Loading...
HomeMy WebLinkAbout0047 LAKESIDE DRIVE EAST IL/17 Lies Or Eo_s-f- �► f f + i - . a : F r< t v i t : +.r N a , w r � r a re ,r tk - + t t 8 ([ r + sa: , u S� ''i� �� _ �. . ,. ,: - . ,� � _ . :.. '�. '., �. e :. � � - � _ _ .. y ., ., _ :. ,- � � o .. .0 �: �. _. �.. -.. . .. .a., ,, ,. �� .� x f .,. .. s :. - .. .. -.. t. - � .. ,. ... .. _ ,.. .. ,. ", _ .. r � y ., ... -. ,�„ .. _ ,. . , .. :. ,, ,.. .. .� r ., ^ - _ �; r z E. „ ' '� ,,, :: �, .. _- _ � ;. Y y. .. M1,. .. ,. ., ,, ,. �.. _ ;.. s; , _ �. . , _, r -. a N _ ., :. - ," �, :- ,h. : a. a., f'- .L ;. y . _ i • .. y .. '� n .. .. _ + �_ .. Town of Barnstable *Permit# v _� ✓��J Expires 6 months from issue date Regulatory Services Fee 9 mass ' Richard V.Scali,Interim Director oAR t634 ♦ 6 Building.Division2 20 Tom Perry,CBO,Building Commie¢ 18 200 Main Street,Hyannis,MA 02601, = www.town.bamstable.ma.us I'I� U790-6230 Office: 508-862-4038 Fax: _ DRESS PERM[T APPLZCATToN - RESIDENTIAL ONLY Q Not Valid without Red X-Press Imprint Map/parcel Number,2 45�Z 0 q 1 Property`-Addess 7 AResidential Value of Work$,7 Y7zp Minimum fee of S35.00 for work under$6000.00 Owner's Name&Address OVAIT914 Oxbpj& I Lakesld� 672 erUi llP, MA Contractor's Name` O>T r &j"IV Telephone Number "7l y`63 if Home Improvement Contractor License#(if applicable) �Z,/7 Email: Construction.Supervisor's License#(if applicable) 07`/ Z�f 7 *orkmin.'s Compensation Insurance Check one: ❑ I am a sole proprietor ❑. I am the Homeowner - I have worker's/Compensation Insurance Insurance Company Name ! ITT�/U�L- Lj/ �D -- Workman's Comp.Policy# 4 S,3q6-11& s Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U Value r z7 (maximum 35)#of wind9os #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: ope wner must sign Property Owner Letter of Permission. o y the Home Improvement.Contractors License&Construction Supervisors License is it SIGNATURE: QAWPFILES\FORMS\buildingp fo \EXPRESS.d c p Revised 061313 �!7W- T 9 f t ✓5e MASSACHUSETTS SUPPLEMENT WARNING—DO NOT MN N THIS CONTRACT IF THERE ARE ANY BLANK SPACES 77 t Name First Name Store /Branch Name PO(sl or Customer Order Salesperson's N e (if any) ac�LA 4o The terms and conditions of this Supplement apply to ail Home Depot(interchangeably referred to as I "The Home Depot") Home Improvement Agreements in Massachusetts and are expressly made a part I of all such agreements. In the event of any conflict,inconsistency or discrepancy between the terms of 1 Your Home Improvement Agreement and this Massachusetts Supplement, the terms of this Supplement shall control. NOTICE TO BUYER You may cancel this Agreement if it has been signed by a party thereto at a place other than an address of the seller,which may be his main office or branch thereof, provided You notify € the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. See the attached Notice of Cancellation form for an explanation of this right. This right shall not apply to a transaction in which You initiated the transaction and the goods or services are needed to meet a bona fide immediate personal emergency and You furnish the seller with a separate dated and signed personal statement in the Your handwriting describing F the situation requiring immediate remedy and expressly acknowledging and waiving the right'i cancel the sale within three business days. E (Custom is signature) TAX IDENTIFICATION NUMBER FOR HOME DEPOT: 584853319 NO WAIVER OF RIGHTS: Your rights under the Home Improvement Contract Laws(MGL Chapter e 142A)and other consumer protection laws (i.e., MGL Chapter 93A)may not be waived in any way, i even by this Agreement. However,You may be excluded from certain rights if the service provider Yoq choose is not properly registered as prescribed by law. i REQUIRED PERMITS: Home Depot and/or its Service Provider is/are obligated to inform You;of any and all permits necessary to complete the work contemplated by this Agreement, and it is the,obligati of Horne Depot and/or Service Provider to obtain said permits. If You secure their building permits,Yo are automatically excluded from any Guaranty Fund provisions of the Home Improvement Contractor € Law. WARRANTIES: Home Depot may guarantee or provide an express warranty for workmanship or materials. Any enumeration of these matters on which You and Home Depot lawfully agree may be added to the terms of this Agreement as long as they do not restrict Your basic consumer rights. MA Sbda sup.(Ro.Ul.20'7) Customer Care:1.877-467-2561 The Home osoot-2455 Paces Ferry Road,N.W.Bldg.B-3,Atlanta,Georgia 3033 Pagd,12 of'P5 Om H2612- Customer Copy V � �, $1� 4 M' ��fd�^i Fl J 7V'# �S/R�•#F •�fi.b{�F l�P�l .� �'4�R ' ., -�,f #CAUL M DOWNINO �r K. g 60 iC SwlCK ROAD - r� OCKTON A 02302 ze �� 10 Cmr»��s e ,n n a' the Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 7=_ Boston,K4 02114-2017 www.mass gov/dia Workers'-Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AAt�lica>at Information ` Please Print Legibly Nallle (Business/Organization/Individual): Address:. City/State/Zip: (� _ , `� ��3 r��-', Phone#: Are you an employer?Cheek the appropriate box: l.El I am a employer with p 4. ElI am a general contractor and I Type of project(required): ,employees(full and/or part-time) have hired the sub-contractors 6. ❑New construction 2•LJ 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 any capacity. employees and have workers' 9. ❑Building,addition [No workers' comp. insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11:❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL I2.❑ Roof repairs insurance required.)t c. 152, §1(4),and we have no employees. [No workers' 1311 Other comp.insurance required.] Any applicant that check 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 anew affidavit indicating such. xContraclon that check this hot 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: Policy#or Self-ins.Lic.•#: Expiration Date: Y Job Site Address: 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 ORDERand 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. ' Jr do herebyZary under the pains and penalties of perjury that the information provided above is true and correct. --------------- ------- Sl�nature: ' / 8,a war Date:' - Phone#: e. Official rise only. Do not write irz this area,to be completed by city or town offrciaL City.or Town: Permit/License# Issuing Authority(circle one): - 1.Board of health 2.Building Department 3.City/town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 40 r Boston,JU4 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Appficant Information Please Print Le 'blv Name (Pr siness(Organizationrindividual): — Address: 90 �6 S7b7V / r/RN�I Ciry'State/Zi : s� sb /� olryr Phone#: 7 7L�- 7S " a s Are you an employer'Check the propriatXa� x Type of project(required): ; _ 4. a general contractor and I : 1.� i am a empiover with ,' 6. ❑New construction / �'employees(full and/or pait-tmme).* hired the sub contractors t listed on the attached sheet. 7. Remodeling I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, Demolition • oiovees and have workers' r— ryorIang forme in any capacity. 9. V Bolding addition; o workers' _comp. insurance comp.insurance.*- ! 10.n Electrical repairs or additions required.] 5. We are a corporation and its u eP 3.[ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. ,No workers' comp. right of exemption per 191GL 12.❑Roof rep s insurance required.] ' c_ 152,§1(4),and we have no' 13 utter ��� empiovee4. [No workers comp.insurance required] Any apphcam that check box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside coat wens must submit anew affidavit indicating such. :Contractors that check this box must attached an additional sbea showing the name of the sub-contractors and state whether or not those entities have --..mployees. ii the Arb-convacton have employees,they must provide their workers'comp.policy number. I alrr an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. L-1surance Company dame: �( r!Zr l/�`r1 b/ycf./ t/N!O�✓ /'//'C� .,Yit/S . �e _ Polio'#or Self-ins.Lic.#: Ci 7 J l o Expiration Date: Job Site Address:— C—GLI��S�`J • / 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 u?to$1,500.00 and/or one-ye imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day ag ' st a lator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLL ri e coverage verification I do hereby certify un a alti at the information provided above" tru and correct Si attn e: Date: Phone#: — Official use only. Do not write in this area,to be completed by city or town official City or Town: PermittUcense Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityi"rown Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: JJ C. -71 a == Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Type: Supplement Card Registration: 112785 HOME DEPOT USA INC 9 2455 PACES FERRY RD C-11 HSC Expiration: 04/22/201 ATLANTA,GA 30339 Update Address and return card. Mark reason for change. ❑ Address ❑Renewal! ❑Employment ❑ Lost Card -_- - Office of Consumer Affairs&Business Regulation ==---- HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:SUDDlement Card before the expiration date. If found return to: Renistration Expiration Office of Consumer Affairs and Business Regulation == 112785 04/22/2019 10 Park Plaza-Suite 5170 HOME DEPOT USA INC - Boston,MA 02116 ANDREW SWEET 2455 PACES FERRY RD C-11 HSC bi6ul signature ATLANTA,GA 30339 Undersecretary d I3 i Aco op CERTIFICATE OF LIABILITY INSURANCE Doza2120% mom' �� 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WANED,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 endorsemerkt(s)- CONTACT PRODUCER NAME MARSH USA,INC. PHONE 1FAX TWO ALLIANCE CENTER I.C.No 3560 LENOX ROAD.SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: NAIC 0 INSURERS AFFORDING COVERAGE CN101642069-HomeD-GAW-18-19 INSURER A:Old Republic InsuranceCo 24147 INSURED THE HOME DEPOT,INC. INSURER B:New Hampshire Ins Co 23841 HOME DEPOT U.S.A.,INC. INSURER C:HomeRisk Came Insurance Company 2455 PACES FERRY ROAD INSURER D: BUILDING G20 ATLANTA.GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-004353439-i6 REVISION NUMBER: 3 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 ADDL SUB POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MWDD MWD RGEN'L COMMERCIAL GENERAL LIABILITY MWZY312717 03101/2018 JU3101/2019 EACH OCCURRENCE S 9•�•0� A D t.OD0,00D CLAIMS-MADE �OCCUR PREMISES Eaoccunence S LIMITS OF POLICY XS MED EXP(Any one person) S EXCLU OF SIR:SIM PER OCC PERSONAL&ADV INJURY S 9,000,000 AGGREGATE(UNIT APPLIES PER: GENERAL AGGREGATE S 9•000'D00 POLICY PRO- LOC PRODUCTS-COMPIOP AGG S 9,000,000 JEC7 S OTHER: A MWT6312718 03l012018 03/01/2019 COMBINED SINGLE LIMIT S 1,000,000 AUTOMOBILE LIABILITY � Fa accident X ANY AUTO - BODILY INJURY(Per person) S OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) S AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED I - Per accident S AUTOS ONLY AUTOS ONLY S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS UMBRELLA CLAIMS-MADE AGGREGATE S S DED RETENTIONS PER OTN- B WORKERS COMPENSATION WC0141225.77(AK,NH,NJ,VT) 03l01I201B 03101l2019 X STATUTE ER B AND EMPLOYERS'UABILiTY YIN WC W4122578(WI) 03/0112018 03101/2019 E.L.EACH ACCIDENT S 5,OM.000 ANYPROPRIETORIPARTNERIEX ECUTNE OFFICERIMEMBEREXCLUDEDT - NIA - E.L.DISEASE-EA EMPLOYE S 5.000.00D (Mandatory In NH) 5•DDD.DIID U yes,describe under Continued on Additional Page EL.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS below 11 C Emess Auto 297-1-10011-00-2018 03101/2018 0310112019 Lird1 4.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION HOME DEPOT USA,INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING C-2D ACCORDANCE WITH THE POLICY PROVISIONS, ATLANTA.GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name.and logo are registered marks of ACORD � MAG 0 NO TOWN OF ' BARNSTABLE . BUILDING , INSPECTOR TYPE OF CONSTRUCTION .......................... ;........ ......................... ................................................. � 6 ........................ig,, TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for o permit according to the following information: 4.� �� ^�Locotion . --..�— ----./ __l'�.�"_=��___.. _. � Proposed � Zoning District M R' -1z,......... � _'- of Builder --��� . - [~^^ Nome of Architect .—�,,-, ---.`J. —�A66res --. --------. Number of Rooms / Foundation ........................ ..._.. .................... ---r-----------------' — � - ` Ex�eho, ' --------,_—Ruo�ng ' ..................................... L� / F|000 —�|/\/ .................... — ---~------------.]nK��r —'l—.I�� .--.--------. . ` �_ Heating —+—�I�������—� '����r��.----'F1um6 ng ---------------..^--------^--.. � � . ~} ^�// Fireplace —��,-- -------------Approximate Cost -- �—.��.`/--.--��---_______. ` Definitive Plan Approved by Planning Boor6 lA-------- . Area ........................................... Diagram of Lot and Building with Dimensions Fee __________ ............. SUBJECT TO APPROVAL OF BOARD OF HEALTH ' , v w � � . ' ` � . ` OCCUPANCY PERMITS REQUIRED FOR NEVV DWELLINGS | hereby og,00 to conform to all the Rules and Regulations of he a An f rns a le regar/ding the above � - construction. ' ...--.-----.—... / ' Construction Supervisor's License ........ f' �� _ CRONIG, S. A=252-99 No .... Permit for ... Y...DWf .0...Q9...................... Location Lot 1.4�7 Lakeside Drive ...... .....9.............................................. .................C.e n te.r,v i l I.e......................................... Owner ................S......0 i .ron. .9.............................. .. . ...... Type of Construction ............Frame._...,;, ............................................................................... Plot ............................ Lot ................................ Permit Granted .......Awg.v.!5.t...6................1984 Date of Inspection ....................................19 Date Completed .... .................................19 07)' r , { ;• TOWN.,OF BARNSTABLE . Permit'No 2 tea Buildang:.;Inspector Cash - -------- OCCUPANCY. .-PERMIT Bond. ---- - ---- ---- Issued to S. S'rli.Q Address. L .14 47�Lakpsiae i�ri�w; �n�rv�.Ilz Whin Ins ector. Inspection date. Plumbing Inspectors C Inspection date ' Gas Inspector i i?.� Inspection date",1 R A•t` Engineering Department .I'r,• L' Inspection date -. "Board`of Health ,;'�; !f j'�tj yG �lte.J', Inspection "date yt, . THIS "PERMIT WILL NOT"BE VALID, AND THE BUILDING SHALL NOT BE •OCCUPIED ,UNTIL SIGNED" BY TIIE ,.BUILDING •INSPECTOR .UPON SATISF ACTOR Y• COMPLIANCE .WITH .TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION.119.0"-OF THE MASSACHUSETTS STATE BUILDING"CODE.. . � s ...: ........................ .:.. ....... 19 •_•... ......... � � .... no, y / �,: • �B i or." :„ u•ldi Inspector- - .. - FROM - TOWN OF BARNSTABLE Mr. Francis Lahteine BUILDING DEPARTMENT Town Clerk, -367 WIN STREET HYAIVNiS, MA OM Phahs, 775-1120 SUBJECT: FOLD HERE - - DATE January 9, 1985 MESSAGE Work has been completed. under under Building Permit #26794 (S. Cron g). - Please release Bond. SIG E zF £,.n..--��.w w.w r µ•a.:5+ r.ew; y. y. ,,. z /r.". - DATE cJ r k - REPLY 4. SIGNED _.. �_tea__.. _ Y, . � �,�..-_ .-. .. '`tea ..'y.•. t i .. _ :r� r