HomeMy WebLinkAbout0259 MARINER CIRCLE , � - -
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Town of Barnstable .*Permit#
Expires 6 months from issue dte
Regulatory Services -,
E Richard V.Scali,Interim Director ;
Building Division NOV 2 2 7�1
Tom Perry,CBO,Building Commissioner
200 Main Street;Hyannis,MA 02601
www.town.barnstable.ma.us TOWN OF BAD=l
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY
r Not Valid without Red X-Press Impr'
Map/parcel Number
Property Address
Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address
Contractor's Name u04W.4 Telephone Numberg0k'7/4i/(31 9
Home Improvement Contractor License#(if applicable) Email:
Construction Supervisor's License#(if applicable) 076o 7
Xworkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner ,
�I have Worker's Compensation Insurance
Insurance Company Name b.6— J&Ab,'Ou— /Ps • (:��
I��d33 Workman's Comp.Policy# s 7j�3 f q
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—C� /�l!/�Ll �
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side //,,
Replacement Windows/doors/sliders.U-Value � 3V' (maximum.35)#of windo �• ,
#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 Aign^perty Owner Letter of Permission.
A copy of the Home o ement Contractors License&Construction Supervisors License is
required.
SIGNATURE:
T:TKEVIN D\Building Changes\EXPRESS PERMI . oc -
Revised 061313
i
Pnnt Form.'
The Commonwealth of Massachusetts _1
Department of Industrial Accidents
Office of Investigations
1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): ®►� F f1—J�tp%
Address• Pet,,e
City/State/Zip: 3 o-33 Phone#:
Are you an employer?Check the appropriate bpx: Type of project(required):
1.❑ I am a employer with 4. 1 am a general contractor and I
employees(full and/or part-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 g. ❑Demolition
workingfor me in an capacity. employees and have workers' -
Y P tY• ❑1 9. Building addition
[No workers'comp.insurance comp.insurance.
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 12.❑ Roof repairs
insurance required.]t c. 152,§1(4),and we have no
employees. [No workers' 13.90ther (,)I MM)
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.
lam an employer that is providing workers'compensation insurance for my employees. Below is the policy.and job site
information.Insurance Company Name: Nuo gao.>4;`L'.. co 4
Policy#or Self-.ins.Lic.#: 1 V � �� � � /q Expiration Date:
Job Site Address: � �l�— �1 City/State/Zip'.. Aq
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 insurancqc?)Iage verification.
I do hereby ce!#&under the gains a d ald o e 'u that the in or_nwion provided above is true and correct
Si ature: __ _ _. _ _y. ._. _:. ----_i Date•. 'rf
Phone#: `w
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#:
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May 11, 2013 , 4
Barnstable Building Dept.
The following is a list of our approved sub-contractors for The Home
Depot: f
Ericsson Torres= CSSL,# 100546 HIC # 163528.
Michael Viola — CSSL# 099403 HIC# 140993
T
Vincent Smith - CS # 106837.. a HIC #-165927 '
Timothy Thomas— CS # 51899 HIC # 152121 '
Ronaldo Solano — CSSL # 101027. HIC # 1S2206 ;
Joseph Duarte - CS # 70077 HIC # 132349
Douglas Szynal,-- CSSL# 103950., HIC #-146142 •. jA
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Brian Laroche — CSSL# 100478 HIC # 152612
Joseph McKeon — CSSL# 98863 HIC#'132614
If you have any questions please contact Mike,Bedard our permit*, _
coordinator at 508-962-6942 or m self at 617-438-901
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S' erel
uss one
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Bra Installation Manager n
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THD At-Home Services,Inc. - _
908 Boston Tumplke- Unit 1 •Shrewsbury,MA 01545 m
Phone:774-275-2139•Fax:508-845-6076•Toll Free:800-657=5182 ,
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c%Ite r,�ec r,� ci
i O ice o ,onsumer ai and usmess Regulation
b 10 Pairk Plaza - Suite 5170
Boston, Massachusetts 02116
jFforne lmprovei)3pVQontractor Registration
Registration: 126893
Type Supplement Card
Expiration: 8/3/2014
The Home. Depot At-Home Servids
f,ANDREW SWEET -
2690 CUMBERLAND PARKWAY`5U1'1a� 1 �'. --
ATLANTA GA 30339
Update Address and return card.Mark reason for change.
[] Address D Renewal E] Employment Lost Card
DPS-CAI 0 °AM-04/04-Q101216
sc�" Office'&"farma rs usifuese egu at� License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to;
1 Office of Consumer Affairs and Business:Regulation
ReglsLfatlow. g, 88-93 '1 Type:
... �,. , 10 Park Plaza-Suite 5170
Expiratte0;,4/3l�:bt4l Supplement Card Boston,MA 02116
901ne Depoi,464'9mis— arvid 6
ANDREW SWE7 :�
2690 CUMBERLAN16 P—AR'`I —
A` 1 �1,GA 30330 ,, j Undersecretary y ah t on signature` —~
` e:16:06 AM PST (GMT-8) FROM: 100005-TO: 15087302086 Page: 2 of 2
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®� CERTIFICATE OF LIABILITY INSURANCE '"TE°'°"°"'M
THIS CERTICERTIFICATE
DO DOE SS ISSUED AS A NATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS _
CERT)FlCATE E8 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 iSSUIN13 INSURER(S), AUTHORFiED
REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poiley(les)must be endorsed. H SUBROGATION IS WANED,subject to
the tern and conditions of the policy,certain policies may require an endorsement A statement on this csttifieab doer not confer riyhu to the
certlticats holder In lieu of such endorsemen a.
PRODUCER PAUL 8 SULLIVAN INS AGCY INC
FALL,RIVER MA 02724
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1 AFFORDINGCOVt;<IAfiE NMCaM
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�JTSEPH DUARTE&JOHN DALEY f4sum■
DBA J&J REMODELING ftummc,
15 WILSON WAY 11"UMMO:
MIDDLEBOROUGH MA 02346
nsum E
asuffeltz.
COVERAGES CERTIFICATE NUM ER,-15914016 ISION NUMBER.,
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
"in.n.cD. MCIUMEEMENT,TERM OR LAAYYi11yN ur AI'IY 80isiKAGi illi VTMEK DOCUMENT WIjT1 REHPECT TO WHICH THUS
CERTIFICATE MAY BE ISSUED OR MAY PERTAM,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN L4 SUBJECT TO ALL THE TERMS,
EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID MAIMS.
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DEBCRi OFOPEM ILDCAT IVEIe (IUhsbACORDWI.AddWond Rom"ecMdul% no►ssprrsbtsgWred)
Workers compensation irmurance coverage applies only to the workers commsaHeon laws of the state of MA-
N. PAkMERS ARE COVERED BY THE WORKERS'COMPENSATION POLICY.
ION
SHOULD THD AT HOME SERVICES,INC.AND THE EV�T oTHE ATiE THEREOF,ABOVE° ef DEC WILL Be OEEL BEFORE
THE HOME DEPOT ACCORDANCEWfTHTHEPOLICY PROVI91ONB.
2690 CUMBERLAND PARKWAY SUITE 300
ATLANTA GA 30339 Aun*xum rx"NMATM
jeffEldrWas
ACORD ZS 20f OVD O 1 988.2010 ACORD CORPORATION. All rights reserved
( 5 The ACORD name and logo are registered marks of ACORO
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�•""'�� TOWN OF BARNSTABLE Permit No_ -----------------------________
Building Inspector
I "mrr."c Cash
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OCCUPANCY PERMIT Bond ----
____�
"No building nor structure shall be erected, and no land, building or structure shall be
used for a new, different, changed, or enlarged use without a Building Permit therefor
first having been obtained from the Building Inspector. No building shall be occupied until a
certificate of occupancy has been issued by the Building Inspector."
Issued to Address
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS.
...................................................... 19... . ..............................................................................._..................._.._._._
Building Inspector
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PLAN SHOWING
FOUNDATION LOCATION
C O T UI TO MASSACHUSE T T S
OWNED BY:
SCALE : DATE.:
NORMAN GR0SSMAN------ REGISTERED LAND SURVEYOR
I HEREBY CERTIFY THAT' THIS FOUNDATION. IS LOCATED ;N a
ON 77HE LOT AS SHOWN AND CONFORMS TO THE TOWN �� ` �qc
IL
OF BARNSTABLE ZONING REGULATIONS REGARDINGoetthrt N�
SETBACKS FROM STREET LINES AND LOT .LINES . cHossary
' 127)5 0
NORMAN GR0SSMAIV R.L.S. DATE
WSsor's map and lot number ... .. ....................G.............. . SNoutignb3b NIVI01 pi THE TO
�S ONV 3003 1V1N31NN0
Sewage Permit number ..........V.......1.......................
9 31111 1'111M t HafiB9TADLE,
ouse number 1IN"&
039.
.............. ...�.-�. ..�..�.�........................... o 3aNVfhdWO� N103llfl
381Sf1W W31SAS �Ild 0 ypY a�e�
TOWN OF BARNSTABLE
BUILDING INSPECTOR k...
APPLICATION FOR PERMIT TO .................... .. .............. ........................ ....................
TYPE OF CONSTRUCTION L� .. ✓��� . ..... ....... ...... .... ................. .. ,.................. ...................... ....................
............. ./�•• ..��....19........
3 TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the followi g information:
Location .. . ...... ...................
Proposed Use .........
Zoning District .............�:�.................0�0�.
..Fire District ...............� ............................................
Name of Owner ��!a-c�... :fir:.... ..:7-Address ..................... ..........
�
.
Nameof Builder. ..: . . .... .... .6.'.L. ........Address ....................................................................................
.Name of Architect ..................................................................Address .........................................:..........................................
Number of Rooms ...........................Foundation/.............. .f .... ... .................. .......
Exterior ..LTV .....all ..�....... .... ...................Roofing .......
.................
Floors i!�� ..5/ `- ..........................Interior G�.
-1 Fieafing ......./; �^, :......i . ...-f:>c?0........................:Plumbing .......... .//........................................................
Fireplace ........ . .....................................................Approximate Cost .......d.4.G!.y'. ...............................
Definitive Plan Approved by Planning Board ___ _ _________/_-1-----19 _. Area .
Diagram of Lot and Building with Dimensions Feed ......................
SUBJECT TO APPROVAL OF BOARD OF HEALTH 80AID
o �
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ...k ... .............
; .CEDAR ACRES REALTY TRUST
a 2234.9.... Permit for One...S.tor.y............
Single Family Dwelling
...........................................................
Location .....Lot....5.5....#.2.5.9...Ma.r.in.e.r...Circle
location
Cotuit
...............................................................................
Owner ....C.eda.r. ...Acre.s...Realty. ....Tr.u.s.t
.. ....... .. .. ....... .. .. ....... ....
Type of Construction ...................Frame.......................
................................................................................
Plot ............................ Lot .....................
............
Permit Granted ......J.uly..17................19 80
Date of Inspection ....................................19
Date Complet .....19
PERMIT REFUSED
C', 19
. ......................................................
............................:................
+ .....................................................
rp - a I.
............................................. ......
0 ..
Apprp,ved ............................................ 19
...............................................................................
.. ....................................
Assessor's map and lot number OF THE To
Ad may/
Sewage Permit number ...................................... �o
Z BAR35TABLE,
`House number .......................................................................... r rose
039.
j �MPY a'
t TOWN OF BARNSTABLE _
BUILDING INSPECTOR
APPLICATION FOR PERMIT TO � !4. ........................................................................
TYPE OF CONSTRUCTION .... rCf/l' Yrt,,....... ................
............ . /� r�J....19........
o'
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby •applies for a permit according to the following information-
' Location .��... ...... �� /.,! /?l ...... .��t.Cr�l�. , rn.l i..... �`:..:........
ProposedUse ....... /,1 . . ....... .............. ..................................................
Zoning District .............//�: ..�.............. ..............Fire District ............ )..............................................................
a Name of Owner ....�' Q'L..� 7..rlj� : ...f ....Address ..................... ........� ..........
A,
..
Name of Builder .. ?-�-!� •�� /!T, l ........Address ....................................................................................
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ................ .............................................Foundation ......... ,
.....
Exierior l ...- #...................Roofing .....1.•��.x.. ...................:
Floors {.�i�'1.1 ..................................:Interior................... . . ...... .......................................................
Heating ...... 1',.LC%•........ <%.......................Plumbing ........... / ,.........................................................
Fireplace .........�y .. .` ............................................................................................................Approximate Cost ........d.!t�...................................................
v .
Definitive Plan Approved by Planning Board ----�Vi _ _ 19_� _. Area 215..,.�.�.Ab .................
Diagram of Lot and Building with Dimensions r Fee 0
SUBJECT TO APPROVAL OF BOARD OF HEALTH
�000 61
i
37
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t.
F
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ..... , ._......a_6..... ...................................................
24-14
A-24-
CEDAR ACRES REALTY. TRUST
ar
No 2.2.3.4.9.... Permit for QrLe...S.tQ.rY............
....Slagle...FamiLly...Uwellinc .................
Location LQJ;...5.5...4.2.5.9...Maxin.er...Cir.cle
..............JcatuLt.................................................
Owner ..Cadar..Ar-r:,/q..MRe.a1ty...Txus.t.
Type of Construction . ra �e............................
..................................../........................................
Plot ....... Lot ................................
Permit Granted .........July...17.............19 80
..J-U.l Date of Inspection ................19
on ............................... .
Date Completed ................... .................19
PERMIT JRFUSED
................................................................ 19
...............................................................................
...............
. ...................
.................... ...................................................
C)
Approved ...D..... ........ . ... ........... 19
..................................... ...... .........
.......................
.................... ..........................................................