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Home My WebLink About0105 CARLOTTA AVENUE _..-_ _ _. dos �a�2o-�� / - -- - - - \ t i t 1 Application number //�� ..... ....................................... . Fee 6...l..f.. ./... � . : ZIP a 0� p Building Inspectors Initials........ :.. . ................... * JUL 5 1019 Date Issued................... 4.1 'I To" CJ. 8 �yt Map/Parcel........ .T.O....'... .............. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOW S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: CO�r�OG� �,r, NUMBER /l STREET VILLAGE _ Owner's Name: Ca-�VA,r t h C(� (16 Phone Number &6• q,3t) -5.4S S Email Address: �G_Cb6 VIC 01 ShE�,net Cell Phone Number &0-Cl'30-'`j4S8 Project cost $ (Q(D5, Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance.with 780 CMR Owner Signature: Date: TYPE OF WORK Siding ED Windows (no header change)# Insulation/Weatherization 21 Doors (no header change)# ..L_ Commercial Doors require an inspector's review 10 Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION x , Contractor's name ` Home Improvement Contractors Registration(if applicable)# I IDA(00 b (attach copy) Construction Supervisor's License#h';r 060P I A (attach copy)- Email of Contractor n�D �a . C0 Phone number �J�S'3 'a4A,5 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ............................................................ *For Tents Only* Date Tent (s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location (s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am -9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date lx 1 f APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents K ? Office of Investigations 600 Washington Street" ri Boston,MA"02111. www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):- Baker&Associates, Inc. . Address: PO Box 923 City/State/Zip: Centerville, MA 02632 Phone#: 508-362-2445 Are you an employer?Check the appropriate box: ' Type of project(required) 1-✓ I am a employer.with 1 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. g Demolition working for me in any capacity. employees and have workers' - 9. Building addition [No workers' comp.insurance _ comp.insurance.+ required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their, Plumbing 11. Plumbin repairs or additions myself o workers' com right of exemption per.MGL`- - Y � P- 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 whosubmit 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 additions(sheet showing the name of the sub-contractors and state whether or not.those entities have employees. If the subcontractors 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: Associated Employers Insurance Company Policy#or Self-ins:Lic.#: WCC-500-5002454 201�A - Expiration Date: 'A a Job Site Address: `6�j : t-L0'}'l, City/State/Zip; M� ! 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 imprisomment,;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. 1 do hereby certi de Ihf pains etPd pefries of perjury that the information provided ahn„e:e e.,.o-»a correct Si ature: Date: f �/,3 114 /. Phone#: 508 362-2445 Official use only. Do notwrite in this area,to be.completed by city or town official City or Town:. Permit/License# Issuin Authorit y ty(circle one): .. L Board.of Health 2:Building Department ICity/Town Clerk r.4.Electrical Inspector .5.;Plumbing Inspector 6.Other Contact Person: Phone#. I Client#:9742 2BAKERAS ACORD,. CERTIFICATE OF .LIABILITY INSURANCE DATE(MMI°D/YYYY) 04129/2019 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 have ADDITIONAL INSURED provisions or 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: The Hilb Group of N.E.dba PHONE 508 775-1620 FA 5087781218 A/C No Ext: A/C,No Dowling 8r O'Neil Insurance Agy E-MAIL ADDRESS: P.O.Box 1990 INSURERS)AFFORDING COVERAGE NAIC# Hyannis, MA 02601 INSURER A:NGM Insurance Company 14788 INSURED INSURER B:Associated Employers Insurance Company 11104 Baker&Associates;lna INSURER C: P 0 Box 923 INSURER D Centerville, MA 02632-0071 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD A X COMMERCIAL GENERAL LIABILITY MPJ7223M 4/19/2019 04/1912020 EACH OCCURRENCE $1 000000 CLAIMS-MADE OCCUR PREMISES Eaoccu.... $500000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 MOTHER: 'LAGGREG�ATELIMITAPPLIESPER: GENERAL AGGREGATE $2,000,000 POLICYX JECT LOC PRODUCTS-COMP/OPAGG $2,000,000 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ WNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N WCCSOOSO024542019A 4/23/2019 04/23/202 -A PER OTH- ISTATUTE IER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 Baker 8r Associates, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO BOX 923 ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE 01988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) 1 of 1 The ACORD name and logo are registered marks of ACORD #S235063/M235062 RPSW1 F Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Corporation before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 162600__=- =' 03/25/2021 One Ashburton Place-Suite 1301 BAKER&ASSOCIATES INc Boston,MA 02108 MARK L.BAKER __ ,.,. ,rcc./��„k 521 SHOOTFLYING:kIILL°f2D" �Y)i �, 3 CENTERVILLE,MA .02632'"' Undersecretary Not valid without signature i ----------- Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:;Suwlement Card before the expiration date. If found return to: Reoisfrati6n Expiration Office of Consumer Affairs and Business Regulation 162600 03/25/2021 One Ashburton Place-Suite 1301 BAKER&ASSOCIATES INC Boston,MA 02108 RICHARD GARNEAU 521 SHOOTFLYING.HILL RD? � CENTERVILLE,MA '02637 Undersecretary Not valid without signature 1 Commonwealth f Massachusetts Division of. Professional Licensure a . Of Building.. Regulatio ' ' r�r Y Con "visor 14 OR ti„. �„J t � i a..'u•.r, rv�>P. � •,lf-KL�, > �, k7�-197 1t�, �; —fir _� } �'4 1�•bM: Aj• �i�-.` j iv I { �. 9�S k''.-;z L r. Ig SS'sll''`u x t.l t F x1 ,:.-:. ,.`:, .:. �:.: '.,: .t .. ,�. ...::. .. ,. .. � ..,.. -� -::a•12 :>•n: -? 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T` Authorization Form: I as owner of the subject property, hereby authorize Baker & Associates to act on my behalf, in all matters relative to work authorized by this building permit application for : Address of property: 105 Carlotta Hyannis, MA Signature of owner: Print Name: Date: Assessor's office(1st Floor): Assessor's map and lot number q,7 g,3 0- S L P�Oi TM tt>o`` Conservation(4th Floor): } ��' �•7LS`i� ew Board of Health(3rd floor): ' • Sewage Permit number ' i DasYY�Dtt Engineering Department(3rd floor): "�i639 House number Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1.00-2-00 P.M.only TOWN ' . Of BARNSTABLE ' BUILDING INSPECTOR APPLICATION FOR PERMIT TO &— /?00f TYPE OF CONSTRUCTION _ 145aA,�It' o files 19 q TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fo_rca permit according to the following information: Location A)q L—g(14_`t q' hVe, 0 4l- Proposed Use Zoning District , 6 Fire District 1 Name of Owner !G k q 2 / Car Lome e Address O q bee lye- �c 0b �� C� / � Name of Builder aCPy �t�S�/G[ C�/r�Lj Address 39 Carr 4z / t d Al"a 11/S Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating �— Plumbing Fireplace �— Approximate Cost Area Diagram of Lot and Building with Dimensions Fee f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Siipervisor's License CARBONE, MICHAEL No 36857 Permit For RESHINGLE ROOF 1 Location 105 Carlotta Ave. Hyannis Owner Michael Carbone Type of Construction _ Plot Lot f - Permit Granted July 8 , 19 94 Date of Inspection: Frame 19 Insulation 19— Fireplace "° 19 Date Completed 19 i i