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HomeMy WebLinkAbout0067 STETSON STREET � � S7-efi�s a�1 -�T� �a _ ,� �� ,:; �� 7�r Town of BarnstableBuilding Post�Ttiis Gard So�That it is�1/�sible:From>the-Street,,Approued Plans Must be�Retamed on Job and;-this Card Must"be•Kept��� - 14AS&i63Posted Unt�I�Final�nspection HasxBeen Made F ��, ° Where a""Certificate;of Occu anc �;sRequredsuch Building"shall Not-be?Occupied�unt�la Fi,nal.lnspection�has been made � Permit Permit NO. B-20-343 Applicant Name: Paul Eaton Approvals Date Issued: 02/25/2020 Current Use: Structure Permit Type: Building-Solar Panel-Residential Expiration Date: 08/25/2020 Foundation: Location: 67 STETSON STREET,HYANNIS Map/Lot 306 058 Zoning District: RB Sheathing: Owner on Record: OKUROWSKI, ROY E&SUSAN L Contractor Name PAUL A EATON Framing: 1 Address: PO BOX 2907 Contractor License= CS 088720 2 J AVON,CO 81620 �Jst Pro ect Cost: $18,000.00. All 1 Chimney: Description: Install 5.355kw solar panels on roof.Will note ceed roof panel, but V errn�t Fee: $141.80, Insulation: will add 6"to roof height. 17,total panels. Fee Paid $.141.80 i Final: Project Review Req: ? Date 2/25/2020 Plumbing/Gas �.. Rough Plumbing: b � � ial DLJIIU - This permit shall be deemed abandoned and invalid unless the work authorized,°by this permit is commenced within six months after Assuan Final Plumbing: -All work authorized b this permit shall conform to the approved a licatiori andctherapproved construction document for which this permit has been granted. Y P pp PP , All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning°by laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access st er et or road a'nd shall be maintained open for public mspedtion for the entire duration of the work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures bythe Building and Fire Officals are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: Ik 1.Foundation or Footing' k Service: 2.Sheathing Inspection ? Rough: 3.All Fireplaces must be inspected at the throat level before firest flue,lin instaIled, g 4.-Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering l P Structural Members Frame Inspection) Final' 6.insulation Rough: - 7.Final Inspection before Occupancy Low Voltage.R Ou g Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Cape Save Inc. 1-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 11/7/19 tgi, :p Brian Florence CBO Town of Barnstable N Building Division 200 Main St. Hyannis,MA 02601 P RE: Insulation Permit 19-3071 Dear Mr.Florence: This affidavit is to certify that all work completed for`.67 Stetson Street, Hya nishas been inspected by a third party Certified Building Performance Institute (BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, r William McCluskey Town of Barnstable uil r � ing Post This Card So,That rt is,Vis ble From=the Street Approved Plans Must be Retained on:Job and this Card Must be Kept t M' Posted UntilFinal Inspection�Has.BeenIVlade. � ` bs� . Permit Where,a Certificate Of Occupancy is Required,such Building shall Not be Occupied until i Final Inspection has been made Permit No. B-19-3071 Applicant Name: William McCluskey Approvals Date Issued: 09/17/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 03/17/2020 Foundation: Location: 67 STETSON STREET, HYANNIS Map/Lot 306-058 _ Zoning District: RB Sheathing: Owner on Record: OKUROWSKI,.ROY E&SUSAN L Contractor`Name:'I.,William J McCluskley Framing: 1 Address: PO BOX 2907 Contractor License,: 102776 2 AVON,CO .81620 � � Est. Proje�t Cost: $5,000.00 Chimney: Description: Add R-38 fiberglass, R-37 cellulose,and R-10 rigid insulation to the l Permit Fee: $85.00 attic.Add R-19 fiberglass,and R-10 rigid insulation to the basement. Insulation: y � � Fee Paid: $85.00 Air seal the attic plane and basement with expanding foam. General Final: weatherization. Date` 9/17/2019 Project Review Req: Plumbing/Gas Rough Plumbing: ,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after}issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for,which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by-the Building and.,Fire`Officials are'prouided on this'permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation- 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund"(asset forth in MGL c:142A). ��. Fire Department. Building plans are to be available on site w'S' Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT o� `,ay� 5 / 116 Town of Barnstable *Permit#I-,-/- act Expires 6 months from issue date 03' Regulatory Services Fee_ _ snxtasTnat e. Thomas F.Geiler,Director MASS F)9 , Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 p .� www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 30 G 0 Property Address S"1 ^ S�• b4-�B�\ S residential Value of Work v Minimum fee of$25.00 for work under$6060.00 Owner's Name&Address 90 Contractor's Name C__. Telephone Number -2 76 -09tf( Home Improvement Contractor License#,(if applicable) PERMIT ❑Workman's Compensation Insurance Check one: ❑ I w-a sole proprietor APR 1 d 2008 �I am the Homeowner ❑ I have Worker's Compensation Insurance f.® N OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) We-'roof(stripping old shingles) All construction debris will be taken to L ❑Re-roof(not stripping. 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 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 is required. _ t� a u - SIGNATURE: Z4:2 Q:Forms:buildingpermits/express Revised 123107 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 U www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aipplicant Information J Please Print Le 'bl Name(Business/OrganizationandividuaI): - Address 7o✓� S'i� IJ A � UZ6J� City/State/Zip: f l`L�'✓�'^�S\ U" � Phone.