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HomeMy WebLinkAbout0004 BLACKBERRY LANE , / 1 I I ' . Town of.Barnstable *Permit#Z0I 52c� p� Expires 6 months from issue date Regulatory Services Fee BARNSTABLE MA38. i639. �� Richard V.Scali,Director r Building Division AUG 27 2015 Tom Perry,CBO,Building Commission , 200 Main Street,Hyannis,MA 02601 ' OWN OF BA R N S TA B L E www.town.bamstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address I s [Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address p f��— lw W� Contractor's Name Baker&Associates, Inc Telephone Number 508-362-2445 Home Improvement Contractor License#(if applicable) 162600 Email: info@bakercape.com Construction Supervisor's License#(if applicable) 009714 OWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Associated Employers Insurance Workman's Comp.Policy# WCCa996AA24a42915n 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 Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑. Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. "Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is �re �!d. SIGNATURE: - C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Int et Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 ' - i - lcense- CS-009714 RICHARD P.GARNFAU,JR PO BOX 476 West Barnstable MA 0206*1t 1. 0410412016 : Office of Consumer Affairs d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement.Contractor Registration w Registration: 162600 Type: Supplement Card Expiration: 3/2612017 BAKER & ASSOCIATES INC. ' Y RICHARD GARNEAU . � 3 P.O. BOX 923 _ _._ _.._......_. CENTERVILLE, MA 02632 ,` µ a ___.____ _ _._. .. ...........__:._ .......... Update Address and return card.Mark reason for change. SCA i G 2OM-05/11 (� Address Renewal ❑ Employment E Lost Card C:�!!6 ij-lYlG'I'lGp7'ldl+L't71�✓Z!kf C3��JbLG!'it.!!dC'C�,S _ ce of Consumer Affairs&Business Regulation License or registration valid for individul use only E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistration 1626Q41, Type: 10 Park Plaza-Suite 5170 Expiration 3J26/2017 ;' Supplement Card Boston,MA 02116 BAKER&ASSOCIATES INC:` � a RICHARD GARNEA6 521 SHOOTFLYING HILL RDA _ .._..... .. CENTERVILLE,MA 02632 Undersecretary &i,;4ihui,4inatuio The Corr mouivealth of.Massachusetts Deportorent of Industrial Accidents Office of Investigations 600 Wa laington Street Boston,M4 02111 gam-°itt.massigot,1dur `Yorkers' Compensation Insurance Affidavit: Builders/Conti-actors/E•1ectiicians/Plumbers Applicant Information Please Print Lezibl� Name(Businemio nizatio 1): Baker&Associates Inc Address: 521 Shootflying Hill Road City/State/Zipc Centerville MA 02632 one;w 508-362-2445 Are you an employer?Check the appropriate box: Type of project(required): 1.a I am a employer with 1 4. ❑ I am a general contractor and I * have hired the sub-contractors 6_ ❑Neu construction employees(full and/or part-true). ' 2.❑ I am a sole proprietor or partner- listed on the attached sheet_ 7- ❑Remodeling. ship and have,no employees These scab-contractors have g. ❑Demolition. y c working for me in an city_ employees and have workers' � 9. ❑Building addition. [No workers'comp_insurance comp.insurance. required] 5• ❑ WTe are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all wore officers have exercised their 11.❑Plumbing repairs or additions myself.. [No workers'comp.. right of exemption per-MGL 12.[1Roof airs insurance required.]1 c.152,§1(4),and we haae.no a employee's_[No workers' 13_LXi other$t b is comp_inswance required.] *Any applicant Char checks box#1 must also fill out the section below showing their workers'compeusatim policy information Homeowners who submit this affidat•it indicatiag they are doing all weak and then bale outside ctmtracmrs nmst submit a new affidavit indicating such- A Ceatractuts that check this box toast attacked as additionsl sheet showing the name of the -contractors tad state whether or not those emities bn-a employees. If the nib-conwaoes Rase employees,they nines[proilde it w workers'comp.policy number- lam an errrpkyer that isprniding workers'courpensetr'on insurance for ncy etr:Pto w.e& Below is tare policy aged job site Informahota Insurance Company Nam-Associated Employees Policy 9 or Self-ins-Lic.4:wcc50050024542015a Expiration Date: Job Site Address: ld/ CityiStatel7 p: 01211 d/ Attach a copy of the workers'corup&sation policy declaration page(showing the policy=I er and expiration date). Failure to secure coverage as required under Section.25A of Ar GL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a Rue of up to$250M a day against the violator. Be advised that a copy of this statement may famrarded to the Office of Investigations of the DU for insurance coverage verification. I do hereby c ' ern 7re ns a id penalties of perjur3,that the information prot4ded ab are is Mw and correct -Si tune:-,, Date: / r Phone#: official use only. Do root nrite in this area,to be cvmpteted by city or totcvr o{ ciaC City or Town: Permitildcense# Issuing Authority(circle:one): 1.Board of Health Z.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone i#. .6 Client#:9742 2BAKERAS ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MfN°°"'""Y) 04/22/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ` IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Dowling&O'Neil PHONE F Insurance Agency E cMA E-MAIL pal:508 775-1620 XC,N., 5087781218 ADDRESS: 9731yannough Rd., PO BOX 1990 INSURER(S)AFFORDING COVERAGE NAIC of Hyannis,MA 02601 INSURER A,National Grange Mutual Insuranc INSURED INSURER B,Associated Employers Insurance j Baker&Associates,lnc. P O BOX 923 INSURER C Centerville,MA 02632-0071 INSURER D i INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LT RR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MWDD/YY MM/DD/YYY LIMITS A GENERAL LIABILITY MPJ7223M 4/19/2015 04/19/2016 EACH OCCURRENCE $1 OOO OOO Xj COMMERCIAL GENERAL LIABILITY PREMISES Ea otNxuErrOence $500 OOO CLAIMS-MADE I X I OCCUR MED EXP(Any one person) $10,000 I PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS � ,AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE I �AUTOS Per aaident $ 1 Is j UMBRELLA LIAB HCLAIMS-MADE OCCUR - EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC50050024542015A 4/23/2015 04/231/201 X WC STATu - OTH- AND EMPLOYERS'LIABILITY Y/N ns ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F_N] N/A E.L.EACH ACCIDENT $500 OOO (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Addi'tional Remarks Schedule if mores ace is required)p req red) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived-,or extended the coverage provided by the policy provisions. . CERTIFICATE HOLDER CANCELLATION town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 - AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. .ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S149786/M149785 MER Authorization Form .as owner of the sub�ecfproperty,-here • -authorize Baker&Associates to act on my behalf, in all matters relative to w4rk authorized by this building permit application for Address of property: 4 Blackberry Hyannis, MA -- ---- Signature of.owner:` . (Print Name: - t Town of Barnstable *Permit# �� Fxplres 6 months from issue date Regulatory Services Fee " Thomas F.Geiler,Director .. Building Division I Tom Perry,CBO, Building Commissioner, 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us : Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERNUT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address u —� 22`% tUtS [y}Residential Value of Work W Minimum fee of$25.00 for work under$6000.00 owner's Name&Address p Telephone Nu Contractors Name mber Home Improvement Contractor License#(if applicable) Uj j Construction Supervisor's License#(if applicable) U Ic{ A�� ❑Workman's CompensationInsurance DEC, 2 7 2007 Check one: TOWN OF BARNSTABLE ❑ I am a sole proprietor - ❑ I am the Homeowner [� I have Worker's Compensation Insurance n Insurance Company Name 'I�c-tcPt2s • dP-'s' Workman's Comp.Policy# V---)c , Q_-0L-1 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. Going over existing layers of roof) ❑ Re-sidedf)lfhirl ' [e Replacement Windows/doors/sliders: U-Value P,SA (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department 1494a*s0.Hilt G�AsL �Z n,etc. ry ***Note: Property Owner must sign Property Owner Letter of Perini ,fit ,� } A cop of the Home Improvement Contractors License is require' t �� `li SIGNATURE: j Q:Forms:expmtrg F. I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' wtvw.mass.gov/dia ' Workers"Compensation Insurance Affidavit: Builders/Coiitractors/Eleetricians/Plumbers Applicant Information Please Print Le "bl ( r Name(Business/OrgmizationAndividual): �^ `1'' ►`-' �CW H J v . •Address: Q. �66x eA <<L `1 A S �-`77 l -+-t•��` Zo / City/State/Zip: �-VT& Z-v< �'l Phone.#: Are you an employer?Check the appropriate bog: ;Type of project(required):, 1,['E-I am a employer with 4, [� lam a general contractor and I * have hired the sub-contractors 6. ❑New construction . employees(full and/or P'� ' 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet 7. [ Remodeling ship and have no employees . These sub-contractors have g, []Demolition ' employees and have workers' • �avorking forme in any capacity. $, 9, []Building addition (No workers' comp,insurance Comp,insurance. 10.0 Electrical repairs or additions required.] 5. We are a corporation and its _ '3.❑ I am a homeowner doing ill-work . officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right bf exemption per MGL 12.0 Roof repairs insurance.required,]t c, 152, §1(4),and we have no 13.❑Other�JJ l ti��►-� employees. [Na workers . comp,insurance required.] 6&e-e M ie#.�t . *My applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Horocowners.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 mutt attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees, lfthe sub-contractors have employees,theymust provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site' information. Insurance Company Name: Policy#or Self-ins.Lic,#: Q:)U 4(°SOU la (,n Expiration Date: U� Job Site Address: w`tce.` (�ti. City/State/Zip: f4+�►--�5 ,�A • U7'!�i Attach a copy of the workers' compensation olicy declaration page'(showing the policy number and expiration date). Failme.to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine lip tb$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form,of a STOP WORK•ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the-Office of _ Investigations of the IDIA for insurance coverage verification. I do here certify unde the pains and penalties of perjury that the information provi d above is true and correct. Si afore 4� Date: Phone#: - Offtcial use only. Do not write in this area, to be completed by city or town.off ciaL City or Town:` -.Permit/License# Issuing Authority(circle one): > , .1:Board of Health 2.Building Department 1 City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: oFTHEr Town of Barnstable ay Regulatory Services 9snsas � Thomas F.Geiler,Director ;p. Building Division Tom Perry,Building Commissioner- 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must ; Complete and Sign This Section If Using A Builder I, Jyx--�.5 , as Owner of the subject property hereby authorize �Cj p•�,J� to act on my behalf, in all matters relative to work authorized by this building permit application for: �-c 3 tom. A.#-�ts arc (Addre s of Job) Signature of Owner 6ate JCL P' = Print Name If`Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION tHE Town of Barnstable �Op Tp�� • y�P� o� Regulatory Services + BARNSTABLE, = Thomas F.Geiler,Director 9 MASS. g 1639• Building Division TED �A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.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 responsible for all such work performed under the building permit.' (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming.the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:fbrrns:homeexempt DEC=Ok-2007(THU) 16: 00 MALCOLM & PARSONS INSURANCE (FAX) 17813441425 P. 001/002 ' OATC(MMIDp1T'YY1�U�B, CERTIFICATE OF LIABILITY INSURANCE 12 10612007 PnODUCCR (781)344-3200 FAX (jai)344-1425 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Malcolm & Parsons Ins. Agcy. Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6 Freeman St. . HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE'AFFORDED BY THE POLICIES BELOW. P.O. Box 527 Stoughton, MA 02072 INSURERS AFFORDING COVERAGE NAIC# IN3URCD JO, n Dunn INSURIVA; Associated Employers Insurance DBA: John Dunn INdURER9; P.O. Box 924 INSURER C: Centerville, MA 02632-0924 INouRBRDI INSURER E: 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 OFANY 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,AGOREGATE LIMITS SHOWN MAY HAVE BEEN REDUCEQ BY PAID CLAIMS, I sR TYPI0I INSURANCI, POLICY NUMI)RA CY L'Ry CTivC POL lu A7 ON LIMITS OENEhAL LIMILITY GACH==RRaN= S COMMENCIAL GENERAL LIABILITYAMAG o t S CLAIMS MADCs u OCCUR MCD191P(My ona Pwoon) $ PERSONAL IL ACV INJURY 5 GI,NCITAI AOOITCOATC S OpNI AOOMIOATP.LIMIT APPLIES PER; PRODUCTS.COMPIOP A013 S . POLICY JGCaT LAC AUTOMOOILa IIAOIUTY COMBINED OINOLH LIMIT S ANY AUTO (Fo eacldonq ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS U)ArPafanl f HIRED AUT09 BODILY INJURY NON-OWNW AUTOS (PereccNlvaO S PROPCMY OAMAGL' 9 (114r occldentl GARAGE LIABILITY AUTO ONLY•CA ACCIDENT S ANY AUTO OTHER THAN 'LA ACC S AU'1'0 ONLY: AOG $ EXCEMUMBRELLA LIABILITY EACH OCCURRENCE: 5 OCCUR CLAIMS MADE AGOREOATE 5 • 6 DrDUCTIQLG S RL'fENT10N S s WORKERS COMPENI%A'nQNAND WCC5004658032007 09/29/2007 09/29/2008 X w�yr 'lu. o H• I CMPLOYERW LIABILITY M ? A ANY I)ROPRIEIORIPARTNFRIMtECLITIV6 1141,MACH ACCIDENT S 500 000 OFFICGRIMWMDSR DILLUD617T RL DIISEAS6.6A 6MPLOYG. $ 500.00 & n M.e..enw under OPCCIAL PROVIOIONS balm C.L DISEASE•POLICY LIMrr S S00 000 OTHER I OBSCRIPTION OP OPLUGTIONS I LOCATIONSI VCMICLGS I EXCLUSIONS ADDED BY ENDORSLMENTI o"r.IAL PROVISION"] rpentry Contractor ohn Dunn is covered by the Workers Compensation policy. I j ERTIFICATE HOLDER CANCELLATION i SHOULD ANY OA THE ABOVB 000CRIO10 POUC1135 BE CANCCLLMAPPOR E THE Z"IRATION DATE THCRno#.THE IMUIN01NOUR12R WILL 4NOCAVORTO MAIL I Town of Barnstable —DAYS WRITTEN NOTICE TO THIS CORTIPICATIT HOLD OR NAMCD TO THE LCPT, Building Department OUT►AILURR TO MAIL SUCH NOTICE SHALL IMPOSE NO ODLIOATION OR LIADIL17Y Main 'Street OM ANY KIND UPON THE INOURdR.ITt AOINTD OR ARPRI931INTATIVll9 Hyannis, MA 02601_ AUTMORLAORCPR03CNTATIVC 11rving Parsons � J ACORD 25(N01108) FAX: (508)790-6230 OACORD CORPORATION 1988 :r ulptn egistra,jq Gt149' i P 6l75/2008 �. TYA Indi dual DUNN .�f 'cnn Did in j c N tl' E,MA 0.3262 `r%` Deputy Administrator i i, Ass e Parcel 126wermit# 'R Q Date Issued `� ' f 96 Fee '2 Engineering Dept. (3rd floor) House# ' BIKE ' • BA MASS LE. Dle 19 059. .e$ fD IMF� TOWN OF BARNSTABLE Building Permit ApplicationPreet Address L.�. F Village 'Owner ��wG� .7?�rp.o Address, Telephone I r Permit Request TFirst Floor square feet Second Floor square feet Estimated Project Cost $ a.74t�� Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Ap eals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name 0.Q,Gi�. _ L� Telephone Number k Address License# — ��_�. COA � /7YA-. Home Improvement Contractor# /Ja$IR 6 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4/1 SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY P RM N U _ D SU D ! F y AR EL NO. , ADR SS - ` VILLAGE - OWN DATE F I SPECTION: e _ S f?'• f FOUN ATION ° FRAME ` ` INSULATION FIREPLACE t ELECTRICAL: ROUGH ` FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING _ I, r � DATE CLOSED OUT + ASSOCIATION PLAN NO. - , t C , . � ' F + I t + r r to • / ..., + ; ' ' 7 .`�. . :o-`4 :w', i,,�",..0�3i" �.`_�.'•,x u ,rs i; ,x:k•� i?!z :tea -c a• E.,x, r"' ""1•sx`.wid 't' £Y. .�..,`' ' � �„°°`a '.r` x t `�,'.'�ro r ...':�. - � t�±rn �...e ,. ..• ., .� ,;�,� �r9,h r=t `�.;r�r.' ���. rk`" �`., � �� :.... � Y;:'fl{ �str '.n.�'"' ��n€+�`"ct.. .*� �� rx-•���xy`�'.�•!�a d i ''��t,�4�n�cr ,•' - rtti��u�ra ��, '� �. � _ .er ,�.4. �s�� � ."''�k'�'a'. j.' .¢�sr����y�-q�� } r t�,. �..m � �a r� -� �',S`..�. :✓ �'rn'�^ £ t lbw t s rd°' q.e ��t fi�"..�_ �i"" ° �:,� / :.xy �t-�.#�a 1"-. 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".,d" ;;�;. �+.,�":.7� •✓ �""� �� ,'.�'p��;'k?�{.�W ��`i .��`+�k•�:"rv � �..a�SVtf�� ':� ' E.��r'ry ��?�y �r"� Mj4`^`Y y"'�.��,�..y.-��(M$�ti/+�y The Commonwealth of Afassachusctts Department of Industrial Accidents ' ►� _. Olficeol/oseSM19 ales 600 Washington Street Boston,Mass. (12111 Workers' Compensation Insurance Affidavit AnnhFant information• Please PRiNT`1�tb]y ,� name: city, Iniq nhonc# I am a homeowner performing all work myself. II±.am a sole proprietor and have no one working in any capacity �1 am an emplover providing workers' compensation for my employees working on this job. compan name' c-4-r address: c'�atwC. MI.: phone#• insure Ceco. li # 1 am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: company name: •tddress• City: phone#• insurance co policy# company name: - ^•+dress• city phone#• insurance co policy# .Attach additional sheet if necessary:;'=.,a�: y:s:a� ::,rrr. , . -.:::, :R<lr,. _ : .::.,£:.•. _ — amass e.,r..•.. b. Fuilurc to secure coverage as required under Section 25A of 111GL 152 can lead to the imposition of criminal penalties of a fine up to SI.500.00 and/or unc years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a line of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do lhereht•eery' •r t «ills d wities of pedwy that the infornrwtion provided above is true and correct S i anat Date q � ore Print name f ,vr Phone# official use only do not write in this area to be completed by city or town official t itv or town. permit/license# nliuilding Department C3Licensing 1laard cheek if immediate response is required 13Sclectmen's Office C3liealth Department 'Z contact person* phone#; nOther The Town. of Barnstable ' A& Department of Health Safety and Environmental Services se� Building Division 367 Main Strut,Hyannis MA 02601 Ralph Cmssen Office: 508 790-62 7 Building Commissions F= 508 775-3344 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 pm- g owner occupied building containing at least one but not more than four dwelling units or to structures which are Aa=t to such residence or building be done by registered contractor$,with certain exceptions, along with other requirements. Type of Work: Est Cost — QL& Address of Work: --- s Oaner.Name: Date of Permit Application: I hereby certify that: . Registration is not required for the following rcason(s): Work excluded by law ob under S1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that:, CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING W ;NDNItEor HAGISTED VE ACCESS TO TFffi FOR APPLICABLE HOME IMPROVEMENT WORK DO 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. LRegistration No. Dat Contractor name { OR r r?amer's name . Engineering Dept. (3rd floor) Map Parcel Permit# s9.2 O House# Date Issued Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Fee ZT Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept. 1st floor/School Admin. Bldg.) �tNE Defi 'tive Plan A roved by Planning Board 19 ; RARNSTARLE, ` CFO 59.�`� TOWN OF BARNSTABLE Building Permit A plication Pr4Streess Village Owner Address Telephone slbY Permit Request 6*2LVQm, First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count t Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Auth rization ❑ Appeal# Recorded❑ Commercial ❑Yes To Q If yes, site plan review# Current Use Proposed Use �r JTT ��Builder Information Name /��' Coe ! ! ��i��.�� (ey. Telephone Number 609 �J%/—,i�7,66 Address 2Qa-3 ay- .e&3 License# o,i 'PlAr i ! d, Home Improvement Contractor# ®g6©l 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 SIGNATURE D BUILDING PE IT DENIED FOR THE FOLLOWI REASON(S) The Ct/jtf/n(;n)4'ealth of Massachusell Department of Industrial Accidents ` OffleeoflayeSM17tlaas 600 Washint;ton Street Boston. Alas. 02111 �'�"'•'� Wuri-ers' Compensation insuranceAftidsvit _ James E . Moriart 24 Plant Rd . #3 ' 508-771= 0"17 ; .hone Cn, Hyannis MA 02601 71 am a homeowner performing all wort:myself. ® I am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. cam Idr t {j(\ incur ince c0 nnlitn, ----�- O I am a sole proprietor, general contractor, or homeowner(circie orie) and have hired the contractors listed below who hz the following workers' compensation polices: m my n•i e: ahone!!• n F DOIICY� _ l cam inw na e- t nhnne a• cin nnlic inwrince co t•+s .lttoch additit'nal sheet if-tic Wes' '.t - r-....a• `,^ �•"�i —� Fuilure to secure cowenge as required under Section 25A of MUL 152 can lead to the imposition of criminal penaltiiy of a fine tip'to S'1,500 U0 ao'tUc Vnc %'cars' imprisonment as left as civil penalties in the form of a STOP NVORK ORDER and a fine of SI00.00 a day against me. 1 understand tb■t cope of this statement may be forwarded to the OfTice of lnyestigutiotu of the DIA for coverage verification J do herebr c ify nder the psi enallies of perjurr that the inJornmfion prmtided above is true and correct Si^natur> Date Phone# 508-771-6768 Print nam J a - - ~Official use only do not write in this arcs to be completed by city or torn amcial cin or town; permit4leetue a rjouilding Department DUccnsing Huard check if immediate ropunse is required �Seieetmea's O(Ilce ❑ C3ticaub Department mother ' p o' - contact person- bone a• � �. Information and Instructions iMass,u:husetis General Laws chapter 152 section 25 requires all employers to provide workers' compensation for th Ieniployces. As quoted from the "laW", an entpluree is defined as every person in the service of another under any (contract of hire: express or implied. oral or written. An emphirer is defined as an individual, partnership, association, corporation or other legal entity, or any two or mo the forc�goin�u enen�ged in a joint enterprise, and including the legal representatives of a deceased employer. or the rccci\•er or inistce of an individual , partnership, association or other legal entity, employing employees. However tl owner of a d��cilinc house Baying not more than three apartments and who resides therein. or the occupant of tite o do maintenance , construction or repair work on such dwelling lie d��clung 11oUSC of another who employs persons t or on the -rounds or building appurtenant thereto shall not because of such employment be deemed to be an employ( MGl chapter 152 section 25 also states that even, state or local licensing agency shall withhold the issuance or i�ealth for and renew-ni of a license or hermit to operate a business or to construct buildings in the common ,applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into anv contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter heen presented to the contracting authority. Applicants Please 11 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplvin_ company names. address and phone numbers as all affidavits 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 require to obtain a workers' compensation policy, please call the Department at the number listed below. Ciry or gowns Please be sure that ti le affidavit is compete an complete printed legible. The Department has provided a space at the bottomc I the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant- rlt be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned the Department by mail or FAX unless other arrangements have been made. -1lie Office of inyestigations would like to thank you in advance for you cooperation and should you have any questio please do not hesitate to ;give us a call. y The Department's address. telephone and fax number- The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 N-'ashington Street - Boston, Ma. 02111 fax #: (617) 727-7749 phone 9- (617) 727-4900 ext. 406, 409 or 375 a r r . Certif irate ofRem'.5tanre��e �STgQ REGISTERED ISSUED BY (�' e� "4• E` FABRIC Date Z' NUMBER SNYDER MANUFACTURING CO. manufactured 3001 PROGRESS STREET PINK M''�oP F-140.01 DOVER, 0H10 44622 4/ 12/90 - F RFTP`� F-140 This is to certify that the materials described on the reverse side hereof have been Flame- retardant treated (or are inherently nonflammable). Top o Tec 1905 NE Main Street FOR _ADDRESS Sim sonvi11e SC 29681 CITY STATE —p c Certification is hereby made that: (Check•( e a orb ) a (a) The articles described on the reverse side of this Certificate have been treated with a flame-retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of t e State of California and the Rules and Regulations of the State Fire Marshal. i Name of chemical used.................................................... .............Chem. Reg. No............................. Methodof application ----------------••-----•----!------•-•-------------.-.._....-----•---•--•---•••--••-•-•----- -- ® (b) The articles described on the reverse side hereof are made from a flame-resistant fabric or material ° registered and approved by the State Fire Marshal for such use. i Trade name of flame-resistant fabric or material used PRV Reg. No. F-140.01 i The Flame Retardant Process Used WILL No B Removed By W shing SNYDER MANUFACTURING CO. By Tom Kelker S `perviso uali y Control Name of Production Superintendent Title