HomeMy WebLinkAbout0010 ISLAND AVENUE /o ,fr/��/ eve g
� � � _ _ �
I
Tay Town of Barnstable *Pcrntit ll X 6-7LO U
q" } c Eyirec 6 mmndis from Wile date
• IIARN9TAIIIJ �+ Regulatory IJel'viCCS
MA lee s �
F,S
A i4sy �0 Thomas F.Geller, Director
TFO"'AK" Building Division
Tom Perry,C130,.Building Commissioucr
i
200 Main Street,I-lyannis, MA 02601
wwwAown.barnslablc.ma.us
Office:.508_862-4038
lax: 508-790-6230
rXPRESS PRRMIT API'T..ICATION - I ESID NTIAL ONLY
Not Valid vidlout Red X-Press/tnprint.
Map/parcel Number q(jc, 5
Property Address � O n(y<_ r nr4..
Residential Value of Work p '
Minimwn fcc of$25.00 for work under$6000.00
c �
Owner's Name&Address
Contractor's Name PCA U
Telephone Number__il \\��
Home Improvement Contractor License#(if applicable)__ '�� I I
Construction Supervisor's License 11(if applicable)
>KWorkman's Compensation Insurance PERMIT
one:
X PRESS❑ 2I am a sole proprietor DEC ZQQ�
❑. I am the Homeowner
• AI have Worker's Compensation Insurance TOWN ®F �ARNST��L�
Insurance Company Name— �(�Q{��_Q ��(`..S
Workman's Comp.Policy 1r �WCv� NA Ao
�
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
A
❑ Re-roof(not stripping. Going over existing layers of roof) .
❑ Rc-side
❑ Replacement Windows. U-Value
' --- (maximum.44)
'Where required: lssua,tcc of this permit does not exempt compliance with other town department regulations,i.e.1'1istoric,Collservation,ctc.
***Note: Property•Owner must sign Properly Owner Letter of Permission,
Homc Improvement Contractors License is required.
SIGNATURE. 7
Q:T•orms:cxpmtrg
ltevise071405
t The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Invesdgations
Uf 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): Po,1) T w C
Address:
City/State/Zip:_ O S+,e r\)i< m A Dc2(G65 Phone#: So S q 2_8
Are you an employer?Check the appropriate box:
Type of project(required):
1.ER I am a employer with }Z 4. (] I am a general contractor and I
employees(full and/or part-time).* have hued the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. []Demolition
working for me in any capacity. employees and have workers'
[No workers'comp.insurance comp.insurance.$ 9. ❑Building 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 I I-[I 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
comn.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.
$Contractors 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: A'v CAe'r'S. IJ S
Policy#or Self-ins.Lic.#: U 3 006,S 6 W 1A NO Expiration Date: O O 0
r
Job Site Address: ff ity/State/Zip: n-1 p-2_(,t4
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 cent' under the pai and penalties f edury that the information provided abo a is true and correct
Si ature:
Date:
Phone#: /U,�-
Official use only. Do not write in this area,to be completed by city or town official
City or Town: PermitJLiceuse#
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#•
Page, 003•-. 0
RfghtFaX H1-2 8/24/2007 1 ;21:48 PM PAGE 003/003 Fax Server
ACORD. CERTIFICATE OF INSURANCE DATE(MMIDD%YY) os.za O,
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
DOWLING&O'NEIL INS AGC HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
973 IYANNOUGH ROAD 2ND FL ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO BOX 1990 COMPANIES AFFORDING COVERAGE
HYANNIS,MA 02601
COMPANY
22LGR A TRAVELERS DIRECT ASSIGNMENT
INSURED COMPANY
B
PAUL J CAT:BAULT&SONS 114C,
COMPANY
1031 MAIN STREET C
OSTERVILLE.MA 02655 COMPANY
D
COVERAGE
THIS IS TO CERTIPY THAT THE POLtCIE9 OF INSURANCE IJSTEO BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE r0R THB POLICY PERIOD INDICATED,NOTWITHSTANDING
ANY REQU1ROMNT,TRW OR CONDITION OF ANY CONTRACT OROTHER DOCUMENT WITH RE9PECTT6 WHICH THIS CERTIFICATE MAY BE Its9UED OR MAY PERTAIN.THE INSURANCE
APFORDBD BY THE POLICIES DE9CRISEO HEREIN(6 SUBJECT TO ALLTHE TERMS,EXCLU810N5 AND CONOITIONSOF SUCH POLICIES. UMfTS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS.
CO POLICY EFF POUCYEXP
LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIVY) DATE(MMIDDLYY) LIMITS
GENERAL LIABILITY GENERAL AGGREGATE g
COMMERCIAL OENERAL LIABILITY GENERAL AGGREGATE
IOP AGO, b
CLAIMS MADE OCCUR PRODUCPERSONAL&BAOV.INJURY i
OWNER'S&&CONTRACTORS PROT. EACH OCCURRENCE b
FIRE DAMAGE(Any one fire) s
AUTOM0111IL6LA81LITY
MED.EXPENSE(Anyone pemon) b
-
ANY AUTO COMBINED SINGLE LIMIT g
ALL OWNED AUTOS 8pp)LY INJURY(Per Pe man)
g
SCHEDULE AUTOS HIRED AUTOS BODILY INJURY(ParAcutlent) g NON-OWNED AUTOS PROPERTY DAMAGE b
GARAGE LIABILITY
L ANY AUTOS AUTO ONLY•EA ACCIDENT $
OTHER THAN AUTO ONLY-
EACH ACCIDENT s
AGREGATE $
EXCESS LIACIUTY
UMBRELLA FORM EACH OCCURRENCE g
OTHERTHAN UMBRELLA FORM AGGREGATE
g
WORKER'S COMPENSATION AND
A EMPOLYER'S LIABILITY UB-00951364A-07 08-10-07 09.10-03 STATUTORYLIMITS X
THE PROPRIETOR/ EACH ACCIDENT
i 100,000
PARTNERSIEXECUTIVE X 'INCL DISEASE-POLICY LIMIT 5 500,000
OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000
07HER
DESCRIPTION OF OPERATIONSILOCATIONSNEHICLBSIRESTRICT(ONSISPGCIAL ITEMS
IMIS REPLACES ANY PRIORCPRTMCATE ISSUED TOTBE•CERTIFICATE HOLDER AFFECTING WORIMItSCOMP COVERAGE.
CERTIFICATE BOLDER _ CANCELLATION
SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES 8E CANCELLED 8EPORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TOMAIL to
DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LE M.BJT
FAILURE TO MAIL 3UCH NOTICE SH&L IMPOSE NO OBLIGATION OR LIABILITY OF ANY
n'NO UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
Charles J Clark
-�
i
""nol
Board of Building Regulati ns and Standards
One Ashburton Place - Room 1301
Boston. Massachusetts 02108
Home Improvement Contractor Registration
Reqistration: 103714 I
Type: Private Corporation i
Expiration: 7/9/2008
PAUL J. CAZEAULT & SONS, INC..,* ,.
Paul Cazeault
-
1031 MAIN ST
OSTERVILLE, MA 02658
Update Address and return card. Mat Ie reason for ch:ro-c. j
Address Renewal I j Lmployment. Lost Card
\7 CG 5OM-05/06-PCO490pp
�se -l�om�sianuira/,(/ a�,/�aaaric/zuaella �
Board of Building Regulations and Standards License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Board of Building Regulations and Standards
Registration;;;103714 Expiration One rton Place Rm 1301
: 7/9/2008
Bo on,M .02108
Type: Private Corporation
JL J.CAZEAULT&.SONS INC
it Cazeault
11.MAIN ST
TERVILLE,MA 02658 Deputy Administrator
Not vali witboktAignature
Boar o�ingat'ons an tan ards
One Ashburton Place Room 1301
Boston. Massachusetts 02108
Construction Supervisor License
License CS: 26325
Restriction: 00
Birthdate: 10/20/1959
r t Tr# 6311
1 Expiration: 10/20/2009
PAU L J CAZEAULT ----
1031 MAIN ST
OSTERVILLE, MA 02655 -- --
Update Address and return card.Mark reason for change. .
i Address ] Renewal. [].Lost Card
DPS-CA1 w 50M-07/07-PC8490
iz� ,. .;/ItG '(009YLi17,0?LUfPQG�L Oy✓/�GlJ.dr1(l! 1LOCLL4 .
Beard of Building Regulation and Standjards
Construction Supervisor License
R; License CS 26325
31 Birth lgte`10/20/1959
,Explratio[t I0120/2009 Tr# 6311
z $' Rstrictin 00
e o �"
f'j t f
PAUL.J CAZEAULTt r
1031 MAIN ST
OSTERVILLE,MA 02656�, . Commissioner
NOV-15-2007 14:42 FROM:inn T0:15084204555 P. 1/1
• - ` I:JV04[VgV'J� CAZEAUITROOHNSCOMPANV
00021002
I
y ..
PrOPOrty Owner Must Complete Sign This Form
If Usinga Roofer/ Builder.ul
der.
' as Owner / agent �7�
of the subjectlmpwty hereby authorizes Paul J. Cazeault&-s RO-011ho Inc.
to act on my behalf, in all#natters relative to work auth0d=d by this build/ng
permit application
for.
AddessofJob s 6 Z-�
Signature of owner
Mailing Aditn of OIWW
Telephoned � �� �� 1 y0
Date U
(Plem rebum this form to Caxeeuk maoling along wth Yow Wgned aordract; it is needed far us to obtain the
building permit mgUkW by your learn,to compkm your roofing project,thank you)fax oso8,4204555 w
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THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINALS)
I M ^C&L
DATA
i -
8.
`,� BA
A
�4
3•a
- n
� AN �
..Y
r
- J
Home
Improvement
specialists
of Gape Cod
SCALE %¢-.' APPROVED BY DRAWN BY
DATE a..
uV
9l t(yYS
DRAWING NUMBER"
e
`t
Assessor's office(1st Floor): 7 t v v yv! a
Assessor's map and lot number - `' J �o*'r"f To`
Board of Hei th(3rd floor): p J S-FPMC SYSMM RPIJ, ♦�
Sewage PwMit number tJ �r` �"/ INOMALLED IN COMar, •'t
En ineerR Department 3rd floor): E WFITH sntL
9 9 P ( ) h JS ^ 79TL ' Sao rb 9 0a
House ri'8nber (� F E% v�F^:3'()j%4VENTA.M)Mt �®
Definitive Plan Approved by Planning Board 19 TOWNY d
APPLICATIONS�Fbdt3 5D SAD-9:30 A.M.and 1:00-2:00 P.M.only
>�g�ns� le nservatid> OF B A R N S T A B L E
geed 1 n� LDIHG INSPECTOR
APPLICATION FOR PERMIT TO rAl g'f-n t4 11 Xa 2 �✓%r�l
TYPE OF CONSTRUCTION CO,yC
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
v Gt-�Gr/ ��T r✓ /S O
Location 10 II
n
Proposed Use s N Le c(/N7/4 tom/
Zoning District Fire District
Name of Owner Nn _ I4_5aAJ 3 Address
Name of Builder ANe e c Address a N S
Name of Architect /V / Address
Number of Rooms Foundation CaN&A_-`_
Exterior l� if cbx /L� r
Roofing s// � UiYI=21 /Y/-lt/
Floors Pit- 0 Interior �Gr5 e2
Heating Plumbing OtPf'YIdA Z- 11-Cf4z
Fireplace y�l Approximate Cost 6 mo
Area
Diagram of Lot and Building with Dimensions Fee
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
Construction Supervisor's License o 30 k�J,2
HUMPHREYS, SUSAN Mrs .
` No 33436 Perm!For Bu i 1 d Sl,n RoOm
S- ngle Family Dwellin7
;3• Location A e
Hyannc snort
Owner Susan_y. mphi
Type of Construction ZFrarnei
C
Plot Lot
r . E
Permit Granted January 1 , 19 90
y
r Date of Inspection 19
Date Completed t// ®� � 19
C"
Nam• { '
•9 iu.�. �3 t L''Z
PS %0 { , • '
E s S j
i • i-fl
�r
j;i$ '•
{
i ,
_. . ...� .. ,;-v. r,_t '.ti..d--.. ... .. .,,. :... � p-"L.a' -..ry . � , ' �j_y' r�yr✓���...`r., � "'!l--.ter-.. �S ,.�-i....f,..-. of ,!a',",f't
Assessor's office(1 st Floor):
Assessor's map and lot number yyy����� o�THE
Board of Health(3rd floor): o� ,/ e�Q
Sewage Permit number i 4,f7
Z BAB.35T
Engineering Department(3rd floor): �JS rasa
House number 0 ° i6}9
r �o�aY d•
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only
TOWN OF BARNSTABLE
BUILDING INSPECTOR d
APPLICATION FOR PERMIT TO r -)g G I /.( X��. i✓�f®d/>'I -^'
TYPE OF CONSTRUCTION Corvj:! 2e-7�- A/ 140etV
19
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Locations
Proposed Use
�-,Zoning District Fire District
Name of Owner SG,'J //GtIVA e4 Address
Name of Builder �/).r1P uP P �o i Address�C _�, 1V l' Z kJ / /U S ��
/� /Name of Architect � Address
Number of Rooms •- 'Foundation
Exterior f/ rt e Y A) Y� �^� Roofing
Floors P1 �+�0 0 Interior
Heating Plumbing
Fireplace Approximate Cost
Area '
Diagram of Lot and Building with Dimensions Fee �.. �, 1
� C
f
r
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name
Construction Supervisor's License
a
HUMPHREYS, SUSAN A=265-004
No 33436 permit For Build Sun Rn m
Single Famil V pjae1jing
Location 10 Island Aveni �
Hyannispnrt
Owner Susan Humphreys
Type of Construction Frame
ca
Plot' Lot
Permit Granted January 3 , 19 9 0
Date of Inspection 19
Date Completed 19
\' I
PERMIT COMPLETED
t
XY
Lakeside Drive ('not built)
�!i
( / Lots 21,22 & 23 ✓/
Area 1.39 ac.+
MARSH -.�3� MARSH
p �r goo
f1. / ry "' 2f., '
—StL IV I--2 st �• s
:pIV
16.8
/ asphalt
parking'-0�
14 .6
ic
n s t 9-8 9
pole
A
Lot 20/
CB U
��o� /,(� / t •/ 2
fnd.
tk�pc�
Island
Ave. o ole r3M 5 Zy Hyd. �b g4 Squaw's Island
23/17 CB. #4 ow/g Road
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49 Harbor Road � v --� Date 12-1-89
Hyannis, Ma. 02601
60. N y�� Sketch Plan of Land in Hyannisport, Ma.
�EILFor Susan Humphreys, ,., ' .,
32490 �,° Being lots 21,22&23 as shown on Land Court +
9EC1STERE�.��``s plan 13772 C sh. 2
LAND s�
Elevations are based on M S L datum.
Ass. map 265 par. 4
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