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HomeMy WebLinkAbout0017 CYRUS DRIVE fi w ry i 1 , ssessor's map and lot number ............................... .... .... / Sewage Permit number .......................................................... �oFTNEtp�I TOWN OF BARNSTABLE r 89,HHSTADLE, i 039. a u BUILDING INSPECTOR � aY°'• /7 APPLICATIONFOR PERMIT TO / ........................................................................ ...................................... TYPE OF CONSTRUCTION ! l�rYc_. .. .... ....... ... ............. ............................................................................................ f..:.'� ....o&................19.. . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following inform tion: � � ....................................................LocationW .... ..... ... : -<.Proposed Use ..... ............. I.............................................................................................................. ZoningDistrict ...........................................................................Fire District ......... ........................�........................................../ Name of Owne>Cz?`C�":.1��. ...... ��fS................Address"!: ,1 ...........,. .`.. i' /1 ,,_^/� Name of Builder �� Zsp/..........................Address�(� f�^ ��/l�j�!��.. C .. .... ......... j.............. Nameof Architect ..................................................................Address ..........................................................,......................... Number of Rooms ... ..........................................................Foundation ....... ...............f... .................J ...... ................... 9 �� �L /l7 G Exteriora..:....'/�C.......:.......................................................Roofing . ..... .......�L..� ....................... ........ .:.......................... Floors ` " 7� ...........................................Interior ......... �. . ....................... ............................................ Heating �- -- -�- :Plumbing ...... '�.:...... v............�7i ................................... .. .....................G ......................................... Fireplace .......................................................................Approximate Cost �...!.. .�............................... ..... Definitive Plan Approved by Planning Board ________________________________19_______. Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 3 i •. met �- ��� I hereby agree to conform to all the Rules and Regulations of the Town of Barnst kyle regarding the above construction. 61'12 Narg).e,:......... ............. .................... --------------------^-----'' Locohon --____..�______________. ,__________________,_______ Owner .................................................................. ' Type of Construction -------------- ' -----.---,-----------------. ' plot ---------. Lnt ----------' . . � , Permit Granted ........................................ g � Doteof |nupection ------------lV Dote Completed ...................................... � ' PERMIT REFUSED ' .----'_--------------.. lg � - ---------.----------------.. ^--.----~—.-----------------.. � ' .------------..-----,—.------ . � . —^--------^---^--'--^--~--'~''' Approved ................................................. lA ........................................... ......... .......................... - , ` ---------------------..---.. � ' U ` z Q�oFTMETo�y TOWN OF "'RAR.NSTARLE B9'SHSTABLE. a Ya�•� BUILD— 11SPECTOR b APPLICATION FOR PERMIT TO ./ /r� l' � C—/>, _ /,Ale ' - TYPE OF CONSTRUCTION .. !'Y..! ® ...../.'...r� �'�'ar:...... ................. .... ................. 19, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora ermit according to the following information: Location .... ��./.....�4.5.......... �� .Ire'. :. .. ��.�'�4� ../.. f?�T ice' iLG j... -�..•.. ProposedUse .... ....... .............................................................................................. ZoningDistrict ........................................................................Fire District .............................................................................. . � .. .. ........ CeN.1�J'lC.�eePs/�41: e Name of Owner��� ...Address �1r..2.p.... ........ r Name of Builder ... Address ..��?4�.1/.Ct.�i�'.... .(i�: ...���A.���57 �yS,/�%ZLS Name of Architect .. ............................Address .......5 �07-de-........................ Number of Rooms ...... jJ �•rC� ,7,c- Foundation .............................................. ..........................—.. d Exterior y, / .............. �.Roofing � �.... /`lllS!�..C: :S:........ ..... ..f...... ..... fl .. Floors .......... ..C� ..r"�...... ........... .. ..��..:..............Interior `c�. j ..1y4� . Heating './ � .... � ...............................' �L .......Plumbing .....f... -....,/ J.� N ,................................L......... Fireplace .. .. ... ...............................................................Approximate Cost . .......'r?.... ......./......../..........:... .......:.� Definitive Plan Approved by 'Planning Board- -------------------_-----------19________. ; Diagram of Lot and Building with Dimensions ,, SUBJECT TO APPROVAL OF BOARD OF HEALTH L® I 2 1 ii�Q1C SC �7 4-zc c zLUO � c0i j) �. CO J � >- — �00.e_L,4L,.,jE r% < co I-- , Lu Q W p I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........ ... ... .... .. .. . r Strazdas, George & dean ti 161.26 Permit for one story /�� S I i single family, dwelling f...� b ' Location ......Cyrus..Drive .. ............................................ ! , ..P®ntery lle Owner ........CTeorge..& r'7;ean•,Strazdas Type of Construction .............IraMe........ ........ ............................................................. . ....... ... Plot ........................... Lot ........... .......... Permit Granted April 19 73 ........ .. S Date of Inspection ... 3 19 Date -Completed ... :.. .. '.... ..:...1_9 P T RE US ... .7,7 .. ........................................... t�1 . ✓� -y. ......... .........................`��................ # ( r 4Jn ^ h ..... ....................... ........................... ................,.... Approved ................................................ 19 - - � - � � � � Y .� ,.•*_► �.,h. + tom-- . ............................................................................... Lt '� ...................................................................... ... A.. i ALTERNATIVE WEATHERIZATION l��ll 19UZI Date: Town of Barnstable 200 Main St. Hyannis,MA 02601 �5 Re:Pertx�it# Villa e• I��e g '- 'c4:'. ::.The insulation/weatheitizap.