Loading...
HomeMy WebLinkAbout0033 GUILDFORD ROAD o e � 6 - o 0 e o o v p � 0 0 o r �. .. �. � .. c P , � ,b �,► , Town of Barnstable *Permit# � J " q (/ b p Expires 6 months from issue date Regulatory Services Fee • anxxsTAH * PERM Richard V.Scali,Director MAR 0 2 2016 R-::Building'DiASi0&' Perry,CBO,Building Commissioner TOWN OF SARNSTA eo Main Street,Hyannis,MA 02601 www.town.barnstable.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 �� �' �i Property Address 343, GutIr1 c r� 't`c� tyke J i Q Residential Value of Work$ S a S Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address V�e r, V. t Contractor's Name Seem �c% �6 b,564­ "ClyleS ' Telephone Number 5_0 a S-66 00 T! Home Improvement Contractor License#(if applicable) 171I 1 6Z Email: y See�nt� t is Cu trw.�yw�5,cG:-►I Construction Supervisor's License#(if applicable) C 5 0$17S 3 Vorkman's Compensation Insurance` Check one: , ❑ I am a sole proprietor' ;. ° •. "__ .__. J. _ �.r . _� _._�_a_. .l l • .. .. r_ ,ti;� r ❑ I am the Homeowner [21fhave Worker's Compensation Insurance,. Insurance Company Name A" A,, Cc_v16or\ _vnsvfc,0Ce A!q enc j I.,A c., Workman's Comp.Policy# WCC SOo5- } 11 3W i ZO1S' Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) [�IRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to &uCYN e f ❑Re-roof(hurricane nailed)(not stripping. Going over 1 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 Property Owner Letter of Permission: ' �' r'=i, : tr. t": % 1, • A copy of the Home Improvement Contractors License&Construction Supervisors License is require . SIGNATURE: C:\Users\Decollik\AppData\Locai\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 + BAIWRrABLE, 639. ' Town of Barnstable ` Regulatory Services ,, T' Richard V.Scali,Director h 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, /M l 0 ,c CJ 1� , as Owner of the subject property hereby authorize 17,,5yn_1t)X)10(� W� S CyAram C" act on my behalf, in all matters relative to work authorized by this building permit application for: r (Address of Job) �( Signature of ner (\ Date Print Name f , If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the a reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Wtlook\2PIOIDHR\EXPRESS.doc - Revised 040215 ,,, Trite CorrrxtEeatia*e&lh of Usetts � Depwarrfinen of Prrdristraral Acc-r lerrts Offrce ofhnwdigatiores - 600.f$'aihiiigto►r Scree '• 4� y Boston,M4 02111 trwwntass gml diaa Workers' Compensation Insurance Affidavit: Builders/Conti actors/Electticians/Plumbers' Applicant Information Please Print Legibly Name(Businemiorgaluzation+`Individual). Jec:v\ G6Vc" kw` s: ` Address: 7 3_7 .V—�a\4-\CVVV\ / b a5 S 6 _. . . r . . City/State/Zip; Oa53 ' 66. 00-g 5' Are you an employer?Check the appropriate box: T3`Pe of project(required): ,. l..�am a employer with -1- 4• I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6_ Near construction 2111 am a sole proprietor or partner- listed on the attached sheet.. "I., Remodeling ship and have no employees Frz ; These sub-contractors have •; . g_ Demolition- ;rl...: working for me in any capacity."-' employees and have,workers`' Q Bixilding addition [No workers'comp.insurance comp_insurance$ required.] < `r 5.'E] file are a corporation and its ' WE Electrical repairs or additians-_ ] ;, ;..,offrcers'have exercised their ,'': t .. : 3.❑ I am a hor6ri Tier doing all work 11{]Plumbing repairs or additions' pelf o'workers" t right of exemption per NIGLI myself [N camp- , 12.d Roofrepairs , insurance required.]t - `c'152;$1(4);and we have uti employees_[No workers 13.[910ther Cho°F camp.insurance required_] *Any applicant that checks box#1 mast sLao fill out me section below showingtheir n*orkeis'coinfo compensation policy rmetion. f Homeowners who submit this affidiw t indicating they are doing all mark and diet hire outside contractors mast submit a new affidarit inddicatini snch. - ?,` =Contractors that check ibis box must attached an additional sheet showing the name of the sub-contractors and state whether or not those enrides have employees. If the subcontractors have employees;they must provide their workers'comp.policy number. ,} , 1 am an errtplof er that is proiddirrg�irorkers'caw'ijreatsrition irtsrirrrrtce for ir�ti e�rrprIoyiees. Beloit is the patio arid�ob':sife.'' ' inforrrradon 11 A Insurance Company Name:J`1 y� .xei d c� (�c (-tf Ott �l/L S y(c.✓�ce /T c,evxc_7. fn L Policy N or:Self-ins.Lic.#: i C.C. 500,S0 l l 3 z i ci 101 SA Expiration Date: Job Site Address: 3 2 L -V i W City/State/Zip. CeAe rv;�ke,1"_ 6a 43 a- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).r 9 Failure to secure coverage as required under Section 25:A of MGL c..152 can lead to the imposition of criminal penalties of a fine up to 51.500.06 and/or one'-year'.imprisoriinent;as irell'as'ci%ril penalties in the foim da STOP WORK ORDER,and'a fine of up to$250.00 i day against tlieviolator.Be advised that a copy of this statement riiay be forwirded to the..Office of ''", Investigations of the DIA for insurance co'stage verification. "s :r r r �. s....• r• Id Irereby ce fly riirder the it ndpenQllies ofperjnrt that the.ircforrn�etion proi�ided cibot a is titre and correct' r :�� {,.9 Srgnahire:. d f. r, -Date:- 4 `j� t Phone#_ i„.. Qkcial use vntt Do not curios in thii area,to 6 completed b/c h) or,tot 4i vf'iefa[ "" 1 _ i. .,�' i .' try r i.rs !•, ?r. .'� t°++t,, :i 1 �ir�'' , City Or�'OlTmm:..k4•t .. , �s'"4r' .Pl rmivlAcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Phrmbing Inspector 6.Other a Contact Persons Phone#: 6 Town of Barnstable y Regulatory Services Richard V.Scali,Director °^ Building Division * a►wvsrAB>: Tom Perry,Building Commissioner NAss. 1639. .0 200 Main Street, Hyannis,.MA 02601 60 �A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street 4 " ! _ + village "HOMEOWNER": ' name home phone# work phone# ' CURRENT MAILING ADDRESS: ci /to state zipcode. wn � r y cc "" : The current exemption for homeowners was extended to include owner-occu ied dwellin s of six units or less and to allow P p � homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner..Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with,said procedures and requirements. Signature of Homeowner F Approval of Building Official - y Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doe Revised 040215 ty f ny� ACORU° CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDfYVYY) 01/27/2016 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(les) 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 Phone: 508-540-6161 Fax: 508-457-7660 CONTACT Bob Allletta ALMEIDA&CARLSON INSURANCE AGENCY INC. PHONE AX P.O.BOX 554 c 508 888.0207 . (508)888-0560 E-MAIL rallietta@almeidacarlson.com FALMOUTH MA 02541 DD INSURER(S)AFFORDING COVERAGE NAIC# INSURER Essex Insurance Company INSURED INSURER AEIC SEAN WATTS CUSTOM HOMES PO BOX 737 INSURER EAST FALMOUTH MA 02536 INSURER D: INSURER E INSURERF COVERAGES CERTIFICATE NUMBER: 32447 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 TYPE OF INSURANCE ADD'L SUER POLICY NUMBER POLICY EFF POLICY LI Y EXP LIMITS A GENERAL LIABILITY 3ED4804 01/24/16Mm/PoNym 01/24117 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABIUTY PREMI wETORENTED PREMISES Ea ocrence $ r50000 CLAIMS-MADE I-1 OCCUR MED.EXP(Any one person) $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE UMIT APPUES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PRO POLICY r JE T LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED CHEDULED AUTOS UTOS BODILY INJURY(Per accident) $ HIRED AUTOSRUTOS ON-OWNED PROPERTY DAMAGE $ r awiden $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ REXCESS uAB CLAIMS-MADE AGGREGATE $ DED I RETENTION$ $ WC SrATU- OTH B WORKERS COMPENSATION WCC50060113492015A 09/22/15 09/22/16 TORY LIMITS ER $ AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNERIFXECUTIVE �fYNIN� E.L.EACH ACCIDENT $ 100,000 DED? F OFFICERIMEMBER EXCLU N I A E.L.DISEASE-EA EMPLOYEE $ 100,000 (Mandatory In NH) If yes,describe under DISEASE-POLICY LIMIT $DESCRIPTION OF OPERATIONS below E.L. 600,000 T1 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: Bob Allietta ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD office�oas�nm nA� Beess"i#"eggo a oa License o....... aim for individul use only 4efore.ib4:lE?� ti6 date--`If found return to: Registration: ..174152 Type. OffI6'of C tasdh r ors_and.Business Regulation •Expiration I/2/2017 DBA to-P�r#t".Ifa�=Sum 5110 Sosfoei: rIa'v SF.ikF1 WATTS CUSTOM H61OE3' SEA" Wlk'(TS 30 BAPTISTE LANE EAST FALMOUTH MA 62538 Undersecretary 3 Uiassac±luse.�� - e �; Unrestl icted-Buildings of any is ,. a use group whieh Board of cotltaint less than 35,000 cubic feet(9911,13)of Con,rrueblP S efIClOSed S Ce. . _:tense:CSp8�753..: SEAK D WATTS 30 D 'TTSTE L East Falmouth V Failure to possess a current edition of the MassachuseM h State Building Code is cause for revocation of this license, �,'�••• For OPS-Utenssing tnforMation V ft wwwmassnoviops s M+31 3� .. �' ..�. - _ -.• .. ....-.,,T,..,.. �u:...-.T.. �":, ., _.._ ..-+,--'fas,,;;::.�...a—:. ,a:.,-_.,,, «.per .vim..,,�..s�',>:,�--.�_..... •�.�1.:�-�...� _ ^-c FEE �Og TOWN OF BARNSTABLE, MASS. �o19 e0 - THIS IS TO CERTIFY THAT A PERMIT IS HEREBY GRANTED TO ................................................... ....... ......... ............................. ......... 4 0.� (PROPERTY OWNER) (ADDRESS) •. - ..._ p�y oc. TO 4........................:..... ......... _.._ ___ I............................................................. (BUILD)�# 'I q�( (ALTER) .(REPAIR) A ad , to (TYPE OF BUILDING) ••..•. (APPROXIMATE SIZE) tS 1-alleod LOCATION ..... _....... _ _..._ _...._... .... _ (STREET AND NUMBER) G (VILLAGE) , wA NAME OF BUILDER OR CONTRACTOR __...... APPROXIMATE COST- _..4, B c I HEREBY.AGREE TO CONFORM TO ALL THE RULES AND REGULATIONS OF THE TOWN d OF BARNSTABLE, REGARDING THE ABOVE CONSTRUCTION. MIA 11:a° ................................- (OWNER) (CONTRA CTO�.1!»:~• Ravi •. . �,��a f.� � , BUILDING INSPECTOR Subject to Approval of Board of Health. I� y y • .ter �T-w' ,� g ,f�. -:e; fie, .ter iA- t , I - - .. .. . ,tS.tip' �. k..` ai I•L i., r,�. ., .. (''� SEPTIC SYSTEM Mqu J l ! C o tui AVIS: 172. . . . . . #82 INSTALLED IN COMPLIANCE WITH ARTICLE II STATE SANITARY CODE AND TOWIM REGULATIONS b�Py�FTIIE• +� TOWN OF BARNSTABLE i 3Z3ASB9TAIILE, • . ' "6 AM a M BUILUNG INSPECTOR ar a• APPLICATION FOR PERMIT TO ......... �1d 4,.0.n—Family Dv911.i.ng ...................................................................................................... Oi$ ✓Aq! `TYPE OF CONSTRUCTION ......Q........... ............................................................................................................... ................................................e 19..73. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora_permit according to the following information: Lot 91 Guildford Road , Centerville , Ma. Location ............................................................................................................................................:.....:.................................... ProposedUse .........�esiQentia1...................................................................................................................................... Zoning District Rost Centerville=Osterville RD ........................................................................ District .............................................................................. Normest Names Inc: ASHLEY Dr: Centerville Nameof Owner ......................................................................Address .................................................................................... Normest Howes Itnd� same Nameof Builder ...................................................................Address .................................................................................... Name of Architect non® ....Address .............................................................. .................................................................................... 6 Poured Concrete Numberof Rooms .................................................................Foundation .............................................................................. S iBin� As.ph&It Exierior ....................................................................................Roofing ............. ...................................................................... Cnrpet Drywall Floors ................'......................................................................Interior ......,............................................................................. farm- Air 12 °_l bath Heating ............ ....................................................................Plumbing .................................................................................. yes 20,000. t Fireplace .................. ...........................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Boards__--------- _______-----------19_______. /�040 Diagram of Lot and Building with Dimensions �3 g SUBJECT TO APPROVAL OF BOARD OF HEALTH P.., ti A ^ C7j f � T A- 40 27 I hereby agree to conform to all the Rules and Regu.ldtions of the Tow Barnsta a re ardin the above construction. Na ... .."�':P..... .....e.. .............. -.__~- _-~_.°^ -.~. ' 16811 �� one No -. ' Permit for single family ` --'-' � � ..� v�.� . .__.. ' . � Locatiob.3.[�zlIdfoz��.I�oazl._______._Centerville ^ . ...,...... �,�,����,,'�����'�'�'�'�'�� r�^' , � Owner ..........Noznoeot. �..Ino�____.. -' | Type ofCunm�uc�on ____.��aoma_____._ < ~ � ' --^'--^^-^'--'--^'-'-^^--^'------ / 1 ^ *�n \ Plot -----.---.. Lot ----..� ---.. ' , December 20 73 Permit Granted ........................................lQ ' Date of Inspection Date Completed ----'^.-..~- -lQ � � PERMIT REFUSED ' .--.--.._-_-----------.-- 19 ' '----'-----'~--'`~~^'--'-----`-^- � � //9 ................... . ....................................................... , � �J��. ' ~^-.~ — ...~~.=°.°��==.^="=",==". ===,~"- ' ........................................... � . / Approved ................................................. 19 } r . ! ' --------------'~^'----~^'^--^- -'---^-----`--'---'--'`-^^^-^'-^' | M-C/T Exc. 6 THE COMMONWFb'L',TQ- OF MASSACHUSETTS REGISTRY OF MOTOR VEHICLES 100 Nashua Street BOSTON, MASSACHUSETTS 02.114 ASSESSOR - COLLECTOR REPORT OF RECORD CHANGE TO REGISTRY OF MOTOR VEHICLES CITY/TOWN Registration No. DATE " Owner U Address Attach a copy complete (or Photo Copy) OR information Year, Make of Vehicle of tax bill in items on question right Vehicle Ident. No. Information has been received to our satisfaction*that the following changes should be made in the excise tax record. I. ( )' Massachusetts plates returned — Date (Please supply photo copy of receipt from Registry of Motor Vehicles) 2. ( ) Massachusetts plates surrended — Date (Please supply photo copy or affidavit explaining where and how surrended.) 3. ( ) Vehicle sold — Date (Please supply photo copy of bill of sale.) 4. ( ) Vehicle removed from Massachusetts — Date (Please supply photo copy of new state registration) - 5. ( ) Correct residential address (If different from address shown on your excise tax bill) 6. ( ) Correct mailing address (Fill in only if different from #5) 7. ( ). Correct place of garaging (Fill 'in only if different from #5) 8. (. ) Correct valuation (In order to correct the valuation you must give us the name of the person in.the Corp. & Tax Dept. whq authorized a change in the valuation of this motor vehicle) 9. ( ) Other This form approved by Commissioner of Corporation and Taxation PLEASE NOTE: If the information requested above is not supplied the computer records y cannot be changed. Signed Authorized Signature Assessors/Collector FORM 830 Hobbs &Warren. Inc.— Rev. 1977 i L � { f t 1 I I I { i 4