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HomeMy WebLinkAbout0865 MAIN STREET (COTUIT) 9 �� I i i i - _ " Application number.... ........�.�.......................... QaFee............................................ ...�......................... Building Inspectors Initials....... ........... ... 16 A JUN 19 201 FO 4��- Date Issued....... IAA � ............... ...................... 1��1HIV8 iABLF I1 Map/Parcel......:......: ::.! ............................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: /!2b.1W 57' NUMBER- STREET VILLAGE Owner's Name: Phone Number Email Address: - E Cell Phone Number Project cost$ Check one. Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize* �J to make application for a building permit in accordance with 780 CMR ' Owner Signature: Date: llqhl TYPE OF WORK - 1 © Siding 0 Windows (no header change)# ED Insulation/Weatherization 0 Doors(no header change)# Commercial Doors require an inspector's review LZ"Roof(not applying more than 1 layer of shingles) Construction-Debris will be going to ,mijrJ���/;�y CONTRACTOR'S INFORMATION Contractor's nameL/r $2 �BX Home Improvement Contractors Registration if applicable) e)& � (attach copy) Construction Supervisor's License# w Email of Contractor YbV60,W Phone number ALL PROPERTIES THAT HAVE STRUCTUR 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 'e t +• 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 must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes No___,if yes, a gas permit is required. Natural Gas Yes No ,if yes,a gas permit is required. 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 APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. Town of Barnstable Building,m.. `r ' ,. ..��,'•r_a' i' Fv ..�'!�3, � .4 � :.W sue. •,. �`€: ^�= "i. �...: „ a"'� `,... '�,r.vE .'�%r rg �. r Post�Thrs<Card So�Thatrt�5 Visible,From t#ie Street-A ; ;roved Plans;<Must be Reia�ned:on Job and"thisCardMustbeyKe t ;;rt enn�vtmwesa ,, y , PP, P.�r �° W<here�a Cert�ficate�of�Occu' anc : s�Re vied,suchBu�ldm �shall�Notbe Occ� iedgnt�l a-Final Inspect�on•;has��,been�made� �: Permit Permit No. B-19-2027 Applicant Name: DAVID COX INC. Approvals Date Issued: 06/19/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 12/19/2019 Foundation: Location: 865 MAIN STREET(COTUIT),COTUIT Map/Lot 035-056 Zoning District: RF Sheathing: �� Contractor Name , DAVIDCOX INC. Framing: 1 Owner on Record: MCGEOCH,JOAN Cz. n g• Contractor License100497 Address:. 69 WOODMAN RD is -r 2 SOUTH HAMPTON, NH 03827 . i Est Project Cost: $7,000.00 Chimney: i Description: roofing i ii Permit Fee: $35.70 Insulation: YA - �Fee�Paidk $35.70 ; Project Review Req: m , Final: Date 6/19/2019 q., .. rp' e Y Plumbing/Gas ' . ;< Rough Plumbing: r µ Building Official final Plumbing: h II b deemed abandoned and invalid unless the work a thorized<b this permit is commenced within siz mbfiths after<issuance. This permit s a e b y p All work authorized b this permit shall conform to the approved a lid tion'and the a roved construction documents for wfiich.this permit has been ranted. Rough Gas Y P PP PP � PP P g g 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 st eet&&!edad4nd shall be maintained open for public inspect on for the entire duration of the Final Gas: work until the completion of the same. i 3 i Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are'p on thispermit. Minimum of Five Call Inspections Required for All Construction Work:,' fi Service: 1.Foundation or Footing } ; 2.Sheathing Inspections '. w 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. j Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). � Fire Department Building plans are to be available on site . All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: The Commonwealth of Massachusetts Department of IndustrialAccidents 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 Legibly. Name(Business/Organization/Individual): Address: /* City/State/Zip: Phone 4: Are ou an employer?Check the appropriate box: ' Type of project(required):. 1.�I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.- 7, ❑Remodel' mg, ship and 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.x required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL w 12.[aRoof 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#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. 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 po114 and job site information. Insurance Company Name: Policy#or Self-ins.Lic.# /� �;i/�'� / Expiration Date: Job Site Address:a City/State/Zip:e lJ27V ZZ . 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 and the pains and enalties of perjury that the information provided above is true and correct: Si ature: -i' Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official F 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#: r . . 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. Y g Y g g PP 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 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 Department of Industrial Accidents Office of Investigations 600 Washington,Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia !-1 np tCr�rr urerrurn�r/!h t� rt ne:�t�.^ir aderrn . Office of Consumer Affairs&Business Regulation Division of Professional Licensure HOME IMPROVEMENT CONTRACTOR Board of Building Regulations and Standards TYPE:Corporation Constructioll supervisor Registration Expiration 100497 . 03/9-4/2020 CS-063537 Expires: 10/1512019 DAVID COX,INC. DAVID R COX _ ? PO BOX 401 s l2 SOUTH YARMOUTH MA 02664 DAVID R.COX y 19 LAVENDER IN W.YARMOUTH,MA 02673 Undersecretary Commissioner r? ti ,ACC>RO CERTIFICATE OF LIABILITY INSURANCE I DATE(.SINVDWYYYY) . 07112,'2018 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(SA AUTNORIZED REPRESEP1TAT%V'E 0%PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: H the certificate holder Is an ADDITIONAL INSURED,the policy(les) must be endorsed, U SUBROGATION IS WAIVED, subject to ( the terms and conditlons 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 Mari Connor SULLIVAN GARRITY & DONNELLY INSURANCE AGENCY INC °H E No.ExIli 508)453-2586 -��F�x•-____ AMAIL , kathleen.geddis@sgdins.com t01NSTiTIJTE RD INSURER s AFFORDING COVERAGE —�rNAlce WORCESTER MA 01609 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA Ll 25666 INSURED INSURER B: -- DAVID COX INC INSURERC: i INSURER D: PO BOX 401 INSURER E: �� I S YARMOUT�i MA 02664 INSURER F COVERAGE'S CERTIFICATE NUMBER: 290863 REVISION NUMBER: jTHIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTNATHSTANDING 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 SEEN REDUCED BY PAID CLAIMS, VTR.LTR: TYPE OF INSURANCE 'A LiTT POLICY NUMBER Q ! Y EFF ICY EX LIMITS —COMMERCIAL GENERAL LIABILITY � ! � i EACHOCCURR_�S i I 1 CLAWS-MAQe '_i OCCUR I � � � I PR��I�Es rea occurreneol 3 MEO EXP An one rs0n) I s NIA I PERSONAL&ADV INJURY f GEN'L AGGREGATE LIMIT APPLIES PER. I i GENERAL AGGREGATE f POLICY L7 JECT i._ l LOC I � I P—R�ODUC75•COMPIOP AGG S OT R: I I ! is AUTOMOBILE LIABILITY i, Q 5 N $� ; ANY AUTO BODILY INJURY(Per person) $ I ALL OWNED SCHEQULL•D N/A I BODILY_INJURY(Per xatlentl f l AUTOS _ NOhWWNED E i f �PROPERTY�� MIRED AUTOS I AUTOS j d I $ UMBRELLA LIAB OCCUR I I EACH OCCURRENCE s excessUAB CLAIMS-MADEI I N/A iAGGREGATE _ 3 I=R I iWORKERSCOMPENSATION i ? ATtIT i ER ANDEIWLOVERS'UAINUTY ANYoROPRIETOR/PARTNERiEXt:CU'TIVE Y/N E.L,EACHACGIDENT f 100,000 A �OFFICERI,MEMt3EReXCLUOI!11 N/A IRA WA 6HUB91oX742218 07/1612018 f 07/16/2019 Wandstory In NN) I £.L DISEASE-EA F.MPLOYtE f 100 000 Il yes.deeaibswufer I �.•. _�— DESCRIPTION OF OPERATIONS U{ E.C.DSSEASE-POLICY LIMIT'f 500,000 I I I N/A DESCRIPTION OF OPRRATIONG/LOCATIONa/VEHICLES(ACORD 101,Addidonal Remarks Sehn le,maybe eeached it mare spate is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires.or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above poiiey precedes the Issue date of this certificate of Insurance). The status of this coverage.can be,monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwdMrorkers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE? WILL BE DELIVERED IN Town Of BarnstableACCORDANCE WITH THE POLICY PROVISIONS. 2W Maid Street AUTHORIZED REPRESENTATIVE 'Y Hyannis MA 02601Daniel M.Crq_t y,CPCU,Vice President—Residual Market—WCRISMA C01NO-2014 ACORD CORPORATION. Ail rights reserved. ACORD 25(2614101) The ACORD name and logo are registered marks.of ACORD A_,A � Assessor's map and lot number .. Sys . :.. .f:�.......... �FTHEtG Sewage Permit number - $ 6 S SEPTIC SYsT :I ,�STIIBLE, House number .....::......:......:........................... INSTALLE0.114 06M 9�d�W 6 9. WITH ff., 5 0 YPY TOWN. OF BARN m -dIdDiAND BUIrLDIHG INSPECTOR �... :.............1 X..1..:11 APPLICATION FOR PERMIT TO :..a.�.�.. :I(2..... (�/l„ D d� TYPE OF CONSTRUCTION ......... .�RIYY ^. ............................ ....................... ....................................... u ....T..............19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a Qpermiit according to The, following information: Location ................:.."..1.I�Q ........�?_. .. ... .... �l.0 1...�.".!:.!..t� :..:........ ProposedUse .....B .......................................... ......................... Zoning District ..................................................:.....................Fire District ....... .���ti••'!:'`/°................................................... Name of Owner ........ ..... .......Address ............. ... Name of Builder .......... .� .....a,?. ..Q.........Address Q�i flJtL -C.Q.. �i."LLL.. ............ Nameof Architect ................................... ...........................Address ......................`.......................................................... Number of Rooms .................................... ...........................Foundation .............. ..V....!.. f Exterior ............... ..41.!d.6!`......Gb.l t �...: ....................:.Roofing . .�.ClX. ' ......................... FloorsC. .. ..... ...... ........................................Interior ...................., ......................... Heating .............. ................................................Plumbing .............................1..1.(%Y. ..................................... Fireplace ........................: .......,.,.......:..,...:.:.........:..................Approximate Cost ....................... ..d..............:............ Definitive Plan Approved by Planning Board _-------------------------------19________., Area ............ ................. Diagram of Lot and Building with Dimensions Fee ........... Cl ................ SUBJECT TO APPROVAL OF BOARD OF HEALTH t�l r (p� I a N < 0 -(Ott I hereby agree to conform to all the Rules and Regulations o the Town of Barnstable regarding the above construction. Name btlyl......C.`....... .1�1.�. CCU.......... McGEOCH, JOAN C. i S , r No .... Permit for ...AL?.Q,1T.-1QN............ To Present...QaXag.e......................... Location ...................... ......... ...Cold.. .................................. Owner ...P M.1....5.o:kQ.I10.............................. r'. Type of Construction .Frame............................ ......... r............................................... r- ; Plot ............................. Lot ................................. Permit",Granted September ;10,r....19 81 Date of Inspection 19 Date Completed .........................`::.�7..19 t PERMIT REFUSED ............................................................ .... 19 ............. { .. / + .. ........................................^.= - �• - .e� e`\ r'^r ' 'y .. * _ �.. - !r ............. ........................................- ............... s. '* yF • 5"' .� - i�.. o. ., r - r ...........................ti........................... ~........... r r ' -fr\' r _ 7!.. .................:........................................... ...... . ✓W ` "�'y # . - - -� Approved ...... .......... 19 ............................................................................... Y I Assessor's map and lot number ....r ....................................... THE Sewage Permit number .................':.... _ Z EAUSTADLE, i Housenumber ........................ .............................. G NAG �00 OV a� t + TOWN OF BARNSTABLE BUILDING INSPECTOR } APPLICATION FOR PERMIT TO ..... .::......t;�:: }C:^.� .....��a-/L C .................................... TYPEOF CONSTRUCTION ........EfL:YmA..........................................................................................................v.................................................... !:.. ..:� ..W..............19.: .�, 1� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according/ to t-h-e—following information: Location .................`:.Yl'1.(kk...;:?............, 1t, ....l t c. . ...;);1 k. ................ ................................... ProposedUse ..... .1 "k f .�t;!u. t> �.................. ..::...........,......... .,. ... ...... :.....; .........................,......................... A� Zoning District ....Fire District . ' L 1( lrtn L ��( F .b:.1^C.�n C9 C ! �...*�... o t Name of Owner ....... ..................... ................ ....I..Address ..............,.. .,..................................... Name of Builder. � .;..... .( 't.p� � � ......Address ......... ,u k ` rC.....t............. Name of Architect —� ..� ..............................�";_............................Address .................................................................................... Number of Rooms .............................Foundation �_l. - R ..................................... `` .................................. Exierior � ,: k' t1vt ( .,�:1-o Roofing C. E sJ kn f ............. V Floors �, ..........................................Interior . �.,1..;, N Lw�..�_ �h�r C � .................... ............. . ............................................... .. ... ...........................Plumbin F ,r..�_... . t� Heating ° ..... g .................................................................................. .................................................. Fireplace ............... ..............................Approximate Cost . 1 f (_-) .......................................... Definitive Plan Approved by Planning Board---------------------------------19________. Area ...... � ?'mot .. Diagram of Lot and Building with Dimensions Fee ............ SUBJECT TO APPROVAL OF BOARD OF HEALTH ly I, CL . � l � I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. McGEOCH, JOAN C. E-56 1 No .D44.0... Permit for .AD.D.ITIOU............. ........TQ..Pxes.ent..Garage........................... i Location B.6.S...Maim...S.tsaet........................ ...............Gotuit................................................ 1 Owner ..John...C.....Me.Geoch........................ Type of Construction ....Frame Frame........................ ..........................................................:.................... Plot ............................ Lot ................................ j Permit Granted September 10,19 81 Date of Inspection ....... ............... ...........19 ti s Date Completed ...........19 i PERMIT REFUSED ....................................... .................. 19 s ................. .� ........ � ................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................