�onl•.work at r $as`-been completed in aamedance with 180GMR Regards; ,. . Timothy Cabral, President CSL-105454 C3 v M 58 DICKINSON STREET J FALL RIVER,MA 02721 J .(508) 567-4240 J ALTERNATIVEWEATHERIZATION@GMAIL.COM .955(1 Application number................................................ Date Issued........ ..�� .�.v........................... e s OCT 2 6 2018 Building Inspectors Initials... Map/Parcel. , I TOWN OF BARNSTABLE EXPEDITED-PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: (� �`G(S (� P . /`rP NUMBER STREET VILLAGE Owner's Name• 8"tr'7L46ta Phone Number,E -077(/1 � Email Address: Qd4je Jd3@QZ[, Co-MCell Phone Number Project cost$ Check one Residential_� Commercial OWNER'_S AUTHORIZATION As owner of the above property I hereby authorize AM -IoGi4t-yP_ 17h C to make application for a building permit in accordance with 780 CMR Owner Signature: -YM 9 4teZ44 Date: TYPE OF WORK ED Siding ❑T Windows(no-header-change).,# Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's.review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR',S INFORMATION Contractor's name hlfef4ahTe, GvC/d .r�2 Ir1� mix. Home Improvement Contractors Registration if applicable)# � (attach copy) Construction Supervisor's License# (attach copy) inrti� Email of Contractor. hone number `g 7-"9 d . ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. I APPLICATION NUMBER ........................................................... *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X bditional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event 0 Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent l a If food is being served at your event please obtain a Health Department pment pp royal between the hours o8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: ele hone Number Cell or Work number P I I0understand my responsibilities under the rules and regulations for Licensed Construction supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 (-MR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE f S �6 a�i I�ature Date ct to a buildin official's a roval prior to issuance. rill permit applications are subJe g o ff ' Pp ilxs .: W'n. ar, t�ma u Prop42,30 w Owner.m.; h;., . .., w........ . . ...,; _, ., . ,. ... _ W EDWARD GARNEAUr � t �� pia r e 17 CYRUS DRIVE, CENTERVILLE, MA 02632 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legib1V Name(Business/Organization/Individual): ALTERNATIVE WEATHERIZATION, INC. Address: 2 LARK STREET City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.[D I am a employer with 16 employees(full and/or part-time).* 7. New construction 2.7 I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3TJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.. 6.M We are a corporation and its officers have exercised their right of exemption per MGL c. 14.E✓ Other INSULATION 152,$1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 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 contractors 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. If 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 the policy and job site information. Insurance Company Name: LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.#: XWO(19)58867158 Expiration Date:6/8/19 Job Site Address: s City/State/Zip: 1 le Attach a copy of the workers' mpensation policy declaration page(showing the policy number and expir tion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d ain a p lti s f perjury that the information provided above is true and correct. Si nature: Date: Ala V Phone#:508-567-4240 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: qf4. tyts �,t�•a€ t�r� rirl;yar �. ' 4- FALL"i lUirR .. ........ 4 `tt'itf3>tif ` ' illi}$i�16"!9 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Mags;99chusetts 02116 Home Improvemeiio3hitractor Registration Type: Corporation ALTERNATIVE WEATHERIZATION, INC Registration: 175683 2 LARK ST Expiration: 05/28/2019 .,�.• '1 FALL RIVER,MA 02721 Update Address and return card. Mark reason for change, -O-Ad&ess El pors+ur_aLr-I!=ninument I-i LQW+. or ...,_., . Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Corati before the expiration date. If found return to: ¢ RegWrartion ggpirstionOffice of Consumer Affairs and Susiness'Regulation 175689 05/28/2019 10 Park Plaza-Su'r#e 5170 ALTERNATIVE WEATNERIZATION,INC. n,MA 02116 TIMOTHY CABRAL f � 2 LARK ST FALL RIVER,MA 02721 Undersecretary fl�v OUt Si a#ure DATE(MM/DD/YYYY) ACC) CERTIFICATE OF LIABILITY INSURANCEF06/11/18 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 have ADDITIONAL INSURED provisions or 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 NAME: Anthony F.Cordeiro Insurance Agency A/CNE.N El; 508-677-0407 FAAic,No): 508-677-0409 171 Pleasant Street ADDRESS:Fall River,MA 02721 HSouza@Cordeirolnsurance.com Fall INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Liberty Mutual INSURED INSURERB: Ohio Security Alternative Weatherizatlon INSURERC: Ohio Casualty 2 Lark St INSURER D Fall River,MA 02721 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 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 UULr POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE - S 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(An one person) S 15,000 A Y Y BKS58867158 06/08/18 06/08/19 ,PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT 7 LOC PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ E 1,000,000 a accident ANY AUTO BODILY INJURY(Per person) $ B OWNED X SCHEDULED Y BAS58867158 06/08/18 06/08/19 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS x HIRED x NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ x UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/08/18 06/08/19 AGGREGATE S 1,000,000 DED I I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STAT Y I N UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500,000 C OFFICER/MEMBER EXCLUDED? � NIA XWO58867158 06/08/18 06/08/19 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary 8r Noncontributory basis per the terms and conditions of form CG2001 (04/13),for Ongoing Operations per the terms and conditions of form CG2010(04/13),for Completed Operations per the terms and conditions of form CG2037(04/13)and Waiver of Subrogation applies per the terms and conditions of form MEGL0241-01 (04-11) Additional Insured for Automobile Liability applies per the terms and conditions of form SCA005(02116) Excess Liabilitv is a following form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESEN` / / Y ©19q�-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD