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Home My WebLink About0109 PHEASANT WAY 15" Wilt Q"TV w HAMA, MIEN W rid MWI milli a Itz i"M 'T ME Y4 join 151110i"; N' "N pt Pit, 4pg/ .......... ',Jg nil N 3 11QSi�t Ij, Nil I AN g"gi I iE It ..;"PA M_v V1 04 fowl mzjwh R- X Out lot 4 Kosovo?toot gi'o ,j gj 21*,'VVs;4aR_ MIT W-W '.W�i Sh "`NMI MMM wool oval F WON _iR R glw kjl W qL,�yr wvz Saw 15611 N gi, I-P TiVi "V .� F ,1-�FRPWR0 J 1A IN NA"MA, -',ova t All"I gg (W.,Q!fif'M - I� ,, - �, ,1 �16§ KOM "V�� gt' mg _MIX 1 pff, -.1. mgjw�k�f Wj,��Riti qgau "M WN -�w -,�q, ,wil y_ IQW.11, T" f-p _0 �.1111,11.1 Q ,plus lot KNf,1K�,1f,4y -4 PON 051 fq! WIA 'i, VW" _,�Msf ARNIM Aphigg ohm F4, .%, -r4-N;, %M11 go _iA A V A Cie '10 "K0 A in 'dp; g R i� Wf D g CON&�OA OZ 43t �1; 2-�e 1 IM"D ILI, MIAMI 1 laissugs. "; f l Wffi� ,g""g Wit "k, B YT f, IS YAW X Wl� Application number......... 0 Fee .......................V ...:.'....<.............. ................ RARNSTASM ' �P Building Inspectors Initials...s67 0 22019 OF I.-PAI Date Issued........................ .................. LE Map/Parcel...n<.r ....... ............................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION 11 Address of Project: OCou\-� ru-); Ue - NUMBER, STREET VILLAGE Owner's Name:` f_iT PaWtCA_ Phone Number Email Address: Cell Phone Number Project cost$ 0 5 l O Check one Residential, Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization Roors(no header change)# Commercial Doors require an inspector's review of(not applying more than 1 layer o shingles) Construction Debris will be going to , CONTRACTOR'S INFORMATION Contractor's name = \' - Home Improvement Contractors Registration(if applicable)# l `f 3_ (attach-copy) Construction Supervisor's License# l 01S9 S k (attach copy) Email of Contractor - Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY.IS,IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ , *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes,a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPV;I 'S SIGNATURE . /4Signature e All permit appliLtLis are subject to a building official's approval prior to issuance. 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):- JPJ21A, C_ Address: - ??yy�� S City/StatteelZip: hone#: Are you an employer?Check the appropriate b x: Type of project(required): L❑ I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* ave hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its P 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself [No workers'comp. . right of exemption per MGL 12oof repairs insurance required.]t c. 152,§1(4),and we have no employees. [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. $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. 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 owing 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 fo insurance coverage verification. I do hereby certify un a' d pe erjury that the information provided above is true and correct z Signature Z 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#: i , Infdtpy don and Instructio 'ff� Massachusetts General Laws chapter 152 requires all employers to provide workers'comp ation for their employees. F� Pursuant-to this statute,an employee is defined as ..every person in the service of anoth under any contract of hire, express or implied,•oral or written." An employer is defined as"an individual,partnership,association,corporation or oth legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representative of a deceased employer,or the 4 receiver or trustee of an'individual,partnership,association or other legal entity,a ploying employees. However the owner-of a dwelling house having not more than three apartments and who resid s therein,or the occupant of the dwelling house of another who employs persons to do maintenance,cons tructi or repair work on such dwelling house or on the grounds or building1appugenant thereto shall not because of such a ployment be deemed to be an employer." MGL chapter 152,§25C(6)als states that"every state or local licensing gency shall withhold the issuance or renewal of a license or permit o operate a business or to construct byildings in the commonwealth for any applicant who has not produce acceptable evidence of compliance ith the insurance coverage required." Additionally,MGL chapter 152, §'SC(7)states"Neither the commonw alth nor any of its political subdivisions shall enter into any contract for the perfo ante of public work until accept ble evidence of compliance with the insurance requirements of this chapter have be presented to the contracting a ority." Applicants *... Please fill out the workers' compensation affidavit completely,by hecking the boxes that apply to your situation and,if necessary,supply sub-contractors)names addresses)and pho a number(s)along with their certificate(s)of insurance. Limited Liability Companies(LL )or Limited Liabi ty Partnerships(LLP)with no employees other than the members or partners,are not required to cant'workers' conipe ation insurance. If an LLC or LLP does have employees,a policy is required. Be advised tha this affidavit ay be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be s e to sign and date the affidavit. The affidavit should be returned to the city or town that the application f the pe it or license is being requested,not the Department of ' Industrial Accidents. Should you have any questions r ar ' g the law or if you are required to obtain a workers' compensation policy,please call the Department at the n 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 1 gibly. a Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office f Investiga'ons has to contact you regarding the applicant. Please be sure to fill in the permit/license number whit will be used a reference number.'In addition,an applicant that must submit multiple permit/license applications' any given year, eed only submit one affidavit,indicating current policy information(if necessary)and under"Job Site ddress"the applic t should write"all locations in (city-or town)."A copy of the affidavit that has been officiall stamped or marked the city or town may be provided to the applicant as proof that a valid affidavit is on file for ture permits or license '. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a 1 tense or permit not relat to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said erson is NOT required to mplete this affidavit. The Office of Investigations would like to thank yo in advance for your cooperate n and should you have any questions, please do not hesitate to give us a call. , The Department's address,telephone and fax numb,,6- The Commonwealth of Massachusetts Department of Industrial Accidents Of ice of Investigations 6ashington Street Boston,MA 02111 Tel.#617-727-4900 ext 446 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.gov/dia . . ACOR& DATE-(M CERTIFICATE-OF-�LiABILiTY INSURANCE MIDONYYY) - 03►29i19 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 REP-RESENTATIVE-OR_PRODUCER,-AND_T'HE-CERTIFICATE.HOLDER, IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,.the.policy(ies)-must-have-ADDITIONAL-INSURED-provisions-or-be-endorsed: If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not-confer rights to the certificate bolder in lieu of such endorsement(s). --PRODUCER NAME: JIM-HINDMAN- Schlegel$$chlegel-Ins Broker- PHONE_ 34 Main Street (c N Ext- 508=7714381_ C No): 50877"15U West Yarmouth,MA 02673 -ADDREss: -schlegelinsurance@gmail:com- INSURER(S)AFFORDING COVERAGE- NAIL#- _INSURERa:- NGM INSURANCE COMPANY 14788- INSURED INSURER B: TRAVELERS HYTECH HOME SOLUTIONS LLC INSURER C: 447COTTONWOOD-LANE INSURER D: CENTERVILLE,-MA 02632 INSURER E: INSURER F: COVERAGES- CERTIFICATE NUMBER: REVISION NUMBER: THIS-IS-T_O_CERTIFY-THATTHE_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 MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED-BYTHE-POLICIES-DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID.CLAIMS. LTR TYPE OF INSURANCE POLICY EFF UC P N POLICY NUMBER MMIDD/Y_YYY. MMID :..... LIMITS_ _ X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 _ CLAIMS-MADE a OCCUR PREMISES Ea ooaurence $ 500,000 MED EXP(Any one n $ 10,000 A MPP5363F 01/24/19 01/24/20 PERSONAL&ADV INJURY $ 1,000,000 GEMLAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑.PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER:- $_ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ OWWNEDNED SCHEDULED _ Ea acci�nt A BODILY INJURY(Per person) _ $ - AUTOS ONLY _AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accdent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSL.IAB CLAIMS-MADE AGGREGATE $ -DED RETENTION$ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N -STATUTE ER ANY.PROPRIETORIPARTNERIEXECUTWE n $B OFFICERIMEMBER EXCLUDED? NIA WC-1163792 01/30/19 01/30/20 E:L EACH ACCIDENT 100;000 (Manda�iln N If yes, under -EL DISEASE--EA-EMPLOYE $- 100,000 - DESCRIPTION OF OPERATIONS below EL DISEASE_-.P_OLICY_LIMR.. -$_ 500,000_. DESCRIPTION OF OPERATIONS?LOCATIONS?VEHICLES-(ACOR)-1ol AdMonal'Rbmarks Schedule,maybe attached if more space is required) CORPORATE OFFICERS-HAVE ELECTED-TO-BE-COVERED-UNDER-THEIR-WORKERS-COMPENSATION"POUCY CERTIFICATE HOLDER CANCELLATION SHOULD-ANY OF THE ABOVE DESCRIBED-POLICIES-BE CANCELLED-BEFORE- THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN BELL TOWER CORP ACCORDANCE WITH THE POLICY PROVISIONS. 1600 FALMOUTH RD CENTERVILLE MA AUTHORIZED EPRESENTA E f Office of Consumer Affairs and Business Regulation One Ashburton Place- Suite 1301 Boston, Massachusetts 02108 Home ImprovemedfContractor Registration Type: LLC Registration:. .184383 HYTECH ROOFING SOLUTIONSUC. E)pi ration: 01/04/2020 12..BALDW.IN_RD_ DENNIS,MA 02638 SCA t 2(1M-05/t7 Update Address and Return Card. E3 _............ . ......._. �e rOosnmasu�ard o��'l{auae/tate�.t Office of Consumer Affairs&Business Regulation HOME-IMPROVEMENT CONTRACTOR Registration valid for individual use only TYF!E:"LLC_ -before-the expiration-date.-If found-retum-tos Registration-. Expiration Office of Consumer Affairs and Business Regulation 184383 01l04/2020" 10 Park Plaza-Suite 5170 -HYTECH ROOFING SOLUTION$.LLC. Boston,MA 02116 PATRICK CUFFORD �c 12 BALDWIN RD - DENNIs,naA 02638 - Undersecretary Not-valid-without-signature Commonwealth of Massachusetts ` F Division of Professional Licensure Board of Buildinq Regulations and Standards Constructio"V4Msor Specialty CSSL-105951-. r > 4pires:06/02/2020 PATRICK CLIFFORD _ 112_BJLLDWIN_I�9AD DENNIS MA 026$8 Commissioner �/" " POSSIBLE EXTRA CARPENTR Y: Any rotted or otherwise deteriorated trim boards, plywood sheathing, missing metal flashing,side walling or.any other carpentry needing replacement will be done and charged for as anExtm materials plus labor at the rate of $ 60.00 per hour. PAYMENT SCHEDULE: A deposit of one half is due at the signing of`this roof proposal and the final payment for the balance is due immediately upon completion. WORK SCHEDULE: All roof work is normally scheduled for completion within 30 days of acceptance and receipt of deposit providing the materials are available. Please Make Checks Payabl'io HyTech Ro,ofng'Solutions HyTech Roofing SOhltions Warranties-the=Shingles and Labor.for 20 years. CERTAINTEED Warranties the shingles and labor 100% for the First 10 Years and the Shingles your LIFETIlVIE if the shingles becomesdefective. . CERTAINTEED Warrants the Shingles up to a CATEGORY 11I,HURRICANE-130 MPH,WIND_WARRANTY. CERTAINTEED Warrants the Shingles to be Algae Resistant. HyTech Roofing Solutions -- - -Carries Workman's Compensation and Public Liability Insurance on the above work Handles all permitting and planning involved with the above proposed work -Is certified'directly by Certainteed, and processes all warranty paperwork.mvolved TOTAL INVESTMENT: (Enter Total Amount Including All Selected Options q 5-000 DATE OF ACCEPTANCE- ft)&,rAj oI 6� f S ACCEPTED BY: SUBMITTED BY: racy Fitip.Mrick Patrick Clifford —Alex Yaskavets MA CSL license 105951 MA MC license 184383 Assessor's office(1 st Floor): - Assessor's map and lot number -"' 3 S C C+ i7T'" ` wo�or,TMf>o`` Conservation(4th Floor): Board of Health(3rd floor) /� b (�. Z. JTLDLL i Sewage Permit number ! 1 HIua Engineering Department(3rd floor): , ///� i It�t,i11N hticGULATION i639' House number Definitive Plan Approved by Planning Board 19 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 TYPE OF CONSTRUCTION C✓/►JCGC'S�� G�PtCIR TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies/for a permit according to the following information: Location�(� ( �rl l�i�5/ 10M19 Proposed Use y A 7-C l,/ S 7�'Y D Jd N Zoning District Fire District Name of Owner d kWf ok%t) f3- 414lyvlZT�� Address /0 Name of Builder�/Ti�Ti1�f�//Ti�il// Address J 1�i5�i/9S +oy Y �� Name of Architect Z3 Address / Number of Rooms a Al Foundation T Exterior �/" ,�� 5 Roofing Floors � ��`� �/ S/y� Interior Heating / 0 Plumbing �/� o a Fireplace �0 Approximate Cost Area Diagram of Lot and Building with Dimensions t b1fTB(aCl Fee i !�X 16 fir 6MM VE Citl 12 X sp o(RCN Hf—: F\ SAtJT WRY OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable-retgarding the above construction. 'I-- J Natts� Construction Si ipervisor's License �" LAWLER, HOWARD o r a Cr No Peimit For BUILD DECK m AND PORCH Location 107 Pheasant Way, Centerville ~►� Owner.9- Howard Lawler Type of Construction Plot' '? Lot ' cr L Permit'Granted July 26 , - 19 94 Date of Inspection: Frame 19 Insulation 19— Fire place 19— Date Completed 19 ` r '