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HomeMy WebLinkAbout0330 CASTLEWOOD CIRCLE 330 ��e�.�a--1 u'ti, Town of Barnstable Building t63Paia c gWPohsettTe rdeh A iUs nC.tailrcHdFr nSao l TInhaspt ertc tisio,Vni sHibalsae, BFeceonrnM.:thaetl eS�tre...et %Apprvedns;MpsFt beRetat'med on cJ,o, b aa�nx d this Cartl Mus#be Kep t � Permit aPoos wnsrw M aCertficate of OccupancysuRequred,suchBldmg shall Notbe Occupieduntila Finallnspect�onhas been made Permit No. B-18-933 Applicant Name: Mark Mordini Approvals Date Issued: 04/02/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors -Expiration Date: 10/02/2018 Foundation: Location: 330 CASTLEWOOD CIRCLE, HYANNIS Map/Lot 273-034 Zoning District: RC-1 Sheathing: A Owner on Record: HEYWARD,ALVIN JR&ROXANNE Contractors ame MARK E MORDINI Framing: 1 Address: 330 CASTLEWOOD CIR _ ontracto ljonse;�CS-D57645- 2 z _ z: , HYANNIS, MA 02601 �� F EstProJect Cost: $ 13,315.00 Chimney: Description: strip roof shingles and re-roof per GAF specs(16 sgdare),ice and Permit Fee: $67.91 water shield 6'from fascia and 3'from rake boards and m valleys, Insulation: Fee Paid ' $67.91 install soffit and ridge ventilation Final Date 4/2/2018 Project Review Req: �s gTM. - Plumbing/Gas �$ M Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six monthafter issuance. Rough Gas: catio , �� : All work authorized by this permit shall conform to the approved applinand the approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structureshall be in with the local zoning bylaws and codes. This permit shall be displayed in a location clearly visible from access street ortroad and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building antl Fire Officials are;p�ovided 9n this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:' F .; ,, Rough: 1.Foundation or Footing a. .. ... . M: . 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: Irersons 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 —'� �j_$ e ti Town of Barnstable REcE� A ` �„ " 200 Main Street, Hyannis MA 02601 508-862-40383 o u Application for Building Permit , t Application No: TB-18-933 Date Recieved: 3/31/2018 Job Location: 330 CASTLEWOOD CIRCLE,HYANNIS Permit For: Building-Siding/Windows/Roof/Doors -0 �. CD rn rn Contractor's Name: MARK E MORDINI State Lic. No: CS-057645 Address: North Attleboro, MA 02760 Applicant Phone: (508) 280-0156 (Home)Owner's Name: HEYWARD,ALVIN JR&ROXANNE Phone: (508),771-9256 (Home)Owner's Address: 330 CASTLEWOOD CIR, HYANNIS,MA 02601 Work Description: strip roof shingles and re-roof per GAF specs(16 square),ice and water shield 6' from fascia and 3' from rake boards and in valleys, install soffit and ridge ventilation Total Value Of Work To Be Performed: $13,315.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have" been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All pen-nits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Mark Mordini 3/31/2018 (508)280-0156 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $13,315.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $67.91 3/31/2018 $67.91 X)M X'xxx xxxx- Credit Card 4147 ......_i ......... ... ...... ..........._ .....: Total Permit Fee Paid: $67.91 a SS PE,R ' T'OW ©���rllSta��� *Permit# CDW Ex 2 9 2oog Regulatory Services Feces 6 month from issue to �nxivsxaate, R Thomas F.Geiler,Director aM. OF BARNSTASL Building Division 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 PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number O�3 0,3q Property Address cl� C A 5—fee il6u eq? N N 5 ❑Residential Value of Work / ( Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address'JQ o Y, -ia i1 Vie_ 5SQ C A C 1� Contractor's Name Nr 6J P po Telephone Number *— 73(�-9(lo '7 Home'Improvement Contractor License#(if applicable) �yL L5 � 2'Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [yfhave Worker's Compensation /Insurance Insurance Company Name Workman's Comp.Policy# 6 ! (16`,� 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-side Replacement Windows/doors/sliders.U-Value (maximum.44) *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 is required. j SIGNATURE:/X1 ;G Q:Forms:buildingpermits/express Revised 123107 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Y Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: o2 6o r 2 S City/State/Zip: b_)-0 u R 1-l M A s5 Phone Are y employer?Check the appropriate box: Type of project(required): 1. I am o n a.employer with— 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 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 many 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 l l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 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#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 a new affidavit indicating such. tContractors 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. 4 Insurance Company Name: Policy#or Self-ins.Lic.#: /G GS Expiration Date: Job Site Address: U0 0 A57ZC (,,JCZC Cl e City/State/Zip:Z&^o r� 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 fore ance coverage i is ion. I do hereby certify der a pains and p al 'es er' that the information provided above is true and correct. Si ature: Date: I 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone# c = _ Board of Building Regulations and Standards HOME OhlPR041E1117EA9T CtDi'37RACTflR Registration: 146589 Expiration:' 5/5/2009 Type:.;:Supplemeni Card NEWPRO OPERATING LLC' ?OM PEACOCK 26 CEDAR ST WOBURN,MA 01801 Administrator ✓✓sty,✓f=�arac�r� a�/I'��� Y , Board of Building Regulations and tandards Construction Supervisor License � yw r License CS 96093 Birthdate 4/8/1965 s' 0 Expiration :4/812010 Tr# 96093 � , Restriction .00 ' THOMAS PEACOCK.JR '38 OAKLAND AVENUE i ' -SEEKONK, MA 02771 Commissioner f t:4A 16177709683 A ANERICAN ''IRS`f' INSU E CERTIFICATELIABILITY INSURANCE OF,Ip Dc DATE(M�vo�YTYT1 APR-1 02 2g 0S PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTE-4 OP INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE American )First Ing Agency lno HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTENO OR 122 Quincy Share Drive (ALTER THE COVERAGE AFFORDED BY THE POLICIES EELOW. north Quincy XA 02171 Fb:0n®s 617--170-9000 INSURERS AFFORDING COVELAOF _ NAIL 0 INSURED INGUR9A A. Arb®11a Protection Ina, C 9 INSURER 8: No r0 era,tina LLC INSURfiRO: PO ox 96 INSURER 0; Woburn XA 01801 INSURER 13t COVERAGES THE POLICIES OF INGURANOC LISTED BELOW MAVL;BEEN ISSU€O TO THE INSURED NAMED ABOVE GOR THE POLJCV PERIOD INDICATED.NOTW IThISTANDINO ANY REQUIREMENT,TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITPI RESPOT TO WKCH THIS CEATIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HFACIN 13:3UBJECT TO ALL THE TERMS,VOL.US10N5 AND CONDITIONS OF SUCH POLICIES,AOOAFOATC LIMITS SHOWN MAY pgvP.$EEN RIZOUCED BY PAID CLAIM$• LTA NSA TYPE OF INSURANCE POLICY NUMBER DATE M/DO DAT® M/ 0 LIMITS OENEPIALLIABILITY EACHOCCVRRENCE i 1.000,000 A a( COMMERCIALGENGAALLIA91LITY 850000010649 01/0 1l0 9 01/01/09 PREMIri49 Ea000vreno® S 50,000 CLAIMS MADE ® OCCUR M6O EXP(Anyone pomon) $S,00 0 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE 132,000,000 OEN'L AOOREOATE LIMI-T APPLIES PER: PRODUCTS-COMP/OP AGC 8 2,000,000 POLICY JtoCT LOC AUTOMOBILE LIABILITY COMOINBD SINOLE LIMIT $ 1 000,000 ANY AUTO 81037400001. 12/31/07 12/31/08 (Eaecoldonp , ALL OWNED AUT05 BODILY INJURY X SCHEDULED AUTOS (Per parson) >I X HIRED AUTOS BODILY INJURY a( NON-OWNED AUTOS (Per sod dent) $ PROPERTY DAMAGE $ (Per a=Iden j GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S ANY AUTO OTHC ON ONLY: EA ACC' S AVTOAGO S EXCe8a1UM®RELLA LIABILITY EACH OCCURRENCE $ 6,0 0 0,0 0 Oj® A x OCCUR �CLAIM3MADV 4600010709 01/01/06 01/03./09 AGGREGATE S5,D00,000, s , DEOVCT18LE _ $ RETENTION !b $ WOflKCR3 COMPENSATION AND TOR LIMITS ER EMPIOYeR9'LIABILITY ANY PROPRIETORjVARTNER/EXECVTiVE 90967.003 s 05i01/07 05/01/00 S.L.EAOHACCIDENT 9 500,000 I OFF10EPUMEMBEREXCLUDED7 ELOI99ASE•EAEMPLOYE S 500,000 If yoe O tefteunder E,L.DISP.AIBE•POLICY LIMIT s 900,000 9PELIIAL PROVISIONS below OTHER OE9CAIP710N OF OPERATIONS!LOCATIONS VEHICLI•S I EXCLUSIONS ADDEO aY L'NOORSEM@NTI VeCIAL PROVISIONS - CIP2RATIONS AF IHMMI> CERTIFICATE HOLDER CANCELLATION SPEC0 O1 SHOULD ANY OFTH@ A80VIe DBSOP11830 POLICIeS VC CANOELLBO OFFORE THQ exPIR19TIL OAT THEREOF,THE 18SVING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTIOE TO THB ORSTIMCAT9 1,1006A NAMED TO THe LEFT,OUT FAILURZ TO DO 90$MAL .SPEC N IMPOSE NO OBLIGATION OR LIA81LftY OF KIND UPON THE INSURER,ITS AGENTS OR i1EM231INTATIVES, _ AUTHORIZED REPRESENTA'nYE Jam® J. HbT$e$ C Ct9 7OF11)COFIP RATION119 •ACORD 25(20DI/08) I a o • >t ' • o e 9 ® =.Qualified In all zones NE VVPRO MANUFACTURING NFRC 2000 DOUBLE HUNG kin. Cellular PVC frame, Triple glazed, National Fenestration Low E Coating (e=0.034,S2&5), RaungCouncll® Kryptonlair filled 6EV-K-20-00001 R ENERGY:PERFORMANCE RATINGS U-Factor(U.SJI-P) Solar Heat Gain Coefficient U117 .90%7 ADDITIONAL PERFORMANCE RATINGS T Visible Transmittance Condensation Resistance ul-Au 70 Manufacturer stipulates that these ratings conform to appllrable NFRC procedures fqr determining whole product performance.NFRC ratings are determined for a fixed set of environmental condltlons and a specific productsize.NFRC does not recommend any product and does not warrant the suitability of any product for any specific use.Consult manufacturer's Gteralure for other product performance Information. ` - vvvvw.nfrc.or 04-28-'08 15:40 FROM-Newpro 'WheelingAve 1-781-932-0860 T-128 P001/001 F-736 :. MA Res:0146M54206 CT R".#0605216 RI Reg.#26463 tits peovm Federal ID#20-2625129 rbiDaNuttsses.ro..se _ e-O,I0e0=11 Wok n,MAOIM (78111180,4800 1,110MAQ-Mn THIS-CONTRACT MADE THE. . . . . . .� . .. day of. ►��, . , , . 200R between. •CI t!LAB . . . ►om7e Pn!onte) (euslCe+1 Phone.). . . . . 0. MrJMr.)3P n _ • . ? . . . a?l (Aadm= csterel ACo on) to"Owner"and NEWPRO Operating,LLC,'NEWPRO". NEWPRO hereby agrees that it will for the consideration hereinafter mentioned,furnish all labor and material necessary I to install the following described work at the premises located at (Job 90Area&) (E fVJ�1 Addrew) TOTAL NEWPRO Additional sty TOTAL CASH VAndV"Purdwm Work >Y PRICE tAfkwWw Color Silding Glass Door DEPOSIT capping Color S f/e, 0 Steel Security Door WITH ORDER XBV O Double HUM t, Picture Window Obscure Glass BO BALANCE I Sffi" Casement SmogA t_ DUE AT Casement-Model# INSTALLATION 2 Late 13 Lite Slider NEWPAW doe* not do any painting or Bay/Bow Frame staln+rro. I I I CASH NEWPAO' is not responsible for conditions dance Paid IO Garden Window or dreumstancen