Loading...
HomeMy WebLinkAbout0072 NORTH STREET rI o� N o� S�-> �3D� �- I q 3 -�pD 1 3 �1 s� o�►�. `�1- w-o� r L rr, r Ln lli< . . ru 0 F F lc-A�A td Ln Postage $ V I o - \\ C3 Certified Fee y BOO O P"-a* Return Receipt Fee z cl (Enclq.Ment Required) ?ere O Restricted Delivery Fee rl (Endorsement Required)co Total Postage&Fees p Sen o t � ��-�...._...r�. .:._... fir►-m�v�--- --�..---- '-- f`• ..... Apt No.,• or PO Box No. .. State Z FL - .i� r� r Certified Mail Provides: s . m A mailing receipt (HS1eAe1j)zoos ounr Vose-oj sd 11 A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail& a Certified Mail is not available for any class of intemational mail. to NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. IN For an additional fee,a Return Receipt may be requested to provide proof delivery.To obtain Return Receipt sernce,please complete and attach a Return Receipt(PS Form 3811�to the article and add applicable postage to cover the fee.Endorse mailpiece'Return Receipt Requested".To receive a fee waiver for ad uplicate return receipt,a USPS®postmark on your Certified Mail receipt is regwred. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". a If a postmark on the Certified Mail.receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. _IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and Ms. Ty gee r v �Pnntec(On 1260 2ff1&9 ,�° � Com�p�lai0nt �Call�R�e�p�a.Frt � � 1 BAMST sM , v �: 72N�ORTH STREET H�YANNIS 7 ° z Case# C-19 873 Case#: C-19-873 Address: 72 NORTH STREET, HYANNIS Date: 12/10/2019 Owner Info: Property Info: JBML ENTERPRISES LLC MBL: 72 NORTH STREET 309-193-001 HYANNIS MA 02601 Owner Notified?: Complaint Details: Type of Complaint Classification of Complaint Method of Complaint Signs,Zoning, Medium Priority Phone Complaint Summary: New freestanding sign installed (reclaimed wood) but former freestanding sign is still in place. Unable to maintain 2 free standing signs. Action History: Action Taken Date Description Fee Inspector Inspector Assigned to Complaint: mckechnr Filed by: andersor Comments: Comment Date Commenter Comment 12/10/2019 andersor They installed a new sign by entrance but did not remove existing freestanding on green space area in front of restaurant. 12/20/2019 andersor RA called on 12/20 to inqure about the removal of the old freestanding sign. Spoke to Sean(?). He said th enew sign isnt done becuase the lighting isnt in,they are working on it. I told him he can only have one-he said you cant even see the new sign yet due to the lighting issue. I said at least cover up the sign so only one is visible. He can select the sign to cover-must be done by Monday. Date12120I2019 M .,, r Town of Barnstable° ' .. Town of Barnstable Post This Card So That it is Visible From the Street.-A pproved'Plans Must be Retained on Job and this Card Must'be KeptMASS Sign Permit i435M Posted Until Final Inspection Has Been Made.. aa.. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit #: B-19-3502 Applicant Name: Jason Calvert Approvals Date Issued: 10/28/2019 Current Use: Structure Permit Type: Building-Sign Expiration Date: . 04/28/2020 Foundation: Location: 72 NORTH STREET, HYANNIS Map/Lot: 309-193-001 Zoning District: OM Sheathing: Owner on Record: JBML ENTERPRISES LLCContractor Name:'11N1 Framing: 1 Address: 72 NORTH STREET 3 Contractor License: 4 2 HYANNIS, MA 02601 f" Est Project Cost: $4,200.00 Chimney: Description: Installation of in round double post sign with a 4 x6-double sided Permit Fee: 50.00 Insta P g P g i sign face. Wood post in sonotubes with concrete,cedar and Fee Paid':''' $50.00 Insulation: reclaimed wood facing with painted graphics! Top oUsign to be 7 Final: feet above average grade. Electrical ground lighting;to be instal-led-,- Date:,, " 10/28/2019 by others separately. Plumbing/Gas 24 sq double sided Rough Plumbing: # Zoning Enforcement Officer 43 ft frontage. No other sign ageag proposed lor approved. - Y " Final Plumbing: Project Review Req: Rough Gas: This permit shall be deemed abandoned and invalid unless the work author¢ed�by this permit is commenced within six?rio`nths after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures'shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and-shall=be maintained:ope'n for public inspection for the entire duration of the Electrical work until the completion of the same. Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on-this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work:[_� ,, _-- 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT a K l re , - w Wca- .,"^ r,.: •a 7' a 4'� YY Y t"k-] K C fT' r,� c �; 2: a< _ v w "kx tr � 3- t Y r - a -w _— yl 10 _ r ' f y- m w„Yea+ BPIF t;.- �a too," „ y - III R , r1R }r p Application number.s. /. a7l�S . ....................................... QR Fee .............A.(.l A.0....... .................... ` VaUV � Building Inspectors Initials...... �... Mfa JUL 0 3 Fq Date Issued.:............. .t°)................................. FOWN O� bAHNS I Abb Map/Parcel.. .0:F.-./.1� .............`..:........... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 2 NUMBER,,�I STREET VA LAGE Owner's Name: 0 8 lv V/Z 4 V Phone Number 50 b Email Address: 6 6 Coy✓`&ra? '(,q Iko Cell Phone Number SOS 22(, ' 7 L/ Project cost$ 18f SQQp Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above prope I he au r cn '1 to make application for a buil g permit accordance with 780 CMR Owner Signa '` Date: LT PE OF WORK ❑ Siding Imo.Windows (no header change)#__7 ❑ 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 CONTRACTOR'S INFORMATION Contractor's name C'®.-�S tevc,-6-0 tf Home Improvement Contractors Registration(if applicable)# I`sq /c� (attach copy) Constfuction Supervisor's License# C S--06 0/6 0 (attach copy) Email of Contractor Zk Cov,1 &/O K4 t0y C� Phone number S� �3�b� 7�� ALL PROPERTIES THAT HAVE STRUCTURES 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 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. i 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 LICENSE EXEMPTION Homeowner's Name: Telephone Number ` Cell or Work number. r 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 All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p Please Print Legibly Name (Business/Organization/Individual): Address: c o N /Q City/State/Zip: t 1t t'¢ Phone#:-Pf-3 U t67 L Are you an employer?Check the appropriate box: Type of project(required): 1.i� I am a employer with 4. ❑ I am a general contractor and I �l6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• r 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work . officers have exercised their 11.❑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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. � Insurance Company Name: C941 Policy#or Self-ins.Lic.#: 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. I do hereby certify under the pains penalties of perjury that the information provided above is true and correct Si ature: pl Date: Phone#: v' � ' t-(-7 T 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#: - cw Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee 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 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 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,§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"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-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 cant'workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit 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. Self-insured companies should enter their 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 permittlicense 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass,gov/dia { _ u 1. 3. 2019 12:07PM No. 4525 P. 1/1 DATE(MMIDDIYYYY) A��® CERTIFICATE OF LIABILITY INSURANCE 107/03/2019 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 John McShera Marshall K Lovelette Insurance Agency Inc PHONE Fax 396 Main St AIc No Ext• (508)775-4559 A/c No):(508)775-4577 West Yamouth,MA 02673 E-MAIL john@loveletteins.com ADDRESS: INSURERS AFFORDING COVERAGE NAIL INSURERA: Western World Insurance Company 13196J INSURED R&R Construction Custom Homes Inc INSURERB: AEIC A0086 90 Nye Road Centerville,MA 02632 INSURERC INSURERD: INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AD L S BR POLICY NUMBER MMLDCY EYF POLICY EXP LIMITS A COMMERCIAL GENERAL LIABILITY NPP1516246 01/292019 01/29/2020 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 50 OCCUR PREMISES Ea occu rence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY a PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED HNON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIMB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC50037992018A 11292018 11292019 \/I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER IN ANY PROPRIETORJPARTNER/EXECUTIVE Y NIA E.L.EACH ACCIDENT $ 500,000 OFFICERJMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 South Street Hyannis,MA 02601 __.......... ._.._._ .... AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts + w �� Division of Professional Licensure Board of Building Regulations and Standards Const` AINJPgrvisor �t CS-060160 vires: 05/09/2020 ROBERT J HAARIS 90 NYE RD s a. CENTERVILLE Mh '02832 , 10J,4S'33L��S I Commissioner Construction Supervisor Unrestricted-Buildings of any use group which contain less than 36,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpi r'�ie �.sn„zofetuea�f�a�./�a'�¢d�uae�la �� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR F TYP,�Corfxxation '. Expiration 04/03/2020 ` R&R CONSTI HOMES INC. r. Registration valid for individual use only =- a; before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation ROBERT J.HAR One Ashburton Place-Suite 1301 90 NYE RD Boston,MA 02106 CENTERVILLE,MA 02632 Undersecretary fit„ Not Ithout signature - - � Application number... Fee .......................l..Lo................ .................. JUL 112019 OWN -- � B Building Inspectors Initials.... Date lssued.'.�........ a.....'?............................... ..I Map/Parcel...... �................ oo..........................i.. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SID1NGAVINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: l olo f 14 a kmi s NUMBER STREET VILLAGE Owner's Name:- ,(3 jrYl (� /'' Phone Number Email Address: Cell Phone Number Project costs (2,1d 8- C7G 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)# F-1 Insulation/Weatherization © ors(no header change)# Commercial Doors require an inspector's review 11YRoof(not applying more than 1 layer of shingles) Construction Debris will be going to & b CONTRACTOR'S INFORMATION Contractor's name Q;r Home Improvement Contractors Registration(if applicable)# ' � (attach copy) `Construction Supervisor's License#Cl 0) `/.� �� (attach copy) Email of Contractor / dv �/h �'I d°ZOv%Phone number . tD ALL PROPERTIES THAT HAVE STRUCTUR 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 a 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. 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 786 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 G l Signature Date l All permit applications are subject to a building official's approval prior to issuance. I c: Commonwealth of Massachusetts t j Division of Professional Licensure �f Building Regulations and Standards �... of B 9 d Boar I f . r Constrt{L��>��$pgrvlso .., CS-074360 ;~ + empires: 06/23/2020 ` F RICHARDVII��kANt, �d 1 PO BOX 682 WEST HYANNIS RT All,A0 6KV At Commissioner ,visor Which contain Construction Su roue of enclos 01 an*,use. Unrestricted au�ubic9 tee (g cubic rt�etersl Iessthan36,0 space. useNtS edition of the of his 1 ce se- cul for revocation ssess a licenseovldpl E Failure t 1dPn9 Code is c on about this ass g State B Fa intor p0 or visit V'WW-- ,f/�e �aminaaieGOP.a��a�.�¢��,2c�1e1/� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only Tl 'E::_Corporation before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Reg tr i g Ex ira=1' 10 Park Plaza=Suite 5170 T21 =08/27/2019 Boston,MA 02116 VILLANI CO C. i RICHARD ViLU;1€ 109 WAGON PYANNIS,MA 026€11: Undersecretary Not valid without signature T, The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): /�. U� / f CL Address: 0 a Viet 5 01, �. l+�Y�A14I4 Ls City/State/Zip: L4 W h Wl J9 Phone#: 3(o Are you a mployer?teheek the appropriate box: Type of project(required): 1. a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have workers 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑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 sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site informatiom y� pp�� ,[ Insurance Company Name: 01 d/ c plo e, C0 6 Policy#or Self-ins.Lic.