Loading...
HomeMy WebLinkAbout0200 SAMPSONS MILL ROAD o;?o o S a-Y1'�PSG S 1 I Q`a3 Oa3 III i Town of Barnstable Bui • lding aaRNNSMB.e Post This Card So That it i5 Visible+rom the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Until Final Inspection Has Been Made. Permit ' c ° Where a Certificate.:6f Occupancy 11 is Required,such Building shall Not:be Occupied until a Final Inspection has been made. Permit No. B-19-323 Applicant Name: RUSSELL CAZEAULT Approvals Date Issued: 01/30/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 07/30/2019 Foundation: Location: 200 SAMPSONS MILL ROAD,COTUIT Map/Lot: 023-023 Zoning District: RF Sheathing: Owner on Record: COTUIT FIRE DISTRICT Contractor-Name RUSSELL CAZEAULT Framing:. 1 Address: P.O. BOX 1475 Contractor License: CS-108157 2 COTUIT, MA 02635 Est. Project Cost: $9,300.00 Chimney: Description: replace tech dem deck and membrane roof. install new deck panels Permit fee: $ 160.00 and new firestone roof. -yarmouth Insulation: Fee Paid: $ 160.00 Project Review Req: Date: 1/30/2019 Final: Plumbing/Gas Rough Plumbing: .. This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced'within six months after issuan e. Final Plumbing: 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. Rough 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. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures,by the Building and.Fire Officials are provided on'.tf is permit. Electrical Minimum of Five Call Inspections Required for All Construction Work:; .1.Foundation or Footing " Service: 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue;lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. 'Low Voltage Final: ., Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map O a 3 Parcel D Z. Application # ' Health.Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 0 ""— Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 4.0 ©-SIR-KI S6'"'' /k Village C d fL_ UT- n) ,4 5_5 Owner I`f l ! f-e 6e Address PC �Jdk' �Cf/ a7�,11 Telephone �a 6 p Permit Request A�e_- )PIR-c e A mG e° pz) &/0 .,V e k/1i 2 e�7c%s+-e x-cr v�- Square feet: t floo : existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation C9 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes )No On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION rr { (BUILDER OR HOMEOWNER) me (� l � - /,��er4,. �'f���v� �-� �-- L! 7 7 Na Telephone Number Address 1V 3 S T_ G'5te �<�1 License# 7 co ���g�s Home Improvement Contractor# Email 06-,"/t tn if 4 c.-/ 141 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE . DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Cu2n aartspeum afmassachmselys'. Offce Of bmI n4afiorrs " 60ffi Was*k4aa greet Bostar•4 M a2 - rvnaw.rn�sxgr, dur - t Workers' Campensatian Insurance davit Builders/C�Ggfractors/Electricians]Mumbers Applicant Infmrmafion Please Print,Legibly Na= caffi divich4: Address. s.;— city/statrizip: Phone Are you an employer?Check the appropriate bo= T of project r 4. I atrt� . ccmtract+x and Z - 3� ' (required): L❑ barn a employer with �� ❑ 6- ❑New you employees{full andlor part4ime)-* have hired the sz fo 2_ I am a sole proprietor or partner- listed on the attar het.sheet 7- ❑Remodel g ship and h2we no employees These s b-matractars have g- ❑Demolifiou woriciug for mein any capacity employees and have wadcers' 9_ ❑Building addition PTO VrQrker&' Comp:iUMranre comp.msuranc regrtired`I 5-❑ We area corporation.and its' ' 10•C]Elettsical repairs or additions 3_❑ I am a homed vvner doing an work of=rs ham e=dsed 9x r 11'-0 Plumbing rep airs or additions myself ao workus' �of einption per MGL I2�Roof repairs. innarequire&]I r-152. §1(4} and we hwe noemployees [NcYwod=& comp_msuranm segmred,J 7�L *lltty sages that checks box-1 tLst also fill ovd ffie suction helaw shag ffiea waikes'mmpnsadw pares HnmeQaaes Vd-submit this afulsvd M&cstiur they are thing sII tso>ic and then huE M=&coningetucs met srahnxit a sSdecit mpg sarI� romwcmrs tbgt check this Na must sttarhed as arlditi— shut showing the name a€the sdu-ohs and staff uhetLer nrnut�sg e�IIies� emplayees_ lEtree sn6-cantractms la-M employees,they nmst lnavide thEir tvarbea'camp.paliry azrmisex lam an inmrrrrice far my emproyem Befan is thepa&cy and job azte Insurance CoarpMYxatne: lD / .FORZY4 or stilt:;n&-Iic-;�- W G ,S'.3 /Ls"3 86 6 760 2 Job Site address: l ��, / CAJ �1/ t l p� Ci 15tafel (�o�� lfi AY!� p Attach a copy of the-markers'compensatitm policy declaration page(shwwing the policy number and expiration date). Failure to swum cm-erage,as repiredunim Section 25A o€MGL c. 152 can lead to the imposition ofcrirwinal peazIfies of a . fine up to$1,500_(}a and/or one-yearimprisonment,as well as civil pemilties in Ire fbm of a STIDP WORK ORDER and a fine ofup to$250.0.0 a.day against the violator_ Be advised that a copy of tbis statement maybe forwarded to the Office of Invest pdons of the DIA for find we coverage 4 on_ I da hcn eby crxirfy voider tkspmhs and penalties of` that the arcf brraufian pratirW above is hue and correct Sifnatare: Ls�� d2 C-1Dal te- Phone i#_5r® g a/ ` 1 ,7 t2f7zd1Ml use aril}. Da not sprite in this area,to be carirgL-ted by di'or tarn offt'er'ul City or Town- PermciiVUcense# Issuing Authority(drele one): L Board of Health 2.BuWmg Depmrtment 3.CaipTiawr Qerk 4.Elechical Inspector -5.Plumbing Iusps ci or .6.Other Coact Person: Phone#: 6 Information and Instructions Massachusetts General Laws chapter 152 requiresall employers to provido workers compensation for their employees. Pursuantto this statute,an employee is defined as"_._every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other Iegal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,-or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees_ Fowever the owner bf 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 Bach employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal 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 compli.aice with the insurance requirements of this chapter have been presented to the contracting authority:.' Applicants Please fill out the workers'compensation affidavit completely,by chedci g the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their cerdricate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partaershilps(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance_ Lf 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 he 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. Sell * ed 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/licease number which will be used as a reference number. In addition-an applicant that must submit multiple permits icense 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 fut=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 venturt (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this aihdav--_t 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. T.e Comma mWth of M=a-rhumtts Depaztmmt of 1i dustdal Accidents Off xee of kvestigatiom &U0�a�shin�ton Sfr� $ostou:MA 02111 Tel,4 617 727-4 i�-xt 406 or 1--&77-MASSAFE Revised 4-24-07 Fax 9 617-727-7749 W .Ma:s�,gavldia f �C'Y ti• Property Owner Must Complete & Sign This Form If Using a Roofer/ Builder. L l s4rF ,r .. as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: Address of Job MI V /`©a d Signature of Owner Mailing Address of Owner -6d It Co- Telephone # 5-0 Date ./'9 Please return this form to Paul J.Cazeauft Roofing along with your signed contract. It is needed for us to obtain the building permit required by your town to complete your roofing project fax#508-420-4555 office@cazeatAt.com a 'k W11 I; a 3 l� 1031 mail) Jta L(?! Oa$r(VIjID, jll]/ti 02 65) if{iij lii?:. :z ,! `_ ;)l 1 1, I,.i..!-fll" .,y_ _I �, I MIA •pJ ' l�.f,i:?ui% _ .$Itl;f3t3 .1' 1 iL•G, Ull¢;bl it f.Ili. t.:Gv..:3 Or if 1 { - b p AAA bbd6iuiovSP,0 C:va"r � / J� t.1 ic(, JI G(.)n tinier Affairs and Bb,,ishes.s Regu,,Ia"iJi;n Boston, i as&,-achuseftts 0211 Home lrr proveme bt C'Qm'rac-,tnr��egistsatian 4� Type: Corporation PFlUL J.CFlZEAULT&SONS, INC. Registration: 103714 Expi 1031 (MAIN STREET ration: 07/0�/2020 OSTERVILLE,MA 02655 Updates Address and Reft n Card, act,i c 2ati•;a5!l� ..//r �oiivr�o�rroca��c�,.��:r)Jacl�IP/J F 0-Face of Consumer Affairs it,Business Regula2io❑ i-10 IPJIf'RCUi=MAN T GDN 6 RAC I C)ln Registration Vaud'for individual use on311 TYPE;Comoration before the expiration do-ie. K found return?o: Re CtP2a IISlf);i Ex0ra-8o;� iJtiice o?Gorsumer As�airs mild Business Peguiafloll 1.PHA4':= 07/08/2020 'S 10001Nas3�ingtan Street.._i9iie 710 PAUL J.CAZERUI-T�-`,dg 1�G i . Boston,MA 021'18 „ r' 1 RUSSELLCAZE•'ULI'i' `,- 1031 MAIN S T REE7;..: OSTEPVILLE,MA 02655'" T - Not valid FvL(If lut signature A Undersecretary } i 1 �ci<af�ee>!�ib�f�:(800)598-5569 , Qstervilie:(508)428-1177 0 earts:(5138)255--5555 Fatinauth:(5 8)457-1141 Fax:(508)420-4555 4 � 7 ®i , DATE(MM/DDIYYYY) ACORO CERTIFICATE OF LIABILITY INSURANCE `� 11/07/2018 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(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: Linda Sullivan DOWLING & O'NEIL INSURANCE AGENCY (PA HONE . (508)775-1620 plc No: ADDRESS: Sullivan@doins.com 973 IYANNOUGH RD INSURER(S)AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: LM INS CORP 33600 INSURED INSURER B PAUL J CAZEAULT&SONS INC INSURERC: INSURER D: 1031 MAIN ST INSURERE: OSTERVILLE MA 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: 334821 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 ADDLTYPE OF INSURANCE INSD SUER POLICY NUMBER MM/DD//YYYY MM POLICY EFF POLICY EXP LTR IDDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ POLICY JECT PRO ❑ LOC PRODUCTS-COMP/OP AGG $ OTHER: - - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A - BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A. AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER STATUTE EORH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBEREXCLUDED? NIA N/A NIA WC531S386670028 08/10/2018 08/10/2019 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under _ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be 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 Great Quality General Contracting Inc ACCORDANCE WITH THE POLICY PROVISIONS. 1099 Main Street AUTHORIZED REPRESENTATIVE Marshfield MA 02050 ��t C Daniel M.C ey.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 f=