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Home My WebLink About0020 BROOKSHIRE ROAD I � �� l _ _ _ _ � _ ______.- ____ _. _._ _� �� _� f f FRIEDLINE& CARTER ADJUSTMENT, INC. 436 Main Street, P. 0. Box 338 Hyannis, Massachusetts'02601 Tel. (508) 771-3232 FAX (508) 790-2344 TO: (4uilding Commissioner or Inspector of Buildings ( ) Board of Health or Board of Selectmen 3 C O Fire Department - TOWN OF BARNSTABLE 1 1s TOWN HALL " 3 :x HYANNIS, MA RE: Insured: SZEGDA, John &Gail A. Property Address: 20 Brookshire Rd. Hyannis, MA 02601 , J Policy Number: DWP00101187 Type'of Loss: Fire Date of Loss: 4/23/2016: File#: 125084- r Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed-$1,000.00 or cause Mass. General Laws, Chapter 143, . Section 6 to be applicable. .If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the attention of this writer and include a reference to the captioned insured, location, policy number, date of loss and file number. On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by First Class Mail. C. WALLACE Adjuster , 4/26/2016 1 o i 12-7 Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee Baaxsxnai,EUV 1 `� Richard V.Scali,Director �� pTfD MA't A u Vtl�p ----.—$niidrng - - -_- _ Tom Perry,CBO,Building Commissioner NQY 2_ 2015 200 Main Street,Hyannis,MA 02601 TOWN OF BA R NSTABLE www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXI?PXSs PERMIT APPLICATION - RESIDENTIAL ONLY d �! Not Valid without Red X-Press Imprint Map/parcel Number d 7 Property Address ez Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address z �y Ir Contractor's Name 1 CGS' ��7 tQ �� ✓/ ` Telephone Number Home Improvement Contractor License#(if applicable) ✓ 6 d 1 Email: Cc, c/ ( � 7 (f 0,;,, Construction Supervisor's License#(if applicable) /G U 3 �( Mkorkman's Compensation Insurance , Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Eff I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# �-0 0�-0 �d 3e` 1?3 Q 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 floo'r 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. SIGNATURE: Q:\WPFILES\FORMS\building permit form XPRESS.doc Revised 040215 I A * CERTIFICATE.OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS t:ERTWICATE 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 INSU REPRESENTATIVE OR PRODUCE AND THE CERTIFICATE HOLDER. RER(S), AUTHORIZED IMPORTANT: V the certificate holder,i3,.an.:ADDITIONAL INSURED,the policy les)must be endorsed. v SUBROGATION IS WAIVED,subiect to the terns and conditions of the policy, certain Policies nay require an endtgSgment. A statement on this certificate does not confer rights to the certificate holder in Deal of such endorsement(s� PRODUCER MCShM Insurance coNrACr sedftA_ss1gnWFtkkSefviws 1550 FalTnoulh Rd RT 28 Sts 2 800 634-45BS Are 866 20-81 18 Centerlriile,MA 02632 _ ._ AcoaEss PollosefftesWeridEWWcom INSURED A: caffin nsuranina rn - _ ... NAMA Richard CMault Jr UOUSER aa- 198 Five Comers Road Centerville,MA 02632 '"'":E`ft USURER e COVERAGES DISURBR F. CERTIFICATE NUMBER REV�N NIBpBER: THIS IS ...O CFJZTDY THAT THE POLICIES INSURANCE LISTS BELOW HAVE BEEN ISSUED TC THE�NMIREO NAMED ABOVE FOR THE POUCY;PERIQD INDIC4TE0.NOTWITIMANDiNG ANY REIlUIREIYIENf TERM OR COND wN OF ANY CONTRACT OR OTHER DOCUNJE#[r W%"1 RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR?MY PERTAIN,THE INSURANCE AFFORDED BY THE POLIES DESCRIBED HEWN IS SURIECT TO ALL THE TERINS, EXCLUSIONS AND ODNDRK)NS OF SUCH POLICIES_LIMffS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 945KLTR TYPE OF @ISURANCE ADDL POUCYNUMOER PO O@lERpLLMDEUITY INBR WW N UwrS AUTOUDWw UAMUTY WORKERS COMPENSATON AND EMPLOYERS-LU1 MlTy';• '. YIN _ _�-. WC$rATU- OTN- ANY PROPRIETOWPAR NERMEECUME a TORY LwT3 U j ER A OFFICEiNB1813t-EXCLUDED NSA ❑ WC-20-20403093-03 S 6 El EACH ACCO)ENT S-5 ftow .(1Nadalm in NIq If Yes.desogbe under D P �•� DESCRIPTION OF OPERATIONS peapN s OEBCRIPTDN OF OPERATK/N5 11DCATWRS/VEfUCtES(ANaCA ACORD 10f,Addi6oaal Remarb SeAetlul,■emre qwq!: EL DNWASE,III $QQ,� . taquFed) EkOm QWM EkM SMIS WM Sole PFtlprk ftr Exck de Rkhwd Ca t � Caze®tult 3r Es>bl Uft j ratiolts Jr = CERTIFICATE HOLDER CANC N JOULD ANYOFTHE ABOVE D .BED POUCIES BE CANCELLED WORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Of Bamstable ACCORDANCE WITH THE.POUCY PROWSIONSL IRuiiding Dept RE 200 Main St Hyannis,MA 02601 Signature_ ACORD 25(2010AIS) BRAC 3139 f )� r d CA . ROOFING MT\R PAIRS PROPOSAL -a Proposal No. 15-1399 (j September 18,2015 To: Gail Szegda Work to be performed at 20 Brookshire Rd - - Hyannis MA We hereby propose to furnish the materials and perform the labor necessary for the completion of: NEW ROOF. -- 1. Remove existing shingle roof .� 2. Install new aluminum drip edge - 3. Ice&Water.barrier first 2f1,all skylights and penetrations A. Cover roof with 15 lb felt 5. Re-roof with 30 yi architectural shingle 6__.Inst0 ridge:vent 7. Flash all pipes and penetrations 8. Remove all rubbish from project - -s r _ Labor and Materials $3,300 All material is guaranteed to be as specified,and the above work to be performed in accordance with the specifications and completed in a substantial workmanlike manner for the sum of Three Thousand and Three Hundred Dollars$3,300 with payment as follows: One Thousand Six Hundred and Fifty Dollars$1,650 with acceptance of proposal and One Thousand Six Hundred and Fifty Dollars$1,650 due upon Completion Respectfully submitted, Richard P. Cazeault,Jr. - 198 Five Comers Road Centerville,MA 02632 (508)420-5482 _ °s Acceptance of Proposal•No. 15-1399 The above prices, specifications'and conditions are satisfactory and are hereby accepted. u ea to do the work as specifie . yment is outlined above. gnature Date OofCoasauier 1tff0.06 {f y HOME lMPRO Lkeftsa or rgoa yid for si dl -. n CSC r z 1Z8 =F6 J tie BZ�n s�mrt if found reBera �CfOlY; �_ RICHARD P.CA&M-8-1M, 4° A OZ116 RICHARD a98 F C4RNE � / Unders� ° , Nbtais7 s7�55`�G�f71Sf?`_=— a�eoertr Of Pir'r.S�' :eea -aB¢ying Construction-super RICEMM P CAZ AII aTg ' '; 198 FWc Corners Roat_ s Center"MA O't63� - . ° s+issioner •. G ' . F • L v , The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �J Please Print Legibly Name (Business/Organization/Individual): <Gla i'C `�2Gec/ I Ad / f r Address: r City/State/Zip: 4YyArc/ll/�e Phone#: 'ro Are you an employer?Check the appropriate bog: Type of project(required): 1.a I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). .. 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 working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp.insurance.: 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ 3.❑ I am a homeowner doing all work officers have exercised their 1 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' 13.0 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.policynumber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. c Insurance Company Name: r G S 1� (a l n S _ Policy#or Self-ins.Lic.#: a 0 d�U D G 3 U T 3& Expiration Date: Job Site Address: ��4u �. l�� n!n.rf City/State/Zip: 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 th pains and penalties of perjury that the information provided above is tru and cor/n ct Si ature: Date: 0v ( s Phone#: J U is 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#: Engineering Dept. (3rd floor) Map .32-4K Parcel O:� ermit# OZ I House# 02® rA-6 Date Issueeyd s� l02 �a Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30) OWN S Fee �Pi oCs � Conservation Office(4th floor)(8:30-9:30/1:00-2:00), 1 Planning Dept.(1st floor/School Admin. Bldg.) BIKE Definitiv proved by Planning Board 19 ; BARNSTABLE. TOWN OF BARNSTABLE Building Permit Application Project Street Address �20 �eao Village ytvy�S Owner Address .20 Telephone Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ ,-"BOO 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 2 o On Old King's Highway ❑Yes WIC 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 ( g ) g 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 Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 2<0 If yes, site plan review# - Current Use Proposed Use �— Builder Information Name e e �Z Telephone Number Address . 6�/S— G ��/✓ C�' /7— License# l6 �76f 3- — o�j 2 Z/ Home Improvement Contractor# /YD 7 416 Worker's Compensation#C194d/,fig 7 Z 8ZG 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 11V 771r SIGNATURE DATE /Z(-- BUILDING PERMIT 6iNVED FOR THE FOLLOWING REASON(S) i � 5• FOR OFFICIAL USE ONLY PERMIT NO. V/ � DATE ISSUED ' MAP/PARCEL NO. + , ADDRESS VILLAGE r OWNER - DATE OF INSPECTION: FOUNDATION; FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL' , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r + DATE CLOSED OUT r ASSOCIATION PLAN NO. - - The Town of Barnstable 1659. Department of Health Safety and Environmental Services Building Division - 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Fax: 508-790-6230 Ralph Crossen Building Commissioner For office use only Permit no. H t Date &—/— AFFIDAVIT HOME UVIPROVEMENT CONTRACTOR LAW SUPPLENIENT TO PERNUT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work:_ Est. Cost cS3Z�Z� Address of Work:moo �2��tr�� iS�yy,��✓�.�s' Owner's Namey�/��y/]�-!�%p�,cJ� Date of Permit Application: -7 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERNUT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME 51PROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply,for a permit as the agent of a owner: �z Date nt ctor Name Registration No. OR Date Owner's Name r _ = CO�.Acta E STP. T�ares HuLicLms FesulzUct's a-,d ��•.art [ . Asic�-tar. FLace -Fccr. 134t [ . C8 [ C6/731,516 Sal �astar:, �•'��a.c�atts GZZ. [ - - . FR;V=1 i c CaRFaR TIGN [ M= j?c= mremCTEF; r .44 CC'tQrc� C2Q1Z ..3. � Sti ,' �• F� i ✓�e Lronr��zanueal� a��.u,;el1N DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE #uEher: Expires: . .� A Restricted Tc: 16 TNOMAS X tAPIt1I JR "; 286. PERCIVAt OR eLE, MA 11666 � BARNSTA f The Commonwealth of Massachusetts W Department of Industrial,-accidents Off/CO Of/Avesifpfffo/f 600 Washington Street 41y V,� Boston,Mass. 02111 Workers'Compensation Insurance Affidavit Applicant namr: location: f G `f'Sr— li(/ rtJ� �1Z cite C_ao'77Ji i G .phone# �2__9; —93'22 C� ( am a homeowner performing all work myself. I am a sole proprietor and have no one workin,in any capacity I am an employer prop iding workers' compensation for my employees working on this job. comijany name: address:' may: phone 0: insurance co �L /�/ �� policy e25�WeBB Z I am a sole proprietor. general contractor. or homeowner(circle one) and have hired the contractors listed below ho hay e the follo«inz��orker_ compensation polices: company name: - address• - city: phone 0: insurance co policy# company name: - address: - civ j phone#• insurance co onex# a Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a flat up to S1WA and/or one years'imprisonment as Well as civil penalties in the form of a STOP WORK ORDER and a fiat of S100.00 a day against me.I anderstand that a copy of this statement may be forwarded to the Otrice of investigations of the DIA for coverage verificatioa. 1 do hereby certify under t ains and pen ffles of perjuJy that the information provided above is true and correct Signature Date -V 7 l' Print name official use only do not Write in this area to be completed by city or town official city or town: YARMOUTIJ _ permitAicense# rtBuilding Department Licensing Board 0 check if immediate response is required 261 ' . QSelcctmen',Office Health Department contact person: phone k;_ (508) 398-2231 ezt. nOther f a i PLOT PLAN FOR LOT # Indicate location of garage or accessory building Additions with dashed lines -------------------- Sewerage disposal (cesspool) Well I I 1 (lot. . . . . . .. . . . . . . . .ft. rear) I Abuttor s Abuttor s Name Name Lot # I Lot # REAR YARD If this is a / If this. is corner lot, . . . . .. �.. .ft, corner lor write in name write in of street. J/ f�P name of i other l� a) street. � b SIDE YARD SIDE YARD HOUSE ; • _ �� FT_ /i _ Z Z FT • Q I - I : SET BACK : • 0 I (lot. . . . . . . . . . .. . . . . . .ft. frontage) \ / (NAME OF STREET) / Information / Supplied by MARK NORTH POINT • i )(Z i3*LUSTaal L �CC • � .. b/xG P-r post . ol r '771 e J 7;r- w-�irJ�a oTAl,brvD • a sue-�"lVS T �• , L/A4te pars • .• � � SAC S Q 102/64 edf%k- y iris o