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HomeMy WebLinkAbout0290 PITCHER'S WAYr 2�� ��,�s �, , � � - - —�� �� E' Town of Barnstable *Permit o l a4 EP N2 8.20�3 Regulatory Fee Services Es 6111 nths jro,nre dare iss • BAartsrAe�, • S,i,ABLomas E.Geiler;Director OF BARN ,.. Building Division Tom Perry,CBO"Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma'.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY �2O a Not Valid without Red X.Press Imprint Map/parcel Number [ Property Address,2 go~���c�e(S .laJc� N M g•.� s . �lL� O Z fo O\ ��x �a Residential Value of Work05�'7S 0,!A)_ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ` J"Act 2e�11M Contractor's Name,_y e^c.a^ h`lc,✓:no Telephone Number .(5 o`d ?n A"0;.( 3 Home_improvement Contract or License#(if applicable) . b 0 5 c\ Construction'Supervisor's License#(if applicable) Cs - 0-c11 �Sy ❑Workman's.Compensation"Insurance Check one-- 1 am a sole proprietor ❑ I am the Homeowner - I have Worker's 6m' p'erisatiomInsurance Insurance CorripanyName Fo Vi��fs � tc,v�_CL Workman's Comp.Policy# 1 IQ. Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) v Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping: Going over existing layers'of'roof) ❑ Re-side a #of doors Replacement Windows/doors/sliders.U-Value .750 (maximum.35)#of windows -7 ❑. Smoke/Carbon Monoxide detectors 4 floor plans marked with red'S and inspections required. •Separate Electrical&Fire Permits required. °Where required:Issuance of this permit does not exempt compliance with other town department regulations,i.e..Historic,Conservation,etc. . ***Note: Property Owner must sign Property Owner Letter of Permission.. A copy of the Home Improvement Contractors License&Construction Supervisors License is require . SIGNATURE: C:\Users\decollil\AppData\Local\M rosoft\WindowsUemporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 MARVIN DESIGN GALLERY a complete window and door showroom by MHC Permit Authorization as Owner of the subject property_ understand that Marvin Design. Gallery by MHC is a department of Marine Lumber Operator located at 134 Orange St..p Nantucket, MA and hereby authorize to act on my behalf, in all matters relative to work authorized by this building;permit application for: (Address of ob) 4dd A�&J�, S'igftaturM of Owner Date Print Name 75 Falmouth Road, Hyannis,MA 026011(508)771-62781(508)771-6219(Fax) www marvindesigngallerybymhc com •T f ?lie Contnrontuealth of Massadnaetis r Department oflndrtstriol Accidents` Office of Investigations r 600 Washiugton.Street d Boston,MA 02111 ,E , inwnnmss gor/din - Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbei's . Applicant Information ( Please Print Le-gib Name(Business/Organizationdadividual):- e.r�..Q. o�. �t . Q�i�,' a r f Address`_ Ci /StatelZ1 • a�� ..mot_ c �A L7 .a1� Phone PP. (� tY p- Sz-I Phone##: l� K �'— C10 Are you an employer?Check the appropriate box: Type of project(requited) 1 I am a employer with 4. ❑ I am a general contractor and I m have hired the sub-contractors 6. New.construction employees(full and/or part-time).* •, ,• ; 2,❑ I am a sole proprietor or partner- listed on the attached sheet. 7.*0 Remodeling M shipand have no employees Th��-contractors have g Q Demolition ` working for me'many capacity. employees and have workers' • 9. Building addition •. [No workers'comp..instuance comp.insurance.-I 0 g: required.] 5. ❑ We are a corporation and its 10.E]Electrical repairs or additions 3.❑I am a homeowner doing myself all work officers have exercised their 11.0 Plumbing repairs or additions 'co _ right of exemption per MGL �o workers comp 12.❑Roofrepaus - .. . c.152, 1 4,and we have no insurance required.]f , , § O employees.[No workers' 13.0 Other comp.insurance required-] f I1 •Any applicant that checks box R1 must also fill out the section below showing theirtvorkers'compensation policy information• t Homeowners who submit this affidnit indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such $Contractors that check this boo must attached an additional sheet shoring 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 inn an employer flint isprotdding it�orkers'compensation insrtrar►ce for n(v employees Be.Ioty is tl►e polic3,ru►d job site ' information. Insurance Company Name: -x e e Policy#or Self-ins.Lic.