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HomeMy WebLinkAbout0225 MAIN STREET (CENT.) ate" ��'� s�' � ',- �_ f O �j 0 1HE Tp Town of Barnstable Office of Community and Economic Development ► BARNSCABLE, + 367 Main Street,Hyannis,Massachusetts 02601 y MASS. (508)862-4683 or(508)862-4695 Fax(508) 862-4725 039. Kevin I Shea Director July 2, 2002 Joan Crivelli c/o Joan Crivelli-Neff 225 Main.Street Centerville, MA 02632 Dear Joan Crivelli: This letter is to introduce you to the Access oryAffordable Housing (Amnesty) Program. The program is a unique way for our local government to partner with property owners like you in providing affordable housing in our town while allowing you to make rental income. You were referred to me by the Building Department because you own a single-family home with an accessory unit that is not currently permitted for use as a f amily apartment; (or you may be the owner of multi-units where there exists one or more illegal apartments). Enclosed for your convenience is a program brochure so that you will have the opportunity to read about the Amnesty Program. Please feel free to call and find out more information on how to participate or to ask any questions that you might have. Looking forward to the possibility of working with you soon. Since ely, r- Paulette Theresa-McAuliffe Special Projects Coordinator r .y 1 Application number,. .. l..... .......... ..............� _ . Fee .............................................................................. KAM owl Building Inspectors Initials... .................................. ! l��(� 49 Date Issued: Il....!l9 ..:..................................... ..... ..... 04 , jk/ Map/Parcel... ©,..I....................`...................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: ���' /y�%/f/ 31_W E_7` 00 %Z/ (J/L LE� NUMBER STREET VILLAGE - Owner's Name: Phone Number .'2,3 —c9kS-3 �7,/,/c;1- Email Address 3 3 d1- nW ell Phone Number Project cost$ `� ' Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize �4D uJavl) to make applicatio �abuil,ing permit m accordance with 780 CMR Owner Signature: Date: TYPE O WORK ❑ Siding ❑ Windows(no header change)# ❑ Insulatiori/Weatherization ❑Doors(no header change)# Commercial Doors require an inspector's review I Roof(not applying more than I layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# /�Z3 �— C (attach copy) Construction Supervisor's License# �'� 3, (attach copy) e Email o Contractor f 1 —� � `f Yam-"7%one number S°/" ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY-IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. i APPLICATION NUMBER ' . ............................................................ *For Tents Only* 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 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 /APP ICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600,Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Uzibly Name(Business/Organization/Individual): � Address: `�� y''j � � �✓ Ci /State/Zi Phone#: . 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 ployees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.[9 I am a sole proprietor or partner- listed on the attached sheet. 7. []'Remodeling' ship and have no employees These sub-contractors have 8. ❑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.❑Electrical repairs or additions 3.❑ I am a homeowner.doing all work- officers have exercised their 11.❑Plumb g repairs or additions myself. [No workers'comp. right of exemption per MGL 12. Ploof 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: Policy#or Self-ins.Lic.#: 7 7 Expiration Date: l / 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 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 underAe pains and pe hies of perjury that the information provided above is ue and correct: Si afore: � o t' Date: Phone#: 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#: 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." 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 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 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. 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 bum 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 Department of Industrial Accidents Office of Investigations 600 Washington,Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia I lmrVK CANT: ff - _••,•�••u,. - — .—n••....,v,wc w certificate holder art ADDITIONAL INSURED,the PoiicY(las)must have ADDITI III ROGATIO bate ins and conditions of the OVAL INSUi�D i or ire ' this certificate PRCDucER holder in lieu of such Policy,do n }es nW require an A an Schlegel 34 n legal We WoMr H N � JitO I DMA N Street West Yammufh,lW4 02873 Exit 501 5�-771-�63 ADDRESS: �8-771-BMH m5ltrai � ,xm NAIC 8 INsuR® INSORERA: NGM INSURANCE COWANY MARCOSWLVA INSURERS: TRAM 14M Oft EMERSON CONSTRUCTION INSURER C: 67 SEA STAPT 11 INSURER D HYANNIS,MA 02M WSIIRER E: COVERAGi�S CiR2TIFiCATE NUif�R; INSURERF: I NIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTEp BELOW HAVE BEEN ISSUED TO INDICATED. �TWMiS'TANDINGANY REVISION NUMBER: EA CERTI>ICATE MAY BE ISSUED OR MfAYREOUIREf�t7 TERM OR COMMON OFANY CONTRACTOR INSURED�I�FOR THE POi ICY SOD EXGLUSIONS AND COND PERTAIN•T INSURANCEAFFORDED BY THE POLICIES DESCRIBED���R�fCTTo jjj1 H TMIS R >TroN3 OF SUCH POLICIES L949tTS SHOWN MAY HAVE BEEN HEREIN IS SURJECTTOALLTHE TERMS. L7R �EOFINsuRANCE REDUCED BY PAID CLAI9lIS. X colrsaL GENERAL LIABILITY POLICY NUMBER P CLARAS... Q LB+sss OCCUR EACH° $ t,0p0,0op A $ 500,00o o,000 cEar� MED EXP ACGRECATELpWApjuLn 75T 11/0g198 1tl�jlg a� $ 1 POLICY❑.PRO- �LOC &� $ 1,000,0� OTHER CAI ANTE $ 2,000,00p AUTOMoMMUAMUTY PRonucrs- , $ 2A00,M ANYAUTOOymm $ SCHEDULE AUTOS $ A ONLY BODILYRIURY{Perp�senl $ AUTOS ONLY ONLY BODILYK1URYil-eat) S UMBRELLA UAB aedderrt $ OCCUR EXCESS LIAB _ $ EACH OCCiBi"m $ P co $ AGGREGATE $ AM ANY PR LOYEW Lmm rf$ IIIIE YIN $ A7UTE DTH yyeess Q EXCLUDED? ® NIA WC-1073205 tU4t17PtS Q9P17t20 �LEACHAt ER DESCRIPT[pNOFOpERpTIONSbelow E.LDISEASE-EAEMPLO $ 100= EL DISEASE-FOL(CYL4VIIT $ 5ldo,000 D>:sCwroPTION oFo�+nDNsr LocanoNs I v�IICLEs lAcortD got,Aa�uo�l ,� . MARCOS Sfi.VA HAS ELECT®TO�CO S �^��»md trm�e sPaa3 g �UNDER HIS CURRENT WORKERS CO!!I<PENSAT�POLICY CERTIFdCATE HOLDER CANCELLATION SHOULD ANY OF THEA13OVE DAM POUCXS DAVID WOOD ACCORDANCE WITH THE T POLICY�OF'NOTICEWILL 13E DES BE CANCEULED BEFORE pRovwow AUTIIOR� E DAIANE BENFICA ACORD 25(20ISM3) @ INS-2M5A CORpORg770N.The ACORD name and logo are registered maths of ACORD Alf rights regerved. i P Commonwealth of Massachusetts. ` � Division of Professional LKensure Board of Building Regulations and Standards Constrrvisor CS-035693 -11 'pires:01/18/2020 DAdID A.WOBpS _ 43 MATTH Ar , .f MARSTONS M LtiS aC _ 1 b/n`i3l��Ja Commissioner tip- Otfim of Consumer Aftaim A Business Regulation HOME IMPRO MENT CONTRACTOR individual I F.W[ation -iY/:07/30/2020 DAVID WOOD`S DAVIDA.WOO�$ ' 43 MATTHEW WA , MARSTONS MILLS,MA 02648 Uttd@tSect@Mry Registration valid for individual use ordy ° before the mcpIration date. N found ratan to: Office of Consumer Affairs and Business Regulation 1000 Washington Street-Suite 710 Boston,MA 02118 i i Not valid without signature Construction Supervisor _ Unrestricted-Buildings of any use group which contain less than 36,000 cubic feet(991 cubic meters)of enclosed space. I Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl