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HomeMy WebLinkAbout0160 MARSTON AVENUE (2) "0 O � �1511, � � �- L�wi��- f - - ----- - -- - - - - - --_ - - -- Town of Barnstable Building Department Brian Florence; CB 0 Building Commissioner 200 Main Street, I4yan ais, MA 02601 www.town bamstable.m&us Pre-application for Business Certificate Date 1 Q Map Sff Parcel _w k Applicant Information -Applicants Name �j ►^- )`e�,j (�(Y'Gl V. Applicants Address- OQUJ r20,Li' r72l P mn r-o� )MC, o 1 Email Address bob- nn la r�" MS'n G©vv, Telephone Number L D-R' g c`7 g 00:7 Listed Unlisted Business Information' New Business? Yes No Business is a registered corporation? ______________________. Yes No If yes Name of Corporation Does business operate under the registered corporate name? Yes No Is the business a sole proprietorship or home occupation? ________ Yes No If yes then a Home Occupation Registration is req�ed—See Building Division Staff ' Name of Business ,��► i'r ��^ -pQ.I(x ' -j p Business Address j(o Q 0C�Z4 • 4 V Q U h IS 1 (fin 4 7 Type of Business �'T rf� r'Q_y► �T���W 0 t44 ml( ng Commission Once Use my � Conditio Building Commissi Date ' Clerk Office Use Only � I 1 (� pplication number �.g..:'1.U... 3��J.....`....1.... Qtie ( l1..........:/. .. ...................................... NAM _ Building Inspectors Initials... ............................. �d ti`Q�,`, Date Issued..`. 0 .� Map/Parcel..... :... ................................. ......... T�O,WN OF BARNSTABLE 1W EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION / � S ib t Address of Project: (�� ►�U�. # I 1 NUMBER STREET ALLAGE Owner's Name: Phone Number O S . - GLt ` I N 06- 1 U Cl � S ArrtVA/ Email Address: soG b ?G kbkN @- VASE - QkCell Phone Number Project cost$ 12 100_ip Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date' TYPE OF WORK Q Siding 0 Windows(no header change)# 0 Insulation/Weatherization 0 Doors (no header change)# . Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shin es) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name 1 ko v(Gait Home Improvement Contractors Registration(if applicable)# P OR 7 (attach copy) Construction Supervisor's License# lQaco (attach copy) Email of Contractor �S O CC.(� _ & l�- (0 vvt Phone number ') ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY'IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. - - _ -r APPLICATION NUMBER '............................................................ *For Tents Only* Date Tent(s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes No____, if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. i Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date (0 Igo /S All permit applications are subject to a building official's approval prior to issuance. 1 The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations ' 600 Washington Street Boston,MA. 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): ��� Address: C DJ S Iv'1J City/State/Zip: W i 0_0c" Phone#: Are you an employer?Check the appropriate bog: Type of project(required): I.PI 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.These sub-contractors have ❑Remodeling ship and have no employees 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.1 9. El Building addition required.] 5. [] We are a corporation and its 10.❑Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work 11.El Plumbing repairs or additions myself [No workers'camp. 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#] 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-contractArs 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: Altt Policy#or Self-ins.Lic.#: 1`2 ��/�'SS�� Expiration Date: (12 zb I(e Job Site Address: 6 I� o y� � Cit)r/State/Zip: poff� 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` tine 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 certify u f e pains and penalties of perjury that the information provided above is Pe and correct. signafore: G Date: l� Phone#: Official use only. Do not write in this area,to be complefed 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.EIectrical Inspector 5.Plumbing Inspector 6.Other' Contact Person: Phone#: Information and Instructions p' Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, mP y an a to ee 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 joint enterprise,and including the legal representatives of a deceased employer,or the ngag a) erP 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, §25Q( 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"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-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLQ 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 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 for the permit or license is being requested,not the Department of r_a.. 4-,: 1_A . ;.io„+� .Clhnnld.vnMbave.anv ouestions regarding the law or if you are.required to obtain a workers' compensation policy,please'call the-Department at the number listed below. Self-instued companies shouia enter ue�r 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 must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current « °° e applicant should write all locations in (city or policy information(if necessary)and under Job Site Address the pp 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 permit not related to any business or commercial venture (i.e.a dog license or permit to bum 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 Common.Wean ofMassaccbusetts Department of Industrial Accidents Office of Investigations 600 Washhagtan Streit Easton,MA N111 Tel,#617-727.4900 ext 406 or 1-977-MASSAFE Fax#6.17-727-7749 Revised 4-24-07 Ra.mass,gov/dia Ago CERTIFICATE OF LIABILITY INSURANCE °ATE'MM,D°"""' k-. � 1 04/27/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE'DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT NAME: Paula Donnelly HUB INTERNATIONAL NEW ENGLAND LLC P"C"; . (978)661-6885 FAX A/C No ADDRESS: paula.donnelly@hubintemational.com 600 LONGWATER DRIVE INSURE S AFFORDING COVERAGE NAICS NORWELL MA 02061 INSURERA: AMGUARD INSURANCE CO 42390 INSURED INSURER a ROOFING&SIDING OF CAPE COD LLC INSURERC: INSURER D: 68 WINSLOW GRAY ROAD INSURER E: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 262633 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POIJCYNUMBER MMIDD/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS MADE OCCUR PREMISES Eaacartence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPUES PER: / GENERAL AGGREGATE $ POLICY❑JE° LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS wA +. BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED ° PROPERTY DAMAGE $ AUTOS Peracadent $ UMBRELLA LiAE. OCCUR - EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A 4 AGGREGATE $ DED RETENTION$ $ ' WORKERS COMPENSATION X STATUTE �R AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED4 wA WA NIA R2WC855686 12/20/2017 12/20/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.' This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/Iwd/workers-compensationfrnvestgatonst. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE e THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED+IN Salt Works Village South ACCORDANCE WITH THE POLICY PROVISIONS. 12 South St AUTHORIZED/REPRESENTATIVE Dennis Port MA 02639 Daniel M.C y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) . f .. The ACORD name and logo are registered marks of ACORD SEE REV # SE Siff �7 Ii1 FI.. 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Ysas.s as a poor year a balance iCursiact Tax : _, .. tors t .... ColteC .. ... .. #fic�for tatat.. z...unt:due.... .. ... _. ...... . ... . .. Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-102600 Construction Supervisor DZMITRY LABKOVICH 4 68 WINSLOW GRAY R.D.. ' WEST YARMOUTH MA.02673 Expiration: - Commissioner 03/27/2019 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 170787 12/18/2019 10 Park Plaza-Suite 5170 ROOFING AND SIDING OF CAPE COD,LLC. Boston,MA 02116 DZMITRY LABKOVICH 68 WINSLOW GRAY RD W.YARMOUTH,MA 02673 Undersecretary Not V81id with0 Signature _ f r p b 4 Of-Cape Cod,LL 68 Winslow Gray Rd West Yarmouth, MA 02673 508-360-2749 e-mail: rsocc yahoo.com roofingandsidingofcapecod.com HIC REG #170787; LIC # 102600 Job Address: Name: Harbor Village Association Town: President: Hollis J McLoughlin Job Phone: 508-775-7581 Address: 160 Marstons Ave Other Phone: City: Hyannis Port E-mail: bob_parlardy@msn.com State: MA Estimator: Scott Dickson ZIP: 09/16/18 We hereby submit specifications and estimates to furnish and,install new roofing as follows: 1. Strip existing roofing and remove debris. Calculated (1 layer). Anymore layers of roofing needed to be stripped will be additional. 2. All gutters will be cleaned out, grounds cleaned up and nails extracted with magnets. We utilize magnets so as to minimize your exposure to personal injure and/or property.damage from nails left behind at the job site. 3. After removal of roof, wood deck will be inspected for splitting, rot or other deterioration. Owner will be advised of need for wood replacement prior to commencement of wood 4 replacement work. f 4. Along all eaves of house. Ice & Water Shield waterproofing underlayment (36 " wide) will be directly adhered to the wood deck. Waterproofing underlayment is installed to eaves to protect against interior leakage and subsequent damage from wind-driven rain, ice and snow dams, and freeze back conditions. 5. Install waterproofing underlayment in full width(36 wide)to all valleys and 12"to all rake edges. Install waterproofing underlayment at all vent pipe collars-and any other projections and skylights.Underlayment adds additional protection against leakage at critical terminations. Over remainder of house synthetic roofing paper will be installed and nailed to the wood deck. 6. Install new copper drip edge to all perimeter cave edges. Drip edge is installed to protect from leakage and rot and to provide a neat and clean perimeter profile. 7. All existing vent pipes will receive new copper flashing with neoprene gasket collars. Installation: Furnish and install new RED CEDAR roof shingles (18")per manufactures specifications as follows: 1. Install cedar breather.Cedar Breather is the easiest and fastest way to create an air space between your wood roof and a solid roof deck. Air ventilation is necessary to allow the shingles and roof deck to dry between rains. 