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HomeMy WebLinkAbout0090 HYANNIS AVENUE ya�rlis ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 77 Map Parcel. I l : Application # 0 LA4I. Health Division Date Issued C -. Conservation Division � Application Fe 4 Planning Dept. •Per'mit Fee • Date Definitive Plan Approved by Planning Board ` Historic:- OKH Preservation / Hyannis Project Street Address qD h rt(�� Village Owner Address % ..Telephone � Permit Request -S 1kV �uzc ' l d!'I L; C70 Square feet: 1 st floor:.existing.' proposed _ ?nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 6c&V Construction Type Z,� 1uv Lot Size Grandfathered: ❑Yes . ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings 'Highway Ye ❑ No Basement Type: ❑ Full,, U Crawl ❑Walkout ❑ Other s°` =, ca Basement Finished Area (sq.ft.) Basement Unfinished Area(sq ft) Number of Baths: Full: existing new Half: existing new c Number of Bedrooms: existing —new w Total Room Count (not including baths): existing new First Floor Room CountN 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: 0 existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded-U - -Commercial—❑.Yes- ___❑-No If yes, site plan review # Current Use Proposed Use - APPLICANT INFORMATION j� (BUILDER OR HOMEOWNER) ,,cc� Name q _ i l� Telephone Number L y 1` d-109 � Address LYk License# C 9� - ,�f • 02 Home Improvement Contractor# Worker's Compensation # (A 1 G�15 3 le?16 L01 R ALL CONSTRUCTION DEBRIS RESULTING_ FROM THIS PROJECT WILL BE TAKEN :P9��c� SIGNATURE 1111WY41 ZM44 DATE FOR OFFICIAL USE ONLY (4 APPLICATION# DATEISSUED r . MAP/PARCEL N0. 4 ' ADDRESS VILLAGE `. OWNER ' } i } c DATE OF INSPECTION: FOUNDATION a ' FRAME INSULATION' FIREPLACE ' ELECTRICAL: ROUGH FINAL Y • PLUMBING: ROUGH FINAL GAS: ROUGH , ,• .-- - FINAL :FINAL BUILDING- DATE CLOSED OUT + ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts t , f Department of Industrial Accidents, Office of Investigations �, I <<r 600 Washington Street t: — Boston,MA 02111 www.mass go v/dia Workers' Compensation insurance Affidavit: Builders/Contractors/EIectricians/PIumbers Applicant Information Please Print Le0b1y Name(Business/Organization/Individual: Address: City/State/Zip: X Phone #: Lf 7-® 6�'TY Are u an employer? Check the appropriate box: Type of project(required): 1.[ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6' El construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I �• Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity.. workers' comp. insurance.. 9. 0 Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ]0,❑ Electrical repairs or additions 3.❑ I am a homeowner doing.all work right of exemption per MGL I LEl Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' comp. insurance required.] 13`❑ Other *Any applicant that checks box#I 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 anew affidavit indicating such. lContractors that check this box must attached as additional sheet showing the name of the sub-contractors and their workers'comp,policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: / . Policy#or Self-ins.Lic. #: L2 f' 3 .I J 31 6 /O l Expiration Date: NM oc I I f I Job Site Address: �� �r City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy num er 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 wel]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 urz r the and penalties of perjury that the information provided above is true and correct Signature: Date: Ph on '7 C 6 [CJ17 only. Do not write in this area,to be completed by city or town official n: Permit/License#ority(circle one): Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5, Plumbing Inspector on: Phone#: riq Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual, partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction.or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to bean 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 