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HomeMy WebLinkAbout0510 MAIN STREET (CENT.) 1t S i Ito 1je t, A.1 ea A E o-, t r .. a .. ., .. '. _. x r t ! a • e r � ' C - .. oF,ME> Town of Barnstable. *Permit# Expires 6 mont .from is ue d Regulatory Services Fee 1AMSTABLE 9 1659 ��� Thomas F.� Geiler,Director ArEo ter°i � � Building Division - a_ P R gT Tom Perry,CBO, Building Commissioner_ 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us �:1UVN �F�BARNSTABLE Office: 508-862-403 8 Fax: 508-790-623 0 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number- Property Address ��C7 �fl"� I - -yd�ijC_ residential Value of Work 1/5-1&Do Minimum fee of$35.00 for work under$6000.00 Owner's Name& Address Th4a O)A_Ll Contractor's Name �� CA tAA S �j>Fi,�) p�-q yTs= Telephone Number Z 1 a 16 -}-,Home Improvement Contractor License#(if applicable) 2D 3 -2 (;h p Construction Supervisor's License#(if applicable) [.;Z_E7 L-MCP• - Y23/9-0 13 ❑Workman's Compensation Insurance 5V3Zg Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 01 have Worker's Compensation Insurance Insurance Company Name Are ,A i'116-c'i L Ate, ��VSLtl'. (0. Workman's Comp.Policy# lC S b �-(�`ICE q 5�b-+ 1P11 3 I Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) VRe-roof(stripping old shingles)' All construction debris will be taken toy AfC 11q CG tic ❑ Re-roof(not stripping. Going over existing layers of roof) Sj�1vcah i /11�. ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum .44)#of windows *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 ofahe Home Improvement Contractors License& Construction Supervisors License is req red. SIGNATURE: QAWPFILESTORMS\building permit formslEXPRESS.doc` Revised 070110 i The Commonwealth of Massachusetts ^; Department of Industrial Accidents tLn Office of Investigations. , tide; 600 Washington Street Boston,MA 02111 w ww.mass.gov/dia. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly Name (Business/Organization/Individual): � C �Uk A--f �}1 A,,*�?Mp ' Address: (L) C .k Arjes S,+ - City/State/Zip: GAAW �h� tl D 2563 `Phone #: �` Zd�O �c�6 Are ou an employer?Check the appropriate box: •,. Type of project(required): 1.[lI am a employer with Z 4. ❑ I am a general contractor and I 6." ❑ pa New construction employees(full and/o rt-tim ).* have hired the sub-contractors ' 2.❑ I am a sole proprietor orjwtner= listed on the attached sheet. t 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. g, E Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] -. � officers have exercised then - 10. `� Electrical repairs or additio ns 3.❑ I am a homeowner`doing all work 'right of exemption per MGL I LEJ Plumbing repairs or additions' myself. [No workers' comp. c. 152, §1(4),and we have no 12:❑ Roof repairs insurance required.] t. employees. [No workers' 13:❑ Other comp: insurance required.] *Any applicant that checks box#I 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 their workers'comp.policy information:" I am an employer that is providing workers compensation insurance for my employees. Below is the policy and jab,site information. Insurance Company Name: . A M� G� �S. _ Co Policy#or Self-ins. Lic.#: 6 S cf ® B 1 3 (0 Expiration Date: 3//S� 2!0( Z (y r1 A-;,J St CL�,+kerui 91� M A 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 under the pains andpenalties of perjury that the information provided above is true and correct. Sitmature: Date: Phone#: 5Z� 2P0 Official use only. Do not write in this area,to be completed by city or town offcial 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 ar Contact Person: Phone#: � 6 CiG r Y1.v e✓�t A/ 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, constructibn"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 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 the Office of Investigations h`as 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 hie 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 5-26-05 Fax 4 617-727-7749 www.mass.gov/dia r1J.un. 1. 2011.,- 9. 09AM Insurance Agency of Cape Cod,GE 2/002 Fa:N.0. 4430ar P. 2 ACORD. CERTIFICATE OF`LIABILITY INSURANCE 06i0112011 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 PD UCIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE N E E ISSUING 1 SURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ias)must be endorsed. It SUBROGATION IS WAIVED,subject to the e terms and conditions of the Policy,certain Policies may require and erdormumerd. A statement on thls eortificate does not confer rights to the certifioale holder in lieu of such enciorsemerd(s).. - - - - - PRODUCER CONTACT NAME: PHONE, FAX INSURANCE,AGCY CAPE COD (A/C,No,Ezt): FAX 430 RT 6A PO BOX 960 E-MAIL (A/C,No)- ADDRESS: PRODUCER EAST SAIMIDWICI3,MA 02537 CUSTOMER I 73LKN INSURER(S)AFFORDING COVERAGE NAIC It INSURED INSURER A: A(T_AIr MCAN IN4;1JRANCI;COMPANY .. INSURER B: GIANFERANTE NICHOLAS F DBA DANIELLE - INSURER C: ' ENTERPRISES INSURER D: 10 CIIARIM ST INSURER E.' SANDWICI] MA 02563 INSURER F- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: rHis IS To cER-nFYTHATTHE POucies OFINEURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDicATED NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISS LIEU OR MAY PERTAIN-THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJE:CTTO ALLTHE TERMS,EXCLUSION@ AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOLBUgq POLICY EFF GATE POLICY EXP DATE, TYPEOFINSURANCe POUCVNUMSER IMNNDDIYYY`) (MMIDDIYYYY) LIMITSLTR INSR WVD ry --•I" GENERAL LIABILITY EACH'OCCUR ENCE C COMMERCIAL GENERAL LIABILITY � DAMAGE TO 41 ED CLAIMS MADE OCCUR, PREMISES(Ea'oct urrerlce) MED EXP(Art one person) 1$ r PERSONAL 1Ih AOV INJURY GEN'L AGGREGATE LIMIT APPLIES PER:' GENERAL AGGREGATE g ! POLICY PROJECT LOC PRODUCTS-COMP/0P AGG Ln AUTOMOBILE LIABILITY COMBINED SINGE ANY AUTO LIMIT(EA occldon' 1^� ALL OWNED AUTOS BODILY INJURY SCHEDULE AUTOS (Per persnn) HIRED AUTOS BODILY INJURY S NON-OWNED AUTOS (Per accbeil0 PROPERTY DAMAGE $I (Per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE g EXCESS LIAR CLAIMS-MADE AGGREGATE +DEDUCTIBLE $ RETENTION $ $ t WORKER'S COMPENSATION AND WCSTATUTORYUMl1S OTHER EMPLOYER'S LIABILITY YIN U_B-4507P11.3-11 03/15/2011 03f15/2012 E.L.EACH ACCIDENT $ 100,000 ANVPROPFRITORrPAATN[Te/EXECUnvs Y FFICER/MEMBER EXCLUDED? E.L.E DISEASE-EA EMPLOYEE. $ 100,000 (Mandatory In NM) E.L.DISEASE'.POLICY LIMIT $ 500,000 w It yes,oeecdbe under Dt8CRIP I'ON OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR X81z. 1CATF ISSUED-M THE CERTIFICArL r-rOTJ)ER AFFECTING W URKI- C COMP COVERAGE. THE WORKERS'COMPENSATION POI-TCYDOES NOT PROVIDE COVERAGF,FOR GIANFFERAN E NICH6"S F: CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE BUILDING DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BED ELIVERED IN ACCORDANCE 200 MAIN ST WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I1YANNIS,MA 02601 ACORD 26(2009/09) 19W2009 ACORD CORPORATION. All rights reserved- f Proposal#0418Zol 1 5 of 6 Contractor Arbitration . The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an alternative to court action)if they have a dispute with a contractor.The same right is not automatically afforded to a contractor,however.The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below.This clause would give the contractor the same right to arbitration as is.afforded to the homeowner by the Home'Improvement Contractor Law: The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter 142A A. Contractor's Signature omeowner's Signature . NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor.The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 1.42A) and. other consumer protection laws(i.e.MGL chapter 93A).may not be waived in any way,even by, agreement.However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed bylaw:'Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law.The contractor is responsible for completing the work as, described, in a timely and workmanlike manner.Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials.In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the tenons of the contract as long as they do not restrict a homeowner's basic consumer"' rights.If you have questions about your consumer/homeow_ ner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached.Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable.One original signed copy of the.contract with attachments is to be given to the owner and the other kept by the contractor.Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure.However, in instances where a contractor deems himtherself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite . to continuing the contracted work.Withdrawal of funds from said account would require the signatures of both parties. r- _ Office of Consumer Affairs and usiness Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 0211`6 . Home Improvement Contractor Registration Registration: 120372 f Type: Individual _ - Expiration: 12/3/2011 Tr# 290658 - --'-� DANIELLE ENTERPRISES NICHOLAS GIANFERANTE 10 Charles Street SANDWICH, MA 02563 Update Address and return card.Mark reason for change. Address n Renewal Employment Lost Card DP-'—CAI 0 50M-W04-G101216 71. License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR. Office of Consumer Affairs and Business Regulation Registration '-.1.20372 10 Park Plaza-Suite 5170 Expiration2f32011 Tr# 290658 Boston,MA 02116 Type: #ndnntluai t. DANIELLE ENTERPRISES- ,i NICHOLAS GIANFERA6Tr1~ IA 10 Charles Street SANDWICH,MA 02563 -`' Undersecretary Not valid without signature Massachusetts- Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License License: CS 50328 NICHOLAS F 61ANFERANTE 10 CHARLES ST ' SANDWICH,-MA 02563 �—�— Expiration: 1/23/2013 ' ('ummissioner Tr#: 9032 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 F The Commonwealth of Massachusetts, ' William Francis Galvin Secretary of the.Commonwealth,Corporations Division One Ashburton Place, 17th floor Boston,MA 02108-1512 �1- Telephone: (617)727-9640 JHR WINGS, LLC Summary Screen Q Help with this form , Request a�ertlficate The exact name of the Domestic Limited Liability Company(LLC): JHR WINGS,LLC Entity Type: Domestic Limited Liability Company(LLC) Identification Number: 262026467 Old Federal Employer Identification Number(Old FEIN): 000971838 Date of Organization in Massachusetts: 02/25/2008 The location of its principal office: No. and Street: 508 MAIN STREET City or Town: CENTERVILLE State: MA, Zip: 02632 ' Country: USA ' If the business entity is organized wholly to do business outside'Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: - Name: GILL,DEVINE&WHITE P.C. No. and Street: 776 MAIN STREET City or Town: HYANNIS State: MA Zip: 02601 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First,Middle,Last;Suffix Address,City or Town,State,Zip Cone MANAGER REBECCA SUSAN HARVEY 562 MAIN ST. BRANFORD,CT 06405 USA The name and business address of the person in addition to the manager,who is authorized to execute documents to be filed with the Corporations Division. Title Individual Name Address (no Po sox) First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY MICHAEL J GILL 776 MAIN STREET - HYANNIS,MA 02601 USA SOC SIGNATORY CARLA MAZZA. 4156 MIDDLE ROAD COLCHESTER,VT 05446 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 5/31/2011 Thq Commonwealth of Massachusetts William.Francis Galvin-Public Browse and.Search Page 2 of 2 r Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY CARLA MAZZA 1156 MIDDLE ROAD COLCHESTER,VT 05446 USA REAL PROPERTY JOHN MENZIES• 1803 N.MOHAWK,UNIT B CHICAGO,IL 60614 USA Consent _ Manufacturer Confidential Data Does Not Require Annual Report Partnership X Resident Agent For Profit Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS f- Annual Report Annual Report-Professional Articles of Entity Conversions Certificate of AmendmentC= x V�ew Filing*7 1 '; u7,f New Search ,x; Comments O 2001-2011 Commonwealth of Massachusetts All Rights Reserved Help. http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 5/31/2011 TOWN OF BARNST ABLE.BUILDING PERMIT APPLICATION Map ,�01 Parcel`_ 6 Application # Health Division t • Date Issued l C) Conservation Division Z- Application Fee Planning Dept. Permit Feb Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 57)O M.AW ST Village CL nne Qyi l I Owner_`The WA-0 &mao T-bbA) Address F crk Z Z 3 , /ti14,r."i (ff Telephone v�3 - 2 �/S= 7 s00c) ' L A:� rl-}AL-v Q t✓�tI G-ry io p b in. co-..., OG �3 Permit Request "Plod 6112C-Cc,�WBJLt- t S+ RwA 2C0/V\. &vd go-d acov-1 1� . CAO-e- A d oS e l C u&rre,+1 y Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation J 0/4r10 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 10D qfS + Historic House: OD Yes ❑ No. On Old King's Highway: ❑Yes UAo Basement Type: 4-Full Qtrawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new 9emod d Half: existing 0 new _ Number of Bedrooms: existing 3 new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑Other CD Central Central Air: ❑Yes YNo Fireplaces: Existing New Existing wood/coal stove: ❑S_Y&s �No 5.y.: e C) Detac : ❑ existing ❑ new size_Peot--. ❑ existing ❑ new size — r ... existing 0 ne�"a size_ co Attache Gage: ❑ existing ❑ new size _mod: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes W(No If yes, site plan review# Current Use 51U11f P4m;1!1 40Mf- Proposed Use S)A)JlF FP^JJ HV/4& APPLICANT INFORMATION f ((11 _ (BUILDER-OR HOMEOWNER) Name Ochc)l os' �FfAA RNr Telephone Number Address 10 C NA-916Y E( License # 5i SSANc With, P/44 Home Improvement Contractor# A;703V Worker's Compensation # wC 0�U ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE / � A o2010 ► FOR OFFICIAL USE ONLY APPLICATION# ' U DATE.ISSUED 1 MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME L'L�6� 7lt.h o INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO The Commonwealth"of Massachusetts: Department of Industrial Accidents 0 iice'ofl"nvesdg'ations , Y 600oWashington Street t 'Boston, MA.02111 y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrictans/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatior0ndivi dual): Address: t(7 C � City/State/Zip:. Wt1(." �fl �� Phone #: 69 Zwo Are you an employer?Check the appropriate box: Type of project(required): I I am a employer with 4.�D,I am a general contractor and I 6. ❑New construction employees(full andlor part-time).* have hired the`sub-contractors . . . .. _ listed on the attached sheet: 7. ❑,Remodeling 2.0 I am a sole proprietor or partner ra , ship and have no employees These sub-contractors have g; 0 Demolition and,have working for me in any capacity. '- employees .. ,.,workers' 9. ❑ Building addition - NO workers' comp.insurance comp..insurance. G required.] ` S. We are a corporation and its 10.0 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 12.0 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.in formation. t Homeowners who submit this affidavit indicating they are doing all woik 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 p'olicy and job site information •e Insurance Company Name: ?flNh � S` Policy#or Self-ins. Lic.#: W D O l 6 T Expiration Date:T&_ ZO II Job.Site Address: SAD MA n1 ` 'Ate Vt U L City/State/Zip: /"I v,f• 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.. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. fitS1>rnature � Date• K ' 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 L 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. defined as "...ever person'In the service of another under any contract of hire, Pursuant[o this statute, an emploJ ee is Y P 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 le gal.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 f dwelling house of another who employs persons to do maintenance, constriction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employmentbe 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 conunonwealth 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 tbe4orkers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone Munber(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, AIso 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 wodkers' 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 licenses. applicant as proof that a valid affidavit is on file for future permits or A new affidavit must be fillCd out each year. Where a home owner or citizen is obtaining a license or permit not related to any business d commercial venture (i,e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavi I. 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. 4 617-727-4900-ext 406 or 1-877-MASSAFE Fax 0 617-727-7749 Revised 4-24-07 www.ina,ss.gov/dia ENE RGY'CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR -ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Site Address: 10'_ AAWN sr Applicant Name: �LC�1a��� CW � J print +'Town: Applicant Phone: 6bg Application:cation: /5 1701 a -- ,. Applicant Signature: (�! �—� Date of PP NEW CONSTRUCTION: choose ONE of the following two o tions 1 iji It 12,EP lice ,=Nsul An04) ;Au &)d-e'12780 CMR TABLE 6107.1 WPHIS whore WA RESCRIPTIVE ENVELOPE`COMPONENT CRITERIA FOR Are 1-cm ovaA NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM MINIMUM Ceiling or Slab ' Basement ❑ Option 1: Fenestration exposed Wall Floor Wall Perimeter AFUE' HSPF SEER U-factor floors R-Value R-Value R-Value R-Value R-Value and Depth National Appliance Energy t R-10, Conservation Act(NAECA)of 35 R-38 R-19 s' R-19 R-10 4 ft. 1987 as amended,minimums or greater as applicable Note: This form is not required if you choose either of the two versions of REScheck as listed below. ❑ Option 2: RES check Version 4.1.2 or later variant software analysis must be completed 780 CMR 6107.3.2 REScheck—.Web which can be accessed at http://www energycodcs.�?ov/rescheck/ ADDITIONS OR.ALTERATIONS,TO EXISTING BUILDINGS.OVER.5 YEARS OLD* i. *Buildings under 5 years old must use option 41 or 42 in New Construction section above.. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equ4ls Formula- (100 x b - a) 233 f SF 100 x l — 2331 _ ,% of glazing: b a (b) Glazing area equals'.�10 SF If glazing is:<_ 40% use the chart below. If glazing is > 40.% ptoce6d to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE-RESIDENTIAL BUILDINGS MAXIMUM MINIMUM ,'`Ceiling and Slab Perimeter ❑ . _ Fenestration Exposed floors w all ' Floor Basement Wall R-Value U-factor R-Value R-Value R-value R-Value and Depth .39 R-37 a R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation maybe used in place of R-31 if the insulation achieves the full R-value over the entire ceiling area(ie. not com ressed over exterior walls, and includin an access o enin s). SUNROOM-An addition or alteration to an ekisting building/dwelling unit Iwhere the total ❑ glazing area.of said addition exceeds 40% of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer.Information Form (found in Appendix 120.P) -mar- 7. 2414 11:43AM Insurance Agency of Cape Cod No..9579 P. 1 k.wCERTIFICATE OF LIABILITY IN PRODUCER (sos)ee8-2766 F INSURANCE = (506)833-0909 3/5/2010 The Insurance Agency og Cod ONLY � -m M&Is 480 Rt.® RUED A3/[(MATTER Op INF0jWT10N P 0 Box 960 �F�$ ��DOES UPON THE CWFICATE A COVERrgGn ECgFFORDE�8Y TM&M' EXTEND OR E Sandwich E PQUCIES BELOW. N8ILRED 1� 02537: MISURERg cholas F, Gianferan ORDlNt3 CpyERAGE NAiC M 10 Charles s etn�farleysmlie iPo zcester treat I►�SURdi i safety Insurence CQmp Zua Co Salndwj KWRR eGranite 3t Wig- y ate -Cy COY 02563 D: ERAGE3 �rsuRErze , THE POLICIES dF INSURANCE LISTED BElQyy M ANY REQUIREMENT.TERM OR CONOTlION BEEN ISSUED TOY C T'HE INSURED mm 1 I'll MAY PERTAIN,THE INSURANCE AFFORpED f3Y THE FUSS DEOR OAR DOCUMENT TM RESPECT FOR pP0liG1f p�ipp fNDICJ►TED,N07VyITHSTAN DING I'OUCtES.AGGREGATE L 6141TS SHOWN MAY HAVE �®HEREIN IS SUBJECT TO ALL THE TES THIS ON3 AND CONDITIONS U INS Da BEEN REDUCED 8Y PAID CLAIMS,- �MAY ISSUED OR �►+�RALLumury Ct'NUaURae PnuC'E THE PaucY _ SUCH EIIPUU►T�N A COWERCM MWER& lnY Ulan 6�IAOE-Q OCCUR 883986 . ' x -` DA E TaOcc R c..p s - '1.GOO 000 3/27/2010 >SEs 3/27/2011 100,00o _ uEDa�taun�ore�n 3 _5.000 GENY,aCGMGAtEullSrpPPtiESPER PERSOnpL&.AM g 1..000,000 X POLICY R Lac a ( NERAt AGGREGATE i 2.000.000 pI1T0>tiDg►I F LUURLI}y, PRODUCTS COMPlOP � s :z,000,000 AVYAUTp ALL OWNED AUTOS j M'uMT a ? X SCHEOULEOA�rrpg 999527 8/14/2009 $/14/2010 HIRED aU►OS 006atr vjmw "ON-OW DAuros ? : 100000 (P-ems}Y s 300000 UNAGE LIAemm PROPERITUMMOE fpw 806fto 3 . 100000 ANYAUTO AUTO ONLY-EAACCIDENT ; TSB/UOIBR131AA LIAgILTM OTHER T"M EA Ax S (�( AM W&r OCQM `J CLAM MADE a AM x EACH OCCURRENCE. DFDUCT&!LE : ,: AGGREGATE _ RE7ENTtAN S 3 C WOR)W SCOMFERsmIDN s ANDEM 4 OFFl ANYP (Mama jnW Y/N - ... 5 ama u, QED' wC sraTU. oY►� '� sd:6 Ionsedoa, 008 291.-398 311512010 �-EACKACpOENT 3/15%201 3 100000 OTHER E.LrDtSEAtiE-EAEMpLp S - EL DI 100000 DISEASE s 50041 000 D�CR►PT►ONpFOPeRATgpgr�►TtoNsivr�LEsr�Us�SAoom • • . OYI�ORSEI�IT/SP6QALPRO1n31ONS • . CERTiFlCATE HOLDER ; Town of CtathamrBuildi CT F 549 rain Street � �t*' THEADMInaSC CDMLM= eeaacea� a DATE TNEREQp,THe�81NEiti a+sUR wu L.ENOEAVan tD oftCATION �� , > 02633 T C�►TE UDLOER NAW T07"E LT.EurFA%Vwr00OSQwpm In SHALLREVREgENT !an ttAaLttY or ANY mNa u t nS AWWR OR ACORD 26(=9101) Tin INS025 The ACORb"Me and 9 1888-2008 ACORD CORP TION. All rights+esew00, logo are Istere� �ft of ACORD .. Office of Consumer Affairs andfwiness Regulation 10 Park Plaza- Suite-5170 Boston,Massachusetts 02116 Home Improvement Contactor Registration z Registrafi"on: 120372 r- F Type: Individual Expiration: 12/3/2011 T1# 290658 DANIELLE ENTERPRISES NICHOLAS GIANFERANTE = '' 10 Charles Street SANDWICH, MA 02563 Update Address and return card.Mark reason for change. "- Address Renewal F1 Employment Lost Cara DPS-CAI 0 50M-0004-G101216 ✓fie�oavnw,wlva�t a�.�aaaaclr..�aelt .___ ____ . License or registration valid for individul use only UiOffice of Consumer Affairs&Business Regulations before the expiration date. ff found return to: HOME IMPROVEMENT CONTRACTOR. Office of Consumer Affairs and Business Regulation Registrati"0372 10 Park Plaza-Suite 5170 s Expiratiorc # 3t1011 Tr# 290658 Boston,MA 02116 TYPe= iielnndua DANIELLE ENTERPRISE = NICHOLAS GIANFWNT1= 64 10 Charles Street SANDWICH,MA 02563 - Undersecretary Not valid without signature I - Massachusetts- DepartnIC-4 11f Puhlic Safe" 4 Boarif of Building Re;sulatiune.and Standard%.: . Construction Supervisor License License:-CS 50328' Restricted to: 00 ' NICHOLAS F GIANFERANTE =- 10 CHARLES ST SANDWICH, MA 02563 Expiration: 1/23/201f ('ummi •irncr Try: 8587 Town of Barnstable Regulatory Services Thomas F:Geller,Director Aiep • , Building Division Tom Perry,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 1Z N 2 1 E_--S as Owner of the subject property hereby authbrize N l C k G 1 A N FF rI A.&J %4 to act on my behalf, in all matters relative to work authorized by this building permit application for (Address of Job)lo - -- - - May171� 2� ( v S Pikc.Name — - If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION t r ®Boise Cascade Double 1-3/4" x 114/8"' VERSA-LAM® 2.0 3100 SP Floor Beam1F1302 BC CALC®3.0 Design Report-US 2 spans No cantilevers 1 0/12 slope Monday, July 19, 2010 Build 440 File Name: BC Job Name: Costa Description: FB02' Address: 510 Main Street Specifier: Nick Gianferante City, State, Zip:Centerville, MA Designer: Nlck Gianferante Customer: Costa Company: Danielle Enterprises Code reports: ESR-1040 Misc: Living Room Beam I I I I I ( I I I I I I I I 1I I I I I I I I I I 13-00-00 07-00-00 BO,3-1/2" B1,3-1/2" B2,3-1/2" LL 2,229 Ibs LL 5,292 Ibs LL 1,329 Ibs DL 605 Ibs DL 1,478 Ibs DL 151 Ibs UP 636 Ibs Total Horizontal Product Length=20-00-00 - Live Dead Snow Wind Roof Live , Trib.(in.) Load Summary Tag Description Load Type Ref. Start End 100% 90% 115% 133% 1M 1 Standard Load Unf.Area(psf) L 00-00-00 20-00-00 40 10 10-00-00 Controls Summary Value %Allowable Duration Case Span Disclosure, Pos. Moment 7,209 ft-Ibs 33.9% 100% 14 1 -Intemal Completeness and accuracy of input must Neg. Moment -7,833 ft-Ibs 36.8% 100% 1 1 -Right be verified by anyone who would rely on End Shear 2,178 Ibs 27.6% 100% 14 1 -Left output as evidence of suitability for Cont. Shear 3,300 Ibs 41.8% 100°! 1 1 -Right particular application.Output here based Uplift 636 Ibs n/a 14 2-Right on building code-accepted design 0.188" , 29.5% 14 1 properties and analysis methods. Total Load Defl. U814 ( ), Installation of BOISE engineered wood Live Load Defl. U1,020(0.15") 35.3% 14 1 products must be in accordance with Total Neg. Defl. U-2,588(-0.031") 9.3% 14 2 current Installation Guide and applicable Max Defl. 0.188" 18.8% 14 1 building codes.To obtain Installation Guide Span/Depth 12.9 n/a 1 or ask questions,please call (800)232-0788 before installation. %"Allow %Allow BC CALC®,BC FRAMER®,AJS rm, Bearing Supports Dim.(L x W) Value Support Member Material ALUOISTO,BC RIM BOARD-,BCIO, BO Post 3-1/2"x 3-1/2" 2,834 Ibs n/a 30.8% Unspecified BOISE GLULAM- SIMPLE FRAMING B1 Post 3-1/2"x 3-112" 6,770 Ibs n/a 73.76/o Unspecified SYSTEM®,VERSA-LAM®,VERSA-RIM B2 Post 3-1/2"x 3-1/2" 1,480 Ibs n/a 16.1% Unspecified PLUS®,VERSA-RIM®, p VERSA-STRAND®,VERSA-STUDS are trademarks of Boise Cascade,L.L.C. Cautions Uplift of 636 Ibs found at span 2-Right. Notes Design meets Code minimum (U240)Total load deflection:criteria. Design meets Code minimum (U360) Live loaddeflection criteria. Design meets arbitrary(1") Maximum load deflection criteria. Connection Diagram �{b d a 04 • O� �Eiri,cJ tD Q Gvz; 'G �H'EETe a minimum=2" c=7-7/8" b minimum=3" d= 12" Member has no side loads. Connectors are: 16d Sinker Nails 4 Page 1 of 1 PROPOSED LAYOUT REMOVE DOOR REMOVE 1 WINDOW Tile Q NEW CABINETS , BATH NEW WALL ' QUEEN BED P c n (\(v\ KITCHEN NEW WALL Laminate Flooring NEW MASTER BEDROOM CLOSET O N 0 carpet Z�ca LIVING AREA REMOVE DOOR REMOVE 1 WINDOW Laminate Flooring RELOCATE 2 WINDOWS PROPOSED INTERIOR CHANGES �rrCr� Nrr� Tt� I�or� � nl0 I"I11IN 5TPfn_ CENTS, A-1-f, /V DPt1WN i3Y; _ 10 CHARLES STREET 5c�: �/4„��,^O„ 5 OF 5 DI &I -E DANIELLE ENTERPRISES . - SA cHAK MS 02563NI GK �I/U V���/l/ V l � 9 2]/��; 508-280-9896 roc r r AY '7n 1n Y r��,r R, „' lj.n� .-, Y ►' _ M•��aY i. r Y ` (' t lt,- l k * k�'�r'i f, v.�,7a• F^�, i i r a. "t 1 �� r�'+ �r .r�.>?-5§. 'i5.'"'�°` - - 1`;'�'"" i^,�'4 k..s ,"�:;. - �` .. .a��i- ttr!'?�" .. "- c., - ,"i i •'.. } •.: `.:w � .:'C,s; ,.:� ,,-.. v' s `. tic,.r .»3 ., t ' ,� .- .:.. JIM 15 ,art"�,D♦fit,.t �.... - sr, larw.e� _ _ _. - wf;►,�uua,ti:yN,E"W`i�rtiNe'3,��: i I 'i'.."r r,,fi�''h,.p1+M' pr>alc?+w1 aan _�*# .• . 11ir+e�, "�;.+��.C7Y�e j�:A:a ► I. ' G i_'i 10 ke� r xr a YYt le 7i1 Lod sr+?• �yN Y:A.. _ Ai.'tr,""..♦aW�♦T fie•..Y1 I 'z' • I......... ■■■ .............� ■■■ ,.......... • • so .........� I■■■■■■■■■■■■■ MESON I■■■■■■■■■ .■■■■■■■■■■■■i i■■■■■■■■■■ .■■■■■■■■1 ■■■ I■■■■■■■■■■■■. ■■■ ■■■■■■■■■■I I■■■■■■■■■ .■■■■■■■■■■■■I I■■■■■■■■■■ .■■■■■■■■I I■■■■■■■■■■■■■ ■■■■■■■■■■I I■■■■■■■■■ ■■ .■■■■■■■■■■■■I ■■■ I►■■........ .■■■■■■■■L------J■■■■■■■■■■■■L---------1■■■■■■■■■I I■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■. immommom sommosommom moommmsm IN ON immosommommomms, i ' l 1 1 • • I s r art. y Lef-15111N GL-E PE1110VE WINDOW 1� 17OVE D00p BACK SIDE- ELEVATION NO CHANGES THIS SECTION I Jill n10 IVIN 57"P)fE7- GEN7- I�l/ILL , l''Itt F-)PAWN 1PY; 10 CHARLES STREET , O„ PAGE: 2 OF 5 D ® E SANDWICH MA 02563 DANIELLE NICK C�lt}N��1��}NT� DanlcJlcenlcipix� ENTERPRISES 508-280-9896 14 MAY 2nn 1 EXISTING LAYOUT REMOVE REMOVE DOOR WINDOW sink Water Heater RECONFIGUR NEW KITCHEN CABINETS BATHROOM PARTITIONS NOTE: KITCHEN REPLACEMENT WINDOWS TO BE z�a INSTALLED IN THE EXISTING OPENINGS UNLESS OTHERWISE REMOVE WALL REMOVE WALLS NOTED DEN Laminate Flooring . REMO WALL BEDROOM o N acc8 LIVING AREA REMOVE DOOR Laminate Flooring ' REMOVE 1 WINDOW ' RELOCATE 2 WINDOWS PROPOSED INTERIOR CHANGES PTcr1ENirPATr1Pf/10 ft- �5/O /1A/N STPff GENFf VlLLE, /\/A OPAW1v py; 10 CHARLES I SANDWIC STREET D s E DANIELLE ENTERPRISES 508-280H98 6 02563 DA7TE, iPEVISION.• NIGK 6/�filV��1�t�N7"� Dm'dlc�rderplx. �a MAY 3 Nw N 16X22 E NK --- V)--- —� -- -----EI.JLL_CEl1JNG_hEI.1- — -- a4 ---- --------EULL_CEWNG-HEl;HT ---- U v z�ce 32 Tile BEDROOM 2 BEDROOM 2 ADD BATHROOM Paint Floor O J O Q N Q = BEDROOM 3 N = BEDROOM 3 ———— ——— ——_——— FULL CEILING HEIGHT ————— —_ ————FULL CEILING HEIGHT t . EXISTING LAYOUT t . PRO-POSED LAYOUT 2ND FLOOR PLAN ' n10 MAIN 5T1pjfftf_r O1'ttWN DY; 10 CfWU ES STREET 5c,�: PAC7f. 3 OF5 D s E DAN I ELLS ENTERPR I SES SANDWICH, MA 02563 NICK 61A1VfTp1V T1 Danldlc enluPdx, 508-280-9896 1 DArE, 1.4 M av '21-)1n lztVlSION: