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HomeMy WebLinkAbout0027 MILLSTONE WAY i ., a .. o r .. .•� � � �' � o I Y r = Town of Barnstable *Permit it Expires 6 months rom issue date Regulatory Services Fee v RARNSTABLE, : Thomas F.Geiler,Director 94, 6 SS. ,m� Building Division ATFb�,t a Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.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 ( �� Property Address P/Residential Value of Work �� 800 ►nimum fee of$25.00 for work under$6000.00 Owner's Name&AddressA'/U 4e-1'r��L Contractor's Name ee fJ A,4)A4--S6-4) IdLo, 6,lnte;� Telephone Number Home Improvement Contractor License#(if applicable) t 3 PWorkman's Compensation Insurance X-PRESS PERMIT Check one: JUL j 4 2008 El am a sole proprietor ❑ I am the Homeowner [tKl have Worker's Compensation Insurance TOWN OF B/- RNSTABLE Insurance Company Name -U Workman's Comp.Policy# g�� t Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to j ❑ Re-roof(not stripping. Going over existing layers of roof) Cz c� ❑ Re-side [replacement Windows/doors/sliders. U-Value ©" 3 S (maximum.44) ` *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e. istoric,CjW—rvati n-etc. CC r_n ***Note: Property.Owner must sign Property Owner Letter of Permission. O i rn A copy of the Home Improvement Contractors.License is required. SIGNATURE: Q:\WPFILESTORMS\building permit forms\EXPRESS.doC Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents x 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): � Address: 3 7 City/State/Zip: V Oc, 9_V099f r Phone #: Are y an employer?Check the appropriate box: Type of project(required): 1. I am a employer with. . 10 4.' ❑ I am a general contractor and I. 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 shipand have no These.sub-contractors have -employees 8. ❑Demolition working for me in any capacity. employees and have workers' insurance. 9. ❑ Building addition comp.[No workers' comp. insurance P• 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._ ther.. [aGOPV40� comp, insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors.that check this boz 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: ?;e,0_C090 Policy#or Self-ins.Lic.#: o���j� o Expiration Date: c9 0 Job.Site Address: Cc! City/State/Zip:. o 3 Attach.a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or.one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be'advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: 7- /-1 ' Date 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 ,defined as"an individual,partnership,association,co oration or other,legal entity,-or any two or more of the.foregoin engaged in a joint enterprise,and including the legal r presentatives of a deceased employer,or,the receiver.or trustee f an individual,partnership,association or other 1 gal entity,employing employees.' However the owner of a'dwelling ouse having not more than three apartments an who resides therein,or the occupant of the dwelling house of and er who employs persons to do maintenance, onstruction or repair work on such dwelling house or on the grounds or bu ding appurtenant thereto shall not because f such employment be'deemed to be an employer." MGL chapter 152, §25C(M also states that"every state or local U ensing agency shall withhold the issuance or IV renewal of a license or perknrt to operate a business or to cons ruct buildings in the commonwealth,for any applicanfwho has not produced acceptable evidence of comp 'ante with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the co monwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until cceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contrac 'ng authority." Applicants Please fill out the workers' compensati, affidavit completel ,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name ,address(es)and hone number(s)along with their certificate(s)of insurance. Limited Liability Companies(L )or Limited L ability Partnerships(LLP)with no employees other than the members or partners,are not required to carry orkers' coin ensation insurance. If an LLC or LLP does have employees,a policy is required. -Be advised that.t is affidav may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Iso be ure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for I e pe it or license is being requested,not the Department of Industrial Accidents. Should you have any questions reg g the law or if you are required to obtain a workers' compensation policy,please call the Department at the er 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 le ibly. Th Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office o Investigati s has to contact you regarding the applicant. Please be sure to fill in the permit/license number which ill be used as reference number. In addition,an applicant that must submit multiple permit/license applications in a y given year,ne only submit one affidavit indicating current policy information(if necessary)and under"Job Site Ad ess"the applicant ould write"all locations in (city or town)."A copy of the affidavit that has been officially s ped or marked by th city or town may be provided to the applicant as proof that a valid affidavit is on file for fu e permits or licenses. A w affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to an business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete is afidavit. The Office of Investigations.would like to thank you' �dvance for your cooperation and\sh�o.'Id you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Common ealth of Massachusetts Department o Industrial.Accidents Office o'investigations 600 Via ington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mas.s.gov/dia � \ � � | From:Shaunna Robinson,Hunter Insurance At:Hunter Insurance.Inc. FaxID* To:Denise Date:9/17/07 12:56 PM Page�2 of 3 PRODUCER THISZERTIFICATE19tSSUED AS A MATTER OF INFORMATION E T AMEND,EXTEND OR nFICATE DO -S NO inter insurance, Inc. ALT-tk:tHE6. VERA*q:;#,A' FF-'0RDED BY THE POLICIES BELOW. Phone- 461-769-9SOO rax:401-769-0502 INSURERS AFFORDING COVERAGE NAIC 9 INSURED INSURER A: rt.ti—i o—n 1400ll Inc. Aliqletsen of RI Woonsocket RI 02,89S INSURER E. rHF POLICIES OF INSURANCE LISTED BELGWi-AvE BEER ISSUED To THE INsuRep ng,�ABOVE FOR THE POLICY PER!OD INDICATED.NOTWITHSTANDING ANY prouIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'WITH RESPEC,I T TOWHI"KTHIS CERTIFICATE MAY BE ISSUED OR M�,Y PERTAIN,THE INSURANCE AFFORDED BY THE POLICFES.DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERW,EXCLUSIONS AM CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS 94OWN MAY HAVE SEEN REDUCED By PAID CLAIMS. PC LIMITS GENt AGGREGATE LIMIT APPLIES PER: ALL OWNED AUTOS BOIDILYINJURY SCHEDULED AUTOS HIRED AUTOS BODILY I"RY NOI,I,-OWNED AUTOS PROPMTY DAMAGE GARAGE LIA I BILITY AUTO ONLY-EA ACCIDENT EA ACC S DEDUCTIBLE Ifyes dascnbo under E.L.DISEASE-POLICY LIM T $500000 SPEEM.PROVISIONS below OTHER � CERTIFICATE HOLDER Moon Associat", Inc DATE THEREOP.THIS 19SUING4NOURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN dba Gutter. ItO.ImOt NoyIC�Tq ne C"T I FICATIE HOWER NAMED TO THE LIE".BUT FAILURE TO DO SO SHALL dba Renewal by,Andiprsen IMP09 NO osu"'noIN OR%LLABILITY'OF AM KIND UPON THE INSURER.ITS AGENTS OR REP "..~s~c~_t ~^ ----- ENTIATIVE ` . ^ . . ' . , ' ^ ` , . � ✓/Le uaett License or registration valid.for individul use only �\ Board of Building Regulations and Standards before the expiration date.,If found return to: HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards One Ashburton Place Rm 1301 Registration: 119535 Boston,Ma.02108 Expiration: 7/24/2009 Tr# 130185 Type: Private Corporation MOON ASSOC INC JAMES MOON ►-,�- ""�-.,-... . 1137 PARK EAST DR. <� Not valid ithout signature g re WOONSOCKET,RI 02895 Administrator Board of Building Regula ions and Standards One Ashburton Place - Room"1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 119535 Type: Private Corporation Expiration: 7/24/2009 Tr# 130185 MOON ASSOC INC JAMES MOON 1137 PARK EAST DR. - WOONSOCKET, RI 02895 Update Address and return card.Mark reason for change. DPS-CA1 0 50M-05/06-PC8490 Address Renewal Employment, Lost Carl All O U u I U Customer Name:11 Alry i-L 2 U Ijii L C to ITT Year Built Renewal by Andersen of RI&Cape Cod y Renewal sales Agreement Addcrss: �ZNI,�t S>vp 1. A v Customer[D#: 1137 park East Drive 'Andersen. City,State,Zip: C 4' NT�1 L L A'; n�7 z Order Number. Woonsocket,RI 02895 WINYOW REPIACEMERT M Aadm Cam V Phone-Home: .F 77/— Z-CD 1 / license#RI 12259-MA 119535-Cr .I Phone-Work:Ca 7 7C —i7 2-3 Page: of Dace: h—S_ 00' 0562725 Email: UNITS tedtmal Measure GRILLES p ohetelnions Si c y.s L �7 s- of -L -S a' g aal� .a x Boom �3 t ! �`g L>o " g� I. �f if oS 'Wa 8' {� x a sp m >;m „� � W gB •� �S - 8 „ag4 y6 r, b°. S PRICE S a F 2€8z Description � all ji V€ `ok is �J s� 7 V �® _ �o ~`o Nb 2- 0— 1 DO 4- z Der ► II „ „ 1 I F COL , 3 aJC- r! -t F n - 11 II i i _ CoL 11 /r -3 2 1 c w ► ,, rl a �. F t s� - ` c- D 13 1 n II II I I 1 eo L-761M, /, 3 7 -b—3 l�jj I U Ir 11 I I F Cot3A714 DO ► >uN 11 I♦P t i F C"� -5 1) 3e 3} coos Credits or rases Sub Total pea.i) Proposal:As of Ihe.bote ®a dtmo m ptwidm the oomt.movm.coed I�ctp 7be S n - P8 M Method t� vaM fm 3o deye and a wbi=m accepuo«br bolh Cunome and Rmcvd by Md�a.�m M.n.ge�.. �P,Rot Repair.Pcom on.etc) Y� Deaei R/Ntwra Price$ Sub Total poor neN 6-5-0k -2:/y 4-S51-Y lls/ /q PI-11h) hzli ✓vh73 �4 Sub rwalw..R.o 3L/ j% � ` Dace Saw Repte> tm Sig— Customer Acoep e:Yoo arc hell y aad,00aed m fum h ou vier s.—ood door q—d comiJeoe tlria Mkt Credits or Expenses G/ Credit Card t for whuhu Bx u.d..V d qp—m Pay the amwmt—md.dlb.g—and accmdiog m d,e- heceoc See Reverse Side for Terms and Conditions of Sale.You,the buyer,may cancel p0c, this transaction at any time Ipgnor to midnight of the third business day after the date of this transaction.Ylease see attached notice of cancellation for an Sells Tax dHre dehe ally explanation of this right. Total Miscella a ous Ctedie or Espaua A¢eped 6-S Oj' X yd?!l,..�/ ,f fd,ry o v rod m ml,c.credit,e:p<a:tdmm m ri waist Permit coat Jj( AMII order rawtApply) dtde aR outAthwh Dote CouametAppmvd 5paoue - Special Order Notes Total Amount of Agreement �� G Rron ae. slam 000r BWB— BOY D— AoccpoM Due Ren dbyAodaamMemgerSgeamee ALL L 900M i'`/7'p7A.nfAI-5 Ank /hC Deposit Required O J s�.aanytta,do. Mq��Pe sena+�Rn RnwY byaeaerun Ralnwl and nYeueadm WMx notasutrwmurDlemeldmrepiag VP7046-tf}• Kilti/r(•- LlFZS /- Balance Due on Completion 1Uo twp�e:ywNdrour does rotquaate>ti damn ramt�aY�an mr,weeal dQelwre.xaeewta ag wetn daiMse ee aeededb rotidided NdedgeW nimw sdely de nsywabslryd kd'ecaeed oeag umeeson ere edl raspier . el thh rder meedlgtaf0anen udo tlr oernwe& aaddiage dlnoe npeat apm yov;poebL H. b N t - I.. L Pria include labor numialt,iawRatioo, y rated teas oe lmoeed, oe,nwee rotes AttheeMdlhejob cl—y lmdedh+il he removal.and of products laecd. mrowd and we will deeeyar luWwYdows old White-Berlevvel try Afldaten YegoW-ImiaBaeMl PYdc-Homeowner dkpaeal P RP customer Customer Customer tie eeaa�tlu,aei - Initialy Initial: Initials: - ro:.dgn.dea.•,.d Ae". •y..ams Nwwn.e,..,b ueMlevr.pevdo.omoe�nd,evn.pw�tla,w.�ee v..e Uro orate.as-wo�A ai rine Dept. ' _0or) Map 6-L,4L Parcel l S j Permit It 1 �Q -. House It Date Issued (p P O / 00 �,5 Board of Health(3rd floor)(8:15'=9:30/1:00-4!39a�n-, "� Fee O O Conservation Office(4th floor)(8:30-9:30/1:00=2:00) Planning Dept. (1st floor/School Admin. Bldg.) �t� �u-t AVw Definitive Plan Approved by Planning Board 19 - BARNS19Z MASS 1 9 j TOWN OF BARNSTABLE Building Permii Application Project Street Address / ( Vh t (! y�i L-V�+c z Village Owner S Lj /� �'I, X Address 5-9 Telephone -Permit Request a First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 2700 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Lk Two Family ❑ Multi-Family(#units) 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) . Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name j.z L �-�, 4� Telephone Number -7 -7 —7 7 6_;1 Address j /. ,� License It LJ_/ )14n^;4 s 1�6 62- oyiL_ Home Improvement Contractor# / D Worker's Compensation It E-v 7 `y' 4 1 b j NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r - SIGNATU DATE lc� BUILDING PERMIT DENIED FOR THE FO WING REASON(S) .r '7 FOR OFFICIAL USE ONLY PERMIT NO. �-rr DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER , DATE OFINSPECTION: FOUNDATION t FRAME 1 INSULATION - = FIREPLACE [ _ / ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL _ GAS:,, ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. ; . Y t i Assessor's office(1st Floor): —� _�J! ® SEP7C SYSTEM'!mu T = tNe Assessors map and lot number Hof Board of Health(3rd floor): UN'S" ALL lMTH IED IN TITLE 5 COMPLIANCE Q e� Sewage Permit number y—�� � • -� r E'ENPUftlb`d0B71®9 ENO IL C00, F t,:.�7if1) MAS&= BAH L i Engineering Department(3rd floor): � rasa House number TOWN REGULATION3 1639 Definitive Plan Approved by Planning Board 19 �Fo rar a APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN .OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO OL J +0 1:Xf o ` (�—QQ TYPE OF CONSTRUCTION �l Q � _ P— ,/�(a _ pi�eQq 19 J ' I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a'� permit according to the following information: /I) Location t-1 s - or C'�^ ✓i l/t` Proposed Use 1 Otn�iA I Zoning District TC- - V"'�_ Fire District Cent , Ae Name of Owner `0 reivy G�Mi C Address At 1164� ram/ _ Name of Builder E &\a n ®LA n.0tk Address 7 S" /✓�-�'' Pam`( //L- Name of Architect Address x Number of Rooms Q°v,:L G I Foundation e6 u✓�(,� Exterior Qn Roofing aS k /7— Floors C py DES Interior 10/' Heating H IAI Plumbing ��nL Fireplace /�� �— Approximate Cost Area Diagram of Lot and Building with Dimensions !— - - �� Fee ®� i goo^ �� 0 S , h - � I Lit LI ne 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 C��r.►n d r► Construction Supervisor's License CHARIF, LOREN No 33183 Permit For BUILD ADDITION -A Single Family Dwelli'ng 4;! Location 27 Millstone Way t Centerville -Owner Loren Charif ;fin r KType of Construction Frame Plot Lot ` Permit Granted September 5, 19 89 Date of Inspection h 19 D'ate,Corripleted /l/ 19 CM " a ` r Y t