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HomeMy WebLinkAbout0095 FIFTH AVENUE (HYANNIS)�� I` BUILDING DEPT. -a20 - leq� r Application number..�....................................... °► JUL 15 2020 Fee .............................................................................. eiABj'e' TOWN OF BARNSTABLE Building inspectors Initials....................................... asp DateIssued................................................................... SCANjVED Map/Parcel......... ? s...®�.. ........................ TOWN ARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 95 Fifth Ave West Hyannis Port MA NUMBER STREET VILLAGE Owner's Name: Grove Harris Phone Number 617-999-6148 groveharris@gmail.com Email Address: Cell Phone Number Project cost$ 16,500.00 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize Sand Dollar Customs LLC to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK 0 Siding Windows (no header change)# Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to Town Of Yarmouth CONTRACTOR'S INFORMATION Contractor's name Sand Dollar Customs LLC - Home Improvement Contractors Registration (if applicable)# 193567 (attach copy) Construction Supervisor's License# CS-091653 (attach copy) Email of Contractor rob@sanddollarcustoms.com Phone number 508-694-5618 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............................................................ ' i j v ' c_ *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 i a Health Department approval between the hours If food is being served at your event please obtain p pp 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: Grove Harris Telephone Number 617-999-6148 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'S SIGNATURE Signature U)aAm' U)a4A0� Date 7/13/20 All permit applications are subject to a building official's approval prior to issuance. rZIN Sand Dollar Customs LLC Estimate 23 Whites Path Suite G2 Date Estimate# South Yarmouth MA . 02664 1/24/2019 290 Name/Address ' Grove Harris 95 Fifth Ave. West Hyannisport MA 02672 r Project Description Qty Cost Total Construction Supervisor License#91653. Home Improvement Contractor License# 193567. Moderate Risk Lead Certificate#MR-001576. Lead Paint Renovator Certificate#R-1-18398-09-00120. Worker Compensation and Liability Insurance to be mailed to homeowner by insurance company upon signing of contract. Additional work not covered in contract but required by local Building Inspector(not expected)to be billed as follows;Labor $75.00 per man per hour.Materials to be billed at cost plus 20%. Additional work requested by home owner to be billed at$75.00 per hour per man.Materials to be billed at cost plus 20%. Paint by others unless specified above. Please checkout our website at www.sanddollarcustoms.com to learn more about our high standards and quality work. Payment Schedule: 30%Upon acceptance. 30%Upon start of work. 30%Upon substantial completion. 10%Upon Completion r Owners Signature:_) Date: Total Customer Signature Page 3 ,74 Office of Consumer Affairs and Business Regulation 1000 Washington Street- Suite 710 Boston, Mi1 husetts 02118 Home ImprovemerafiLofltractor Registration Type: Corporation z Registration: 193567 SAND DOLLAR CUSTOMS LLC M r 1851 FALMOUTH ROAD Expiration: 10/29/2020 w CENTERVILLE, MA 02632 i �w a ti� iCA 1 O 20M-05/17 Update Address and Return Card, Office of Consumer Affairs 8 Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TY, orooration before the expiration date. If found return to: Unlration efflea J(;snaumer Affairs and 5-1..sa Raeulatbn 10/29/2020 1000 Washington Street-Suite 710 SAND DOLLA 91 Boston,MA 02118 x ' o bjtw WALTER R.WAIF • W k� r'i0 n 1851 FAIL UTH CENTERVILLE,MA 02fi 2 Undersecretary Not v out ignature Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons#�rr�libpervisor CS-0"6S3 ��' �ires:09130/2020 V WALTER:R J RRF�40 ALEXANORYARMOUTH67'MA Commissioner Client#:765382 2SANDD01 0/2020 M/DD/YY ACORD. CERTIFICATE OF LIABILITY INSURANCE 04/1 DATE(M M/DDNYYI) 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 AIC No Ext: A/C No Dowling&O'Neil Insurance Agy E-MAIL ADDRESS: P.O.Box 1990 Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIC 9INSURER A:NGM Insurance Company 14788 INSURED INSURER B:Associated Employers Insurance Company 11104 Sand Dollar Customs,LLC INSURER C 23 White's Path,Unit G2 INSURERD: South Yarmouth,MA 02664 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 POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY MPP9284Q 2/15/2019 12/15/2020 EEAACMHq�OECCCUR�RENCE $1 000000 CLAIMS-MADE a OCCUR PREMISES Ea occurrence $500 000 X PD Ded:250 MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY a J LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY M1 P9336Q 2/15/2019 12/15/202 COEaMBINED accidentSINGLE LIMIT $ e00Oe 1 000 ANY AUTO BODILY INJURY(Per person) $ OWNED X SCHEDULED AUTOS ONLY AUT OS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE X AUTOS ONLY X AUTOS ONLY Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION WCC50050197212019 12/04/2019 12/041202 X PER OTH- AND EMPLOYERS'LIABILITYATUTE ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? � N/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/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) "Workers Comp Information** Voluntary Compensation;Other States Coverage Proprietors/Partners/Executive Officers/Members Excluded: Rob Warren,Owner/Member Steve Bobola,Owner/Member (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Sand Dollar Customs SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 23 Whites Path G2 ACCORDANCE WITH THE POLICY PROVISIONS. South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE �+ "i�f✓�me.+>fba.,,. a G>G....w.um�'�-:.;«.,,n-Una. ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD _ #S257684/M257683 LS1 DESCRIPTIONS (Continued from Page 1) 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. SAGITTA 25.3(2016/03) 2 Of 2 #S257684/M257683 I Lauzon, Jeffrey From: Lauzon,Jeffrey Sent: Friday, July 17, 2020 8:51 AM To: 'rob@sanddollarcustoms.com' Cc: Lauzon,Jeffrey Subject: ViewPermit, Permit No:TB-20-1846 Applicant, Please be advised that the above application has been reviewed and the following is noted: 1) No fees have been paid. 2) Worker compensation affidavit not submitted. The application is denied pending payment and submission of required documents (780 CMR R105.3).And, if aggrieved by this notice;you may appeal to the Building Appeals Board within 45 days in accordance with M.G.L. Chapter 143 Section 100.Thank you. Jeffrey Lauzon Chief Local Inspector (508) 862-4034 Jeffrey.lauzon(cD_town.barnstable.ma.us 1 "'E�'a. Town of Barnstable Building t o m Post This Card,So That it is Visible From the Street.=Approved roved Plans Must be Retained on Job and this Card Must be,Kept o "' �' Posted Until'Final Inspection Has Been Made. � y. �� •MA � 1l1 Md` Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-1846 Applicant Name: Sand Dollar Customs LLC Approvals Date Issued: 07/29/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/29/2021 Foundation: Location: 9S FIFTH AVENUE(HYANNIS), HYANNIS Map/Lot: 245-094 Zoning District: RB Sheathing: Owner on Record: HARRIS,JUDITH G Contractor Name.' Sand Dollar Customs LLC Framing: 1 Address: PO BOX 9 Contractor License. 143567 2 ` WEST HYANNISPORT, MA 02672 Est. Prole t Cost: $16,500.00 Chimney: Description: windows&roof Permit Fee: $84.15 1 Insulation: Project Review Req: GLAZING REPLACED IN HAZARDOUS LOCATIONS AS EFINED Fee Paid-1 $84.15 IN 780 CIVIR MUST BE TEMPERED OR EQUAL: _ Date: 7/29/2020 Final: Plumbing/Gas Rough Plumbing: a - - - Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced witFiinlsix months after}issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall b in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road aL shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. i Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy "Low Voltage Final: 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. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: CeK A:3;1_ s64J-T- z3 - } Y � 's�� �`.,.."�.�m<m ... � 'lw`„ ,'s�3�a >7 e :}�i• �� 1� �.kIT Town of Barnstable Final Inspection Affidavit .f Date o Building Division 200 MairStreet Hyannis, MA 02601 RE: Insulation Permits Dear -.. - - This affi vit i q ify that all work completed at: Street: Village: has been in ected by a certified Building Performance Institute (BPI) Inspector. All work performed meets or exceeds federal land state requirements. Permit appli ati n mer: � / �'-3�- Issue date: 0�1V Sincerely, 9 Francis Sheehan President Frontier Energy Solutions, Inc. 502 Harwich Road Brewster, MA 02631 Office: 774-237-0410 Email: fssfrontierenergy@gmail.com r a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2gS7 Parcel Application_# � Health Division u , ';; i t 9: 23 Date Issued Conservation Division Application Fee Planning Dept. - Permit Fee 6 6 Date Definitive Plan Approved by Planning Board 14 Historic - OKH _ Preservation/ Hyannis Project Street Address I Village ih Owner jL1;Z�)r C-g Address [ Telephone Permit Request vJ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation. —Construction Type Lot Size ' \ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No 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 Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 0 If yes, site plan review# >Current Use V0I 6�P�/1. Proposed Use APPLICANT INFORMATION - _ - (BUILDER OR HOMEOWNER) Nam �- ) le hone Number 7]q—��A7— r WO Address License # `-C Home Improvement Contractor# , �. oo-- 60(5 3i 5 Ce) b�4- Email f'�Vbrker ompe sation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS ROJE T WILL BE TAKEN TO 0 4�m�. MADAL U �- SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE t , OWNERr DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. HOME OWNER WEATHERtZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. hereby consent to and agree that weatherization work may done b�t a Weatherization Program of Housing Assistance Corporation on the property loca at: i The weatherization work done wil be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping;air sealing; attic& basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5)years after the weatherization work is completed. I have read the provisions of this agreement and give my consent. Home Owner(signature) Home Owner email: ( g,, � ; t ; ` tyr1' (B ra Date: �t 9 v ,{ r Agent:(signature) Date: Weatherization Contractors: Adam T Inc LFro=tier All Cape Energy n_ers SoWti Alternative Weatherization Lohr Home Improvement Building Science Construction Tupper Construction Cape Cod Insulation -- Thc' C:nmtrtnrslvttttltlr of rYLrr;s'ttchusetts` (i ( : Department of Industrial 1 cccdents,y aj .l Congress Streeti S'i(cte.100 Boston, .MA 0?114-1(J.17 a. ►+nyw:m(tss.g o v/(filr Wovkers' C.`onrpcn:satioii Insurance Affidavits.guilders/Cunt.racto"rs/Elt:r.tricians/1'lumbcrs. I'U 13P: ('I LED VVf`I'H TGfI;P 'R '(I'1'l'liv('; Al TfIUEtI'I'Y'. .-1;ppficvnt lnforniation� .__..�_ _ _ Please Print .Legibly Name (Business/UrganizatioMii(liviilu<tll. L l� Address: CJ�: - :jl.��_ C; �,lStatel"I_,tE�:_1 ,�o_L'�le-r MA 612 S i � Phone fl _.... �- Are you un emptover?Check the.appropriutc hnx. ff Type of project (required). 10/1 am a employer with !_©,___cmploydes tftdl anwor part•'timc).' 7. New ConStf 11CIlUt1 2.111 am a stilt proprietor or partnr,ship and have no eniptoyecs working for me.ill C 8. l'elnodeling any capacity.[Nit workers'cump insurance requinaLJ r l:at am a homeowner doing all work myself.[No workers'comp.insurance required.J' 9,- F-1 Demolition to Q Building additiony.0l am a hotneowne.r and'w'ill be hiring;contractors to conduct all work on my twoperty: I will ensure tint all contr,n tors either have workers'compensation insurance or orc suit I L.[]C.Iectrical repairs or additions proprietors with no i mployces. 12.0 Numbing repairs or additions ' 5.E]I am a general contras for and I have hired die sub-contractors ImNl on tht.attached sheet These wb-contractors have employeos and ilave wcxkers'crimp insurance' 13.�RUof repairs (_ f 6.a We.rirc:a corporal on and its:oWteers grave exbrc sed their riol,(of exciuption per IM01,C. j 1.52 §1(4);and we hriwe no em(tloyec3.(Nip corkers'torrid.insurance required.1 'Any applicant that checks b-ox pl must;d:4 till nut the sectionbrlow'showing their workers'compensation policy information _ t lioincowiicrs who submit this afdavii.indicating they are doing all work and then him pu cidt rontractors mast sutiinit it ncty atliduvit indicating such gContractors That check This box mim attached an additional sh"t showingth shame.or the sub•ciyntractors and state whethct or not thosr,i:ttities have ethplovers:.If this sub-cgiitructors Irrivc employee, they must:.provtdte their workers'comp.policy number. I ain an enepinyer that U providing workers'compe►rsrttion insurance for my emrltloyees. 'Below is the policy rind job site information, Insurance Campany Name: r .�� A._ ..rC'n\ 1 ^,�• '9.. n. )_" _�____..—``-_ •nS u v C... �' � to Policy 9or Sclf-ins. Uc. fi q 2 C T7 C Job Sitc Addre . -- ..__City/Suite/Zi(5 ,Attach a copy o the workers' compensation policy declaration page(showing the policy a rm a ne expirat n d a— ! Failure to secure coverage as cecluired under MG1,e. 152,§;?5A is a criminal violation punishable by a Fine up to S 1,50U. and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up'to$2.5 .0 a l day.against the violator. A copy of this statement may he forwarded to the Office 0.1'1nvestIgations of tire- DIA for insurance l I Uftr- ge verification. I _ i _I to here.hy certify under the pants a mattes of1mrjury that the information provider! hove i, true and corset'(. _ DatN.../ 14 Ili l 11: 7 1 G � Ofeial use only, Do trot write it, this area, to he corrrpleled by city or town offreaaL i City or Town: _ 1'r,rmit/I.,icensc fl Issuing A.trtbori:ty(circle one), 1. Board of Health 2, B.01ding Department 3, Citsyfrown Clerk 4, Electrical Ias.pector 5, Plunthing inspector 6. Other' Coilin.t Person: I. Phone tt -......_: �._ ,> 4�(ii rr�rea�re?rr�0 cf��<f;m lrirZ�� w _,w License or registration valid for individual use only Office,of Consumer�ffaics B.nsinEss Re�ulaho�i before:the ex�li ahon date If:fo.und return to. s :; �� HOME IMPROVEMENT CONTRACTOR` Office.of Consuier Aff irs ind Business Regulation rz, Registration „ 160854 Type* 10 park P 9 laza-Smte:5170 r € Expitahon l8/2018. LLC Boston,iV1A 02 L 16.- FRONTIER ENERGY SOLUTIONS FRANCIS SHEEHAN 562 HARWICH RQz BREWSTER;MA 02631 Liiderse`crefa�} _ N f val" _Titiiou signature i r 3 I �I Construction Sup.e.rvisorSpeciaaty Restncted to: I�iassachusetts l?epartmenlf P€al�Tic Safety GSSL-IC- Insulation Contractor 8o2 d of Building 2egulati4ns anti Standards . . Lice.rtse GSSL-.105941 a ' ttnS$rl9Cki-p Su pervsser spec€alty FRANGIS S SHEEHAN ` Y 56414kwli _RD BREWSTER MA 02631. Failure to possess;a current edition of the tvlassachuseits State Building Code is cause for revocation of this t►cense. a . DPS Licensing informationvisit:,tNWW.MASS.GOV/OPSartisssiefiei _ 02/17l2018, i i i ® � - - ACC)Ro CERTIFICATE�OF LIABILITY INSURANCE OATE(MMIDDIYYYY) 04/05/2016 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 ADDI710NAL 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 endorsement(s)., PRODUCER `. CONTANAME: Krystal Doyle - ROGERS &GRAY INSURANCE AGENCY, INC. a"c°NN E:t: (508)398-7980 A/C No: ADDRESS: kdoyle@rogersgray.com , 434 RT. 134 - - INSURERS AFFORDING COVERAGE _ - _:NAIC# SOUTH DENNIS MA 02660 INSUkERA: AIM MUTUAL INS CO - 33758 INSURED _ - _ INSURER B: .. _ FRONTIER ENERGY SOLUTIONS INC 114SURERCr - - INSURER D: - 502 HARWICH ROAD INSURER E BREWSTER MA 02631 INSURER F COVERAGES CERTIFICATE NUMBER: 42389 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 T2WHICH 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 _ ADDL SUBR - POLICY EFF POLICY EXP -LIMITS LTR TYPE OF INSURANCE POLICY NUMBER, MMIDD/YYYY MM/DDIYYYY _-. - - COMMERCIAL GENERAL LIABILITY - - - - _ EACH OCCURRENCE, _$ DAMAGE TO CLAIMS-MADE OCCUR PREMISES Ea occur RENTED $ MED.EXP(Any one Person) $ N/A PERSONAL&ADV INJURY $. - GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE. $ POLICY PRO JECT ❑-. LOC - PRODUCTS-COMPIOP AGG $ - OTHER:AUTOMOBILE LIABILITY LIABILITY r - - COMBINED SINGLE LIMIT $ - Ea accident ANY AUTO - BODILY INJURY(Per person).. $ALL OWNED SCHEDULED AUTOS AUTOS N/A - BODILY INJURY(Per accident) $ HIRED AUTOS. NON-OWNED - PROPERTY DAMAGE $ - AUTOS Per accident $ -UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE N/A �. AGGREGATE - $ DIED. RETENTION$ $ -. WORKERS COMPENSATION X STATUTE ORH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN _ - E.L.EACH ACCIDENT $ 1,000,000 - A OFFICER/MEMBER EXCLUDED? NIA NIA N/A VWC10060153152016A 03/14/2016 03/14/2017- - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 - If yes,describe under - - - DESCRIPTION OF OPERATIONS below E.L.DISEASE--POLICY LIMIT $ 1,000,000 . N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule;may be attached if more space is required) - - Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy.precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage.Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER : ,CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,.NOTICE WILL BE DELIVERED IN Frontier Energy Solutions IncACCORDANCE WITH THE POLICY PROVISIONS. 502 Harwich Rd AUTHORIZED REPRESENTATIVE - - Brewster MA 02631 Danlel M Crow y,CPCU,Vice President-Residual Market=WCR(BMA w ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD b YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years , business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission t operate.)to You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. xirt. �3 ,g N, ,, -. DATE:' d Fill in please: , � APPLICANT'S YOUR NAME BUSINESS YOUR HOME ADDRES J S AV-W Of— f-F ya-N Nt3 TELEPHONE # Home Telephone Number Ge f.l l y �-4 U t L�j NAME OF CORPORATION: .s r wfi 4� NAME OF NEW BUSINE8S r: 4 µ u, w ,,s: ;.TYPE;OF,:BUSINESS C-A ' �P�=VLCoil IS.THIS A HOME OCCUPATION?:' YES NO_ ADDRESS OF BUSINESS MAP�PARCEL NUMBER:a (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 M inM in St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate Tour business in this town. 1. BUILDING CO ISSIO ER'S OF ICE This individual hays n i t a d an p mit requirements t1jat pertain to this type of businessMUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO COMMEN S AG on Si nit ** l OMPl_.Y MAY RESULT IN FINES j 2. BOARD O EALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: } Town of Barnstable Regulatory Services Richard V. Scali,Interim Director Building Division MASS 1639. � Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Approved: Fee: Permit#: - HOME OCCUPATION REGISTRATION Date: 1 1 Name: ffe ff � �j nq (1 /� Phone#• Address: � � M4) Name of Business: Type of Business: - _n Map/Lot:_ C�` INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated-by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary.Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registe ' Applicant: Date: J Homeoc.doc Rev.103113 91 ceU � -moo �= �2�m — i B 13 G � TOWN OF BARNSTABLE 2 M VUARR -4 PIM _ 43 DIVI , MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392-6108,FAX(8001851-8424 7/7/2017 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch.139,Sec.313 BARNSTABLE BUILDING COMMISSIONER 367 MAIN STREET HYANNIS MA 02601 f Re: Insured: JUDITH GROVE HARRIS Property Address: 95 FIFTH AVE.,WEST HYANNISPORT,MA 02672 Policy Number: 1428070 Type Loss: Water Damage:All Other Water Damage Date of Loss: 06/20/2017 Claim Number: 415741 + , Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 36 is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss 4. and claim or file number. rn l MPIUA Claims Division cMA00021 _— I Assessor's map and lot numb.. .......... ..�...�... •••�°�� � v ���G SEPTIC SYSTEM MUST BE, INSTALLED IN COMPLIANCE Sewage'K�Permir number ............. /f/s!lif�.. � !J WITH ARTICLE II STATE c:= t / SANITARY CODE AND TOWN r, C. TOWN OF BARNSI'A E T14 E Z SAHHST/►II 0 MAX D 'i63Ift U �LDING INSPECTOR' 00 9• �� �: .._� :�-i C1, � ��d d Sic vt C'A.e� �� APPLICATION FOR_ PERMIT TO ........................................................................ r .. ..................................................... TYPE OF CONSTRUCTION ............................................. ................. ................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ermit according to the following information: Location ......��. .��-.......1..- .. ......., :.... G`-��........�iC!!.�Z�.. ...... .�'��?.h/...F,/ c�iz ProposedUse ............................................................................................................................. ZoningDistrict !� .................Fire District..c' ��......................... ............................. ............ ............................................................ Name of Owner .....................�.....e....h...� ...�. .. � ... /'/.sAddress -If. �. . . ..I... 7/,5, hc%.. te- Name of Builder ..��. ........Address.. C.4..!.... j`` ���� ' ............. Nameof Architect ..................r.rG ...........................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ................... .............................................................Interior................................................................Roofing .................................................................................... FloorsW0.0-0 .................................................................................... Heating ..................................................................................Plumbing .................................... ........................................... Fireplace ..................................................................................Approximate Cost .................... ®. ...................... Definitive Plan Approved by Planning Board ________________________________19-_______. Area ...... ..(®......... ............ • SO Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH t n. M . � co I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .G........ ...... .......... . .. f... HARRIS, IRENE r • J 20299 add deck " t� No ................. Permit for .........................to........... single family dwelling ............................................................................... 382 Fifth Avenue Location ................................................................ West Hyan*isport Irene Harris ° Owner .................................................................. Type of Construction frame ................................................................................ Plot ............................ Lot ................................ June $Z 12 78 Permit Granted ........................................19 Date of Inspection .......... ...A..............19 Date Completed �j � PERMIT REFUSED ................................................................ 19 ..........................................................:.................... ............................................................................... ............................................................................... ............................................................................... E Approve ................................................ 1 ............................................................................... ............................................................................ Assessor's map and lot number .. . . Sewage, Permit number ��k'��.. ...!..... •v�.'��'?�'� Bpi?NEr��y Ja ARNST IDDLE BAPSTADLE, • ®pp 9 �•2IABa 0 �= oaf 'TOR G0�0 AlPY a\e� D I N I N S P E G' APPLICATION FOR PERMIT TO TYPEOF CONSTRUCTION ..........................................................................:......................................................... � � f ................................................19........ TO TFIE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ,•--- Location .......f:y... t.. ........./I .(A.. �....p.... t'`....... :�!� �' ' .......'�``! .`...R�...... .......:�✓`r.,T /L r?.''f..: .....?"''"'..r'.'. ProposedUse .................. .. . ... .... .............................................................................................................................. Zoning District r- ......... Fire District ................. ............... Name of Owner . G: � ... ,k, r;J`.-` Address .r.`.!? �.` .. t ..'.. ..:...: :::. lCr�'nr7j^ ,�rZ �• „�� � cr fn ca.�� e,.F!' � � r �-� � -.•� r , Name of Builder . ..d. tr..`..... . . . RYA` ."!r.'.T ........Address !' F .............................................f r r ;�.............. .: /* Name of Architect - `£ '"...........................Address .......... Numberof Rooms ..................................................................Foundation .............................................................................. Exierior ....................................................................................Roofing ..................................................................................... r! l Floors .Interior y f ¢ .!............................................................ Heating ..................................................................................Plumbing ...................... Fireplace Approximate Cost ................................................ Definitive Plan Approved by Planning Board ________________________________19________. - A Area ..... 'A: Diagram of Lot and Building with Dimensions k Fee "'' SUBJECT TO APPROVAL OF BOARD OF HEALTH ;¢ a 5. 9 .. .. -..�, ...,.-.. . ...Q,.......,.._u .ur.....,.d�,��..�.�.._�.x.zr'' ...,._�.._.,� �.._,,..,,..ram,.. � .........,..,r._=._.,..u.....,.�-•.,.r�...-,..,....o...,.,Y.,__ _..tea,.... r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �.. ........... . ..... Harris, Irene A=245-94 ^ +a^ 20299 add deck-to No ................. Permit for .................................... single family dwelling ............................................................................... G�Fifth Avenue Location ................................................................ West Hyannisport ............................................................................... Irene Ha is Owner ..:.................... .... .................................... Type of Construction ....fra . me.. e........................... Plot ............................ Lot ................................ �� June 12 78 Permit Granted ........................................19 Date of Insp Lion ....................................19 i Date Completed 19 PERMIT REFUSED ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................