PF P F � 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-contractor(s) 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 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 number Iisted 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 t submit multiple must s bmr mul rpl permit license applications in any given year, need only submit one affidavit indicatingcurrent urr nt 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 proofthat 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 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 Industrial Accidents Office of InvestigAtions 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-97.7.-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.m.ass..gov/dia a °� rti 4 Town of Barnstable • Regulatory Services • _ • BAAIJcrA RT--v s . MAEL Thomas F. Geller Director , Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstab le.ma.us Office: 509-962-403 8 Fax: 509-790-6230 Property Owner Must Complete and Sign This Section If Using A B udder as Owner of the svbject.pro e • P rtY hereby authorize 5. 37. O e*OL IW to act on my behalf, in an matters relative to work authorized by this buz7ding permit application for: 90 1It1*1U is /hit: (Address of Jab) S tore of Own Date PILL[ Print Name If Property Offer is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:F0 RMS:0 V1NERP ERM1BS)02Q r tr+e Town of Barnstable of Town . Regulatory Services s.�xxsrAar�, : Thomas F. Geiler,Director MAIR& , g EL6 Building Division Tom Perry,Building Commissioner 200 Main-Stroet,_Ayannis,MA_02601 W WWAo wn.b arnstab I e-rna-us Office: 509-862-403 8 Fax: 508-790-6230 HOhMOV NERLICENSE EXEmrTTON Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# t CURRENT kfA�G ADDRESS: city/town states r, aP code The current exemption.for `homeowners was extended to'include owner occupied dwellings of six units or less and to allow homeowners to a gage an individual for hire who does rot possp-&s,a.license,provided that the owner acts as super-Viso .w DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, an which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constr4cts more than tine home in a two-year period shall not berconsidered a bomeowner, Such "horneowner"shall submit to the Building Official inn a form acgeptAble,to t[ze Bii�aing Official, that he/she shall be responsible for aD such work performed under the building,permit. (Section I09.1.1) Tlie undersigned"homeowner"asm es responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. a The undersigned"homeowner"certifies that.he/she understands the Tovcin of=�arnsfable:Building DepartmEnt mum inspection procedures;and iC[ItIircu3cnts and that he/she will corr;ply:,wrth said p'rot: and rcqu remcnts. d t t a Signatim of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger vU be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWriER'5 EXEMP'ITON .The Code states that: "Any hometrwnrr perfom ing work for which a building permit is required shall be e t from the provisions zcirrp P y of this section.(Seetion ID9.1.1-Licensing of eonshvetim Supcvsors);provided that if the homeo-vmcr engages a persons)for bin to do such woe that such Homeowner shall act as supervisor."*x. pan � Irl`any homeowners who use this excmptioa are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Pemsing C=struction Supervisors,Section 2.15) This lack of awaruress bftat results in serious problems,particularly when the homeowner hires unlicensed persons. In.this case,our Board cannot proceed against the unlicensed person as it wrould with a lic used Supervisor. The homeowner acting as Supervisor is ultimately responsible, To ensure that the homeowner is fully zwaro of his/her responsrbilitics,many communities mquin,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 it farm currently used by scvcml towns. You may can t amend and adopt such a forra/ccrtification for use in your coi=nunity. Q:forms:homerxempt :INSURER:A: LlDgrty Mutual GfOUD ,. INSURED �J DELANEY INC INSURER 9:- ___ ---- -._- --- 10, �f 20 RASCALLY`RABBIT ROAD UNIT'2 INSURER c: _ _... NIARSTON MILLS MA 02648 ' INSURER I)t C�a I INSURER E _ INSURER F: v COVERAGES CERTIFICATE NUMBER: 955371.4 REVISION NUMBER: i 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. INTR TYPE OF INSURANCE ea POLICY NUMBER MWDrULAD L Mr DD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ _ Di GE TO'RENTED _COMMERCIAL GENERAL LIABILITY PREMISE6 iEa occurrence $ CLAIMS-MADE. OCCUR MED EXP( one person) S PERSONAL d ADV INJURY $ GENERAL AGGREGATE S _ 'PRODUCTS'=COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: •- j POLICY 'PRO- LOC NN S AUTOMOBILE- Ee amidenl LE LIMIT E L S. _ BODILY INJURY.(Per.person) $ pnY AUTp . ? ALLOWNED' 8 SCHEDULED BODILY WJURY.(Peracddent) $ AUTOS AUTOS PARTY AMA GE NON-OWNED HIREDAUTOS AUTOS er BCGoenr�._, $ S $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S _ EXCESS LIAB. AGGREGATE $ CLAIM_S•MADE _ - DED' RETENTIONS — § - $ j A WORKERS COMPENSATION WC2-31S-318101-010 1172/2010 1112I2011 WC TOMIT 11 AND EMPLOYERS'LIABILITY . YIN MITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500000 OFFICERIMEMBER EXCLUDED? .. N t A. .(MandatorIrin NH) - E:L DISEASE-EN EMPL4Y8E S 'TO 100� If Yee,describe under E-L.DISEASE-POLICY LIMI 3 500000 DESCRIPTION OF OPERATIONS below' DESCRIPTION OF OPERATIONS I LOCATIONS7 VEHICL.ES�(Attach ACORD 101,Addltlonai Rem rke'S?h'edule,,it mor6 apace Is required) Workers Compensation Insurance:Part One of the policy applies only.to the Workers Compensation Law of tfie;Statl3 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 INNS. Al1TTN: BUILDING DEPARTMENT ACCORDANCE WITH THE POLICY PROVISIO 200 MAIN STREET, AUTHORIZED REPRESENTATIVE HYANNIS MA 02601 Jeff Eldridge ID 108.2610 ACORD CORPORATION. All rights reserved. ACORD,25(2010105) The ACORD name and logo are registered marks of ACORD I CERT NO.: 9563714 CLIENT CODB: 1315596 Anne Chandler 2/16/2.e11 ei10,U1 AM Page 1 of 1 I I i Town of Barnstable *Permit Expires 6 months from issue date,l RigulaIr®lr°y Se It��� Fee Thomas F.Geller,Director �Bu;ilding Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis;MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERliHT APPLICATION s RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address C6 0 rtir t S ►5-�t� J ` Sg Residential Value of Work �OwC)- Minimum fee of$25.00 for work under:$6000.00 Owner's Name&Address 4`J ' ~ d9 `S. ✓}Ls Ll -i dry 0 Contractor's Name, F,�G¢AL-t- Lzltt Q Telephone Number Home Improvement Contractor License#(if applicable) 1 o��j 3 ' Construction Supervisor's License#(if applicable) A-PRESS PERMIT Workman's Compensation Insurance Checl one: EJ U N 1 .7 -2 010. s ❑ I am a sole proprietor ❑ 1 am the Homeowner TOWN OF BARNSTAKE 04 have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# LL 2 0 3 g l M,5,5 6 ^� 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 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement,Windows/doors/sliders. U-Value (maxnnum.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 getter of Permission, A copy of the Home Improvement Contractors License is required. SIGNATURE: - Q:Forms:expmtrg Rgvise061306 —� VD0 Frasert' Construction . LL CONSTRUCTION Home Improvement License #1:12536.. P.O. Box 1845, Cotuit MA.. 02635 Email: fraser constructiona,verizon.net 508-428-2292 www.fraserroofing.co FAX 1-508-428-0.123 HICL#112536 CS#97668 RE-ROOFING PROPOSAL DATE: June 17, 2010 NAME: William Weik JOB ADDRESS: 90 Hyannis Ave Hyannis MA 02601 FRASER CONSTRUCTION hereby proposes to perforin'the following services in a neat, professional like manner in accordance with the manufacturer's specifications and local building code. -Remove and Haul away all of the old roofing material -Re-nail all.plywood sheathing as needed. *****RED CEDAR RE-ROOFING**** •' Supply &Install 18" #1.Perfection Blue.Label Quality, .20-Year Warranty Red Cedar Shingles,At 5.511_TTW. Or Pressure Treated 18" Perfections Supply.& Install Aluminum White/Brown Drip Edge if needed.' Supply & Install CertainTee.d Winter- Guard: (ice & water shield) Waterproof Underlayment Paper 36" Eves,-18" perimeter, cheeks, skylights, 36" valley Supply & Install Trir Flex 30 - High.Strength Polypropylene Underlayment Supply & Install: Stainless SteelFa§teners Supply & Install, Cedar Breather Supply & Install 16 oz. .Red Copper Valleys as needed. Supply & Install Ridge Vent Under Custom Copper cap (option)' Clean &Remove Debris from work area daily. Re-roof Garage with Red Cedar TOTAL INVESTMENT: PRICE- $5,000.00 Initial Re-sidewall Garage TOTAL INVESTMENT: PRICE- $5,000.00 Initial 2% Discount if paid by check immediately upon completion NO MONEY DOWN-NO Payment AT THE START OR PARTWAY THRU Payments accepted are: , CASH—CHECK—MASTER CARD-VISA—AMERICAN EXPRESS *Any payments not made within 30 days of completion will be charged 18%for every. 30 day the payment is late. POSSIBLE EXTRA: After the shingles are removed from the roof, we will lift one'sheet of plywood to make sure that the insulationis not up against the plywood sheathing preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by,removing the plywood sheathing, installing the panels, turning the plywood over and then re-.installing the plywood. If needed, this would be charged for•as an extra at the rate of$6.00 per panel including materials and labor. There are 6 panels per sheet of plywood. r , Possible Extra'-An rotted or otherwise'deter'iorat ed tr im m boards ,s 1 wood sheathing, plywood hmg, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$60.00 per hour, plus 15% mark-up materials. FRASER CONSTRUCTION Warranties labor for 12 years. FRASER CONSTRUCTION is an Approved Applicator/Memb'er of The CEDAR SHAKE and SHINGLE BUREAU. THE,CEDAR SHAKE AND SHINGLES BUREAU Warranties the shingles for 20 YEARS if installed by.approved applicator. Any deviation or alteration from above specifications will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado,'and other necessary insurance'upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: 1 E . H EOWNER FRASER CONSTRUCTION, LLC 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 Applicant Information Please Print Legibly Name (Business/Organization/Individual): TA a L� L L(a. Address: I �p0 9O)L/ 1 g City/State/Zip: C� MA— 0,;�635 Phone #: 56 a 9o� Are you an employer?Check the appropriate box: Type of project(required): 12�,l am a employer with _� 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. 7. ❑ Remodeling shipand have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' insurance. 9. ❑ Building addition comp.[No workers' comp. insurance p• 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 I LE] 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. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: -t-k-0- Y n Polic #or Self-ins.Lic.# 4 B -®� �'.� `'� _ ,.�x�ir-aliorl Date:-! � Q RW� 4��. . C_A c Job Site Address: 97 *nkr� 47)--e City/State/Zip: iy,�.^-,� 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 cep he nd pe lties of perjury that the information provided above is true and correct. Si ature: Date:CC ohe Phone#: CJQ�' ya 0 ' 9 a 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#• a..s paa..a wr• vr., a. yr t_.vi •..v vv . vv . ar ar a••• a a•�r a.., a.• vv•. • wr• vv� •vi ACORD. CERTIFICATE OF INSURANCE DATE(MM\DD\YY) 09-29-09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE WISE&QUINN INS AGCY IN HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 449 PLEASANT ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BROCKTON,MA 02301 COMPANIES AFFORDING COVERAGE COMPANY 24WCB A HARTFORD GROUP INSURED COMPANY B FRASER CONSTRUCTION LLC COMPANY P.O.BOX 1845 C COTUIT,MA 02635 COMPANY D COVERAGE THIS S 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 WSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN S SUBJECT TO ALL THE TERNS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMOMYY) DATE LIMITS GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL PRODUCTS-COMP/OP AGG. $ CLAIMS MADE OCCUR. PERSONAL&&ADV.INJURY $ OWNER'S&&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ MED.EXPENSE(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY(Per Person) $ SCHEDULE AUTOS BODILY INJURY(Per Accident) $ HIRED AUTOS PROPERTY DAMAGE $ NON-OWNED AUTOS GARAGE LIABILITY ANY AUTOS AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGREGATE $ EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'S LIABILITY UB-0341 M556-09 09-26-09 09-26-10 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 500,000 PARTNERS/EXECUTIVE INCL DISEASE-POLICY LIMIT $ 500,000 OFFICERS ARE: X EXCL DISEASE-EACH EMPLOYEE $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTEFTICATE HOLDER AFFECTINO WORKERS COMP COV ERAGEL CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE FRASER CONSTRUCTION LLC EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT PO BOX 1845 FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. COTUIT,MA 02635 AUTHORIZED REPRESENTATIVE ACORD 25-5(3/93) Ramani Ayer hoard ofBnPldPngRand 19tondards HOME IMPROVEMENT CONTRACTOR and tend License or registration valid for individul use only Y be£or ym a the irate Regist `(�• egP on date. If found return to: i 112538 Board of.Building Regulations and Standards r MM'ftff*K�� 3/2011 Tr# 281021 One Ashburton Place Rm 1301 Typel Boston,MR.02108 FRASER CONST Ij jI N ca '"1 DEAN FRA3ER � 104 TW1NN VIEW lfil E FALMOUTH, AdmPnPetrator riot re a i(on!S an ra n S One Ashburton Place m Room 1301 Boston. Massachusetts 02108 Hone TmProvement-Cbntractor Registration Regist sHon: 112538 Type: DBA FRASER CONSTRUCTION CO. Expiration: =312011 Tt# 281021 DEAN FRASER P.®. SOX 1845 COTUIT, AAA 02835 UPdate Address and return card.karlt reason for change. Al �8 a0M-0,/08-DB8uF0F1MGAjosi12GG8 ❑ Address ❑ Renewal LYn 1 ment ❑ P o'Y ❑ Lost Card Ei p .� �9t � � ���,�, j .�fl t�Aa�d�y . Town of Barnstable *Permit# 2y9 7 o Expires 6 months from issue dote • ,AaNs,•snr c Regulatory Services Fee Thomas F.Geiler,Director ' .asp .m �+ Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601w MIT Office. 508-862-4038 X.pRESS PER Fax: 508-790-6230 J U N 2 1 2005 9 EXPRESS PERMIT APPLICATIOhi Not Valid widwut Red X-Press Imprint TOWN OF BARNSTABLE Map/parcel Number.26 Property Address Residential OR ❑Commercial Value of Work �� O Owner's Name&Address , Contractor's Name 404 c 125X tea-r `�V -.Telephone Number Home Improvement Contractor License#(if applicable) 12 $e1 5 7 Construction Supervisor's License#(if applicable) 0 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑yam the Homeowner . ff-I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) W c, E�Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) Other(specify) •Where required: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic.Conservation.etc. Sienature R r .. _U05 12:24 FA% 212 593 7241 CARRET SECURITIES INC. 0001 7 KELLY FAX NO. :S8 7fM 4498 nay. 30 2M 02.16PM Pi KEILY>i;00I:1NG 9 FERE MM j Am MWAX SOS 775 4M BTSURm SOU H YARMOUM MA.RFXr #1 25957 MA 02664 May 30,-=5 ... _._ Pmpol wbmieed to Mr.Trig►Raic of 90 Hyamae Am Hyamis port Mai We propose w supply&0 materials arai labor nmmwy to remove nd moam tW edsdag ar&aid rear porch roofs at the mires above. All debris to be removed to town traasfir. S"Awminm drip edgy to be%%shed at eq eaves I=8114 water dare prateation taaabrrme to be ioat"on firer tleae fm t of eaves. Remmder of4OAto beOv"WM 00 fit pepoc I r ftfoom Red ceder"SW to be insetted oval cdr knOw vent system am I Vr suialeas steer Awlee at 5r'expoew+e. "brooar vem pipe boots to be re*wd wft mew.(Copps) Cobra Mp wmt m be instetled an le oh of main witbt htd ailed aw M� Op caps to be=toned over B'copper fiasbiQg AD chimw flasbinp lo be mod as necamy. Ptded aU wa11a,wWovm decks`> nd*ubs etc.dmag w of Wip. Obtain ft of town panut. At atolat of PwflmW SehAft;30%witb ftoW mono,belme upon cmple6oa Rcspwd Sr eubmitbed,OH �Cetly Pmp*W occWmd b% 1 e /2W This Ptvpo�!to void 43 dsya� above. ' 1����t T" IA D/�( Cl; A'#\ ?W t-tltrl-lN(r- P` ' . Board o Bui ding Regula ions and St One Ashburton Place - Room 1301 lards lop Boston. Massachusetts 02108 Home Improvement.Contractor Registration Registration:, 128957 Oliverype: Individual liver Kelly 8/14/2007 Expiration: Oliver Kelly 9 Peregrine lane S. Yarmouth, MA 02664 oas-cni ey soM oa�o4O1o�2�s Update Address and return card.Mark reason for change. �., ❑ Address Renewal Employment ❑. Lost Card;-. IF, ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION fl,a Parcel_1 q[ Permit# � O l UN r STABLE B f; Health Division its as-bK� Ix ¢u.net «�T?�tlU3 BECK Date Issued Z 4 .3 { �' HH13 JUL -2 �� Application Fee 10 Conservation Division s Tax Collector ROO�a 6 k- — N�— (9 30 D 3 Permit Fee Treasurer N L "" n/D�_�,._ 'VISION Planning Dept. SEPTI4 SYSTEM MUST EE INSTALLED IN COMPLIANCra Date Definitive Plan Approved by Planning Board WITH TITLE 5 ENVIRONMENTAL CODE ANE Historic-OKH Preservation/Hyannis TOVWI RECUL,TfONS Project Street Address 6�j Village ,l 11 Owner k Address Telephone i Permit Request � �(� rJu c3 �r/1 e-(.,J VIN Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay UCH _Project Valuation Construction Type R' 1 Yp Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. V f Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes Cf No On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other v Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:El existing ❑new size Pool:Clexisting ❑new size Barn:Elexisting ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: p Zoning Board of Appeals Authorization ❑ Appeal# M Recorded❑ Commercial_.O._Yes_ _LI-No .If yes,_site plan_review#. -- Current Use Proposed Use BUILDER INFORMATION , Name i x md)"CUVA Tw,e. Telephone Number(S_y � O —� �0 366sN36 Address r: & License# CS:,/yv1S / ' ( i t //CGS• r� T� Home Improvement Contractor# nnv Worker's Compensation# :0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE U,' DATE 1� 1 FOR OFFICIAL USE ONLY _ urn l r PERMIT NO. } vDATE ISSUED MAP/PARCEL NO. ; ADDRESS VILLAGE OWNER ' 'p DATE OF INSPECTION: ; FOUNDATION 1 ? FRAME .+6/C/1/!'1 Q A `7A 7La 3 , t =� INSULATION a r� FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING:' ROUGH"'' FINAL GAS: ROUGH,,-Z _ '. FINAL FINAL BUILDING' DATE CLOSED OUT -! ASSOCIATION PLAN NO. 1 ' Town. of Barnstable r _ Regulatory Services i BASN E, Thomas F.Geller,Director XAM 9�'OjE 61rg ",4� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax:- 508-790-6230 Permit no, s - Date . AFFIDAVIT r HOME 1MTROVEMENT 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 than four dwelling units or to structures which.are adjacent to ne by registered contractors,with certain exceptions, along with other such residence or building be do requirements., b - Type.of Work: et�(/ X Estimated Cost Address of Work: Owner's Name' r Date of Application: I hereby cer*that: Registration is not required for the following reason(s)c MWork excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IIYIPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c, 142A. SIGNED UNDER PENALTIES OF PERJURY hereby apply for a permit as the agent of the owne9orNam4e a3 Date. �. Contr Registration No. OR _ _ a r,-+e Owner's Name The Commonwealth of Massachusetts -_- Department of Industrial Accidents Office 0110yesaft/aas _ 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit C. location: l ,� ; > Go hone S-4 3 ci • ❑ am a homeowner performing all work myself. ❑ I am a le rietor and have no one worldn in ca acitp rs' co ensation for employees working on this job: ;....:.:.•:Y.:•.t•::::y.;:.. ,;,,;;,r v$ ,,.},>;:$: rovidin worke mp F....:........:.y ::.:;. ...:.:.::.;:.:{{.t:.::.