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HomeMy WebLinkAbout0101 FOURTH AVENUE (HYANNIS) i�i � ', i ,� I r 1 - Town of Barnstable *Permit# o� 00 6 ova I Expires 6 mont:s from issue date ®PRESS PERMIT Regulatory Services Fee APR 2 5 2008 Thomas F.Geiler,Director Building Division — TOWN OF BARNSTABLETom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number 2 6 627 Property Address y `�+� A j rr . j�ti> YY\►4 , ❑Residential Value of Work -VYA) Minimum fee of$25.00 for work under$6000.00 Owner's Name&AddressrN Y�ll4 C crt '�C il'.7\ c{� (A V(' I)u•. �+.�u.,n rtn S env�/'� ��/�..tA. . LLC m Telephone Number" 2 z/ 3 Cz F — l 0 Contractor's NameA�C Ro t 3- (C err �- .7 Home Irnprovement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) of-5 C?(0 .7 2 tq. ❑Workman's Compensation Insurance Check one: ❑.I am a sole proprietor ElI am the Homeowner I have Worker's Compensation Insurance Insurance Company Name ?flu L r-t e az LA c) C-NA Workman's Comp.Policy# Copy of Insurance Compliance Certificate must.be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to y, r sJ e- 6, ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders. U-Value (maximum A4) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,.Cons=,Yatioan,,1e$c�y��.� ***Note: Property Owner must sign Property Owner Letter of Permission. , A copy.of the Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 T7te Commonwealth of Massachusetts Department of Industrial Accidents Offzee of Investigations 600 Washington Street Boston,MA 02111' www.mass.gov/die ' Workers"'Compensation Insurgnce Affidavit: Builders/Contractors/Electridan.s/Plumbers APD l�l liCant Information Please Print Lei I b v Name usiaess/Organization/Individual): 1 rn1 rye.' ��° `� L L C- (B 5 •Adciress: ,(U City/StateJZip: in k of Phone.#: �( - 36� - o 10 0 Are you an employer?Check the appropriate bog: :Type of project(required):. 1.❑ I am a employer with 4 �I a general contractor and I ' * ve hired the sub contractors 6. ❑New construction •. 'employees(full aiWor part time). Remodelin 2.❑ I am a'sole proprietor or partner- listed on xhe'attached sheet 7• ❑ g ship and have no employees These sub-contractors have 8. ❑Demolition �vorldng for me in any capacity. employees and have workers' 9• ❑Building addition ' [No workers comp,insira comp.insurancet'nce 10.❑Electrical repairs or additions required.] 5. El we are a corporation and its re 3.❑ I qu a homeowner doing all work . officers have exercised their 11.❑Plumbing repairs or additions ' right bf exemption per MGL myself[No workers comp. • 12�Roof repairs insurance.required.] t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other- comp.insurance required.] "Any applicant @rat checks box#1 must also fill out the section below showing their workers'compensation policy information. t liomeownera who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tt:ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. if the sub-contractors have employees,theymust provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below isthepolicy and job site information. Insurance Company Nmme: TA jL AS;, V\4 Policy#or Self-ins.Lic.# Expiration Date: - 5 4 •M4i - City/Stat&71 �Aj -1F��AAI5e,6 t'F MA-o'Zb L-1 Job Site Address tO l "I�'A�c ice- i+�tanvl�o P 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 maybe forwarded to the-Office of Investigations of the IDIA for insurance covers a verification. Ido hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct Date Si store: Phone# , official use only. Do not write.in this area, to be completed by,city or towmofficial, City or Town: ' Yermit/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#: . s , _. — i Board of Building Regulations and Standards lugHOME IMPROVEMENT CONTRACTOR Registratiiorts, 158315 Expiration 1/9/2010 Tr# 262965 pe. Ld iabilityCbrporation 1 ALPINE HOME BUILDERS.bF CAPE COD LLC . I ; JEFFREY MACHADO 40 S.SANDWICH RD ' Administrator MASHPEE,'MA 02649 r I � , License or registration valid for individul use-only before the expiration date. If found return to; Board of Building Regulations and Standards One Ashburton Place Rm 1301 ` Boston,Ma.02108 Iot`valid'without signature fi • I License or registration valid for individul use only before the expiration date. If found return to; Board of Building Regulations and Standards ; One Ashburton Place Rm 1301 Boston,Ma.02108 ' V J of vali without signature 1 4 f1 J ` Date:3/27/08 Invoice# Jain R- Halbert III ..1.836-6030 .THalbesi1110�esoas.N - PO.E-2221 It adl p-MA 02649 , Bill To: Address: Ken Maccarone 10I 4h Ave— W.Hyannisport Quantity Description Rate Amount Strip roof,pull all nails from sheathing $4,400.00 Apply bew 30 yr architectural shingles over 6'of ice and water shield,new drip edge,and tar paper. Install a new pipe flange and reflash chimney. Disposal and cleanup included. Total: $4,400.00 i Deposit: r Balance: $4,400.00 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers APPUcant Information Please Print Le bl Name(Business/Organization/Individual): ()-l ^' Address: Q X` 2 Z z City/state/zip_&k0 Phone • QU30 Are you an employer? Check the appropriate box: Type of project(required): L MCI am a employer with 4. I am a general contractor and I , 6. ❑New construction employees(full and/or part-time).* have hired the stab-contractors 2.❑ I am a•sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 Q Building addition [No workers' compAinsurance comp.insurance.$ required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself[No workers' comp. right of exemption per MGL 12 Roof repairs insurance required.]t G. 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'cotvpe umdon 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-contractams and state whether or not those entities have employees. If the sub-conhwwrs have em ployexs,they must providt their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. I Insurance Company Name: WC000,"� �" Policy#or Self-ins.Lic.#: ? I Expiration Date: �O U �� �� Job Site Address: ()- ` A c 4- GImis 2,4 City/StaWZip: S l^ �2(fl0� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required raider Section 25A of MGL c. 152 can lead to the imposition of rrimiTal 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 coverer a verification. I do hereby certify under a Gins• aloes of perjury that the information provided above,is a and correct Si ature: Date: O Phone#: �_ Official use.only. Do'not write in this area,to be completed by city or town offWaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department I 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 hiie, 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 certificates)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 that 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 nurgber listed below. Self-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 permit/license applications in any given year,need only submit one affidavit indicating can ent policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A ebpy 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 (ie. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit:. The Office of Investigations would like 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. The Commonwealth of Massachusetts Department of lndusWal Accidents Office of Investigations 600 Washington Street Boston,MA 02111 W. #617-727-49-04'ext 4-06 Qr 1-977-MASSAFE Fax#617-727-7744 Revised 11-22-06 www.mass.gov/dia Ws esso4office(1st Floor): Assessor's map and lot um _ S Yw E>o`. ` q SEPTIC SYSTEM MUST BF- Conservation � _ I a` r). INSTALLED IN COMPLIANCE Board of Health(3rd o Sewage Permit number WI"t1TITI.F 5 { a�srani ; ENVIRONMENTAL CODE AKU 'moo `e7p. Engineering Department(3rd floor): � House number : TOWN REGULATION'S Definitive Plan Approved by Planning Board 19 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 RPM aj p , RJL d TYPE OF CONSTRUCTION r/ 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 161 V h Az P //�a v►y� t 5 ors r� Proposed Use S'a 10 — La.a j iQ v c Zoning District / Fire District Name of Owner ( i 1�9 P_ �mBerra re)Li P Address Name of Builder i e I�.n A L k&%(L , Address �O K 6 6 7 Va, Name of Architect Address Number of Rooms Foundation Pc6f �Fc�tM Exteriors 14 Roofing Floors / Interior Heating (� Plumbing Fireplace Approximate Cost 0., Area Diagram of Lot and Building with Dimensions Fee 1C7 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. Name (2- , M Construction Supervisor's License �.� ►r 7 x MACCARONE, OLIVE REMODEL j t' No 34936 Permit For DWFT.T.IN a e v. < Single Family Dwelling ' .Location 101 4th Amen„e —r - ' 'Olive `Maccarone Owner r -Wood Frame'`. Type of Construction a � +fir t _ ' � 9 � § f _� '^#.' £. ., 6 • �. t - � ` Plot tot April-2 '. � '92 Permit Granted 19 •� s T � Date of Inspection ;` ` 19 s Date Cor=npletgd 19 a j 3ft i Avg - - --- -- v r Ki7 a h _ 3 a ---� r �+ao ce ku Pro Pns � n ✓zr j. 'O n u► 4 M"a O -W o F�a�• T , El - j �L h �_o t ,!;Etta- _..._ ._.__. __ .._.__._. _ _. vE WT t a o i 1 T Q �'hc _ � j Q ar 3 �y V W F�OCJ rd PrO POS � fl V EMT Q O3 ui E I' � M1b fat _ o nW o l�J hdan[•. ll ki}ctie.� r • .�. 47 I - DEPARTMENT OF PUBLIC SAFETY. COMMONWEALTH 1010 COMMONWEALTH AVE. j OF BOSTON,MASS.02215 MASSACHUSETTS LICENSE EXPIRATION DATE' CONSTR• ..SUPERVISOR JEST3CTr61 93 a EFFECTIVE DATE LIC-NO. a_ NOfVE 0 05/01/199© 053837'. RICHARD C LYNCH' m PO 80X-657 •SS N C32—+44--1162 HYANNIS NA 02601 PHOTO.(BLASTING OPR ONLYI..- FEE: r0000 - HEIGHT: NOT VALID UNTIL SIGNED BY LICENSEE.AND OFFICIALLY �.' - STAMPED OR-SIGNATURE OF THE COMMISSIONER"' DOB: 09/1111954 �4 > $ THIS DOCUMENT MUST BE .i. CARRIED ON THE PERSON OF 94VJFTUBE O ICENSEE I t - THE MOLDER WHEN ENGAG '-OTHERS:RIGHT THUMB PRINT ED IN.. THIS OCCUPATION. _ ! ISSIONER I `:1200M•2-87-81429 0