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HomeMy WebLinkAbout0120 MAIN STREET (COTUIT) U`F. l ,� L Town of Barnstable Building B 1 , ..� 1 -d s Post This Card So That it is Visible°From the Street"-Approved Plans Must be Retained on"Job and this Card Must b a Kept BAMSTABM 7NAS& Posted Until Final Inspection Has.Been Made t a te �� ?Where a>Certificate,of Occu Occupancy is Re aired,such Buildin shall Not-be Occu ied until a Permit s p y q g p Final Inspection has,been,made. Permit NO. B-18-4198 Applicant Name: CAREY GROVER DBA GROVER BUILDING+ :Approvals REMODELING Structure - Date Issued: 01/03/2019 Current Use: Foundation: Permit Type: Building-Addition/Alteration- Residential Expiration Date: 07/03/2019 _ Sheathing: Location:._120.MAIN.STREET(COTUIT),COTUIT Map/Lot 023-010 °"Zoning District: RF Framing: 1 l� Owner on Record: COBB, EILEEN D&HARPER, DIANE E TRS Contractor;Name, ` CAREY C GROVER 2 Address: 64 RUSSELLS.PATH ,_,Contractor License:CSFA-077754 Chimney: BREWSTER, MA 02631 Est. Project Cost: $ 15,000.00 TATE Insulation: Description: INSTALL NEW KITCHEN CABS&APPLIANCES,RELOC 1� Permit Fee: $ 126.50 Zi `3 WINDOW, ELIMINATE 1 DOOR 1 WINDOW, REMODEL EXISTING ov� BATH. RAISE LIVING ROOM AND KITCHEN CEILINGS Fee Paid: $ 126.50 Final: l = ="Date:/ 1/3/2019 Project Review Req: ) "``.r Plumbing/Gas Rough Plumbing: A Final Plumbing: eBuilding Official :- Rough Gas: Final Gas: This permit shall be deemed abandoned and invalid unless the work authorized by-this permit is commenced within six months-after issuance. All work authorized by this permit shall conform to the approved application and theta_pproved construction documents for which tlis permit has been granted. _- E Electrical All construction,alterations and changes of use of any building and structures'shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained'open for public ins�pe Lion for the entire duration of the Service: work until the completion of the same. Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building"and Fire'Officials"are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Health 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). OF Application Number....3—.) BUILDING o ........................... .............. Per MASELDEW t Fee. ....... ........................ ..............Other Fee........................ 2-8 20,8 -'0WN0F8,4%,,S, Total Fee Paid............................................................... ...... -ABLE TO" OF BARNSTABLE Permit Approval by... On..... ................ BUILDING PERNUT Map.....od.s.....................Parcel..... . ......................... APPLICATION L Section 1 — Owner's Information and Project Location Project Address 420 Village—�7�,24 Owners Name. Owners Legal Address City State Zip Owners Cell# --5SA!1 E-mail Section 2—Use of Structure Use Group_ ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structur6 under 35,000 cubic feet 9-*'Single,/Two Family Dwelling Section 3— Type of Permit EJ New Construction E] Move/Relocate E] Accessory Structure ❑ Change of use El Demo/(entire structure' El Finish Basement El Family/Amnesty -El Fire Alarm Rebuild El Deck Apartment El Sprinkler System Fj Addition ❑ Retaining wall ❑ Solar FoRenovation F1 Pool El Insulation Other—Specify Section 4 - Work Description Ace" Last updated. 11/15/2018 Application Number.................................................... Section 5—Detail Cost of Proposed Construction Z� a ` Square Footage of Project T� Age of Structure Dig Safe Number #Of Bedrooms Existing -3' Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist WFCM Checklist ❑ Design Section 6—Project Specifics �i.ring OR Tank Storage ❑ Smoke Detectors ��Iumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom • . I Water Supply ErPublic ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: Gib. 5' I am using a crane ❑ Yes I_J No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland;coastal bank? ' Yes ❑ No B Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard, Required Proposed i Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 our s S-fc Yc Ne S ems, 6 4 ow0vfV) a .� A I �d proof of same to the permit issuing office. 