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HomeMy WebLinkAbout0283 LONG BEACH ROAD - fj ..,. d lic- •ir ai. +. R •' a�'1r tiiN,..�' � �} +Y( Y�a r � d q A' �yi�� u}'dry .� ��t� �•, r"t dt.' r ; `t,'P Ji�+;ei `�' �'Ck� ����. � , e • r a N 4 { 1 4 5 '.i 8 ru _ 1 a , f �t Town of Barnstable *Permit ire Regulatory Services ifees6mont x x x x • BARNSTABLE, y MAW. Richard V.Scali,Director iG39• ♦0 �FD1"0''A Building Division Paul Roma,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 Not Valid without Red X-Press imprint Map/parcel Number h ©�� •� art •, ' Pro perty p Y Address -- L O h& REAG1•f lZb [Residential Value of Work$ f , 000 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address :To A t j 6 e�O Contractor's Name_ RV p=0 CC41 57Q-U l o r1 Telephone Number �jQ�t '369'6-75 Home Improvement Contractor License#(if applicable) I Sq 96 2 - Email: (Ls-,6CtMS jw�}Ifp'1 Palnial�� Construction Supervisor's License#(if applicable) L S " Oq 40 fo .1 Workman's Compensation Insurance Ch;K one: [� I am a sole proprietor ❑ Lam the Homeowner b ❑ I have Worker's Compensation Insurance Insurance Company Name A` r~+i C. cl -1 h esAi 6C9 ,t `l�/V 1 4 ,t Workman's Comp.Policy# W V O 1 2 9 2q® I Copy of Insurance Compliance Certificate must accompany each permit. F !l ��� Permit Request(check box) 1 " ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to D- f) e-roof(hurricane nailed)(not stripping. Going over existing layers of roo y. Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.32)#of windows #of doors: *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. Acopy of the Home'Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: U r C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.0utlook\L7U69LF2\EXPRESS(2).doc 01/25/17 f tHE tq x x x x + BARNSfABLE, `""SS. i679• Town of Barnstable ��� ' CFO MAC A ' Regulatory Services Richard V.Scali,Director. „ Building Division •Paul Roma Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder A 1JG& 4) ,'as Owner of the subject property hereby authorize �y�y 60VI1-41TrV to act on my behalf, in all matters relative to work authorized by this building permit application for: 2.0�> REAcM Q6 Cev,ifervo ll'e (Address of Job) signUure of Own 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\lNetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 i 77ae C'ommennealth of 4fassachusetts Department of Industrial Accidents 09ice of Investigations 600 Washington&met Boston,11 4#2111 wn w.mass.gavIdia Workers' Compensation Insurance Affidavit:Builders/ContractorslElectticians/plumbers Applicant Information r� Please Print 'b Name musi r'ora niaationilndividivaij: ?n U 1.\��y C��G_ k t, �y✓� e,t rz•_,&- Address: ?U City/StatetZip Phone* �Oo Are you an employer?Check the appropriate box: Type of project(required): I.❑ I am a employer with 4. ❑ I am a general contractor and I,ofirp 6. ❑New construction loyees(full and/or part-time).* have mired the sub-contractors 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 1❑ 1 am a homeowner doing all work. officers have exercised their 1 i.❑Plumbing repairs or additions myself[No workers'comp_ right:of exemption per MGL 12-❑Roof repairs insurance required.]I c. 152,§1(4),and we have no employees.[No workers' 13. Other comp.insurance required.] 'Any applicant that checks box#1 avast also fill out the section below showing their workers'compensation policy informaticaL I Homeowners who submit this affidaarn indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such- (Contractors that check this box must attached an additional sheet showing the name of the sob-contractors and state whedw or not those entities have employees. If the sub-contractors bare employees,they must provide their workers'comp.policy number. I am an employer that is providing g workers'compensation insurance for Ivry employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.l.ic.