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HomeMy WebLinkAbout0055 PUTNAM AVENUE i CAPE' CO 19 PH � �8 IEIMIEROY S ILLMC>MS 378 Route 130 �� 5��� Sandwich,MA 02563 PH:774-205-2001•844-90-AUDIT Permit Affidavit Permit#:, I •— �� I,Craig Bishop,confirm that the weatherization and air sealing work completed at has been completed in accordance with 780 CMR. Signature: Date: -. - Town of Barnstable , .. .. __. x Building t Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on lob and this Card Must be Kept t. MAC p Posted Until Final Inspection Has Been Made. _ Pe�'I111t 1 111 l� Where a Certificate of Occupancy is Required,.such Building shall Not be'Occupied until.a Final Inspection has been made Permit NO. B-19-33 Applicant Name: Craig Bishop Approvals . Date Issued: 01/04/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 07/04/2019 Foundation: Location: 55 PUTNAM AVENUE,COTUIT Map/Lot 036-045 Zoning District: RF Sheathing: Owner on Record: COLLINS,SHANN.ON .. Contractor Name:``°l.Craig P Bishop Framing: 1 Address: 55 PUTNAM AVENUE ; Contractor License CS=109777 2 COTU.IT, MA 02635 - '" t Est: Project Cost: $7,817.00 Chimney: Description: Air Sealing and Weatherization Permit Fee: $89.87 r" Insulation: Project Review Req: Fee Paid.:' $89.8.7 Date. �� 1/4/2019 Final: Plumbing/Gas Rough Plumbing: > g g v - -- "!,,Building Official 1 Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after`ssuance- Rough Gas: All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion-of the same. . — _- Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on th sfpermit. Service: Minimum of Five Call Inspections Required for All Construction Work: * 1.Foundation or Footing ,. Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 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. 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 Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 0,J t�,rs t� 9t'IJT Town of Barnstable *Permit# 6D 7oi0 Expires 6 months from issue date O Regulatory Services Fee o 6ro Thomas F.Geiler,Director /a3/0 7 Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA.02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230loin EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint . Map/parcel Number Property Address 00 esidential Value of Work J��O� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address c� �l�f/���1/ 0cp`l W,9 Contractor's Name Telephone Number;1 Home Improvement Contractor License#(if applicable) / Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: Ej I am a sole proprietor + the Homeowner I have Worker's Compensation Insurance FEB 2 3 2007 Irourance Company Name4&, W6rkman's Comp.Policy 4 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) rn 12 Re-side f �eentWindoNA/doors/sliders. U-Value + (maximum.44) : *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic, onservatida,'etc. ***Note: Property Owner must sign Property Owner Letter of Permission. ' `n A c f the Home prov ment Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations + d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legi Name(Business/Organization/Individual): . �� ? Address: 9­0,ac7X City/State/Zip: C %� ne.#: �7( Are you employer?Check the appropriate box: Type of project(required):_ 4. I am a general contractor and I 1. am a n employer with ❑ 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors listed on the a 2.❑ I am a sole proprietor or partner- ttached sheet. 7. []'Remodeling and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.$ 5. ❑ We are a corporation and its 10.�lectrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11. a. 'lambing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[Goof repairs insurance required.]t c. 152, §1(4),and we have no 13.[ Othe employees. [No workers' iG vuX/q� 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 01 Insurance Company Name: Policy#or Self-ins.Lic.#: y � � Expiration Date: R h A--7-- /�� Gl/h� City/State/Zip: Job Site Address: i 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 pains and nalti ' o perjury that the information provided above is true and correct. Signature: Date: D Phone#: 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#: 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." d as"an individual partnership,association corporation or other legal entity,or an two or more An employer is define ,p p, rp g Y of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiv�o-r-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-contractors)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. 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 bum 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 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia Town of Barnstable P °^# Regulatory Services 9BAP Thomas F.Geiler,Director . Eo,+99' ' Building Division { Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ffice:. 508 862-4038 Fax: 508-79076230 Property Owner Must Complete-and Sign This Section If Using A Builder Loa�i`6�� , as Owner of the subject property hereby authorize � �'�/ to act on mp behalf, in all mattets relative to work authorized by this building permit application for: (Address of Job) Signaturlo er Date S"n 4V VA tj s Print Name Q.FORMS,O WNERPERIM SION CERTIFICATE OF LIABILITY INSURANCE -7 j :DATE(7/206 THIS CERTIFICATE IS ISSUED AS A MATTER OF IN ORMInsurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTruin Street, Suite#H HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXT sterville, Ma. 02655 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 508-420-9011 NSURED Carey Grover Buildin & R INSURERS AFFORDING COVERAGE g emodeling INSURER A: Western World Insurance compan NAIL# and Remodeling P.O. Box 1080 INSURER 6: The Hartford COtuit, Ma 02635 INSURERC: 508-364-56.51Cell INSURER D: :OVERAGES INSURER E: 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 BYFAID CLAIMS. iR D'L R NSRD TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION GENERAL LIABILITY DATE MM/DD DATE MM/DD/YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 OOO OOO lk CLAIMSMADE Ej]OCCUR PREMISES Ea occurence $ 50,000 PP916247 MEDEXP(Anyonepe.- - 9/ 1 000 1/0 6 9/1/0 7 PERSONAL&ADV INJURY $ 1 000 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ .2 OOO OOO POLICY JE� LOC PRODUCTS-COMP/OP AGG $ 2 0 0 0 000 AUTOMOBILE LIABILITY ANYAUTO = COMBINED SINGLE LIMIT ALL OWNED AUTOS (Ea accident) $ SCHEDULED AUTOS ' (P DI URY HIRED AUTOS person) $ NON-OWNEDAUTOS BODILY INJURY (Peraccident) $ PROPERTY DAMAGE GARAGE LIABILITY (Peraccident) $ ANYAUTO AUTO ONLY-EA ACCIDENT $ OTHERTHAN EAACC $ EXCESS/UMBRELLA LIABILITY AUTOONLY: AGG $ OCCUR 0 CLAIMSMADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ WORKERS COMPENSATIONAND EMPLOYERS'LIABILITY $ ANY PROPRIETOR/PARTNER/EXECUTIVE X TORYL MITS E OFFICER/MEMBER EXCLUDED? ER 360IB46505 E•L.EACH ACCIDENT $ 100,000 Ifyyes,describe under 31 I 0 6 0 8/31/0 7 E.L.DISEASE- SPECIALPROVISIONS below EA EMPLOYE $ 100 000 OTHER E.L.DISEASE-POLICY LIMIT $ 500 000 :RIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS TIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIO 200 Main Street DATE THEREOF,.THE ISSUING INSURER WILL ENDEAVOR TO MAILIO DAYS WRITTEN Hyannis, Ma 02601 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO.SHALL 508-7 9 0-623 0 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE 2D25(2001/08) ©ACORD CORPORATION 1988 -P .✓ 0 tx BOARD"OF BIHLDIN( R GgLAT10144 License: CONSTRUCTION SUPERVISOR Number -CS 077754 _ Bir>hdate : 1/22/1,957 zpires 11/22/2007 Tr.no: .8693.0 = t CARE Y C GROVER PO BOX 1080 li GOTUIT, MA 02635 i commissioner J ,9 72. lopBOardd o ul dipg�t� .,.,.,� _ egula.tio�fs'and StQal dlMss HOME IMPROVEMENT CONTRACTOR Registr ko 144322 E>E €att 7 312008 GROVER BUILD +" CAREY GR DEL-I �G OVER 1 z1� 56 QW4OIN'RD MASHPEE "4,11 y Administi•atois