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HomeMy WebLinkAbout0028 BAY VIEW TERRACE I a n d l . Town of Barnstable *Permit IT Expires t- 14 fr d �— r a Regulatory Services Fee `S a •. BAMA 91639. 2012 Thomas F.Geiler,Director MAC 1. Building Division L TOWN OF EIARNSTA13Lffom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 O C.��t - r esidential Value of Work . Minimum-fee of$35.00 for work under$6000.00 Owner's Name&Address d'\ W (Ya C- 'ry M f Contractor's Name 'mo f Y1_ In Telephone Numbered�)- 1 7 � �- Home Improvement Contractor License#(if applicable) Construction Supervisor's License.#(if applicable) D,9�0'rkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request heck box) Re-roof(hurricane nailed)(stripping old shingles) .All construction debris will be taken to A Y ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors El Replacement Windows/doors/sliders.U-Value (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: Properly Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATU C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Oudook\DDV87AAZ\EXPRESS.doc.. Revised 072110 * BARNSCABLK , ' ,� Town of Barnstable CEO MA'S A Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 1Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder , O'M 0, l IC. ,as Owner of the subject property hereby authorize ���C 1� �C�� to act on my behalf, in all matters relative to work authorized by this building permit application for: y � �Q C (A ess of Job) 1 ignature of Owner Date PaAo ` C Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. r C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doe Revised 072110 Office of Consumer Affairs&Brinell R'9�11-tiln License or registration valid for individul use onl y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: + a Registration: ,M1,36160 Type: Expiration: Office of Consumer Affairs and Business Regulation :8/�19/2014 Individual 10 Park Plaza-Suite 5170 MA LEMON Boston,MA 02116 /411 4,. 1 =_•it MARK LEMON - 490 PITCHERS WAYS •- �`"" r HYANNIS,MA0260Ir', \M•1'L.!t e� Undersecretary Not valid without signature Safety ent$f public Depart rt d Standards ssachu$etts" e ulations an ^ So of Suildir.9 R 9 S ':d Board coon Super`i'or S►c ia. Conytru se.CSSL-100207 �. �i 'en �•c S 14.�, J I,EMS� 0 - �Qg 423� gl �026'F WEST !, *` Expiration mmissloner I - - The Commonfi ealth of Massachusetts - _-- Deparbluent of Industrial Accideats Office of Imiestigadons 600 Washijigloir,street Boston,K4 02111 timv.mas.Lgov1dia Workers' Compensation Insurance Affidavit: Builders/Cflntractors/Electeicians/Phunbers Applicant Information Please Print Lejdbly Narne(Busi[LeWOrganization&diuiduai): ma.f ------ Address:_ bo 1 ' G``S� YY�fn k�1� City/State! p: t Phone#: Are yop"n employer?Check We appropriate boa: �/ Tyke of project(required): I am a employer with 4_ ❑ I am general contractor and I employees(full and/or have hired the sub-contractors 6- New constructiog 2.❑ I am a sole proprietor or partner- listed on the attached sheet, 7. ❑Remodeling ship and have na em►ployees These sub-contractors have g. ❑Demolition working for we in any capacity. employees and have workers' 9. ❑Building addition [No v;orlon'comp.insurance comp.insurance•, required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all ivork officers have exercised their 11.❑Plumbing repairs or additloms myself [No workers'cvrup. right of exemption per MGL 12: oof repairs insurance required.]'s c_.152,§1(4),and we.have no employees.[No workers' 13.❑Other comp.insurance required.] •Any applicant that checks box#1 must also fill aw the secdan below showing then vmAea'con pensafm policy infoam idom 1 Hoeacmms who submit this affi lm-k iadicabng they axe doing all wat and then here au�ide coataactars.mnst.submias> affidavit indmaung such_ = mContractors chat char this box mast amchad mr additional street showing the x>ame of the sub-cwtr rwn and state whethea or not those en fides have employees. I€the sub-coattacmrs have employees,dial tmest pnnide their workers'comp.-policy munber. lam an employer that is prmidhW markers'conapeasadon insurance for uty eatlployees Bel©w is the policy and job site iatfornlati0at. ' Insurance Company Name:' ::Z - Policy#or Self ins.Lie.#: SA)) Expiration Date: Job Site Address: a �) Ea LA V \,4 L( 0_6 C7� City/State/Zip: 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$1500-00'and/or one-year-imprisonment,as-well as civil penalties.in the fwm><of a STOP WORK ORDERand a fine of up to$250.00 a day againstthe violator. Be advised that a.copy of this statement may beforwarded to the Office of Investigations of the DU-far insurance coverage verification. I do hereby cer*u der thepains and..penalties of pprjaary thatthe ittformazion prodded eabolr is tniee said correct Si tur . Date: — "( Phone#: Official use only. Do not write in this area,to be completed bra city or twn official. City or Town: a PermiVUcense Issuing Authority(circle one): 1.Board of Health-2.Buil::ding Department 3.City/Town Clerk 4.Electrical Inspector 5.Pltumbin�l ispector. 