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HomeMy WebLinkAbout0064 TOWNHOUSE TERRACE y -7c-zw m ND t Town- of Wrnstabte (0 � �'� `� OFTHE T ti mit# Expires 6 in jr orn issu Regulatory e da r * Services Fee * BARNSCABLE, r 639 Thomas F. Geiler, Director �AlFD MA'S A Building Division 4 � g 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 without Red X-Press Imprint Map/parcel Number Pro rty Address w/V U ✓�- V coo/ Residential Value of Work dV Minimum fee of$35.00 for work under$6000.00 Owner's Name& Address ����� (, C' Contractor's Name � ^ „ 7 F 501v 0 PJ Telep one Number Home Improvement Contractor License#(if applicable) Tl . a Co 'ruction Supervisor'.s License#(if applicable) Workman's Compensation Insurance a >. Check one: ❑ 1 am a sole proprietor . aP E S PERMIT - ❑ I am the Homeowner ❑ 1 have Worker's Compensation Insurance JUL 2 1' 2010 Insurance Company Name fVeLt/ /y1 CA F BARNSTABLE Workman's Comp. Policy# 5 � Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ' ❑ Re-roof(stripping old shingles). All construction debris will be taken to [] Re-roof(not stripping. Going over existing layers of roof) ❑/Repilacement # of doors Windows/doors/sliders. U.-Value ' Q/ (maximum .44) # of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations, i.e.Historic,Conservation,etc_ + ***Note: Property Owner must sign Property Owner Letter of Permission: A copy of the Home Improvement Contractors License &Construction Supervisors License is �required,' SIGNATURE: _ Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc ' Revised 0701 10 r The Commonwealth of'Massuchusetts i ) Department of Industrial Accidents Office oflnvestegutions +,y SflD Washington Street Boston,MA 02.111 ^,vw.mass. U viti%tt Worl.ers' Compensation Insurance Affidavit Builders/Contract©rs/Electricians/Plu,�h$ts r�pnlicant ntor atifln Please Pri t l_.eably Name(Business/Organization/individual). r Address: City/State/Zip: Phone Are you an employer?'Check the a pro riate b : Type of project(required): 1. I am a employer with ��4• I am a general contractor I 6 w construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. Remodeling 2.❑ I a sole proprietor partner- These sub-contractors have g. Demolition shipip and have no employees working for mein any capacity. employees and have workers' 9 Building addition [No.workers' comp. insurance? 0 orkers' comp.insurance 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its 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 c. 152,§1(4),and we have no insurance required.]t 13.0 Other employees. [No workers' comp.insurance required.] *Any applicant that checks box k 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 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. ✓'� Insurance Company Name: &411 .> - a Expiration Date' : ` Policy#or Self-ins.Lic.#. �!' J � - f r'City/State/Zip: ' V Uo, Job Site Address: - 'Attach a copy of the workers'compensation policy declaration page(showing tite policy er and expi tion date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine 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 tine 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. do hereby certify and ie ins and penalties o ' ry that the information provided above is true and correct. ..ate: 7 9-1 - 0 Si nature: j� Phone# 5_0 '�—�J -- 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 1.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other f Contact Person: Phone#: r The COFri morrive lth of Massachusetts.. -- Departwent of Indrrstr ial Accidents '--# Office of Invesdgai6ans t, - 600 Washington Street Boston, M4 02111 wnw.rnass gov/div Workers' Compensation Insurance-Affida,,zt: Builders/Cantr•dictot-sJElec.ti-icl tnsTlumbers Apph-cant Information Please Print Legibly Name(Businew)Orgam--ationindMdualj: s SoSow, O n Address: City/'State Z_ U 6. O 11 l}ll0i]C Are you a. ruplover^ iec -the appropriate bos. Ty pe of project(r. wire p . 3 e"4 d):. 1.❑ I a employer wrath 4. I am.a general contractor and I 6. ❑ construction mployees(full and/or part-time). have hired the sub-contractors 2.. I eras a sole proprietor or partner- listed on the attached sheet y. Rermodeling p�'1 ship and have no employees These sub-contractors have g_ Demolition working for tree in an employees sand have c voi efs' y capacity. 9. F-1 Building.'additiou [No workers' comp_insurance comp-insurance./ required..] 5.'-0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeoumer doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No vrorlrers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]F c. 152, 1(4) and we have no employees.[No workers' ers' 13,❑O#her comp.insurance:reguii-ed.] Any appficaut that checks boa#1 mast also fill out iheL section below showing their workers'compensation policy infonnatiaa 1 Homeowners who submit this affidm't indicating they are doing all work and then hire outsitte contractors must submit a new aflsdnit indicating such lContractors that check this box must attacked an additionA sheet showing the name of the sub-cotiira?crors and state whether or not those entities have employees. If the sub-•co—nuaccoes have employees,they must provide tMr Workers'comp.policy number. ' I ain art etnploy q that is proizdirrg rtrork rs'corPrperas rtivn nsatrar ce for'n;ry einployees. Below is the policy wid Joib sife anfortnatioPb Insurance Company Name: ' Policy#or Self--ins.Lic.#: �e N�e� Expiration Date:' �[OWAI /kf)_Ge� l � �� �l �)n J Job site Address: City,City/State/Zip. /�/V t.� a V Off/ :attach a copy of the.ivorlrers'compensation policy declaration page(showing the policy number and ex ati on crate). Failure to secure coverage.as required under Section 25A of MGL c. 1:57 can lead to the imposition of critt in I penalties of a fine up to$1,500.00 andfor one-year imprisonment,as wreli 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 he►ebl certify ra the ins and penakws o info.rtuation provided above is tnie and correct. Si ture: Date: Phone# O,�cial use only.:Do not write in this area,,to be completed bye city or tolvifafciaL , City or To`m. Permit/l.icense# Issuing Authority(circle one):: 1.Board of Health 2.Building Department 3.City/Toom Clerk 4.Electrical.Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#. 6 _ ` ✓die -�nom�.no-ru..eall�z o�'✓G'(.tzJa¢r.�se�a -% Board of Building Regulations and Standards f HOME IMPROVEMENT CONTRACTOR Registr4ti0" 126893 1 n 9h12010 hype .Supplement Card -The Nome Depot At-fTome.Senrr ce DARREN QEMEiZS - ' 3200 COBS GALLERfA PK;f1/y 1t20 ATLANTA,GA 30339 Administrator, ,. r^+nT-+`89'RY .Cwy�.y' :.m;,�u.o.'.fM',"S•sa..t.�A'L•v-�'P-�.-C��'�^?*g�F :..y... License or registration valid for individul use only before the expiration date.'If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 4 • t F. 1{{m Not valid without Signature ----- ' ' ^7�1�"v:A+iW... :c�C�.4�..`�-res�ra-r�.aaa•.� .. - Ju I. 2J. 2009 9: 20AM l ha r I e a s e J r. 1u0. 41 1 I r. j W feo"o n s u m e&M airs andusiness egu ion 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 163528 Type: DBA Expiration: 7/7/2011 Tr# 285903 ERICSSON HOME IMPROVEMENT ERICSSON TORRES 16 HOOVER RD ---- ----- WEST YARMOUTH, MA 02673 Update Address and return card.Mark reason for change, Address Renewal d Employment Trost Card 'IPS-CAI A a0M-08/08.0088LIF.00RRMCA108212008�i/ ,� A&3Y2'�RsPPa'�`i( lire& 6wk*,Ioit ucense or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expirotion date. If found return to: Office of Consumer Affairs and Business.Regulation i Reglstras<I'on: 163528 10 park plaza-Suite 5170 Expiration: .7I712011 Tr#, 285903 Boston,MA 02116 Type: ERICSSON HOME;IMPROVEMENT �~ ERICSSON TORRES 16 HOOVER RD' WEST YARMOOT—k MA 02673 Undersecretary Not valid without signature r Jul, 23. 2009 9: 20AM Charles C. Case Jr. No. 4717 P. 6 i R®StrlGtl>Id t0:,t.ro•i 1°1:►ss,tchu�ctts- I)CImi'tmcnt of Public'safm IA.- Masontj'o.nly 'Board of Building R(-giihitionx and St.indards RF- Root Coveting- Constructi.on Supervisor Specialty License VS-Windo4s aril Siding License: CS St. 100546 SF- Solid Puel Bum iag:Devices Restricted to:. W.S DM-Demolition only ER105SON: TORRES Failure to possess a currant edition of the Massachusetts State Building Code 16 HOOVER ROAD is cause for revocation of this license. WEST-YARMOUTH, MA 02673 Refer to: .WWW.Mass.Gov/DPS jog& �- expiration: 811M- 2, (l Haul+rl ncr Tom: 100546 i FIbME IIVVt[PROVEMENT C0N'TRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name: Boston Date: /51 THD Al-Home Services,Inc. d/b/a The Home Depot At-Home Services- 345A Cmenwood Street,Unit 2,Worcester,MA 01607 Branch Number:31 :_ Toll Free(800).657-5182;,Fax(508)756-R823 Federal M#75-269M60;ME Lie#C 02439.;,R1 Cont.Llc#1.6427 . LT Lie#56gS22;14A.Homo I7nprovcmcnt C'ontruc tcrr Reg,41 26893 Installation Address: tO ��{U� LJ�Q �G�QG� ua-/919175 G Citv ,f— State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: no 1�0 [ l [ l [ J Home Address: (If different from Installation Address) City State Zip E=mail Address(to receive project communications and 110111e Depot updates): ❑i DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersigned("Customer"),the owners of the,property located at the above installation address,awes to 611y, and THD At-Home Services.Inc.("The dome Depot")agrees to furnish,deliver and arrange for the installation("Installation")of r n �� �l all materials described on the below and on the referenced Spec S11eet(s), all of which are incorporated into this Contract by.this l l� 'V reference,along with any applicable State Supplement and Payment Summary attached hereto and.any Change Orders(collectively, "Contract"): Job#: nn+ r ire > Products: Spec Sheet(s)#: Project Amount ❑Roofing ❑Siding indows ❑Insulation ❑Gulren/COVerS MEntry Doors ❑__..- -��!k=--- KVfing Siding Windows Esublion. ❑Gutters/Covers ❑Entry Doors ❑ Roofng ❑Siding ❑Windows ❑Insulation $ ❑Cotton/Coven; ❑Fntry Doors❑_..... ❑Roofing ❑ Wi Siding ndows insulation $ / P� ❑Gutters/Covers []Entry Doors ❑ ►/vf`�'%q`T—"Minimum25 Depadtcf Contract Amount due upon execution of this contract. Total Contract Amount $ Maim Purdiasers may not deposit more than one-third of the Contract Amount. Customer agrees that,immediately upon completion of the work for each Product,Customer will execute 1i Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer udder this Contract agrees to be jointly.and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual'Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations flue to a structural problei.n.with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors.or because work required to complete the job was not included in the Contract.. Payment Summer]'• The Payment Summary # included as part of this Contract, sets forth the.total Contract amount and payments required for the deposits and-final payments by Product(as applicable): NOTICE TO CUSTOMER. You are entitled to a'completely f Ded-in copy of the Contract at the time you sign. Do not sign a Completion Certificate.(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agr'ecr..to pal The Home Depot the costs;of nrrterials,labor,expenses and services provided by The Home Depot or Authorized Service Provider tbrouggh the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. rLeceDtan-e and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer :hid The Home Depot with regard to the Products and Installation services aril superu:des all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed py Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands.'voluntarily:accepts the terms of and has received a copy of this Agreement. A�uftmer's;�n, b Submitte Sales Consult is S• atnle Date Date TelephoneNoustomersDate Sales Consultant License No. ' (ss applicable) CANCELLATION: CUSTOMER MAY CANCEL THIS AGREEMENT.WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SiCNING THIS AGREEMENT. THE. ; STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRFSCMED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND('ONDITTUNS ARE STATED ON THE REVLR$E SiDR AND.ARL TART'OF THIS CONTRACT szm r.-S� White-Branch.Fite Yellow-Customer Td Wd9T:V L00Z 61: LL?ZZ9P_80S: 'ON Xtid p26wpt : Wodi