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HomeMy WebLinkAbout0061 JOAN ROAD k, n aq 6�w v 4; win 'k, ","if $Ipman log �xf ,A "W"ItAr, solo%, Wom r, 0. MA .'a Mi QVW, AW, W10i,-, Evil .0q W o0i .......... `tv WO R. N, I SAW q0 OEM W.V"Iffl,�1. ,i Mm"N'. 'q, Ne---1901- M EMU My NO ,x, U-1 CP kLj'--f."5':Pg vqi RL; ym ti�,1,449"gi qvl Y9 p-MRIgg TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel C✓ Application�k.x(J Health Division Date Issued- Conservation Division Application Fee INO Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address -"Jo c� Village U Owner dam,►-a Z ec l v I el- —Address-3-2 & ha /( d Alde i 410 L1r&lo Telephone -7—1 '4 "I(Li V 3 53 Permit Request �„1 �. .nn i 2=—°�'1�•, �' A+i-r /r �� Square feet: 1 st floor: existing proposed 2nd floor: existing i/proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation i Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Ld/ 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) Number of Baths: Full: existing new Half: existing new Number of.Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count t Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ 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 Jasqt, elephone Number Address Po t5x+C 0 License # /(0 ;L -7 5 .•IkAs=i L AAA- 0411 I Home Improvement Contractor# J(0 Email r o e re 11/ �i5 C /. C Worker's Compensation # VJ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �• SIGNATURE DATE I > FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE f' OWNER l DATE OF INSPECTION: FOUNDATION r FRAME E INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE CLOSED OUT i ' ASSOCIATION PLAN NO. y Department of Indus&ialAccidents Office oflnvestigadonsA,. I Congress,street,Sui#e 1 if ,8estan,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Afildavit: Buflders/Contractors/Electriciam/Plumbers Awficant Informatior Please Print Letsibly Name( usiness/or 'on/7ndividual : � �u. /c, i•-� _ Address: City/State/Zip:,. 'J g e L o It- Jol?7� Phone#: C�c � '(D ��� Are yon4n employer? Check the appropriate bog: Type of project(required} 1. � I am a employer with L d 4. [� I am a general contractor and I 6 New construction employees(full.and/orpart-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 worlds for me in an capacity- employees and have workers' g Y P t5'• 9. ❑Building addition [No workers'comp.insurance comp.insurance.$ 10. Electrical airs or additions required.] 5. 7 We are a corporation and its ❑ � 3.❑ I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions ❑ g eP right of exemption per MGL f r irs myself. [No workers comp 12.❑ epa f c. 152,§1(4),and we have no 4 insurance required] 13. Other dC, lip Z� employees. [No workers' y comp.inssuranCe 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 tt=hire eutside contcac tDrs must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have cniployees. If the sub-contractors have employees,they must provide their workers'comp-policy number. s 1 am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: AC 2 6�y Policy#or Self-ins.Lic:#: V �(7 S� (� Expiration Date: //L / o�6,3 Job Site Address: � I .J�o.:n i2c� City/State/Zip: (J��n �>'✓� 'a 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 S 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 certi u e and enables o er ury that the in ormation provided above is true and correct Si afore• Date ` 1t1 . JS_ Phone#: Official use.only.. Do.not write in this area,to be completedby city ar.town.offw!aL- -. . _ _ . .... 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 InsDector 6. Other Contact Person: Phone#: .Rightfax C3-2 8/4/2014 8:44 :21 AM PAGE 8/022 Fax Server AC a CERTIFICATE OF LIABILITY INSURANCE 0& 2014 �....- 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 INSURERS'.AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(m)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 endorseme"s� PRODUCER CONTACT NAME: VIVEIROS INS AGCY INC PHONE FAX 140 PLYMOU T H AVE -cxt': iA'_C-No is FALL RIVER MA 02723 E-MAII INSURERS)AFFORDING WVERAGE NAIC k INSURER A ACE AMERICAN INSURANCE COMPANY INSURED ItSUPER B RETROFIT INSULATION CORP PO BOX 105 NsuReR SEEKONK,MA 02771 INSURER D MURER E: NSURE.^<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 DCI;UMENT 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 WSURANCE JADDLISUBM POLICY NUMBER t ylp yy)` POLICY EXP S GENERAL.W1BILnY +i EACH OCCURRENCE S �M AERCJAL GENERAL LIABILITY - I DAMAGE TO RENTED S LAIMS-MADE OCCUR - PREMI EXP(ASES Z !ua9nceJ . MED ny one person) S PERSONAL BAJ-J?NJURY S i G34ERAL AGGREGATE S GEN-L AGGREGATE LIMIT APPLIES PER PRODUCTS-COOMP.'OP AGG S POLICY P£4 I LOC ! S AUTOMOBILE LIABILITY lABIINED,SINGLE L UT S ANY AUTO a-.mdenl i t SCo-:EDUL=O ! 50DILY IN.IURY JPar person) S AUTOS NEa A:;IDS i SCOILY INJURY(,Peracadent) S HIRED AUTOS NON-0'ATIED. ' I O ?AMAGE S A,;TCS S UMBRELLA LLAS OCCUR EACH OCCURRENCE S EXCESS LIAB r.LA�S MAt= AGGREGATE S DIED R_GT_NTIONS I - S WORKERS COMPENSATION wCSTATU- 6TH- AND EMPLOYERS'LULBI FTY ` X -DRY 0AITS ER - A TY PROPRIETORPAP.TNER'.:XECU-I N=�� ' OFFICERB.NEMBER EXCLUDED? I N I N J A 6So"2U6 - 08-02-2014 '�023-02-2fl15 EJ_EACH ACCIDENT $1,000,000 ,fdandatory m NH) "--"�� I 1ymdaftwder 4705PE15 a El DISEASE-EA EMPLOYEE $1:000,000 D SCPJP7JON OF 0PERA7IORIS t>eaaY, E.L.DISEASE-POLICY Uri $1;000,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 V89CLES(AibcJ1 ACORD 101.Addoona!Remarks SchedL&-If II We space Is requtreo THE INSUREDS MA WORKERS COMPENSATION POLICY AND ITS LIMITED OTHER STATES ENDORSEMENT AUTHORIZES THE PAYMENT OF BENEFITS FOR CLAIMS MADE BY THE INSUREDS MA EMPLOYEES IN STATES OTHER THAN MA, NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFITS IN STATES OTHER THAN MA IF THE INSURED HIRES,OR HAS HIRED EMPLOYEES OUTSIDE OF MA. THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA. CERTIFICATE DER CANCELLATION BPI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES B 107 HERMES RD SUITE 110 CANCELLED BEFORE THE EXPIRATION DATE THEREOF, MALTA,NY 12020 NOTICE WILL BE DELIVERED IN ACCORDANCE NTH THE POLICY PROVISIONS. AWHORMD REPRESENTATIVE flu ACORD 25(2010A)5) The ACORD name and i are ©ISM-2010 ACORD CORPORATION.All rights reserved. logo registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement C` for Registration _ Registration: 1&x61 ! ; Type: Private Corporation Expiration: 7282016 Tr# 252815 RETROFIT INSULATION, INC. JOSEPH REILLY V >i P.O. BOX 105 SEEKONK MA 02771 'Update Address and return card.Mark reason for change- Address RenewalElEmployment ❑ Lost Card icA, 0 2DM-06/1I Office of Consumer Affairs&Bnsiaess Regulation License or registration valid for individul use only �E NPRpyEMENT COFACTOR before the expiration date. If found return to: won. 461 Type Office of Consumer Affairs and Business Regulation ration:, private Corporation 10 Park Plaza-Suite 5176 Boston,MA 02116 RETROFIT INSULAQ � �` f0$EPH REILLY � ,w i44 RODMAN ST=ALLRIVER,MA 02721 — Undersecretary o alid without signature Maw--; :-777 '> 71— cf.TT.. •- � _ - I OWNER AUTHORIZATION FORM (Owner's Name) , owner of the property located.at ; (Property Address)' ti (Property Address) hereby authorize r +/ (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behatfto obtain a building permit and to perform work on my property: 1 Owner's 'Signature.; `Date 4 s • t • i • I i 1 i a i• Faft iDd054405M RISE Etagineerbg Rl4fon!"dor Rs I 'IF tt No etas ah 4ktdtuamr "D rum Q Dupont Avenue,Sardb Yw magb,KA 01;M64 CONTRACT S om FAX tU ftp RISEPROGRAM etnootasat7,atatttewSrtoseresmtaaa ex aeao atmwsrorarruettomrao LNGINRERINC cacs CUSTOM storm mne auene wataaaout Robert Rayla (774)364.4333 111142014 18S060 00002 woe aaaar - _sum eraser 61 Joan Road 37 A1pta Road SWA;i a". Caserville,MA 02632 Holden MA 01SZ0 JOB