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HomeMy WebLinkAbout0039 SHUBAEL GORHAM ROAD Qmoon r °Fs .r ` 'own of Barnstable -Permit# Expires 6 months from issue dare Regulatory Services Fee � M � 1.1RN 07 STAla 'Thomas F. Geiler, Director 7�, 1639. .�� Building Division Prep tAn't a Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstab1c.ma.us Office: 508-862-4038 Fax: S08-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY t-7 i Not Valid without Red X-Press Imprint Map/parcel Number TT— Property Address FSI ��`�( l �f 'd [1 Residential Value of Work �����t 0 Minimum fee of$25.00 for work under $6000.00 Owner's Name Address C'� F�Iq Contractor's Named�',L —I iC }�j"A Telephone Number Home Improvement Contractor.License#(if applicable)�f ❑Workman's Compensation Insurance PERMIT Check one: ❑ I am a sole proprietor ❑ I am the Homeowner OCT 3 Z008 [—rI ave.Worker's Compensation Insurance vr®WN OF B/aRNSTAKE Insurance Company Name /n-,,� V L�� A / /�{�. 4 � Workman's Comp. Policy# Copy of T�surance Compliance Certificate must be on file. Permit Request (check box) dRe-roof(stripping old shingles) All construction debris will be taken to C A6 ❑ Re-roof(not stripping. Going over existing layers'of roof) ❑ `Re-side ❑ Replacement.Windows/doors/sliders. U-Value (maximum..44) *Where required: Issuance of this permit does not exempt compliance with other town departrnc"ut lations,gj.Mgp,Jc,Conservation,etc: ----`JJff A/C 'Note: Property Owner must sign Property Owner Letter of Permission. A'�`"'— -• A copy of the Home Improvement Contractors License is uired. 30 992 SIGNATURE: QAWPHLESTOFMML-61d.ing permit forms EXPRESS.doc NOTICE NOTICE TO TO EMPLOYEES K EMPLOYEES The Com- monwe alth ®f Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENT'S 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I(we)have provided for payment to our injured employees under the above mentioned chapter by insuring with:. . ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE, P.O' BOX 4070, BURLINGTON, MA 01803-0970 ADDRESS OF INSURANCE COMPANY AWC 7016215012008 01/10/2008 - 01/10/2009 POLICY NUMBER EFFECTIVE DATES P O Box 494 Leonard Insurance Agency Inc Osterville,MA 02655 (508)428-6921 NAME OF INSURANCE AGENT ADDRESS. PHONE Mark Herbst 35 Peep Toad Road Centerville, MA 02632: EMPLOYER ADDRESS 01/04/2008 EMPLOYER'S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. . A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonablb cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified that the insurer has arranged for such attention at the - NEAREST.AND.BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS r TO BE POSTED BY EMPLOYER The Commonwealth of MasSCicArtsetfs Department of Industrial Accidents Office of fnYestigati.ons 600 Washington Street Boston, MA 02111 www.mass.gcv/dia Workers' Compensadon Insurance Affidavit: Builders/Contractors/Electricians/P lumbers A licant Information Please Print Le `bl Name (BusinessJotaaizafzonJInaividual): ��- e � s • Address: c� .• 1 D(�-� �� _• _ City/Statc/Zip: Cco Phone.#: ly �-b Are you an employer? Check the appropriate box Type of prof ecf(required): . 1.�r am a employer with 4_ ❑ I am a general contractor and I 6 ❑Ncw construction employees (full and/or part-1jmL).* have hired the shb contractors 2-❑ I am a sole proprietor or pariner- listed an the attached sheet 7. ❑R..emodeling ship andbaveno employecs These sub-contractors have g• ❑Demolition employees and have workers' working for me in.any capa�ty: $ 9. ❑Building addition [No workers' camp.'m Cntt�nc God-1S7stlranGe. 5. [] We arc a corporation and its 10.❑E1cclxical repairs or adriiti r6quirni] officers have exercised their 11.C1 Plumbing repairs or additi 3.❑ I am a homcowncr doing alt work myself; [No workers' comp_ rigjit 6f exemption per MGL 12 [ oaf repairs ir,srrr�ncc r d� fi c- 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.in&uraricn required.I *Any aPpliannt&iat chxkc bOX#1 roust also till out ffic=Ccftn lydrJw showing their warkas'cnr0PM=fi-ML poficy infMTM imt t Horncownat who submit this effidavit indcafing Seep=doing aIl workand than biro out Ads contractors miist mbn it anew a$bavit indicating wdl- YContiacinrs tlixtebak thin baX mast atiatlicd as additional shoat showing the name of the sob-cantratturs and st&whether or not thosd entiba have c su it cWTr have 1 tb must i&then- VvM :- 'coinP•policy number. car-cployccs. If th b-con ���, e3' PiII� I am arc employer that is_providing workers'compertsa.don insurance for my employees. HeLaw is the Pc ry and job sift ircformatiort. Inm-zmc-Comp any NaTn :_ n\" Policy#or Sc1f ins.Lie.#: U0 b Expo tion Date: Job STtL Address: I" 'J �fL�` \r3 ► I Clty/St3tt Zip: Attach a copy of the workers' compensation police declaration pace(showing the policy number and ezpirafion der Failure to secure coverage as required under Section 25A of MGL a 152 can Iea;d to thr imposition of crirtan.al pcn dtics c 5nc up to S 1,500.00 and/or one-year mprisonmcnt, as well as ciVA penalti-es in the form of a STOP WORK ORDER and of up tv S250.00 a day against the violator. Be advised that a copy of this statLmarit maybe forwarded tD the Ogre= of ITrymfigAtions of the Mk for insurance coy, e y cation.. I do hereby certify under th airs-an en of perjury OF at the information provided above is true and correct Si Date: %d Phone#: ofj7cw use only. 1}o not wrlie in this area, to be completed by city or town offcciaL City or Town: Permit/Urense# Is Aag Authority(circle one): 1.Board of Health 2.Building Department 3. CitT/Toym Clerk 4.Electrical Inspector S.Plarnbing lagpectat' 6. Other Board of Building Regulations and Standards HOME I License or registration valid for individul use only MPROVEMENT CONTRACTOR before the expiration date. If found return,to: n Registration 126.480 Board of Building Regulations and Standards Ezpirat�on 618/2010 ' Tr# 267766 One Ashburton Place Rm 1301 71 -p` f Boston i Type Indiuidual ,Ma.02108 MARK HERBST i ei j MARK HER BST , fi'3 1` 35 PEEP TOAD RD f� r CENTERVILLE, MA 02632� Administrator Not valid without signature 7 S O�� ..- fk,� • a. i. ! ,y" } it•`hY F 4Ztl �C�i '�i-s x 4• .t4S, ' b,. z t�' } s t a r fi 2 F� 3ux x 1L ' /_ t t h" 5 :�r{ rwr vi.' -..t \ ofli - ifaP� A...F+ • • 11� c7 `� 1? 5 �' f 8 � >9 Fs ; C ys gtl t. Y, nz. d ryf s.,y sv ,,a N -l - F s"'4•sJ�-_' f � � . t ^ ,1VIA kHERBST 35 PEEP TOAD ROAD r CENTERVILLE MA 02632 508-420-6216 CELL PHONE 774-238-2938 www. MarkHerbst.com PROPOSALS TED TO: WORK PERFORMED AT: � Ed Fhavlin 39 Shubael Gorham Road SAME Centerville MA 02632 508-428-3008 We herby propose to furnish the materials and,perform the labor necessary for the completion of the • following;New Roof Remove I layer of existing shingles Install 8"drip edge " Install ice&water shield at edge&in valley areas a Install 151b.,felt paper Install Certainteed Woodscape 30yr. shingles Color=Birchwood Cut ridge&install cobra vent Replace plumbing boots k Storm nail all shingles All debris cleaned daily krn Price includes material labor&dump fees , , F : All material is guaranteed to be as specified.The above work will be performed ft accorandance with the specifications submitted and completed in a substantial workman-like manner for the sum of; Eight-Thousand Three-Hundred& Twenty dollars(,$8r3-- -06—)with paym nts as follows;full.amount due upon completion E YAny alterations)from above proposal involving.extra costs will be added under'a separate written agreement and become an extra charge.: RESPECTF LY S ED:: %�.. r k 09-16,-09 367- Mark Herbst ; Y. ACCEPTANCE OF PROPOSAL The above price,specifications and conditions are satisfactory. We herby accept this proposal. You 1 s are authorized to do the work and payments will be as specified above. L SignatureZL :1 / u *This proposal may be withdrawn by said company if not accepted withiaa,30`days e , } � 1 ".x"x rr kz , 6 e wyl �ck r 2r 47 Y ° Y u t4 s t � , � E.:i '� � �'�9 �t6' t'k ff .qf �7� A fs'�'S aHa�t t�ti• F� "''; i x a 1 s t � r �^.: r .f tf�' zir:: k � �+. �;,n 4�u 5.>•,�r�t� � ���r�s„,� fs7���`��'�'.F`a rti d� �s, -.t 1 `1 tF �s �� y i�"��t J y7�' �r 4 �+�� , u,.� - .' ,�.,<..v..�r._Y.,,.5,v_ .,r�,3„xfnea�,r>•s>`L;3.-aAe1 t ,--:,� 4 -'TOWN OF BARNSTABLE_ -- Permit.;No =-----20889 1 V:sr>rPYP Building Inspector Cash $304.oho i y i t6,0 -.. OCCUPANCY PERMIT - --No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarg.e.d use-without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until'a certificate of occupancy has been issued by the Building Inspector. Issued to Alan Small Address Centerville lot 0135„ 39 Shubael Gorham Road, Centerville Wiring Inspector S / � Inspection date - Plumbing Inspector, e �r� Inspection date Gas Inspector- Inspection date /,'Engineering De artment /.� �. inspection date, THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE• OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR` UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. - l1 e � t .............. ........._, 19 k .............. ,..Building..Inspector............. �� QCI GA2'aAAGf-r- t>&l %4 F'Wwv SEP'T't G TAB.l tC = SSO,r f G 7, ■ 4-95 6.P. U Ste: i Oc?© 6�s,t_. ! Pam-t�•�i �j�? C�%--r.4 ,��r TO-rAlr "C7EStGt.l = .r 25 F?D. r t7A.t�t_`-( Fi..Uvc/ = 33D c5 PU. / 7 LL,{ pt1 *• /� ' GpL&TloLj tZATE= t"tw 2kt € 02Vr l _ Y�Y ze • 4 � Tor Pwo s tcaa.o LoAc c,=. 4'Prp� �w. �aQL. q�7 ' Sepnc t p' t -ro�K loon FIT A ��� t N N ♦� WASMPM r� mE-- STOWE IIlr� -F--Z TtFtEfi� pLc,'T- OF-11... GGA T!D N 4 t/l raGALC t Lit t Get T1F�f Tl-4A*r TOG- WIT" 'Y`IAG AkJtr7 �iE"t`�ACK �'C4G.31QEitrlc�T'S d� TNt;. i...Ui" ��� ,'R46 4�' C ._ ..� "T'1415 V LA W l,$ U OT CA ,$ A W b 5 TE.2vu._Lr= a Art A54. AF?P U CA "-7 t-t,'t' er= USCG ro Dc-*t rt_t Mo,-4C t,.o lrt Ni._a _ � '. 2� . , � <; E v t Assessor's map and lot Aumb .. /....a.1 ......�. LRf,�5SEPTIC SYSTEM MUST BE Sewage Permit number .. - INSTALLED IN COMPLIANC '• B8SB9TAD ,E V1ITH ARTICLE.fl STATE Z L i House number ......:.... ............................................ SANITARY roao�M639 CODE AND TOWN 'Ea MAI a` RECULATIO , TOWN OF 'BAR,NSTAUIE BUILDING ., INSPECTOR APPLICATION FOR PERMIT TO ..........y. ....... ....................................................................................... TYPEOF CONSTRUCTION ...... .... ... ............................................................. . '......:.:........................................:. ...........................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for 9 permit according to the following informati n: Location .... ... /c—'J ' ��...................'........ .............. ........ ......... . -�°!��........ ..................... .. ............ ProposedUse . . �.�!' Q ................................ ........J...........,..................:...... Zoning District ............................. .. . ...................................Fire District ... ....... ......... .............. Nameof Owner .... ...................Address ........ ,................................................ Ile Nameof Builder ....................................................................Address .................................................................................... Name of Architect ..................................................................Address ............ ...... .. V Number of R oqms ....... ...................................................Foundation ... :................................................................ Exterior .. .. ............!.: ............................................Roofing ... . ......................................................................... ,tom Floors ............................................. ........................Interior ...... . ..: ..... ....................................... 6 Fieating........ . �.t.../..'..�.......................................................Plumbing ...... ., . .. ...............................:......... . Fireplace .d �� 6 ?... ... ...............................................Approximate Cost .... .:P..` ....'.............. Definitive Plan Approved by lanning Board -----------_______-----------19________, Area ..... . . Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnsta le regarding the above construction. Name .. . .............. . . ... ........... .................................. Small, 2lao 9 � ` � � 20889 one story No ................. Permit for .................................... � single family dwelling � ----.—.--.----------.------- / 39 3bubaeI Gbrbam Road Location -----_---------------. � Centerville � ^^--'—'---^----------^—'-----'' � Alan Small Owner —r...-------------------. i ' - ~ frame Type of Construction .......................................... ' . --------'—'---------'°------'' #l35 P�i'---------. Lot ----------- ^ ^ ' - December 5 , 78 ' Permit Granted -------------]g � note of Inspection -- . ----l� � � ~~'~ ~~ ^r~~~ ~ . ^ 72 PERMIT REFUSED ,~ .' --t---,--...�.—.--------- lV � � � � .—._—..—~------.--.--,------- . � .`-'--'---^'~^^`—''--'--~~--'^----' . . � ^ � ...—.......--.......--.--,......,-~—..~.—.. . ~ ' ^ . - . --^c^^^—'�--^---^—^^—'—'--'--,'—'^' � * lA ---�--..�---------.....-------. � . ................ ............................................................. . . / � ^� . arc y, - Assessor's map and lot number ..............�1........:f..... ... of THE to Sewage Permit number .........,.............. ")..F. .....................,...... row o� ��(fs�. Z BABWI ABLE, i House number '�"'�1' 5 9 9 MAO& ............�..................................6........., �p t639. ♦� 0 MPY a` TOWN OF BARNSTABLE BUILDING INSPECTOR 11�, I "ZI,/ APPLICATIONFOR PERMIT TO ........:..........................................................................................................:.......... TYPE OF CONSTRUCTION ... ►.. 1 --f- ^..................................................... S/z, -IN---11 .........................................19:....... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... ............................."(� �°',�v 1t F:. .......;Il � � .........'... ':..�...... :. '.: ... .......... ProposedUse Z!..1 /i..1: ..:..: ........................................................................................ ................................:..... ZoningDistrict .......�....�..........................................................Fire District ............................................................................... Name of Owner .........................` .:.` .`... ` .................Address ..............!.....�f. ?:�:�:� ............................................ jr el' Nameof Builder ........................................r..........................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... m Number of Rooms Foundation ...�.......................................................... ............................................................... Exterior .....Yr...: 4. s y. �� w, ,f 4 ............. ....Roofing ...t ...d......,....................................0................. ....... r Floors .......` `......� :.............................................................Interior rr /.rt,. f Lj Heating .............................Plumbing C. ~ ....: ........ ................................................ tr Fireplace ........................!... ?.. ..............................................Approximate Cost ......: .. .C.... �....................... Definitive Plan Approved by Planning Board ________________________________19________. Area ..... ......................... 7� Diagram of Lot and Building with Dimensions F ee ............ ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH �� i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. {..,Name 7.« '.... :. r- t r Small, Alan A=171-134 r ✓ ' No .....20889. Permit for ....,,, one story singl. ...e family dwellinG................... ...... . ...... Location .........39 Shubael Gorham Road Centerville ............................................................................... Owner Alan Sma3� .............. n.............. ............................... Type of Construction .........fr„ e .......................... Plot ............................ Lot ..........ttX.u.............. December Permit Granted .............................5 ...19 78 Date of Inspection ......................... .........19 Date Completed .............. ........................19 /1", PERMIT REFUSED .......................... .. ......... 19 .... ..... ... .... ........ � 1 ...........................;................................................... Approved ................................................ 19 ` ............................................................................... ...............................................................................