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HomeMy WebLinkAbout0245 CEDAR STREET IN SMEA® No.53LOR UPC 12543 smead.eom a Made in USA ICY 2Jet CLb�'� Ak iSOERTSW FmusmlmTmp Dwtm SFIAlEMW M, ° UWNG _ I � October 30, 2012 Robin C.Anderson Town of Barnstable Zoning Enforcement Officer 200 Main Street Hyannis, MA 02601 From: Karen Cooper 245 Cedar Street West Barnstable, MA 02668 Dear Ms.Anderson: Re: 263 Cedar Street,West Barnstable MA 02668 Please consider this document a formal letter of complaint regarding the property located at 263 Cedar Street,West Barnstable (Denise Bell residence). The regrade of the Bell property along our property line at 245 Cedar Street was completed in such a way that run-off from the construction is causing°clear water damage to our property.Visible silt from the construction site is now making its way 3/4 across our property line (photo attached). Please note when the property was first regraded,we reached out to the owner regarding our concern and were told that they were working on a drainage plan with Down Cape Engineering.As I understand,the plans were drawn up, never paid for,and they instead created a makeshift and unsightly berm (photo attached) to P S retain the water that is clearly failing.Additionally,you'll notice the area has been lined with stumps left over from the regrade, creating what may be considered a "stump dump"and contributing to an unsightly property border.We also have concerns of fire hazard given the excessive and dried out nature of the stumps. As the property has recently gone up for sale,and we are at the same time in the process of attempting to build a house in the area of the construction, I am eager to come to resolution with the current owner, or,have record of the issue so that it be addressed by any potential new owner. That said, I have communicated my concerns with Denise Bell and she has indicated that they do not have the funds to resolve as they are in Chapter 13.She also indicated an expectation of foreclosure/auction. Please let me know what can be done to resolve this issue. It is a clear and unreasonable nuisance that is negatively impacting our property value,use and enjoyment. Many thanks, Karen Cooper Cell: 617 480 1574 _ Email: kcooper521@yahoo.com cc: Thomas Perry i Message O csl�l W6 Page 1 of 1 Anderson, Robin From: Anderson, Robin Sent: Wednesday, November 14, 2012 3:10 PM To: 'kcooper521 @yahoo.com' Subject: Bell Property -263 Cedar HI Karen, I re-read your letter and have spoken to the building commissioner about this issue. First, because the subject property is currently in Chapter 13 ,-all bets are off. We can't force the applicant to proceed with site improvements if there is no money to pay the contractors for labor or materials. Certainly, the Bells are not skilled and able to perform the necessary site work themselves. At this juncture, suggesting anything to Mrs. Bell is pointless and as you are aware communication would be difficult at best as well as not likely to be received well. I think we must now rely on the hope that the property will convey to some other party who may be more financially stable with desires to be a proactive member of this community as well as a good neighbor. I will advise you if I hear of any proposed sale or project involving this site. I hope you are not discouraged and I anticipate that this will work out for the best of all involved. ft6in 7Zobin C -Anderson Zoning Enforcement Officer Town of BarnstabCe 200 .Main Street Hyannis, NA 026o1 5o8-862-4027 11/14/2012 Town -of Barnstable *Permit#P?a - E R M IT Expires 6ma dateRegulatory Services Fee B&arvsr 33 Thomas F. Geiler,Director Building Division TOWN QR EARNSTABLE 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 APPIKATION - .RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number oo Property.Address L L(s G-Gt-(i_� s Residential Value of Work /�B®®�Q�O Minimum fee of$35.00 for work under$6000.00 Owner'sName&Address Contractor's Name .,� G S (�7'L C ec4 Telephone Number_ (o'� , V,0. (S Y Home Improvement Contractor License#(if applicable) I S 3 1 t Construction Supervisor's License#(if applicable) i0 q 1 O T OWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 0 I have Worker's Compensation Insurance Insurance Company Name ' Ft-Cq-�-n, Workman's Comp.Policy# LA-,-,f = D—a G .