6.Other Contact Person: Phone#: ACC 529/® CERTIFICATE OF LIABILITY INSURANCE o/29/2012 roo `� 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-ehdorsement. -Astatement.on:this:certificate=does:not confer rights:to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Cristina NAME: T. 'Edmund Garrity 6 Co. , Inc. PHONE • (617)354-4640 ac No:(617)354-5ee8 545 Concord Ave. .ADDRESS:Icristina@garrity-MAIL __._._�...._ .._,.._: INSURE S AFFORDING COVERAGE NAIC# Cambridge MA 02138 INSURER A:Scottsdale Insurance INSURED INSURER B:C I TAT ION 40274 Mark Lemon, DBA: ML and Son Construction INSURERC:The Hartford 490 Pitchers Way INSURERD: PO BOX 423 INSURERE: West Hyannisport MA 02672 INSURERF: COVERAGES CERTIFICATE NUMBER:Kaster COI 2012 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 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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR _D. POLICY NUMBER MMIDD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ r A CLAIMS-MADE Fx-]OCCUR CPS1399527 /7/2012 /7/2013 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000 r 000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 $ O- X .POLICY. ,,, JE PR LOC.,_.._ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaeddent 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED BBSTLT 6/14/2012 6/14/2013 AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED Peor PERZtDAMAGE $ AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE r AGGREGATE $ DED RETENTION $ C WORKERS COMPENSATION `. WC STATU- OTH- AND EMPLOYERS'LIABILITY I IT E ANY PROPRIETOR/PARTNER/EXECUTIVE M N l A E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 051SN280 /18/2012 /18/2013 E.L.DISEASE-EA EMPLOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) Certificate Holder is named additional insured for general liability if so required by written contract as it relates to named insured's operations. CERTIFICATE HOLDER CANCELLATION ml_sonconstruction@ comeast SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable 4 ACCORDANCE WITH THE POLICY PROVISIONS. i . AUTHORIZED REPRESENTATIVE W Garrity/CRISTI ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 ignionm n1 Thu ACr1R11 nomu anr1 Innn nru runiefuruA marlre of Arnpn Assessor's map and lot number ..,.....: ..l ...:...................... TI� Y�Td f:^'-)ST BE SEPSewage Permit number � ...... a�, I I'D TOWN TOWN OF BAR& TA' LE y�F TH E TO Z BAHHSTODLB, i 679 .•� E M BUILDING INSPECTOR PY a' APPLICATIONFOR PERMIT TO .............. ..../.. ................................,................................................................ TYPEOF CONSTRUCTION .............I. .. ......................................................................................................... 4-1 ..........,9. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ��.(�p .. .% 7......./..�°%F..............�5 ( /LLt...................................................................................... .............. ProposedUse ... E /OG?✓CE........�D!.y7 o''f... ..................................................................................... ........ ZoningDistrict ........................................................................Fire District .............................................................................. vST/�✓ �� LGG3� �e voAE� ................ ecc�' Name-of-Owner ......... ...................... .... ..................... .Address ............................ .��......f..... .......... rYr' v M Name of Builder ......e4�7� A/..#... .... VL ....Address .............. ............... ................. ............. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...........:...............:......................................Foundation ....... /✓ � �Z- O .................................................. .........................................................Roofing ........... .¢ Floors /...L I �. ........................................Interior 6,4.1 i Heating .............. ........................................Plumbing ................... ........................................................ Fireplace ..................................................................................Approximate Cost ..........D/....................................................... �........ Definitive Plan Approved by Planning Board --------------------------------19--------. Area ......�Z2...G�.�.......... Diagram of Lot and Building with Dimensions Fe '7 SUBJECT TO APPROVAL OF BOARD OF HEALTH 07 C I hereby agree to conform to all the Rules and Regulations of the Tow Barns. ble r rding the above construction. Name . .....4. ............... ........... 187 10 Austin O'Mall.ey t No 17390...... Permit for ...mddi.t:a.ox+................ i .�. .. . Location ......�.. _, ?.]C....nc� "r+....LE'. r� r fOwner .........&?.stir.f..0.!Mal1a;' ..................... � L Type of Construction ........L1ood.................................. y � I i ................................................................................ � r Plot .......187.......10... Lot ................................ r October 24 74 Permit Granted �' = h .- ' Date of Inspection A.„. Q . :7' l Date Completed �1............ � j t � T PERMIT REFUSED tt F ....................... ........................................ 19 t ........................... ................................................ 4 ................................................................................ � F Approved ................................................ 19 ............................................................................... .................... .......................................................... ! U �,_-._ •.��,..r £... {! •a,r.. ..,i.--,.«�.-...-.,., .._.. 'P".T.�.r« ;-.;�r�-- c.-.. •;,:..,,�i�^.,w-�—s,.:y. r. .... ....�*a,n+s:,.,-�ws.• �Y'-a-.f.,. .'..w.^+'L^_';a.'.� /v D�� 10C4 �- is-� Assessors map and lot number .........., .�.............. \ Sewage Permit number ........ ...�. TNEr°�� TOWN OF BARNSTABLE $�$HSTODLE,;i M6 9 p MAX BUILDING INSPECTOR O'�Efr I APPLICATION FOR PERMIT TO ........//vo Tj Z;) e ..................................................................................................................... TYPEOF CONSTRUCTION ......................................................................................................^.. .... ........................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...........v .: ................. )4..........:.......... ..................J../r`;h'i../C....~.................................................................... ProposedUse .............. .................................................................................................I......................... �fCL ZoningDistrict ................!.`...✓.................................................Fire District ...............5�......................................................... Name of Owner f7 UY7-/A/ t ,i /1�i .� C ........Address �- C uG'�` ( //��C�, L; Fq—,✓IG[L� ............ ...................: ...... ...............................................................................':.. Name of Builder X��N�/ t/ `�' G--Vd.t W...Address )174 )It11,��6v%?/ 14E S ................. ........................... Nameof Architect ...........................`.......................................Address ...............�.................................................................... Number of Rooms f......................................Foundation C rf ............................ ............................................................................... Exterior �! ��, t)/?.........................................................Roofing .......... /tt�sr G j f�i . .......................:.. .......................................................................... Floors 1`�F.. /Y( ,Il� .................... . .......... ........................................Interior ....................!...� '.................................................... .. .Heating ..`rt .' ............Plumbing Fireplace ..................................................................................Approximate Cost ...........f�e .................................... ..................... Definitive Plan Approved by Planning Board ________________________________19________. Area ..........5Z .....r................. Jq)— Diagram of Lot and Building with Dimensions Fee' SUBJECT TO APPROVAL OF BOARD OF HEALTH r I hereby agree to conform to all the Rules and Regulations of the Town/of Ba nr stable regarding the above construction. Namet..`.:....:'"��..........................�; �......... 1.87 10 Austin O'Malley / e No17390 . Permit for ......Addition Location ..........:.....:.: ....... .......r.................:..... ................................ . .... .. . ..t-U .l...C.�,��... Owner .;A,Maks ,Q"MalJ Pv............................... Type of Construction ..........xQQ.6....................... ............................................................................... Plot .......1.8.7.....la..... Lot .............:................. Oct. 24 74 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................