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HomeMy WebLinkAbout0129 KATHERINE ROAD I si TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION o� PrpamiMap Parcel V ication # Health Division Date Issued t 2 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board e l 4 P7 f 13 Historic - OKH _ Preservation/ Hyannis t Project Street Address Village V ` Owner Al ddress S cty'I e a✓ ��� Telephone sug / 36 Permit Request ` �� Q a 14a4 10 Cte//klaT `ns k/4ri`U✓! 1 a e yI of e 1-/C ly k K10 C -�✓ f;4�cP Vg,`1, Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new. Zoning District - Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) ^, Q Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: O�Yes 4 No �t I o Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other - Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)u f, : Number of Baths: Full: existing new Half: existing new 4"?J Number of Bedrooms: existing _new � o n Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 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: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) AveName M �. ` 14Ve r-14C- TeIe p hone Number -E0 �� �`� 70 Address C iIW4 14 l "PI fye License# 10a W SC N,+ � �� / Home Improvement Contractor# Worker's Compensation #PVC 3 _396 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# i� DATE ISSUED MAP/PARCEL NO. F ADDRESS VILLAGE OWNER f } DATE OF INSPECTION: FOUNDATI.ONst.�=! ± uL •UA-4 r FRAME INSULATION,?. x FIREPLACE 4 ELECTRICAL: ROUGH FINAL 's PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING.. ' ' DATE CLOSED OUT ASSOCIATION PLAN NO. fy fJ F n � F�nr The Commonwealth of Massachusetts nt Fo me; Department of Industrial Accidents 1 Ogee of Investigations _ 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Cape Save,Inc. ' 7D Huntington Avenue Address: City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑ I am a employer with 17 4. ❑ I am a general contractor and I 6 New construction - � have hired the sub-contractors employees(.full and/or part-time). 7. Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. g ship and have no employees These sub-contractors have g, ❑ Demolition employees and have workers' working for me in any capacity. 9. ❑ Building addition o workers' com insurance comp. insurance� p' 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their l l.❑Plumbing repairs or additions right of exemption per MGL 12.❑Roof repairs myself. [No workers comp. and we have no insurance required.] c. 152, §1(4), 13.0 Other insulation 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Technology Insurance Company Insurance Company Name: Policy#or Self-ins.Lic.#: TWC 3353968 Expiration Date: 04/09/2014 Job Site Address: >� i City/State/Zip: 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 insurance coverage verification. I do hereby certify under the pains and penalties of erjury tl at the information provided above is true and correct. Si ature: —- -- -- — -- _ - — JDate Phone#: 508-398-6398 . Official use only. Do not write in this area,to be completed by city or town offciaL 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#: 1.. A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYM 10/22/2013 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 endorsements). PRODUCER NAME:CONTACT Colleen Crowley Risk Strategies Company PHONE E (781)986-4400 FAX No:(791)963-4420 15 Pacella Park Drive ADQSSI `Quite 240 INSURER(S)AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURER A:Selective Ins. , oE' America INSURED INSURERB:Safety Insurance COmpany 33618 Cape Save, Inc tNsuRsRc:Teahnology Insurance Company 7 D Huntington Ave INSURERD: INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL13102268490 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,TERRA 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEff- PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE a OCCUR S1994480 0/16/2013 0/16/2014 MED EXP(Any one person) $ 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 PRO POLICY X X LOC $ AUTOMOBILE LIABILITY COMBINED Ea aocident SINGLE MI 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED M SCHEDULED 208200 1/6/2013 1/6/2014 BODILY INJURY Per accident $ AUTOS AUTOS ( )NON-OWNEDPROPERTY DAMAGE X HIREDAUTOSAUTOS Per accident $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ S1994480 0/16/2013 0/16/2014 $ C WORKERS COMPENSATION Officers Included for X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ORY I IT ER ANY PROPRIETOR/PARTNERIEE)(ECUTIVE Coverage OFFICER/MEMBER EXCLUDED? [ME NIA E.L.EACH ACCIDENT $ 5OO OOO (Mandatory In NH) 3353968 /9/2013 /9/2014 E.L.DISEASE-EA EMPLOYEE $ 500,000 If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Weatherization Specialists GL: Blnkt AI, Blnkt PNC, Blnkt WOS, Per Proj Agg, Per Loc Agg / GL Exclusions: Snow & Ice Removal/OCIP/Wrap Ups 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. AUTHORIZED REPRESENTATIVE PlItchael Christian/CLC � ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD F >i 9 Massachusetts -Department cl Flub is Sar'e',? Board of Buddino Regula ions and Standards Construction Supervisor Specialn" License: CSSL-102776 r WILLIAM J MC CLUSKEY- ' 37 NAUSET ROAD West Yarmouth NIA 02673 � X c missicnzr 06/28/2015 gxn', _c I Office of Consumer Affairs and eusness Regulation �d�%t 10 Park Plaza-- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2014 Tr# 222184 . CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. i Address 7, Renewal Employment J] Lost Card DPS-CA1'ai 50M-04/04-G101216 ✓fie Vo�rv»zarzcueal�l r_��,`i'a4:tcefiusefd`a -- _ � Office of Consumer Affairs&Bdsiness Regulation License or registration valid for individui use only c� ;%HOME IMPROVEMENT CONTRACTOR before the expiration date. ff found return to: 11R'', Registration _.171380 Type: Office of Consumer Affairs and Business Regulation Expiration 3/1412014 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CD SAVE INC.. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH;MA02664 Undersecretary Not valid w'it o signa Building Permit Authorization I, Robert CaseyY t Yz as owner hereby give my permission to Cape Save,, Inc. 7-D Huntington Avenue ' , South Yarmouth, MA 02664 Office:508-398-0398 . to take all necessary steps to obtain a building permit to perform work at my property located at 129`Katherine Rd Centerville, MA 02632 Signed C `w Date L : O i Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 11/10/2014 ' Thomas Perry CBO Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for 129 Katherine Road (#201309244) has been . inspected by a third party Certified Building.Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. . Sincerely, William McCluskey NOISIAIa 319VISOVO JO Nhi01 x ram.., XPRESS PERM ' MAY own of Barnstable *Permit# Y 24 2013 Regulatory Services pees6munthsfrom issue date p + � �ate, A Thomas F.Geller,Director QF 8AMISrABL E Building Division ® SI? I Y,4 Tom Perry,CBO, g Buildin Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us 'Wfice: '508 ts62-403u 'rax:'568490-6230 EXPRES PERMIT APPLICATION - RESIDENTIAL ONLY Not varid withourkedx-press Finprint Map/parcel Number/ ` Property Address 2 7 ���{�-ityf�,�'T 0 ex v Q2 6?2 14 Residential Value of Work Sao °c Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 7 rd GJ �(Py e ki d?d32 Contractor's Name M Pc f7�nS Telephone Number Sam -7tzU 7U Z Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) %5 (_�Workman's Compensation Insurance Check one: , 1•em,a-sale•praprietor ❑ I am the Homeowner ❑ I have Workex'.s Compensation Insurance Insurance Company Name �,/v✓¢ Workman's Comp.Policy# C onv of Truquranrr..Compliance,C-ertifirate_must acemm�anv each nermit, Permit Re uest(check box) ., Re-raaf( .a ieenc n ed3(3tirppin �Id 3trYngles� All,ansttu,tian tieb:is v, :be ttd en tr, ���j�ae��Z, 1111 Re rnnf...thurr�canr.,nailgdl,Lnnt ctrinnina (mina nver evicting lavarc nfrnnf) ❑ Re-side - - 4 of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ Smoke./Carbon Mnnnxide deter_.tom 4 floor plans markp.d with red C nod ingnertionc required, Separate Electrical&Fire Permits required. where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.•riistoric;Conservation,etc. 1FaFk1U..�±`o D-.. `.•4. l�.r... �� Dr i{. ll.. ..Wi Letter .f Do t. .j <....:....., .,:b.. .vt'...�. .; ....... ... ................. A cony of the Home Tmn_rovement Contractors License Rc Congtrnrtion Snnervignrs License is required. SIGNATURE: C:\Users\decolU\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\ORE6ZUBN\EXPRESS.doc Revised 053012 CERTIFICATE OF LIABILITY INSURANCE DATE IMNVDDNYYYI 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 h an ADDITIONAL INSURED, the policyfies) must bg gn¢grg1-U. If c11BROGgTION IS WAIVED, subject to te 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). r34 UCER legel 6 Schlegel Insurance Brokers Inc NAME: PHONE AX [LAIN STREET (A/C,No,E.): E#iAIL ---- ..wncoo: PRODUC R West Yarmouth, MA 02673 CUSTOMER ID k: INSURED ---------- .-______._ INSURER(SI AFFORDING COVERAGE NAIL Timothy Keating Dba Keating Construction INSURER ACOLONY INSURANCE 54 Lower Brook Rd INSURER a CNA INSURERC: •_..a_..—__.___.--___ _.__--___-_ INSURER D: � South Yarmouth, MA 02664 - ----INSURER E COVERAGES INSURER F: CERTIFICATE NUMBER: CERTTHIS IS T OTWI H THAT THE POLICIES OF' INSURANCE LISTED BELOW NAVE BEEN fSSUED TO THE INSUR DE NIAMEDkABOVE BRFUR T INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY HE POLICY PERIOD CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY HOENTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL IMS,IES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. LTR I TYPE OF INSURANCE WV D I POLICY NUMBER I POL INSR j I�EFV A ;GENERAL LIABILITY (MMIDONYYY) I (MM/DDN-ryy) I LIMITS - GL3594908 iO3/10/201203/10/2013 E.ACHOCCURP,H•JCE 31,000,000 i X ;COMMERCIAL GetJcRFi LIA.BILiTY I , / -_—_ i i ! ::LAiMS-MaGE X OCCUR i / / O1 ` cD 103 10/2013�03 10 2 4i PREMISES(Eaoxu eecel s1D0,000 --- .) MED EXP jAny one oetson! 55,QQQ i � I LV 1 000 00— PERSONAL&.AD`e URY ' c Q _- 'EN GEIn:c AGGREGATE I;;.A:-APPLIES o ERAL A < v vv ER " r POLiC,Y 'FRO _ 1 PRODUCTS-COMP'OPAGG 5 2 r OOP,OOO CaLor AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i ANY r.UTG - (Ea acc,deno r ALL OWNED I ! I - ! I BODILY INJURY;,Per nergnn SCHEDULED?:UTOS ._._._ _— j !BODILY INJURY(Pe,accident) -- -- - • I IP i ROPER7,DAMAGE ( I iPer accident) 15 I NO,•r-O'V`:EC:AL,•rc. t j UMBRELLA UAB I s---------- OCCUR ' ! =EXCESS LIAR EACH OCCURRENCE ' I AGGREGATE DEDUCTIBLE ! 5 i RETENTION 5 _ 1 $ B i WORKERS COMPENSATION 1 (0`.7.4N„�'7 AND EMPLOYERS'LUIBILITY i -2-10 103 j 09/2012iO3/69j2013!X I WO ST - 1 OTH '--Y' ANYPROPRIEOR.PARTNERIEXECLIT:Vr N i TORY LJ;dITS _ �R JNaOFFtCE^MEMoE EXCLUDED' may 3/09/20131!03/09/2014!E.L.EACH AC—CIDENT(MynNM) L f 100, - xntie QQQ Ifyes,descn I I E.L.DISEASE E<EMPLOY 100,000 . DEuCRIPT!ON OF OPERATIONS G-low I - E.L.DISEASE-POLICY LIMIT S 500,000 I � I I ESCRIPTION OF OPERATIONS:LOCATIONS 1 VEHICLES (ARdCII ACORD lei.Additional Remarks Schedule,if more space is 'IMOTHY KEATING HAS ELECTED NOT TO BE COVERED ON HIS WORKERS CO dMrequirePENSATION RTIFICATE 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 PROMIONS. i AUT ED REPRESENTATJVE i ORD 25(20091091, v iS& _ 9 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD • ' License or registration valid for individul use only .Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR Off ce of Consamett Affairs and Business Regulation ;egistration 143053 Type: 10 Park Plaza-Suite_5190 xpirationc,-6/14/2014 DBA Boston,MA 02116 j 1 KEATING CONST. s . TIMOTHY KEATING ' ;_. 54 LOWER BROOK RD SO.YARMOUTH, MA 02664- Undersecretary Not valid without signature i I y Massachusetts -Department of Public Safety Board of Building Regulations and Standatds Construction Supenisor Specialty �� License: CSSL-099351 s TIM B.KEATING-` 54 Lower Brook South Yarmouth 1�IA 0266�, 3 �J,•G..- �i` ` „ },�`� Expiration 05/1112014 Commissioner �IKE r t • BARNBTABI.E, � - r 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 s Property Owner Must Complete and Sign This Section If Using A Builder I. /rLv✓i �9 T /" �' r ,as Owner of the subject property hereby authorize Pc �,°n (16PnS to act on my behalf, in all matters relative to work authorized by this building permit application for: p ell OZG'f 2 (Address of job)' Signature of Owner Y Date 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 Internet Files\Conten_t.Outlook\QRE6ZUBN\EXPRESS.doc - Revised 053012 r R. . i a The Contmorr+ ealth e 'iVlrssgclrns men#vfIndr ,91 Accidents . . (I�/ace O.fTnvestrgatio�es 660 Washington f Bt'ston, w mas .gtiv/dit� Workers'CoinipensatiowIs nraace Affidavit Blil",n/Conh2darsMectricianstRumbers A►nnticant Information _ Pease Print Lt�Zv ire:aair+� u�rvabaur�oaavarnaa►mmuuoaf.:. M 1Yc'. '1s1 eftyrstea : Cyr-„k��'coA loz6 L i 5Of- � 0 2 Arc you an employer?check the appropriate baz. Type of protect(r red} am a employer vrith i , ❑ I am a genet couttaetor and I Al M per n.n.tn . employees{full attdldx psc#-tie}* nave mreat me u ' ,sew tin Ine •. 2:U I am sole propaie#ar or parer $ub6id ShLML tvorkmg we ffi ffimy c City employees and have workers' Mo teoAms'conw insurance p Q Bu c#iag addition required 5. Q>We are a corporation and its l�.l--1 tIIectnceal vepam tar adftow ( ( 3.❑ I am a hapmeovener doing all.work officers have elegised `1l.❑Plutas6iag repaus or additions 12.Q Rsaocfrepaim u sunmce rbloired.j t c..252,§1(4�audwe have no I emnlo -iPto workers' "13 Mother ��y ����y�q� {� wwH_aX� i wwi 1�c{ 1.�m 1 ]I'.` ::AnygpHc ilE[ 6[mdLs m Tl YAW aise�am�whan Wd sbawing WS4. CMPO yC •••- -•wma wAM MEU=i uus 6UAUMVU ucey one daub Au we&if iauffi A. c`uas maa buoumabiW�auiwvra:iti�ca��esuu_ kcn=wn mat cbwk Ws bm ant attacWd m sddibaast shee s2 Mft the sme of ee S v tam ad Stm-whe&M or am ftse iftitieslare emplayees.if tine t thsy amstpmvide ffiear wank s'comp:policy a>agber r Ams on omnij."if fi Fla n#%vc4A iNwv AM An wnw-fin{�m�vrw�n��r an��g�sM��a a�era RBI +»ia'ld��n+��Dr w�m�i rat►w/s in rntalion. Iasmaace.Company Nam. 7 Policy#or Seif�.Inc.# z Z )V�7. Expiiation Dam, 7. lPl �tic��'. l�1il� �d�L.,:: Attach a copy of the workers'tolapensatioti poling de ratioa page(showing the policy umber and expir ati"date}: . rsetwm M gpwae.n w�<rn.a�-oQ.mrnalmn ,me r Cawlaev.,'*KA� _OXSM n-:110 e*na lmn�el iv�'4Daa i�uns+�+lanes-n$n_w.aai_wod.pan nI►�.a -Ira- fine up S 1 500.00 andJor one-year m .ss well ss civil i ffi the&,in of a:'STOF'pt�4RK OItDER.axtd a fine of up to$250.00.a day against the violator.'Be advised that a API'of this s May be fixrwar-ded to the Office of Investigations of The UlPl.for coverage venftcation I;la h by COW&nadir to 6Pns and amamm ofw rium,that the infarmathi n air iAff d ahow,is true and correct I'fioae :7 0-:2. Wag arse only. ram+list wnt'e in ma 4m,to be eoinjHeted by' or town atptc t tt _ Essurug Aathflrity{&Ck one) It _ _ ,a. r Town of Barnstable *Permit a" 3T -3 j Expires 6 months from issue date Regulatory Services Fee axnea. Thomas F.Geiler,Director t639. � 7� D k 10l23(v� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY yy Not Valid without Red X-Press Imprint Map/parcel Number OZ 9 / Property Address , �I �/Y��!eo'ie�� �G• ��'I t/i 44' IMA . �sidential Value of Work 170D -Gp Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address /P e.elt fC j ey Aew Contractor's Name ELT I,ONJr /o✓C ✓ f,&1;mot; Telephone Number 522 1— 7-7(v `"IY Home Improvement Contractor License#(if applicable) /3 91 Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance X-PRESS PERMIT Check one: ❑ I am a sole proprietor OCT 12 2006 ❑ I�rrt the Homeowner have Worker's Compensation �Insurance / TOWN OF BARNSTABLE Insurance Company Name Jl A-""e— , Workman's Comp.Policy# 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) D/Re-side ❑ Replacement Windows. U-Value (maximum.44) *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. Ho Improvement C actors License is required. r SIGNATURE: v Q:Forms:expmtrg Revise071405 Island Siding and Roofing a dh4sion of RLTConstruction,Inc. September 1, 2006 eSVl ymo Bob Casey �� a�S v00� Cola` �Ve 'SAOX 129 Katherine Rd. Centerville, Ma. We are pleased to submit the following specifications and estimates for residing. Ena ng cedar siding on right side gable and 2 cheeks only. ar housewrap e A R&R white cedar shingles d haul away all debris to landfill. propose to furnish materials and labor—complete in accordance with the ' for the sum of: $3200 Q0 Fnr-blesadd $500. For front of house only $1300.00 For bleached add $200.00 For garage gable and breezeway $1900.00 For bleached add $300.00 Payment to be made as follows. Payment in full due upon completion. . All material is guaranteed to be as specified. All work to be completed in a workmanlike manner according to standard practices. Any alterations or deviations from the above specifications involving extra costs will be executed only upon written orders,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents,or delays beyond our control. Owners to carry fire,wind damage and other necessary insurance. RLT Construction,Inc.carries General Liability and Workers Compensation Insurance. Certificates of Insurance provided upon request. ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. Date of Acceptance: signature Start Date: Signature 31 Manni Circle Centerville, Massachusetts 02632 Telephone 508.42a5243 and 508.833.5249 • .fax 508.420.1776 • EmaiCcaperoofer@caperoofer.com DATE MM D::.: ..................... �:�.:::�.�:::�. ; DDUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DwARD a GRazuL INS AGCY ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 0 BOX 337 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ARSTONS MILLS MA 02648 COMPANIES AFFORDING COVERAGE COMPANY t8Y2K A HARTFORD UNDERWRITERS INSURANCE COMPANY URED COMPANY R L T CONSTRUCTION INC B 31 MANNI CIRCLE CENTERVILLE MA 02632 COMPANY C COMPANY D 71, AIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE I NSURED NAMED ABOVE FOR IDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS I ERTIFI MAY ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, {CLUSIONS ONS AND CO NDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE(MM\DD\YY) DATE(MM\DD\YY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG. $ CLAIMS MADE F7 OCCUR. PERSONAL&ADV.INJURY t OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE $ FIRE DAMAGE(Any one fire) $ \UTOMOBILE LIABILITY MED.EXPENSE(Any one person) $ ANY AUTO COMBINED SINGLE $ ALL OWNED AUTOS LIMIT , SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per Person) $• NON-OWNED AUTOS BODILY INJURY (Per Accident) $ PROPERTY DAMAGE $ ARAGE LIABILITY ANY AUTO AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY: EACH ACCIDENT $ KCESS UABIUTY AGGREGATE $ UMBRELLA FORM EACH OCCURRENCE $ OTHER THAN UMBRELLA FORM AGGREGATE $ YORKER'S COMPENSATION AND MPLOYER'SUABIUTY (UB—1051C04-5-05 12-24-05 i 2-24-06 HE PROPRIETOR/ AFITNERS/EXECUTNE INCL EACH ACCIDENT $ ,FFICERS ARE: D10L DISEASE-POLICY LIMIT $ rHER DISEASE-EACH EMPLOYEE $ 100 000 91PTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS HIS REPLACES ANY PRIDR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER ;:;.:.;:;.: :;:.;:.;;;;:.:.;:;.;:.;:.;::::::.::::::::.:.::.::.::.:::::.;::;:::..::..::.:::............. AFFECTING WO R K :.;;•.;::::::::::::::.:::::.:::::::.:.:::.:.::::::::::::.:: .::.::. ::.::_:::............... E R S COMP COVERAGE. _::::::.:..:.:::.:.:::::::::.::::.::::.:::.::::::.::.;::,::,::::::._.::;:.:: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE INSTABLE BUILDING DEPARTMENT EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL IN OF BARNSTABLE 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE MAIN STREET LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR NNI S MA 02601 LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE � f i \ • 'Mlf'S�F / Y \ 3;4- sum �LPOrYIUri7b�'1kIIE .. Board of Bui dme Iiegulatans and Stand ard= < ,�C.ense or registration valid for iniLvidul.us only. HOME IM?ROVEMENT.CONTR/rCTOi ? wore they:XOration date. if foltrd retB "b ftegisfraf on 4286 ? tjoard of Buildrng Regulations +nd Stand ` m Ex ratro-&l}/#� 2007 �?e AshbOrCon Plan Rm 1361 ®1 Boston,N[a 02100: „,RT CNS [NCJr$ APf�;F©ING&ROOFIN , µ yRON IlE TAYLOR t x 42`� z'i�MPTt�C11�CL✓' �-�-_}-=`' �!� "" k T ; ,.•fV� 1,'LCE A 02�G2 _ t � � _--� .- .Y _�- .z r.:: ,�:;�d�uii�`ra �.`•� _ ,� r 1`Jot Va1111:��ltl�is nr.� ``�- I i l The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 c a� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):. Ll N Address: City/State/Zip: //f Phone 7 7& E�61 Are you an employer?Check the appropriate box: Type of project(required): 1.Li�am a employer with /44 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers' comp.insurance. Y P tY• 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 13.[]rOther S/� *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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: TQ`7-�4� Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: /a 9 Ile',4e1'/07 e �d— City/State/Zip: 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 insurance coverage verification. I do hereby certify under the pains an enalties of perjury that the information provided above is true and correct Si nature: Date: /0 — I0,1 — Phone#: IV I 77d- 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#: r I � t 1 � I � � I . I s � � � , � � a ' 1 ' 1 I � t � � I � � � I � I � 1 1 � � , � I , � i , I , ' I � ( i . , � t I i � � � � I I 1 I t I � J ' t i I I 1 ! I 1 I I � � I � 1 I ' � � ' ' � , , ' i I � � � I f r e I ' � � I _ , I 1 � � i � � I � � 1 � I � � 1 1 1 � i I � I � 1 I I 1 I , I t i � ' 1 , I 1 I i , � ! I I � I I , i 1 , I ' � , I ' i i i i i � i i � I �; � f � I ' � I I � I I ( { � ' I i � I I �� I 1 ! � I i � 1 ; � � 1 I i i i + } i i .> j j ` I i , I I ` � � � � � t i i I I � � I �; � � 8 � ! i i i ' i ! � � � � � i � I � � � I '� I � — i !, I . i � I ( ! � � �' i i 1 I i 1 i � I � � � i ' i , � I I ! , ' I i I { j I ` �' ' ' , I � , I I I , I I I I I l 1 1 � � ' - I I I ' � I 1 � ' ' I � 1 j I I � j I i I � ! ' I I i I � I i I , � I � � 1 I � � I ' I � I � � � � � � t I r � � I I I I � I i I I I I � � I i � ' I I I ! I I � ' j � � J e I i i I i r � I I ' � � � I ' I 1 � I 1 r I I � 1 i I � , 1 ( 1 I � � 1 I I I I I I , 1 I 1 I I ( I ( 1 1 1 ( I 1 ( I 1 1 1 � i ' I I ' 1 , � 1 I I I , I 1 I 1 ' � ; � .1 I I I i ' � I I I � I Qy�FTNET��I TOWN OF BARNSTA,BLE fob O� • SAUSTADLB, i Mb 9 N BUILDING INSPECTOR ,sue 'EO PY a' APPLICATION"FOR PERMIT TO ... v: � ........�.. .. ...... ....` ! . ...<!//&-ow ................................. TYPE OF CONSTRUCTION ��'`� �� �''° "A' ........ . ......................19�7 TO THE INSPECTOR OF BUILDINGS: The undersigne hereby applies for a per it according to the following information: pp �,,�y Location .................../0.........!�(�.G:... . . ..... ........... ... .... .... .............�u,...........................'............................................ s ProposedUse .... . ... .. ... ......... .. .... .............................:....................................................................................................... Zoning District .. ...... .. ........... .. ...Pre- Distri t �2� ,•„•„„•••••,•„ I .. ............ .............................. Name of Owner' .... ............ .......... ................. ... :'.........Address ........ ... .... I Name of Buil .... ...............:...............:....... .. .... . ............Address ..../ �� � ......................... ............................................ Nameof Architect ....................... .....................................Address ...........:..:...................:...:............................................. Number of Rooms ...... ........�l .. ...... . Foundation Exterior ,7�� ��.i N :...................................Roofing ..... ......... .... ..:........................................ Floors ....... � :...........................................................Interior .. .. .... +...................................... Heatin (sue'- /� .......................Plumbin ....�% / Fireplace .... `.... ............:......:...:................................................Approximate Cost ........�.1.�..��...:................../.................. Difinitive Plan Approved by Planning Board ________________________________19________ . Diagram of Lot and Building with Dimensions e e AL�i 14 G / z— hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the a ove construction. Name . ..... Cape Cod Building Supplies 11278 Permit for 1 1/2 story, No ............. .................................... jr single family dwelling garage ............................................................................... Katherine & Joan Roads Location ................................................................ Centerville ............ ............................................................... r Cape. ..Cod. . Building. ...Supplie. .s --` Owner ............. .. .. . .......... .......... ........ ...... ... Type of Construction frame ................................................................................ Plot ......................... .. Lot ......'#18................... � r t Permit Granted ....:A August 29 ..............19 67 ` U� .Date of Inspection .... .................. .........19 ,�/7 -_ —... Date Completed ......................................19 PERMIT REFUSED ............................................................. 19 ....................................................................... ............................................................................... j ............................................................................... Approved ............................................... 19 _ ............................................................................... r