#: Expiration Date: f ® —`0 Job Site Address: /o? fU6 / /' ^� / City/State/Zip: tv, c� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi der the p ms and a 'es of perjury that the information provided above is true and correct: Date: ature: Si !� Phone# (J 36 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee 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 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 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, §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"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,su 1 sub-contractor(s)names address es and hone numbers along with certificates of PPY � ) ( )�address(es) P ( ) g ( ) insurance. Limited Liability Companies(LLC)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 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. Self-insured companies should enter their 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 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 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia. r I �` ;+1� f >Yatlktfrn l,at ilt �'` & 1 c�E, .II. Fi , 4 A +�tfr' [[�� �- I r�I� '1:�l{}' �t ��n� t,f�rf�E 1•.� i ilk vt h;+ ' 1A1 + � Vt aPxa EG ,11 Ira x E xan t #niE yl §} ti � n�s r l� lestl pc1'rY drMA{426712 .frt+�,rl;i'ft. ,uu�tiliix�-i+�,a�+���.,�a,`�'�bE:.�}�t�� s7f7�. i< ,.feC,��Il1h:J,,.'.4di;G: 50$-3604481 11, ll4'ember°of the Better Business Bureau—Insur ed Licensed—Free Estimate II i Proposal E 11 i1,:, Bo'U Murphy May 10,2019 Poi Side Tavern I' 72 North St.Hyannis Ma. t� lit i, II; DESCRIPTION Furnish and install the following,labor and materials to re-roof building at 72 North Tavern Hyannis Ma.As follows: I�I i`' III•i' Remove existing asphalt roof shingles. Supply and install:30yr.Landmark Series AR:Lifetime warranty,10 yr.sure start protection,class a + � fire rated Copper ceramic stones for a'fttll 15yr.warranty against algae contaminant,250 pound extra heavy n Aveight, I•, . 110 mph wind warranty.Multi layered',laminated architectural shingle. Supply and install: New aluminum drip edge to eves and rakes. I4' I Supply and install: Synthetic underlay petit paper, i hjl y pl Install certainteed ice and water shield to eves,valleys,penetration and low pitch ares. Ii Supply and install:Cobra ridge vent. Supply and install:Aluminum neoprene pipe flanges. Remove debris. ,!!!r•' Villani Construction warrant workmanship for 5 years Any work and beyond the specification outlined in this proposal will be performed at$50.00 per man br.plus material,or priced °I I! upon request.No work will be performed without prior discussion and approval from the home owner or contracting party. We propose hereby to furnish labor&materials complete in accordance Avith above specification for the sum of: TWENTY TWO THOUSAND EIGHT HUNDRED DOLLARS: $22,806.00 lfj ll 1ti � l 1 1, 11�1iI,l fy ACo CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 07/11/2019 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: Erica Barrett OLDE CAPE COD INSURANCE AGENCY INC PHONNo Ext: (508)771-3300 FAX No: E-MAIL : ADDRESS: ericab@occia.com. 300 WINTER ST - INSURERS AFFORDING COVERAGE NAIC9 HYANNIS MA 02601 INSURERA: ACE AMERICAN INSURANCE CO 22667 INSURED - INSURER B: - RA VILLANI INC'' INSURERC: - INSURER D: PO BOX 692 INSURER E: WEST HYANNISPORT MA 02672 INSURERF: COVERAGES CERTIFICATE NUMBER: 424017 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 ADDL SUBR XP LTR TYPE OF INSURANCE WVD POLICY NUMBER MM/DID/YYYY MMIDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGETO CLAIMS-MADE OCCUR PREMISES EaREN occTurrenceED $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'LAGGREGATLIMITAPPLIESPER:E GENERAL AGGREGATE $ POLICY❑PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY Y/N X STATUTE ERH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDEDT NIA NIA N/A 6S62UB1K20133319 02/22/2019 02/22/2020 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500.000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I 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/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWn Of Barnstable Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 230 South Street AUTHORIZED REPRESENTATIVE - Hyannis MA 02601 Daniel M.Cr,vy,CPCU,Vice President—Residual Market-WCRIBMA ©1988-2.014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD