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HomeMy WebLinkAbout0192 MOORING DRIVE E T . .... ............ Application nut(mber ..�..�� Date Issued.....Ji.1.................... .......... SARNSTABLE, ,' ��� NOV 2 $ 2018 Building Inspectors Initials.. .�........................ 0��/ //3 TOWN O� BARNS ABL' Map/Parcel..........................................:...................... TOWN OF BARNSTABLE � b . � 657 EXPEDITED PERMIT APPLICATION: a ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY 1"ORMATION Address of Project: / ,7- Ho o ri n 15 "�,:>r fu,' NUMBER STREET VILLAGE Owner's Name: M;I<e- 140 fv hes ko Phone Number Email Address: M a /u /,eL G 876-!�A,,.'l Corn Cell Phone Number Project cost$ /l 7 7 Y — Check one Residential ✓ Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: S:�-e e P,4(4-dle,� Date: TYPE OF WORK ❑ Siding U Windows (no header change)# /0 ❑ Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) / Construction Debris will be going to (&)a s'C�7haAA 5-ClK e •--f (,JB � E o v C t-� .m CONTRACTOWS INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# /L/&5 B 9 (attach copy) Construction Supervisor's License# /D S / K k (attach copy) Email of Contractor siVee495-@ C- Phone number F00- 'W2 -Z 2 1 S ALL PROPERTIES THAT HAVE STRUCTUR OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY 15 IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X. X X Additional tent dimensions can be attached on a separate piece of paper. 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 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. i a Page 1 of 12 M�.Reg#146589 CT Reg#0605216 ANN= Federal ID#20-2625129 Window/ Door Contract Customer Information Mike Holubesko (508) 641-3461 O Date: 10/27/2018 192 Mooring Drive Cotuit Ma 026.35 mholubesko87@gmail.com Rep: Ryan Powers Cotuit MA 02635 Office# 800-242-9974 Location Agreement NEWPRO hereby agrees that it will, for the consideration hereinafter mentioned, furnish all labor and material necessary to install the goods purchased by Owner in accordance with the terms described on the following pages of this agreement (collectively, this "Agreement") at the premises located at: 192 Mooring Drive Cotuit Ma 02635 Cotuit MA 02635 Windows Being Installed: 10 Doors Being Installed: 0 Window Details Location: Living Room Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: None Hardware Finish: White Grid Type: None Additional Labor: None Glass Options: None i-- _ Location: Living Room Series: 'Ecomax Picture j Interior.Color: White Screen Type: N/A Exterior Color: White Grid Pattern: None Hardware Finish: N/A Grid Type: None Additional Labor: None Glass Options: None Location: Living Room Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: None Hardware Finish: White Grid Type: None Additional Labor: None Glass Options: None Location: Dining Room Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: None Hardware Finish: , White Grid Type: None Additional Labor: 'None Glass Options: None Location: Dining Room Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: None Hardware Finish: White Grid Type: None Additional Labor: None Glass Options: None Page 2 of 12 W - Location: Bedroom 2 Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 1 Exterior Color: White Grid Pattern: None Hardware Finish: White Grid.Type: None Additional Labor: None Glass Options: None Location: Bedroom 2 Series: Ecomax Double Hung _ = Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: None Hardware Finish: White Grid Type: None Additional Labor: (Sill) Glass Options: None Location: Bedroom 3 Series: Ecomax Double Hun Interior Color: White Screen Type: 1/2 ~' Exterior Color: White Grid Pattern: None Hardware Finish: White Grid Type: None Additional Labor: None Glass Options: None Location: Bedroom 3 Series: Ecomax Double Hung r. Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: None Hardware Finish: White Grid Type: None Additional Labor: None : Glass Options: None - �` Location: Bedroom 3 Series: Ecomax Double Hung Interior,Color: White Screen Type: 1/2 (. "- f Exterior Color: White Grid Pattern: None Hardware Finish: White Grid Type: None Additional Labor: None Glass Options: None Window Capping Type Standard Capping Capping Texture PVC .Capping Color Aspen White 28321 Additional Details Newpro will remove any demoed or installation debris from the property in relation to this contract. All promotions were applied at the time of purchase and can not be combined with any future offers. Payment Total Price: $11,774 Deposit $1,000 Due Upon Completion $10 774 Payment Method Finance Estimated Start &Completion Dates Estimated Start Date 12/10/2018 Estimated Completion Date 12/11/2018 Customer understands that these are estimated dates and will be contacted to schedule actual date. T;'is space intentionally l it i 1pnk Page 11 of 12 .epms and Conditions Owner has read and agrees to the terms and conditions of this Agreement. Owner specifically agrees to the (1) Total Cash Price; (2) work being performed; and (3) work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two (2) copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. YOU THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY OF THIS TRANSACTION. SEE THE. ACCOMPANYING NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. The undersigned gives NEWPRO permission to debit their checking/savings account, or process a credit card transaction, for the deposit amount indicated on or after the contract date. Subsequent payments, such as start payments, or completion payments will remain in effect until I cancel it in writing, and agree to notify NEWPRO of alternate payment intentions. If the above noted payment dates fall on a weekend or holiday, I understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that NEWPRO may at its discretion attempt to process the charge again within 30 days. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. 1 certify that I am an authorized user of this credit card/bank account and will not dispute the scheduled transactions with my bank or credit card company; provided the transactions correspond to the terms indicated in this authorization form. vvy� Mike Holubesko 10/27/2018 Date Ryan Powers 10/27/2018 Date crs clCe .i.to n%f-CMEifV 1iji` iJ 13r,1' ',Vmrnonweai[n of Massachusetts r` Division of Professional Licensure Board of Building Regulations and Standards Constru.c6on'Supervisor C5-105188 EA: pires: 11/01/2019 =i VLADIMIR KRUCHYNSKYY;' 1 PAVILLION ROAD ` AMHERST NH 03031 1 `� T Commissioner Fla' Office of Consumer Affairs&Business Regulation _:;.• HOME IMPROVEMENT CONTRACTOR TYPE-LLC k' 'Bhoigt Mon Ems na_ tion c r - -- 5_. 03/23/2019' ALL W ORK CoNsiSEYCYd£�•t- c VLADIMIR KRUCHYNSKYY' 1 PAVILLION RD. AMHERST,NH 03031 Undersecretary r The Commonwealth of Massachusetts Department of lndustrialAccidents I Congress Street,Suite 100 Boston,M4 02114-2017 ' www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electriciaus/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual): Ale_ p i-o OOP t G'1;nc, L—L C Address: a (a dLoc(al S� City/State/Zip: 4/ b vren P1 A 0/9b I Phone#: /- 000 -3 4/2-L z 11 Are you an employer?Check the appropriate box: Type of project(required): I&am a employer with S Q�employees(full and/or part-time).* 7. n New construction In I am a sole proprietor or partnership and have no employees working for me in g. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.[]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 4-❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I L F❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.+ /-I / 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14 LJ ether�/1/1 Ct fTw r 152,§1(4),and we have no employees.(No workers'comp.insurance required.] ��lG ram.► �� S *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees;they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:U CI I C l � �. G("CD Policy#or Self-ins.Lic.#: ,✓ewe 5? 74 oGtG Expiration Date: 5- /— I F Job Site Address: /9 Z City/State/Zip: Attach a copy of the workers' compensation policy eclaration page(showing the policy number In expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisot'ment 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 copy statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificati0 . I do hereby certify un er Repa'Au and penalties of perjury that tAeinformadon provided above is true and correct Signature: Date: Z 0 —l Phone#: /- 906- 3 qZ - Z 2 1 1 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#: C Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: Supplement Card NEW PRO OPERATING,LLC. Registration: 146589Expiration: 05/04/2019 26 CEDAR ST. WOBURN,MA 01801 Update Address and Return Card. Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SUDolement Card before the expiration date. If found return to: Registration. Expiration Office of Consumer Affairs and Business Regulation 146589 05/04/2019 10 Park Plaza-Suite 51.7,0 NE`rdPRO OPERATING,LLC.: Boston,MA 02116.,"VLADIMIR KRUCHYNSKYY 26 CEDAR ST. J WOBURN,MA 01801 Undersecretary Not valid without Signature aACO® DATE(MM1DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01/05/2018 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(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy()es)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: T Melissa Pflug Mackintire Insurance Agency Inc PHONE (508)366 6161 F (508)366-5202 A/C No Ext: AIC,No 11 West Main Street E-MAIL ADDRESS: melissap@mackintire.com INSURER(S)AFFORDING COVERAGE NAIC# Westborough MA 01581-1931 INSURERA: Sentry Insurance INSURED INSURER B: Guard Insurance Group Newpro Operating LLC INSURER C. Colony Insurance Co 26 Cedar St. INSURER D INSURER E Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER: 18-19 Master 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 A1J0L15U8R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MM/DD MWDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.000,000 CLAIMS-MADE OCCUR PREMISES Es occurrence $ 500,000 MED EXP(Any one person) $ 15,000 A A0062403003 12/31/2017 12/31/2018 PERSONAL&ADV INJURY $ 1.000.000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 3,000,000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ A OWNED SCHEDULED A0092403004 12/31/2017 12/31/2018 BODILY INJURY(Per accident) $ AUTOS ONLY X AUTOS X HIRED � NON-OWNED PROPERTY DAMAGE $ I�AUTOS ONLY AUTOS ONLY PBracdd I Uninsured motorist BI S 250,000 UMBRELLA LIAB "' " OCCUR EACWH OCCURRENCE S 5,000,000 A EXCESSLIAe HCLAIMS-MADE A0092403006 12/31/2017 12/31/2018 AGGREGATE $ 5,000,000 DED I X RETENTION$ 0 r $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? NIA NEWC874066 05/01/2018 05/01/2019 (Mandatory In NH) E.L.DISEASE-FA EMPLOYEE S 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S Pollution Limit $1,000,000 C CSP304242 12/31/2017 12/31/2018 DED $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached B more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Boxborough Town Hall ACCORDANCE WITH THE POLICY PROVISIONS. 29 Middle Road AUTHORIZED REPRESENTATIVE Boxborough MA 01719 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26(2016103) The ACORD name and logo are registered marks of ACORD Town of Barnstable IECEtP�T ` UAPUNW„ " 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-18-1097 Date Recieved: 4/12/2018 Job Location: 192 MOORING DRIVE,COTUIT Permit For: Building-Insulation-Residential Contractor's Name: RETROFIT INSULATION, INC. State Lic. No: 160461 Address: 644 RODMAN ST, FALLRIVER, MA 02721 Applicant Phone: (508) 989-6436 (Home)Owner's Name: HOLUBESKO,MICHAEL J& EMILY E Phone: (508)641-3461 (Home)Owner's Address: 370 ROUTE 6A, EAST SANDWICH,MA 02637 Work Description: Air Sealing,Attic Flat-Open 10",Crawlspace wall R-10 rigid,4x16 Soffit Vents,Propa Vents,T-Dome, Vent bath to roof,Basement Sill:R-19 FG,Common Wall: 2" Rigid Board,Insulate Crawlspace door, Future Bath Fan Vented To Roof n Total Value Of Work To Be Performed: $6,160.00 —t Structure Size: 0.00 0.00 0.069 Width Depth Total Area m I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: RetroFit Insulation 4/12/2018 (508)989-6436 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $6,160.00 Date Paid ? Amount Paid Check#or CC# Pay Type 4/12/2018 $35.00 Xooc-XXXX-�- Credit CardN Total Permit Fee: $85.00 � 3296 Total Permit Fee Paid: $85.00 _...,0 ,,....., .....�...$__...__� _......... . ......—-- __....._._......._. ant/tots so.00 XXXX-X000XxXXc-i Credit card 3296 f • Town of Barnstable ^PertnYt# 761jg3 4. IUW&u.1 monthrfFom duty 4sT�p� Regulatory Services Fee__�— .a 9: Thomas F.Geller,Director ° Building Division Tom Ferry, Building Commiasioner X® E�S 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 MAY 2004 Fax: 508-790-6230 EXPRESS PERMIT APPucAmON - IZFSIDEgLULN G V sTA3L Not Valid without Red X-Pruj 1'rnprint Mapiparcol Number N —1 Froperty Address &_ Lq /1 Value of Work tee ' Owner's Name 8t Address 23 (Q�, �a ► Contractor's Na1ru�G.y S �Z�CL nS ��► Tcicphono;lumber-`_� Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) �(p 5Worina2n's Compensation Insurance Chock ono; ❑ I am a sole proprietor ❑ I am thy Homeowner I have Worker's Compensation Insurance _G� Insurance Courpany Nasno ram e_`�r`, C�.�2Y'n(1 t I .CEO- vY workmen's comp.Policy# -1PJ U 13—q as Ce 5, _ ij02-. Permit Rcqu03t(chock box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to XRe-roof(not stripping. Going over ' existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) 'Whore required: Issuance of this pa init does not exempt compliance anth other town dcputmertt regvlso one,i.e.I'USEWIC,Conservation,rtc: Signature Q:Forrsu:wmtrg . kavisedl11901 I -- The Comnlori lvealtla o f Massach use tds Department of Irtdusi'rial Accidents 0lf�f�i�tdll4�'f:8Gt08dl0'�.s� 600 Washlngtort Street -� 1lostou, Mass. 02111 Workers, Compensation Insurance Affidavit 0 ,/ D�►n.(on ❑ [am a homeowner performing a work mysel ❑ [am a soic proprietor and have no one working in any capacity a 9lillli t i an unploycr provldln wo�kcrs' cornhcdsation t'or m employees working own this jv g a?1�61$1 ��t1eI80tti li�lAi oat;i o::: 17 ��- ❑ 1 am a sole ro rictor P p. ,genera!contractor, r Iwmcovrncr(circle arre)and have hirc ��contractol-s listed below vtl�iool ` the following workers'compeasation polices: nn va�rr., .moo cv— 41.. -- _ Failure to recnre--rage as required under Section 25A of A1CL t5I can lead to the imposition of crimin al penaltJ� es of a qnUn e u t one Years,Imprisonment statemataeat as erell as civil penalties in the form OCR STOP WORK ORDER and a fine of ' �~ MSIa .u :. copy of this atatement may be forwarded to lite OMce of invcsUgatiotts of the D[A for coverage verJAcatlo,a• p o ndcri(A0 and ar S(tO.IfU a day against Inc. l undcntaad lhar r< Ido hereby certl rider the pains and penalties of perjury that the lnfortnatiot,:provided above Is:'rue and correct: Signature - . •Print atone �— Phone.41• ��1: of(idai use only do not write In this area to be completed by city or town o 111clii " � t city or town; permlt/llccnsc N ❑check if immediate response Is required Building Department QUccnsing hoard contact Perron; QSdcctmen'a Office phone 9;` ❑!{ealth Department _.__�QOtlacr ffi° 1.: tr�a sAs�l�l A �a(i>G���setar.��;;s�cl?L�,nm:o.n,•r:ar"L�� Information and Instructions ti Massachusetts General Laws chapter 152�section 25 requires all employers to provide workers' compensation for th.cir employees. As quoted from the"law", an employee is defined as every person in the service of another.undcr 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 mire cal the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer;or tile 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 thrce.apartments and who resides th.rcin,or the occupant of the dwelling house of another who employs'persons to do maintenance,construction or repair work on such dwelling f.n.ous� or on the grounds or building appurtenant thereto shall not because of such employtn ;tit be dcccmed to be all,cmployer. MGL chapter 152 section 25 also states that every state or local licensing agency A all withhold the issuuuce ol. renewal of a license or permit to operate a business or to construct buildings in the coulmonwcalth for any applicant who has not produced acceptable evidence of compliance with the insu rai tee.coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall en,or iiJito any contract for the performance of public work until acceptable evidence of compliance with the insurali cc requirements of this chapter 1-1•_ beca presented.to the contracting authority. Applicants Elm MM ME :lt4tli,'st Please fill in the workers' compensation affidavit completely, by checking the box tL at applics to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign aild date the a(,9(idavit. The affida-vit should be returned to the city or town that the application for the permit or liccase is being requested, not the Department of Industrial Accidents. Should:you have any questions regardini;tlic"law"or if you are rc(lui)-c:cJ to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns 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. The affidavits may be zcturnetl to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation :nd should you tulvc any qucsl��nrs, please do not hesitate to give us a call. W6 Dopartment's address, telephone and fax aom?�� Tltc t:atrzrit�rri�r; ;aiftli fit:I;� sS::<",l6tt;t59;.. Departnnext G:'IndusiriLal A(:C:`•.;5c .h ..c.tJ office of iilucsficanous '^ 600 Washington Street Boston,Ma. 0211' �pF THE Tp� Town of Barnstable P �'0 ' Regulatory Services w snxxsrasLE, v MASS. $ Thomas F.Geiler,Director pOp 1639. TED MA'S a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, PA-PAde-111-1,S0 , as Owner of the subject property hereby authorized/ � to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of ) / Signature of Own Date w Print Name Q:FORM&OWNERPERMISSION . z L ATE ImwDUFY/) 1 .ACORDry CERTIFICA►rE OF LIABILITY_ INSURAN-FE ogonucER TVK; CERTIFICATE iS ISSUED A3 A 1 TATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE: CERTIFICAT- Dac$hea I>nsuriance Agency, Inc. HOLDEFI. THIS CERTIFICATE DCIES 140T AMEND, FXTEND Oil 749 Main Streot, . Suite#H THE COVEI4AGF AFFORDED BY T'1C Kik_IC'IGS BELO'N. I Ooterville, Na. 02655 _ i INSURERS AFFOFIDIN.CO £RAGI:i INSURED Paul J-Cazeault & Hoila Roofing ZnC. IN:__ A. We8-nxjk_Ueri 3L,�i]H... hN FR 9_ Trmvel.4:urc ndmai:may_ Co oa:_�:i1lncii. 