2. At all eave,edges double starter-course will be installed.at lower edge of roof according with manufactures specifications.This provides water tite and wind resistant termination for your'roof. 3. After double first course,remaining shingles will be installed at approximately 5 %2 inch exposure unless otherwise noted. 4. Roofing to be installed using 2 1/4'stainless steel fasteners,using two per shingle 5. Shingle joints to be at least 1/4 away from fastener and 1" away from.previous course joints to minimize exposed fasteners as roofing shrinks. 6. Hip Roofs will have cedar cap shingles woven along all hips. v 7. All existing vent pipes will receive new copper vent pipe flashings with neoprene gasket'collars. 8. Install new 12"copper flashing to all valleys with W style center rain channel . 9. At peak of roof red cedar ridge boards will be used. Labor and Materials:$12100.00 . .� I acce table, initial here ` P The above s specifications are.required to meet the National Roo_fmg Contractors Association (NRCA) roof standards, as well as to meet manufacturer's specifications for warranty requirements. Touch-up painting may be required and is not included in this proposal. Roofing and Siding of Cape Cod, LLC warranty: products and'workmanship (100%o Labor and Materials)for 10(ten) Years after installations. Job is estimated to commence approximately—4_weeks after deposit received unless otherwise noted here: Work is scheduled to be substantially completed in approximately: days If acceptable,(both)initial here: Start and completion times are approximate and subject'to change due to,but not limited to;the following circumstances:weather delays, additional work on previous jobs,permitting delays, etc. This is the entire agreement. Any discussions or,verbal agreements are superseded by this agreement: Such agreements, even those of the smallest nature,must be in writing to be recognized. Any work above,and beyond the specifications outlined in this proposal will,be`priced on request. All' additional work,including travel time and lumberyard runs,will be subject to extra charge. In the event, of rot repairs, roof repairs or any related work requiring immediate attention, we will proceed without . customer approval. : • ; . We look forward to working with you;please call if you have any questions: ROOFING AND SIDING OF CAPE COD;LLC will provide cleanup on a continuing basis and all debris will be removed from site.All-products installed by ROOFING AND SIDING'OF,CAPE..COD, LLC, will be to manufacturer,specifications. All work will be performed by.ainsured professionals. All material is guaranteed to'be as specified and the above work to be performed in accordance with the- drawings and/or specifications submitted'for above work and completed in a substantial workmanlike manner. There will be no refund for,'special-order windows; doors or any other non-stocked materials after three days from approved proposal. All warranties will be null and void if account is not current and paid in full ., ' Owner to,move all personal objects;furniture, etc., from work areas. All items,against walls.should be considered for removal'during any,exterior sidirig jobs, additions, etc. to guard against damage. In the . case of any roofing and ridge venting, dust and debris should be expected and any items in the attic r should be removed. ROOFING AND SIDING OF CAPE COD,LLC is not responsible for any damages if said items remain in place. ' Curtains, drapes and window and door`treatments may'need proper reinstallation or:replacement by customer due to sizing on any window,or door replacements and is not included in jobs contracted with ROOFING ANUSIDING OF CAPE.COD,LLC.' ,- • Any alteration or deviation from above specifications involving extra costs will be executed only upon_, written orders and will become an extra charge over and above the estimate. All agreements contingent m e r t- c. .� .tea f _ •.:2 ' .. A • ., upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and other necessary insurance upon above work. Workmen's Compensation and Public Liability Insurance on above work to be taken out by ROOFING AND SIDING OF CAPE COD, LLC. Owners who secure their own construction-related permits or deal with unregistered contractors will be excluded from access to the guaranty fund. This Contract not valid unless si ed b Co` orate Officer: J� �Jjl �)A/ Acceptance of Estimate The above prices, specifications and conditions are satisfactory and are hereby accepted. ROOFING AND SIDING OF CAPE COD, LLC.is authorized to do the work as specified. Payment will be made as such: 1/3 Deposit 1/3 Beginning of work , 1/3 upon completion Date: 1b l Signatures: lo 'S Note: No work shall begin prior to the signing_of the contract and transmittal to the owner of a copy of such contract. You, the buyer may cancel this transaction at any time prior to midnight of the third business day after the day of this transaction.