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HomeMy WebLinkAbout0082 SAINT JOSEPH STREET C�.� �f. vosc fx,s �f. �' L r SSP Kwil of Barnstable Permit# SEp .. 6+ 2013 Expires 6 onehs from issue date * Regulatory Services Fee Thomas F.Geiler,Director " Building Division Tom Perry,CBO, Building Commissioner, 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 9 f o y Not Valid without Red X-Press Imprint Map/parcel Number l L U T 3 9- t� Property Address T' a S f, 3 D S,- ❑Residential Value of Work$ S , a��� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address p rn 1 4-r wT � 6'C-2— 1 r\ - Ta S4- SoSI_P HS -77 Contractor's Nape Telephone Number So 1 as 1 MS � Home Improvement Contractor License#(if applicable) l 6 7 -7 8/ Email: M u L L I Q RdQ T=./6y 6 0 6M 1 L,t`_blh Construction Supervisor's License#(if applicable) 0 07 ❑Workman's Compensation Insurance I Check one: I ❑ I am a sole proprietor ❑ I arn the Homeowner I have Worker's Compensation Insurance Insurance Company Name Vf Z. Workman's Comp.Policy# Ug 4 3 3 ®y s Copy of Insurance Compliance Certificate must accompany each permit. Permit Reques heck box) e-roof(hurricane nailed)(stripping old shingles) All constriction debris will be taken t044±2� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ 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 required. SIGNATURE: QAWPFILESTORMS\building permit forms\EXPRESS.doc Revised 060513 CONSTRUCTION CONTRA6T This Construction Contract (the "Contract") is made and entered into as of 8-23-13 (Date), by and between Dmitry Berezin (Name, hereinafter called the "Customer") and Mark M. Mullin, DBA Mullin Roofing and Siding, having its principal office at 7 Connemara Way, W. Yarmouth MA 02673 (hereafter called the "Contractor"). Property Location: 82 St. Joseph St. Hyannis, MA In consideration of the mutual promises hereafter set forth and intending to be bound hereby, the parties hereto agree as follows: Contractor's Obligations. Contractor shall complete the following Project herein described in and shall provide supervision necessary to commence and finish the Project expeditiously, in a workmanlike manner, in accordance with the "all applicable codes, laws ordinances, rules, regulations and orders. Description of'Work". Contractor shall do all the work in accordance with the terms of this Contract, as described: Remove existing asphalt roofing from the home while protecting the home and landscape. Inspect the roof decking for rotted or damaged decking and replace up to fifty square feet of. roof decking if necessary. Nail down any loose decking with ring shank nails to ensure a solid roof deck. Install ice and water shield on all eaves, rakes, and pipes. Install a high performance roofing underlayment on the remaining roof deck. Install.new drip edge on the eaves and rakes. Install Pro start starter shingles by GAF on all eaves and rakes. Install new Timberline . architectural roofing shingles by GAF using six nails per shingle, and installed to factory specifications. Install Cobra ridge vent by GAF on the ridge of the home, and cap the ridge with Timbertex ridge caps. After completion of the roof, I will register your roof with GAF for the fifty .year 100% labor, 100% material warranty. Contract Sum. In consideration of the performance by Contractor of its duties and obi tions, hereunder, Customer shall pay to contractor the sum of '$ '5— 5-001�� 1 Payment schedule: Owner shall pay the contractor 0% of the contract sum upon signing the contract, 50% upon start of the work, and 50% upon completion of the contract work. Contractor's Responsibility.:Contractor is an independent contractor for all Work to be performed hereunder. The detailed manner and method of doing the Work shall be under the control of the Contractor. All employees of the Contractor performing Work under this Contract shall be and remain the Contractor's employees. a. The Contractor shall supervise and direct the-Work, using its best skills. Job Safety. Contractor shall be responsible for initiating, maintaining and supervising all safety precautions in connection with the Work. Page 1 Permits Fees and Notices. The Contiautoi shall sectire and pay fQF all perraits and governmental fees, licenses and inspections necessary for the proper execution and completion of the Work. Such permits and licenses shall be the property of the Customer and shall be delivered to the Customer upon request. The Contractor shall.give all notices and comply with all applicable codes, laws, ordinances, rules, regulations and orders of any public \ authority in connection with the performance of the Work and the Contractor's obligations hereunder. `,. Insurance. Contractor acknowledges and agrees that Customer or Owne r shall not be •z. obligated to carry any insurance in connection with the Work for the benefit of the Contractor. Contractor's Insurance`. Contractor shall at all times maintain and keep in full force and effect, at its expense, any and all insurance coverage which is prudent, necessary or desirable for the protection of the interests of Contractor. Contractor shall furnish to Customer certificates of insurance for the following types of insurance. a. Commercial General Liability Insurance; b. Workers' Compensation Insurance to cover full Liability under the Workers' Compensation Laws. IN WITNESS WHEREOF, the parties hereto have executed this Contract as of the day and year first above written. Customer Contractor Company By; By: Z -�7, Print: Dmitry Berezin Print: Mark Mullin dba Mullin Roofing & Siding Inc. Address: 82 St, Joseph St. Hyannis, MA 7 Connemara way W. Yarmouth MA. 02673 60157 5—7 7-— ! 508-221-8591 Phone number: - - Date: 8-23-13 Date: 8-23-13 Email: dmberezin@hotmail.com License No. HIC# 167281 CSL# 104076 Page 2 the Comrnounwalth ofMassachuse& Department of Industrial Accidents ......: Office of Im estigations s 600 WashiWgton Street Boston,MA 02111 wnm rtrasmgovldirt Workers' CompensationInsarance,Affidavit:Builders/ContractorsMectriciansMumbers Applicant Information ® �' Please Print LegiMTy Name Musmessldrganizationffndiaidml): A &ens: oD 6el V 7 3 City/Sta&Zip_ Phone s 1 4- S 9 Are you an employer?Check the appropriate boz: T}Ipe of project(required): 1.H I am a employer with 4. ❑ I alai a general contractor and 1 6- ❑New construction. employees(full and/or part-ime)* have hired the sub-contractors. 2_❑ I am a sole proprietor orpartner- listed on the attached sheet y- ❑Remodeling ship and have no employees These sub-contractors have g- ❑Demolition. w for me in an capacity employees and have workers' orktng y apa. ty. 9. ❑Building addition [No workers' camp.insurance comp.insurariml _❑ We area corporation and its 10-.❑Electrical repairs or additions 3_❑ I am a homeowner doing all wort{ officers have exercised their 1I-❑Plumbing repairs or additions mys9f [No workers'conip- right of exemption per MGL 12-.❑Roof repairs insurance required-]3 c. 152,§1(4) and we have no employees.[No workers' 13.:❑Other comp-insurance required.] *Amy wpNomt that checks boa#I/dull also fill out the:section below showing lieu worikes'compensation polio}'infurnutian- T Sameowners who submit this sitidM indicating they are doing all txadk and then hie oumde contractors mast sdbr it a mw affidavit indicating such_ tractors that check this boa must attached as additional sheet showing the=nee of the sub-caatractdrs and state whether ormot those eatities have employees. If the suh-contraddrs have emeplDyeies,they must provide their workers'comp.policy number., I am an employer that isproviding workers'colt mnsation insurance for irz.y employes. Below is the policy arld job site information. Insurance Company Name: U i lt�— K, Policy#or Self-ins.Lic.4: -- g o T S F$3` Y~Expiration Date: Job Site Address: g D. St -o s e p h C STi C ity/S taWZip:- � y a h n i S' Attach a-copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requireduuder Section.25A o€MGL c. 152 can head to the imposition of criminal ptmalties 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 maybe forwarded to the Office of fineudgations of the DIA€or insurance coverage veriffcation- I do hereby cerhfyunder the pains and penalties ofpedury that the information primided abmwe is true and correct Date: 9--6-1 /3 Phone Qjki.aI use only. Do not write in this area,to be completed by city or town officiaL. City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Binding Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Ph-one#c Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 constrict buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally;.MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(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 Departr-ient 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 burn 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 Industdal Accidents Office of lvestigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4940 W 406 or 1-9 77 MASWE Revised 4-24-07 Fax#617-727-7749 www.mass-gov/dia 9LOVOl1` :uoite;idx3 L0Z/L(6 A 8£9Z0 VN 'INV ,38`dhR 3 3n`d AN83d 0L a N-11nw iadw a (s 0 o pa;�r r;sa21i asuaoa yes+nin iroiloni;suoD pua�tS [fur. uc�prin;oa� 1u P'��9 i �[z;S.'�ryynd�01uiiuir�. aQ ti11-)sn _ t= {airs&,B.asness Regutatton License or eXg ration date. If founds return to: ©fie{pt�onsnmer A€ TOR I.: before the p ' "1VtPROV �COW(iiAC Type: _ Office of Consumer Affairs and Bus►ness Regulation e'g�stratro� �67281` DaA: 10 Park Plaza-Suite 5170 t 8/30/2014 Boston,.MA 02116 ` r xprration t._. .. MIILLIN RbOFING AND SDING 1 i MARK MULLM' ` �,i 7 CONNEMARr+1NAY �- MA 026 3 budersecretary . Not valid without signature W.YARMbUTHr . �!:, _ - ® DATE A��� CERTIFICATE OF LIABILITY INSURANCEF771/4/13 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: Margaret J Grassi Ins Agency PHONE Fax (508) 295-2007 / No: (508) 291-1707 1188 Main Street E-MAIL : debmjgins@comcast.net West Wareham, MA 02576 -ADDRESS - INSURE PAS)AFFORDING COVERAGE NAIC# _ I NSU RER A:A111 ed INSURED INSURERB:ColonV Insurance AqencV Mark M Mullin INSURER C: 7 Connemara Way INSURERD: West Yarmouth, MA 02673 1NSURERE: INSURER F: 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 MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POUCY EXP LTR TYPEOFINSURANCE INSR WVD POLICY NUMBER M/DD/Y MM/DDYYYY LIMITS B GENERALLIABILITY GL3818794 1/5/13 1/5/14 EACH.000URRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED rrence $ ZOO OOO CLAIMS-MADE DOCCUR ME EXP(Aryone person) $ 5,000 PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 . GENLAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,0 0,000 1-1 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMB Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL 0 WNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS _AUTOS (par.. Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 6ZZUB-4083P83-4-11 12/8/12 12/8/13 X WC STATUS OTH- AND EMPLOYERS'LIABILITY YIN ANYPROPRIETDRIPARTNER/EXECUTNE E.L.EACH ACCIDENT $ .1,000,000 OFFICER/MEMBER EXCLUDED? 7 N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ .1,000,000 If yyes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Renerks Schedule,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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZ PRE ENTATIVE i ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Town of Barnstable *Permit#�2e���a4��— V' l Expires 6 anihs from issue date Regulatory Services Fee Thomas F.Geiler,Director n g' PERMIT IVI[ Building Division APR 0.5 2007 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOW,N OF BARNSTABLE www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION .- RESIDENTIAL ONLY Not Valid out Red X Press Imprint [ap/parcel Number roperty Address ]Residential Value of Work �46`87® Minimum fee of$25.00 for work under$6000.00 iwner's Name&Address y(_�w •;P6s10A/ lhtl- Id- -z :ontractor's Name �'� / '"'`�i /i�C, Telephone Number 7 3 — d777 lome Improvement Contractor License#(if applicable) / 3 g!O h Licerrse-#�if-applreablej .. . ._.. Kkman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner e Worker's Compensation Insurance asuranncece�TT111TComp any Name Vorkman's Comp.Policy# :opy of Insurance Compliance Certificate must be on file. -emut Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(no. tripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: issuance of this permit does not exempt compliance with other town departmentregulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property.Owner.Letter of Permission. A copy of the H me Improvement Contractors License is required. IIGNATURE: I:Forms:expmtrg .evise061306 Board o Build►ng Regulations and Standards HOME IMPROVEMENT CONTRACTOR f� Registration 139665 Expiratwn 8G112007lug Type p- to Corporation EARTH SAFE,INC1 {''3 STEPHEN ORBS :y 140 PLEASANT LAKE3AV G�--� HARWICH,MA 02645 Administrator .. , e Y License or registration valid for individul use only I i before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 i Boston,Ma.02108 ' j I Not valid without signature j .t d9 .. .may II Stephen L. Ore Earth Safe, Inc. 140 Pleasant Lake Avenue Harwich, MA-02645=2532 (508)430-0777/Fax(508)430-0730 Change Order I authorize Earth Safe, Inc.to proceed with the additional work required due to rot occurring between the.deck structure and the sill plate in the rear of the house. This necessitates the need for new: sill 2X6, 2X10 support on top of sill plate, 2X4 studs, plywood sheathing, clapboards, and affected trim areas. Supporting the rear of house was necessary while new sill structure was being constructed,to prevent sagging of rear of house. In addition, I authorize Earth Safe, Inc. to remove and replace the rotted plywood roof decking, and any other adjacent rotted members under the existing robber roof,prior to repairing roof. I understand that there will be an additional charge for this work, because of the added labor and materials required. In all other respects,the contract work(Quote.no. 032407-1) shall remain unchanged. Customer Signature: Date:3/30/07 Contractor Portion All change order work shall be completed as noted above, including all work in accordance with�the Massachusetts Building Code. Contractor Signature: Date: 3/30/07 + " The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations d 600 Washington Street Boston,MA 02111 5� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information J Please Print Lezibly' Name(Business/Organizationadividual); Address: � �LG' � /i� �/ City/State/Zip: }�9z / Phone.#: L0 --'77. Are you an employer?Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6: ❑New sstruction.. 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 tY 9. ❑Building addition [No workers' comp.insurance comp.insurance.t 5. We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work fficers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 oof 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. R I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: /7 W C -7 0-;�L- Expiration Date: Job Site Address: 'Tbs-V 5'11tf�i9rJ,1/ts City/State/Zip: �alS Q26o% . 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: o 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#: ' i Information and Insttuctions 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 hiie, 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 receiveLnr tnitee 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 vsrith 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-contiactor(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 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 �tovvn)."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 Nlassaehusetts De,paranemt of Industrial Aeeiclents Office of Investigations 600 Washington Street Boston,NIA 02111 Tel. ##617-727-4900 ext 406 or 1-977-MASSAFE Fax##617-727-7749 Revised 11-22-06 w.mass.gov#dia 4 1 .T, Assessor's map and lot number ...�.. . :���....!. a !OoOe / 9-•7 d SEPTIC SYSTEM MUST BE ,,.,. Sew' ";ageL'Permit number ........ ...� .. ... ..... :7.ty. r�.,c/%� INSTALLED 'IN COMPLIANCE ' . WITH. ARTICLE If STATE �Qyofs�+E r �o 7 TOWN- OF 'B A t T�^�Yr, RD"Ll N Z H9HFSTADLE, i {, ' ,ED"b ` BUILDING ' INSPECTOR O 39• �0 APPLICATION:FOR'PERMIT TO Rf.M!�.�.T... . �Tr�cN��....G.!�R;A6£:............ TYPE OF CONSTRUCTION ..........;. BP.. ...4c RA/!'RA ...................... ............................ v :........0ew7�Q 19................19.�.7: TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 8� S�'",. f� ... �T• y�4K�S 4 ...................... ............................................ .............. ............................................................................................... ProposedUse ....... !9i'/l119�►. .................................................................................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner /4dR�....1?/A*V ......................Address 7z Sr. X 5,cpH SY #Y,+,Y,#/s Name of Builder .... ffr, CON3T � /�►���/Y �� /` // !I!i./..1/ !7,.................. ��-- .........xx ...........Address ................. ................ ..... ..... Nameof Architect .....ud ......... LO.......................Address .................................................................................... Number of. Rooms ........."" ..Foundation ,.. PRAPO CO/V�C.24F.re........................... Exierior ...Roofing ..... /0d Floors ....... �ac l�r ..................................................Interior ....4, 0 Iy .10M Heating .............Plumbing "" Fireplace ..................................................................................Approximate Cost .................................................................... .Definitive Plan Approved by Planning Board -------__�'"'""_________ Z d. -------19--------. Area ......... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH - -i o a ---� 0 a, I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. J�:.�:Name ......... .............. .�. ....................... ^ Ribeirov Laura ' -- Permit for —. --- ' to --------'--``------~^^—'—^--'--- , . Location ...... ..................... . ' - ' ---.—.--����m����---..---------- _ . ' ^ ' Owner .--]�axura.]RKbw�izo-----_.---. Type of Construction- -._----.. ---.. .'. --_- _—.---.^----.---...---.--.------ - ' . Plot ............................. Lot ................................ ' - . . ' - - . Janury 11 78 Pernnh`Gronta6 ---...����...-----]� ' - . . . - � Do�a of�| —. ' ----l9 � � -�� Dote [omo�to6 ---..� —'�--l� � � . � k PERMIT REFUSED . * �-,--...---.--...,�..,----.—,. 19 - .^---..—.. ................. ..—^.~--..—~..--. ' � . .= `. ~^'~—~^`~~`~^--'—'r-----',^~^~^—'`^' ` ~ - . -^ �^ ^ -,,,,,'..,____._.,_,._,.'?,,,,._,.',,_.___. ` ^ .' .--.—.' � . .� --_-.. . �..,..'-.—.,.'-....~..— .—. —. . ` _ _-----------.---. l� ^ ^ Approved . ^ ' —.------.—.-----.---.--~----.—.. ^ . . ---------'----'----'—'~^—'r--^' ' � [^ . Assessor's map and lot number ........1.1....... ............� 9 -7e- - Kf Sewage Permit number. ............. All Er TOWN OF BARNSTABLE DARIMBLE. 1639. 0 BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ............................................................................................................................... TYPEOF CONSTRUCTION ..................................................................................................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...................... ................................................................C I ProposedUse ........................................................I.......................................................................—(................................................ T I ZoningDistrict ........................................................................Fire District ................................. . .............................................. Nameof Owner ......................................................................Address .................................................................................... Nameof Builder ....................................................................Address ..................................................................................... Nameof Architect ..................................................................Address ................................................................................... Numberof Rooms ..................................................................Foundation ............................................................................... Exlerior ....................................................................................Roofing .................................................................................... Floors ......................................................................................Interior .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board --------------------------------19--------- Area .......................................... T) �15 Diagram of Lot and Building 'With Dimensions Fee .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ................ ................ ............................................ Ribeiro, Laura A=291-41 f 19892 add garage _ No ................. Permit for .................................... _ to dwelling ............................................................................... -..._ Location 82..St. ....Joseph. . ...St............................. .. ... .. . ........ .... . Hyannis ............................................................................... Owner ........Laura Ribeiro............................. Type of Construction frame ............................................................................... Plot ........................ Lot ................................ j anuary 11 78 Permit Granted ...... Date of Inspection ....................................19 Date Completed ......... ............................19 PERMIT REFUSED . ............................... . ........... .................. 19 ....... . .... r. ................... 'V ................................\, .. ..................................... ................................................................................ Approved ................................................ 19 ..................... ......................................................... �Vt'17--3 Assessor's map and lot number 9 i............"�1.... S'PTIC SYSTE MUST BE I `ST!!LLED IN COMPLIANCE V.`I T H A—TIC E II STATE .Sewage Permit number .......................................................... SANITARY COOS ANC TOWN REGULATIONS, - �QyoftNEr TOWN OF BARNSTABLE i 99HH9TODLE. i 9� ,639M. BUILDING INSPECTOR APPLICATIONFOR PERMIT TO ....j../J..�. .�..�...4. .. ................................................................................................. TYPE OF CONSTRUCTION ............ .W...U.�' .................................................................................................... .. ...... .....................19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for na�permit according to the following information: jLocation ....4 ..... ...... !`....`... ..0..4 ......................................:................................................... ProposedUse .....�. ............. .............................................................................................................. V � Zoning District ...........� .. ............................Fire District ...� ..<.� 1! .1 .......................................... P.A. q� Name of Owner .....)C...A.CT�C�Lrt�ll....0....... .. .................Address .... ....�......1..�..� ,......w. .......... Name of Builder ....v?.�.-� !1......e. ... ................Address ............ ............................................. Nameof Architect .......... .. ...........................Address ................................ .........-c.—................. Number of Rooms .......S. ._.........................Foundation ...... ............................................. Exterior ...... .... ...........:................................Roofing ....... ..... ............. .. ................................................. Floors ..... ..:.........................................Interior .....�C�:?. ......................................................... Heating ....... .a.1\iYV1,_.....CR.t .....................................Plumbing ... Fireplace ..../ � J�✓ ... ....................................................Approximate Cost ....4. ..4J.vS'.. . +:. Definitive Plan Approved by Planning Board ------------'_-------------------19________. � Area ..........&.z .... i Diagram of Lot and Building with Dimensions Fee // 'f 1...�....................... l SUBJECT TO APPROVAL OF BOARD OF HEALTH If roe I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... Drouin Corp. ^ ' one , a~~ � 'No Permit for ----- ' ' sin � le dwellin ---.��.����..������.,���������--.----. St Jo 8t � Location'-----.�—.. ���.--'�-------'' Byam- is —.--.----- ------------. ~ I��ozlo C"'`"° / Owner ------_—__...��--.-------. ' Type of Construction -----.�����----- | { , --------------------.-----' ^ � R Plot �� ` | ------___. Lot ................................ ^ Permit G,on*s6 --'October 31 .� lg 73 ' Dote of Inspection .... ' ------.]A Dote Completed � ^ » . . ^ PERMIT REFUSED -----_.-------------.. lg ' ' 4\0 «�^ 1 m ' / ............ ' ' � ^----~--~.-----------,-----~— ' � x .—.—.-------.-------.--.----- | � � � -----------.---....—~--.--.—.— � Approved _--------------. 19 -------------'—.—..--------.. ---------------------.~---., . � '