'n on this application is true and complete. /2018 (774) 539-2016 to Telephone No. signed, and attached to this Permit Application. Iic Safety "S" License: arm inspections are performed by the FD having jurisdiction. ermit Fees Amount Paid Check#or CC# Pay Type $30.00 3962 Check ....... .... __ ......... .......- _ _ ........- __ ......._._ 1.2 HASS;ACHUSETT$.STATE EXCISE TAX MR'NSTABLE COUNTY fREGATRY' €fE' DEEDS 3 D#40 12-12-2018 'a 12 37vm # Ct,4", 67U Dots: 61668 f ee,o , 94�7 5G Gans. ;; 275 U+�D n 00 BAkSf A LE Cb'WTY EXCISE, TA,` EARFtSTFtDLE LtSUtTY REGISTRY OF 'SEEDS` 12 a7wd QYJITCLAuVI,D.EE, 67O b oe tu16€tE. Fee V34taS0 Consv '$215,i33.4-iA# EILEEN D. COBB, unmarried, having-a rrialmg;address<of 64•Russell's Patti; Brewster, Massachusetts 02631 for consideration paid of TWO HUNDRED SEVENTY-FIVE THOUSAND AND j 00/100 ($275,000.00)Dollars, [ -� grant to LINDSAY E. GROVER, 'unmarried, and CHRISTOPHER. M. FAZZINA, unmarried, as joint tenants; having a mailing address of 53 Uncatena A�enue,;Worcester,. �- Massachusetts 01606, with QUITCLAIM covenants; A certain .parcel of land -with buildings .thereon in that part of Barnstable, Barnstable' County,Massachusetts known as Santuit,-also bounded and described as follows: 1 Beginning At,the SOUTHWESTERLY corner of the granted premises on the EASTERLY:side of Main Street and,at land of Udall Perry; Thence EASTERLY by said Perry'•s land NORTH.9,70,26'"3.0''' EAST,five s hundred three,and 4611Q0(50146),feet to;a°point;{ Thence NORTHERLY,-•NORTH 30 33'.30" WEST;:one hundred twenty r and 43/100 Q20.43) feet to,a point; _ s ` Thence WESTERLY, SOUTH'87° 58`15" WEST,four.hundred ninety . nine and 10/100 (499.10)feet to Main Street; Thence SOUTHERLY by Main Street,one hundredawenty-fM(125)feet to the point and place of beginning. i Reference is`made to plan entitled,"Land of Seaver Harlow Santuit Surve e&b .E.G. y Y Bourne, February 1., 1929", which plan is recorded'with Barnstable County Registry Deeds in Plan Book SO, Page 51,.upon which plan the southerly, easterly and westerly lineslft+delineated, the northerly line having been'changed. Subject to and together with all matters:of record insofar as the sarn'e�are;now in force'and c applicable.. For, title, see deeds recorded with Barnstable.Coun5' Registry" of Deeds at Book 31651, ;Page 47 and Book 31.651.,Page-50.. 81 i886.v1 ; f 0 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstructionA$ 1 &2 Family CSFA-077754ON Ai gg spires: 11/22/2019 s. CAREY C GROVER PO BOX 1080� COTUIT MA 01W Commissioner vvv--.--_--- , �e lPaniinzarzusea/�o�UGlaa�¢�uvetta ..-_.. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:;Individual before the expiration date. B found return to: Registration=, Expiration Office of Consumer Affairs and Business Regulation 144322E 09/22/2020 1000 Washington Street-Suite 710 CAREY GROVER =— Boston,MA 02118 DB/A GROVER BUILDINGc REMODELING CAREY C.GROVER 56 BOWDOIN RD '. - CY - MASHPEE,MA 0264s -== Undersecretary Not w without signature r A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) —i 2 0 18— THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDE . 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 endesed.It 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: PHONE FAX Awlied Risk Insurance Services, :Enc. (A/c,No,Ext): _ (A/C,No): _ u 10825 Old Mill Rd ADDRESS: Omabil, NE 68154 PRODUCER CUSTOMER ID# (877)234-4420 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: 282-,8 Grover Building and Remodeling Inc. INSURER B: tmR Graver Building and Remodeling Inc. INSURERC: 444 Poponessett Rd INSURER D: Cotuit, mx 02635-3216 INSURER E: CTL 1273 1474912 INSURERF: 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. INSR • ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/D MM/DO GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY ❑ ❑ DAMAGE TO RENTED $ CLAIMS q PREMISES(Ea occurrenw) MADE OCCUR MEO EXP one person) $ PERSONAL&ADV INJURY $ -- --- - - GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ POLICY PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ❑ ❑ �� - (Fa accident) $ BODILY INJURY(Per p2rsopl $ ALL OWNED AUTOS BODILY INJURY eraaidem $ SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS Per accident) $ HNON-OWNEDAUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE ❑ ❑ AGGREGATE. $ DEDUCTIBLE $ RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION. T RY LIM AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/ Y/N E.L.EACH ACCIDENT $ 100,000 - A EXECUTIVE OFFICERIMEMBER ® N/A ❑ 4:0-805700-02-02 .08/31/2018 08/31/2 . EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 100.000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 000,000 SPECIAL PROVISIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION and �fC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Gkover �l' M EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH 444 Viaponessett Rd THE POLICY PROVISIONS. cotuit, MA 02635-3216. AUTHORIZED REPRESENTATIVE Attn: Project Manager n�/✓ 17 8 3 118 ACORD 25(2009/09), The ACORD name and logo are registered marks of ACORD ©19a8.2009 ACORD CORPORATION.All rights reserved. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 wwlw.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): 62 0�. Address: /�O City/State/Zip: 6,&7 �4 11A 0v.26__P one#• Are you mployer?Check the appropriate box: Type of project(required): 1.020fam a employer with-_ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6:.❑New coon 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, employees and have workers' [No workers'comp.insurance ce.comp.insuran t 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10❑Electrical repairs or additions 3.El officers have exercised their I am a homeowner doing all work 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.[1 Roof 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 A 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 contractor;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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration.Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(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 ksurance.coverage verification. I do hereby certify cerfifyypdor the pains p ofperjury that the information provided above is true and correct Si Date: Phone#: at� Of,7cial 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#: 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 iri 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 buu7dmgs 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-contractors)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 mast 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 burn 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 ` Dgwt rent of Industrial Accidents Office ofluvestagataons 600 Washington greet Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-8 7°7-MASSAFB Fax#617-727-7749 Revised 424-07 r.maw.gov/dia Application Number............................................. Section 9- Construction Supervisor Name �,�� Telephone Number Address i00, City_ State Zip License Number. License Type Expiration Date A. Contractors Email 5"d a, �� � Cp Cell# 5� 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 �780 CMR and the Town of Barnstable.Attach a copy of your license. t Signature Date Section 10—Home Improvement Contractor Name Telephone Number —5-6L37"' Address of 4gD city. p �}�� ty � �` State Zip Registration Number/ � _Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachuse Building Code. I.understand the construction inspection procedures,specific inspections and documentation d b 780 CMR ai4 the T wn of Barnstable.Attach a copy of your H.LC... 1 Signatur Date v? Section 11 —Home Owners License Exemption Home Owners 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 PLICANT SIGNATURE Signature Date Print Name k �41ee-. Telephone Number E-mail permit to: C onCc,—1 61'!/1 NJ Last updated: 11/15/2018 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ 3 Conservation r For commercial work,please take your plans directly to the fire department for approval Section 13—Owner's Authorization I, ,Ael YZZI�ao. as Ownei�f the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (A�dress of job) Si tune of Owner date PriidName Last updated. 11/152018 HEATLOK 0- 1 'goo Company Name Cape Cod Insulation Inc. Phone Number. 508-775-1214 Applicator Name Installation Date 1-11-201`9 Job.site. Address rain St-Cfltu�t-lea., , A-Side Lot #'s PA86401801 Permit Number B-Side Lot 's P347701.7818 Walls st R720 1;00 Attic 5.711 R-3.8 480: 47 www.DemJ%[ec,.co.fn., . c& D LEC Town of Barnstablerm � � Regulatory moires 6 o sue„� m' date ry Services Fee 16� T homas F.Geiler,Director- . 