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HomeMy WebLinkAbout0274 NOTTINGHAM DRIVE ,a a .�,. :': �.:, � �...,�..,• �. .. ;1..-� _...ur -.. ...: b. �,u+"�,.�.�:��' S.•,i. 5., � a. �k :.�v. ;fii .?'. C' •��'Zt j y � F�' 1�... ��d,, - .� •„' '.W. - � .. ,rta .•,. - .r,+ �. ��4AF i (��� x�. i d�. �r~ .S.. -c C ',_.. �'- p. •� \, :.� Yb �:a. � -r-Y l.• .,: .).. � � Y,F4 r�tt ?� rr j,. - � .. � w : �,V f.•.:� ^,. ^^ ar ,. � b - F .-.. re.�"',�.v. .. .•e � .�"S. r ti~�r.� m,. ,r.. �,.;' t� -r�•�' .�' to ''�W ��• �'` ;r� �°::.,. C - 'R. r`. i i r , ' ' ok 9 J13�13 ,,Z& 206lime Town of Barnstable *Permit# Expires 6 dhs from issue date } Regulatory Services Fee / a D MASS: e$' Thomas F.Geiler,Director Building Division Q� Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.townbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number l'7 k D 39 Property Address_ 7 n� ae22=. Residential Value of Work$ Qr�� _ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 4^9/ -2lw O'5 . Spf (2—'D Ft Contractor's Name �1 �� Telephone Numbe Home Improvement Contractor License#(if applicable) ` 6) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance X-PRESS' PER Check one: ��� I am a sole proprietor .' I am the Homeowner S E P 11 2013 \]� I have Worker's Compensation Insurance Insurance Company Nam M1A/h: vF BARNS TABLE ABLE Workman's Comp.Policy# 2_j9—2-0�'� er­(Z i Copy of Insurance Compliance Certificate must accompany each permit. Permit Request check box) Ze-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken tca e ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Ze-side - ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 Improvement Contractors License&Construction Supervisors License is re d. SIG MR. QAWPFl1M\F0RMS\building permit formAEXPRFSS.doc Revised 060513 the COMMorlyff'ahk of Vassal husetts Deparftenitof1'rstks l4cciderzts - - Office of Imatigations ... 600 Washington Street Boston,MA 02LU wnnmrrlasmgm/d,ia Warkeis' Compensatian InsuranceAffidavit:BtrildersfContractorsMectricians/Plumbers Applicant Information 1 Please Print Lezibly Name(SusmewOrganization/Individual): 4�on tA-S Address: City/Statrizip: < b�� ; Phone Are you an employer?Checkthe appropriate box: �� Type ofproject r . 4. I a�a contractor and I 3'i� (required): 1.❑ I am a employer with - 6- Q New.comstnscticn Ioyees(fill andlorpart-fime}* have hiredthe sub-contractats. 2:VI am a sole proprietor or partner listed on the attached sheep 7- E50=-m deg ship and have no employees These sub-contractors have 8. Demolition e la and have workers' wo�ng for in any capacity. � 9_ ❑Building addition [1tiTo workers' comp.,nwrra.,re cep-itisuranrt regi&ed-] 5..Ej We area corporaticnand its MCI Electrical repairs or additions 3111 am a homeowner doing all work officers have exercised their 11.-❑Plumbing repairs or additions myself.[No workers'camp. right of exemption per MGL 12-D Roof s insurance required]f c-152,§1(4} and.we have,no ME]Other employees-[No workers'. comp.,insurance required.] *Amy appUomt that checks boot#1 mast also fill out the section below shnwiag rhea woodkeie compm ution pvliry mfurnudan- �Hameaaners who submit this afUdxvit mffofmg they are doing all wm k and then hire ant ace contractors mast subutit a new aft iiidsrit mdusting Soch_ TContractors that check this box mast attached an additional sheet shawh g the name of the stub-cmrtr2cbon and state whether ornot those ea bjes have empkgees. If the sib-contmaurs base employees,they mist provide me3r'w den'comp.policy number .I'nm an employer That is prm4ding itrorkers I compe?Lvadon insurance for nzy employees: Below is Ste policy and jolt site informahon. Insurance Company Name: 1 Policy 9 or Self-ins.Lic.4: � ExpirationDate: Job Site Address- ' i City/State/Zip: Attach a copy of the workers'compensaticm policy declaration page(shoeing the poliq number and expiration date). Failure to secure coverage as required under Section 25A o€MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or.one year hnpriso»eat,as well as civil penalties in the fomr 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 maybe forwarded to the Office of . IMestigations of the DIAibr inm ante coverage verification I do hereby certift under the pains and penalties ofptdury that the nforrma#ion prat�izled aboue fs true and correct Sitmatu _ ��a _ Date: Plume# 01kial use only. Duo not(trite in this area,to be�ampieted by city or town o f 9ciaL Qfty or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CiVrown Clerk 4.Electrical Inspector 5.P-lamb ng Inspector 6.Other 9 formation and Instrncdons a Massachusetts General ws chapter_152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an layee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or tten" An employer is defined as"an dividual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a jo t enterprise,and including the legal repres ntatives of a deceased employer;or the receiver or trustee of an individ artnership,association or other legal e tity,employing employees. however the owner of a dwelling house having n more than three apartments and who esides therein,or the occupant of the dwelling house of another who emplo persons to do maintenance,co etion or repair work on such dwelling house or on the grounds or building appurten thereto shall not because of suc employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that' very state or Iocal licens' g agency shall withhold the issuance or renewal of a license or permit to operate a iness or to construct uildings in'the commonwealth for a)ay applicant who has not produced acceptable a 'deuce of complianc 'th the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states' ither the common ealth nor any of its political subdivisions shall enter into any contract for the performance of publi work until acce le evidence of compliance with the insurance requirements of this chapter have been presented to th contracting thority." Applicants Please fill out the workers' compensation affidavit complete l by pecking the boxes that apply to ycur situation and,if necessary,supply sub-contractors)name(s),address(es)and ph number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liabilt Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compens . insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit ma be omitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sur to si and date the affidavit. The affidavit should be returned to the city or town that the application for the permi or lice is being requested,not the Department of Industrial Accidents. Should you have any questions regardin e law or you are required to obtain a workers' compensation policy,please call the Department at the numb below. Self-insured companies should enter their self-insurance license number on the appropriate lime. City or Town Officials Please be sure that the affidavit is complete and printed legit The Department provided a space at the bottom of the affidavit for you to fill out in the event the Office of estigations has to con ct you regarding the applicant Please be sure to fill in the per ait/license number which will e used as a reference n ber. In addition,an applicant that must submit multiple permit/license applications in any 'ven year,need only sub afone affidavit indicating current policy information(if necessary)and under"Job Site Addm "the applicant should wn e"all locations in (city or town)."A copy of the affidavit that has been officially stain d or marked by the city or wn may be provided to the applicant as proof that a valid affidavit is on file for future p its or licenses. A new afEkavit must be filled out each year.Where a home owner or citizen is obtaining a license o permit not related to any bus Ness or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person- NOT required to completeIsho davit. The Office of Investigations would lice to thank you in advan for your cooperation and you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Co=anwm1ffi o IvMmsachusetts- DegattrMM of ln' Accidents Office of l avesti txans 600a hingtaa t 1304o341l4A G21 I I Tel.#617-72 r-4900 W 406 or 1-977-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.nass_govfdia ,, AcoRv CERTIFICATE OF LIABILITY INSURANCE DATE(1104mo'y" THIS MICAT CERTIFICATE[,S NOT A A5 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERr1RCATE HOLDEP./TICS t» CERTIFlCATE DOES NOT AFF=ATIVELY OR NEGATNELY AMED, EXTEND OR ALTER THE COVE VGE AFFORDED BY THE POLICIES BELOW. TM5 CERMCATE OF 94SURANCE DOES NOT CONSTfTUTE A CONTRACT BETWEEN THE IsSLANG NIStIRER�S). AUTW 0 REPRESENTATIVE OR PRODUCER,AN D THE ClER11RCATE HOLDER AIR: the holder is an ALFIIA N%L INSUR®,fie potic 05)must be endorsed UBROGA N 1$W ,Zqi to thY terms and conditlrrs o of the policy.certain pnlcies nay require an endorsenmut. A daWmeM on tflis cerbTrote does not confet rk"b the cerdita*holder in lieu of such endorsetne PRODJCBt CONTACT Dolan 6 MaloneY Ins. Agcy, LLC IwunE: PAOI, MALONEY 141 nPiJce Road r (508 -4 FAX (508) 808-3631 Westborough, MA 015812803 R a'0NEx#Dm1A.Cox INSURE ACvrAnIN3 COVERAGE NAIC t 1NVJKER A:ACADIA INS CO Thomas P Coder INWRER8: -.-- 3 Moulton Rd INWRERC: Southborough, MA 01772 I RFRn: INGURM E- COVERAGES F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: INS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 8E EN ISSLE675 THE hNSURED NAMED ABOVE FOR THE POLICY PERIOD IAIDICATED, NOTVATHSTANDNG ANY REQUFtENIEN r TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WfrH RESPECT TO INIIKI H TM CETY'IFICkTE MAY BE ISSUED OR MAY PERTAIN.THE INSUR 4CE AFFORDED 3Y THE POUCIES DESGRIBE.D HEREIN IS SUBJECT TO ALL Tr+E TERMS, EXIMMSONS AND CONDITK)NS OF SUCH POLICES.LVATS SH04AN MAY HAVE BEEN REWCED 8Y pAD CLAIMS. LTR LTR I TYCEOFSGURAHM PQuclrNW®ER P OLcY EFF �umso LIMITS GB16rAl 1IA87LrTY EACH OCCURRENCE 3 + CCAM1IERCIAL(SWPALLMUTY I DAWGETO ICt?146retA0E OOCUR _12 i I ( I ME0 EXP(Antes p. f . I PERSOML d ADV 1KMRY E l ° GBJERAL AG'.�i'LEGATE Is G8LAC-'GRmGATELUTA*LESPER FRO0k;Crs-ODWIOPMG jS POLICY S AIMMONE LIAOr,ITY N 5teieertl j ALLOVOJED I B002Y INJURY IPffMn , i.S - .. AUTOS A t� 80D0. f1 YAF3YereWWn:j!i HREC AUTOS AL(TOSNHFD --_-- _AUTOS PROPERLY I I ig ! !UmeREY.ALUIe 000UR .. i EAC14 CCCURRENCE S E7CCESSUA6 CLPIiLalt4� AGGREGATE S 3� RETENTIONS - A f ANDE7IPLO ERS'GAMUTY TrTC-20-20-004219-00 1113112 11/3113[LEACH ANCPROPRIm%PARTI�EIi/EX8WTWY7NOl fo�V.")EXCLtO£O? NJ A ArOOENT S 100.000 r yypvss oownteunatr ! E L CIS EASE-EA euP LOYEE S 100,000 DESCRlPThDNOFOPERATIONSbelow - - I E.L.DS EASE-POLICYIM5— S 500,000 4 I ESDIPTMNOFDPE -LMSrLOMTIONSIVlFt@CLES IAeta4ACORDtot,.AEIStiwvlFNanebSdwdJa,Itmwa Mokngdnet FING CONTRACTOR. SOLE PROPRIETOR. THCMM CODER, HAS NOT ELECTED INTO COVERAGE. CERTI_ICATs FAXED TO .TCY- CODER @ 508-283-4789 CERTIFICATE HOLDER CANCEI-LATION SHOULD ANY OF THE ABOVE DESCRSED POLICES BECANCELLEO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CSRTI?TCATE ISSUED FOR ACCORDANCE WITH THE POLICY PROVISIONS. -INFORMA'TIONAL PURPOSES. • - AUTHORUM REPRESE9NTA'NE PAUL E MALONSY, CPCU ---- QV IM-2010 ACORD CORPORATION. An rights reserved. https://m.efax.com/myaccount/messageCenter#message?id=3158&tit...+%22508+898+3631%22+=+1+page(s)%2C+Caller-ID%3A+508-366-0086+ Page y Massachusetts Department of Public Safet e ulati sand Standards Board of Buildi 9 Consti tion SuPer�isor Lice e: CS-040610 j THOMAS P COD 3 MOULTON RD01771 SOUTHBOROUG1H M A ,11fj(f• �r�e��� Expiration 08110f2015 Commissioner License or registration valid for individul.use only /,c�pp y�nc ztaeu�t/�a�C/f/Ccr�aac�i��eGt� i before the expiration date. If found return to:. Office of Consumer Affairs&Business Regulation Office of Consumer Affairs and Business Regulation ( OME IMP EMENT NTRACTOR 10 Park Plaza-Suite 5170 egistraf n: ,..17Q383. Type: Boston,MA 02116 Expiratio >=10/18/215 Individual 0 THOMAS CODER — Q THOMAS CODER , r Not valid without signature 3 MOULTON RD SOUTHBOROUGH,MA 01772 Undersecretary i - PROPOSAL Thomas Coder General Construction LIC. #40610 • H.I.C. LIC. #170383 617-669-1212 Z- [op osa Submitted To: Job ame " Job# .. s c- ddress Job Location 72- `( /�l ,j p Gr Date Date of Plans one# Fax# Archit We hereby submit specifications and estimates for 6U 4(� (-574 !. !L Az� ELC C�i1�,la !6-0 toa 4el_ Sw,LD '/ e W R IA)(-(� �i Ll il r�-�► ,4 y,,-.<n a,t3�. 4J P-v S-1 ,;� 1r Gem ,� � c-�5 5,4011 We propose hereby to furnish material and labor.—complete in accordance with the above specifications for the sum of: r Dollars with payments to be made as follows:l TSio-.XK � ���!am Any alteration or deviation from above specifications involving extra costs will Respectfully su t be executed only upon written order,and will become an extra charge over and. above the estimate.All agreements contingent upon strikes,accidents,or delays beyond our control. Note-this proposal may be withdrawn by us if not accepted within - days. ACCEPTANCE OF PROP SAL The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payments Signature will be made as outlined above. Date of Acceptance: Signature TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel_ Application #W-` . 109I Z6 I6)— Health Division Date Issued Z �— Conservation Division Application Fee Planning Dept. Permit Fee ,Z? ` Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner_ t'n r l� Address Telephone R �� Permi R quest G N46 3 MR fAMAR 1AARDW00D 00 J culvj4kL-ra 'bWNl�Ur ROII'AA EAR Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ,Project Valuati` 7� d� Construction Type Lot Size y Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age a4 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 N) 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name - ��� Telephone Number Address 0 J`� �n✓� `'�� V " � � U License # s 00'�5 Home Improvement Contractor# l h q-616 Worker's Compensation # W CC 2 -3 I S-3 7R 1 4 4r Oa 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - DATE t FOR OFFICIAL USE ONLY APPLICATION# . DATE ISSUED i MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION Qb 's IL FIREPLACE . ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINALi GAS: ROUGH FINAL+ FINAL BUILDING t DATE CLOSED'OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts t 1 Department of Industrial Accidents i� , Office of Investigations 600 Washington Street Boston, MA 02111 r - www.mass.gov/dia Workers' Compensation Insurance Affidavit:.Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): e nt._ J►-n 6 v� Address: a City/State/Zip: /_V; L Je6 T Phone #: Are you an employer?Check the appropriateb .:, Type of project(required):1.ElI am a employer with 4. 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 working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12;❑.Roof repairs . insurance required.] t employees. [No workers' comp.insurance required.] 13.❑ other *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. QContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'compypoiicy information. 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. #: Vic � Expiration Date: Job Site Address: d-�"YuOT/ N G I1 A�" R City/State/Zip: CEIQ"56.a V I LV MA D q 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 and r the d t�_penalties of perjury that the information provided abov is true a d correct signafore: Date: Phone#: ^f'� 0 ) 9 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#: CERTIFICATE OF LIABILITY INSURANCE MMIDDIYYYY) F11272011 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 policy(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 GUNIACT NAME: JONATAN DALLA COSTA A—COSTA INSURANCE AGENCY INC PHONE FAX (508)675-3488 (A/C,No,EXt): (a/c,No):(508)875-9388 2 FRANKLIN COMMONS E-MAIL on@a-costains.com ADDRESS: FRAMINGHAM, MA 01702 PRODUCER CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE - NAIC# INSURED INSURERAESSEX INSURANCE COMPANY LUIZ CARVALHO D13A JC CARPENTRY AND PAINTING wsuRERBMASS ASSIGNED RISK POOL INSURER C: _ 12 FAY ROAD INSURER D: FRAMINGHAM, MA 01702 INSURER E: INSURER F: 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 BY PAID CLAIMS. INSR AUDL SUBRI I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICYNUMBER (MM/DD/YYYY) (MMIDD/YYYY) - LIMITS A GENERAL LIABILITY NNP01035 12/21/201112/21/2012 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $1 OO,000 CLAIMS-MADE Fx I.OCCUR -� - MED EXP(Any one person) s5,000 PERSONAL&ADV INJURY_ S1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMP/OP AGG $1,000,000 PRO- POLICY JECT LOC - $ — AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ,. (Ea accident) ANY AUTO " BODILY INJURY(Per person) $ ALL OWNED AUTOS • '' '` - .. ` BODILY INJURY(Per accident) $ SCHEDULED AUTOS ` _ PROPERTY DAMAGE HIRED AUTOS I .'(Per accident) $ NON-OWNEDAUTOS - _ - $ UMBRELLA LAB OCCUR s - EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ' DEDUCTIBLE $ RETENTION $ - $ g WORKERS COMPENSATION WC1-01028=011 12/21/201112/21/2012� we sTATu- oTR AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICERIMEMBER EXCLUDED? ❑ NIA -�-- (Mandatory in NH) ° E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION EFFIE LAFAROS 274 NORTINGHAM DRIVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE _ .THE. EXPIRATION DATE T E E NOTICE WILL BE DELIVERED IN CENTERVILLW MA ACCORDANCE WITH THE POLICY ONS. AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/06) The ACORD name and logo are registered marks of ACORD 12/27/2011 9:40:14 AM PST (GMT-8) FROM: insurancevisions.com-TO: 15087`906230 Page: 2 of 2 NOTICE OF CANCELLATION DATE(MM/OD/YYY1) 12/27/2011 AGENCY/PRODUCER CANCELLATION DATE(MMI DDIYYYY). - AAW INSURANCE AGENCY INC 1/7/2012 S' 373 CAMBRIDGE STREET `" c ALLSTON, MA 02134, POLICY NO. (617)783-1010 WC2-31S-378144-021 INSURED TYPE WORKERS COMPENSATION JOSE RONALDO MARTINS DBA THREE BROTHERS HOME IMPROVEMENT& ROOFING PO BOX 4802 ATTACHMENT FRAMINGHAM MA 01704 " 774-386-2842 Fax: SUBJECT ACORD 25 (05/10) Certificate of Liability: JOSE RONALDO "MARTINS REASON Non-payment of premium Your company is currently named as an interested party on the certificate of insurance issued through this agency for the below named insured. As such, you may be entitled to notification in the event any of the policy(s) shown on the Certification of insurance are to be canceled for any reason prior to either the normal expiration date. This correspondence shall serve `as notification that cancellation of the policy(s). is effective as of 12:01 a.m. on the date shown above. If you wish to verify this cancellation with the insured, our records reflect they may be contacted at the address and.phone number listed above. 'f ' CERTIFICATE HOLDER r, C. EFFIE LAFAZAROS 274 NOTTINGHAM DR CENTERVILLE MA 02632 AUTHORIZED REPRESENTATIVE NOC(07/111 - - NOTICE OF CANCELLATION CERT NO.: 11984878 Deb Derochemont 12/27/2011 9:37:06 AM Page 1 of 1 This certificate cancels and supersedes ALL previously issued certificates. _ - FEr Town of Barnstable ti ° Regulatory Services • saaxsT"LF. r crass. Thomas F.Geiler,Director 16.39. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 wwW.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section g If Using A Builder Po,-,zG a .s as Owner of the subject property hereby authorize �] to act on my behalf, in all matters relative to work authorized by this buiil&4 permit application for. (Address of Job) t I tore o er " Date i E P i P L ,.Pa-:2 G n•o s " Print Narne . l , If Property Owner is applying for permit please complete the Homeowners License Exemption-Form on the reverse side. y Q TO RM S:O W NERP ERM IS S ION Town of Barnstable �oFVE Teti Regulatory Services BMWSTABM Thomas F.Geiler,Director MAss i63;9. ,�� Building Division TED MA't A Tom Perry,Building Co ssioner ` 200 Main Street, Hyannis, 02601 www.town.barnsta e.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICEN EXEMPTION Please Pr' t n DATE: O , JOB LOCATION: .? © l I '. I4o C 7" 63.� number street Q(� vi age "HOMEOWNER": 6 Ck `r]/ "!U Is- name A' (� horn phone# work phone# CURRENT MAILING ADDRESS: A I`� (�C GL , f CM city/tXe state zip code The current exemption for"homeownerse ded to include owner-occupied dwellings of six units or less and to allow homeowners to engage an indive who does not possess a license,provided that the owner acts as supervisor. TION OF HOMEOWNER Person(s)who owns a parcel of land on he resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attachehed structures accessory to such use and/or farm structures. A person who constructs more than one hoo-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Buildinn a form acceptable to the Building Official,that he/she shall be res onsible for all such work erformedildinpermit. (Section 109.1.1) The undersigned"homeowner"ass/equirements sponsibili for compliance with the State Building Code and other applicable codes,bylaws,rules andions. The undersigned"homeowner"cerat he/she and stands the Town of Barnstable Building Department minimum inspection procedures an and th he/she will comply with said procedures and re a nts. il ure of Ho o er Approval of Building Official i Note: Three-familydwe lings containing 35,000 cubic eet or larger will be required to comply with the State Building Code Section 127: Construction Control. . HOMEOWNER'S EXE PTION The Code states that: "Any h meowner performing work for which a •uilding permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensi g of construction Supervisors);provide that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as pervisor." Many homeowners who use As is exemption are unaware that they are as ming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Cons ction Supervisors,Section 2.15) This la of awareness often results in serious problems,particularly when the homeowner hires unlicensed p sons. In this case,our Board cannot proce d against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as S pervisor is ultimately responsible. To ensure that the homeown is fully aware of his/her responsibilities, ny communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervis . On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in our community. Q:forms:homeexempt 1-BOY BEDROOM -REPLACE WINDOW -INSTALL HARDWOOD FLOOR z . -PAINT -INSTALL NEW DRYWALL -INSTALL NEW LIGHTS $1,860.00 JUST LABOR.