HomeMy WebLinkAbout0471 OLD STAGE ROAD ICI
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Giangregorio, Robin : oor1 7l ( �
To: Kalweit, Doug ,
Subject: NR Dilemma
Hi Doug,
I got a complaint from a woman who lives next to some the Andrews property owned by the town. I spoke to
her about 15 months concerning abuse by 4 wheelers riding in the area. She says that DNR installed some
large boulders to discourage entry. Whereas that was successful in the beginning they have now found other
points of entry and are once again abusing the area. Is this a complaint I may forward to you for resolution
and if so can you keep me posted accordingly? If I should be contacting someone else please let me know
and I will do so immediately. The caller identified herself as Debra Cahoon. You may reach her at 508-771-
9774.
Thanks for your anticipated assistance.
Robin C. Giangregorio
Zoning Enforcement Officer
Town of Barnstable
200 Main Street
Hyannis, Ma
508-862-4027
I "
z
3/23/2006
�QFT T , Town of Barnstable *Permit#
�p Expires 6 months rom issue date
.• Regulatory Services Fee
• RARNSrABL.E,
9cb MASS.
,� Thomas F. Geiler,Director "
AlfD�rp
Building Division
Tom Perry, CBO, Building Commissioner �Ru EE % PERM
260 Main Street, Hyannis, MA 02601 ,
www.town.barnstab le.ma.us
Office; 508-862-4038 'OWN OF AiPRI98 8U-3
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
�(hh Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address..
residential Value of Work ? .o .&5 Minimum fee of$35.00 for work under$6000.00
Owner's Name& Address C41A6 D11
Contractor's Name . MAW- `Ae PVIA Telephone Number q--:�. j9�� (o
Home Improvement Contractor License#(if applicable) k c9 b q 76
Construction Supervisor's License#(if applicable) Q {j 1 1}b
❑<rkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
[D'f6ave Worker's Compensation Insurance
Insurance Company Name_._' km
Workman's Comp. Policy#
Copy of insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
Re-roof(stripping old shingles) All construction debris.will be taken to.
❑Re-roof(not stripping. Going over existing layers eof roof)
❑ Re-side
#of doors
❑ Replacement Windows/doors/sliders. U-Value (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 mu sign P ope ty Owner Letter of Permission.
A copy of a Ho elm v nt Contractors License & Construction Supervisors License is
uire i
SIGNATURE:
Q:IWPFILEST0RMSlbui1ding permit formslEXPRESS.doc
Revised 070110
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
\V_ /IBoston, AL4 02111
c- www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): 2�— �A2
Address: bO 7
City/State/Zip: C � WI. Phone #: -1i c9b L.91 b
Are you an employer?Check the appropriate boz:' Type of project(required):
1. B-1-am a employer with 3 4. Ell I am a general contractor and 1:
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. t 7•. ❑ Remodeling .
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. workers' comp. insurance. r 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a,corporation and its
required.] officers have exercised their ]0.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions
myself. [No workers' comp. c. 152, §](4), and we have no 12. )woof repairs
insurance required.] t : employee's. [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. :
lContractors 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 employees. Below is the policy and job site
+ information.
Insurance Company Name:
Policy#or Self-ins Lic.#. 'Expiration Date:
Job Site Address: 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 c era a verification:
I do hereby certify u er a pa d pe al f perjury that the information provided above is'true and correct:
Sig-nature: 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#:
tt
Information and Instr ctions
Massachusetts General Laws chapter 152 requires all employers to provide wor ers' compensation for their employees.
Pursuant to this staNte, an employee is defined as"...every person in the servic of another under any contract of hire,
express or implied, o al or written."
An employer is defined "an individual,partnership,association,corporati nor other legal entity,or any two or more
of the foregoing engaged a joint enterprise,and including the legal repre entatives of a deceased employer, or the
receiver or trustee of an in 'vidual, partnership, association or other legal ntity, employing employees. However the
owner of a dwelling house h ving not more than three apartments and o resides therein, or the occupant of the
dwelling house of another wh employs persons to do maintenance, c struction or repair work on such dwelling house
or on the grounds or building ap urtenant thereto shall not because o such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also s tes that"every state or local censing agency shall withhold the issuance or
renewal of a license or permit too erate a business or.to co truct buildings in the commonwealth for any
applicant who has not produced ac ptable evidence of co pliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C )states"Neither the ommonwealth nor any of its political subdivisions shall
enter into any contract for the performan e of public work til acceptable evidence of compliance with the insurance
requirements of this chapter have been pre ented to the con acting authority."
Applicants
Please fill out the workers' compensation affida 't com etely, by checking the boxes that apply to your situation and, if
necessary,supply sub-contractors)name(s),addre s(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or L i d Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry worke ' compensation insurance. If an LLC or LLP does have
employees,a policy is Tequired. Be advised that this a davit maybe submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. A o e sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for e p it or license is being requested, not the Department of
Industrial Accidents. Should you have any question regard' the law or if you are required to obtain a workers'
compensation policy,please call the Department at a number 'sted below. Self-insured companies should enter their
self-insurance license number on the appropriate e.
City or Town Officials
Please be sure that the affidavit is complete d printed legibly. The D partment has provided a space at the bottom
of the affidavit for you to fill out in the ev t the Office of Investigations as to contact you regarding the applicant.
Please be sure to fill in the permit/license umber which will be used as a \\ ference number. In addition, an applicant
that must submit multiple permit/licensei pplications in any given year, nee my submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant§�ould write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by Ale city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related 6 any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.)said person is NOT required to co lete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation d should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone a_ fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations' '
600 Washington Street
Boston,-MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass.gov/dia
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PEEP TOAD ROAD 'rF, 7 st r �
K'�
} y Y z CENTERVILLEMA 03632
f 508-420 6216/774-238-2938 s ;
www.markherbst.com
l` S
PROP A B TO: WORK PERFORMED AT: k r ttF
i
at; William Cahoon
�� 47101d Stage road SAME
Centerville MA r$
508-771-9774 y 4
We herby propose to furnish the materials and perform the labor necessary for the completion of: 24h
New Roof, Eli
�48 }
f}Y u Remove 1 laver of existing shingleKPI
f "�✓i, � .; a ,- }
=i Install ice&water shield at edge 7
• 3; + Install 8n drip edge £ y y~ t
Install 151b.felt paper
• ` Install Certain Teed LandMark 30yr,algae reisitant shingles T
tx
Cut ridge&install cobra vent
r ,
z, rtit; Storm nail all shingles
f All debris cleaned daily
.Replace side wall shingles from roof line up on cheak area above doorway - - ;lA�' Gh X1-Fr'.f
: :. Replace cheak flashing „� l
Price includes material,labor&dump fees } 5v }?
w
� r %ti
k�'�'�k.0 1� } � R ;i:. � .jt t i •grR�y'+f`'1S�FSr4'a3,.
All material is guaranteed to be as specified. The above work will be performed in accordance with the specificafions submitted`z
and completed in a substantial workman-like manner for the sum of: Three-Thousand Eight-Hundred&Fifty
Dollars($3,850.00)with payments as follows: Full amount due.upon completion
ng
5 *Any alterations from above proposal involving extra costs will
be added under a separate written agreement grid become an extra'
` charge over and above said proposal.
r x+ '
{ � RESPECTFU UB TE2/19/11
t
Mark Herbst
k i p ,
ACCEPTANCE OF PROPOSAL , ,r
The above price,specifications and conditions are satisfactory.I herby accept this"proposal. .You are authorized to do fhe worked.
payments will be as specified above. ,
SIGNATURE:
{ aka t * 9 ° rJ � a
t� ,� Sr.z , .:.This proposal maybe withdrawn,by said company..if:not accepted.within 30:days :_• , R � .•
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. a
� a
�/,� License or registration valid for individul use only
Office of Consumer Affairs&Business Regulation g
HOME IMPROVEMENT CONTRACTOR t before the expiration date. If found return to:
Registration 126480 Type Office of Consumer Affairs and Business Regulation
Expiration: 6/812012 Individua}. 10•Pitlrk Plaza-Suite 51,70
Boston,MA 02116
MA K HERBST T =
4
v
MARK HERBST
35 PEEP TOAD RDA
CENTERVILLE, MA 02632 Undersecretary. Not valid wi o t signature
= •- Massachusetts- Department of Public,Safety
Board of Buildinly Regulations abd Standards
i
Construction Supervisor License ,
License: CS 48546
Restricted to`. 00
MARK D HERBST 41.
t
35 PEET TOAD RD.' E r
CENTERVILLE, MA 02632
Expiration: 1/27/2012 .
('ummissiuncr Tr#: 13699
COMPENSATION AND..EMPLOYERS LIABILITY INSURANCE POLICY
WORKERS INFORMATION PAGE
/ fated Industries of Massachusetts Mutual tts Insurance Company
ASSOCNCCI NO 26158
54 Third Avenue,Burlington,00)876-2765 sa
POLICY NO. AWC 7016215012011
PRIOR NO. AWC 7016215012010
ITEM. Mark Herbst
1. The insured MA 02632
35 Peep Toad Road
Centerville
Mail Address: State Zip Code
County.
Town or City
Street No. FEIN 02-8402887
Indmdual ❑Rartnership ❑Corporation njointVenture ❑Association. ❑Other
Other workplaces not shown above:
to 01l10I2012 12:01 a.m.standard time at the insured's mailing address.
2, The policy period Is.from 01/10/2�— — lies to the Workers Compensation Law of the states listed here;
3. A. Workers Compensation Insurance:Part One of the policy applies
MApolicya lies to work in each state listed in item 3.A.
B. Employers`Liability In Part Two of the PP 10000 0 each accident
Bodil Injury b Accident$ 500 000 Dolicy limit
The limits of our liability under Part Two are: Bodily Injury by Disease $
Bodily Injury.by Disease $ 100.000 each employee
C. Other States Insurance:Coverage Replaced By Endorsement WC 20 03 06A
D. This policy iudesthese endorsements and schedules:SEE SCHEDULE
nd
for this policy will be determined by our Manuali of Rules,Classfications,Rates and Rating.plans.
4. The premium audit.
All information required below is subject to verification and change by Rates
Premium Basis Estimated
Classifications Per$too Annual
Code Estimated Or
N Total Annual Premium
' . Remuneration
Remuneration
INTRA 150 148 -
SEE
NSION OF INFORMATI N PAGE
Total Estimated Annual Premium $
Deposit Premium
Minimum premium$
$
As indicated interim adjustments of premiumuarterly shall be Monthly
® Annually ❑ Semi Annually ❑ MA Assessment Chg.
$824.60 x 6.8000%
01l0412011
This policy,including all endorsements,
is hereby aDunteigned tiy. A�tlwrized signature
NAME SAFETY Leonard Insurance Agency Inc -
GOV GOV KIND PWCING CLAIM P O Box 494
Osterville,:MA 02655
STATE CLASS . AUDIT 00F4FICE OFFICE CHECK GROUP
MA 5645 2
WC o 00 01 A(11-88),
Includes�ppyrighted material of the National
Council on Compensation Insurance,
used with its permission.
FRIEDLINE& CARTER ADJUSTMENT, INC.
436 Main Street, P. 0. Box 338
Hyannis, Massachusetts 02601
Tel. (508) 771-3232
FAX (508) 790-2344
TO: ( Building Commissioner or Inspector of Buildings
( ) Board of Health or Board of Selectmen
( ) Fire Department
TOWN OF HYANNIS
TOWN HALL
HYANNIS, MA
RE: Insured: CAHOON, William & Debra
Property Address: 471 Old Stage Road
Centerville, MA
Policy Number: H0344899
Type of Loss: Lightning
Date of Loss: 7/2/2004
File#: 99975
Claim has been made involving loss, damage or destruction of the above captioned
property, which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143,
Section 6 to be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate,
please direct it to the attention of this writer and include a reference to the captioned
insured, location, policy number, date of loss and file number.
On this date, I caused copies of this notice to be sent to the persons named above at the
addresses indicated above by First Class Mail.
R. M. NEGUS
Adjuster
11/30/2004