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 Map/parcel Number 2 Property Address y _ C6 ------------- [1(Residential Value of Work- 1 2 0,70 - Minimum fee of$35.00 for work under$6000.0 0 Owner's Name&Addressa In ------------- Contractor's Name_� � � Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) � 2 �oran's Compensation Insurance PERMIT p Check one: X-PRESS 9- ERMIT ❑❑ I aam a sole proprietor El am� LaJxhave Worker's Coer A U G 2 0 2012 ;npensa 'on Insurance Insurance Company Name ' TOWN OF TABLE Workman's Comp.Policy# 0-4ti& 2-kf4 f0 Y _Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ------------ ❑Re-roof(hurricane nailed)(not stripping.. Going over existing layers of roof) LEI Re-side ` #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum:35)#of windows ❑ 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 mprovement Contractors License&Construction Supervisors License is requir SIGNATURE: �z �AWPFILESTORMS\building permit formsTMRESS.doc- Zevised 053012 a r c: The Cormnonwealth of Massachusetts Departnrerat of Industrial Accidents Office oflnvestigations r, 4 1 Congress Street, Suite 100 Boston, MA 02114-2017 wwivanass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Coatitractors/Electrieiaiis/Pluuibers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 00-FREE HOMES 1K. 23"0TTL ON AVENUE Address: FAHWAVEN, 10A 02719 City/State/Zip: Phone#: Are W.", an employer? Check tl r appropriate box: Type of project(required): 1. a employer with kA__ 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑Ne onsttuction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Egofemodeling shipand have no employees These sub-contractors have g ❑.Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp.insurance. 5. We area corporation and its .,- 10.❑Electrical repairs or additions required.] ❑ P , 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 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 employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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 erirployees. Below is the policy and job site it for•rnation. Insurance Company Name: Policy#or Self-ins.Lic.#: � d 2�Y C��"+'< Expiration Date: `Zc� Job Site Address: ,t ((� — 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 imprisomnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations the A for.insurance coverage tion. I rlo hereby cer; r the acid a It' erjur that tlae irforrnatior:provided above ' tru a�rd correct. Si nature: Date: Phone - Official use only. Do not tvr•ite in this area; to be contpleted,py city ortown official City or Town: Permit/License# i Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Cleric 4.Electrical Inspector j.Plumbing Inspector 6. Other Contact Person: Phone#: Client#:33723 CAREF ACORD. CERTIFICATE 017;1IABILITY INSURANCE °ATE(MMI°D/YyYy) 9/07/2011 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(les)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). PRODUCERCONTACT Herlihy Insurance Agency,Inc. _ NAME: DNE 508 756.5159 51 Pullman Street ac No exl; A/c No): 508 751.6747. . a.• Worcester,MA 01606 ADDRESS: ,.77777 ' 508 756-5159 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A:Interguard Insurance Company Care Free Homes Inc ' 239 Huttleston Avenue INSURERS:Safety Indemnity Insurance Comp Fairhaven,MA 02719'. INSURER C INSURERD; 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. INSR LT& TYPE OF INSURANCE g L D POLICY NUMBER RI POLICY EFF POLICY EXP GENERAL LIABILITY MM/DD MM/DD LIMITS EACH OCCURRENCE $ 5:. COMMERCIAL GENERAL LIABILITY T PREMISES Ea occurrence $ t CLAIMS-MADEEI OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ • „t GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC B AUTOMOBILE LIABILITY 6213850 COMBINED SINGLE LIMIT 7/01/2011 07/01/201 ANY AUTO (Eaaccldenq $1 OOOOOO i' BODILY INJURY Per person). ALL OWNED AUTOS ( P ) $ i X SCHEDULED AUTOS BODILY INJURY(Per accldant) $ 9 X HIRED AUTOS PROPERTYDAMAGE $ (Per accident) X NON-OWNED AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE $ AGGREGATE $ ` ai DEDUCTIBLE $ RETENTION I A WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N CAWC244043 9/01/2011 09/01/201 X WC STATU- OTH- I} r ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? FN NIA E.L.EACH ACCIDENT $1 OOO 000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 II yes,descibe under ; DESCRIPTIrON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 5 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 107;Additional Remarks Schedule,If more apace 14 required) I ` CERTIFICATE HOLDER CANCELLATION . 