(ELECTRICAL LABOR NOT INCLUDED) 2-GIRLS BEDROOM -INSTALL HARDWOOD FLOOR -REPLACE WINDOW -PAINT -INSTALL NEW LIGHTS $1,260.00 JUST LABOR (ELECTRICAL LABOR NOT INCLUDED) MASTER BEDROOM -INSTALL HARDWOOD FLOOR REPLACE WINDOW -INSTALL NEW CLOSET DOORS -INSTALL BATH DOOR -INSTALL NEW LIGHTS -PAINT $2,160.00 JUST LABOR (ELECTRICAL LABOR NOT INCLUDED) TOTAL. .... ............................... . ........... .21,840.00 *******MATERIAL NOT INCLUDED****************** PAYMENT- WILL BE BEGING OF THE JOB 1-$7,280.00 INITIAL JOB 2-$7,280.00-MIDDLE OF THE JOB 3-$7280.00-THE END OF THE JOB 6 AGREE: EFFIE LAFAZANOS - DESIMONE CONSTRUCTION 3TO3 r ' -CHUSETTS- I%,DRIVE s - r = { E : IS ;I , -_( �DESIMONE1 � GENE) 18 MAIN ST 1 • NORFOLK, 020560404 �. N1a%,;:tchus4:tI%- OcItarunrrtt „f Public .Nafct% Board of Buildim, Re--,ulations and Stand u•ils Construction Supervisor License License: CS 61871 , GENE J DESIMONE- ` •18 MAIN ST NORFOLK, MA 02056 ,y Expiration: 5/11f2013 C.nuni..i..ncr Tr—': 16980 + �� Po;,ynw-nuedl�t a�✓l�a�fac�u�de�Ca • Office of Consumer Affairs&B smess Regulation - HOME IMPROVEMENT CONTRACTOR' Registration: --164616 Type: Expiration: 10/26/2013 Individual De IMONE CONSTRUCTION GENE DESIMONE 18 MAIN ST - NORFOLK,MA 02056. _ -_ Undersecretary i Office f�Conumer A�"ftai s`&Bifsi'nesg I tiorci License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 164616 Type Office of Consumer Affairs and Business Regulation �. Expiration 1 0/26120 13 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 INONE CON��RUCTION (; GENE DESIMONB t ' 18 MAIN ST NORFOLK,MA 02066 Undersecretary ;+Not valid withou si g nature ry 0,*1HE JA Town of Barnstable Regulatory Services 9� .IE� Thomas F.Geiler,Director - i639 �� 039 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 December 13, 2011 Spiros & Effie Lafazanos 1503 North Burning Bush Ln. Mount Prospect, IL 60056 RE: 274 Nottingham Dr., Centerville Map-, 171,Parcel: 039 Dear Property Owners: In accordance with 780 CMR R113.2 you are hereby notified that a stop work order has been issued on the above property for violation of 780 CMR R105.2 which states-in part "It shall be unlawful to construct, reconstruct, alter, repair,remove...without first filing a written application with the building official and obtaining the required building permit and all other required permits therefore." You must contact this office and arrange for compliance. Thank you for your anticipated cooperation in this matter. By Order, 4 r L. Lauzon Local Inspector (508) 862-4034 Q:zoning5 c� 274 Nottingham Drive Ce ville 11 / 16/ 11 o - l �1 4 b 274 Nottingham Drive , Centerville 74 Nottingham Drive , Centerville 11 / 16/ 11 274 Nottingham Drive, Centerville 11 / 16/ 11 1t f 274 Nottingham Drive , Centerville 11 / 16/ 11 ` I 5 �i' 274 Nottingham Drive , Centerville 11 / 16/ 11 f k 274 Nottingham Drive, Centerville 11 / 16/ 11 s 274 Nottingham Drive , Centerville 11 / 16/ 11 � 1�11 V LWA f PROJECT ADDRESS: a 1 L-1 K)O-' -� C�w1 ✓�. PERMIT# I PERMIT DATE: 7i1 GP ( Z M/P: LARGE ROLLED LPL ANS`ARE IN: BOX c(R) SLOT j . 4 Data entered in MAAP�-program on: j BY: r