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Home My WebLink About0390 WIANNO AVENUE 3�jo (�i�.h ro (� v e, --...��- - - �. r _ oF� Town of Barnstable Zr (o P�' O Expires 6 months from issue dales' Regulatory Services Fee , * BAMSTABLE, i6T9. ,0$ Thomas F.Geiler,Director I / / ArFDMA'IA q � �D/I/O Building Division V .Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number d 159 MO Property Address 90 �,y(Q 11✓�� f/40 e 01SS Residential Value of Work Minimum fee of$25.00 for work under$6000.00 �1 . Owner's Name& Address d�V rz hod1h�; Contractor's Name Telephone Number_ Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 3:5�/ /A Workman's Compensation Insurance PREE Check one: XI am a sole proprietor O f'T ..., ❑ I am the Homeowner �� ❑ I have Worker's Compensation Insurance TOVVN C1 BARNSTABLE Insurance Company Name�/��•,L,. Ma-L't' /f �t_0 Workman's Comp. Policy# A?e,"g— /S' �9 71"12'—D/9 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) XRe-roof(stripping old shingles) All construction debris will be.taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required:. Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Lefter of Permission. A copy of the Home Improvement Contractors License& Construction Supervisors License is required. SIGNATURE: l , Q:\WPFILES\F S\building permit forms\EXPRESS.doc Revised 09Q� 9 I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street =�•� 2 Boston, MA 0 111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):_ /yr�� 117" Address: City/State/Zip: ^ ,;U- Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 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 sttb-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its ME] 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 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. 1 / / Insurance Company Name: Policy#or Self-ins. Lic.#:�1�' Z 3/� 371�/D �-�/�' Expiration Date: 3 Job Site Address: L,�� City/State/Zip: d ,1tE e 1%+ LV4_ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si natur . / Date: Phone#• �l — 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#: 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perinit/license number which will be used as a.reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture " (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia JAW Maling Construction 4196 Main Rd. Tiverton, RI 02878 Contract No. 72006-DL (401)624-6824— cell (401) 640-5639 Page t of 2 MA Lic. # 035196 — RI Lic. # 14967 MA HIC # 151245 I/We hereby agree and authorize you as contractor,to furnish all necessary materials,labor and workmanship,to install,construct and place the improvements according to the following specifications,terms and conditions,on the premises below described which VWe represent than we have good record title in our own name. Owner Name(s): Javier Kuong Home Tel.No.: 617-235-2895 Job Phone No.: 781-235-5446 Address: 390 Wianno Ave City. Osterville State:MA Zip:02655 Detailed Description of Work to be Performed and Materials to be Supplied 1. Strip existing wood roof shingles 2. Install 6' of Ice and Water Protection 3. Install 8"Drip edge to all edges 4. Re-lead the chimney 5. Flash valleys with copper where possible 6. Install Certainteed Architectural roof shingles - Color: Resawn Shake with 20yr sure start warranty 7. Hurricane applied 8. Replace Gable Vent on 1 side of house 9. Repair small piece of fascia approx: 3 ft Permits: The contractor agrees to apply for and obtain all constmction related-permits related to the above described work.The contractor shall not be deemed responsible for delays in the work described in this.agreement caused by regulatory,permit granting,or inspection agencies,authorities or individuals. Page 2 of 2 JW Maling Construction 4196 Main Rd, Tiverton, RI 02878 Price: The contractoragrees to do all work described above to the total price of $17,500.00 Payments Terms: Advance Deposit $5,834.00 Payable on signing of the Contract. Materials Delivery Payable on delivery of the Materials Final Balance $11,666.00 Payable on Completion. of Contract Special Payment Terms: The contractor does not have the right to request payments in advance of the times set forth in this agreement, although by agreement, the parties may jointly agree to escrow any portion of the.contract amount. In the event that it becomes necessary to the contractor to employ an attorney to collect any balance due the owner agrees to pay in addition to the said balance, the costs of collection and reasonable attorney' s fees. Work Schedule: The contractor will not begin work or order materials before the third day following the signing of this agreement unless specified in within. The contractor will begin work on or about Sept. 30, 2009. Barring delays caused by circumstances beyond the contractor' s control, the work will be completed in approx. 5 days. The homeowner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the contractor shall not be considered as violations of this agreement. The contractor shall not be liable for any delay or non—performance caused by strikes, accidents, weather or any other contingency beyond its control. Warranties: The contractor warranties its workmanship for a period of two years and assigns the rights to any manufacturer' s warranties to the home owner after the substantial completion and payment of the contract terms. You may cancel this agreement, provided you do so in written, not later than Midnight of the third business day following the signing of this agreement. This instrument sets forth the entire contract between parties and may be modified only by a written instrument executed by both parties. HOMEOWNER: Do, not sign this contract if there are any blank spaces. IN IYITNESS WHEREOF, the parties hereunto signed their names this rn TKday of _ 2005 1� 1 JIMaling Construction Homeowner Repre/7,,l ative Homeowner Notes: a 71. y Board of Building Regulations a nd Standards HOME IMEMENT CONTRACTOR Registry Ion, •151245 E p'rat'9n-5J23/2010 Tr# 266180 ffi s S1 Et=CTI 1, JW MALING CO - JAMES MAILING 4196 MAIN ROAD T-- r TIVERTON,RI 02838 Administrator 71. Coanvnzo�zure o�✓�aoaacfcu4Plta oard of Building Regulations and Standards Constructioh Supervisor License Lic rlse: CS 35196 I E1 p raflo:n: Q/2010 Tr# 12612 '. R -- • Srfctio._. 0 � JAMES W MALIN, 4196 MAIN RD I TIVERTON,RI 02878 Commissioner ( License or registration valid for individul use only before the expiration date. If found return to: i. Board of Building Regulations and Standards ! r One Ashburton Place Rm 1301 i :.. Boston,Ma:02108 Not valid witho signat e Assessor',map`mnd lot number .. ........................ �'j�1.A IN 6OMPUA1104 � W TH TITLE 5 � y°F t,�♦ Sewage Permit numb r 3. �v. �....:�. .. ONMENTAL C£9 '"� � THE 9� Ve�� Ta� � � Z HASd9TAM i House number .... ... ... ....4�.......�..................................... T 9 rasa 00 t639• 0UPYa TOWA OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....�°'`�s...'?rn 4.�r......��.....�`!.,E�c%u :............... 1AJ2 TYPE OF CONSTRUCTION /4'*,4 �Q ........................................................................... ......................... .................. 7 .v.............19.. 3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �0 / 5 li()/ Ar A]4J d �� QS'r�tZ d 1,e .- Location ...............................................................................:....................................................................................................... c ProposedUse ....................� .................................. ......'.................................................................:................................ ZoningDistrict ....... G......................................................Fire District ..... ve- .......................................................... Name of Owner .!!..:�"2r� `" .� .................Address 0t /t/ cJ t // ....................... ..............................,l................................................... !/• Name o 'Builder ! ...........Address .. h........! .............�.................................................. Nameof Architect ..................................................................Address ............................. ..................................................... y v N Number of Rooms .........1........................................................Foundation f............. 0`..c...'G............. Exterior ...�.(.fda4llr.....G�G' iC.4fZ�Q...................Roofing ...........................................�J` l> .. -c........ Floors ...................... ........:............?....g .�.:7........Interior ............L�$ ........................................................................ . I Heating ................Plumbin... ...... i4-?�LIL......... ........! g ................. .. Fireplace ................`g................:..........................................Approximate. Cost d�.........r.............................................. Definitive Plan Approved by Planning Board -----------_------_-----------19_______. Area �- YC. 2........... Diagram of Lot and Building with Dimensions Fee IF SUBJECT TO APPROVAL OF BOARD OF HEALTH B6 410 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To of Barnstable regarding the above construction. , Name . ... ..... . ....... ..................... l Const uction Supervisor's License .................................... SHIELDS, ROBERT MrN25446.... Permit for __tort'. ......... r ...... .... .. 0 ............. -,, Single Family Dwel i�ng ................................................... ....... .............. -L cation 390 Wia b. Avenue ........................ ................... Osterville ............................................................................... Owner R6bert Shields .......................................................... Frame Type of Construction .......................................... ............................. ............................................. Plot ............................ Lot ................................ Permit Granted ......August 19,..................................19 83 -,Date of Inspection ....................................19 ..,Date ............:7....... 19 mple e ... ......... 2�g Q � - ��•�y �`w TOWN OF BARNSTABLE Permit No. ----------25446 { ��n Building Inspector cash -------------- -- OCCUPANCY PERMIT Bond _____ r Issued to Robert Shields j Address lot #15 390 Wianno Avenue, Osterville Wiring Inspector � Inspection date Plumbing Inspector Inspection date Gas Inspector Ave,? � /5, Inspection date Engineering Department ,! / � Inspection date, ' Board of Health f�...,f ��!¢- � Inspection date THIS PERMIT WILL'rNOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 1190`°OF THE MASSACHUSETTS STATE BUILDING CODE. ............. 19...... .......... r Building Inspetictor FROM F r TOWN OF BARNSTABLE Mr. Francis Lahteine BUILDING DEPARTMENT Town Cork 367 MAIN STREET HYANNIS, MA OM Phone: 775-1120 L i SUBJECT: FOIDMERE DATE May 220 1984 MESSAGE -Work has been completed under Building Permit #25446 (Robert Shields). Please release Bond. SIGNED' DATE REPLY U SIGNED N87-RMI RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. SENDER:SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. M 1 , �_ JI I � ' a • 0 0 D C WILLIAM Pi r E Nv Iu_:34 o LOGATI VS �U( rAA ofJti /�LGCA ; �V'� G 6 R T I F Y T►4 A T T I-r E CU,,C, RA.AJ p 5"ary►J pLA►,1 R�FEczE►.1GE NFREo►� Go1NtPL�lSU1REN�EuTS OFI T1.1rG � �� ` `� �w(CW►-� .•of ��J S�i�l.lE A�.tD 1S Nu 1 .�LOG•ATE� . WITNI�. F'LoOD PAIIJ 11 ,'LU :�J REGISCCIZ>=D l- wD pAT� o5TE2�/�1_l.E o THIS pLAN IS Ljo TS r-- TS 5140e"w APPI-.I C.A.ti1T" / f I1-4 UM EI•lT 2V C`{ �V GrJ�..t..�-1 t,k,T 8C-. •USC t� To De PC P_titl W� LET Ll i4a,