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HomeMy WebLinkAbout0016 SUOMI ROAD �T(o S m', �' (PCI - io6 qs95 ' ..-. .-. o ... Application number... l.. . �t r #Ci 00 N ' D Fee.................. '.... ........................... ................ �.vsr�►sx,e. e�A. � Building inspectors Initials.......... ... .................. s639. Date Issued................?i�..?r�l.i.�.1.................... Map/Parcel....... C�( ..A..^...�..Ql/.... 4��T.......... TON" OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 16 S 00 M l R 09® A l a ( 37 9 W•11 kl dl/ 5 T V 7 1-114AIlVI 5,1`'4 NUMBER STREET VILLAGE Owner's Name: KAR EJk/ (S UYLCI K Phone Number ,5_0 3 L 7- S 3 7 1- Email Address:m o 5 Ot V t S b 5 ( t )P-t-0-% ne,4- Cell Phone Number Project cost$ 101 0 Check one Residential Commercial ,1 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 E Windows(no header change)# F-1 Insulation/Weatherization 0 Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) ConstructionDebris will be going to �a vmki: t CONTRACTOR'S INFORMATION Contractor's name Al Home Improvement Contractors Registration(if applicable)# ( g 3 20 Z (attach copy) r Construction Supervisor's License# 1 0 d f (attach copy) Email of Contractor t o e d JC0y e /o o e.j 5Lot Phone number D B- ;7 761- 2190 b ALL PROPERTIES THAT gAvEsMuctuRis bVER 7S YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................. *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one:this event is a: for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s)of each tent 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 pm4:30pm. 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 1 F- LICANT'S SIGNATURE Signature Date All permit applications are su je t to a buil2ing official's approval prior to issuance. • A The Cominonwealth of Massachusetts Department of Industrial Accidents I Co!gress Street,Suite 100 Boston,MA 02114-2017 mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly i Name(Business/Organization/Individual): P}A IN L- Atf—P 1Z yg A/ Address: -7 S 1- City/State/Zip: t-t Y R iv' N i">I 14 G ZG!01 Phone#: SV 2-7.7 t Z q U Are ou an employer?Check the appropriate box: Type of project(required): LI am a employer with employees(full and/or p I-time).' 11 7. New construction IFI am a sole proprietor or partnership and have no employees working for me in an capacity, 8. Remodeling y p ty.[No workers'comp.insurance required.] (' 3.O I am a homeowner doingall work myself 9. ❑Demolition y [No workers'cotpp.insurance required.]t 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 D Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 L[]Electrical repairs or additions proprietors with no employees. 5.[]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.❑Plumbing repairs or additions These sub-contractors have employees and have workers comp.insurance.: 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their riiht of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'compY(insurance required.] ;Any applicant that checks box ff 1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. is Insurance Company Name: Policy#or Self-ins.Lic. Expiration Date: Job Site Address: I` 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 MGL c. 1152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year nnpnsonment,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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. . ! I I do hereby certify 71 r tl ai s d e a ie perjury that the information provided above iss��true `and correct, l t>L to Si nature: Date: Phone#: O - 7 (, L 1 O FOfficial use only. Do not write in this area,to be completed by city or town officiaL I City or Town- 1 Permit/License# Issuing Authority(circle one): L: 1.Board of Health 2.Building Department 3.Cif /Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ,acoRo® CERTIFICATE OF LIABILITY INSURANCE DATE / 09/1313/2018 Y) 018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ashley Paiva NAME: Eastern Insurance Group PHONE No, Ell: (508)997-6061 ac No): (508)990-2731 439 State Rd. EMAIL apaiva@easteminsurance.00m ADDRESS: P.O.Box 79398 INSURER(S)AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURER A: Arbella Protection Insurance 41360 INSURED INSURER B Armen Safaryan INSURER C: DBA:Corey and Corey INSURER D: 67 Sea Street Unit A4 INSURER E: Hyannis MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER: 2018-2019 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. I�TR TYPE OF INSURANCE IN WVD POLICYNUMBER MPMOIIDDD EFF MMMILDID EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR PREMISES Ea occurrence $ 100,000 MED EXP Any one person $ 5,000 A 952004644104 09/18/2018 09/18/2019 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO - BODILY INJURY(Per person) $ OWNED F SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY Per accident UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EEXCESS L.IAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER �/ OTH- STATUTE X ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTNE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? NIA 952004644104 09/18/2018 09/18/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Display Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Office of Consumer Ir ffairs and Business Regulation One Astb rton Place - Suite 1301 Boston, Massachusetts 02108 Home improverPerit--Contractor Registration Type: Individual ARMEN SAFARYAN Regisbadon: 183202. 67 SEA ST APT A4 Expiration 09/13/2019 HYANNIS, MA 02601 1 8 2DM-W17 Update Address and return card. OHtce of Consumer Affairs.&Business Regulation HOME IMPRovEMEA1T CONTRACTOR ` LiSt"on TYPE:IndBiidual valid for Individual use only before the expiration date. H found return to:Registration i o i Office Of Consumer Affairs and Basin Regulation .09/1312019 10 Park Plaza-Suite sl ARMEN SAFAR3fAN _- -- Bon,MA 02116 DIB/A coA�Ania=coeF r` ARMEN SAFARYAN 67 SEA ST APT`A4.'.- —' HYANNIS,MA 02601= -: .. Undersecretary i Not valid wI#tOut gn re OFMassactlusei#s De Board of'Buildin partment of Pubiic,Safety ji i g RegUlations and Standards License CSSE_106102 Construction Su pr isor Specialty ARMEN SAFARYAN "try 67 SEA STREETIAP7 A4 HYANNIS MA 0 r E Comrriissiorier ExPiiration: 10/02/2020 ,3 Y; . 1 { • M b I F (tF ' 1 { I it (I E y CuKEY, & CUR 11 The Roofers 67 SEA STREET APT#A4, HYANNIS MA 02601 t PHONE 1-508 -775-8240 l CERTAIINT ED LANDMARK LIIFETIIMErALGAE RESISTANT ACETECTURAL STYL E RE - ROOI,FING PROPOSAL February 15, 2019 KAREN BUTLER I. 16 SUOMI ROAD#1 OR 379 W.MAIN STREET#1 EM: misakisushi@comcast.net -367-5393/508-737-2124 HYANNIS,MA Tel: 508 f r. COREY & COREY hereby proposes to perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles(One Layer)from the Entire Building and Old Clap Board Siding from the One Story Wall/Cheek Only.Re Nail All Plywood Sheathing as needed. Supply and Install CERTAINTEED LANDMARKAR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION ,CLASS A FIRE RATED9 COPIER/CERAMIC STONES for a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT,240 POUND,EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY,CATE.GORY III HURRICANE STORM/I URICANE NAILED (6 NAILS PER SHINGLE), MULTI-LAYERED,LAMINATED ARCHITECTURAL STYLE,FIBERGLASS BASED ASPHALT SHINGLES. COLOR: CHARCO .`' BLACK _ _ Supply and Install 8" WHITE ALUMINIIM/HICK'S VENTED DRIP' EDGE on All of the Eaves. Supply and Install CERTAINTEED WINTER-GUARD (gce c Wa�eY Shield)WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves & Valleys Under the Step Flashings,on the Skylights and Chimneys. Supply and Install CERTAINTEED'S "ROOF RUNNER" 9YNTRETIC ROOFING PAPER Supply and Install .AIR SHI&N���NE SOIL PIPE FI.,ASHIN,GNT H RIDGE VENT on the sntire Ridge. Supply and Install ALUMINUM Supply and Install WHITE CEDAR CLEAR B R&R SHINGLES at Average of 5"Ex bsure with Galvanized Staples and/or Stainless Steel Ring hank Nails On The Small Wall Cheek, Over the One Story Asphalt Roof Section Only Clean and Remove Debris from work area job is completed. TOTAL INVESTMENT-------------- $10,000.00 . I i i �s r t f COREY! & 'COREY' The Roofers " I4 , OPTIONAL ADDITIONAL RECOiVIiV11END t D WORK: Supply and Install ALL 318 EXTERIO PLYWOOD OVER THE EXISTING ROOF BOARDS ON ALL THE ASPHALT ROOF SECTIONS---------------------------$4,000.00 i POSSIBLE EXTRA CARPENTRY: Any Rotted or Otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing,Side Wal ing or Any Other Carpentry Needing Replacement will be done and charged for as an Extra: Mate ials Plus Labor at the Rate of S 60.00 per Hour(For Each Laborer Involved). PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Roof Proposal and the Final Payment for the Balance is Due Immedi�ately Upon Completion. WORK SCHEDULE: All Roof Work is Scheid` uled for Completion Within 90 Days of Acceptance and Deposits Received are Non-Refundable Aftei a Three Day Cooling Off Period from the Date of signing. Please N ake Checks Payable to: COREY 8z COREY COREY c& COREY Warranties the S it gles and Labor for 10 years. o CERTAINTEED Warranties the shingles and abor 100/o for the First.10 Years E and the Shingles your LIFEs17IME if the shingles becomes defective. R CERTAINTEED Warranties the Shingles up too a CATEGORY III H CANE-130 MPH WIND WARRANTY. CERTAINTEED Warranties the Shingles to (Ie Algae Resistant for a Full 10 Years. I COREY & COREY carries Workman's Compensatior and Public Liability Insurance on the above work C' DATE OF ACCEPTANCE: 1 . j ACCEPTED BY: S MI D,D I I i rf r 77. I�AREN BUTLERARMEN S �(RYAN AUTORIZED PERSON I COREY COREY. HIC # 183202 CSSL# 106102