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HomeMy WebLinkAbout0104 FIFTH AVENUE (HYANNIS) oq rT Qi► Application Number........B...................J ........................ MASS. Permit Fee..... .... ..Z...............Zoning District.R .............. i639. � TotalFee Paid............................................................... ...... TOWN OF BARNSTABLE Permit Approval by.................................on........................... BUILDING PERMIT Map....... ..................Parcel...!.!P'�................................ APPLICATION _ Section 1 — Owner's Information and Project Location Project Address /o ye U, Village Ules± ec yvl! pot,4- Owners Name G�'�- Vl S"' Owners Legal Address 45 C-CL S Ln 122 qsi� KAN City State Zip 0 Owners Cell # l9 � I "C� I E-mail C n54 a CL i(, Caws Section 2 -Use of Structure Use Group ❑ 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 1p- Deck Apartment ® Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar E ❑ Renovation ❑ Pool ❑ Foundation Only Other-Specify r Section 4 - Work Description Re b lace-F ot-ea a�w S DN e1xi5f7n4 ae-&- C&"Cl! A DI) A/OW .f ee —Apt? lO .s/? x 13 -to --tt u C--j( r3-h L ri o a- k lei' G A ��-` 1' G�Vt / cf� Ga by 2 !f Z elf mil'/0 k a 4 ��af v - f F Last updated: 1/31/2020 . C � Application Number.................................................... Section 5—Detail Cost of Proposed Construction �, U 0 Square Footage of Project / Z `,13 D PGl2 Age of Structure t 1 Dig Safe Number # Of Bedrooms Existing j 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 ®iPPl0umbing = ❑ Gas ❑ Fire Suppression SO ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am-using a crane ❑ Yes ❑ No Section 7—Flood Zone ,f Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8 — Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) r 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� i Last updated: 1/31/2020 Application Number........................................... Section 9—Construction Supervisor Name Jo Ao Dc J�0 y 1A Telephone Number 5 obi 36 � Address a yt S rn 1 Mj City �A✓1 j(S State MA Zip D a 6 O 1 License Number C S- 10 9 9 B License Type ko i?E S Tk�c►-Expiration Date Contractors Email C R En TC 1) C C A P C Cc3 D cmnl Cell# c��1 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Bu'. ing Code. I understand the construction inspection procedures,specific inspections and documentation required 78 C R and the Town of Barnstable.Attach a copy of your license. Signature Date .i l o Section 10—Home Improvement Contractor � Name D (--rnOVE Telephone Number 5o'8 3 0 88,5 6 �h Address 99. 5rn l TY 5-' City h8v)n1 3 State AA Zip Oa 6o i Registration Number 3 B Expiration Date 0 . �a� I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Build* g Code. I understand the construction inspection procedures,specific inspections and documentation required b@ 780,5 and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date 11 i 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 A Date 11 - Oc) - v� Print Name 50p(:) DR)A0 U LA Telephone Number S ga 36 E-mail permit to: h n C CA C Pn A l l Last updated: 161/2020 Section 12 — Department Sign-Offs 1 _ 1 Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ , , a Conservation ❑ For commercial work,please take your plans directly to the fire department for approvak b a Section 13 — Owner's Authorization i I, I rote �IF� lc►k , as Owner of the subject property hereby authorize J p c,n _Akv arc\ to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) i Signat a of Owner date �w Print Name n ' i Last updated: 1/31/2020 i Commonwealth o Massachusetts The Commo f Department of Industrial Accidents Office of Invest1gadons 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le:ibly Name(Business/Organizadon/Individual): CQG I-E- Mdo C7 CC-"-0c I Y,) c Address: 1-04 S T City/State/Zip: ►S m A 0 601 Phone M 36 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4./V I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 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 ancapacity. employees and have workers' 9. king y ❑Building addition [No workers' comp.insurance C0�'insrnaace' 10.❑Electrical repairs or additions r�eA]. 5. ❑ We are a corporation and its rep 3.❑ 1 am a homeowner doing all work officers have exercised their 1 LEI 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contracrors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. y I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site injorrnation. I Insurance Company Name: I C C T i V C 10 S O M O C-C Co�PAn N of A m e r i e4 1 M� ►l � Policy#or Self-ins.Lie.#: WC J®83 3 6 _S Expiration Date: I 1 ob Job Site Address: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi tnder pains and penalties of perjury that the information provided above is true and correct: Si atru-e• Date: Phone 36� ��56 Official use only. Do not write in this area,to be completed by city or town ofj`rciaL 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#• L 1 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 mafi teaance,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." 1 Appicants 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 number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)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 first this affidavit may be submitted to the Department 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 any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-instaed 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 permWlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permitillicense 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 burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Me to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Departments address,telephone and fax number: The Commonwealth of Massachusetts Department of Indushial Aocidents omee of Westigations 600 Washington Sheet Boston,MA 02111 - Tel.#617=727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mm.gov/dia • J 1 f TOWN OF BARNSTABLE PERMIT CH ECKLIST Sign off hours for Health and Conservation are 8-4:3a am. and 3:30-4: p.m, A wwokPelt W#kadOn 19tudel l iNg aU Ju 1-13 1. NEW STRUCTURES/REMODELING/RENOVATION/ADDITIONS ❑ Site Plan showing setbacks of proposed and existing structures ❑ Commercial—One complete set of full sized plans one reduced 11"xl7"(plans may require a stamp by an architect or engineer). ❑ Residential- 5 Sets of floor plans no larger than 11"x 17"smoke/co detectors marked ❑ Worker's Comp.Affidavit and policy(if required) ❑ Res Check or COM check from the 2015 International Energy Cod Council(IECC) Letter of financial Interest for new houses only(not required for rebuild after teardown) ❑ Performance bond made out for$4.00/foot of road frontage(new construction only) 1-2. DEMOLTION OF A BUILDING (NOT PARITIAL) ❑ Everything above plus shut off letters from following utility companies: ❑ Gas ❑ Electrical ❑ Water ❑ Sewer(if required) 3. DECKS/PORCHES/GAZEEBOS/INSULATION/SOLAR/POOLS/SHEDS Site Plan showing proposed location ❑ Construction plans showing framing detail(if new framing), ❑ Pools—Barrier details, pool specs(engineers design) Q Workman's Comp Affidavit and policy(if required) FAMILY APARTMENTS ❑ Section 1 Plus: ❑Family Apartments are subject to approval from the Building Commissioner. Agreement must be signed, notarized and recorded at the Registry of Deeds and returned to the Building Department. THYASIL-01 JP WE ACORO` DATE @"MDNYM CERTIFICATE OF LIABILITY INSURANCE 9/1412020 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 pollay(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 endorseme s. PRODUCER License#1780862 fi2IJACT John Powers HUB International New England ° ; 608 946-7866 Fvc No): 266 Orleans Road L North Chatham,MA 02860 John.Powers hubinternational.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company of America 12672 INSURED INSURER B:Selective Insurance Company of New York 13730 Thyago Silva&David Barboza dba Barboilva Painting INSURER C: 798 Old Bass River Rd. INSURER D: Dennis,MA 02838 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 UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX�OCCUR S2397660 2J1312020 2/13/2021 DAMAGE TO RENTED $ 500,000 MED EXP(Any oneperson) 16,000 ' PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: a GENERAL AGGREGATE $ 3,000'000 RPOLICY❑w,� LOC PRODUCTS-COMPIOP AGG 3,000'000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea acrodent) $ ANY AUTO BODILY INJURY Per arson $ OWNED SCHEDULED AUTOS ONLY AUTOS WNED BODILY INJURY Per accident $ AUTOS ONLY AUTO ONLY PPer a4de I AMAGE UMBRELLA LIAR OCCUR. L. ' EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ u - $ B WORKERS COMPENSATION j PER OER TH- AND EMPLOYERS LIABILITY Y i N C9083366 9/11/2020 9/11/2021 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT ,6FIW MEMBER EXCLUDED? N i A 100,000 (Mandatory m NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1 600,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I 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 MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main St. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ACORD 26(2016/03) 01988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD -commonwealth of Massachusetts Division of Professional Licensure } Board of Building,Regulations and Standards onstrvembfitiSpery iso r t: CS-109981 "cplres 12/22/2021 ALI JOAO DEMOf1RA 22 SMITH STREET HYANNIS MA.:�92601 ., Commissioner i Office of Consumer Affairs&Business Regulation HOME IMP�O ME CONTRACTOR KE Re— %g_ft= Ex°tra8on , t97 - -�12/10/2021 CREATE BUIL[ �i� jyC JOAO DE MOURA 22 SMITH ST k�_ HYANNIS,MA 02601 Undersecretary y -S;W�- a tit AFT Frf � . _ Epp `� .+wn To: Page 2 of 3 2020-07-16 15:21:56(GMT) 15083022566 From: Anne Louise Hanstad Dep'artrn -ices 00 79. 3B1 Q�AA�j C i�1101�'�,S10iCf:1('• . 20 Wain S hut.,Hyannis,ik9A..02601 ... . : •.. •. ... .. '::� vvaet�xdu�n.�rm�sfab6e.ana.,a�$: . .:.. Off�i 0�=86 ,403. i~a�t::508-790fi230: ...: rop�> y vtr use 01. d f s>lr cr :as..Ownexof rho.subject:property' c beteby:authorize; CEO... ...: .t t to.act:on nny..behal.f; isnrltvetowkuthorid:b h.. s n for.a .iti etmi ... . .. .... . Address.., Pool#epees and alarms:Ue the:respoiiisitailiq Qf;tlie applicant:: 'ools arc:niot'to:be.filled.or utilized before:fence s:.iistalled and p bonsre::perf ccepted p ��•:.' Uzmed and.a BV�VOW afore :Qw er . . ,.... .... Si ature..of li ant �° pP.' Of STp�L .... ',..'.... . . :..:: . : . :. : .... ... .... . . .. ;....-.....• .. .:.... . ....,._ .. • . . : .. TOW . . ..• N'�F 6AR�_ • Priflt.N:ame.. ::::: :.....: :::: Print Na • Date.,,.''.. ;:.; :. :: `.,';<;:.` � �: :'..: .. ::'':`:::.:.:.,.. ......;::• : •.:: :..: .::,:' .' .:: -- ' . • s{ 4- �P.C' ..cam. ...�c1... S;. ... .. .01 Q:FQItMS OWIYGRPI~RMTSSIQNPC)O:LS. Rw,99/1011T To: Page 3 of 3 2020-07-16 15:21:56(GMT) 15083022566 From: Anne Louise Hanstad . :: ... , ' .... .:.. % .... ... ...'.. .. . .. .. . r pq/� p �p q ,B a (� q ' : :':.,..:'::. Ryla 9.0+6,:�t:P'.\IB.C.� .: U,�9� G:.#..9 Iee� .C�.. ... ..:.. .. . ... .. . . I. I . . .. .... .<..:. 9leSt.tyatltilS�OQ�,fv11o►:D26 ''z :: ..:: . ....:. ... . . . .. .. .,..a '...::.,* me:.30,�2020.. % . ... '....... :'..:.. .. ...,..: . . . . .. . ........ .... . . Mr Brain Florence :::'':`..::.-. ;' . .. . . . :': . Bui[din .Commissioner;:.::;: ..: .. 9. :. :... . ... . ...: . . .. .: . :.. : . ..::.'... .. ..... .' .. . ' ".:.Town of:l3amstable .. ....:. ..:.:: .20.0 nSr . . :. :. Mal. Street' ..' . ,. . . H annls Y:.,..... , AAA 026Q1 ;... : I. Dear lUir.Florence ..._.. . . .... .... ......,. : . . . . . .. . This:[ tterheretiy authorizes;.F'eter:Meom..artin.o:af'Segolini Gonstrucfiont.o pull a:permit on.our ' •. , .: . behalf for the..purpose.of.rebuilding;o�r:.back:deck. If:yQu require any other lnformatiori,pease ; . . ".: . do.not_hesitate to..contacfi pis.;t.( contact:irlft�rrnati. bei. ° :' .. . R land Hanstad. .. . .. . . Y . .. ... . . . . ,' .: .. E. rc . , a'I: gym'; ' . .. - - _. .. r G"1�tgY1 s�Crc3.:. coal:' :�: O::�I?+(1 . M 17.9. . . fi �3. 91 ,. : : . P ,, .... ... .: ......:. ':Anne L60se'Hanstad:. .. : :.. ".:'.:'.: ::', .:. IL LNG: �E.... . : . B .E: 1h;;net d m ii.cart'. .. � _ .. ... '. . �.. �1 . . .. ..7 335.3722 .. ..' , ... ... : . . :,: .::Thank ou in..a a y�1N;:QF BPiRNSTA�LE...:.• . y .. . dv noe for..qur.help fi0 .:.. .... .._ !. Gere ' . .. . . . I ' .. :' .::... ' Y� . . . .. .. ._. : .:: Anne:L . i.. R Iand:Flan ou 5e:8�: :tad .':... .. ,. . y. .. Gt. :..:: Ad11SOh C. oli$� ... ... ....':' �' . . ,.: a ol': . ,.. . . ... 9:. !nf Constivctlo .. . ;117 Minton.tn ;: : :. :`: ''. •,:.'... E segoJirfl@hotM tam , ... ... . . . .. .. : To: Page 1 of 3 2020-07-16 15:21:56(GMT) 15083022566 From:Anne Louise Hanstad i f FAX COVER SHEET TO COMPANY FAX NUMBER 15087906230 FROM Anne Louise Hanstad DATE 2020-07-1615:21:33 GMT RE Authorization for 104 5th Ave., W. Hyannisport COVER MESSAGE --2 Pages NOT including Cover— Dear Mr. Florence, Following is a completed and signed copy of the Town's authorization form authorizing Mr. Peter Meomartino of Segolini Construction to act on our behalf in matters related to rebuilding our deck My husband, Ryland Hanstad, is currently in.Washington, D. C., so I am also sending you a.copy of our original authorization letter, which he has signed. This project is a matter of some urgency as the deck is unstable and there are many areas that have rotted through. The deck is the 2nd egress to our house. Anything you can do to help expedite this project would be much appreciated, l sent Mr. Meomartino pictures of depicting the state of the deck. If you require further information, please let me know. Thank you in advance. Anne Louise Hanstad pEP . M: 617-335-3722 1 E: aIhanstad angmail.com 6UILpING V JUL 16 ZOZO TOWN pF BARNSTABLE WWW.MYFAX.COM a60�)t) � Town of Barnstable *Permit# Regulatory Services F e�6"'o"�Sho"`;ss"e�'`e Thomas F.Geiler,Director � Building Division - "IoApjwe ,CBO, Building Commissioner . 1 6 2009 200 Main Street,Hyannis,MA 02601 T www.town.barnstable.ma.us Office: 508-862-4038 BAR/VST Fax: 508-790-6230 EXPRESS Par APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address Q'Residential Value of Work Z S' S) .00 Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address to LJ O V A GA11 jCL 12. P o r.a c r� ►2� 1-1;rJ g l-)AM , ►► AK s , o 1 o' Contractor's Name '-i i ICI-1C(7('VC COc�1 (fZL��d� Telephone Number �-77S-?7(o3 Home Improvement Contractor License#(if applicable) Cl g`Z ❑Workman's Compensation Insurance Check one: ❑ I am a sole EE99netor ❑ I am omeowner Z-k<Ve Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to S 4, l; A G D Ci�1.J S ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A of the ome Improvement Contractors License is required., SIGNATUP Q:Forms:buildingpermits/express Revised 123107 PALUMBO INS COTUIT PAGE 01 5084204474 12/16/2009 14:34 nAv LLwWw.t^i APORD_ CERTIFICATE OF LIABILITY INSURANCE Bx�so 12 6 09 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION PwwvCM�LOm9►N s ASSOCIATB$ nasysArrcE ONLY AND CONFERS NO RIGHTS UPON THE CERt'IFICATE HOt.OER THIS CERTIFICATE DOES NOT AMEND,EXTEND OR rluwcrAL SERVXCBS INC. ALTER THE COVERAGE AFFORDED 6Y THE POUCIF,S BELOW. 933 SALTMUTB F0• ByMNIS h® 02601 I INSURERS AFFORDING COVERAGE -- I NAIC 9 Phon,o: 500-775-6010 Fax: 508-790-0249 --- —- --- I --• R,runroA: IC.AI'ICN11L BtiAPGE b1VT9AL •_-- myvneRn: ST PASJ>;. TRLVELERS T.L.BZTCBCOM CCNSUUCT70N _-- _ --- RrJpnFP C: SZMCE9 MC _ 55 L28A LAIeB xwn-=a? _-__. _—_• WEST BAMSTABLE Ill 02668 I MUM r. -- — COVERAGES THE POm MMDIoorc umb=LOMNAVE omm-AEDTD-9 M1AM PwGDAPOvE Pet'TNe PDu6YtmDo MOM" a,pT1MTPSTANpNT! 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I�iRfpO0�10A110M� I 11/11/10 aL.cAcPnccnrnr i 100000 mw owrtwumam *I19834t436709 11/11/09 I B ANrMtOPMDciopneym+ERAaCCImuE r_L.oOf"E.P," ,!T.s i 100000 af•FlCFAA1�lALL'A irCl•VOEb+ i 500000 t?1.bruTS•POIICT ILAa IIMl,61.pD•Nip+ We PROM-10NRrMT I I OTHER bO1CriP'RON W a.A7iTTOMG r WlATpP/i rKTMCtf,*)EMGILI9WNA AOeQI OT pWDAM,POR17PiC1�I.MROYWWNA CERTIFICATE HOLDER CANCELLATION TOWP70FB ePOlwrnameaobwDFeWbcDwuoeebccnNLvu�bRwWTNFannnTWn y,Tr TRtrfCaP.TIN,ANMa Mp1Rp,RrALLCAbGAVdITONAL 30 oATa nwnTlN AVTWnTv+M'r.QIIRiCAn NOWCa MLTFO TO 7T1llKT.BIRNMItMF.meb eD�w•Ll. ,PPME naaAwATgPonuMllnr OAAm MMMIlAg11TMC MMMWER.DC AariTrA DR TOWja OF SI�ANrP•,TnABx.E �gbylNTArPIla 200.t4ailn-9t rArtPmesebacsaFRrRenmc glmms i% 02601 !37le LOT7iSL" II.AN� 0 ACORD CORPORATION 1968 ACORfl;25;12001m8)� _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Narne(Business/Organization/Individual): N' j CA fne,VL (,cLo 1, T/_U G i DIVI Address: City/State/Zip: 0, 13A RAJ S i80 CC 0 No tog Phone.#: SO$ -7-7S. • 7? 3 Are you an employer? Check the appropriate box: Type of project(required). 1. I am a employer with 7 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. T. ❑Remodeling ship and have no employees These sub-contractors have g,'❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its '10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees Below is the policy andjob site information. Insurance Company Name: MA I :O n)ttl S-1 R-�")1 Rf1�C—:�C iLS Policy#or Self-ins.Lic.#: )83.gH3 L 7 b) 9`� 2 2 T Expiration Date: I `7 O 1`L Job Site Address: (fly STtf A N City/State/Zip: (�-�{fWal i S PU47 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 S 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$250.00 a day against the violator. Be advised that a copy-of this statement maybe forwarded to the Office of Investigations or insurance coverage verification. I do�hecerf er the pains a enalties of perjury that the information provided above is true and correct Si atur Date: O s� Pho/e#- — 7 L-Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: f ®� e� HOME� � ' �atla�iN F 11�ontj= lamaGmAslftrtm �aats 68 T,L.HtTc tCOCk mim i � TED HM]jjCOCK 105 FERN00C tat HYAANNIS.MA 02568 Mat eea�� �tae�,1c611a%etc%-Dcttartme"t 11f tl Puhiic B(Mrd or Suitin., ltcF� ORS 'LCt'O (jpei�S;JrtGFl!)PED 6PtidJ tit:111[t:lyds License: CS SL t,,-°ery gg�8 Restricted to: RF WS TED "TCfiCOCK 55 LISA LAME WEST BARNSTABLE= MA 02668 t =utmi.�im•r EXPiraiion: 6i1 /20j2 i Tr--:99828 Baia One Ashbmto,Place-ROOM Boston. 1301 Home s h 02108 ® t Contactor Re i T.L. HITCHCOCK SERVICES INC. Type: J'tf'late Co/poration TED HITCHCOCK �pi�ion: 2/812olo TO 264153 105 EERNDOC Rp HYANNIS, MA®266,3 sou-o:in;-pCiNDo Update,Adder and t ebirm ca�.I�dartt re�sen gPas shame. 11$ Lmst Cajd 55 Lisa Lane West°Bamstable,MA 02668 (508)775-7763 (508)775-7763 Fax T. L. Hitchcock Construction Services, Inc. SANDRA BARKER TEL: 1-781-749-6635 25 PIONEERRD FAX: 1-781-749-6635 HINGHAM,MA 02043 EMAIL:CCGAL@AOL.COM December 7,2009 FURNISH AND INSTALL MATERIAL AND LABOR TO RE-ROOF PROPERTY AT 104 FIFTH AVE WEST HYANNISPORT,MA AS FOLLOWS: • REMOVE EXSISTING SHINGLES FROM ENTIRE ROOF AREA OF HOUSE. • INSTALL NEW ALUMINUM DRIP EDGE ON ENTIRE EAVE AREAS. • INSTALL ICE AND WATER SHIELD ON ALL EAVE AND VALLEY AREAS OF ROOF. • INSTALL ICE AND WATER SHIELD AROUND CHIMNEY,SKYLIGHTS,VENTS AND OTHER PENETRATIONS. • INSTALL#15 FELT PAPER ON ENTIRE AREA TO BE RE-SHINGLED, • INSTALL CERTAINEED WOODSCAPE 30 YEAR ARCHITECTUARL SHINGLES. (DRIFTWOOD) • INSTALL VELUX 306 VENTING SKYLIGHT WITH SCREEN. • INSTALL NEW ALUMINUM PIPE FLANGE. INSTALL RIDGE VENT ON ENTIRE RIDGE AREA OF ROOF. • CLEAN AND REMOVE ALL TRASH FROM JOB SITE. • LABOR WARRANTY= 10 YEARS. MATERIAL WARRANTY=30 YEARS WE HEREBY PROPOSE TO FURNISH MATERIAL AND LABOR IN ACCORDANCE WITH THE ABOVE SPECIFICATIONS FOR THE SUM OF$5,150.00 PAYMENT TERMS:DEPOSIT OF$2,500.00 DUE UPON ACCEPTANCE OF PROPOSAL AND THE BALANCE OF$2650.00 IS DUE UPON COMPLETION OF JOB. ACCEPTANCE OF PROPOSAL:THE ABOVE PRICES,SPECIFICATIONS,AND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED.PAYMENT WILL BE MADE AS OUTLINE ABOVE. SIGNATURE OF CONTRACTOR: ATE: SIGNATURE OF CUSTOME DATE: HIC Reg.# 158587 . . . . . . . . . . . . . . . . . . . . . Assessor's offioe (1st floor): /l ) (i� COMPLIANCE Assessor's map and lot number ....d 6-�00 C oo-TH TITLE 5 Q��FTNETO�` Board of Health (3rd floor): • r .:':' E' ��°L gd®�� � R Sewage Permit number ..... 7-.. .(..`d-................ ......,.. E ;�ovhi REGULATIONS t 33AWSTAXLE. : Engineering Department (3rd floor): f�'' . O �o ems K MMa House number �..... .................... °'°�163ga� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR l�Ot l51 t3tJG( Z N D �'LOD+�j ��D1 7f 10 1 /6 ro5 f ,=4 APPLICATION FOR PERMIT TO .............................................................. ..........�`1............................................... TYPEOF CONSTRUCTION ........... .. �.....ftt�� .................................................................................................................................................. �� �.....I........................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ................................F......................�.............................................................................................................................. I1 15 51 DSe-1e-a...... � F� z-zfC YProposed Use ................ ..... . ................................ ..................................................... ZoningDistrict ......... ....................................................Fire District .......................:...................................................... Name of Owner . 4.. ;�Ip.!??TJE6>k1' .l4.F1A-t......................Address Z.J....I..IP .��.+ �, I�it{�lf 1?'f T�d..... Name of Builder .. p?. I?' ?.f.... k!'fo??K.....................Address L�.. �6 ?1SLyE�••` ll>IGLCi( Name of Architect ....................Address .Z�J.. r�.F SDe,t ST• ! �I�i�, io5 i1. Number of Rooms .......... ...................................................Foundation �Y..� t.'C .....`..�i1S . .......... .................................. Exterior .... .Fi.►?& ... ` Roofing ... LIA',T F . 4......�1-lor+r LdS, ..................... Floors !..i.`1.Lt3t3U.p.....h...... i!�..�.t................................Interior ...... /��j. ? .1?z. <<i........................................... /9 Heating .....P. �.+.... ?►� s�.a.............................Plumbing ..... .t?P�i .��v ..... ... .............. Fireplace ............. ..............................................................Approximate Cost ....:—As-l.b�,. .......... ..,......................... =1 VIP Definitive Plan Approved by Planning Board _______________________________19________ . Area ...-�1 � F- ........o;................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin the above construction. Name . .. .:'..... .�1` .... ....... .............................................. Construction Supervisor's License ....Q(5: J 1............ ......... BARKER, ROBERT No .31257 Permit for ,ADD 2r�Floor Sing le FamilX Dwellin • ............... ..................... ..................... ........ f it LocAtion ...104 Fi f.th Avenu.e .... ......... . West HXannisport .................................. Owner Robert Barker - .................................................................. Type of'Construction Frame _ .................................. _ V,............. ............................................................ , Plot .. ..................... Lot ................................ t October 2 ...iq 87 Permit Granted ...... . . ............r........ Date of Inspection .......................... ....:.....19 Date Completed ......................................19 V o Assessor's offioe (1st floor): THE �^ , Assessors ma,;y,and lot number 7b. QO �-�°�:,"--, c� ro♦ Board of Health (3rd floor): Sewage Permit number ......Fi...7: ...:................:..::.. i B9H39TGDLE, : T Engineering Department (3rd floor): kWj- �o M o• House number / o �0 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING _ INSPECTOR APPLICATION FOR PERMIT TO ... (.,,Z........I�Laan, ��9►Tc o� I c��i s 1 Dr%Kc�? TYPEOF CONSTRUCTION ........... .. .... itT?. .................................................................................... �GT...........................•19 ' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby appliesfore a permit according to the following information: ...Location ........ .....................[rt 3.......................... .............................................................................................. Proposed Use ......!... .511� r�4.�1.......... )..T(4.1 t .. A1-z�C.Y.............................................................................. Zoning District !.................................................Fire District ............................................ Name of Owner D. ?.�.�!?. ...J.✓.. .'R.K...t`9......................Address 2.J....t..( l.Frfz c?� T�. l I iY At( TO , Name of Builder ..,�LE.! Mt. .....................Address .Via... r�t s Lsl.,�Gih'7fri llltC � eft Name of Architect M.t.09.F.,(A-de.... OC.....................Address .2:�✓..r-t�.f���aK�T;. 5�3aSE,�„! l . •.. }-� . .....:... . ............ Number of Rooms I^...................................................Foundation [.?` 5r.! 'tG?......1„�/15 . ........... .......................... Exterior ....Cr.R,A.2�7.-!51 S ..............Roofing ...A;5•i''.laf+... ... Floors ..... ..... ......E,/..'An...............................Interior ....... �1�s.�s:7.. .( ........................................... Heating ..... .c.�-?�.�..... �r)�?f>.0. !dam.............................Plumbing 6.19— .. ?.f ........................................... s Fireplace ".' .Approximate Cost ... ....................................... Definitive Plan Approved by Planning Board ---_�: - ____ ✓'.,8a5 Z — FZ�. "D - - 19 Area .........©U .............. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding�'the above construction. a Name ............... ................................. Construction Supervisor's License ....( f.J g �G1 \ ........... BARKER, ROBERT A=246-100 1 No .3.12.57... Permit for .Add...2nd._Floor. ............Single.,,Family... welling... LoAtion 104 Fifth Avenue ................................................................ West Hyannisport ............................................................................... Owner Robert Barker .................................................................. Type of Construction ..Frame... ..................................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ..........October .2 , 19 87 ................. ..... Date of Inspection ....................................19 Date Completed ......................................19