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HomeMy WebLinkAbout0040 TOWNHOUSE TERRACE Town of Barnstable �3 �oFctrt roly *Perntit 2 o Regulatory Services Fee�6mo,r!/rs ronrissrredrrlr * ARVSt tHGB. * i ,619- �m�q Thomas F..Geiler, Director �J Building Division ��.�=�,. . S Tom Perry, CBO, Building Commissioner � HT 200 Main Street, Hyannis, MA 02601 www.town.bamstable.rna.us Office: 508-862-4038 TOWN OF EBARNM-M,-,.f1 30 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 1yof Aar[willout)?ed x--Press Imprint Map/parcel Nurnber,=,2 f�1Q y��� 7IZesidential Address o /0WA1 VS G ejr Le � a r�/��� rJ p�Value of Work 60 3 6 Minimum fee ofS35.00 for work under$6000.00 Owner's Nam e cC Address J.S C �'/�/►�C Contractor's Name .I s ��Se ^� 014A41f Telephone Number Home Improvement Contractor License#(if applicable)_ / 2 C V3 Co ruction Supervisor's License#(if applicable)_ 700/7,� — Workman Compensation Insurance Check one: ❑ 1 m a sole proprietor ❑ am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 614) /� r Workman's Comp. Policy# O / 7 � Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed) (stripping old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) -side 30 #of doors Replacement Windows/doors/sliders. U-Value (J, (maximum .35)#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 must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License & Construction Supervisors License is required, /PFILEs\FORM�uildingpernii formsTXPRESS.doc The Commonwealth of Massachusetts ��- Department of Industrial Accidents Office of Investigations 600 Washington Street "x ¢ Boston, MA 02111 i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Ei Please,Print Le ibl ARvlicant Information Name(Business/Organization/tndividual): Address: Phone#: City/State/Zip: Type of pro' t(required): Are you an employer? Check the approp 4 to b I am a general contractor and I 6 construction I am a employer with�_ __ have hired the sub-contractors _.. employees(full and/or part-time).* 7. Remodeling listed on the attached sheet. 2.❑ I am a sole proprietor or partner- These sub-contractors have 8. ❑Demolition ship and have no employees employees and have workers' 9 Building addition working for me in any capacity. comp, insurance.t o workers comp. insurance 10.❑ Electrical repairs or additions [N ' ce 5. C] We are a corporation and its required.] officers have exercised their I I.❑ Plumbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 12.❑ Roof repairs myself. [No workers' comp. c. 152, §1(4),and we have no 13.0 Other insurance required.]t employees. [No workers' ` comp.insurance required.] w showing their workers'compensation policy information.aidavit indicating such. below w *Any applicant that checks box#1 must also fdt out the sectio n b ne t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must to he a : cton that check this box must attached an additional sheet showing he name rs'of the sub-contraPolicy tci number. date whether or not those entities have Contra they must provide their employees. If the sub-contractors have employees, eY to ees. Below is the policy and job site I am an employer that is providing workers'compensation insurance for y y information. .5 /Lt r.� 1•�}5 -- co ` Insurance Company Name ?� j l — � Expiration Date: Policy#or Self-ins.Lic. #: l \'� N1�✓,S � � �CB 0®� �66e City/state/zip: Job Site Address: showing the policy num er and expiration date). Attach a copy of the workers'compensation policy 5Adeclaration of ah L page( imposition of criminal penalties of a Failure to secure coverage as required under Sections SW of civil penalties in the f lead toorm of a STOP WORK O}tDE of d a fine fine up to$1,500.00 and/or one-year imprisonment, be forwarded to the office of up to$250.00 a day against the violator. Be advised that a copy of this statement may Investigations of the DIA for insurance coverage verification. provided above is true and correct I do hereby certify under the ' sand penalties of erjury that the information Date: Si ature: �} Phone Do not write in this area, to be completed by city or town o.�iaL official use only. Permit/License# City or Town: issuing Authority (circle one): t 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 1.Board of Health 2.Building Departmen 6.Other Phone M. r ..+ ��.•1 tGAt!°li:A;-Il6.,dGLS�i �._.�FCe;.i%1 wQw.%9St:.i of Ccusamie Aff;irs&Rmxiy:st r%eeulrtioe :-HOME WROVEMENT CONTRACTOR Y Registration—*126893 'Tyre: Expiration; &�t2012 Suopte�.oa�;t i ne Home Depot A,-f-leme Services UARREN QEMERS.:; 2690 CUMBERLAND PARKWAY S GA 30339 U-ndermeretarf License or registration valid for iudividul use only before Me expiration date. If found return to: Office of Consumer Affiirs and business Regulation 10 Park Plaza-Suite 5170 ;ard Boston,M. A 02116 Not valid without signature Office of Consumer Affairs and Tfusiness Regulation 10 Park Plaza- Suite 5170 Boston,massa5�vsetts 02116 Home Improvement Ctitractor Registration Registration: 132349 Parbmship - '-- Expnation: 11112013 Tr# 2D7392 J &J Remodeling ' Joseph Duarte 15 Fat{ St. . Wareham, ma 02571 " �. ::`::_" --- Update Address and return card.Mark reason for eba a.C ud Address ❑R"wwal 0 EmPle"Acut []Lost C ypg.�rn o �o�-ncoczce /� a egu s con License or registration valid for iudividul use oniY Office o m before the expiration date. If found return to: HOME IMpROVEMEMT CONTRACTOR office of Consumer Affairs and Business Regulation Registration: .; 132349 Type: 10 park Plaza-Suite 5170 Expiration: :1./1112013 Partnership Boston,MA 02116 - � emodeting;:• .. Joseph Duarte 15 Fall St. of v d without signature Wareham,ma 02571 ..,: Undersecretary saChuwtts-Dcl+.+c'+me»t art Puhtic�afrt� 1 Bourtl of Buitdi»�Ri•�3ulatiu»,u»d�t:uulur�l� Construction Supervisor License License: CS 70077 jp$E,PH C DUAATE 15 FALL ST p�571 WAREi1AK MA Expiration: 7048 012 TrM: 7048 ..nvul•.cwMar " - - Z9L696Z £S:TZ TTOZ/ZO/TO TO 39Vd Nov 03 11 09: 09a Michael Bedard 1-401-246-2868 p. 1 FAY t ft)_ :nft-%3G2inZ1 ter_ 18 2eLie I I 2:7NAr•1 P6 Ft.t7tM .laomrlad iwwt .impkov.'EMENT CONTRACT pL7sASK RFrt n T11u; 1 Sold,Furni. and and Installed Ity: IYwle•' TUD At-Roane SexL'lcrs.lt+r•. Erancb Mane: past— } JJJ t dAwIL The Houle DopoL At-Horne Services --�—/ 345A fireeawmKI Street.Unit_,Worcester:.MA 016(Y7 Toll pre*(Soft)A57-5182;Fax(50s)7SCr3823 3i Fedora M a 75-2ftgt AI.ME L,:c x Caiat9:Rl ConL Lids leis?,^ lit>rnclt NtltrlbOr: G"I Lic th E21C- 9°e3?.:H4A t tome ravestiom C:oatrnetor Reg.u 7 26RrA irestsdtsltion Address: City S to _.� rs �Z Pnrc itcr(x) _�yyrit Phuae I�Oa11r yPtn+nC Ce tIt Phione: Id— Home WdresR., City —'- 3tatc— Ziff "� ^ (Tr jiff, from Instxilarian Address) Dl/JJ'�9 '.1nall Address(to reoeive project eommunicatiol"and Romc ukepoc npdatas) --- -- - (-{J L1t_l NO'r wish to receive any rnarketinM omall It frotn The Hmmm Depot trt oiett.inftr <m: Uilderaigrtt"17te Hottote DepoY')n the VVAc- rocalsb, deliver fca at the und artAt ah C,r theve tinsnilaiion I1MW Ces It a I'..)of and,*tl tD A .MM, ctvict+.Inn-I sit of with my iineorpore"itdo Llr1s ContraCr by this All motesrlattts de+scribud can tL1t basw and un Lhe referenced Spec Shontls). rest netlCe,tSong with any applicable`.IA10 Supplenlrnt and I}et1rl7Rertl Summary afta:itrd ht ri:ep rued pny t'liangr C)rdarte Cso4teatuvely. "Coriti•ar't")• �. 1a6/Js porw,.�t y.w..ov) P rri -, Stirc•tih�:s)/1: 1�t�Atuoun r^ flng�R-d*n Wtnttows Cf tnsteWtitaayC $ ./ I� f / 1 00utters/Covet.• Ornr y Tani: [] r" ^T — ��L'7 !i pgrig [(Siding Inui7seinn QGniter+/C-giv(.rS (rVCxirE ©Siding Q Wintlnwc rtlollatitlA $ 1 c3Caacer/Covexs ❑Barry ovota ice..... - AooflaS• 1iQing 1 VYindnwr 1wailAtleln $ ClCluou rs i Covers 01� uuy Doors 0.. -- r 6tininpun TS`Ie pepledt sd Guuttac!Am11mt '�1OT psrtitt►goi of dau r lntitict. Total goat 1•itCt Amount Lvtaitie Ynr etu a"Mew a l depru"w4wa durn true-WCO of and GiafsndAmww4 d v� ree wor Customer agreees that.imiltedistely upon ck.rMptetton of tk for each�product.131i l e due. A4 appl'tcabl*.each Ctistumor un&A-this lone for each Product uts dctlned by ae+ individual $Peel: Sheep) atld Pay y. fjnvu Contract nereex to iie jointly and Sev6calty obligated and ruble to munder. _ The Firntoes t7apnt ill-At rdServes tbr,right to issue a C•bani'e C�rdt r vv ders A rmi this dial it eanttol perluvrm ittii4gt�tt:n atdud u a srrnctxtrxl iK di'crgrion.if't kts•Home L)cpot or its autiiwrizvl:tCrviCa pm »rublerso with trot 11ume:,eltvirtltomental huyurd%such as*Hold.ej%bertt>x or lead paint.othrt sirl'I:ty concern pricing eaw�ea or tiCtntute uyui>~hl to cutrWlt tc.thc,job wxs rlr7t included in t e,-,,g rlia ItOW ntraa wturk r Included as F of diix Cooeitiltct seta forth PavnwtL,ti'�t I�nmary: The Payment Snmmp+y #__s1_ate .-�' (tentrxt amrnrnt.xtxi pnymants reeptiroet for the dnpoaktt and final pnymeat3 by i'roAUCt(as 1iPPl'e nblc)• NOTiCR TO CUb"TOMER You ace.entitled to x cutttplr!rly tiilcd'iu co y of the GuHrrnt at the tine•you xian. no not sign A Completion Certificate(aMe: there lx tuts+Cuainlatltln C ertittt'uta for 4ese i Ii:ltr Product d Pduct:u defillmd by indl;Q621 5pee Sheets)before wfurk on that Product is tstompicte. In thr event of tcrrnlnatim of this Contract.CtisteltiW Agrc--t*pay The IIemG I)elset tltr le 4) t ireninati s.In r,exit and servictx ioEoviekxl by The Iiumc Y?elrttR of Antlxoriaa6��cd ficrvlee Provider ttttr� ettp date wf tertnil.atinn,pips um outer alnnuntst ud tiirth is this Agt+eeeniraet ur utito�ved tut;W, L SxT PkYN1"T AR OTI" PAYMRNTS V- WrrHOXIT OWED T(> TlA r ROME DEPOT FROM T7EiF LIMi'1'1NG'r iRE HOML DEPa 'J OTLIbER ktLM1sUIES YCtit 1tLCtywERY I?F SUC:I3 A1NO7lN9 S. e ettin UlOri7eit o ; Cu%ttlt+wr agXtx:s and und,_r,Stands that 4b6 Agrocrrtcnt ix the entire agtolts tot belwern Cuctcnnrr _ 11 spot with n-mwvr- to the Ysoduum and installation ac7vicos turd euRcr+cdss all Pr ltu discuaato(ts and abraxraWtta_citkter. Ora.)fir wrietrn,tslattng to said Ateduclt atul Installation.Inns Ar.r c duo int btne�r4tla�ad.isr undzrs�kin dr. vohtutn9t'!ll •arLe the tci-»xtof and has rec¢iveetl a COP of thvlA1,KaaM011t,Uwlcdyt s am3 t f Sub -fed by: nenlcant's Snn Q;••"A•tid.'.rMl tyTv_Sig i rA -'— X Dow Customer's Si}tnatnre� Ssles Conwitnat l.art:nttr:No. (nx yM.lirahlet.... CUSTOMER MAY CANC'RI, Til1W A(31tltiiTlENT�1trrMf)LlT PENAL Y on OB1-I{'AT1014 itY 1)1:t.IVP.RINCr QpRYr7'ie.N NCyriLC:E TO THP IIOME I7RP¢T By MiDmcur ON Trill: '1'fn" RUSINEW AAV AT'7'i U SIGNING THIS AGRISEMW-r- THE STATE $UI►1`L 11uS. "XREL - CQNTAINS A FORM To gy T.A.W 1N SPYs("11s�'x(:AI.1.Y rRERC:Rrtfl'i:iT _ C;USTOMUI ISSTA71L cAN1C�e tstCotCtv+•a>wuA.RTA't'oa 0"Yt1P.utvrRta¢irtslil art>sAtiP.nwetY+tfv rrstne 6iArSRA�+' NC?lltgte ADnt'tYt1NATi7'I;ItM. ' - d auw c< �i6Lhl56$05 3NOHd'l�14dX3Z69Z '1��`Ifl b0��6�464Z �,1 b SHtl �oda H Q EN011eolldd The Commonwealth of Massnckuseits went of Indushial Accidents +cs of bn% tigafions 600 Washington Strom Boston,MA 02111 w ww-mass gov/s a Workers' Compensation Insurance Affidavit: BufldeTsdCantractors[Eledz iciamdMumbers. A , hcant Information Please Print Lggkly Name pasi���du4: 70sep tlAtIOLL , Address: J v/I/ VV �� QWState/zip: . ,' l C p, �/ 3 Phone C� - �/7` o .Are}wa emapWyer?Check the riate box: Type of 1� "ect(required): l.❑ I a employer wi& 4- ❑ lam;;a gen contractor amid I (fall MUM r part-hffie). have hared the sate d ❑ 2 1 anm a sole pmpajewr or p listed on the amr-hed sheet. 7- ship:andhave no enmployees 'these mb-amtracwrs lie g ❑Demb6i mi waking forme in any capacity. employees and Have vvorkers' 9. ❑Building addificm [No words' comp imsarance 'co®p. squired) S. ❑ We,ame a cmporatiomm and its 1 G.❑138eL6aical repairs or add tiaras 3.❑ I am a h rnmaner doing all wont officers have¢xem md their 11_❑Plumbing apairs or addition myself[No worke& caW- rightof exemption per MG L I:B ❑hoof repairs insurance realaIIed..]f c- 1.52,§1(4X and ve have no ems-[No workers' 13.❑Odw commP,insursncerequired-]' tP6�oomams sub 3t7isaFEI %ca gthoq�dni a�actaad Leo caaoc�omact�zm c:anb®ean�a ae;Gmdnc eon tCanft nit flf&;baK®nee -cbodaa addfwaai shm dka n—o aetbo and s=wWwor mat*MQ=f1fier bz= om;P -1r*2bmK*MYzMdPMViktbM wodim,caffl%L PUBCT amubm lam are eavpl ak at i's,pv�addmq' i 'eo ance m),srartplaysa x Bekw ar&8p�=d jab sirs .n sraa a 1�Tamme: rid ✓ Al „r Co Pig Policy#or Self ins.Lac.f. I. 0 Exgaat k Dim: .Job Ske Address: City-"StaaerZ la: /V✓1/S .V�1 .Attach a copy of the airWfl pease page('showing the policy nnma er andkipiration date). Fail m to secure coverage as rid under Suns 25A of MCL c- 152 can lead to the imposition of criminal penalties of a. fine nP w S 1,500.00.andlex one-year in:Fd9omnent,as well as asE penal ms in the fay of STOP WORK ORDER and a fine of aP to 50-00 a day against the viob=- Be adr-md that a copy of this statement may be fbmm—died to the Of ce of Investigations of the DIA for insurance coverage verificadon. f do hereby ea " + Me aid paav�i ded alWe is aurae as 3i tam: . Date: �r ✓ how_ : Ojrdal xte ox&. Do aunt a iie A&area,to be mated by coy or.rown did City or Toga: PermiMcom# hmin�Authoritp.(4&cle one): L Board ofldealth 2.Building Department 3.City/Town Clerk d-Electrical Inspector S.Ply Inspector 6.Otber �Centact Person: Plmoru d: ` 'vATE jM2l7F)6.%yyy; ACa CERTIFICATE OF-LIABILITY INSURANCE aa/=1«°l; I 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. SUBROGATION WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on thiss certificate does not confer rights to the certificate holder in lieu of such endorsement(s). Coa PRODUCER 1-404-995-3000 NAA1E: _ iFAX�—' - - Mareh USA, Inc. PHONE - E-NIAIt ....-- homedepot.certrequestNmarsh.Com ORES ' Two Alliance Center, 3560 Lenox Road, Suite 2400 INSURERSLAFFORD94GCOVERAGE —___--. NNO,fs,-• Atlanta, GA 30326 NSURERA: Steadfast Ins Co 26387 I _ Fax (212) 948-0902 _ -- Zurich American Ins Co 16535 INSUREo _ NSURERS: _ .. The Home Depot, Inc. shire Ins Co 23641 RISUREa C:& Ham Home Depot U.S.A., Inc. 23917 ...___ Home Paces Ferry Road NW INSURERG: Illinois Nat' Ins Co 24SS Faces ing s Fe tNsuRERE: NATIONAL UNION FIRS INS CO OF PITTS 19495_._Buil __ Atlanta, GA 30339 -- R+suRER FIllinois Union Ins Co 27960 COVERAGES CERTIFICATE NUMBER: 19834602 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERiOQ 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 B POLICY CLAIMS. TYPE OFINSURANCE EMP — UrrtTs — $ INSR A U U POLICYNUNBER M LTR A GENERAL LIABILITY GL09887714-01 03J01/1 03/Ol/12 EACH 9,000,00 31,000.000 ....._. X COMMERCIAL GENERAL LIABILITY s EXCLUDED MEO EXP are --- CLAIMS MAQE X OCCUR 9,000 000 7t LIMITS OF POLICY XS PERSONAL 8 ADV 0tR1RY f GENERALAGGREGATEP S 9,000,000 X OF SIR: $1M PER OCC 91000,000 PRODUCTS-COMP /O AGG 8 GEN•L AGGREGATE UMR APPLIES PER : X POLICY,E PRO . O IN 0 U 11000,000 S AUToMoauLIABILITY BAP 29 863-OS BODILY R0.fURY(Par pasanl X ANY AUTO BODILY"RVALL OWNED SCHEDULED (Per ) t AUTOS AUTOS PROP TYOAMHGE s _�--- NON-OWNED HIRED AUTOS AUTOS >i SIR AUTO P Y _ X _ EACH OCCURRENCE UMBRELLA LIAa OCCUR T . AGGREGATE -- EXCESS UAD CLAIMS•AADE f DED RETENTIONS W C STA OTW WORKERS COMPENSATION wC061967352 (AOS) 03/01/1 03/OI/12 a C AND EMPLOYERS•LIAB►LRY 03/01/12 EL;EACH ACCIDENT f 1.000,000 D ANY PROPRIETON4PARTNERIEXECUT(VE YIN NC061967354 (FL) 03/Ol/1 OFFICERNEMBEREXCLUDED? NIA WC061967353 (CA) 03/0111 03/Oi/12 El DISEASE-EAEMPLOYE S 1,000,000 E (MsnJatory In NH) E1.01SEASE-POLICY LUT i 2,000,000' I1 as,desenbe under 0ESCRIPTIONOF OPERATIONS beWw wcO61967355(KY,MO,Ny-WI, 03/01 ' 03/01/12 . C workers Compensation TNSC4b244'S1 lilt? 03/02/2 r 03/01/12 Occurence/SIR 301I/1M F TX Employers XS Indemniti 03/01/1 . 03/01/12 SIR IM 8 Workers Compensations wC1192378 (4SI) DESC;UpnoN OF OPERATIONS I LOCATIONS r VEHICLES lAnwh ACORD.101,AdditleaN Rome"SdaduK H sit epsn b $ RZ: EVIDENCE OF COVERAGE •CERTIFICATE HOLDER CANCELLATION SHOVLO ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE p(pOtATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THE HOME DEPOT, INC. ACCORDANCE WrM THE POLICY PROVISIONS. HOME DEPOT'II.S.A., INC. 2455 PACES PERRY ROAD Pw AVTHOPMDREPRESEKTATIVE BUILDING C-20 ATLANTA, GA 30339 USA 01985.2010 ACORD CORPORATION. All rights reserved. ACORD YS(2010105) The ACORD name and logo are registered marks of ACORO ' 'tier o_ d h 7 , 19834682