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HomeMy WebLinkAbout0177 LAKE ELIZABETH DRIVE A911 �,JMGJ i0l� V4 �­v v ��ft �M "Pil t Uuu ELM III 1, t, "I 11i.111 F,,l WWI Ahl PIN L�1 11,1�11 1*-IF"P �RIA NOW gusrig#. ,W! '10 WN T '0� j 411 '�pv"'..'1g.f� Zl qgf lv A"f u m im" JR k Iwq il IV 111"DA"W�,W ill"M"I F �ir il!ei, ,J�Tfi R'It! R , qi , '§i 6i, i ,u,, illalil "gigs—, il fp jj '!1w NA'.�'j I i, it ar, MN N :10 -f nw,v�_j w .f�4t il gg li"'O u V k,. It Z n�gogij,!�J'I i i�� ;AYN" Rr "461 C5 44 -4 z p� kti i� ��Ii g, "al. jjl� - , ., ,1%,R,;"X V gT!g. 4 Mi A� Oi �"n�V I n rf, All T-i IR 'i,WMA"i W,11 Tiltic"_4 w 1 4 Ao I paw mi"n, R M1 11 1�1 _,J� :yp i,q­ ef';i:11I' 7 1j 1,"1,vf,,jj;gj i4i P I 4� IwO.19Y A4 t-( .o�jKE r� `own of Barnstable *Permit#QD ( S 36t I. Expires 6 months from issue date Regulatory Services Fee .. i,A k Thomas F. Geiler, Director p�PrMAS& r� Building Division C /a1614 �C 4.2008 Tom Perry, CBO, Building Commissioner (/ �O�N .200 Main Street, Hyannis, MA 02601 OF BARUSTASLe www.town.barnstable.ina.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Nor Valid without Red X-Press Imprint Map/parcel Number Property Address1-77 //Zip r ❑ Residential Value of Work al ell Minimum fee of$25.00 for.work under$6000.0.0 t Owner's Name & Address -117 _ )Jill Contractor's Name Telephone Number�,�t Home Improvement Co tractor Licens # (if applicable) ao CJ ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance n � Insurance Company.Name Workman's Comp. Policy# v Copy of Insurance Compliance ertificate must be on file. Permit R=(stripping kbox) old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side [] Replacement Windows/doors/sliders. 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. A copy of the Home improvement Contractors License"is required. SIGNATURE: i r Q:\WPFILL-S\FORMS\building perm'- rms\EXP S.doc Revise02O108. Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR f o before the expiration date. If fountf return to: Registration r 125799 Board of Building Regulations-and Stam0ards E prat on--1�30/2010 Tr# 262231 'One Ashburton Place RW 1301 `s tType=Private Corporation Boston,Ma.02108 G.J. RILEY BUILDER'INC I, CRAIG RILEY 10 B WIANNO AVE OSTERVILLE, MA — Administrator of lid wi out si na g tur 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectriciaPrplumbers A Iicant Information Please Print LedN Name (Business/Organization/Lndividual): ' Addre55: , City/state/Zip: �� one.#: ya� 7 Are an employer? Clieck the appropriatE bon f9. 0 f piojmt(required): 1. I am a employer with 4- [] I am a general contractor and I New construction employees(fall and/or punt-time).* have hired the sbb-contractors Z❑ I am a-sole proprietor or parincr- listed on the attached sheet Remodeling ship and have no employees These sub-contractors have Demolition employees and haveworkers' working far me in any capacity. $ Building addition [TIO workers' comp.-insnrancC Comp.inerTra�7Ce- 5. n We arc a corporation and its 10.0-Electrical repairs or additions rbqurr h] officers have exercised their 11.0 Plumbing repairs or additions 3.❑ I am a home-.awnLr doing all work. nryselE[No workers' comp. right of exemption per MGL 12 ❑goof repairs c. 152, §1(4), and we have no - insurance required]t employees. workers' 13-[] Other, [No cow,mmnance required-] *Aay applicant that chxla box#1 mist also fiD out the rml ion below showing their warkcrs'compmsa4an policy information t Homncownas who cub frdt this z idavit indicating they=doing nM work and than hire outside contractors must submit anew a$davit indicating such tCantractors that chak thin box must atache td an additional sheet showing the name of the sub-eanh drA rs and statz whether or not thost entities have mnployccs. If the sub-contrarbxr have employcea,they must provi&their woriccas'camp.policy numbcr- I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site infor radon. Insurance Company Name: Policy#or Self-ins.Lic.#: D f © Expiration Date: tw, rob siteAddress: !^ icy/5tatraZap: � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as regtrned vndLr Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a f=tip to S1rSNM and/or onn-year irprisonment,as well as civil penalties in the farm of a STOP WORK.ORDER and a f of up to$250.00 a day against the violator. Be advised that a copy of this state= t may be forwarded to the Office of Investigations of the DIA for iiranee coverer e verification. I da hereby certify the pains an er of perjrcry that the informaion provided ove true and Correct Si c: Date: — Phone O fzchd use only. Do not write in this area, tb be completed by city or town official City or Town: PermitUrense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Toyin Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Phone#: �0f-THE r, Town of Barnstable Regulatory Services BAHNSTA13M ` Thomas F. Geiler,Director lEpµp�a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us F ' Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A. Builder 7 , 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: d ess of Job) Signature of Owner Date Cr�- , Print ame l If Property Owner is applying for permit please complete the Homeowners License Exemption Form on tb:e reverse side. Town of Barnstable , 010HE r� / 0 Regulatory Services sABAtsrwsL.E, .• Thomas F.Geiler, Director p MASS. ib59. ,� Building Division ;" oTEa �a Tom Perry,Building Commissfi ner 200 Main Street, Hyannis, IvIAJ 2801 wvm.town.barnsiable. y� Office: 508-862-4038 Fax: 508-790-6230 OMEOWNER LICENSE�MPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': name home hone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extend to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire w o does not possess a license,provided that the owner acts as supervisor. DEFINTT N O HOMEOWNER Person(s)who owns a parcel of land on'which he/s resid s or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detae ed struc es accessory to such use and/or farm structures. A person who constructs more than one home in a iv -year pe 'De shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official n a form cceptable to the Building Official, that he/she shall be res onsible for all such work Performed under the uildin e st. (Section 109.1,1) The undersigned"homeowner"assumes responsibility for comp 'ance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that be/sh understands th Town of Barnstable Building Department minimum inspection procedures and requirements d that he/she. 11 comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35, 00 cubic feet or lar r will be required to comply with the State Building Code Section 127.0 Construction Contr HOMEO" R'S EXEMPTION The Code states that: "Any homeowner performing work f which a building perm t is required shall be exempt from the provisions of this section(Section tom.i-Licensing of construction Supervisors provided that if the ho eowncr engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they a assuming there onsrbilitics of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) Thi lack of awarcne s often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against th unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a forrr✓certification for use in your community. Client#: 10798 2RILEYCJ DATE ;0RU. CERTIFICATE OF LIABILITY INSURANCE 09/11108° IYYYY _C R THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIO /ling&O'Neil Insurance ONLY AND CONFERS NO.RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ,ency ' ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. /3 lyannough Rd., PO Box 1990 ,Iyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER& National Grange Mutual Insurance C.J. Riley Builder,Inc. INSURER B:'Associated Employers Insurance Compa P.O.BOX 382 INSURER C: Osterville,MA 02655 INSURER D: 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 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. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MMIDD DATE MMIDD A GENERAL LIABILITY MS059664 05/02/08 05/02/09 EACH OCCURRENCE $1 000 000 AGE TO NTED X COMMERCIAL GENERAL LIABILITY PREMI ES( a occurrence, ccurr ce $50 000 CLAIMS MADE F_X1 OCCUR MED EXP(Any one person) $5 000 X BI Ded:500 PERSONAL&ADV INJURY '$1 OOO 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1 000000 POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO 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 ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR 0 CLAIMS MADE � - AGGREGATE $ i DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND WCC5001591012008 05/05/08 05/05/09 X' we sTATU- oER TH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE - - OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under SPECIAL PROVISIONS below 91.DISEASE-POLICY LIMIT s500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS Operations performed by.the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER_ CANCE CATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIP Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRI' 230 South Street NOTICE TO THE CERTIFICATE.HOLDER NAMED TO THE LEFT,BUT.FAILURE TO DO SO SI Hyannis, MA 02601 IMPOSE NO OBLIGATION,OR LIABILITY OF ANY KIND UPON THE INSURER;ITS AGENTS C REPRESENTATIVES. ' AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #53598 I' MAK © ACORD CORPORATIO Assessor's office(1st Floor):. a G Assessor's map and lot number SEPTIC SYSTEM A, Twt ' + INSTALLED 1 ` Conservation(4th Floor): `- N CO °► Board of Health(3rd floor): WITIi%, Sewage Permit number 'EN NMEII se8asrLnt L d° Engineering Department(3rd floor): �L n ^ TOWN REGULATI Mix�, House number Definitive Plan Approved by Planning Board 4 .19 APPLICATIONS PROCESSED!8:30-9:30 A.M:and 1:00-2:00 P.M.only i TOWN Of BARNSTABLE BUILDING INSPECTOR i APPLICATION'FOR PERMIT TO ��iYlO\6�\ TYPE OF CONSTRUCTION ` \�A - 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location \ i �— \ e 7;Z)\Z, 11)C S> N\ Proposed Use Zoning District -- Fire District G Name of Owner �2nhe�n E ekAned C fNA j ddress Name of Builder J . � t.�l \�� nC Address OX -,-VA Name of Architect ��t�nmAn! Address �Rm�iZ���g� � 0�`3S Number of Rooms�p Foundation Carcy�e Exterior ",41 S\tS Roofing Floors N\ Interior Cz-)(yc x J V�Pcs \cif �.2 Heating p, Plumbing Fireplace ` rJ 2\C Approximate Cost C7 Cx00 Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS � r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding t above con ion. Name Con ruction Siipervisor's License Ovh;)s� HANSON, KENNETH & HEATHER 5 } � 707 REMODEL & No Permit For ADDITION ? Single Family Dwelling 'Location J77 Craigville Owner. Kenneth- & Heather. Hanson t`' <� ��, r>j, - Type of Construction- Wood Frame ' . Plot Lot �h ' Permit Granted September 16z 19 93 Date of Inspection: r. Frame 19" J } Insulation 19 Fireplace 19 " Date Completed f 1T� 1,9 V , .. '� ecmyor W I ISSUE DATE (MM/DD/ Y) I CERTIFICATE OF INSURANCE I 11 1 09/14/93 1 i PRODUCER —1THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS I I IND RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND,I I Horgan-James Ins. Agency, Inc. (EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW I 1 44 Barnstable Road I ----I 1 P.O. BOX 250 I COMPANIES AFFORDING COVERAGE I I Hyyannis MA 02601 I -- ---------------_- -_--- —1 1 An) ii1 -5m ICOMRANY Commercial Union Insurance Co. I I---_ ---------------_----------------ILETTER A 1 I INSURED ICOMPANY American Policyholders' Insurance Co. I i ILETTER B 1 I J. Tarabelli, Inc. -IMME . i I PO Box 564 (LETTER C I I Mashpee, MA 02649 ICONPANYI I (LETTER D I I I I I ILETTER E I 1= OVERAGES =- ---------- -- --I I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ! I INDICATED NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS I I EXCLUSIONS AM CONDIAk MAY BE TIONS OF SUCH POLUED OR MAY ICIh. LIMITSIN 1HE ANCE SHOWN MAY HAVE POLIREDUCED BY PAIDBED CLAIIMMSEIN I5 SUBJECT TO ALL THE TERMS. i . ICO ! I I POLICY I POLICY I I ILTRI TYPE OF INSURANCE 1 POLICY NUMBER (EFFECTIVE IEXPIRATIONI LIMITS 1 I I I I DATE I DATE I 1 I 1 GENERAL LIABILITY I I 1 1 GENERAL AGGREGATE If 1 000 000 I I A I I CBRI36565 1 10/07/92 1 10/07/93 1 - I I IEX] COMMERCIAL GENERAL LIABILITY( 1 I I 1 I I [ J CLAIMS MADE [X] OCCUR. I 1 1 I I I I[ J OWNER'S B CONTRACTOR'S PROT.1 1 I I one ire I I 1[ J 1 I I I y one persowis , I I I AUTOMOBILE LIABILITY I I I I COMBINED SINGLE I 1 I I I i ! I LIMIT if I 1 11 ] ANY AUTO I I 1 1------ I 1 11 ] ALL OWNED AUTOS I I I I BODILY INJURY 1 I 1 11 J SCHEDULED AUTOS I I I I (Per person) If I I 11 ] HIRED AUTOS I I I I--------- ----------+--- --I 1 11 J NON-OWNED AUTOS I 1 I I BODILY INJURY I I 1 11 ] GARAGE LIABILITY 1 1 1 1 (Per accident) If I I I[ J 1 1 I I------------- +---------I I I I I I I PROPERTY DAMAGE I I i I 1 I 1 1 if I I I EXCESS LIABILITY 1 I I I EACH OCCURENCE IS I 1 I[ ]Umbrella Form I I 1 1 I I I[ ]Other Than Umbrella Form I I B ! WORKER'S COMPENSATION- i WCC 209543 02 92 1 11/01/92 1 11/02/93 1— 1 STATUTORY LIMITS I I ! I AND I I I I EACH ACCIDENTI 1 I EMPLOYERS' LIABILITY I 1 1 1 DISEASE - POLICY LIMIT WIWI I 1 1 I i I DISEASE - EACH EMPLOYEE I I OTHER I I I I I I I I I I 1 1 i i I 1 I I I I I I I ! I 1 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS 1 1 I I I I i I I 1 I 1= CERTIFICATE HOLDER ----= CANCELLATION ---- _ - ---1 i I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE I I Town of Barnstable I EXPIRATION DATE THEREOF THE ISSUING COMPANY WILL ENDEAVOR TO I I South Street I MAIL 10 DAYS WRITTEN kTICE TO THE CERTIFICATE HOLDER NAMED TO THE 1 I Building Dept I LEFT BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR I I Hyannis, MA 02601 1 LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGE S OF REPR ENTATIVES. 1 1 1 AUTHORIZED REPRESENTATIVE op 06 I PAX as ' Fits,IW141c4NC... aNepN, ►�/H�FvuNG�-TioN � ' rjW IN 14/ elvNG. ALIGN T1/ N&-W uNp^�pCPN WPw i j Nc ! Z�G"T„(P ,+��ctbTNG GMv . 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