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HomeMy WebLinkAbout0015 WELLESLEY CIRCLE �� t/i/e/1�1�e,c. C'i�l� �� y, �� ��� 1 I i rear Zp 'fl� 3 i i i C �U Town of Barnstable Kxpbw 6 mmdu dOe Regulatory Services MAW sluutsTesu, + ' Richard V..Scali,Interim 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 Jot Valid without Red X-Press Imprint Map/parcel Number Property Address Residential Value of work$ &/7 A Minimum fee of$35.00 for work uPder$6000.00 Owner's Name&Address J 51>5AJ14K� S / GUeI%sV ���P� yvv�s Contractor's Nam l GJ elephone Number'�o�- Home Improvement Contractor License#(if pplicable) Emit: Construction Supervisor's License#(if applicable) © 3-70 7 ® W PERMIT *Orkman's Compensation insurance FEB 2 7 2014 Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance TOWN OF EARNSTABL.E Insurance Company Name_ IL7 lG Workmen's Comp.Policy# A/C/ /Z 7 U 6 e35,23 l 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) ❑ Re-side Replacement Windows/doors/sliders.U-Value - 3 0 (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. •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 cop f the Home Improvement Contractors License&Construction Supervisors License is equir x SIGNATURE: TAKEVIN D\Building Changes\EXPRESS PERMIT\EXPRESS.doc . Revised 061313 K The Commonwealth ofMassachusetis Department of Industrial Accidents Office of Investigadons ' 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibl Name (Business/Organization/Individual): F/Us ue, Address: tl (o City/State/Zip: I-/A C-a N , -/e,1. ligi.5- Phone#: !/DJ ?YeD Are you an employer?Check the appropriate box: Type of project(required): 1.[�I am a employer with A 0 4. ❑ I am a general contractor and I 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 ees �es e sub-contractors have P P oy 1 8. ❑,Demolition working for me in any capacity. p oyees and have workers' 9. Building addition [No workers'comp.insurance comp,insurance.$ g required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 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 12.0 Roof repairs insurance required.]t c.152, §1(4),and we have no employees.[No workers' MJ20ther U)/PQD k) comp.insurance required.] R� lrr� 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy info ation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mustsubmit 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 worker;'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees Below is thepolicy andjob site information. Insurance Company Name: SVi—Qly Q;9V Policy#or Self-ins.Lie.#:�J� �/���J 3�� Expiration Date: d oZ/ Job Site Address: Cii p sl Aw, Cm,/State z, �/u�s Attach a copy of the workers'compensation poi• declaration page(showing the policy num er 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 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 beforwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certl under the pains and penalties of perjury that the information provided a a;1s7;e and correctrSignature: Date: _ Phone#: �b l' C2 19 9- �M)n Official use only. Do not write in this area,to be completed by city or town official City or Town: PermitAL,icense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk. 4.Electrical Inspector 5.'Plumbing Inspector 6.Other Contact Person: Phone#• Client#:30124 SOUTNEW ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE 612013(MM/DD/YYYY) 8/0(MMIDO 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.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 NAME: Anita Little Willis of New Jersey,Inc. PA"/CONrEo Ext:856 914-4660 FAX 1015 Briggs Road,PO Box 5005 EMAIL ac,Nc: 856-914-1881 PO Box 5005 ADDRESS: anita.little@willis.com Mount Laurel,NJ 08054 INSURER(S)AFFORDING COVERAGE NAIC q INSURER A:Selective Insurance Co of the S 39926 INSURED Southern New England Windows LLC INSURER B:Argonaut Insurance Co. - 19801 D/B/A Renewal by Andersen INSURER C:Beacon Mutual Ins.Co. 24017 26 Albion Road INSURER D: Lincoln,RI 02865 INSURER E: INSURER F: - COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD MMIDD A GENERAL LIABILITY S202945900 8/10/2013 08/10/2014 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea aiEoNcTErrance $100 000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $3,000,000 POLICY EC7 LOC $ A AUTOMOBILE LIABILITY S202945900 8/10/2013 08/10/201 .COMBINED SINGLE LIMIT Ea accident 1,0009000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident A X UMBRELLA LIAB OCCUR S202945900 8/10/2013 08/10/2014 EACH OCCURRENCE $5 000 000 EXCESS LIAB HCLAIMS-MADE AGGREGATE $5 000 000 DED I I RETENTION$ $ C WORKERS COMPENSATION 0000068028-RI 8/21/2013 08/21/201 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY - B ANY PROPRIETOR/PARTNER/EXECUTIVE .AIC927818352394 8/21/2013 08121/201 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION Southern NE LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26 Albion Road ACCORDANCE WITH THE POLICY PROVISIONS. . Lincoln,RI 02865 AUTHORIZED REPRESENTATIVE Pox ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S215109/M215088 AXL Southern New England Windows d.b.a Renewal by Andersen of SNE r.. Massachusetts-Department of Public;Safety, } ' Board of BU.lding Regulations.and Standards, Construction Supch:jsor License 6S-095707 t I I'j a BRMNDDENMSON ' 7,I:AlY1BS POND+�IRC �- �%. Cksirlton MA 01507. R i Commissioner .09/08/2014 O>�ce of Consumer A airs Business a ation 10 Park Plaza;-'.Suite 5170 Boston,Massachusetts 02116 Home ImproVementjContractor Registration Registration: 113245 „] Type: -Supplement Caryl SOUTHERN NEW ENGLAND WINDOWS�LL� F�'rauam gnsnola DENNISON BRIAN 1137 PARK EAST DRIVE l WOONSOCKET,RI 02895I,L ,' "-. LANs. Update Addresapnd return card.Mark reason for cbaugr. nearest-❑Renewal (:].Employment'Q 14wt Cara sut ozait .. Isee etCo samerARain&Basiem Aegalatbs License or registration valid for Indlvidul use only E MPROYEaIENf.CONTRACTOR before the expiration that,If found return to: Office of Consumer Affairs and Business Regulation ice 173245-. Type: .IOPark Plan-Suite 5170 - Eaplratlon:­gnSn111/ Supplement lard Botioo,MA 02116 SWTHERN NEW ENGI'AND WI1,150VIS I.I.C. RENEWAL By ANDERSON> DENNISON BRIAN 1' 1137 PARK EAST DRIVE �-1—'—,5L§-- . WOONSOCKEf,RI M895. Limit errehry Not valid without.signature. r% Kenewal byAndersen. RF_NXM,AL By AN- DERSENT WMI10. 26.11bim Road - Lincoln,R1 02%5 1&.4 Min V.;L47 • Rhone 96063.2235-Rrus 401.63SAW2 -4re, 6 d Soothes Nov lingLmd WlWo",,LLC d/6/it Remeoval by Andersen of Soutbern New Fog"] CUSTOM WINDOW AND DOOR REMODE1 NO ACAELMENT CfA"==V .2=- 41— Buyelx%,lie rAA-iDintly.171 i nverilly v grcui io purchme the pixiduc-a-Vur Aenicea Of SclufaerriNew Enghild%Mrid-owl.,.LLC d"Lla Rrntnval by Ander-c"a Of SWIlief-L NinvEnglarid("Qimwztor`*'i,in a6cilydance t%ith Oc termiwrit]crim.66P ris desailied-on die 11kint and dir ivott-so of tb;ng meo tou and on ffie mim d ied6 v/cifi7mticn shrcrOj(cd lee ljwtv dii!"Agmemem"I C Iliaore J Cando D 110AT Tolapb Anwugt 2 Iff0invef VANIVE Que: Metbod exi Payinern: Q Check 0 C.*tk 3e"nced DeFcsir RLc6m.d(33'4)!.. CAvd:i;Ards aft actepLedfor d:pcsh city-ffmarnurn 1#3 oftlier 4picin COW.C,%M see Gelk codobm- evil ft m�j liv signing la's 811riteat Stert of lzbo(33%): lines:. ad caellpWim Fr C9 Agreemzrti Wj MripMote xbr,the Dalurive W.Suit VjGb and the Wince on Subut: / P_ Balance w Subt!nnii-J Comps ion of johzanncr be made by oreft card test moat be irade-Try poesikW d-,cd:,.!t2i%kcheck,mrcxh, Buyerfs)agrees and understands that this Agretuvheat constitutes the entire understanding he 'ca t1he porgies,and that there are no verbal understandliag U`vc l7s changing any at die terms of this Agreement.Bir x(s)jW acima"iedges That Bayer(s) 1)has read this Agreement,understands the terms of this Agreement.and has recti6rd a caimplefed,signed,and dated copy of this;Agmcnwnt4 inetudlaS the tivaattacked.Notices of Carics-Sation,on tht dutt firstvrritten olimleand 12)was orally iniftirme d or Boyar's;right to coned this ASreement.DO NOT sioNnas cowmg:-T IF nMRE AIRE ANY BLj9x st-AcEs. llftaAe.IslasidSaW 0n1j)Notice to Bul;cr3(11 Do not Sign this Agreement if key lot the spaces;intended ror the agreed terms m the extclatrotthea available iaw7nadon are left blank,(2)'16P are calitle4l to a copy of this Agreement lattheximey 8 ousi a it,(3)You may at any time pay aff the full unpaid balance due under this Agreement'and in so doing you may be ands led to receive a partial rebate of the fidance and hwurance chane&_(4)The seller has no right to Unlawf4y enter v our promises or commit any breach of the panes to eepossess gootis purchased under thii;Agreement.