Loading...
HomeMy WebLinkAbout0037 TREE TOP CIRCLE 37� IM572 o a . C T OF THE Tp� Town of Barnstable *Permit# 2 U 15-D Y Expires 6 mon�s from issue date Regulatory Services Fee BAMSTABLE. v� 1 : `� Richard V.Scali,Director �OP ATFD MA'I A RESi ��r�"w9 Building Division Tom Perry,CBO,Building Commissioner DEC 16 2015 A200 Main Street,Hyannis,MA 02601T��NOFB www.town.bamstable.ma.us ARNS oP �W Office: 508-862-4038 Fax: 508-790 6JZr3 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid witleout Red X-Press Imprint Map/parcel Number 15'0/03 y Property Address ,-y -AebFe- -7--z)P G(�(�L-� xp- fivDJy Jt& I C.L�S esidential Value of Work$ .3,,g Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address JAI- 1. S V A,-t J 3� T '1✓ TO(� L� 12G L L l M A�►'ZS�N /mil 1 wS l MA OZ 6¢g Contractor's Name .P A V V J- CA ZC A U LT' -I- ScaN_S Telephone Number Home Improvement Contractor License#(if applicable) f .0 3'+(4 Email: 8 f f i (-e 9 c,0 Ze a_LJ-f. Cox-, Construction Supervisor's License#(if applicable) S t o s ( 5 4- ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ,[J�ave Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# k/C- - ! 3 a to 6 -:4-6 U 2 S7 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request heck box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to VA-EMOUA ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#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: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 pp- " L Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. I (print) , 7o-ma SvIJIVA,111 , as Owner/Agent of the subject property hereby authorizes Paul J Cazeault & Sons Inc to act on my behalf, in all matters relative to work authorized by this building permit application for. Address of Job 't'r l 1` �0 C1 rc i M a"v' . S' 6t-t. H f Signature of Owner Mailing Address of ner Telephone # 5-6 o '-(24 Date Please return this form to Paul J Cazeault & Sons, Inc along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeault.com Client#: 19989 2CAZEAULTPA ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 05/05/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil PHONE 508 775-1620 F 5087781218 A/C No Ext: A/C No Insurance Agency E-MAIL ADDRESS: 973 lyannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis, MA 02601 INSURER A:First Mercury Insurance Company INSURED INSURER B Paul J.Cazeault&Sons, Inc. 1031 Main Street INSURER C: Osterville, MA 02655 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 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY MACGL00000101570 4/30/2015 04/30/201C EACH OCCURRENCE $1,000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES Ea occurrence $50 000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $ X BI/PD Ded:2,500 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY jEc07 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 PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Paul Cazeault SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1031 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Osterville, MA 02655 AUTHORIZED REPRESENTATIVE �,✓/�., a T '�� ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S150526/M150525 LS1 �_ C' r�i ��i'��'��md���'�'r�2��: �/L% ff• bA�.l,��t'��"F���%l �liC.J Office f o Consumer AffaIzs and Business Regulation j 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home improvement Contractor Registration Registration: 103714 Type: Supplement Card Expiration: 7/9/2016 PAUL J. CAZEAULT & SONS, ING:' :....' RUSSELL CAZEAULT ------ 1031 MAIN ST -- OSTERVILLE, MA 02658 Update Address and return card.Mark reason for change. sCA 1 Co 20M-.05111 ❑ Address ❑ Renewal ❑ Employment Lost Card cU/ze ina�rrirrarzcaealU a/Pi��uttuc�usehJ _ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only r before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR p .:- Office of Consumer Affairs and Business Regulation Reg istration;:.;;gA37.1.4, Type: 10 Park Plaza-9uite 5170 S Ex iratibhl ..: .:.:.:::.::':. P ,7/Ql2016.., Supplement';ard Boston,MA 02116 PAUL J.CAZEAULT&'SONS;';I Ct L •.t: ' RUSSELL CAZEAULT:; `e 1031 MAIN ST _ v OSTERVILLE,MA 02658 Undersecretary Not valid witho nature Coll 1 Massachusetts -Department of Public Safety �-� Board of Building Regulations and Standards Construction Supervisor License: CS-108157 t RUSSELL CAZEAULT.-., i 2071 MAIN STREET Brewster MA 02631 t_ - V=s" 5i 41— Expiration Commissioner 11/23/2018 I ' i The Commonwealth of Massachusetts Department of Industrial Accidents .; 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass golv/dia Workers'Compensation Insurance Affidavit:BtWders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): f-q_z -(p J_ C.A'-z_a&,e_—t 4- f Sc�y�S Address: l©S/ �T- City/State/Zip: Os Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. am a employer with It employees(full and/or part-time).' 7. ❑New construction 2.O[am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑ Demolition 3.❑[am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10 ❑ Building addition 4.❑[am a homeowner and will be hiring contractors to conduct all work on my property. [will ensure that all contractors either have workers'compensation insurance or are sole 11.❑ Electrical repairs or additions proprietors with no employees. 12 �Plumbing repairs or additions 5.❑ — [am a general contractor and I have hired the sub-contractors listed on the attached sheet. Q ROOF repairs These sub-contractors have employees and have workers'comp.insurance. 6.Q We are a corporation and its officers have exercised their right of exemption per MGL C. 14. er 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 0 Policy#or Self-ins. Lic. #: WC J5' — 31 — 3 66 b Expiration Date: f o Job Site Address: 31-1 212P—k�E 219 City/State/Zip: 03 IX)*'yll'e'� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: ,,, Date: Z!S Phone#: ,fib Official use only. Do not write in this area,to be completed by city or town offieiaL 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#: oFt►te rq�� Town o arns anle *Permit# �= 070 Expir s 6 s r issue date Regulatory Services Fee Thomas F.Geiler,Director 9`bp 1039. 1% ��� �7" . Building Division _ 7 2008 Tom Perry,CBO, Building Commissioner TOW 200 Main Street, Hyannis,MA 02601 N ®F www.town.barnstable.ma.us Office: 508-862-03sNSTggLE Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of Work 0 o Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address /v,/9 p e- W7A7sAll Contractor's Name zy, Y.r4 Telephone Number : L Home Improvement Contractor License#(if applicable) ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to 1 ❑ Re-roof(not stripping. Going over existing layers of roof) t ❑ Re-side ene X/✓G1211ef'W l�•rr�llu/f `T ®' Replacement Windows/doors/sliders. U-Value (maximum .44) *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. I; A copy of the Home Improvement Contractors License is required. ' _ r r} I yl SIGNATURE: y? Q:Forms:bu ild ingpermits/express Revise112807 I I I j ✓die V ominwm�u o�✓ aaaac�u A. a Board of Buildin Itc ulapons aitd Stantiard� Licerse.or re istration vabd d' tndividul use onl HOME~IMPROVEMENT'CONTRACTOR ueforeahe expiration date II found return to: - Board<of BSildmg Regulations and Standards Registration 133032 One Ashburton P,Iace Rm 1301 ' Expiration 5/1-/2009 Tr# 128912 Boston,Ma.02]08 .Type Individual DAVID SILVA DAVID SILVA 3` _ :. Administrator - Not valid without signature W.WAREHAM,MA 02576 _ . . r ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' wrvw.mass.gov/dia ' Workers'Compensation Insurance Affiddvit: Builders/Contractors/Eleetriciam/Plumbers A licant Information Please Print Lefdbly Name(Business/Organ-tiowbdividual): A VA: Address• City/State/Zip: �SW Phone.#: Are you an employer?Check the appropriate box: :Type of project(required):. 4. I am a general contractor and I 1.❑ I am a employer with 6. ❑New construction . employees(full and/or part time).*• have hired the sub-contractors �I am a'sole proprietor or partner- listed on llte•attached sheet. 7. []Remodeling ship and have no employees 'These sub-contractors have g• Demolition' �Vorldn for me in an capacity. employees and have workers' g Y P tY 9. ❑Bwlding addition [No workers' comp.insurance comp.insurance t 5. We are a corporation and its 10.❑Electrical repairs or additions required.] ' 3.❑ I am a homeowner doing all work . officers have exercised their 11.0 Plumbing repairs or additions ' myself[No workers' comp. right bf 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 anew affidavit indicating•such. 1Contractars that check this box mutt attached an additional sheet showing the name of the subcontractors mad state whether ornot those entities have employees. If the sub-contractors.have employees,they must providb their workers'comp.policy number. I am an employer that is providing workers'compensation insurance fir my employees. Below isthe policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.A Expiration Date: - lob Site Address: City/State/Zip. Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Fadure.to sectae 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 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 1)IA 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 ature Date: ' •/ _ Phone 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#: I , o f FtHEl Town of Barnstable Regulatory Services BARNSrABMAB&1 E Thomas F.Geiler,Director 1639. i°lF 3.+' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, ariY��P,: 11 , as Owner of the subject property hereby !'F authorize ,���`� J y��� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) O 2) nature of Wr D to Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&O WNERPERMISSION Town of Barnstable I MWETDwti o� Regulatory Services � BARNSTABLE, Thomas F.Geiler,Director MASS. 9q, .639. � Building Division AlfD �p Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt