'r Gl CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE T P O I I ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), ED i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT: If the certificate no 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). PRODUCO' SMALL BUSINESS INS AGCY ING COIYfACrIjWE; 542 MAIN STREET _Pr _(ac 15081 i.B5-063.5 _.—�Ft'x_LG^�1;._.(501 i!i��QqP .� WORCESTER, MA 016150027_ • j INSUREP�/]S AFFOtOING COVERAGE INSURER-. : Lib r Minual .-.-....------------- .—�--- IfLSURED INSURERS_-- RESOLUTION ENERGY INCORPORATED InsuPEPC: 1 dig HCRRING POND ROAD ____—._ ----•---•—•--------•---._....____.-- -.._._....... I BUZZARDS BAY MA 02532 11�41RERo: __---• -----..—.._-__-- -•-- _-- I INSURERE_ js i InSUREn F: _•-- COVERAGES CERTIFICATE NUMBER: 13 9 741 REVISION NUMBER: GY THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELOWr HAVE PEEN ISSUED TO THE INSURED NAMED ABOVE FOR,THE TrC VJ IC'4 11 Ilfi + INDICATED. N 3f tviTHSTANDIWo ANY REQI.1IREI-AF..NT, TERM OR CONDMCIJ CF ANY CX)NTRACT Cn OTH_P,DCX:IJIvLI�'T V CERTIFICATE I'IAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DE,rr_RIBED HEREIN IS SUBJECT TO AI I THE TcRn i EXCLUSIONS AND CONDITIONS OF SI-0 I pC)UCIES.UNITS Sl-CWN MAY HAVE SEEN REDUCED BY PA)O CLAIMS VT 1 - POUCY NUMBER 1(hiVtill7 Y �{1T C�Yy-y'Y1 I UP :c TR; TYPE 0=INSURANCE I , i i'.....I lit•A,lEF2;,IAL'; ..___ {I I ! II ii E.—hEACH .C._=IJ_R.R_El-%= GBIERALUABIUTY ] - wl g EN9141-JFAIJT1 ._. j ' i �i:✓^rbWDE ! Gh7.�'. 7EDEXP?Fve:r_v.cii _—_._.____._..._...... f L i I --,..- --3._._.._ j �"- I ! Fr cR�JVAI:ADV IN URY I S— - : PFL�DIXT ( '• VF/QP t _At EC TEUhi1TAPFI�E PEP. I ------ -- - i I roux,11 PIPjT- r 'n AUiONOBILEUABIUTY I 2�LOcffr -----• I � I t I EC?DI_Y IN;URY(�perc'ri) i g -..--- .. ..! ' _!ANY AUTO -- I ALL OMVEDIvLiL�Y It)1111RY —j ALM-S F•pI:F(k9t�2 J FUPEOP11TOS ( AU`rO_ I - i i ( I r U FELLA UAB , —f rti'Y:UP. CGGURREV:E _• J. ---�_.....__.J - I I Ar�REc�Tt — EXCESS UAB i_J CLAIW,11,�ADEi I J DED :_-_; ;-------..-....... I MRCEFtS MUPEtsAn0N I +AlCS-315 370523-052 13112I2012 1312/2013 s !T( L i A IYIN, AS-M e7pLOYEFS LIABILITY YIN: ( ' ANY PROF?,IETCd-7FARTr<P,-yr-MMVE I I j i E!.EACH N/Ai i i !O==ICf-:AA0vL'ER EXGIJJDED: N E.L DaFASE-EA fiVPLOYEE�S 10JU�t i (Nesn aivry in NH) j l S-- -- 00co .dexllx E.LDISASE•POtC1L.A[r DXvnCNCFCf'ERAn(NSwnvj i • 0E5CRRP"n0aN UP AnO^S+LOrTIOt'tSI V&OCLES(AtMeh ACORD 101,Additional Rerrerks Schedlde,if more space is reruited) t 1 Mlorkers rotnpansafion insuranre ravarage applies only to the Workers compensation Iat%s of the state.MA... 1 E CEfiTir!CATE_.rIOLDEP i CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLIGES BE CANCELLED BEFORE I HOUSING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED iF! I 460 Vt/EST MAIN STREET ACCORDANCEIAr(THTHE POLICY PROVISIONS. 1 HYANNIS MA 02601 AlJi riOR12ED REPRcSEMATfVc , Jeff E!dridae :�7988-2010 ACORD CORPORATION. All rights reserved. -CORD 25 (2010/05) The ACORD name and logo are registeredmarks of ACORD • -� - �4�7; �:l w- r•',-r.r': Irrc ,. ,•-.y-ra:,n 8' CrJ�Ot' [ia' ". Eta r•.�e ..of 'R,i.a .___._:.iL�•'JC)�__l:- ``t� , t'-_:�:-`�..,.� 1-,.. _:y\,Sly I.�uej_earL iriCd.CSC w i% s_. \(;t��;t l'hUnCf tF - �l l'1t8I'I IYI I'Itl u� ��II iI�IC �:IiCI� a Bnarll ni (3uiltlin_ Rc;Cnlatinn> ,In/l `I,Intlarcl� Construction Supervisor License License: CS 53202 JEFFREY R TONELLO " i PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( „nimissi mrr T r9: 21481 c /,� �ja„r„naruuea�C/ a�'✓ � { License or registration valid for individul use Only Office of Consumer Affairs&Business Regulation before the expiration date• Tf found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Re;;ulation Type Registration:.:=171991 10 Park Piaza-Suite 51 i0 Expiration:. 5/9/2014 Corporation Poston,MA 02116 RESOLUTION ENERGY.;NC<::::..;. JEFFFEY TONECLO`, '-_;-:, . . 43 FIELDWOOD DRIVE_ t lid w' out Signature SAGAMORE BEACH,MX.'•02562 Undersecretary ' I1ne t.ornmonweaian-ui lecua�ucnis�GEa ' Department of Industrial Accidents Office of Investigadons 600 Washington-Street Boston,MA 02111 www.mass.gov/dia Workers'.Compensaiion Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apuhcant Information Please Print Legibly Name(Business/organization/Individnal): �j nszo l yi-t C9f1 E n -Address: 4-R rr r Ci /State/Zip: `U U LLCti-dIs.t. t'Yl A (.4 S 3 L-Phone A: CSC 17.-/1 0 Are yo employer?Check.the appropriate box: :Type of project(required .:. L I am a employer with ( Q 4. Q I am a general contractor and I 6. New construction . employees(foil-and/oi part lime).* _ _have hired the sub-contractors listed•on the attached sheet 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have -8. .Demolition ship and have no employees employees and have workers' working forme in any capacity. 9. ❑Binding addition [No workers' comp,insurance comp-insurance.$ 10. - 5. �] We are k corporation and its ' ❑Electrical repairs or additions required.] officers have exercised their 1 L[]Plumbing repairs or additions 3. I am a homeowner-doing all work right of exemption per MGL myself[No workers comp. 12.❑Ro repairs c. 152,§1(4),and we have no insurance required-]fi to ees: o workers, 13. Cl`i � y . comp.insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy informahom 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 employccs. If the sub-contractors bane 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: . e/ (/ n S Policy#or Self-ins.Lic.# IA-) t:S 3 -1 S.. 3'7 6 S a 3 v S Expiration Date: .3 Job Site Address: w- Q[,7 S Q _City/State/ZipTr CL0il 13 ,na�- X 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- I52 can lead to the imposition of criminal penalties of a fine up to S 1'500.00 and/or one-year imprisonment,as well as civil penalises 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 Investigaiions of the DIA for insurance coverage verification. X do hereby certify under the pains-andpenalties ofperjury that the information provided above is true and correct d, = 3 Si afore:• - . Phone 4: SZ 869^.rl 7 Q Official use only. Do not write in this area,tb be completed by.cFoir town aff vial _ 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 V TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 13001 00 Map Parcel Application # Health Division Date Issued I L32 Conservation Division Application FeeU Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address I4F tQ eS/—('L/U K7 11CAfl h'Y s Village Owner -C-/ZLS Address �U �x /(� 7g�-� /rVin�, / ,C Telephone C93b -1_2 / ,.Permit Request �h 5 � ��'�S�. l_e - L. 8Z= 2 3O t Y7re-sL,? t//cr� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation O O O Construction Type u.,. _ �:.a Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sup, orting documentation: Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 128 3 Historic House: ❑Yes ❑ No On Old King's I jighway: 0 Yes-�❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including bath,): 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 b Telephone Numbe� SbF ) FN" / 7 10 Address 4 License# (4- 5 S 3 a 1 &1-4. 6&V Mp Home Improvement Contractor# Worker's Compensation # U) C S'3/S"3 OT-A 3 o ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 44 /-9on& 6L1a-44v SIGNATURE DATE /a- t T FOR OFFICIAL USE ONLY APPLICATION# ry DATE ISSUED +} MAP/PARCEL N0. -ADDRESS VILLAGE OWNER `i s DATE OF INSPECTION: . .FOUNDATION. FRAME it INSULATION r_ • s FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL w GAS: ROUGH FINAL :z FINAL BUILDING s� A *; DATE CLOSED OUT t ASSOCIATION PLAN NO. t F .13AMsreBrs, a �� %639-.. ,� Town.o f BarnstAble prED�pp't a - �. Regulatory Services Thomas F.-Geiler,Director Building Division Thomas Perry,CBO. 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 I, tV—P a L L {ti ' - : ; as Owner of the subject*property hereby authorize _ = _y ` ��z to act on my behalf, U U in all matters relative to work authorized by this building permit application for: FYI I (Address of Job) Signature of bwkeer , ' t % ��r.'I) r� Date � . �, . Print Name if Property Owner is applying foe permit,please complete the Homeowners.License Exemption Form on..the reverse side. :: V/ !7.J GV 1 L 1 V, G V V J ['tt'1 c'nl1G of vva rax ocl •,c: o•f • OAT,(ASS09 M!) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFCATE 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. I IMPORTANT: It 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 SMALL BUSINESS INS AGGY ING CCNTACTrNAME: 542 MAIN STREET Ax /VGI'ti3 i PfgN= ac,ram,�igl•(50g);.;��0635 -_.__.J_�_L-1:._.(�_�_ WORCESTF_P,,!AAA 01615DO22 EtYLRII aCo;Ess _ — ---_-- _•__ i INSURER AFFORgNuCgg�W+GE ..--'----'------ .m+sugt a�Lih'�n1'-MiL' I,rsura e....._..._._....__- INSURFJJ INSiIRER �..----.-- RESOLUTION ENERGY INCORPORATED IISURERC: ........ I d9 HERRING POND ROAD --- __ -------------'- -- BUZZARDS BAY MA 02532 II.xJREr±D_----- ------..—..__---- -'-' _-- - I COVERAGES CERTIFICATE NUMBER: 13 9 741 REVISION NUMBER: HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSI.JED TO THE INSURED NAMED ABOVE FOR TFF_ PCi ICY PF�,Ii C INDICATED. Nj-R,%ITH,STANDI!sa ANY REQUIREMENT,TERM OR CONDmCY11 OF ANY M\n-RACT cR OTHER DC)CMlEhIT VATH FESPECT TQ Vf,-40 'PHIS y CERTIRCATE NIAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HE2E10 IS SU2,jr-C T D ALL TtiE TERIA, j EXCLUSIONS AND CONDITIONS OF SI.Kd I POLICIES-OMITS SHOWN MAY HAVE BEEN F�DLJCED BY PAID CLAIMS. -- ----__,--------' _ - --IAGIfiSL18R 2 P''b�i1T7�� �C1TEr--�---- il,sti i TYPE 0 INSURNNCE i POLICY nV11BER i heVtL\7'Y ernvvY I Ur, S ' TR GENERAi_UABIUTY i ( r -��_.-�_._...-_...__..._. _ fi.L4CIAL�;ENCRilL_UARI!JT• ------ - , r i ,ter. I i E. i I�7EU i EXP iM�e� j 1�urr.S-nmLE i I Gt?:J.JP. j i I - L-- PER VAL`ADV IN:URY IS _ G_JERALAGGFEGATE Is I ! I PFL�DLYTS•Ca%kP/CP AC i S !GFN AGGSEG_aTE LIN4!TAPPLi_ES PEP.: ------- ---I ) -�PPO 7 S I OLICY aLJrL-ArOBILEUABIUTY ' I I, ezcarSrJri . .� IT'-__-..........- I— PurIaRo ! I BODLYI NJURY(Perjmr-m)i iS _..___ .. ..i PLL CMNf� H®L!ED I I. 01_Y IC L111RY;Pa h:c[1xtT- Aurc S atrres I N;lviir/vE1� iJ WFEGPIJTC$ i_- AL!TCh EACH OCCURRENCE s I LIVORELLA UAB J cx7r>P L----- .:� —f ! I i ;Art, I I EXCESS LIAB n[>E .i._.�_ClrJnr,-wti i i I r---- ix ---•— ...I DED Ant- ca , A IWORKERS•CDNNPOVSA'nON I WCS-31S-370523-052 13111201.2 3i1J2013 I ,/!T__LIETgI I cri A(�eviPLOYER.S'LIABILITY YIN; ( i -`---_. t ANY PRCPRIETC,PJ?ARTK-r, XEtamVE , I ! j ! !El-F1CH A IOENT - S ---1(.100Ofa OF>•IfF:s1.£-NL'ER�C-Uireo� N iN!a( I(Natt;a�ry'in NH} E.L OaEl;E-FI+6',/PLOYEE'S_-.-_. hy .desoibi I I ! I I DE I Lvlda 'E IPTICNOFCPERA'na rwn,-J ) I L DISEASE•F000YLP I!T S; -5000017{ 0E5 ;;FRCrV QPERATIaxS r LOCA71 ONS1 VEI-BCLES(Atm;h ACORD t07,Additional RarreAcs SdtedWe If more Space is ret u,r I Y-Jorkers r onipensalion insuraJtre coverage applies or.lyto the workers colnpensPlion lags of the state IAA.-. I j u Ifc;efiT!r!caT trOLOEP CANCELLATION - , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE j USING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WELL BE DELIVERED IN HOUSING WEST MAIN STREET ACCORDANCEWIT'HTHE POLICY PROVISIONS. HYANNIS MA. 02601 + x - - AIJT?•IORtZED REPRcSEYiATiVc i Jeff Eldridge :g 1988-2010 ACORD CORPORATION. All rights reserva�. -CORD 25(2010105) The ACORD name and logo are registered marks of ACORD -. 1?.:e?;at •:ice-r 78:: Ir^. ;; 2,;�_rc.oa S 2,)t' l :ZicaLr.?t' Eh r•.,_-w_ ", '15ir _.___._GiL� v:��z.i:• �:» , +..•'=•:4:.`r..,.,.lr: .4usl'� i.��zj��.rL-i � v I �- E�-1:1SKeCItUjCttF - �)CIIat'1111Ctt1 ul ��U11�IC 1aIC(� i a Bnartl nl Built)in_ Rc;ulatinn. :tntl `I:uttlartL Construction Supervisor License License: CS 53202 hP M.I JEFFREY R TONELLO i PO BOX 1516 r -A- 4, ,.... SAGAMORE BEACH, MA 02562 ., t� �,;'." Expiration: 7/14/2013 ( nnni<si urr Tr9: 21481 c f/,e .�o�Trnnaruuea�/z• a�✓f ���r'`� License or registration valid for individul use only a, �\ off-ice or Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation ,• _ Type: Registration:.-171991 10 Park Plaza-Suite 5170 1 Expiration;. 5!9/2014 Corporation Boston,MA 02116 RESOLUTION ENERGY°;.IUG:.:-::;-- JEF=REY TONEL00` __ _ — 43 FIELOW000 ORIVE?':.:.. — t lid w" out signature SAGAMORE BEACH,MX02562 Undersecretary M ti - Ine c;ommonwearun ui 1r1cc�'suc niswGtr� Department of Industrial Accidents office_of Investigations 600 Washington-Street Boston,MA 02111 w wwmass.gov w. /dim Workers 7.Compensation.Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apiohcant Information Please Print Legibly Name(Business/Orgmdmtion/fndividual): �Sc7 y t C9/1 Y1Cr l.1 �1L - Address: City/State/Zip:3 U zLa ecs rnM (.1S3-)-Phone.#: Are yo employer?Check.the appropriate box: :Type of project(required):. 1- I am a employer with- 4. ❑ I am a general contractor and 1 6 ❑New construction . to Rill.and/or art time)* have hired the sub-contractors • � =s(full P - listed-on the-attached sheet: 7. ❑Remodeling - - - 2:❑ I am a'sole proprietor or partner- .fie sub-confraciors have ship and have no employees 8. ❑Demolition Y capacity• employees and have workers' B addition working for me in an9. ❑ � [No workers' comp,insurance comp,incrrra�hCe ' 5. [] We are a corporation and its 10.❑Electrical repairs or additions required-] officers have exercised their 11.❑Plumbing repairs or additions 3.❑- I am a homeowner-doing all work right of exemption per MGL myself. [No workers comp. 12.❑Ro repairs quired.]t c. 152,§1(4),and we have no insurance re to o workers, 13. er� ClM 1 emp Yam•[N 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. Contract=that check this box.must attached an additional sheet showing the name of the sub contractors and state whether or not those entities have employers. 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.#: w S 3 ( J.. 3 7 6 S a 30 5-Q- Expiration Date: .3 G /If3n� C a- �d t Job Site Address: City/StaeZip: l / � . 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 tip to$1;500.00 and/or one-year imprisonmeid�as well as civil penalties in the form of a STOP WORE.ORDER and a fine of up to$250.00 a day ao act the violator. Be advised thaf a copy of this statenaerit may be forwarded to the Office of Investigg4ons of the DIA for insurance coverage verification. I do hereby certify under the pains-and penalties of perjury that the information provided above is true acid correct i� = 3 Si attne: � Date: — Phone# } Official use only. Do not write in this area,to be completed by city-or town off chat City or.Town: Permit/IA.cense# Issuing Authority(circle one): J.Board of Health 2.Building Department 3:City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other ' Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma cl O a_7 O(� al SOD 03 p Parcel ?ppliocation # I Health Division Date Issued Conservation Division Application Feed 8 Planning Dept. Permit Fee .07 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address l 46 tk)-e St- �L, V0,4 n i s Village Owner FgLjc e Address PD �Sv>c /G71 L F, lr✓�n 1 X Telephone �SD�,/ —7 7 f 4 70., Permit Request �-�,2 -3 0 .Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation t2.060 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docume►�tation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 963 Historic House: ❑Yes ❑ No On Old King's ighway:""U"! Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other i:l Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ; ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name /rvA4110 Telephone Number Address pond License# C 5 rn a CDC 3 1 Home Improvement Contractor# J 7 9 S Worker's Compensation # W 6 S"3 If-3 70 j-,) 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Pond b✓i� Q4Li SIGNATURE 4 aTU_(J,40- _ DATE /d - 3 " /� FOR OFFICIAL USE ONLY RPPLICATION# K DATE ISSUED MAP/PARCEL NO. H ADDRESS VILLAGE OWNER t. } s v DATE OF INSPECTION: k . FOUNDATION . ' FRAME INSULATION FIREPLACE I ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING >L Y i DATE CLOSED OUT I ASSOCIATION PLAN NO. lne uomlmonweaun U)1M.ua�uc.ci�aCcta Department of Industrial Accideids office of Investigations 600 Washington Street Boston;MA 02111 .' www.mass.gov, is Workers'.Coln ensation iusurance Affidavit. Builders/ContractorslElectricians/Plumbers P n Please Pn ' t Legibly Applicant Information Name(Business/Organization/fndividnal): . nSo(yl� c9n •�Y1e`�1 S-i /1C -Address:- 4�- �r` •(Jc��d . . City/State/Zip: L�U Zr1t�'c.�S mA C,4 S 3�-Phone.#: Are yo employer?Checktthe appropriate box. :Type of project(required):. 1- I am a employer with L c7 4. 0 I am a general contractor and I 6. ❑New construction . employees(full and/oi part time).* have hired the sub-contractors listed.on the-attached sheet: 7. ❑Remodeling . 2:❑ I am a'sole proprietor or partner- .fie sub-contractors have . ship and have no employees '8. ❑Demolition •. _ _ . working for mein any capacity employees and have workers' g Bwlding addition o workers' co�'insurance comp ice$ 5. We are a corporation and its ' 10.El Electrical repairs or additions _. required"] officers have exercised their 11.❑Plumbing repairs or additions -3.0- I am a homeowner•doing a71 work right of exemption per MGL myself.(No workers comp. right Ro repairs we have no . ;,,em�r+cp required_]t c. 152,§1(4),and 13. employees'.[No' workers' comp.insurance required.] "Any applicant that checks box#1 most also EU 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., lConiraetors 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 bane employees,they must provide their worlo:rs'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: k;6 el-b Oq yJ4j - IDS C!Q- Policy#or Self-ins.Lic.# -3 -1 .S 3 7 Q .S- a 3 Q.S 3 Expiration Date: . Job Site Address: I w- t Ql�� S P Q Gity/State/Zip: /- (/GCr'!✓i Attach a copy of the workers'compensation policy declaration page'(showing the policy number and expiration date). Fail=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 th6 Office of Investigations of the bIA for insurance coves a mdficatiom I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct t�t•�.Lc� Date: y� Si afore: — . Phone# � 7 Q Official use.only. Do not write in this area,ib be completed by.city.or town offzciaL City or,Town: Permit/License# Issuing Authority(cirde one): :1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: s.,r'r tl �/ G7.l LV1L 1VGV Vr n['t c'nVC. J/ Ul/J rGl: Jcl vGt DAM-:(rddliWYVYV) ACT' FI ��°� �� ��BIL(TY INSURANCE a`�i lhrl THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS z 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: It 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 certliicate does not confer rights to the I certificate holder in lieu of such endorsement(s). PRODUcul SMALL BUSINESS INS AGCY INC 542 MAIN STREET acNa !' Srpa � VJORCESTEP,, NAA 016150022 E-MNL ADORES I INSURERnAFFCAD(rZCOVERAGE _ II�SIJRER a_ t? '-Mit Insy�r�_rc2._.._....._...._-- .......... �.._. I ..__......___.__._._.-__.- . RESOLUTION ENERGY INCORPORATED s9 HERRING POND ROAD _ INSURERC: :I BUZZARDS SAY MA 02532 LK-;JFfr±D_----- --^—••------... _..-- -_-- . INSURER E: COVERAGES CERTIFICATE NUMBER: 13897741 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PF;,IC0 i INDICATED. NWJTMTHSTANDIRa ANY RECUIREMFNT,TERM OR COND! OrJ OF ANY CXyTrRACT C'R OTHER DOCUMENT WITH PCSPECT TO WHICH THIS %ERTIRGATE NI4Y BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIIJ ISSUBJECT TO A!L THE T_RW7. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES UMITS SH)WN MAY HAVE BEEN FED�jUCED BY PAID CLAIMS -- ——1At3t5L'SOBF VlS1 il:t5>l I TYPE p=IP1 Sl.IRMAE: POLICY M1V.YiBER j Ihr ,Y F ( GY E? j UPl*5 r: ( 1 GENERAL LIABILITY � EAC!HOxLIRR�V;.c �� .._. _ i :(�N,.IEF�:IALi;ENC+7AL_JFRI!JT•' I I � --•--�-- ---•-----------.. . • �O�+I:.+Sat°DE i �Gt7:J.!<'. I: i i —' -- '! Pcc.>YiVA!`ADV IN.:URy I c _; I I PF0DLGTS-CCI,/P/CP AC" ._ i g L. - '-- I GE.N_ACEC?+tTEUAiITAPC+UESPER. il7iJf,Y it i _.�_L AUTt7VOBILE LIABILITY - ---•, P , � ;NiTJETI y„Iir'DULED I I I !4w'1�1'-Y INIURY(PF a7c[t�el AA`uLr4�s" I--i°r`i �vE� J HPEDA.UTOS j I I ' UvMF*LLAUAB I I {XY.'.t IP. I j !EN HOCCURREN;E-----I---------,-- J � �!(EXCESS UAB—.—.1_—i...CLARVStMLDEI — DED ' -- q VV0FKERS•CCWaJSAn0N I �WC5-31S-370523-052 3/12/2012 I ail2/2013 1 v T'; '�—• "IAr,si N A I AJ®EEtu�LOYERS LIABILITY V i N j I ANY PROPRIcr,'PJPARrh[f_TYr,-CiTIVE[-NJ!NIA ' lE1.EP.CHACCIOENT — I ' 100f)Dr i J I(Y vAt�IvLER JCG_U�r_C^ i i I I E.L DSEASE-EA EVoLO0-S 10�Un f l (P.:ldaivry in" ( - v,jes.desuibavdar j I i E.L DISEASE-POLICY UAIT j S —50000t D cmiP'ICNOFCPERATIOVShvn�l I I OESCF;" OPERA a\S LO:A_n0tJ3r V&DELES(Atrarh A(ZW 101,Additional an-arks°dtedWe,if more Space i5 reGuireQ t tAlarkers compensation.insurance coverage applies,only to the workers compensation laws of the state IAA._. i I ' _J �C EfiTInCAT r+OLOEP CANCELLATION f SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE j HOUSING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED it,' 460 WEST MAIN STREET ACCORDANCEVVJTHTHE POLICY PROVISIONS. e HYANNIS MA 02601- At-m-gaZEDREPRe"SEMATvF r Jeff Eldridae <e)1988-2010 ACORD CORPORATION. All rights reserv.. -CORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ' � - -- -.-•- ' •:1.—" r '.-7.F:: I'r'=' t „'.w� •. ' ��r2i1i2 l :!' -. Gh Per,e ..oi: _ �.SL+•caaw i:• ��:75 , i�=-:6:ar..... i' -;ue-l; t�:_,ej�c�rt i[ica.ec. o V �. �Ia»at•hu.crt. - f)cltarimt•nl of hnitliC �,II•CI� Bnartl nl Builtlin_ Rc;,ulatinn> :uttl `t:uttl;trcl> Construction Supervisor License License: CS 53202 , A � JEFFREY R TONELLO ? i PO BOX 1516 SAGAMORE BEACH, MA 02562 r; Expiration: 7/14/2013 Tr9: 21481 o f/,� ,�o�,,,�,:o,uuea�L/ a�✓ �� { License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: 90�— HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation WIMAN Type: Registration:.:-17.1991 10 Park!Plaza-Suite 5170 1 Expiration; 5/9/2014 Corporation Boston,MA 02116 REgOLUTION ENERGY.,'I.NG.:: .;,.- JEFFREY TONEL`LO'" `-=_• _ . � 43 FIELDWOOD DRIVE SAGAMORE BEACH,MA=02562 Undersecretary ' t lid w' out signature you r . Bt n Brs isre 9 " Tow of Rarnst2 ble a6;q- 1� Regulaioll-y Services Thomas F.-Geiler,Director Building Division Thomas Perry.CBO- Building Commissioner 200 Main Street,-Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862403 8 Fax: 508-790-6230 Pro n . . .Property Owner Must Complete and Sign This Section If Using A Builder tl ' as Owner of the subject"property x : hereby authonz 5'` .;kP:'�:- C,€ �. " r A- i� to act-on my behal>; in all matters relative to work authorized by this building permit application for: j (Address of job)- k CA, Signature of Ow - '�` �� Date�r tf OLLAf: Print Name if Property Owner is applying for permit,please complete the Homeowners License Exemption Form on:the. reverse-side. ,< TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ego- �3oo t Map._ Parcel Application # Health Division Date Issuedf 13 Conservation Division Application Fee Planning Dept. Permit Fee '� 3 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 146 We S/- ` naic 9-ua 9"t16 Village //___� . �//�� /� Owner�uU nt# Pa/7 .� A22 Ki-m e_nl-S Address_p'moK I1a 79,)r-, T) Telephone�� �7?1 - -7 0.)_ :Permit Request 14 S h,U 5 71 .34 (,LI- &- /L-30 (!.k-d _�e dk cl oj_L l U lb 4. If) a,lfi c , �`h,3 a _ caM s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new .Zoning District Flood Plain Groundwater Overlay �1 Project Valuation oty 000 Construction Type ' = c-3 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting do�oumergation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) IS ;;"• a t Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's I ighway:tO Yes�❑ No. Basement Type: ❑ Full 0 Crawl ❑Walkout ❑ Other `I, Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing ( new Half: existing new Number of Bedrooms: / existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name / �n.�-��� Telephone Number Address n s a Ad C/ License# C S S' 3 .10 -Z &A,V tr&L C -a_,? Home Improvement Contractor# Worker's Compensation #We S 3/S 3 70,-d 3 G S_�-L ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE I afL (o DATE /1 -3 -/ ,� i` 4¢ !; FOR OFFICIAL USE ONLY APPLICATION# z DATE ISSUED _ MAP/PARCEL NO. ri -ADDRESS VILLAGE OWNER 4 DATE OF INSPECTION: FOUNDATION FRAME INSULATION s FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL FINAL BUILDING r k DATE CLOSED OUT ASSOCIATION PLAN NO. w 1ne c;ommonweatm of trlttJ�ucreirweafa Department of Industrial Accidents UT07. Office of Investigations 600 Washington Street Boston,MA 02111 mm.mass.gov/dia Workers'.Compensation Insurajnce Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information -Please Print pgib1Y r-- Name(Business/Organization/Individnal): 31Sc F-nc r �u ��1C_ •Address:- re-' (Jc��d City/State/Zip: l� Lt�irG�SA C9 S 3�-Phone.#: Are yo employer? Check.the appropriate box: :T•ype'of project(required).:. I. I am a employer with 4. 0 I am a general contractor and I 6. El New construction . employees(full and/oi part time).* leave hired the sub-contractors hsted.on the-attached sheet: 7. ❑Remodeling 2:❑ I am a bole proprietor or partner- These sub-contractors have - - ship and have no employees -8. ❑Demolition •. worlding for me in any capacity- employees and have workers' 9. ❑Building addition [NO WOIkerS' COmp.insurance Comp.incrTranCe - 5, We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 1 LE]Plumbing repairs or additions 3.0 I am a homeowner-doing all work - right of exemption per MGL myself [No workers comp. 12.❑Ro repairs insurance required]t G. 152,§1(4),and we have no 13. er�)e-Ct employees.•-[No workers' comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the naive of the sub-contractors and stale whether or not those entities have emmmployees. rf the sub-contactors have employees,they must provide;their workers'comp,policy number. I am an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: In S Policy#or Self-ins.Lic.#: � 6-S 3 -( J.. 3.7 0 S 130 S Expiration Date: . — I Job Site Address: aL ,7 City/state/Zip: 14�/u .3 n�� •�-C`� l 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 tine 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 covers a Y%ification. I do hereby certify under the pains-andpenalfies of perjury that the in formafiorcprovided irbove is true and correct , Si glare: Date: -1d, 3 d— Phone '7 Q Official use only. Do not write in this area,tb be completed by-city.or town official City or,Town: Permit/License# Issuing Authority.(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing.Inspector 6.Other Contact Person: Phone#: +V V/ G7./ 4V1G 1VGV J! [1l'1 YANG ! l.'lJo t Gl: JGl v G1 n� A I-- CERTIFICATE OF LIABILITY INSURANCE 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 DOGS 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,subjJ ect to i the terms and conditions of the policy,certain policies may require an endorsement A statement on this certlficate does not confer rights to the certificate holder in lieu of such endorsement(s). PRocuceR SMALL BUSINESS INS AGCY INC CONTACT NAME: -- ----- i 542 MAIN STREET PHONE WORCESTF_P,, MA 016150022 EMaII ACO-n^_6S ---- ---- - -•--' I I INSURES AFFCADNG COVERAGE -----_._- ( tV 11114URm INSURER 9_-- RESOLUTION ENERGY INCORPORATED tr1RERc: sy HERRING POND ROAD __—_•-'--- --'--'--_.._._...__ .__._.. '. BUZZARDS BAY MA 02532 thSDRERD_ -- -------'—.•---_-- -'-• _-.._ . . I INSURER F: _-- COVERAGES CERTIFICATE NUMBER: 13 9 741 REVISION NUMBER: THIS IS TO CERTIFY THAT THE PGtIGES OF INSUfiA1VGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PF�li'O INDICATED. N"J_RNITH,STANDII4i ANY REOIJIREMOVI, TERM OR CONDMCYJ OF ANY CXWrRACT OR OTHER DCX:MIEN�'T WITH ASPECT TO V'f'ICH THIS C,ERTIRCATE NIAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRO21)HEREIN I.S SU°JcGT TO ^AI THE T_INRl'. j EXCLUSIONS ANC?CONDITIONS OF Sl}l i I POLICIES.LIMITS SHOWN MAY HAVE BEEN MDUCED BY PAID CLAIMS. t 1aGt50508F � -r-.---___—_-....._—_.. It•ISrRA TYPE 0=Ir15L1RAN„E I POLICY h[MR, i(P 'YYVY)`(Ni'lJ�Y1Y1 I Urrrs L I GENERALUABUY I t EACHOxIJRREw•= S.. ._...-_._..__.-._. .. i I tX7Jcd R tALGENL-F1AL JPRI!JiV --•----- -'------- -- I : I I I C�slv'.i-nnJLEi^!u'cDEXF;w aie:rar.aii—I. - -----'--t i ?Pr c�VAL`.P,DV IN;l1RY IS GENE.4ALAGGFL-CAT- j F PrL)DU-T CDJP/CP AC i 4 . i CF 4-AC-CREC.ATE UI.IIT APF4i_:,PEP.: { rl7UCY u uTL --1 AU IIIOBILEUABIUTYd[i[f�rY:i ___ •----....-...- . .� i I I BMI_Y IN IURY(tom PEMrltl c I -- - I 1 - i PNYAdFO PL_L NED -'Y1'iEDILED I f I I EfJDI_Y IPLn1RY w' P.UfCS ' , w+`6VEP _-ta�l�vTnT�_-14'--..._-..__.-- I I J WFEOP1IfC6 (_- AtlrO I I I I 1 • I I I l t EA;,H CC;CURREN CE ! J ( I tkABtiELLA UAB I I rX_2JR I I i ' --- '' I I Afr3R=C ATE EXCESS UA&--I� CLAIN.Sit/rE{ ------- !__�LIED A I WORKERS MVIPENSAnON I ` I INC5-31 S-370523-052 1311212012 13N 212W 3 �!Tc�_Lu T81 I lc� Ate evpLOYERS'LIABILITY Y1Nj , ._ 8,rVY PROPR ET, 'PARTCP.T.•XE{'dRlVE❑t I 0z=IC i 1 i i E._.EP.CH A(,�.,IDEtr - !a 1(000C) i YERr1.C4vLER t. _41YJI=D7 N'A I I i I j '(Nalr;aary'in Pki) � , 'EI L DGF1iSE-EA 6yPLOYEE'5—.— 100061 Ken.de ll>diad3 AS FI i I i E.L DISE-Fl^UCYLPv10 (S —500000� D X'AIP•f1C7V OF C+'ERATIG.VS tstow I I --( �4 I i OEy-Cgp•n OPERA-nO,S.LO:aTOrtS!ve-eCLEs(Attach AcORD idi,Aaawonsi Ranmrks Sdzdde,if Tigre space is requir4 11t/orkers comDensation insurinre coverage ipplios Orly to the worl<ers ronq.jensation la�%s of tha state I+AF.., I! I C EfiTIfICATE HOLOEP CANCELLATION i SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE j HOUSING ASSISTANCE CORPORATION ddd THE EXPIRATION DATE THEREOF, No710E I"VILL BE DEUV=RED 9F! r 460WEST MAIN STREET- ACCORDANCE WITH THE POLICY PROVISIONS. I HYANNIS MA 02601 _ „ AUTeiORRID REPRcSENfATiVc i .r l i:: �� I 1 i • Jeff Eldridge <CJ 19BB-2010 ACORD CORPORATION.. All rights reserved CORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1'2:17 .! GN r---,:_ ..of - '1'.•1.!. _.___._i.iC�•CA, ?.l: •;T} ,--�a:6.�..,...1A" _i�r-`.l'� L_'..-..2j�a..2Yl'i['1fd:Y.c d ' .�. �las�;ichua•rt. - f)cltartirunl nl PuItIiC �,Ill'I� � Board (it' Buildin:: RcCulntinn. untl `I:uicl;iril> Construction Supervisor License License: CS 53202 _ JEFFREY R TONELLO PO BOX 1516 'u SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 Tr»: 21481 t „nuni.ci,nu•r . L92. p �X-jeo License or registration valid for individul use only \ Oflicc of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Type. office of Consumer Affairs and Business Regulation Registration:. =171991 10 Park Plaza-Suite 5170 Expiration:_ 5/9/2014 Corporation 73oston,MA 02116 RESOLUTION ENERGY-:ING::::,. { JEFFREY TONELLO` :': 43 FIELDWOOD DRIVE `-`- � lid w' out signature SAGAMORE BEACH,MA>02562 Undersecretary - MAM. g Town-®f B arnstAle %6f9. Regulatory Sei-viees Thomas F.-Geiler,Director Building Division Thomas Perry,.CBO. Building Commissioner 200 Main Street,-Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A wilder I, ` E`� 1� as Owner of the subject-property hereby authorize -y - C. `��%; � to act on my behalf, in all matters relative to work authorized by this building permit application for: 'ccj"'iL IFS.. ' �m�•�i ,��/'.f���� E%rl ���Q- ' tJE2`���' . (Address of Job) �. i f�u Signature of 0,wHer Date Print Name if Property Owner is applying foe permit,please complete the Homeowners License Exemption Form on:the. reverse side.:.-. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION oZ�7 C1�-� 06 t � 1 d Map Parcel Application # Health Division Date Issued sk n ry in Division o se at o A, li tin F o pp ca o Fee C Planning Dept. Permit Fee �3 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address P15 V! cyn(7 S Village _ Owner Address t0U .6 -79i Ir��r� �C Telephone 085 —771 r -70,-k :Permit Request l n,S imi— _ S 7 SSC. CA/ 4 &Z- t2 30 U�YeS���C�c c,l bt Alt l `Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total ne Nr C. Zoning District Flood Plain Groundwater Overlay 91 i! Project Valuation $02 066 ' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting i ecum�tation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)� II 3 i s « Age of Existing Structure / 9 Historic.House: ❑Yes ❑ No On Old King's HighwayF'U 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: t/ existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION -(BUILDER OR HOMEOWNER) Name Telephone Number 0 Address ! 9 c rl%r s 06,1d Ad License # d-5 S3 L y &L�L. 6 CL V 0 Fl Ua-S 31- Home Improvement Contractor# 1 -7 S Worker's Compensation # CSC E /I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE AA4 `o DATE r, y FOR OFFICIAL USE ONLY `�. APPLICATION# r a' DATE ISSUED = MAP PARCEL NO. ADDRESS VILLAGE ' OWNER ,k DATE OF INSPECTION: ,f •FOUNDATION_ FRAME INSULATION - '" FIREPLACE a Zk ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 1 - DATE CLOSED OUT ASSOCIATION PLAN NO. -1ne (,ommonweaan ud lvccc�au�rccs�en� Department of Industrial Accidents Office.of Investigations 600 Washington Street- Boston.,3M 02111 UV www.mass.gov/dia Workers'.Compensation lasurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name;(Business/Orgmiz�on/Iudividual):'�C-SC7(044 an EY C r!1 L4 • Address: 49 kerrtn�: �c� d '(L �. City/State/Zip:.3 U LLArdS� (Y)19 C,D S 3-D-Phone.#: (S`00 - 1 •� Are yo employer? Check.the appropriate box: .Type of project(required): 1. I am a e to er with` L 4. ❑ I am a general contractor and I mP y _ 6. ❑New construction . . . employees (full and/or part time).* have hired the stab-contractors 2:❑ I am a sole proprietor or partner- s listed on the-attached sheet 7. ❑Remodeling hip and have no employees These sub-contractors have g. ❑.Demolition workingfor me.in an capacity. employees and have workers' y p ty $. 9. ❑Building addition [No workers' comp,insurance comp.insurance, required.] 5.'❑ We are a corporation and its 10.❑Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12:❑Ro repairs insurance re ed.],t c. 152,§1(4), and we have no . employees. [No workers'' 13. ther (�2Gt�-!'l1Ul comp.insurance required.] .. Any applicant that checks box#1 must also fill out the section below showing their workers'compensa ion.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:' I`;6 t°� 01 d i-u /11 S �d- J Policy#or Self-ins.Lic.#: �.1� �° S 3 1 S 377 0 5- a 3O S Q_ Expiration Date: Job site Address: I =:fY1 Q(.� SAY Q:� City/State/Zip: N Va 7i' i ,M14 d X(00 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. 1.52 can lead to the imposition of criminal penalties of a . fine up to$1'500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator._Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under.the pains and penalties of perjury that the information provided above is true and correct Signature:.... c7 Date: Phone ,Offcial use only. Dowot write in this area, to be completed by.my.or town ofzciaL City.or Town: Permit/License# Issuing Authority.(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other w Contact Person: Phone#: Information. and Instructions Massachusetts GeneralLaws 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 pr.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( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the ped-omiance of public work until-acceptable evidence of complia ice with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es) and phone number(s)along with their certificates) of insurance..,Limited Liability Companies(LLC)or Limited Liability Partnerships,(LLP)with no employees other than the members or partners,are not'required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should, be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents.. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their Self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations:has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that=must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Sile 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 fo any business or commercial venture (i.e.a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do riot hesitate to give us a call r The Department's address;telephone-and fax number: The CQmmo wMIth of Massnhusdt Office a nee t �nr 60. Washm&4 Sty Ra tG4 MA 02111 Td.#617-727-49410 ext 406 or 1-M—MASSAFE Fax#617 727-774 : Revised 11-22-06 wwv mass goo/dia RARNSTABLA "9. Town.of Barnstable Regulatory Services Thomas K Geiler,Director Building Division Thomas Perry,.CBO- Building Commissioner 200 Main Street,-Hyannis,MA 02601 www.town.ba.*rnstable.ma.us Office: 508-862' 4038- Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A: Builder as Owner of the subject property t - hereby authorize -6 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) -Signature of Owner _, _ Date_ Print Name If Property Owner is applying foe permit,please complete the'Homeowners License Exemption Form on:the reverse side...... LV . 01 t'rr Y111UG Jt VUJ rux zDerver DATE(n'8'hDD!YYYr) ACC>R0� CERTIFICATE OF LIABILITY INSURANCEl 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)7 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 SMALL BUSINESS INS AGCY INC gLY, ACTNAME: _---542 MAIN STREET . .L_G -1_t.....(_5-0.8._ 4'PO ( _F 8 — Lx. .� WORCESTF_P,, l\AA 016150022 INSURER A' Li�.��M.S!t;L�.I rPSFrO�R�e COVERAGE ._...... NWCI;., t� I INSURED INSURER B. RESOLUTION ENERGY INCORPORATED Ih6l1RERc: 49 HERRING POND ROAD --- BUZZARDS BAYMA 02532 INSURER D: L __.-.—_.--- ..._._-_ INSURER F—__.--_____-.—.—_..__-..._.._—.__..._._... COVERAGES CEF1'TIFICATE NUMBER: 13897741 REVISION NUMBER: THIS IS TO CERTIFY-THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSI JED TO THE INSURED NAMED ABOVE FOR TF'C- POLICY P;j,K INDICATED. W,,.MAAT)-(STANDING ANY REQLJIReKAF..NT, TERM OR C:ONDITIO'J OF ANY CONTRACT OR OTHER DCCUMENT VATH RESPECT TO N/HICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM`:',.. EXCLUSIONS AND CONDITIONS OF St.)CH POLICIES.LIMITS S40M MAY HAVE BEEN REDUCED BY PPADDiCGLAIMS. _ - -- --1------•-------_..1'A-60CSOaa!-----'--'-_ rv9yl�0' YYY) rAr DI� II 15R PE OF I NSURAN:.E S-qI yy�/p, --POLICY t•ILbVIBER _--- ( Y ( A ]NVYYI UI�'s TYPE LTA' T i GENERAL UAB(UTY I O�•Ir✓`rPiWLIE I CO-)r? t iEl U EXP;FL'� L_.___..._ i.........i PcF,SU\UIL:ADV I�ULIRY IS _.__._..------- -.._..._...... - - .........._. j I _ h G6"JER4LAC/�RK�ATE I$ _GCN�_Ai�C,RE('ATEUL:IITAPFAIJE^PLR'. i I � PFL"?DlYTS CQ,AP/OP AC i I , AUTDNfDBILE UABIUTY E°a o Hri 0' f DI,.Y6WURY(Perwtsrn) ANY AUTU I '� --- --- PLL BODILY ED I y HEDLI ED i I LIIIRY(f w ardA r[ , Aurc A.ur(;9 HIF.EGPiJTC6 -- --- -L_ ^HC CURREN E 4 I I UMBRELLA LIAR rgy;L IR j ACrRECATE ----' -- ._..._,. _ EXCEL LIA6 I J cLAws,4,AADE, 1 .'— jDED ' i I ! �"TATLF OI' A woR<eRs'ccrJ��scnoN WC5-31 S-370523-052 1 3/12/2012 13l12/2013 1 /!T(._` '0 TS I = -t I.AND=LOYER5UABIUTY V/N1 I i ANY PROPRIETC*�7PAR iNE1=i7;ECllrIVF I i 1 I_E.L.EACH AC-J1 DENff J==1CC�'1.h NLER EXCI:JDED7 i N'A I I E.L.DISEASE FA BAPLOYEE' 10790 I ([Vanda�ry in F E•dL-aiW I.vdei -_Wow I I I I I E.L.DISEASE-POUC!LIMIT 1 s 50000 D `sC,R1P`nC N OF 0PCRAIICJi I I , L _ DESCF�PTIIXJ OF OPERAT C%S+LIYAT10f15/VEl BOLE'(Atiaoti AQDRD 101,Additionaf R ma ks Schedule If rbre mace ie requirEd) • I V-1orkers Compensation 111611r811f.,e COV0r.ige gpplie8 only to the workers compensation laws of the state MA... I i ;C I ERTFICATE IjOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. HOUSING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED Its 460 WEST MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 ALM-tORIZED REPRE-SENTA"n VETt ipI — Jeff Eidridae cD 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACOFID name and logo are registered marks of ACORD -.• '.SDI 201 1::'?' F9�h I?n;_ �. .i r. _ ::t'r tTuq?^ i ''l,i�i'r �:I',f': 1-�,.F.-:• � I"i :'i�.::.t`j i.,_:,.:'.I-..et'L i.f.'i,G7:Fg. . -. `i;t��ncliu�ctt. - Oclt;trlint•nt nl Pultlit' �,�ft•n Bo;ird ill' Building Rc;(ulntinn: :uul �t;in(I;irtl. Construction Supervisor License License: CS 53202 JEFFREY R TONELLOl�p s i F �t PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( nuniaiiici. Tr#: 21481 c 92. �a„r,�nareuea o�✓ � �{ License or registration valid for individul use only Office of Consumer Affairs&Business Rcguletion before the expiration date. if found return to: HOME IMPROVEMENT CONTRACTOR Type. Office of Consumer Affairs and Business Regulation Registration: :' 1.71991 10 Park Plaza-Suite 5170 Expiration 5/9/2014 Corporation Boston, MA 02116 RESOLUTION EiNERGYt :ING::;:;:::',:: JEFFREY TONELLO ? ��' 43 FIELDWOOD DRIVE;';,'.:.. tea -7� -- — t lJwiout signature SAGAMORE BEACH, MA;02562 Llndersecrewy x 9 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1�'?O Parcel 0"L7 0t Z Application 2,67&9 Health Division Date Issued Z C) t Z ` Conservation Division C "� �_ 7 - 1 �2rn I Application Fee Planning Dept. Permit Fee �— Date Definitive Plan Approved by Planning Board QF "to tZ Historic - OKH _ Preservation / Hyannis Project Street Address _ _ l LAJ C r MA-ivv j Village '/rt1/I N✓�(l AI A �� o l Owner 1-i4,.Lj el—C. 1S po,,�y 60, Address 130 X Telephone Xj h 7 Permit Request A40- r"bl a c i<_ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �f�D Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 30 I) Historic House: ❑Yes 'No On Old King's Highway: ❑Yes XNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood%coal stole:' ❑1Ce ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: O„existing L11new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: "' w Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ `t u 4„I`t �'cti Commercial Yes ❑ No If yes, site plan review# Current Use 0 G i< Proposed Use G K APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name, G1 Telephone Number Address License #__ J Home Improvement Contractor# l f Z r Worker's Compensation # ALL CONSTRUCTI N- EBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE �-- , r FOR OFFICIAL USE ONLY t - .APPLICATION# t` DATE ISSUED _ MAP/PARCEL NO. - 4 ADDRESS VILLAGE F' -` OWNER • } DATE OF INSPECTION: FOUNDATION FRAME 4 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL I I= PLUMBING: ROUGH FINAL I ; i t GAS: ROUGH - FINAL } FINAL BUILDING is - 4y I DATE CLOSED OUT i 'i 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/Plumber's Applicant Information PIease Print Legibly Name (Business/Organization/IndMdual): Address: 2 - City/State/Zip: 4 Phone#: 0 VL 3// (� Are you an employer? Check le appropriate box: Type of project(required): 1.�I am a employer with l 5- rl, 4. [] I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. El New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g, 0 Demolition working for me in any capacity. employees and have workers' insurance.$ 9 ❑Building addition comp.[No workers' comp.insurance required.] 5. 0 We are a corporation and its 10.0 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.Q 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 hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they 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: 5�.-y- L. klel.-" we-U-0 Policy#or Self-ins.Lic.#: / c �� / Expiration Date: 111113 Job Site Address: 1 f� We- ,f' J- �. ,% City/State/Zip: 4"vA.( Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of,MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify r the pains and en es of perjury that the information provided above is true and correct Si attire: Date: Phone#: S (:!::j .7 // / 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#: Clie n :t# 241369ra _ ,a r OCEANSIDEIN ACORD CERTIFICATE OF LIABILITY INSURANCE °ATE(MNIIDD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD 18/2012 S CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY.AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE& BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE.A CONTRACT BE'TVEEN;ITHE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:Ii the certifleete holder is an ADDITIONAL INSURED,the policy(iet)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 - HUD International New England NTACT NAME: Christopher Hedetniemi. 265"Orleans Road PHONE A/C No E.t:508-946-0446 ' AIC No:508.945.9136 North Chatham;MA 02650 EMAIL DDRESS• 508 945-0446 INSURERIS)AFFORDIN--------- INSURED NAIL p .INSURER A:EVereSt NatlUnal Ins CO. 10120 ...- Oceanside Inc; 'INSURER B: . . S Clark Inc. INSURER C• - ' 217 Thomt011 Drive . . - " .INSURER.D: "- - 'Hyannis,MA 02601 INSURER E:" '"i COVERAGES:: - INSURER F; ' CERTIFICATE NUMBER: ' THIS IS 70 CERTIFY THAT THE POLICIES UI INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE..INSURED NAMEREVISD 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.:LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID.CLAIMS. IN SW ADDL U R•LTR .TYPE OF INSURANCE IN D POLICY NUMBER - POLICY EFF POLICY EXP - . 'GENERAL LIABILITY MM/DD/YYYY MMIDD/Y LIMBS - COMMERCIAL GENERAL LIABILITY -PpEACH OCCURRENCE S . - .P MI TO RENTED n" -S . CLAIM-MADE �.OCCUR; _ _ (Anyone raon • s MED EXP .. PERSONAL dADVINJURY. ,S ,... q. • GEN'L AGGREGATE LIMIT APPLIES PER:: " GENrRALAGdREGATE s RP. :.. -. .. POLICY PRO- - LOC . . ... PRODUCTS-COMPIOP AGG S . .: . . .. S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO Ee aeetdenl ALL OWNED SCHEDULED, BODILY INJURY(Per persort) S - OS AUTOS - NON-OWNED' _ -.. BODILY INJURY(Per academ) It HIRED AVTOS. AUTOS PROPERTY DAMAG . ... . Per eddam - S. f UMBRELLA"A8_ _ OCCUR EACH OCCURRENCE E ' . EXCESS LIAR - .CLAIMS-MADE . DED RETENTIONS .... :.`� _ . ' AGGREGATE.' � � '_ A WORKERS COMPENSATION S AND EMPLOYERS'LIABILnY` CF4WC00045121 1/01/2012 01/011201 wcsTAru•,..,x oTH A ANY PROPRIETORPARTNERMXECl1T1VE YIN' OFFICERIMEMBER EXCLUDED? Q NIA E.L.EACH ACCIDENT $1 000'000. .: .. (Mandatory In NH) . ..... If a•describe tinder ya E.L.EJ_.DISEASE•FA EMPLOYEE Si OOO ODO. . .DESCRIPTION OF OPERATIONS.pelOw E.L.DISEASE-Pot ICY LIMn si 000'000. " " DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remaraa'Sch•dul•..If mon spa"is nqulr•d) - 1. CERTIFICATE HOLDER CANCELLATION ! .Town of.Barnstable SHOULD.ANV OFTHE ABOVE.DESCRIBED POLICIES SE CANCELLED BEFORE f - THE'.EXPIRATION DATE.THEREOF,. NOTICE WILL BE DELIVERED IN . 200 Main Street - ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 026D1 AUTHORIZED REPRESENTATIVE' ©1988 2010 ACORD CORPORATION.All rights.reserved. ACORD 25(2D10/05) 1 Of 1 The,ACORD name and logo a.re registered marks of ACORD #S645521/M64551'8 TC002 I; Client#:23059 OCEAINCI ACORD�, CERTIFI'CATji OF LIABILITY INSURANCE o reaMMroomrrr► THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO,RIGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE ODES 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 eertificete holder is an ADDITIONAL INSURED,the Iw1iCy(ies)must be endorsed,N SUBROGATION WA IS NED,subject to r the terms and conditions of the policy,certain policies mayrequie an A endorsement. statement on this certificae does not confer rights to the certificate holder in lieu.ot such endorsement(s). t . PROOUCFA " ACT Rogers&Gray ins. Plymouth NAB 341 Court Street W Ro III 508-209-6028 EdNAiL • P.0.Box 3700" D s• AM NO: Plymouth,MA 02361-3700 1 INSURERS AFFORDING COVERAGE NAIL• INSURED INSURER A:Arbelia Protection Co 17000 Oceanside Inc INsuRER e 217 Thornton Drive INSURER C: Hyannis,MA 026014105 INSURERD: . INSURER E• COVERAGES INSURER F: CERTIFICATE NUMBER:THIS IS TO CERTIFY THAT THE POl NC REVISION NUMBER: B S OF WSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMEOABOVE FOR THE POLICYPF�X)0 CERTIFICATE NOTWITHSTANDING BE ISSUED ANY REOUREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEO'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 CLAWS. NNSR LTR TYPE OF III RANCE WOOL FUSS POLICY EF POLICY EXP A GENERAL LIABILITY POLICY NUMBER M O/YYYY MMaOD/YYYY LIMBS 8500029947 1/01/2012 01/01/201 EACHoccuRRENCE s X COMMERCIAL GENERAL LIABILITY 1000000 ELATED CLAIMS-MADE a OCCUR mn 000,00 DDO MED EXP OAy an peneml) $5 000 PERSONAL 6 ADV INJURY $1 DOO OOO GENL AGGREGATE LIMIT APPLIES PEQ GENERALADGREGATE 32000"000 PO ' PRO-ECT IOC PRODUCTS-COMP/OPAGO s21000.000 A AUTOMOBILE LIABILITY S ANraulo 59456400002 1/01/2012 01101/201 COMBINEDst"GLeuM1T 1,000,000 ALL s J_ AUTOS-OWNED X SCHEDULED BODILY INJURY(Per Del S AUTOS BODILY INJURY(Par N cdeenQ $ IRED AUTOS XADO OWe Oth Car A MBRELLA LIMBC, 4600029948 1/01/2012 01/01/201 eAcH occuRRENcE s2 000 00D XCESS LIAS CLAGGREGATE s2000000 EO X RETENTION A000(1 WORKERS COMPENSATION S AND EMPCOYERV LIABILITY WC STATU- OTH- ANY PROPRIETOWPARTNERJEXECl1TIVE YIN ERI OFFICMEMBER EXCLUDED? E]MIA E.L.EACH ACCIDENT S (Mandalory In III If yet dembe under E.L.DISEASE-EA EMPLOYE E S DESCRIPTION OF OPERATIONS debr . EA.DISEASE-POLICY LMIT f DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(Attach ACORD 101,Adclidl Remarks Schedule,If mom epees fe raqubadl CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELL ED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 367 Main St. ACCORDANCE'WITH THE'POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 0 198 -2010 ACORD CORPORATION.All rights leserved. ACORD 25(2010/05) 1 of I The ACORD name and logo are registered marks of ACORD #S76669/M76267 niI I CERTIFICATE OF LIABILITY INSURANCE DATE(MMMONYWI 12/07/2012 THIS CERTIFICATE 16 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 INSUlqED. the policy(iee) must be cndorsed. If SUBROGATION 1 AIVED, subject to the terns and condKlons of the Policy, Certain policies may require an endorsement. A statemont on this cer"(1cato does not confer rights to the certificate holder in lieu of such ondomement(s), PRODUCER Schlegel A Schlegel Insurance Brokers Inc NAME: 34 MAIN STREET fA/C,No,E>It: (508) 771 - 8301 (AX NoC('S08) 771 - 0663 AO01IW3: oDUCEq- CUSTOMER ID p! West Yarmouth, MA 02673 INSURED meURER(SI AFFORDING COVERAGE NAlcp Manoel OzanO Neto Dba Rj Painting INSURERANt$S INSURANCE 176 Sudbury Lana INSURERBNUM INSURANCE , INSURER C! INSURER D: HYannls, MP, 02601 rNgUR@RE: 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. NOTWITHST/WOINO ANY KOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MATH 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. TRW LTR TYPE OP INSURANCE INSR. wyn POL(GYNUMBER (MMtDD/YYYr) (NMA)D/rrrYl LIMITS A GENERAL LIA9ILITY MPT5945B 07/26/201207/26/2013 EACH OCCURRENCE s2,000,000 . X COMMERCIAL GENGRALLIABIUTV Epp p—• •— CLAIMS-MADE 'I .• �^ PREMISES(Ea occurranCol $500,000 v 'OCCUR r MED EXP(Airy one peron) $1 O,O OO . PERSONAL g ADV INJURY s2,000,000 GENERAL AGGREGATE s4,000,000 DEN`L AGGREGATE LIMIRO'_ E$DER: PRODUCTS-COMPIOP AGG 84,000,000 POLICYPRa JECT LOC S AUTOMO6ILR LIABILITY COMBINED SINGLE UNIT ANY AUTO (Ea oCCIden' S ALL OWNED AUTOS BODILY INJURY(Per paron) S SCHEDULED AUTOS BODILY INJURY(Per 2edooAQ S HIRED AUTOS PROPERTY DAMAGE S (Per oCAdoAU NON•OWN60 AUTOS S 9 UMB=L-A8OCCUREACH OCCURRENCE S EXCCLAIM$•MADE AGGREGATE S •DEDUCTIBLE S RETENTION S 8 tlUOPKERe-O NIIATION S AND EMPLOVER$'UASIUTV WCT5943B 07/26/2012 O7/26/2013 X T'ORV LIMITS ER ANY PItOPR1ETORIPARTNER/FJ(ECUTIVE V I N _ OFFICER/MEMSER EXCLUDED? N/A� E.L.EACH ACCIDENT $ 100,000 (Mandatory In NMI 1/yea.4owbe undor E.L.DISEASE•CA EMPLOYEE S 100,0 00 DESCRIPTION OF OPERATIONS bola. E.L.DISEASE•POLICY LIMIT S 500,000 DESCRIPTION OP OPERATIONS/LOCATIONS/VENICLeS(AtUcq ACORD 101.Additional Rrmsrlcs BUcdoIA,if mom space I.nqulled) MANDEL HAS $LECTED TO BE COVERED ON NIS WORXERS COMPENSATION POLICR LISTED AS ADDITIONAL INSURED BY CONTRACT ONLY:ktTLLER ST. fjCR CONSTRUCTION INC CERTIFICATE HOLDER CANCELLATION OCERNSIDE RESTORATION 217 THORNTON DRIV$ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL AC DELIVERED IN HYANNIS, Mh 02601 ACCORDANCE WITH THQ POLICY PROVISIONS. FAR# 508-775-2848 AUTHORQ REPRESENTATIVE 1 B- RA OB ACORD CORPOTION. All rights reserved. ACORD 26(2008109) The ACORD name and logo are registered marks of ACORD Tomn of Barnstable •� �, Regulatory Services WAS& Thomas F.Geller,Director.. WON Building Division Tom Parry,Building Commissioner :. 200 Main Street,Hyannis,MA'02601. www.towa:barnstable.ma.ns Office: 508-8624038 Fax:•508-790-6230 Property.4winier.Mtasi . i Complete and.Sign This Sectioi If Using A Bititder I, J 'as Owliet of to subject propest)r hereby authorize - j' ti to act on:my belial in_0 mitten relative to work authorizecl by this building petnit. ; (Address of Job) pool fences'and alarms are the responsibility 4 the applicant.:Tools are not to be filled before fence is installed.and pools are not to be utilized until all final inspections are performed.and accepted. ignatuxe of Owner tote of Applicant Jo> . Treaa�sor.CAR)IIaC:Ja►o:: TM MI Print Name . . �'rint NataF. e N. - i Date j. QT0RMS;O`YYJQ FMSIOMGI!S TOWN OF RARM TABLE . Z DE DIVISTili 2 14/aN �rf s �)c9 04 � �CrsT Zoo 2 x/Si oA-J / d t .. Massachusetts - Department of Public Safety 'r Board -of Building Regulations- and Standards Constructio-Super isor License: CS-000043 ' . r RICHARD W 65 ACRE HUM 1' BARNSTABtli J.rG•-� �r� � Expiration commissioner 01/2WOU 10 on some. Affarrs c �u�`nes�::�.�gulahon �tegi$trati,�n 411 Type: Expiration:. 4 Pri�a#eorporatio 4..:.. : I . AN ieMat lark. I `` fiFiorntQn.Dr ya ms, "M":— 01 UadcrseeretarX y _ Unrestricted - Buildings of any use group wmcn !, contain less_than 35,000 cubic feet (991M, of 1 enclosed:space. i Failure to possess a current edition of the Massa'husetts State Building Code is cause for revocation of this license. For DPS Ucensing.information visit: www.Mass.Gov/DPS License-or r�egistatit .kvli fir:fiaiiiie Only . t. I i before the ezr: �tion=Mete. If _fou +d �un:to: y Off ce of Consumer•A Mrs 4 timoiWO1101t 10 Park P.IAza -.Suite 511 Bnsxon;,-M- 02:1:16 Not: id.-:without si.g�etut