beyond Ito control including Installer at Installation A condeneI resuttrng from or due to pro. eafeting conditions.f,�thgf Bank Completion GRIDS I I Colonial I Diamond �Fbimgned at Installation DESCRIBE WORK: — - , 4r rj a 0- eu r 0- d r 7.. a w a9 Ati efod sow my donim Nil have 9 3/V aluminum th Id Inapt over existing threshold. Customer in@a16 Est.Start Data: 0 gas Est.Comp,Date: wo 't o u n The Owners who WCWO SW be tie lion bl NE YYPRO to t>bmin any and eu petmita necessary under thta agreement,fla ate Owrxrra Agrrnt- trtelr own related permits,or coal vAth tin red Contratxots wiu De eltelude0 hem the guaranl�fund Prbv•iors of N+GLC.142& AN Fldne t�I70weWetan and SubconoacOOre II Oe 7e0isTared 0Y the Ofrector and arty lrtpumes allow a Contractor or Subcontntctor rtdav g ro a regtatretidn ernould be directed 00:. Olreetor, Home ImDrovemenl Contractor Regtatretion, One Ashburton Place, Room 1201, 6bston,tnA ortoe,(slat y2��sge, . n me Owner to obtemlftg tinandng by.ray of a Ratbl+IrtsfaAmem SalOg AQroemerN,aucn AQresmart snfln Include a time arhaduln of payments to be tirade IIf10af 8e10 corttreq erM the dnrounl 01 Ouch paytnem tasted In dollars,Induamp aG tlnanC6 d1ar�88. 119 Retail Installment Sawa Agreement shaD De r10Drperteta0 neraln Dy reterorlce.Ir the Qwnor Is obtalning a rovolVing credit Ilia to pAy,to Waot0 Or In Part,Ior the contract arA herein, the tmnts a tl1e faVOMng tlrr6 er wed i Inducing Interest rste and payment farms,shall b0 dearly set out on the Green appnwtion.Tina Portion of the -crest approsition reterenGng a time schedule or payment,to be mede under this contras,and init amount of each payment stated in doltani,inducing an maflCe Welga9,shall be InCitif retdd Heroin by r=anoo. NEWPRO regresenta that it carries WOrkman's Compensation and Public Uabil*Insurance in the amount of$t00,oD0-ww,000. if the Owner refuses to permn NEWPRO to pi with the work heroin,or in the ovem of any cream of the owner of this agreement,for any reason wltataoaver 81re11 f:euraa the owner to pay NEWPRO a sum M monoY equal to thirty-three and one,tmro percent of the price agreed to be paid,as fixed, ti000ete0 and esEendiftfld damages,site not as a penalty,without tuner proof Of lose w damage, Y NEWRO and not to held Matte In damages for deimys In the peAormorco at this oentran due to causes beyond its reasonatole oontrol, Owner Warrants awl he is Me owner of tie Property on which the work is to be performed or that he is otherwise authorized on behall of the owners to%that Into this Agreement. This bOnAttCl(®presents that entire agreament between rite Owner end NGWPFO and cannot be changed excopt by a writing signod by both the Owner Wild NEWPRO. Vol are ontitlett to a copy of the Commit at the time you sign,Keep R to protect your legal rights.We,the aforesaid owners,cerdty that Immediately after the signing of the aforesaid agreement,a copy was furnished to us. ' You may cancel this agreement If it has been slgnad by a party thereto at a place other.than an address of the seller. Which may be his main office,or branch thereof,provided you notify seller In writing at his main office or branch by Ortdiaery mail posted,by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement(Saturday Is a legal butalness day). Sae rho attatdred motto®01 cancellation ttxm br an explanation of this right, 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. The Owner has 66e11,'81Imple WarrantiSS that Will be provided by NEWPRO upon installation, Sampie wernanses provl0dd to owner, n, IN WITNESS WHEREOF,the parties have her6unto signed their names day of �� 200 Y EIN# Signed k Qs-P-- Marltoting Raprown a Printed Name OWn 3r Arimnled-,NFWDRn brePr9tinn 1.1(' n a a - � S �^w>.