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HomeMy WebLinkAbout0038 PRISCILLA STREET n i � W n e , ti 1 F INE t Application number..................... ............: - _ Date (ssued...........`.��1. �,�...................................... MAM EWLN BM KNOW Building Inspectors Initials... ... ............................ SEP13 2018 Map/Parcel.............................. ......................... Tn1 IN iiJ� 6ARN I U TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/VVEATHERIZATION PROPERTY MORMATION Address of Project: 3 NUMBER STREET VILLAGE Owner's Name: G.-e�, s k a i ko W S K,/ Phone Number _ 2-o I- 5 6 (- N 7 7.F Email Address: Cell Phone Number Project cost$ 41.7 q 2 -- 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: S e* .4\- ,,JKa 06-76,4 Date: TYPE OF WORK Siding Windows (no header change)# l Insulation/Weatherization ��- Doors (no header change)# Commercial Doors require an inspector's review J Roof(not applying more than 1 layer,of shingles) Construction Debris will be going to Gcl&s4e-1- 14n g P�'Jf/1 - ,�c of s�, J.— CONTRACTOR'S INFORMATION TIO Contractor's name (mod;un`��n.�,'sor, �„(-fiecn dP� Home Improvement Contractors Registration(if applicable)# 17 3 2.q 5 (attach copy) Construction Supervisor's License# 09 E 7 07 (attach copy) Email of Contractor S V3 6*9l 2 q frla I CoYA Phone number 1101' z Z g ALL PROPERTIES THAT HAVE STRUCTURES 6VER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS BN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents OnIV* 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. 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 If food is being served at your event please obtain a Health Department approval betwen the hours of 8:00arn-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 NS R'S LICENSE EX.9.ME IOlV Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the roles and regulations for Licensed Construction Supervisor in accordance with 780 CM R the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 980 CMR and the Town of Barnstable. Signature Date PLICANT'S SIGNATTRE Signature v Date c1- 2 / S All permit applications are subject to a building official's approval prior to issuance. z - Renewal Agreement Document "and Payment Terms byAndersen: dba:Renewal By Andersen of Southern'Neiv England. Greg Tsthaikowsky , o l Le a Name:Suthern New"Eri ,"LLC land Windows 9 9 •" ' " �" ,38 Pricilla Street " RI#36079, MA#173.245,&#0634555, Lead Firm #1237 west.HyannisPort,NIA 02672 wiaoow ar ueerear 10 Reservoir Rd I Smithfield,.Rl'02917 : .: -; - '- - H:2015614778 Phone:866-563=2235 1-Fax:401,-633-6602 1 sales®renewalsne.com' - Buyer(s).Name: Greg Tschaikowsky: Contract Date: 08/14/18 Buyer(s) Street Address: 38 Pricilla Street,West Hyannisport;_MA 02672 Primary Telephone Number 2015614778,.: : Secondary.Telephone"Number: PrimaryEmail: 9 p @o toiiline.net. t m 1 p Secondary Email Buyer(s)hereby.jointly:and severally agrees to.�p ' .hase theproducts and/or.services.of Southern.Nev.v England Windows,LLC d/b/a_' Renewal By Andersen of Southern New England("Contractor");in accordance with the terms and con'ditions.described in this Agreement Document and Payment.Terms,any documents listed in the Table of Contents -and any other.document'' tached to.this Agreement D.ocumenf, the terms of which are all agreed to b the parties and incorppgrated herein by reference,(collectively, this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor hascompletedA work under this Agreement. Total Job Amount: $4,742 By signing this Agreement;you acknowledge that'the;.Balance Due;and the Amount Financed must be made by personal check,:bank check,credit card or-cash. Deposit Received:Balance Due:' : $3,162 Estimated Start Ed Completion 1. stimate 8-10 Weeks 8-10 Weeks. Amount Financed: $0 'Method of Payment: Credit Card We schedule installations based on the date:of the signed coritract'and secondarily on 'the date in which we complete the technical:nieasurements:The'installation date that; we are providing at this time is only an estimate.We will communicate an official date. and'i'me at a'later'date:.Rairi and extreme.weather are the most cotnmon causes for . delay'. Notes:. 1/3 DEP"1/3:ON START 1/3 ON COMP Us,PD in Hyannis"MA. Buyer(s)agrees and understands that this Agreeinent.constitutes:the entire understandings between the parties and that there"are no verbal.. ' understandings changing:or modifying any of the-terms of this Agreernent.No alterations to or deviations from this Agreement will:be- valid without the signed,written consent of both'the Buyer(s):and Contractor.Buyers)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms'of this Agreement;and has received a completed,signed;and dated copy of this Agreement,including_ the two attached Notices of Cancellation,:on the date first written"above'and 2)war orally informed of Buyers right to cancel this Agreement: ' NOTICE TO BUYER: Do:not sign this eontract•if blank.;You ate entitled to a copy,of the.con"tract at the time you sign. YOU,THE BUYER,MAY.CANCEL..THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 08/17/2. 018 OR THE THIRD BUSINESS.DAY AFTER.THE DATE OF-THIS TRANSACTION, . WHICHEVER DATE IS LATER.SEETHE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT Legal Name:Southern New England Windows,LLC. dba:Renewal By Andersen of Southern New England Buyers) Signature of Sales Person.-. Signature _ i g .,., 'Signature . Eric Woods Greg Tschaikowsky Print•Name"of Sales Person. Print Name,, Print Name., UPDATED;.08/14/18 Page-2 / 10 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement-Contractor Registration a Type: Supplement Card Registration: 173245 SOUTHERN NEW ENGLAND WINDOWS LLE £ = Expiration: 09/18/2020 10 RESERVOIR ROAD !- - - M= SMITHFIELD, RI 02917 Update Address and Return Card. . SCA 1 u 200MM-05/17 ,%/LP �GY77�7'!.L'�I.L!/P.L2%CG/J L�✓%/�CLriJC/�(/LGI.1�il Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE'Suoolement Card before the expiration date. If found return to: Reoisfraf"ion.__ Expiration Office of Consumer Affairs and Business Regulation 42 -,09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEI FNGLAND WINDOWS,LLC Boston,MA 0211 BRIAN DENNISON, 10 RESERVOIR ROAD SMITHFIELD,RI 02917 Undersecretary without signature Commonwealth of Massachusetts Division of Professional Licensure - Board of Building Regulations and Standards 3 ConstrvC#!0i .U: Iry i s o r s . CS-OS5707 f � E i res: 09/08/2020 BRIAN D DENNISON 8 BLACKWELL�.DRl11fE .x CHARLTON MA�-01607 N y Commissioner z +� The Commonwealth o Massac 'f h usetis Department oflndustrial_Accidenis 1 Congress street,,Suite 100 Boston,K9 02114--2017 www massgovJdia Workers'Compensation InsnraI M Affidal-&-Builders/Contraetors/Electricians)Plumbers. TO BE FILED WITH THE PERMTITIT,G AUTHORM. A-2plicant Information Please Print Le ' h- )"'aMe (Business/Organizarion/Individual): Address: /1 City/State/Zip: Are you an employer?Cb!MI*L the appropriate boa _- Type of project(required): l I am a employerwith : O t'emploYem.(full and/orpan--time)' i. ❑?vein construction 1•11 1 am a sole proprietor Or parnership and bc-ve no employees worl3ng for me in xn. ae E. Remodeling !�P n3•jlao workers'cotrtp.insumme reouirec. i am a homeowner doing sll wort myseL r' i 5. ❑l�emobtion 'jlvt:worke._ camp.ksv.-nm reaurec;' I ! i -n I wr.a homeowner and wt7i be hiring contractor:to conduct all work or.nw pupp", 1,;;1; i Q Building addition easare thai a1 ContrMom either hove womm5-cotnp aim or•msuraace or uE sole 1 ! prtiprietots with no emnlrn em le . ' Electrical repairs or additions I..Q Plumbing repair.or additiow i I am a genera con actor and 1 have hired the sue-contmwors lister or the attached sneer ! aese sue-contrctors have empica•ee<and heve womer-'comp.insurance= 1�- R el repair 6.�-we area corporation ane its ofcem nave exerciser:ihei-right of exemmior.pert✓a c ! i -'� C�utLer(�/'A ' I i �� Gce�'iBn 'S'i c i(fi),ant we havetre employe•jAla worker'rnmp.inswrance requirae 'Am,applrcao,that cbed-_box fl mast also Mow the section below showing thei-workers'caamuen=M poitcV irL*n=MDT_ 'Homeowners wbc subini t this a5—davir indicating tbee are doing aL wort and tbec hire outside cot Irmots mur,submit s new hard-vh urdicming such. =Contractors that check this box-mum a mcbec ar additional shee shorn riq the nzmt of the sub-cmua;.ma and.sme viretaa w nor those entities rave employees I=the sub-eonbwtomhcave emplovcc%the.,mug pruvidetneir wmxer-'toms.noUry nrnniam I mr,ar. employer Mar is providing workers=compensation insiirarce 10r rnv employees. Beior, is the pDli_r aFrd io%Sue iY.Torrnatior insure Company?Name:+F re me af)S G a Policy_or 5elr ins.lac.= -t.� — — • ' job Site Sda*ess: 3 g ?r Gt t �(;� CmrlStar>r'Lip:�✓' -R r mA Attach a come of the workers'compensation policy declaration page(showing the police numbe and eapira•on date): Failure to secure coverage as required under MGL c.1:52,925E is a criminal:idolatio=ptiiiishabie by one up to 1I-5QL_OG and/or one-year impsisonmentL as well as chdl penalties in the foam of a STOF WORE ORDER ant a fog afut tc S250.00 a d2y against foe violator_ t copy.of chi statement maY be forwarded to the O uce Of,lrvesdgations ofibe DLAi for insurance coverage vericatan I do hereby centi j-,under A&nwins andpenahles ofpelwy Thar the informatiar,provided above it ME an4 cDrrec;_ Si�ature: B 1 � IT phone t'_ �{®[����—OP ge,; / official use onlLy. Do no;write ir,this area,to be completed by Thy or Town of ciai City or ToWn: Fermit:3_,iceuse y i Issuing Authority(circle one): ;- 1_Board of;Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector. 5.Plumbing inspector ! 6.Other Contact Ptrsm Phone'—: ACCMV CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 12/29/2017 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 CONTACT CoBiz Insurance, Inc.-CO NAME: 1401 Lawrence St,Ste. 1200 fAtc.No.PHONE ,303-988-0446 F4AlC No:303 988 0804 Denver CO 80202 ; ADDRess: COMaiI cobizinsurance.com INSU S AFFORDING COVERAGE NAIC N INSURER A:Acadia Insurance Company 31325 INSURED ESLERCo-01 Southern New England INSURER B:Firemens Insurance Company of WA,D.C. 21784 dba Renewal by Andersen of Souern Southern New England Windows, INSURER C:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURER D: Smithfield RI 02917 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:1252851165 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. tR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MOLIC EFF POUC EXp - LIMBS A X COMMERCIAL GENERAL LIABILITY CPA3158728 1/12018 1/112019 EACH OCCURRENCE $7,000,001) CLAIMS-MADE OCCUR - PREMISES Ea occurrence $30D.D00 MED EXP(Any one person) $10.000 PERSONAL&ADV INJURY $1.000,0D0 GENL AGGREGATE LIMB APPLIES PER GENERAL AGGREGATE $2.000.000 X POLICY JJEECT 7 LOC I PRODUCTS-COMPlOP AGG $2,OOD,000 OTHER $ A AUTOMOBILE LIABILITY N CPA3158728 I 1112018 I 1/1/2018 COMBINED SINGLE LIMB Ea accident $7 000 000 X ANY AUTO i BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ALTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS NON-OX AUTOS�ED i I PROPERTY DAMAGE $ Peracddent I $ A X UMBRELLA LIAB X OCCUR CPA315&728 1 1/112016 1111201E EACH OCCURRENCE $10,000.000 EXCESS LIAB CLAIMS MApE I AGGREGATE $10,000,00D DED I X I RETENTION$ $ B WORKERS COMPENSATION WCA3158729-20 11112018 1/112019 AND EMPLOYERS LIABILITY Y/N X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? N/A $1.000.000 (Mandatory in NH) EL DISEASE-EA EMPLOYEd$1.000.000 If yes describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $1,000,D00 C PoOufion Liab�ly 793007334000O 1/12018 1111201E Each Occurrence $1.000.000 Qauns Made Pobcy Aggregate $1.000.0(10 Retroactive Date 06/202013 Deducible $10,DOD DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Informat anal Purposes AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD =y• It- q - 15 f Town of Barnstab`fe! r EiAi - 1: NSTAB E Regulatory Services. r:w Richard V. Scali,Interim Director 4 � i 1 a MASS. Building Division 059. Tom Perry,Building Commissioner__. 'FDMA'� ,krie , 200 Main Street, Hyannis,MA•0260jt[q www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# p9D/,�lS 7(1�S FEE: $ 3U L. SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less 38 PRISCILLA STREET.,. w C,Y\ Location of shed(address) Village TSCHAIKOWSKY, G.N. & P.L. 201-561-4778 Property owner's name Telephone number 10'x12' 246-063 Size of Shed Map/Parcel# 0(- . is /® iG `Zvi l Signature Date Hyannis Main Street Waterfront Historic District? NSA Old King's Highway Historic District Commission jurisdiction? NSA _ If over 120 square feet,you must file with Old King's Highway ! . Conservation Commission(signature is required)___:. Sign off hours for Conservation 8:00-9:30&3:30-4:30 , PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. . THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:110413 iT PROPERTY LINE PLOT PLAN 246063 #38 t= t= 3 D —I C/o PROPERTY LINE • d �ROPERTY LINE o 55'-0" q_ EW 12'x10" PROPERTY LINE SHED LOCATION o a MAP: 246 PARCEL: 063 OWNER: TSCHAIKOWSKY, GREGORY N & LOCATION: 38 PRISCILLA STREET PAULETTE L, MOTTA TSCHAIKOWSKY ACREAGE: 0,38 ACRES