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HomeMy WebLinkAbout0067 FIFTH AVENUE (HYANNIS) RoLl (P / a Town of Barnstable Building .: a �""; 'w^ -�' ,: "�e^�?.,�..-sn-,,.._......... � -� ".:. � 'V�. . ^+red a�•-» �.,�,. �,...... „��- ..,..r;-, "'� s �u-..w„�»v--"�'-...».,-a�,. ...— x ennNsrsc� Post This Card So Thatrt is,Visible From the Street ApprovedPlans,llAust be-,Retamedgon:'Job and th�s.Ca%d Must be Kept b"� Posted Until Final lnspecton Has Been}Mader �F Permit Luc+° EWhere�a�Certificateof Occupancy'is Required,such Bwldmg shall�Not be Occupied until a Final inspection has been made� , Permit No. B-19-246 Applicant Name: NELSON DEMORAESJR Approvals Date Issued: 01/23/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/23/2019 Foundation: Residential _Map/Lot: 246-126 Zoning District: RB Sheathing: Location: 67 FIFTH AVENUE(HYANNIS), HYANNIS sCoritractor Name''` _NELSON DEMORAES JR Framing: 1 Owner on Record: HARTIGAN,MICHAEL D&SUSAN M Coritractor.License- 113100 2 Address: 50 SADDLE RIDGE Est Project Cost: $22,000.00 Chimney: MILTON, MA 02186 tA Permit Fee: $ 162.20 Description: repair water damage and paint Insulation: Fee Paid.I $ 162.20 r � _ �:; Final: Project Review Req: Date 1/23/2019 14 h Plumbing/Gas . S�f Rough Plumbing: � � $., k Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by his permit is commenced within six moths after issuance. All work authorized by this permit shall conform to the approved application and1he approved construction documen for whic;hthis permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by lawsxa d:°codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for_pubhc inspection for the entire duration of the Electrical work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the,Building%r d Fire Officials are provided on,tt is permit. Minimum of Five Call Inspections Required for All Construction Work:' - Rough: 1.Foundation or Footing P 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) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Person racting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: �r Building plans are to be available on site �� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT tNE �p •U Application Number.............................. .�. . . a 1KASEL $ _ Permit Fee..........: . .......... .......Other Fee........................ s639. TotalFee Paid............................................. .............. ...... TOWN OF BARNSTABLE Permit Approval by..... �J'LGI�t. ......On..... '?3�11...... BUILDING PERNIIT a Lj I (� Map.............. .. .....................Parcel..........1. .......................:... APPLICATION Section 1 — Owner's Information and Project Location Project Address r -!5'7"'ATE Village /-/YO-- Owners Named t Owners Legal Address ��A City -,State✓1,. �t .� Zip Owners Cell# E-mail, Oho Section 2 —Use of Structure C� Use Group/1L, c;,rTxAe- ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment El Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar Renovation ❑ Pool ❑ Insulation Other—Specify_A Q�I�yn WA 7 9t 1Jf ,w7 AGC- - Section 4 - Work Description Last updated. 11/15/2018 Application Number.................................................... Section 5—Detail Cost of Proposed Construction 2 00-0 Square Footage of Project Age of Structure - Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors (g Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom f . Water Supply �K Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: (fJ /,� ������ I am using a crane ❑ Yes No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No 1 Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 Application Number............................................ Section 9- Construction Supervisor NameMZ5n,J ,0 0y olzA&S <7� Telephone Number V g/- Addresses tiL►'eSo,oj,DatZG 6l City A Vat- State _Zip Va0 3 U License Number - 06 3 7-O 3 License Type �$ yp & AVexpiration Date R142 a Contractors Email AD-,6c1->�t.�+�,( ,�L�I i,14er Cell# ?-9 655-5z f�l 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.Attach a copy of your license. Signature /i% ice/ r �2- Date '! Section 10—Home Improvement Contractor Name , ,WJ&Z ,j3 y-X Telephone Number Address 0 gj City State/-I Zip Q010 �U Registration NumberV&ao Expiration Date o57--�6 I understand my responsibilities under the rules and regulations for Home Improvement Contractors 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.Attach a copy of your H.LC... Signature Date A* l Section 11 —Home Owners License Exemption Home Owners 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 APPLICANT SIGNATURE Signature Date c 2- c/ Print Name r4-6,,^Yp14 65ftlls �` - Telephone Number 95P Ll E-mail permit to: Last updated: 11/152018 Section 12 —Department.Sign-Offs Health Department ❑ Zoning Board(if required) ❑ { Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval i Section 13 —Owner's Authorization I, /V /--/,V 2 6-4 A/ , as Owner of the subject property hereby authorizeI /11� E S to act on my behalf, in all matters relative to work authorized by 's building Permit application for: 1-2 47 S , (Address of j ) { Mi ature of Owner date Print Name 3 i i 1 1 a j 1 i 3 t J i 1 Last updated. 11/15/2018 i-� NELSDEM-02 WALKA1 ACORO" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 01/23/2019 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER N MTACT Salem Five Otis Brown Insurance Services LLC PHONE 1 Militia Drive (A/C,No,Ext):(781)862-7700 ja/c,No):(781)862-7479 Lexington,MA 02421 ADD IEss:insurance.services@salemfive.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Western World Ins.Co. WW INSURED INSURER B:Citation Insurance 40274 Nelson DemoraesJr INSURER c:Atlantic Charter Insurance Group 38 Wilsondale St INSURER D: Dover,MA 02030-2259 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 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 TYPE OF INSURANCE ADDL SUBR WVDPOLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRMMIDQIYYYYl A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE F_X]OCCUR NPP8296821 09/22/2018 09/22/2019 DAMAGE TO RENTED 100,000 REMISE Ea occurrence) $ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ 1'!]00,000 OTHER: 1 $ BINEB AUTOMOBILE LIABILITY Ea accideDtSINGLE LIMIT $ 1,000,000 ANY AUTO BBZSLC 04/30/2018 04/30/2019 BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY Ix AUTOSSWN BODILY INJURY Per accident $ X AUTOS ONLY A&TOS ONLY PPeOacEcldent AMAGE $ $ c UMBRELLA LIAB B OCCUR EACH OCCURRENCE $ ,XCESS LIAB CLAIMS-MADE AGGREGATE $ r DED 'RETENTIONS, $ C WORKERS COMPENSATION SER T ORH- AND,EMPLOYERS'LIABILITYCV00811311 12/29/2018 12129/2019 500,000 ANYrPROPRIETOR/PARTNER/EXECUTIVE Y❑ E.L.EACH ACCIDENT $ %FFICERIMEMBERtEXCLUDED7 • N/A (Mandatory in NH),_. E.L.DISEASE-EA EMPLOYEE $ 500,000 Ii yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD o \ , svjr�.� r �r ENO`,�' r} c AIM l p' 61:1 ��4 ov F�l The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street - Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/organization/Individual):Z12 iJ 14671-)01146-ES: . Address: City/State/Zip: 0a030 Phone Are you an employer?Check the appropriate bow Type of project(required): 1.El I am a employer with 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. A Remodeling slip and have no employees These sub-contractors have g• Demolition working for me in c employees and have workers' any �'• 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 11.❑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#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,policy number. . 1 am an employer that isproviding workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: /g l G/g'IJ!z:f Policy#or Self-ins.Lie.#: WL 1100&' -0 Expiration Date: Job Site Address: "V 7�/of o City/State/Zip:IR Z446� 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 insurmce coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: i7/77J y —�G Phone#: — G Officfal use only. Do not write in this area,to be completed by city or town official City or Town: Perinit/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#: Information and Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to.construct buildings in the commonwealth for any applicant who has not produced*acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of i isu ance. Limited Liability Companies(LLQ or Limited Liability Partnerships(LLP)with no employees other than the ,members or partners,are not required to carry workers compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Depariment 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.= questions res riling the l if yo"?'e required to obtain a workers' compensation policy,please call the Department at the number listed below. Se1f-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant; Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been.officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a calL The Department's address,telephone and fax number. ne CQmmcwealth of Massachusetts Department of Industrial Accidents face of Investigations 600 Washington Stet Bostan,MA 02111 TeL 4 617-7274M ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 WWWMass,g0v/d18L