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HomeMy WebLinkAbout0086 EMERSON WAY r. e. e s s ' y .. a . '�, � r r. it _ ' .. � .. - ,. � '. a - ,. ,_ � ... .. i .. ..� _ n ,. � .. .. .r .. F - .. .I, ', ' � ,. > � ,� ` �. u .. � � �VMS Town of Barnstable *Permit# �'��' ► I(�(o Expires 6 montlss from issue date �T Regulatory Services Fee > . 1639. Richard V.Scali,Director Building Division " . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 %/V ��YQj8'u Pwww.town.barnstable.ma.us O' ` Office: 508-862-4038 >�x',�0+8`790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ��L� Map/parcel Number 06. 0 I3 Not Valid without Red X-Press Imprint / �� 0, �s Property Address ' y �J o Ur l� V� Residential Value of Work$ t/ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address _Tbii Contractor's Name "I)a &AP"C' ,,kA( . Telephone Number 7 Home Improvement Contractor License#(if applicable) �- Email: `�0-! 1(05b fj E U Y-i f 2.)s i .A& i Construction Supervisor's License#(if applicable) L .,b 4 356-6o ❑Workman's Compensation Insurance Check one: VIha a sole proprietor the Homeowner ve Worker's Compensation Insurance i Insurance Company Name yt'fG i Workman's Comp.Policy# P a?� 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 ❑ -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: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 copy of the Home Improvement Contractors License&Construction Supervisors License is required. / SIGNATURE: C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utIook\2PI01DHR\EXPRESS.doc Revised 040215 77he Ctrrrorrwealth`of Massachusei�s '-- . D�partrnrt of Irrdisdriad 4ccides . , ` O,,Qice of Irrvesdgatoru . _ `� . 4#0 Washington S1r7eed &osloil, D2111 _ w ,rrras�g�uldta Workers' Compensat=on Insnranc�e Affi a� Btn�ders/Cont actorsJElectrzcrauslF�mben licanf Infmrnition' . Please Frint b Naine Addre�_ :; Ill Stan -f-- City/StateAZp ;✓ Phone# � Are an employer?Check appropriate boa. TYPe of PSI (Te9 �} I P I am a to with 4 ❑I am a gea16ral t ontractvr and I: 6 ❑Idev consfiactton I mployees(full an&or pa[t-Ume);, have hired the sub-conbsctors 2.❑.I am a sole or listed:an the attached sheet ? ❑Rtnodelrng Pry ,.P � have u ti o 1 ees These`sab-co�tractfl an .Lave ay. 8: ❑Demolition w, forme c t employees and hsve"auoalo rs ° �Y t3' " I 0 ❑Building addition o wmters co insttiaace cotrtp'msuratice . i0❑Electrical : or adtithaas reqw d 5 ❑ We aye a corporation and its , ; 3.❑ I am a ham_ eowa do all waa9c osces have exercised their I Plumbm aus or adc>rhons myself- o workers right isf exempttoa per MGL ❑ g P c 152, 1 4 and we have no` 1Z❑Ro f repairs it>starsnce retlatreed Y ( �:;.f � l3 Cher �f�� ti�,1 l :• ' employees-[No workers ca�;`.iasucai�regiured j '�Y aPPficaat thaq checks box�l nffist aLvo fill vot the section below showing then wrorkes'.cormpensatroa policy rafotrneteoa � - i Iiameaiv rs who snhmit this affidavit indicating they are doing all warp ail then hm outside caa>zactors nmst:sutr=anew affidavit todicatin swch koat wtors that cbeck ibis b ak must attad.ted au additional sheet shossmg the nazae of the sub-cn m and state whethei:or not those e�te�haae employees. if the sub-contractors base a irplqees;they paw piovide it".wiorxers comp,policy nurdber. I snit at::errtpinyer that is providing tvntcers'coiazpertsativrt tnsrartiurce jor arty ettrptoyee� `Bednty is,theticy and job site' iaaforraatlliort: - Insurance Company Name . Policy#or Self ins Tao �# � 1 Expiration 33a4e �J Job Site Address: CitylState/7.ip: ey, -. Attach a copy of the workers'compensation pthey d ration Page(showing the policy member sad ezpn anon date). -.. Failure.to secure.coverage as reginted udder Section 25A of MGL:c_ 152 can l6d to the mposition of criminal penalties of.a fine up to 1;500.(f0 andr'or txi year i svn eat,as well as civil peaialties in the farm of a STOP WORK ORDER and a`f ie of up to$250.80 a day against the violato &:atl�tsed fat a t:op-of this statement may be forwarded to die Office:of Investigations of the DIA for insurance coverage verifxttion . - I do hereby certify atulet�the pains.,ndpeataTties qfpeo?uty that the anforute4h priMded above is liege and c het Signa - ture. Date- II Lf✓ Phone V_ --- -- o, �use an;y D®irvt wr to an this area.to be cvanpteted by tiny or linos o acraL ` 1 City or Town - Pert�tlLeectse# :-: Issnrig Anth`orrty(tdrele one) 1 Board of Health 2.l3n�ding I?epartmenE 3 Ci tyLTown Clerk 4._Electrical Inspector lu S..Pmbing Inspector - Coutact Person Phone i�: - - - 6 ' , Y .4co CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYI'Y) 10/08/2015 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: German)Insurance Agency PHONE FAX 908 Main Street C. o 508 428-9194 Alc No: 508 428 3068 Osterville,MA 02655 ADDRESS:certs@qermaniinsurance.com INSURERS AFFORDING COVERAGE NAIC N INSURERA:SAFETY INS CO INSURED INSURERB:SAFETY IND INS CO Scott E.Crosby Builder,Inc. SAFETY INS CO 1112 Main St.Unit 7 INSURERC: Ostervllle,MA 02655 INSURER D:Hartford 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDDY EFF POLICY MMIDD EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY BMA0022636 10/12/2015 10/12/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ M'OTHER: L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000POLICY PRO ❑JECT LOC PRODUCTS-COMP/OPAGG $ 1,000,000 $ B AUTOMOBILE LIABILITY 3953278 9/7/2015 9/7/2016 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Peraccident) $ AUTOS X AUTOS HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident C UMBRELLA LIAR HOCCUR CM00001805 10/12/2015 10/12/2016 EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DED I I RETENTION$ $ D WORKERS COMPENSATION 6S60UB-4727P23-8-15 6/23/2015 6/23/2016 SPER TATUTE ERH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? IN I NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 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 Scott E.Crosby Builder,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1112 Main St.Unit 7 ACCORDANCE WITH THE POLICY PROVISIONS. Osterville,MA 02655 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety i Board of Building Regulations and Standards ConstrucLlon Supervisor License: CS-043556 SCOTT E CROSB)" ' 62 CROSBY CIR OSTERVILLE ba )i'w1� Expiration f Z2 I - Commissioner 12/13/2016 1 C�fc ee�pavamc,rzcaea16/z cwv�aJJccc�ccaelt Office of Consumer Affairs&Business Regulation, License'or registration valid for individul use only = ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: 151882 Type: Office of Consumer Affairs and Business Regulation expiration Wd!2016 Private Corporation 10 Park Plaza-Suite 5170 g t Boston,MA 02116 SCOTT E CROS;BY,BUILDE ZINC SCOTT CROSBY K 1112 MAIN ST UNIT#7 OSTERVILLE,MA 02655 Undersecretar Y Not valid without signature _._.. _ ._ ............._ _. . ..__ ....._ oar i 3 BAnxsrise�a3 , ai.►sw .: bs� Town of Ba>f nstable ► ' Regulatory Services Richard V.S cah,D,.rector Budding Dlvislon Thomas Pe rry,Cho 8'Odm Gomm4ssionei g..::: 1 200 Mom;Street, Hyanms`MA 02601 tiv�nv tolvn b'arnstable ma as' Office 508-862=4038 a� _508 790 �_ 230. i .. Pro eir Owner Must P ; tY Complete;and Sign This Secnor If Usrng A Builder i U .. 1}� ,as OnTner of the subject propertg hereby authorize �i't3 1 + ` to:act on mT behalf, In all matters.:ielative'to ;�orl�authorized by this builcltng peimlt-A-pplication foi {Address 6f ob) l .. ... .. _ . ...<: 1 S e of Owner,' ate Print<Name ,, If Pi operty Ortine> js'a.ppIymg for permit,please complete the H0 eo��per s License Eaemphon;Fo�m on the everse side . I C lUserslDecolliklAppDatalLocallAticrosoRlNmdo�tislTempoiary[ntemet nib ii 0161biPRESS.doc' Revised 0402l5 : :. ;:. r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map !a Parcel d/ 0 Application #,-.?6 1-36 26 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board DID �o�3a_ 13 Historic _ OKH _ Preservation / Hyannis ,.--Project-Street Address 00 Emerson Wa y Village cnkrvp')le ' mot-Owner-- J-n n /l/.eozwetC Address Telephone ' _50 -771-AMP Permit Request &(Add elYf 451�'nA 6A,;Mrr" tronn �P. t'o1� n�a.