#: 7 ?6 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 employees(full and/or part-time).* have hired the stab-contractors 6. ❑New conshvuction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have 9. ❑Building addition workers' r [No wo rs'comp.-insurance t comp.insurance. A�amhomeowner 5. ❑ We are a corporation and its10.❑Electrical repairs or additions 3. doing all work officers have exercised their 11.❑Pl g 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 fiU out the section below sbowing their worker'compensation policy information. t Homcownm who submit this affidavit indicating they are doing all work and then hire outside contractors must subrnit a new affidavit indicating such. tr—ontractors 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-contractnrs have employees,they must provide their workers'comp.policy number. lam 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 M Expiration Date: j Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of _ Investigations of the DIA for'insurance coverage verification. I do hereby certify u th pains d penalties of perjury that the information provided above is true and correct Si at are: Date: Phone Official use only.'-Do not write in this area,to be completed by city or town officlaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws-chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hue, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-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-amwimce 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 afldavit 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 io 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 Ummonwealth of Massachusetts Department of Industrial Accidents Office of Investigations .00 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 Qr 1-$77-MASSAFE Fax#617-727-774 Revised 11-22-06 www.mass.govldia r r Town of Barnstable Regulatory Services '13ARNS1'ABt�, Thomas F.Geffer,Director MASS. 1639.& ' 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number f' street (� village "HOMEOWNER": ��`( 0 t�✓tl O l�S�'Ei 5a O'�J� G name ! 1 Lhome phone# work phone# CURRENT MAILING ADDRESS: 6 7 S Two - 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 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_pgrmit. (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 requireinggits. 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 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. Q:forms:homeexempt i Town of Barnstable *Permit Expires 6 months hom 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: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid wi&out Red X-Press Imprint Map/parcel Number 30U � Z Property Address -1 J Residential Value of Work NOD Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address O S� r» l ► I ©'off COW Contractor's Name �.X �(� CISSOG . �j�G . Telephone Number SOa off'3100ks Home Improvement Contractor License#(if applicable) I ALIbc Construction Supervisor's License# (if applicable) 5(workman's Compensation Insurance 'r2 s SS PERMIT Check one: ❑ I am a sole proprietor U/am AY — 2QQ7 the Homeowner I have Worker's Compensation(Insurance TOWN OF BARNSTABLE Insurance Company Name �SSOc 10. @,� �1rY1�`O U1L° S . Co . Workman's Comp.Policy# S66 aAS I�C)13.00 S Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ..e ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,Le.Historic,Conservation,etc. ***Note: Pr rty us 'gn:, perty Owner Letter of Permission. o prov Con tors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 I 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' d 600 Washington Street Boston,MA 02111' wivw.mass.govldia ' Workers} Compensation Insurance Affiddvit: Builders/Contractors/Electricians/Pluinbers ,A-plplicant Information Please Print Lelzibly Name(Business/Organizatiowlndividual): • Address: ©� City/State/Zip: Csyl-�O-N 142— Phone.#: �Ggj ` �;� rc;�4-AE� Are you an employer? Check the appropriate bog: ' general contractor and I ' :Type of pioject(required), • 1.[ I am a employer with 4. ❑ T am a g ..employees (full and/or part-time).* • have hired the sub-contractors 6. New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition 4vorking for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp,insurance comp'insurance,$' required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their '3.❑ I am a homeowner doing ill-work . 11.❑Plumbing repairs or additions • .lf m se o workers'co right 6f exemption per MGL y � �• 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 boz#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 anew affidavit indicating such. tCentractors that check this box must attached an additional sheet sbowing the name of the Sub-contractors and state whether ornottbose 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 jab site information. Insurance Company frame: Policy#or Self-ins.Lic.#: Expiration Date: Tab Site Address: City/state/Zip: Attach a copy of the workers' compensation policy.declaration paae'(showing the policy number and expiration date). Failure.to secure coverage as recrahed 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 7"ORK•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 0:ffce of Lvestizations of the!)Wnr imti=ance cov acre verif cation. I'd o hereby c r ' u er t e pains•an enalti s of perjury thai the in provided above is true and correct. Signature: Date: Pbene Ji OfZcial use only. Do not wriie in this area; to.be completed by.ciry or town official City or Town: Perrm't/License Issuing Authority(circle one): 1i :1.Board of Health o.Buildi Department . ty/Town Clerk 4.Electrical lnspector 5.Pli:mbing T spector 6.Other Ai �I Contact Person: Phone#: 1 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Piursuant to this statute, an employee is defined as"...every person in the service of another under any contract of bile, express or implied, oral or written." An employer is deigned as "an individual,partnership;association,corporation or other legal entity,or any two or more of the foregoi g 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.th.e 'n g �e another whoemploys ersons to do maintenance construction or repair work on such dwelling house dwelling house of anon r w , P . P n employer." - Q errant taeretn shall not because of such employment be deemed to be a_employ or on�h.. mounds or buildup,app1�rt MCYL 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." AdditionaIly,MGL chapter-152,§25C(7)states`Neither the commonwealth nor any of:its political subdiv,:sions shall public work until acce table evidence of co latrce with the insurance- enter into any contract for,the performance or w p mp 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-conti:actor(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 Towti 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 yoti 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 imformation(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 maybe 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 commercial venture e e e a home owner or citizen is obtaining a license or permit not related to an bu siness or comet year.Wh r wn r o P Y (i.e.a dog license or permit to born 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 CO-MMORW aJ.th of Mas h tts Dtpartment of WwWal A.eozdents Offico of Q Wagtoli Street Rs s�an,.MA 02111 • Tel.#61 7-727;400 ext 406 or 1-377-MASSAFE Fax#6-17-727MO Revised 11-22.06 WWw.mass.gov/d;a • Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Tom Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I0�10M12rbL% ,as Owner of the subject property hereby authorize .Xl,� I TJ � . TV1 G. to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Sign re of Owner Date Print NaVne Q:Fomm:expmtrg Revte071405 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 118494 One Ashburton Place Rm 1301 Expiration: 2/1/2009 Tr# 126302 Boston,Ma,02108 Type: DBA BAKER CUSTOM ALUM&VINYL INC. MARK BAKER 521 SHOOTFLYING HILL RD. CENTERVILLE,MA 02632 Administrator Not valid without signature ✓fie �o?z�neooz�vea�.�.o�./�,aaarzc�auael./a - Board of Budding Reg""i lations and Stan' s ConstruGtton Supervisor Lice = License:. CS 7 -Brrtt3date 7�3 is raft 1� 1,ltaf2009 Tr# 8.139 ton 'QO BRETT J BU IERE AM LAKI EAS AREHAM MA.02538 Coinmissione"r Delta 5/3/2007 Time: 3:59 PM TO: M 9,15083626115 Dowling & O'Neil Page: 001-002 ClierTW#:9742 2BAKERAS ACORD. CERTIFICATE OF LIABILITY INSURANCE 0DATE(MMID 5/031071Xrrrvl PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 Iyanough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A Harleysville Worcester Insurance Co. Baker 8 Associates,lnc. INSURER a Associated Employers Insurance Compa P O Box 923 INSURER C. Centerville,MA 02632-0071 INSURER D. INSURER E COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. "3R ADDLT TYPE Of INSURANCE POLICY NRMBER POLICY EFFECTIVE POLICY EXPIRATION DATE IMMIDDNYI DATE IMMIDINYY1 LIMITS A GENERAL LIABILITY _ CB831748 "19107 04119/08 EACH OCCURRENCE $1 A00,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 1 OOQ CLAIMS MADE 51 OCCUR MED EXP(Any one person) $5 000 . X PD Ded:250 PERSONAL 8 ADV INJURY $1 000 OOO GENERAL AGGREGATE s200,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 WO 000 POLICY PRO- LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS .. BODILY INJURY SCHEDULED AUTOS (Par person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS - (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY EACH OCCURRENCE _ $ _ OCCUR ❑CLAIMS MADE AGGREGATE $ $ I DEDUCTIBLE $ RETENTION $ $ dB WORKERS COMPENSATION AND WCC5002454072007 04/23/OT 04/23/06 X WC STATU- OER TIi- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $10Q 000 OFMER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEEI$100 000 It yes,describe under SPECIAL PROVISIONS elow E.L.DISEASE-POLICY LIAR $500 OW OTHER " DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions,'excl lions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN Thomas Perry NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 200 Main.Street IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis,MA 02M REPRESENTATIVES. JA ORIZED RESENTATIVEE �ftZC.__dit "mow ACORD 25(2001108)1 of 2 #47454 JV a ACORD CORPORATION 1988 ell Town of Barnstable *Permit# f p� Fac h=6 mondhs from issue date Regulatory Services Fee LA) MAM Thomas F.Geiler,Director i639 �0 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 TQ Sep 13 Office: 508-862-4038 1�/v .. ?004 Fax: 508-790-6230 EXPRESS PERIVIIT APPLICATION - RESIDENTIAL ONLY q/��STqgL rNot Valid without Red X Press Imprint �` Map/parcel Number d 5 b 5-(`f� Property Address Residential Value of Work $SLY) Minimum fee of$25.00 for work under$6000.00 e •, Owner's Name&Address ( t s34 (t xoyjlu ,tA • '� fie, S - 1/�1 �- Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance " Check one: ❑ I am a sole proprietor �? I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of r000 Re-side [�Replacement Windows. U-Value (maximum.44) '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. me ovement Contractors License is required. Signature , Q:Forms:expmtrg Revise063004