HomeMy WebLinkAbout0062 MERIDETH WAY
Town of Barnstable *Permit#��
Expires 6 months front issue date .
Regulatory Services Fee .
�� PERMIT Thomas F.Geiler,Director ��� ��'•�I5�07
Building Division
AUG 1.5 2007 Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
TOWN OF BARNSTABLE 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 y
Property Address (o \J3 P C C3
9-1 esidential Value of Work �t�j C). (9 0 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address � � \3 e _ f V►N,
Contractor's Name \Le 1^I St Telephone Number
Home Improvement Contractor License#(if applicable) k �3 (c Ll
Construction Supervisor's License#(if applicable)
orkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
n-Thave Worker's Compensation Insurance
Insurance Company Name AN W.\J�M l
Workman's Comp.Policy# b l i,nn-2
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box) l
0-Re-roof(stripping old shingles) All construction debris will be taken to tz( I�
❑ 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 Owne must si Prop ty 0 ner Letter of Permission.
A co y of th m rove nt C tractors License is required.
SIGNATURE:
Q:Forms:expmtrg
Revise061306
t
The Commonwealth of Massachusetts
Department of Industrial Accidents
52 Office of Investigations
600 Washington Street
Boston,MA 02111
www.mass.gov/dia
Workers`Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le 'bI
Name(Business/Organizetion/Individual):. VA(t�))�— �P_oLst
Address: e• 'r
r .
City/State/Zip: e ut Phone.#: '-f'OIL) 6 0l I•(0
Are yo -an employer? Check the appropriate box: -Type of project(required):.
1. I am a employer with 4. I am a general contractor and I
have hired the sub-contractors 6. ❑New construction .
employees(full andlorpnrt-time). .
2.❑ I am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. employees and have workers'
$• 9. (]Building addition
[No workers' comp.insurance comp.insurance. 10. . Electrical repairs or additions
required.] 5. We are a corporation and its ❑ P
3.❑ officers have exercised their I am a homeowner doing all work 11. Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.[� Df 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.
ZContractors 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 providb their workers'comp.policy number..
I am an employer that is providing workers'compensation insurance for my employees Below 1s.the policy and job site
information.
Insurance Company Name: VAS 0 �r I
Policy#or Self-ins.Lic.#: "-2 c) o� l c7(� \ o'l��7 Expiration Date:
V
Job Site Address: �} R'�/ City/State/Zip: oerA ro
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. a advised t4at a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance c era e erifi lion,
Ida hereby certify:cn r the i d e t' s f rjurj he information provided above is true and correct
Simature: Date:
Phone#:
Official use only. Do not write in this area,'tb 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#:
ISSUE DATE(MM/DDIYY)
c:
�+�j FICAT� �F INSugANC1
C,l`RTIa �g CERTIFICATE iS ISSUED AS CER 1P[CATE Ii��T�9 CERTIFICATE
AM
CONFERS NO RIGHTEXF aR ALTER L liE COVERAGE AFFORDED 8Y 1
DOES NO
PRODUCER CI1 S BELOW
Leonard Insurance Agency Inc COMPANM FORDING COVERAGE
p 0 Box 494
Osterville, MA 02655
INSURED LE1M"1P��Y A A.I.M. Mutual Insurance Co
Mark Nerbst
35 Peep Toad Road
Centerville, MA 02632
ISSUED TO
THE INSURED NAMED ABOVE POR THE POLICY PERIOD
COYE�GES TI{E POLICIES DESCRIBED HEREIN[S SUBJECT TO ALL THE TERMS,
DOCUMENT q+rrH RESPLC PTO
WHICH THIS
T THE PO TERMED CONDITION OI ANY CONTRACT OR OTHER
_ LICIE50F[NSUItANCELISTGDEF-LOW HAVEB
THIS 1S TO CERTIFYT ANY i(T;QUIRhMI3NT, RDED BY
INDICATED,NOTWITHSTANDING
CERTIFICATE MAY BE ISSUED OR MAY PBRT CIEIN,THE INSURANCE MAY
UCBD
LIMITS
AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN Mg CTt g PGL C X IUATI BY PA
EXCLUSIONSPOLIC pL' MJDDJ Y)
POLICY NUMBER DATR(MM11)" ) $
GENERAL AGGREGATE
CO TYPE OF INSURANCE GE
f.TR PRODUCTS-001MP1OP AGO- _-..
GI;NRRA1.LIABILITY PERSON AL&ADv.INJURY
a
,C,,FRCiAL GENERAL UABILITY OCCURRENCE s
CIIR EACH
IMS MAD- 3
FIRE DAMAGE(AnY one Art)
PROT. M 1111/1 S
OWNED S g CONTRACTOR'SMED.gXPENSE(Atop
_ COMBINBDSINGLB S
61Mrr
UTQINOBILS LIABILITY BODILY INJURY b
ANY AUTO Av peaoa)
LLOWNW AUTOS $
BODILY IN)URY
CHEDULED ALITOS (Pnr acc,&-)
HIRED AUTOS PROPERTY DAMAGE S
NON-OWNED AUTOS
S
GARAGE LIABILITY EACH OCCURRCNCG
S
GGREGATE
EXCESS LIABILITY
WCSTATU- OTH_
MBIIELLA FORM X S
ER THAN UMBRELLA FORM 500 000
QtltOl20(}S- Y IMIr f
WORKER'S�UAENSATIO14 AND _-- Di!10/20(J7 EL D65EAS. 3 100 000
CMPI OYCRS' 7(}J{f2 H5012�"
E 0 gE--EA EMPLOYEE
A THE PROPRIETOR)
1NC1-
PARTNERSIEXr"TIVE X X
0FPICM1;ARM
(YnIER
5JSPECIAL ITEMS
Dt7:CRIPTION OF OpUR-ATIONSILOCATION5IVRN1C1.R
CANCELLATION
NCEL
ATE HOLDER THEREOF THE ISSUING COMPANY WILL NAmFm/OR '
CERTIFICATE SHOULD ANY OF TH ROVE DESCRIBED POLICIES BE CFO ILL .ENDED O T
EXPIRATION DATE It
MAIL 10 DAYS WRITTEN NOTIC>CH No E CERTIf1CAT AGENTS
gUT FAILUR,To KINDSUU�N TTHE II COMPANY, ITS$LIGATION
LENT,
LIABILITY Of ANY
REPRESENTATIVES. ATIVE
A[frHOR[7.ED REPItFS�T
I
✓/ze �omazanufe�tf �,/��aetivae�
Board of Building Regulations and Standards
i
HOME IMPROVEMENT CONTRACTOR. Y
? License or registration valid for individul use only
f
RegistrailO.'a126480
. before the expiration date. If found return to: j
'
Expnafion Board of Building Regulations and Standards
J 6�8!2008 One Ashburton Place Rm 1301
I Type IndiJiduat Boston,Ma.02108
MARK HERBST g'' I
MARK HERBST
35 PEEP TOAD RD
CENTERVILLE,MA 02632
Ceputy Administrator � _
Not valid witho t nature _
r
y -A
MARK HERBST
a440
10, 35 PEEP TOAD ROAD
g CENTERVILLE MA 02632
B
508-420-6216 CELL PHONE 774-238-2938
ROB U TTED TO: Wofm P-R ORME AT
y, =�
Steve m
25 Stanford Roa 62 Meridith Way
Centerville AM
Wellsley Hills MA 02481
781-929-0046
A, ials and perform the labor necessary
We herby propose to furnish the mater for the completion of the
following; E
New Roof,
F s ,
Remove 1 laver of existing shingles
R Install ice&water shield at edge L ,.
Install 8"drip edge
Install 15 lb. felt paper.
Install Certainteed shingle of choice
q Cut ride& install cobra vent .
r Replace all plumbing boots
All shingle will be stormed nailed
Counter flash sky lights&chimnjU flashing with ice&water shield
Replace frontgable trim by chimney �
>V Replace gpprox 18"on Left gable front
s4' Replace window sill&exterior trim on left window
$S 850.00
Certainteed XT 25 r. algae resistant shin les
Certainteed Woodsc�e 30yr algae resistant shingles 6 I S0.00( ( '_
*Please check&initial choice above Thank You ,F
All debris cleaned daily
' Price includes material labor&dump fees
x;.
All material is guaranteed to be as specified.The above work will be performed in accorandance with
_g
the specifications submitted and completed in a substantial workman-like manner for the sum of; ,�
As specified above&veri fed with our initials
r Y v ;,P
dollars( )with payments as follows; full amount due upon completion _
t '
L *Any alteration(s)from above proposal involving extra costs will be added under a separate written
agreement and become an extra charge.
5'Y
RESPECTFULLY S D'
/A zY, 07-09-0/ '
Mark Herbst
4 >
ACCEPTANCE OF PROPOSAL
ZA The above price,specifications and conditions are satisfactory. We herby accept this proposal. You
are authorized to do the work and payments will be as specified above. a
Signature
f *This proposal may be withdra n.by said coanpany if not accepted'within 30 days
'o
o� TOWN OF BARNSTABLE Permit No. ---------- _
11AWnA ; Building Inspector cash
...� ------------
— -—
OCCUPANCY PERMIT Bond _.-_-------------
Issued to Address
Wiring Inspector Inspection date
Plumbing Inspector '�r Inspection date
Gas Inspector Inspection date
Engineering Department ;r Inspection date
Board of Health —� ..!? Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED [?NTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TORN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
....................................................... 19........... ..........................................................................................................__....
Building Inspector
a-. - FROM -
TOWN OF B'ARNSTABLE
suiLDi G DEPARTMENT
Mr. Francis Lahteine 367 MAM STREU . HYANNIS, 14A 026D1
Town Clerk. �i'Sv�,s sr'£'tr."•,r�ss",�°Y�'a.e ,r..::.a�.�,«R;rp.-s'sF;.. .•s-�. -
.� Phone: 775-1120
SUBJECT:
FOLD HERE -
DATE
July 16 i -1984 MESSAGE
Work has been completed under Permit #25267 Alden Homes, Inc.
Please release Bone r-- ----
DATE - - - - -
REPLY.
SIGNED -
N87.RM1 RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY-
PRINTED IN U.S.A. "
SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT.
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U45- OAAF- JT '5UQVc`f T.aL- UF�S�rS Sldoe,�W APPLI CA-"-r
t�f-T er USCo TO va:razMINC LoT LI��S ' ,
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ssdssor's map and lot number ....... 7 V
3
ppSINE
TOE`
Se age -Permit number ..0...... �...... `? ...:... e�Q
,E. :➢G _ 1
House number ......... - "�
.. ..................... gg���� �q•�0{{ 55 ��. z n Z BAHb$T11DLE, i
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TOWN OF =BA .
S� ~:ABLE
BUILDING_ INSPECTOR
APPLICATION FOR PERMIT TO ....O.Q.i k 0.........S.P. .....Z: ixC./:L. J QL.".e. .:.................
TYPE OF CONSTRUCTION ..... .O.Q..�...:.L Rome..............................
....................19.c
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit:according to the following information:
location /.10......../ .�r ....1.:. &...........{!: Y............. !�'4.�/ �.�..1=.........................
Proposed Use z.w.C—.k.0........ram lt�.:�C.........N.0.Zylle.f m..................... ...... ....................................................
Zoning. District ........................................................................Fire District : ..�.�'11.('. f�U.[..1„�E......Q.ss.!
Name of Owner .Address, 4 X..... '7a... ..Q.S . ...................
Name of Builder .. 1r ..t :.... .f. ........:.Address . ..Q.1�.....8. .4?...:....a .!'. l�.1/f.r�L ..............:..
,
Name of Architect ... .:...�tr V.?'. ...........................:.,..;...:......Address ...... .C3.lu. ?...W. ..4.G,lat............. ..................::...........
Number of Rooms .Foundation ..I:.Du. .u....... ......
6
Exterior ......W0Q.1?........ . .i.i1/� f.Qi,S.......................................Roofing ...... .....................................................
Floors .....R.0 .......................................................................Interior .......S.H.:i.I :T J.aal-;:r/•<........:................................
Heating .........:............................................. ..........Plumbing ... . .. ........ .....................
Fireplace .. .O5 RAC,.K.................................. ...::..Approximate Cost ... ®.a'p ...
........../.... _
"Definitive Plan Approved by Planning Board -------__------____-----------19________. Area ...........................................
Diagram of Lot and Building with Dimensions Fee ,.
SUBJECT TO APPROVAL OF BOARD OF HEALTH
0G0' o.0
n / Pie 0
0
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.
=I1J Ifvrx.�SNIC=
r , Name ....�C`...... ,..: „°,. ec a.................
Construction Supervisor's License g l°
MES, INC: yp:
�5267 One Story _
No ...,............... Permit for .................................... ;
, inc�le FamilX• Dwelling t `
5.
Location ....Lot 1.6 r 62 �jerideth way
} Centerville r
.............................................................
Owner .. 'Alden •Homes,. ....Inc......:...........
Type'of Construction Frame _
G ................................
..........................................................
-Plot...:......................... Lot .............:...................
t w ;
Permit Granted ..June..30.'.......• :.... 83
' .19 y _
T11flop Date of'Insp cti 19
� ate Co pleteo ..<.. sL.. 19
4 .