Loading...
HomeMy WebLinkAbout0024 CLIPPER LANE � z W" �! 5,„ x s w ti.s rt f .r.,:ts.. ,t, y 4.r ws<s .r .<�. ti ..,�. . , — - �.+� ,G N '� -r- 4,x..'.:`� s. - , e? _?. i e - y .+' . �� ,.„-a,, rL .�7.< .."r," r:Y .'!5. Y•, v `r R ,,r r �i+(i'.i .�5 I A � t d !�`'+ 'd :s ` a ,e' *j 'ji 1 e� G i {+ y r,:1 °'p. ''r �.+.F. y 7' � '�q•id:� 6^ ff x4`.. !,i�. .1! '.. r .. �.( �., ..,,r ,r' �5'; r t.. µ . ` ,-. 3 ;,4 „y 3i : cj a, v:, r ., 7.-j'W s .,r n' '3! .gyp �.q��' ..; �! Y/ �' [, t �:.f y:. `Ru' '4 u h ..+. ..�w, ,'P , :... ,+z•. b,.. a.,t, v ,e.`.,:_.y, =u; 'n.:..,.,. ....f. $ a... '.} .�''ai u a:- w�..-..v, .�,.+•� ,.n 'u r �.�y's .v�'< t a+' ,k ..�,.-6n. >,'• 4.+,ne. xw,, S" :>. ;!n. ..-, ,t" J 5511 +x :L. " `!. •y�} '.h.. ,`5 ?.' µ...,.S€::..e. :a +.,,°. ,.�. li�da #.ynYs. `,y- ; n a ' tpr ,F ' _ ,�I '"f,."O.,. ;•f1.a ,S, i - r-. ,*�i ` £x!'+�a f/p >¢ i�'F "!�> t � �{• RFx J'% :X ".,a i12 3 e. a� % CT 4� p i a , rt, ... r. • k.. .. . .. .: - . :: e . r- ' „ r .'.:. ,- e Rx - - .. i V }t k Z ..* .'... .. ,-. "1 C t c - e r< h S,r r .. -'-l-'l 11'1'1"�"'--"-'-""�'l'�"�`11`11-1""""-11��-'; n' 'e s :� i' �,_ . Y , �.{� - .� 0 Town of Barnstable Permit# U Expires 6 months from issue date Regulatory Services Fee w BARNSTABLE, Mass. Richard V.Scali,Director jes0 , 39. Ajtb MA'I A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIA QN&Y I _ ! Not Valid without Red X-Press Imprint Map/parcel Number ( AfAY 1 Property Address ® ?416 vy� ®Residential Value of Work$ ?.<06 ' Minimum fee of$35.00 for work under$000 00��e�� Owner's Name&Address 1-4z,4-t P ee-n paw C a/`l e lkh Contractor's Name /�j c�a.e C�T.�/ e1.a✓aj1_arzs .S1 Telephone Number �� $ ??6 d rink Home Improvement Contractor License#(if applicable) ISf tf 9-6 Email: W ak fig ov Construction Supervisor's License#(if applicable) C 54:- C `/ 9 AT MN U OF DN 1 t N STABLE ®yorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name S 5 Q r a. r'cy� ►►�p 16�j r•s�5 -1- n S Workman's Comp.Policy# IN C C S�d Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over - existing layers of roof) ❑ 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 ign Property Owner Letter of Permission. A copy of the Home rovement Contractors License&Construction Supervisors License is required. SIGNATURE: A Mi C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Cone t.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 oFr►�rqy, aAMMASLE. , MAN. , Town of Barnstable AjFp�.lA Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.m a.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, kr e el ,as Owner of the subject property hereby authorize it%fie At aaz/!� to act on my behalf, in all matters relative to work authorized by this building permit application for: CP.n1k r U--fi l'/e n4 (Address of Job) 20 V, Signa Owner Date L A u-P ; /C t22e, Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.0ut1ook\2P101DHR\EXPRESS.doc Revised 040215 ACOBQ'." CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/9/2016 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MCSHEA INSURANCE AGENCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1550 Falmouth Rd Ste #2 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Centerville, MA 02632 5 0 8 4 2 0-9 011 INSURERS AFFORDING COVERAGE NAIC# INSURED Aupperlee, Michael DBA INSURER A: National Grange Mutual Ins Co. # Michael Aupperlee Renovations INSURER B: Associated Employers Insurance 169 Sandlewood Drive INSURER C: Cotuit, MA 02635 INSURER D: 508-428-6654 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. INSR ADDI - POLICY EFFECTIVE POLICY EXPIRATION LTR NSRDINSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ i 300000 g COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 500,000 a U CLAIMSMADE OCCUR MED EXP(Any one person) $ 10000 A MPJ26304 2/9/2016 2/9/2017 PERSONAL&ADV INJURY $ 300000 A 2/9/2015 2/9/2016 GENERAL AGGREGATE $ 600000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 600000 A POLICY PRO- A] LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANYAUTO (Ea accident) ALL OWNED AUTOS BODILYINJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO EAACC $ OTHERTHAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CICLAIMSMADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WCSTATU- OTH- WORKERSCOMPENSATIONAND TORYLIMITS PER EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE WCC 5 01 10 9 7 0 6/19/14 0 6/19/15 E.L.EACH ACCIDENT $ '500, 000 B OFFICEPMEMBERyes,decdbeun EXCLUDED? '6/1 9/1 5 6/1 9/1 6 E.L.DISEASE-EA EMPLOYE $ 5 00,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500, 000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Carpenter/ Included CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF BARNSTABLE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. { /{ rAUTHORIZ;MENIVY E ACORD25(2001/08) \. ©ACORD CORPORATION 1988 . v The Commonwealth of Massachusetts Department of Industrial Accidents •y Office of Imestigalions 600 Washington Street Boston,4 02111 Irivi:massgot/dia Workers' Compensation Insurance Mfidasit. Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bh- Name(Busine Orgauization4n&-vidual): Pl �/'a,`G- Address: / h oY a Lbo o 0,J City/Stat&Zip: 8-J�-6f M4 e2Z3 Ir Phone k. a- Are you an employer"Check the appropriate box: Type:of project(required): 1_® I am a employer with�_ 4. ❑ 1 am a general contractor and 1 ; employees(full and/or part-time).' have hired the sub-contractors 6. New construction 2.[] I am a sole proprietor or partner- listed on die attached sheet_ 7- ❑Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working for mein any capacity. employees and have workers' [No workers`comp:insurance comp. 9. ❑Building addition c insurance..- 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 LE]Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]I c, 152, §1(4).and we have no employees,[No workers' 13.0 Other rC'_—tlbo comp.insurance required.] O.-'L y applicant that.checks box#1 mnu also fill out the section below showing rhea workers'compensation policy information. i Homeowners who submit this affida tit indicating they are doing all work and then hire outside contractors trust submit a new affidavit indicating such. :Contractors that check this box roust attached an additional sheet showing the name of the sub-coauactors and state whether or not those entities have emptoyeas. if the sub-cozncton ha%-e employees,they Must provide their wwkeW comp.policy tsumbet, lam an employer that is protidillg workers'conymnsation insurance for m}employees. Belong is the polio,and job site information Insurance Company Name-.- Policy 0 or self-ins.Lic.#: u j cc 5,0 2/ b 1? Expiration Date, 1r11,6 Job Site Address: 0ff-t1 � �fl-Pr City/State/Zip: C. P.n `yj 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.c-iolator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the.DIA for insurance coverage verification. l do herebv cerrify under the pains and Pena 'es of perjury :tat the information presided above is true and correct. Sitmature: Date: ' Phone : 5�68 776 3!s Official,use only. Do not write in this area,to be completed by cih,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 S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 I U/ze�parivr��ancue�clC�o�� aacluaeGtr Office of Consumer Affairs&Business RiCation License or registration valid for individul use only (POME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: eegistration: , 153440 Type: Office of Consumer Affairs and Business Regulation xpiration:..._12/:1L20=16 Dgq 10 Park Plaza-Suite 5170 Boston ,MA 02116 MICHAEL AUPPERLEE RENOVATIONS MICHAEL AUPPERLEE:':'': . 169 SANDALWOOD DR e'G� COTUIT,MA 02635 Undersecreta. rT Not valid witho si ature = cso w N g. r O �} - to a C O N C E ca o -a co ag 0 w LL MOD � � q'r o a M r- Q . n o 0 a b. C GV Q ` y i N; � m a 9G .t a) ..rn cVi. ►aaaQy ' 1UE : 0 a in E CO cu V OO y :E 7 o c o c� 03 mUr? V 0 -� N CD �? - (A O ►+,QQ — ofLn n c N. O CA 7 ' ( x