#: Expiration(Sate: Job Site Address: 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 M:GL 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 co%-erage verification- I do herelty cerfi&udder the pains and penalties of perjury that the inforaration provided above is true and correct S t mre: Date: 114 17 Phone#€: O,;Qicial use only. Do not write in this area,to be completed by city or ttattarr official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Tovim Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 ACC?R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/13/2017 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 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSU THE POLICIES RE BY AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the poiicy(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 endorsement(s). PRODUCER 01902-001 NONrE4CT O'Briens Centerville Insurance Agency,Inc. ApMNE X PO Box 610 aC.No.Ezt: (508)775-0005 �c.No.: Centerville,MA 02632 ��� ss: I S RE AFFORDING CQVERAGE NAIC INSURER A. Atlantic Charter Insurance Company VDAC 44326 INSURED Paul Rufo I s B- Rufo Construction INSURER PO Box 648 West Hyannisport,MA 02672 INSURER • IN E: 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 C yBYppppPAID CLAIMS. IMR TYPE OF INSURANCE ANSR WVU POLICY NUMBER MINDDIYYYY MM%DDVYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES E occurrence)CLAIMS MADE OCCUR MED EXP(Any one person) $ _ e PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS.COMP/OP AGG $ OLICY ECT OC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ac ' en ANY AUTO - BODILY INJURY(Per person) $ALL OWNED I SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-O (Peraccident) PROPERTY DAMAGE $ $ UMBRELLALIAO OCCURr , EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ yyp KKDEEEppDgg pp�� RETENTION $ yyC g UU 7H- $ AND EMPLOYERS�LIABILITY - X TORY LAf�ITS OER A AFFICER/tv1EMBER DUMP Y N N/A WCV01282901 12/14/2016 12/14/2017 E.L.EACH ACCIDENT $ 100,000.00 (Mandatory in NH) ��I E.L.DISEASE-EA EMPLOYEE $ 100,000.00 ''ff dd �be ��dd Policy Coverage State:M D�WsbO N VbPERATIONS below _ _ E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Job site address:283 Long Beach Road,Centerville,MA 02632. ' _ r CERTIFICATE HOLDER CANCELLATION Barnstable Building Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 367 Main Street BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY Hyannis,MA 02601 WILL ENDEAVOR TO MAIL NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE HOLDER COPY t Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-094062 Construction Supervisor f PAUL A RUFO P O BOX 648 WEST HYANNISPORT P11A,,;"02672 ' CA--- Expiration: Commissioner 12/01/2017 (- rrcc en���r�C-:`r'�rrJJ2afernr ill . =" Office of Consumer Affairs&Business Regulation �� (b HOME IMPROVEMENT CONTRACTOR TYPE:Individual 1� Registration Expiration 04/09/2019 PAUL RUFO s` D/B/A RUFO CONSTRUCTION .:y a'- PAULA.RUFO \,Q 10 OLD TOWN ROAD U u HYANNIS,MA 02601 Undersecretary '.,R�P�+l� i��ti45h� ��'�•t�l�t7l� � �. '`A�N P° ��� ;B4 .. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 'Application# © l� Health Division Date Issued Conservation Division Application Fee Tax Collector Permit Fee Treasurer ) Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 2—e5 LQQG- 9F4R-r~t F--,D Village QZI YVE�QV QQ Owner %ky(k?-' Nl\, NJG�tlao Addresses \U W4t- k MO �5�. -FR. Awl , ,Mn/-\ Telephone T6� 431 5 J15c) 01--le 9 Permit Request �GY(P,6NI D 5&%A�oM ?:1!f LXk . CON M `( F-UOM ' r � ��' R- 11J l RAT -t✓ ( �'� Square feet: )st floor:existing proposed 2nd floor:existing proposed Total neiv-'_ Zoning District Flood Plain - Groundwater Overlay Project Valuation �G00 \0'3 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family I9 Two Family ❑ Multi-Family(#units) r Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑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 BUILDER INFORMATION &e- O =Fl� Name mF—NE z_ko Love&DA Telephone Number (oR I�2F3 V452. Address NeG F10CKS1))E fit. License# 914L` MC—D�MD , N"A 02155 Home Improvement Contractor# 2S A(O Z 3 Worker's Compensation# At& OW (62.0 2,b- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i F 1 D(Sfb V_k -- DATE SIGNATURE -� , w FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. y ADDRESS VILLAGE s r OWNER DATE OF INSPECTION: f FOUNDATION FRAME �' -712JOE,4e= INSULATION (Dle '7I2-�0�, , a FIREPLACE 1 ELECTRICAL: ROUGH FINAL y - , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 161 T DATE CLOSED OUT ✓ ASSOCIATION PLAN NO. / r. It E) l5 7 1 N;;— N A:� I C 3L7+Ar'<)cDM j Rr Z n I C;I.O'�E7 I GAO` 7 z - r �rJGt•1 LP ViiNzDW r , �JYGE �n16�� 283 tsarJ�- �� �04� -C,�nr���v���.c'� P✓lA . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' ' d 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information �^ Please Print Legibly Name(Business/Organization/Individual): E)R Ole EY a &av&� Address• ei City/State/ZipiWrom 0,215 Phone.#: (Y� Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.ElI am a sole proprietor or:partner-' listed on the attached sheet. 7...URemodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P t5'• 9. ❑Building addition o workers-comp. insurance comp.insurance.$ 10. Electrical or additions repairs required.] 5. ❑ We are a corporation and its ❑ P F 3.❑ I am a homeowner doing all work officers have exercised-their 11.❑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.❑ 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. Idontractors 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: 'Q/U 0qj/1 �� ✓/l l ' ds' Policy#or Self-ins. Lic. #: 00 .1 1p LG Z C Expiration Date: O .Z Job Site Address:2_8 3 4-_-7�V 6 &q e6 /1d City/State/Zip: A V V p w-O 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. Ido hereby certify under he pains and penalties ofperjury that the information provided above is true and correct Si ature: Date: �o` /a OF _ 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-contractors)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' acompensation 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 bum 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 1-977-MASSAFE Fax# 617-727-7744 Revised 11-22-06 www.mns.gov/dia `� �/e�om�mz�.iuiea,Cl� �.aaaac«u�ortla � Board of Building Regulations and Standards License or registration valid for individul use on1Y ; HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 1.54570 T One Ashburton Place Rut 1301 Expiration: 3/21/2009 Tr# 254623 Boston,Ma.02108 Type: Private Corporation EAGLE EYES CONTRACTOR INC. MENEM LOUZADA 366 RIVERSIDE AVE ..�Q.a�•-� MEDFORD,MA 02155 Administrator ° v 10 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): )Ur, GAAZAt/O AkCA vTAP,4 Address: 9(o C—,U,-T N Crr City/State/Zip: CjEnrrc->;v)tte.l Mtn p2(�t3Z_Phone.#: ZQ8 2 O Are you an employer?Check the appropriate bog: Type of project(required): 1.El am a employer with 4. ❑ 1 am a general contractor and I . employees(full and/or part-time).* have hired the sub-contractors 6. Ne❑ w construction 2.14 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 workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers'comp.insurance comp. insurance. 10. Electrical repairs or additions required.] 5. 0 We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑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.❑ 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. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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: Policy#or Self-ins.Lic.#: Expiration Date: ._ t ' Job Site Address: 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 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 statement_may be forwarded to the Office of Investi ations of the DIA for insurance coverage verification. I do hereby ce u r the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: OZ L L1 . O6 Phone#: Official use only. Do hot write in this area,to be completed by city or town offcciaL 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, 25 7 states"Neither the commonwealth nor any of its political subdivisions shall P § � ) 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 permittlicense 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 bum 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 1-977-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.govfdia AGLE EYES CONTRACTOR INC AW1111k Member( of 66 R 1 VERS I DE AVE #2 Amerkm Dltmattai Group iEDFORD, MA 02155-0000 DOEpmYE Off 76 PINE 57REEf.MW VO K N,Y. 119M SEE MANE AND ADDRESS SCHEDULE - WC990610 D# OCEANPOINT INSURANCE AGENCY INC. WORKERS CompEmAFIB AND ®iI"YMS 272 VALLEY ROAD LtAI31L TY poLWy amFolWAATM PAGE MIDDLETOWN. RI 02842—OGW A � ED —]RENEWAL NUMBER02026 0 TI EUL — wnOYE SEE NAME AND ADDRESS SCH D E WC10 nit 2 vouctr dM08t*a ensM'd"s mWnmaddrom mom 09/21/07 To 09/21/08 meta A. W rkws COMMSOMM ftwramw Part Otte of**WftW fD don- Cow*m=dmlair of flee stases gsftd here: MA B. EmploVers UabMft blouramm Pwt Two of*9 poscV appose tQ om work In each sty listed to ltoM WL Tha Rmits of oar saber Part Tyro am Soft ft*nv bV/fit S 100.000 each saddent Bodft bfuW bW Dbmg S 500.000 pofty Wnit soft b*w►by WAGM $ 100.000 each empkWu C. 0bher States lasuraum Pwt Tom*of So posoy to the states,if any.salad hems . SEE ENDORSEMENT - VC200306A MWa Tft preadwn for this poSar w®be dMa00d16d bF otw lAbaaat bf . Rates and Rating Plans. AN ledbi bolMISS~10 -mffipnlimmwMcboWbyandL { Est3maAsd Toad hate per Estimated C cbteHae�u SW OFFft• Premium Aar❑g ynmwauon X Anna) 3 Ye SEE EXTENSION OF INFORMATION PAGE - WC7754 $10i . TAXES/ASSESSMENTS/SURCHARGES > cnnartoec�rMntEtiaAnpttotatEBarsrw� _jS318 MA wauum Pritaeum $500 MA S 2,241. iadkaW bakm iaftfl-WON of pwoh m sba be wane tasaaactstaal SEE ATTACHED FORM SCHEDULE — WC990612 0/03/07 ASSIGNED RISK 66 issue Date oraoe AWft med PApmewftUm VJC 00 Co C i r ,1 BOARD OF,BUILDING REGUL.ATJONS 'r l " 1 License CONSTRUCTION SUPERVISOR Number,CAS 094477 C$ , ) ! 'Expires 03/09/2 10 Tr no 94477 �tN � � Rest+cted00 �` f: ++ I' IVIENEZIO Lou , 366,RIVERSIDE + MEDFORp MA I Commissioner � + �? i - I i r i k , To: Building Inspector Town of Barnstable, From: Joyce M Angelo This letter is to authorize the contractor.and Plumber to apply for a building permit for my home at 283 Long Beach Road, Centerville. We will be retiling 3 baths with slight remodeling of the master bath/closets. Thank you for your consideration. ' Joyce M Angelo Property owner I S�S'd 0229062-80ST :01 T8b78T280ST 3d'JM13OS HS3IdJ3d:WO�A S2:8T 8002-bT-813 Town of Barn table �etvsrnarr. Z . °A Regulatory Services Thomas F.Geiler,Di ctor . Building Divisi n Thomas Perry,CB Building Commissio ier 200 Main Street, Hyannis,NIA 02601 www.town.barnstable. a.us Offi ce: 50 8-862-4038 Fax; 508-790-6230 Property Owner Must Complete and Sign T is Section If Using A Builder I, �� ,as Owner of the subject property ' /I Lte hereby au orize ��cs �cG LAC /%��' �� to act on my behalf, in all matters relative to work authorized by this building permit a placation For: j » 127/U u ' . ddress of Job) Signa tt of wner Dat • Print Name Vorrns:buildingpermits/express . Revised 123107 S��'d: 022906L80ST:Oi TB"eT280ST 3aWiAOS HS8�IH8� :W0�1A t72:8T 8002-t7T-88J . i ' Bob Angelo To: Building Inspector....Barnstable County—Centerville project Subject: APPLYING FOR A BUILDING PERMIT FO 283 long BEACH RD CENTERVILLE The attached request signed by my wife,the property owner, is for ME nezio Louiada and Gus Dealcantara to manage and complete the retiling of 3 bathrooms at our home on 283 Long Be ch Rd Centerville along with revising the closet configuration in the master bath dressing room. Thank you. Bob Angelo 781439 5559 f o t 1 , S/t7'd 022906Z80ST :oi T8t7t78Z280ST 3�]WiA0S HS3dAEa:W0�id t,2:8T 8002-bti-833 ... �i `� r • �1. ` r, Assessor's map'and lot number- OFT E , , z r, Sewage Permit number ......te ..... . a s.. ......... ZF3 � . % t BAHHSTADLE • House' number ....................., ......... .. .............................. aea M 0 MAY TOWN OF BARNSTABLE BUILDING INSPECTOR ....�. .. - � � APPLICATION FOR PERMIT TO ..........:L!I� ......... 6................. . .......................................................:.. , TYPE!OF CONSTRUCTION .........IfK-.7_ .........ll.. ...........................................'r...................... ........... .8p ..................19 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby app'es for a permit according to the following information: Q �q 00". -,-' Location, . 4�.�..................... .................................. ......................../!../.....•....................................................... ProposedUse .... �..�}YL... ............... ................................................................................................... li Zoning District ....................!..\.2........................................Fire' District ...............(f±0............................................... Name of Owner_12,4,14-4..... ..rc�,,:�.Adclress3.� ..Address .....:'�.1.�I k!� ..�...w.................................................... Name of Builder �1!J�l ✓...... ..... ......... ..... ......V Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................Foundation .............................................................................. Exterior .......... .. ..............................Roofing IAI�...� �. . �°�"` ... Floors ...........Interior ... .. Heating .......................... ...................................................Plumbing .................................. ............................................... Fireplace ............ ............................................................Approximate Cost J 0 d �............. !/ �rrr..rr. Definitive Plan Approved by Planning Board ________________________________19________. Area `.. ........................ A Diagram of Lot and Building with Dimensions Fee .Q�.................. ...... SUBJECT TO APPROVAL OF BOARD OF HEALTH �,�1�(� 41201 Tnf": � 6irrr5��� . �• ,•.. S .t /00 «- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS \ I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name %..V �..-.. ...... Construction Supervisor's License ..1.... .c <_ .... Spenlinhauer, Stephen A=185-38 No ......26.2.1.9 Permit for add. . to...dwe.l.l.ing. .. . .. .... ...... . . ...... .......... .................................................................... Location ..........283. . ...Lon.g..Be.a.ch..Road .. . . ...... .. .... . .... .. . ................ Centerville ............................................................................... Stephen Spenlinhauer Owner .................................................................. Type of Construction .................f.ramc............... ................................................................................ Plot ............................ Lot ................................ March 29 84 Permit Granted .................. ....................:19 Date of Inspection ....................................19 Date Completed .......................................19 �:.•;s ..�y�fi.. . ro yfAS 4 ,k. t•�>.1... � 6,;.. ..p ' .. �. `��4�r,—�'7+.- ..� , _ �1-- Assessor's map,and lot nu er.....,..�:�..�.... ...`�..�. YHe O O Sewage Permit i �'. B AR3STAXE, i House:number ..................... ... ..F..... ... rasa. 2 9 TOWN OF BARNSTABLE BUILDING , INSPECTOR y ''A 'APPLICATION FOR PERMIT TO .....� .... . ........... . ... .. .......................................................... TYPE OF CONSTRUCTION. ........ ..........��... ................................................................. ? w ........... ld. .............. .19g.I. TOf,-HE-INSPECTOR•,OF BUILDINGS: 'The undersigned hereby app 'es fora permit according to the following information: Location ........C.1Z ............ .... .... ............ .�!':.�...... ...... .................................. ProposedUse` .... .. .................... • ........ .......... .................................. ZoningDistrict ....................!..1. . ..........................................Fire District ............��.o... ........................................... Nameof Owner•. . ..... .. ... . ....... . .. ...... .....Address .................. .. .. . ......... ......................................... Name of Builder .. .. ....... ......./ rA. .........................Address ./................. .......... ... ...2.04........... . ..... ..,. Name of Architect Address Number of Rooms .O.. ... .....Foundation ' . M Exterior ................. ............. ......... ..............................Roofing .. �-�! ...... .......� � �... r.. Floors Interior ......... L........ ........ '. G� ... ... . Heating ............ ................................................Plumbing ..... �J........... Fireplace . ......................... ...............................Approximate. Cost .......`D...O �, Definitive Plan Approved by Planning Board __'_____________________________19________. Area ... � ........................ Diagram of Lot and Building with,Dimensions Fee .......AV,-1Q0. e SUBJECT TO APPROVAL OF BOARD OF HEALTH , 30100 01 4,ppljgj, S gv,a i9gy_-2 a � 16 00 �RoPos a _ O /00 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I' hereby agree to conform to "all the.'.Rules and -Regulations of the Town of Barnstable regarding therabove construction.' Name Construction Superv;isor's License ...�..J.......�.�.�.... Sperilinhauer, Stepfieri—� No 26219. Permit for ....................................add to dwelling if .. '� • - h ................... . r:... ... Location 28.3...LongBeach...©sd .... . ... .. .. .. .,' y •.r�s ' I � -_ .a , .. • s' ' b Centerville �4 Owner," ..............Stephen S e a....x�hauer....... Type of Constructiori. ...f rame...................... � .....................f.............................................................' ? Plot ... Lot ................ ... -z • • ' 1 Permit Granted March'2� `19 8 ......... y: •' Date of-Inspection ........................ ...........19 i Date Completed �! .'zl............ ....19� '�• e F l i r /moo• pi�"�'uscns 4 _a /77, In �a �a�t,E'�' � ��,�'/,�/G�,�',lZ.. /OD.�+j �� ,z�•pox. s7-� �G use- �`a'.S` ..�s,,�.`3 ti. : .� / r'.�,�.r+la T� -d c pESicr�/ — G �'�7. !� •� 7T/G Al E'.QTF ; l „/iA/ Z /q/A/ I � O 1 �J t j 7 44 ! i Nv?' Wi rft/�" 5 v /C/A --- /t/G� .•fG.ct Lam• . SA [ ti tr /mac_`•,�' .► ` .__._ . .- _ _� il. ' � � i"�•y' /U�'/ /ors. '� 5F �''T.�G,. � _.s'.4ic/Z7 N � Coi'rIf�LY'' N%/TN 1 _ lr(/id Tt�� �I�.4�✓. •"' �y'..iy/ f-//.JC-/��` c-_7�,.7!D � [1( „�•./„' � � ,J.`"'+".. �� �. �'�t, 1 _ /YfrF. 7'_j I I f E