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HomeMy WebLinkAbout0007 ISALENE ROAD 71'S�C�s� � R 0�4� J - - - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division / 'a Date Issued :2 19 A d C Conservation Division DE l� �T, Application Fee Planning Dept. TAW C 1 320i6 Permit Fee Date Definitive Plan Approved by Planning Board /V®PgApii, Historic - OKH _ Preservation/ Hyannis Project Street A''d//dress ,�,/�/� � �- Village Owner� a� o��� Address �/�/✓� Telephone�$ Y JE1�4F Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation/Do b Construction Type / —'e.,eD 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 )2Wo On Old King's Highway: ❑Yes ONo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existingnew Half: existing new 9 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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name 4W Co,91 IAILZzQ moo!/ Telephone Number Address , 1241)t� elk?- License # /d f,14t; > Home Improvement Contractor# Email �d -�'�/� Worker's Compensation #�JCQU .T/e2 ` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED 4' 'y MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: r s FOUNDATION FRAME �I INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t a GAS: ROUGH FINAL FINAL BUILDING x DATE CLOSED OUT ASSOCIATION PLAN NO. TUNFU Urlwamoq sue• ~ � � OII Lom • 200M* a Q16it1 Of$ce; SQ$. ti2-4i#38 Fax: •SW790423 is almatters. ti�+eoiias' ig lap for. Pool fetes a .a e 'Och isas !C&ns am fotm :and acc p . . Q Date 4:so�sas:owr�er:�sstor�aa� � i The Con l ltmonfvea h of Mrrssachusetls Department of Industrial Accidents h 1 Congress Street, Suite 100 Boston, MA 02114.2017 1Vww,mass,gov/rlta VVcjvkers' Compensation Insurance Affidavit: Bililders/Contractors(Electricians/P)umbers, Applicant Information TO BE FILED WITH THE PERMITTING AUTHORITY,. Please Print Lc i� Name(Business/OrgenizntioNlndividual); Address: / " /'. Phone #; Arc you an employer? neck the approprlate box; Type of project (required): I.(�t am a employer with�._cmployeos(full and/or parl.time),' 2.Q l am a sole proprietor or partnership and have no employees working for me in �' El New construction any capacity,(No workers'comp. insurance required.) U-C] Remodeling 3Q 1 am a homeowner doing all work myself, (No workers'comp.insurance required,)t 9• ❑ Demolition 4.(][am a homeowner and will be hiring contractors to conduct all work on my property, l will 10 [] Building addition ensure that all contractors tither have workers'compensation insurance or are solo Proprietors with no employees: 1 l.[] Electrical repairs or additions S.Q►am a general contractor and I have hired the sub•oontractors listed on the attached sheet, 12,❑Plumbing repairs or additions These subcontractors have employees and have workers'comp, insurance.l 13,[]Roof repairs 6.p We arc a corpora fen and its officers hevo exercised their right of axeer �{ 152,§I(4),and we have no employees.(No workers'comp,insurance p MGL e. required.) )4' Any applicant that checlhbox compensatio a I must also fill out the section below showing their wor kers' n policy information. t Homeowners who submit 4his affidavit indicating they ere doing all work and then hire outside contractors must submit a new affidavit indicatingsuch. (Contractors that check this box must attached an additional shoot showing the name of the sub-contractors and state whether or not(hose entities hve employees. If the subcontractors have employees,they must provide their workers'comp.policy number. !am an enrployer that is provlrling workers' i co»rpensatton lrsurance formemployees', Below!s the petity nnrl ab sit e mm Insurance Company Name: Policy a or Self•ins. Lio. f' `',c;"'j�,p . -- Expiration Date: �. Job Site Address: Attach a copy of the workers- cvmpt nsation petit declaration page (showingryhe ptol cipaumbe zL Failure to secure coverage as required under MOL c. 152, §2SA is a criminal violation punishable by a fine u pti o ration date), and/or one-year imprisonent, as well as civil penalties in the form of a STOP WORK OR and a fin p $I,S00.00 tv day against the violator. A copy°of,tliis statement may be forwarded to the Office of Investigations o e of up to�7.50.0.0..a coverage verification, f the piA for insurance !rlo hereby cer under lire patrrs arcr(pettaltles of per tifyjury that the 1jE/ormatlon provtrtecl above is true and coffee - - t natu e: i'� t, Phone b: �� � ✓ Dat ' 1r l 3 OfJlclal use only. D9.Acot write In this area, to be completed by city or torwt of/lclai City or Town: Permit/License Issuing Authority (circle one); 1, Board of Health 2, Building Department 3, City/Town Clerk 4, Electrical Inspector S. Plum, T 6, Other olag Inspectol' Contact Person: Phone#: f ' ,rb CAPECOD-27 DEATON A`oRo- CERTIFICATE OF LIABILITY INSURANCE 77129/2016 TE(MM/DDIYYYY) 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. 0* IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 Ileu of such endorsements). PRODUCER CONTACT 4g NAME: 34 R e&3G4ray Insurance Agency,Inc. PHONE aC No): 877)516.2156 South Dennis,MA 02660 E-MAIL DRESS:mall@rogerogray.com AN MAIL INSURERS AFFORDING COVERAGE NAIC p INSURER A:Peerless Insurance Company INSURED INSURER B:SafetyInsurance Company 39454 Cape Cod insulation,Inc. INSURER C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURER D:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E: INSURER F: . COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY.PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEADDLISUOR P LIC FF PO C E P LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE M OCCUR CBP8263063 04/01/2016 04/01/2017 PREMISES Ea occurrence $ 100,000 ` MED EXP(Any one arson $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X ❑LOd'JECT PRODUCTS-COMP/OP AGG $ POLICY a 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a cadent $Ea 1,000,000 B ANY AUTO 6232707COM01 04/01/2016 04/01/2017 BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPER DAMAGE AUTOS Per eccide t $ X UMBRELLA LIAR X OCCUR i., EACH OCCURRENCE $ 2,000,000 C EXCESSLIA13 CLAIMS-MADE EXCI0006636001 04/01/2016 04/01/2017 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate $ 2,000,000 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N PER I I RR"* D ANY OFFICER/MEMBER/EXCLUERIE ECUTIVE NIA WCE00431902 06/30/2016 06/30/2017 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 11000,000 If yyes descrlbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) Workers Compensation Includes Officers or Proprietors. Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CLEAResult,Eversource and National Grid are listed as Additional Insureds on this policy on a primary,non-contributory basis. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 4 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION. All rinhta rastarvari T^---�-^^ i• Massachusetts Department of Pubilc Safety—� � lit " , Board of Building Regulations and Standards License: CS•10098e Construction Supervisor � HENRY E CASSIDY� 8SHEOROW WEST YAR M O U`H 1Mtt�' Z' I ':• rail' 1t;. !gyp 1 Expiration: Commissioner 11/1112017 yyT x , Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Mai�; , usetts 02116 Home Improvemer,00.6 tractor Registration Type: Corporation Z. Registration: 153567 Cape Cod Insulation, Inc IL Expiration: 12/14/2018 18 Reardon Circle So. Yarmouth, MA 02664 a w •U fQ t Q' jhr'a�F Sva Update Address and return card. Mark reason for change, 3CA 1 0 20M•05111 &L�par�r��car2cuea�G/c o� aaaac%tcoeltd Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only T s Type; Corporation before the expiration date. If found return to: Expiration atlon Office of Consumer Affairs and Business Regulation - 10 Park Plaza•Suite 5170 12/14/2018 ,�;==.f,�;::_= 1=1� Boston,MA 02116 Cape Cod Insu ate==;t. — ! Henry Cassidy I`�, T Iyj � � 18 Reardon Ciro( !a C�L CC So.Yarmouth,MA\ �^ Undersecretary Not valid without signature I 71 ,. UWE Town of Barnstable �eermit(?)C' �T Regulatory Services Expires 6Fee anatasTesM « v� MASS. `0 Richard V.Scali,Interim Director ATFp��� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601" www.town.bamstable.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 (J l l Property Address —7 ky, {� C L4n A Ytl\ I'.s O C: $Residential Value of Work$ S®o o Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ( Contractor's Name � ��u�?m I ,P Telephone Number S6% "C L `1 Home Improvement Contractor License#(if applicable) Q q Email.X-PRESS PERMIT Construction Supervisor's License#(if applicable) (Op DEC_ 11206 (9Workman's Compensation Insurance Check one: ❑ I am a sole proprietor TOWN OF.BARNSTABLE ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance'Company Name PK e- (t`U o\C Workman's Comp.Policy# A g, Copy of Insurance Compliance Certificate must accompany each permit. Permit Re est(check box) 56\Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ 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: Zh Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 The Commonwealth ofAfassackusear Department of Industrial Acciden& Office ofInwsligadons 600 Washington Street y Boston,M4 02111 ,. wmv.mass:govfdia Workers' Compensation Insurance.Affidavit: B.alders/Cont chwslElectricians/Plumbers Applicant Inf©imation ] Please Print Legibly Name(Bnci,essiiOrganizationandividnal): Address: MG City/stati/ziP at,U-- 1 Ph.#Sad 9yg-a 3� Are you an employer?Check the appropriate bez: Type of project(required): 1.N=a employer with._p 4- ❑ I am a general contractor and I 6. ❑New construction employees(full an(/or pact-time).* have hiredthe sub-contrarrtors 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 Rm me in any capacity. employees and have workers' [No worloers' comp-insurance comp_insurauml ❑wilding addition 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 1 L-❑Plumbing repairs or additions o work ' right of exemption per MGL myself � workers'comp- 12_:❑Roofrepairs insurance rewired.]F c. 152, §1(4X and we have no employees-[No workers' 13.❑other comp-insurance required-]' #Any applicauE that checks boa#1 most also fill out the section below showing their woakers'compensation policy informmtinu_ 1 Homeowners who submit this affidavit imdikatmg they are doing all.wait and.then hire outside contractors mast submit a new affidavit indicating such- !Contractors that check this boa must attached an additional sheet showing the name of the sub-contractors sod state whether or not those entities have employees. If the sub-cantreccors have employees,they—1st pmvide their vmkers'comp.policy number. I am an employer that isprm iding workers'congmisadon insurance for my enrplaj ees. Below is the policy curd jab.site information. Insurance Company Name: 9— c t_13 00 Policy#or Self-in- T s Lie.4:_�S C0 U 9 9 Sir 7�3 �' ETcpirationDate: � 6- Job Site Address: / s.A(�h,e �J City/State�:('t t4 n n e46 r3" hn!"T 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 f:rry wded to the Office of Irvestigations of the DIA for insurance coverage verification. I do hereby ceWhr 4under the p-ains and pen ahies ofperjuty.tit fo at the inrmatian prmided abmv is one and correct Si>inatuoe: Y &n�l an 1 I?ate-/,2-i/- (3 Phone#:SoSc Official use only. Do not write in this area,to be completed by city or town afficial City or Town: Permitff kense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: 6 I _.. d V P%%.0 r. ®ace group WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S62UB-4507P37-1 -13) RENEWAL OF (6S62UB-4507P37-1 -12) INSURER: ACE AMERICAN INSURANCE COMPANY:.:: . .: NCCI CO CODE: 1 2165 . INSURED: `PRODUCER: TONELLI , MARK NONE 336 THATCHER STREET 2420 LAKEMONT AVE STE 300 BROCKTON MA 02302 -•ORLANDO FL 32814 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 03-17-13 to 03-17-14. 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE Part One of the policy applies to the Workers Compensation Law of the state(s) listed her"e; ' MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in o item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit o=: Bodily Injury by Disease: $ 100000 Each Employee a-- C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 0GA a D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o —_ 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. I DATE OF ISSUE: 03-08-13 WC ST ASSIGN: MA OFFICE: ORLANDO DA ACE 24M PRODUCER: NONE 22LMJ 010456 L-- PROPOSAL Mark A. Tonelli Home Improvement PROPOSAC-NO ' 336 THATCHER ST., BROCKTON,MA 02302 " # 508 588-8498 HIC # 124225 SHEET NO. Free Estimates Interior&Exterior Residential&Commercial QUALITY ROOFING -- REASONABLE RATES DATE MA CONST. SUPU. SPEC. LISC. 100202 PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NA ID ADDRESSAc - ADD S ® ( DATE.OF PLANS; PHONE N0. � � � ARCHITECT jses We hereby pro ^o to furnish the materials and perform the'labor necessary for the completion of lsq . r��r (, LicKh ` r (F 4� 1 Skifi�a One_ r h .4 5� lime r 6ho. 4 All material is `guaranteed to be as specified, and the above work to be,performed in accordance with the drawings and specifi- catio s bmitted for above work and completed in a substantial rkmanli a manner for the sum of bM,40 Dollars with payments to be made as follows. TIN Respectfully submitted Any alteration or deviation from above specifications involving extra costs . will be executed only upon written order, and will become an extra charge Per over and above the estimate. All agreements contingent upon strikes, ac- cidents,or delays beyond our control. Note—This proposal may be withdrawn by us if not accepted within days. = 3 r x f ACCEPTANCE OF PROPOSAL" s The above prices, specifications{and conditions are satisfactory''and are hereby accepted You are authonzedto do the work as specified Payments,will be made as outlined aboveT f Si }naturev K s g Date Signature c' : NC 3818-50 PROPOSAL ,,pper� CJ/e YparrvnzoaecueaGG/�a��C�/l�Gaa ac/%ccaeCGJ; 4 \ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: .'124225 Type: Office of Consumer Affairs and Business Regulation Expiration:,:-.?.5%29%2015 Individual I 10 Park Plaza-Suite 5170 j Boston,MA 02116 Mark Austin Tonelli Mark Tonelli ' 336 Thatcher St t.: Brockton, MA 02302. Undersecretary Not valid without signature j Massachusetts -.Department of Public Safety Boar"of Building Regulations and Standards Crinstruction Supery isor Spccialh License: CSSL-100202 MARK A TONELI 336 THATCHER STREE' BROCKTON MA 023U2 I , Expiration 05/08/2014 Commissioner