`-�.� � `-y-5`a'�" •#• -�� r.�-'"' *4_11 ,shy �"�•w ,.,�_'s� _ '.I_.'- _ r Y qzf t '4;"3i K. 4 _ WOLIUI's/f.) JCG it Tii'nCvLncei•Irir+r w Iwe;v oP.r. . F t5 e J--7- 4r } 1 T N6 R�;, - I:,RODUr;T 3(%ECIP.JLT �c-. r Es Tllvl,,l.rtz�START DATE C_1 (/J — 0r ri0 iFS L'Jli•1DC��'J(,rJIUR WINDOW`•% u c.71=tiP,i,1/J .t��Y ;ARPEN _ :.r m gwpi,i'aho nsi7rlri,l :.ie A.F't: :II Gf- •••- �•ram � �� n r ,'—~l � (/C. r�'� Si'`(LF V>. xH _ U.I— LOCATION GRID :iia? Ihi-T ('111T Al.)( I'rlt-)N�, QI1ENING GUT x x 27sS— IY,y `f x MeasUfC'rr .L._ x ar Crew Size 1iroe t-ram�,to c�'I,job _—Capping Type, --- Spe:'cialIncl,llotionIn\irUCl Qo�rl� C4ta.� �ar Cjz/t�7^(py ��13t�d•t, (�•,f��,t°o'c.J 0M, 'ic10. LOV.-Wjc,-1�� " \.,." � ¢ � -. mow.._--ter.•. ' to aitp. i§ "+ �` .`' '+-SL. •� "jx-�^i •tea -r .. . . . Lor- 1 .n So PR SASH o tAl� e CJ � - -- L SA5R1-4 C easure C�Sinq 56 , f .0 • J THE REPLACEMENT. WINDOW PEOPLE page of name address -i ? please circle all info home style EXT O SIDE CASING CASINGS raised ranch oo�d_sJh i1gIRS ffl� ate 212 cape inl sidding 908 12 to�nail tri level alumiun sidding 4.bend anch asbestos blind stop 312 colonail. t T1 -11 crown headers - flat camponellis brick permashied belly 3 story eo - narrow metal fin 2story type of install STOPS STOOL construction thumb latch colonail / � barnsash weight pockets (21 a� %-3772— mullion removal ' steele frame 158 ranch 41f4 enlarge opening, anderson bull nose V5 reduce opening wood conv Scotia 6 bay removal inu�k"'i none latex bow removal c si cone garden removal replacment r. wttiitc n outside install _ List all other info and stock+needed ' a=' * ORS x - , s= Ez "' V } - f , ' Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee V5, � Thomas F.Geiler,Director Building Division 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 PERMIT APPLICATION - RESIDENTIAL ONLY -7 Not Valid without Red X-Press Imprint Map/parcel Number � [ 3 0-3 T Property Address - 3 3 0 NSTLe W oo-b C 1,0'et f J s Residential Value of Work oZ0 6 Minimum fee of$25.00 for work under$6000.00' Owner's Name&Address �,D►-(, � Cl�2c . Y/�-OAr1S Contractor's Name 9 U 8 c/2T Ty t bA UL Telephone Number qs�o Home Improvement Contractor License#(if applicable) it 60 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance '� Check one: ESS PER ❑ I am a sole proprietor ��� ❑ jLam the Homeowner S�P 1 0 2007. I have Worker's Compensation Insurance Insurance Company Name ,g-7t A"T1�' Cj+/K7fR Tp\NN OF BARNSTASL� Workman's Comp.Policy# W 0 1 0 O130 aD , 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-side rl': ;4", ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) - -- - *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. :6 L{V i ***Note: Property Owner must sign Property Owner Letter of Permission. Arfpy of the Home Improve"Pent Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 a ` The Commonwealth of Massachusetts Department of Industrial Accidents r Office of Investigations J _ d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers" Compensation Insurance_Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n Please Print LeZibly Name(Business/Organization/Individual): .IJ_ Al b+,t-C "U06 nl 6-' •Address: -It{3Q T W 4-"A0S t,J4 y City/State/Zip: Sm�S' 2CS ��D Phone ' q�— y •5 _ Are you.an employer? Check the appropriate box: Type of project(required):. 1.[]I a a employer to er with 4. I am a general contractor and I , y 6. ❑New construction . epployees(full and/or part-time).* have hired the stab-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' [No workers comp.insurance co insurance.$ 9• E]Building addition 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 11.❑Plumb' ng 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 •. r employees. [No workers' 6— 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. 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 providt:their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is.the policy and job site information. Insurance Company Name: A-TL/Q b�'T 1�C ci� i1� Policy#or Self-ins.Lic,M t4l e yoo -7 3 ool-o f Expiration Date: G/ 6? Job Site Address:0.336 eiF$'TLttJGbb 64,'nCfiC City/State/Zip: 1Yrhe1S, 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investieations of the WA for insurance coverage verification. I do hereby certi - der the pains-and penalties ofperjury that the information provided above is true and.correct Si afar Date: I® .o 7 Phone#:Phone S0��o2U" yS�Lf yS� Official use only. Do not write in this area,to be completed by city or town aciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: �oFIHE� � 'Town of Barnstable °" Regulatory Services r13AMN �'$ Thomas F.Geller,Director BuRdiIlg D1Y1s1UIi Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 v-vrrv.town.barnstable.ma.us Office: 508-862-4038 Fax: 50.8-790-6230 Property Owner Must Complete and Sign This Section If using ABuilder 7, lL tIA t 0oo b ,as Owner of the subject property hereby authorize n&((_ {G8 to act on my behalf, in all matters relative to.work authorized by this building permit application for: , 3 30 C6mf Woob CIP-eLf- (Address of Job) S gnaiure of Own Da e Print Name Q FO RM S:OwNERP ERM IS S ION 07/05/2007 11 :03 FAX 5084201637 FREDERICKS INSURANCE IA002/006 ' • G ..� 1{V Yi.- �'::1, �:'1•J Ji- ri�J11....: M '1 ll' � ''Y.'�f Fr[: rr: "Y;IJ!I7',il •h h$:' J V. t� ``'',,'' a I I ' r 1 99 ' {{ Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV00730201 1. INSURED: Prior Policy Number: WCV00730200 Tyndall Roofing LLC Producer: 30 Jillian's Way Fredericks Insurance Agency, ber:204616445 Inc. Marston Mills, MA 02648 Federal ID Num R 1046 Main Street Risk to Number: Osterville, MA 02655 Business Type: Urni:ed Liability SIC:9999 NONCLASSIFIABLE ES-fABLISHMENTS Other Named Insured: Other Work Places: 2. POLICY PERIOD: The Policy Period Is From: 7/11/2007 To 7/11/2008 12:01 A.M. Standard Time at The Insured Mailing Address j 3. COVERAGES: i A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA i B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our I liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A All states except Monopolistic State Fund States D. This policy includes these endorsements and schedules- See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Total Rate Per Estimated Code Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $607 Interim Adjustment: Annually Estimated Premium (Minimum Premium) $500 Servicing Office: Surcharge(s) 7 25 New Chardon Street Boston, MA 02114-4721 Total Premium and Sur harge(s) $507 Issue Date 05/25/2007 Countersigned By: , - _ Daty Form:f00m Copyrlaht 1987 National Council on Com tio pensan Insurance r ,per �ie �om��noouuealff a��/�ac�ucaeCta �-\ Board of Building Rcgclations and Standards Liceni:e or registration valid for individul use HOME IMPROVEMENT CONTRACTOR beforelthe expiration date. if found return to g Regulations and Standards Boar&of Building Registration:, 116C.fi4 g lug Expiratitini..;[15'�008 One Mliburton Place Rm 1301 Tye a Lto liability Corporation Bosto ,Ma.02.108 -rYNDALL ROOFING LLC = { ROBERT TYNDALL` - 30 JILLIANS WAY`` MARSTONS MILLS, MA 02648 Deputy Administrator Not valid without signs ure. x , TOWN OF BARNSTABLE ]BARNSTLBLE, MAO& 039. 