Loading...
HomeMy WebLinkAbout0424 CRAIGVILLE BEACH ROAD i-i a � -C rc�,l cJ i ���. �-CcZL'-�1 _ � �d oFn,e Town of Barnstable *Permit Expire mont fr�rissue date PERMP Regulatory Services Fe Richard V.Scali,Interim Director F 5 2014 Building Division TOWN OF BARNSTABLE Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PEMUT APPLICATION - RESIDENTIAL ONLY ( Not Valid without Red X-Press Imprint Map/parcel Number ` Property Address /L �� � Ili g.I, ®Residential Value of Work$ 600 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Aw 'TV;41, � J Contractor's Name C ,9, Telephone Number �,� -7 t9 G Home Improvement Contractor License#(if applicable) (o`j 3 (a Email: O �� �r�1��,��`Slgs d�( �ai�v VA C_J Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Co1mp�e�nsation Insurance Insurance Company Name r % k4/LA Workman's Comp.Policy# 5 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 Y (maximum.35)#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 pf the Home I;n rovement Contractors License&Construction Supervisors License is req ' e SIGNATURE: TAKEVIN MBuilding Changes\EXPRESS PERMMEXPRESS.doc Revised 061313 A 40RO CERTIFICATE OF LIABILITY INSURANCE DAt712014 M/DD,Y,-YY, 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), AUTHORI7_ED 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 endorsements . PRODUCER FRANK L HORGAN INSURANCE AGENCY INC NAME: 44 BARNSTABLE ROAD PHONE FAX PO BOX 250 WcN N A/c No: HYANNIS, MA 02601 ADDRESS: INSURERS AFFORDING COVERAGE NAIC 9 INSURERA: LM Insurance Co oration 33600 INSURED CAPE&ISLANDS CONSTRUCTION COMPANY INC INSURER PO BOX 210 INSURER C CENTERVILLE MA 02632 INSURERD: INSURER E: INSURER F: — COVERAGES CERTIFICATE NUMBER: 20102526 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR -LTR TYPE OF INSURANCE ADDL SUBRPOLICY EXP INSD D POLICY NUMBER MM/DDY EFF MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE TO FMTrEff— MED EXP(Any one person) $ PERSONAL$ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT PRO ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGTU97 $ - (Ea accident ANY AUTO - - - BODILY INJURY(Per person) $ - .-. ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Par accident) $ NON-OWNED - PROPERTY DAMAGE HIRED AUTOS - AUTOS Per acddenl - $ UMBRELLA LIAB OCCUR EACH OCCURRENCE - $ EXCESS LIAB HCLAIMS-MADE - - AGGREGATE $ DED RETENTION $ A WORKERS coMPENsanoN. WC5-31 S-377540-014 5/7/2014 5/7/2015 ,i STATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y1 N E.L.EACH ACCIDENT $ 10000( OFFICER/MEMBER EXCLUDED? ❑N N/A (Mandatory in NH) EL.DISEASE-EA EMPLOYE $ 10000( If yes,describe under 50DD0( DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) .. Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage . .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 ZOO MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIvE -A4 LM Insurance Corporation F . ©1988-2014 ACORD CORPORATION.All rights res.erved. as ACORD 25(2014/01) Th'e ACORD name and logo are registered marks of ACORD CERT NO.: 20102526 Lucy.GarfieLd 5/7/2014 7:38:38 AM (PDT). Page I of 1 - 4 � I y.. 9 Massachusetts Department of Pbblic Safety License or registration valid for individul use only ( Board of Building Regulations and Standards ; before.the expiration date. If found return to: Construction.Supen-i+or Office of Consumer Affairs and Business Regulation License: CS-074660�� f . 10'ParkPlaza-Suite 5170 Boston,MA 02116 JOSHUA X KOURf PO BOX-,21-6 iP = { " CENTERVII,L>E'NIA 02632 f Expiration . v d w hout signature Commissioner :'' 02/12/2015 - - t ' V �e �oomzinzo�rurseaLl�C o��tu�etcc�2c�eL� - ---. _ , Office of Consumer Affairs&Business Regulation " I it Massachusetts -Department of Public Safety ME.IMPROVEMENT CONTRACTOR s Board of Building Regulations and Standards gistration 165936. Type Construction Super',isor I' I�WrE piration:�4/9/2096 Private Corporatio 1° License: CS-074660 , CAPE&ISLAND CONSTRUCTION CO INC. 4 r I 1 JOSHUA X KOUR JOSHUA KOURI fi PO BOX 210 -"s CENTERVII,LE IiIA Zj6k55 ELM AVE. - � I;HYANNIS, MA 02601Under--secretsry ' ' J.•�..- �tii. fir„! Expiration - 02/1 2/2015 Commissioner THE T » eaxxsrnste, MASS. Town of Barnstable • �AjFG NIA'1 A Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO 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 Gt, J ,as Owner of the subject property hereby authorize C L9 to act on my behalf, in all matters relative to work authorized by this building permit application for: P II ( ddress of Job) Signature of Owner Date -Tr' a-51- Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN D\Building Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 The Comimiounwalth of Massachusetts Department of Inditstrial Accidents Office of Investigations WJ 600 Washinglon.Street. - Boston,M4 02111 ivwlv.miass,gov/din Workers' Compensation Insurance Affidavit.Builders/Contractors/Electricians/Plumbers Applicant Information Please Print L.eLibly Natne(Businewogmiza[iouthdividoal): Address: , c�. Z City/State/Zip: jv ` Phone.#: Are you an employer?Check the appropriate box: Type of project(required): 1.V I am a employes with_� 4. ❑ I am a general contractor and I 6- New construction ❑ employees(full andlor part-time)* have hired the sub-contractors 2.❑ I am a sale proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employers These sub-contractors have g_ ❑Demolition working for me.in any capacity. employees and have wodoess' 9. ❑Building addition (No workers'comp,insurance comp.insurance- required.] 5. ❑ We.are a corporation and its ME]Electrical repairs or additions 3_❑ I am a homeowner doing all work officers have exercised their I L n Plumbing repairs or additions myself workers'comp- right of exemption per MGL �o workers 12-❑Roofrepairs insurance required.]i c- 152,§1(4),and we have no employees-[No workers' 13.0 Other comp.insurance required.] Any applicant that checks box#1 mast also fill out the section below showing then workers'compensation policy infonnatian. Hameawirm who submit this affidsit indicating they ate doing all work and then hire outside contactors mast submit a new affidavit indicating mcb_ +Contractors that check this hart must attached an additional sheet shoving the name of die sab-comaactors and state whether or not those entities have employees. If the sub-contmctors have employee%they mast provide their workers'comp.policy number. lain an eiployer tliat is proddYrig nwrkers'coirpensation iummuce for my empeoyem Below is the policy acid job site in foranalion. Insurance Company l`rarne: 1 �il r t2 lot, Policy#or Self-ins.Lie.#: <:-- 915-)— 3 5-%C-)—C-9/3 Expiration Date: 5` -721 Job Site Address: V) T ,', /�✓� �s'1/� City/StatelZip: Attach a ropy of the workers•compensation policy declaration page(showing the policy number and expiration date.). Failure to secure coverage as requited 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 chril penalties in the form of a STOP WORK ORDER and a fine of up W S250M 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 piSvnage ve5ification. I do hereky certif p under the poi d nal ties f perjury that the information prodded above is Min and correct Si tune: Date: Phone#: O,(Iiciat use only. Do iaot unite in this area,to be completed by city or town g0'iciaL City or Town: PermitUcense 0 Issuing Authority(circle one): a 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: L S 7 �o t,►tE": /p Town of Barnstable . *Permit# T @"' Expires 6 mouths from issue dale Regulatory Services Fee C— 8ARY9rBss. r �y ���Q Thomas F. Geiler, Director r�q Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Off-ice: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valiri without Red X-Press Imprini Map/parcel Number U Property Address 72V 11, lk,q, d1w P27 HY2i C �� S� r ❑ Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name & Address Contractor's Narne Z, �;/��<</ fijr7 t' C �L Telephone Number I'p`y5,, Home Improvement Contractor License#(if applicable) Construction Supervisor's License# (if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner EP-1-have Worker's Compensation Insurance Insurance Company Name IAA ti ---------------------------------------- Workman's Comp. Pol icy# eyi ��� � 7� c/C) Q� U . Copy of Insurance Compliance Certificate must accompany each permit. Permit Request (check box) tda"4-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to C. ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement.Windows/doors/sliders. U-Value #of doors (maximum .35)#of windows 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'ifbrms\EXPPESS,doc the Home Improvement Contractors License & Construction Supervisors License is SIGNATURE: QAWPFILESTORMS\buildin ermi Revised 072110 f ' llSIDING-CAPE-Cm-FOR 1 1 1 1 M l � CO TR 'fie C° To Whom it may concern: 1 authorize Cape& Islands Construction Co. Inc. to re-roof my home located at 424 Craigville Bch Rd. W. Hyannisport Ma. James Triaht,Owner. ` j v P.O. Box 210 • CENMVMLE, MA 02632 • PH: 508-775-ROOF (7663) WWW.CAPEANDISI.ANDSCONSTRUCTION.COM Massachusetts- Department of Public Safet% 4 Board of Building Regulations and Standards ` Construction Supervisor License License: CS 74660 Restricted to: 00 JOSHUA X KOURI PO BOX 210 CENTERVILLE, MA 02632 Expiration: 2/12/2011 Tr#. 14076 U'f �fze -Dorn nzo�uuea, zf �; _ ce of ConsumerAf aij-; B sines Regulai.on i HO,!E IMPROVEMENT.CU-4TRACTOR Regi4ration -f65936 4 Expira',on 4t9f2012 PrivateType. Corporato CA ' 8 ISLAND Gs i „ rr (fCOTt ONr JOSHUA KOURI f t 55 ELft1J AVE. F r' HYANNIS, MP 0260T q 1 .I + r 7/30/2010 5:42:24 AM PST (GMT-8) FROM: insurancevisions.com-TO: 15087756688 Page: 2 of 5 H a� ® CERTIFICATE OF LIABILITY INSURANCE DATE 7/30/201030l10 PRODUCER FRANK L HORGAN INS AGENCY INC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 44 BARNSTABLE ROAD ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HYANNIS, MA LE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 508 775-5830 508 775-6688 INSURERS AFFORDING COVERAGE NAIC# INSURED CAPE & ISLANDS CONSTRUCTION COMPANY INC INSURER A: LIBERTY UTUA GROUP PO BOX 210 INSURER 8: CENTERVILLE MA 02632 INSURERC: INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MMIDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS MADE DOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 77 GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRC FCT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY (Peraccident) $ NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC2-31 S-377540-010 5/7/2010 5/7/2011 1 WC STATU- OTH. j AND EMPLOYERS'LIABILITY Y/N DRY IMIT ER— ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? ❑N (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 f yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Workers Compensation Insurance: Part One of the policy applies only to the Workers Compensation Law of the State of MA. PHYSICAL ADDRESS IS 55 ELM AVENUE HYANNIS,MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF BARNSTABLE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 200 MAIN STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL HYANNIS MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Jeff Eldridge `)_ �; .. (..,, )f `L C f . ACORD 25(2009/01) ©1988-2009 ACORD CORP/ORATION. All rights reserved. CERT NO.: 7955970 Anne Chandler 7/30/2010 5:39:18 AM Page 1 of 1 The Cotninonwealth of Massachusetts y Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 yy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): AGAO ;M _��(9�'l1 �� Address: City/State/Zip: Leh 4✓ti •` `,,L - Phone #: . 5—, - 6 Are yo an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I ❑ * have hired the sub-contractors., eiiiployees(frill and/or part-time). 6 New construction listed on the attached sheet. . 7. ❑ Remodeling 2.❑ I am a sole proprietor.or partner- 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.$ .] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required 3.❑ I am a homeowner doing all work officers have exercised their I LE] 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.❑ Other comp. insurance required.] "Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit anew 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 policyand jab site information Insurance Company Name: L,,' �✓Yll '-�+ Policy#.or Self-ins.Lic:#: C� tq^t,4'U Expiration Dater Job Site Address: _ !I ���/� � h- lGd 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 $250,0*agao,,ao ato . Be advised that a copy of this statement may be forwarded.to the.Office of Investigations e overage verification. I do hereby cepenalties of perjury that the information provided above is trice and correct. Si nature: 'Date: Phone# r Official.use only. Do not write in this area, to be completed by city or town offcciaL'. 'City or Town: Permit/License# Issuing Autliority (circle one): i.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - Phone#:Contact Person: _ ;�._