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HomeMy WebLinkAbout0097 CEDRIC ROAD .u '-a :., n. ve .,. „'. Y Y �+..N.. �' P. f^ (,...vA.. y. v '. ZI' "3.p .a,. Ti r; .r ..tn' .� :•� :'i' x} �},. !� t�� Y� .. Y'. .. ..�` '�'w. .aN�..� _�_.- . „� .. r . z �, �_,..., u: -f..• rF .:r .r.. r, '.1,w. .. •^P ',• ,.' rf �.� �`a` 'N�tb ,b, .a��' ,#�t� ..., :.,1 ..,,5 x,.« :k, .. ✓'.:,. �'h.'<., �7 n: b a v. c., t7!t. e P�,,.. { h ,. ;,..,.. � ..,r�4 @xp e*,r n. ,.• �e..'. .} .,��' .,y,�..>K a�. •ar-. �M1 k T� }r- tr' A= •.,i: _ ,, +5. �y„ �. n.. „- .- y �.;•..�, x � +.u rr r, +x. n� .,�r w ,.s',;:',,.; .: ` ., •,,. �;. •• ', x 3 w P 1 Y i a e t. P 4 p d v x u r f o' q. , NY +, N �M` • a x. C��li�7y O ` 6, Town of Barnstable Permit 9i Regulatory Services ' 6KAM �"f Richard V.Scab,Interim Director X-PALIP - C,, I Building Division Tom Perry,CBO,Building Commissioner MAY — 1 2014. 200 Main Street,Hyannis,MA MI www.town.barnstable.ma.us ' Office: 508-862-4038 TOWN OF B&Z: TA30 EXPRESS PERMU APPLICATION Not VaN wMkwt Red X,P►m bWft Map/par+cel Number !7 aL Property Address esidential Value of Wank$ �. Qb Minimum fee of$A00 for work rder$6000.00 Owner's Name&Address 14n ?,/lyi/l, n 'b A ; R-7 Ceoi6 rid ' dZ(o32 oO ContracWs.Nam tj jl Aiyc� I0I04u) 10 WS Telephone Number'90I Home Improvement Contractor License#(if applicable) L 73 ZTJ Email: Construction Supervisor's License#(if applicable) O I Lzo ofkman's Compensation Insurance . \\ Check one: ❑ I am a sole proprietor I am the Homeowner I have worker's Compensation Insurance Insurance Company Name�;[—f/'C�uMUT `/US Workman's Camp.Policy# ,4 r2-.3 9y Copy of Insurance Compliance Certificate most accompany each permit. Permit Ruest(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 mot) Re-side 4Replacement Windows/doors/sliders.U-Value c 3U (maximum.3�#of windo 0. . #of doors ❑ Smoke/Carbon Monoxide detectors 4 for plans marked with red Sand inspections required. Separate Electrical&lure Permits ra un edr •Where Issuance of this permit does not exempt compliance with after town dWwtnWA MgWOU GM i.e,historic,Comovaticn,etc. ***NOW Property Owner must sign Property Owner Letter of Permission. A copy of the Home Emprovement Contractors License&Constracdor Supervisors License is . aired. r . SIGNATURE: T:WEVD DBudding QWWMASS FEW&TUMPREWdoe Revised 061313 The Commonwealdi of Massachusetts u Department o-f 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/OrganizariorAndividual): �N Lte, Address: d2 (o /oJl/ �0 J. City/State/Zip: /A/CDlN , ./� i ��245 Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.I I am a employer with AD 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 These sub-contractors have g, []Demolition working for me in any capacity, employees and have workers' [No workers'comp.insurance comp.insurance.t g addition - required.] 5. ❑ We are a corporation and its M 9. Building Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roof re airs insurance required.]t c.152,§1(4),and we have no, 13. Other t�/It-�d`y employees.[No workers' comp.insurance required.] *Arty 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 contractor,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. ff 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 thepolicy and job site information. Insurance Company Name: OAIW V50,dwu s rtJ Policy#or Self-ins.Lic.#: / a .3Expiration Date: qI Job Site Address:_ .2 7 L4 City/State/Zip: 01 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$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certi under the pains and penalties of perjury that the information provided above is ue ano correct Signature: Date. Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# ' Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S.'Plumbing Inspector, 6.Other Contact Person: Phone#: C11WO:30124 SOUTNEW DATE(MMIDDIYYYY) ACORD.,, CERTIFICATE OF -L-IABILITY INSURANCE t1%W813 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLCM.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATMELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 I�NTi Anita Little Willis of New Jersey,Inc. �018 a�,q;856 9144660 I...': 856-914.1881 1015 Briggs Road,PO Box 5005 EMAIL , anita.Httle@willls.com PO Box 5005 INS AFFORDING COVERAGE NAIC S Mount Laurel,NJ 08054 INSURER A Selective Insurance Co of the S 39926 INSURE INSURER B',Argonaut Insurance Co. 19801 Southern New England Windows LLC INSURERc,Beacon Mutual Ins.Co. 24017 DIBIA Renewal by Andersen INSURER D 26 Albion Road 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 CO!iITRACTOR 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, ADOL TYPE OF INSURANCE POLICY NUMBER �MlBDY i LIMITS A GENERAL LIABILITY S202945900 81.10121)1310811012014 EACH OCCURRENCE S1,000,000 °PREM X COMMERCIAL GENERAL LIABILITY + ISES Ea oea renoe $100 000 CLAIMS-MADE I n OCCUR I �M'ED�EXP(Arty one psa,) $10 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMPIOP AGG s3,000,000 POLICY PROCT LOC $ A AMOMOIULE L-1ABILITY S202945900 8!10/2013 08/10/201 CO e deentsINGLE LIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per perm) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per aeddent) $ X HIRED AUTOS X AUTO ED I P>'ROPE DAMROE $ — A X UMBRELLA LIAR ocCUR S202945900 D81.1012013 0811012014 EACH OCCURRENCE s 00010—W EXCESS LIAB _t ClA1MS-MADE AGGREGATE $5 000 000 DED i RETENTION $ C WORKERS coMPENannoN 0000068028-RI 8/2112013 08/21/201 X "'C STATu oT AND EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNEIVEXECUTIVE YIN AICS27616352394 81g1/2013 08121/201 E.L.EACH ACCIDENT S1,000.000 OF-FICERIMEMBER EXCLUDED? N f A l I i (Mandatory In NH) I I ;E.L.DISEASE-FA EMPLOYEE 511,000,000 oEor s('.RIP�TION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES( W'n ACORD 161,AddltWnal Remark Schedule,I inore space is requited) 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 11 i 019U-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #3215109/M215008 AXL Southern New England Windows d.b.a Renewal by Andersen of SNE Massachusetts-Department of Rublic.Safefy ggArd<Of Building Regulations.and Standards+ 6 CUnstT:uction Superti^isor :Y License C3.095T07 ,tr1 BRIAN D DENMSE)N: - A' 7,LA11IBS POND EIR4% C6aritun MA 01�07i �.•- Expiration Commissioner 09/08/2014 Office of Cons�um A B s > n l0 Park Plaza=Suite 5170 Boston,Massachusetts 02116 Home lffprovemeqt,Cofitractor Registration e ., 'Regitdr80on; i79245 - Type;. SUPPt?ment.Card SOUTHERN NEW ENGLAND WINDOWS LL' rallon; 9t19no14 DENNISON BRIAN t_;:.:_,: t-y 1137 PARK EAST DRIVE WOONSOCKET,,RI62895. r K 'Update Address Aud raw=card.Meek reasae for change, au r o rawasm. , Address p Beaewal O Emooymeat Q L"Card s c afCoaso rARsksA Bo Begsladao Lianas ar regutratl0n.valtd for lndivtdaloseoaty - EOIPROVFJdENTCONfRACTOR. before the expiration data utoued retaru'to: Office of Consumer Affairs and Bmiaess Regulation �n 173245 Typo: to Park%ata-:Sucre 5170 Ecplraftnn 8N9l201�; SWplemaul.:;rd batten,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC.. RENEWAL BY ANDER6514 DENNISK BRIAN 1137 PARK FAST DRIVE /1 A� WOONSOCKET,RI 02895 Uedersecremry Not valid withautsipature r ev, ewa- 1 ,1= w Wy. *WMITsm _y OF MOM*Uift"Wil '4yNi0l4e 1!lr Al;r gy� t +t ArAvr:ir .,.a• , __ $. �43r i nl�•d: �.+6►1�0.ugp A61�0 �,&1 :e .. ♦ . #Ad 1XIM 4i*0.'• Yi� 0a �8. 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BUILDING INSPECTOR �YpY a' APPLICATION FOR PERMIT TO ...............Build One Family Dwelling TYPE OF CONSTRUCTION Wood Frame.................. ........... . ............................19 .... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..�Q .... .D .......ee,.O'eic......Bvi. V.................... �r'n�.l.�rf v��` ...........:........ ....::.................................... Proposed Use .......ReSide2ltial............................................................. Zoning District ..........RD-1...................................................Fire District ..Centerville-Osterville Name of Owner .........Norma Realty..Corp.. .. ,.,.Address .... Ashley Drive j Centerville Name of Builder .,,, Normest Homes! Inc. Address ......:....same .................................................................... Name of Architect none ....Address Number of Rooms 6 Foundation Poured Concrete Poured SidingRoofing Asphalt Exterior .................................... .......................................... ................ ............................................................... Floors ........................Car. et.............................................Interior ..............Dr�1J811................................................... Heating ....................WarI11-Aj:r........................................Plumbing .................bath...................................................... Fireplace Y..eS.....................................................Approximate Cost i2Q%Wp................................... Definitive Plan Approved by Planning Board ________________________________19--------. / `P Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH Lu 0 -r Q ®d r t. a cr w I f t '� t� q s') tn <� fir„ f c� 1m � L Ir- ?l e J _J V t Yy y Z LU I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... ... Norma Realty Corp. r No ................. one t y 157 Permit for .................S....r.......... single family dwelling ............................................................................... Location q.1 Cedric..Road.................................. Centerville ............................................................................... Owner .......... orma Realty Corp.. f L_ • Type of Construction ..............................frame............ L. Plot ................................Lot .........#26A............. L ITr7 December 20 , 2 r Permit Granted ........................................19 7 Date of Inspection ..................... :..............19 L Date Completed .....Z ...7. ....Z. `.....19 ro PERMIT REFUSED t ................................................................ 19 ..................................................... ...................... ............. 1 a � 1 L ` i ............................................................................... L i" � t 4 L. . r Approved ................................................ 19 1 ............................................................................... 1