(3)IOU.nvay oristrell this Agreemeng if it has not'lliven signed at tho amin office or a branch office of the tclllcvh provided you oatify the seller at his or her main Office Or branch office shown in the Agreement by regsstejf*d Or vertified wag,which rJkaR be posted 604 later than midnight of the third calendar day after the day an which the buyer signs dit.ftreement,excluding Sunday and any holiday on which regular mail delivreries lure eat made.Scathe ascantyJaamyiuS ttatire of cancellation form tar an explanation of buyer%rights. KLqx,r.':i)fe m. %wl I lie cfm suilric r cdacni ii>n mateikils pix-Aick,d by the R. t,'14,17)j CA)I I I Fa Ct---i J'j Rr,&4&JV.j L-U 1-1 BMI rd. ff3irnn I-1A birdf� Renewal by Andersen of Southern New England Buy Buyty(s) Inv: or 11 duel Mimarr x1.Nil 151r. Si-nature 7/Z" vv Priall 1%atfii:if Produrt hiLinazor Paint Nam; Dint Name YOU. THE SMA(SI, Al"CANCEL TEAS TRANSACTION"ANY TWIS PRIOR TO XMNIGHT OF TIM THIRD BUSINESS DAY AYTER THE DATE OFTMS TRANSACTION.SEWME AMCKED NOTICE OF CJkN`CEI1X1'fON FORWIS FORAN M-tANATIOV OFTHIS RIGHT. --- - - - - - - - - - - - - - -be- - - - - - - - Mg-mc.6�0zgAug'ELLa ION �t ;�- NP=E_QF_CWCr=Ll_ATIQN Date of Transaction You may cancel Date of Traiisketion 16f--,l You may cancel �this transaction,Without any penal[ ar obligation,whillin this transaction,withoa any penniq or obligation,within three business days from tile above data.If you cancel,any 1 three business days from elle above dam if you cancel,any prop"traded in,any payments made by you under bhe 1 property traded in,any payments inade by you under the Contract Or Sa1c,and any negotiable Instrument executed I Contract or Sale,and any negotiable instrument eLmmuted by you will he rewrimod wkMn ten business days Follovil"s 1 by you will be returned within ibeirm b"rte-m days fallowing receipt by the Seller of your cancellation notice,and any i receipt by the:Seller of your cancellation notice,and any securiLy interftt wising out of the transaction will be Security interest ansing out of the transaittibn will be canceled.If you earictil,you mustrinake available to the Seller I canc*W-Ifyou cancel,you must make available to the Seller at your residence,In substitntially as good condition as,when 1 at your r1BsidCnCe.jD Substantially as good condititm as when receiveA any goodly delivered to you under this Contract or I received,awry goods delivered to you under this Contract or Ash' -in ply with the instructions of p Sallw.or you may+if you wish,comply with the instructions of Sale;or YoUirnay'll'YOU*I Co Om Salle r regarding the return&1hiproent of the goods at the the Seiler regarding the return shipment of the goods at the Seller's expense and risk.if you do I Mw the goods available Sefferlk expense and risil.Of you-do make the goods available to the Seller and the Seller does not pick them tip within I to the Seller and the Seller does not pick them up within twenty days of the date of cancellation,you maV retain or — Y days of the date of cancellation;you may retain or disgust of the goods without a further obligation.Of you dri,;,T,,of the goods without any further obligation.If you fid I to make the goods available to the Seller,or if you a" I fail to'make the goods available to the Seller,or if you agme to eett"the goods to the Seller and fail to cla so,-then you 1 to.return the goods to the Seller and(Al to do s%then you remain liable for performance Of all obligations under the remisin I iahh,-for performance of all,abbSotiong;under the ContrAtt.ro cancel this transaction,riiii]or ciciNcra signed 1 Corkti-acLT6 tanca this transaction.'mail or deliver 9-5goed and do" copy of this cancellation ekocke Or any other I and dated copy of tiffs cancellation notice or any other written no 0rce,or send a telegrarn to Renowal brAndersen of I written rtatite,air send a ttlegram to Renewal byAri derse".of South"New England at 26 Albion Road.uncopp,10 02065, 1 Southern New En land at 26 Albion RoA Lincoln;RI 0266S, M40T LATER THAN MIDNIGHT OF a- NOT LATER TRN minniGmv OF _g-2 (oato) (Date) I HEREBY CANCEL TH IST RA141SACTION. I HEREBY CANCELTHIS TRANSACTION. savar-6 sizoutwo Punciftne Dl Buyer's S"anue Pwial rdwne 0=0 AbA Co*,Wrict Buyer Cop)r Yd3ow Poyer C:ip�.:PIA L-d °FIME Town ®f Barnstable Regulatory Serivices sAMMBLE• Thomas F. Geiler Director MASS. 4'Al26-39. Building Division Thomas Perry, CDO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5Q8-790-6230 EXIT ORDER DAT LOCATION: Z5 Ayz�" Under the provisions of 780 CMR,-the State Building Code, Section 3400.5.1, you are hereby ordered to immediately discontinue4he use of the cellar/basement area for sleeping purposes. LOCAL INSPECTOR SIGNATURE OF IPIENT JA0 o Frw, ''own of Barnstable Oo �y ° Permit# Regulatory Services � �Fe��6,n�rsf m ' trdare 161 9- p Thomas F. Geiler, Director Building Division - Tom Perry, CBO, Building,Comrnissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Off]c e: 5 08-862-403-8 Fax. 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY - Not Valid)PYhout RedX-Press lnrprint` Map/parcel Number '8 l Pro erty Address I/�/e (�S .e A " �Als �aC© Residential Value of.Work 4 T r� Minimum fee ofS35.00 Cor work under S6000.00 ` Owner's Name & Address �aC� 90S.IV /) /O Contractor's Narne eS / ? Telephone Number Home Improvement Contractor License#(if applicable) ZWorkcnan'tion Supervisor's License#(if applicable)s Compensation Insurance Check one: am a sole proprietor MAR 4 4 2012 I am the Homeowner I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name u VA Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request (check box) ❑ Re-roof(hurricanenailed) (stripping old shingles) Al1.cons tr.uction debris will betaken to ❑ Re-roof(hurricane n.fiiled).(notstripping. Going over existing layers of rooi)� ❑ -side d�� #ofdoors Replacement Windows/doors/sliders. U-Value (maximum .35)#of windows *Where required: Issuance of this permit does not of 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, 3NATVRE: VPFILESIPOPNtSlbuildingpe—,nii formskEXPRrSS.doc The Commonwealth of Massachusetts Print Form`' Department of Industrial Accidents Office of Investigations ]- I Congress Street,Suite 100 s Boston, AM 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeilbly Name(Business/Organization/Individual): {� Address: //3 Y ow--(L Dct y City/State/Zip:-W���CI4."f" Phone 4: 'Y o f-6 7� 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 sub-contractors 6. ❑ 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 workingfor me in an capacity. employees and have workers' y p �'• 9. ❑Building addition [No workers' comp.insurance comp.insurance.T . . required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 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 insurance required.] T C. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *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. :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. i Insurance Company Name:. j Ci L0-10 MV,�1J?Jzh Policy#or.Self ins.Lic.#: f�.; 3 �J CMG Expiration Date: Job Site Address: (/V,e e ,e �/ City/State/Zip: 4/1/4/ 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 certiunder the pains and enalties o erju that the information provided above is true and co Signature: Date:. :_ Phone#: t 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 2.Building,Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: OP ID:JV DATE(MWDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 10/04111 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(les)must be endorsed. if SUBROGATION IS WAIVED,subject to the terns 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 Ileu of Such endorsemen s. PRODUCER 401-769-9.500 NArrER Hunter Insurance,Inc. 401-769-9502 IPMNE No 389 Old River Road,P.O.Box 1 Manville,R102838-0001 ADDRESS: c T MER 1D w MQONA-1 ENSURE s AFFORDING COVERAOS NAIL it INSURED Moon Associates Inc. - INSURER A-:National Gran a Insurance Co. 14788 Renewals By Anderson INsuRERR:Beacon Mutual Insurance Co. 1137 Park East Drive INSURERc: Woonsocket,RI 02895 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO T)4E 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, iL TYPE OF INSURANCE POLICY NUMBER MID POLICY EFF EllP LIMITS DEHERAL LIABRTTY EACH OCCURRENCE $ 1,000,00 DAJUGE To A X COMMERCIAL GENERAL LIABILITY MPS26619 09l18111 09116l12 PREMISES Ea ocal nce $ 500,00 CLAIMS-MADE X❑OCCUR MED EXP(Any one per4on) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GE14L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,00 POLICY PRO- EJ LOC $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT 3 _ 1,000,00 tEa i A X ANY AUTO B1S26619 09116111 09/1W12 BODILY INJURY(Per parson) $ ALL OWNEDAUTOS BODILY INJURY(Per accident) S" SCHEDULED AUTOS PROPERTY DAMAGE S HIRED AUTOS (Per ecident) S NO"WNEO AUTOS S UMBRELLA UAII 1 X OCCUR EACH OCCURRENCE S 1,000,0() EXCESS LIAR CLAIMS-MADE 09116111 0911611? AGGREGATE i A CUS26619 DEDUCTEBLE $ X RETE"ON 10000 $ WORKER$COMPENSATIOK WC STATU- OTH- AND EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNERrEXECUTIVE NIA Y VY�C47731 $30427 _ 10101f11. '10101112 E.L,EAGHACCIOENT $ 500,00 OFFICERIMEMBER EXCLUDED? 300,00 (Nand*tbry IA NH} El,DISEASE-EA EMPLOYE $ If yea,datuit* rAer E.L.DISEASE-POLICY LIMIT S 500,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATION31 LOCAnON81 VEHICLES (Attach ACU2D 101,AddlflorNi ReMArim$p►Imduim,If mom Simon 16 ppulrbd) CERTIFICATE HOLDER CANCELLATION DEPARTM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 13ATE THEREOF, NOTICE WILL BE DELIVERED IN Department Of Administration ACCORDANCE WITH THE POLICY PROVISIONS. Bldg.Contractors Reg.Board One Capitol Bill AUTHORIZED REPREESENTATWE Providence, RI 02908 0 1988-2009 ACORD CORPORATION, All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD ` `✓fr�eitnou�re1 Vusisne's"s, office of Consumer Affairs anal Re ulati.on 1Q Park Ply tilt SI70 Boston, Massachusetts 02116 Home Improvement t~ontrac"tor.RegistrA ion ° "»a `�!r' RIWkStr�uOrt L1f53� x �£�� Type Prs"vaL£c*rparatfon T Exxir*(k 7*412013 T-4 liUil MOON PS$QC 1NC JAMESMOON �,ti ,.�..��....�..,.,�..,:...:.._:....�,.,„,�__..�_.......,._,._..:�.�... 11 Y PARK EAST DR... . . WOONSOCKET,Rt Q2895 t�rrt t rU{alate Addrtsa gad retura read 59ark repsau for ingr. a Addres's Rio e�r•al Empfoy`ment Lost.Card r�rs iati+aaa�z��a�ato ()tticednsumer Airs';:B iorx `nln�od 1 tceuse oritrniian vutid Cur incYipidul uSe bnt}' HOME IMPROVEMENT CONTRACTOR htCore the expira110a dale, if found rcLurn tri ,-'ReglstiaU0o: g 119535 Typo; Otfice oCConAu urrAftairs and litisiness Rcgutation 1cYplratlon `7/24t20t3 Pri rate Gorporaii0n f0 Park Ptara-«Suitt$174 I30ston A1.102116 kltStSt�ASSOC INC1 l JAIVAES MOON 4 t 1137 PARK EAST W16ONSOCKET R102 95 -�ti k;.,` l 0itenecre{ary 3Y0t�mlyd�.'tthou{signature '' ' [ ;R!►Rit KCN. Ste t �.1 tip' Gild ng RO latton itil ' taildAt-tl v' . � ,s s 1'' fts .. K a , LlGe!'ISC�;� � $�. 99$4Q ,, ° w Restritte tt��a RF;1NS �r r='� fYp � � 4 ER �AQQ,. {{�� ,s`9.'?.4ti ;y,�f.^•�a...�� y-�4w�f iP.SF Na''�i4 µ� •rcr ';' �ro �'r ^��° . 41 Ott r'j `��ti.'St,. "Y ..,ro.+ � /201 ;��""r r i+• ��.v3 a4.�w..,; t�. S . Explira ton: 1 �r a Cop � 1�- ��� ��� � �-�►1.L s. lip . � .. ;, —'"—` by .ant.cr.+c c.�.cpa �+ s saes, a aw,%.d m mas sy P+@- L.,i Paw _ _ .e,.9as�s,�.12M A ,. wan c ASra,�two uss scr.stets GUM fl 0 VON was r j L c"/ 2 1 �-1 3•- L AUL =FR l4wr�r+w�iib = fV rrrcrr/arer�err�wl4�r..r7L� AwMMfi� EIE "' Moftd yr�" 'u wMr.+r«w.wwa�ww�M�.�r.�rr. � !�►W�� • l�ru�q !klaw somew" rP•++k� M r1r� Awv Ti�.�ts � u ❑H-ft ��-.Frs�i' ✓AC 1�w+�rr�C1�i��r�wM--�v� 7Msti rll�i�IMrY or irti�r.wrw4.rirl�rirAr�r�� - 1Mrfce�Gar !h wrrrr.ar..+i.w A-few ,,. �+Y4Yr?h aral�eMaAe� a�irau�t�air �aMae6e�illu ` 00-4 apAaii�Uw.•a.wY.aY-M....,,, ..t,+l�r+ • w ' Zoning Team Field Report Date: Thursday, May 3, 2007 Locations: 5 Alicia Road, Hyannis 108 Walnut Street, Hyannis 85 Spruce Street, Hyannis 196 Craigville Beach Road, Hyannis 55 Straightway,Hyannis 229 Sudbury Lane,Hyannis 15 Wellesley Circle, Hyannis , 7 Lexington Drive, Hyannis Inspectors: Don Desmarais, Health,Paul Roma. Building & Robin Giangregorio, Zoning Fire Dept: No Representative. Police: Officer Kevin Donnelly ADDRESS: 5 Alicia Road, Hyannis Zoning: RB-AP - Unrelated lodgers Owner of Record: Libernia Pinheiro 5-28-45 017706323 Contact 508-360-5345 Number of Bedrooms 3 Bedrooms BOH 3 Bedrooms Actual 6 &Beauty Salon w/2 chairs • No response on initial attempt at 5 PM. • Returned at 7:45 PM • Found one Portuguese speaking male adult, Jaimi Q De Souza • Officer Donnelly confiscated counterfeit international driver's license. • A church representative stopped by to transport another occupant to services. • Subsequently accessed dwelling thru side door to 2-chair beauty salon. • Found 3 locked bedrooms on 1st floor and a locked room in salon(likely supply room). •` Found 3 bedrooms in basement=individual locks. No egress. • Door to bulkhead stairs secured with wooden bar. • Left exit order&business cards on salon chair. • Upon departure, Geraldo (formerly a temp custodian in S&G) stopped by. • He stated he does not know where Lena resides but will call her and advised her to contact us: , UPDATE - 5 Alicia Road • Lena came in at I I AM on 5/4/07. She informed me that the salon has been removed. • I advised her that a permit is required- also in`part to document compliance. She left with a building permit application for this work and the elimination of the 3 bedrooms in the basement. • Confirmed salon is removed. UPDATE • 5/25/07 Geraldo came in. Work on basement to be finished by 6/8/07. ADDRESS: 108 Walnut Street, Hyannis Zoning : RB-GP Unrelated lodgers Owner of Record: Mirian Oliveira Contact Sandra Lucia De Oliveira Number of Bedrooms : 3 Bedrooms BOH sewer Actual 3 • Found three cars on site—2 on front lawn near front door. • Owner lives here with adult son & one friend. • Found only 3 bedrooms occupied/set up as bedrooms. • Son is in a band and has music room downstairs. • Owner stated that son's band mates come here to practice. • Advised owner to restrict parking to edge of lawn so others will not complain. • One car currently on lawn belongs to former owner and will be relocated soon. • No other issues at his site. ADDRESS: 85 Spruce Street, Hyannis Zoning : RB-WP Unrelated lodgers Owner of Record: Gilberto DosAnjos Contact Number of Bedrooms: 3 Bedrooms BOH sewer Actual f • No response to Amnesty letter dated 11/14/06. • Spoke to brother-in-law of owner. • He resides here with his wife, young child. • He has adult son living in basement unit. • Wife's child may also move in later. • Advised couple to apply for family apartment. • We were unable to access unit but owner will call & set up appointment. • Unable to confirm or dismiss egress concerns. Advised owner accordingly. • Discussed previous complaint regarding used car sales at this site. • Owner has ceased activity • Found no evidence of continued activity. ADDRESS: 196 Craigville Beach Road Home Occupy— Cape Fitness Repair Zoning: RB-WP Unrelated lodgers Owner of Record: Raul & Gilber Souto Contact Thiago Souto (son) &Mrs Souto 508-778-2940 Number of Bedrooms : 6 Bedrooms BOH 4 bedroom cesspool-location of 2°a tank unknown Actual 6 • Found 4 cars in driveway upon arrival • 4 adults live upstairs, M&M Souto, Thiago and a cousin. • 3 Adults live downstairs. another cousin, his wife and a third unrelated adult. • Found interior downstairs door to apartment in split-level to be padlocked from inside apt. • Advised Thiago to remove. (He did not have key) • Smoke detectors not working. ADDRESS : 55 Straightway, Hyannis Zoning : RB-WP Unrelated lodgers Owner of Record:Joao Pimenta Contact Number of Bedrooms : 3 Bedrooms BOH 3 Bedrooms Actual 5 • 6 Adults and 1 infant reside here. • Joao owns the tow truck that was parked at 166 Beth Lane. • Left instructions with daughter, Diane (owner of 166 Beth) to contact me ASAP. ., • This is a split level home. • Basement finished with 2 rooms that qualify as bedrooms. • Room immediately to right of stairs with fireplace was open but set up as a bedroom. • Entrance was segregated with a typical door. • Obvious that original layout intended this to be a family room. • Windows did not satisfy egress standards.Second bedroom in basement had 5' cased opening determined by P Roma. • Mattresses and furniture were stored here. • Diane stated this belongs to her brother who moved to N Carolina and left his stuff here. • For safety purposes, sleeping area should be in 2"d bedroom as egress window is ok. • Left exit order on site. UPDATE • Came in with interpreter as requested. • PR reviewed egress issues and septic concern. • Discussed complaint regarding tow truck at this location. • Advised to find new location to park truck within 2 weeks. • Must advise me of new location or be ticketed. ADDRESS: 229 Sudbury Lane, Hyannis Zoning :RB-WP Unrelated lodgers Owner of Record: Wanderson Figueiredo: Contact Number of Bedrooms : 3 Bedrooms , BOH sewer Actual 3 • No problems here. • Garage looks like apt from outside but is actually storage only. • Tenants moving this month. • No apartment in basement—partly finished walls & floor. • Basement used for storage only. ADDRESS: 15 Wellesley Circle, Hyannis Zoning :RB-WP Unrelated lodgers Owner of Record: Paulo Hoffinan Contact Number of Bedrooms : 3 Bedrooms BOH sewer Actual • Language issue.4 • Tenant called someone who spoke English. Did not want to let us in without owner's approval. • Advised me that someone is sleeping in basement—temporarily and moving next week. • Apparent that there are egress issues here for basement. UPDATE - 15 Wellseley Circle • Received call 5/4/07 and made appointment to view property at 3:30 PM. Will return with BI JL. • Advised BOH of appointment. ADDRESS: 7 Lexington Drive, Hyannis Zoning:RB-WP Unrelated lodgers Owner of Record: James Tobin Contact Number of Bedrooms 3 Bedrooms BOH sewer Actual 4 • Found there to be 4 cars scattered between drive way and lawn. • English speaking residents invited us in. • Arrived at dinner time. • Found man at table drinking Bud and woman eating meatloaf out a brownie pan. • All zoning team members declined an invitation to partake. • Found there to be an unregistered family apartment. • Advised that`Bill" owns home and lives in attached apartment with girlfriend. • Girlfriend is in hospital—sick with cancer. • Ex-wife resides in main house with young adult son. • Son had a friend over for a cook—out on rear patio. • Found basement—no working light in stairwell. • Stairs very spongy—no railing. • Basement had two bedrooms —no windows, bulkhead exit. • Bill was very,inebriated and became agitated when over-crowding issue was identified as a concern. • Ex-wife also appeared to have substance-abuse issues. TOWN OF BARNSTABLE Per No. 26049 11AUn.m Building Inspector cash -------------- — URI OCCUPANCY "PERMIT Bond Issued to Cci ricorn 1?egt1ty-TrUSt`- Address Lot 21,` 15 Wellesley Circle, Mrann;s Wiring Inspector �- ; / ' Inspection'date Plumbing Inspect- Inspection date Gas Inspector Inspection date 1 a a o !l l�'�P".'n,nY+f J--N. .�.`t_ s.✓e'9ry�sy,n r i�:.-n e,A4-• yXngineering Department Inspection date r''" C Board-of-Health �JJ��. 9 ��� Inspection date TIIIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ......................................... er r:r' X�e'e ............. 19 ;.....................................................................................................`......... t �/ Building Inspector f -Al FROM TOWN of BARNSTABLE BUILDING DEPARTMENT Mr. Francis Lahte ne , 67 MAIN STREET HYANNIS, MA 02601 Town Clerk ��-------.',. a ,�. . Phone: 775-1120 SUBJECT: FOLD HERE - DATE I MESSAGE Work has'been ca feted unr er Permit .426049 C,a�pricorn B� Trust) . { Please Tease-Band low • - SIGNED DATE � 7 REPLY SIGNED N87-RMI RECIPIENT: RETAIN.WHITE COPY,RETURN PINK COPY PRINTED IN U.S,.A.' SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE.AND PINK COPIES WITH CARBON INTACT. Assessor's map'and lot number_...Q.70 J .a.a q ............. f A � ,' '• �' - 0 ��F THE tp�4 r �y rr P Sewage Permit-*number ' ....M S OAKCI.i.V.f.M:. f _.-_. _ Z BAHB3TOBLE, i .House. number 15..............::...:.��:q��.:.�.��:...... ., 90 rb a O 39- OF BARNSTABLE TOWN t - , BUILDING .INSPECTOR. APPLICATION FOR PERMIT TO . .. ...................................Construct Single Family Dwelling ..................... . .... rr Wood .Frame ^ :'. `TYPE OF CONSTRUCTION{............................... Nov„ember...22.�.................19....83 TO THE INSPECTOR OF BUILDINGS: rF: The undersigned hereby applies%for a permit according tofthe f lowing information: .Lot 2 Suw&-bU-7r- _'46&X:e . - s Location ............................................ L���S;CE� : .MA::............................................ ProposedUse .............:................... ...................... ........................................................... ................. ....................... f Zoning District R.'.B'................................................:...:........Fire District ..HyaTlnl.s.�:..�........ Name of Owner Capricorn Realty Trust...........................Addr&ss 765„Falmouth Roads Hyannis, MA „ Name of, Builder Franco Real .Estate' Dev. Co Address .765 Falmouth Road, Hyannis, Ma„ .............. ... , Name of Architect ..........................::........::............................A'ddress Number of Rooms Six .......Foundation .... ................................ ......:......................... Exterior .Clapboard and/or...shingles..........:......Roofing Ash. ...ski. b7g2, .s................................. ........ Caret ....5 �. .K.QG ...........................Floors ........................... .............................................Interior . .............................. Heating Gas — F.W.A! Two —' Co er ...........................................................................Plumbing .................... L?L�............. Fireplace None ............„•.....Approximate. Cost $40,00... 00 Definitive Plan`Approved by Planning -Board -------_- =1 9 ---: ' Are �.......�•�•.�.L.(.� Y`T. Diagram of Lot and Building with ,Dimensions Fe . .� ......................... A SUBJECT TO APPROVAL' OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS a. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. , Name .. ... .. .......Pres.... t 000 � 9 i ' . Construction Supervisor's License ....9... ` C-APRICORN, REALTY TRUST 26049 = No ...............:.Permit for One Story............... Single--Family Dwelling Lot 21 - _ Location _ r.......................... Hyannis......... . .............. ......... ........0 ricoRal� Trust .. . ....Owner ..... Type Construction Frame................... s ......... . .............. ........._. ......k........... b �r Plot ....................... Lot ...... ................ Perm ranted Date Inspection .. .................................19 .mow► ' Pate m.pleted � ct .t....:../J.....!........19d'iJ � \ /J CL i l Pi N L qw a � J Y� /000� N� :P Al r, 5a III . /Ov `G./spJP� �r CERTIFIED PLOT PLAN .. R0"SERT D7— 2- 77 NE'W CONSTRUCTION ONLY �; ' E1DR �' _ /y/V f T 0 P OF FOUNDATION. 19 .., FEE �, :IN -- .4BOVE LOW POINT- of ,ADJACENT J6A A h S'f. , 16 24 111 A�t ti SCALES / � * DATE, Z� /8-4 }. Gy' QRE`�iG ' ENQIAIEE'R/NQ Ct�i,lN 1 CERTIFY THAT THE Faweyos; 7io f GLf ENT EGISTERED REGISTERED =F; gam~"' SHOWN ON TN19 PLAN 19 LOCATlO . <' SZ "`� y JOM�;i�0a Ok. THE AROUND A9 INDICATED ,AIr1P1 CIVIL LAND -*--- --,_ ENGINEER SURVEYOR r CONFORMS' TO -THE ZONING LAWS t�,. CI�t.,eY���`g'� .. OF 8ARNSTAB MASS "t x#n 7-12 MAIN STREET= &AT HYANhlI$ MA REG. LAND SURVEYOR,• fi „ i - .a ., r• .+., .w-..wseT..nwa:rv.,...xs* ,a Assessor's map i3nd lot number .... THE 7-] �. � | ' House number ---------- ^,�*�.~�. �'����-- ��` ' v ` / ` �/ °~~ |� 039- /X , � ������7�J ���� �� �J�� �� � �� � �� -- �� �� �� |� � �]� �� /� ���� �� �� ���� ���� / . . ' — BUILDING � N N 0 �� INSPECTOR ���� �� �� ���� N0_0NN �� �� N �����=��0� 0NN �� � Construct Single Family Dwelling .~. ,L~4..~.. FOR "~R°""" TO -------------_--_---..=------..*...---..`-----.. / / Wood Frame TYPE OF CONSTRUCTION �����������������������������������..��������.. � ` - 22' R� �H������..=="-----.l��—,:� . ` TO THE INSPECTOR OF BUILDINGS: - The undersigned hereby applies for permit according to the following information: �ot # 21 Lane ^ Location -----------�.��v����—.---�-----.--------��5�?IRls.f... �.............................................. ProposedUse ---------.—.-------.—,----.---.----.---.--------------------- Il Zoning District —!—B.�---.-----------------Fire District ..113! .------.-------_. j Name of Owner C i Be l ..�z���tA66r�s75.. Road _ .. �... �]�_ ` Nome of Builder Franco .Beal E state Address .7.§5'��� 'Boad��.. x—Ma—I^"-" _ ' ^ Nome of Architect ...................... .----�---'Addreo -----------..---------------- -^ ' -Number of Rooms .....Si.x......................................................Foundation ......P={|M.............................................................. ~ Ex/e,ior §!�inQ]!�!§�................Roofing ......................................... Floors ----------'-----------..|nterior —�� 9-1.tX.0 C1.k........................................................ .�� ' - -- ` Gs��- ���V & ��n ------�----�—.�Heating --------------'Mum6ing —..�::`—�..��[�RIP�.—______________. � � Fireplace —.0oue ---------------------.Approximo«e Cost ...�!.O0O�00...................................... Definitive Plan Approved by Planning Boon] lV--_- . Area ----' Diagram of Lot and Building with Dimensions , Fee _______________ SUBJECT TO APPROVAL OF BOARD OF HEALTH " / | � . `. jV ' ' | V \ / \ / \�\ . [ � | ` y | OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS � | hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardingthe above construction. � . �r�8 Nome . ______�� X. ' Construction Supervisor's License ...ODUQRo _____ | CAPRICORR REALTY TRUST A=270-229 No . 26049 permit for One Story ................. ................................... Single Family Dwelling " ............................................................................... Lo Locatio ...........21.'............................ .................Hyannis......!.. .,./ .. Ci� Owner ..Capricorn Realty Trust ................................................................ Type of Construction Frame ..................................... t ................................................................................ Plot ............................ Lot.................................. Permit Granted ....F ??y....7-g............19 84 Date of Inspection ....................................19 Date Completed ......................................19 2 7o - z 455