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HomeMy WebLinkAbout0025 EDGEWOOD ROAD ` � c . •.' �� � � • � w .t 1 • it _ i M ! .l' i a t� t i o NfBarnstable Permit firesJUN02 .?URegorY Services fee MASS. WN Richard V..Scali,Director ding Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-403 8 Fax: 508-796-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / Not Valid without Red X-Press Imprint Map/parcel Number 19 49-1 D?6 Property Address (�"S r,D Gf�O p L� tZ C& f J [Residential Value of Work$ <_0 G Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 13 Z I A AJ R 2�4C>)/_' J' SJ Contractor's Name �lfiC .417"LD (S—A 2 Al I-AL) T Telephone Number '7H 93FL5 Home Improvement Contractor License#(if applicable) 6 17 0 Email: of Oki Construction Supervisor's License#(if applicable) q 7 / 14 ❑Workman's Compensation Insurance s 7 k one: am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance" Insurance Company Name Workman's Comp.Policy# 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 [Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors:_0 *where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission.A A copy of the Home Improvement Contractors License&Construction Supervisors License is re uir d.' • SIGNATURE: Q:1wPFi ES\'F0RMS1buiiIding permit formsoTRESS.doc 01/25/17 b . - Jqr The Cornno'mmalth of-Va"adiusetts De, artraet ctflfrrrlxctria �cciderats- a a '.�m�s#gtons _ 600 Washington JS eet - Boston,AM 02I11 , 4 iPrvtuntassgvPfi>a ' t Nr rwimrs' Caffipensati=Insmrance Affidavit]3cederslContractrrsMecfdcianslPluin.hers- tE (�ApPHcan Inf nMficvII - -. Please print N am D n 4 7� awsta e MA Z>q 3 - Are you an employer?C heclr the appropriate boom Type of project(required}_ I_❑ I am a employer with 4_ ❑I am a general contractor and I 6 �� - MpIoyees(fTI1 arWor part-time).* have]siredthe sub conntmcfors i - 2-L'1l1 I am a sole pzvpEietar or fisted on the,attached sheet~. 7. odelhrg , partaer- These smb-contractors have shsp and have no employees . 8.-❑Demolition vvodi,6. forme in any capad employ andhave wogs' [No erg,' comp-insurance. comp.i,nertranM 9. ❑Builtiirig Sdditioa repaired j 5. ❑ We are a corporation and its 10❑Electrical repairs or add lions officm have exercised ti it 3.❑ I am.a hotneou�ner doing all iror3r 11-0 Pluarbingrepasss ar additiams set€ o wokkecs right of exemption per M-GL my F- ` 12.❑Roofrepairs, iasmance repaired,]1 c-152,§1(4)6 and we have no 1 o Other employees-� warke& _ coup-insurance required-j '�.ny app5c:a Met cbedsbos#I toast also fRoutthe sectioabeRmshoaang&&waikeie compeasstianpaUcy ia�EiaL #Sameuwners who submit dtis affidavir inbficatmg tky are doing sal Vrak aa4&=him outside coutmctommmst submitanew affidazit indicating smrR fCautmct=ff=t ebecYthis boat must attarhed as addili®al sheet aawingthe?,—of the sob-cont=toa.amd statewhed"ar not fmse eatitiesbwe -gdoyen.Ifthesvb-cant=tatshacemupIcyee-%they mastpnnrZ*dwk warken'camp.paIicgaumbeL I arrr ari erspl�vr'er f7trrtisprmatiitt;tt�vrkets'caerrperesrdiare insrirarresjar nr,1*earploy�ees Selory is the paticy rtrtri job siife . €n,jormatian. _.. . hsurance Company Name: Po-ficy 34F or Self-ins ISC. irati�a Date: Job Site Address City/Stafel.tg: # . Attach a campy of the wort ers''coaapensationpolky-declaration page(showing the policy,number and expiration date). Failwe to secure coverage as required.under Section 25A of MGL m M can lead to the imposition of criminal penalises of a fine up to$1,500.OU andlar one-yearimprisonm�as vc&as civil penalties,in the form of a STOP WORK ORDERand a Kne of cep to$250-00 a dap against the violator. Be advised did a copy of this statement.maybe forwarded to the Office.of Investigations of the DIA fey i si uance coverage vdfrcation. IdoheMbycew naULV tTr pians an ps wNes a,#pet j�c fliatt7te irrfarwratrartptrotz dabot�s i�bars acid correct . ;�i�atttrer 7}ate 7 Phone iF D,Qfcfd use wiry. Do not write in this area,ter be compl<eteJ by city arts i n ofrcirrt City or Town: PerrahMicense;9 Issuing Authority(code one): L Board of Rialth .BurTffing Department 3.City6rown.Clerk 4.Electrical Iasgector rr..Phunbing Iuspectar 6.Other Contact Person: Phone#: ormatio n. alad �nst c��ns Nfas rhnaetts Geb=al Laws c ap er 157 regones all employers to provide wo=keas comp=mdon for their employe:M P this stat of�,an e�lapre is detme as";every person in the service of another under a¢y cmtf and of hi ry express or implied,.oral or wutt� An aIvyer is defined as-am iudjvidnal,partnmmbi m,associaii an,corporation or other legal entity,or aaY two or more . of the foregoing is a joint .and inrhu mg the legal representatives of a deceased employer,or the receiver or trustee of a a individual,pa tam ship,associahnn or oilim legal entity,employing emploYM However the owner of a dweIlling]mouse having not more than.three apartments and who resides therein,or the occqM33t of the- dweIImig house of ano9mer who employs p=m3s to do maintenance,consixuction or repair wo$c on such dweIImg house or on the grounds or bmldmg appuctenanf$hereto shall not because of such employment be deemed to be an employer_" MGL chapter ISl,§25C(�also sues that¢every state ar local licensing agency shall wMhoId$ze issuance or renewal of a license or permit to operate a buskess or too mnstract bindings in the commonwealth for any applicautwho has not produced acceptable evidence of complianm witTX the insurance.coverage required_" Additionally.M(ff chapter 152,§25C(7)states-Teifher the connaaaweaM nor iay of its political subdivisions shall entr into any contract for the performance ofpublio wD3k uohZ acceptable evidence of compliance with e msor�ce. e tin have Been erred to the ml f,-�i-„��aufha ity." regnn�enfs of this chap Pry Appliraats , Please f M out the wo&ers'compensation affidavit completely,by checl®.g the boxes$mat apply to your situation and,if, necessary: Ply sab�ontracior(s)name(s), address(es)and phone number(s)along whit theircer(fficate(s)of insurance. Limited LiabU4 Companies(LLC)or Liwi Liabi-LityPadnerships(LLP)withno employees ot3mer than th0 members or partners;ale not regal ed to carry workers'compensation finTim _ If an LLC or LLP does have employees,apolicy is required. Be advised that this a-H$dayit may be snhmitti-,d in time Department of Industrial Accidents for confirmation of iosurauce coverage. Also be sure to sigma and date ire affidavit The affidavit should beret»ed to ihe city or town that the application for the permit or license is being mgnestA not the Department of In±istrial p rpi Pnt_s TXMICI you have aay questions regarding the law or ifyou are reqaired to obtain a workers' eomp=sation policy,please call time DepartraeEt at time number lrstedbelow. Self-fimmed companies sho-nId east-ar 11iea self-iusou co license number on the approprmatn line. City or Town Otficials r Please be sure that the affidavit is camplete andprinied legibly. The Department has provided a space at the bottom of thin affidavit for you to fM out in the event the Office of Invesfigat<ons has to coact you zegardmg the applicant_ P leas a be sin:e to hill in the,p ennitlacrose mnaber which will be used as a reference rmmber. In addition,an appIir`t that must submmit mint pl0 pemmitllicense applications in aay given year,need.only submit one affidavit indicating=mt policy m,$iumation.(if necessary)and under"Tob Sib-,A-Adrese the applicant should wIIte"aU locations II (CfiY ar town)."A copy of the-affidavit that has been officially stm:rped or mmiced by the city orr trovm maybe provided to the ' vit is on file for futore'pcnnits or licenses_ A new affidavit mast be fill--.oimt each applicant as proof that a valid affida year.Where a home owner or citizen is obtaining a license or p=mit not ielaiod to any business or commercial Y613t= (ie_a dog license or pewit to burn leaves et said person is NOT zegrm ed to complee this affidavit The Off m of Tnvesiigaiions would Him to tick you in adv-mce for your cooperation and should you have any questions, please do nothes� to give us a call- The,Deparimezes address,telephone and fax numb T Ca=jOU Sri[of Massachusetts , Dent t?f�dn�ia�Ac�dt�-is . 64 Woman St Bwt n.MA Fi11I Fax-#617` 27 7749 WwwMaz Kevised424-07 �fdia Town of Barnstable Regulatory Services Richard V.Scab,Director �39 1 Building Division. - Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 50&790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L 06 z�jl an J)r ,as Owner of the subject � �,ti"•- l property Ce hereby authorize h 14, 'to act on ray behalf in all matters relative to work authorized by-'this building permit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature-of Owner Signature of Applicant s Print Name Print Name lirZ Date QFOR NMOWNE"ERWSSIONPOOL4 Town of Barnstable .. Regulatory Services Richard V.Scali,Director Building Division nwarra AX= Paul Roma,Building Commissioner M03 ASS. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPnON Please Print DATE: CrJ d /� I .JOB LOCATION: o�5 Q.�&D d �� -�-k�/ S number street village -HOMEOWNER": 6r-1'co 8, 3(o`I 5331� name home phone# work phone# CURRENT MAILING ADDRESS: San-) a e s ab O t-1- city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person'who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work Rerformed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and regrn�iTements d that he/she will comply with said procedures and requirements. Signature of Homeowner ' Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shaaact as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\wPFMES\FORMS\building permit forms\EXPRESS.doc 0620/16 r ACC)OR ® CERTIFICATE OF LIABILITY INSURANCE 75T; E(MWDD/YYYY) 31/2017 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 such endorsement(s). PRODUCER CONTACT NAME: Maureen Roderick Horgan Insurance Agency PAH0Nro Ext: (508)775-5830 (A/C.No: (508)775-6688 44 Barnstable Rd. AIL ADDRESS:maureenr@horganinsurance.com P.O. BOX 250 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURERA:Commerce Insurance Co. 34754 INSURED INSURER B: Richard Garneau INSURER C: PO BOX 476 INSURERD: INSURER E West Barnstable MA 02668 INSURER F COVERAGES CERTIFICATE NUMBER:16 - 17 GL 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 I ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. A CLAIMS-MADE 1XIOCCUR DAMAGE TO RENTED 100,000. PREMISES Ea occurrence $- BGLVNX 12/19/2016 12/19/2017 MED EXP(Any one person) $ 5,000. PERSONAL&ADV INJURY $ 1,000,000. GENI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000. X POLICY 7 PRO ❑ LOC incl JECT PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE ! OFFICER/MEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ ' - If yes,describe under -- - _ - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main St. ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTA� ! ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered.marks of ACORD I NS025(201401) .. 1. y .y \ t - a .. n s r ..4 1 y ,� * a-Y t 't w I. ti , `'x Y r s t r ; `, `_ _j_ M y 1 G a It y. •2 r t. r1. ,,` + ~ a .. "i _I s 'Ia. 'G -,tl fit , `* t _ a µ} _ .. _ _ _ y:' i ,I i ' N 1. 'I is � 4 —, r 't- d ;`t 3 i' z t .Massachias�tts Department of Public Safety 4 , }, f F. ,Board of Buildrn_g'�Reguiations grid Standards 1 5. , -, "? Y-t t _tot t Lcense:'CS 009Z14 .; Co'nstruction Supervisor' . l y RICHARD P GARNEAU,JR t � ;tt r j '` ki PO'BOX 4 1 'T ;WEST BARNSTABLE'MA 026613 r; :S t ti' " t F A Expiration 3 s,Commissioner ,, 04/04/20W8 x � r t` ," t i t 3, r y 6 a` Y Y,e 7 '�/ j ` t 0 t'I i 5j = P a.t _ `,. ° _ . ." (9/1e 6 onar��aiue��f!/�fC/0�lv,,c/,it ells t µ Ucense or registration valid for individual use only Office ofConsumer Affairs&Business Regulation , before the expiration date If found 'return to " , h @ HOME IMPROVEMENT CONTRACTOR' Office of Consamer ASairs sud Business Regulation. Registration 166170 ,Ty , t 1 10 Park Plaza-Smte 5170 r �, —. Expiration 5/5/20. IndividuaF + . Boston,MA 02116 `' `'RICHARD..P.GARNEAU JR 0 rid ,4 t ° ,. RICHARU G-AI RNEAU JR'=y ` 1 ;, t 1 l A" -""251 WOODSIDE RD �:�_,_`—ii< e" n, , ter,, W BARNSTABLE,MA 02668 < Undersecretary Not valid without signature . 1,aY•,";"k i 'iv T '7 f ) hR 4 r-f ;" i� t- / K i •` t t .'l A' t•f 2 i 3• t ", r,'' S t > 'Y Y § � t y. '5 f 3 t r, a ...y t t. s! ., �' 4 ; \a' _-�j� w„ +- it '' ,t '� x ,,p - s t.w •'y ` .v �t t •y t st a„y t t X. ".� °1 t, �+ r .t4 r� l a. a .. F �. r t a. V� �- .� A:`t 1. I� A" 2 t x, r.' 9 t tw. s. 4g r 1 h^ i - + _ 'ty, N ,, fit. ..4• -j.' r� 1. - 1 P. y ., `Town of Barnstable THE r Regulatory Services Thomas F.Geiler,Director Building Division • BARNSUBM + v AS& � Tom Perry,Building Commissioner no Main Street, Hyannis,MA 02601 Office: 509-862--4038 ax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: (Y o� Name:. Phone#•6 Address. lea( Village: `S Name of Business: Q6t/O' I`ype of Business: '(p';or Wedasi4ir) S' JW . Map/Lot: INTF2,rr: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit;located within that dwelling unit. • Such use occupies no more than 400 square feet of space:. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does snot involve the production of offensive noise,vibration,smoke,dust or other particular matter,' odors,electrical disturbance,heat,glare,humidity or other objectionable effects, . o There is no-storage-or use of toxic or-hazardou$materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met.on the 'same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment • There is no commercial vehicles related to the Customary Home Occupation, other than one van or one pick=rrp t�uekc not-�to•exceed•one tomcapacity,and one trailer not to exceed 20 feet in length and-not to -- exc�ed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit . I,the undersigned;have read and agree with the above restrictions for my home occupation I am registering. Applicant / - Date: l� YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINE�it NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1St FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: 0 U yr APPLICANT'S NAME: YOUR HOME ADDRESS. 0?5 c wG�ci ��. /-�y�,� si iy> A 0J1_;�wo i BUSINESS TELEPHONE # HOME TELELPHONE #t: NAME OF CORPORATION: r��r NAME OF NEW BUSINESS C e6LIo d,�'� L .' TYPE OF BUSINESSA,/�2,si9nn IS THIS A HOME OCCUPATION? )_YES NO ADDRESS OF BUSINESS 5 Zce�pp ; d an ;s rn � MAP/PARCEL EL NUMBER a � � ���' / (Assessing) When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in town. 1. BUILDING CONE NER'S OFFICE This individual has en7.nfo of)an permit requirements that pertain to this type of business. Authorized Signature** , e N COMMENTS: RULES AND REGULATIONS. FAILURE TO CUMPEYMAYRs r . 2. BOARD OF HEALTH This individual has e formed of p rmit r q.uire. is that pertain to this type of business. Authorized Signatur COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTH ITY) This individual e e n i Ed of th li n n r uirements that pertain to this type of business. Authorized Signature** COMMENTS: