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HomeMy WebLinkAbout0025 DONEGAL CIRCLE one Ct�r; D . A ..., I �, I ., 1, r. a ,.y I i aI -, - .: ... t, ,.,.," , „h,' „:, k.. , -:: _ >,_ .,., ,,' - .. ::, 1 - :,' ,Y,:' rt „. , r ,. _., , s' , ,. ., ,, . ... „_ , 1,11" -kegs •, ..,. .,- ,_ t.: _ -......::,. .: 4 irk -to n , ' .::. , „....,.,,,, £Y a..... L...r . ,.. ,.... ..t ..f, , ^, r. .-ti .., r:v ... kt, ,.,,- .,. , - , .. ..r..- ,. ...R. J 2. Y t .: ...: .:..k .E,.:, , t.. .:i ..,,:Z,r .,,. .x,.-2 ..w. . v -..... , invv ri .. „ .::µu: .:n,:ig .. :. `5 - r§ .. , —min r ..,: , -- .: .i:,. n ,. a1 ..,..:n V,. 1 Y. _ ,..,. , .. „ ,e..._ ,r -J7 -,v-;.,r, ,. ...,. 00 - come A My -:i µ,: - - .,,. r', �: .. y l ,it Yf, f: 1 ALTERNATIVE WEATHERI,ZATION �01291i �- BUILDIN(; d)Fp, OCT 2 6 2010 Date: D j TOWN OF B/d1UST;acs Town of Barnstable 200 Main St. Hyannis,MA 02601 Re:Permit# J/ ���"-'� Village" i 'The insulation/weatherizatiori.•work at MUQ It f, has been completed:iu `aC�ordahce v4th.790CMR Regards,".— Timothy Cabral, President CSL405454 ' 58 DIMNSON STREET I FALL RIVER,MA 02721 1 (508) 567-4240 1 ALTERNATIVEWEATHERaMONOGMAIL.COM t ® ..Application number.. .: .....'.. .... i SEP 0 5 2018 Date Issued....... ...:.. ............................................. 1 T slogs. rOWN 0�- �.� ����� Building inspectors Initials.. . . .. ..................... .... ..... ... ........ .-y y/ kpap/Parcel./..S�J. ,....��..o��. ..................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project 60n e NUMBER `' STREE VILLAGE Owner's Name: _ G er(-' /hl- lk-s Phone Number Cps L' �KS- Email Address: 5 YV iY)`C 5-I. P— C.t)yn C-s+,/1t- Cell Phone Number Project cost$ Check one Residential _ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize � to make application for a building permit in accordance with CNM W tAe f-he 12-&AVYI-, Owner Signature: !�)M Q,60-rj A Date: 81d,74 a TYPE OF WORK ED Siding ❑ 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 j yY►[� ,�Y _ Home Improvement Contractors Registration(if applicable)# "7 S (attach copy) Construction Supervisor's License# ®Sc��`� (attach copy) Email of Contractor W�t`1�a�'i Phone number 519 -ieol y 0 ALL PROPERTIES THAT HAVE STRUCTURES OVEVR 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *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 Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event 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 If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STONES , Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION • . _ . - ti , Homeowner's Name: -. Telephone Number Cell or Work number I understand 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 CMR and the Town of Barnstable. Signature Date AP LIC T'S SIGNATURE Signature DateqL1 R, All permit applications are subject to a building offcialls approval prior to issuance. s , , a i Town of. .be Building Departnient&Mces g t� D"Iffing commissioner 2Qf1�"�.ain Street,Ilys Ili 02601 v efwtv.ta .b arrzstable�mxs t Fay: 509-790-6230 Office: 509.-862-4038 Property Owner Mu9t complete and. Sim. This Section, RUghW A Bider .- /6-S sject p OP=,t7 C� b&tcby autha to act oa my ssx all=2ttC-n reladce to-atk authorized by budding pit app3.icadaa.f'arn of Job) pool fences aricl alarm are the responsibilit7 of the app .cast,Pools ar ace'Ica be filled of u. ed be�oxe fence seed azzd ail, ins eettoj:�ar pe cizmed aid accepted. 1 f S" ig€zat e C)f f hex of cant: C. . �dat N z M r c oa s:awN ERIZssIoru LS asrct The Commonwealth of Massachusetts 02 4*9 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 Leeibly 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): I.❑✓ I am a employer with 16 employees(full and/or part-time).* 7. New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3.[:]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 l l.❑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. These sub-contractors have employees and have workers'comp.insurance.- 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.�✓ Other INSULATION 152,§1(4),and we have no 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. 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: P6 d� City/State/Zip: ' / �e //1� Attach a copy of the workers' comp sation policy declaration page(showing the policy number and expirati n 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the D1A for insurance coverage verification. I do hereby certify u d ain a p !ti s f perjury that the information provided above is true and correct Si nature: Date: a 7 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#: AC�® DATE(MMIDDIYYYY) �i CERTIFICATE OF LIABILITY INSURANCE 06/11118 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 AHCNE.No Ext: 508-677-0407 FAX No): 508-677-0409 171 Pleasant Street ADDRESS: HSouza@Cordeirolnsurance.com Fall River,MA 02721 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURER C: 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 RUMbULSK POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 `E TEEN I L CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 15,000 A Y Y BKS58867158 06/08/18 06/08/19 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 JECT LOC POLICY❑ PRO- ❑ PRODUCTS-COMP/OPAGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 ANY AUTO BODILY INJURY(Per person) S OWNED SCHEDULED BODILY INJURY P B AUTOS ONLY X AUTOS Y BAS58867158 06/08/18 06/08/19 (Per accident) S X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident S 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 $ 1,000,000 DIED I RETENTIONS $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STAT Y/N UTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 500,000 C OFFICER/MEMBER EXCLUDED? n 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 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/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(02/16) 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 024$1 AUTHORIZED REPRESENT ` I 9 � f ©19q,2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 3 q. s t f:�il ��tsit�lsrts�l�i Sta� �+d�c:. +. 4C`.'onr .ttnjc on Supervisor a l Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home lmproverneia : ontractor Registration ' Type: Corporation ALTERNATIVE WEATHERQATION, INC. r 3 Registration: 175883 2 LARK ST . Expiration: 05/28/2019 FALL RIVER,MA 02721 ;', e Update Address and return card. Mark reason for change, Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Catia3 before the expiration date, if found return to; ;stration gairail2a Office of Consumer Affairs and Business Regulation 1156$ 05M/2019 10 Park Plaza-Suite 5170 4 ALTERNATIVE WEATHER17A71ON,INC. an, A 02116 TIMOTHY CABRAL 2 LARK ST FALL RIVER,MA 02721 Undersecretary Tt V Otlt 3i Hture ��QyoFTNeTo��o� TOWN OF BARNSTABLE i BA.HBSTABLE, i ABIL ;pY9.ae�e BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. �. ..� ...... �0...�............................... ........ .. TYPE OF CONSTRUCTION .... .. . ........ ... 41 .. .. ............... ...... ;. ..... ...... .................19.�l.. TO THE INSPECTOR OF BUILDINGS: The undersigned ^ hereby applies.for a permit according to the following information: D...t..Location . ....�....... ............... Proposed Use ... ................. ....:....... ........................................................................ ✓ l ; :. . Zoning District ........... . .. ....................................................Fire District .C7.(:) ......... .............. ................................. Name of Owner ... . . . ......C</hn,.. ...... .. ...... ....... ........... Address ��� K/� /'�r. ......sw . . . Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address ..................................................................................... 1 4 - -L Number of Rooms Foundation Exierior ..• r:6s"..... ��E ......t!Fe.O .. .........................Roofing ......... J'� 110j .......... Floors .........................................Interior Heating �..!4�..............'..1.(...(.......✓4�..�'..I... ........Plumbing .................................................................................. Fireplace ..........:y`! ................................:...........................Approximate Cost ......... ',...�. .......�.......................... (� «� Difinitive Plan Approved by Planning Board _________________________ Diagram of Lot and Building with Dimensioros O �6 -� -HE ROVIDING �UK PROPC3SEQ MF �-C�� �� P�:�G�` DtSP®SAL SA !(TARP WATER S�°PPI..Y, SEWAGE�- AN DRAINAGE IS I�tERE�3j 6�P��7`�E� Y 10�''VN OFYBH ALTO BLE, BOARD Car }y ET�SiD ICISTALLEE� M1�ST OBTAIN SEINAG A Li 1 INSTALL SYSTEM• 44, PE R,VII Al 'o a % 7 • 00A) 6G 4 C I I hereby agree to conform to all the Rules and Regulations of the Town of B stable regarding the above construction. Nam ... .. . .............. ! ` � Dxmoy, William E. Jr. . ! � � DEC � 1 1�`�� »�o_w = ^ ^�, " No —. Permit for .......o??a.. ....... � ---.��?U�I�.. .cb�� .................... . . LocohJ'�.�A?�/���..������---------' _______.Cm ----------' Owner --.. | ` ' Type of Construction .............Xrmo................. —^—^--^--~^^-------------'--- ` Plot .......................... Lot ......#5..................... ' ^ Permit Granted -- .�....... .....lg 71 ^ Date of Inspection — ...... ........ 7) ` � Date Completed --------.--.--lg ` � | PERMIT REFUSED \ -----'----------------. lA . \ � __.. .__. —.--...--.--------------' ^^~~^^^^-~----'--~^^^''`^--~^—'`~^— \ | .---.—...--.,~....~.—....-.--...--.- , ' . . ----.—.--.~------.---.~..---.Approved ^.. ' ................................................. lA ` . � --_—.--.-------~.....--....~.,.. . . -------.---..—...—..---.—..—...-, | � *