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HomeMy WebLinkAbout0110 JAMES OTIS ROAD h:, .�. H :� _ � ... ., : . q ., a: , �. �, � �. a a o � . o _ o e a o �. �m Town of Barnstable *Permit#_ X6�0.. =�- Expires 6 months from issue date Regulatory Services Fee ' 01 } Thomas F.Geiler,Director` Building Division Tom Perry,CB®, 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 without Red X-Press Imprint Map/parcel Number -o d 15-3 r Property Address ❑Residential Value of Work ^ Minimum fee of$25,00 for work under$6000.00 Owner's Name&Address C ® T / J Co ntractor's Name t✓ Telephone Number a 3O Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance -PRESS PERMIT Chec e: I am a sole proprietor MAY 2 5 2007 ❑ I am the Homeowner ❑ I have Worker's Co ensation Insu`rrannce� N OF BARNSTABLE Insurance Company Name Worlanan's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(c ck box) e-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof] ❑ Re-side Re lacement Windows/doors/sliders. U-Value ( 44) y� . ❑ P ��. �is *Where required: Issuance of this permit does not exempt compliance with other town department regal-RUn—i;%e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Ow4 e�rp f P ssion. A c me vement Contractors Licene i c• f� SIGNATURE: Q:Forms:expmtrg Revise061306. AX The Commonwealth of Massachusetts Department of Industrial Accidents F Office of Investigations . 600 Washington Street Boston,MA 02111 5 _www.mass.gov/dia Workers' Compensation Insurance,Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ise 'blv Name(Business/Organization/Individual): . 1,-<_ r V(3 Address: -,9 C City/State/Zip: ne.#: b 6 Are you an employer? Check the appropriate box: Type of project(required):. 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. El New construction . employees (full and/or part-time).* have hired the sub-contractors 2.A am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity, employees and have workers' Y P tY 9. ❑Building addition [No workers' comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance.required.]t c. 152, §1(4),and we have no employees. [No workers' .13.❑ Other 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: ` Gti e/' u? Policy#or Self-ins.Lic.#: r 2- Expiration Date: Job Site Address: ! I G,. �� (/Li��t� .`l d 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 urede pains--and p . aloes of perjury that the information provided above is true and correct Signature: � Date: Phone#: Official use only. Do not write in this area,to be completed by city or town of cciai City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Dealth 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." A a 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-contiactor(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 Sile 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 of Massachusetts Depa iment.of Industrial accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov(dia � a �N P.O. Box all 508-367-1679 Centerville, MA 02632 Fax: 508-790-1856 , . PROPOS UB :TTED T PHONE: DAT 0__ ' v h � — ��-20 o STREET: 1 ' � .rpj JOB NAME: JOB#: CITY,STATE a d ZIP CO]gE. �p p� JOB LOCATION: ARCHITECT:' DATE OF PLANS: JOB PHONE: We hereby submit specifications and estimates for: =I , i-r WoQVe ® A C� 0 A00 �EaCcAeo< L - d� v a;d-o o. o1®� Ve Vro pose hereby to furnish material and labor- complete in accordance with the above specifications, for the sum of: ($ ). Payment to be made as follows: dollars All material is guaranteed to be as specified. All work to be completed in a workmanlike Authorized manner according to standard practices. Any alteration or deviation from above specifi- cations involving extra costs will be executed only upon written orders,and will become. g an extra charge over and above the estimate. All agreements contingent upon strikes, Note:This proposal may be accidents or delays beyond our control. Owner to carry fire,tornado and other necessary withdrawn b us if not accepted within insurance. Our workers are fully covered by Workman's Compensation Insurance. y P days. L nce of roponr-The above prices,specifications s are satisfactory and are hereby accepted. You are authorized Signaturk as specified..Payment will be made as outlined above. tance:. '� �C� —1� 0 0 Signature: Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registrations 145356 Board of Building Regulations and Standards Ezpiratipn 1/12/2009 Tr# 127522 One Ashburton Place Rut 1301 Boston,Ma.02108 t� Typdi DBA( EMNIANUEL CONSTRUCTION 4 HECTOR SANCHEZ i 286 STRAWBERRY HILL-,' CENTERVILLE,MA 02632 Administrator Not valid without signature ' EMMANUEL CONSTRUCTION - A"i . Specializing.in Painting; Finish Carpentry, Roofing&Siding Serving alf of Cape Cod&Vicinity CenBox e,. Hector.Sanchez Centerville,.MA 02632 Cell: 508-367-1679 Owner Fax: 508-790-1856. E-Mail:emmanuell @gis.net rra�y www.emmanuelconstruction.com CertainTeedo FULLY INSURED COMMERCIAL I RESIDENTIAL i _ i TOWN OF BARNSTABLE Permit No. -_--_-------- Build,ing Inspector Cash ---------__-- °Val OCCUPANCY PERMIT Bond Issued to ' an Sm& Address "r� 7 n Tar s ^tis Read-. CentrT.-1?le Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ....................................................... 19............ .................................................................................................................. Building Inspector �,�rvGu� FAMILY � LJD- GAQ9AGE-x(?¢�idDE2 .; � - i P^JL.!(°'Fhow' s Ilvx � c �3oGRq a .SEPT G TpwiK' _ 33OX150% =A 9 6.P o r � , q UsE A00o Off'SppSA%- 'PIT° V66 ' k D6WALL. ARF.I► b.R . X •5 3�5 G.Po r -80T�'O/K AIM AR . Ir oF. P 1 / �� d So 'S.F x 1•o A 5 G o, , Prr ` Ana. N1 s «rA�.. o>sS1�N a►r = .¢25 GPI p •�'Ya!TAt. T�A►1L`� F�-ova! - 33oG?c'• - ��.� rA�r. r � r r N r o N pG iZLO�ATION RATE = V'tN 2MtN 09LDSS p , o. PESTER �>,�'. 1S,Q-l2 . stiff o SULK!':Af� `= t x.. ZR104AFID !1`3 BAXTEAAA ee, ��-:- r33 �1 T6�11' 'P UM, (Wr 76S �L= SS ToP Fao• •� N 01.fer ('t-1�$3- s r7S 'l6TCs�� �r ' � k GG - D16T. iNJ. CAL. 7 BpX !'sCPTIG _ F ' - 2:• tOdO t�1�/, y2V TANK . 4 Tu tNY 1NY r' Ji WASNGO ` ' fiTaN6 oT PI-A1•J Ofp1 I s , GE2TiFIGC . n FILE LoC4�loNi.hEt�-V�u.� ' S 1' WO SCALE SC-ALE C,O vA r= io-l�-S4- �aT t- p A N RAF rmmN G& 3 �� CE ta.TIFY THxT THE 1-ov►��T►oL1 SNovYN i 4. A`N6RtiaO1J GOMPt4!j 1n�►TN'T HFs S I�IrLIN E �(' LOB p►ND �3E'1'�►GK R�6G�VIR.rcMENT> oF'tN� k'ToWN OF �3�IJ�1Tbr3LL AND le., P�AI� �o� /�LaA� aw I s LOCA'PSO WITNI TH6 FL.00D /P��e•11J t. OAT Q 1 S gAXT6�i� IJ Y6 I W C. f � ♦ '' iCE61 SZ Rgo;►��ty o gu tcv��� . 4/1 l.aN 1�j tJOT [�yl��jCaD Old A'IJ dsTteR.V11.1.8' • MASS• 1uSTR.�M�NT ZuQvt`Y 'rHE nl=t✓SETS sucU0 APPLICAI�"r N., u T_�.t= .v�EDTo 0e7eW^►N� o,- ,.iNE� /�c:��J ALL trJL .'� )' t � �l t ��.. y•'��°4i J_. _S. ' •��i�y'..'.�i,•-'l.Y"��qn�� sr.,_ - � •—..-.�- r ✓.�i-1 ,V Q lid,/ o -ir - Assessors map and lot number ........... THE Sewage Permit number ... . ...l.. . ........................... House number ....- ...�, :^......... ..... ........................ p p{�g g ��� 90 sON P�36�K ARNSTLUE. IT14 TITLE 5 o "6 9. \0� rYl � � AL CODE AND A'�oyava ..' T OWN OF B ART T FARL( �_I BUILDING :INSPECTOR i } APPLICATION'FOR PERMIT TO ......./.............. ... ................... .......................:........ ... TYPE OF.CONSTRUCTION ° .............................................. ......... ................................................19.......1` z TO THE INSPECTOR. OF<B�UILDINGS: x The undersigned hereby`applies for a pe it according t the Aoing; information: Location ... .....�..... .... ......... .........:. ............... ............................................ Proposed Use ................. ............. Zoning District ................. ....../.... ....... ............... .Fire District ............... Nameof Owner .: F'. ................:..Address ..................... ............................................................ Name of Builder " ..Address`. ................................ ...................................................... Name of Architect .........................:......................................::Address .' . Number of Rooms ......... ........................:......:....................Foundation ...� .............;.........:..:..... ....,.... Exterior .. `- ............................. . .......:...... Roofing Floors . .......................................... ....... ....:.........Interior ...................... Heating ............:......................................................Plumbing .. .�—........ Fireplace .......................... i p .... . .........................: ..... ...'............. ........Approximate. Cost ..... �l`�/` l�J'�...... ................ Definitive Plan Approved by Planning Board ________________ `. --------------19--------. Area- ,���.�.......... • Diagram of Lot and Building with Dimensions Fee C �....... ......... ............. .............. SUBJECT TO APPROVAL OF BOARD OF HEALTH fC�j OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS - I hereby agree to conform-to all the Rules and' Regulations of the Town of Barnstable regarding the above construction. ` JA Name ... ...................................... A = Construction Su p ervisor's License No 27475 Permit for One Sto ...........Sing q..Famil�'.. Location ..�?t...Q.$....1a.0.s?: .........Cen texvi.l�........._.........._............... Owner .................................. t- 3 ,`. Type of. Constructiori` ......Frame........... ' ..... ............ yy ............;................. ......... Plot ........................... Lot ........................ .- - a Permit Granted .....Januax.y..29!...........19 85 .. }_r Date of Inspection ..........................:...........19 , �.-� z rr - p ...r..................................19d Date C m lete i t + tom,.• .. � - ( � 'Ile� • Assessors map,and lot number .............................:j............ f ,. o`'�f TOIL D r� _ T E Sewage Permit. number ....(�.y'.../..Y.�'?�........................:..... roe' ♦� Z 33AWSTADLE, i House number` ..... ✓ ... A ......................................... q Maea � 1 639 9� 'FO ypY a� TOWN : OF BARNSTABLE { BUILDING INSPECTOR ,�� � APPLICATION-FOR PERMIT TO ....:........................:..,.:.............................................................................................. TYPE OF CONSTRUCTION ......... :, ..........................................f................................................... GG ..... .. .................19. ,V i TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to-,the following information: Location � — ...cg.© ..... .............. :........................... j. ProposedUse ................ .;�� ... ........................................... .... ............................................................................ /.... . ZoningDistrict ........................................................................Fire Dist�rlgt .............................................................................. Name of Owner ...� ., ..�1-r--k-:....fr......................Address ........f................ .......................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address ................................................:................................... Number of Rooms ..... '".......................................................Fouridation �/ �« {' ..................................e......................................... Exterior t, 2.., :...................................................Roofin G� f-�Z+ E.. :.. ............ ... g Floors ..:...... .......G...-.-................................................................Interior / e�. A., ' Heating ............Plumbing ..^?.......% - .. . Fireplace ..................................................................................Approximate. Cost ....... ...! ........................ Definitive Plan Approved by Planning Board --------------------_-----------19________. Area ......../.J.�.............. Diagram of Lot and Building with Dimensions Fee 9 vv. ............ ................................ ti SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 4 4 ` i i f f' e ` OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I\hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. • r Name :::......................% ! :y.` ... Construction Supervisor's License 4�1% �!:.� SMAL,L. AL,AN A=170-ate } 274 75 Permit for ...One..S�tto No fir.............. Single Family. D yguin5....................... Location .Lot..6Q$,...... Ct-1,S..Road Centerville Owner .Al al? S?tla] .............................................. 4 Type of Construction' ....Frame........................... � ............................ .............................................. Plot ............................ Lot ................................ Permit Granted .....4anua ' 29�...........19 85 Date of Inspection ....................................19 Date Completed ......................................19 ;a r ti ti