1031 Main Street INSURE:RC I Osterville, ma 02655 19nn-69H-rustic) IN':VHIAF - COVERAGES _ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE I-OR THE POLICY PER.OD I IDICATED NOI WITHSTANDIN(i ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT.OR OTHER DOCUMENT WII H RESPECT TO WHICH THIS C[F TIFICATE MAY BE ISSUED OFI MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCL'.)SIC IS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IN811 TYPE OF INSURANCE POLICYNUM8EN _ 17 F_YfAM�FEC7!VE POt.I�Y Eri PIRM10N LIMBS -- L. T (M�VUDIY _ GENERAL LIABILITY LTI FA OCC RHENCfCOMMERCIAL UENFRAL LIABILITY }( DAMP 1[(Any ona lua)CLAIMS MADE OCCUR :7(P(.ny onoPonon) iA SCP0467325 CA13G/03 04/3O/04 (1NA1 .4 ADV I'JJIIRVVOO�IIQQ RAL, !iGRFGATEQ0Q_..GEN'LAGGREUAIt LIMIT APPLIES PEA'. UCT! COAuvOP AGi, S��Q_QQ.a.I�Qr1 POLICY PRO- LOC Ll JCCT � AUTOMOBILE LIABILITY —"--- ---l—_" "3" - _ COMOINCC 31NOLL.LIMIT I I ANYAUTO IEea:udw 1 ALL OWNED AUTOS - FIODILv IN unv S SCHCDULE1)AUTOS IPo,Peso, - HIRED AUTOS BODILY IN UR'f NON-OWNED AUT09 ---- I - - F HOI'ERT UAMA(W (Pe/nCOldl q) GARAGE LIABILITY --" ^— -- �-- AUTO ONI ! l:A A,;CIDENT ANYAUIO OTII:R T1 4N CA ACC "_. AUTO ON +'. AW -- ERCE99 LIABILITY - LAUA OCt VRHENCE t OCCUR l I CLAIMS MADE _ AGGNEG/ IC OFDUCTIDLE HE FFNTION S - WORKERS COMPENSATION AND �fATtJ-I IO1 i- - EMPLOYERS'LIABILITY LIMITS 1—1_CIl 7PJUB-922X653-i0a = )0/10/U3 08/10/04 E.L EACI AccIDENT T 8 I E.L.OISE .iC•EA EMI`LOn_C- F 0 EL DISE SE•POI ICY LIMI F OTHER --_..---- --' �-1- --DESCRIPTION OF OPE RAT ION97LOCAf10NSIVENICLEbfEI(CLUSIONS AOUGD OY CNDOR6EMENTBPECIilI PROYI910N7 I CERTIFICATE HOLDER ADDITIONAL INSURED:INSURER LEI-TfiH: CANCLLLATION T SHOULD ANY OF THE AI)UVE DE9CH19ED 1.OLIC 6S OE(A CELL;;01IF FORE THE E WIRATION DAI E THEREOF,'FHE ISSUINU INSURER WILL E IDCAVOR TO MAIL ln_ DAYS'N911TEN NOTICE TO THE CERTIFICATE HOLDER NA NEO'D THE LEFT•BUT FIILURE TO DO SO SHALL , IMPOSE NO OBLU)ATION OR LIAPILITY.OF ANY KIND qPON THE IIISURER,ITS AOI.NTU OR REI'RE9ENTA I :9. r AUT HORIZEO R f1E T ACORD 2 . 7 =s S ®7) 6)AcoNp(;oia RATI h Po o�(Hoe I t Board of Building RCUulatlons and Standktids One Ashburton [ la e - Room 1301 Boston. Massacl Alsetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2004 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault P.O. Box 2781 Orleans, MA 02653 Update Address and return card. i11:u9c reason for chanl,e. Address Renewal 1 P.111ployment Lost Cm(I - Board oI Building Reguhlions and Standards License or registration valid for individld use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found rcluro to: ReOistration: 103714 � �lio:urd of g g Building Regulations and SL•oitlards Expiration: 7/9/2004 Om.Ashburton Place Rm 1301 Type: Private Corporation Boston, kla.02108 PAUL J.CAZEAULT&SONS, INC. Paul Cazeault 22 Giddiah Rd. r l.L_e e� r�.a� i [ °� ✓�ie ��ar//mtaivae(zl� o/��f�r:JJuc�TCJe�fJ Orleans, MA 02653 Administrator I`lu' BOARD OF BUILDING REGULATIONS yt. License: CONSTRUCTION SUPERVISOR Number: CS 026325 Birthdate: 10/20/1959 Expires: 10/20/2005 Tr. no: 8603.0 Restricted: 00 PAULJ CAZEAULT 1031 MAIN ST ZZ., OSTERVILLE, MA 02655 Administrator Board of E►ueld[rAc. e ulationc> One Ashburton e m' 1301 Boston, Ma 02108-1618 License: CONSTRUCTION :SUPERVISOR LICENSE Birthdate: 10/20/1959 Number: CS 026325 Expires: 1012012005 Restricted To: 00 PAUL J CAZEAULT 1031 MAIN ST OSTERVILLI , MA 02655 Tr.no: 8603.0 Keep top for receipt and change of address notification. 1 TOWN OF BARNSTABLE ____________ _ `y, •e Permit No. ________________. : Building Inspector 1 "L"T`"� Cash 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 .Ieu :;Ori LZ"il. t lOi: Address � G+-j1 Yarmouth 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. .....................................................1 19......_ _ ._, „..........................................................................................._ Building Inspector 00 10 C ' Qlcg ' r 4� PLAN SNOWING ;YuyFOUNDA TI.ON LOCATION c O TUI Ir MASSACHUSE T T S OWNED BY: 'Ti��'icd G'd�VS'TA CUp_ 'SCALE : / — 4 0 ' . OA TE: NO.RMAN GROSSMAN--- --=REGISTERED LAND,SURVEYOR. ll'HERfBY. CERTIFY THAT THIS;FOUIVDAT•ION IS L06ATED tN of gf dN VNE LOT AS SHOWN AND CONFORMS .TO THE TOWN OF BARNSTABCE ZONIIIIG REGULATIONS REGARDING SETBACKS FROM STREET,LINES AND LOT LINES .- � A{s11 Mgrr • ' 12775 Q f F _7?-1-6 A or's map and lot number 7 Is.* 0*TNE Ts 10:n-113................... Sewage Permit number ....................... ................................... SEPTIC SYSTEM MU • : House number ...............ft..../.Y.z................................. INSTALLED IN COM STABLE. WITH TITLE 5 0 1639- O A TOWN OF BARN4T=L CD LATIONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... .....................I ......z***­****­**­* TYPE 'OF CONSTRUCTION .940VW/.......................................... .....—7........................................................ ..........IZV17{ ................19........ TO THE-INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: oe Location ........ 41�, . ....................... ...... ;4-�. ...............J;.........6 .. .................................................................. ProposedUse ....................................................................................................................I......................... ZoningDistrict .......A.4........ .................................................Fire District .......... .................................................. Name of Owner ....Address ... . .. .................................... ....... Name of Builder ..... ........................Address ............. .................................................... Nameof Architect ...................................................................Address .................................................................................... Number of Rooms ............ ... . ................ ............................Foundation ... .....Ie ........................... ............ ... ... Exterior ...d4�...J10.(AP. ......................Roofing ... .......................... 11................................ Floors .... .................. Interior .................................................... Heating- 0 t4M.1 ...........................Plumbing .......... ..... ....................................................... Fireplace .....Firep .............................................................................Approximate Cost .......;;p /**"*""*"**,"***"*"*,*,****.**I................. Definitive Plan Approved by Planning Board Z-3---------19 Area ......... Diagram of Lot and Building with Dimensions Fee ........... 1 .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH C) lye) t 30 I hereby agree to conform to all the Rules and Regulations of the Town of Barns le regarding the above construction. Name ..... .. .. ... ............................ Theo Const. A=24-113 sewage #79-468 # Nc ...2.1664... Permit for ....ane..storvN..dwe•1.1 i nq` ............................................................................... - r Location ........1.QL.#94.....192..Moo.r.i.nq...Dr•...... ...................... ............................................ Owner Mt-.Q.....C.QrlS.t.......................................... � Type of Construction .............. .Frame............... .............................. ..............................:.............. t Plot ............................ Lot ................................ Permit Granted ......�eat....20..................1979 Date of Inspection :19 Date C pleted ..... .......... ..0 ...19900" r PERMIT REFUSED ?.. ': ....L....................................f 19 f _ '• 1'ri C ... . „ . ... .: . ............................ ............. ........................................... + ......... . . -� ►. ..' .......................................... + ...... . ,,. .� . .................................... ,/ f .gym & Approvl ......�'.................................... 19 ....................................................................:........... ............................................................................... Assessor's office -(1st floor): 'It ME TO Assessor's map and lot number ................................. � �♦ Board of Health (3rd floor): Sewage Permit number ..... .. ............. ........,:: ..:...... i Baaa9TsnLE, S Engineering Department (3rd floor): --,'1 � t � ��p 36319. \0� Housenumber ........................:............................................... o war AV- Definitive Plan Approved by Planning Board --------------------------------19_______ , APPLICATIONS PROCESSED 8:30-9:30 AM, and 1:00-2:00 P.M. only TOWN 'OF BARNSTABL.E, BUILDING INSPECTOR, Z APPLICATION FOR PERMIT TO ......C.C.D. 1.5.f 1,c,.!.t�. ..........:✓:�.t�.�..2�e,t�,{nay/.� t'f!<.fd t� q..�......��.Q.XA.5.1? F TYPE OF CONSTRUCTION ....... 