�on 6179 V6 3 ` .c,� UG J,".14e Xft 7h: tka46AS 6eY Q A Me lam; t Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project-Valuation. - OW Construction Type Lot Size ' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑,Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other o ' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ I Commercial ❑Yes ❑ No If yes, site plan review# { Current Use Proposed Use �. m 1:F7 i APPLICANT INFORMATION - - (BUILDER OR HOMEOWNER) Name Telephone Number ,rob- 33.! 0 2S (Say wo 1220 Address-,-- - e28 i1xiten License # 0o J 20.L V AreW,3&rp;g his.. Home Improvement Contractor# /76?7M !I 1 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE FOR OFFICIAL USE ONLY APPLICATION# f DATE ISSUED MAP/PARCEL NO. F ADDRESS VILLAGE OWNER k I 4 DATE OF INSPECTION: FRAME - - A INSULATION_ ,- :;> FIREPLACE x ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING Illq 1 DATE CLOSED OUT 3` ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industr,Ral Accidents Office of Investigations +600 Washington Street Boston,MA 02111 wnw.mas&gov,1dia Workers' Compensatian Insurance Affidavit:Builders/Comtracturs/ElectriciansMumbers Applicant Information {{ Please Print Legibly Name(Busmess/O lln andividnai): 1 aZ11-1 ke Aers Address: 21, r rcerN 5-4 ot�t5 City/State/Zip: r'eu, Le-11 r 11 Phone# -335— 7.2 5 PS-1-q/ta,-2 Are you an employer?Check the appropriate box: Type of project . . am a general contractor and I (required): L El I am a employer with 4 ❑ I g 6. New construction loyees(full and/or part-time)_* have fired the sub-contractors 2.0: I am a sole proprietor or partner- listed on the attached sleet y- ❑Remodeling ship and bane no employees nurse sub-contractiors have 8. ❑Demolition working forme in any capacity. employees and have wodcus' 9. ❑Building addition [No workers'comp.insurance comp.insurance.1 required-] 5. ❑ We are.a corporation and its 10_❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 LE]Plumbing repairs or additions myself.[No workers'comp- right of exemption.per MGL 12..❑Roafrepairs insurance required.]1 c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required_]. 'Any applies that checks box#1 umst also fill out the sectionbelow showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all waA and then bi a outside contractors must submit a new affidavit indicating such- tContractors tbat check this boa mmst attached an additional sheet showing the name of the sub-c=Uacbm and stele whether or not those entities haae employees. If the sub-contractors have employees,they mast pwvide their workers'comp.policy number. lain an witptoyer drat is providing ttwrkers'compensadon iztsurarcce far nzy employees. Bdoty is the policy and job site irforrrralion. Insurance Company Name: Policy#or Self-ins-Uc.#: Fxpiration Date: 9-2 3 Job Site Address: Ot Lon ePJon L&y s Cityl5tatelZip: 0ty0Let yt U, ,,6t'�-,. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration 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$1,500.00 andlor one-year imprisonment,as well as.cavil 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 maybe brwarded to the Office of Investigations of the DIA for instri-ance coverage verification. I do hereby,certify under the pains andd penalties ofperjury that the information provided above is bw and correct Sitmature -�Z�� Date: Phone#- QjVkhd use only. Do not unite in this area,to be completed by city ortmm o.�tjitgaL City or Towa. PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Fown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Gther Contact Person: Phone#: 6 r440 CERTIFICATE OF LIABILITY INSURANCE �0/3/2013(MMIDDNYYY) 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 O Arau O NAME: 9n 3 Daniels Insurance Agency PHONE (508)842-8822 FAX e.(508)842-9922 543 Main Street E-MAIL O S: INSURERS AFFORDING COVERAGE NAIC# Shrewsbury MA 01545 INSURER A'Arbella Mutual Insurance Co 17000 INSURED INSURER B MISCELLANEOUS Scala Brothers Masonry, Inc INSURERC: 28 Green St INSURERD: INSURER E: Shrewsbu MA 01545 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1310300961 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 AD L SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE iffa POLICY NUMBER IDDIYYYY) (MMIDDNYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISESS Ea occurrence) 50,000 A CLAIMS40ADE aOCCUR TBI 9/9/2013 /9/2014 MED EXP(Any one personI $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY 7 PRO LOC $ AUTOMOBILE LIABILITY CEO acOMBINED cident SINGLE:LIMIT ANY AUTO BODILY INJURY(Per person) $ 50,000 A ALL OWNED SCHEDULED 1020023075 /23/2013 /23/2014 AUTOS X AUTOS BODILY INJURY(Per accident) $ 100 000 NON-OWNED PReOPPER'�de tDAMAGE $ 100 000 X HIRED AUTOS X AUTOS Under insured motorist 81 split $ 50 000 UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT S 500000 OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory in NH) BI /23/2013 9/23/2014 E.L.DISEASE-EA EMPLOYEd S 500000 If yes,describe under DESCRIPTION OF OPERATIONS below E•L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE. WILL .BE DELIVERED IN ACCORDANCE WITH THE POLICY:PROVISIONS. rsg masonry AUTHORIZED REPRESENTATIVE 1- Traci Daniels/TRACI ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS02512010051.01 Tha ACARn nama and Inn^ara raniatarad manta of Amps Town of Barnstable ° Regulatory Services RARNSMAZBIAMI'a'g Thomas F.Geiler,Director 16,19. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 7�w JF--C7ZWV--CNeI , as Owner of the subject property hereby authorize :SCk_A EAcMAEm2"i AkASc)N P— to act on my behalf, in all matters relative to work authorized by this building permit. �6 &+&ZJSQC-J JAY cfatyzukul e (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. JS' ure of er Signature of Applicant Print Name Print Name Dae ' Q:FORM&OWNERPERMISSIONPOOLS 62012 Town of Barnstable Regulatory Services a,6'15=M ' Thomas F.Geiler,Director •`�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us " Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six touts or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts ds'su'pervisor. DEFINITION 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 performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility foricompliance 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 requirements and 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 shall act 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 of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\QRE6ZUBN\02RESS.doc Revised 053012 fi T I I = Office of Consumer Affairs and Business Regulatlo�, 10 Park Plaza - Suite 5170 L, r Boston, Massachusetts 0211E �.; Home Improvement Contractor Registlratio Registration: 17675Q Type: Individual Expiration: 912512015 JOHN SCALA JOHN SCALA 25 GREEN STREET SHEWRSBURY, MA 01545 `Update Address and return card.Mark reason for change, U Address — Renewal Employment Lost Card $CA 1 0 2OM-0511 t r'7- C1JlfJ/L4JZ-(1Aet fd7, C� /G�4Y1SGlt'LtGS(' tf _Office of Consumer Affairs& Business Regulation License or registration valid for individul use only �PME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Oegistrabon: 176780 Type: ! office of Consumer Affairs and Business Regulation xpiration:• 9/2512415' individual 10 Park Plaza"•Suite 5170 , M 4,- Boston,MA 02116 JOHN SCALA }; - a - , JOHN SCALA 25 GREEN STREET SHEWRSBURY, MA 01545 Undersecretary Not valid without signature Massachuse"s - Department of PubhC Safety Board at Building Regulations and. Standards License CS-M342 ti <ti JOHN A SCAL A JR 19 LONG M E,AMW AVE WORCESTQR MA 91606 m w rp Qd �go o C /D III c N 0 � 601 C m .?` 0 o m o m ; Q CD pjO od (� W D O» D N (n a j�f C o p y d �'r N 2 N a m oA oto a 0. y Q NOD O O) O CD Z wW aD m m rn m N m m m X o m cn O x - Z - o 0 m Z O� 0 o o m Si co D D) O) y a Prot, ex'rr4fn �� � o.boue N C O0D I� vJ3 0 vV O O CU Cr m EMERSON WAY N x 0 4 N CD N A fD C T CD 04-2 o nrk j w � w Town of Barnstable *Permit# i Expires 6 months jrorr issue date Regulatory Services Fee � snartsrnat.e. tKnas.1639. Thomas F.Geiler,Director LIP �� Building Division r , alg/) 3 Tom Perry,CBO Building Commissioner �J 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number A I n ,Q Prope Address jp �✓UI�G��+� 1 .�1. (�Q, U� / esidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ' ,o 00 51,48 460 r lle c %" T S 4 Contractor's Name r L Telephone Number Home Improvement Contractor License#(if applic le) pww r Email:. Constm 'on Supervisor's License#(if applicable) _ C S' d 41 XPRESS PERMIT zorkman's Compensation Insurance Check one: AUG - 2 2013 ❑ I am a sole proprietor U'll the Homeowner have Worker's Compensation Insurance+ TOWN OF E3ARNSTABLE Insurance Company Name (�' 6�(� Workman's Comp.Policy# »4_y ,Pat t� 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 g -roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Areired. Ow er must sign Property Owner Letter of Permission. . f th Home Improvement Contractors License&Construction Supervisors License is SIGNATURE: C:\Users\decollik ata\Local\Microsoft\W. ows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 I Tlee C��r�arr�vealth of 1�assacRruse�ts Dgraurt if of ZaL shied Accide►ats 0 ce of InvesJrgetions j b04 Lot " _, Bostarr,�A R2111 • � wtc�v rrttzgrn�/du Workers'Cdnipeh a6an Insurance Affidaviti Btnlde /Cat tracto s/EZectric"asffl tubers ApiplicantlInflorination. Please printLe6blv Name(Bttsinew t���'�.A� / Addr�: l M M.[U yt :.�T'r° ��►Cl i��.. city/sta/zip:. . . P. Are an employer?Check appopriate box. T of ro ect r 4. I am a t omttactaf aid l:. Yl P.. l 1. I am a employer with � _ to full and/or #. have hired the sub-contractors 6 ❑New Sion ew Y�t Pam) 2.❑.la' a sole of or listed.on dle attached sheet .. ;: 9. ship acid have ao employees T116 sub-coatractozs have 8 ❑Demolition w for me in an employees and have ° $ Y� citY 4_ ❑Building addition [No works is'comp insuraace ctm�;msuratii 3 required] 5 0 We ate a cotparagon and its - : 10❑Ele tncal repaus or addthons 3-❑ 1 am a homeawnef doing all wodc offioeis have exercised dteir 11❑Plumbing repaus or.addttlama myself,[No virorkets comp. right`of ttton per RIGI: 12 Roof ,e,,,,,,�q c 152 i 4 and we have ao. ❑ insurance".�""` ' f �.,. 13❑Oilier employees [No workers comp.Insurance redtnred) •l,ny appHrsin fat checks box#1 nmsi a]so fill out the section below showing their wo¢kew eompenseiteoa policy im nemat on. i.HamesrE mm wiev submit this dHsvk indicating they ere doing all Arai$and then hire outside contractors in=subs a new affidavit indicating such-. aCaattecUors that chheck this box must attached an additional sit ghowk the name of the sub-cantractm said state vrhetltea�nit those enf tee have, emp"es. Uthe sttbcontractm bsre:m"li3ym%ti"angst pia 4 t k workers'comp.policy®imber I am an enttployer that is pr�ttrorlrers'coieasahn rarace for ray ee¢ployees. Below is'the policy cad job sits tnformahon. Inslgance Compatly PtasYae. .j Policy#of Self I ac # Fpuattort Date (0 t Job Site Address GttyJState�Zip .- Attkh a copy of the workers'•:t omgensatttm p' declaration page(sltowiag the policy nnmliex aad.eipiration date}, Oxire­ secure coca!rage as required under,Section 25A of MGL c 152 can lead to the impos on of t runinal ptnalhes of a _ -: fine up to$1,500 00 and/or one-year i"'oLrtment,as veil as civil penalties m the farm of a STOP WORK ORDER and a fine of tip to$250.. day against the violator: Be advised that a copy ofthis statement may be farvvarded to tie Office -of Itivestigati` 'of j)J4 or insurance coverage: firm - I do li b3' ni the s a d` 'es o f1>e>;art}a that the N orr�esiion pr�at�xded absve is bue ead corr$ct Phme Or&;f d use:orily. Do not tvrite in this area,ftbe cat tpleted by city!ir tawvt,o, ciaL: City or Town: ense p.: Issuing Authority(circle one). 1.Board of Health Z.Buffing Department 3 C tyffown Clerk 4.Electrical Inspector S::Plumbiag Inspectoa. 6:Other . Contaet Person: Dane:# : 6 i AC�R : CERTIF'ICATt OF LIABILITY INSURANCE DATE(MM/07/31/201YYYY) 013 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 Germani Insurance Agency 908 Main Street FAX c No: 508 428-3068 E-MAIL Osterville,MA 02655 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: Essex Ins.CO. INSURED INSURER B: Scott E.Crosby Builder,Inc. Scottsdale Ins.Co. 1112 Main St.Unit 7 INSURER C OsterVllle,MA 02655 INSURER D: Hanford 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY) (MM/DDfYYYY1 LIMITS A GENERAL LIABILITY 2CN6590 10/12/2012 10/12/2013 EACH OCCURRENCE $ 1,000,000 x C DAMAGE TO RENTED OMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F—IOCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROzCT LOC $ 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 $ $ C UMBRELLA LIAR XBS0025685 10112/2112 10/12/2013 OCCUR EACH OCCURRENCE $ 2,000,000 x EXCESS LIAB CLAIMS-MADE AGGREGATE $ 2,000,000 DIED RETENTION$ $ D WORKERS COMPENSATION 4727P23-8-11 6/23/2013 6/23/2014 WC STATU- OT H- AND EMPLOYERS'LIABILITY Y/NLIMI IQRY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 r DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Scott E.Crosby Builder,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - AUTHORIZED REPRESENTATIVE ' ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2610/05) The ACORd name and logo are registered marks of ACORD I i or. .. 1ARNSTASM ;� ,� Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, 'Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �L(Z6-y Ole& wC,(ih 1 l ,as Owner of the subject property , hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) ogn tore of Owner Dat Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 I Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-043556 ``ti._rr,e SCOTT E CROSB)- 62 CROSBY CIR OSTERVILLE MA 02 Expiration , Commis�sio�ner" 12/1312014 Vlze eparr�mzoaausea�a�C�oxic�ccaeCL1 C\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only UqxPME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:gistration: . 51882 Type: Office of Consumer Affairs and Business Regulation -t 10 Park Plaza-Suite 5170 iration �7/1;3/244 Private Corporatic Boston,MA 02116 SCOTT E CROSBY BUILDER'INC. ' SCOTT CROSBY 1112 MAIN ST UNIT#7( OSTERVILLE,MA 02655 "- Undersecretary Not valid without signature Assessor's offioe (1st floor): v_ O / c $ S�"�'�` �',y�.�"�`EPA MUST PL THE Assessor's map and lot number 0 1. A F ' - fed' w Board of Health (3rd floor): a Sewage Permit number ......31n.7.:L?. .......................... p� �a W. .i ::tt-I AL CODN', ;e�e�' t Bl8II9T1►DLL, Engineering Department (3rd floor): REGULATIONSTOWN roc +rb3c House number ..................................✓...................................... � c yAY APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...G� ?rim... .\.^...... .......................................................... TYPE OF CONSTRUCTION ..........t�(j Q'0 . .............................:...................................................................................... ....19. G.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permi-t1 according to the following information: Location .....e..�.....1,..!!v��.✓.:��?�.......��.C.✓ .`t vV.v. . .................................................................................................. ProposedUse ...... ....Cti,�t.c.�........................................................... Zoning District g o 1 ................................................Fire District e ) — � l / ' ................... .........................................:.................................... Name of Owner rl~.Gf:w;e• KD.7.7 Cn 4��!.4-��............Address .R�.�?...........��.�../Sd:Z�....��. Name of Builder .........Address r.6...CTcJv.-...„. S.t0�-. ...4C Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ...........r....................................................Foundation .............................................................................. 1 , / S ............................Roofing ....iPs-.S.- Exterior ............�° 1.�!-c f?.............................. ............................................................ Floors ......................................................................................Interior ........ Heating ......�`.�..4.- ......................Plumbing .................................................................................. Fireplace ........Approximate Cost ... �v.......................................................................... ... ......................... ........................... Definitive Plan Approved by Planning Board ________________________________19________ . Area D. . :.. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . .................. Construction Supervisor's License .., 1r4`���................ DWARD No Permit for ..... n lose ..Breezeway p.g I.q...F.4Mj.jy..Dwellin ............. Location .......U...Emerson........Wav . .............. ......Q.ent.er.v.i.1.1.e............................. -Edward Doudican Owner .................................................................. ame Type 'of-Construction Frame Fr.............. .......... .................................................................... Plot ... ...................... Lot ......... ...................... Permit Granted .....q!AIY...TI.......... .......19 88 Date of Inspection ....................................19 ;Date Completed ............................ .........19 t r Assessor's offioe (1st floor) _ d V t �I OF THE TO Assessor's map:and lot number ...,................... ..... �y�. Q., �` Board of Health (3rd floor): Sewage Permit number ..... . '..7.: ? ................:....:......... 2 BASd9TA11ILL, Engineering Department (3rd floor): +o "b s a� ' 9. House number .?`� o }v YP a� APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR c4,t.lam APPLICATION FOR PERMIT TO ....q.•6:�........ .a...... 1 ;-t; .... ' TYPE OF CONSTRUCTION t,, .......................'." ........................................................................................ ............ -74)........�`.- ........19.�Ga. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .................... .........R....................................�::..e... _ . .................................................,................................................. nn � a ProposedUse ......C!!..e.,n,..,:.:•.,.�.�.....��.�,t.:r.-..:.............................................................................. ........................... :............... Zoning District /� �...................................................Fire District .......... / 1 ` !'► - ..................... .................................................................... Name of Owner ............Address I� $ �7 .7..... ' ................ Name of Builder .........Address (t... ,� ?. ..... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ...........(......................................................Foundation ....................`.......................................................... Exterior ............�.�li- 5.....:..............:..................................Roofing .:.c c. 1T` ry.......................................................... Floors ...................................:......Interior ........1 .1! . <.J� ............................................ f. .. Heating :..........................................................:...............Plumbing Fireplace .............................................,.....................................Approximate Cost .....�.Tp1..).........:....................................... Definitive Plan Approved by Planning Board ___'------------------ ___19-------- . Diagram kof Lot and Building with Dimensions Fee . o SUBJECT TO APPROVAL OF BOARD OF HEALTH v fi OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...t --, .-.... �4.................. Construction Supervisor's License Ai "7�................ Do EDWARD A=188-018 No Permit for ..Enclose Breeze-way .................................. Single Family Dwelling ...........Single Location 86 Emerson Wa ....................... Cenrvlle ............ ........................ ......... Owner .Edward..D.ou.d.i.c.an......................... .. .. .. .... .. . .. ..... Type of Construction .......FX4M9....................... .......................... ...... Plot ............................ Lot ................................ Permit Granted .........j:q!Y...7.,r..............19 88 Date of Inspe"ctioh .....................................19 Date Completed ......................................19