10 Days for Non-Payment t w. t ` SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. Town of Barnstable THE'EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ;. ` I 1`'Y � ' ACCORDANCE WITH THE POLICY PROVISIONS. Building Department d 367 Main Street - AUTHORIZED REPRESENTATIVE Barnstable,MA 02601 G ` ®19 - 009 A SOWORATION.All rights reserved: ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered ma of ACORD #S48858/M48747 - PB2 ' Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supcn isor �. License: CS-095228 tz ' DANA J PICI" 19)EIAMLET�ST. I� Fairhaven� 02719 ti Expiration Commissioner 03/22/2014 � ��e�pan�no�uue�a�CY/iGccaaac�cr�eG� .� _ Mee of Consumer Affairs&Business fiGgulation" ! License or registration valid for mdividul use only ME IMPROVEMENT CONTRACTOR i before the expiration date. If found reN��rn to: _ Office of.Ctinsumer Affairs and Business Regulation egistration 100503 TYpe'I 10 Park Plaza-Suite=51.70 Expiration 6/,,I 2§ 14 = Supplement 1.,ard Boston,MA 02116 _ CARE FREE HOMES, INC a ;j`. '-1 DA.NA PICKUP JR 239 Huttleston ave Fairhaven;MA 027,19 Not valid,without si na e Undersecretary g III OFFICE: (508) 997-1111 MA. Builders Lic. #021330 FAX: (508) 997-1297 ACWA R E F R E E Home Improvement TOLL FREE: 1-800-407-1111 Contractor's License WEBSITE: MCS Inc. #100503 MA. www.carefreehomescompany.com 239 HUTTLESTON AVE. (FIT 6) • FAIRHAVEN, MA 02719 #15179 R.I. NAME ���—[� W�� DATE r, �`� ADDRESS C�/,) /�CST, 7 U/ T r � '. ZIP CODE U �S ADDRESS OF JOB —HOME�DP� EMAIL ADDRESS CELL JOB DESCRIPTION [ill -���s c c5'�1J1� Ciiz Srs l'D ctot�iiy � Gi�;► :�� Scheduled Start Scheduled Completion /2 A. Replacement of missing or rotted lumber is not included unless specified. B.All start&completion dates are approximate and could change due to weather conditions. C.Stripping of roof includes removal of up to two(2)layers of shingles, each additional layer to be charged @ ft2. D. Replacement of rotted roof boards/plywood to be charged @ ft?. E. Existing chimney flashings will be reused; replacement, if necessary, is not included. F.Care Free Homes, Inc. is not responsible for mold/mildew conditions that are pre-existing or result from leaks not brought to the attention of C.F.H., Inc. promptly. The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this order is contingent, however, upon the want of strikes,fires, and any natural disasters,the ability to obtain materials,or any other conditions beyond the control of the ComyZapy. Cost of Project$ PAYMENT TERMS aw /- Date 1. You,the Owner may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. 2. You,the Owners agree to pay any and all expenses incurred by Care:Free Homes, Inc. in collecting money due under this contract and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees, interest and court costs. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CARE F E HOMES; INC. ACCEPTED: ./ Buyer acknowledges Owner: By: receipt of fully completed �� 7 copy of this Agreement Owner: All contractors and subcontractors shall be registered by the director and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617)727-8598 Town of Barnstable *Permit# 713 76% Expires 6 months from issue date srAsm : Regulatory Services Fee v XAM Thomas F.Geiler,Director , Building Division Tom Perry, Building Commissioner o E TMIT 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 5 8-790-6230 , EXPRESS PERIMT APPLICATION - RESIDE9QVV6gL*RNSTAELE Not Valid without Red%Press Imprint Map/parcel Number PZ/2 of 0 Property Address 77 ❑Residential. -;I 4 ' Value of Work /o Owner's Name&Address [1,14 Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor M I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Permit Request(check box) ❑'Re-roof(stripping old shingles) All construction debris will betaken to Re-roof(not stripping: Going over_ existing layers of roof) �f Re-side ❑ Replacement Windows. U-Value (ma_ximum.