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HomeMy WebLinkAbout0108 HIGH STREET �� ���� s� �; Application on numbe 3— ...........**.......pp r...6-15- Fee.....................(oD,IF......................... SUM& SEP 04 MASS. 201,9 Building Inspectors Initials..... ................ TO[4�Aj �IFB�"SABLE Date Issued...... .... ....&......I.?............................ Map/Parcel.....jo.a,5........0..-14.0.............. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION:. ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WE,&THIERIZATION PROPERTY INFORMATION Address of Project: M5� xm NUMBEn STREET VILLAGE Owner's Name: Phone Number Email Address: 4 i�o /1, Cell Phone Number ht, 9; Project cost$ v Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize .to make application for a build' tm, accordance with 80 CMR Owner Signature: Date:, Y// TYPE OF WORK 0 Siding ED Windows (no header change)# 0 Insulation/Weatherization E-1 Doors (no header change)# Commercial Doors require an inspector's review ..Roof(not applying,more than I layer of shingles) Construction Debris will be going to Oe 41 A� CONTRACTOR'S INFORMATION, 4 Contractor's name Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# j�6 ,V 7Z (attach copy) f Email of Contractor Wf/bne numb er, ALL PROPERTIES THA AVE 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 musf 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 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 APP T S SI NATURE Signature r Date 9 1� //7 IV All permit applications are subject to a building official's approval prior to issuance. .CCU AW 4, CERTIFICATE OF LIABILITY INSURANCE DATE 09/04/19 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 have ADDITIONAL INSURED provisions or 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 NAME: JIM HINDMAN Schlegel&Schlegel Ins Broker A/cCNo E : 508-771-8381 ac No): 508-771-0663 34 Main Street E IL West Yarmouth,MA 02673 ADDRESS: schlegelinsurance@gmail.com INSURERS AFFORDING COVERAGE NAIC# INSURER A: PHEONIX MUTUAL INSURED INSURER B: TRAVELERS RICHARD H GARDNER INSURER C: 92 PARK PLACE WAY INSURER D: MASHPEE,MA 02649-2725 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE POLICY FF POLICY E P INSO WVD POLICY NUMBER MMIDD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 50,000 MED EXP(Any oneperson) $ 5,000 A CPP0709341 08/20/19 08/20120 1 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY❑ OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per..ident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICERIMEMBER EXCLUDED? N/A WC-0179798 06/03/19 06/03/20 . (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) RICHARD GARDNER HAS ELECTED NOT TO BE COVERED UNDER HIS CURRENT WORKERS COMP POLICY 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. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs&Business Regulation. HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: . Reaistiatlsn Expiration Office of Consumer Affairs and Busines egulation i4 0- 06/22/2020 1000 Washington Street-Suite 710- RICHARD GAFk6'7 r ;�.,.-; ,:.: Boston,MA 02118 i3a i -L RICHARD H.GAiil 92 PARK PLACE W.,Y -"—"� C�z a,,_ �41 MASHPEE,MA 02649` Ot vall WI ut S' a ure Undersecretary ; . i Construction Supervisor Specialty Commonwealth of Massachusetts ® Division of Professional Licensure Restricted to: Board of Building Regulations and Standards CSSL4tF-Roofing CSSL WS-Windows and Siding COnstructiq 'S t�i/5 fr Specialty f r;. CSSL-100471 `� i� �ires: 01/29/2020 ! RICHARD H li4 Dm y 92 PARK PLA NIAIf? MASHPEE MA 019149 , Failure to possess a current edition of the Massachusetts 'VC)►SS ow . State Building Code is cause for revocation of this license• For information about this mas license Commissioner Cap(617)727-3200 or visit www. 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 Le ibl Name (Business/Organization/Indivi.dual)' & Address: City/State/Zip: /¢ Vb � Phone #: — S Are you an employer? Ch ck the appropriate box: Type of project(required): 1. I am a employer with 4. 1 am a general contractor and I employees(full and/or rt-time).* have 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 employees Demolition working for mein any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.T required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. 1 am a homeowner doing all work. officers have exercised their 11. Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no 13. Other employees. [No workers' 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: d� ? /�„�J Policy#or Self-ins.Lic.#: �� ��� Expiration Date: Job Site Address: , City/State/Zip: Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violato e advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurancejpvejage verification. I do hereby certify u d e es of ry that the information provided above is tr a and.correct. Signature: // Date: 7 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#: Assessor's map and lot number ....��...'... .................... -, Inc Sys" MST BE INSTALLED IN COMPLIANCE WITH ATTIrLE II STATE Sewage Permit number ......... ; .......................... a SANITARY CODE MD TOWN RMULATION& y�FTHETO�♦ TO ' WN OF BARNSTABLE Z IMMSTOILE, i "6 9 �•� BUILDING INSPECTOR .F0 MPY a' D APPLICATION FOR PERMIT TO ....... ... .. .4.. .................................................................... TYPEOF CONSTRUCTION ....................../.......: .................................................................................... r..�f..�. ....I9.,. -TO THE INSPECTOR OF BUILDINGS: . The undersigned hereby applies for a permit according to the following information: Location ..4 e!flyle.X.....�........�d./d ye.....`? ...���G�t....................................................................................... ProposedUse .. �.!/{�?4j,....y...:i� o r.a..g.te .............................................. .............................................................. ZoningDistrict .......0—A.../..r...................................................Fire District ... ...............?.............�................................... i' , Name of Owner ... ......Address ?.....�..�,lJ��� °� 1 000"` Name of Builder Gt.1I.Ma..*1....�I.a.r........................Address .. , .Tt!..r.Y.r/. .....—.................................. ...............Address -Name of Architect .......�.IY..I°......................... ..................................:.... Numberof Rooms ......Z......................................................Foundation .....It/cs...-......................................................... Exterior ...0m O.. ......5.... iv4.5..................................Roofing .....�,�..C.A.......cT.!I BCJ��"�......................... K Floors ........ IQ� ..................Interior .......... (/ Heating ........................................................................Plumbing ...........f�lt..P...................................................... Fireplace ..........................................:.......................................Approximate Cost � /, . ' J Definitive Plan Approved by Planning Board ---------------_---------------19--------. Area ..... ..' :........ Oa Diagram-of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH o � ' So \ . _ I hereby gree to conform to all the Rules and Regulations o the Town of Barnstable regarding the above construction. TALLIMAN BROTHERS, f9C. 3S SYLVAN LAN,-,_ Name ... fi......... ...s �GGl�1....... . .. .. ... .. €JSTUIZVItLL7 41ASS,: Pierce, Richard B. 16939 add zsinagle ,No ................. Permit for .................................... family dwelling /001) Location ........M ...... ...................cotu.it................................................. Owner ......Richard..B....Pi.e.rce....................... Type of Construction .......frg)no......................... ..................................... Plot ............................ Lot ................................ March 8 74 Permit Granted ............................... 19 1 Date of Inspection 1 74 X40k ow Date Completed ..:J9 PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ . ............................................................................... ............................................................................... Approved ................................................. 19 ............................................................................... ............................................................................... �-o3 j pFT r Town of Barnstable *Permit# ` `i Expires 6 months from issue date , s�,BLE, : Reg ulatory Services Fee v mass. e+ Thomas F.Geiler,Director Qt6 q. ., 9p 3 p� l E 't D Building Division Tom Perry, Building Commissioner X-PRESS PERMIT 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 SUN 1 4 2003 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESEDEMMALLOUXRNSTABLE Not Valid without Red%Press Imprint Map/parcel Number Property Address d � co 41 U- v Residential Value of Work o 0 b O . Owner's Name&Address Ma V . P 1 o K G► st CA t�it MA 0.21� 35 Contractor's Name S AM._�� PJLi&CL1 J__A Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) EjWorkman's Compensation Insurance Check one: I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) LYJ Re-roof(stripping old shingles) All construction debris will be taken to _t4 v ) _ ❑Re-roof(not stripping. Going over existing layers of roof) - ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) Other s ❑ ec'P �Y *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. Signature . w4nl Q:Forms:expmtrg Revised121901 Assessor's office (1st floor): A , SEPTIC SYSTEM MUST ,,oF?aETo� _ /�// Assessor's map and lot numbei .:....L.N.....:...l...d....... � Q f Board of Health (3rd floor): INSTALLED IN C®MPLIAN Sewage Permit number .............. .-.... ; �" WITH TITLE 5 Z BAUSTLBLE, Engineering Department (3rd floor): �L ' � ONMENT AL CODE A?''oo 039 EPI@✓I RMAX • ,yy�� (( House number ..................I..........:.....C!...�.�.4...�............`..... TOWN PEGLNI__fA�"o -+3 RFD YPY a' APPLICATIONS PROCESSED 8:30,9:30 A.M. and 1:00-2:00,•.P.M.;only TOWN 'OF . . BARNSTABLE BUILDING` INSPECTOR �7, APPLICATION FOR PERMIT TO .........��,.....l .....J.,;o .... . . TYPEOF CONSTRUCTION ............................................:.......................................................................................... ........4f..19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: " Location .........zo....F............ ...... ....... - ': ............................................................................................................. ProposedUse . 4..................................................... ............................................................... ZoningDistrict .........................................................................Fire District ............ ...........I..................................................... Name of Owner ... .. ... ((A4,e-...........Address .........1... . `. ........;1�.......................................... Name of Builder i ........u ..................................Address ........ ........:............................................... Nameof Architect ..................................................................Address ................................................................:................... i ...... .............................................. ..Number of Rooms ..........0-4,je..............................................Foundation Exterior ....................................................................................Roofng ...... )-y-Z 4...........................................Floors � n� Interior ......... ...........PA .................. ..................... .................................. Heating .........��4................................................................Plumbing .......... Fireplace — ...............................................................Approximate Cost ... ! 6. .. Definitive Plan Approved by Planning Board ________________________________19________ . Area �.Y.. ... .. . ..G�!'!�� Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... . . .. ... G........... .... ........... Construction Supervisor's License ®�/� v.................................... PIERCE, RICHARD B. No Permit for ...�!IS.1.o.se...Deck....... . ........ ..Sinle .Family Dwelling.................... Location........1.08 . .. . ..... .... ................ r Y Cotuit ............................................... B. Pierc................................ Richard Owner ...................:........................ Type*of Construction .............-Frame................ ......... .................... 4A Plot ....... .................... Lot ..... .......... ............... April 22, 86 Permit Granted •............. .........................19 1% Date of ln�pection ........19 y� Date Completed . ................19 M re - M rj Assessor's office (1st floor): /� Of1HEto Assessor's map and lot number ............�....... ........................ Board of Health (3rd floor): Sewage Permit number ............... . 8�................ .. 1 BA"STAMiE, Engineering Department (3rd floor): D nl f 9° MAO0 39• House number 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 ....... C .....G�....,.. Hr' .`..... lr�w .' .......................... TYPEOF CONSTRUCTION ..................................................................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 9 / Location ���.. ...........r ........ �j. ........................................................................:. ..................................... ................ je- ProposedUse ............... / ?!df..� ?e.... ?e° -................................................... ...•......... ..........................I......................... ZoningDistrict .....................................Fire District .............................................................................. Name of Owner ...... ...............�..... ...-:..........Address .........1. :. .t'.....�................................................ .... ............. Name of Builder .f. .....�...�L.�'� ......................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... +� Number of Rooms Foundation ......: 4...................................................... .. Exlerior ...Roofing —�' r'`............................................................................. Floors ih't-Q .Interior ........ ................................................................. Heating .!: .............................................................Plumbing .......... ................................................................. Fireplace ....................................................................I.............Approximate Cost ............. !. .......... Definitive Plan Approved by Planning Board _________________________ �f . 9 Area ...................... per Diagram of Lot and Building with Dimensions Fee .... SUBJECT TO APPROVAL OF BOARD OF HEALTH I OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ='7 Name ! ;YO401e— r XeZo-, .. -f... ... ............ Construction Supervisor's License PIERCE, RICHARD B. A=35-40 No ...292z7.... Permit for ...Enclose Deck ........................ .......Single jamilx Dwelling................ Location .....1..High„Street........................... .......................G.P.Z Ill.t............................................ Owner ....... �,ehard..B. Pierce..................... r. Type of Construction ........Frame........................ ............................................................................... Plot ............................ Lot ................................ Permit Granted .........April 22, .........19 86 Date of Ins ection 19 Date Completed ...................:..................19 l obi 0/0