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HomeMy WebLinkAbout0064 HARRISON ROAD 'x �r��I(/ 'a�'L/(/r � �� �� 4 � :, ,.. s- , . :. 'ham r , :, .. ;t r r � �t � � ... .. �. � - .. .. .. _ � O .I _ ,. � _ , .- V � .. _ '. a �. .. ', .. � ,.,_' � � � Ali v ' .. .. ,: '.. i I... .. .. .. ..: .: .` .. _:: �FINKE Town of Barnstable Regulatory Services BAUMMS'" . ' MAS& Thomas F.Geiler,Director 1639. 16 9 ``� Building Division Ralph Crossen,Building Commissioner 367 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 SHED REGISTRATI0N Location of shed(address) Village one number ; 3 ;o,per'y owner's name - -Teleph - _ f Shed Map/Parcel# (A Si tune ,.... Date Hyannis Main Street Waterfront historic Districts ' Old King's Highway Historic District Commission jurisdiction C� ~ Conservation Commission(signature required)` PLEASE NOTE: IF YOU ARE WITHIN`THE-JURISDICTION OF ANY OF THE ABOVE CONOUSSIONS,THERE-MAYBE A-REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE"CONIlVIISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg s. ' S 84043'00" ,o I !1 1 I I bA 107.20 ' o 0 Il 1 1 1 1 1 1 11 1 1 1 \ R = 841. 6' \ f.� 08 j'ot \ ,.off .TH, ; w qCIO ti stic Storage j fi 0 � Storage � ���' J I``l -Z0 m 1z 64 Sty W/F v+� p W Dwelling I� • 1 I I I J ! ! CRAWL SPAc� DO I , 11 , Il111 , . ( 11 1111 111 l :� ^ 1 o I I 1 1 1 1 I I I NOTE j W I I I I I 1 /Existing Sgptic System to be Pumped ` - I I I J I 1 a Filled With Clean Material. I O Boa' I o I o post vU Fence i I I I , „ W 85"3745 — — — — - - - - - - � � eRe I I I III �\\ I Fnd 1�44 °FINE r Town .of Barnstable " *Permit &6 3 a 'Expires 6 months from issue dateM Regulatory Services Fee BARNSTABLE, : Thomas F. Geiler,Director Mass. r r 9�A %639. A,�� Building Division TEh MAI 7✓ 3o Ja Tom Perry,CBO, Building Commissioner , < 3 200 Main Street,Hyannis,MA 02601 0 Ep` dagj,& www.town.barnstable.ma.us Office: 5087862-4038 Fax: 508-790-6230 . ' EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY , k` Not Valid without Red X-Press Imprint Map/parcel Number =10777 Property Address L l�f (Ltd�1C� esidential Value of Work 1 , Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Contractor's Name WAl Tele hone Number / Home Improvement Contractor License#(if applicable) t MI ❑Workman's Compensation Insurance ,-PRESS PER Chec e: 2��8 a sole proprietor J U N 2 5 ❑ I AM the Homeowner. I have Worker's Compensation Insurance TOWN OF.BARNSTABLE Insurance Company Name Workman's Comp. Policy# �j tt 600 4109PRA'1)•00 0 Copy of Insurance Compliance Certificate must be on file. 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 F E Zeplacement Windows/doors/sliders. U-Value 0 , .(maximum.44) f *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 is required. SIGNATURE: .. ' Q:\WPFILESTOWS\ ui ding permit forms\EXPRESS.doC R Revise020108 u E 3- - �l e �om�na�uuea�l�i �,/�aaac�c�uiae�a Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR I ;' Registr4im",101149 267680 Efcpeti0� 125/2010 T►# I i ►dual PeVj t ._s {: JOHN P.DUNN ;F ( ' John Dunn 80 MARIE ANN.TERR� ; CENTERVILLE,MA 02632 Administrator �' ense or registration valid for individul use onl i` Y � its Ltc i t`, i before the expiration date. If found return to: i Board of Building Regulations and Standards One Ashburton Place Rm 1301 t E ;. Boston,Ma.02108 ' 4ii�' i I q } i ld without sig Notva nature I t 1el �I .. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, 11IA 02111 www.mass.gov/dta Workers'.,Contpensat on lnsurance Affidavit: Build'eri7Contractors/Electricians/Plumbers ' f��F, .p licant Infomation = - - Please Print Legibly Name(Bus'mess/Organizarionflndividuil): City/State/Zip: C°-1WMa-,j°L1 j:. HA G;;G3�Phone.#: A;4�a"ma, employer? Check the appropriate box: Type of project(required): I employer with t 4. I am a general contractor and I employees(full and! art time . * have hired the mbb-mnt actors 6. ❑New conshuctian 2-❑ I am a'sole proprietor or p - listed on the attached sheet 7. ❑Remodeling ;�• ship and have no employees These sub-contractors have g• ❑Demolition workingemployees and have workers' far mein anycapacity. 9. ❑Building addition [NO workers' comp,mSUrdn= comp.incur ncej req ffir,&] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 LEI Pltubing repairs or additions myself-myself-[No workers' comp. right 6f exemption per MGL 12 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [NO workers' 13.❑Other .�i camp.insurance 1eguired_] `Any applicant that ehwim box 91 must also fill out the section below showing their wmi=s'compensation poky inf -rnation. t Homeowners who submit this affidavit in =tiong they are doing zU work and then hire outside contractors must submit a new affidavit indicating such. TConbactors that check this box umst attached an additiomal sheet sbowing the name of the sub-wnh artom and state whether or not those entities have employees. if the sub---oahaetars have employees,they must provi&their woA=M'comp.pD1cy nwnber. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Na=: Policy#or Self-ins.Lie.#: Vim-'U LA(gw (o-O�Cj Expiration Date: C. 9 b Job Situ Address: ,9(A (40Ms J City/StawZip: C�`� "A.,A., 09f. Attach a copy of the workers'compensation policy,declaration page(showing the policy number and expiration date)., ., Faihu-e to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of ciimi ial penalties of a fine tip 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 statcmerit may be forwarded to the Office of Investigations of the WA for insurance coverage verification. I do her Si e: tf undler�e✓r a pains•and penalies ofperjury that the information provided aovetrue and correct Date: (O G?) _ 3 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#: L .7: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. �r br i pursuant to this`statute,an employee is defined as"...every person in the service of another under any contract of hire, express or im&d, 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.cngaged in a joint enterprise,and including the legal representatives of a deceased employer,or the ,i 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 budding 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." k Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall N` 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 tk necessary,supply sub-conlractm(s)name(s),address(es)and phone number(s).along with their certificate(s)of incnranrr 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. B4 advised that this affidavit may be submitted to the Department of Industrial r_Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit+ The affidavit should be retuned to the city or town that the application for the pert 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 mimbcr 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 wire 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 ono affidavit indicating ctnzent policy infoimaiion(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or F. 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 F year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture ' (ie. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit 7 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. 1 F a. The Ummonwcalth of Mussaohusotts ' Y Dgwtraent of Industrial Accidents office of Investiptions 600 Washington Street Boston,MA 02111 TO. #617-727-4900 ext 4-06 Qr 1-S77-MASSAFE Fax#617-727-7749 Revised l 1-22-06 www.mass.gov/dia r - '.k .• 5, ACORD. CERTIFICATE OF LIABILITY INSURANCE 05/14/2008 { PRODUCER (781)344-3200 FAX (781)344-1425 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIGHTS UPON THE CERTIFICATE Malcolm & Parsons Ins. Agcy. Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 6 Freeman St. ALTER THE COVERAGE AFFORDED BY THE.POLICTES BELOW.- P.O. Box 527 - Ir Stoughton, MA 02072 INSURERS AFFORDING COVERAGE + fi' NAIC#` ��?r INSURED John Dunn INSURERA: Associated Employers Insurance X INSURER B: P.O. BOX 924 ,., .. INSURERC: - s ' F Centerville, MA O26YZ-O924 INSURER D: s. INSURER E: COVERAGES 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 w;E MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR kDOIN TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY t DAMAGE TO RENTED $ CLAIMS MADE �OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ s: GENFRAI.AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 7-1 POLICY JECTPRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT t $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS ` - (Per accident) PROPERTY DAMAGE " ~ (Per accident) $ ; GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA QCC $- AUTO ONLY: - . AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE 8 OCCUR CLAIMS MADE AGGREGATE - $ $ DEDUCTIBLE $ RETENTION $ $ ` WORKERS COMPENSATION AND WCC5004658012007 09/29/2007 09/29/2008 X WCTATU LIMIT OTH- t' L F •r EMPLOYERS'LIABILITY 500,000 jr E.L.EACH ACCIDENT $ us A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $ 500,000 H yes,describe under -.•' �'_ SPECIAL PROVISIONS below. E.L.DISEASE-POLICY LIMIT $ SOO,OOO �.� y OTHER - DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS .✓',: arpentry Contractor a '� John Dunn is covered by the Workers Compensation policy. CERTIFICATE HOLDER CANCELLATION z SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL u DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, y•$ BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KINP UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. - ' Insureds Copy �h*` AUTHORIZED REPRESENTATIVE •`'11 Evidence of Insurance . . Irvin Parsons " ©ACORD CORPORATION 1988y ACORD 25(2001/08) - A r% °FTHET Town of Barnstable Regulatory Services r � ' I'e Thomas F.Geiler,Director rs �16 Building Division Tom Perry, Building Commissioner ,- ` t 1200 Main Street, Hyannis,MA 02601 www.townbarnstable.ma.us T ' Office:. 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder I, /3 I ypolm Ee 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) kii Sign' of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. � ,-`Y�,i�, ;fAat.M<.;£i�'-SxId,:.:.ta7�'`fix.:•',�i«�,� s , • t Town of Barnstable c 1HE Regulatory Services t sa>wszAt3r Thomas F.Geiler,Director 'HAS& Building Division pTE•t)MA't A Tom Perry',Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnsiable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE JOB LOCATION: lP I C I 1 I�R SQ N I I M number street village "HOMEOWNER": name home p one# work phone# =' CURRENT MAILING ADDRESS: i city/town siate zip code The current exemption for"homeowners"was extended to include owner-occupied dwellinas 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. 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 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 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 theyare 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'applicition, that V homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by cat' o use in our community. orm/cernfi ion for such a f several towns. You may care t amend and adopt y tY