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HomeMy WebLinkAbout0250 GREAT MARSH ROAD L oFt r Town of Barnstable *Permit# Expires 6 monthsfrom issue date * Regulatory Services Fee * BAMSTABLE. ` 9� MASS. 1�� Thomas F.Geiler,Director pTEO MA'I A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 ✓ I www.town.bamstable.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 Property Address a 56 ��C�� �(l���` �' � �e V-1 [ Residential Value of Work — Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address V" Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Lo Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: OCT 9 ❑ I am a sole proprietor TABLE ElI am the Homeowner _-OWN OF BARNS ❑lf�have Worker's Compensation Insurance Insurance Company Name l Workman's Comp. Policy# o �0 �7 �P3 cc Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 4�1__Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner m t sign Property Owner Letter of Permission. A copy the e I r ement Contractors License&Construction Supervisors License is requi SIGNATURE: / Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 090809 j777,7 IiH8P9 k � Construction Super jsor License L cense CS', 48546 Expiration 1/27/2010. Tr# 14362' ;. ! R se tnctton OQ i MARK D HERBST �-- , 35 P�7 i TOAD RD> ;E✓ CENTERVILLE,MA 02632 Conin�ss�one �„ • x < 1,,.n ' d for ul use Board of Building Reg ons•and Stan3a�ds License or registration vbefore the expiration dater If founds return to:only HOME IMPROVEMENT CONTRACTOR ! 1 Board of Building Regulations and Standards Registration:, 126480 �' One Ashburton Place Rm 1301 Tr# 267766 ExPiration 6/8/2010 Bo ton,Ma.02108 ' yp e Individual j e T TI MARK HERBST MARK HERBST 35 PEEP TOAD RD , Not valid without signature ! e J Administrator CENTERVILLE MA 02632` y n.: E r - 4 t :J: i t� l .Y { } .S ,6 F '� �.�'•2 Yyi a¢, R L �i [� 51��4,�FK1j,� i}+, h -6 k� YY- {' # 1 14� x j - .; ��� �L� :L�� rc��''.,,��v'A'C.i'�4�.".�ray ,+ l. i , +." .. Y ..� } y,'E•e3R � a. . s? � WAY y y"1s, � y s Hm -Pa HERBST zf�.�. .�,,, l� s e 14 �} U$L� '��4h 1 k :t'� ��r Si �' a• 7 - .t.�`,a � "�,,,g't � ,t _ �3 i'EERQ 0Al7 ROAD r� 1 k k1T*. SCENT:R'VILLE:IV�A03632 u ;008' 20=5218/774-238-2938 + ri y N ry} ;www.markherbst.com f PROPOSAL SUBMITTED T0: WORK PERFORMED AT: Maureen Daley 84 South Street 240 Great Marsh,Rd } Jamacia Plains MA 02130-3143 Centerville MA We herby propose to furnish the materials and perform the labor necessary for the completion of: New Roof.House&Garage Remove 2 lavers of existing shingles W �s Install ice&water shield at edge&in valley areas Install 8"drip edge ! .. 7 : Install 151b.felt paper Install Certain Teed 30yr.Architectural shingles { t� Replace plumbing boots r Cut ridge&install cobra vent Storm nail all shingles - - : All debris cleaned daily r Price includes material,labor&dump fees CG b.•'r W d .� .. e } .P 5 All material is guaranteed to be as specified. The above work will be performed in accordance with the specifications submitted , and completed in a substantial workman-like manner for the sum of Eight-Thousand Seven-Hundred&Fifty 3, Dollars($8,750.00)with payments as follows: full amount due upon completion Any alterations from above proposal involvihi extra'costs will be added under a'separate written agreement and become an extra r <` charge over and above said proposal. " RESPECTFUL SUB T r � r , a 08103109 Mark Herbst ACCEPTANCE OF PROPOSAL The above price,specifications and conditions.are satisfactory.l herby accept this proposal. You are authorized to do the work an payments will be as specified above. 2 SIGNATURE: �- -A, This*This proposal maybe withdrawn by said company if not accepted within 30 days t t` '�. ''� re.§,s T'34 +'.5�* Y i t r r - { NOTICE NOTICE, TO TO EMPLOYEES EMPLOYEES The . Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30; this will give you notice that I(we)have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE, P.O. BOX 4070, BURLINGTON, MA 01803-0970 ADDRESS OF INSURANCE COMPANY AWC 7016215012009 01/10/2009 - 01/10/2010 POLICY NUMBER EFFECTIVE DATES P O Box 494 Leonard Insurance Agency Iric Osterville, MA 02655 (508)428-6921 . NAME OF INSURANCE AGENT. ADDRESS PHONE Mark Herbst .35 Peep Toad Road Centerville, MA 02632 EMPLOYER ADDRESS 12/23/2008 EMPLOYER'S WORKERS COMPENSATION OFFICER(IF MM DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and.medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby noted that.. the insurer has arranged for such attention at the { NEAREST AND BEST MEDICAL FACILITY * NAME OF HOSPITAL ADDRESS TO BE POSTED PY EMPLOYER PERMIT PAYMENF RECEIPT TOWN OF BARNSTABL..E BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 10/05/09 TIME: 13:06 ------------_---TOTALS----- PERMIT $ PAID 44.62 AMT TENDERED: 44.52 AMT APPLIED: 44.62 CHANGE: .00 , APPLICATION NUMBER: 200904758 ' PAYMENT METH: CHECK ' PAYMENT REF: '1549 The Commonwealth of Massachusetts. Department of Industrial Accidents 0 Office of Investigations f_ 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �,e Please Print Le ibl Name (Business/Organization/Individual): l�'t�1Cy r Address: City/State/Zip: e V�t Phone #: t'} 0�b (off I Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 1�7 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the.policy and job site information. Insurance Company Name: A\v/1/1 Policy#or Self-ins.Lie.#:--) b Expiration Date: Job Site Address: (:94z) �� �� D�� �. City/State/Zip: (� ✓1t 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 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 may be forwarded to the Office of Investigations of the DIA for insuranc coverage-veiification. I do hereby certify it der t -e pains and p ies of perjury that the information provided above is trice and correct. r` Signature: Date: �— Phone#: 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as".-every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. . City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Assessor's map and lot number ? c, r u SYSTEM MUST SEPTIC Sewage, Permit number j.. ... .. .. TEM MANC INSTALLED IN COlIPLI T CLE II STATE = BJHBSTAML AR yea Ffouse number ... ro WITH SANITARY CODE AND TOW o ' M63q \0� ION 'TOWN OFBARN T'A:BLE k B.U11Dt.-NG INSPECT0R 1 + APPLICATION FOR PERMIT TO . :... .. . P. �'�%..l .a../44���✓✓��...:... TYPE OF CONSTRUCTION ....�o :�.K l ........�7aO+Q� �,s .�.............. .. .. ... :. c; .......�J.v..� .:,.....19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .! .vim ........ ........... Ct .......................................................... ProposedUse ..... ....... �� 1.............................. ......................................... ..................................... ..... .. Zoning District .. . ..... .....................................................Fire District ...... 'kzeC...p....................................... Name of Owner ..15645K. . ......� h& //t/ = U !�Si%. r....... ...r..........�f..........................Address P��....:�.....t.�T. ../�.1. ......�'�'4. .... D Name of Builder .�..........................j U(.fI7.E,5 .............Address Nameof Architect ...........Address ...................:.................................................................. Number of Rooms .0!V9.......................................................Foundation . 8.�?zo� N5..... . .................................................. Exierior .. .!`f lT .........>4 /9 .. �sf.... ��,� ........ g. ..... �.. ......... ........................ C ,c), /il/lr... ........ .....Roofing ..... ..�.5����..�.. .. .. L U/r9.C�C Ce.,. SET/N E,E L Floors ..�i�l�l...r�.:".........:................./�............r�T...............lnterior ...��.....T.�Q:�� ..G//./„!'�...5. Heating ....:-'.....po?!.EQ......!!�V-�.fPlumbing ..................... ................. Fireplace ....................:..........:.............:.................................... Approximate Cost ..... s��Q ............ ............................ Definitive Plan Approved by Planning Board -------------------_-----------19________. Area 0..:4.................. .Diagram of Lot and Building with Dimensions . Fee ... . ........ , ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH fh0 . F-�}Rf?-CrE { m Cx rsrr yG-bW6.4A S- �S` �� 35 ► g, la =,0 )f,0,0171PA/ /p .� 4 I hereby agree to conform to all the Rules and Regulations of the Tow f Barnstable egarding the above construction. Name . ... ' Lmm,8nwu° Robert G. ^ 20429 add to single . No ....:............ Permit for .................................... ' family dwelling . , -------.-----.------------.. 250 Great Marsh Road Location ---------.--.---------. ' ' Cwmmterviiiii. ' . .._________________________.. Robert G. Levine Owner -----.----------------- ' ' ' 'frame Typo of Construction -------------- � -�--.�.-.-------------------- ` .` P|c* ............................ Lot ----'------ July �� �� _~ Permit ' lV ' ------------- ' ~ Dof6 of | ~ ~ .. . . lg.-r_-_�. .��-. .. --. ....... �&�y ��� \ Date' Completed _-»-- 'J'----' . � |! . PERMIT REFUSED / : . � lV-----,--------------.- � .--�-.---...-------.-.,------.- . � `^-_^--^-'-^--'`'-----^-^-^^--''_- ~ �� -'--'-` ~ - '-------.-,-...---..-...-.-..--... ^ 'r .` lA ��~�^r--'/ ----___.__.___.. ` _- .' / �------'-.----.-.-.-.--------. ^ . ' .. � -------`--.-------..-.-~.--.... ` . ' , Assessor's map and lot number ................•................. ....... ... �FTNETO Sewage Permit number ... * - o ... .... ......................_ si. r i EAWS'TABLE, • Housenumber ........................................................................ 90o rb v 0� �f �EYPya\ TOWN OF BARNSTABLE 1 BUILDING INSPECTOR E APPLICATION FOR PERMIT TO T r �— ��/�,I�F ..................................... TYPEOF CONSTRUCTION ..................................................................................................................................... ............................[� ....19.1 . . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .: ..r'.{:........rr.x.'f-WT....�Jy'u�'' tsf....��.�.....................� Fi1�FP /i// f=......:... Proposed Use ........................ ,-;=,-, i4 r ........../'�(? ........................................................................................... ...... i. ... .........b�... Zoning District .... �... ..................................................Fire District ...... F ......................................... AYName of Owner ..•1°RPi.....t:..:..'��Fi//A/ =...............Address ,��I> '. . T/ICSt ....... rr:�, i �E Name of Builder YVC7-I) I A o-e ..............Address �y f&A!Z-t/ PoA,1 % �r.� ; t �11N . .................................................. ................ ............................... ..... ... .......... Name of Architect �1A Address .................. : ......................................... .................................................................................... Number of Rooms ........................................................Foundation Exterior ...l (l!+r7 (�F/�,�lz .S/f/A/lr.0(. ..................Roofing .... ..-"/ 4 s o,�t4 c.r........................................ ............................................. ............ Floors /r- .Interior 7"�P A ,a r 1Af/ < Heating .. atis i..rn..... ?....'..... .; «:?.... !?APlumbing ................"'............................................................. Fireplace ... ......... ........................................................ ......Approximate Cost ......./0 5� !?il....................................... r' r� Definitive Plan Approved by Planning Board -------------------_-----------19 . Area ^f. . ............................ Diagram of Lot and Building with Dimensions Fee .......... ...�.............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I c I � of 6-- - r^ A ( i f I `I I g !7 Ai 17 i � f'RQPos v � r Ir I I hereby agree to conform to all the Rules and Regulations of the Tow-of Barnstable-regarding the above construction. Name / •l. ......... ............................................................. Levine, Ro§ert G. A-210-72 20429 ' {, a isl io`single No ................. Permit for .................................... f am fly dwe l ling y ........................................................................ ... 250 Great Marsh Road Location ............................................................ ... Centerville ............................................................................... Robert G. Levine Owner .................................................................. frame Type of Construction .......................................... Plot ..................... Lot ................................ Jul- 26 78 Permit Granted ......................................19 Date of Inspe -ion ........... .....................19 Date Completed ........ ...... ........:..........19 PERMIT REFUSED ..................... ...... ............ 19 ... :..................... ................. . . .......................... . ........................ ............................................................................... ti l ...............................................................................