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HomeMy WebLinkAbout0271 AMES WAY 2 6 AMES � r t Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee • 1 PERMIT Thomas F.Geiler,Director 'q,Ar 1639 �• Building Division (0 S 1 S�a� E 5 2008 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE 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 Property Address 1 [Residential Value of Work (O �` Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address /'�.i Contractor's Name optt� �r teat Ted"-'mil elephone Number s-Dg. ?6-7— 6 Home Improvement Contractor License#(if applicable) f :�-6 e c 39 PWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ am the Homeowner W,have Worker's Compensation Insurance Insurance Company Name 4vt Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. 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) ❑ Re-side 2 ^� ReP lacement Windows/doors/sliders.U-Value 3.� (maximum'�l *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 is required. SIGNATURE: Q:\WHILESTORMS\building permit forms\EXPRESS.doc Revise020108 . NFRC MFG WE: SIL SERIES 1200 Dual Glazed NFitC Vinyl DCouble Hung Mortal Fenestration Argon f ile Ming counde 3. Low E Glass ENERGY PERFORMANCE RATINGS U-Factor(U.S./1-P) Solar Heat Gain Coefficient 0.32 003 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0.57 Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a foxed set of environmental conditions and a specific product size.NFRC does not recommend any product and does not warrant the suitability of any product for any specific use Consult manufacturer's literature for other product performance Informadon. www nfrc org This window is ENERGY STAR@ qualified in all 50 States. ta �\-C, acrim • • � � . 1200C Design Pressure Rating Ratings for sizes up to 40"x 72" : DP-30 Ratings for-sizes up to 44".x 60" : DP-35 Ratings for sizes up to 48" x 72" : DP=25 QUALITK. E�RTIFICATION : .D 22. -- Rev.9107 671 54 V/On7gJ2ryIZUJ�'�GGft /�j� ;.'-�_ "v�06C�tlLQp�6 ... Board of Buildin -lug g Regulations and StandardsHOME IMP_.ROVEMENT CONTRACTOR License or registration valid for individul use o Re istr..ation my g before the expiration date. If found return to: m 126893 I p Board of Buildi g Exrrati�on gj3l2008 ding Regulations and Standards One Ashburton Place Rm 1301 AYPe Supplement Card Boston,Ma.02108 1 , THE Home Depot qt Home Servlc "CHAEL BEDARD� j 3200 COBB GALLERIA PK yf` 0 &ANTA,GA 30339 Administrator Not valid ithout signature Apr 27 08 04:21p Hession Enterprises 781-545-6266 p.1 HOME IMPROVEMENT CONTRACT n Sold,Furnished and Installed by: Branch Name: 9V Dater THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services �Z 23 345A Greenwood Street,Worcester,MA 01607 Branch Number:,�j Job#: }' ✓ Toll Free(800)657-5182; Fax: 508-756-2859 Federal ID R 75-2699460 ME Lie#C 02439 R1 Cont.Lie#16427 CT Lic#565522; MA Home Improvement Contractor Reg.#126893 Installation Address: Z� 1 ��7� (J[,f 1.�y�-f 2 y1 f l e AI A I2 1v 3 7 City 11 State Zip Purchascr(s): Last 4 Digits of Driver's Lie.#&Ex .Mo/Yr: Work Phone: Home Phone: Home Address: I (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): Project Information: I/We/You("Purchaser"),the owners of the property located at the above installation address,offer to contract with THD At-l-Iome Services, Inc. ("Home Depot")to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet# D ig 3 ,incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home, pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit approval.) CONTRACT AMOUNT $ 3 .3� 1, Check",Cashiers Check or US Postal Service Money Order fiLESS DEPOSIT �O (Made payable to The Home Depot). $ �'Z 2. Credit Card**and/or other payment options-Circle One Below BALANCE DUE n r1 Visa MasterCard Discover American Express ON COMPLETION $ _ The Home Depot Homc Improvement Loan he Home Depot Credit Cardl� tMinimum 25%of Contract Amount due upon 0 New Account glxistingAccourtt (HIL&HDCC ONLY) execution of this contract. Available Credit:S 2I ' O (HIL&HDCC ONLY) Indicate Payment Method For Acct#: I Exp.Date: BALANCE DUE ON COMPLETION• / �AO�q 00 �n� 5 Name as it appears on card: /� 1�, ��S SQL l,1 1 I **By my/our signature below,I/We agree to allow Home Depot to �g y V►n FXt - charge the ab v /e en reed,,credit/card for the deposit i icated. 'When you provide a check as payment,you authorize us either to use information from your check to make a one-time electronic Cardholder's Signa Da fund transfer from your account or to process the payment as a check transaction.When we use information from your check to make an electronic fund transfer,funds may be withdrawn from HIL or HDCC Authorization Codes your account as soon as the payment is received,and you will not Deposit Final Payment receive your clicek back. # 2/ F,410 2 7(eo amount if job is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered.There will be a service charge equal to 25%of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW,I/WE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNA BEL W, VANE AIGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. 1/WE .ACKNOWLEDGE CEIPT O A COPY O THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLAT N. zy SUBMITTED BY: Date: GpU S s Consultan ACCEPTED BY:/� ��✓``;�� ��G>� � Date: Purchaser Date: Purchaser NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE.PART OF THIS CONTRACT Pink—RalPc nnnSl dtant i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): .S Address: 5 �i City/State/Zip: 7 Ger111 b�3 Phone.#: 9F3 " �'� 4 (��" Are you an.employer? Check the.appropriate box: Type of project(required): 1.[ I am a employer with . 4. 0 I am a general contractor,and I 6. ❑ New construction r 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 g. Demolition workingfor in an capacity. employees and have worker's' Y P ty. 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. 0 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 12.0 of re airs insurance required.]t c. 152, §1(4),and we.have no r employees. [No,workers' 13. Other ;comp,insurance required.] r„r � *Any applicant that checks box"#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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors 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: aw_P W0,04,0,1ips Co Policy#or Self ins. Lic.#: O Expiration Date: t� Job Site Address: 5 City/State/Zip: Attach a copy of the workers'compensation policy, claration 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 ify de the pains a ena ces of perjury that the information provided above is true and correct Sig,afore Date: ' Y Phone#: Official use only. Do not write in this area,to be completed by city or town offcciaL 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-contractors)name(s),addresses)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 required. 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 Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for 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 policv 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 burn 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 fax number: The Commonwealth of Massachusetts Department of Industrial Accidents off ee of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4000 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.geav/dia A�QRD,M CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD 02/26/08/YYYY) PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequest@marsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 INSURERS AFFORDING COVERAGE NAIC# ENSURED Home Depot U.S.A., Inc. INSURERA:steadfast Ins Cc 26387 The Home Depot, Inc. INSURERB:Zurich American Ins Co 16535 2455 Paces Ferry Road Building C-8 INSURER C:Illinois Natl Ins Co 23817 Atlanta, GA 30339 INSURER D:American Home Assur Co 19380 INSURERE:New Hampshire Ins Co 23841 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD PE NS RANC POLICY NUMBER DATE MM/DD Y DATE M /DDIYY LIMITS A GENERAL LIABILITY IPR 3757 608-02 03/01/08 63/01/09 EACH OCCURRENCE $4,000,000 X COMMERCIAL GENERAL LIABILITY LIMITS OF POLICY ARE EXC SS DAMAGE TO RENTED PREMISES Eaoccurence $1,000,000 ,000,000 CLAIMS MADE OCCUR "OF SIR: $1,000,000 PER CC" MED EXP(Any one person) $EXCLUDED PERSONAL&ADVINJURY $4,000,000 - � I GENERALAGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: M..._. .PRODUCTS-COMP/OPAGG- $4,000,000. - X POLICY PRO- JECT LOC B AUTOMOBILE LIABILITY BAP 2938863-05 03/01/08 03/01/09 COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY;: $ SCHEDULED AUTOS (Per person) HIRED AUTOS. • BODILY INJURY $ NON-OWNEDAUTOS - - (Per accident) X SELF INSURED AUTO PROPERTY DAMAGE $ PHYSICAL DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ "- ANY AUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY IPR 3757 608-02 03/01/08 03/01/09 EACH OCCURRENCE $5,000,000 X I OCCUR El CLAIMSMADE AGGREGATE $5,000,000 $ DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION AND 1928757 (FL) 03/01/08 03/01/09 -X TORYLIITS 0 R .D EMPLOYERS'LIABILITY 1928756 (CA) 03/01/08 03/01/09 E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E OFFICER/MEMBEREXCLUDED? 1928755(AOS) 03/01/08 03/01/09 E.L.DISEASE-EA EMPLOYEE $1,000,000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER F TX Employers Excess TNS-C45197967 (TX) 03/01/08 03/01/09 Occurrence/SIR 25M/2M D Workers Compensation 1928759 (QSI) 03/01/08 03/01/09 E Workers Compensation 1928758 (KY, MO, NY, WI) 03/01/08 03/01/09 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS *FOR EVIDENCE ONLY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE HOME DEPOT, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 2455 PACES FERRY RD., N.W. BUILDING C-8 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR " _ - REPRESENTATIVES. ATLANTA, GA 30339 - AUTHORIZED REPRESENTATIVE USA i d� ACORD 25(2001/08)datkinson ©ACORD CORPORATION 1988 8213215 - s TOWN OF BARNSTABLE I Permit No. 21295 _________ Building Inspector 1 saua.ne Cash --__—_-- �Q {� � OCCUPANCY PERMIT sond. X A-5-1? <. No building nor structure-'shall be erected, and no land, building or structure shall be. Q used for a new, different, changed,•or, enlarged use without a Building Permit therefor. I '� first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has -been issued by the Building Inspector." Issued to John. J. Delaney Address 113 Samill Road, M. Mills lot #35 271 .Ames Ways, Centex:7il le wiring Inspector f . ; �` - °'" Inspection date Plumbing Ibspect�oi [ / Inspection date Gas Inspectorf Inspection date ,/IEngineering Department Inspection date /.11-YL THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ................_._7 _..._ 19-27 ......... � ,4A4- B`lding Inspector f AssAors map and lot'number ....:.. ` THE.p� Se*age Permit number .................... .....�................... SF` •�` rO�Q �+► .:;, � ►: House number ` L . ,. o� cow Em WrN rrrLE .5 �. TOWN :OF BARNST L CooE AND '« riolysr . 1 BUILDING IN3PECT0 F . APPLICATION FOR PERMIT TO 4. . ........... ....... ............... .............................::.... �..•r TYPE OF CONSTRUCTION i 4!�.................. ........... ...........................19.l TO THE INSPECTOR OF BUILDINGS: The undersigned hereb�ie���ermi��ording to the fo wing formation: II Location ......�If� ......................................... 999 ..... 1....................... ........................... ProposedUse � :. ................. ............. .......... ................................................... Zoning District ........ .. ......................... ...................Fire District ........ ............... 4 Name -of Owner ... .. -�j/ 3 ..:.........rs°�'t ........Address lk'.� � .! �:�1... /�� .......'V�. G��"t It t .. .... ...... ....y ..... ' Nameof Builder ....................................................................Address .................................................................................... I( " y r, 'r ,' 4 . t. Nameof Architect ..................................................................Address ..................................`.................................................. Number of Rooms Foundation ...... .......... �...........................:.............::...::... i ..................... ..................... Exierior•N:....... � .................. � ff ...... ........ .................... ...'........Roofing .....�..��.�........:....... .. ............................. ' 4 j J4 } # Floors ...... . '`l........:.... ;. Inferior €r'' ........ :•� s' *. . Heating ........ .........Plumbing, Fireplace ................./r............................................ Approximate Cost ...... ";t..:..!0..'......................................... r. Definitive Plan Approved by Planning Board _ __________-----------19_ Area ...� .9 ......... .............. .. a Diagram of Lot and Building with Dimensions Fee " ...... ...../.11.......................... + SUBJECT TO APPROVAL OF BOARD OF HEALTH • f . I hereby agree to conform to all the Rules and Regulations;;.e Tow '"'f Barnstabl r gar g the above construction. Na ✓ .................................. ..................... Delaney,,John J. No Permit for .........one..St!:�U. ....... sinzle famil dwellin .......................................................g........... ........ Location ........... ........................... Centerville ............................................................................... Owner ................:John J. Delaney Alqey............... Type of Construction .............f ram.................. ................................................................................. Plot ............................ Lot ..........#35............... Permit Granted ........ ........ ........19 79 Date.of Inspection .......................... Date Completed 19 PERMIT REFUSED ........................ .....................I............... 19 .......... .............................................. ...........W . .fie.7?............................................. ............ies ........................................... 21.5....................................... 0 Approvedo".1....... -,N).......................... 19 4A ............................................ .......... . ..r ± ,. '•i T. r :a r.'' r. _ t .mot •Fr 1{l:{ �,i.: s.. "� •� -1"a - `�- _ "; �..���9 Y 1: {.✓Rw '„ 'r•/ :+d 4 y' 'u''�sr�. �. A .�`T CJ -q . i - a s' '"`i'tN' ° .s 4...�.'' #.' r •i " ..-a �'..#fi.... 'k - Jhx \-�' * ���:Ji/. CSLV Rt♦ ! % l ,.t' 7, t,' t O - 9 'IrcQ,t4J� �Ary N C./" t t�+9 77 } F id& k1�:7•� /yED1tJl�'I SA rat t3. KUUPVOA`fION ti 74. Q TS$Tlw SEPTf6 HOL. ;d, ' j Q �, ,TANK- � , iY1 - .. 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