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HomeMy WebLinkAbout0072 DONEGAL CIRCLE ����a r �e '�1 CG� �-, :�� =. '� ; ,. �� `. a a ♦ � A �: ., :., ^� ,. y yy ��. ,i; f': i. .. ,:. .-:� r: � ,. ` - � - '. �: � _ - _ .. � �- - _ Y S �� m nmii wea: th of Massachusetts SheeNletl Perm map.. Parcels. bk_ __. Persxtt�: l stated:3ob Cost, Perm:.Fee Plans Submitted: YIEs NO Plans-Reviewed. Ids lr'fO Bess License � F� Applicant Li�cens�e, Business at op l raperty Qwn�r./Jdb Looatlon T format as : aer�9��Sn�cnn _ �C. '?•ramie, c5ai� . Street Street; LAG T hope: Photo I I}: recluized 1 Gogy of Photo T.I? attached: YES � �1?YI unr�trcte�.license 21 -2-restncteel to ell s` stozies or Ie- a i corr m06 1 up tip-10,00.sq , 'L!tc es o less Itesdentra ; 1,21,fam�ly ._ uit- at Gonda/Tt�wnliouse Go mere Office Retaal Izidustr al Fed o . . Ic�3re l3ept.Appraval Institutional ttlaer JUDO. 820�6 Sgnre I oatage.- undue 1:40aQ sq, ft., v era�tlt3 sq ft lV nI Sheet.ametal>�ork#o tie eompleteti News V►;ork, �-� IZepov��onsrqBCE 4 lkle Waters ed Roofing�� �ito�a���us°t S' Este ,. M.et G zt raey 'Vonts A'Salanc n r,. ?rt vi de detaaled description.ofwork to*done. J NSURANCE COVERAGE l have a current Ilaltll if Insurance,policy or its equivalent which meets the requirements of M,G.L.Ch.112 yes s? No if you have checked YSS indicate the type of coverage by checking the appropriate box below: A liability insurance policy F Other type of indemnity Bond OWNER%INSURANCE WAIVER: am aware that.the llcensee does nit have the insurance coverage required by Chapter 1-12 of the Massachusetts General Lays,and that my signature on this permit application mmilys this.requirement Check,One tartly • Owner Agent. Signature of Owner DI Owner's Agert by checking this ba WC,thereby certliy that all of the details and infolynation 1 have submitted(ter artlered)regarding this application are true and accurate-to the best of my knowledge and'that all sheet metal work and installations perft7rrned under the permit issued for this application will be. . in compliance with all pertinent provision-of the Massachusetts Building Code and Chapter 112 of the General Lars. Duct inspection required prior to insulation installation-YES No r Date C6mments Final i`us ►eetago } 'Tpf 3 Maser Cease: - OJoumeyperson Signature of Licensee oJoumeypersori-Restricted License Number, y s • Check at www. 3 nspector Signature of'Permit Approval i f The Commonwealth.of Massachusetts Department of Industrial:Accidefto } I Congress Street,Spite IDD Boston;MA 02114--2017 www massgovfdia Workers'Compensation Insurance Affdi vtt:Builders/Contcactois/E ectr c anslPlyinbers To BE FILED WI'IAIRE PCAMITTINGAU:THO:RITY. Applicant.1nfortnO16u _ .._.... Please Print :Legibly Sandwich Chinne Swee ,Inc/Keifh Cliff Name (Business/Organization/lndividual): Y P Address. Post Office Box 90 City/State/Zip:Sandwich,MA 02563-0090 pone#:(508}888=5114 Are you"an employer?:Check the appropriate boz; Type of project(required.); l.Q F am a employer:widi employees(full and/or pan nine);* 9. New construction I I am a sole ro r�etor or iutnenh� and have iio em to .ees working for me in D ❑ p p . p ? ?_Y 8 RemodC-ng an ca aci ❑y; p tv.lNoivorl.ers comp uisurance.:reguired:] 9 Demolition 3:❑.l.am a.homeowner.doing allwork myself tN6:workers'comp.insurance;required:l t 4:❑I am aft and will.be hlrifipcdhtramirs to conduct all��orl.on my property; I will 10 Building add$iorl ensurzahat all contractors either Kaye worl ers'compensation innsurance or.are sole I LF]Electrical repairs or additions prdon-Oors with no-employees..` 12 Q:Plumbing repairs or additions. 5,01 am a general con'tract,or and I hmOired thesub contractors l fisted on the i dkhed sheet. 13.❑'Roof repairs These siib-contractors have employees and have workers'comp.insurance. 6.;Q We areta corporation and its otticers have.exercised their right of exemptiori.per. 14.Q Other J 52,§1(Q),and w.e have till ernplopees.[No'workers'comp.insurance requrzd.] ti 'Any applicant that checks box'#I must also fill out the section:below.showing their workcrs''compensation.policy informal of. Homeowners who:subm t*is,Alidavit indicating they art,doing a{{work and Alien hire outside e6nftetors niust.submit a new.affidavit indicating:sueh. ,Contractors that check:this box must.attaeWd an.additional.slieet show tie the name of thesub contractors and"state whether or not.those entities have employem If the contractors have employees,they musc:piovide:.tfieir workers comp:pohcy;numbec l am:w employer Matz.providing Wo kers'coinpoodlioir insurance for my eri hloyees: Below is the policy undjob s to informaliob:: Insurance Company Name:-Atlantic Charter Insurance Co Policy#or.Self ins.LX # ......:WCV01153101 E�tpirat on Date,05/13/2017 Job:Site Addiess C. f M Ulm tk It 15�� City/State%Lip: i,I 1Ai 'a e Attach a.copy of the workers' co pensation policy declaration:page(showing.the policy number and exp► ation date). Failure to secure coverage as required under MGL c. :152;§25A is.a.criminal violation punishable by a.line tip:to:$1,5.00.00 and/or one.year ilnptisonment,as well:as c.ivit penalties ill the form of a STOP WORK.ORDER and a fine of up to$256:00.a day'against the violator.A;ebpv of;this statement may be fonvarded.to.tile;Office of.lnvesttgat ons of fhe DI A for insurance coverage verification. I`do hereby re'tify,u er' e pains and penalties of perj r I that'tlie inforrnattoti proyitled.above is true and correct Si nature l` Date. 7, i Phone# (508)888=5 4 P J' n D cial use only: Da not write to this area,to:he corm.feted b ci or to►vn.offrcerll City or`I owq ._ Permit/License _._ jobiting.Authori_ty.(circle one): F.:Board of Hea th 2.:Building Department .3;Ctty/Town Clerk 4 EtectricaLlnspector S.Plu.mbtng:.Inspector b:0ther Contad..Person . Phone ACQRD' DATE(MMIDDmrYY) CERTIFICATE OF IABLITY NSURANCE 05/23120 s 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 A.MEND, 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(les)must b.e endorsed. If,SUBROGATION':IS WAIVED,.subjectto 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 endorsements:. . . PRODUCER Enca H;.O'Connor HART INSURANCE AGENCY INC;. PHONE 508-759 7326.x205 FAX 508 759--366 243 MAIN STREET aC.No PO BOX 700 E.MAIL.... ` ADDRESS: :eoconnor@hartinsuranceagency:Cohi: BUZZARDS BAY,MA 025320700 INSURERS AFFORDING COVERAGE NAIC# INSURER A:; ESSEX INSURANCE GO 39020 .INSURED Sandwich Chimney:Sweep . ARBELLA PROTECTION INS.CO A1360 INSURER e PO Box 90 INSURER t: ATLANTIC CHARTER INSURANCE COMPANY 44326 Sandwich,MA 02563. INSURER D,r INSURER`E': INSURER Fe COVERAGES CERTIFICATE NUMBER: REVISION`NOMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED"ABQVE FOR THE POLICY PERIOD' INDICATED NOTWITHSTANDING ANY REQUIREMENT;TERM OR CONDITION OF ANY CONTRACT:OR-OTHER DOCUMENT VVITH RESPECT TO WHICH THIS. CERTIFICATE MAY BE ISSUED OA;MAY PERTAIN THE INSURANCE AFFORDED:BY THE':POLICIES.'DESGFIBED HEREIN IS'SUBJECT TO ALL THE TERMS;. EXCLUSIONS ANp`CONDITIONS OF SUCH POLICIES,:LIMITS SHOWN MAYHAVEBEEN RED_UCED BY PAID:CLAIMS:._ L R, TYPE OF INSURANCE ADDL SUER POLICYEFF: POLICY POLICIC NUMBER. ..... MMJDO MMpO _..,. _..... LIMITS.... . _.. A GOMMERCIALGENERALLIABILITY 3EC014-1 1,0/091201,5 10/09L2O16 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCGUA DAMAGE O'RE — 1 QQ 000 PAEMISES:.(Ea occurtence} MED EXP Ad.one arson PERSONAL&ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER;: GENERAL AGGREGATE POLICYF JECT LOC. PRODUCTS:=COMPtOPAGG OTHER! $. :AUTOMOBILE LIABILITY 1020,01.5930 03/22/2016 .03/2212017 COMBINEDZNGLELIMIT $ a acrid n ANY AUTO BODILY INJURY(Per person) $ 100 OOl) ALL OWNED, SCHEDULED t BODILY INJURY(Par accident) $ 300,000 AUTOS AUTOS NOWOWNEO PAOPERfV"DAMAGE HIRED AUTOS AUTOS. 1.Per ac 7,', UMBRELLALIAB OCCUR. EACH OCCURRENCE.,,, EXCESS`LIAB CLAIMS-MAOE. AGGREGATE'. $_.. DED C WORKERSCOMPENSATION, :WCVO11,53102 O5/13/20'16 05/13/2017 PER U OTH- I AND EMPLOYERS`LIABILITY Y'A N..�. - . . .. TATUTE ER ANY PROPRIETOR/PARTNEFi&XECUTIYE. E:L.EACH ACCIDENT $ 5OO OOO OFFICERIMEMBEREXCLUDED?' NY A. (Mandatory In NH)' EL..DISEASE_EA EMPLOYEE $ 500,00.0 It yyes,'desoribe under" .....__ . DESCRIPTION OF OPERATIONS belotiv . .. _ .. E:L.DISEASE=POLICYILIMIS $ 500000 DESCRIPTION OF:OPERATIONS J LOCATIONS:'!'VEHICLES(ACORO'.101i AddW6mWRemarlrsScKW41%may In of 6hed If more space is ro 6lred) CERTIFICATE HOLDER. CANCELLATION .. Fax;#:(508)544-429Q. SHOULD ANY OF'THE ABOVE DESCRIBE BE D POLICIES- CANCELLED BEFORE TOWN OF FALMOUTH THE,,EXPIRATION DATE THEREOF, NOTICE. WILL BE DELIVERED IN 59 TOWN HALL SQUARE ACCORDANCE:WITH:THE PbLICY PROVISIONS: FALMOUTH,'MA 02540' .. ........... ::AUTHORIZED"REPRE$fNTAT1VE � 01,9884014 ACORD CORPORATION. All rights reserved.. ACORD 25{2014/07) The ACORD name:and;logo;.e6 reg'We red marks of ACORD Berard of Building t2egatatons and..ta 4a s ,;a„ �It. f trt.Ir."rri tt trill/r tlf(Glf✓frilztlt%�a`'.. L't�nsttiy.i;ots Sups;Eor i aCifi' Offi�c urCoTsumer Atfairs S'Busraess iegutatEvn License C3Fp-058557 HOME IMPROVEMENT CONTRACTOR. Itr 5 6+ t L F ? eg�stratiort 920859; Type: KEITH A CLIFF = E rr'- : - � >fpiratron = 3i12/201& ]PO BOX 90 _ y ate Priv Corpbratic SANDWICH MA=025 3�p, SANDWICHCh(i1tiNEYSWEEP` tNC: KEITH CLIFF ✓.�.» . J,. . ��'�:Y Expt"tarit3l 28 EMERAMWAY Commissioner 0212712017. FflRESTDALE.,MA 0244 L3udcrsetrett'ry OMMONWEALTH OF Mi4SSA°CHUSE.TTS F a • i e e Cq SHfET�i'tf L W0RxKERS'� � N. t=� a3j ISSUES SHE f(?LLOWIIGLICENSE $` A ! ASTER 4 l f";STkidfD �CRO A CLIFF Lt3 WAY. J' J Restricted One-and two-family dwellings.or any. License or'registraiion va{id for individul us 'only accessory build' thereto resPt' Ve ofsize. t dt iffound return;o:xionae Office of consumer Affairs.and Business Regulation lo Park,Plaza-Suite 5170 Bostan,�'tA 0211:6 j Failure to possess a current edition of the Massachusetts w _ Stale Building Code is cause forrevaeaton of this license. Tot va out signature far DIPS:i.➢eeraing information visit:. vmw:Mass.Gov1DP5 CON7FIOL# # 7 . Q�a�®�mapSRy s-aj �a ma0 a w>:a�4 IMPORTANT ` m ^_amro<ga8 _a �a "�°�a n m m4a sa K?aK 0LL+pp+Sn Na M Oro� �a3 t � a� a�Omro4 Y-K pGS3Ga G43�, t� �/� Cm� y `ACC �G OfT.smm y%4ZL P:: mC p H your license is last,damaged:or destroyed;is inaccurate or r . ro _, a m t needs to,be corrected;visit our web site at mass. ov/d I far :_ a m a 4 a s n 9 p mro _ x .a instructions to-ensure the proper mailing of your Renewal- G a G: , G Qa m a'y' o ro°$ m Application-and any other correspondence:. a r - "° a Q°4 3:G O c This license:'is subject to Massachusetts General Laws and a m - ;, n m a s G "'>> j. "a D m �Ct y D°i i` i s 3 m,.ac regulations.Y.Our'license is a priviiege,and cannot tie lent or. K 3 noro'm`� :roro aY,:4 1° 4c r�i> oa.�(%i m�: assigned to any person or entity under penalty of lam Keep this t.LA a.� license on your person or posted"as required by law and/or' p> v 4 ro%.' s `�' -'4 _- a o regulations: Tows of ArtistAW, RgqlatQr ,ServGes a Thomas Geier;iUtrector Tom Perry,Bu cug Commmoner 3fl4 tvfatza Street,kiyartnts,M11;�25t3I: . v tov -bariastable.ii s Ofce: 508 86240t Fait; .5(?8-°79Q-6?3 �arnplete and Si '�` 9 Sectto Sys 1�I a as per.o :suer ex bv-,alAort a�rt� ers xelatx�e r�wt� .a�t�Zflrzed b� is;bI '-pes�i d ssf db ' Poo #en.€es and alazxns are tlae repons�bity cif tkle applicant. '40Is are nog to be filed before fence is i�astalled and pools ate not t© b'e untied t�ril all final mpect atas are per#'az rigid and accepted:: ar pf"TE ae macnat` SUES Lt�1-t c` P tt a i e. Piihf l ime Date, QJFOR 3 .S: *THE TOWN OF BARNSTABLE AMUN 9 T am& 1639. BUILDING INSPECTOR APPLICATION FOR PERMIT TO .....C.1p,... ............. .......... ................... ol TYPE OF CONSTRLICTIOx,,,.-2- .. -III-rx"t, ..41 . ...... . .. .. . ..... ... A.......... ...................... ....... .............�,-.7................... ..... lqz... TO THE INSPECTOR OF BUILDINGS: . The undersigned hereby applies for a permit according to the following information: Location A.P.77...�77......!20hx... ....( CZ Proposed Use .-4,-jt....... ......4'. ..&*-.. Zoning District A Fire District Name of Owner ............. .........Address ...r7�..... .......4 Nameof Builder .....................................................................Address .................................................................................... Nameof Architect ..................... .........................................Address .................................................................................... Number of Rooms ...............Z-:....:.........................................Foundation ........ ........... . ..................................... Exterior ....... .:.............Roofing ..... .. .. . .......... ..... ................... ........................... Floors 15� 2- ........... .............................................a....................Interior ................ ....... .................. ....... .......................... Heating ........ ..........................:...........Plumbing ....../ ............................................................................ Fireplace ......... .. ..........................................................Approximatt- Cost .... Difinitive Plan Approved by Planning Board -------------------------------- 9 I --------- 4:- 7S- Diagram of Lot and Building with Dimensions 0 01 0 CL U) Es O > < Ur -0 I —r n < I M 0 U- ct 0 in 0 U) U) 0 x ) C) < Ld (D 0 CA, M Lux to C,,-, ,i LQ to V) J S 1 6 Cf) {- < C- �4 < W LLJ TI- 0- z - LLJ 1-- z < z I hereby agree to conform to all the Rules and Regulations of,the Town of Barnstable regarding the above construction. m . ........... 11. ............................. ....... Dacey, William E. Jr. I DEC 31 1971 13638.. Permit for one story, No ........... ................................... single familyg dwellin } ............ .................................... ........................ Location Donegal Circle Centerville ............................................................................... �.. Owner ....William..E.....Dacey,. . ....Jr. ................... .. . ...... . ... . ... t Type of Construction frame ............. ............................. ................................................................................ Plot ............................ Lot ........+57....... Permit Granted February 2 2 71 Date of Inspection ... ta !� .:..41!..........19 r Date Completed ......................................19 M PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved .............................................. 19 ........................................................................ ............................................................................... f