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HomeMy WebLinkAbout0231 MONOMOY CIRCLE :0�31 ono mo Cfl! q A Town of]Barnstable *Permit# Expires 6 months rom issue date Regulatory Services Feed Thomas F. Getler,Director Building Division U/OY Tom Perry,CBO, Building Commissioner 00 200r 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 widtout Red X-Press Imprint , [ap/parcel Number, 710 roperty Address (Residential Value of Wo k Minimum fee of$25.00 for work under$6000.00 wner's Name&Address �• @'� SC44rlV411(1: 1 C-17S)e, :ontractor's Name y IL Telephone Number So $ 71 S 1A 4- [ome Improvement Contractor License#(if applicable) :onstruction Supervisor's License#(if applicable) ]Workmen's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [V] I have Worker's Compensation Insurance zsurance Company Name Vorkman's Comp.Policy# C,2S k a 3 3 `6 C) q 025 :opy of Insurance Compliance Certificate must be on file. 'emut Request(check box) �e-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contracts License is required. 'IGNATURE: UL Z:Fonm:expmtrg tmse071405 Liberty Mutual Group PO Box 7202 Portsmouth,-NH 03802-7202 �VL11tua�. Telephone(800)653-7993 Fax(603)431-5693 May 25,2006 TOWN OF BARNSTABLE 720 MAIN ST HYANNIS,MA 02601- 1t i: Certificate of Workers Compensation insurance Insured: OLIVER KELLY 9.PEREGRINE LANE SOUTH YARMOUTH,MA 02664 Policy Number: WC2-31S-338804-025 Effective: 12aWO05 fiapira*1n-. 1228/2006 Coverage afforded under-Workers Cation Law of the following stat*): MA E=,overs L:tability Bodily Injury By Accident: $ 100,000 Each-Accident Bodily Injury by Disease: $ 10000 Each Person Bodily Injury by Disease: $ 500,000- Policy Limits As of this date~the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terms,exclusions and conditions, and is not altered by any requirement,term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right:upon you,the c�cote holder. This certificate is not an insurance policy and does not amond,extend,or alter the coverage. by policy listen above. If this policy is cancelled before the stated expiration date,Liberty Mutual will endeavur to notify you of such cancellation. . AUMORIM REMESEUMF IVE LiBERIYMUTUALIMURMCE GRMP Thi mead!isemmltdbYinERTlmuNALnouRAHCEGR=asasrdsw&i u&anumby6meowPnes : Insured: : ,Producer of Record: cc O Insured: KELLY SANDPIPER INSURANCE AGENCY INC PE:P;EC�RII�B LANE 12 ENTERPRISE BD 9 SOUTHYARMOUPH,MA 02664 - gyANNIS,MA 02601 •� GTE. -� Boar ' o B T�id 'tla ionsAant="One Ashburton Place - Room 1301 Boston. Massachusetts 02.108 Home Improvement:Contractor Registration Registration: 128987 Type: Individual Expiration: 8/14/2007 Oliver Kell Oliver Kelly 9 Peregrine,lane S. Yarmouth, MA 02664. < • Update Address and return card.Mark reason for change. DP8•DAt o sorn4Q04410121e - • . [] Address n,Renewal M ll mployinent n Lost Card. b,9910 VW'41n0Uuek 41noS v euel auV61 Od a JOA110 j AIIeH JOAn0 IenplMpu! s. Loa O u �9eezi iuop�itrys®a as 0"IN001N8WSA01i 3iN0N, • �JNPOWS O°PRO pslnBev 01PIaas8o jo pJroS - �� 1/{G IJVI/L/IrV Ir/►VNr►ir � i•+»vu»�..-.......- , Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mas&gov/dia Workers' Compensation•Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADDHcant Information Please Print Le 'bl Name (Business/organization/Individual): Address: � : CLk)r, City/State/Zip: ,-�o• Phone#: O g �`� Lk Lk O-1 Arun an employer? Check the-appropriate box: Type of project(required): 1•L1 I am a employer with 1,- 4• ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired 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 8: ❑ Demolition worldng for me in any capacity. workers' comp,insurance. g• F� Building addition o work ' insurance 5• El area corporation and its � workers' comp. 10:❑ Electrical repairs og additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11-❑ Plumbing repairs o:r additions myself.[No workers' comp. c. 152, §1(4),and we have no 121-1 Roof repairs insurance required.] t . employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below sbowkg their workers'compensation policy information' t Homeowners who submit this affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such 1Contractors tbat-checkthisboamust attached as additional sheet showing the name ofthe sub-conhaators and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.Innrrance Company Name: L Rio-7-0 4 Policy#or Self-ins.Lic.#: '�2� �S ���� Expiration Date: 2� �c� ` L_6\�U Job Site Address: 2 � C� City/State/Zip: t;l_3�� Attach a copy of the workers' compensation policy declaratfoa 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 cetwA under the pains and penalties of perjury that the information provided abov is true and correct. Si afore: Date: O C� Phone#: O [6.10ther se only. Do not write in this area,to be completed by city or fawn o ficiaf own: Permit/License# Authority (circle one): of Eealth 2.BuildingDepartmema 3.City/Towu Clerk 4.Electrical€nspector..5.7iumbina Inspector Person: Phone#: i 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 commomarealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 afiridavit. 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 contactyou regarding the applicant. . Please be size to fill in the pernrit/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 of 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. Anew 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 Investigation 600 Washington Street Boston, MA 02111 Tel. T 617-727-4900 ext 406'0r'1-S77-MASSAFE Fax# 617-727-7749 Revised 5-26-05 www,mass.gov/aia Town of Bar'astable yo Regulatory Services MASS. g Thomas F.Geiler,Director a►�;►�° ,r Building Division.. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA b2601 www.town.b arnstable.ma.us 508-862-4038 Fax: 508-790-6234 Property Owner Must Complete and Sign This Section. If Using A Builder I, S N Z GAZ'3� ,as.Owner of the subject property hereby authorize ®��.� l� to act on behalf, my in all matters relative to work authorized bythis building permit application for. (Addres�of b) &0 to Signature of Owner Mte Print Name j Q:F0RMS:0WNERPERMMS110N OLIVER KELLY 9 PEREGRINE LANE SOUTH YARMOUTH PH/FAX 508 775 4498 MA. REG* 128957 MA 02664 INSURED June 25, 2006 Proposal submitted to Mr. Lester Schmeisser of 231 Monomy Circle Centerville Ma 02632 We propose to supply all materials and labor necessary to remove and replace the existing roof at the address above. All debris to be removed-to-town transfer.- v. _ 8" Aluminum drip edge to be installed on all eaves. Ice and water damage protection membrane to be installed on first three feet of eaves and in all valley areas. Remainder of deck to be covered with#30 felt paper. 25:year.limited,warranty 3;Tab style shingle to be installed(similar to existing) Bathroom.vent,pipe boots to.be replaced with new. Cobra ridge vent to be installed on entire length of all ridges with hand nailed caps. Protect all walls, windows, decks, plants and shrubs etc. during roof strip Repair Chimney flashing as necessary. Obtaining of town permit. At a total cost ofe For use of 30 year limited warranty architect style shingle add $390 To go over existing roof Total cost would be $3200 / $390 for Architect style shingles ,Payzuent:Schedule; 30%.with signed contract, balance upon completion. •,Respectfully,submitted, Oliver Kelly Proposal accepted by, j �.e� ' Date 7/ !p /2006 T A ©© � rs,v� sF I.CG-r S4. +: k ZI 't uwAAi1U rJ At WC) 1 IA 0 V Y2> CU'-r C I RC L:G: , V� WILUARIf chi NYE f. q 49'IQ334 ' FL6 F u l 4.,Wu 0 o ki i-H 1 5 A c.s,►.,� at)vi Fo F M S L -ro TH e Zv QI LA4vU5 of Tt-� C�r..r t/ i t._ C ►- t�N�.A�Q Assessor's •map,and lot'number � 1 ,,/ — STALLED IN CQ9wf� Sewage Permit number ' ...... ' 14 DTI............ t Xf WN OF BARNS °FT"Er°�y TOWN` " ABLE ° t BARISTODLB, y MABB. r }639 " ' BU �LDING ' INSPECTOR i (Ti , APPLICATION FOR PERMIT TO ' .3 :................................. TYPE OF CONSTRUCTION ...... . ,/ - �� �. ................ .. .................................................. ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned /hereby,appli s for a permit according to the following information: Location ....................... ............. ..... ................................................................................................. ProposedUse ..... . J .. ........ l. . ............................................................................... ................................. Zoning District .Fire District .......... ...... Name of Owner .... ....................... ....................::Address ............. C. . ........ . e ' A Nameof Builder .............. ........................................... ....Address .........:............................................ Nameof Architect ...................................................................Address .............................a.. ................................................ Numberof Roo ...........`. ..............................................Foundation ........ ................................ Exterior ;.... Roofing ..... ., ............................... .. .. ......... ..................................... .... Floors ......................................Interior ... ................ -Agw................................................. .....Plumbin. .. _ g_..... ............. .. ................................. Fireplace ............... .... .. .....:................... . .............................Approximate Cost . ........................ ...... Definitive Plan Approved by Planning Board --------------------____________19________. Area ......................_................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ' a I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .!................ ..... Small, Alan E. . " 18127 . ��.�m�e otpry, ' -----.. per�k for --.------___.. -z� s1aglm faouily 1 . ` lllng .. -----------../�--...---.------- � p Moiiomoy Circle ^v^"/��/ —__ __ � ..� . . .7_____.�______.. � *' Centerville ^------------------'-------' . ' Alan E. Small Owner ------_� __...----------. � ^' Type fype of Construction --�rame............................--- . ^ � ---~------------.—�—..----' . ` #55 Plot ---------. �t ---.c------. ` . /6 January 3 '^ ,Permit Granted — � .............' lg . -~� �Do�e of |nspe��n --l�]A _ ~ Comp|e�� � �� /v�, �g uon, .���.�—,�----..�-- ' ' ~ / . ` . � PERMIT REFUSED ' �� --~—''~---.--..—..`—.---,�—. l9� ^ , '—''-----'—~----------------' � . � ~'----,---.—.---��..—..—~,—.-----. `= ~` —^^~----.c�—.....-----,..—....—.—. _--------'.^----.—..,... --~—..-.. .� . . . � Approved ................................................ lg . ------`------------,-----.—. --._----------------.----.—. ' i ` , +