0 M ING INSP. Apo, ,ECTOR APPLICATIONFOR PERMIT TO ... .. ........ ........ ........I...................... ............. .................................................... TYPEOF CONSTRUCTION ........... ...... . ... . ....... ........ .. . .......... ... ... .............................................................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersig ed hereby applies for ermit apprding tot Lation *ng information: Pn ,p7 ............ ..... . ... ..... ................................... ProposedUse ...... .. .. ........................................................................................................................................ Zoning District . ................. .......................Fire District ............. ......... Name of Owner . ...... ........... . ...........Address.... .... . ..... ... Name of Builder .. ..... . ........ .. Address .................... ....... ............. .... ............... ele Name of Architect ......Address .... ... .... . ..... .... ...... ..... ... ............................ {..:.. ............ ....................... ...... ...... Number f R &.M. 0 ...................Foundation ... . . ........ ... ............................... Exlerior .�;.o ... .....c6l'(........ ......Roofing .......... Floors ....... . ................................................................Interior ..................... . .... . .................................. Heating . ...... .. ..... .. ... ... ............................................Plumbing .. ........... . ...... . ....... .....C2. ................ Fireplace ............/,**,**""C*/*,***,**",***"**,***"***,**""**,******,*...Approximatt- Cost .......4/1...4.. 0"'o..... .... .......................... . . Difinitive Plan Approved by Planning Board --------------------------------19--------- Diagram of Lot and Building with Dimensions 0 40 I hereby agree to conform to all the Rules and Regulations of the--­fa'�In of Barnstable arding the above construction. . Name ......... .. .. ...... .... .. ................ .......................... ,Ginn, Russell E. DEC 31 1971 j _ f �+vo R...13609.. Permit for ...., one story, ,N single family dwelling-garage k• Location .........Castlewood Circle I ..........................H�ranri s..................... Owner .............Russell E. Ginn i Type of Construction frame ................................................................................ Plot #112 ..Lot ............... ............ Permit Granted ........... 7 February 8 19 1 Date of Inspection ./...�.. r''-..:./.. ........19/7/ Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... Approved ................................................ 19 ............................................................................... ..........................".................................................... I l z� s k - l i4 - x Ir 9 18.0 - FOSS E ,. �0 R SANITARY WATER SUPPLY, SEWAGE DISPOSAL -t AND DRAINAG IS IiG �IrD ' 'P 'I:OVLD TOWN OF SARNSTABLE, A ILWENSED INSTALLER 1VIUST- OBTAIN SEWAGtr • BOARD OF HEALTH tMIT. AND INSTALL SYSTEM,. R U S S E LL E. G I N N Bathrooms, - Kitchen Cabinets General Contractor + Building & Remodeling 77 Appleton Road Telephone 832.4281 Auburn; Massachusetts ` I r