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Home My WebLink About0025 BEE LANE V L "I The Town of Barnstable Department of Health, Safety and Environmental Services NAM Building Division Ar i639' ilk 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: 19 J Name: �?JU it td/-� Phone# O —�)1 Address: atz I 'UJ L Village Type of Business: U Vy�.e� ��_7°;�1 Wa Map/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: / Homeoc.doc YHE r ICOS Op � Town of BarnstArble *Permit# Erp 6W it sfram issue date ys 'Regulatory ServicesEARN F jl E'�'` - I I Thomas F.Geiler,Director q 1 n►�tay v Building Division d ? l Tom,Perry, CBO,°Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town bainstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint 5 - Map/parcel Number 2 Property Address ;� 13cE Z// A,2«e �d '_ - [�Residential . Value of Work �•� Q� a� Minimum fee of$25.00 for work under$6000.00 ' Owner's Name&Address Tc -+Ja/ >i�7 H G6 Contractor's Name �S�GrL/e�/' i~STiCC1 /G�s✓ TelephoneNumber 936 659d 5 Home Improvement Contractor License#.:(if applicable) ,5 91 9112 Construction Supervisor's License#(if applicable) 9 2 ❑Workman's Compensation Insurance Check one: ❑ I am.a_sole proprietor ., I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name 5#6E GE Workman's Comp..Policy# Copy of Insurance Compliance.Certificate must,accompany,each permit. Permit Request(check box) s Re-roof(stripping old shingles) All construction debris will-be taken to ❑,Re-roof(not stripping, Going over existing layers of roof)' Reside #of doors ❑ Replacement Windows/doors/sliders.U-Value ' (maximum.44)#;of windows *Where requiied: Issuance of this permit does not exempt compliance with other town department,regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must sign Property Owner Letter of Permission: A copy of the Home Improvement Contractors License & Construction Supervisors License is re fired: SIGNATURE: - Y Dep ti tment(it publi<. Saf(t, Bo4ir(1 of Build��. Construction Su Rc f ulahor ; tnd;Stanil:ir(Iti _ License C$-SL, ji j ' -lsor Spec altyglrf e�sr Restricted to RF 99�07 ,t WS ADM - ADILSON SEGOLINI -� a 117 MIIVTON LANE ` WEST BARNSTABLE p ' MA 2668 Expiration: -- ��_-(uinmistiiuue; 10/14/2011 } Tr#: 99907 . Ir r t �arvrswouuealC�iaeaac`ivae�6 Office of.Cpnsumer Affairs&B siness Regulation, "License or registration valid for individul use only HOME IMPROVEMENT::CONTRACTO:R bPfore.the e�cpri^at�on date Ii`46hnd retui➢rto:: : Registration „59597 Type: Office.of Consumer Affairs and usiness.Ibegulation n 5/1a5/2012 DBA I 1�1'�r1.41'$aza SON 5170' Expirat�o � v lEosq n M f1211�6 S LINI CONSTRUCTI�QN r. ADILSON SEGOLFN.I F 1,17 MINTON LAI'3Ei_ry 4�t� WEST BARNSTABLE 141IA a6§$ . Unc7ersecretar _y N/adthout signatur e i ' �All r - AM r'I2 Owe, �fI1L I / MAW, 7` 1 ' .� � I � s `. '� a rS�1s .. f , DATE CERTIFICATE OF LIABILITY INSURANCE 106/01/2010 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). IRODUCER NAME: Schlegel 6 Schlegel Insurance Brokers Inc PHONE Ax (AIC,No,Ext): (508) 771 — 8381 (A/c,No):(508) 771 — 0663 34 MAIN STREET E-MAIL ADDRESS: - PRODUCER _ - CUSTOMER ID f1: West Yarmouth, MA 02673 INSURER(S)AFFORDING COVERAGE I NAIC9 NSURED Adilson Segolini Dba Segolini Construction aNsuINSURERANGM INSURANCE REReGRANITE STATE I 117 Minton Lane INSURER C: INSURER D: West Barnstable, MA :02668 INSURER E: INSURER F: - ;OVERAGES 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 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. VSR -TR TYPE OF INSURANCE INS', VIVID POLICY NUMBER POLICY EFF- POLICY EXP (MMIDD/YYYY) (MM/OD/YYYY)' LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 MPT848 6U 05/07/2010 05/07/2011_DAMAGE TO-RENTED — g ;COMMERCIAL GENERAL LIABILITY - PREMISES(Ea occurrence) $500,000 ! CLAIMS-MADE C,OCCUR - - MED EXP(Any one person) $1 O,000 PERSONAL&ADV INJURY 'S 1,000,000 GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER: __ �__ _ PRODUCTS-COMP/OP AGG $2,OO O,OO O r - _ -. - t POLICY JE PRO CT LOC g AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT $ ! i ANY AUTO (Ea accident) � _ ALL OWNED AUTOS BODILY INJURY(Per person)- $ r I —Jl ,SCHEDULED AUTOS BODILY INJURY(Per accident) S � - PROPERTY DAMAGE / HIRED AUTOS- - S - - _ (Per accident) - '1 ' NON-OWNED AUTOS - - $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE - AGGREGATE S ' I DEDUCTIBLE S 1 RETENTION S $ B AND KERS EMPLOYERCOMPENSATION'LIILIT WC-007-648-4368 05/23/2010 05/23/2011 x WC STATU OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE - EACHI OFFICER/MEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT $ SOO,OOO (Mandatory in NH) _ - E-L.DISEASE-FA EMPLOYEE $ 100,000 11 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 5500,000 IESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) ADILSON SEGOLINI HAS ELECTED COVERAGE FOR HIS WORKERS COMPENSATION POLICY :ERTIFICATE HOLDER CANCELLATION L�O-N—ENEE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 'THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZ - REPRESENTATIVE ' 4 s 1 09 ACORD CORPORATION. All rights reserved: The ACORD 0 name and logo are registered marks of ACO Commonwealth of Massachusetts r The Co ' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Elepleasefrint lie bl Applicant Information Name (Business/Organization/individual): Address: ('� f�'I�T�� ,�✓cr U Phone#: �/ 9-3 ` � City/State/Zip: �t.�cs/ � � Are you an employer?Check the appropriate box: Type of project(required):. 4. [] I am a general contractor and I 6 New construction 1.[�I am a employer with: have hired the sub-contractors employees(full and/o part-tun }. Remodeling listed on the attached sheet. 7. :®' 2.El am a sole proprietor eT- These sub-contractors have g. Demolition „ ship and have no employees employees and have workers' 9 Building addition working:for me in any capacity. comp.insurance [No workers' comp..insurance 5 We are a corporation and its 10•❑Electrical repairs or additions r required.] officers have exercised their I I.❑Plumbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 12.❑Roof repairs myself[No workers' comp. c..152,§1(4),and we have no 13 ❑Other insurance required.]t employees. [No workers'; comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tside contractors must submit anew t Homeowners who sub hit this affidavt indicating they are doing all wrk is box must arttached an additional sheet showing he name oaf the sub-contractors and state whether or notaffihose'ent ties havech. tContractors that check employees. If the sub-contractors have employees,they must provide their workers comp.policy number. 'compensation'insurance for my employees. Below is the policy and job site I am an employer that is providing workers information. Insurance Company Name: G (�5 Expiration Date: Policy#or Self-ins.Lic.#: Z� �f? 2 City/State/Zip: Job Site Address: (shoAttach a copy of the workers' compensation policy declara icon page 152 �lead to theomposition of criminal penalties ing the py number and expirationd of a Failure to secure coverage as required under Section 25A of can 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 certi i er the and penalties of perjury that the information provided above is true and correct. Date: Si ature: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/L.icense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector . 6.Other Phone#: Contact Person: