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HomeMy WebLinkAbout0360 BUCKSKIN PATH ., . : ��� � r �: r, r. .e d ro { i _ _ T S � � .. t � _ �1 y�F THE TOWN OF BARNSTABLE • EARNSTAILE, i NAM BUILDING INSPECTOR a xaY a. APPLICATION FOR PERMIT TO ..Z;�.-/... ? e- ....: .........,� TYPE OF CONSTRUCTION ...........�,�, ................ ic= ........... Q 19 ' Q TO THE INSPECTOR OF BUILDINGS:, The undersigned hereby applies fora permit according to the following information: Location ... .... ........... .... ....... ..: ....................................................... ProposedUse .. ..................... .... ................................................... Zoning District ........................................ ............ ..........Fire District ....... .. " .. ..... ' ...:............................. . .... . . Name of Owner 'p .:..:..... ...': .... . Address ........ .............................. Name of Builder 41......................... .....Address ............ Nameof Architect ..................................................................Address ................ .......................:.....................................:.... Number of Room .................................................Foundation ...................................... Exterior ....... °"^°: ...........................................Roofing .............. . .............`....... ........... .... . Floors ..................Interior ..... Heating ' r ..... .... .........................Plumbing .....':ter ..'.':�...... ... .....� ........................ .... ..... ost ........ . .. Approximate C ..............Fireplac A n _____________________ 9Definitv , an �. .. 41 Diagram of Lot and Building with Dimensions Uj SUBJECT TO APPROVAL OF BOARD OF HEALTH LLLLJ � � Z } LLJ IDS ti.. W ta t N:O,O " 0 (r) < ;� r� > �, _ ., O J m s d 1 1,, cL X cn ?>. _�� , �•1 W Z) L L1 )k�)LU Cry LF Q> Lt► U co ::!F W LJ rri < I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable rej%rclirla the above construction. 71 Name .. . . ..... ..• . ............. ......... Small, -Alan /�y/- / ��`^ �� ' / / / �~�_/ ` �� � one ator7 No -.��-..-. Permit for .................................... ' single f"~�+x dwelling _ -^---^---'--'-'-''--'--'-^--`--^^'- ' - Buckskin Path ' Location-,.:..............................................................Centerville \ . � . ~'-^~-'-----''--~---------' ' ' Alan Small Owner ..------------,--------.. ! \ ^ . Type or Construction ----- ] ' ' \� plot Lot ���� � �������������� �� ������-� ���������� -- � � � \ � Permit Granted --J ..I5----lA � uure Completed /9 � . � ~ X [J ~~ PERMIT REFUSED ----.-_-.------------' lg ` [ | � -'---''---'-----'-'--------'---' (� � ..................................... -............... ..................... � . -,-~-.^~...------.-.-..-,..-.-.-.-.- � ' � '-'-'-^---~-^^~^'-'-----^~~'~^^'`^' ` < ' ~--------------- l9 Approved ~ ` -------'--------~'^'--~^~^'---' | ' ----------------'--'`-'---^^^^ \ / . , / ^ | | ONO(, 'Town of Barnstable Permit# 60 Expires 6 mo s from' to dale I f .atttvsr,�st�, • E PEPaplatory Services Fee 0 ` nines: $ Nov U 7 2006 Thomas F.Geiler,Director f Building Division 'A/N.OF E3ARNSTABLiLvm 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 oNot Valid without Red X-Press Imprint Aap/parcel Number 'ropertyAddress. � �U `S_,Ozb esidential Value of Work Z Minimum fee of$25.00 for work under$6000.00 )wner's Name&Address ✓G /`�/'� �U,ls� A10 A/ea .'ontractor's Nam -C— I—le.) Telephone Number Lome Improvement Contractor License#(if applicable) ;onstruction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance isurance Company Name ✓orkman's Comp.Policy# :opy of Insurance Compliance Certificate must be on file. ermii Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to /y�e4/ AXz "rX ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum .44) *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. 2He Improvement Contract6 License is required. IGNATURE: :Forms:expmtrg ;vise071405 OFFICE: (508) 997-1111 0§11 MA. Builder's Lic. #021330 FAX: (508) 997-1297 CARE FREE Home Improvement TOLL FREE: 1-800-407-1111 Contractor's License omen inc. WEBSITE: #100503 MA. www.Carefreehomescompany.com 239 HUTTLESTON AVE. (FIT 6)•FAIRHAVEN, MA 02719 #15179 R.I. NAME W DATE Ae 3c7 L10 ADDRE ZIP CODE ADDRESS OF JOB TEL t Q - �2 JOB DESCRIPTION e l f O OA Scheduled Start — Scheduled Com letion A. Replacement of missing or rotted lumber is not included unless specified. B.All start&completion dates are approximate and could change due to weather conditions. C. Stripping of roof includes removal of up to two(2) layers of shingles, ea dditional layer to be charged Q _ )�50 ft2. D. Replacement of rotted roof boards/plywood to be charged @ ft2. E. Existing chimney flashings will be reused; replacement, if necessary, is not included. F. Care Free Homes, Inc. is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the attention of C.F.H., Inc. promptly. The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this order is contingent, however, upon the want of strikes, fires and any natural disasters, the abilit to obtain materials, or any other conditions beyond the control of the Company. Cost of Project$ /!��� 'PAYMENT TERM Date 1. You,the Owner,may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. 2. You,the Owners,agree to pay any and all expenses incurred by Care Free Homes,Inc.in collecting money due under this contract and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees, interest and court costs. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CARE F E HO SAC. PT By: Buyer acknowledges Owner CARE FREE HO S,INC. receipt of fully completed --------- copy of this Agreement Owner _ All contractors and subcontractors shall be registered by the director and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 f . ✓1� V007L%77.0'J7.C({P,(LLLfG 06�i!�uC062G12lCQeuU I Board of Building Regulations and Standards i HOME IMPROVEMENT CONTRACTOR Re$rstFa�r n :tW503 I E-_R�t^afr� I: upplement Card CARE FREE HOIMENC _ t} JESSE MOTTA !a 239 Huttleston ave i, Fairhaven,MA 02719 �" Administrator 1 �DATEM/ODc. THIS CERThTEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW 02361-3700 INSURERS AFFORDING COVERAGE Care Free Homes Inc INSURER A: National Grange Mutual Ins 239 Huttleston Avenue NAIL# INSURER B: Acadia Insurance Co. Fairhaven, MA 02719 INSURER C: COVERAGES INSURER D: INSURER E: THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ANY REQUIREMENT,TERM NC CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THISMAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED RI PAID CLAIMS. ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING LTR NSR TYPE OF INSURANCEL THE TERMS,EX CERTIFICATE MAY BE ISSUED OR EXCLUSIONS AND CONDITIONS OF SUCH A GENERAL OF POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION APP258739 DATE MM/DDlYy DATE MM/DD/YY X COMMERCIAL GENERAL LIABILITY 09/01/06 09/01/07 LIMITS CLAIMS MADE EACH OCCURRENCE OCCUR DAMAGE TO RENTED $1 000 000 n $250 000 MED EXP(Any one Person) $5 000 GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY GENERAL AGGREGATE $1 000 000 POLICY PRO $2 000 000 JECT LOC AUTOMOBILE LABILITY PRODUCTS-COMP/OP AGG $2 OOO OOO ANY AUTO ALL OWNED AUTOS COMBINED SINGLE LIMIT SCHEDULED AUTOS (Ea accident) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per Person) $ BODILY INJURY (Per accident) $ GARAGE LIABILITY PROPERTY DAMAGE ANY AUTO (Per accident) $ AU'r0 ONLY-EA ACCIDENT EXCESS/UMBRELLA LIABILITY OTHER THAN EA ACC $ OCCUR ❑ AUTO ONLY:CLAIMS MADE AGG $ EACH OCCURRENCE DEDUCTIBLE AGGREGATE RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY APP258740 $ ANY PROPRIETOR/PARTNER/EXECUTIVE 09/01/06 09/01/07 WC STAT $ U- OFFICER/MEMBER EXCLUDED? OTH- Ilyes,describe under E.L.EACH ACCIDENT SPECIAL PROVISIONS below OTHER $500000 E.L.DISEASE-EA EMPLOYEE $500 000 E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PRO VISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL II) DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURRE_To DO SOS ALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 � #24141 ---- DAC © ACORD CORPORATION 1988 CL Q x The Commonwealth of Massachusetts Department of Industrial Accidents i 1n,��: E Office of Investigations ' 600 Washington Street 4 j = Boston,MA 02111 ziy www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers pplicant Information Please Print Legibly acne(Business/Organization/Individual): A C �.� ddress: � /L�U �G c� U� «,��v�A27, )W, 0 2 7/f3 ity/State/Zip: Phone re you an employer? Check the appropriate box: Type of project(required): [ I am a employer with ,30 _ 4. ❑ I am a general contractor and I 6. El New construction employees(full and/or part-time).* have hired the sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet. t ?• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions ❑ I am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or additions myself. [No workers':comp. c. 152, §1(4),and we have no 12.[ oof repairs insurance required.] t` employees. [No workers' 13.❑ Other comp.insurance required.] y applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Peowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. m an employer that is providing workers'compensation insurance for my employees. Below.is the policy and job site ormation. urance Company Name: licy#or Self-ins.Lic.#: c1V_ tq S/S El'f D Expiration Date: Site Address: YKI�6445/611i) City/State/Zip: tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a e 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of estigations of the DIA for insurance coverage verification.. o hereby ce der the pains and penal ie ojperjury that the information provided above is true and correct ature: .one 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#: