Loading...
HomeMy WebLinkAbout0035 MARYALICE LANE �� �� ��� - --_ _ _V _ - - W. --- ---- ,����, -_ -- -_ Town of Barnstable Building ;�. �' `',' �,,.� '"'�. q ' �a ;\ � •,° �p�� `%,a ':� fir ....t+ eta �„i "� e '^`Y x 1'.. :'�`z�s`�` :'� �` PostrThisCard So That•"it is Visible From":the Street Approved:Plans Must be'Retamed onJob�andAthis CardfMus be Kept •, Post d Until'Finallnspect�on Has Beef Madek Permit BARIMA ° When a Certificate of Occupancys Requred;such Building hall Not beOccup�ed until Final Inspect�onhas been made Permit No. B-26-439 Applicant Name: SWEET,ANDREW Approvals Date Issued: 02/14/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 08/14/2020 Foundation: Location: 35 MARYALICE LANE,HYANNIS Map/Lot 291-077 Zoning District: RB Sheathing: Yr, Owner on Record: GUY,JEFFREYJ t ; t" Contractor Name-" JOSEPH C DUARTE Framing: 1 Address: 4382 HEATHER STREET , '' CoritractorLicense CS 070077 2 GREAT MILLS,MD 20634 � E "° Este Project Cost: $4,618.00 Chimney: Description: 1 Window Permit Fee: $35.00 Insulation: ' Fee Paid !" $35.00 - Project Review Req: z Date 2/14/2020 Final: a Plumbing/Gas Rough Plumbing: 4 f a; BuildingOfficial Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced with 'six months a14r4issuance. All work authorized by this permit shall conform to the approved application and theapproved construction documents for wh chAhis permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall'be in compliance with the local zop ftby laws and codes. p Final Gas: This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building an ffire Officials arewproded on this permit. Minimum of Five Call Inspections Required for All Construction Work:'s r w Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection - 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Per ontracting with unregistered contractors do not have access to the guaranty fund (as set forth in MGL c.142A). Fire Department INtk Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: i Application number .a .. . d DEPT. Date Issued. ....... ............................... `j " 1ARNSTABM r „�II_DING D .. �l. ..... MAM 1163 h � FEB 13 Ma Building Inspectors Initials....................................... TOWN OF BARNSTAB►-E Map/Parcel 3 1..0 7 ........................... TOWN OF A ST O A LE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY WORMATTON Address of Project: NLR%4BE STREET VILLA E Owner's Name: Phone Numb 2L/O = 37S T 2� Email Address: qua a7 1D ,u� Cell Phone Number SCANNED O Project cost$ �(l Sr Check one Residential v Commercial FEB 14 2020 O V1'VJL`WS AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: *See ,A- azAj eQ �gc-,—�— Date: TYPE OF WORK ❑ Siding XWindows (no header change)#' ❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to�J w s� ,,, f ��f'-G J-e,,m o.,-'L, M,A CONTRACTOR'S INFORMATION Contractor's name A� ie��/ Pe� arm e l us Home Improvement Contractors Registration(if applicable)# //Z 7 (attach copy) Construction Supervisor's License# �� �� /- (attach copy) Email of Contractor 5we.,-1 J2 S—e 5mg • c C3''i'` Phone number 4/o/- 7IV- 6 3'�9 ALL PROPERTIES THAT HAVE STRUCTURE OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. 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. 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 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. Fuel Type Testing Lab Offsets from combustibles:front back left side right side HOMEOWNER'S 1V1U`R'S LICENSE A'r19EWTJION 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. g 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 �. 3 to issuance. All permit applicatio are subject to a building official's approval prior r c� Home Improvement Agreement: Pagel Home Depot License#'s - For the most current listing www.Homedepot.com/LicenseNumbers MA: 107774, 112785 Janice Campbell Salesperson Name: Registration No. (if applicable): Home Depot U.S.A., Inc. ("Home Depot") or Service Provider named below will furnish, install and/ or service the equipment listed below at the price, terms and conditions as outlined on this form. GUY JEFF New England South 1-PT3ISZW Customer Last Name Customer First Name Store #/ Branch Name Customer Lead/ PO# 35 MARYALICE LANE Hyannis MA 02601 Customer Address City State Zip (240) 925-3758 guyjj@starpower.net Home Phone# Work Phone# Cell Phone# Customer Email Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip Or Email' customercancellationnortheast@homedepot.com Service Provider Email Address BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A DIFFERENT CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR SERVICE PROVIDER, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE HOME DEPOT GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NOTICE RIPH74Q CANCEL. Acknowledged by: 01/14/2020 Custo s Signature Date Contract Price and Payment Schedule : Payment of the Contract Price is due upon signing unless a different payment schedule is required by law, specified below or in a payment addendum. Contract Price: $ 14618.00 Includes all applicable taxes. Excludes finance charges.* Sales Tax: $ 10.00 (If applicable) *Maximum deposit ONLY applicable in MD, MA, ME(331yo), NJ, WI(99%) Dep. 125.0 1 % Deposit Amount $ 11154.5 Remaining Balance $ 3463.50 The Home Depot-2455 Paces Ferry Road, N.W.Bldg.B-3,Atlanta,Georgia 30339-Customer Care:1-800-466-3337 460FI HDE Customer Agreement(24 Jul.18) v 0.1.8 Home Improvement Agreement: Page2 Finance Charges: *Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which The Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Service Provider; however, Service Provider may collect Customer's payment(s) made payable to The Home Depot. Insurance proceeds will will not be used to pay some or all of the total amount of sale. Description of Work to be Performed: Installation of 1windows A more detailed description of the work to be performed is included in the section entitled Sco=pe o l�= Work which appears on page = of this Agreement. Anticipated Delivery Date/Installation Schedule Approximate Start Date: 03/10/2020 Approximate Finish Date: 04/07/2020 All dates are approximate and subject to change based on unforeseen events including inclement weather, permitting delays, and delays in confirming insurance coverage of Your claim for any repair, if applicable. Electronic Records Authorization: You are entitled to a paper copy of this Agreement if you choose. If you consent to an e-mailed copy, your consent applies to this Agreement and all subsequent documents and written communications related to this agreement. By contacting your Service Provider, you may update your email address, withdraw your consent, or obtain a paper copy of the Agreement or related documents at no charge. By providing your consent and verifying your email address above, you confirm that you have access to a computer that can receive and open emails and PDF documents. By i ' ' ling this paragraph, I consent to receive only electronic records related to this transaction. Initial Acceptance and Authorization: By signing below, you authorize Home Depot to (a) arrange for Service Provider to perform Installation and/or (b) order and arrange for the delivery of special order merchandise, including special order merchandise that may be custom made, as specified in this Agreement. Do not sign If blank or incomplete. (Service Provider's/permitting information may need to be provided to You later.) By signing, you acknowledge that you have read, understand, and accept this Agreement in its entirety, including the General Terms and Conditions and State Supplement, if any. You further acknowledge receiving a complete copy of this Agreement. Keep it to protect your legal rights. X E 01/14/2020 The Home Depot Customer's Signature Date Service Provider Name X 1 01/14/2020 908 Boston Turnpike Unit 1 -S ner (if applicable) Date Service Provider Address 01/14/2020 Shrewsbury M A 01545 Si natu a On Behalf Hom De of Date City Zip R-1-073-13-00016 Service roiNder Phone\4umtler Service Provider License Number The Home Depot-2455 Paces Ferry Road,N.W. Bldg. B-3,Atlanta,Georgia 30339-Customer Care:1-800-466-3337 460FI HIDE Customer Agreement(24 Jul.18) v 0.1.8 1'he Commonwealth ofMassachusef#s' Y Department of industrial Aceidents r- 1 Congress Street,Suite 100 Boston, A 02114-2017 www,mass.gov/dia 'Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.- TO BE FILED WITH THE PERNETTING AUTHORITY. Applicant Information )!_Tease Print Ledbly Name(Business/Orcanization/Individual): H n rn e Address: 010S +moo S- Dn Tu rn g i K e_ City/State/Zip: &mAjS �v MA O15 Lk S Phone#: -7 7'4 '1 -1 5 - 2-IS-5- Are you an employer?Check the appropriate box: Type of project(required): l.�am a employerwith - employees(full and/or part time). 7. E]New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.(No workers'comp.insurance required.] 3.®I am a homeowner doing all work myself(No workers'comp.insurance required.]t 4. El Demolition 10 Q Building addition. 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.❑Blumbing repairs or additions IM I am a general contractor and I have hired the sub-contractors listed on the attached sheet 1ese sub-contractors have employees and have workers'comp.insurance) 13. oof re airs (. /Nil We t e i GL c. -14'. Other r 6. are a corporation and its officers have exercised their ugh of exemption per M 132,§1(4),and we have no employees.[No workers'comp.insurance required.] To J Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information. I 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 ofthe 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 thepolicy and job site - information. Insurance Company Name:. 6�?M/ (/YYI iCVI 11-G II_Y7 d ra/1(_P_- ai."+04e�1 i Policy#or Self-ins.Lic.#: X S (0 5 5 `1 7 Expiration Date: 3 — L—2 O Job Site Address: City/State/Zip: Attach.a copy of the workers'compensation-policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL C. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonm as ell as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. py this statement maybe.forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un an enallies o information provided a ve is ue and correct. Si mature: Date: Z 3 Z� Phone#• Official use only. Do not write in this area,to be completed by city or tmvn 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#: 4. O• vealth of Massachusetts u_f Division of Professional Licensure Board of Building Regulations and Standards ConstWc& enrisor CS-07 077 Ekoires:1213U1202a .I� }. 1 .tOSE#?H C D7� 15 FAl.l_ST WAREHAM MA�AZSf� Ai ��•.�" ' commissioner �/��� . 2 gi Office of Consurm r Affalrs-& 3u ki*Regulation s' _ HOME iMPEtOVEMENT'GONTRACTOR Regislraffonvalidforindn►idualus only TYPE Parh�ershm `.- tuetare the expuabon date> 1f fouttd��m to: z Rea ort Expiration office of Consume-Aft—0 s`. 0 Busipess IR0,106h 4 23¢g- D11t0/2021 900o Wa- ---- n.Street Suits 71Q 5� JOSEPH C.DUAL�IEti DB1A J&J REM0QEfAf G t ' JOSEPH G DUARTE i- 15 FALL ST of Kalid wittouE sfgnaEitre W AREHAM"MA'02571 Undersecretary' r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 ,= Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: 15 F.9L - S City/State/Zi 1026-7 77 7lo 6 Phone#: � ' o�c3o1� Are you an employer?Check the appropriate box: Type of project(required)' 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. New construction 2.K 1 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 for me in any capacity. employees and have workers' comp.insurance.* 9. ❑Building addition [No workers comp.insurance p• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their 1 L 3.❑ I am a homeowner doing all work ❑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. $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 subcontractors 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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address; City/State/Zip: 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. 1 do hereby cer 'y unde the pains4nd penalties of perjury that the information provided above is true and correct. n l Phone#- 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#: r Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improve ment.Co n tractor Registration - Type:, Supplement Card HOME DEPOT USA INC - Registration: 112735 P O BOX 105451 Expiration: 04/22/2021 ATTN: LICENSE MGMT TEAM -_- ATLANTA,GA 30348 - - - - - Update Address and Return Card. SCA 1 ci 20M•0507 - Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE-,tuonlement Card before the expiration date. If found return to: Reaist hft Expiration Office of Consumer Affairs and Business Regulation 04/22/2021 1000 Washington Street Su' 10 HOME DEPOT _ Boston,MA 02118 ANDREW SWEET 2455 PACES FERRY:FUC 11 HSC � ,,yel'G,"� a ATLANTA,GA 30339 Undersecretary NO slid !t ut sl nature r + ��� iD DATE!MM/DDIYYYY) �/ CERTIFICATE �F LIABILITY INSURANCE )206l2C19�' 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 have ADDITIONAL INSURED provisions or 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 MARSH USA,iNC. NAME: PHONE FAX TINO ALLIANCE CENTER c o E (A/C,Not: 3560 LENOX ROAD,SUITE 2400 =_-MAIL A T LANTA.GA 30326 ADDRESS: _— INSURER(S)AFFORDING COVERAGE . NAIC 4 ON 10 1 642069-HomeD-GA W-19-20 INSURER.A:Old Republic Insurance Co 24147 INSURED THE HOME DEPOT,INC. INSURER B:New Hampshire ins Co .23841 HOME DEPOT U.S.A.,INC. INSURER c:HomeRisk Captive Insurance Company 2455 PACES FERRY ROAD INSURER 0: WILDING C-20 AILANTA.GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439-28 REVISION NUMBER: 21 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. r INSR; TYPE OF INSURANCE iADDLISUBR POLICY EFF I POLICY EXP LIMITS LTR' POLICY NUMBER MMIDDIYYYY ':fMMIDDIYYYYI A X I COMMERCIAL GENERAL LIABILITY 'MWZY 314574 031011Z019 03IO1IZ022 : EACH OCCURRENCE S 1.000,000 DAMAGE TO RENTED •I.000,000 CLAIMS-MADE -�OCCUR PREMISES'Ea occurrence) X SIR:61.000,000 ytED=_XP j any ane oersani 5 EXCLUDED _ 'PERSONAL 3 ADV INJURY S 1.000,000 GEN'L AGGREGATE LIMITAPPLIESPER, GENERAL AGGREGATE S 1,)00,000 %< I POLICY E� LOC • PRODUCTS-COMPIOP AGG' S 1,)OOA00 OTHER: - A AUTOMOBILE LIABILITY 'MWT8314573 I03/01(2019 '03101i2022 COMBINED31NGLEUMIT i 1.000,000 _ iEa 3ccidentl :( i ANY AUTO a BODILY INJURY(Per person) S OWNED SCHEOUL O SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) i AUTOS ONLY AUTOS HIRED .VON-OWNED PROPERTY DAMAGE i _ .AUTOS ONLY —.AUTOS ONLY Per accident) i UMBRELLA LIAR : OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-.MADE; ,, '.AGGREGATE S DIED RETENTION i 3 B i WORKERS COMPENSATION !INC 012717099(AK,NHAJ,VT) i 03/011,201903/01/2020 X ';TATUTE I EERH B AND EMPLOYERS'LIABILITY Y I N 'INC 012717100((WI) - 03/01/2019 03101/2020 5.000,000 ANYPROPRIETORIPARTNERlEXECUTIVE - - E.L.EACH ACCIDENT S 'OFFICERIMEMBEREXCLUDED? N iN/A , (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEj 3 5A00,000 Ir yes.describe under Continued on Additional?a a 5,000,000 - DESCRIPTION OF OPERATIONS below 9 'c.L.DISEASE-POLICY LIMIT S C :Excess Auto 297110011002019 03101/2019 03/01/2020 Limit: 4,000,000 A Excess General Liability MWZX 314580 0310112019 03I01I2022 Limit: 8.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION i HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE' 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-20 ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Nlukheriee �iatin�lea ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r AGENCY CUSTOMER ID: CiN i016a?C69 _ LOC#: ,Adartta -- - - - ALA D ADDITIONAL REMARKS SCHEDULE Page -_ of _3_ AGENCY - - NAMEDINSURED MARSH iSA.INC. rHE HOME DEPOT.INC. -- ---__-_-- _- HOME CEPOTU.S.A-INC. - POLICY:NUMBER 2455 PACES BERRY ROAD 3UILDING 0.20 rLA CARRIER NAIC CODE EFFECTIVE DATE: -. ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance 'Norkers Compensation Conlinued: Carrier Indemnity Insurance Company of:North America e Policy;Number:''NLR C65890549(AL.ARFL.ID.iA.i(S.KY.LA,MS.MO.;VE.NM.NO:OK,3C.30.TN,'NN.'NY) Effective Dale:03101019 ' s Expiration Date:0310112020 (EL)Limit:S5,000,000 Carrier:New Hampshire Insurance Company " Policy Number:INC(112717098 (DC.OE.HI.iN.MD.MN.MT.NY,Ril a Effective Date:0311 Expiration Date:03/01/2020 (EL)Limit:35.000.000 Carrier:ACE American Insurance Company y Policy Number:WCU C65890586(GSI) (AZ.CA.IL.NC.OR,4A.'NA) (festive Date:03101/2019 Expiration Dale:03101/2020 (EL)Limit:54.000.000 SIR:31.000.000 SIR for the Mates of.AZ,CA,IL,NC:OR.'/A."NA Carries National Union=ire Insurance Company t ' Policy Number.XWC i565596(QS0(CO.CTGA,ME,MI.NV.OH.PA.UT) s Effective Date:0310112019 Expiration Dale:0310112020 (EL)Limit:$4,000,000 31.000.000 SIR for the slates of CO.MEAVAI,OH,PA.UT *_ 3750,000 SIR for:he stale of i.A 3350,000 SIR for:he;late of CT Carries National Union P;re Insurance Company Policy Number.XWC 5565591(QSI)(MA) Effective Oats:03101/2019 Expiration Dale:03/0112020 t - (EQ Limit:0.500.000 ' SIR:3500.000 rx Employers XS Indemnity: , Camer:Illinios Union Insurance Company Policy Number TINS C65221019 M) Effective Date:03101 019 Expiration Date:0310112020 (EQ Limit:310,000.000 » SIR:31.000,000 ACORD 101 (2008/01) J 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD t - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _ Parcel 7 Permit# SEPTIC SYSTEM MUST BE c� , Aealth Division INSTALLED IN COMPLIANCE Date Issu d / ,r WI H TITLE 5 ��1� ,�d �l6 ," F � s. Fee /Tax Coll • ��`'v X/I I - ' .,/Treasu _ 32 ,me apt• ti J KH p eonie+inn/uv�,;ni$ -Project Street Address Village s AW/S fi . Owner sS(�/� „�LU "� av ' � Add ress .� ��-��� ��� L�i✓� Telephone l� 6 Permit Request �If�bElk Square feet: 1st floor: existing //C proposed ���' 2nd floor:existing — C proposed �' Total new S Estimated Project Cost © Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. . y Dwelling Type: Single Family , Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes No On Old King's Highway: ❑Yes l No Basement Type: ❑Full ❑Crawl Walkout ClOther . Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing 3 - new .� Total Room Count(not including baths):existing 19 new 8 First Floor.Room Count Heat Type and Fuel: ❑Gas WOil ❑Electric ❑Other . Central Air: ❑Yes Y No Fireplaces: Existing New C Existing wood/coal stove: ❑Yes )&4 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:O existing ❑new size Attached garage;-Yexisting ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes �;`Vo If yes, site plan review# Current Use / �i�/,��L Proposed Use BUILDER INFORMATION Name 0/twD ItIz /N Telephone Number 7- f5y� Address �1/ License# K' -S G 6 7-13 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE�d DATE a_ FOR OFFICIAL USE-ONLY •. ' PERMIT NO. s DATE ISSUED MAP/PARCEL NO. _, , • - 1 .f H `ADDRESS r VILLAGE I t OWNER DATE OF IVSVECTI t ~- FOUNDAT£,ION; FRAME r, - INSULATION"! FIREPLACE ELECTRICAL:- ROUGH FINAL' y + PLUMBING•t ROUGH FINAL - GAS: r . •ROUGH FINAL r _ ', : • f r f �, t, ' FINAL BUILDING + -DATE CLOSED,OUT ASSOCIATION PLAN NO. i ' The Town of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 4' Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT 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 such residence or building be done by registered contractors,with certain exceptions,along with other requirements. �pType of Work: fZ" /�&A-® U,4p,4 1�jf— Estimated Cost ����� Address of Work: L1 Owner's Name: �`� i(,� 'dl 1yz� Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work 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 IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I here r. /by apply for a permit as the agent of the owner A . 0 �7n zki)4/7) Date Contractor Name Registration No. OR Date Owner's Name gIbmis:Affidav .....----------- The Commonwealth of Massachusetts �-fO Department of Industrial Accidents . 14 Ar Olfice 0/I0YOSI%980/IS 600 Washington Street Boston,Mass. OZlll Workers' Compensation satin ance%%%/%O/%%%/�%%/%%/���///%�%�%////%/r:" davit name: U,� J. L � /- ` / /location: 7�/ &rc&gA-.s T aT /city AWI r/ D-2 6 a hone#50R 771y5 /0 ❑�am a homeowner performing all work myseif. .lam i am a sole proprietor and have no one tivorking in anv ca acity ❑ I am an employer providing workers' compensation for my employees working on this job. comnnnv name - address: _. .. city phone#- insurance cn. nolicv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: compnnv name• address: :•:,: :..:. city phone#r ...... insurnnce co. comnanv name: .. .. address' city: ... phone M Insurance co. oll&# FaQure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SI00.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verincation. I do hereby ce 'y under a pains and penaltz of per' ry hat the information provided above is true and correctcL Q Si ture Date Print name D�U N / Phone f✓ JO S 771 T i Mcial use only do not write in this area to be completed by city or town ofQcial city or town: permit/license# ❑Building Department o ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Offlce ❑health Department contact person: phone#; ❑Other (tevLwo 9M P1A1 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 co=z= 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 receive: c: 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 renewa: 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. 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 applicanL Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned io 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. MEN The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of levesduatlons 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 f --- _'_ �1LC Ur omvl)t!»uuepLUG O�✓�%CWJCtc�2 �t; e' S9FE OEPARIMENT OF PUBLIC Y CONSTRUCTION SUPER;'ISGN ICEN E NUM er :CS �C9"43 ,96,1"!, '0t.0 �j Restricted a': 09 EONUNO J ;FLYNN PO BOX.31. CENTER,'IL'i_E MP 1 6 , THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) m A- �C&' L T--- D. ATA JLI= t;ummuNMALTH ur hL4ZaAU1USk 15 Board of Bnilding Regulations and Standards Transaction No. One Ashburton Place-Room 1301 Boston,Massachusetts 02108 Registration No. Application for Registration as a Home Improvement Contractor or Subcontractors Date MGL Chapter 142A, CMR 780.6 Expiration Date FOR OMCE USE ONLY Q 9 F L Name Print the name of the individual or business applying for the registration(not both) Z Mailing Address /3 lX / 3 Qry State 22p 01932 Area Code&Telephone N==. 4. Street Address(if different, 9 e Print street and Number(P.O.Box not acceptable) 6ry, State Zip S. Applicant type Vftidiviclual ❑ DBA ❑ Partnership ❑Trust ❑ Private corporation ❑ Public corporation (See instructions on back regarding eadosmg a dry or town registration under the DBA or"fictitious name"law-MGL a 110,ss S A 6 4ecuncy NO. W;' as.0 below. Use 1.4 .. Last Fuss, Middle initial Mlle in Applicant Busines %Owner Address AINAIA &aWgie ov IZ h the applicant chiming exemption hum the registration fee? (See the instructions an the bade) ❑ U yes,mdude a a W of a current Comtrnaion Supervisor Qcease or motor vehicle repair shop Masse or registration. Yes No 11 Registration fee ecdosed:S Gmramy Fund fee endomat S Indude two separate eertined drams or money orders-one marked"Regisrstim Fed:are marked"GuataM Fond'. ALL APPLICAMS MUST ]N=E A GUARANTY FUND FEE EVEN IF E7fEMPT FROM THE REGISTRATION FEE See imtructi m an back for amount of fees. Make all certiIIed dwcb or money orders payable to Mommonwealth of Mamehnsede Pursuant to Massaehmeus General Uwa Chapter M secdon 49A,I ear ily under the peraltles of paiury that 14 to my best have Ned all side ts:rstmaa and paid all state lasses required under law. i / I Signature of applicant or applicant's rdpremtative Title held with applicant A false answer to art)question in this application constitutes grounds for suspension or revocation of the applicant's registration. I ,✓,✓ D� l A G -f- 10"im-41-0-15 � Alo Aa --------------- 4-1 ilk oFIMEr The Town of Barnstable Department of Health, Safety and Environmental Services BMWSTABLE• " Building Division y MASS. 3%k 039. �0 367 Main Street,Hyannis MA 02601 rFn Mn�a Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date:Aij tl Name: �Sl�(/I !/��/L(i 1-� l�/� ) Phone#: Address: s d��D Li/f 4 141 . Village: l /AX Type of Business: )axd_5 cu&I A>? CiJ Map/Lot: ®� INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the..Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial.vehicles related to the Customary Home Occupation, other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. AApplicant: Date: Homeoc.doc TO ALL NEW BUSINESS OWNERS Fill In please: YOUR NAME: ILS621,11 Q >>r APPLICANT'S ,/ , ► YOUR HOME ADDRESS: BUSINESS TELEPHONE telephone Number (Home) E O BU$1 ESS ,� - ZrTYKE OF BUSINESS!:: M F �r ' $i SSS 1011* PPARCEV BE it AppItESS �! .:. .. . . When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures listed below, you may apply for a business certificate at the Town Clerks Office (Ist floor-Town Hall). 1. GO TO BUILDING INSPECTOR'S OFFICE 4TH FLOOR TOWN HALL) This individual has been info of an p i uirements that pertain to this type of business. Aut o ze gnature COMMENTS: 2. GO TO BOARD OF HEALTH (3RD FLOOR TOWN HALL) This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature COMMENTS: 3. GO TO CONSUMER AFFAIRS (LICENSING AUTHORITY) - (3RD FLOOR SCHOOL ADMINISTRATION BUILDING) of the licensing requirements that pertain to this type of business. This individual has been informed9 Authorized Signature,, COMMENTS: i After obtaining the required signatures you must return to the Town Clerk's Office to obtain your business certificate (cost$20.00 ! for 4,years). A business certificate ONLY REGISTERS YOUR NAME In the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments Involved.