0 4-�............................................................................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a perr0it according to the following information: Location ... �...... .... �.......!!)i,�z.:. .......... _ 0) .0 ProposedUse .............. r�� aw...4..,��, �, .......................................................................... - r Zoning District ...... + ql� .................Fire District Name of Owner .. ^V`+5..........P.P...0,4..4f!S.........................Address .................................................................................... Nameof Builder ..............................................Address .................................................................................... Nameof Architect ... ;;,.6.................... �...............................Address .................................................................................... Number of Rooms ....... ....................... +3 d6'+`^ "f� Foundation ... .4�.�F*.C.. C ��fC k . Exterior !►vc Roofing . 2X...1.P.. ....\talc ......r�4;..c.0.K..,S.t .�... '�,N.nc� /cYw-Interior/�...�.1".....Floors . 5 ....As./..Q..!.�................... .................................. c o&c.+- W i L�l C� 1, 1u FS Heating ...V.O.Xt.�S...............................�..�g..�.......................Plumbing .....Nts.�.s�!.8.,e,....................!..,...�"��?.!u,nn.. .................. Fireplace .......N6.A.j.��.............................................................Approximate Cost ................. .0�..b :E►.......................... Area /((... ................. .. Diagram of Lot and Building with Dimensions Fee .. ................... i ff � I �f C' t} I1a; a t-i r M � k- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above > construction. Name .....r....L ....... �--�.... ?................. Construction Supervisor's License .......... PAPADELLIS, CHRIS A=024-113 /� = 6.2y-113 No ..32454.. Permit for Bldg. Addition/Remodel Garage Single Family Dwelling Location ....Lot._ #94, 192 Mooring Drive Cotuit ............................................................................... Owner Chris...Papadellis Type of Construction ..,Frame ............................. ............................................................................... Plot ............................ Lot ................................ Permit Granted .....November..21 ,....19 88 Date of Inspection ....................................19 Date Completed ......................................19 Assessor's map and lot number .., / P�oFTHEro�y Sewage Permit number ............... ....?..�..... ..................:.... d� (� t fiUSTAXE, i House number .............. ...1_ !92.1.............................. MALL r �O 1639• �fp MPy a• TOWN OF BARNSTABLE k BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...... t ...... ........... _ ...................................................... TYPE OF CONSTRUCTION !Wit?! G/... ':.'�G � !P..................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ?........................... ........" ..................:............ ........................... . ... r. ProposedUse ....................:. ............................................................................................................................................. ZoningDistrict ....... ........'.................................................Fire District .......... / .............................................. Name of Owner /i�.G� .. .....+®.......Address ... 7;.... .................................... !%I Address 'Name of Builder ....:................................... ............f ........... Name of Architect :.............Address Number of Rooms ...........„1„;;� ........a............................Foundation ... ........................... . Exterior ....... ...............................................Roofing ........j............................... 7 /p Floors .Interior ?'�� Q !� � � � ! ./� . Heating ................. ....... ....................................Plumbing .......................... ....................................................... Fireplace i iEaQ...................:1.......................................Approximate Cost ..... ..�. !v[/ .............. f 03-- l./i;� Definitive Plan Approved byP.lanning Board __� ______19 �_. Area ...... Diagram of Lot and Building with Dimensions Fee � SUBJECT TO APPROVAL OF BOARD OF HEALTH75 Y 34 r 30 l R I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. / Name c!-e'�1' ......... .......... GCS.......................... 24�13 W-468-1 Theo Const. =24-113 sewage 79 No ...2.16.6A... Permit for ane..s.tory. ...dwel.].i nq ............................................................................... Location ..I&t...#94......1q2--Moor.i-i4q-.D-r............ .....................r-.Ztu.i.t............................................. Owner ...Mea...Coja 5 t......................................... Type of Construction ........Fr.46me....................... ............................................................................... Plot ............................ Lot ................................ Permit Granted ....... ......Sep.t....210.........1979 Date of Inspection .................. ..........19 Date Completed ...................... ...............19 PERMIT R FUSED ..................................... ...................... 19 ............. .............. ........ .. ............ ................... ............................. .............................. . ......... ..................... ....... .............. Approved .................... .......... ............... 19 ............................... ...... ....... ........................................I...................................... tz Assessods office (1st floor): - OFT Assessor's map.'and lot number. -W4 ...... `��.. 8E ETo� N Board of Health (3rd floor); Q r `E .....L?.�.-.. .V t ... p Sewage Permit number ,. 9 �d�� Z 139H39TGDLE, � :ENTAL CO ►� rasa Engineering Department (3rd floor): cj Z �o House number .........................:.............. ;...........: TOWN REGULAT16NS °moorava�0 ' Definitive Plan Approved 6y Planning Board '_____'_________________________19________ . APPLICATIONS PROCESSED- 8:30-9:30 A.M. and' 1:00-2:00 P.M. only. TOWN ;OF BARNSTABLE BUILDING -INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ........1�d.C) .................................. ......................................................................... .... .........................19... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: y Q � . Location ......'..L. ...........n!IID.O,E^1.tv( ,..- E ................, .. .cr.¢. .,.... .5�........................................................ ....... Proposed Use ... .. .H..y-.®.�em.... ..:.; .��.(c+rarth. ..t3�t .� : ..:.: .... ............ Zoning District ..:..2. .5:.! et .. . .......................................Fire District ..............:.....................:... Name of Owner .. " ,l!IClS.. P.a.�a. .�¢.I.I►.S:..,........... ...'...Address .......... ... Name of Builder .. .C�.�?.!.a ............... .... .:..::......... .......tAddress Nameof Architect ... ................... '.......,....................Address .................................:..................................................... Number of Rooms ..... ................. 04-.k+1...... Foundation .. :G�.✓v.C1�......C:n;u.fr.C.>P2...................:............. Exterior ..�4�,r. ..C........�f!.lw. j .S ....:.......................................Roofing .....Iff. �If' .....:................... S .. . . ...........,...:.................... �. ..��.5....`�UtS��. S ...C.1�Z';.Sub......:` .u.a�i�L. Interior Floors /� �.... .. CO (� e Z .l". LU Heating 1 Plumbing .....Ylic.rf✓.x..............�1.'.�.1�:..Q.............. :.. ........ �..(Ja.. ......:.......... - :.s1.................. Fireplace .......F:V.0.iti. Q ... ................................:.....................Approximate Cost .: 6....................... Area PF �..... '.. Diagram of Lot and Building with Dimensions Fee .'.: `.......................... Q. CWO J. 4 r M t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ` I hereby agree to conform 'to all the Rules'and Regulations of the Town of ,Barnstable regarding the above construction. ..1 S - Name . ... .. f �Q .... . Construction Supervisor's. License .. ... ..... 1 2' s MPAPADELLIS, CHRIS „ 'rho 324°54_ Bld Addition/Remodel Garage Permit for .........g• q > ..'............ ` ' 4 { :� r Sin 1`e .Famil Dwellin 9. .... .....Y......................q...... location Lot. #94.r.... .192 Mooring Drive r'.••, _ �' _~ �+ Cotut .......... ......... Owner ..Chr'is...Papadellis..................... Type of'Con'structionFrame .:.. .......... ..... .... '.'. .r7�. ...... ... ........ Plot y ..., .......... ....t. Lot ............................. Y� _ c X. V. y November 21 •'" 88 Permit�Grantecl .. ........ !. .19 ' Date of Inspection ....... - : to Completedt .`�............19 a t' im Pt J 1. �+ � ���,i �- - _ � ••) r ,�'- I 14SP.hoJ� rvof.\NS I� pX 2x& rai4cr IL be coil . 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