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HomeMy WebLinkAbout0016 SPRUCE STREET l(� 5 Pk vC � t tt Application numbere..... Date Issued.................... .. .... MASS ! Building Inspectors Initials....... Map/Parcel..... 91... .......... ... ............. AUG 0 8 2010 nIfllA� ��= - TOa �ALANSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 1� vZ5,PQU Ct �` "Y)( &4)- NUMBER STREET VILLAGE Owner's Name: CEN �Out p Phone Number 36 — D.t Email Address: CC..9611 vl o(A Y A440- 6ot4 Cell Phone Number Project costs 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 0 Siding 0 Windows (no header change)# ❑ Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer q kshingles) Construction Debris will be going to 9-P�,C CONTRACTOR'S INFORMATION Contractor's name bP6 VA V( Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# ®Z6 (attach copy) Email of Contractor R9'0 YALAW.(10 Phone number 15019 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS 1N A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent (s) will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the locations of each tent P P ( ) 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 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 Please Print legibly Name(Business/Organization/Individual): ( ;QIA ze 0 U-lam Address: O8 OWS 6-) PO City/State/Zip: W' MUD ' Phone#: 5VY- 360' YK Are you an employer?Check the appropriate box: Type of project(required): 1.pn I am a employer with S 4. ❑ I am a general contractor and I 6 ❑ n New constructio employees(full and/or part-time).* have hired the sub-contractors . 2.El 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' i [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 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#I 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 anew 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: Policy#or Self-ins.Lic. Z g Expiration Date: ( 0® l� Job Site Address:- t 6 City/State/Zip: Attach a copy of the workers' compensation policy declaration page.(showing the policy num 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 d the pains and penalties of perjury that the information provided a ove ' true and correct, I Si ature: Date: Phone#: 36� 2r �� 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 7 V 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 aJoint 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-contractors)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 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. S 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 t Fax#617-727-7749 a. Revised 4-24-07 vAm.mass.gov/dia R ew � . I of Casse- Cod.LW I I fib Winslow Gray Rd West Yarmouth, MA 02673 508-360-2749 roo fingandsidingofcapacod.com HIG REG #1 787; L1G # 102600 ------------------ Job Address. Name., Shannon Moloney Town: Address: 16 Spruce St Job Phone. 508-364-2609 City: Hyannis Other Phone: State. MA E-mail: cc shannon@yahoo.com ZIP. 02601 Estimator: Dmitry tabkovich i 07/30/18 e hereby submit specifications and estimates to furnish and install new roofing as follows; 3 1. Strip existing roofing and remove debris. Calculated (l layer). Anymore layers of roofing ' needed to be stripped will be additional. i 2. All gutters will be cleaned out, grounds cleaned rap and nails extracted with magnets. We utilize magnets so as to minimize your exposure to personal injure and/or property damage from nails left behind at the job site. 3. After removal of roof, woad deck will be inspected for splitting rot or other deterioration. Owner will be advised of need for wood replacement prior to commencement of wood replacement work. s 4. :"along all eaves of house. lee & hater Shield waterproofing underlayment (36 " wide) will be directly adhered to the wood deck. Waterproofing underlayment is installed to eaves to protect against interior leakage and subsequent damage from wind-driven rain, ice and snow dams, and freeze back conditions. i ll k r llje abovc Prices, specifications atld c:t�n(�t�tcsli� U1't; Wtislttc;torry aad ttt4; ht;r+.:h ND SIDING OF CAPE COD, LLC; i5 authorind to do tic; work sjx;cAic;& payment will be made as such: 1/3 Deposit Y 1/3 Beginning of work 1/3 upon completion Date; ` ,. I Signares: prior to the signing of the wntract and transmittal to the w c�t�. NO w�srk all b� er may cancel this tra.nsdction at any time Prior to Mid the buy such co,��rac 4 V after e day of this nsactts�nb business tay Roofw►g.aad Siding of Cape Cod, LLC will obtain nece ,-ry pa mils'rzquiW4 t ertainTeed warrants that its shingles will be free atom manufacturing defects. Below are ha t U Athe warranty for Landmia.rklm. Sce C'crtainTeed`s Asphalt Shingle Prods Limitedes W ~ a �k- ment for specific warranty details regarding this product, Lifetime, limited transferable warranty l0-Year SureStarffm warranty (100% mplacernent and labor e:osti, due tc) manufk==9 10-year Streakyighter"I warranty against streaking and Esc olorAtivn caused by aL-bvm; 1 5-year, 130mph wind-resistance warranty ' Landmarlk, with Life-'Time Warranty � Labor and Materials: $6,720.00 i � r J ff acceptable, initial here Cafar lid, { I � s 15 la DISCOUNTSCDISCOUNT +�f paying with check or cash. ASK ABOUT OUR FINANCING OPTIONS" *subj ct to credit approval. Ask for details. i I I .lob is estimated to commence approximately 4— weeks after deposit reces%• un'ess o ' noted here: Fork is sc heduled to be substantially completed in approximately: �_ days if acceptable-, (both) initial here: n times are approximate and subject,to change due to, but not limited to, t Stun and completion delays, et following circumstances: weather delays, additional work on previous jobs, perm1 ttu eement, Any discussions or verbal agreements are superseded by this ettt. This is the entire agr Such agreements, even those of the smallest nature, must be in waling to be recagniZ Any work abo ve and beyond the specifications outlined in this proposal will b�i�� chve. In the additional work,..�including travel time and lumberyard,runs; Will immediate� attention,,we will pDceed tars roofre airs or any related workrequiring IMPORTANT- p to cetlllc^miholder 6 an �6AL INSURED.the mustbesndarsed. If SUMMATION 0 WANED.subject to .m; the tee mid aamdiions of the policy,ae"n pale may reW ire an endorse ewt A statmma an thk verdlicate does natcurler rdyihts to the \ h*Mer in lieu at such an s Am*Est HUB INTERNATIONAL NEW ENGLAND LLC &? s . F " AS ORLEAM RD Ntlltl tI CtiATiiA DIAL 02M rmwmA: ALWARD PISURANCECO Vaumv ------------------------ -------- ------------- ---------------------- ROOF]NG&3IJIG OF CAFE GOD LLG WESTYARMDUrN MA COVIEiA:GES cornRCATE NUMEW. a' REV151CM INIUMBIft TKS R4 To CERTIFY TKAT THE IMIMES OF INSMUM LISTM EEWW BEEN MUM TO THE INSUREDMANED MOVE FOR Ti POLICYPERM • INDICATED NOTYATMTANEMG ANY RECkAWNUIT»TERM 'fki OF ANY CONTRACT OR OrMaR DOCUMBIT VVWH RESPECT TO TT/O CERTIFICATE MAY.BE D MAY KTAl'Ht,T P AFFO BY T :.1 ES[DE D N M SUBJECT TO AIL Td TEAS, I "- E UM AAA tdB' _._ OFS"90LICES.MM SHOWN MAY RAW GE09REVJCEDBY FARO CLMW, aADDL LIS M, ;_ixrer�e s.6s&PE 8Y...f.M a Ssx n e EKL f� [f T£taA .s 5. .. °PAS#Ffii7 scour OWED scour AF93 M i� a 8 �._.., Emm mms Camps- 1. AGUWGATE ".h. €I88 mmuftDIEWMALTY 6L% ' EQC�.�'ii3'4'i 'Crd. LA'3k ' '- E£.EI�E#�FA :dp"eF $. ., ._ NIA Worowt be pad V Manwhaft WODyees ea*.Pu t Endwse merAWC2003,06 B.noaMorkabon gVento M dws h for bwmft to,w0wess in 5We300w#m l was 31 V tie ammed lam,ar tea tam e s mauded Massadxzeft. Tbb cedfime 4k=vwm shms t*pokyin lomew thedale a`l tm cerdirsew t*above paiq t:e Tom, tvl4P sr ser t n tap s rprw40t ' -CavmwVffdtCatw Search a4 www gtea CE"RMU tK LDER CAUCIE1 LATIDN. SIDULDANY'OFTi EDP - 9E LLMO THE EIPtATION [DATE TWHEQF, NOTICE WILL BE tELWEHM IN Roaring &Siding of Cape Cod L.L� a4CC t�E PIfNTDlE1~�]C1PPAt7 tit& Gawkdow0gy Road 3� tY iaccc t .F MA t TT `w iss"ou AcowcowMA'nort meigift tvwma& a. AC0RQ25 pW ;I The ACtiRD namta and 10!aM reyiistw*d mew Of ACOW r: d x..,a �a, ..:�"�, fia•� ""� �s A � o • Board of Building Regulations and Standards License: CS-102600 . Construction Supervisor DZMITRY LABKOVICH " 68 WINSLOW GRAY RD 'h WEST YARMOUTH MA 02613' Ex pi ration: r i •diti=`i..CKi � P %Commissio er 03/27/2019 -------. Ci ,n arr�r�oouaecc�(�o/,��"�creeac�rr�e/(.i , Office of Consumer Affairs&Business Regulation Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 170787'" 12/18/2019 10 Park Plaza-Suite 5170 ROOFING AND.SIDING OF CAPE COD,LLC. Boston,MA 02116 s / DZiNAITRY LABKOVICH i��cc�� -- ` JZ� 68 WINSLOW GRAY RD �� Not valid witho t signature . W.YARMOUTH,MA 02673 Undersecretary i l f I PERMIT PAYMENT-RECEIPT TOWN OF BARNSTAMEN r BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 12/04/07 TIME: 10:00 -----------------TOTALS----------------- PERMIT $ PAID 25.00 AMT TENDERED: 25.00 AMT APPLIED: 25.00 CHANGE: . J APPLICATION NUMBER: 200707696 PAYMENT REF: CHECK Town of BarnstablePermit: Co Regulatory Services ate: Thomas F.Geiler,Director BARMABLL Building Division e" MAW 1639. �� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: 1 mf\ 5PRA0 Phone: ��' 360 �� j �� t ...J Install at: '*yce. S�. Village: 00AW'5 _s _ r ' Map/Parcel: l V Date: c i Stove A. New/ sed W - B. Type: Radiant/Circulating C. Manufacturer: Cow s4D e La , Lab.No. D. Model No.: Chimney A. Ne /Existing (If existing,please note date of last cleaning) B. Flue Size �" C. Are other appliances attached to Flue? Uo D. Pre-fab Type and Manufacturer E. Masonry: Lined/Unlined Hearth A. Materials: "A c,`C WkAA B. Sub Floor Construction: Installer Name: I 1�m 5mo Address: 54 Met Phone: ,' 16 Location of Installation: e j APPROVED BY: - Please make checks payable to the Town of Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove Rev 122801 as, f- Town of Barnstable - Regulatory Services ■ARNSTABLE, Thomas F. Geiler,Director 16.19. A Building Division CP Tom Perry,Building Commissioner 200 Main Street, 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 2 village "HOMEOWNER": �nA� ���() Sad " )��' 9U7Sq name rr / home phone# work phone# CURRENT MAILING ADDRESS: b S�Nth 7 j ,,,��� obo 1 ci /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 homeowner. 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 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. ign [p owner ., . 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 10.1.1-Licensing ofconstruction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner 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 responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community.