Loading...
HomeMy WebLinkAbout0063 VICTORIA STREET � �����u 6 b� ace- . � - Town of Barnstable *Permit# Expir 6 months fro 'sue date ' Regulatory Services F MASS! � � 039. r gARNSTABLE Thomas F.Geiler,Director . Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY - Not Valid without Red X-Press Imprint Map/parcel Number ��$ ' ('Y jo Property Address l(p 3 U l& 0 r I Q ��' Av(wmll Q EXM /Y( Residential Value of Work f �Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address��(/ �Q ��►� 6 3 f Contractor's Name Q Ae ,Z'Q''1 C- Telephone Numbek!!!�d9t/o '(aws Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Q r] [<orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [g'Thave Worker's Compensation Insurance Insurance Company Name 4 Zc Cza MC Workman's Comp.Policy#1.t/ 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 #of doors [�Replacement Window oors/ iders.U-Value (maximum .35)#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 of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 Authorization Form: I :�.:�Cc.�� �` •� as owner of the ' subject property, hereby authorize Baker &Associates to act on my behalf, in all. matters relative to work authorized by this building permit application for Address of property: 63 Victoria St. ; Centerville, MA Signature of owner: ✓ � Print Name: �' —� Date: The Commorm-ealth of Massachusetts Department of Industrial Accidents Office of lmtestigations rT t R 600 Washington Street Boston,M4 02111 ",*"wv.rnass.gov/due Worlters' Compensation Insurance Affidavit- Builders/Contractors/EIec.tricianslPlumbers �pplieaut Information Please Print Legibly Name(BuamsiiOtga=ation�ln&iidual): 5 4- Address C`tnr:�tate,•Ztp. i #_ t���6a ��� N _ :ire`•o an employer!Check the appropriate box: Tj Qe of project(required) I I am a over with emP l 4- ❑ I am a gel contractor and I _�_ 6_ ❑New construction tm entplaveea(full and or part-time).* have hired the sub ct;sctors y listed on the attached sheet_ 7. ❑Remodeling _ ❑ I am a sale proprietor or partner- ship and have no employees These sub-cuaixac#ors have 8. ❑Demolition - working for me rn any; c citt. employees and have workers' 9. [-]Building addition [No.corkers` comp. insurance ccmtp.insurance: required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 I_❑Plumbing repau-s or additions myself [No workers" comp. right of exemption per MGL 12.❑Roof repairs insurance required.]' c. 152, §1(4) and live have no employees.[No workm' _ comp- insurance:requared.] 'Any app kani itim checks box nI must also fill out the section below showing their weaken'compensation policy infarmation.. Finnieoauners who submtt=.his affidavit indicating they are doing all work and they trite outtside cons acmr>must submit a new affidaa n iadicatin�sat€6 n :f'onirac;ors=.hat chuck this box must attached am additional dim showing the time of the sty contractors and state whethff or not those entttte.s have emplovees. If the tub-contractors have mWloyees,they must pmide their workers'comp.policy number. I ant an ernplo,'1•er that is prm idng otorkers co radon insurance for ng Via}°ee& Below is the polio'nerd job sire info ral ation. Insurance Company Name:���/.Y'/F f�sll �0.4i1 - ---•--- Policy»or Self-ins-Lie.#:Z"61��2o�1f5 Facpiratiuu i f �/ , d Job Site Addtess.4 3 1 t .�L -hi'cryyll� t ityi5tatefzip:�ai :attach a cope-of the workers'compensation policy declaration page(showing the police number and expiration date). Failure to secure coverage as required under Section 2.5A of MGL c. 152 can lead to the imposition of criminal penalties of s fine up to 51,500.00 and`or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statem�t may be forwarded to the Office of 111 estigaticnis of the DIA for insurance coverage verification. I do)rereb" IA'cruder the pains andpenahies ofper uty that the information protided above is tnae and correct Si =ature:k Date_ I — i'hontr= - y I tl,(jicial use ortTt. Dv not+t°rTtet in this area,to be carnpt€ted by cite or town otciaf. CitV or Iow-v: Permit/License# __ Issuing Authority(circle one): I.Board of Health 2. Building Department 3.CItyrromm Clerk 4..Electrieal Inspector 5.Plumbing Inspector . 6.Other - Contact Person: Phone#: 6 Client#:9742 2BAKERAS ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE02/20IV1 0512/2011 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 be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT - NAME: Dowling&O'Neil Insurance AHcONN,EXc:508 775-1620 -.- 1-FAX Noi_5087781218 - Agency ADDRESS: . -------- - -_ - 973 lyannough Rd., PO Box 1990 -- ----— -------- Hyannis,MA 02601 INSURERS)AFFORDING COVERAGE. NAIC# ---------- INSURED INSURER A:National Grange Mutual Insura_nc INSURER 8:Associated Employers Insurance �- Baker&Associates,inc. - P O BOX 923 INSURER C: i INSURER D Centerville, MA 02632-0071 ---- --------- ---------._._,------- ---_------_-- INSURER E-------..__._-------- '-----------.^— _._.- INSURER F, - - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECVTO 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----- — ADDLSUER � POLICYEFF POLICYEXP r---------_.,__..._._.____.___.._-__.__ _____��._ - LTR TYPE OF INSURANCE _�INSR WVD _POLICY NUMBER MM/DDNYYY MMIDDIYYYY LIMITS- A GENERAL LIABILITY MPJ7223M 0411912011104/19/201 EACH OCCURRENCE -- $1,000,000 DAMAGE TO RENTED I 0 X COMMERCIAL GENERAL LIABILITY - ! - PREMISES SEa occurrence) $500,00i CLAIMS-MADE [A]OCCUR i MED_E_X_P(Any one person) -_ $10 000 ___- 4 PERSONAL&ADV INJURY $1 000,000 GENERAL AGGREGATE $2,000,000 _— GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 PRO JCT POLICY LOC AUTOMOBILE LIABILITY COMBINED LIMIT a t _ r BODILY ANY AUTO - _ > .Y INJURY_- RY(Per person) -I$ t ALL OWNED I SCHEDULED _ i AUTOS AUTOS - i BODILY INJURY(Per accident) $ NON-OWNED -- _ I PROPERTY DAMAGE �$ _HIRED AUTOS AUTOS i - Per accident) T UMBRELLA LIAR I •v - - ACH OCCURRENCE __ $ OCCUR 4--_— �,--� i 1-----`-- --- _- I EXCESS LIAR I I AGGREGATE -$ �— -_ _ -CLAIMS-MADE i _ _..T _— -- DED RETENTION$ — $ WORKERS COMPENSATION WC STATU- OTH= iANDEMPL EMPLOYERS' �I 104I231201 X LTQRYLIMIT$_,I --IER_. _ B. v/N j WCC5002454012011 4/23/2011 EL EACH ACCIDENT - $500,000 AND EMPLOYERS'LIABILITY OFFICER/MEMBER EXCLUDED? I__N I I N 1 A I - i -- -_ _ (Mandatory in NH) J.I E L.DISEASE EA EMPLOYEE $500 000 If yes,describe under I DESCRIPTION OF OPERATIONS belowIE L DISEASE POLICY LIMIT. $500 000 -` DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - t Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of s insurance shall be deemed to have altered,waived,or extended the j coverage provided by the policy provisions: j -CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE { THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Thomas Perry ACCORDANCE WITH THE POLICY PROVISIONS. i 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE_ t - ^! 4 { ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S804021M80401 LS1 f Massachusctts— Dcpiart ucm III Public 5afct• Roard of Buildin- R-gulatiuns and Stalidards Construction Supervisor License License: CS 9714 Restricted to. 00 RICHARD P GARNEAU JR A 251 WOODSIDE RD W BARNSTABLE,_MA 02668 Expiration: 414/2012 Tr#:'25310 %} = Office,d Consumer A fairs nd B n usl ess Regulation ' 10 Park Plaza - Suite 5-170 { Boston,Massachusetts.02146 Home Improvement Contractor Registration Registration: 162600 Type: Supplement Card Expiration: 3/26/2013 BAKER & ASSOCIATES INC. RICHARD GARNEAU 521 SHOOTFLYING HILL RD - CENTERVILLE, MA 02632 Update Address and return card.Mark reason for change. Address 7j Renewal ';Employment Lost Card SCA I L:• 20M-05/11 . 14 Assessor's mtap and lot number ... J31 � .......' ._ ,_. . OF THE Tp�� ,i v Pr n + .Zewag� ''Pe''r it number �. a9-. d r � , BARNSTABLE, i I 1 HoUS2ifi , number ................................�-P..3................................. 9�� Mb I 9. MR-(a�0 TOWN OF BARNSTABLE B U I L D I NO I N S P EC T-01 APPLICATION FOR PERMIT TO ........ ...f .L.� ......... ............................ V... )� � r TYPE OF CONSTRUCTION .........: ). . fi.er�...tXe.... ..........................................:.....................................: ...................l�.. . .........19...��S TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... ?... .....!... .......V(C7i?.1�.�..�/. ........ .! ..Y............`.. .` N '1/t..(. .... ............ Proposed Use ... &..5L/ /° ...4A..1.......1,���. j.�. ��.�. .��...t�.��?.f...�/.......................................... V Zoning District ....... .Sc.�:P..�.�.c�..(..........:.................Fire District ..................... r f AA// � Name of Owner ........................�r ..I , ..............Address ........... :�... .. ... .!!�. .•.4.:a�� wt S �fin 3 c� ... ... ..:�n Name of Builder ........ ! .. ......:................................Address ..................tl .,....... ......... :.E.... %f .. ...... .... U'd c ..............Address ........................................... Name of Architect ...... �'.��.�...�:...�a�..........n ..........:....:......................... .. Number of 'Rooms ............. 7.......r..........................Foundation V�� Exterior . ...J. .ln. . � ..J.....� �{.. �.L/(.���%!..L� "''cf'�fng ........../....! .. . .G'.. P....., . .�. ....... /I . Floors3/� L1 . . .... .......... ....t ......................... .............Inferior ......... Heating ....�5..../,.,.�..<'C. t. ......... .................... ..Plumbing ......... t� .. .................................................. t 'V l �S�� Sao Fireplace ..... ... .. ........... .. .. .... .. . ...�!.�... ........................Approximate Cost .:. ��1 �,.. ............ .:r.;.�_ Definitive Plan Approved b Plan PP Y Wing Boa•d --------------------------------19--------. . Area ....... ... . .....v ... ............... Diagram of Lot and Building with Dimensions Fee ..................... : ............. ......... SUBJECT TO APPROVAL OF BOARD OF HEALTH � � i- } _ a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the/To 'n of Barnstable regarding the above construction. Name .... i�. ... ......................................................... �. ConStructio, Supervisor's- License ................ .......... ..... COOLIDGE HOMES A=148-45 No 24953 permit for One Story ................................... Single Family Dwelling ............................................................................... Location ,Lot 11, 63 Victoria ........................................-... Centerville ............................................................................... Owner Co.olid. . ...ge...Homes .......................... .... .. .... .. .. ............. Type of Construction ........Fr. ame ................................. ................................................................................ Plot ............................ Lot ................................ Permit Granted „April 14, 83 .............................19 Date of Inspection ....................................19 Date Completed ......................................19 166 a I k r Assessors. map and lot number .............. oFTHE ro .. . ... ... . FSewage Permit number .... ` House number .............:...............MCP 3 ..........: �.,� 9 BABa LE.� ;. O/.!G jU TALLER R C0fN'1'?U"��Ct: �O i63q. `00 CIT �'0 TOWN. OF . Al Amg,,XAt E TOWNI MILDINS ' INSPECTOR APPLICATION FOR PERMIT TO �. ..�G'...1'Ca(.�'Ll'.�..1. " .lt.:.4 y /........ ....... ....................:..... )� v TYPE OF,. CONSTRUCTION .........�G1.�D..Q.�...Ji.P..�.�................................................................................. i ..................................` �. .. .a.........19...� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordiinng to the following informatio/n::�, Location .....Z.0..�....l..J.......1/f . C?.Y. .. !1........ /. .. /i..[.1 .. . ................................. Proposed ,Use ..... 1.�f•V`G°A-t a.j....... r�.�l.f✓lire ........ . ....... ( ..T✓ Zoning District .......M. ...�1':P P'1. ...1. ......... District .. ........ ...................................... .............. Cap e�eName of Owner ................... ......�GI�C/..!.......,...............Address ........... ( ��:... ..... .!!�. .......(�� �. Name of Builder ..... `..1..'. .....................Address ...........31-�... 5... `..�.. .../J a...1� 1......C.` .:C'/r'/� Name of Architect ......�i>°..(/�.....5...VY...............................Address ................................. ........ Number of ooms .......... ................. ....... ..........................Foundation ..... . T/.:L. . ....... Exterior �t �. ... .:.n.. . 5..... . �17 .........n U.l Floors : ...................................... .......... ...: ...........................................Interior ......... g � � :h.�, .....................:...:.............Plumbing ........Heating ........ Fireplace .... ... ........................Approximate Cost ............................. Definitive Plan Approved by Planning Boa - --- ----- - - t 9 -- --. Area ::. .. �. .. Diagram of Lot and Building with Dimensions Fee 7. ...... SUBJECT PTO APPROVAL OF BOARD OF HEALTH �� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the o n Barnstable regarding.the above construction. Name ... ......................................................... - Construct{o Supervisor's License ....... COOLIDGE HOMES 4t 24953; One Story ,,_:,No ................. Permit for .................................... Single Family Dwelling .................................................................... Lot 11, - 63 Victoria Location .................................................... ........... Centerville ............................................................................... Coolidge Homes Owner .....................:...........:................................ Type of Construction. ..Frame.......................................... .a ................................................. ............................ Plot .......... Lot ...................... ........................ April 14, - 83 Per�iit Gra e ........................... ........Granted ... .19 Date of Inspect .. Date Completed ..... //Z............... 19--, 3 �x t� o�J �AtrA .. 2° 1 5o$ No P o � C'A:?4 r r" 50• =A*r r ic 8 3 � t 2 NE, EC►Y c�,�»7°�.=r� 7-A,loq7" Tx/E aUl .Z�ZA,/ SNOK�.V O.CJ' 7's•//S .aG A.4! /,S �C.QCATEZJ Off/ T".ti/E ���� �C'i:C`?t2 �� u vl:3 ,Qd WOWO WA.1 "B.R"'&CWV s*Av'D THS►T /T COiWPO,CA_f 7-0 TM_AL H✓•�/E�t1 CC3 /�STG�C/G 7"E E>. t_ . F + G. -O ail! !it/ L L_ c-- �e IAIC. ,P,9 Toe- f3l - 11,E C� t-Jo r; e ► TOWN OF BARNSTABLE Permit No. ---------24953-_--.IMST .--- ¢ _ _ Building Inspector cash .gnu. ' �7 rOCCUPANCY PERMIT Bond --_--_�-_ --- -7 Issued to "'3001-.dge Homes ! Address lot #11 n fx3 Vitoria Irony, Centerville ' Wiring Inspector J �� `' �'t '� G,- Inspection date Plumbing Inspector/° ( F 1 °f Inspection date Gas Inspector , .,.,l��s,Y x Inspection date ✓Engineering Department_- yi � Inspection date t .-l.if��..J/ ice...,, ... �^// k` Board of Health 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ...................... Building Inspector