Loading...
HomeMy WebLinkAbout0012 IYANOUGH ROAD JyL P 1, y : f Commonwealth of Massachusetts Sheet Metal Permit Map:5 Parcel Date: 1� ► Permit J0 D 1 Estimated Job Cost:$ tA m Fc. ^� Permit Fee: $ An r 6 PERMIT Plans Submitted: YES NO Plans Reviewed: YES NO Business License 4 5�j MAR 2 7 2015 Applicant License# TOM OF 1A1111hB Business Information: OP6yOwner/Job Location Information: Name: IAyQ - to Kax .vyv _t Name: L �`��— � •�� Street: .2c"a LJ E4,1-,.._._.__ Street: City/Town: i"jA City/Town: "_t-1 L_vV N► Telephone: �6� ? — 7�� Telephone: .5 Photo I.D.required!Copy of Photo I.D. attached: YES_\Z NO staff lot" J-1/M-1-unrestricted license J-2 I M-2-restricted to dwellings 3-stories-or less and commercial up,to 10,000 sq. ft.!2-stories or less Residential: 1-2 family Multi-firmly Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept Approval Institutional_ Other Square Footage: under 10,000.sq. & over 10,000 sq.ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: 1` HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: �,�V,►c.� -�� i �l-� �, �r�� r.�-t.�- �..�� wc�r lam, ��s�.t- 1 T 71 1� � INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L Ch.112 Yesa<011 If you have checked Yal indicate the type of coverage by checking the appropriate box below: A liability insurance policy [� Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the:licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent. ❑ Signature of Owner or Owner's Agent By checking this bo ,1 hereby certify that all of the details and Information I have submitted(or entered)regarding this application-are true and accurate to the best of my knowledge and that all shoot metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision.of the Massachusetts&iilding'Code.and.Chapter 112 of the General taws. Duct inspection required prior to Insulation installation:YES NO Proms ions Date Comments Fii tal InWeyflon Date Comments Type of License: 3 Master j rrtfe 0 Master-restricted ;fty(Tow+m pJoumeyperson Signature of Licensee �emaT# [] . .loumeyperson-Restricted License Number, 5 1 �` zee$ Q Check at vwvw.mass.aovtdnl nspector Signature of Permit Approval Town of Barnstable 'Regulatory Services es�se Thomas F.Gefler,Director Building 1,?ivision Tom Ferry,Bsflding Coin-issioner 200.Main Street,Hyamus,MA 0260.1. www.town.barnstahle.ma.us Office: 508-862-4038 Far: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder + b\ ,as Owner of th'e subject property hereb authorize 4 r 4 c c--\ to act on m behA Y in all matters relative to work.authorized by this building permit (Address of job) "Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted:. WN ) er Stnat= o€Applicant ^ r ``r- Print Name_ Prsat'Nsme, Date Q:FORMS:OWNF.RPERAMIONMOLS DATE(MMIDDIYYYY) % moo CERTIFICATE OF LIABILITY INSURANCE I 9/23/2014 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. to IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,shts to h 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 endomement(s). oN ACT PRODUCER NAME: Michael Edwards Lawrence Carlin .Insurance Agency PHONE (508)540-7100 ' ac'No:(508)540-8426 230 Jones Road EbDRE MAIL .Michael@lawrencecarlin.com INSURE S AFFORECOVERAGE ENAIC Falmouth MA 02540 INSURER & Dedhns CoINSURED INSURERB.Technolo Ins Cape Cod Mechanical Systems Inc. INSURERC: 8 Fruean Avenue INSURER D INSURER E: South Yarmouth MA' 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:2013 Master 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. ADDLSUBRI POLICY EFF POLICY EXP LIMITS INSR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIDD LTR GENERAL LIABILITY EACH OCCURRENCE $ DA 0 RFNTLU COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADEEl OCCUR` MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $is PRO- POLICY LOC , COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident .1 000 000 BODILY INJURY(Per person) $ ANY AUTO A ALL OWNED X SCHEDULED 91275445A 2/22/201312/22/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ X HIRED AUTOS X NO AUTOS Per accident Uninsured motorist combined I$ - 50,000, UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED F—JRETENTION$ IWC STATU- OTH- B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ 1,000,600 ANY PROPRIETOR/PARTNER/EXECUTIVE N I A OFFICERIMEMBEREXCLUDED? C3067846 9/21/2014 9/21/2015 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory in NH) s If yes,describe under E.L:DISEASE-POLICY LIMIT, E 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more apace is required) CERTIFICATE HOLDER CANCELLATION (508)790-6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable Building Dept. AUTHORIZED REPRESENTATIVE 200 Main Street Hyannis, MA 02601 David Lawrence/MEDWAR � ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS02517n10n61 nt Tho ArfIRrt namo and Innn aro ronic4orort mar4c of ARf1Rr1 _„ ' The CommomveaUh.of Massachusetts Department oflnAwWdAcddw& • 0ffce of Inva gatwns 600 Washington Street Bostoii,.MA 02111 www.murs.goyld'ia Workers'Compensa iion hom .ce Affidavit Bulders/ContractorsMectricians/Phimbers Anniieant InforMRtion Please Print Lem Name O�onftdividud); Address: T!' ' City/State(Zip: �, VP A Phone g ?SV f Are you p employer?Check the appropriate box: -Type of project(regWred): i. am a empioyet with r 4. I am a general contractor and I 6: ❑New ocastnotion employees(fall and/or part#une)* have hired t ie sub-contractors 2.❑ I am a sole proprietor or pa t=- lis#cd tm the attacht;d sheet 7: ❑Remodeliztg. strip and have no employees These have S. ❑.De=lifiou woo ing for mein any capacity, �ye4:and have workers' 9. ❑ g addifion [No workers'comp.insurance- insurance: 10. Electrical repairs or additionsrequire�) 5. E'We area co;poration and.its ❑. officers have exercised their 11.Q Plumbing repairs or additions 3.0 I am a homeowner doing all wok myself[No work='compp. right of exemption per MGL 12.❑R:oafrcpairs e )t 13.Q- c.152,,§1(4),and we have no iasoranc ' _vim employees.[No workers' . comp.insmance:regmrecl *Any h=t fat clsoels box 01 mast also f Il oa do Ica bdow shvwjog d=ir wozi='compd=tim jk&y m t Fimmeovvnaxs rotas aeb this athdmt indicating$try=;doing&work and.tbaar bat outside can=cta m mist submits new affilrnt indimthg MdL 3Comtracta:s 8sat check this box most nftchm as ad&TfiIE nal j6A shaiwingthaMM of ftimsb-ccneiieta¢a and shft wbether or mast those eastitua bava =Tbyem If the mb-�a}'m employees,flteq mwtprovidt&cir wariaaa'cornp.-poftymazaber.. I am an employer that isproviding workers'eompsnsartfon i►mrmwe for my employees Be1or►`is uiepolies'aid n3 site infonnadom _ Insurance Company Nacre: Awrl TV Policy#or Self-ins.Lic.# w VJ t", i.D ro ? T V Expiration Date: Job Site Address: Cityjstabw7jp: Attach a copy of the workers',comVensation.policy declaration page•(showing the policy number anad expiration date). Failore.to secure coverage as regutred::under;Secdon 2SA of MGL e. 152,caa leads p:&e imposmon of.Criminal.penalties of a fine tip to$1,500.00 and/or cure-year:went,as weI1 as d7il penalties is the form of a.STOP WORK ORDER and a fine of up to$250.00 a:day against the violator Be advised that:acopy-of this staatmaerit may be fan—died to the Office of Investigations of the DIA for insurance coverage verification. I Ao hereby ow#ry:under the pains a%d p=a&IM of per,jury.that ai...informatiox provided above is and can eat .�cv tL Da Phoned Official use only. Do Rot,write in this area,stir be coterpleted by-city or.town,o;�ciar City or Town: Peratit/Lieeuse#.. .Issuing Authority(rirele one): 1.Board of Health 2.Building Department 3.aty/Town Clerk 4:Rlecfrical Inspector 5.Plumbing Inspector 6.Other Contact Person: phone* zt ,. iu¢ � S YAitNIOI�TH 1�t��a F �f .'.! f i •—'�W070&20tNRev 0716�2uuy % �q ��' �'. DIVISION OF PROFESSIONAL LICENS5' Eli ,. ! I ' yP EL NO '� ��y���w���pp��z� u�yax3�"' rye-�z• • � t4F90 1,3 � R24 MW ' ,`a S 11 tN TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION to Map Parcel ®5 If Health Division e. Date a s d 3 -9- �9-Conservation Division Application Fee Planning Dept. rc-�¢¢ ¢, ._ Permit Fee lu•$,`I„f,"J.l 4,d.�ti .re_na'm.eyc�wa Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 12 TVA D(4,J7 Village Hymvp;< Owner ��r c s Address 12 Z;hrvC-_-E s R gYAN14 Telephone PLO -- G,04 - / 2 S"1 Permit Request � ire �J pW N RP l i2B Square feet: 1 st floor: existing W9 proposed to 2nd floor: existing proposed Total new Zoning District R S Flood Plain- AE Groundwater Overlay NO Project Valuation 25�000•'�' Construction Type Lot Size 1141 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 1 0r Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full 'Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) IeN Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: 3-- existing"'NQew �. Total Room Count (not including baths): existing _ new First Floor Room Count 4 Heat Type and Fuel:�Gas ❑ Oil ❑ Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing A_New Existing wood/coal stove: ❑Yes XNo 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 17, � ��i Proposed Use _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name IJAmori L Q•en d&Li• Telephone Number Address fl• i4ox �qO License # S''o7a0 05T Home Improvement Contractor# Email Worker's Compensation # opt( 03.5 f9YS1s ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ` FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ; 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. T7te Commonwealth of Massachusetts, Department of lndusfrial Accidents OTce ofbrvesfigationr 600 Washington Street Boston,MA 02111 www.mussgov/pia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plmnbers Applicant Information Please Print Legibly' Name(Business/organimfimmAividma : leg4-AM-1 M/ (r4" 66-r _ Address: ?�, ' X �-��R Vl��P City/Stawzip: Phone#: Are you an employer?Check the appropriate box: " Type of project(required): 1.U I am a employer with. . . I am a general contractor and I employees(finIl and/or part time)_ have hired the sob-contractors 6 ❑New constuction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7.A'Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have workers' 9 *Buildingaddition [No workers'comp.ksurance comp.hmnance.t ❑ rtqaired-] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 3.0 I am a homeowner doing all work 11.❑Plumbing repairs or additions myself- o workers'co right of exemption per MGL Y � camp. 12.0 Roof repairs insurance required_]t c. 152, §1(4);and we have no employees.[No workers' 13.0 Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compcnsation policy information_ t Homeowners who submit this affidavit indicating they are doing all work and then hint: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-contrartnrs and state whctbcr or not those entities have employees. If the sub-cofactors have employocs,they mast provide thcir workers'camp.policy number. I=an employer that is pruvOng workers'compensation insurance for my errrplayees. Below is the po&cy and job site informmfion, pp � '^ \ Insurance Company Name'P'arT- F4/' Policy#or Self-ins.Lic.4 6 01 Sp?j�g- S' Expirafi.Date: 2 O l Job Site Address: City/State/Zip:V/y/qn/-)r � pl)4-. 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 cifinmal 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 finis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.. I do hereby c under the pains wed penalties of perjury that the information provided above is&u-e and correct Si Date: c(• 6 Phone# !7 r ' 11 a (� Official use only.Do not write in this area,to be completed by city or town ojjzciaL City or Town: Permit/License# Issuing Authority( circle one 1.Board of Health 2.Build ng Department 3.City/Towa Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#; Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. to this statute an In ee is defined as"...every person m the service of another under any contract of hire, Pursuant enP Y express or implied,oral or writtm." An anplayer 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 - dweIIing house of another who employs persons to do maintenance,construction or repair work on such dwelling house or oa the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance,coverage required." Additionally,MGL chapter 152, §25C(7)states"Neithex the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 cary workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe 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 far 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. Self-insured companies should enter their self-januance license number on the appropriate line. City or Town Officials r f 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 perm.it/]icense number which will be used as a reference number. In addition,, an applicant that must submit multiple permit/license applications in any given year,need only-submit one affidavit indicating current 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 proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or pennit not related to any business or commercial venture (ie. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lake 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 nummber The Commonv�wlth-of Massachusetts Ilepaztment of 1ndustial ADcidents Offke of Wesfigattio= 604 Washivola Sfz-Cet Bnstau,MA Gl 11l Tel,9 617-727-4900 ext 4-06 or 1--977-MASSAFE Fax##617-727-7749 Revised 424-07 www.mass,govf dia f -� AllC '6Q®�' �' CERTIFICATE 6C LIABIUTY INSURANCE. DAT 1 WDD1YYY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS1 NO AlGHT$ UPON THE CERTIFICATE HOLDER.201!ETH CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND.OR ALTEeFt THE COVERAGE AFFORDED T THE ER, TII BELOW. THIS, CERTIFICATE OF INSURANCE DOES NOT CONSTITUYE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT; If the cartrgl the terms and conditions of the poldicyer!certa ns an ADDITIONAL PoUC�e8 may requireU �an e Whe ndolrseme)—muet be neat on thils Certifc to does not confer ,¢.o t PRODUCER holder In IIeU Of Ouch endorsement e , PRODUCER CONTAC Murray & MacDonald Insurance Servi.cee, Inc. PNONP. Jiudrew Roth _® (509)540-2400 A 550 MacArthur Blvd. • EMAIL rA![ Net• (300)289.d�,1;1 .arothSmmi®i.dom —� Bourne D6�L 02532 INSURER(SIAFFOROINGCOVERAGE Ni Bourne INSURED � � INSURER A IQotih)n1w Insurance Kendall & Walch Conatructiois Inc -INSURER 9:04;t6ty Indemnity33618 F0 Sox 490 INSURER0%Hartford Insurance Co. INSURER D 1 I.®8 terVlll® INSURLR E: MA 02655 INSUR6RF: COVERAGES CERTIFICATE NUMBER:15-16 maet.er THIS.IS TO CER REVISION NUMBER.,TIFY THAT ThIE POLICIES OF INSURANC E LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO fNDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE T@RMI EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAIp CLAIMS, LT ADIX TYPE OF INSURANCE POLICY NUMBER POLICY EFP POLICY EXP _e GENERAL LIABILITY r yl LIMITS EACH OCCURRENCE S 1.000. X COMMERCIAL GENERAL LIABILITY DAMAO A 5 1Q10,7C CLAIMS•MADE �OCCUR Ld013LII800796 6/13/2014 6/13/2015 MEDEXP(AMY One etecq g 51 PERSONAL 8 AOV INJURY 5 110001 L AGGREGAT LIMIT APPLIE ER- GENERAL AGGREGATE S 2 r OQ10, XEPOLICY GE S P p D. PRODUCTS•COMPIOP AGG S 2,000, LOC r 8 AUTOMOBILE LIABILITY rCOMIINF011ANY AUTOIN L LIMI _-� ALL OWNED R BODILY INJURY(Par person) $ AUT08 7C SCHEDULED 6207230 BODILY INJURY(Pv aeeldenq AUTOS B/4/20i9 B/4/2015 HIRED AUTOS AU OS ED PROPERTY DAMAGE —'- 5 PIP•Bealc S �� UMBRELLA uA9 .00CUR7. ;� EXCESS LIAR EACH OCCURRENCE 5 _ L I S•MADE AGGREGATE o OED RETENTION , � -- C WORKERS COMPENSATION WG 9TATU• OTM•AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXCCUTIVE YIN —_-- OFFICERIMEMBER EXCLUDED? N/A - EA,EACH ACCIDENT Ifgas dlwyIn NH) 696OTTB5033P4351S /6/2D15 /6/2016 EMPLOYE S "g If YYua aoaribE undr E.L.DISEASE-EA 500 ,I OE5 RI ION OP OPERATIONS eelew � � P L DISEASE.POLICY LIMIT ® 6-M-1 DESCRIPTION OF OPERATIONS/LOCATIONB/VEHICLES (Atwen ACORD 101,A414111onal Ramgrk■BchIaduln,If moro epeeede required) r CERTIFICATE HOLDER ®. CANCELLATION .' SHOULD ANY OF THI:ABOVE DESCRIEEO POLICIES BE'CANCELLED BEIFOR, THE EXPIRATION DATE THEREpF, NOTICE WILL, BE DELIVERED 1 Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS, Building Dept 200 Main Street: AUTHORIZED REPRE9E ri%TIYE _HYA"nis, MA 02601. 9 Harrington. CIC/amH ACORD 26(2010I06) 01968-2010 ACORD CORPORATION. All rights meem INS026 t201005).Ot The ACORD namA And Inan ara raaistared marks of ACARn Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction suporvis.or r � License: CS-070086 DAMON L KENDOL -48 KOMPAS9 DIW 's FALMOUTH MR.02 Expiration Commissioner 11121/2016 • . 6'E'T fs�OI11I11P1/lllRC(•lr�(1/1�?��t/IfJJC1•!.'�llJliCt'J i� 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: 1.28405 Type: Office of Consumer Affairs and Business Regulation Expiration: 4/5f201;5. - Partnership 10 Park Plaza-Suite 5170 Boston,MA 02116 KENDALL&WELCH CONSTRUC71.ON DAMON KENDALL 54 KOMPASS DR. � � / FALMOUTH,MA 02536 Undersecretary ,Not valid without signature Massachusetts-Department of Public Safety Board of Building Regulatlons and Standards } Construction Supervisor - ` License: CS-083484 W WELSH - ItONALD .. _ 85.BRIGANTINEDR: E HATCHVILLE)VIA n 10 0, Expiration 0711112016 Commissioner —O ce f Consumer ff rs&Business Regulation L nse or registration tration valid for indi i ul use only • -r r OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:a - — •. Office of Consumer Affairs and Business Regulation _ Registration; 128405_ Type, 10 Park Plaza-Suite 5170 Expiration Y415/20:15: .;. Supplement Card Boston,MA 02116 KENDALL&WELCH CONSTRUCTION RONALD WELCH P.O.BOX 490 ;`;, - --'� c'�'..�• - - �'aF1MH Tpyy `^ e• ,• � a. .` _ �' b• E a J., .' d uAQMSTABLE, ° Town,of Barnstable . Regulatory Services , Richard V.Scali,Interim Director a Building Division r Thomas Perry,CBO Building Commissioner a 200 Main Street, Hyannis,MA 02601 �' t!.,Yw - • www.town:barnstable.ma.us" ;. Office: 508-862=4038 Fax '-508-790-6230 _- Property Owner Must Complete and Sign This.Section- a If.UsingyA Builder } � 1 A n t I, ,as Owner of the sublect,property, hereby authorize C d/ifYi✓!^�/U/` / -act on my behalf, t / _ in all matters relative to work authorized by this building permit application'for; t " (Address of Job) ( yr 4 Y „ w i Signature of Owner ,. ::, t Date 2 -, Print Name If Property Owner is applying forpermit,please complete the Homeowners License Exemption Form on the,, :A r reverse side TAKEVIN_MBuilding Changes\EXPRESS PERMITIEXPRESS.doc { ' Revised 061313 • t. . r . 1 h i : �I _ r r I � . � r i 4 " a : I va t ipEJ L �tn i ON 25 f pe5 SL6 _ { •i r � ', u l 1 : i I Cel f.. { 1 r I I r T • 7/1 rF' ,• C t a • I' • i ' ...-.. e. '� 4- M .• l� R 'rF, ' - it �. s! !�" ',� ! � i :, TT r � + -, `•T�I s I s,t �� ¢ I. 1.t I f ��• � ° ,�".r,..�� r.<'�` �'t -. � *� �'' µ ' _ $ 1,; L$R/Tcsf� 14 r 1 r j I rh • r 1 r t N } I " 1 r ✓ ,..,, w.. .�,« *,,..... SLIDER, r - ry s , �• d f � e E 1OL(MO 47 I, if f I J , I r V p 1 • , I i , I . .. i Pi6,14d rf f. !+ 1 �K3 Ise �$p��ItQ o :� _ 1 - r F , T - 1 4 1 I - i •. /ff + i , I : I 1• •'. i•, I i' .. t I M4 • y� • - .. �r• : Y I. � f • , i , , - • I , , V aye °gr 24 Oi IA I if. w Bv�e�iw I - I - - : • Doe- .r _ • I i �ra I R• { 1 G I r � .ir I 1 , _:-.-.' t t i ' i �.:e�.l.�'I I { �: •tom, Q , 4.�4115n., I + I e I ,.�« r. ♦ .L: •.1: ! x, I - I ! ,• 'i .: .��• .� .i I 'y I i fr-��`, -I 1 s I ,Y _ i✓ I i ti , i 1 I, I NW , 1 I i I I I' I, , F m : I : 4 ' a - s 1 _ I I j •� ! � i I �� j I , j i _ I 1 ' I 4 i. j .,. ��_ ` .;• I I 1.4 i.'h I• I _1 ! � j 1. I- 11 e 1 1 j : I I - 1 t � �:. I «c,�s..-.«r:n..�,+ =c t> rw:..:....��.�.�# ,...�.,Tm„e,'� i ,..,.i.•.�.....w..l. "'!"' � .. I. � t j : • , r_ 1 ' , r I t ;r I { I 1 t I I r Y • , , I ' i I I j j w ! I V a! j s• I � i i I - - 7 j I l � j � �~ 'l i TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. c - i9 S 3a 3 DATE �'7�d'�B�/z. i �1 JOB LOCATION /02 L�19141PI211S Number Street Address Section Of Town "HOi-1 EokiiER T NAme Home Phone Work Phone PRESENT MAILING ADDRESS 127/9 Oda r/.3 City/Town State Zip Code The current exemption for "homeowners" was extended to include owner- occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official, %-ha V he/she -spo s ble for 'a all such work Perform under the e uaaai� .mac 'rc.,�....a.�� � a building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules. and regulations. The undersigned :'homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. MISC5 HOME OWNER'S EXEMPTION The code states that: "Any Home Owner 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 Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor.." A Many Home Owners who use this.rexemption are unaware that they, are assumin the responsibilities of a supervisor (see Appendix Q g for Licensing Construction Supervisors, Section 2.15) .RuThisalackeoflations awareness often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the unlicensed person as it would with licensed supervisor. The Home Owner acting as supervisor is ultimately respozsblz. t To ensure that the Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that the ,Home Owner 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 to amend and adopt such a form/certification for 'use in your community. Assessor's office(1st Floor): Assessor's map and lot number Conservation(4th Floor): Board of Health(3rd floor): { r • t Sewage Permit number i' SAR33T►OLE■y& 1 v Engineering Department(3rd floor): :� °' A o,.�.639•`\�a' House number o VA-1 Definitive Plan Approved by Planning Board i 19 APPLICATIONS PROCESSED'8:30{9:30 A.M:and 1:00-2:00 P.M.only ; TOWN Of BARNSTABLE MILDING ; INSPECTOR 'APPLICATION FOR PERMIT TO ///� � / /��L{L 6� TYPE OF CONSTRUCTION i /R� i .r 3U 19 / 3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location /a �'� 2:2/ Proposed Use Zoning District /� Fire District V4°/�/ /0 IFS Name of Owner �� Address W �j Name of Builder Address Name of Architect Address Number of Rooms q 6f- Foundation Exterior /y Roofing / 5,ohr+LT Floors /u/ Interior Heating A Plumbing Fireplace N114' Approximate Cost 1 Area A-re4 C44AjSe_ 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. I Name Construction Si ipervisor's License K.ELLEY, MARY F. (s ` No 36206 Permit For Re-Roof Single Family Dwelling Location . 12 Iyanough Road Hyannis Owner Mary F•. Kelley Type of Construction Frame - a ; Plot Lot r . Permit Granted September 30 , 19 93 Date of Inspection Frame 19 Insulation 19 Fireplace / 19 Date Completed ����/ 19 i