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HomeMy WebLinkAbout0021 FRANBILL ROAD o� f FRdi 0e��.�. Ra�� 57 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 4/8/15 Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 201501120 Dear Mr. Perry This affidavit is to certify that all work completed for 21 Franbill Road,Hyannis has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. w <k `1r7 kx..e SincerelyZR William McCloskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a Parcel Application 60 d I�l� Health Division 'Date Issued3'—g- 155 P Conservation Division Application Fee . Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address a Fran 61 !A Rai " Village OL IS Owner 4- r0L Address me . Telephone y (3 56 3_ 39 95 Permit Request fDen 3C c nn ac_�I(,S c�,�-��, - 13 c sad �, r c C. plae _14AI ,, ex an J if Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 44 Flood Plain Groundwater Overlay Project Valuation ~ U Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting`docurrntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) ; Age of Existing Structure Historic House: ❑Yes 0 No On Old King'SHighway:'❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ___ 2 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.4 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 A'�o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) W i 1 �r✓ C, tirInc— Name Telephone Number 3 93 0� l 8 it I Address - D �w 44l'�f ID n a v e.. License #_ J—L L a o2 b 56wA YOLPM DWA i'L Cr 66 Home Improvement Contractor# Email Worker's Compensation # W W C 308- -5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Y�,a-naLt+ SIGNATURE DATE 3 c5J,5 F FOR OFFICIAL USE ONLY J � APPLICATION# DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth ofMassach'usetts Department.of Industrial Aceirlenis Office of Investigations. ,r 1 Congress Street, Scene 1110 Boston,MA 62.114-201 7' . www.massgov/dia ' Workers'Compensation Insurance.Affid'avit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly. Name (Busincss/OrganizatioWlndividual}:. Cape Save Inc Address:. 7D Huntington Ave City/state/Zip: South Yarmouth, MA 02664 _ 'Phone.'#: 508-398-0398 _ Are you an employer?Check the appropriate boz: Type:of project(required): 4. , 1 am a eneral contractor and 1 1. ✓l ! am a.employer with Q�G g 6. E New:construction: employees(full and/or part-time).* have hired the sub-contractors 2;❑ ! am a sole proprietor or partner listed on Q ,the"attached sheet.. 7. .Remodelmg; ship an0ave no employees These sub-contractors have g; 0 Deinalition workiri for in at capacity. employees and have=workers' g y A ty- 9. [] Building addition [N o workers!comp.>insurance:: comp.insurance required.] 5 ( We are a corporation and its 1-0 Electffcal repairs or:additions 3.El t am a homeowner doing all work; of!'icers have exercised their 11.(Q Plumbing repairs or-additions myself. [No workers'comp::: right of exemption per MCL a p c. 152 1 4 and we,have>no 12• .. Roof.:re airs insurance required.} ( � employees. [No workers' 1 Other Insulation comp. insurance required.]; `: _ *Any.'ipplicant hat checks box#1,must also fill ottt the section below showint;2hear.vorkeis'compemationmpolicy information: t Homeowneis:wha suhniii this at1'idavit inc►icating they arc doing all work and then hire hutside,cnntractpr;must submit"a neti<;aflidavii indicating such. Contractors that.check this box iinist attached an additional sheet show ng the name of i6::sub-contractors and state wl ether or?itot those_-'entities Have: employees. If the-sub-contractors have employees,they must.orovide their workers'comp.p olicy number: I ant an employed that is providing workers',compensation h! .1lrance for nry:eniployees. Below is tliepolicy andjo/�sife inforination. Insurance Company Nam',q Wesco Insurance:Company Policy#or Se if!,ins,.Lic.