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HomeMy WebLinkAbout0018 GREAT MARSH ROAD ��� �� �a��/���s�,� �ol. .� .r �. - :. . .. - - f ALTERNATIVE WEATHERIZATION in "1 C>� Date: -n 0� cry k o M Town of Barnstable 200 Main St . Hyannis,MA 02601 S f Re:Permit# ' 1 0' aoZ y� Village: 3M f6ry j 1`C The insulation/weatherization w- ork at has`been completed Ui accordance with.780CMR. I Regards,:. Timothy Cabral President , CSL-105454 r 58 DICKINSON STREET 1 FALL RIVER,MA 02721 I (508)567-4240 1 ALTERNATIVEWEATHERIZATIONOGMA1L.COM p� :..Application numbe 4...... C90.'�a Date Issued.............�11..�. .:1............................ sue, Building Inspectors Initials..... ......... .................. JUL 1 62018 ;Map/Parcel. TOWIN 0 ARN IML s • J TOWN OF BA"STABLE' EXPEDITED-PERMiT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: l rcru t as� / L NUMBER = STREET .VII LAGE _ Owner's Name: l.d 1Y'l Sip Phone Number Email Address: e c'S --+IC@ U a Cell Phone Number Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize_-77mpYVWC J�Ct to make application for a building permit in accordance with 78 CMR Owner Signature: a�C_1 Date: TYPE OF WORK ❑ 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 1A1k1f' vt TI �, V , J Home Improvement Contractors Registration(if applicable)# � �C�' (attach copy) Construction Supervisor's License '(attach copy) Email of Contractor `/, y -m. Phone number ALL PROPERTIES THAT HAW STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN. A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. A APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor,plan with exits marked) Dimensions of each Tent X , X 5 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 STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: 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 APPL C T'S SIGNATURE ZYSignature zi/ Date %Z _ All permit applications are subject to a building official's approval prior to issuance. WIN IHr r Town ®f Barnstable Building Department Services MASS. Brian Florence,CBo . 39. Eo MKA Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office:508-862-4038 Fax: 308-790-6230 Property Owner Must Complete and Sign This Section s If Using A Builder 1,kris,V6 a, c I e. as Owner of the subject property hereby authorize � _ 6 to act on.my-behalf, )"-0®,V,/,V't 1-,1ZX,I- in all matters relative to work authorized by this building permit application for: 18 Great Marsh Road Centerville (Address of Job) Signature of t)wn Signature of Applicant 4^� ,ritit'Namc$ Print Name Date r , The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 } www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organization/Individual): ALTERNATIVE WEATHERIZATION, INC. 2 LARK STREET . Address. City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1..❑✓ I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 3.F�T 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❑ Building addition ensure that all contractors either have workers'compensation insurance or are sole I L Electrical repairs Or additions p ❑ p proprietors with no employees. 12.❑Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs ' These sub-contractors have employees and have workers'comp.insurance. 14.❑✓ Other INSULATION 6.7 We are a corporation and its officers have exercised their right of exemption per MGL c. 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. 1 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:/9 � k&rJ_X_ Xd City/State/Zip:&tef 'b /t Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.`A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u d ain a (!��erjury that the information provided ab ve is true and correct Si ature: Date: 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#: l ® DATE(MMIDDIYYYY) AcoRO CERTIFICATE OF LIABILITY INSURANCE 06/11/18 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Anthony F.Cordeiro Insurance Agency acNN Ell: 508-677-0407 aC No): 508-677-0409 171 Pleasant Street AODREss: HSouza@Cordeirolnsurance.com Fall River,MA 02721 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Liberty Mutual INSURED INSURERB: Ohio Security Alternative Weatherization INSURERC: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721 INSURER E: INSURERF: 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. LPOLICY EXP TR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDY EFF MM DD/YYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO HEN I EU CLAIMS-MADE �OCCUR PREMISES Ea occurrence S 300,000 MED EXP(Any oneperson) $ 15,000 A Y Y BKS58867158 06/08/18 06/08/19 PERSONAL SADVINJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JECT PRO- ❑ ` LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ B OWNED x SCHEDULED Y BAS58867158 06/08/18 06/08119 BODILY INJURY(Per accident) S AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident $ x UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/08/18 06/08/19 AGGREGATE $ 1,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? n❑ N/A XWO58867158 06/08/18 06/08/19 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 600,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA its direct and indirect parents,subsidiaries and affiliates is added as an Additional Insured for General Liability on a Primary 8A 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 Liability is a following form. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT ©194$-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD vy+ SM3N, "'I'�� .h u y4.Y Kk ft� 9: 5 �J 1 i/L.� ' f��[/�"f 1 i.•lIr V iJ'I�������/ii Y'/ \...J�/����'J�L1"Vi/V/G�ai�C!L/l/ay , To J Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Mas^ chusetts 02116 Home Improvernerw ractor Registration 0 w Type: Corporation Registration: 175683 ALTERNATIVE WEATHERIZATION,INC, £' 2 LARK ST Expiration: 05/28/2019 FALL RIVER MA 02721 ;. t rF Update Address and return card. Mark reason for change. _........ _........_ _....., .._II-Address..1-1.Pmrawat_. 1ovmnt ("I Office of Consumer Affairs&S"nass Regulation HOME IMPROVEMENT CONTRACTORRegistration valid for individual use only TYPE,Comoration before the expiration date. If found return to: 1 Reuis#ratlon 948i.CatI.o31 Office of Consumer Affairs and Business Regulation K17%6 G 05/2812019 10 Park Plaza-suite 5170 ,ALTERNATIVE WEATHERif()N,INC, n,MA 02116 TIMOTHY CABRAL ��Q 2 LARK ST1 FALL RIVER,MA 02721 Undersecretary Ot V f3Ut si 8tU1S 63 �pUL IHE ro Town of Barnstable *Permit# DEC° Expires 6 mo from issue date Regulatory Services Fee RAMSrnst.E, • ly �b XAM 9�p ���� Thomas F.Geller,Director ���� Building Division ESS PERPAI r y Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 TO JUL 3.1 2006 Office: 508-862-4038 WN OF BARNSTASL Fax. 508 790-6230 E EXPRESS PERMIT APPLICATION_-_RESIDENTIAL ONLY Not Valid without Red%Press Imprint Map/parcel Number J 3v Property Address D S ceki -uJ Residential Value of Work Owner's Name&Address Ga(0.2, Contractor's Name (l n� 4 'n 1-0!-C mQ' Telephone Number Home Improvement Contractor License#(if applicable) 10 37115 1 Construction Supervisor's License#(if,applicable) ❑Workman's Compensation Insurance !3 Check one: ❑ I am a sole proprietor ❑ I am the Homeowner j?'I.have Worker's Compensation Insurance - Insurance Company Name Workman's Camp.Policy# 06�� ` 'fib/ y Permit Request(check box) ❑•Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side -0-Replacement Windows. U-Value! (mum.44) *Where required issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: PropeZyJavm=must sign Property Owner Letter of Permission. Improvement Contractors License is required. Signature Q:Forms:expmtrg . Revise053003 The Commonwealth of Massachusetts Department.of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ' www.mass.gov/dia Affidavit: Builders/Contractors/Electricians/Plumbers Workers'Compensation Insurance A_pplicant Information Please Print Legibly Name (Business/orpnization/Inaividual): 1)r i1 k.� ry�e_ -1-col D fGV2 m e n Address: 199 City/State/Zip: . Phone#: ,50a - 71L of r Are you an employer?Check the appropriate bog: Type of project(required): 1.•�'I..am a employer with y ' 4• ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet # 7• emodeling- 2.❑ I am a sole proprietor or partner- Demolition ship and have no employees These sub-contractors have 8. ❑ working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition (No workers' comp..insurance 5• ❑ We are a coe exec on.and its 10.❑ Electrical repairs or additions required.] officers have exercised their per MGL 1�1.❑ Plumbing repairs or additions ri t of exemption 3.❑ I am a homeowner doing all workp myself [No workers' comp. c. 152,§1(4),and we have no. 12.ElRoof repairs insurance required.] t . employees:[Na workers' 13.0 Other comp.insurance required.] •Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information ' t Homeowners wbo_subanit this affidavit indicating they are doing all work and then hire outside contractors must subunit a new affidavit in dicatYng such :Contractors that check this box must attached an additional I sheet showing.the name of the sub-contractors and their.workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my.employees. Below is the poluy andjob site information. _ II Insurance Company Name:. �ll'n mtn LAJ S. Policy#or Self-ins.Lic.M y 9 y Expiration Date: 5 - i 3 O 7 Job Site Address: $ r /11a rt h City/State/Zip: ll P. /�1✓� .(5 (9 3 Attach a copy of the workers' compensation policy declaration page(showing the policy number and,expiration date): Failure t6-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 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. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce u Ze and penalties of perjury th&t the information provided above Is true and correct: Si a e: Date: Phone#' SO 0 " 7 Official use only. Do not write In this area,to be completed by city.or town offictal 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#: 8 o . x. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job (i.e. permits, applications etc.) if necessary. Aoz XMI Owner gna ure Contractor Signatu e 7 J>—Ad to Date MAY. 23. 2006 10:26AM ASS'0C1AiED 1NS11RANCE NO. 7283 r, 2%2 CERTIFICATE OF INSURANCE IS=DATE(Ma1/DD/YY) P80D[X8R COMPS NO RIC•HTS UPON THE CERTIFICATE BOLDER. THIS CERTIFICATE B-yden&Sullivan Ins Agl nq DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Inc �I.LCIss BELow. 88 Falmouth Road COMPANIES AFFORDING COVERAGE Hyannis, MA 02.601 --•I "._. -- -- ......._..---- INSURED �...M. I Sprinkle Home Improvement Inc P [CBTMTPIEAINY A A.I.M. Mutual Insurance Co 199 Barnstable Road Hy6lmnis,MA 02601 I i COVERAGES THIS IS TO CFRTIFYTHAT THE POLICIES OP INSURANCE LISTED BBLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE}TOR THE POLIC!PERIOD WDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDrrION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE 1854T D OR MAY PEATAIN,THE I.OLMANCE AFFQRDEI)9'Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OP SLTCH PO).Ca3S. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICYIMCTIYE POUCYEXhIL%Tl0, TYl'L OF INSURANCY POLJGY M)AItdBR � LTTR 0A1l1(MMJ0DIYY) DATL(MM/DINYY) ObnIC&LLWILIT'Y XNZRILAGGAJWATE S -- COMMEP.CIALODNGRALUADIL17Y j 0DUC"-(;0—PlOPAGG.--�—I ..AIMSMADB[�CUR ISKSOKAILLADV.IRJUgy I S 1JNrR's @ CONTRAcrot S PRrr. I •ACN OCCURRENCE I S I IRS DAMAGE(Any an lire) .�I ED.EXPENSE(Any ono perm) I I WrOMOSILL LIASIUTY MY;N6D SINGLIt ANY AUTO I I ILIMIT = I AU,OWNSDAUTOS I 0MLYINJURY = RULED AUTOS i I I(Por PorwrN MIRED AIJ1'O.S 1._•.......�...----....�..�,_-,_ BODILY INJURY S NOW.OWNED-AUTO$ I I hr �idew) ; ARAODU4111LITY I i 0.0PCATY DAAfAGB I S I MRXCF.SE I.IARIL.TY CN OCCURS GK6 $ MIRDLLA FORM OGR14ATB b TIIGRTHAN UMBRELLA FORM WORKERS COMPENSATION AND I YCNXTU- X 9MPL0Y6kS'LIA6tUTY T R.Y IM ER, ,, * 170049a;tn12006 05113=6 I JS/13/2007 $ A.TI(EPROPIUG-TOJO �{ 1%CL I I - DISEASB..POLI LIMIT s ,GOO PARTNWLT IiXGCL'TIYS OFRCDRSARD f IS' S -• Fl FF S SOO 0w 101'llfi.a 1 I i ESCUMION OF Or aATTONSJL XC..'tTOtS(Y}7iJCLESWZCIAL 1TfX$ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE,CANCELLED BEFORS H}i EXPIRATION DATE 7-AM MOP. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE MOWER NAMED TO THE LEFT,BUT FAILURE TO.MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Brad Spninkle LiABII.ITY OF ANY KIND UPON THE COMPANY, rTs AGENTS OR REPRESENTATASS, 199 Barnstable Rd. AVMQR17PJ)REPRESENTATIVE Hyannis, MA 02601 Board of Building Regulations and Standards , I HOME IMPROVEMENT CONTRACTOR Re " Expiration 7/ /2008 iA Type Pn�ate Corporati x SPRINKLE HOME , QUEMENT Brad .Sprinkle 199 Barnstable Rd. M' Hyannis, MA 02601 Deputy Administrator \ A K z �12P U�arrali�a�u.�re� o�✓��a.:1:la,��iuoe�6 " $ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR YNumber CS 006643 Birthdate 10/08/1955 zf t k ` # ;Expires 10/08/2007 Tr no;'`66380 Construction Restricted 00r � { BRAD:K SPRINKLE ' 190 LOTHROPS LANE , � � .. W BARNSTABLE. MA'`'02668 Commissioner