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. Home ImprovementContractors License is required. Signature Q:Forms:expmtrg '7 Revise053003 ___ C R M d N f.1 WALL / DEMO DEMO NOTES cc WALL5 AND ITEMS TO EXISTING DASHED WINDOW5 g AALL5 ` w ea BE REMOVED TO BE REMOVED AND PATCHED A5 r.1 NEEDED OR REPLACED A5 NOTED. o o y EXI5TIN6 WALLS TO 2 t REMAIN o c V 41 NEW WALL5 oI� pIW o W h E m DE C. o wIQ XIO z. w.�- i i I I y 0 OFFICE I W I I I EXIST. WALL5 D .I I TO BE REMOVED /1 O a� 1 �_ DGE OF FLAT/ ; � SLOPPED CEILING i O D -------------- V MSTi�. V V I 1 1 NTH X15T. WALLS a �, ALIGN NEWS O TO BE REMOVED E3l�TH l l i i WALLS W/ EXIS�i --------- -;W DINING <17rHEN ` `�� p 0*0 % EXIST. WINDOW TO BE REMOVED r � W +6 e l � --------------- I REF. ' i I o.l 1 ----------- ------+------- NEW 7-O X EXIST. G.O. / , I L 11M4-0 4X6 DECORATIVE +� a)BEAMS (ABOVE) _- a �------.-- ---- cu L EL — ------ mMA57ER o BEDROOM 2 LIVING EXISTING DOOR BEDROOM N c co TO BE REMOVED (Q U) O o (� L- 4-0 m L LL in DN Job no.: 1525 date 27 DEGEMSER 2015 IQ w Scale A5 NOTED A Barnstable Bldg. De t. o> drawn : E.L.G. A-2 D V Approved by: �Iw �m A- Permit #: �� L@ GI C_ "' ISSUED FOR PERMITTING E O E • V y 61 YP. BOARD o cc ON IX3 5TRAPPING C> m cn I I I I I I I I I 11 I I I I 11 I I I I I I I I. I I I I I I I I I ,r - �+'� '•' R I II II II II II II 11 III $ II II II II II II II II I � � V t II II II II II II III II II II II II II 4X6 DECORATIVE BEAMS V i• I II II II II II it II III II II II II II II I II I o r0 N (ATTACH TO EXIST. RAFTERS) v 41 II II II II II II II II II II II I II II I II it I _ C' � c0 2X6 CEILING JOI5T5 s-iry s-b° s to +- EXISTING CEILING , y e JOISTS TO BE REMOVED o EXISTING CEILING o +� JOISTS TO BE REMOVED + co o CO U Frl 'Jill � DINING LIKING 1+��11 V W hEc [--� cc x r- ----------------------------- ------------------------------------ --- 5Er--, T10N A • Fil (/� N 5 G A L E I / 4 = I ' - O m L 0*0 r � I I , I I , GYP. BOARD—� n' I I I I Il I I I ON IX3 STRAPPING I I I I I I I I I I ' - ;` 4-1 I II II II II II 11 II II II II I LJ '�'� III II II II II Il II 11 I �.d --------------- - - ------------ ------------------------ --- W .� L � I +•r XI5TING CEILING (n N C: JOISTS TO BE REMOVED c N O U 4X(o DECORATIVE BEAMS(REFER TO PLAN FOR WALL DEMO DEMO NOTES E N ) I I LOCATIONS) N �= ___________________ WALL5 AND ITEMS TO EXISTING DASHED WINDOWS I WALL5 BDSM• 2 L.I V I NG BDRM. BE REMOVED TO BE REMOVED AND PATCHED AS O NEEDED OR REPLACED AS NOTED. f 11 U EXISTING WALLS TO REMAIN I 1 - NEW WALL5 . I Job no.: 1525 --------------------------1-7--------------, date 2l DEGEMBER 2018 `�-'` } stele AS NOTED E !9 T 1 0 N � ( _ drawn El.G. ems/ ` S G A L E I / 4 = I - O '�%o ISSUED FOR PERMITTING A-2 t 3LUILMIVG LEFT DEC 2 8 2018 C���lli� CIF=B A NS T ABLE /2- BABirSTASL TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION TO THE INSPECT^OF BUILDINGS: The undersigned hereby applies for o permit according to the following informotion: Locotion Proposed Use Zoning District i Fire District Name of Owner .1A™H..,WP.Address .«MS..§5BP.5.....6.0.mT.....MA.?.S. Name of Builder Address Nome of Architect Address COKCmTB 1L08K Exterior Roofing Floors 7.I|!TI'...ASBBST0S Interior ......P^T...7:^... Heoting ....TO.MISTIfiS.STSm Plumbing ....PM..TOIMT .TWO..L^^^ 7,400.00 Fireplace ...P.PI®Approximotf Cost Diflnitive Plan Approved by Plonning Boord 19 Dioorom of Lot ond Building with Dimensions •^HITVHH JO OHVOa 'jiavisr^va jo nmoi .^ ajAOHddVTvajHJH SI JovNivaa qnv ^A "IVSOdSIQ JOVMJS'AlddflS^JJtVA^HVlR^ Number of Rooms Foundotion ASPEilLT an,Q T.A3 TTyH BXPOS^ l> <24SSSf«»L ^rUCeATl€?»J fi»l=W&u t-M/.+T<>tUBT UUf'tfTtoKt Vj—^A J I Atellrt -Itr—y — 'P«»rnn>uwfec*6#4«pvu pATV tf p Y «&iuA<%E lb feMSTiw^-OysTerM. WILL esE eSArVAB AS E'^lSTI^dG-»V/SidAfS AiVjO W AAVsJ SnSEllSlT c:^ZC>:s>T^^J * I hereby ogree to conform to oil the Rules ond Regu lotions of the Town of Bornstoble regording the above construction. Nom ooDD,waiter ec ibiieen 129^^3 . r add beauty shopNo....-rfrrt:.-?...Permit for to dvjelling (Appeal 1970-5) ao Location Owner Type of Construction Plot Main Street V/alter &Eileen Cobb frame lot Permit Granted 19 Date of Inspection Dote Completed 19 PERMIT REFUSED 19 Approved 19 >n /.•'