#: 0 ,to 1 t�© 5-1 Expiration Date: /a' — tom Job Site Address�r'(d-1'�tc � 5 wki : 5. CitylStatelZip' t1 Q h n f 1�A oa(p b 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 fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in form of a STOP 117ORK 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 r►ii .r tl epains and penalties of pedury that the information provided above is true and correct Signature: _100 Date: oZ 1- . Phone#: 65 tt>, � a5 Official use only. Do not Write in this area,to be completed ky city or town of ciaL City or Town:._; ',,.•. . - PermitUcense 0 Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 3/2013 8:36:06 AM PST (GMT-8) FROM: 100005=TO: 15087716279 Page: 2 of 2 4C40RZ> CERTIFICATE OF LIABILITY INSURANCE DATE ,M,ID°"YY" I 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 1NSURER(S), AUTHORRED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT If the certfcate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. N 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 endorsements . RODUCER Risk Strategies Company CONTACT NAME.Chnsgrie Watson 15 Pacella Park Drive Suite 240 Randolph, MA 02368 PHONE - INC.No E-MAIL ADDRESS: INSURER 9 AFFORDING COVERAGE NAIL N sk-strategies.com wsURERA: ISURED INSURERS: TrayelerS .. .. Marine Lumber Operator, Inc. DBA Marine Lumber Co., Inc. INSURER C: 134 Orange Street PIsURERD Nantuckef MA 02554 - INSURER E INSURER F: :OVERAGES CERTIFICATE NUMBER: 15686723 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.LIMBS SHOWN MAY HAVE BEEN REDUCED.sY PAID CLAIMS. ISR DLSUBR POLICY EFF POLICY EXP TYPE OF.INSURANCE INSR WVD POLICY NUMBER MMIDDIYY MMIDDI YY LIMITS I'I GENERAL LIABILITY 7140075780000 8/22/2012 6/30/2013 EACHOCCURRENCE $: ; 1000000 FWGE TO NiED 50000 ✓ COMMERCIAL GENERAL LIABILITY ISESS a occurrence $. CIAIMS•MADE a OCCUR MED EXP(An one person) $ 5000 PERSONAL&ADVINJURY $ - 1000000 GENERALAGGREGATE $:. 2000000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMPIOPAGO $ 2000000 7-1 POLICY PRO ✓ LOC $. AUTOMOBILE LIABILITY ADN-8739221 8/22/2012 6/30/2013 a eee�r�en°►S INGLE LIMIT $ 1000000 V ANYAUTO ` BODILY INJURY(Per person) $, ALL OWNED . R SCHEDULED AUTOS BODILY INJURY(Per accident) � $ ✓ , RTY HIRED AUTOS AUTOSWNED PeOr eeddenl A G $ UMBRELLA LIAR OCCUR 7140075780000 8/2212012 6/30/2013 EACH OCCURRENCE $ 10 000,000 EXCESS LIAR CLAIMS MADE AGGREGATE $ 10,000,000 DIED RETENTION$ $ 3 WORKERS COMPENSATION. 6KU60167N03512 1211B/2012 12N8/2013 WCSTATU= pT�1 AND EMPLOYERS'LIABILITY Y!N ✓ TORY LIMITS EK ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT- $ 600,000 OFFICER/MEMBER EXCLUDED? ❑N ,N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT :$ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) 'ertificate Holder Is additional Insured where required by written contract or agreement. I ERTIFICA E HOLDER CANCELLATION. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Marvin Design Gallery THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE VWTH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Bernard Gitlin ©1988-2010 ACORD CORPORATION. All rights reserved. kCORD 25(2010105) The ACORD name and logo are registered marks of ACORD tT NO.: L5666723 CLIENT CODE: MARLN-2 Christine Watson 3/8/2013 6:32:36 AM Pave 1 of 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-091884 VINCENT J rAmoo - 58 LIBERTY LANE MARSTONS lYiIEIS Expiration Commissioner 01/2412015 f:. ✓� i�Olnyl�zdzfl� O�✓� LllJec� i I Office of Consumer AtfaiKs&Business fiegulahon. �i License of re rstrat!on vaffd for rndtvtdut use ottf r s' before the eggrratian date 1(f found return to: OM�IMPROVEMENTCONIRpGT(JfZ 1? - Office of Consumet Affairs and Business Regplation Reglstratiott pggl Type 1(i Parkpiaxa Suite 5t* . Sxpira 4 5tippCerhenitartlastonf MARINE LtJ ql ` 1 !� a VIN:BrhARINO j t t�4 LOWER OliAiS �fit �nderscretary otv f►d.Wtthout!sfgnatit?e i TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION .. v Map G Parcel 5 Applicatioh # U `Y 7X-) Health'Division Date Issued -I Conservation Division `-- Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address 90 )P1 7 C_ Village 4-viA .5 Owner 7ud t —Tl.w, /401Jvn('AAA,1 Address f Y ' Telephone_ 3 7 $ - / S 9 3 Permit Request ,24 e 4,�e s F /oori .1 hsvls �i o l*) l oo k't i) {1 e t t iid e;p q Re v-4 -r,*,G IV a eHi , i ► .v i' 4C err ! 0 1 ' ✓-i ��' v� Square feet: 1 st floor: existing p oposed 2nd floor: existing proposed otal new Zoning District Flood Plain Groundwater Overlay Project Valuation D Goo _Construction Type i'�i^l n CCU t Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family�d Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: A Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 2 new 2 Half: existing new Number of Bedrooms: 3 existing 3 new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ))J Oil ❑ Electric ❑ Other Central Air: ❑Yes P No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# _ . Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) / / Name :r L bS uct Z. 6dh e x) Telephone Number �d �v�19 ' C1,990 Address Addresszoga. Old ,54cfqf, t' License # CS 7/ %Q a• ce44eyvl Ile , m14 D Home Improvement Contractor# 11��j(o o2 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE C-+/ l DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED , E MAP/PARCEL NO. re ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: a FOUNDATION r: FRAME INSULATION: "a Y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL I ' FINAL BUILDING-- DATE CLOSED OUT ASSOCIATION PLAN NO. 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): ��1 y1y � �� � n e aj,S+S Address: Po, Rw( /-/ 9 :o� � -�a�l�ri u� City/State/Zip: w/ Phone#: ///. Are you an employer? Check the appropriate box: Type of project(required): 1.DQ I am a employer with 1O 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 8. ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp.insurance comp. insurance.$ 9. El Building addition required.] 5. ❑ We are a corporation and its 10.® Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 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. $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'camp.policy number. I am an employer that is providing workers'compensation insurance fir my employees. Below is thepolicy and job site information. Insurance Company Name: ur Policy#or Self-ins.Lic.#: p Expiration Date: b 42 Job Site Address: - Clea City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy nu ber and a pvration 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 cer tf un a the pains and penalties of perjury that the information provided above is true and correct. Ll SignE Date: 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#: Aco CERTIFICATE OF LIABILITY INSURANCE D9 IDOIYYYY) �.,..� 12/2/9/zolo 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(les)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 Ileu of such endorsements. PRODUCER c Catherine Murray Oceanside Insurance Group PHONE (508)775-0500 PAC No:(500)790-7955 Oceanside Insurance Agency Inc E-MAIL Oceanside oceansideinsurance.com 52 West Main Street PRODUCER IDP0006116 H annis MA 02601 INSURERS AFFORDING COVERAGE NAIC0 INSURED INSURER A Arbella protection Insurance Benabby, INC. INSURER B:Zurich-American Assic jned Risk DBA: Disaster Specialists INSURER 0-Aockhill Insurance Cc P. 0. BOX 480 INSURERD: INSURER E: Sandwich MA 02563 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1012901739 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. LTR TYPE OF INSURANCE I; s POUCYNUMBER MMIDO FFI IMM(WAR-Y, LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE a OCCUR X 8500038944 /1/2011 /1/2012 NED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 X1 POLICY PEO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB (Eaaeddent) $ 1,000,000 ANY AUTO A ALLOWNEDAUTOS 7018400003 1/1/2011 1/1/2012 BODILY INJURY(Per person) $ X 5CHEDULEDAUT05 BODILY INJURY(Per acIdent) $ X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS PIP-Basic $ 8,000 CMPBI $ 20,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ A RETENTION S X 4600038945 /1/2011 /1/2012 $ B WORKERS COMPENSATION WC.STATU- I OTH- AND EMPLOYERS'U ABILnY y I N YI d ITS FR ANY PROPRIETORIPARTNERlEXECUTIVE E.L. CH ACCIDENT $ 5OO OOO OFFICERIMEMBER EXCLUDED? NIA 102P700 /1/2011 1/1/2012 (Mandatory In NH) If DISEASE-EA EMPLOYE $ 500,000 yes,describe under i DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 C Contractor Pollution Liab X RCPLE002420-01 1/22/2010 1/22/2011 Per Occ/EachOcc $1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddKlonal Remarks Schedule,If more space Is required) Crawford & Company and Crawford Contractor Connection, a division of Crawford & Company, Frankenmuth, USAA and The Hartford are named as additional insureds for the above listed coverage's and policies, as they apply to work performed for Crawford Contractor Connection (excluding Workers' Compensation). The policies shall not restrict coverage for completed operations for the insured or the additional insureds. The General CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C Murray CIC/KG ACORD 25(2009109) 01988-2009 ACORD CORPORATION. All rights reserved. INS025 pcogog) The ACORD name and logo are registered marks of ACORD 0 ice o onsumer A fa s an Business Regu ation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improver d,Contractor Registration Registration: 108642 Type; Supplement Card "{ Expiration: 8/20/2012 BENABBY INC/ DISASTER SPECyFS, JOSH COHEN 9 Jan-Sebastian Way Sandwich, MA02563 Update Address and return card.Mark reason for change. Address Renewal ❑ Employment Lost Card )PS-CA1 0 50M-04/04-0 1 01 2le 92. rellw arecueaa a�✓�aaocac�uaelta Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: s / Office of Consumer Affairs and Business Regulation Registration;; ;108.642 J TYpe: 10 Park Plaza-Suite 51'70 Expir4tlt5h $M*012 Supplement Card Boston,MA 02116 BENABBY INC/"b[SASTtR---SP;EGtALIST JOSH COHEN � __°`_}� - - _ /J✓ Box 480 Sandwich,MA 02563``:^"` `' Undersecretary Not valid without signature f ' Massachusetts- Department of Public Safety -Board of Building Regrejatiorls and Staridarcls Construction_Su rvisor and License: CS 71402 Restricted to: 00 JOSHUA L COHEN - 1082 OLD STAGE RD CENTERVILLE, MA 02632 Expiration: 1 2131/201 1 i Corlunitsinaer Tr#: 12833 Restricted to: 00 00- Unrestricted IG=1 2 Family Homes i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: www.Mass.Gov/DPS Town of Barnstable o� Regulatory Services s� `�$ Thomas F. Geiler,Director�EO► A. 'Building Division Tom Perry,Building Commissioner 200 Main Street,Hyamais,MA 02601 www.to wn.b arnstab l e.ma.us Dfice: 508-862403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject ro e P P rtY hereby authorize 7SA U Le,v to act on my behalf, in all matters relative to work authorized by this building pew application for. 90 -4( Lee V-S 06 (Address of Ja �La7oll. 5zgna o Owner Date Print Name If Propertv Owner is applying for permit please complete the Homeowners License Exemption Form on -the reverse side. Q:FoRMs:oVINERPERtY ISMON ' s - F THE r Town of Barnstable o Regulatory Services y w r Thomas F. Geiler,Director �E ;,•�� Building Division Tom Perry, Building Commissioner 200 Main-StrcetHYannis,MA 02601 www.t o wn.b arnstab l e.ma.us Office: 50 8-862-403 8 Fax: 50 8-790-623 0 HOMEOWNER LICENSE EXEMPTION Pleare Print DATE': JOB LOCAnON: numbs street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS:- city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a•license,provided that the owner acts as supervisor. DEFT CTION OF HOMEOWKER Parson(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to- be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constrgcts more than one home in a two-year period shall not be considered a hameowncr. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work perfarnzed under the building permit. (Section I09.1.1) T4c undersigned"homeowners'assl es responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies thatWshe understands the Town of Barnstable Building Department minIrmim inspection procedures and requiremcnts and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Budding Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to,6oaq)ly with the State Building Code Section 127.0 Construction Control. HOMMOWNER'S EXEMPTION -The Code states that: "Any bornmv ner performing work for which a building permit is requimd shall be exrurpt from the provisions of this section.(Seetion 109.1.1-U=nsing of emutruetion Supmrisors);provided that if the homeowner engages a persem(s)for bin to do such wor,that such Homeowner shall act as supa-visor^ XLny homeowners who use this ezcmptioa arz unaware that they an assuming the responnblities of a supervisor(see Appendix Q, Rules&Regulations for Liecsrsing Camstrvetion Supervisors,Section 2.15) This lack of awareness eft=results in serious problems,particularly when the homeowner hues unlicensed p=DTM* In.this case,ow Board cannot proceed against the unlicensed person as it Wrou)d with a licensed Supervisor. The homcown er acting as Supervisor is ultimately responsible. To ensure that the hamcowncr is fully awarz of his/her r<sponsibilities,many communities require,as part of the permit application, that the homeowner certify that helshe understands the rapemm'brlities of a Supervisor. On the last page of this issue is s form ever errt]y used by several towns. You may care t amend and adopt such a fora/certification for use in your community. Q:for ns:homco cmpt o2825 ! SUBDIVISION PLAN OF LAND IN BARNSTABLE Nelson Bearse - Richard Law, Surveyors i ~ November 28, 1962 E $ 22 ( a0 h L b .goo . 25 at.660... _8J17- P re e h W . ! j 24 ! P7 Q - 2 lit ' i I I c.i ` ' '�2p� • I I ee i I � I Su visioh of Lot 23 9h on Plan 228251 Ril with Cprt. of Title No. 17164 No try District of Barnstable County to cerri eOeS of rite may be issued for land Copy of paA of p/Jn LAND RMISTRAT/oN OF17CE LIST_ Seale of thisp✓en 60 feet to an ina C.M.Anderson,&VhWr 16r Cow!'Z �G /ram �,� : , . �d v� o�X �j �! L ih .. ,, Y Y r � � x- �00 �' i o 104� 1 v 9 1 V 1\ I ' Barnstable ry Services Geiler,Director g Division ding Commissioner Hyannis,MA 02601 Fax: 508-790-6230 rcial Additions/Alterations (if applicable). g the location and setbacks of existing/proposed of the Mid Cape Highway) istrict(See map for boundaries) full sized plans and one complete set lized must be submitted with the building original architect or engineer's stamp. Note: plans tothe appropriate Fire Department nat LP vied-d-ntpa nri 228205K SUBDIVISION PLAN OF LAND IN BARNSTABLE Nelson Bearse - Richard Law, Surveyors H November 28, 1962 . W E - y � 22 Q o0 3 �o �r c6C..9Y �c g °�B7 25 k8T°r6 00"E R' .-� C.B. = 3 26 0 0 ' 16 a 9 2 .En 9 F 24 2a Q o � c.B /2pp0 T.9u ya.si" jar 4. - I s Assessor's ma. �iand'�=mot number o��d. `7S M1 a y Sewage Permit number ...,j o...,.. ......,��.f!f lk .....Qi� T"E.r TOWN OF BARNSTABLE i i 33nNSTOILE, i O�Yae�, : BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......:...e... .......1.4......................................�........>�.............................. TYPE OF CONSTRUCTION ..................0-9.0.:p................................................................................................. .........5� T..........�...::....19.T... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........................ ....... .......... .. ................................................................................ ProposedUse ....................s ..6,..,v.......A9:k G/�.................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner .....4.t.1.."I.P.../-�' �.c�F 4. ........................Address ...s .`/.d...../..l..T...�-!` . �i.5....... t.Y............ Name of Builder ............................../{26 !moo �f �vE7Z�Y � .... ..........................Address .... ....... ... ................ ................................ ......... Nameof Architect ............:........................I............................Address .................................................................................... Number of Rooms ..................................................................Foundation .../css�-s c.� C.cflE:v.T....��4 ................................ Exierior ......... .........................................................................Roofing ..........:......................................................................... Floors ......... Q. .................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ................7................................................ Definitive Plan Approved by Planning Board ---------------_---------------19________ . Area ....... ..,� ...�:. ....:....... Diagram of Lot and Building with' Dimensions Fee ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH T dou.v D X y 1 , yI 5 c U I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 4 Name ... .......... .... ............... Rivers, L. H. ` ' 17333 deck No ................. Permit-for .................................... ...................................... ........................................ Location .....29O..I,1tuhero..Way............... ............................... /w ^ Hyannis � '---------------^----^------' �1�era Owner -- ^ ^ ^ '~ ----------------.---. \ , � � Type of Construction ---—�rame---------- -------------------^------'' } ^ ^ Plot ............................. Lot ................................ ( ^ ~ � �8 25 74 / Permit Gron*a6 .---..�� —..�lP Date of Inspection ......................................lq � Dote Comu|afa6 � � . r PERMIT'REOUSED ' ( ^ ' lA-----_—.----.--------,. - ' . . ---------------.---.':'-----.. . —_---..---------~----.----. . � ° ................................................. � —...--.------.—.---.—.--.—.---. . . Approved ---------------.. lA / ^ -----------------,---...---. . ~ ---..--------..------,—.—.—_. ' � ^ � � � + Fr _ �y� 'P4� fir` — .i l - - �• 1. �r r ' . , Assessor's m d dot; numberR a ti..,, .r •.,; Sewa&e I?erm:it r w-9ber ...tau., : ? rl<L 'A' `O 0 ARTSIv BL fe B'U�I !D I:UG a ��H R '���O R. . , ApA ICAT10K E�OR PERMIT TO,;,�.�.x.v!'r4d'! : ae�. : .�. ? ,,. ,.._ rYfB `QF COiwSTRUtTION' ;'.............. ,>rt.s�t.. �� ..............._ ,;... . .. 1u, l T4 NHL' IM PtCTOR OF BUILDINGS: The undersigned h-ir ' 7 gppl es #or ; permit ,according to the following inf-oT.mation, + 4 Lgcotlon ....; •y . .. ,�,,: ,:. � 1!,� rr+l»',~ .. .,.,. ` . ... ...................... ..... .. ......... . ............. .f Coposo4 Qse- '.. ..g.4y�.y."Iff-e. .,.,9dC• ..1wK'6?,:....... .... .............u_:++.�{; ... ... ..... .. . . -Zbning '.Qistrict .,...f...... ..,•.................. a. .:Fire District ...... ., . ... .. Name ofj Owner d/•, ,,pq4 I, « .Z , , . .I...... . .:Address.`. .. a..:��. � s �E: .S.. .I,�: r:. .... •�+ ,_ 'Nam@ ull der '4',! '.�✓..�r .,.. G'4.. ib'�'-J .nt. .Acld1$ss. .: ......••��.L r, .. ,T.. . . .'..J?!..;:' r� .r Name; o ',rIiict, �. ., .., ..,. .. .+�.•......, u ...... .... :..Address :. ,� a..: .. ... . L ., . . ..... k a .� ton4� ter✓ . f*. '? . .s- { Nurnbgr of Rooms. Foundb s r'� = Exleri_or , .� r., _ �....,,�r.r, ........ .................Roofing �. 4 Hoof, � /- JJII,d.�.d,:.. Lr.� .. .Jffler.ior' ....... .. ....... ........ ..: ... . .� .1T.. . ;Rltirr�bun., ;. ,:.. . .rv.,: . ... . ... .y J y V T 1 / ' .. .. i=rr place a .., , . .., ....... .Ap�,roxi�niote Cost ...............?nq , .... ... L t r.L Def�nit,�.e PlsaryApproved b}r RlQnning Board' _ - — 1.____19 Area. I i s- D`agrgm of Lot and Building with Dimension's t u BOAR W SUBJEQP TC7 A, 'OVAL OF B OF HEALTH° k l r • K 1 T ' r ' ,I +heireb r4�argree to conform to ail the RulJes and Re';ulations'of1he Town.of Barnstable regarding the.above . r ;cpnstru tion.. �{ Rivers L. l9. � �w�� No _�����'.' per�itfor ^'^~--._._-^,-,^,^ ' ` ` _.°--~^�.._, ~-..^~.-.�'~_^.......................... ~ ` `290 Pitchers Way ~~ .^."~ "". -._----~-'~-'~-_-_--'--_---.- ` ' ' Hyaula � �-.^_----_-..........._.------. .................... � L. B. Rivera ' ~~..~ -_--.._.___..~-'^--__^~~_ � :f came Type of Construction ........................................... .........................~ ~~---'-~-'~~—^~'--'~-- Plot ..................;........ Lot ................................ ' Permit Granted ' ........ ,�� l� 74 ` Dote of Inspection ........ ..........................19 � Date Completed ............ ............... .........l9 ' ` ` . ` PERMIT REFUSED ' -.~',.-.~-'.-..�-...._--_--.-.... 19 ~ . . _~..~......,- .......................................... ' -._--_---_-,___.`~._'-,~--._-_.-^ ` ' �~..........................`F^—~^^`~~^~—~^-'-- -~~ ~ � ................-,__u..'-,~__'.._._,................... ' . ' Approved ................................................. 19 ' ~ .-.-.`.---~...~-....'._~.._-..-..._.~_ � _-'-.---~-.-.-..'--._---^,_.~.,.~^~... ' � | TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION Map Parcel QzA5 Application # �''^a Health Division Date Issued Conservation Division Application Fee } Planning Dept:. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 90 / ns 6c-� Village w A_� Owner 9�7k-ia Address ��G cc 5 VIv1 r` /14 Telephone 7-2 /.5-�/ 3 41l3 2640 04 (� Permit Request - l2emov e �l/ Lcae & ,,hx//J 44 d/4AS pev IU Square feet: 1 st floor: existing— proposed 2nd floor: existing ►� f�proposed � � Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ®®�' Construction Type Lot Size 6�, QC Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family- Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes �(No On Old King's Highway: ❑Yes I-No Basement Type: W Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas 4 Oil ❑ Electric ❑ Other I� Central Air: ❑Yes 40 No Fireplaces: Existing 1 New jj Existing wood/coal stove: L3 Yes Jk No Detached garage: ❑ exig?140 ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing '❑new size_ Attached garage:' e isting ❑ new size _Shed: ❑ existing ❑ ee44-size _ Other: f�J- Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )d No If yes, site plan review# Current Use Proposed UseC�LI'n'1eJ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �0��'1 C1�1�6'� Telephone Number Address jb eq, (:�d mil.[� License# 7l)-/ o� Cr"a PcL2i 11.E Home Improvement Contractor# R(0� Worker's Compensation # U a P 7 00 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE v 2 •' FOR OFFICIAL USE ONLY i f - APPLICATION# 4 DATE ISSUED MAP/PARCEL NO- ADDRESS VILLAGE OWNER y i DATE OF INSPECTION: ,FOUNDATION: .' { FRAME INSULATION ,w FIREPLACE ,r ELECTRICAL: ROUGH FINAL r� PLUMBING: ROUGH FINAL 'GAS ROUGH _: �' FINAL F +INAL BUILDING $ -!"RP, DATE CLOSED OUT E ASSOCIATION PLAN NO. 4 The Commonwealth of Massachusetts ` r Department of Industrial Accidents 'R 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):�aLbW �T , �/)✓1A �nnSl� SDECI �ISIS Address: Po, Roy q�/9 Tan SSe ��inn J�`��('1 V City/State/Zip: W/ Phone#: rg g08 / Are you an employer? Check the appropriate box: Type of project(required): I. I am a employer with 1O 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 8. Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ 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. I am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Zuri —Ame-rinan Policy#or Self-ins. Lic.M Expiration Date: Job Site Address: City/State/Zip: P Attach a copy of the workers' compensation policy 9eclaration 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 cer fy un a the pains and penalties of perjury that the information provided above is true and correct. Signature: P1441 Date: 12-DI Phone#:t6e= 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 M A��V® CERTIFICATE OF LIABILITY INSURANCE 12%9�2010 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(les)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 NAME CT Catherine Murray Oceanside Insurance Group PHONE (508)775-0500 nl�cNo:(5oe)79o-7955 Oceanside Insurance Agency Inc ADDDRESS:catherine@oceansideinsurance.com 52 West Main Street PRODUCER p0006116 Hyannis MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER AArbella Protection Insurance Benabby, INC. INSURER B:Zurich-American AssicIned Risk DBA: Disaster Specialists INSURERCRockhill Insurance Co P. 0. BOX 480 INSURER D: INSURER E: Sandwich MA 02563 INSURERF: COVERAGES CERTIFICATE NUMBER-CLI012901739 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. 1�R DDLyUBR POLICYDY EFF EXP7 TYPEOFINSURANCE I POLICY NUMBER POLICY MM� LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY D ( REN ED PREEMIMI E SESS Ea occunence) $ 100,000 A CLAIMS-MADE 5XI OCCUR X 8500038944 /1/2011 /1/2012 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JE4 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED AUTOS 7018400003 /1/2011 /1/2012 BODILY INJURY(Per accident) $ rXX SCHEDULED AUTOS PROPERTY DAMAGE HIREDAUTOS (Per accident) $ NON-OWNED AUTOS PIP-Basic $ 8,000 CMPBI $ 20,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAR Hx CLAIMS-MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ A RETENTION $ X 600038945 /1/2011 /1/2012 $ B WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) 4102P700 /1/2011 /1/2012 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL. DISEASE-POLICY LIMIT $ 500,000 C Contractor Pollution Li ab X CPLE002420-01 1/22/2010 1/22/2011 per OcclEach Occ $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Crawford 6 Company and Crawford Contractor Connection, a division of Crawford 6 Company, Frankenmuth, USA& and The Hartford are named as additional insureds for the above listed coverage's and policies, as they apply to work performed for Crawford Contractor Connection (excluding Workers' Compensation). The policies shall not restrict coverage for completed operations for the insured or the additional insureds. The General CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C Murray CIC/KG ACORD 25(2009109) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(200909) The ACORD name and logo are registered marks of ACORD OfriceM�onsumerai s an Busi�Reguon 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvee_rt Contractor Registration a- � Registration: 108642 Type: Supplement Card Expiration: 8/20/2012 l BENABBY INC/ DISASTER SPECIALI:_. JOSH COHEN = =- =` 9 Jan-Sebastian Way Sandwich, MA 02563 -- Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card )PS-CA1 0 50M-04/04-G101216 �le -�orr�:naruuealt�i a�./l�ac�iccaet7a Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration•.n-108642 Type: 10 Park Plaza-Suite 5170 Expirat on 98 20/2012 Supplement Card Boston,MA 02116 BENABBY INC%DISASTER SPECIALIST JOSH COHEN Box 480 Sandwich, MA 02563 = %' Undersecretary Not valid without signature " IIassacbusetts.- Department of Public Safet Board of BuildinI Regulations and Sturidurds Construction Supervisor License License: CS 71402 { Restricted to:.00 JOSHUA L COHEN 1 1082 OLD STAGE RD CENTERVILLE, MA 02632 ; Expiration: 12/31/2011 ('unmnisiuiicr Tr#: 12833 i Restricted to: 00 t oo- Unrestricted 1G.1 2 Family Homes • i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: Y;",Mass.Gov/DPS i ;Sts Spe��a1 We Make Disasters Disappear DISASTER SPECIALISTS PROFESSIONAL RESTORATION ASSIGNMENT AND AUTHORIZATION TO PAY The undersigned, herein called claimant, has authorized and ordered from Disaster Specialists, the materials and/or services as agreed upon. This agreement shall not be considered a release and/or proof of loss. Claimant hereby assigns to Disaster Specialists any unpaid proceeds due or to become due, under the claimant's policy with the insurance company to pay direct to Disaster Specialists or to include Disaster Specialists'name on check or draft. In the event that Disaster Specialists'claim herein is not covered by, or paid by, insurance company, claimant agrees to pay Disaster Specialists within sixty(60)days after work has been completed. Claimant understand that Disaster Specialists is working for them and not the insurance company or the adjuster. Payments remaining due and payable after claimant has received payment from the insurance company shall bear interest at a rate of one and one-half(1-1/2%) percent per month. In the event of breach by claimant of any of the conditions of this agreement, Disaster Specialists shall be entitled to recover, as additional damages, attorneys'fees, costs and any other collection expenses reasonably attributable to said breach. If payment is not received within 60 days, collection action will commence without further notice to Claimant. Date 4.4 4"'o ClaInt's Signature Disaster Specialists • Post Office Box 480 • Sandwich, Massachusetts 02563 508-888-1113 • 800-675-3622 • FAX: 508-888-2951 • info@disasterspecialists.com OFIKME . Town of Barnstable ` Regulatory Services saxxsxea[.e. ueas. �, Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property p rty Owner Must � Complete and Sign This Section If Using A Builder �1 1, ce iV , as Owner of the subject property hereby authorize D/:SC ,,— to act on my behalf, in all matters relative to work authorized by this building permit application for: � S (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FO RMS:O WNERPERMTSS]ON Town of Barnstable _ Hof t�try Regulatory Services Thomas F.Geiler,Director ''s� Building Division rfD `i Tom Perry,Building Commissioner 200 Main.Sireet,_ Hyannis,MA.02601. www.town.barnstable.ma us Office 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a bomeowner. Such "homeowner"shall submil"fo the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that,he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homcowncr shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responnbilitiu,many communities require,as part of the permit application, that the hDlneoWner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currcndy used by several towns. You may care t amend and adopt such a forrri/certification for use in your community. Q:forms:homecxcmpt