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Home My WebLink About0028 TANAGER ROAD 0� 8 �n401- er LAne 1 .Zo(( ® ( ^7 oF1HE r Town of Barnstable *Permit# Expires 6 1n ntlrsJrom issue d to Regulatory Services Fee ` BARNSTABLE, Thomas F. Geiler,Director �rfD MA't a 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 � / C Not Valid with oui RedX=Press Imprint Map/parcel Number C� �/ Q�3 ` f Property Address VI q e`11 �17� Residential Value of Work Minimum fee of$35.00 for work under$6006.00 Owner's Name&Address \� �6JP' o vvl `�L/ F 5 n , r Contractor's Name af` �e{ 6S Telephone Number G b b ( (o Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(ifapplicable) `i ❑'�rkman's Compensation Insurance t' vv' ! Check one: ❑-I am a sole proprietor ❑ lam the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name t l \✓�\. \V`J 1 J �' Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. ° Permit Request(check box) ET-I�e-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof.(not stripping. Going over , existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner mu isign Pro ty Owner Letter of Permission. A copy o e Ho a Imp v ent Contractors License & Construction Supervisors License is r quir SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 070110 The Commonwealth ofMassachusetts c ^ i Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, ALL 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):, Y t tRk�V— J Address: �7 City/State/Zip: '�{\� V :: Phone #: Are you an employer?Check the appropriate box: Type of project(required): q 1. 1 am a employer with 4. ❑I am a'gerieral contractor and I 6::.❑New construction 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 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. .9. ❑ Building addition' [No workers' comp, insurance 5. ElWe are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4), and we have no 12.016of repairs insurance required.] t employees. [No workers'. comp. insurance required.] 13.❑ Other *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 a new affidavit indicating such. lContractors that check this box must attached an.additional sheet showing the name of the sub-contractors and their workers'comp:policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site + information. Insurance Company Name: Policy#or Self-ins. Lic.#:. r�� \06,9,N Expiration Date: -� Job Site Address: ri rl 'eC^ City/State/Zip:.QJ 1 Attach a:copy of the workers'compensation policy declaration page (showing the policy numbe 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 cove a veri t ion.'. I do hereby certify er t p e tie o ury that the information provided above is true/and correct Signature: : Date: g / Phone#:' Of use only. Do not write in this area;to be completed by city or town offciaC 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 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 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-contractor(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 Tequired. 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 •m Please be sure that the-affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidaviffor 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 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 faz number: q 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' Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia # 1}„'zJ SKv�':kr 'r{ .Y.n:!cis q'✓f;7'ki ,,.`if;��},+1 h f.'?t(;.itl i i ;.,!'`fl: tf { -ti'7„�'*4 my:WWII T ,Yn ns 1'x0, .c.LS'f t„'" r„v y> a r, c - 9:" M' a ..:rfe dA, 2{'�'_: ¢ 7`„ �,'�,T•0� 's'y�,,�,,�t,,:ss. '�' ,x,�...•,r �'i, ;.kw�,. r��..,T .,..s'j,,7tyx'A^ x C?:Y S.f.,,�,.n, {ki ir'-�14�`2•Y. Sr ," n... :ra. u. ;,iT ,�� ,m"" ",E e 4. 'Skat4:C.- , � : { 1P • v. x � 4r. y .w riF €Ir ,? c ,� s!!';�3^!,. d+sl' 's;•tc`'%V�r¢�r �?a. ,t nq � rtt `s .E•. ro ?. :4..�' { . ' s�nA , _ sF {6 ,S:s+-'a y 1„`v!" 4•. Ji }.x'r4g•56 e .3"i rWr .s =a :.m. ,M "-� rT :`"'h , '+.+�vr'' � F,a3.tY'#' 7• ' ,�# �c s„ x3 xa s-''}s t t� ><�a ,'y� n." M?�'1 "�v' yY^ +4 J lr Y' Y' t d,� F t'{;Czid4+' .v. �, ,3a� `�r�'' t j`- ,�,'�sn f. 5t�� s L�l��...{�t ,h�+i `"'ir�.Ji.� .X"{t�+'gr ? o ,�,� � '`' .,.�- �"-::'i. ♦t�' - 'i"T ' ?fit-�"q�� 9+.n'n}•- s CKx H'Bx'�..'M;��j.J' d,�.,t��t�iyt� w k, rfi Sra { t , pp� a RK��HER85T #� �� _} , • a,�_+i 4 jrkri, 'F i fiJ. F , r' t,'i�.'_:3. 'T'.{er. ;'2<S N..C,,,.o-'AEC'��t �i 'C>:b lY tr,}rs '.. 'rina',iX"r„�`a. -},`.=.`t�ris :r �,j i �+L .. nF' s !{>•�' � �r '�J•.�,• � r F t ,; ,br .ytTc � 35PEEi?FTOAD ROAD ;z ;' Rix f .yx tj�tG 4M, 508420-6216/774-238=2938 Wm-markherbst.com k ` KA IV iRd PROPOSAL B TO: WORK PERFORMED AT: 3 7s ' Robert QC6i avt tIR k' ' ri" Stre 4 Frost et . r , Cambridge 28 Tanger Road MA Hyannis MA �F '`:: k •, r We herby propose to furnish the materials and perform the labor necessary for the completion of:zfmz y New Roof,putters.trim&sidewall cheak area r " emove 7 laverotexis,ma s rng es on left and 2 layers'on right ' Nm Install ice&water shield at edge Install 8"drip edae rg L }, i ' r Install 151b.fell paper WR ' £: '� z ," Install CertainTeed LandMark 30malgae resistant shingles Cut ridge&install cobra vent Replace plumbing boots Storm nail all shingles s ti All debris cleaned daily Price includes material labor&dum fees 7 200.00• �e rJ� r Rerilace all gutters&install white aluminum over exist_g facia boards 1550.00( 1 { W Replace siding on check area with white cedar xtra R&R shingles $1 100 00( *Please initial choices)above Thank You , ; § � me guaranteed to be as specified. The above work will be performed m accordance with tfiespecifications submitted . and completed in a substantial workman-like manner for the sum of as specified above and verified with youriritialss r, Dollars( )with paymerlis as follows: %at start with balance due in full upon completion 1k, . An alterations from above proposal involving extra osts wilt be added under a separbte written agreement and become ark ex`xr Y. p p r dry charge over and above said pro osal. ,+ ( . d RESPECTFU ED ,t 02/16/11 t Mark Herbst a ACCEPTANCE OF PROPOSAL The above price;specifications and conditions are satisfactory.I herby accept this proposal. You are authorized to 64he work and F payments will b as spe 'fi d above. n r v f of 2 rta SIGNATURE: r t * This proposal may be withdrawn by said com an :if notiacce ted within ` p Y p thm 30 days: u r � Ti..irr n1 rw y + ' !4 m"! 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'1J �,t ar y's:rF 1 a-i t 1 :,F .tm t t Y �, t :. •* IE, s:r'd'.t T�gr.. ?�. `cti'+'Ss x�,«,.z?%-� 7£:� :'r��+�''.ea�; .�`^';t:' �'�;{-�•'c k�1-R- a� -t°-r" � '§.- - 3. t s^- � �. !! ..a.»��' .3�- 1.�r�-.?�-�I`.•.`�"_r�k. .,7„r;f.��.RN�r.'� ..{u€'. z�-q�d I�t .t�.tSt�i rS 5,,:.4�ya olt {`<' � -n,si ie :�j�, r f'u x��,r ��:. .}a{ '� .1. 'r' i�'.^ " ��, x 'z. m,c.s.:E.'1�r7.,.�ktYxr:�:�.v&"1;�.1a�°j�pnCt�'i'-4'�°u. ,.` t�'.. ..i a -.s.rr...,� ;f 3'fF''d...+,.:�ITP�id u..a•`v,#�l XI„.�' "a .u.,;.w..�a�?.r.n�.... .. � r,; WORKERS COMPENSATION AND.EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Industries of Massachusetts Mutual Insurance Company 54 Third Avenue,Burlington,Massachusetts 01803 (800)876 2765 NCCI NO 26158 POLICY NO r AWC 7016215012011 PRIOR NO. I AWC 7016215012010 u ITEM 1. The insured Mark Herbst Mail Address: 35 Peep Toad Road Centerville MA 02632 Street No. Town or City County State Zip Code FEIN 02-8402887 I4R �^Ce eratien ^ einli Vents ram. rp —od n� �.ssoaetien--fie Other workplaces not shown above: 2. The Policy period is from-01/1012011 to O'U1012012 t2:Q:a.,;s.sta an;ti. at Lie�su�d's�ailing address. -_ - 3. A Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here; MA B. Employers Liability Insurance:Part Two of the policy applies to work in each state listed in item 3A The limits of our liability under Part Two are: Bodily Injury by Accident$ 100,000 each accident Bodily Injury by Disease $ 500.000 policy I'unit Bodily injury by Disease $ 100.000 each employee C. Other States insurance:Coverage Replaced By Endorsement WC 20 03 06A D. This policy includes these endorsements land schedules:SEE SCHEDULE 4. The premium forthis policy will be determined by our Manuals of Rules,Classfications;Rates and Rating plans. All information required below is subject to verification and change by audit Classifications Premium Basis Rates code sec PerWo Estimated No. Total Annualof Annual Remuneradon Remuneration Premium INTRA 150148 SEE E 47ENSION OF INFORMATI N PAGE Mininnum premium$ Total Estimated Annual Premium $ , As indicated.interim adjustments of priemium shall be made: Deposit Premium $ ® Annuany 0 Semi Annually [I `Quarterly 0 Monthly NIA Assessment Chg. $824.60 x 6.80W% This policy,indudirig all endorsements,is hereby countersigned by 01104=11 Ard waned Signabue Date GOV GOV KIND 'PLACING CLAIM NAME SAFETY Leonard Insurance Agency Inc STATE. CLASS AU_ Dfl OFFICE OFFICE CHECK GROUP P O Box 494 MA 5645 2 704 Osterviile,MA 02655 WCP0 00 01 A(11-88) trtchides c�yrighted material of the Nafimml Counal on Cam►iristrar�ce, used wvt b petmisr ✓/ze oonirizo�rzuseczll� o�'./�aaoczclu�aelta '' _, Office of ConsC umer Affairs&B siness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If,found return to: Registration:.01,26480 Type; Office of Consumer Affairs and Business Regulation Expiration 61862012 'Individual 10 Park Plaza-Suite 5170 s ' Boston MA 02116 MA K HERBST MARK HERBST a\ 35 PEEP TOAD RD A i! CENTERVILLE, M 02632,- Undersecretary. Not valid wi o t signature k•._ M ►ssachusetts Department of Public Safet'� I _ Bdard of Building Rculafi'ons .ink Stand irds Construction Supervisor License License: CS 48546 j Restricted;to: 00 MARK D I-IERBST t - 'r MA �. '' •s 35 PEET TOAD RD E' ,-CENTERVILLE, MA 02632 i Expiration: 1/27/2012 C ommissioner Tr#: 13699 _ \ r Assessor's map and. lot number ...... ......2.,3........... SEPTIC SYSTEM MUST BE %THE Sewage Permit number .......................................... ............ INSTALM I%COMANCE WIMMUS 13AUSTAMLLI House number ... N"& ..................... ....... . ......................... ENVIRONMENTAL CODE AND 039. TOWN REGULATIONS TOWN OF BARNSTABLE BUILDING INSPECTOR .APPLICATION FOR PERMIT TO ............. ...................................................................................... TYPEOF CONSTRUCTION ................. .............................................................................................. ................................... .....19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... .................I........I........ ...................................................................... Proposed Use ....2�............. T.............................. Zoning District ............... .............................................Fire District .......... ..................................... Name of Owner .7----------- �tn .................................Address A d d r e s s 6. (OfL,.O.t ,�v.................. . T.....- _�..WMET Name of Builder :-:7�....... ...........................in....Address ......................../........................................ ........... Nameof Architect ........ ...............Address .................................................................................... JNumber of Rooms ....Foundation ... ?�F(z.............................................. Exierior ....................................................................................Roofing ......A / ..T..........................................:................ Floors ........Clq?!�(-XAJt...`S1.6...........................................Interior ......JkvG.w ................................................................. Heating ........ .....Plumbing .................................................................................. 1A.... ........ Fireplace ........:0�/�................................................................Approximate Cost .............. '), t A90 .... .. ......... ............. ........... Definitive Plan Approved by Planning Board -----------—-------------------19--------- Area ......... ................... Diagram of Lot and Building with Dimensions Fee .........12.?�....................... 11�RIECT TO APPKUVAL Or 50 R15 OF ''EAi"' (u 7J)9)t L/ II OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town off Bar stable egarding the benve r construction. ego he bove.................... No ...... ............ .. ................... . .............. Construction Supervisor's License ...............t HARTY, TOM J No .28923.... Permit for ..ANITION ri Single Family Dwelling ' Location Lot 16, 28 Tanager Lane n ............................................................ West H< annis ort ri . ,7 p i .................................!............1................................ Owner ..........Tom Harty ................. .................................... + Type of Construction .......Frame..............:.......... .................................................. ...................... Plot ............................ Lot ._................ .......... A.= February> 10, 86 _ + Permit Granted ................................:.......19 t 1 Date of Inspection ...:.................................19 Date Completed .............................::.......19 - ! F np � r m _ r�1 Assessor's map and lot number �6................................(.......... Q CF THE tp�♦ Sewage Permit number' .........................................�..`.......... ` V Z BARNSTABLE, i House number ...........:..k .ZS.. S.......................... s rasa 3 �p 1639. 6� �B YPY a\ TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION.FOR PERMIT TO .............I..... ..........:..�...............................................:...................................... TYPE OF CONSTRUCTION .. D...�... lct� ............................................................ .........................�."../4 ......19. TO THE INSPECTOR OF BUILDINGS: - The undersigned hereby applies for a permits according to the (following information: Location .........� .....��. ! !` .... 2......°t.N.............!";......'.: /9/�!t�!s y�a/? ................ ..............�0................... Proposed Use ..... ..�z ............................................. .....(...................................'...... ,..... ZoningDistrict .............. .............................................Fire Distract ........... ... f�l.�y/............................................. Name of Owner ..�0../?'/......./..f.�. TV.................................Address ..�. ...` Ix/. .,1.`.}............f...:d/.� _ / lr ,� f Nameof Builder ........%-1/,,1 !....................................Address .............................................................................. Name of Architect e Y ...........................................Address ....Foundation ....J�. ....... `" .Number of Rooms ......._ c�wc?.........:2T. ............................................. Exierior ....................................................................................Roofing ......v ??`{.:` .:............,............................................... f/�, Floors r.nn�l�lE L...'�'`.' �...........................................Interior ....... u ciu r� .......................................................................... r Heating .....Plumbing" r" ...................... .................................................................................. Fireplace !.:. ................................................................Approximote Cost .......... ............................................... Definitive Plan Approved by Planning Board -----------_-------------------19________ . Area ......... tn'7'.................... Diagram of Lot and Building with Dimensions Fee n SU BJ E T-TO A-PFR'OG-AL—O'F D-eF-MEAL-T" _ J / 3 l� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barn table regarding the bove construction. r Nam .......:.......... ................. ............ t /`,- Construction Supervisor's License HARTY, TOM A=268-23 No ..U.92.3..... Permit for ....AUDITION Single Family Dwelling ............................................................................... Location .., Lot 16, 28 Tanager Lane West Hyannisport ............................................................................... Owner Tom Harty Type of Construction Frame . ................................................................................ Plot ............................ Lot ................................ 1, , Permit Granted ..Febr. . u. ... ary 10.,........19 86 . . . ...... ...... ... . Date of Inspection ....................................19 Date Completed ......../.00.................19 _ o