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HomeMy WebLinkAbout0288 ARROWHEAD DRIVE a�88 �b'iau �i�ao� c� � . Town of Barnstable ��Il��Il� `Post.Th�s Card So That it is.Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept .� !Posted Until Final Inspection Has Been Made. Permit ell 1}. m t Mld• Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. 11 Permit No. B-20-2276 Applicant Name: Adam Glenn Approvals Date Issued: 09/02/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 03/02/2021 Foundation: Location: 288 ARROWHEAD DRIVE,HYANNIS F , Map/Lot: 270-_094 Zoning District: RB Sheathing: Owner on Record: CHAUSSE,AMY SEVANNE&SCOTT WAY NE Contractor NameNADAM GLENN Framing: 1 Address: 288 ARROWHEAD DRIVE ' Contractor License: CSSL-106148 2 HYANNIS, MA 02601 , Est. Project Cost: $7,000.00 Chimney: Description: Residential weatherization/air sealing through the Mass Save Permit Fee: $85.70 f Insulation: Program. No structural changes.Site I.D:291836 Fee Paid:, $85.70 l Date: 9/2/2020 Final: Project Review Req: L� Plumbing/Gas Rough Plumbing: E�. \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after`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 shall 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. i 1�------ 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:i re' Service: 1.Foundation or Footing � Rough: 2.Sheathing Inspection -- 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 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). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable *Permit Regulatory Services fee 6mo om Issue date MASS. Richard V.Scab,Director. 163 Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 r www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERAHT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �7 y Property Address r,? RRC)(,A El/Residentiai Value of work s. 3, 09 a , 7 5 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address I'?�� c VIP. Contractor's Name OLV l� C, Telephone Number Dfb- QI f-f5—"C)3-m Home Improvement Contractor License#(if applicable) 3/ / Email: Construction Supervisor's License#(if applicable) Q 9 O=D 9 I. 6 Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I e the Homeowner AU , D have Worker's Compensation Imurance- OM1 Insurance Company Name / C_ ✓ 64 Pq . Workman's Comp.Policy# U) CC "�()� ' �')0 --QQ 19 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) I [ale-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to, � LCJ ►J 1 -- ❑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: *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 requi SIGNATURE: Q NWI)FILES\FORMS\buildmg permit fbrmsWMRESS.doC 01/25/17 ` The Commonwealth of Massach tcsetts W Department olIndustrialAccidents 1 Congress Street, Suite 100 Boston, MA 027114-2017 ww),lk inass.govIdin «=oricers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/P lumbers. TO BE FILED WITHTHE PC,RAI1'Pl'ING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Muto Inc Address: 1621 Orleans Road City/State/Zip: Harwich,MA 02645 Phone#: 508-945-0300 Are you an employer?Check the appropriate box: Type of project(required): i IijeI am a employer with employees(full and/or part-time).* 7. New construction 2.Q i am a sole proprietor or partnership and have no employees working for me in $. Remodeling. any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t .10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property..I will ensure that all contractors either have workers'compensation insurance or are sole 11:❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired thesub=contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp. insurance.$ 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[�OtheC 152,§1(4),and we have no employees.(No workers'comp.insurance required.] *Any applicant that checks box#I 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. LContractors 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 ant an employer that is providing ivorlcers'compensation insurance for.my employees. Below is the policy and job site information. Insurance Company Name: Associated Employers Insurance Company Policy#or Self-ins.Lic.#: WC:C-500-5007100-2017 Expiration Date: 4/24/2017 Job Site Address.,C�9&8 A-17RDl.✓.!'1 ,�i2 CitylState/Zip ,,��,,,l/' i��vf S r Ij v' 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 bya 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 tinder he prtins aced penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official ff use only. Do not write if:this area,to be completed by city or tmvtr-offtciaL City or Town: - Permit/License# Llls4sudrngority(circle one):Health 2.Building Department 3.CitylTown Cleric 4. Electrical Inspector 5.Plum bins Inspectorson: ., Phone#: j i MUTOINC-61 AONEIL CERTIFICATE OF LIABILITY INSURANCE °"�`��°"YYY' 06/28/2017 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 7 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(les)must have ADDITIONAL INSURED provisions or be endorsed. N SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certaln policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CT Rogers 48 Gray Insurance Agency,Inc.34 NONE ,Eye FAX,N.):877 8162158 South Dennis,MA 02600 Mkss:mail ro ers ra .com INSURE S NO COVERAGE NAICg INSURER A:Selective Insurance Com an Of South Carolina 19259 INSURED INSURER e:Associated Employers Insurance Company 11104 Jason G.Muto INSURER C.,1621 Orleans Rd Harwich,MA 02645 INSURER D INSURER E: INSURER F OVERAGESCERTIFICATE NUMBER: REV N NU B R: 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. IDISR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP POLICY NUMBER LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1+000,000 CLAIMS MADE OCCUR S 2207035 04/25/2017 04/25/2018 DAMAGE TO RENTED 10,000 100,000 MED EXP An one amn $ PERSONALS ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMp u LOC LIMIT APPLIES pR POLICY JECT f GENERAL AGGREGATE $ 31000,000 X I PRODUCTS COMP/OP AGG 3,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO 1 -- $ --- OWNED SCHEDULED 130DILY INJURY Per eraon AURT�0p3 ONLY AU�TNOpSyED BODILY INJURY Per accident $ AUTOS ONLY AUTOS ONLY Per a JY,AMAGE $ A UMBRELLALIAB H)C OCCUR 1.000,000 X EXCESS LIAR CLAIMS-MADE S 2207035 EACH OCCURRENCE $ 04/25/2017 04/25/2016 AGGREGATE $ 11000.000 DED X RETENTION$ 0 B JZ0?aMX=NSATION LIABILITY OTH ANY PROPRIETORIPARTNERIEXECUTNE YIN WCC50050071002017A 04/25/2617 04/25/201$ 50000_ ?z-SERIM 1 FuMW1 EXCLUDED? ri 1 A E.L.EACH ACCIDENT r 0 If es desaibe under E.L.DISEAS�-EA EMPLOYEE $ 500,000 DE IPTION OF OPERATIONS below E.L.D E E-P LI Y 0U 500,000 � t DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addidonal Remarks Schedule, ha attechad H more space Is required) Certificate Holder is listed as Additional Insured for General Liability when requlred gy written contract i : CERTIFICATE HOLDER A CEL ATI N 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 2 •. ���� __.""" 5(2016/03) 0 1988 2015 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and BuS-ness Regulation ` I = 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Y Home Improvement Contractor Registration Registration: 183111 Type: Corporation �z Expiration: 8/28/2017 Trp 270022 F z� '• MUTO INC. UP JASEN MUTO , 244 COMMERCE PARK S. CHATHAM, MA 02659 l:pdate Address and return card.Mark reason for change. Address F.� Renewal ..1 Employment Lost Card registration�•.i lid for individul use only ' ''�, Office of Consumer A �irs Business Keguort License or re g i fli hit before the expiration date. If found return to: 1 - HOME IMPROVEMENT CONTRACTOR Registration: 183119 Type: Office of Consumer Affairs and Business Regulation r, Expiration: •812812017 Corporation 10 Park Plaza-Suite 5170 Ruston.MA 02116 MUTO INC. JASEN MUTO J 244 COMMERCE PARK .. S:CHATHAM, MA 02659 Un dersecroam Not valid without signature e,orrucc�on Supervisor f ,r •-,cvccsF..71 iR°a�''nia i?2 3s'ti?i t of i-.:t''a ii-::7 --- �oQrd of Suildin R ad_LV t=ResWctedto 9 eguiations and Standards V�Unrestricted Buildings of any use group rvhlch contain: CS-109029 less than 35;000:cubic feet(991'cubic,rneters)of enclosed Const►uCtion Superrvrsor - >space. . JASEM MUTO Y 294 0 COMMERCE ppjW- SOUT11 CMATHAM MA66z k `Failure to possess a curter*edition of the Massachusetts State Budding Code is cause for;revocaton of this license. Commissioner 10%224018 �,DFS L�censmg mformaUon v�sR WWIN.MASS GOV/DFS i Muto, Inc. IG21 Orleans Rd HarwichMa A4UTD, m . . CONSTRUCTION CONTRACT This Construction Contract(hereinafter the"Contract") is hereby made on 8-15-2017 by and between Amy Chausse of 288 Arrowhead dr,Hyannis Ma 0260 f(hereinafter"Client") and Muto, Inc. (Jasen Muto Construction) of 1621 Orleans Rd Harwich Ma 02645 (hereinafter "Contractor"), collectively referred to herein as the"Parties." Article I ENGAGEMENT/DESCRIPTION OF THE WORK A. Contractor shall provide the following construction services(the "Project"): The contractor will be removing the existing Roofing at 288 Arrowhead rd,Hyannis Ma 02601. Then the contractor will be installing new CertainTeed Landmark shingles on roof,New Azek Trim and White Cedar Shingles on siding as specified in estimate#1886 from Muto,Inc. Contractor is responsible for all materials,labor, disposal, and permitting- B. Client engages Contractor and Contractor agrees to provide to Client all necessary services,materials, and labor necessary for the completion of the Project including,but not limited to, all building and construction materials,requisite labor and site security, and all necessary tools and machinery needed for project completion. All construction materials should be new and of the highest quality,unless previously specified by Client. C. Contractor shall provide the construction services for the Project at the property located at 288 Arrowhead dr,Hyannis Ma 02601 D. This Contract shall be comprised of the following: this Construction Contract,Plans, Specifications,Addenda,Drawings,Photos or other visual representations of the proposed work, and the written Modifications attached to this Contract,properly signed and witnessed, all of which are attached hereto as exhibits. E. The Price will increase by 20 per Square foot in thezvent of rusted out nails, leaving rusty stubs of nails in the roof deck. © Copyright 2013 Docstoc Inc. 1 V i • Article II SCHEDULE AND TIME OF PERFORMANCE A. Contractor will begin work on 8-28,2017 to be completed by 9-18,2017. B. In the event that Client.and Contractor agree on changes to the Project after this Contract is executed,the Parties will agree to new time deadlines that are reasonable in light of the modifications. Article III PAYMENT SCHEDULE A. In consideration of the performance of this Contract, Client agrees to pay Contractor the sum of Seventeen Thousand,Five Hundred, Thirty Three Dollars and 55/00 ($17,533.55) (the "Contract Price") on the following payment schedule for the services. B. Contractor shall be.paid as follows: The first 33.33%or$5,843.93 to be paid upfront as a deposit for the materials, disposal, and permitting. A second payment of 33.33% or$5,843.93 upon start of specified work. The final 33.34% or$5,845.69 Article IV CHANGES TO THE WORK F A. All changes or modifications to the work ordered by Client must be made in writing, with appropriate adjustments made to the total payment and payment schedule. The approval of both Parties shall be required for substantial project changes such as the date of completion,project price, and substantive modifications to the project itself, and notification of these changes must' be made in a timely manner. B. If.these changes should require additional expense to Contractor, Contractor must make a claim for increase in payment, in writing, to Client, in a timely manner. Client must approve this claim for increase in writing prior to any changes to the work,project, or schedule. a Article V DELAYS A. If Contractor is delayed from completing required work due to unavoidable casualties, Client shall grant Contractor an extension for the completion of work equal to the delay. Unavoidable casualties include,but are not limited to, fire,flood or natural disasters, delayed acquisition of materials or material delivery, and negligence on the part of Client. 0 Copyright 2013 Docstoc Inc. 2 B. In the event of unavoidable casualties, Contractor shall properly document both the event and the impact of that event on project completion. Documentation shall be presented to Client in a timely manner. Article VI. RIGHT TO STOP WORK A. If Contractor fails to correct defective work or persistently fails to supply materials or, equipment in accordance with the Contract Documents, Client may order Contractor to stop the work, or any portion thereof,until the cause for such order has been eliminated.. Article VII ACCESS AND CONDITION OF PREMISES A. Free access to the work and project site shall be granted by Contractor to Client, the designated agents of Client, and all necessary public authorities. B. Contractor agrees to keep the premises clean and orderly. Contractor shall remove all debris as needed during the hours of work in order to maintain work conditions free of health or. safety hazards. Article VIII WORK PERFORMANCE AND WORK QUALITY A. Contractor shall conduct its activities in a professional manner and adhere to the reasonable wishes of Client in relation to its working schedule. Additionally, Contractor's work . shall adhere to and be in compliance with both the Standard Practices of the Trades and any relevant Manufacturer's Specifications. B.' Contractor shall protect,all work adjacent to the Project site from any damage resulting from the work of Contractor and.shall repair or replace any damaged work at its own expense. Contractor shall take all precautions,to protect personsTrom injury,and unnecessary interference or inconvenience: Article IX WARRANTY. A. Contractor hereby warrants that the work performed and the Project completed will meet the standards set forth and agreed upon by the Parties.. Contractor agrees to fix and otherwise remedy any defects found by Client in the work within"five (5)years" after the date of final completion at Contractor's own cost. This includes defects caused by natural phenomena. © Copyright 2013 Docstoc Inc. 3 r B. Contractor is only responsible for damage resulting to the Project from negligence, dangerous activities, intentional disregard of professional standards of care normally exercised within the industry, or breach of any governmental statute, ordinance, local rule, or law. z f Article X INSURANCE A. Contractor shall be responsible for insurance to protect against any property damage, bodily injury, death, or other claims for damages that may result from the commission of the work, including general liability insurance,builder's risk insurance and workers' compensation insurance for its employees or sub-contractors. Article X1 LICENSES AND PERMITS A. Contractor will be responsible for obtaining the necessary permits and licenses to fulfill the services specified in this Contract. Article XII FINES A. Contractor is responsible for maintaining proper work, safety, and environmental protection standards. Contractor agrees to hold Client harmless for all fines from federal, state, or local agencies and regulators. Contractor will work in compliance with all standards required by the EPA, OSHA, and other applicable federal agencies. Contractor will be responsible for paying all fines and judgments levied by these agencies resultant from the performance of this Contract. , Article X11I RELATIONSHIP OF PARTIES A. The relationship created between the Parties shall be limited to that of independent contractors. Neither party shall undertake any actions that would imply or seek to establish, any partnership,ownership,employment,joint venture, or trust relationship between the Parties, except by amendment to this Contract. Article XIV GENERAL A. Both Parties are expressly prohibited from assigning this Contract or any rights or interest flowing therefrom. Assignment will only occur with the express written consent of both Parties. © Copyright 2013 Docstoc Inc. 4 ` B. This Contract contains the entire agreement and understanding between the Parties and supersedes any prior or contemporaneous written or oral Contracts,representations, and warranties between them respecting the subject matter of this Contract. C. This Contract will be interpreted and enforced under the laws of the State of MA,without regard to conflict of laws: IN WITNESS WHEREOF, the Parties hereto execute this Contract: CLIENT O RA T R uthorized Signature Authorized Signa r Y Name and Title Name and Title License Number: MA HIC# 183111 CSL Number: CS-109029 4 , f .t f D Copyright 2013 Docstoc Inc. 5 q f/ war 6 5V ,...ae.- 4fIV, MA 026U 1 K o,roperty Aadr6ss 28$ Arrowhead Hyarinls, r V 4c� �€ ..s'z^��atit �3<� Witness my hand»a77 nd sealthLs6 ' day ofAugust"2417/7,7 `T'�" - s a ,M f x esg rr IM Am a _ uss eVWMe Na , -- ,-�-� JP «. ... :. , .�_-71 ---�...,.--sue, ..r• .. ..,.-.{yr. ..:- ---...-�... `mac:•°�,.. V4 I- ` RE 1vIASSAC TTS COMMONWEALTH v IEJSE - . jp} stable ss _. '.` x , .fi k , e46 vehausse,fonerly � ., . Then personally appeared the aboVe Warned Amy _ . � 3 rVed to metlrouh sat�sfactar}+ evidence o �dentaficaton, known aspArhy S.�IeLlm r,s LAG [ other y.whLch_was. 1vIA or DrLv -e-they: esc� whose Warne xs signed`on 3� to �-.p " �„.�.:��` a;,�,,., � ""'•� cknovvledgedt�one thatshe=signed r attached dQc> en�t�ar�d a , _f7 --the preceding e _��. �` fQr Lts$tated.puri?ose h r , -_ "r 9 voluntaY`Lly � � �. 'vOr ,y. ,..ry.-z. �._.q-..,.-.t�,. .�s.�"��n-�--•�-"s�<- � rw.-a� " ."" _ �r4^F.-a--r. Commission Expires -..•.,,.��Ysr+ 166 - r `1-7 _ `Ccrmonweth cf'f�savhu�etls ��.° ,�'.�",'� � % ���- , � s �.:r � -�-; - � •.�- �- A Wly, mar Y 2-si �k E� ' � � A -)a1 o® 3a `i3 oF1HE T Town of Barnstable *Permit# Expires 6 monthsfront issue date ~' Regulatory Servic"es gee * uxxsrnsi,E, r r"9 Thomas F. Geiler,-_Director, lED MA'I A Building 'Division E- Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 t www.town.bamstable.ma.us Office: 508-8624038 Fax:-508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Prop Address .�.4 Z5 '(��.(� eve lJ�' rLAWi �d Residential Value of Work "Z `" Minimum fee of$2S.00 for work under$6000.00 Owner's Name&Address �(�. Contractor's Name c /1')_, Acotil Telephone Number, 4o l—C 21—lam Vc)O 170 Home Improvement Contractor License#(if applicable) Cons ction Supervisor's License#(if applicable)- Workman's Compensation Insurance . Check one: ❑.I a sole proprietor 3 vehWHomesner ow nsurance �N 209❑❑ rker' CompensationI Insurance Com an Name a ecyn) , �nn P Y. 'T TOWN - RNSTABL Workman's Comp.Policy# CJ Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) El Re-roof(stripping old shingles) .All construction debris will be taken to ❑Re-roof(not stripping. 'Going over existing layers,of roof] El R/Replaceme side: #of doors Window /doors/sliders.U-Value. (maximum.44)#of windows,. *Where required: Issuance of this permit does not exempt compliance.with'other town department'iegulations,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:\WHILESTORMS\building permit forms\EXPRESS.doC _D_:,.,a nno onn The Commonwealth of Massachusetts Department oflndustkialAccidents-; '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 Legibly Name (Business/Organization/Individual): 50 } Address: ] J� 7 Po-lc. gco' City/State/Zip: �Oc� __ 0,_r_ ®_a Vs Phone#: `Z 61" Are you an employer? Check the appropriate bog: Type of pro' ct(required): 140 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 ❑ construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.. 7. Fj�Remodeling ship and have no employees' These sub-contractors have 8.,, ❑ Demolition ` workingfor me in an capacity. employees and have workers' y p 9. ❑ Building addition . [No workers' 'comp. insurance ". comp. insurance.$ ; � _ �. required.] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions officers have exercised their I LE] Plumbing repairs or additions 3.❑ I am a homeowner doing all work 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. Insurance Company Name: O . Policy#or Self--ins.tic.#: �0 Expiration Date: © % /0 Job Site Address: 25 0W X, e JCity/State/ZipA,"Alvltl ;XC0, 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. Signature: i.—.- Date. _9 So 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): L-Board of Health 2.Building Department 3. City/Town Clerk 4.-Eleetrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#:. 1> 8-0I+CK 1 II'iL+l� I C VI" LIHtSIL1 1 Y �I1IJUKHIVI�C OP ID rlt :;. 05/07/10 PRoouC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hunter Insurance, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 389 Old River Road, P.O. Box 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Manville RI 02838-0001 Phone: 401-769-9500 Fax:401-769-9502 INSURERS AFFORDING COVERAGE NAIC INSURED Moon Associates Inc. INSURER A: q DBA Gutter Helmet national Grange Insurance co 14?$$ DBA Renewal b Andersen of RI INSURER6: Beacon Hutual Insurance Co. DBA Gutter Hemet Roofing DBA Moon Works «i URERC: 1137 Park East Drive INSURER D: Woonsocket RI 02895 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING PIWY REGUIP.EMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MP,Y PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN NA.Y HAVE BEEN REDUCED BY PAID CLAIMS. LTR 1NSRD11 TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY'YY) DATE(MWODIYY M LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X CONMERCIAL GENERAL LIABILITY MPS26619 09/16/09 09/16/10 PREMiSES(Ea ccc e�cs) $500000 CLAIMS MADE -1 OCCUR MED EYF(Any one person) $ 10000 - PERSONAL&ADV INJURY $ 10 0 0 0 0 0 GENERAL AGGREGATE $2000000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $2000000 PRO- { POLICY JECT LOC AUTOMOBILE LIABILITY COMBINEDSINGLELIN11T $ 1000000 A X ANYAUTO BIS26619 09/16/09 09/16/10 (Edaccldent) ALL OWNED AUTOS BODILY INJURY $ 1 SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ i (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THA14 EA ACC $. AUTO ONLY: AGG $ Ii EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE _ $1000000 A X IOCCUR CLS,IMSMADE CUS26619 09/16/09 09/16/10 AGGREGATE $_ I $ DEDUCTIBLE $ X RETENTION $10000 $ WORKERS COMPENSATION X TORt'UM ITS ER _ AND EMPLOYERS'LIABILITY Y 1 td B ANYPROPRIETOR.IPAF'TNER,'EXEC ITIVE ❑. 28586 10/01/09 10/01/10 E.L.EACH ACCIDENT $500000 9FFICER/MEMBER EXCLUDED? "-- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500000 It yes,describe under SPECIAL PROVISIONS below El.DISEASE-POLICY LIMIT $500000 SO OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION y, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION RENEWAL DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Renewal By Anderson REPRESENTATIVES. 1137 Park East Drive AUTHOR Woonsocket RI 02895 I D REPRESENTATIVE ACORD 25(2009/01) O 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks,of ACORD � l f ter•- as yx re r $ Oh WON A, _ AMEN OO4 t,1I ', k MWUokrse _ tape Awe s br - Off " v !0A Renewal -t.' Q� Customer Name: Year Built. � �Z — Rcriewal by Anderscu of Rl,CT,&Cape Cod Sa1CS f�gIeetnent Address: Customer lD#: 1137 Park East Drive ITYA &rse . City,State,Zip: Order Number: Woonsocket,RI 02895 ((�� Phone Home: warraw asasr►aftlucwr anMdaraa+r�wa ��V , license#RI-30$39 R1-12259 MA- Phoue-Work: Pa$e: of Date: 119535 CT-562725 Email: UNITS a'piiruabins'"e GRILLES N 8 a i Cr $ E . RoomIs�lppl� $pa$ D.scrfptllt , a � G t: ; 7 i8 ! � N N N spnals o S t N )s � a as �� i � � I a YtC E t it] ft 6) x x3 I z - r y ywo • w >k 3 r x is i IfA xS xv f i N L'�, X3 r 2 3 . M '' 2 L ? Pro NI of rhe,bm uw„L,wa rrf w w fm rho Wool amuum.fatal in the 4—rtau.Thy pnryxu l n,lid h,r l0 days SMi Scs $b Total aw,i ftyrant MethodiclWopyCdoomn nbr box Qnrm W Rrnrwrl byAndemn M-W w 1110 .. �_-�jy Sab soul laaam.Navel vcxriprmn/Nom S Prim S l Ch Doc Rcmwal by A ad Saki Sipnnau Sub Total ue hP�i C.urjynm A CCZ Yau any MIMI m f rrtah all wi&mi end.lane m -f w cn ew this - UK �� <lar a*-W agreco to par the m.pied in d»s � � �MIIG CrNitt or EaplllflS a�� eµenaner,r for whrch umk rgn:wnent anJ accmdi.gt ro tlsr tcma hcn rG _ See Reverse Side for Tertw and Conditions of Sale.You,the buyer,may cancel Tout ❑ anc1ng this transaction at any time tior to midnight of the third busineaa day after the date of this traoftnsaction. o attached noti ceila. r an SalesUa offlotd^ IW4 explanation of this right. Tad Miscdlaneow Cmau or 4pemn Work Pervtit CCU �../' ad&ftwf onW ranmA9adrd (CAM�caxp'cd < (ea over tool to n11m cradh!eapenrr column at xpyQ .•{plxs.rhde all that eAPh1 C. .1 ire $pedal Order Notes Total Ammo Of Agreement k W 1)am Rcn--A by Andcaen Manager SiAwatarc - .. Deposit Restirad Spalahrw� Mrpam mj not N m Itenoval byAodwsa Aommml end rdleMbdmt Pow ma*MW w.are uwbh 10 bid on rapaldltp fdalance t11w W1 Cattplettran np,Mkh taoy don nmg�ramte tice ofww MA me a�Y arseaidau�HawveiR m4 arawe�iR OeaeedW hnor7rtWed 1il d:11 rvwdaa mldymera=pptlaup�ol bdbcarcreddergr.aletimwa rPd mn�eee M lids urdea mankw after,ww units meaatoaeta,W6 and rhageYpu hr meiOfMbaupon paa apprtrcal � /�, Q Nice inchedes labor.natcdA.imtallsttiioen,, Doted ara irwtstkd. otMrwae noted,• At�tMaM OItM I.Dan cerolNrtian ddobwa be U y7 �97(�/O�CLs2 au�2� I!Ctptowrr Caotorllerf��-(A/� C,eatrutwr bid wwaldan rme new wlntban end White-(taefevi.nl byA„dwsen •ImtalWw Pink•Nomowrw u q. JtJ 7r+ fnitl�71%��/ f` InitlalC��/,y ' L��!.�,.�,�1,11Gdiacw••. r.rm no +....a.r:�ur,,,s.ae.rau, .dM�eJnari u,a dr anewd�r Maurd4� w.n dh4 MbM,'+u `��" •w Town of Barnstable A roved Regulatory Services pp roved tO Fee =00 Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Home Occupation Registration Date: Z` G Name: °�. i �> > Phone#: Address:222 c) 1 -C Y Village: p ho Name of Business:' kl�&J11 �c c vt c C dOc�►-� Type of Business � P(Le.�R Map/Lot: 6 C/q4 Zoning District( Zoning Districts RF and RC-1 require Special Permit fiom Zoning Board of Appeals. INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials, or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity, and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigne ve read and agree with the above restrictions y home occupation I am registe ' g. Applica t: Date: z Homeoc.doc r TO AL ANW BUSINESS OWNERS DATE:Fill in pe t � APPLICANT'S � �' � `� ,;. YOUR NAME:�1 ,;-,-��r lA�rao�" BUSINESS q YOUR HOME ADDRESS TELEPHONE Telephone Nu mber Home :,"',';..,..: r rr0. ...N E ... .._U.S..,�..... _r... ...: �:.,:r.G� .. ,•:. ter:. _ ....: ,, ... NQ When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. -(corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S OFFICE This individual h4beinformed ny permit requirements that pertain to this type of business. d Signature** t COMMENTS: 1`fa 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Business certificates (cost$20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY.