HomeMy WebLinkAbout1525 SANTUIT-NEWTOWN ROAD now
15 0�nY c�j vr�
Town of Barnstable Building
rnxwxrner = Post This Card So That it"is'Visible From the".Street-Approvedy be Plans Must Retained on Job and this-Card Must be Kept
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M"S& ,p�' Posted Until Final Inspection Has Been Made.
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Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until"a Final Inspection h-as been made 4 llll l
Permit No. B-20-855 Applicant Name: MURRAY, DAVID A Approvals
Date Issued: 06/19/2020 Current Use: Structure
Permit Type: Building-Addition/Alteration-Residential Expiration Date: 12/19/2020 Foundation:
Location: 1525 SANTUIT-NEWTOWN ROAD,COTUIT 'Map/Lot: 024-013 Zoning District: RF Sheathing:
Owner on Record: MURRAY, DAVID A Contractor Name:` 11� Framing: 1
Address: _1525 SANTUIT-NEWTOWN ROAD Contractor License: _ 2
.
COTUIT, MA 02635 Est Project Cost: $ 25,000.00
I Chimney:
Description: REMOVE CEMENT PAD AND RAMP AT REAR OF"HOUSE. ENCLOSE '" Permit;Fee: $ 177.50
ALCOVE WITH 14' LONG WALL MATCH ROOFLINE WITH ADJACENT � Insulation:
k i Fee Paid:f $ 177.50
BEDROOM PTICH. REMOVE ORIGINAL KITCHEN WALL ADD' ,/ Date Ott 6/19/2020 Final:
SUPPORT BEAM
Project Review Req: ��-�� Plumbing/Gas
Rough Plumbing:
., Building Official
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authorized by thi's permit is commenced within six months aftersissuance.
All work authorized by this permit shall conform to the approved application and the`approved construction documents for which this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structuresshall"be in compliance with the local zoning by-laws and codes.
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 Final Gas:
work until the completion of the same. �r
' Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit.
Minimum of Five Call Inspections Required for All Construction Work: Service:
1.Foundation or Footing
2.Sheathing Inspection h rr Rough:
3.All Fireplaces must be inspected at the throat level before firest flue lining is iristalled"_
4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final:
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.
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:
Fire Department
Building plans are to be available on site
All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final:
-7
THE
OF e
Application Numbei.........) ....................................................
IRA STABLF,
Permit Fee.....1.2.2.......... ......Zoning District........................
Mass. � Total Fee Paid":''.'�
................................. ..................
TOWN OF BARNSTABL -Permit Approval b Y...... h Vzo
.. ............On...........................
,7-
BUILDING PERMIT
Map....... . ............ ....Parcel........ . ...................
APPLICATION
-Section 1 — Owner's.Information' and Project Location
Project Address /�S Village
Owners Name. Az,V JA M v rra
Owners Legal Address
City_Cd` ,4— State MA zip 0?,635
Owners Cell # E-mail (4
Section .2 Use of Structure
:Use Group
❑ Commercial Structure over 35,000 cubic-feet
V Commefcial�$,�udtu�e under 35,000 cubic feet
Single Two Family'Dwelling
Section 3 Type of Permit
❑ New Construction El, Move, /Relocate E], Accessory Structure E] Change of use
❑ Demo/(entire structure) 0 Finish Basement ' El Familly/Aninesty ❑ Fire Alarm
Y Rebuild El Deck Apartment . Sprinkler System
Addition ❑ Retaining wall ❑ Solar BUIDING:DEPT.
El.`Renovation El Pool ❑ Foundation Only MAR I 7 2020
Other—Specify
I UVVIV U� BARNSTABLF
Section.4 7 Work Description
Pern' Cement PAaA gael Ot rA 0 4'1
Q
EM c IaSe: Vt ove, 1W 10,104 1 Wq 11
6® VIA me wiflN exame-eh+ B001radfA Ri*CL
0 4i nq't
^A
Last updated: 1/31/2020
i
Application Number. .. ... ......... .............:....
Section 5—Detail
Cost of J
Proposed Construction �S 0®� _—Square Foota a of Project AJ
p � g
Age of Structure �ga?` 196'5 Dig Safe Number �O 0Z5 7
# Of Bedrooms Existing 3 Total# Of Bedrooms (proposed)
110 MPH Wind Zone Compliance Method ❑ MA Checklist 0 WFCM Checklist ❑ Design
Section 6— Project Specifics
[� Wiring Oil Tank Storage ❑y Smo,
_ ❑ g , � � �; � ke Detectors
Plumbing Gas .Fire Suppression
❑ Heating System ❑ Masonry Chimney. ❑ Add/relocate bedroom c'
Water Supply ;Public El Private
Sewage Disposal ❑ Municipal �On Site
Historic District ❑ Hyannis Historic District f ❑ Old Kings Highway
Debris Disposal Facility:
— bwn Ir_ I am using a crane C Yes R�No
V
Section 7—Flood Zone q
Flood Zone Designation
Within or adjacent to a wetland, coastal bank? Yes ❑ No
Section 8 — Zoning Information
Zoning District Proposed Use Lot Area Sq. Ft. V 3 tJ 1"
Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site)
Setbacks Front Yard rRequired Proposed A/a C. an
Rear Yard Required Proposed d �h q y�
Side Yard Required Proposed NO Q C n PJ-e
Has this property had relief from the Zoning Board in the past? ❑ Yes No
Last updated: 1/31/2020
Application Number...........................................
Section 9— Construction Supervisor
Name Telephone Number
Address City State Zip
License Number License Type Expiration Date
Contractors Email Cell #
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.Attach a copy of your license.
Signature Date
Section 10 —Home Improvement Contractor
f
Name Telephone Number
Address City State Zip
Registration Number Expiration Date
I understand my responsibilities under the rules and regulations for Home Improvement Contractors 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.Attach a copy of your H.I.C...
Signature Date
Section 11 —Home Owners License Exemption
Home Owners Name: D di,y 1 eQ M u r cc l
Telephone Number Cell or Work Number 603-S'�O o?31
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 SIGNATURE
Signature �4e� Date r
Print Name D cL V 1 Mwfco'y Telephone Number CO3—6 6 0 _131
E-mail permit to:
f'
Last updated: 1/31/2020 ,�
Section 12 — Department Sign-Offs
Health Department ❑ Zoning Board (if required)
Historic District ❑ Site Plan Review(if required)
Fire Department ❑
Conservation
For commercial work,feaseke your plans directly to the fire department for approval
Section 13 — Owner's Authorization
as Owner of the subject property hereby
authorize to act on my behalf, in all '
matters relative to work authorized by this building permit application for:
(Address of job)
Signature of Owner date
Print Name
f
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Last updated: 1/31/2020
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Offue of Investigations
600 Washington Street
Y Boston,MA 02111
wwM.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ApWicant Information ) Please Print Legibly
Name(Business/Organization/Individual): E)G 9/�/�0,1 t'/d ► ' 1IA'e r CI
Address: `JF�J� r nC Imo`/o wi l �I [d�l�{i ct
City/State/Zip: 5 Phone#: 603-66d w 073.1
Are you an employer?Check the appropriate box: Type of project(regnired):
1.❑ I am a employer with- .4. I am a general contractor and I -
employees(full and/or part-time).* have hired the sub-contractors 6. New construction
2.❑ I am a sole proprietor or partner- wed on the attached sheet. 7. ElRemodeling
ship and have no employees These sub-contractors have g• Demolition
won for me in an capacity, employees and have workers'
> Y 9. [ Building addition
[No workers'comp.insurance comp.insurance.:
req �] 5. We are a corporation and its 10.ff Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 11.[` Plumbing repairs or additions
uirright of exemption per MGL
myself.[No workers comp. 12.[ErRoofrepairs '
insurance regui e1]t c. 152,§1(4),and we have no
employees.[No workers' 13.❑Other
r..
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.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: - `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 the pains and penalties of perjury that the information provided above is true and correct
Si store: D9 Date:
Phone#• 60 d�O" 7�j
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/Lkeise#
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."
An employer is defined as"an individual,pmtnership,association,corporation or other legal 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. 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 it license or permit to operate a business or to constrict bulldi4e 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."
AppIicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractor
,(s)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 burn 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 dMassachusetts .
Department of Industrial Accidents'
Q�ce of Investigations
600 Washington Street
Boston,MA 02111 _
Tel.#617 727-4900 ext 406 or 1-877-MA.SSAM
Revised 4-24-07 Fax#617-727-7749
www;maw.gov/dia
Lauzon, Jeffrey
From: Lauzon,Jeffrey
Sent: Friday, April 03, 2020 11:15 AM
To: 'dam96136@yahoo.com'
Cc: Lauzon, Jeffrey
Subject: ViewPermit, Permit No:TB-20-855. `
Applicant,
Please be advised that the above application has been reviewed and the following is noted:
1) Construction documents are incomplete. Beam sizing and details not provided.:Rafte'r sizing not provided. No
insulation details provided. No ventilation details submitted for under floor space. No landing shown outside of
door. No smoke detector information provided (additional square footage may require additional smoke
detector added). (780 CMR R105.3)
The application is denied pending submission of the required documents. And, if aggrieved by this notice;you may
appeal to the Building Appeals Board within 45 days in accordance with M.G.L. c. 143 § 100.
Respectfully,
Jeffrey Lauzon
Chief Local Inspector
(508) 862-4034
Jeffrey.lauzon(a)-town.barnstable.ma:us
1 '
i
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I Ir,
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concrete Patio and Ramp Re rHo Ve d
5' to' lot
bath # vAdditio�
14'
Ocher Ciedraortl �,,
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RedtoollR BC40001
� Bath
14' - ___ _._�._ __
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• Building Sketch
Borrower David Murray
Property Address 1525 Santuit Newtown Rd
City Cotuit County Barnstable State MA Zip Code 02635 i
Lender/Client American Neighborhood Mort a e Acceptance Co. `
z
16'. �
9'
IV
1,Car Detached
[493 Sq ft]
9'
16'' Ln
Concrete Patioand Ramp
,[214 Sq ft]
� ,B th a `<
14' 7' 14' '
Kitchen: CL Bedroom
Dining
� Living Room. J CL
...... ... . .... ...........D. ..........................Bedroom Bedroom Bath
14' � 22' '�. '_ 24'
first Floor '
[1337 Sq r
TOTAL Sketch by 5 la mode,me 'Area Calculations Summary w 'i
Town of Barnstable"
Building
3• G�AENsb�'i'Api l�,�.'s WPoost e�T.�h�i s oa.T'�, teitrdSnsp cnin Ui ha t_ic.si ouUPdrfiatfcnmp ' t ;b.
Permit
itsereaCetce"o Required such Buildinging s� be Occwpiedsul. na pq z
Permit No. B-20-55 Applicant Name: RetroFit Insulation Approvals
Date Issued: 01/08/2020 Current Use: Structure
Permit Type: Building-Insulation-Residential Expiration Date: 07/08/2020 Foundation:
Location: 1525 SANTUIT-NEWTOWN ROAD,COTUIT Map/Lot: 024-013 Zoning District: RF Sheathing:
Owner on Record: MURRAY, DAVID A ContractorzName RETROFIT INSULATION INC. Framing: 1
Address: 1525 SANTUIT-NEWTOWN ROAD Contractor:Ucense 160461 2
COTUIT, MA 02635 - � Est Project Cost: $7,130.00 Chimney:
Description: 12 layer Cellulose open attic,attic damming,,4 layer Cellulose ;Permit Fee: $86.36
floored attic,propa vents, Install insulated hose'and roof-vent to
Insulation:
11
Fee Paid. $86.36
bath fan,air sealing, Install cellulose to exterior walls;Install R-19 Final:
unfaced fiberglass to sills, Install 10 ml poly over open ground in, Date. � 1/8/2020
crawlspace, Install 2" rigid board to perimeter,walls within
Jtl
G ``'✓ � y Plumbing/Gas
crawlspace71
Rough Plumbing:
Project Review Req: — _R;y�g Building Official'
Final Plumbing:
This permit shall be deemed abandoned and invalid unless the work authors ed by this permit is commenced within s�x months after issuance.,
All work authorized by this permit shall conform to the approved application and-the$approved construction documents forwhich this permit has been granted. Rough Gas:
All construction,alterations and changes of use of any building and structures shall:tie in compliance with the local zoning by-laws and codes.
This permit shall be displayed in a location clearly visible from access street orroadand-shall be maintained open for public ihspectwn for the entire duration of the Final Gas:
work until the completion of the same. )
Electrical
The Certificate of Occupancy will not be issued until all applicable signatures by the(iuiiding and,Fire Officials are provi don this,permit.
Minimum of Five Call Inspections Required for All Construction Work: ' Service:
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
CM kmL. SSl_ j 7—
t
�VMKE T Town of Barnstable *Permit# �-
I D V
ires 6 month
~°^ Regulatory Services e e h m P,t dote
a a
a •
a IAIWSfABI.E, •
9�prMnss Richard V.Scali,Director 31JJ6
FD Mf►l
Building Division
Tom Perry,CBO,Building Commission'
er�o
200 Main Street,Hyannis,MA 02601
iss
www.town.barnstable.ma.usAR 24'Z0iZ
Office: 508-862-4038 Fax:. 5508-7-99 6230
EXPRESS PERMIT APPLICATION RESIDENIV i '00-SI L
Not Valid without Red X-Press Imprint
Map/parcel Number �� /� / - _
Property Address S�� St:i((� t 1 I��(,J b�•JIr1 (('//� Coh)t 1-
(J�Residential Value of Work$ S Minimum,fee of$35.00 for work under$6000.00
Owner's Name&Address a r y4 A S" k b/ 11 Gv S
Contractor's Name �(,L,C'?tn -e C6 Telephone Number ')3 U` 2 � 3
Home Improvement Contractor License#(if applicable)M/ '� ;'y l Email: /4]r3 S( A ooy,I vu 1()V-0 V,,•dALyl
Construction Supervisor's License#(if applicable) l O 5 1
[�orkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I an the Homeowner
have Worker's Compensation Insurance
Insurance Company Name aC.a A t/) S 12 (�
Workman's Comp.Policy# 00
Copy of Insurance Compliance Certificate must accompany each permit.'
Permit Request(check box) /
®-Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to
❑ -roof(hurricane nailed)(not stripping. Going.over existing layers of roof)
LRe-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 Improvem t Contractors License&Construction Supervisors License is
required.
.SIGNATURE:.
QAWPFILESTOR7 ]ding permit forms RESS.doc
Revised 040215
t
27ze Commortweaiith o,f-Vassadiusetts
Departrrrent o,fludustrialAcciderds
Of, -cue of MACS igations
600 Washington Street
n y Boston,MA 02222
r
I V I V MHIasm.gov1dia
Workers' l Umpensaf an Insurance Afflidavit:BnilderJC+antractarsJElectricianslPhu nbers
AppEcant IllfGi-M-2fihln Please Print 1, . 'b
Name(BUs�esstOrganrcatioaflad�vjdnal� �n•�
Address: 3
City/Stater- 3
A; J��wn
pemployer?Check the appropriate box: 'type of project(required),:1. a employer with Z 4 ❑I am a general contractor and I
employees(full andlor part-time).* have hired the sub-contra foss 6. ❑I*1 construction2.El am a sole proprietor or partner- listed on the attached sheet. 7- odeling
ship and have no employees These sub-contractors have g_ ❑Demolition
wading for me in any capacity. employees aiid hay a workers'
9.. Building addition.
INo tti-ozloers'comp.insurance comp-Fnstz[aut�l ❑ g
rewired_] 5- ❑ We are a corporation and its 10:❑Electrical repairs or additions
officers have e=cised their 3.❑ f am EvomeovEmer doing all work 11_❑F grepairs ar'additions
set£ o workers' right of exemption per MGL
rnmp c.152, 12 Roof repairs
c�inirr�r ae required-] §1{�and we have no
employees.[No workers' 13-❑Other
camp.insurance required-]
*Any WUCMC&atcbedus box#I must RkefiIloutthe•sectioaberawsha%dxg[b&waaereca®pensatin,paHcyinfncrosd0n_
T home +art wbo submit this af5dmg1 indicating they axe Mg alf wC*auli&M hie outside conttactas omit submit a new aMdark indicating-sacb_
ZConuactars[fiat check this box must attached an additional sh w shouirrg the nme of the sub-comtrsctars and state whether or not those entities ham
employees.Tfthesvh c=tnrctnrshave employws,&eYamstpmv-i&-&&warken'romp.policy n=ber.
I all,an empLoyer that is praridirW workers'congwisadias inmirance for my emp&yces Betow is diepoUcy and job site
informafian '-
Insurance Company Name: ei Gil 1 ,-,
Policy 4 or Self--ins.Lic_ Vl P-► � C�� lJ F-Viration Date:
l ,
Job Site Address- J15 5a�n 'U(l �e-L.) CitylStatel2.tp: C)�L) r\,N
Attach a copy of the workers'compensationpolicy det:Iaration page(showing the policy number and respiration date).
Failure to secure coverage as required.unnder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a
fine up to$1,50D OD andlor one-yearimpFisonmeut,as will as civil penalties.in ifie form of a STOP WORK ORMERand a fine
of up to$250-00 a dap against the-violator. Be ad6sed that a copy of this statement may be forwarded to the Office of
Iavesfsgations ofthe DIA for insurance coverage yerifrcation.
I da heret:y&i;;i under theprrins al pe a,"s, Ferjurp that fete in,formadozi prm tied abmw is Grua arrd carrect
' . .
Bate:
Phone 7 3 U 3
Official use only.. Do not avrrte in this-area,to be campTetesd by city or town official
City or T"u: PeruiWI icense#
Issuing A-uthority(circle one):
1.Board of Health 2.Building Department 3.CItylIbwn Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone ih
IP
-- ---- --- — - - 6
- ormation and lastructions �,. :•--a.
I&Ssachuseths Geheral Laws chapter 152 requmes all employ=to provide workers'compensation for their employees.
Pmsuantto this stye,an.rinplvyrZ is defined as_°`_.everypersonin ffie service of another unnder any conf act ofbite,
express or implied,oral or written."
Aa errPIoyrs is defined as"an individual,parhammbip,association,corporajaor,or other legal euatiiy,or any two or mare
of the foregoing engaged ina joint enterprise,and inclU the legal representatives of a deceased employes,or the
receiver or trastee of an individual,partaersbip,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 -
dw Ui g house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appuatenantthereto.shallnotbe�cause of such employmentbe deemedto be an employer."
MGL nbapter 152,§25C(t]also sins that"every stain or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a bgssiaess or to construct buufldings in the commonwealth for nay
appUcantwho has notprodncad acceptable evidence of cdmpfiance With the tasarance-coverage requi r-ed."
Addiiionany,MCM chapter 152, §25CM states aNeitherthe�a*nmanwealthnor any ofitspolitical subdivisions stall
enter ruin any contract for the performance ofpubho work unfit acceptable evidence of compliance with the ins ce%
rMfu it�enfs of this chapter have been presented to the contracting authozity.-"
Appficaurts ' . . .
Please fill o:Ct the workers'compensation affidavit completely,by checlong the boxes that apply to your situation and,if
nmessary,supply sub-contractors)name(s), address(es)and phone nu rnber(s) alongwiththear certificate(s)of
hisu once. Limited.Liability Companies(LLC)or Limited Liabiity Partnerships(LIT)withno employees other than the
members or partners,are not required to carry workers' compensation MMICaace. If an LLC or LLP does have
employees,a policy is requin�d Be advised that this affidavit maybe submitjrd to the Department of Industrial
Accidents for confamation of insurance coverage. Also be sure to sign¢and date-the affidavit The affidavit should
be retammed to tine city or town that the application for the permit or license is being requested,not the Department of
Ladustrial Accidents. Should you have any questions regrrdmg 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-fi su ce license nummber an the appropriate Tune.
City or Town Officials .
Please be.sate that the affidavit is complete and pried.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 peunitllicense m=ber which will be used as a reference number. In addition,an applicant
that must submit multiple perr itllicense applications in any given year,need only submit one affidavit indicating r
p olicy hafbrruatiom(if necessary)and under"Job Site Address"the applicant sho7Sd-Frite"all locations in (crty or
town)"A copy of the-affidavit that has berm officially stamped or marked by the city or towm 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 oiut each
year.Where a home zen owner or citi is obtaining a license or permit not:related to any business or commercial ventzre
a dog license or permit to bum leaves etu.)said person is NOT requaed to complete this affidavit
The Office of Invm gations would lake to thank you is advance for your cooperation and should you have any qum'dons,
please do not hesitate to give us a call.
The Depart =rs address,telephone and fax number.
-
Depactnent cliff 1adutcial Accadenta
Off ce OVXLve&-dgattio=
�Q4,� tQn Sit _
Bastou,MA 02111
Tf,-L 41 617-T27-49QO Qx- 406 ar 1-4` -MASSAFF.
Fa 9 617 727-77D
Revised.424-07
` Herbst Home Improvements LLC
35 PEEP TOAD ROAD
CENTERVILLE MA 03632
774-238-2937
www.herbsthomeimprovements.com
PROPOSAL SUBMITTED TO: WORK PERFORMED AT
Lauren Kleinas A,r v v\CLS W e.\hCL S 1525 santuit Newtown rd Cotuif
We herby propose to furnish the materials and perform the labor necessary for the completion of:
Garage
New-garage roof
Remove one laver of shingles
Inspect roofing deck for loose plywood
Install ice and water shield
Install new drip edge
Install 151b felt paper
Install Certain Teed Landmark shingles
New siding on garage
Replace trim including
-6 rakes
-6 corners
-5 fascia
Rot repair when needed billed as completed
House
New siding and clapboard on front facing walls
New trim including
-8 comers
-5 windows
-2 doors
-1 slider install
rot repair where needed billed as completed
Demo front concrete ramp/step
Replace 2 gutter sections
All material is guaranteed to be as specified. The above work will be performed in accordance with the specifications submitted
And completed in,a substantial workman-like manner for the sum of:twenty thousand nine hundred fifty
Dollars($20,950.00)with payments as follows:
*Any alterations from above proposal involving extra costs will be added under a separate written agreement and become an extra
charge over and above said proposal.
RESPE ULY SUBMITTED
- 3117/2018
j n Herbst
ACCEPTANCE OF PROPOSAL
The above price,speci ' ations and conditions are satisfactory.I herby accept this proposal. You are authorized to do the work anc -
payments will be as s c*ithdrwn
SIGNATUR .
*This propos m y b company if'not accepted within 30 days.
DATE
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)03/23/2016
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 NAME CT Ashley Clark
LEONARD INSURANCE AGENCY PHONE , (508)428-6921 FAx
AIC No
ADDRESS: Ashley@Leonardagency.com
683 MAIN STREET SUITE B INSURERS AFFORDING COVERAGE NAIC#
OSTERVILLE MA 02655 INSURER A: ACADIA INS CO 31325
INSURED INSURER B:
HERBST HOME IMPROVEMENTS LLC INSURERC:
-INSURER D:
35 PEEP TOAD RD INSURER E:
CENTERVILLE MA 02632 INSURERF:
COVERAGES CERTIFICATE NUMBER: 39114 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 LTR TYPE OF INSURANCE AINSD Vivo DDL SUER POLICY NUMBER MM DCDY MMIDDIYYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE OCCUR DAMAGE TO
PREMISES Ea occurrence) $
MED EXP(Any one person) $
N/A PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
JECT
POLICY PRO LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $
Ea accident
ANY AUTO - BODILY INJURY(Per person) $
ALL OWNEDSCHEDULED 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 /� SPER TATUTE EORH
AND EMPLOYERS'LIABILITY Y/N
ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 100,000
A OFFICER/MEMBEREXCLUDED? I NIA NIA NIA MAARP300898 11/18/2015 11/18/2016
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
N/A
DESCRIPTION OF OPERATIONS/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
Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS.
200 Main Street
AUTHORIZED REPRESENTATIVE
Hyannis MA 02601 C
Daniel M.CCro 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
License or registration valid for individual use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
Not valid wit out signatu
- _
a
.... ..:. ... . . .
�j
j Qf lice of Consumer Affairs&Business Regplation I
'0WHOME IMPROVEMENT CONTRACTOR
Registration:,. tZ1331
Type:
Ex iration:_ LLC
HERBST HOME IMPRf1FfLC
'=
_77.1
l
JASON HERBST �5� i
35 PEEP TOAD RD r i
I CENTERVILLE,MA 02632
Undersecretary
R
R Massachusetts Department of Public gafet
f, ulations and Standards
tel cif Building Reg
i License: CSSL-106051
'Construction S:apervisor-Specialty ,
JASON HERBST
36 PEE.OiOAD ROAD.. r� k •.
CENTERVILLE MA 0 63
' . ;
Expiration
" Cbmmissioner� ',10101.12018
Construction Supervisor Specialty
•Restricted.to:
csSL-RF-Roofing
: I -
Failure to possess a current edition of the Massachusetts.
State Building Code is cause for revocation of this'license.
-.DPS Licensing information visit:tNWWMASS.GOV/DPS e
!
Assessor's map and lot number ...... 7„ ..;�-3. SEPTIC SYgT -
�T BE
OMPLIA�E
Q /!.•� % -A - 7S' INSTALLED IN O
ARTICLE
Sewage Permit number �v....s��`' � S.4i ITARY II �T�
Cam
REG
Q�oFT"ET°�� TOWN- OF BARNSTABILE
i
i SAWSTABLS, i
9� 0 pYa��� BUILDING INSPECTOR
APPLICATION FOR PERMIT T.Q. ...... lL..r...,�../....�.H........ ......... 9.f rx..y//qy..e....................................
................C7. ............. ....
TYPE OF CONSTRUCTION � .Ga FJ.:.r-...l��t..�.....................................................................
ky....... . .�...........19.7 S
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby appliesapplies for a permit according to the
the following information:
Location ....lY. �'!...../..�.w.!'1............... �..�4t.. ...........4!.&i.! .. !!.1.!../.../...........!....l.K. ..S.... ...................................
Proposed Use ....:. .'1. ./�.............. .r
Zoning District ....... ....................Fire District
Name of Owner .I,GE.U..I."qm.0... ..........(.VR .........Address .....
Name of Builder ..il t t1.f....... .o..�.C...l..l.v................Address .....�o N'....��! ..........!!: 4.t��f�1 ....!5..........
.
Nameof Architect...................................................................Address ....................................................................................
Number of Rooms ......... ......................................................Foundation .... .?{Y. /. ......... .�°. ./1.s.............
Exterior .f.00.4 .....Sl.l.l..�! .l.P.......................................Roofing ..!`I,Se..tq-- .E...................................................
Floors ....Wo.v'..d...............................................................Interior ......5 ...................................
Heating ....Q.,...I....................................................................Plumbing ..................................................................................
/ co
Fireplace ..................................................................................Approximate Cost ...1(� .ads.......... . ........... .. .......
Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ........... ............  ............
Diagram of Lot and Building with Dimensions Fee � -
........... ............ ... ..........
SUBJECT TO APPROVAL OF BOARD OF HEALTH
�r(�
` sy2s �
e-
C�°J i
� I
V� PqG f
� �d< '{ � CFI �•� �
L"r
a s el.iJ)a U."ti'1 0°Z
1 hereby a gu a ions of the Town of Barnstable regarding the above
construction.
Name .. .
Rogers, Laurance T
17695 add to single
No ................. Permit for ....................................
family dwelling & build garage (existing garage to be dem6lished)
......................... ..........................
5�,�. ........
3 k 1 Newtown Road
Location ...........................:........................:...........
...................... ......................
Owner Laurance Rogers
.................................................................
Type of Construction frame
. .......................................... .
_ b
...............................................................................
Plot ............................ Lot ................................
Permit Granted 1`1�y..�................19 75
Date of Inspection � �5 `
CC
i Date Completed Jp/'. ..7./.............19
PERMIT _REFUSED
......................:.:..................:.................... 19
1
....................................
...............................................................................
...............................................................................
Approved ................................................ 19
l ..........._...................................................................
...............................................................................
II —
Assessor's map and lot number ...... .................
� 4` �./4 {-14 - 75"
Sewage Permit number .....ti.G.:. ` �'" . � '`"LL......
Qy�FTHIE TOWN OF BARNSTABLE
33AWSTAMLE, i
"6 9 BUILDING INSPECTOR
APPLICATION FOR PERMIT TO .... /; al.,. ........7....7
...............................'::.......M . f. .........................................
TYPE OF CONSTRUCTION .........r�� ......... r rR!!..<"........................�..........................................
.....Z./.fit .�........ �. ............19..�.
t
r .
TO THE INSPECTOR OF BUILDINGS:
The, undersigned hereby applies for a permit according to the following information:
4 Location /"�.�4� T r.v H ��) ,-,2 �,� ��, r — m o S
........................ ............................ ....... ... ......................................................................
Proposed Use
Zoning District t �..............................................Fire District ... .. .. t
Name of Owner ...:.:.:!. w4 !� S.....'.. ^ .,?F...:!. Address ..... 0ran r- o a.+ l ./
Name of Builder � t-a r... ..�.G................Address ..�!,►.t�vV- ( �� t� r (/G4f t
Nameof Architect ..................................................................Address ....................................................................................
Number of Rooms ' r rm-e i ff c ,
1......................................................Foundation ..... .....�................7............c. .........................
Exterior t� �nn,�.......r/�,,,..ks J�/,�? Roofing ..; ,. .h... ..............................................................
Floors .... fate,.,.: ...............................................................Interior ........ �a............
Heating ..........................................Plumbing ..................................................................................
...!! ..t...........................�:.
Fireplace ..................................................................................Approximate Cost .... ...............................................
yr• ,
......,
Definitive Plan Approved by Planning Board ----------------------•---------19________. Area .... ... "- .......-� '. ...:...... ...........
Diagram of Lot and Building with Dimensions Fee ...................� .. .
SUBJECT TO APPROVAL OF BOARD OF HEALTH
r
�ays
i
I hereby agree-to-conform-to-al l-the_Rules-and-Regulations of the Town of Barnstable regarding the above
construction.
Name .. f� :':...!....... ...... .-J... .............................................
V;.
Rogers, Laurance i 1
No 17695 permit for add to single
...................................
family dwelling (existing garage to be dmmolished)
...............................................................................
i59,5 SanLUl ewtown Road
Location .................................. .............................
............................................... .. ..rs........- ..... .
Owner Laurance gers
F
Type of Construction ...fr me
..................................
............................................ ...................................
Plot ....................:... ot ................................
Permit Granted .......... ay 16 19 75
Date of Inspection .... ...............................19
Date Completed ................ ....................19
PERMIT REF ED
....................................... .................... 19
............................:"/.............................................
............................ ..............................................
0 1/,�
Approved .......... ..................................... 19
..............................................................................