- ©©4 -Q Copy of Insurance Compliance Certificate mast accompany each permit, ' Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to t/f ► ,�C, c u�,,. �, ., ❑Re-roof(hurricane nailed)(not stripping. Going over existing-layers ofroof) ❑ Re-side #of doors �] Replacement Windows/doors/sliders.U-Value o1 (maximum 35)#of windows D ❑ 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 uired. i SIGNATURE: Q\WFIL.ESTORMS\building permit formsUDIPRFSS.doo i 1 \w \ The Commonwealth of Massachusetts VDepartment 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 Lezibly. Name(Business/Organization/Individual): '� W_ G��" Address: Y_0 i� City/State/Zip: Phone.#: S U!9 -1 3. `7 q� Are you an employer? Check the appropriate box: Type of project(required):. 1. I am a with employer 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. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp. insurance.t 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 l l.❑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. xContractors 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: -A—CA-0(V}- i4v�. o� t/AA-V- Cc Policy#or Self-ins. Lic.#: W C _-10 -d-G - OQ 00 'v Expiration Date: 0S Job Site Address: � ,5 C,04, �' City/State/Zip: 9W'Xl 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 certi r the pains and penalties of perjury that the information provided above is true and correct. Si afore: C_ y Date: a lad 12 Phone#: SO 13 .� S 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#: J, 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,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall 4 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-contractors)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 permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"I:he applicant should write"an-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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call.. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of lndustrial Accidents Of-flee o'f Investigations 640 Washington Street Boston, MA 02111 Tel. #617-727-4500 W-406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749- www.mass.gov/dia ' THE toys Town of Barnstable Regulatory Services _. iARNSTABLE, • y M+uss. g Thomas F.Geiler,Director �fo.19. Building Division Tom Perry,Building Commissioner. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8. Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder I, 1 �R�-- , as Owner of the subject propeity hereby authorize �° F �iw`��x(.�^� to act on my behalf, in all matters relative to work authorized by this building permit. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. CA Signature of Owner S' ture of Applicant Print Name Print Name ® Date Q:FORMS:OWNERPERMlSSIONPOOLS 62012 f r r Town of Barnstable Regulatory Services BARNszABLE, : Thomas F.Geiler,Director nsnss. 9q,,o 1639. .m� Building Division . Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 .,w .town.barnstable.ina.us Office: 508-862-4038 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 s 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 5, 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 Barnstable Old Dings Highway Historic District Committee 200 Main Street, Hyannis,MA 02601,TEL: 508-862-4787 Fax 508-862-4784 MASS APPLICATION, CERTIFICATE OF APPROPRIATENESS Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter. 470,Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application for: Check all categories-that apply; 1. Buildiniz construction: ❑ New ❑ Addition Alteration 2. Type of Building: *Ouse ❑ Garage/barn ❑ Shed ❑ Commercial ❑ Other 3. Exterior Painting roof ❑ new roof color/material change, of trim, siding, window, door 4. Ste: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign 5. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Retaining wall ❑ Tennis court Other,w (]Y 6. Pool ❑ Swimming ❑ Other man-made pool ❑ Solar panels ❑ }ther � : Type or Print Legibly: Date '7111 r=p 7 Z NOTE All applications must be signed by the current owner ,•.;T1 O Owner(print): li/W 9 Telephone#: 2- Address of Proposed Work: 2 L4 S Village td, jlo Liv s"Ti4/3G6 ap Lot# %-4S/aQ2— Mailing Address(if different ��-� Owner's Signature Description of Proposed Work: Give particulars of work to be done: " 1 r v Li s Agent or Contractor(print): C�,1 l�S 7Cl e— /`-0 - Telephone#: .5�f 93 79 t_­i Z Address: Contractor/Agent' signature: For co 'ttee use only. This Certificate is hereb APPROVEDJDENIED Date Members signatures RECEIVED OA�4 ALI Aug 0 0101Z OWTH NAGNT APPROVE® Town of Barnstable 1 Old Kingt Highway QABoards wui Commissions\01d Kings Highway\OKH Applications\OKH DRAFT 2011 Cen Appropriateness DRAFT.doc Committee CERTIFICATE OF APPROPRIATENESS SPEC SHEET Please submit 5 COpieS Foundation Type: (Max. 12"exposed) (material -brick/cement, other) Siding Type: Clapboard_ shingle_ other. Material: red cedar white cedar other Color: Chimney Material: Color: Roof Material: (make&style) Color: Roof Pitch(s): (7/12 minimum) (specify on plans for new buildings, major additions) Window and door trim material: wood other material, specify Size of comerboards size of casings(1 X 4 min.) color Rakes Ist member 2i'member Depth of overhang Window: (make/model) material V1.il color (.J�4-' (Provide windom,schedule on plk for new buildings, major r dilions) Window grills(please check all that appl)j_: true divided lights— exterior glued grills_ grills between glass removable interior_ None Door style and make: material Color: Garage Door,Style Size of opening Material Color Shutter Type/Style/Material: Color: Gutter Type/Material: Color: GROWTH MANAGEMENT Deck material: wood other material, specify Color: Skylight, type/make/model/: material Color: Size: Sign size: Type/Materials: Color: A P P R \I M Fence Type(max 6' ) Style material: Color: 2-2 2012 Retaining wall: Material: Town be.of Barnstable MS ACommittee Lighting, freestanding on building illuminating sign OTHER INFORMATION: THE ATTACHED CHECK LIST MUST BE COMPLETED AND SUBMITTED Please provide samples of 4paintrs,manufacturers brochure of windows,doors,garage door,fences,lamp posts etc Signed: (plan preparer) Print Name `� � ica�>✓7� 2 QABoards and Cointnissions\Old Kirzgs Highwa)AOKH ApplicatiotLAM DRAFT 2011 Cen Appropriateness DRAFT.doc Town of Barnstable Geographic Information System August 6,2012 131058 131013003 • 131O38 131051 131047 0390 131006 0312 131013006 4111` 045 060 039' 131035 0339 818 t0 Z7 13044 10 30 131014 �0272 . 131019 0326 131034 131053 108008 030 0 500 131005 131 Q32 0919 8353 t 02311 238 1310/8 0 385 131016 ® , �B 226 131028)l' 0 340 191033 0 38W 191003 0263 131080001 lb 0 015 625 c 131017 Q� 131027001 0 825 13100 ��VV 0 396 �V ♦ 0 378 #245Oyu 191027002 131059 0 394 0206 130008 � an 0400 13106DO02 031 •• 130007 ® 491 0�6a #431 190008 �0 130005 130033 0449 (1#30 07A448 `� 130009 ♦ 0571 � . 8136 130001 130003 • ♦130010 00 r 0496 0`Z2 . . 130004 • 130023 190036 0476 0� 13 028 �0145 0474 190022 130035 0 108 Feet �.0575 V % 0135 130031 0106 0111 OISCLAIMERS:This map Is for planning purposes only. It is not adequate for legal Map:131 Parcel:002 boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner.COOPER,JOHN E&KAREN M Total Assessed Value:$240100 Selected Parcel V.100'may not meet established map accuracy standards.The parcel lines on this map E are only graphic representations of Assessors tax parcels.They are not true property Co-owner: Acreage:2.22 acres Abutters ' boundaries and do not represent accurate relationships to physical features on the map Location:245 CEDAR STREET '! ' such as building locations. Buffer �fZT; W+ 1. r . 1 ,•..-�-..-.-.,..lam �-_� .a.__ ,,.,.,, c Y � � x 4 JCDP � 0 r , r �;p r f F� D-0 HARVEY Mt BUILDING PRODUCTS Classic ' Double Hung Replacement Window ol 1 1191 � ..1 �rs� .y. ,� •� +, --y-��,. * Yam, ,i. Y_ i -- �� APPROVED �. 'AUG 2 2 2012 1� Town of Barnstable -Old Kings Highway_ _ I Comma 1 0 ' r I le Classic features The Harvey Classic vinyl double hung replacement window offers a variety of styles,colors and options to meet any homeowner's needs.The Classic window is custom made to tit with very little carpentry needed,reducing installation time and mess.Our sleek fully welded sash and frame design provides a one-piece sloped sill and better performance than ordinary vinyl windows,with an air-tight seal that keeps wind and water where they belong—outside.Consult your professional contractor to discuss which options are right for you. A •ENERGY STAR'qualified with optional ENERGY STAR glazing package •Available with BetterGrainTM premium woodgrain finish •Factory calibrated block&tackle sash balances never need adjustment or lubrication �., •Ventilation limit latches that keep top or bottom sash partially open •r �wt :t& rigs„p •Locking fiberglass half screen F •Color-matched hardware with Brasstone and r ti optional Brushed Nickel F •Vinyl head expander and adjustable vinyl sill expander •Available with optional Harvey Virtually Invisible Enhanced Window Screen(VIEWS) }� APPROVED � AP 0 ---- AUG 2.2 2012 3 E Town of Barnstable - Old Kingt Highway i Committee Tift-in top r<_ and bottom ! sash for - �y� easy cleaning. t hardware Low-profile Cam Lock White Almond Bronze Brasstona Brushed Nickel OB-Bonded Bronze (standard white) gr. configurations oMe ed Exterior Simulated 1 P o� rids Between Glass)Glass) Grid PackageDividly!ed Lites / :� N s/B � SIB' 7(' SIB^ ��.4 .rl�lf■ tt� AED AUG 22 2012 �"* ram. Town of Barnstable Interior Applied, son Old Kings Highway �. Committee t" t GBG and Exterior Applied •"""""'�• Colonial Prairie Custom configivations available upon request. Color-Matched Color-Matched glazing additional options packages .Low-E •Bronze Tmt Half Screen Full Screen •Base •Low-E/Argon •DP 50 Upgrade •Rberglass Wire •Fiberglass Wire G on •ENERGY STAR •Douce low- � SftcW NkAlion •.Aluminum Wire •Alumnum Wire •Osage •Foam Wrap .WWly Invisible MEWS) •Uutually Invisible MEMj •Tempered •AMrays Active Limit Latch exterior colors Exterior colors are paint finishes and are available for products with whHe or almond Interior only. AlMh 0 Amazon Green Backwood Black Bronze Buff Burgundy Cashmere Gay Copper a • a • O • Cranberry Fire Engine Red Forest Green Grey Harvey Almond Harvey Bronze Ivory Ivy Green Leaf Green Old World Blue Sable SandaMrood Sandstone Silva Metallic Tile Red Universal Wedgewood White Wicker Broom interior colors BetterGrain finishes • O @ • Almond Bronze White Pine Red Cedar Dark oak „P—JAR HARVEY Interior colors are dear-through vlq colors.Painted or BetterGrain Interiors will not have limit latches. Iff 0, BUILDING PRODUCTS I Or r u; Massachusetts Workers' Compensation Insurance Plan Acadia Insurance Company Administered.by Berkley Risk Administrators Company, LLC PO Box 1100, MpIs, MN 55440-1100 222 S 9th St, Mpls, MN 55402 Acadia Insurance® Phone(605) 945-2144 Fax(866)215-8118 Toll Free(800)634-4589 NCCI Carrier Code 33391 CERTIFICATE OF INSURANCE 1. The Insured: WCIP Policy Number: WC-20-20-000092-05 Carlos Figueiroa Tax ID#: F 01-8723094 dba: C N F'Remodeling 20 Captain Noyes Rd Policy Period: From: 5/1/2012 To: 5/1/2013 South Yarmouth, MA 02664 Date of Mailing:..5/15/2012 The Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Cerftifiqaite does.not amend e..tenri Cnwprp^o of ordod-b j the PC!.--y lictord help f:_ ... . This is to certify that the Policy of Insurance described herein has 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,... insurance afforded by the Policy described herein is subject to all the terms, exclusions and conditions of such Policy. P ,0 f1NSURAINM LIMITS Coverage 9 Part One State(s) Workers'Compensation Statutory MA Part Two Bodily Injury by Accident $500,000 each accident. Employers' Liability Bodily Injury by'Disease $500,000 policy limit. Bodily Injury by Disease $500,000 each employee. Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. All Entities/Insureds: Certificate Holders Name and Address: Figueiroa Election Election ;;�ceve Fuw) %r Category Status Name 166 Ubper,.'-: Vjntv.R:! Sole Proprietor Include Carlos Figueiroa i ^his, MAU12:,za Date Issued: 5/15/2012 Leonard Insurance Agency Inc 683 Main St B Ostervil le, MA 02655 Signature_ •:: #' i .LoIt7OI . ,:a1.. £LOZ/SZ/8 :uoi{endx�- • `p'il . b99ZO VN 'H.Lnovvi•v k H1f1OS (18 S3AON NIVIdVO70Z V0O 113noiJ S0i21Ho . . I LOIh0L SO :aSuair{ • asuaOI-1 aoslnaadn' uol�DI-111S O-) j'•.51j.11;I1u1:)sj pllr. .unilv.p1':;)N u11jIi11fi.J(i Il.lr.(1� A ` all C 11 f n /1 {II Yt11J.11:(IJ tiIjJILI ,11:�`1: .. License or registration valid for mdjvidul ruse only, before.the expiration date. If found return to; Office of Consumer Affairs and Business Regulation '10 Park Plaza-Su.ite.5170 i! Boston,MA 02116 � Not-vali. without signature k, Ed 11 'r'NY:ei) :��i•� i ' ti.""'me``:'µ'`'LO L4p"L . ;tJ.1 '.i.��n•�>-��iui r.��"j. i " ;�• 1199ZOVNW Hinovy iv A. > 08 S3J.0N".NIV-Ld` 0-TDZ c^ tf02i13C1J1-A S0�2i`d� LOLti0L S3 :asua:Jl� i F • asuaol-j Jaslr,JaclnS uoi;,-)!1 S jc� "."! !j T � i 4 5x. off-Ice.(if Consumer Affairs&B siness Regulatton { HOME IMFROVEMENT'CONTRACTOR Type ; Registration ,,153792 " pBA a Expiration 11812013 4' r- �a C& .-REMODELING �,I y icl C'ARLOS FIGUEIRA �> ' 20 CAPTAIN NO..... S.YARMOUTH;MA 02604= Undersecretary" Town of Barnstable *Permit ' Regulatory Services F e 6�° sate >�ar�srwsie, 1 L ' Thomas F.Geiler,Director rft)MAt e Building Division Tom Perry,CBO, Building Commissioner j 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508'-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY .�7 L Not Valid without Red X-Press Imprint Map/parcel Number T//�� (� f Property_Address �'1 G_ S C - '. o t `�— l�J ❑Residential Value of Work U� a-0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 14tk—, C4`d c-- 1 N1�4 Contractor's Name Telephone Numb A � c7��.) Home Improvement Contractor License#(if applicable)_ 15 j I ct..- Construction Supervisor's License#(if applicable) 0 it 0.4 j ❑Workman's Compensation Insurance X Check one: ❑ I am a sole proprietor AUG — 3 2012 ❑ I am the Homeowner �. I have Worker's Compensation Insurance Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy#. Ca 0 "(.2 ,r0 .Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 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 #of doors ❑ Replacement Windows/doors/sliders.U-Value (ma)imum.35)#of windows ❑ 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. P SIGNATURE: Au Q:IWPFILES\FO bpi ' g permit forms\FMRFSS.doe ° Revised 053012 i t The Commanwea#h of Massachusetts Deparhnent of Industrial Accidents Office o,f Inticestigations ' 600 Washington,Shwet Boston,MA 02111 wwm mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Ekectricians/Plumbers Applicant Information Please Print 'b Name . Address_ o t�s ff2 0 cityis zip P � SOP � 3 �1 Are you an employer?Check t appropriate bo�j�'',��� Type of project(required): I_V4amaemplorrwith 4� I�• ;Ze al contractor sud iloyees(full and/or part-time).# have�the sub-contractors 6. ❑New camstnxtion 2_❑ I am a sole propriekw or partner- listed on the attached sheet. 7-�Remodeling ship and have no employees Thane:sob-contractors have g- ❑Demolition o and have workers' woticing forme in any capacity. '� 9_ ❑Building addition [No workers'camp.invxm,re comp_insurance.$ mod_] .5. ❑ We area corporation and its 10.❑Electrical repairs,or additions 3.❑ I am hbmemmer doing all wodc officers have exemsed their ME]Plumbing repairs or additions, myself[No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required.]T c.152, §1(41 and we have no 7 employees [No worims' 13.❑Otther comp.insurance required] ' Y aPPh�Pont sheds boa#1 mast also fill oat the section below showing-ffi&wodces' polscy infnrmatim T Hnmeawuets who submit this affib"mfficating they ate doing all woA and Poem hit outside contractors must submit anew affidavit is ksung such TC'mtrar>ds that rhea this boor must zttarhed art additiaaal sheet showing the nine eftbe and:stsct whedw otmt these®cities bav-e empk7m. If the subtnatmdaTs hzat employees,they art provide their warlteW comp.paltry mmdw. I am an emplotw that is providing workers'compensation iwurance far arty amply gem Below is the policy and f ob site information. Insurance Company Name: - 1 /— Policy#or Self-ins-Iic.4: �C t CJ CQ��C/�"�-Expiration Date: o l Job Site Address: CJ,,,. 5�. City/Stateizip: ftJ. (� Attach a copy of the workers'compensationpolicp declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL a 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 may be forwarded to the Office of Investigations of the DIA far snsmance coverage verification.. I do hereby certify a a rs and penahies ofpajury that the informathmptmvided above is bus and correct Si Date: a- e Ph 4 - 4q 7 �s � 01'Z r rise only.. Do not awrW in this.area,to be completed by city or town offidat City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health Z.Building Department 3.City/rawn Clerk 4.,Eiectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone N: 6 Massachusetts Workers' Compensation Insurance Plan Acadia Insurance Company Administered by Berkley Risk Administrators Company, LLC PO Box 1100, Mpls, MN 55440-1100 222 S 9th St, Mpls, MN 55402 Acadia Insuranceo Phone (605) 945-2144 Fax(866) 215-8118 Toll Free (800) 634-4589 NCCI Carrier Code 33391 CERTIFICATE OF INSURANCE 1. The Insured: WCIP Policy Number: WC-20-20-000092-05 Carlos Figueiroa Tax ID#: F 01-8723094 dba: C N F Remodeling 20 Captain Noyes Rd Policy Period: From: 5/1/2012 ' To: 5/1/2013 South Yarmouth, MA 02664 Date of Mailing:5/15/2012 The Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder. This Certificate does not amend, extend or a!ter the coverage afforded by the Policy listed below. This is to certify that the Policy of Insurance described herein has 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 Policy described herein is subject to all the terms, exclusions and conditions of such Policy. P. O INS; RANCE IiiItRS®I ,;, Bll l°. Coverage Part One State(s) Workers'Compensation Statutory MA Part Two Bodily Injury by Accident $500,000 each accident. Employers' Liability Bodily Injury by Disease $500,000 policy limit. Bodily Injury by Disease $500,000 each employee. Should any of the above described policies be cancelled before the expiration date thereof, notice will be delivered in accordance with the policy provisions. All Entities/Insureds: Certificate Holder's Name and Address: Figueiroa Election Election Steve Fuwler Category Status Name 166 Upper County Rd Sole Proprietor Include Carlos Figueiroa Dennis, MA 02638 Date Issued: 5/15/2012 Leonard Insurance Agency Inc 683 Main St B Osterville, MA 02655 Signature_ I3r,:irrl of Loiilrlir���l�iirtnl�•,:t �r llt r utiljc it Lion Su �Onstruc nlrrCi'ort.� ;►nrl •S : sty..•: pervis� Licens or Lice tl� i ; e. CS 104107 nse Wm 20.'. . S FIGUEIROA 7-Ai NOY 1.. i SOUTH YAF? ES RD n4 N. MOUTH .MA`02664. n rrnni. , ExpIr ation 8/25/ 261.3 ..a• fr# 104107 ' r ✓/ie eo�neal/,� t i2Zpabacwti Office of Consumer Affairs&B"sineffis'Regulatton: . HOME IMPROVEMENT'CON''TRACTOR `= Registration: 41,53792 TYP?: Expiration: 18/2013 DBA 1 C;8 REMODELING CARLOS FIGUEIROA__, ?> <i 20 CAPTAIN NOYES' Fy 5.YARMOU vri MA �,- ,,e� .•-,.=- Undersecretary cr ' '`�'rl�5�",.,�f�i�"uR—'"r'_--�°_a ..^r«..--�•.,.-2�;•.tu',Rn.:ros'-*^ .�m7�t,�t� ,,�?m�C�.,,'.`' License or registration valid for individul use only g . <beforeathe;expiratio.n date. 'If found return to Offce•of.Consumer-Affairs,and`Busmes�S;Regulation. . , ZO.park Plaza Suite 51'70 - ' k Boston;MA 021i6 . y G Not valid wi 4hout'signature t ll,�a`-wY�t"'�•��c�i�`e'�2.2,�fizz:rtw�-:...� ,.,',_'_"' - .--�-r y I i 7 � � CFTHE - + IARNSfABI E i Town of Barnstable y� 1639. ,eg Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.nia.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section ' If Using A Builder I, . k. r� , as.Owner of the subject property hereby authorize eAr Z, r7 r gL— to act on ray behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) I Signature of Owner Date F Print Name If Property Owner is applying for permit; please complete the Homeowners License Exemption Form on the . reverse side. Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 051811