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HomeMy WebLinkAbout0525 SOUTH MAIN STREET ,, . .,. u _ o .. � , . �� PROJECT NAME: ADDRESS: _l �^ �t�"� / ✓ lC.�c�i 5 PERMIT# PERMIT DATE: C71 Q> ct Z M/P: LARGE ROLLED PLANS ARE IN: BOX ) a SLOT R Data entefed in MAPS program on: BY: q/wpfiles/forms/archive �tH T Town of Barnstable i m t# 0 Expires 6 months from issue date Regulatory Services Fee 4 Y Y • BARNSfAB...'. « mass. $ Richard V.Scali,Director 039. ArFO MA'S p Building Division . Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 g/! www.town.bamstable.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 �®(p.� ow Property Address SZS Sdal �^ Yr �^- �� _ l ��A��/%A 1� [Residential Value of Work$ ��� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name K1 Gkg/d -Telephone Number t?C t j,3_L (07]� Home Improvement Contractor License#(if applicable) [ 3 _ Email: Th4 (2) Vote- A,, ✓ (( _T,�G_ Cowes Construction Supervisor's License#(if applicable) [TWorkman's Compensation Insurance N PERMIT Check one: ❑ I am a sole proprietor ❑�am the Homeowner SEP 08 2014 lJ I have Worker's Compensation Insurance Insurance Company Name t~rq✓�LerS TOWN OF RARNSTABLE Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Req st(check box) FRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to, ���� a� �e✓I��.�— ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) �Re-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 ire SIGNATURE: Q:\WPFILES\FORMS\building permit forrns\EXP S.doc Revised 061313 t � 1 za Cortx�rxcrrtfet7x o��assae�trts>�€s Deprtwwnt of lidm3f id Accidents 600 Wayhington Street Boston,ALI 0211I --- - Wf1`f1?7tIaSmgaWdia 'workers' CompensatioxtInsuran,ce davit:Builders/Contra:ctors{Eiec4riciansMum6ers- `caut Iufarmation. r / Please Print ib . Name(Bast s Oizanizaf oaadividwl)= �1' (.ovt r✓ — titytS:ateJzzp= f�cG� a� - Phone tires an,employer?Check the apprapriatebo� T , of o•—I :r ,—,� ,�y 4-_ I o�a. e�r-a1 crinfractor and I Px J C �_ 1_f�?zm a�p?ayer tuiflt U g 6. 0 Neste�s.u, Boa emu%oyees{hill arxilorpart-tirae}* Ir Ve hired.the sub-ontEactors. 7_ elta, ?_❑ I am a scle pmpr�:or or partner- listed on the attached sheep d g T�.�zse sub-confractorg have sly aa;d have no employees many capacity 8- ❑Demolitioa 3c i`'g -For e ci �_ e In}yes a have wormers' � � � 9- ❑Euildir?gaddifion FN r3• aetS comp_i,ts�e cc np_insurance_ yc i 7_.0 %e,ue a cctparauoaaud its 1 ..0 Electrical repairs or additions 3.❑ I am a bomexr,-ner doing all work o_ffize:rs bates exercised heir 1I-0 Eumb ng reppais or adAitims. Dyself [IQo oomP_ right ofesrmptioa per MGL 12_.El R.00frepairs rt?arxance rer�ui*ed,�f c-152, g1{ ,and )st ena employees [No workers' 1 _.�O.hes comp-iasurancz required_j Anyap_a`nzzitffixich,ed-s-r=fltrms eso fin oii the recdaelh shiningweirwoffkm'comnensadoaEgoiirgmfb 3flo • 9�-nec-,��s:c�;w�itmis�rlfo:fi,rnr�.gtneys.eriGi+�g�:�r�a�-d�t�L�oatridecoiFtxacmrs�sisnbc�rta�r-�P.aYsn�;rt��snciz C v�rc3s t�i r cl this bc,,gust a tachiid aai.ridiuonA sliezt s2u n iag tb--tism--of t7ie Vk-mu r:x�—AS,, xhetet oEuo:fi osg�mif�es hzv� IoyeFs_ e s�c�o cerirs h re eaWIoyees,they-*:um pTm-,de ram-aor3�s'comp.polscp mmmmbcs ax;i arz�:,zp�r'i?zrt.t isgr�t�idict�ttror�grs'carr�t,sr�lw.n irrs;tf�-rrtcg for��.p�gla}-gam B�tarF is fft�pL7ic} and j`ob s-rls iiz,for mho:;x_ fp II _ � Insurance Gcmpart-1F�£ame: 1�0.��.KN�.. _ Poi cy L�or Self ias_Lim 4:- 055 7— ` _ ExpirationDate= fobSit� �.dd ess= �Z� �d.✓ ^ UVI� Citwv'Sta1FJZip= . �1��1 �.�yy t�t �� OuD3-2. Attach a Cccpy of the-tsorkers'compensation polio-dec7wrstiou page(sh—uN g the policy number xud emotion date). Failure fo secure coL erage as mquired.aackr Sectioa 25 A o€MGL c. 152 can Lead to the imposition of criminal penalties of a fine-up t4$1,50D_00 andler one-year impri'soa as-tell as cilc ii peaalhes in the.form of a STOP'WORK ORDER-and a fine of up.tc,5250.00 a-day against the violator_ Be advised that a copy of tbig statement maybe farwarded to:the Office of lnvesfrgatto._.s of the DIA for insrra ce-coverage 4eri icaticn- Ida hgr-ebl rt. ns;1n[fp naiiiss of ar-p fiistthe irr1{prnzat&n prm2dRd a&n ir.hun ant£carrect Sit> Bate= PhMe A_ OfffciaL ttse On Ty. Da trot twits in this area,to bg co,npL? ed by ci(y ar"town oficiaL City or Town: _I'urrttit fLicease YssnT Authority(arde one)= 1.Saard of 3ezlth 2.Duil ing Deparhnent I OityffowuL Clerk d_Electrical baspector S.Plumbing impector 6.Othher Cca-tact Person, Mime#_ 6 j 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,coas-fraction or repair work on such dwelling house or on the grounds or building appu tenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also-s—�_es 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 buildi,:Lgs in the comraonweuith for:_iiy applicant who has not produced acceptable evidence of compliance,0,,�da the iissura.nce.coverage rcquircd." Additionally, MGL chapter 152, §25C(7)states`Neither the commonwealth r-or any of its political a2bdivisior3s shall enter into any contract for the per o_:ancc ofpublic work until acceptable ev ideiice of compliance wida the insunzance rec t;,meats of this chapter have Deem presented to the contracting authori y_" Applicants _ -- — — Please fill out the workers' compensat;.on a fidaviit completely,by g;ire boxes that apply to yrur sitLa ion and i.i necessary,supply sub-contractor(s)nain-,,,r , address(es)and phone->mbe,-(S) along with heir cert:ficatc(s) of insurance. Limited Liability Com,7n : S lLJ C)Or Limited LiabilityPu T1ci�I-:5(l_L P)Yr7L7Il0 eTSi l0)`�5 O RCr '�?r i17 r1i embers or partners,are not to carry workers' compensation_isi?-aac _ if an LLC or LLP does have employees, a policy is required. Be advised that this is affidavit may be s 1br_�ri.fted to the Department of indu_s'u;aI Accidentsrm for confation oft sr�nce c�ve_age- Also be sure to sign zn.d date the a�da- t- 'lhe affidavit sho? ld be returned to the city or town that th.e application for the permit or license is being rt.qulc led, aot the Department cf lndaiStriial Accidents_ Should}-ou.rave t_,y gpl est.ons regarding uie la.Vv or if you are required t0 obL--?a workers' cor_2peiisatioa policy,please ca17 by Depa neat at the number listed belmv. Sets'.=insured companies should enter. the r set=ias, mrance license number on the appropriate line. City or Town Officials Please be sure that the affidavit i�cm-plete and printed legibly_ The Depart tat has provided a space at the bottom of the ai-ndavit for you to fi11 out ,the event the OEdce of Investigations has to contact you regarding the applicant_ Please be sure to fill in the perm J cease number which will be used as a reference number_ In ad.diticu,an.applicant that must subinit'multiple permiif_ictnse applications in arty given year,ti ed only submit one arffid4vit indicating c-.rrent policy information (if necessczy) and order"lob Site Address" he applicant should vane"all Iocati0-i2s in _(airy 0r toy, r)."A copy of the a.r 7i davit that has been officially stamped or marked by t e city or town may be provided to ule applicant as proof that a valid aiid_vit is on file for future persits or Jicenses_ A new affidavit must be tilled out each year_Where a home owner or citizen is obtaining a license of permit not related to any business or commercial-,lenture (i_e. a dog license or permit to burn leaves etc.)said person is NOT required to complete tJs af�i davit- The Office of Investigations would Eke to thank you in advance for your cooperation and should your have any questions, please do not hesitate to give us a call_ The Department's address,teiephcne and fax number: h CODaiaonw,an of Massachu Ott Dtpasfiinent of Iadustaal AQc_:d ry fs Q tee offuyestzg tons G G Washzngtaa gt;-��z $astern_? 02111 TtI, G 17-`2 7-4900 W 406 or Fax 4'617-727-7^744 evil cd 4-24'-07 FdWP�.�aS��avt CERTIFICATE OF LIABILITY INSURANCE I E2MM/DD/YYYY)2I i2a I%aj�iWll 11-11URIL 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE GEKTIFIGATE HOLDER. 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. MPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the erms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the rtificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: SULLIVAN INS GROUP INC PHONE FAX 10 CHESTNUT STREET (AIC,No,Ext): (AIC,No): E-MAIL WORCESTER,MA 01569 ADDRESS: 22JKY INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERSINDEMNTTYCOMPANYOFAMERICA RAF CONSTRUCTION INC INSURER B: RICHARD FARRENKOPF& INSURER C: LAWRENCE BRUTTI INSURER D: P O BOX 92 HARWICH PORT,MA 02646 INSURER I=: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISIONNUMBER: NOTWITHSTANDINGINTIb WULKIII-Y INAI IKLFULUEb BELOW HAVE BEEN 155UED TO THE INSURED NAMED ABOVE INDICATED. ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMXDD\YYYY) (MMIDDIYYYY) LIMITS GENERALLIABILITY iACHOCCURRENCE $ COMMERCIALGENERALLIABILITY DAMAGETORENTED $ CLAIMSMADE ❑OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ PERSONAL & ADV INJURY $ GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS-COMP/OPAGG AUTOMOBILE LIABILITY COMBINEDSINGLE $ ANYAUTO LIMIT(Ea accident) ALLOWNEDAUTOS SCHEDULEAUTOS (Perperson) HIREDAUTOS (Peraccident) NON-OWNEDAUTOS (Peraccident) UMBRELLALIAB OCCUR EACHOCCURRENCE $ EXCESS LIAB CLAIMS-MADE RETENTION$ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN U13-613033217-14 06/04/2014 06/04/2015 LIMITS ANY PROPERITOR/PARTNERIEXECUTNE © NIA E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below 500,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIRESTRICTIONSISPECIALITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. SHOULD ANY OF THE ABOVE DF:5GRI5F_L)PULICIE3 BE GANCIZILLED Lorraine O'Liva BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED 525 Main Street IN ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632. ACORD 25(2010/05) The ACORD name and logo are registered marks of A ORD 1988 20 R '' erved. g � eornrrearzioea e�bAcr,ae�trreClr t tj trse or registrat�n vasZd for iadrvidul use or. 1 Office of Consur•e Affai &Business Re L: _ �OME.IMPROVErPFaJT CONTRACTOR ` for €he egpjr2ti6n C g' lf- ound return,to Pgistration ��� , yr: n,Of: ons tne, Ea�r� rc�buo1I1C v r. k. zlzr h xpiration ,ri �x�J+ Indiv'd�a i - ii iD FARRENWOPf E '1 rIH4RD PARRENKOPF a 37 R ERDALE SOiJT�i t DENNIS;MA 02660` 4 — 1 Undersecrefar� Not v2led�l f Yoe ,�,nrzture': oi 1 Massachusetts-Department of,Public Safety . e Board of Suildirig Regulations-and Standards Construction:Supervisor i License:.CS-015041 RICHARD R FARRENKOPF - 37 RIVERDLE SO S DENNIS MA 02660 � .+ Expiration. 11/22/2015 .. Commissioner " a Ili Office of Consumer Affairs & Business Regulation- Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation s Home Consumer Rights and Resources Home Improvement Contracting - HIC Registration Complaints Registration# 173796 Home Improvement Contractor Registrant Registration Home Page Name RICHARD FARRENKOPF Address 37 RIVERDALE SOUTH City, State Zip SO. DENNIS, MA 02660 Expiration Date 11/13/2014 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search a http://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=75681 9/5/2014 I �mE rti Town of Barnstable . x x Regulatory Services * BARNSTABLE, 9 MA-Q& g Richard V.Scali,Director 16.19. �ATfDµplA`� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, L(&-'N\A- lJ i U�- ,as Owner of the subject property hereby authorize r�1n�n/ 4:�a VV�.,�-(� to act on my behalf,' in all matters relative to work authorized by this building permit application for. (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applican jp F C- Print Na me me Print Name Dat Q:FORMS:OWNER.PERMISSIONPOOI S Town of Barnstable Regulatory Services P�pFTxe rory,L Richard V_Scali,Director Building Division snxxmAs Tom Perry,Building Commissioner 9°0 S. 169. ��� 200 Main Street, Hyannis,MA 02601 pTFD MAI a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION -' Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone it CURRENT MAILING ADDRESS: --.-- city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OFHOMEOWNER Person(s)who owns a parcel of land on which he/she resides.or intends to reside,on which there is,or is intended to be, a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner" shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buiidin2 permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Tovim of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.11-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &ReguIations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. 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 your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 oFzi Tow Town of Barnstable *Permit# ~O* Expires 6 months from issue a to BARNWABM Regulatory Services Fee 7 MAM s639. �0 Thomas F.Geiler,Director iOrED ruy a Building Division Tom Perry, Building Commissioner m PR P R > 200 Main Street, Hyannis,MA 02601 �'�`.,�T 1 Office: 508-862-4038 NO `•` 0 2004 Fax: 508-790-6230 TOWN O q� EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLP-ARNSTASLE Not Valid without Red X Press Imprint dap/parcel Number ?roperty Address u _&A&AL esidential Value of Work 7700 Minimum fee of$25.00 for work under$6000.00 owner's Name&AddressF li 0 1 Contractor's Name "I dlephoneNumber ed ��� �P Home Improvement Contractor License#(if applicable) ,r Construction Supervisor's License#(if applicable) �Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner �.I have Worker's Co rM ensation Insurance Insurance Company Name Workman's Comp.Policy# / / Copy of Insurance Compliance Certificate'must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to. ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side jKeplacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Ho Improvement Contractors License is required. Signature O:Fonw:exnv WHET Town of Barnstable o� Regulatory Services Tbomas F.Geller,Director VAM zE,$ 9� $679' p•� Building DivisYon 'OtFD MAC Tom Perry, Building Conunissloner 200 Main street, Hyannis,MA 02601 . - - www.town.barnstablema,us _ Fax, 508-790-6230 Cgice: 508-862-4038 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject property hereby authorize 'to act on mybehalf, Or- in all matters relative to work authorized by this building permit application for. (Address of job) afore of Owner 4Dee:�, Punt Name iarlss�syle Y B£CO£VS`V1NV1lt •' dry ` "7-� ou AM)W v1bgTiv`J SaC►z.dots. 3i.L3-(nV tiVyy ovics W mq rw Wfta OWGH 3}4l • 900Z1£en :ue�dec� iearww fts4 A it prs" r aialav* a PPA ON Rote on mm mow"w ago } CPO p"A"prA ampsasibA as snmli' A