# . WWC3085633 ___ > xpiratton Date: 04/09/20115"' �• I_ 1 Job Site Address. I'f� yt II �h q c� C,ity/Stat040;_ �l �1 IS Attach a copy of the workers'compensation policy declaration page(showing the"policy<number And eapiration.date);, Failure to securecoverage.as.required onder Section 25A,0P:MGL e. 152 can lead to the imposition of criminal penalties of a fine'up to S1,500.00 and/or one-year imprisonment,as well as civil penAtieI in;the form of a_`ATOP WORK ORDER anda.fine: of up ro$25Q.Q0 a•day against the-violator': ge advised that a copy of this statement tray be"forwarded to the Mce:oT investigations of the DlA.for insurance coverage eritication. do:hereby eerti ;under the gins and enaltieso er" that the in orrnution provided above is true and correct;: i nature; _ ' Date` 3 ": Official use ohly. Do not write in tlris':area,ao be cortrpleted.Pj!7 city<nr t6ult Offtcial City or Town: Issuing Authority(circle on .1.Board of Health 2. Builtling Department 3.City/Town-'Clerk. 4.Electrical nspector 5 Plumbing lrispectoh 6..Other Contact;Person: _ Phone#� AC- CORL] CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �.•� 11/10/2014 THISCERTIFICATE 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 INSURERS►,.AUTHORIZED REPRESENTATIVE OR'PRODUCER,AND.tkg CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,this policy(les)must be endorsed. If SUBROGATION JS 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 certfftcate holder In lieu of such endorsements. PRODUCER 1ONTACT Colleen Crowley Risk Strategies Company PHONE (781)986-4400 F C No):(783)963-4420 15 Pacella Park.w�Drive ccrowley@risk-s.trategies.com 813it@ 240 ,. INSURER§AFFORDING COVERAGE . NAIC0 Randolph MA, 02368 INsuRERa:Sel6 , ive Ins,. of America IkSUREo `1NSURERB.Allmerica rinancial Alliance 10212 Cape a Save, Inc INSURER c:.Wesco Insurance Company 7 D Huntiagtow.Ave INSURERD: INSURER E;: South Yarmouth M V2664 INSURERF COVERAGES CERTIFICATE NUMBER:CL14111085532 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS.SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR' . LTR. TYPEOF INSURANCE ICY POL NUMBER PO'ICY EFF PO��EXP ;LIMITS GENERAL LIABILITY EACH OCCURRENCE $: 1,000,000 X .COMMERCIAL GENERAL LIABILITY PREMISES Ea o rre e $ 100,000 A CLAIMS MADE Q OCCUR 1994480 0/16/2014 0/16/2015 MED EXP(Any one person $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,:000,000 GEN L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $. 2,000,000 POLICY rx PRO- X: LOC $: AUTOMOBILE LIABILITY Ee accident LIMIT _ 1 000 000 B ANY AUTO SODILYINJURY(Per person) $ ALL OWNED X SCHEDULED 6196600 i/6/2014 1/b/2015 BODILY INJURY(Per accident $' AUTOS AUTOS _ ) X? X NOWOWNED P OPEf TY DAMAGE ac HIRED AUTOS AUTOS Per "Ient $ X UMBRELLA LIAB X - OCCUR EACH OCCURRENCE. $ 1,000j000 A ' EXCESS LIAB F. CLAIMS-MADE AGGREGATE- $ 1j000,000 DED RETENTION s 811 S1994480 0/16/2014 0/1.6/2015 $ C I WORKERS COMPENSATION Officers Included for X WCSTATU- H- AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTiVE YIN overage. EACH ACCIDENT 500 000 EL. $ OFFICERIMEMBER EXCLUDED? a NIA . 3088b33 /9/2014 /9J2015 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,desaibe under DESCRIPTION OF OPERATIONS below El,DISEASE POLICY LIMIT $: 560,000 DESCRIPTION OF oPERATIONS I LOCATION$I VEHICLES(AKach ACORD 101,Additional Remarks:ScliWule;1'more space Is required) Issued as evidence of insurance. Issued as evidence of insurance. ThielschEngineering, Inc: is listed as additional insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION msong@capelightcompact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Margaret Song PO -Box 427/SCH AUTHORIZED REPRESENTATIVE 3195"Main °Street - Barnstable, MA 02630 � � _ chael Christian/CLC ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. Al rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD Building Permit Authorization I, Fitzgerald, Scott , as owner hereby give my permission to c Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 . to take all necessary steps to obtain a building permit to perform work at my property located at 21 Franbill Road Hyannis, MA 02601 Signed �. Dates 4 F Office of Consumer Affairs and Business Regulation t` 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 y Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. WILLIAM McCLUSKEY - 7-D HUNTINGTON AVENUE ; SOUTH YARMOUTH, MA 02664 ----- ---- Update Address and return card.Mark reason for change. sca zone-osni Address Renewal Employment Lost Card . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only TOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: j713gp Type: Office of Consumer Affairs and Business Regulation 9 Expiration 3/_1,,4/201.6. Corporation 10 Park Plaza-Suite 5170 _ I I r Boston MA 0211.6 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE g �s� � SOUTH YARMOUTH,MA 02664 Undersecretary Not vali ithout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specially License: CSSL-102776 L W ILLIAM J MC C-LUSKEY 'r 37 NAUSET ROAD West West Yarmouth NU 4 6 3 r Expiration Gommissioner 06/28/2015 Tawas of Barnstable *Permit# Expir months from issue dale ° Regulatory Services Fe' $ G Thomas F.Geiler,Director 16gAR`a,M & � '�P Building Division �® Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town barnstable.ma us Office: 508-862-403 8 Fax:.508-790-6230 EXPRESS PERA UT APPLICATION - RESIDENTIAL ONLY;- Not Valid without Red X-Press Imprint Map/parcel Number 63 9A N q ,,pp - , Property Address U�/ > �4 n b®�l/ X d P y y n n i s dResidential Value of Work ��s0 o. o o Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address W_ Contractor's Name �G4G Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) C'S- 0$a 9.58 UJI(Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑�I am the Homeowner [Z I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# IX/G 0-t v 3 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) l ®'Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to J?6�� r ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side oZ #of doors 5/Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. . Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors.License is required. SIGNATURE: (� 4 r%Aurocn T7Q%rr)0AA4QU ,;ld;na nermit fOnns=RESS.doc a lc - f. Massachusetts _ Board of Buildin Department of Public Safety Cun.►tructiug Regulations and Standards "pert isur License: CS-a92958 • r :t r.ti• 143 PA CO HAY - , :... ES_ CENTER E -- ,; _ 02632 Cornmissiciner Expiration 10/17/2013 s License or registration valid°for'►ndtvidul use only ` before the expiration date If found return to Office of Consumer Affiiirs and.Business Regulation ` . 10•Park Plaza =Suite 5170. Boston,MA 02116 -A4Z Not valid without signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards G nstruc`tiun ..c uper%isur License: CS-092958 i SHANE PACHE60 143 HAYES Rv . i F CENTERVII LE 1VIA �02632 Expiration Commissioner 10/17/2013 lahon ,. Jsiu ess Re u . Affairs&B S fta� .. onsu mer A �'•! Office ot`� HOME IMPROVEMENT CONTRACTOR .Type: Registration 454 0 `. Individual1A/ 2013ExPitation: c.; -_ 4 PACHECq I { SHANE PACHECO1FF3 ?i 143 HAVES RD. CENTERVILLE,MA`02�,32� Undersecretary , is z H t a i The Crrmwonlveaitit rrrf Massachuse& D4219whnent of Ind=rikd A ccidexft Office of Invesfigafions 660 WasJsuYg �.et Rolston,M4 62111 . rt tM nnsLgvv1dia Workers' Compensation Iusurance affidavit BuildersfCon#ractar&rUectriciansfPhLmbers Applicant Information p Pease Print LIfi Name 1): S�G�..-- C, ' Address: �S v e l d �ityfSta fZsp: u�5 can c l I,S G phone##_ S 6 3 3( - �S Are a>r employer"Check the appropriate boa: Type of project(regnired): 1.IJ I am a employer with .3 4 ❑ I am a general ountractor and I 6- ❑New, cansIxucfion employees(1611 andc rp )-* have hired the sub-contcactm 2.❑ I an a sole pl a{niektr or partner- listed an the attached sheet~ 7- ❑Remodeling ship.and have no employees 'these sub-contractors have g- ❑Demolition wcdrinb for me in any �! Q employes and have wakers' 9. ❑Building addition 1N,o worrlmfs'comp.insura ce Cam_mstuarsc requ . 5. ❑ We are a corporation and its 1�.❑Eltrctrical repairs or additions ired] 3_❑ I am a homeovcrne.€doing.all work officers have exercised their 11_0 Plumbing repairs or additions myself [No workers' rigbtof ememgtian.per MGI., 12 21flof repairs insurance r 1 andwe have no required,]r employees-� at`[ o workers' 13.❑{ether comp.insurance reTired.j 'Any appEcam:that checks boa#1 must aim Main the section helaw showing ilea wares'—peosatum police imformstiob T Fiameositners who submit this a€ubmit indicata ig they atedmng sa wad and then hie outside caoamuctors must submit anew affidavit aidicstaig such lCanimcias thatched this box must attached an xddifi mat sheet shaWing the name cf the s6-co3ftactm and state whether or namose endfies lase emplayem If the snb-�s have employees,tleyasust provide their warkers`ramp.policy number- I afn au a�p�8r fFsatispi�ovidiag ivor&+ers'coisrrteirn i�eranc�for aiy aa:gFoy B�elniv is dtepoiliryT atxrf jab szle information. Insurance Campa ayy Name: Policy#or.Self-ins.Lic. C,Z v 3 I S _ 3 8(01 1 4- 0 13 Expiration Date: _q 17 i V Job Site kddre s: Attach a copy of the workere compensation policy dechration page(showing the policy number and aspiration 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 andfor one-year imprisonment,as wen as civil penalties in the form of a STOP WORK OItL1F.lt and a fine of up to$250.00 a day against the�,iolatar. Be advised that a copy of this statement may be forwarded to the Office of Investigations of tiie DM for wsix-ance cm-erage verifcation_ ' _... do hereby ceriafy under thepai ns Wpena&as of fury Ant the Wo ma&rn pm ir£ed ahm is tnw and convct 5sgflainne: Date: Phone# ©VIdArL=a only. Do not write in ihis amen,to be cmpWed by city or taim o faiaf . Chy or Town:. PermitUcense At Issuing Authority(circle owe): . 1.Board,of-kealtli 2.Bu ding Deparhmeut 3.CVyTf'own Clerk' Dectrical hupector.3.Pbmb ng Inspector ..6.Other.. Phone if: . i Pv � + lARNSTABLE, * . 9� ,�� Town of Barnstable - Regulatory Services Thomas F. Geiler,Director. Building Division Thomas Perry,CBO Building Commissioner 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder h_ �AYNC ?i4CN0C& ; as Owner of the subject property hereby authorize S NA N f ' A CItEC b to act on my behalf, in all matters relative to work authorized by this building permit application for: f PAAt'04ILL (Address of Job) a- fazw Signature of 6wnet Date Print Name tf Property Owner is applying for permit,please complete the Homeowners License Exemption Form on,the reverse side. WPFILESIFORMSIbuildin' g permit formslEXPRESS.doc - .. zHME Town of Barnstable Regulatory Services S'AB'- Thomas F.Geiler,Director Mass. 1639. ��� Building Division iOTeo I„a�t e` g Tom Perry;Building Commissioner - 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m-a.us Office:. 508-862-403 8 Fax: 508-790-623 0 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village. "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town to zip code The current exemption for"homeowners"was exten d to includ wner-occupied dwellings of six units or less and to allow homeowners to engage an individual for-hire who does of pos ss a license,provided that the owner acts as supervisor. DEF I N OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resi s or intends to reside, on which there is, or is intended to be,a one or two- family dwelling,attached or detached structures access t such use and farm structures. A person who constructs more than one home in a two-year period shall not be considered a meown r. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she sha a res onst le for all sucKwork erformed under the building permit. (Section 109.1.1) The undersigned "homeowner"assumes r onsibility for complian e with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned "homeowner"ce es that he/she understands the To of Barnstable Building Department minimum inspection procedures and.requirements an that he/she will comply with said proce ores and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors),provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of.a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. . 5/3/2013 10:58:16 AM PST (GMT-8) FROM: 100005-TO: 15087756688 Page: 2 of 2 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) �.� 5/3/2013 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER FRANK L HORGAN INSURANCE AGENCY INC CONTACT NAME: 44 BARNSTABLE ROAD PHONE c EXt A/c No HYANNIS, MA 02601 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: INSURED INSURER B: SMP REALTY DEVELOPMENT LLC 81 JASPER RD INSURERC: MARSTONS MILLS MA 02648 INSURERD: WSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: 16236444 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 SUER POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ POLICY PRO JFCTLOC $ AUTOMOBILE LIABILITY CO .id. LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS R AUTOS $ HIRED AUTOSNON-OWNED PROPERZrAGE AUTOS (Peracadent $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC2-31 S-386119-013 4/17/2013 4/17/2014 WC STATU- 9x- AND EMPLOYE RS'LIABILITY YIN / TORYLIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100000. OFFICER/MEMBER EXCLUDED? F N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN ST ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD it SN C27t13 1C3 t2 CdI7C2�S: 161d1716 eZ52 25g s 5/3/2013,10:1 46-T Pa e 1 of 1, fs p d° �LL previously issued certificates. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). 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, 151 FI., 367 Main St.,,Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. VL b DATE: Fill in please: S"7� `( Cass-ems APPLICANT'S YOUR NAME: BUSINESS YOUR HOME ADDRESS: 2 " TELEPHONE # Home Telephone Number: 5-0 F 36,7 O NAME OF NEW BUSINESS eCo Pit(GL / ?PSS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the buildi di vi ion? YES NO ADDRESS OF BUSINESS Al ff ! au�r f G76 4 MAP/PARCEL NUMBER 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 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO MISSIO ER'S OF E This indivi ual as n"info any per it requirements that pertain to this type of business. COMPLY WITH HOME OCCUPATION )MMENTS: A i on Signal e** L AND REGULATIONS. FAILURE TO Ly MAY RESULT IN FINES. / 2. BOARD OF HEALTH This individual h be i formed-oft it requirements that pertain to this type of business. --- �j( Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual h en in� ed of the i ns'n re irements that pertain to this type of business. W67th-orized Signature** COMMENTS: 1 i Town of Barnstable � THE Regulatory Services oF rqy, Thomas F.Geiler,Director Building Division RARNSTA13LE MASS. Tom Perry,Building Commissioner ` no Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: , Permit#: �� HOME OCCUPATION REGISTRATION Date. 0 Name:': l�/�f V� S� Phone#: 0 / Address: p2I (o� b/ff Village. Name of Business: 0 a66 G'(O✓ �fj Type of Business: 4 75"• Map/Lot- 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 anot 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-hazardou$materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be mei.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 is no commercial vehicles related to the Customary Home Occupation, other than one van or one pick-up-t uek-notto•exceed•one ton:capacity,and one trailer not to exceed 20 feet in length and not to. _-- ex=d 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 dw,p#ng unit. . I,the enders' e ave read and agree with the above restrictions for my home occupation I.am registering. Applicant' Date: /� r Town of Barnstable *permit#5/3-2-- � � Expires 6 monshs from issue date Re ulato Services Fee �� . t�rABL& g rY 659. Thomas F.Geiler,Director 1 Wg3>/0/ 6s� .� �EOt. Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w X-PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 F E B 2 9 Z 0 0 1 / �i T APPLICATION 7 EXPRESS PERMITC� Not Valid without Red X-Press Imprint TOWN OF gARNSTABLE Map/parcel Number �) f F . r314 e_ Pa �� 0 Property Address r d' esidential OR Commercial Value of Work ,.. �d Owner's Name&Address J b Y[,, Contractor's Name VC7�5g /A/`/l L// ,A`.�:/A( Telephone Number 50�,—34�2—ct>g 1 e Home Improvement Contractor License#(if applicable) Z ✓� Construction Supervisor's License#(if applicable) F-lWorkman's Compensation Insurance Check one: E� a a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) Re-roof(stripping old shingles) Re-roof(not stripping. Going over existing layers of roof) C b r Re-side Replacement Windows. U-Value (maximum.44) Other(specify) S7,9I d f-��S �S7'� � [�.G�l/11�c'o > �P c� O V✓1/�� ck9 *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signature expmtrg TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map z Parcel 4 Permit# Health Division Date Issued 1—[. —0 Conservation Division Fee Tax Collector :' •` 3�fJp .i Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 6 t� ZYZ(( 949 Village is Owner 3V5 � ddress��XW114 1'a,_PIP / Also) �Q!` Telephone (� ,pC Permit Request �Q �' /�� /`f P� le� Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation �)966 ' 00 Zoning District Flood Plain Groundwater Overlay Construction Type PJ 0 6 !D Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 4V Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes fGo On tOld King's Highway: ❑Yes U -4e Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Y-2, ,A;, CC ram. C,4�40;u, C 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 4-0il ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes 4iiu"' 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 ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Lcio:/g J, t sal �!EI° Telephone Number '— la Address Oeq�eoo rc:y License# Qdc l z 1' Home Improvement Contractor# Worker's Compensation# ALL CONSTRU ON DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE "O '—/3 FOR OFFICIAL USE ONLY . . PERMIT NO. DATE ISSUED `u MAP/PARCEL NO. ADDRESS VILLAGE DATE OF INSPECTIONm _ FOUNDATION m - FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL , FINAL BUILDING - DATE CLOSED OUT ADre7,00 n . ASSOCIATION PLAN NO.- i , The Commonwealth of Massachusetts ' 7. - _-• Department of Industrial Accidents ,�. -== •- Ohice o1/osestigatioos r�• _ '' 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit Jame' C �' ` ` t'� f• location:7 D � G� / city l3X 0 �� �� �Q phone#/V� ❑ I am a homeowner performing all work myself. �1`am a sole r rietor and have no one worki>l in ca achy I am an employer providing workers' compensation for my employees working on this job. .. . com an ,name. cites ahtme# M. .insurance co _;: oLcv# ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: com an name. _. X a _ :'; >:.>: tidress ......::..:.......... ...... < . .... one XX d .. .:...::::::::::.:::.::::.:::.::::::::::.......................................................... ...................... ...................................................... rx �<.. ;.;;:.:•:•:...:. .:: c an name:; ci :»::>:. one . XX _ .......:.... . ..::::......::....:::::::...... .....:. ::::..,..:...:::. ax ...... Olit v# Fan=to secure coverage as required under section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to s1,500.00 and/or one years,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a flne of s100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby c th sins penald of perjury that the information provided above is true.and correct. Si Date /t6 gnature `�• � _ Priest name �lD official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if lmmediate response is required ❑selectmen's Office ❑Health Department contact person phone#; ❑Other (nursed 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits maybe 4"1 �` submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and b 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. City or Towns 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 perinit/license number which will be used as a reference-number._ The affidavits may be returned io the Department by or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 Industrial Accidents Me of Inllestigallons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 cF tME r� - �: The Tower of Barnstable - - • s�xnrsTi+er.e. • q�: 1659. `m�' Regulatory Services '°rED nw't Thomas F. Geiler, Director Building Division Ralph Crossen, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT { HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more thanfour dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. 1-1560 �iTe;, Type of E RL Work OO b k F rAAP /� ` � �l Estimated Cost Address of Work:,;�,/ �e6llv"9/& 9,4 1 s l d�100 Owner's Name: V6 /�/w, l AY'<[\ ��/cr 2/Y Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDF/7 ALTIES OF PERJURY I hereby apply for a permit as the agent of the %O/�J tIxy,Z/i Date Contractor Name Registration No. OR Date Owner's Name q:f6nns:Affidav HOME IMPROVEMENT CONTRACTOR Registration: 100053 Expiration: 06/08/2002 Type: Individual g VICTOR J. VIINIKAINEN e Victor Iiinikainen &�miCAPE COD LN ={ ADMINISTRATOR BRRNSTABLE NA 02630 7A y = BOARD OF BUILDING REGULATIONS -' License:.:CONSTRUCTION SUPERVISOR Number ES . 000998t Birthdate 09/29/1940 09/29/2001 Tr.no: 4330 —_-- = Restricted To: 00 VICTO R J WIINIONEN PO BOX 69 W BARNSTABLE, MA 02668 Administrator t