DESCRIPTION AUt SBALM-Aovfda Idar mad muaiab toad mean of your hams apinet wasteful,sasses air leafuae Ibis work win ba petPornted to oanoat wGh die flee atspedd lush aced dignostic tens to seams dtu goartgme wen be tell wbb a leaghlktl krd of air eschmp and hedaor atr quality.hided tb to be used to sent your home egs WAC txottu,famok weubastr*ft and albs ptodam Primary area forsuling W%&ak leakage to atria,bnw mtM a=dtod garega and odeer nrdeea0ed atess(tea m not generally addetatad.) (4)wor"bona• At the cmpkdme of the weaftba lm work,and at no sddtdonat cost to the bomaotvnei.a fmd bower door and/or combustion safety malysis vM be ewAveted by dtomb•conuuor to eemre the safety of dto hdoor air quality. s3o8.00 AIR SBALJN&.Pm tdo labor and matabb to hunD Q•bte wa ippbg and a dooramep to(1)doer(a)to rewfa air kdmsL VnAa ATM FIAT.Pmvids labor and muaiab to hmUA a&UO layer of R--19un-heed fibw&m buts to(1040)agum feet of ante $1.766.G11 VEMLATiON hwAdo boor and m eetab m hautl vmdladoa dm u b(60)ratter bays to mdmfn air flow. SIo9.40 WALL:Furnuh erred kwA bbwn he Clint CdMboe m(9?J)sgwuo feet ofddrele saW dapbomd exterlar waft Us bats of*a upperconrse of your woad std'mg is at to drM bates huc dew was dwdft behtad.The bola as 6m progged and die wood ddtag is rdeWWW using WNW sled f aM asps.Tbude V palming.R seeded,w'hl be deg rtuooma's raspmedDOity.Lrvoidag mM soar wmoompwmofhswbdw Subm mt to yarer payment,a an eases RLRB>aegbeaing wen tetwa VA=wades pewit to chock for any voids wide an hefwmed acaeeer.Arty mtijor voids dot may be fi and wBl be tilted st ao addklmat east SI.6ti A BASEhff P CEMM Provide labor and matarisb to ImmA(132)Uueerfeet of R•19 unfha d thergiw iaso s to the pahrAw of des beaenersa oettiag at du boos sill S299A RiSB Bagtrxving war apply ail appPcabre.eligiDb incentive to deia eontraa Yea wiU be biped only the Ifet w=nL Gu a fly, for etigible menums.dtc Cape Light Cmnpeq olfm 7S%bomdvs.ant to oweed S4AW per c&Un rya.mrd sn bwmtin of 100%for die AirSeaRag maa>rcs. Par the safety and bakA of your homda hedoor mrgsaltty.we wHI be coadoeft a bbwa door Mpaatk of the available air flaw in your horn both before des work is begun,and Sher the weadtmisatim work is ComaviaL Wa vaD also cmdm a fall mewr m of ft eombeadon safety of your beating systan and water hema.Tots tors a vates of S90 mid is at mew toy= 590.00 i Federal to It OS M05SN RISE Engineering R1 Conlreetor ReplWWon No 8106 MA Gontrador Regfstrellon No 120979 A division of Welsch Engineering CT contractor ticplatration No GSM S Dupont Avenue,South Yarmouth,MA 02664 CONTRACT SW68.1926 FAX gWi- S-1933 11 �+ Page 2 1 s 1C PROGRAM two CONTRACT is Enier orro eerwea wsE CLC-RCS mova�IIM _O wYMCUETdNBNPOTIWORWAS ENGINB81tING DESCRI BELOW - CUSTOMER PHONE DATE CLIENT" WORNORDER ,{ Robert Rayla (774)364-4333 11/14J2014 41831* "00002 SERVICE YIRELT e�. mum MIRES.: .. 61 Joan Road 31'Alpha.Road .SERVICE CITY,eTATE�IZIP RLIMO CITY. Centerville,MA 02632 Holden;MA 01526 JOB DESCRIPTION Total: $4,441.46 Program,inceptive: $3,44984 Customer Total: $991.62 WE AOAEE HEREBY TO FURIMH SERVICES,-COW-LtU IN AGOORDANCE WITH ABOVE SPECCFCOATIOHS.FOR THE SUN OF $; *'*Nine Hundred Ninety=One&621100 Dollars $991.62 _''���"f'' ._ UPON FIN N�Eft AND. AL BY ON EMOUIEERING 0U5MYER fYNREEETo RENm ANDUHT DUE IN FULL INTEREST OFf%WILL OS piAR<IW MOIRILL�oN ANY UNPAID OMAN=l TO DAY& REVERSE FOR DIPORTANT bffOINUITION ON OUARAMEES,RIOHra OF IIECOOK SC EVW AID CONTRACTOR REOISTRATIO►L . Do NOT SIgH jH%CONTRACT IF THERE ARE ANY ELAN ACES s — ' - _ eusroANEA AeANce A�RffW S161CATURE-RISE HIOY�INO t 1 ti { r NOR&TNS CONTRACT MAY EE KQrIbRA.YMi,BY US tf [>D NOT W►®NRINl1 OATS OF.'ACCWfAMCE - -�-. _ AC�F'iiliN80F O0NrRACT•711E ADOYE�RCES,WEGROAnON$AND CDNDIrMItB,A(E"-' N _ BATISFAQfDAYTO{B IIND ARE NER®YACCERIW.YOII ARS Aur"ORM ODolw% w , DAYS, ; IAED.PAYM9T WEL BE MADE AS OUn1NW MOVE' , i s 2` f J 1 s` I i