<:$'}:$:;i.r::.:::;::.:.:.,.:..}::.,,.:.. em .............::.r::.y.y::n.,.:.::n•:::: ..... ::�Yi$::>::$$::;.:...,..;: .:.::::::::-yy.�:.y.:;.>:.;:.:........::.::....:. ..;>•:{->'.Yryy.}:,y..{,i; . n.-.r..... ...r... ........ ......... ...n.. .......... ............ ...... .-......:...:...... ......................:.::-::Y..... ..,;r•i;{•Y:•....}�....•..... ........ -...: rr:::$:2::':;.; : ::::•..:. y :....::... ......::•:i::::n••.:. ::::-::.•:::. :r:r..:. ::.:... .:.:::.y:,•:v;n.!K .•??r:.v .. .. ::...;.::: Y?•%}' :Y.{.:.;•.Yv::.v.}:•r:Y>.+';. sine... .Y".:: .... ., ..:: .i'Om 8IIt' .............:.......::.:�n::.:.,::.i.:::...:.:....,: ...;. . ::::•:::::..• r.. t+y::.n•,•}:::. ,•n ..... .......... ........... ...::::::::. ::.:.;;:.r:•::•:n•:::.iri>•;.• .t•.. ..y .?:a:::n•::YY:•-.ry::. :. �:�:3w•Y;r?•a�...}.. ...... .....t..... ........... ....... ... ...$r..... ... �y, .... ....... .......... ..y... ... ..t .... ,{ ....:..... ..... .............. ... .......iF.... -- {:•x•.v.}Y• t••:`r}Y•%;: L;.{\(:;.}?ni.Y;.},L{;.kr LLLiY4ti:,;•::,}. t:.v:r::...:vn•.v:.......:?::f.v...:.d:y9.::•......::::.}.�..: .n•.v;n•.::....r`:%:+«- :Y:n•.Y:..v:...: .. .. t{i• ... • r<;. :..................:w.::::.::J.;•.v:>•. :•4•:.:••...:X• •rf.v.v:::: iv::; .-.. ur...•.•..,:1•t• •9.. 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' n.1k.:v(fY.}::{•?)i}:•}:?:tii;4}:i�J:j•i i:v:{L:•}:J}}:v:;^}}:4$Yri?�$:}�$i:•r$:v}}}:.:.:::::.?• ............................... .:::n•:is•:::::•.:y:•:. ' gym a to secure coverage as regtdred tinder Section ZSA o[MGL 152 can lead to the imposition of criminal penalties of a Ste up to S1rS00.00 and/or one yam, cure coverage imprisonment wen at civil penalties in the form of a STOP WORK ORDER and a 9ne of 3100.00 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 certi under the pains and penalties o p� ' that the information provided above is t and orred Date d 0 . Signature Phone# Print name official use only do not write in this area to be completed by city or town official aA " ❑Building Department perndt/iicense# city or-town: ❑Liceruing Board ❑selectnteres Office check if immediate response is required ❑Health Department contact person: phone#, (—]other__. (nuad 9/95 PJAJ 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 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. mom PE 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 peimrtlhcense number which will be used as a reference number. The affidavits maybe retariR to the Department by mail 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 Office of Inyestigallons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 i nhone#: (617) 727-4900 ext. 406, 409 or 375 °FTHETw Town of Barnstable Regulatory Services * snxxsr"LE, • mess. Thomns F.Geiler,Director c;o. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I IN t l.�-11�'�M ���� ►l-L-- as Owner +of the subject property hereby authorize f�r►e C�/l�O�.( (j-/� to act on my behalf, in all matters relative to work authorized by this building permit application for: 90 05 &_ (Address of Job) � 30 103 , Signature of ner Date c c (z j� Print Name - r. Q:FORMS:OWNERPERMISSION k f ✓fie TDorrvnw�ziueai ��aaOacfeuaet! BOARD OF BUILDING REGULATIONS R License YCONSTRUCl ION SUPERVISOR Numb,d' 4S 074,823 B #1dai 04[ 11 g65 a7- 1 Rww ©4 f z 05 Tr.no: 10199 RE Ret� '" r JAMES C MCD6 G. 1 k� 1471 OLD POST RtA ��Y .i 1. ..�, MARSTONS MILLS,IVIA'02648 _ Admurisf'rator _ s Board of Building Regulations and Standards HOME I. OVEMENT CONTRACTOR Re�tration 435781 a �F4— p � y3,`"erluate Corporation JAMES C.McDo • JAMES McDONO Gl _=� 1471 OLD POST Rd � MARSTON MILLS,MA 02648 Administrator > ` a a Y �5 J'� u �� y Map 287 # 0 � � r Ma 12 2 - ,'0 0 Map 287 . 123 F:\dgn\conservation.dgn 06/30/03 09:58:50 AM Jo.* ,ej �/n�(by .R-v�c `�(J CIKVIi,J /1't!.m OldJJart � � � �!/ avirtiS{�aY�' / �' M avY�s/h�Ur �vJ-G`l6' "Ti -7\ 6-i-p-dar- el OIP IL (�O. / 9"riP(e 'J�x1m (r,'vd�r r