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HomeMy WebLinkAbout0746 MAIN STREET (COTUIT) L��� 1� �� 6 t �y� � To wn of Ba rnstable b 1 e *Permit# i �tegulatory Services ]EAPee 6 months from issue date Fe • eaRrrsrsaie. • .. 165 Thomas F.Geiler,Director FDMArp Building Division di)9/4 /3 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Map/parcel Number Not Valid without Red X-Press Imprint (�3�/ �� Property Address I V v1 13 I{v V. C 61yl r (� �3 esidential Value of Work$ Q CID Minimum fee of,$35.00 for work under$6000.00 Owner's Name&Address 1 �N/WL� O'dl.1V 1�( !Mt 1 y 6 pw- 3 T rd till Gz(,Sr Contractor's Name 1^-(P(4 P U fiU L,W Telephone Number_ d� Home Improvement Contractor License#(if applicable) - 03 Ig'l Lail:_ L-6wG1.cl CduSril�t _li6t�� Cll Construction Supervisor's License#(if applicable) 0 Il ❑Workman's Compensation Insurance ICI�T Check one: ❑ I am sole proprietor SEP — 3. "2013 ❑ I the Homeowner have Worker's Compensation Insurance Insurance Company Name ( S_d �tif'C� lsl v ) s o N OF BA }STABLE Workman's Comp.Policy# lN' : �� A Copy of Insurance Compliance Certificate must accompany each permit. Permit Re ues eck box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �L (/}/51�f/S� ❑Re-roof(hurricane nailed)(not striPPin . Going over existing layers of roof) J � ❑ Re-side ❑ Replacement WindowsMoors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate.Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Lett ermission. A copy of the Hors License&.Construction Supervisors License is required4777 SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 Zhe Contntounwalth of Massachuselts DePartmrent of Industrial Accidents 1 Office of Investigations 600 Washington Street = Boston,MA 02111 111Mv ntas&gov/din Workers' Compensation Insurance AffidaA it: Builders/Contractors/Plectticians/Plumber s Applicant Information Please Print Leeibly Natne.(Busiuess/0TAnizatiaWb&vidw1): Address: Vh Gt f. City/State/Zip: C d 'iv t'T 02 G 3 Phone#: 74�f g t) 6= 6660 Are you plot er?Check the appropriate boa: _ Type of project(required). 1._ am a employer with D 4. ❑ I am a general contractor and I employees(full and/or pant-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees• These sub-contractors have g_ ❑Demolition working for me,in any capacity. employees and have workers* [No workers,comp insurance comp.insuuance.I 9 ❑Building.addition required.] 5. ❑ We are a corporation and its 10.0 Electric repairs or additions 3.❑ I am a homeoumer do' all work officers have exercised their 11.0 Pl g repairs or additions , myself.[No workers'comp. right of exemption per MGL 19 Roof its insurance required.]I c.152,§1(4),and we.have no - employees.[No workers' 13.0 Other comp.insurance required.] 'Any applicant that checks box Al Must also fill out the section below showing their workers compensation policy infortnation. i Homeowners who submit this affidaait 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 uatne of the sub-contmactors and state whether or not those entities have employees. If the sub-cantracton have employees,they must paoiride their workers'comp.policy number. I ain all employer that is protading workers'conrpensadon insurance for nry enupiol-ee_s. Below is flee policy and job site information. Insurance Company Name: Policy#or Self-ins'.Lic.#: (A) C:(, -t-n Expiration Date: J Job Site Address: " ')(1G A-y-1t; °o j City/State/Zip: C61 /i1 • �l Z 6 S Attach a copy of the workers'compensa tion policy declaration page(shorting 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 S 1,500.00 and/or one-year imprisonment,as well as 661 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 herebyr ceWA,u7derepains a i t d penalties of pe 'ii t the information p rot aded a ba*to is true and correct Si tune: g- Date. Phone#: ? 0- /nn l L C66� Official use.on v. Do not wi to in this area,to be completed by citJ,or town official. City or Tobin: PermitlUcense# Issuing Authority(circle one): 1.Board'of Health 2.Building Department 3.Cityllown Clerk 4.Electrical Inspector S.Plumbing Inspector. 6.Other Contact Person: Phone#: 6 , '* anntve'eM MAS& Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division. .Thomas Perry,CHO 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 Thi's Section' If Using'A Builder VL I• � ���-1" '� V�'1 as-Owner of the subject property hereby authorize P" ' t�J ; to,act on,my'behalf, " in all matters relative to work authorized by this building '"permit application for: 1 (Address of Job) l Date Print,Name If Property Owner ik applying for permit;please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollikWppData\L.ocal\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8R76BDVA\E)CPRESS:doc Revised 061313 Client#:38438 2CENTRALCA ACORM CERTIFICATE OF LIABILITY INSURANCE 05115/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.- IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Dowling&O'Neil e No 5a8 Insurance Agency 775-1620 No; 5087781218 E�aL 973 lyannough Rd., PO Box 1990 ADDS: INSURERS AFFORDING COVERAGE NAIC d Hyannis,MA 02601 INSURER A:National Grange Mutual Insuranc INSURED SURER 0:Associated Employers Insurance Central Cape Construction Company,Inc. 820 Main Street c Cotult,MA 02635. INSURER D: INSURER E MURER 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. IV TYPE OF INSURANCE D S POLICY NUMBER POLICY PO EXP LOA1i3 A GENE IJABUTY MP19764A 1H412012 11/1412013 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREAISES EaRE�rED. $500 000 CLAJMS-MADE F OCCUR MED EXP y one person $10 000 PERSONAL&ADV 04JURY $1 000 000 GENERAL AGGREGATE s2000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY PRO LOC s AUTOMOBILE LIABILlry CE M SINGLE LIMIT L_ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S er acddent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UA13 CLAIMS-MADE T AGGREGATE $ . DED RETENTIONS } $ AND EMPLOYERS ' B WORKERS COMPENSATION WCC5005001992013A. 5114/2013 05/14/201 X WC STA716 O_TH LIABILflY ANY PROPRIETORlPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT SSOO 000' OFFICERIMEMBER EXCLUDED? If yes.describe under N/A (Mandatory In ander E.L.DISEASE-EA EMPLOYEE s500 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddMonal Remarks Schedule,N more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained In the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. } CERTIFICATE HOLDER CANCELLATION Town of Stoughton SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE' THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 10 Pearl Street,2nd Floor Stoughton,MA 02072 AUnmoiffiED REPREsENTATNE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S111265/M111262 LS1 _ Office of Consumer Affairs and Business Regulation 10 Park Plaza -Suite 5170 Boston, Massachusetts 02116 Home Improvement Coitractor Registration Registration: 131841 i Type: Private Corporation *_ w Expiration: 9/26/2014 Tr# 230130 CENTRAL CAPE CONSTRUCTION�U-Efji ; 1 STEPHEN DEVLIN4 820 MAIN ST. j COTUIT, MA 02635v. pdate Address and return card.Mark reason for change. [j Address Renewal ❑ Employment Lost Card SCA 1 C- 2OM-05/11 F eoryr�ncdna�e" l a�C�/f�"laacluueCtc License or registration valid for individul use only $ p Office of Consumer Affairs&BusiGess Regulation g y ME IMPROVEMENT CONTRACTOR before the expiration date.. If found return to: egistration: 1'31841 Type: Office of Consumer Affairs and Business Regulation xpiration: 9/2.02614. Private Corporation 10 Par4,Plaza-Suite 5170 Boston,W[A 02116 CENTRAL CAPE CONSTRUCTTONGO.INC. STEPHEN DEVLIN `;;;;.t'>'-_�.:.,.•' 820 MAIN ST ` COTUIT,MA 02635 Undersecretary NoKv4lid wit&Kut signature Massachusetts-pepaatinent of Public Safety Scaard of Building Regulations and Standards Construction$ ' uPCrq•isor License:C"41003 820 MAIM Cotuit MA C : . a 71 tits s Expira tean OWN2014 Engineering Dept. (3rd floor) Map Parcel DES Permit# House# 7 y� `3 Date Isssuujed _/ Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30). - Fee Conservation Office(4th floor)(8:30-9:30/1:00-2:00) ' Planning Dept.(1st floor/School Admin. Bldg.) Definitive Plan Approved by Planning Board 19 ; !,BARNSTABLE. ^'''��FD TOWN OF BARNSTABLL f ," f65 9` Building Permit Application _ Projec treet Address Ma I a in s+ Village . Owner Address / 5 Co+,Aa, Telephone Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 0 � 00 Zoning District Flood Plain Water Protection Lot Size Grandfathered. ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure (� J S Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other �0*�� Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use .�" Builder Information J L� 5 Name��j/�k1�.Qi h-� � ��0 l Telephone Number .4 3 Address M afil License# Home Improvement Contractor# � ' % L3O® 40U / l Worker's Compensation#621'6—U 9-'09k 1 L 4-97 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRU ION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURFft DATE / �/ / BUILDING PERMIT DE D F THE FOLLOWING REASON(S) 7 FOR OFFICIAL USE ONLY ' �3 PERMIT NO. - DATE ISSUED - . t MAP/PARCEL NO. ADDRESS_ % VILLAGE- OWNER , DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL.BUILDING DATE CLOSED OUT t ASSOCIATION PLAN NO. , IP�DltENE1VI CDIIrRACrQR: Re�istcation 119344: D9A `fxp ratiOP 66119/99 ISLAND SIDIRG 3 R9DfIN6 IANNI CIRCLE y _ i Tilt.. Cl11111110111 rea 11 O lLT.ti aC l U ti Cl1.S' Dc-11urt111eny of ludrlstrial.Accidcrrts • ,i '�. '.1"''l�•• �� OflicPa/I�yesrlgatlons 608 [Va.vIihigmlr Street Maas 03111 Workers' Compensation Insurance Affidavit i lirint infr7rne innAAA • Pl —p ^►--•�"'^"�'—"_'--� Lf or nc^:inn• ' &/-7 Whim.d ez, � �J 177 1 am a homeowner performing all work:myself. I am a sole proprietor and have no one wonting in any capacity — I am an enip, - ovidinc workers' compensation for my employees working on tfus ob. 4 cmm�:rn� namt ' Aau---� -- ��Txa�� �. " ' If 61 t e � atirlrr<c• / Lee r. o 6;zcirs-• nhnnc�• 47�1�/ i in<nrnnrc rn. J lr nlic� t� c2l — i am a sole proprietor. -enerni contractor, or homeoivner(critic oite) and have hired the contractors listed beio%% •a•ce z the "OHONving %vori<ers compensation polices: cmm�•rn� n•trnr• .1611rr— in,iir77 ^nrr rn nnirc�' --_ -..�....- _- _ -r►wr--_ _.�.•.r.-..•...ti7. .. - ... .�.-.-.. rmmnnn% Warne^ atl�}rr<c• nhnnc try - in-znrnrc rn nniiC` Atlzzh additio_n3i shUf if CCS]ar'V�.���. .�.c. ._.;. Fauure to sect(re cttver-me as required under 6eetton-- of AWL 151 can lead to the imposition of ertmmai penaities of"a line up to St.SOU.uU anurc. unc cars imprisonment :t.% weil as cit•ii penalties in the form of a STOP WORK ORDER and a fate of S100.00 a day against me. r understand th=t copy of this statcmcnt may dC furn-arded to the orrice of In,cstiestions of the DIA fur coverage verification. 1 rio irA,rr7jt-j- er t/rep ridpenairies of perjun•that the information prorided above is true u.-td correct,Phone tt i'eiai use univ do not writc in this area to be eompicted by tiny or town olTciai t city nr tn%ctr permitilicense> -,Buiidin,Dcpnrrmcnt CUcensin_Board check irimmediatc response is required Q Scicetmcn•s orlicc t. C:1lc2i1h Department phone te• r-t)ttter�— coma:: nerson: Information and Instructioas Massachuscits General Lmvs chapter 15Z section 25 requires all employers to provide workers* coil'Pensatitln :k-: emnloN-ces. As quoted from the "ia��". an cfyrpturec is defined as every person in the service of :111other undl: :::: contmci of hire. express or implied. oral or written. An c•mpinrcr is defined as an individual. partnership. association. corporation cir other Iega1 entity, or any n%el ar the Foregoing cnuiucd in a joint enterprise. and includilia the legal representatives of a deccascd emplover, or:1:c rc_ci%•er or trustee of an individual . partnership. association-or other legal entity. employing einployecs. Ho«e•. c 0WIler of a dwelling house having not more than three apartments and who resides therein. or,the occupant of ate dw ellinu house of another who employs persons to do maintenance ,construction or repair work: on such du-ellir_ or an the _rounds or building appurtenant thereto shall not because of such employment be deemed to be ::n MGi_. chapter l5: seciion'•:5 also.states that ever• state or local licensing agency shall_withhold the issuance ar 1­)V:il „f a license or hermit to operate a business or to construct buildings in the coinmoirwealtli for any !cant who fins not produced acceptable evidence of complianee tivitli the insurance coverage required. neither the commonwealth nor any of its political subdivisions shall enter into anv contract for ale per:u­rill:.::ce of public work until acceptable evidence of compliance with the insurance requirements of this c:::.c:. he,-- prezc:lted to the -o ,tract iiig•authority. Appi:cants P!c_sc .'iil in the %vori:ers* compensation affidavit completely, by checking the box that applies to your situation c:: succivine company names. address and phone numbers as all affidavits may be submitted to the Departmc^t of ncust:iai accidents for confirmation of insurance coverage. Also be sure to sign and date tite affidavit. 7lie it silould be returned to the city or town that the application for the permit or license is being requeste'. r :ire Dc;,cr talent of'Industrial .-accidents. SItould you have any questions regarding the "law" or if you are req o ��cc in a workers compensation polic%.. please call the Department at the number listed belo,.t,. Croy or Fwxn.s Ple ;%e..urc alit the affidavit is complete and printed legibly. The Department has provided a space at the bor:or. the for vcu to fill out in the event the Officc of Investigations has to contact you regarding the applicant. F be _ : to fill in the permit/license number which will be used as a reference number. The affidavits may be return: -:ie DL�parmem by mail or FAX unless other arrangements have been made. The Off-ice of Im'estiaarioils would like to thank you in advance for you cooperation and should you have art} que piecse do ilot hesitate to _lye us a call. Tile Decarinnent's address. telephone and fax number. ' The CommomveaIth Of Massachusetts Department of Industrial Accidents -• Office cf Investigations 600 Washington Street Boston, Ma. 02111 fax r: (6I7j) 727-7,749 nitone =. : 61—) " =900 e�:r. 406. '09 or _ . The Town of Barnstable ta M— eg Department of Health Safety and EnvironmeIIl Services Building Division 367 Main Stn:et,Hyannis MA 02601 Ralph Crosse.^ Office: 508-790-6227 Building Comr� Fax: 508-790-6230 For office use only Permit no. Date AETMAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION ` MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or contraction of an addition to any pre-existing more than four owner occupied building containing at least or building t be done by registered contractors,'units or to ath structures which are adjacent to such residenceg certain exceptions ng with other requirements Est. Cost Type of Work: Address of Work: Owner's Name Date of Permit Application: I hereby certify that: - Registration is not required for the following renson(s): Work excluded by law _Job under 51,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR PERMIT EMrROVEMENT WORK D DEALING WrM ORNOT� CONTRACTORS FOR APPLICABLE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL� 14ZA SIGNED UNDER PENALTIES OF PERJURY I hereby a ply permit as th ag t f the owner. P fora per Date Contractor, ame Registration No'