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HomeMy WebLinkAbout0228 HUCKINS NECK ROAD , l t r • , rr w • r X . 7'~ � .. .. '� yr +' ; .i, - � � � �. •. .> � u l , s y v r, � •sty L 'h *� lM'a ;:4' .., , � u 1.� �` .. Av Vn • ,k H• l k .t �.y. ,.,, M .. ` 3 ,.� r �.. ' 1. � Yr. � ' ,. �A i. # As r - m Kill! l ,1 r ` , �4� }I .FYI a<�' Y+s k�-'' �� .. • `• r .. ` t-•. „. :•• C� ,. , < j� .. -' r rr a i`.. .r. ^ F : q. , nA v t• `"� X,...a fin,a' rx f 1: � r�. , r +ti:, '4'" �, .} ,,�:. ✓( D ^e • a , . v „ r L • 1 { , r V`I�� , ,� .. • Y �ti ' ' ' �. o _ � , i f '- r .: �. -. .� � .. ,. � m . � r. i : - .. 7-.- i, ry F.. _ . a ' � r ... :., .. F r � .� �. �' `. V '. - � � ' ' t'� 1 w n '.� � �. .. a_ .. .,: � r o x y � s '� ,. �� i fiy ��:uY r �x a ✓, _ ti � ..` Y tr. e ,.,d � .. .. �..,,. .. � ._ �.., .. k v . . F � p ., �1 �.t .� .� t .. ... � .. ., r ;. � .. � rt. - -- ,� e .. .. .' .. .'- - ''f ., .. ., _ H .. � _ - - �- s v .� i, .. .w-.. T�. .. .. .. .. > �. ". Y r � ., .. _ .� � .. r �' � s ,' � .� , .� 4 .'� § _ _. ... ,r: y . ,. 'n.A' � Y v` ' � eT.. 9 .. �.. r .: � _ �, ,. a �, ..• " ' s Z.. �ha; k . � .� ' <: � . . . ,. .: •.. ,� � � , iv� ..� �, , r p -, _ .. �� i _ , -. � ... - ., . .. �Y .t i _ .. .. Town of Barnstable Building e Post This Card So That rt is Visible From the Street Approved Plans,Must beRetained on Job andthis Card Must be Kept * BA1L4"SCABLE, • 9 v� 6 Posted Untd`Final Inspection Has Been Made Feg'n11� > Where a Ceft ticate of Occupancy is Required,such Building shall Not be Occupie, until a Final Inspection has been made ) 11 .., Permit NO. B-19-3818 - Applicant-Name: Peter Kimball Approvals Date Issued: 12/02/2019 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 06/02/2020 Foundation: Location: 228 HUCKINS NECK ROAD,CENTERVILLE Map/Lot: 252-138 Zoning District: _RD-1 Sheathing: Owner on Record: FOLEY,BRIAN D&WENDI L Contractor Name'. Framing: 1 L ZA �(J Address: 228 HUCKINS NECK ROAD Contractor License 2 Est Project Cost: $215,000.00 CENTERVILLE, MA 02632 Chimney: Description: remodel master bath, remodel bath/laundry,remodel kitchen,open Permit Fee: $ 1,146.50 Insulation: l wall at living/den, change front windows(4),; add rafter ties in Fee Paid., $1,146.50 living room, no change in footprint all work is interior Final: y Date- Project Project Review Req: Structural stamp needed for framing inspection per request �dV� Plumbing/Gas Rough Plumbing: Building Official 1_. Final Plumbing:. This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months`after•issuance. All work authorized by this permit shall conform to the approved application and the=approved construction documentsjfoe which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street orroad and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. F 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 ) "` Rough: 2.Sheathing Inspection ' ' 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 Final: . 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation ti Low Voltage Rough: 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). Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: s (E)PLYWOOD .r _ SHEATHING r f 20'-2"± Qo4 � 4x8 TIE BEAM , I E E 4x8 ROOF BEAM � I4x85.5.CHORD { it ' « t x �':�• � i � , i SIMPSON 1212HL Y ; EA SIDE(J"O THRU BOLTS) I. E 4x8 ROOF BEA (2)1/4"OxV TIMBER LOK 4.8 S.S.CHORO F r; 4x8 SELECT OF.Q COUNTER SUNK STRUCTURAL TENSION --+--- CHORD 6+Q (E)2x4 WALL FRAMING - --E x 0OF"eEAM 4x8 S.S.CHORD 4 } SECTION A 02.03.19 E zBROOFBEAM 4x85.5.CHORD ,,{OF 141y, a� THOMAS N� o GALLIGAN cx ONIL m No 3 190 'Ao CLIENT: T. GALLIGAN PE SCALE: DRAWN BY: OB NO. DATE: —228=HUCKiWNECK=ROAD AS NOTED TVG 19130 02.03.2018 CIVII,/STRUCTURAL ENGINEERS BARNSTABLE;=maw TITLE; SKETCH N0, ADDRESS: 27 SUMMER LD, EET WAKEFIELD,MA MAE PARTIAL FRAMING PLAN , Tel: 617.548-1407 I � - A A lication number..'' . .� .. ................... . . QaOCT 16 2018 F . . FWAIN (k bAHNSTABLE Building Inspectors Initials............. ....................... s � Date Issued......`a...-V2z. . . Map/Parcel....... -.... ..`.1..3..�(�. ................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WIND O W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: oq498 14j /Ve-dC, t , CZ VJ II p NL MBER STREET VILLAGE Owner's Name: �l AO(/ Phone Number �GGtC Email Address: �Z� � Cell Phone Number Project cost$ 10� Gw 0 0 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: cokwl-'azw Date: TYPE OF WORK Q Siding 0 Windows (no header change)# 13 Insulation/Weatherization Doors(no header change)# Commercial Doors require an inspector's review E Roof(not applying more than 1 layer of shingles) ay Construction Debris will be going to I 5 /,)e,;,7 YL/ s CONTRACTOR'S INFORMATION Contractor's name ��� Cod A&9(ik l 22DYD Home Improvement Contractors Registration(if applicable)# '�� ®�� (attach copy) Construction Supervisor's License# A06 0 q ® (attach copy) Email of Contractor eC®11�vr.� �rt,Q,/ W*si Phone number 5V'f�9 69010 e• ALL PROPERTIES THAT HAVE STRUCTU S OVER 7S YEARS OLD OR IF THE SUBJECT PROPERTYES IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER.....................................................J..... *For Tents Only* r � Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X. X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No ,if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9.30 am or 3:30 pm-4.30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side z . HOMEOWNER'S LICENSE EXEMPTION Homeowner's,Name: Telephone Number Cell or Work number 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' TURE s Signature 't/ (/� I Date to ✓t All permit applications are subject to a budding 0 s approval prior to issuance. ommonw , e alt t r t�b * �••.J,.a✓5 ;k:. x ' s4 E 'tr s,.a w � �, ,�M1t+* �� �{{u �6 ='.�,. "�w "Is"U "e ,e a"A at '11" in.rd M ,. ,. , ;t,of alu" d �. :q Re, �Ulatont s, and . :f�N " .1 c ftons I'l.r.e. -4/2 7 ► AT Rt - ..7 - f' .� � a .4 T.S .g- �+ r `� W s c i .�' !�. � A `$d �. `� y , • r as,„ I'll, N e'""" U. Iv 01-FiNI 'l awe; V q ry The Commonwealth of Massachusetts Department,of Industrial Accidents I Congress Street,Suite 100 . Boston,MA 02114-2017 www.mass.govldia lVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMT17MG AUTHORITY.' Applicant Information _ Please Print Le gib_ Naive{Business/Organization/Individual): Q- iv v�� Address: s "�',I rV!/L� ��I City/State/Zip: cz�vc e Phone#: 86 91 0/0 Z-- Are you n employer?Check the appropriate box: Type of project(required): 1. I am a employer with � employees(full and/or part-time).* 7• New construction 2.❑I am a sole proprietor of partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] In I am a homeowner doing all work myself-[No workers'comp.insurance required.)t. 9. El Demolition 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or.additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑ p Roof repairs These sub-contractors have employees and have workers'comp.insurance°= �0 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other 152,§1(4),and we have no employees-[No workers'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., tUntractors 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. lam 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.Lie.#: ����� Expiration Date: '0610� Job Site Address: J99 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 MGL c.152,§25A is a criminal violation punishable.by-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.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 thepains;Qofperjury that the information provided above is true and correct Si ature: Date: Phone#: C� ,6 o101-a Official use only. Do not write in this area,to he completed by city or town ofjiciat City or Town: Permit/License# Issuing Authority•(circle one):' 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 zequires all employers to provide workers compensation for their employees. Puquant 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,partnership,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 a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please.fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone mrrnber(s)along with their certificates)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 th�Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense number which will be used as a reference number.'In addition,an applicant that must submit multiple permit/licerise 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. Anew 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 Department's address,telephone and fax number: The Commonwealth of Massachusetts _ Department of Industrial Accidents 1 Congress Street', Suite 100 Boston,MA 02114-2017 Tel. # 617-727 4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia IF l F (2/1 b- A7j�� { Office of Consumer Affairs and,Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement,CoritFactor Registration j Type: Corporation �, ."'" - CAPE `OD HOME IMPROVEMENT, INC. Registration: 168043 , # 9 r 'i` Expiration: 1 2/0 612 01 8 27 FRILL POND RD WEST YARMOdTH,MA 02673 Update Address and Return Card. t-�`%r�r�wra�raanrrne<r.�/��°E,��fias�rrr,�rute/h1 w ` Olficc of Consumer Affairs&Business Regulation HOME IMPROVEM ENT CONTRACTOR Registration valid for individual use only TYPE:� oaration before the expiration date. If found return to: 8—QuistratE-qa Expiration Office of Consumer Affairs and Business Regulation 210 6/20 1a 10 Park Plaza-Sui ---�` <;Ar'E::OD I VDME,IM171` 3QyEMC�IT,INC. Boston,MA Qaog- >NAT OLI W.SKI 2� Nil! POND FiD. EST AP100 'Trit MA 012b73 Undersecretary Not valid wit out signature 4 { 0 DATE(MMIDDIYYYY) ACORO® CERTIFICATE OF LIABILITY INSURANCE 06/1512018 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 PHONE _ Ext (508)775-1620 AAIC,No): aDDRRESS: Iullivan@doins.com 9731YANNOUGH RD INSURER(S)AFFOR DING COVERAGE NAIL# HYANNIS MA 02601 INSURER A.- AMGUARD INSURANCE CO 5 42390 INSURED INSURER B: CAPE COD HOME IMPROVEMENT INC INSURERC: INSURER D: 27 MILL POND ROAD INSURERE: WEST YARMOUTH MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: 281511 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 ADDL SUBR - POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDDIYY MMIDDIYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TRENTED PREMISES(Ea occurrence) !$ MED EXP(Any one person) $ N/A, PERSONAL&ADV INJURY j $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ECOT- LOC PRODUCTS•COMP/OP AGG.l.$ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident)i $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Per accident I$ $ UMBRELLA LIAR OCCUR ij EACH O—CCUR—RE—NCE 1.$ EXCESS LIAR CLAIMS-MADE N/A [AGGREGATE $ DED RETENTION S i $ WORKERS COMPENSATION I I�(I PFR I OTH- AND EMPLOYERS'LIABILITY (_ STATUTE ! ER ___ ANYPROPRIETOWPARTNERIEXECUTIVE YIN I E.L.EACH ACCIDENT $ 1,000,000�� A OFFICEWMEMBEREXCLUDED? NIA NIA NIA R2WC940123 06/03/2018 06/03/20191 1 (Mandatory in NH) [ E.L.DISEASE-EA EMPLOYYE I $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below {� E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 I N/A i 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 Anatoli Sivitski ACCORDANCE WITH THE POLICY PROVISIONS. 222 Buck Island Road 6-8 AUTHORIZED REPRESENTATIVE West Yarmouth MA 02673 Daniel M L� I DaDaniel M.Cr 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 k i CAPE COD Home Improvement CAPE COD HONE IMPROVEMENT TM 27 MILL POND ROAD, WEST YARMOUTH MA 02673 (617) 710-1001, (508) 469-0102 CAPECODINC@GMAIL.COM, WWW.ROOFCAPECOD.COM, WWW.FACEBOOK.COM/CAPECODHoME --------------------------------------------------------------------------------------- ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS WILL BE EXECUTED ONLY UPON WRITTEN ORDERS,AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE.ALL AGREEMENTS CONTINGENT UPON STRIKES,ACCIDENTS OR DELAYS BEYOND OUR CONTROL.OWNER TO CARRY FIRE,TORNADO AND OTHER NECESSARY INSURANCE UPON ABOVE WORK.WORKMEN'S COMPENSATION AND PUBLIC LIABILITY INSURANCE ON ABOVE WORK TO BE PLACED ON THE RESIDENCE AS A CONSEQUENCE OF THE CONTRACT.OWNER WHO SECURE THEIR OWN CONSTRUCTION- RELATED PERMITS OR DEAL WITH UNREGISTERED CONTRACTORS WILL BE EXCLUDED FROM ACCESS TO THE GUARANTY FUND.COSTS OFF COLLECTION,INCLUDING ATTORNEYS FEES WILL BE RECOVERABLE,IN THE EVENT OF NON-PAYMENT. WE LOOK FORWARD TO WORKING WITH YOU: PLEASE CALL IF YOU HAVE ANY QUESTIONS. SINCERELY CAPE COD HOME IMPROVEMENT TM THIS CONTRACT NOT VALID UNLESS SIGNED BY ANATOLI"TONY"SIVITSKI ACCEPTED BY Brian Foley SIGN �26CLyL ZBATE 10/13/2018 ACCEPTED BYE SI ATE ACCEPTED BY SIGN DATE • CAPE COD HOME IMPROVEMENT TM GUARANTEES THAT ALL COMPONENTS INSTALLED PROPERLY PLEASE FEEL FREE TO CALL CAPE COD HOME IMPROVEMENT TM WITH ANY QUESTIONS OR CONCERNS PLEASE INITIAL THIS PAGE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel_ Application # �*� 2S «� Health Division Date issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board_ �p� 01z_�rl7 Historic - OKH _ Preservation/ Hyannis Project S eet Address '� _ _�_ Village (' Owner E _ Address 53 Onk- C Telephone� "� Permit Request 5 O_V cubUz Square feet: 1 st floor: existing proposed 2nd floor: existing proposed otal new Zoning District Flood Plain Groundwater Overlay Project Valuation ` 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) t7 r.a O Number of Baths: Full: existing new Half: existing nee � Number of Bedrooms: existing _new N Total Room Count (not including baths): existing new First Floor Roor Count -o Z Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other r IV � Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/c I stove:..❑Yeg'U 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 (BUILDER OR HOMEOWNER) Name —�rl �311_� ��RaTelephone Number Address License#// LI-6 V 0 _k- Afi 0-2 N Home Improvement Contractor# 9 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FR M THIS PRO ECT WILL BE TAKEN TO U SIGNATURA4dDATE 0 113 • Y � FOR OFFICIAL USE ONLY APPLICATION# _DATE.ISSUED i .MAP/PARCEL NO. �1 ADDRESS VILLAGE OWNER DATE OF INSPECTION: t, ._FOUNDATION .r ' FRAME f INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:- _ ROUGH FINAL : ..FINAL BUILDING GI/� DATE CLOSED OUT t ASSOCIATION PLAN NO.' 1 e i k The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations e 600 Washington Street Boston, AM 02111 www.nzass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers . Applicant Information Please Print Legibly Name (Business/'Organizatiojt/Indiv:dual): JM of New Bedford Co. , Inc. Address: 423 Coggeshall Street City/State/Zip: New Bedford, MA 02746 phone#': 508-992 . 5770 Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with 4 4. ❑'I am a general contractor and 1 6. ❑New construction employees(full and;'or part-time).; have hired the sub-contractors ; 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition working for me in an capaci employees and have workers' b Y n' 9. ❑ Building addition . [No workers' comp. insurance comp. insurance.* f addition 5•❑ -We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ lam a homeowner doing all work officers have exercised their 1 I.❑ Plumbing repairs or additions myself. [No workers' comp right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, 51(4),and we have no• . employees. [No workers' 13.[ Othei In comp. insurance required.] 4 *Any applicant that checks box#f 1 must also fill out the section below sho-wing 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 newatidavit 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. Ifthe sub-contractors have employees,they must provide their workers'comp:policy number. I am an employer that is providing workers'compensation insurance for nzy employees. Below is the policy and job site information w Insurance Company Name: Continental Indemnity Co. Policy#or Self-ins.Lie.#: 4 6-8 5 5 6 3 7-01 -0 2 Expiration Date: 6/2 2/1 4: Job Site Addressvo . City/State/'Zip: e 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/zereby tify under the p ' s and penalties of perjury that the information provided above is true and correct. Signature: VDate: w k�l � Phone#: 508-992-5770 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4:Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: / CORD CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY) TM 1 10/21 /13 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: Applied Risk Insurance Services, Inc. PHONE iFAX 10825 Old Mill Rd (A/C,No, (877)234-4420 ;(Arc,No): (877)234-4421 Omaha, NE 68154 E-MAILADDRESS. PRODUCER, - .- (877)234-4420 cuSTOMERID# ' INSURER(S)AFFORDING COVERAGE +` NAIC# INSURED INSURERA Continental Indemnity Co. w 28258 I. _ - INSURERS: Atlantic casualty JM of New Bedford Company, Inc- INSURER C: 423 Coggeshall St ' New Bedford, MA 02746-1758 INSURERD: . INSURERE- - CTL 1273 755668 . INSURER F. ' COVERAGES CERTIFICATE NUMBER: 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 j ADDliSUB - - POLICY EFF POLICY EXP j LTR' TYPE OF INSURANCE I INSR WVD POLICY NUMBER i MM/DD I POWLIMITS GENERAL LIABILITY 1 j COMMERCIAL GENERAL LIABILITY i , EACH OCCURRENCE I$ ��� ,, x i DAMAGETO RENTED B PREMISES(Ea occurrence z5 Goo i I CLAIMS MADE I _j OCCUR t—,!, L 0 81 0 0 0 8 9 3=1 1 1 /1.5/12 1 1 /1 �(an one ern $-f—� I I ,, `'f"• I � PERSONAL&ADV INJURY i $ GENERALAGGREGATE I GEN'L AGGREGATE LIMIT APPLIES PER: - j IPRO- PR DUCTS-COMP/OPAGG; $ `-POLICY JECT LOC S 1 AUTOMOBILE LIABILITY ' COMBINED SINGLE LIMIT ANY AUTO ��i�l Ea accident S I, ALL OWNED AUTOS - _ - BODILY INJURY Perperson) S !SCHEDULEDAUTOS i ; •� - BODILY INJURY PeraccideM I HIREDAUTOS - I - PROPERTY DAMAGE I Per accident $ NON-OWNED AUTOS UMBRELLA LIAB I !OCCUR �.. • i EACH OCCURRENCE S EXCESS LIAR r1 CLAIMS MADE AGGREGATE S DEDUCTIBLE f 1RETENTION 8 I 5 WORKERS COMPENSATION I WC STATU- I AND EMPLOYERS'LIABILITY Y/NI 1 X I K 1 i IANY PROPRIETOR/PARTNER/EXECUTIVE�N/A; ` 46-855637-01-02 '0 6/2 2/2 01310 6/2 2/2 014!E.L EACH ACCIDENT ;"S 11000,000 Py j OFFICEWMEMBER EXCLUDED? `_-I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE] S 1,000,000 If yes,,descnbe under .. ; SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT j $ 1,000,000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach Acord 101,Additional Remarks Schedule,if more space is required) *10 day notice of cancellation for.non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Town of Barnstable BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED' 200 Main Street IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE �1783118 ACORD 25 (2009/09) ©1988-2009 A ORD CORPORATION. All rights reserved License or registration valid for individul use only Office of Consumer Affairs&Business Regulation b _ OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Type: Office of Consumer Affairs and Business Regulation �k,l!egistration: 103195 b 4xpiration: 7/6/2014 Private Corporatic 10 Park Plaza-Suite 5170 Boston,MA 02116 JM 0 W BEDFORD CO. INC. ELWELL PERRY 423 COGGESHALL ST. g � _ NEW BEDFORD, MA 02746 Undersecretary Not vali with ut signature t • 'vtassac_ �e s i • Boas o g Re arc QS Construction Supenisor _ense: CS-104088 r ELWELL H PERKY , 1454 MAIN ST - `; - Acushnet MA X143 k 05/20/2015 k 201 -�4-0 16.25 Mi l l ipor'e 9787151391 >> 4:q1 784 371q F 2y2 : OWNER AUTHOR"IZATIOIN FORM I, _.,,. . Owner's NambJ �l�� ( owner of the property located at sY Z 2 ; yCi { jtLcc{ (Property Address) `r (Property.Addres�s} hereby authorize . ($gbcontractor) x 'i an authorized subcontractor for RISE Engineering,to act on my behalf to obtain,a building permit and to perform Work on my`property: L. Owner's Signature Cate Y 09,/06/2013 .FRI 16:49 [TX/RX NO 9240) Z 066'2: 1;7: ESS RMIT Town of Barnstable *Permit# R - 6.2013 FApires c Regulatory Services Fee rrs one snsxsrwa�, i 1 omas F.Geiler,Director / A QF 1�����T��L1� BuildingDivision Tom Perry,CBO, Building Commissioner 200 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 nathout Red X-Press Imprint Map/parcel Number Property Address Z tlZ.!✓t (� X Residential Value of Work jC7 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address We_,VA i e,.4 S 1 ?­,4 Contractor's Name ve— y)yi,& Telephone Number `"7-7 L� —:?>(o 16 `QS� Home Improvement Contractor License#(if applicable) 1 (Q�4 Construction Supervisor's License#(if applicable) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name `_IM V L Lk--V—S -NUS A LT Y 1� Workman's Comp.Policy# _7?, U F — 98 06 M -7-7 ._ 4 — �- 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 #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum 35)#of windows ❑ 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 Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windo-.vs\Temporary Internet Files\Content.Outlook\QRE6ZUBN\E%PRESS.doc Revised 053012 1 i t Town of Barnstable iOrFo�°i Regulatory Services Thomas F.Geiler,Director 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 as Owner of the subject property hereby authorize >Q_U�Q- ��`JW �-'\ to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner e 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 Intemet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doc Revised 053012 2, z The Comrrtoiriverrr'tId of Hassrrchnsetts Depnrnnew of Industrial Accidents Dffice of hivesrigrrtiom Boston, M4 02111 F9'tt,4"tV.ilia S5.go lditf X'Vorl:ers` Compensafian lusurauce kffetlatit: Bltilder�;`C ar�tr�Ctot'�'Electllelaus Flutnlaer Applicant luformation Please Paint Le 'bl Narrw Bttsitle>,C?t attv-a`i-nIndiszrlu(a�tl: 1 l J �- Address: CityrStatA'Zip: W' GtILM 02/03 Phone,-F r77 �36 Are you ati etuplover'.Check the appropriate box: Type of protect (required): 1.❑ I am a eniplo er--xifh 4. ❑ I atu a general cantrac3 r and.1 ha a hired the Sub-comractc+rs 6. El New con trtution en;lllc--ee.(full and'orpan-time).T I am a sole proprietor or partner- listed on rate attached slyest- ❑Reuic+dehng ship and have rc etuployees The:_e sub-courr•actorz.have S. ❑Detnclitiou working .forane in any-a a,_im eu�l+mree.and have workers* p 9. ❑Building}addition [No i-vefkeri comp.insurance comp.iniurance.- required.] 5. ❑ axe area corporation and its 10❑E:le try'.-11 repair--o;addifxcns 3 ❑ I aria a hcmeovvuer doing all vort. officers lia.v a exn!:i5ed their 11 ❑Plumbing repair.of addition rn.elf. N.�;rork:ers' eoaa3 right of ex ern per:'NdGL L -P• '. I .❑Rcfre".airs t. 15I_ §1f4 and r:eha,eno insurance required.*]- )': erx>1s!Lyee=. [�Ic s=.crl€er•_" il2.�(�ther le >� €omp. m-,urauce required.] "Aay q—p ieart -c`iacks -:s=l mit-t ah -fill 011-the w'_oa bet nti -toa°ing: e r;x.:kFr'ro.pegs»nau pabi:v iufo-tr<eou- t:ardP-otene:3 a-Lo=.ubm_t-Ws affidavir indicating they axe doiag art trofs an::tie.Lie outside cemhae'o:a m^.ut str:mic a Lew aff-.da;-_t iadi atiag each :£antric'o-, cbs•:-.d:_s`lox wan--hatted as Aditiaaa sheet s c>%_ug&c-none of-.be tIft-canrr-tcxs.aud stars n-Lethec o:apt those eu'_t:e=.have emplo}-ee:. F tte stir-:oatractoss?xare ear_tmr.-es. er u.rm pro-Vide thei. lvo:kern"c,'.Ir-p..polk'.!�nrayibem Fa11rtlfFPPlelp� l ,•f�P�t.r4�r�tirfitt, +°ork es°ca+rrlx€rr.snPxnrrirtsJ+,nrtee�v+ arrt'�u�lrTrrae s. .9ilowis rite pnl:ct'nojdjob.sfre In.larance Cornlaarw Name_ Pol;cls or Self-ins.Lir-."-: -�P J UJ --9``506 Yv`'�-� (I/--41ZExpiratior Date: �1 7- 3 Job Site ddre i.: ?i2,� 4L,,J"VN S Oecf&M City.•:state.Zits:' ---- Attach a cope-of the-workers'compensation polio•decl:ar ation page(shoeing the policy-number and expiration date). Failure to secttre cc veraZ,e as requuPd under Section'4 A of 11 G . I:I=vin lead rc)ttee imps;.tticarl if--firniraal penalties of a ft.e up to S1.5-10 DD and cr crze-vear unprisonmew as:;:ell a:civilpenalties in the.f;=of a STOP'M- K ORDER and a fine of asp to$?SD.OD a day a1zain.t the violator- Be ad.:.ed that a-op e.f hi i,.tater:a.ut iui�--be fcf,,Ya=tied tc the Off;:e of Itrs estigat-icra-,of the DLA,for inuirance ec:erage verification. [do heir eke certf ft.rfrider r1wImiris and— 017'es ofiaer Wry that rite r', fivnitarrofr pro4ded above is terie and corvec#. Sie:tvsture: ` Date: 3 S17) Phone i=. Of 1ciral rise oir tv. Do not irrfte fit firis area,to be eottrpletetf fit•eitt,or town official. Ciry or Ton-n: Permir-License 9 Issuing Authority(circle one): 1.Board of Health ;.Building Department 3.City--'Town Clerk t.Electrical Inspecror f.Plumbing Ianipecror S.tither Contact Person: Phone 4: WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY Y.� TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (7PJUB-9806M77-4-12) RENEWAL OF (7PJUB-9806M77-4-11 ) INSURER: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA 1. NCCI CO CODE: 13579 INSURED: PRODUCER: KENNEY, DAVID L M K LOVELETTE INS AGCY 300 BUCK ISLAND RD UNIT 413 PO BOX 836 WEST YARMOUTH MA 02673 WEST YARMOUTH MA 02673 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 06-02-12 to 06-02-13 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in o� item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: o; o� COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A D. This policy includes these endorsements and schedules: o� SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by ouc Manuals of Rules, Classifications, Rates and Rating =— Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 05-23-12 DS ST ASSIGN: MA OFFICE: DIRECT ASSIGNMENT 701 PRODUCER: M K LOVELETTE INS AGCY 25F4J 000838 ot 3 r - License: CS 89280 DAVID L KENNEY 300 BUCK ISLAND RD U-413 WEST YARMOUTH, MA 02673 Expiration: 10/14/2013 ('nounissi...I r Tr#: 4424 � 1 GTt0 f�"Nawl e`eU a - g elta Office o oosumer airs mess e u a on License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: s,165466 Type: Office of Consumer Affairs and Business Regulation TDL.KENNE Expiration: .2 22/2014 Individual 10 Park Plaza-Suite 5170 Boston,r4A 02116 Y F DAVID KENNEY , 300 BUCK ISLAND WFUNtRA78 WEST YARMOUTH,MA 0267 r` Undersecretary Not valid without signature k 1