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HomeMy WebLinkAbout0019 SECOND AVENUE .. S -. .� ,- ` _ �� _., V _ J M l ++�� P � � r z ,. r..�«T.�.«.. _e....�,� .--,.+-..-�+-, —��1�.-«.......m .. �,,.,.f_ _...,r.�......., ..._ .,a.•.,.,.-T-„�.�.Aw....�.i..rr.� .. ..` _....._. .ter. _ ..++*+w+'. - - --+�..w+w...f.. .w.�.+�-�`'.'^\ .- ..•.. i I i I �5= ` " _V 0 0 r Application number......./& • O� 111E ,�? ..................... Fee ......................... �A �............. � BUILDING DEPT. ..... .......................... ` SAMSTAB'E' Building Inspectors Initials.. KAM��6� ��0� JUL ,0 9 20�� JJ Date Issued....l.nl�/�DA. .............................................. TOWN OF BARNSTABLE E Map/Parcel........A� �. . .............................. 9 ao TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WIND O W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 19 Second Avenue Osterville NUMBER STREET VILLAGE Owner's Name: Peter&Conway Van der Wolk Phone Number N/A Email Address: ConwayvanderwolkAyahoo.com Cell Phone Number 804-335-9192 Project cost$8,000.00 Check one Residential �_ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize Macallister Building,Inc. Mark Macallister to make application for a building permit in accordance with 780 CMR Owner Signature: V-- r ate: 7/7/2020 TYPE OF WORK 0 Siding ® Windows (no header change)# 3 0 Insulation/Weatherization © Doors (no header change) # 2 Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to S&J Exco,Dennis,MA CONTRACTOR'S INFORMATION Contractor's name Mark Macallister Home Improvement Contractors Registration(if applicable)# 133744 (attach copy) Construction Supervisor's License# CS-079358 (attach copy) Email of Contractor mark.macallister@gmail.com Phone number 508-889-2441 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. APPLICATION NUMBER .............................................. ............ *For Tents Only* Da Tent(s) will be erected Removed on number of tent otal Does e tent have sides? Yes No (If yes please attach floor plan wit exits marked) Dimensio of each Tent X X , Additional to dimensions can be attached on a separate piece of paper. Purpose of Even Check one: this ev t is a: for profit non-profit event Check one: Food sery Yes No Flame Spread Sheet of e tent must be attached. Provide a site n with the location(s) of each tent If food is being served at your ent please obtain a event epartment approval between the hours of 8:00am-9:30 am or 3:30 pm- . Opm. Commercial ev is may require Fire Department approval. *WOOD/CN/PELJZT STOVES Manufacturer# Model /I.D. Fuel Type /ng.L Offsets from combustibles: frontk left side right side HO OWNER'S LICENSE EXEM ION Homeowner's Name Telephone N er Cell or Work number I underst d my responsibilities under the rules and regulations for Licensed nstruction Superv' or in accordance with 780 CMR the Massachusetts State Building Code. understand the nstruction inspection procedures, specific inspections and documentation requ ed by 780 C R and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature 41a4kftxz pb Date 7/7/2020 All permit applications are subject to a building official's approval prior to issuance. I CERTIFICATE OF LIABILITY INSURANCE DATE / 0 3/0/02/2020 1) 020 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 have ADDITIONAL INSURED provisions or 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 Kathy Silvia NAME: The Fair Insurance Agency Inc. AICNNo Ext: (508)775-3131 FAC No): (508)790 1677 619 Main Street EMAIL kathy@thefairagency.com ADDRESS: Suite 1 INSURER(S)AFFORDING COVERAGE NAIC# Centerville MA 02632 INSURERA: Evanston Insurance Comapny INSURED INSURERB: Safety Indemnity Ins.Co. 33618 Macallister Building Inc INSURER C: Star insurance Company 18023 64 Ebenezer Road INSURER D: INSURER E: Osterville MA 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: Updated 19-20-21 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDDY EFF POL ICY EXP Dl LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 500,000 CLAIMS-MADE DAMAGE TO RENTEIT- a OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any one person) $ 10,000 A 3ET2763 08/11/2019 08/11/2020 PERSONAL&ADV INJURY $ 500,000 GEN•LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 1,000,000 POLICY JECOT- El LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ 250,000 B OWNED X SCHEDULED 6248835 10/12/2019 10/12/2020 BODILY INJURY(Per accident) $ 500,000 AUTOS ONLY AUTOS HIRED HNON-OWNED PROPERTY DAMAGE $ 250,000 AUTOS ONLY AUTOS ONLY Par. er accdent Underinsured motorist BI $ 250,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ ;EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED RETENTION $ $ WORKERS COMPENSATION RA OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 100,000 C ONYCERIMEMB R/PARTNER/EXECUTIVE ❑ NIA WC0632030 03/01/2020 03/01/2021 E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) 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. South Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Co nskv9-t*-A%Wp��rvisor r CS-079358 w <,.4 apires:08/12/2022 MARK A MACIALLIS°°TER" 64 ESENEZEk,RD; OSTERVILLE NA,02655 Commissioner dtQ CUIIL�M' ala— Y` Office of Consumer Affairs&Business Regulation } HOME IMPROVEMENT EONTRACTOR Registration valid for individual use only. ' V-PE:Individual Registration Expiration - before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation 133744 08/02Y2021 T 1000 Washington Street -Suite 710 MARK MACALUSTE-R Boston,MA 02118 MARK A.MACAL�IISTEf.Z/ �✓ 64 EBENEZER RD:< ; ;,_,.. � fCG•�c/.(s�i't OSTERVILLE,MA 02655 F Not valid without signature ' Undersecretary 9 i • 4 t Assessor's Office(1st floor) Map Lot Permit# q,3 Conservation Office(4th floor) `7 I �af�r Date Issued Board of Health(3rd floor)(8:30-9:30/1:00-2:00) '-' l lo 2 5 -C-Tee IP 16 . Rb Engineering Dept.(3rd floor) House 4 Planning Dept.(1st floor/School Admin. Bldg.) ?� �; • BARNBTABIE. Definitive Plan v by Planning Board o 19 059. SEPTIC SYSTE TOWN OFBARNSTAB PLLED IN COMP L,IAN-SC WITHJITLE5Buildin Permit Application Et / OMMENiAL CODE ANE D Project Stree t Village ea.yy/l Owner AdfZ g.,m �� /1f /fw/T'!� Address LS�r�y Telephone —�"Q$1 --12-g — !�116 Permit Request —70— ✓'`'vivo &-Wy 6 ` 8 Total 1 Story Area(include 1 story garages&decks) /,3'L3(0 square feet Total 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ ,/Z411�". Zoning District C Flood Plain Water Protection Lot Size •Z7 Grandfathered? Zoning Board of Appeals Authorization Recorded Current Use s�'l�`` � ��� , Proposed Use .��{ Construction Type '46Dp )eifo ,n Commercial Residential Dwelling Type: Single Family il� Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House A2 Unfinished Old King's Highway 11114 Number of Baths Z. %� No.of Bedrooms 3 Total Room Count(not including baths) 9 First Floor Heat Type and Fuel 60(41 /a,#S Central Air Nei FireplacesOF Garage: Detached. Other Detached Structures: Pool Attached Barn None ✓ Sheds Y� Other Builder Information ,4/3 713£ --So/Z Name /��¢�,�{ lyj, k..V cC6r&,.4sr/ Telephone Number Address n. ,l3dx /O¢3 License# G 0 > 03 •4wGo il7/� . O/Z3? Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUREZI DATE BUILDING PERMIT 6E IE FOR THE FOLLOWING REASON(S) r FOR OFFICIAL USE ONLY PERMIT NO. 9389 DATE ISSUED 7/2 7[9 5 " MAP/PARCEL NO. 116 066 M 19 Second Avenues a "Osterville a ADDRESS , p VILLAGE Roy & Helen Markwith -d OWNER. DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE, ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f DATE CLOSED OUT ASSOCIATION PLAN NO. �;�!�`���� .. � r is �, - •". OEPARTHENT Of PUBLIC SAFETY CONSTRUCTION.SUP.ERUISOR LICENSE •1 Huber: a Expires: Y Rest ricte4jj E' 00 • ...., t� � HARK.q NCGOYAN _ 'PO'BOX 1043•HAI.N ST !I HANCOCK, hA 01237 � t ,r 1 r { ' r t } S r • --,��r'•�. �, ..tom t��'�"�C>.� . �- � ' . i , 10 Alto ry i �'l�p. .�,'�iSt'If7� .4pb7F'_ 8leN 'is •O.� •. E,aGi,�t,In Confavr : a .... .... �.- -. .,.- , xg pray. -fir7. tor►*oui- _ --e ........-,..-..: I tiIZ s4 747' LOC T1ON SEWo.C,E PERMIT Q0. IWSTQLL R� �� E e�DDR S 4Ee �tGC. ti t-'- - - - DUI DE 5 L�,t�l I-DORE SS DLkTE PERtAVT 155UED DATE CONAPLI &&ICE ISSUED : L� Ll\ c� 7 i 30.9 i 62 r r X28 6,4 7 30.2 -� 6 65 76 117 - , jr r 2 9.0 ' r 132 r , .2 133 i� 13.6 26.3 �i 5 69 34.5 0.6 -- /\34 34. J ; 7� ~ 75-1 33.2 �i 5.3 \3 1 75-2 ;t M 116 75-3 Sz�m LC, 1 = (of) r . . • The Town of Barnstable a►Rrrsr�arE. �0g Department of Health Safety and Environmental Services 1659�- Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-775-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or-to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work: 'Ag/&4 s Est. Cost%?-�T�, doo Address of Work: /z Owner Name: R(V!E4 f,'�0,0 Date of Permit Application: f/g I hereby certifv that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000 Building not owner-occupied Omer pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: z?;' ate Contractor name Registration No. - OR Date Owner's name 111102•'94 17:02 $817 727 7122 DEPT IND ACCID 1600 Cot)unoniUeaftla o/ &Jacf/u6etb �Pft V.0 0 oUoPartmenl o��ndu�fria[.�1ccu�enrF! 600 Wuhinglan Stmsl James J.Campbell & on, ///amac" 02f f f Commissioner Workers' Compensation Insurance Affidavit with a principal place of business at: Via-adx la, -3 9 do hereby certify under the pains and penalties of perjury, that: () I am an employer providing workers' compensation coverage for my employees working on this job. insurance Company Policy Number () I am a sole proprietor and have no one working for me in any capacity. ( I am a sole proprietor general c�ecrllorwing r homeowner (circle one) and have hired the contractors lined below w workers' compensation policies: WC Contractor Insurance Company/Policy Humber Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number () I am a homeowner performing all the work myself. I undt::-stind t :t a copy of dais sltenent will be fomzrded to cite Office of lnvestirations of the 01A for cos�erage verification and that failure to secure cove-age as recc-ired under Section 25A of MGL 152 can lead to the tnposition of criminal penalties consistintt of a fine of up to s 1,so0.00 and/or cc years' impriscrrnent u well as civil penalties in the tom:of a STOP WORK ORDER and a fine of S 100.00 a day against me. Signed this / day of 'd/ 19 Licensee/Pe tee Building Department Licensing Board Selectmens Office Health Department TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 � ..,...... .... .....w.nm�n7 r+ r.•.Tr rTw.n rirn�,f.TT lf... � l ti. e y ;k + I , At a - I O • M s n I • � a N c v IR h � ' 0 �n n ' N R � O fit y � A� y o � c Ve I _..._......._.._'......._..... — I. s• 14 El Io ^ I c 1\ ( I I ' h i-�---- r ---- 3i I I I a �o O O P N4► � I 13 �44 a I • I. I , i '! I , 1 I Z j + V V r m h v ; ';� � _ Ire � � - ��� , •; ,�lK II N � A A h \a , i 0� h a � � t � 1