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I Town of Barnstable Building Post Th��Card So�Ttiat itsyUisible From the Street.', Approed Plans Must be Retained on Job antl this Card Must be;Kept v�„ + MAM�a�r. .� Posted Until Final Inspection Has�Been Made �� � � �� � r qx Permit ° W,,heea Certificate of OceupancyisRequired;such Building halt Na Abe Occupedun�tif a Fiat Inspection hasbeen.made -F Permit NO. B-19-1288 Applicant Name: TROY A THOMAS Approvals Date Issued: 04/25/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 10/25/2019 Foundation: Location: 3620 MAIN STJRTE 6A(BARN.), BARNSTABLE Map/Lot: 317-019 Zoning District: RF-2 Sheathing: Owner on Record: ANGELI MICHELLE K Contractor Name:'* TROY A THOMAS Framing: 1 Contractor License aCSSL-099913 Address: PO BOX 219h 2 BARNSTABLE,MA 02630 Est Project Cost: $2,200.00 Chimney: Description: Roof Permit Fee: $35.00 Insulation: Project Review Req: Fee Paid:` $35.00 Date: - 4/25/2019 Final: yx r " Plumbing/Gas Rough Plumbing: ,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afte,issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shalt be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of occupancy will not be issued until all applicable signatures,by the Building and Fire Officials are provided on this,permit. Minimum of Five Call Inspections Required for All Construction Work ;. Service: 1.Foundation or Footing e2 Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Application number.... Fee ....................0.�.b .......................... e.- MASS. Building Inspectors Initials-cck. ................... &63 APR 18 2019 Date Issued...... ............ Map/Parcel........... .. .........I......... TOWN 0� TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHEPJZATION PROPERTY INFORMATION Address of Project: le NUMBER STREET VILLAGE Owner's Name: /i Phone Number Email Address: Cell Phone Number Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature:-N�C uw cV2 1,k) Date: TYPE OF WORK raa Siding ED Windows (no header change)A_ED Insulation/Weatherization Doors (no header change) # Commercial Doors require an inspector's review FlRoof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name a A-f `Ilh Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# OZZ g -1,7 (attach copy) Email of Contractor s-%y -4(Phone number ndo ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. JOUOISSItu Ujob Mn bW 3111,4U31N33 z AIaQ,S iJN1UON 66V tNOH1 v AOa j [tjle €L6660tds� � 1SSO sPaepue;S 3!l leu Pue suol S+ o iona3suoO a}nsua Jetn6ay 6ulPlrne jo P,eo8 sJJasn �o►ssa o d{o uo!slnlQ yoesse � W;o 4Jleamuouxuoz) 4 e ���c t�'nurrrrr-ejr[ueu t�:.r�C etri Office of Consumer Affairs&Business Regulation License or registratiou'vand.for individual use only - -before the expiration date.;*found return toc't HOME IMPROVEMENT CONTRACTOR Registration: 1g: 22 Type: Uffce of onsumer Affairs and Business Regulation Expiration :679CL018<. LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 TROY THOMAS HOME J1VIPi:OVE.MENTS,LLC TROY THOMAS 499 NOTTINGHAM DR; ' CENTERVILLE,MA 02632 Undersecretary Not valid w' ut signature r A. .. �. DATE(MMIDD/YYYY) A o✓ o CERTIFICATE OF LIABILITY INSURANCE `j r 05/23/2018 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 j 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 have ADDITIONAL INSURED provisions or be endorsed.•. If SUBROGATION IS WAIVED,subject t.o 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). CONTACT PRODUCER NAME: Donna OStrOWSkI Mark Sylvia Insurance Agency,LLC PHONE 508 957-2125 AIc No): 508 957-2781 404 Main Street E-MAIL Centerville,MA 02632 AooRE s:mark marks Iviainsurance.com INSURER S AFFORDING COVERAGE NAIC# INSURERA:Farm Family Casualty Insurance INSURED INSURERB: - Thomas Home Improvements LLC INSURERC: PO BOX 177 INSURER D: - Centerville,.MA 02632 INSURER E INSURERF COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE.LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE.INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.POLICY EFF POLICY EXP LIMITS ADOL SUER INSR TYPE OF INSURANCE _ POLICY NUMBER MMIDDIYYYY MMI DDIYYYY _ LTR 5/01/2018 5/01/2019 EACHOCCURRENCE $ 1000,000 . A X COMMERCIAL GENERAL LIABILITY 20OIX1416 DAMAGE 10 RE TED 100,000 PREMISES Ea occurrence $ CLAIMS-MADE F—x1 OCCUR S,000 MED EXP(Anyone person) $ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE • $ 2,0.00,000 GEN'L AGGREGATE LIMIT APPLIES PER: . PRO, PRODUCTS-COMPIOP AGG $ 21000,000 X POLICY❑JECT 0 LOC $ OTHER: COMBINED SINGLE LIMIT $ a ccident _ AUTOMOBILE LIABILITY BODILY INJURY(Per person) $- ANY AUTO .. OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE $ HIRED NON-OWNED (Per accident AUTOS ONLY AUTOS ONLY $ EACH OCCURRENCE $ UMBRELLA LIAB OCCUR - AGGREGATE $ EXCESS LIAB CLAIMS-MADE DED RETENTION W8053 5/01/2018 5/01/2019 AWORKERS COMPENSATION 2001 STATUTE ER AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $ 11000,000. ANYPROPRIETORIPARTNER/EXECUTIVE NIA E.L.DISEASE-EAEMPLOYEE $ 1.,000,000 OFFICER/MEMBEREXCLUDE D7 a (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $ 1,600,000 "'as f yes,describe under DESCRIPTION OF OPERATIONS below ' DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attachetl If more apace Is required) - Carpentry ts. Nothing contained in the certificate of insurance shall be Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsemen deemed to have altered,waived or extended the coverage provided by the policy provisions. CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Troy Thomas ACCORDANCE WITH THE POLICY PROVISIONS.. 499 Nottingham Drive Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2616 ACORD CORPORATION. All rights reserved.. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD APPLICATION NUMBER ............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. I 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 Ledbly Name(Business/Orgwdzation4ndividual): —/f'►d S 4L� o �ROr�/✓� S Address: P� gee /KO City/State/Zip: IM 4&9M Phone#: SM? ZA? AMY- Are you an employer?Check the app opriate box: Type of project(required): 1.[ 'am a employer with J . 4. El I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. remodeling ship 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.[:1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.]t, c. 152,§1(4),and we have no employees.•[No.workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state vyhetber 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: '�'�J'VL ►yli Cam'°'"� �., ' Io Policy_ #or Self-ins.Lic.#:� jD/ �/F(l� 3 + Expiration Date: Job Site Address:, f d�-d 6 /✓l ,i City/Stata/�. � ,� 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. t I do hereby certify under the pains an penalties of perjury that the information provided above is true and correct: S i ature: Date: — k Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Information and Instructions 4 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a ceased employer,or the receiver or trustee of an individual,partnership,>association or other legal entity,employ' employees. However the owner of a dwelling house having not more than*ee apartments and who resides Cher or the occupant of the ons to do.maintenance,construdtion or r air work on such dwelling house dwelling house of another who employes pers or on the grounds or building appurtenant thereto not because of such emplo ent be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every s to or local licensing age shall withhold the issuance or renewal of a license or permit to operate a bnsnnes 'or to construct build* in the commonwealth. ommonwealth for any applicant who has not produced'acceptable evidenc of compliance with a insurance coverage required." Additionally,MGL chapter 152,§25C(7)slates"Neithe'the commonweal nor any of its political subdivisions shall enter into any contract for the performance of public wo until acceptab evidence of compliance with the insurance requirements of this chapter have been presented to the co`trading au rity." Applicants Please fill out the workers'compensation affidavit complete ,b checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and a number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Li ty Partnerships(LIT)with no employees other than the members or partners,are not required to casy workers'comp ation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affida m be submitted to the Department of Industrial Accidents for confirmation of inm=ce coverage. Also b sure o sign and date the affidavit. The affidavit should be returned to the city or gown that the application for the ermit o ,license is being requested,not the Department of T-o--.�_ou ha -. on ma the l am,or if you are r&miirf d to obtain a workers' ndlLSirldl ACCIQcutS. 3!ivLLits You 4u�e wi;�u'o. 5 re dWD` y _are policy,please call the Department at the umber]iste 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 p ' ted legibly. The D artment has provided a space at the bottom of the affidavit for you to fill out in the event the ffice of lnvestigatio to contact you regarding the applicant. Please be sure to fill in the permit(license numb e which will be used as a eference number. In addition, an applicant that must submit multiple permit/license appli ions in any given year,n s only submit one affidavit indicating current policy information(if necessary)and under"J Site Address"the applican shoWd write"all locations in (city or town)."A copy of the affidavit that has been., cially stamped or marked b the city or town may be provided to the applicant as proof that a valid affidavit is on a for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is ob ' ' a license or permit not relate to any business or commercial venture (i.e.a dog license or permit to burn leaves )said person is NOT required to c plete this affidavit. The Office of Investigations would like to you in advance for your cooperati and should you have any questions, not hesitate to give us a call. please do giv The Department's address,telephone and number. e Corx mmwealth of Massachusetts parbment of Industrial Accidents + Office of Investi.ptions 600 Washington Beet Bostm,ILIA 02111 Tel, #617-727-4900 ext 406 or 1-8 -MASSAF- Fax# 617-727-7749 Revised 4-24-07 www.rr-=,gov/dla 1 a � ® 1 l � �t Town of Barnstable *Permit# v� Re lllat0 Services ���6 months from issue date g ry i�xtvaresi.e, ems.039. Richard V.Scali,Interim Director ��JJ �1� �Ep MA'I Building Division 9-PRESS PER"""' Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 OCT 1 7 2016 www.town.barnstable.ma.us Office: 508-862-4038 TOWN OF AR508ST74PA1-o EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY y' Ci Not Valid without Red X-Press Imprint Map/parcel Number �_ J Property Address r 6 a� / 4�iysn_yf��f'�/� ,f � ❑Residential Value of Work$ 6 000.60 Minimum fee of$35.00 for work under$6000.00 Owner's Name,&Address cA p llt__ Aage- Contractor's / y Name f'�I Al A S Sie. Telephone Number , .% a Home Improvement Contractor License#(if applicable)P� f Email: Construction Supervisor's License#(if applicable) 6 ❑Workman's Compensation Insurance Chec ne: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name e &I-tmLsom �e (6)ln /g/f Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) � Sfi ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurric ne nailed)(not stripping. Going over existing layers of roof) / �( ®fie-side (,()611 r� ce-O& ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A.copy of the.Home Improvement Contractors License&Construction Supervisors License is r quired. SIGNATURE: Q:\WPFILES\FORMS\building permit fomns\EXPRESSo.doc Revised 061313 Ema . . ... ..-- ---- The Corrsmosraveakh of Vassachusetts Department of Indushiai Accidents - Office of Investigations 1 .. 600 Washanglon Street � Boston,MA 02111 YlTF4w mass goWdia Workers' Compensation Insurance Affidavit:BuildersfContractnrsMectrieians/Plumbers Applicant Infarmation Please Print Legibly Name{Bvsmess/Organizafiao/taditridnan: L M 10 4 S�1� Ad&m: 1�7Ly Af 6s : pI1,4;. IPA 0 a c3> CityfStatxlZip: U d!� Phone #'ire you an employer?Check the appropriate bo= Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6- ❑New eonstiuctRa )artployees{full andlor part-time)* have hired the sub-contractors 2.R I am a sole proprietor or partner- listed on the attached sheet. y- ❑Remodeling ship and have no employees 'These sub-contractors have g_ ❑Demolition w for mein an capacity- employees and have workers' o�g Y � t5'• 1 9_ ❑Building addition [No workers' comp.insu=e camp-insuratl�ce required] 5. ❑ Vote area corporation and its 10..❑Electrical repairs or additions 3_❑ I am a homeowner doing all work of Ecers hn-e exercised their 11..❑Plumbing repairs or additions myself,[No workers'gyp- right of exemption per MGL iZ. insurance r f c. 152,§1(4} and we have no ❑Roof repairs �j emp1oYees-[No workers' 13.0 Other comp insurance required-J. *Play agpti�ut cut checks boa#1 amst also fill out the section below showing their workers'compensation policy infbrmatiom �Homeowners wbo submit this affidavit indicsting they are doing all ucA and then hire outside contractors a submit a new affidavit md'*�such konttactots that check this boa mist attached an additional sheet shoeing the tome of the sub-couft2ctocs and state whether or not those entities have employees. If the sub-caatmctms bade employees,they must provide their workers'romp.policy number. I am art employer that is prmidirtg workers'compermulon irmirance for my emp&ym- Below is the policy and job site information Insurance Company Name: Policy if or Self ins.Ile-#: Fxpiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required.under Section.25A of MGL c. 152 can lead to the imposition oferiminal penalties of a fine up to S 1,500.00 and/or one-year itnpcisanment,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 ince coverage r eeification. r I do hereby certify tinder thepains andpenakies ofperjuty that the in formitiart pravided above is tuna and correct Sitmature• Date- ' Phone ©,, E al use only. Do not write in this area,to be completed by city or town official City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health. 2.Building Department 3.CitylPown Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and Instructions Massachusetts General La chapter 152.requires all employers to provide workers'compensation for their employees~ Pursuantto this statute,an loyee is defined as"...every person in the service of another under any contract of hire; express or implied, oral or n." An employer is defined as"an ' dividual,partnership,association,corporation/or other legal entity,or any two or more of the foregoing engaged in a jo enterprise,and including the legal represe tatives of a deceased employer;or the receiver or trustee of an individ partnership,association or other legal ty,employing employees. However the owner of a dwelling house having t more than three apartments and who ides therein,or the occupant of the ' dwelling house of another who emp ys persons to do maintenance,co ction or repair work on such dwelling house or on the grounds or building appurte ant thereto shall not because of suc employment be deemed to be an employer." MGL chapter 152, §25C(6)also states at"every state or Iocal Iicensin agency shall withhold the issuance or renewal of a license or permit to ope to a business or to construct b ildings in the commonwealth for any applicant who has not produced accep ble evidence of compliance 'th the insurance.coverage required." .Additionally,MGL chapter 152, §25C(7) tes"Neither the commonw, alth nor any of its political subdivisions shall enter into any contract for the performance f public work until accep le evidence of compliance with the insurance requirements of this chapter have been pres ted to the contracting ority." Applicants Please fill out the workers' compensation affida it completely,b checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), addr s(es)and p ne number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or invited Li ility Partnerships(LLP)with no employees other than the members or partners,are not required to carry work ' comp nsation insurance. If an LLC or LLP does have employees,a policy is required_ Be advised that this da ' may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Al o b ure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for th p "t or license is being requested,not the Department of Industrial Accidents. Should you have any questions re ding the law or if you are required to obtain a workers' compensation policy,please call the Department at the n ber 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 printe legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Offic of Inve ations has to contact you regarding the applicant. Please be sure to fill in the permit/license number whi will be us as a reference number. In addition,an applicant that must submit multiple permit/license applications any given y ar,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site ddress"the a licant should write"all locations in (city or town)."A copy of the affidavit that has been offici stamped or m ed by the city or town may be provided to the applicant as proof that a valid affidavit is on file for tore permits or h rises. Anew affidavit must he filled out each year.Where a home owner or citizen is obtaining a 'cease or permit no related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)sai person is NOT r ed to complete this affidavit. The Office of Investigations would like to thank ou in advance for your operation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax n ber: The Commonwealth of M:aAac tt s Deepattment if lgdustrial cci ents Office of Uv'Ps# t iG 600 Washington Street Boston,MA 02111 Tel.A 617-727-4900 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 4-24-07 wt .mass_govfdia THE A Town of Barnstable Regulatory Services ELAMSr"s r'Eg Thomas F.Geiler,Director �p s6;q. ♦� ri 619.I" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder Aftal , as Owner of the subject property e hereby authorize 1 to act on my behalf, in all matters relative to work authorized by this building permit i �l0 ?\o &&YnS& U— (Address of job)' 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. i i Signature of Owner Signature of Applicant Print Name Print Name i Dae Q:FORM&OWNERPEPNISSIONPOOLS 62012 — �VIM, Town of Barnstable Regulatory Services snnNsrwsr E Thomas F.Geiler,Director 16 . `0$ Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02.601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXE ION Please Print DATE: JOB LOCATION: village number street "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS:__ 1`\ city/town a zip code The current exemption for"homeowners"was extended to include o e -occu ied dwellinLys of six units or less and to allow homeowners to engage an individual for hire o does not possess a nse,provided that the owner acts as supervisor. DEFINITION OF ' MEOWNER Person(s)who owns a parcel of land on which h she resides or inte to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures ecessory to such and/or farm structures. A person who constructs more than one home in a two-year period shall not be considere a homeowner. ch"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she sha be res onsib or all such work Derformed under the building ermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibili for co pli ce with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she un tands th Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comp with said rocedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings contai g 35,000 cubi fee or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEO EXEMPTION The Code states that: "Any hom weer performing o k for which a building permit is required shall be exempt from the provisions of this section(Sectio 109.1.1-Licensing o construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such w rk,that such Homeow er shall act as supervisor." Many homeowners who use this exemption are unawarf at they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations f Licensing Constructs ' upervisors,Section 2.15) This lack of awareness often results in serious problems,particularly hen the homeowner hi es nlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed u rvisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her re o ibilities,many communities require,as part of the permit application,that the homeowner certify that he/she unders d the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care mend and adopt such a form/certification for use in your community. CAUsers\decollil\AppData\Local\MicrosoR_\Windows\Temporary Internet Files\Contentoutlook\QRE6ZUBN\EXPRFSS.doc Revised 053012 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-099406 Construction Supervisor Specialty KIM M BASSETT � y P.O.BOX 75 CUMMAQUID MA 02637 Expiration: Commissioner 12/12/2017 �lti�ca�iinwauuecc�CLc a�C�cu�aac�uureCtri• ; JD Office of Consumer Affairs&Business Regulation License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration ]59706 Type: Office of Consumer Affairs and Business Regulation Expiratiort 5119[2018 Individual 10 Park Plaza-Suite 5170 = ,,<+ KIM M BASSETTM' ;, : Boston,MA 02116 KIM BASSETT 3775 MAIN ST CUMMAQUID,MA 02637 Undersecretary Not valid without signature i" of Ir Town of Barnstable *Permit 1` osedc Expires 6 mo-14fio issu ate Regulatory Services Fee t BARNSMBLE, v Mass. $ Richard V.Scali,Director i639• ♦0 ArFD��A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL. ONLY 2 Not Valid without Red X-Press Imprint Map/parcel Number J I D I Property Address 10 MA(n ST�C'.ter.i 6��jT14h�f- , or I A 6 a(3 Ej Residential Value of Work$ Qr 0 06, © 6 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address e l i c � ( 3690 .0140 Ei 64,,.6 S7A ,e 04 626 30- Contractor's Name K I M s-�t Telephone Number Home Improvement Contractor License#(if applicable) �jEmail: O❑/�nn y� Construction Supervisor's License#(if applicable) �� Q(e dN�����3 tru �J ❑Workman's Compensation Insurance SEP 03 2014 Check one: I am a sole proprietor TOWN OF BARNSTABLE ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name V r r Q��L ,(t'jY► P U I V � 6sy1 9,.,)ce Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) [d'rRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑ e-roof(hurricane nailed)(not strippping. Going existing layers of roof) Re-side \f►/5t 064-Me<, (,Li 5ver ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑'Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 061313 w Depwftnent of bukstrid Acadents ...... aywe afrrrest�gaiians 600 Wayhington Street Bastan,MA 02111 rtmlv.razasmga�rt'icr / W,orkets' CompensaticiaL suranr davit_$uildersICantractors[ElectricianMumbers pUcant Infarmat on Please Piint Lepibly I�Tam�(E��-.�to�anizaticu�.lfndivi�naq: K�/� I��} S� A dream: 3:77!� 4i ti SE Cuof Mq 0) 11 'l71 (�a 637 City/Stat�JZip= It I Phom , Q Areyov an,employer?Check dLeapprapriatebt,,,u e a T of project 4-_ ur �al confractor and i }� �'o J tr edl.: 1_❑ I am a employer with ❑ I o g 6- ❑New wnsfxctioa fo ees full andtorpart-time-).* haveh redthe sub-cont�fors. Y �' listed on the attached sheet, 7- ❑Remodeling L I ain a sofe prapr e or orpartner- sbip and hazie no employees These subcontractors have g_ ❑Demolitioat worlci.ng for-�--in an-Y c ci r emploS�and.h2Lve workers' � f5 $ 4_ []I3uildsng addition [N`a.workeis' comp.insurance comp_insuxance-•_ nit-d-] 5_❑ We are a corporation and its 10_Q Electrical repairs or additions 3.❑ I am a homeowner doing all worL officers bave exercised fheir I1_0 plumbing repairs or additicns arysel£ [No workrs'comp. riEt of e�ptioaper MGL 12-.[]Roof repaas iaasuRmicQ regaLred]F c_152,§1(4),and wefiavt' no emglayees-[Na tuorlcers' 13_.❑Q.tiu ac comp_msarenc raquuExl. 'Any appuosst$ut che&.s box f1 trmst also fall out the section below slowirna ft eir workers'coapensKdon policy infonmfion- T R..x naeis rho sabm t dais afdxm indicstig toey ate acing 2E xm*and then bae offside:coutractors most submit a nm:sffidm it rodirs`mg M)d ^Gtmiazctors t}ast check this boz Est crrnnc�vi�sr�itit3nsI s�ezt shacrmg��e of�salt-ems xnd stste uhetiec pcnui f3�sg.--,.:�•':-�have employees. If th..--sob-co-ut;actvs hare employees,they Est pm-Ade�s wzwkess'comp.policy number- Insurance GompanyName: Policy 4 or Self ins_Lim Expiration Date: Job Sim Address: CifyPS to zip: AttzcIr a cap of the-workers'compensation palicy decT--xrztion page(showing the policy xrumbez-and expiration date). Failum to sr:,=e cavi--rage as wired under Sectioa 25 Ai of MGL c 152 can lead to the imposition ofrr,mina l penalties of a tine up to$1,5 MOD andlor one-year impri as well as cizrli penalties in the farm of a STOP WORK ORDER-and a fine of up.to$250.00 a.day against the violator_ Be advised drat a copy of this statemem maybe fmrwarded to the Office.of T�rvesfigntto 7s of the DIA for iusnnrnce coverage verification-_ I dri hgrebl,crrttfy turd-r tha pruns and penaIft-es ofptdary thatfhe.information pravidRd t b n,e is bite nerd correct: Date- Phone#_ t),f cL�d use rznT . Eta trot write in this area,:a ba campleted by dif v ar town officiaL City-or Town- _PerraitfUceuse# Issuing Authority(drele onaf: I.Board 4f Health 2.Building Department "K C=ity,T i ov u Clerk 4_EIectrical lnspec#or 5.Plumbing Isec€or 6.Other Cosb�ct Person, Phone#_ _ 6 Information and Instructions , Massachusetts General Laws chapter 152 requires a1I employers to provide workers'compensation for their employees. Pursuantto 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 ferprise,and including the Iegal representatives of a deceased employer,-or the receiver or trustee of an individual,p ership,association or other legal entity,employing employees. Flowever the owner of a dwelling house having not ore than three ap tents and who resides therein,or the occupant of the - dwelling house of another who employs ersons to do maint ante,construction or repair work on such dwelling house or on the grounds or building appu ttnant` ereto shall not b ause of such.employment be deemed to be an employer." MGL chapter 152, §25C(6)also stzi?s that every state or ocal licensing agency shall withhold the issuance or renewal of a License or permit to operate business or construct buildings in the cominonrrealth for applicant who has not produced acceptabl evidence co nap Han.ce�dtn the insurance.coverage required-" Additionally,MGL chapter 152, §25C(7):to s"Neith the commonweal`u nor any of its political subdivisions shaJ1 enter into any contract for the performance o ublic rk until acceptable eZ2derice of complial�ce vriL the insurance requirements of this chapter have been present d to e contracting authority." Applicants — Please fill out the workers' compensation armed t ompletely,by checicirg the boxes that apply to y cor situation and,if necessary,supply sub-contractors)name(s), dress s)and phone mnrber(s)along with then cero_ricatc-(s) of insurance. Limited Liability Companies(LL ) or Li - eed Liability Pp�trsli_;,s(_.LP)with no empioy� s other than the members or partners,are not regl.?red to c workers' .mpensation== erce_ if LLC er LLP does have employees, a policy is required- $e advise Mat his affi vit may be s bL iited to the DeparT b-J ient of indu 'al c Accidents for onfrmation of in_Tm2rice cro l e-rage. Also b sure to sign and date the a`fii day:t 'l1?e af%ciavit sho lld be returned to the city or town that the app icatioa for the pe it or liczsse is being requested not the Departinent of lndustrial Accidents. Should you have questions regardin the law or _you are requ1-ed to obi ilz a worker' compensation policy,please ca_Il by Dep-tmeat at the number - Led.below. Se'in n u-ed companies should enter e r self-insurance license number on t%e app opriate line. City or Town Officials Please be sure that the affidavit is comp ete and printed legibly_ The epar;ment has provided a space at the bottom of he ainaavit for you to nll out e vent the Office of Inver gauo�s has to contact you regarding the applicant Please be sure to fill in the permitllice^ e number which will be us�-i as reference number. In acid:tion,an applicant that must submit multiple peiiai lLcens applications in any given year, eed only submit one al-Scavit indicating cif-ent policy information (if necessary) and der"Job Site Address" he appiic . t should V rite"ail locations in __(city or town)."A copy of the affidavit brat h . been officially stamped or markced y ure city or town may be provided to uhe applicant as proof that a valid affidavi is on the for future permits or Lcens . A new a f fida davit m��t be tilled out each year.Where a homeowner or citizen i obtaining a license or permit not rel-� ed to any business or commercial venture (i_e.a dog license or permit to buns le ves etc.)said person is NOT requ*ed t complete this affida�vit- The Office of lnvestigations would i e to thank you in advance for your ration and should you bane any questions, please do not hesitate to give us a ca i _ The Department's address,telephone and fax number: Th4 Corm aaw--al&of Massachustts, D¢paitnent cif 1ndustaal Acczdct�Ls Q-Mfi e of Iayeest gafQ7xs GOG Washington St,c-� T tL 4 617-727-49( U i�xt 406 or 1-RTC-NMASSAFE Fax-' 617-727- ��n Revised 4-2�07 - .www_anas5.gnvf d_a � E rti Town of Barnstable Regulatory Services RMW9 MSS. Richard V.Scali,Director 163 9- Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign ThislSection If Using A Builder I, I ' ' , as Owner of the subject property p t hereby authorize 1�/� jQ S,S�—�y-' to act on my behalf, in all matters relative to work authorized bythis building permit application for. (Address of Job) 1 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. Signature of Owner Signature of Applicant '1^ r Print Name Print Name Date Q:FORMS:O WNERPERMIS SIONPOOLS Town of Barnstable Regulatory Services �oF T�cyti Richard V.Scali,Director Q P ° Building Division Tom Perry,Building Commissioner Mass. 9�A i639 ,0$ 200 Main Street, Hyannis,MA 02601 lED a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENS EXEMPTION Please P 'nt DATE: JOB LOCATION: • number sheet village "HOMEOWNER": name home phone work phone# CURRENT MAILING ADDRESS: -------------- city/town state zip code The current exemption for"homeowners"was extende to elude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does n possess a license,provided that the owner acts as supervisor. DE ION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she res de or intends to reside, on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures access to uch use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a ho eown . Such"homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall b res onsr le for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibi ty for complian with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/s e understands the To of Barnstable Building Department minimum inspection procedures and requirements and that he/she wil comply with said proced es and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings con g 35,000 cubic feet or larger will required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any home wner performing work for which a b 'Iding permit is required shall be exempt from the provisions of this section(Sectio 109.1.1-Licensing of construction Sup rvisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as su ervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &ReguIations for Licensing Cdostruction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 ;/` ��e�o�n�n�ao�ra�ueal.�i c�C�/vGbt�ac%ccae%ry Office of Consumer Affairs&Business Regulation OMEIMPROVEMENt.CONTRACTOR egistration 159706 Type' i Expiration '- 5/19/2016 Individual KIM M BASSETT l i" KIM BASSETT a 3775 MAIN ST g�_-- CUMMAQUID,MA 02637 ` - Undersecretary 1 �^f M ass ac ho. Gl.s 1 -vent of Public Safe* Boa{d of B iilding -gwiations and'Standarc Construction Supervisor Specialty License: CSSL-099406 IQM M BASSETT= PO Box 75 Cummaquid MA�026 I I Expiration. 1.2/12/2015 Commissioner I 0 License or registration valid for individul use only before the expiration date. If found return:to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 j Boston,MA 02116 ,��7— Not valid without signature Mar>z chu et S C `anent of Public Safet >>"• Boa{•d 6.f B.uilding "9alations and`Standarc Construction Supc.n-isor Speciulh< , rt% License: CSSL-099406 " E M M BASSETT PO Box 75 '• � s - Cummaquid MA fi26377 - 954—� . �� �s,0 Expiration Commissioner 1.2112/2015 Town of Barnstable Ta°�IN OF �,��;��ST� LE �TME'�Iq, Regulatory Services Q' Thomas F.Geller,Director '2"" � 40 '"M,► `� ` Building Division 9. ► Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-$62-4038 Fax: 508-790-6230 PERMIT# D1 7 6 , �0-- FEE: $ SHED REGISTRATION 200 square feet or less Location of shed(address) Village rYli c\xt te, A (99 qq4- 99 1 Property owner's nam&J Tel hone number Size of Shed Map/P cel# signature Datel Hyannis Main Street Waterfront Historic District? ® 'Old King's Highway Historic District Commission jurisdiction? f If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:304:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. TINS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-she&eg REV:05201 r OWNER OF RECORD I CERTIFY THAT THE EXISTING DWELLING Michelle Angell SHOWN HEREON 15 LOCATED AS IT Deed Book 2G7 17,Page 4 EXISTS ON THE GROUND. Plan Book 94, Page 79 DATE Assessors'Map 3 17 Parcel 19 p ru CB P.L.5. (FN D) BENCHMARK: Top of Concrete Bound - EL=GO.2t(Assurned dat—) n , i /g m c o eh - PROPOSED - s 5'XG'SHED pOf LEGEND a CB Concrete Bound MHB Mass.Highway Bound - S - - - FND Found 2� 0'x nJ �11 9� ' O 8S. Le O� FND) PARCEL 19 Area=7,500 5F± CERTIFIED PLOT PLAN STgT v c r 0 SHOWING PROPOSED 5HED AT 3G20 MAIN STREET, ROUTE GA, BARNSTABLE, MA PREPARED POP . CB MICHELLE ANGELI (FND) 0 20 40 GO SCALE I"=20' FEBRUARY 4, 2014 G:0AJob5\Anye1,G8G IVdwg\G8G I-CPP PROP05ED 511ED.dwg Drawn by:JFM JMO-G8G I J.M. OREILLY&ASSOCIATES,INC. 1573 Main Street,P.O.Box 1773 Professional Engineering&Surveying Services Brewster,MA 02631 (508)896-6601 I �.:Iti . ?v�?c j �'J9 .ate-;y03 2v ?r_e� 4 9L9. = 29� Town of Barnstable . Zoning Board of Appeals " Decision and Notice Variance No.2014-024-Angell §240-11(E)—Bulk Regulations: Minimum Side Yard Setbacks To construct.a shed within the required 15' side and-Tear yard setback Summary: Granted with Conditions Petitioner: Michelle Angeli Property Address: 3620 Main Street (Route 6A), Barnstable Assessor's Map/Parcel: 517/019 E,,cea< 'ABLE_T�i I,;t LE Zoning: Residence F-2 '''`� ,l ei'<I':!� F:.' ��' Hearing Date: May 28,2014 :�'i't . Recording Information: Deed: Book 26717, Page 4 Plan: .Book 94,Page 79.(shown as Herbert Jones et ux) Background-& Relief Requested In Appeal No. 2014-024, Michele Angeli applied fora variance from Section 240-11(E-)- RF-2 District Bulk Regulations, minimum 15 foot side and rear yard setbacks. The applicant sought to construct a 6' x 8' detached accessory storage shed within the minimum setback required to the rear and eastern side,property line. The.subject property is a 7,405 square:foot (.17 acre) lot,,rectangular in shape, with 75 feet of frontage on Main Street/Rte 6A. A review of the title history for the property,reveals the lot was in existence by 1929. The•parcel is improved with a 1 Y2 story;two bedroom single-family dwelling with 1,176 square feet ofliving area. Records indicate the house was constructed in 1820. It is' set back 53 feet from the front property line, 20`and 27,feet from side lot lines, and 20 feet from the rear lot line. Surrounding property is developed with single-family residential dwellings. Procedural& Hearing Summary Appeal No. 2014-024 for a variance from Section 240-11(E) to construct;-an:accessory,storage shed within the required side and rear setback areas at 3620 MainStreet,:Barnstable was filed at the Town Clerk's Office and office ,of the.Zoning Board of Appeals on April`29, 201.4. A public hearing before the Zoning Board of Appeals was duly advertised and notice sent to all:abutters in accordance with 'MGL Chapter 40A. The hearing was opened May 28, 2014 at which time-the Board found to grant the variance subject to conditions. Board Members deciding this appeal were-Craig Larson,Alex Rodolakis, George Zevitas and Herbert Bodensiek. The.Applicant represented herself before the.Board. Ms. Angeli discussed her need for a shed, given the size of the house and the inaccessibility of the basement for storage. `She explained that storing a lawn mower and .other outdoor items in the basement created a hardship for her. She presented alternative. locations. showing the proposed shed in conformance with the 15' setback. requirement, ;pointing out that it would`be on top of he steps to the dwelling. She explained that shape:of the;lot and location of the house did not allow for a shed to be built in,conformance with setback requirements. Ms. Angeli confirmed she had spoken with abutting property owners and they-had no concerns. The Board Chair confirmed that the shed would be constructed on blocks or sonotubes and not a permanent foundation. The Board,expressed concern about the proposed one foot rear yard setback, stating it should:be slightly greater.to. allow for maintenance of;the shed',without trespassing: The Board Chair requested public comment and:no one spoke. Town of.Bamstable Zoning Board of Appeals Decision and Notice Variance No.2014-024—Angeli Ordered ,AppealNo. 2014-024, a variance from,§240-11(E)—RF-2 Bulk Regulations,:15 foot minimum side, and rear yard setbacks to allow the construction of a 6 foot by 8 foot accessorystorage-shed located not less than two feet from the,rear lot Iine and fourfeet from the side lot line at 3620 Main Street(Route 6A), Barnstable hasbeen granted. This decision must be recorded at the Barnstable Registry of Deeds forit to be in effectand notice of that recording submitted to the Zoning Board of Appeals Office. The relief authorized by this decision must be exercised within one year unless extended. Appeals of this decision, if any,shall be made pursuant to MGL Chapter 40A, Section 17, within twenty days after the date of;the filing;of this decision, a copy of which must be filed in the office of the Barnstable Town Clerk. i � r Craig G. Larson, Chair Date Signed I, Ann Quirk, Clerk of the Town of Barnstable,;Barnstable County, Massachusetts, hereby certify. that twenty(20)days have elapsed since the Zoning Board of Appeals filed this decision and that no appeal of the decision has been filed in the.office of the Town Clerk: Signed and sealed this day of under the;pains and penalties of perjury. ,*,, UJ Ann Quirk,Town Clerk s, P Town of Barnstable Zoning Board of Appeals—Decision and Notice Variance No.2014-024—Angeli Findings of Fact At the hearing on::May 28,'2014, the Board unanimously made:the fbilowing..findingsi of fact for, Appeal No. 2014-024, a request for a variance from:the:minimum side and near yard setback requirement of Section 240-11(E)'to construct;an accessory, storage shedwithin 15 feet.of.the side and rear lot lines at 3620 Main-Street/Route 6A, Barnstable: 1. In Appeal No. 2014-024, Michelle Angeli applied fora variance from.§240-11.E Bulk Regulations to construct a 6'x.8'accessory storage shed'located within the required 15 foot' side and rear yard setback areas. 2. The property is located at 3620 Main Street(Route 6A), Barnstable, MA as shown on Assessor's Map 317 as Parcel 019. It is in the Residence.:F-2 Zoning District. 3. There are circumstances related to shape or topography of such°land or structures and especially affecting such land or structures but not affecting generally the zoning district in which it is located. Given the shape of the lot and location of the dwelling, a shed built;in conformance with the setback requirements would be on top of.the steps to the house. 4. A literal enforcement of the provisions of the:zoning-ordinance would involve substantial hardship, financial or otherwise to the petitioner. There is no storage for outdoor items other than the basement, which has extremely steep steps. 5. Desirable relief may be granted without substantial detrimentto the public good and without nullifying or substantially derogating from the.intent.or purpose of the zoning ordinance. The abutting property owners have no objections to the requested variance. The vote to accept the findings was: AYE: Craig G. Larson, Alex M. Rodolakis, George Zevitas, Herbert K. Bodensiek NAY: None Decision Based on the findings of fact, a motion was duly made and seconded to grant Appeal No.'2014- I 024, a variance from-Section 240-11(E)to construct an accessory storage shed within 15 feet.of the side and rear lot lines:at 3620 Main Street/Route 6A, Barnstable, subject to the,following conditions: 1. A variance from §240-11(E)—RF-2 Bulk Regulations, 15 foot minimum side and rear yard setbacks is granted to allow the construction ofa 6`:foot by 8 foot accessory storage shed located not less than two feet from the rear lot line and four feet from the side lot line at 3620 Main Street(Route 6A), Barnstable. 2. The shed`shall be.constructed in compliance with the plot plan_entitled"Certified'Plot Plan Showing Proposed Shed at 3620 Main Street, Route 6A, Barnstable, MA"dated February 4,: 2014 by JM O'Reilly&Associates, Inc, except the rear setback shall be at least two feet. 3. The shed shall;be constructed in compliance:with the Certificate of Exemption approved by the Barnstable Committee of the Old Kings Highway Regional'Historic District Commission.. 4. If=the-variance has not'been-recorded.at the.Barnstable County:Registry of Deeds within one year from theAate of issuance,this variance shall expire,-unless extended by the Board; The vote was: AYE: Craig G.Larson', Alex M. Rodolakis, George Zevitas, Herbert'.K. Bodensiek NAY: None Page ZQf 3 �t1KNE Town of Barnstable *Permit 4 Expires 6 mondis frous issue date Jl Regulatory Serv"ices Fee ta.►ttrrsrABi , MASS, Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02..601 wwwaown.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red.X--Press Imprint Map/parcel Numbers `" $ 11 ' pn r Property Address Darn sN-" l 1 v 1 Vol(o (7 �A Residential Value of Work:A&-S Minimum,fee of$35.00 for work under$6000.00 A a ( ` /� i Owner's Name&Address ��e�1 t+y PtA— 3z) 'Contractor's Name Telephone Number..(5��� act.-)-—Or (a� Home Improvement Contractor License#(if applicable) 9. X-PRESS PERMIT Construction Supervisor's License#(if applicable). CS 0•c1 I %LL ❑Workman's Compensation Insurance APR 1 Q 2013 Check one: . ❑ I am a sole proprietor ❑ I am the Homeowner TOWN OF BARNSTABLE I have Worker's Compensation Insurance Insurance Company Name c— 1 CiV c`e t s J�- t&rc,-LV_ Workman's Comp.Policy# (F, K 6'� N o S 1 ;:t Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) El Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side 7 i #of doors Replacement Windows/doors/sliders.U-Value 7 1 (maximum.35)#of window El Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. °.Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsofl\windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc :Revised 053012 MARVIN DESIGN GALLERY a complete window and door showroom by MHC Permit Authorization I, A l; , as Owner of the subject property understand that Marvin Design Gallery by MHC is a department of Marine Lumber Operator located at 134 Orange St., Nantucket, MA and hereby authorize V r A,o to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of ner Date Print Name 73 Falmouth Road I Hyannis,MA 02601 1(508)771-6278 1(508)771-6279(Fax)I www.marvi ndesigngailery6ymhc.com Massachusetts Department of public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-091884v Is ` VINCENT J MARJNO 58 LIBERTY LAME iVIARSTONS MMS Jar Expiration Commissioner 01/24/2015 • GTI� �omvyw�cu.�a�lc;o�'✓�zaoach.,�elA � � flfticg of Consumer Affairs&86smess fTegaiaHon: $ ense of regrstratron valid for indMdul'use only bm before the egp�ration date; U found returwtos ' s=� Oft-►ce of Consumer Affarrs and Business Regulation Regtatration 6 991 7yPez1 ib.T%kkPlaza Suite5 Expirat14 Supplett�ent and Boston,MA 02116 MARINE LUlV18E�� �� 134 COWER QRA �' K ......4.... s RAI UCKEfi,IVIA 02h'� 3 �'f Undersecretary , of v Iid;w�thout signatuNe 4 . 3/2013 8:36:06 AM PST (GMT-8) FROM: 100005—TO: 15087716279 Page: 2 of 2 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/OOIYY1fY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy((es) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement s RODUCER Risk Strategies Company CONTACT ME. Christine Watson 15 Pacella Park Drive Suite 240 PHONE a)c Ne Randolph, MA 02368 .E-MAIL ADDRESS: C 0 INSURER(S)AFFORDING COVERAGE NAIC S sk-strategies.com INSURERA: 4SURED INSURER B: TraVelOrS Marine Lumber Operator, Inc. DBA Marine Lumber Co., Inc. INSURER C: 134 Orange Street WSURERD: Nantucket MA U554 WSURERE:. - INSURE 'OVERAGES CERTIFICATE NUMBER: 15686723 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY'PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PO Tit TYPE OF INSURANCE ADD S BR POLICY NUMBER MMND�FF MMID YYYY1fI L01tITS GENERALLIABILITY 7140075780000 8122/2012 6/3012013 EACH OCCURRENCE $ 1000000 ✓ COMMERCIAL GENERAL LIABILITY S WIE EnBf� $ 50000 CLAIMS-MADE a OCCUR MED EXP(An one person) $ 6000 PERSONAL BADVINJURY $ 1000000 . GENERALAGOREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGO '$ 2000000 I POLICY PRO• ✓ :LOG $ AuromoeiLE uABarrY ADN-8739221 8/22/2012 ;6/30/2013 a BBIV DINGLE LINT E 1000000 ✓ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Perecadent)' R7y S HIRED AUTOS R AUTOSWNED Pe�eecident A GE' $ $ . umeRew►Luae ✓ OCCUR 7140076780000 8/22/2012 6/30/2013 EACH OCCURRENCE $ 10 000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE a 10,000000 DED _ RETENTION$ - $ S 3 :WORKERS COMPENSATION 6l<U80167N03512' 12/18/2012 12/18/201.3 ✓ .oc sTATus, c�71: AND EMPLOYERS'UABILTIY Y I NLIM ANY PROPRIETORIPARTNERIEXECUTNE E.L.EACH ACCIDENT $ 5OO 000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE•EA EMPLOYEE $ 500,000 If yes,desenbe under DESCRIPTION OF OPERATIONS below E,L.DISEASE-POLICY LIMIT $ 500,00 IESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) certificate Holder is additional Insured where required by written contract or agreement. *ERTIFICATE HOLDER . CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Marvin Design,Gallery. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Bernard Gitlin 01988-201 O.ACORD CORPORATION. All rights reserved. kCORD 25(2010105) The ACORD name and logo are registered marks of ACORD �- t% NO.: 15686723 CLIENT CODE: tMAiN-2 Christine Watson 3/0/2013 0:32:36 AM Paae 1 of 1 n � The Commonwealth of Massachusetts Departinewt of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,MA 02111 imvir:massgoi/ilia Workers'-Compensation Insurance Affidavit:Builders/Cenh'actois/Electricians/Plumbers Applicant Information ( Please Print Legibly Name(Busineworganization'Individual): Address: 1 � we- (3 /_ City/State/Zip:- �.��'„�� � . tAA baSS`r Phone#: l�bjb p1;0�_OclOO Are you an employer?Check the appropriate box: Type of project(requited): ` 1/ '•��I am a employer with 13C) _ 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.JA Remodeling shipand have no employees These sub-contractors have g F1 Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance I 9. ElBuilding addition required.] 5.❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LE]Plumbing repairs or additions myself. o workers'co right of exemption per MGL y � �� c.152, 1 4,and we have no 12.❑Roof repairs insurance required.]i § � ) 13.❑Other employees.[No workers' comp.insurance required.] 'Any applicant fnat checks box#1 roust also till out the section below sbowing theirworkew compensation policy information - Homeowners Homeowners who submit this affdnit indicating they are doing all tti oik and then hire outside contractors must submit a new ambvit indicating such. tContractors that check this box trust attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I alit an eniplot'er tliat is providing ntorkers'compensation itisitrRnce for irty employees. Beloit is fire policy and job.site information. ` Insurance Companyl�ranie: \(emu¢.\�(s v ,�ra.•s C P Policy it or Self--ins.Li,.#: �, F� O (o-T t�C) e� Expiration Date- l Job Site Address: 34,)o �L; ,S�, , 1+ o A l�L. City/State/Zip:�r;..s 6U_-,UTA\ OA 310 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. Ida hereby certify in er a pmits and penalties of perjt►►3,tliat tlee information prof-ided abot'e is trite alyd correct Siemture: Date: g `3 Phone#: C,5 `A°l s 0,�>63 Official use only: 'Do)tot write in this area,to be completed by city or town official City or Town _-.. _ . PermitUcense# Issuing Authority-(circle one): 1.Board of Health_1.Building Department 3.City/Toiim Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION odMap Parcel Application # (D?4 3 0 D 6 70 Health Division Date Issued Cam" t Conservation Division Application Fee ( 0 Planning Dept. Permit Fee 3� Date Definitive Plan Approved by Planning Board r 3 Historic - OKH _ Preservation / Hyannis Project Street Address \\ ( St , sk Village `(''(l `�� e_, Owner / Address ► Telephone I Permit Request - � � ��e ' 1c:)Lk�; 111C C ke�_ R� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ® Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) _ Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New _ Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size Shed: ❑ existing ❑ new size _ Other: ® � o '< , Zoning Board of Appeals Authorization ❑ Appeal #_ Recorded ❑ 6 Q Commercial ❑Yes ❑ No If yes, site plan review #Current Use Proposed Use co 5 g9•gT APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name. _ — Telephone Number'Z\ ! �� Address GLQ License # � 97 ome Improvement Contractor# _ Worker's Compensation # "' ��J�►� !-yp � ALL CONSTRUCTION DEBRIS RESUL IN FRO THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1� F FOR OFFICIAL USE ONLY s APPLICATION# M1 .. DATE ISSUED rc. MAP/PARCEL NO. r i e ` ADDRESS VILLAGE ` OWNER r DATE OF INSPECTION: ` FOUNDATION`•, f. FRAME 'p INSULATION Y F FIREPLACE ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH FINAL ,GAS: ROUGH FINAL .,FINAL BUILDING DATE CLOSED OUT ; ASSOCIATION PLAN NO. The Gomxrrrtunwatth of assachusetts Department of Industrial.Accidents a Office of lnuestigrations +600 Waskingtaan.,street Boston,MA 02111 wwnz moss gvvIdia Workers' Compensation Insurance Affidavit- B er nt ctorrsfEE tliri nslP"lumbers Applicant Information Please Print Lelub' Name R_),)6 L�2 Address, �s Czqnesk ri,I t Z City/Stately l� � ` you an employer?Check thf appropriate box: Type of project(required): I am a employer with 4- ❑ 1 area a general contractor and I p y� 6_ ❑New cacti-oia. employees(full and/or part-trine)-" have hued the sub 1❑ 1 am a sole proprietor or - listed ion the attached sheet_ 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition. 'work' for the in c employees and have workers 'working . any alra€ Y _ ❑Budding addition (No wmicers'comp.insurance comp_insurance-'s required-] 5. ❑ We area corporation.and its 141-❑Electrical repairs or additions. 3_❑ 1 am a homeowner doing all work: officers have exercised their 11_❑Plumbing repairs or additions myself [No workes'damp_ right of exemption per NIGL 12-Q Roof repairs insure rewired.]1 c_ 152, §1(4� and we have no employees_[No workers' cam-ffi .] 'Any apphcaut dnt:checks box#1 mast also sill ow the section below showing their wateis'conq*lLwAanpokcyinfannaum 1 Homeowners who submit this:affidavit attar c=g they are-dGmg all work and Shea hire outside€mtrwmrs mnstsubmit a new of davit aadicatiag such :Gout wtors that died this box must atttachad an addidandr sheet showing the tam of the tears gad state whether or riot those entities have employer. If the sub-santtactois have employees;they must pmvide fir °comp.policy mmnber. I aaat an eanptojw that is providing nwrkers'com parisadan insurance for my a e-es. Below is thepo iy dad job site in,forma a vn. insurance Company Name: �(J �� i - C1'J Policy#car Self-ins-Lic_4: "C�- Ip�l /— ®� —0 1 t Expiration Date: ' L�_ C Job Site Address:E> 0 1 /'� � City/state/zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number umber and expiration da 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 S 1,500-00 and/or one-year imprisonment,as well as cixil penalhes 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 fogy insurance coverage verification. I do here f v mar es^/lag rr aand of pedury titat tJee iriformaiion protri abos a try and correct Si t Date: O Phone 0: d QJ7cial use only. I3o not write in this area,to be completed by c4,or town official City or Toast: PersmmitfLicense Issuing Authority(circle one): 1.Board of Health.2.Building Department 3.CitTdlown Clerk 4.Electrical.Inspector 5.Plumbing Inspector 6.Gther +Contact.Person: Phone 6 JMOFN-1 OP ID: LG DATE IMM/DD/YYYY) '4�R� CERTIFICATE OF LIABILITY INSURANCE 1/18/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. I Hls CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER 508-997-3321 NAME: iumphrey,Covill&Coleman PHONE FAX nsurance Agency,Inc. A/C No Ext: A/C No): 195 Kempton St. P.O.Box 1901 ADDRESS: 4ew Bedford,MA 02741 2aymond A.Covill INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:LIO ds of London INSURED J.M. of New Bedford Co.,Inc. INSURERB:Atlantic Casualty Ins.Co 423 Coggeshall Street INSURER C New Bedford, MA 02746 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDTCA-fED. NOlVVITHSTANDING ANY-REQUIREMENT'TERW OR CONDITION OF ANY CONTRACT OR-OTHER DOCUMEN-l—iTH-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. NSRPOLICY EFF Po LTR TYPE OF INSURANCE INSR WVD SUER POLICY NUMBER MM/DDNYYY MM DDY/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 21000,00 AMAGE TO B X COMMERCIAL GENERAL LIABILITY L081000893-1 11/15/12 11/15/13 PREM SES Ea occurrence)nce $ 50,00 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 2,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED Per accident) PROPERTY DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DIED RETENTION$ $ WORKERS COMPENSATION CS OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A C+ . (Mandatory in NH) �E� 46-855637-01-01 6/22/12 6/22/13 E.L.DISEASE-EA EMPLOYEE $1 ,000,OOO If yes,describe under _DESCRIPTION_OFOPERATIQNS_below__, ._____ ____ _—__._______..___.___ __ -_ _ __— E.L DISEASE_-POLICY LIMIT_ A Property Section CCO28148 11/11/12 11/15/13 Building 10,000 Contents 20,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) 3usiness Income: $70,000 rools: $10,000 - )eductible: $1,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street • Hyannis, MA_02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I �e llnii nrniru�n�/�r,^l(ril rrc�rrJtf/1 Office of Consumer Affairs&Business Regulation License or registration valid for indivk ul use only OME IMPROVEMENT CONTRACTOR before the expiration date_ If found return to: egistration: 103195 Type: Office of Consumer Affairs and Busine s Regulation xpiration: 7/6/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 JM OF NEW BEDFORD CO.INC. c ELWELL PERRY r i �- 423 COGGESHALL ST. i Q NEW BEDFORD,MA 02746 Undersecretary Not vali with ut signature Nlassachusett.- Department of Public Safern Board of Building Relyulation. and Standar(l. Construction Supervisor License License: CS 104088 Restricted to. 00 ELWELL PERRY j 75 MYRICKS ST BERKLEY, MA 02779 Expiration: 5/20/2013 (' mmi>.i ncr Tr—': 104088 I OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at S( �0Molt,o S d JJ (Property Address) (Property Address) he reby authorize -T V , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Own is Signature Date' J1\40F NEW BEDFORD A WEATHERIZATION CO. www.JMofnb.com T: 508.992.5770 info@jmofnb.com 423 Coggeshall Street F: 508.992.5773 New Bedford,MA 02746 March 21,.2013 Thomas Perry, CBO Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 RE: Insulation permits Dear Mr. Perry: This affidavit is to certify that all work completed for insulation work at 362_0 ' GMain`-St.;_Barns ab a has been inspected by a certified Building Performance (BPI) Inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Matthew Perry JM of New Bedford t13 a