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HomeMy WebLinkAbout0388 OLD OYSTER ROAD 3438 Otd Qis-;e,e- 4:A f �d f4� ' 1 Q- MAi led C �.►,E Town of Barnstable *Permit# 46/6 — 31 2 p Expires 6 months from issue date Regulatory Services MAM Richard V.Scali,Director pA Building Division TOWN . OCT 27 ?016 Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 W " %13A www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 4600 03PA Pro rty Address 3eKb (1� �j � (b�yT- �f Residential Value of Work$1440-<D Minimum f f fee o $35.00 for work under$6000.00 Owner's Name&Address It Let. d1l Contractor's Name yetw Paavoc, ( Telephone Number 5112 �v� [(E,c Home Improvement Contractor License#(if applicable)12�157 Email: [1,eL(i'Y4qMo16-i�o C"CLoop - 6w Construction Supervisor's License#(if applicable). `(0 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor WI am the Homeowner have Worker's ompensAtlon Insurance Insurance Company Name IL hawA­ Workman's Comp.Policy# 5 Gj UT O 6 3111 Copy of Insurance Compliance Certificate must accompany each permit. Permit Re est(check box) Lvj Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to -4 �Q A Al ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)r ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#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 Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is Coquired. _ SIGNATURE: C:\Users\Decollik\AppData\Local\MicrosoMWindows\Temporary In et Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 oF� * •nxtvsrns�. • "'"� i6gy. Town of Barnstable 9� �0� A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO 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 This Section If Using A Builder I, `-��'' "t� �'� , as Owner of the subject property hereby authorize LwFQ— 1 eLA4 to act on my behalf, in all matters relative to work authorized by this building permit application for: DLD 04 GTe2 . C-40, 1 (Address of Job) R V® 1 l M Si ture of ner Dat Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\LocaIMcrosoft\Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\FMRESS.doc Revised 040215 I SINN The Commonwealth of Massachusetts Department of Indusbzal Accidents Office of Investigations IF 600 Washnisgion Street Boston,MA 02111 fvwtn masxgm,1dia Workers' Compensation Insurance Affidavit: Bmlders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name ahzinness/ an/tndividual): Address: v City/State/Zip: c Phan# 50 Q6 Am y/op an employer?Chet the appropriate boa: Type of project(required): 1. I am a employer with 4. I am a general contractor and I employees(full and/or part-time). s 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 sob-contractors have S. ❑Demolition working for me in any capacity_ employees and have workers' [No workers'comp.insurance comp_insurance-1 9- ❑Building addition 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 I LF]Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.ET&of repairs insurance required.]I c. 152,§1(4),and we have no employees-to [No workers' HE Other comp.insurance required.] ;Any applicam that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this afi5dmrn indiratiteg they are doing all work and then hire outside contractors un st submit a new affd=indicating such tCoattacmrs that check this box must attached au additional sheet showing the time of the Bubb comrzctois and state whether or not those entities bsve employees. If the sub-contractors haee employees,they in=provide their workers'comp.policy number.. I am an employer that is p ding workers'compensation insurance for my enipioywes. Below is the policy and job.sue information. Insurance Company Name:/�� Jr- ALII--� Policy#or.Self ins.Lic.#:V eQ Expiration Bate: Job Site Address: City/State/Zip: L� 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 cix it 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 tin epains d pens it that the information provided aabmte is triter and correct tbS true Date: to 'Z� ` Phone#: Official nse only. Do not write in this area,to be completed by cio or town official. City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/I'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 9: Massachusetts Department of Public.S•afety r Board of Building Regulations and Standards License: CSSL-099167 Construction Supervisor Specialty OLIVER M KELLY.'} _ 8 RHINE ROADs� YARMOUTH PORT MA;tt026Tbh 3. i a Expiration: Commissioner 09/28*17 Office of Consumer Affairs and Business Regulation y 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 128957 _ - Type: Individual Expiration: 6/1412017 Tr# 266936 Oliver Kelly Oliver Kelly - 8 Rhine Rd Yarmouthport, MA 02675 _ _ Update Address and return card.Mark reason for change. scA 1 o 20M-osn, / J Address ❑ Renewal C Employment Lost Card rT11r. iSt�✓ lrr�:ar.�rr�c/1� _ _..__ �_._�� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only s '#1OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - gistration: 1.28957 Type; Office of Consumer Affairs and Business Regulation Expiration: Individual individual 10 Park Plaza-Suite 5170- �`-'' Boston,MA 02116 Oliver Kelly -_- - Oliver Kelly 8 Rhine Rd. Yarmouthport,MA 02675 Undersecretary Not valid without signature DATE(MM/DD/YYYY) ACOO CERTIFICATE OF LIABILITY INSURANCE 10/11/2016 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 CONTACT NAME: Christine Davies DOWLING & O'NEIL INSURANCE AGENCY P"�"0 508 775-1620 iV No: E-MAIL ADDRESS: cdavies doins.com 973 IYANNOUGH RD. INSURERS AFFORDING COVERAGE NAIC A HYANNIS MA 02601 INSURER A: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B t KELLY ROOFING INC INSURERC: INSURER D: 8 RHINE ROAD INSURER E: YARMOUTHPORT MA 02675 INSURER F: COVERAGES CERTIFICATE NUMBER: 92639 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. tLT R TYPE OF INSURANCE ADOL SUER POLICY NUMBER MWDD EFF MAD EXP LIMITS LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO_7CLAIMS-MADE 7 OCCUR PREMISES EaENTE occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO JECT ❑LOG PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS $ NON-OWNED PReOr a ER ccidenDAMAGE HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ V WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY /� STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED?- WA WA WA 6S62UB2E90137116 05/06/2016 05/06/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space 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 policy 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/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Judy Pendergast ACCORDANCE WITH THE POLICY PROVISIONS. 4713 Ravensworth Road AUTHORIZED REPRESENTATIVE Annandale VA 22003 Daniel M.Cro y,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD } jal 605 'own of Barnstable *Permit# �c@Erpimi 6 riondrs jr�sue date arvsrA,sr $� Regulatory Services Pe` Thomas F.Geiler,Director ,Q Building Division Tom Perry,CBO, Building Commissioner K ll1(��� �� 200 Main Street,Hyannis,MA 02601 �v 1 w www.town.bamstab l e.ma.us Office: 508=862-4038 Fax: 508-790-67.30 1E"PRESS PERMIT APPLICATION -- .RESIDENTIAL ONLY Not Y:alid without Red X Press Ihnprini Map/parcel NumberJ„ �j �1C� Property Address Residential Value of Work �J ©O Minimum fee of$25.00 for work under$6000.00 . Owner's Name& Address Contractor's Name_ ���/� /. �� Telephone Numbers Home Improvement Contractor License#(if applicable) Z,e 7� Construction Supervisor's License#(if applicable) F orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [have Worker's Compensation Insurance Insurance Company Name Z14 IPA. Workman's Comp.Policy Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) e-roof(stripping old shingles) All construction debris will be takemto ❑Re-roof.(not stripping. Going over existing layers of roof) ' e-side ❑ Replacement Windows. U-Value (maximurn.44)' 'Where required: Issuance of this permit does not.excmpt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. SIGNATUI2 Q:Forms:cxpmtrg Revise071405 Property Owner Must Complete & Sign This Form if lasing a Roofer / Builder. I (print) g I co as Owner / Agent � of the subject property hereby authorizes Paul J. Cazeault& Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for. Address of Job OVA stit Signature of Owner S Mailing Address of Owner Telephone# , v 0 D-C) 3q Date (Please return this form to Cazeault roofing along with your signed contract; .It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you) fax#508-420-4555 � -�e P Office of Consumer Affairs and Efusiness Regulation 10 Park Plaza - Suite 5170 Boston, MassagW§etts 02116 Home ImprovementCtractor Registration Reqistration: 103714 Type: Private Corporation M Expiration: 7/9/2012 Tr# 297676 PAUL J. CAZEAULT & SONS, IN Paul Cazeault � jot 1031 MAIN ST �Q OSTERVILLE, MA 02658 7nMva�l� Update Address and return card.Mark reason for change. —- ❑ Address Fl Renewal 1-7 Employment Lost Card )PS-CA1 is 50M-04/04-G701216 License or registration valid for individul use only Office of Consumer Affairs&Business Regulation IMPROVEMENT CONTRACTOR before the expiration date. If found return to: HOME Registration: • Type: Office of Consumer Affairs and Business Regulation . 10 Park Plaza-Suite 5170 Expiration: Private Corporation - -_; Boston,MA 02116 PAUL J. CAZEALf-l' Paul Cazeault W7+i 1031 MAIN ST OSTERVILLE,MA 02 ,, J;,% Undersecretary Not valid without signat re k3 QW I I-W. —A •x�` - yx�+, .sS- .ae33.ec �X.th3"- „r .R• _ �� u� •a ��' - _ -`` .-'U' __ d r _ NLv,.Sachusett.s Depatizment of Public �,:ifetN Board of Buildint Relulutions and -Standaf Construction Supervisor tense ` License_ CS 26325 !� as - Resiricted'to: CO PAULJ CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 E pirauon: l0/20i201 i rr < unuiTi ur.urr T 7088 im 'lac-� � Yf �y ? '�.�'�,."� '�€�rt*� 4i1.��'�`R-� � ��,. � ��✓-' ,�,�, L - __ .�y'L's-A �•�1rmrS ,' '�'h`x, - '-a�7z ,ate ate-t. rr : r- - y 3 J %� >� -r ��.a,,.-��+- it 7.-.s� L "�,� r,�'"'�- -' t�.�2^' �ru fli,,,,^'��c�a ,�z�x}� �.' �`z"k�__a •CY'� .2;.� - c-- - { _- Client#:19989 2CAZEAULTPA ACOR& CERTIFICATE OF LIABILITY INSURANCE 0901/2010 PRooucER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION .Dowling&O'Neil insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR. Agency ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: First Mercury Insurance Company Paul J..Camult&Sons,Inc. INSURER B: National Union Fire Insurance C 1031 Main Street INSURER C: Ostervitle,MA 02655 INSURER Lx -INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR POLICY EFFECTIVE POLICY.EXPIRATION LIMITS LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE IMMMI)IMDATE M D A GENERAL LIABILITY FMMA0027012 W30/10 M0/11 EACH OCCURRENCE $1 000 000 DAMAGE TO RENTED SSO OOO X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR MED EXP(Arty one person) $O X BUPD Ded 2.500 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE S2 O00 OOO toucy AGGREGATE LIMIT APPOES PER PRODUCTS-COMP/OP AGG SZ OOO O00 PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NONOWNED ALTOS PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ ' AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ .00CUR CLAIMS MADE AGGREGATE S S S DEDUCTIBLE S RETENTION $ B WORKERS COMPENSATION AND - WC003603096 08/10/10 08/10/11 �( WC STATU- OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $500 000 ANY PROPRIETOR/PARTNEFVD(ECUTIVE EL DISEASE-EA EMPLOY S500 000 OFFICERIMEMBEREXCLUDED. NO It Yes,describe under E.L.DISEASE-POLICY LIMIT $500 000 SPECIAL PROVISIONS below OTHER �.�,.�,..�.. .. ..... bESCRIPnoN oF-OPEFtATToNSfLbdoM.. I IVEFi1CCE5xEXCLLSIONS ADOED&Y`EN[>ORSEJ19i1 ksPECIAL PROVISIOP Operations performed by tt"d namedAnsuredsub�ec to�oltcy rondrtrons "` cy ter , I and:exclusions = z .35M CERTIFlCATEHOLDER - "�` .GANGELIATION: SHOULD-ANY OF'.r ABOVEDESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Paul J.CaZeaUlt&::Sons DAAT.ETNHtEOF THE:ISSLUNG�WFM wn�L ErwEl►voR ro MAu__lOf:D tr x RooSng,lnc F 3 a NOTICET0,m. CERTIFICATE HOLE) TO TH... BUT FAILURET:O DOSOSHALL 1031 Ma�n:Sireet`:- r.t' NO OBLIGATION OR LIABILTY OF ANY KIND NPOMTNEINSURER FTSsAGEIETSIOR _ Osterville MA 02655 r r REPRFSENSATNES. AWHORDED REPRESENTATIVE. O.RD ACORD 25(2001108):1 of 2 #57173O1h1471729.: ', L$f; 0 AC CORPORATJON 1988 The Commonwealth of Massachusetts. Page 10 of 10 Department of Industrial Accidents - t Office of Investigations 600 Washington Street Boston,MA 02111 r z www.mass.gov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers Applicant Information Please Print (L'e;?ibly Name(Business/Orgmization/Individual): PA t�L S 2 Z e Q V 9 n S ' ►00't—t Address: _ a 1 Yl S� City/State/Zip: -5 T-e ry I e MPT0-2 5S Phone#: 11 —1 Are you an employer?Check the appropriate box: Type of project(required): 1Z I am a employer with �2 4. 0 I am a general contractor.and 1 6. New construction employees full and/or part-time).* have hired the sub-contractors ( p ) ' ' listed on the attached sheet x �- Remodeling , 2.❑ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers'comp.insurance. 9. Building addition [No workers' comp.insurance 5• We are a corporation and its 10 El Electrical repairs or additions required.] officers have exercised their right of exemption tion per MGL I Q]Plumbing repairs or additions 3.❑ I am a homeowner doing all work g P p myself.[No workers.' comp. c. 152,§1(4),and we have no 12.N Roof repairs insurance required.]t 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 anew affidavit indicating such. tContractors that check this boz must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site . information. l Insurance Company Name'�i�/rl.���a_ %-- � �J - 7t,5 t�� l� r✓ ly �(� Policy#-or Self-ins.Lic.#: L�l[' i?rl �4 -'Z/1> ��D 97� `Expiration Date: Job Site Address: t�A �, �` City/State/Zip: Attach a copy of the workers'.compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the,imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under t ins and penalties of perjury that the information provided above is true and correct. Si afore: Date: Phone# r fcial use only. Do not write in this area,to be completed by city or town o,�°icial ity 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 Phone#: `Contact Person: