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HomeMy WebLinkAbout1220 CRAIGVILLE BEACH ROAD cur M ' Z , - _,.', r..•A.k. .r,., .. .,.! �. �;...!'. ,.-,��. ,:... .. �.�• a _�T'fi., r;q�� ,�" .at`r '•'�.: ,�+:: +a ,r�• ...a+ w KShg.. 4° ,:1 za •`;. µ v, �'.,,k.r, R<� ,., e.: r .,.•,`�,.... .,. �.. .. „_: ,„�. n, .c -�,.i� 1 �.. .� u' t :u ..} xR#" �k.+a��>'�".—i5..,��.?�. be ."r•y*�,, 6 :',R;,FS . .,s:.Tr.. �:,,�' .. , ,:: ir'�t °.:.,cam. *►��.. �, w,.�' Yt,> ;`:. , r.r .,.,..* �Y+it,.Yti �'�t. �. ...r�`,,< <✓� .rt. x _ ,., '. S.f� 'inn y. ` .;�y:.. ��.tiNJ dtG,��.`� tin.`.'•j' S�a`� `i F'9 Yt'r f ^�''�'f,St.° :' �',,y,� O'.. .}�'�•.,�.+'� s 'C A. tx� ,.��,":� v�;�#... l,.s.- �'-.,, ?�r � � .tits: u.�•r 'rfi. _ =L,k. �. t., is r � a •��� '�" ,u X` -� o.:'tx' sr '� �. +'. s" , itv Ww"Mov WAY wit OEM n7sn", em JAY r � _ a x d C jr � �'.t •ram} f ,f f 1 • r.: Y } r } r - - _ r k' { a i 31 �( v �FIHE r Town of Barnstable *Permit# Erpires 6 mo tl from issae date Regulatory Services Fee aAatvsenst.E, !_ 9� S. 039. Thomas F.Geiler,Director RFD MA't A Building Division �t7 )13 Tom 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 j Not Valid without Red X-Press Imprint Map/parcel Number 12 d L 'U Q 5 Ot73 ti i p , Property Address. I Li2� N16V`Ult k7�411- 96&& 668J}: VA. MA MIN- Residential Value of Work Zo_ 00,0_0 Minimum fee of$35.00 for work under$6000.00 j Q Dj_f Owner's Name&Address 122o Ga&VA 6WL Qdod efo Py lfwJ do ✓ fq)hoNy J : AWV E fto i is 1Z2o C/.Al-vale- 6tAc. Qdod. Ct�ylvilL I6 ot�52 Contractor's Name ;squi is CottUlluolm t USG Telephone Number Soo -999 .2310 Home Improvement Contractor License#(if applicable) 141ooLo Construction Supervisor's License#(if applicable) �S' l g3� 'v PRESS DER I � lWorkman's Compensation Insurance Check one: j MAY 15 2013 ❑ I am a sole proprietor ❑ I am the Homeowner [� I have W Irker's Compensation Insurance :. - SQv�s Pr �� ` Cp�upl.l y TOWN OF SARNSTASLE Insurance Company Name - y , I Workman's Comp. Policy# WCo 22�11 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(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 roof) ❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows ❑' Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate jElectrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: I Property Owner must sign Property Owner Letter of Permission. ! A copy of the Home Improvement Contractors License&Construction Supervisors License is requir SIGNATURE: C:\Users\decollik\Ap ata\Local\Microsoft\Windows\Temporary Int et Files\Content.Outlook\QRE6ZU3N\EXPRESS.doc Revised 053012 i i The Counnorxivealth of Massadnisetts Departinent of IndustrialAccidents Office of Investigafions - � 600 Washington Street { Boston, AM 02111 ' wirttt niass:govldia SNorkers' Compensation Insurance Affidasit: Builders/C'ontractors/Electi cians/Piumbers Applicant Information Please Print Legibly � CC Name(BusinessiC rgmiization'Individual): Uq U 1411 t PU o f m Or- Address: �82 by �ly� City/State,'Zlp: Ic�v�E! cJ�is mA �11032 Phone _ so4. 949 . 2310 Are you an emplo4er?Check the appropriate box: Type of project(requit ell): 1. J 1 am a employer with 4. I am a general contractor and I 6_ Neu constconstructionemployees(full and/or part-time).* have hired the sub-contractors ❑ 2.❑ 1 am a sole prropnetor or partner- listed on the attached sheet; 7- ❑Remodeling. ship and have o employees These sub-contractors have. 8_ EJ Demolition. working for tie in any capacity_ employees and have workers' 9_ Building addition. [No workers' comp_insurance. comp.insurance. required.] 5- ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ :I.am a homeoiamer doing all work officers have exercised their 11. Plumbing repairs or additions myself No w1orkers' right of exemption per A•IGL ❑ l � i co�- 12. Roofrepairs i insurance required.]Y c. 152,§1(4),and we have no employees.[No workers' fs.LWJ Other Qf pl au toltYGl&b comp_insurance required.] *Any appE cant that checks box 01 must also till out the section below.showing their weTkers'compensation policy information - I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mast submit it new affidavit indicating sucb. ;Contractors that check.this box must attached an additional sheet showing the name of the sub-cimtractors and state whether or not those entities have employees. If the sub-contractors have employees,they must groiide their workers'comp.policy number. I alit net entploter thntis proridierg n�orkers'co�rrperisatiolr irtsrtrnrrce for rrrt eariployeas Below is file polagy nerd job site fi forrnation. Insurance.Comp an),''l�ame: �ovf/1 �/OQ��y '• �$Uauy Policy or Self-ins.Lie. ODD Z Z q I Expiration.Date: I1110 f 13 Job Site Andress: Z Z D U Q 1 G V(.i11 g�At;�- �+� City+Stateizip: C FJ`l 1'EI V J I E. MA t A Attach a copy of the workers'compensation policy declaration page(showing the policy number and exp"tion 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 51,500.00 'and%or one-year imprisomnent,as well as vigil 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 D1A for insurance coverage verification. l do herebV certi !Jolt e r enalties of per uty-thatthe it forruntion prarlded above is tare and correct. Signature. Date: /a, Phone 1 0 Q ' g 9 Z 310 Official use only.;Do not write in this area,to.be completed by'cite,or totter ofriaL i City orTown: PermitfLicense Issuing Authority(circle one): 1.Board of Heald► 2.Building Department 3.City./Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other ' Contact Person: i Phone#l: 6 i r i ACORO® DATE(MMIDD/YYYY) C� CERTIFICATE OF LIABILITY INSURANCE OP ID DL 02/20/13 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 Suchendorsement(s). PRODUCER - NAME: Debra Landry ONE FAX DGP-Miles Insurance Agency,Inc AIc No, o Ext: 508-824-8961 (A/C,No): 508-828-191 3 School Streets P.O. Box 1018 ADDRESS: dlandry@dgpmilesins.com Taunton MA 0270-0957 MUIJUkohK CUSTOMERID#: SQUIR-1 Phone:508-824-8'961 Fax:508-880-2734 INSURER(S)AFFORDING COVERAGE NAIC# INSURED F - I" INSURER A: Savers property a Casualty Ins Squier Construction Inc. INSURERB: National Grange Insurance Co. Michael Squier 582 Bay Lane INSURER C: Centerville MA 02632 INSURER D: r INSURER E: I INSURER F: COVERAGES I 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. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MMIDD/YYYY) LIMITS GENERAL LIABILITY j EACH OCCURRENCE $1000000 B X COMMERCIAL GENERAL LIABILITY MP1278OZ ' 03/15/13 03/15/14 PREMISES(EaocKtNcurr — $500000 CLAIMS-MADE �X OCCUR MED EXP(Any one person) $ 10000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $2000000 i GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2000000 POLICY PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ` (Ea accident) B ANY AUTO I 14112140Zi i 03/10/13 03/10/14 500000 I BODILY INJURY(Per person) $ ALL OWNED AUTOS i BODILY INJURY(Per accident) $1000000 X SCHEDULED AUTOS _ PROPERTY DAMAGE $ X HIREDAUTOS (Per accident) X NON-OWNED AUTOS 1 - $ t $ B X UMBRELLA LIAB X OCCUR CU1278OZ 03/15/13 03/15/14 EACH OCCURRENCE $5000000 EXCESS LAB CLAIMS-MADE _ AGGREGATE $5000000 DEDUCTIBLE I $ X RETENTION $ 10000 $ A WORKERS COMPENSATION I, WC0002241 11/10/12 11/10/13 - - AND EMPLOYERS'LIABILITY i Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIV E.L.EACH ACCIDENT $100000 OFFICER/MEMBER EXCLUDED? NIA - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Proof of insurance subject to actual policy terms, conditions, limits, definitions, and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWNBA2 THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN j ACCORDANCE WITH THE POLICY PROVISIONS. Town Of Barnstable AUTHORIZED REPRESENTATIVE 200 Main Sltreet Hyannis MA102601 i © 88-2 CO D C R RATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks CORD i { Massachusetts -Department of Public Safety. Board of Building Regulations and Sfan.dords Consh-u4,01,SuperI isor License: CS-051830 MICIWLKQ,[IIER:u it i 582 BAY CENTERVI�-LE / tilt' Commissioner Expiration 02/03/2014 l I i � ` 1 t l f i 1 ! I f 1 l I F o�✓l�o�l�o� Office of Consumer Affairs&BJsiness Regulation HOME IMPROVEMENT CONTRACTOR I Registration:r�4111006 Type: I Expiration: A�2014 Private Corporatio: PCQSONSTyJG31t�`l i j MICHAEL SOUIEFtf - 582 BAY LN }# =;1 CENTERVILLE,MA Undersecretary r - I I i I I I , i I i 1 I , I 1 i i . i i I License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 N t valid withou signature 1 i I I 1 I Tony a Mari , 239-236-1274 p. 1 NEESE ® .( MASS, Town of Barnstable 1 639. .� 6 Regulatory Services k Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us O.Vice: 508-862-4038 Fax. 508-790-6230 Property Owner Must ' _K Complete and Sign This Section If Using A Builder I A cs mO 2USTfi,as Owner of the subject property . hereby authorize r Q to act on my behalf, in all matters relative to work authorized by this building permit application for: 0 re 46 0�qd/_/ /15 C��Al"Vllle_. (Address of Job) f S"' T , aa-- 13 Signature f Ow er I Date n Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. j i CAUsers\decollik\AppData\Local\Ivlicrosofl\WindowATemporary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 i i