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HomeMy WebLinkAbout0018 MILLSTONE WAY , « 18� �s �I�������F � c; �, � � . .: . � �. _z n � : ,, .. . � p, �� e _ �� . 4 e p � o e � ti �. a z � . . . � — .. o . � _ , � .. v r, ,t . ,. i a ,. ,. .. j .. � c ,. .............. Application numbe .. ............q.q. .... Fee ..... ......................... ............... JUL 29 2019 • BAPMADL& • KAM Building Inspectors Initials........ . .................. 1039. TOWN O� RARNSTABLE MIS Date Issued..........? 5............................... Map/Parcel.....,............................... ..................... TOWN OF BARNISTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WfNDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: vyo-q - NPM4ER STREET VILLADE Owner's Name: di,[Vet Phone Number a04Email Address: ovaCell OhoneNumber 000- Project cost Check one Residential V Commercial OWNER'S AUTHORIZATION As owner of the above p perty I hereby authorize 1/,Lj) to make application fo,la :)uil inrrmit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK 0 Siding 5eWindows (no header change) # ..L_0insulation/Weatherization ❑ Doors (no header change) # Commercial Doors require an inspector's review Roof(not applying more than I layer of shingles) 9 Construction Debris will be going to rc CONTRACTOR'S INFORMATION Contractor's name V Home Improvement Contractors Registration (if applicable)# (attach copy), - .,Construction Supervisor's License# 09� (attach copy), q -7, Email of Contractor CC�,46 Phone number 7�f ALL PROPERTIES THAT HAVE STRUCTURES 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED: 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/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual):K 4/C,V( Address: zox6ckxl!A City/E54/tp�o' Phone#: c3c 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 1 employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling These sub-contractors have ship and have no employees T 8. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. We are a corporation and its 10. Electrical repairs or additions 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 U.) dGtJ comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. 1 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: Y Job Site Address: A wl 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 ce fertheLvainsandpen lties of perjury that the information provided above is true and correct. /Signature: Date: Zq —` Phone#: —7'7q $5CP 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#: t. . ..M . w � � Offl4"f Con'sumer airs&�usih lation,' HOME IMPROVEMENT COWl RACOR ••Iridhndnal " '" 02'22/2020 1 t KYLE A mARTff KYLE MARTIN N Commonwealth of Massachusetts A'IOFDivision of PrpfeulationsLand Standards Board,of Building Reg rvisor C.onst`q §���j r .: U- pires. 11/11 19 CS-094654 �` : KYLE A MARN '466 BOXBERf�(HIML ,02336 t. EAST FALMOTA ..��'. civ Co rpissioner „ . Town of Barnstable Building A Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept *ASK Posted Until Final Inspection Has Been Made. 16;4 Q� Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit Permit No. B-19-2350 Applicant Name: Dean Fraser Approvals Date Issued: 07/23/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 01/23/2020 Foundation: Location: '41 MARTHAS WAY,CENTERVILLE Map/Loth 214-063-T03 Zoning.District: SPLIT Sheathing: Owner on Record: TOOKER, MATTHEW C,&CYNTHIA A TRS Contractor Name -,Fraser Construction Company Inc. Framing: 1 Address: 41 MARTHAS WAY Contractor License: 154747 2 CENTERVILLE, MA 02632 i�, Est. Project Cost: $2,550.00 Chimney: Description: remove and replace shingles Permit Fee: $35.00 Insulation: Project Review Req: Fee Paid:,i $35.00 Final: Date. ` 7/23/2019 ” Plumbing/Gas Rough Plumbing: .. � .,Building Official Final,Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within`six months after:issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: . All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes.. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Y . _/ Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this„permit. Minimum of Five Call Inspections Required for All Construction Work: ' Service: 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed * Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection - 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT OlJ4Tn►C o�TME Town of Barnstable' 0?6Ile 3 q of Permit# Regulatory Services Exph=6mon&sfrvmissugdff • s M Fee 039. e� Thomas F.Geiler,Director Building Division X-PRESS PERMIT Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 '!ti' www.town.barnstable.ma us Office: 508-862-4038 TOWN OF EXPRESS PERMIT APPLICATION - RESIDENTLAL ONLY 5 23f7-` Not Valid without Red A--Press Imprint Map/parcel Number o Property Address w Residential Value of Worker p� Minimum fee of`$35.00 for work under$6000.00 Owner's Name&Address I bs . Contractor's Name Telephone Number_�[j�; Home Improvement Contractor License#(if applicable) \ p.4 01 `a Construction Supervisor's License#(if applicable) ._Q ]Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner C.I have Worker's Compensation Insurance isurance Company Name J rorkman's Comp. Policy#_ \"� opy of.Insurance Compliance Certificate must accompany each permit. *� :rmit Request(check box) t �Re-roof(stripping old shingles) All construction debris will be taken to V ❑Re-roof(not stripping. Going over existing layers of roof) 4- ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value , 0� #of doors (maximum.44)#of windows *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 Impr ement Contractors License&Construction Supervisors License is required. NATURE: i PFILESTORMSIbuilding permit formslEXPPESS.doc sed 070I10 �i The Commonwealth of Massachusetts Department of Industrurl Accidents Office of Investigations 600 Washington Street 41 Boston,MA 02111 k � r www.massgov/dirt Workers' Compensation Insurance Affidavit: Builder_s/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual) f -t�►� �� ,� :Q Address: -F City/State/Zip: C of v1�\� 'Phone #: E3.01 an employer?Check he appropriate-box: Type of project(required):' a employer with 4, ❑ I am'a general contractor and I 6. ❑New construction loyees(full and/or part-time).* have hired the sub-eontraciors a sole proprietor or partner- listed on the attached sheet t 7.. ❑Remodeling and have no employees These sub-contractors have 8. ❑•Demolition ing for me in any capacity. workers' comp, insurance. 9. ❑Building addition workers' comp. insurance 5. ❑Ve are a corporation and its 10.❑Electrical repairs or additions ired.] officers have exercised their a homeowner doing all work right of exemption per MGL ]].❑ Plumbing repairs or additions lf.[No workers' comp. c. 152, §1(4), and we have no ]2.❑ Roof repairs ance required] t employees.[No workers' 13.❑ Other comp. insurance required.] *Any applicant that cheeks box 11 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 erirpinyees Below is the policy and job_site information. t Insurance Company Name: Policy#or Self-ins.Lic.#: W Z, Expiration Date: ' Job Site Address: M `� City/State/Zip: It�x Attach a copy of the workers'.compensation policy decla :on 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 S250.00 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 c under t nd aloes of perjury that the information provide above is true an correct ' Sip-nature.- a .Date: �© Phone#: So zg Official use only. Do not write in this area;to be completed by city or town bfficiaL 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 r Informatio and Instructions Massach etts General Laws chapter.152 requires employers to provide workers' compensation for their employees. Pursuant ' this statute,an employee is defined as"..every person in the service of another under any contract of hire, express or' `plied, oral or written." An employer is fibed as"an individual,partners 'p,association, corporation or other legal entity,or any two or more of the foregoing en in a joint enterprise,and cluding the legal representatives of a deceased employer, or the ' receiver or trustee of an in. ' 'dual,partnership,as ociation or other legal entity, employing employees. However the owner of a dwelling houselm�vin of more than apartments and who resides therein,or the occupant of the dwelling house of another whalemp persons do maintenance, construction or repair work on such dwelling house or on the grounds or building app rrten thereto all not because of such employment be deemed to be an employer." MGL chapter 152, §25C(t7 also states that"e a state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate b ess or.to construct buildings in the commonwealth for any applicant who has not produced acceptable ence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states er the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of p blic rk until acceptable evidence of compliance with the insurance requirements of this chapter have been present to the ntracting authority." Applicants Please fill out the workers'compensation affi avit completely, checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), ddress(es)and phon umber(s)along with their certificate(s)of insurance. Limited Liability Companies(LL )or Limited Liability erships(LLP)with no employees other than the members or partners,are not required to workers' compensation ante. If an LLC or LLP does have employees,a policy is-required. Be advised at this affidavit may be su ed to the Department of Industrial Accidents for confirmation of insurance coverge. Also be sure to sign aYsd to the affidavit The affidavit should be returned to the city or town that the applica 'on for the permit or License is ein equested,not the Department of Industrial Accidents. Should you have any qu stions regarding the Iaw or ifyo are. uired to,obtain a workers' compensation policy,please call the Departure t at the number listed below. Se ure companies should enter their self-insurance license number on the appropria a he. City or Town Officials Please be sure that the-affidavit is complete and printed legibly. The Department has provi \nt at the bottom of the affidavit for you to fill out in the event th Office of Investigations has to contact yod rea applicant Please be sure to fill in the permit/license numb which will be used as a reference number. In, an applicant that must submit multiple permit/license applic ions in any given year,need only submit one aindi ating current policy information(if necessary) and under"Job Site Address"the applicant should write"all l ' (city or town).".A copy of the affidavit that has been oil ially stamped or marked by the city or town o ed the applicant as proof that a valid affidavit is on file r future permits or licenses. A new affidavitfilled ut year. Where a home owner or citizen is obtaining a license or permit not related to any businessercial v(i.e. a dog license or permit to burn leaves etc.)s d person is NOT required to complete this af The Office of Investigations would Like to thank y u 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 numb r. The Comm nwealth of Massachusetts Department of Industrial Accidents Office of Investigations* 600 Washington Street Boston,-MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MA.SSAFE Fax#''617-727-7749 ofTy Town of Barnstable Regulatory Services s►' Thomas F.Geiler,Director. �.� Building Division Tom Perry,Building Commissioner 200 Main 5trcet,Hya=is,Mk 02601 www.town.barnstable-ma.us Office; 508-862-4038 Fax: 508-790-5230 Property Owner Mus t Complete and Sign This Section If Using A Builder R i b as owner of the sub ect ro J P putt' hereby authorize S �`\� to act on my behalf,, U in aII matters relative to work authorized by dais building permit application for. '(Address of Jab) { Signature of Owner .`' Date Wt �I� Print Name If Prop e , Owner is applying for permit please Co. nplete.the Homeowners License Exemption Form on :the reverse side: ��Tttar Town of Barnstable Reg lato Services Tbamas F. Ge ler,Director • asiss. • �+ 4 . sb39. ,b Banding ivalon Tom Perry,Buildi g Commissioner 200 Maid.Strcct; A annis, MA 02601 www.town-b table nia.us Off c: 508-862-40 8 Fax.- 508-790-6230 HOMEOWNER U 'SE=MMON Plus Print DATE JOB LOCATION: number s t village 'HOMEOVrHER": name b phone rK work phone# CLWBq f MAr G ADDRESS: aty/town states zip code The euirrmt exemption for"homeowners"wasI�Mdiffin o include owner-occupied dwelimes of six its or less and tc allow homeowners to engage an individual fo dots not possess a license,provided that the owner acts as sunci-yisor. . H0112EOWPcrson(s)who owns a parcel of land on which hd or intends to rt side; on which t$cre is, or is intruded to be, a one or two-family dwelling, attached or de accessory to such use and/or fans structures. A person who constrgcts more than bne home in a eriod not be considered a homeowner. Such `hommeowner"shall submit to the Building Officim aceep ble to the Building Official, that he/she shall be r orisub)e for all such work eufornrrd under th cumit ( an 109.1.1) The undersigned`homcowner"assumes responsibility for omplianco Stith State Building Cade and other applicable codes, bylaws,rules and regulations. The undersigned"homcownce'ccrdfi s that,be/she.undcrs .ds the Town of Ie Building Department ,,,;,,iTn'r*,inspection proccdures an4 rr quir===ts and)13Atshe.will comply with sai roeed==and requirements. Signature of Homeowner val ofEuilding,0$cial AFPm Notc: Three-family dwellings contain 35 00c feet or lar er will be•r d to co 'thdY g g g wigcq�rc mplYState:Building Code Section 127.0 Construction Control_#mM0WNExmmON•The Code states that Any berneawner pefmrrmrg work fo a bin3ding perrnit is required shaD be exempt from the provisions of thi c scetion.(Secticn l D9.I.1-11=aing of wnztruetion Supervisors) dedthatifthe homra%m engages a poson(s)fro hire to der suchwork,that such Hamcown err shall act es supuvisar._ lv any homeowners who use this cxrmpti®are unaware thatc sssurrring the responsr'bilities of a supevisor(see Appendix Q, Rules&Regina tions for;jec sing Construction Super isms,Section 2.15) This lark of awareness Men r=ulte in serious problems,particularly when the homeowner hirer unliernsed persons. In this ease,our Board Innot proceed against the unlicensed person as it would with t licensed *pervjsor. The homeowner acting as Supevisor is ultimately respoTW'81r. To==re that the honvrowmcr is fully aware of hiArrr'esporimbrlitirs,many Barr=mitics requa-e,as part of the pcmit appbradon, rat the homeowner edify that bdshe undcstands the rrspaanbilitics of a Supervisor. On the last page of this issue is a.form eurrrndy used by necral towns. You may care t amend and adopt such i forrr11Certi5cxUoA for use in your convrnmity. f ; r - ✓�ze t�arninzoouuea�i o��aaoac�auael�a office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Type. Registratiom.: �132149 Expiration 11128/201.2' Individual DEAN F.STANLEY +` DEAN-STANLEY 359 CAPT.LIJAH RD':;; CENTERVILLE,MA 02632- Undersecretary Nlassachusetts- DePillIment of Puhlic Safety Board of Building Regulations and Standards j Construction Supervisor License License: CS 35037 Restricted to: 00 4 DEAN F STANLEY 359 CAPTAIN LIJAH RD CENTERVILLE, MA 02632 i Expiration: 1/19/2012 (' nunisxio+�rr Tr#: 12334 10/29/2010 15:56 5083932273 NORTHWOOD INSURANCE PAGE 01 �+ + OF ID:TO CERTIFICATE OF LIABILITY INSURANCE DAT10129INYYYYI �- ERTIFICAT �o,z~irlo 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 pollcy(les)must be endorsed- If SUBROGATION 18 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 endorsemen s. PWUCE►t 508-771.1632 NAME T NE Northwood Ins.Agency,Inc. 508-303-2956 P,a N .E FAX Na "0 Main Street,suite 9 Hyannis,MA 021801 9!9953TANL-1 INSURMSt AFFORDWG C WERAOB N=F INSURED Dean Stanley Building INSURER A:Liberty Mutual Insurance Co, Contractor,Inc. INSURERS: 350 Capt.Ujahs Road INSuRtrR C: Centerville,MA 02632 INSURER D INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THI$I$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 BY PAID CLAIMS. APPL Ovum POLICY EFF POLICY I TYPE OF INSURANCE POLICY NUMBER 1111"aY MM EXF L LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RERTEV— COMMERCIAL GENERAL LIABILITY P MI Ea ocClurar>a $ CLAIMS-MADS OCCUR MED EXP(Any ane person) E PERSONAL 6 ADV INJURY 9 + GENERAL AGGREGATE i GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG 3 POLICY P LOC S AUTOMOBILE LIABILITY COM15INED SINGLE LIMITMe accklw) $ ANY AUTO BODILY INJURY Par ALL OWNED AUTOS 8DD4Y INJURY tPer acdtleM) S SCHEDULED AUTOS PROPERTY DAMAOE HIRED AUTOS (Per amIdent) NON-OWNED AUTOS $ UMBRELLA UAV OCCUR EACH OCCURRENCE S 19XCEBB LIAR HCLAWS-MADE AGGREGATE E DE~DUCTIQLE $ RETENTION S WORKERS COMPENSATION WC STATU- OTFi- I ER AND EMPLOYERS'LIABILI Y p r N A ANY PROPRtETORIPARTNERIEXECUTIVE ❑ NIA C13133743140110 08,31,10 08,31,11 E.L.EACH ACCIDENT S 100.0 OFFICERIMEMBER EXCLUDED? 9OO 00 (ruandOW In NH) E.4.OIBEA19E-EA EMPLOYE 9 r H yes,deetxlbe under E.L.DISEASE-POLICY tjMrr $ 600,00 DESCRIPTION ofO-I.ERA71ON 6 1910W DESCRIPTION OF OPERATIONS I LOCATIONS I VBNMEs (Atleeh ACORD 101,AddRlonil Remarks Sthedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Dean Stanley Building ACCORDANCE WITH THE POLICY PROVISIONS. Contractor,Inc. 369 Capt.UJahs Road AUTHORIZED REPRESENTATIVE Centerville,MA 021B32 �&' 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD