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HomeMy WebLinkAbout0015 GERALDINE ROAD Town of Barnstable *Permit#/3 gyres 6 months from issue date Building Department Vee f -� ` v �: Brian Florence,CB lcpo cb�i639 A,m Building Commissioner Fps 200 Main Street,Hyannis,MA 02601 NOV 3 2077 www.town.barnstable.ma.us Office: 508-862-4038 w�U�U��� ��� ��� :.508-790-6230 � ABU EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number y S P Property Address ."4 AA-4 O aco,3 S Residential -Value of Work$ 9 ODD,M imum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number AA tt Home Improvement Contractor License#(if applicable) Email:`_ �} ACGt.k&VA,e 7 t V/10\ 1,cry 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 Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. ` Permit Request(check box) 5 Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to P;V%4 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) �-Re-side] Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *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 required. - SIGNATURE: i QAWPFILESTORMSTXPRESS2017 The Cowmomv=hh ofMassad juseffs. DVartment of1ndustrid Acciderxtr - Office Oflinvestigafiens _ 600 Washington Street Boston,AA 02111 1VFtgV Ma goP1dia Workers' CampensatsanInsurnceAffidavit Bader-JContractarsMecEr cianslPIumbers AppHcant Inform,atian Please Print 'bl Nice f,3ncin�ccli�rog W. '�:Ow. � /L.n1 `—I — Addre=s: 1 �� �=��2. d� .. Are Fe'u an employer?Gbecl€the appropriate box: - Type of groject(regnired}: I.❑ I ant a entployer.�ith. 4. ❑ I am a getseral coafraetos and I 6. ❑New oonsfruciion eatployees(fi�11 artdfor par�time�* have lured the sub�vn4rat-ta�s 2.❑ I am a sole propdetor or partner listed on the attached sheet �- ❑ od g have no and . 1 ees These contractors have g P �� naP - �lorw andhnesgar�s' ❑Demolition o�g any �. ❑Building addition o tvarloers comp.i,7sm,„ce �- 1 Electrical or re�ued� 5- ❑ We are a corporation and its 0 add'rhoas 3. I am a homeowsrer daittg all wwk ofcs have exercised their I L❑Plumbing repairs or additions o right of exemption per MGL � (� c.152, 1 andwe have no U.❑Roof repairs istcaixanre iellt7.tred.�� employees.(No wod=' 13.❑Other cam-insurance j 'ftrxy a"Hc>mtd2atckeft boa 0.El—st aLsa fillonithe swd=belowshewag di&wutme compeasatiaapariicgin5rmsdan_ I Ednswwners who submit this affulinI kfficatiag they axe doing all Wade and dm bim outside contxactaxsmnst submit a new aSidnt indicating-sacs.. fContxactMM eF t eheclt this boat must zMu+ed sa addidana2 sheet showing the name of the snb-contrscm¢s and state whether cir not tlmse entities hsae employees.I€thesnh-cmunct eshavemnplayea.%dieymustpmna&iheir worken'rrmp palicynumber- .Tam an empLayer Mat is praWdbW ivw*ers compensaftern inuirance for ury errrp£aywes Below is Ilia pa£icy and job site infornzir ate. Insurance Company Name: Pfllicy or Self-ins Lic. Expiration Date: Job Site Address: City/StawZip: Aft2ch a copy of the workers-"compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as raequired.under Sermon 25A of MGL c 152 can lead to the imposition of criminal peoalfies of a fine up to$1,50D OD and/or one-year imprisonment:as well as cif peualfies.in the farm of a STOP WORK ORDER and a&e, of up to$250-00 a clay against the violatm Be advised flat a copy of this statement may be forwarded fay the Office of Itrvestigtrtions of the DIAL for:insmanca coverage verifica#iom- I ifa hemby cerltf3,usufer&a pain s and1penfibVesofpai ue3°that As infornmthpa pmignf abm a is true and correct i�atur>r Date V s Phone ik f3(jFcial use only. Do not wrote in tiers area,to be cawrnpFeted by city or town of ieiat City or Town- Perrmttlicense# Issuing Anthority(circle one): L Board of Health 2.Building Depw meat 3.Citpfrowa Clerk 4.Electrical Inspector S.Plumbing ELTe-tor 6.Other Contact Person phone#: 6 Laformatzon and Instructions Maccarlr etts Cr=- =-l Laws chapter 152 re lams all empIoyeas to provide warms'competeion for thew MIPIoyees- Pm o this sf&ft,an ea17lo5 sW is defined as.¢..every peasan in the service of another under any cOn bmd ofbire, express or implied,oral or wrfttr a" An emr�aTny�is defined as"an indiYidnaI,parin,rshi�,association,corporaion or other Legal,rutty,ar any two or more of the foregaiag engaged is a Joint mtmptise,and mclnding tile,legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However tie owner of a dwc ing hoase having not more than three apartments and who resides therein,or the occupant of the - dwelIing house of another who employs persons to do maim ce,consfruc on or repair work on such dwelling hoes, or on the grounds or building app thereto shall not becanse of such employment be deemed do be an employer:' MOL chapter 152,§25C(6)also staffs that"every sty or Loral licence agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for airy applicantwho has notproduced acceptable evidence of cdmpIiancewith the insurance cove�cagerequa'ed_" Additionally.MCHL chapter 152,§25C(7)states"Neither the comm onw hh nor airy of ifs political subdivisions shall enter into any contra et for the perfimmaaca ofpubhc work until ac rzptable evidence of oompha acewith the in sm"an ce. regtm ements of this chapter have Bean presented in the cont=dng authority." A_PpHczuts Please fill out the wo&ers'compensation affidavit completely,by checldng the boxes that apply to yovr sitnation and,if necessary,snppIy sub-cOd=tar(s)n3a ets), addresses)and phone numbers)along with their cmtificate(s)of n urance. Limited Liability Companies(LLC)or LmaitedLiability Parfneaships(LLP)withno employees other.than the members or partners,are not required to cant'wYmiceus'compensation inSM71 ce. If an LLC or LLP does have empIoyees,a policy is requirC& Be advised that this affdayitmaybe submitted to the Department of Industrial Accidents for confnmation of msniance coverage Also be sure to sign and date affidavit The affidavit should be-ret>=ed to tie city or town that the appficaiion for the peunit or license is being regnestExL not the Depaitm.eut of . Ldustrial Accidents- Shonldyou have ray questions regarding the law or ifyou are rcquued to obtain a workers' compensation policy,please call the Depar(me t at the number listed below. Self-iosi d cmmpanies should enter their self-h sT-ance license number on the appropriate line. City or Town Officials t - Please be sore that the affidavit is complete and printed legibly- The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigafians has to contact you regarding the applicant Please be scare to f ll in the pen�itlliceose number which will be used as a reference number. Iu addition,an applicant tart must sabmit mu14Ie pmmitllicense applizmflons in.any given year,need only submit one affidavit indicating rrnrent policy information.Cif necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the-affidavit that has bey officially stamped or maiked bytihe,city or town may be provided to the " applicant as proof that a valid affidavit is on file for future pemi!s or licenses_ A new affidavit mint be filled oitt each year.Where a home owner or citizen is obtaining a license or permit not related tQ any business or commercial vertu, (i.e. a dog license or permit to Moan leaves etc_)said person is NOT required to complete this affidavit The Of of Investigations would lake to thank you in advance for your cooperation and should you have any questions, please do not heshafe to give us a call. The Department's address,telephone and fax mmmber. Thy Ca=anweattlr of MasSachmtis ,IIegatmeat cif l i&u tdaal Accidents f Ce of k.Ve%ff0ti0I= Raster MA()2I11 TtrL 4 617' -4 f�xt 406.Qr l-4�77 MASS.4FF, Fax 9 617727 7749 Revised 4-24-07g��� °F'ME tp� Town of Barnstable ti Building Department BAM MAM Brian Florence,CBO i639' a � Building Commissioner ED MP•l 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 5 as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized b this building ermit a lication for: y gp :pp (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 P are inspections performed and accepted.. P Signature of Owner Signature of Applicant ti Print Name Print Name Date , r Q:FORMS:OWNERPERMLSSIONPOOLS Rev: 10/17 Town of Barnstable OFTHE row Building Department 'w cs Brian Florence CBO Building Commissioner MASS. ,�� 200 Main Street, Hyannis,MA 02601 'OlFo 39. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 1 Please Print DATE: ` JOB LOCATION: number f ,(� street village "HOMEOWNER": VV r nine home phone# work phone# CURRENT MAILING ADDRESS: 0 a4p->5 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. DEFINMON OF HOMEOWNER 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 building yermit. (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 Town of Barnstable Building Department minimum inspection.procedures and requirements and that he/she will comply with said procedures and requiremeRg-. 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 109.1.1-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&Regulations 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 to amend and adopt such a form/certification for use in your community. ler�/di.�e .eo Ord o - O C /�`/opos'e�a� /oCdl�oin 3 Ge oo ct/d�n c a 615 oFj"E rqk, Town of Barnstable aeVrmit �. 1. Expires 6 months roni issu date Regulatory Services Fee * BARNSTABLE. " K`SS. $ Thomas F.Geiler,Director 039• . prED NtA't� Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid.without Red X-Press Imprint 77 Map/parcel Number Prope Address Resid entiall Value of Wo# �® ®® F Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address .�1��^�`'"`'►'\ .3�-� d.]i� Contractor's Name L0.19 -I Telephone Number ® t Home Improvement Contractor License#,(if applicable) 0 0 Construction Supervisor's License#(if applicable)' O 0 q 0 ❑Workman's Compensation Insurance -PRESS PERMIT' Check one: ` El am a sole proprietor' �� Q�� ❑ am the Homeowner []I have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Workman's Comp.Policy# 1 �.2 1 NJ 14141 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) o 2f"Re-roof(stripping old shingles) All construction debris will be taken to tat- ❑Re-roof(not stripping. Going over existing layers of 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 must sign n Property Owner Letter of Permission. P rty g P tY A copy of the Home Improvement Contractors License&Construction Supervisors License is re fired. SIGNATURE: G � . QAWPFILESTORMSUilding pemvt forms\EXPRESS.doe Revised 090809 ;r The Commonwealth of Massachusetts Department of Industrial Accidents lyer Office of Investigations h 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): L= Address: City/State/Zip: Phone #: 5 6 0- 77 A01am ou an employer? Check the appropriate box: Type of project(required): 1. a employer with Q, 4. I am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.❑ I am a sole proprietor or partner- ship and have no employees '. These sub-contractors have g, � Demolition working for me in any capacity. employees and have workers'comp. ❑ Building addition [No workers' comp. insurance comp.insurance, 5. We are a corporation and its ME] Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ P tmbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.VRotof 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 41 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. tContractors 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. A Insurance Company Name:�`J� � Le — Policy#or Self-ins.Lie.#: . 07S f /y Expiration Date: —7-- 1 1 - Job Site Address: J G.��,� 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 coverage verification. I do hereby certify un the pains and penalties of perjury that the information provided above is true and correct. Si ature: �M ,9'y1 Date: D" ®— O Phone G OS- _7 a" t i 'If 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 S. Plumbing Inspector 6. Other Contact Person: Phone#: 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, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states 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 buildings in the commonwealth for any . applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number 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 legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a.reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the.applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 i Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE 1 Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia .I SHE Tom Town of Barnstable ~T Regulatory Services �BARNSrABLE, $ Thomas F. Geiler,Director KAML fo;A.� 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 as Owner of the subject property hereby authorize�2G ,o-Z to act on my behalf, in all matters relative to work authorized by this building permit application for.(Address of Job) ,moo, O - Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side.; Q:FORMS:O W N ERP ERM I S S I ON Town of Barnstable OF SHE Tp� Regulatory Services .� MARNS BU Thomas F.Geiler,Director MASS. 9�{, 039. ,�� Building Division prfp MA't a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 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 4 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 OF HOMEOWNER 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 building 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 Town 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 109.1.1 -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&Regulations 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\bomeexempLDOC i09 13:13 5084204474 PALUPIEO INS COTUIT PAGE 01 CSR AB DATE(MMIDOIYYYY) t D CERTIFICATE OF LIABILITY'INSURANCE WENZE50 09 1a o9 iEA THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION . ;AMAN & ASSOCIATES INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ��NANCIAL SER�IZCES INC. HOLDER.THIS CERTIFICATE DOES NOT AAAEND,EXTEND OR �333 FAZMOUTI3 RD. ALTER THE COVERAGE AFFORDED 6Y THE POLICIES BELOW HYANNIS MA 02601. INSURERS AFFORDING COVERAGE NAIC# - Phone:508-775°-6010 Fax:508-790-0249 I INSURER A: SCOxTSDALE TNSURAN• - ._._CE... _.CO:_ - INSURED - ----• —•- .. ..... ...__... INSURERD: ST PAUL TRAVELERS -- WENZEL FRAMING INC_ �INSURER..... .- 45 WHIDAH WAY INSURERD: -•_-... __.... --.--. CENTERVILLE MA 02632 INSURER E;_.._.__.. - _• ------ -..... COVERAGES TI1E POLICIES OF INSURANCE I,ISTED BELOW HAVE BEEN ISSUED TO THE.INSURED NAMED,ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMFNT,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,AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCEO BY PAID CLAIMS. __-., _._ _._._.._. .-.•--•..--- T _-_.. ---- PblTlC EPF Z�19V2 P�LTi`Yi�XPIRAT(bA LIMITS LTR NSRL) TYPE OF INSURANCE POLICY NUMBER DATE MMI�DIYY , MMIDDIYY ENCE 1000000_ G2NERALLIABITY IL I EACHOCCURR 13 OAMAz TOT, _._._.. 60MMERCIALGENERAI.LIABILITY CLS1400422, •... 07/10/09 07�10�10 PRC°MISES(EaoCC�arT�nce) S SOOOOd •- - -- I MED EXP(Any one pomon) s 5000 -_----_ - CIJilMS MADE PERSONAL. OCCUR I N' I _. .. - . "s 1000000 CENF_RALAGGREGATE S 2000000 - I. OEN'L AGGREGATE LIMIT APPLIES PER I I PRODUCTS_COMP-OP AGG 9 ZOOOOO O _- POLICY PRO• LOC JFCI' I L AUTOMOBILE LIABILITY I I I COMIRINED SINGLE LIMIT (Ep accident) ANY AUTO I ---•--- .. ._-.. -----•• _I ALL OWNED AUTOS BODILY INJURY y RV Pmeon) SCHEDULED AUTOS —- -- -- -" HIRED AUTOS I I DODILY INJURY (Per eccldgnt) 1 NON•OWNED,4IJTOS _ - _... •_ - . _.-.... __.._-.. PROPERTY DAMAGE I a _—._. -__.__ ••-- (Peraccident) GARAGE LIABILITY I °. AUTO.ONLY-EA ACCIDENT 6 • -•- ANY AUTO AUTOONLY: ACG I$ ---- _ E%CF=UMBASLLA LIABILITY I EACH OCCURRENCE __.__ S __..__ -.•_ _f OCCUR I CLAIMS MADE I AGGREGATE IS DEDUCTIBLE -- _ -- LLRETENTION S _ WORKERS COMPENUATION AND - I l ITOftY LIMITSy__.I ER -• „__„ ._— B EM.PLOYERS'LIABILITY. � fi7PJT)B903X389500 07�10�09I 07�10�10 -E.L.EACI•IACCIDENT__- s.100000 ANY PROPRIPTORIPARTNERF-XECUTIVE OFFICFRIMEMBEREXCLUDED? E.L,DISEASE-FA EMPLOYE S 100000 Ifyee,deacdbounder I E.L.DISEASE-POLICY LIMIT $ 500000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS ILOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS < Q +r_I f r"n CC) CANCELLATION CERTIFICATE HOLDER CI7 POLICIES SE MYHOMEK SHOULD ANY OF THE ABOVE DESCRIBED E AMC FILLED"POMP T(( 'XPIRATIO DATE THEREOF,THE ISSUING INSURER WILL ENDEAV;;TOMAIL 30- OAY�3•WRITTEN 1'T1 NOTICE TO TH15 CERTIFICATM HOLDER NAMED TO TM t.EFT,BUT FAIGRE TO DO SO SHALL IMPOSE NO OBLIG ON OR UABILrrY OF ANY KIN D UPON THE INSURER,ITS AGENTS OR MYRNA WILLIAMS REPRESENTATIV 0, _ 148 MILNE ROAD OSTERVILLE MA 02655 AUTHORIZED REP E=TlE VV ANN LOUTS ACORD 25(2001/08) Q ACORD CORPORATION 1988 Nlassachusetts- Department of Public Sufct� a Board of Building Regulations and StandardsNNW G Construction Supervisor License License: CS 9055 Restricted to: 00 MARK A WENZEL 45 WHIDAH WAY CENTERVILLE, MA 02632 c- - -�� Expiration: 6/17/2010 CA)nIIl]ISSIUn Cr Tr#: 26876 1 fi - - - � - ✓die ZJo�rv�noruuea,�C�2 a��iaGaaact�uael�b � .. Board of Building Regulations and Standards HOMEIMPROVEMENT License or registration valid for individul use only CONTRACTOR before the expiration date. If found return to: Registration 100285 Board of Building Regulations and Standards Exprratron 6/15/2010 Tr# 268322. One Ashburton Place Rm 1301 E Type Pnvate Corporation Boston,Ma.02108 WENZEL FRAMING+.INC ' Mark Wenzel 4 / _ r 45 Whidah Way Centerville,MA 02632 Administrator Not valid without tgnature Engineering Dept.(3rd-floor) Map "Jo Parcel Permit# 3 House# 45 Date_ Issued ,/Board of Health(3rd floor)(8:15 -9:30/1l00�4;3Q�. !� , 0 �nservation Office(4th floor)(8:30-9_:3Q/1:00_ 2:0.0 I QZ ' SEPTIC SY STBE P ) _ INSTAI.LE CE 19 ENVIRONM E AND I2 S TOWN OYBARNSTABLE TOXIN RE ONS' Building PP Permit A lication 7i*ectet Address /� Village ►A_ C'e fr�sf t Owner ,y/e//iaa� .e..Be�xy.r✓�oriz` Address snsyz e Telephone S'08 -Y,28 2889 , -Permit Request .First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District S Flood Plain Water Protection Lot Size Grandfathered ❑Yes Cl No Dwelling Type: Single Family a_-_-Two Family ❑ Multi-Family(#units) / Age of Existing Structu Historic House ❑Yes �On Old King's Highway ❑Yes 2, o Basement Type: Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) - Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing o2 New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not includin7bathn ): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Electric ❑Other Central Air ❑Yes �O Fireplaces: Existing / New Existing wood/coal stove ❑Yes Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) - ❑AAtta d(size) ❑Barn(size) one 8'Shed(size /4) X p Other(size) Zo 'ng Board of Appeals Authoriz n ❑ Appeal# Recorded❑ Commerci Yes ❑No If yes, site p view# Current Use roposed Use Builder Information Name ®dui Telephone Number ,5 y,R 7'7/ .ro© Z Address License# C> s - t,�r Home Improvement Contractor# J0 7 Z_)! Worker's Compensation# 200 f NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO /V SIGNATURE - � DATE BUILDING PERMIT DENIED TuP OLLOWING REASON(S) i/1 �2 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED • #" - 1 ` � j i r � �. MAP/PARCEL NO. ADDRESS VILLAGE OWNER � ,, t . ` ._. # _ • . - - DATE OF INSPECTION: t FOUNDATION ► a p. FRAME t INSULATION FIREPLACE ELECTRICAL- ROUGH FINAL ' PLUMBING: N R)UG.-", , ' FINAL GAS:, F UG9 !3 FINAL y FINAL BUILDIN co mo DATE CLOSED C F t 7 J # ASSOCIATION Pit, 0. w . ' ' 41 ~ 5 4.1 this Pia legs sVOwn es only Prof E i / 5 \•1 , , are for asssneo e�rese�ctu��ts �\ and do. to�hwsecaI obi 3 � / relatlanst"Ps 5 131T 67 r i 1 6 9.5 58.7 Ji XX 68.4 1 ^68.5 6 .5 27 \/ 56. .\ \/ \69.2 l .B i\ �•: • '68.2 ` • ,� 132 T 69o0 ��� `'� �•v 46.7 38 2� \ ;\ 8.2 3C 6.8 \/62.8 B 1 8 //47.2 2 41 7. 165.3 4 4. 19`- \ 9 -- The Town of Barnstable 1E' .° Department of Health Safety and Environmental Services Building Division ` BARNSTABLF. 367 Main Street,Hyannis MA 02601 1639- Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner HOMEOWNER LICENSE EXEMPTION Please Print ATE: ,"JOB LOCATION: c/ number street village HOMEOWNER": Gf/////dry "e. _Z_ -IZS Z SP,9 name home phone# work phone# 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 OF HOMEOWNER 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 building1ermit. (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 Town 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 109.1.1-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&Regulations 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 to amend and adopt such a form/certification for use in your community. Q:FORMS:EXEMPT °p THE tpy,_ The Town of Barnstable MAM• a�►s�vsrnsix, • �0 Department of Health Safety and Environmental Services Eo ' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building'Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work:t0©j-21 e ae e o Estimated Cost e /ao " Address of Work: /J' 6 ,r'alcr!is�f� ,�oo'o° �"e ylrity` tea, 0x a cr s- Owner s Name: 1A111//ia-t,, Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law OJob Under$1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR og Date Owner's Name q:forms:Affidav i OWNER: Map Lot DATE: The Commonwealth of ltilassachusevs Department of Industrial Accidents ,�• � -- �, 0117coolhvestlga�loas r 6001 Washington Street Boston,Mass. 02111 Workers' Compensation Insurance Affidavit name' - -- location - city nhone 0 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this jobmi eG lJoy name- address: 341�1 C4 r M Lh ko a d �o cac phone 0: 1 t 1f I am a sole proprietor. general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: rmmnany nam • +ddr Ss, city- ohone#: insurance ca. nolicV M company name• iddr cc• city: - Phone 0: + incnr�nr�rn- OOIItV� Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penaltia of an.ran to.S1300.00aaWor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement be forwarded to the Office of Investigations of the DIA for coverage verification. 1 do hereby certify u d t p &dIi ojperl'ury that the information provided above is true and cbrretxQ Signature Datc � `— Print name Gm p S "LL V r� Phone Fontnct nly do not write in this area to be completed by city or town official town:— _ - permittlicense N riBuilding Department C3Liceu3ing Board mcdiate response is required Oseleetmen's Office. o C3Health Department n• phone a• ( 50 8) _ mother ]P' 11 N1E \iR,iB, o iR, MV 0 c > ID PRO ID C T S Post and Beam Garden Sheds SWI n� Salt Box Design f 8'x 8' 880 8'x 10' 1100 8'x 12' 1260 s 10'x 10' 1380 10'x 12' 1490 10'x 14' 1760 10'x 16' 2040 r 12'x 12' 1780 12'x 14' 2120 12'x 16' 2460 Storage h. , ge Sheds Even Pitch Design 1 y � Have Many Uses... 6'x 8' $ 900 8'x 8' 950 ` •Riding Mowers 8'x 10' 1180 •Workshop 8'x 12' 1360 10'x 10' 1480 • Garden Tools 10'x 12' 1590 • Garden Tractors 10'x 14' 1860 • Outdoor Furniture 10'x 16' 2140 1'- 12'x 12' 1880 •Motorcycles 12'x 14' 2320 •Pool Supplies 12'x 16' 2640 QE HARBOR' . y Bic cles d� 259 Queen Anne Road 344 Yarmouth Road (Willow St.) Harwich, MA 02645 Hyannis, MA 02601 508-430-2800 ���PRo� G 508-771-5007 1-800-368-SHED (7433) The Outdoor Storage Specialist Licensed • Registered • Insured �f0soi'L t �0 V9�� x PRO Since 1980 Pine Harbor Wood Products has built thousands of post and beam sheds throughout New England. t Our family owned and operated business would be pleased to quote you on one of our designs or custom design of your choice. + �� All of our quality crafted storage sheds are full dimensional, sawmilled pine.We deliver-and construct our products at an affordable price and on schedule. 1 Sheds are precut at our shop and usually assembled in one day on your site. v � Thank you for your interest in our post and beam buildings. Please call us for more information. Our post and beam sheds are built on your property.Our standard sheds come with: g •Concrete block •Handmade oak handled t •5/8"plywood floor •2'x 6'Pressure treated floor framing [ •Ramp •Stationary window •Post and beam frame •Shutters and flower box r •Board and batten siding •Asphalt shingles •36"door • 8"x 12"louvers for ventilation ( fl'= Heavy duty hasp Available options to further customize your storage shed: •Double Doors •Extra Windows •Higher roof pitch •Longer Ramp i •Double hung windows •Loft •Cupola •Cedar shingles •Cedar clapboard •Sona tubes •Work Bench •Shelving Give us a call for pricing on options. •Please check with your local building department regarding : permit requirements, setbacks and other regulations that apply. •Payments are due in full the day of delivery.Credit card sales must be processed before the delivery. No exceptions. •We ask that you properly prepare the site location on which the shed is to be constructed.Trees, shrubs,and miscellaneous items need to be removed before we arrive to do the building. •Please notify us in advance if the site you have chosen is not WARRANTY accessible by truck, or is in excess of a 50 foot distance. Sheds Pine Flarbo-wood Prcducts provides you with a Limursd one(1) are built on location for your convenience. Year Guarantee against defective materials and worsrr_ansh.lp. •All sheds come in natural pine.We recommend staining after Damage by accident,neglect or natural disaster is not ncluded in this guarantee.The warranty period begins upon completion of construction to preserve the wood. construction. 2 /c.2 THE.r TOWN OF BARNSTABLE i BAHISTADLE, 1639. i "Q w BUILDING INSPECTOR pY a' " APPLICATION FOR PERMIT TO ............:��✓.... .fir a�r� 'o�i%....dwP//*.-c..................... ....................................................... .. TYPE OF CONSTRUCTION .............. d.....: 1-cx:rr.e................................................................................... ............. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for"a permit according to the following information: Location .......... /...o.... ...... a..fx��.f.............................................:........:.....:.................................... ProposedUse .......!Call. y...............................................................:.................................................................................. Zoning District ....15.4--'.....................................................Fire District ...�,IA,.Il........................................................ Name of Owner �t//1/`iz l?.. .. 1.t �o�fi�e odo� Name of Builder . W11&11 .............Address ..S ? c ....a.s......n.....6..o....v.e............................... Name of Architect .............Address ...5�?%��� Q s a ��✓e e......................................... Number of Rooms .......!�2ef:�e...............................................Foundation ....�i:W.,r.e,,e ..................................................... P.0 Exterior .........................1N .�11.........................................Roofing .......... ................................................. Floors w�J..O.d............................................Interior ......... ��. ✓.r/ ..................................................... ........................... . Heating .................. .........Plumbing ........ ............................................................ Fireplace .... .......................................................................Approximate Cost ....... 000. �...................... .. Definitive Plan Approved by Planning Board -----------------------_- iQ� do Diagram of Lot and Building with Dimensions SUBJECT TO APPROVAL OF BOARD OF HEALTH IL CO Z o O Uj0 U) 1'1� -10W � 4< M- c 3 uJ F-- >- -o J ---� (. of Q ".eJ t L.r.J � � W L I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .� �...... .... ..... .. . . .. . . ............ j Beaumont, William R. & Janet E. C�dui No ....160�F Permit for .......add o. A....l® 010 ,�. 4 family dwelling per, ...................................................... ............... Location � 13 Geraldine Road ................. i Cotu , Z �� ...........i.t................................ Owner ......William R. & Janet E. Beaumont �,/ ®� G � +v C ` ... ......................... mod' Type of Construction .frame 1 ................................................................................ Plot ......................... .. Lot ................................ Permit Granted April 11 .... 19 73 I ....................... C� Date of Inspection . .. .... .4?........19 ' P d Date Completed ...... ...�.�! ..."..1. ..19 �� � > >L( PERMIT REFUSED ................................................................ 19 ...................`.................................... ................... ' ...........``...��../....... .......................... ..................................... .. + ............................................................................... Approved ................................................ 19 } ............................................................................... ...............................................................................