Loading...
HomeMy WebLinkAbout2895 MAIN STREET q,5 ��� =F Q � _ o d 0 Town of Barnstable *Permit# Expire,6 mo the fro rtssue dat r Regulatory Services Fe y J snaresrest e I M"M Thomas F.Geiler,Director i63q. ��0 Eb MA'I Building Division X-PRESIS PERMIT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 A P P o 4 l I www.town.barnstable.ma.us Office: 508-862-4038 TOWN OFFIRRAMMME EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint �) v Map/parcel Number Aj Property Address eZ V (2 S'' 51- Residential Value of Work Z7 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address mg ga GRarS Z45_Akl j &� &O Aj 7724 100- G LG �u Contractor's Name l.T ' F. S Telephone Number Home Improvement Contractor License#(if applicable) 0 q 5,3 Construction Supervisor's License#(if applicable) w [o-y 0 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. ' Permit Request(check box) �, p Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to��w/ ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.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 Rome Improvement Contractors License&Construction Supervisors License is re uired. SIGNATURE: C:\Users\decolli.k\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 Office of Consumer Affai and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ' Home Improvement-Contractor Registration Registration: 104531 Type: Supplement Card G.F. SPRAGUE & CO. INC. Expiration: 7/14/2012 ROBERT SCRIBNER JR e 45 KEARNEY RD — NEEDHAM, MA 02494 _ Update Address and return card.Mark reason for change. 4 DPS-CA1 Co 50M-04/04-G1012166p Address Renewal ❑ Employment Lost Card � fie L�o�rvrrcooxuiea,�� o�./�aaaae�ivaetta - Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration:: 104531 Type: 10 Park Plaza-Suite 5170 r Expiration: 7/14/2012 Supplement Card Boston,MA 02116 G.F. SPRAGUE&CO.INC. F ROBERT SCRIBNER JR 45 KEARNEY RD NEEDHAM, MA 02494 Undersecretary Not valid without signature Massachusetts- Department of Public Safety 9 Board of Building- Regulations and Standards Construction Supervisor License '1 License: CS 104210 J ROBERT SCRIBNER JR. '` '� . 6 GRANBY ROAD NATICK, MA 01760 - Expiration: 7/27/2013 Tr#: 104210 U > �i��/f7✓�r�l 3G $ �J/ �Cn� O pU 60 BUILDING PERMIT(not included in above options) Add$ Payment to be made as follows:One-third upon signing of proposal. One-third at half completion. Balance to be paid in full promptly upon substantial completion or as billed. NO RETAINAGE TO BE HELD. 1.25%finance charge monthly on overdue payments. THIS PROPOSAL MAY QUALIFY FOR SALES COST SAVINGS PLAN.I HAVE BEEN OFFERED AND HAVE DECLINED THIS ONE TIME ONLY SALES COST SAVINGS PLAN X ADJUSTMENTS—IN THE EVENT OF SIGNIFICANT DELAY,CHANGE,AND PRICE INCREASE INVOLVING LABOR, MATERIALS OR EQUIPMENT THROUGH NO FAULT OF CONTRACTOR,THE CONTRACT AMOUNT,TIME OF COMPLETION AND/OR OTHER REQUIREMENTS SHALL BE ADJUSTED EQUITABLY BY CHANGE ORDER. YOU,THE BUYER,MAY CANCEL THE TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE REVERSE SIDE OF FRONT PAGE(1) FOR AN EXPLANATION OF THIS RIGHT. $ 2LL2.77A"ao (Total) $ .�75'9 (Paid with order) CV $ 7.75 > (Due upon half completion) cx $ 7 7s9 (Due upon substantial completion) DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANKS SPACES. Date: �.F.Sprague&Co. Date: By: Date 1 ?lie Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washirigton S"hwet Boston,MA 02111 w�vrt.n�ass.gov/dire Workers' Compensation Insurance Affidavit.- Bmlders/ContractorsXlectricians/Plumbers Applicant Information / Please Print Legibly Narm ahminessmMulizationandividuat): (J` r'• J 17 A-A4 Address: Y city/state/zip:*e-edif tljl /u Phone:#: - 7 227 2 Y 6f Are you an employer?Check the appropriate boa: Type of project(required): 1.§PI am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition 1 and have wo d=s° working forme.in airy capacity. �° 9. ❑Building addition [No worloers'comp.insurance comp.msluanml required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12_❑Roof repairs insurance requited.]Y c.152,§1(4X and we have no employees-[No workers' 13.❑Other comp.insurance required.] 'Any applicant Poai checks bob#1— also fill out the section below showing�wumrea'compensation policy informatim i Ifameonmm wbo submit Pois affidavit indicating they ace doing all work and then hire outside contractors must submit a nea,affidavit indicangr,such. ZUnuactots Poet check this boa mast ittached an additional sheet showing the acme of the sub-cmius mas and since whetbir or not those entities have employees. If the subcontractors have employees,they must provide theu workers'comp.policy number. I am an employer that is providing workers'coaipertsation insurance for my eng9aym& Below is thepolicp artd job site information, d Insurance Company Name: Policy#or Self-ins.11c.#: / Expiration Date: / Job Site Addressd t5-IA41/`1 sr &/>-IX r,4-! City/StateJZip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as;equired under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties ofa 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 Cactia the pains:an:dg7:hie:s�qfpqedWy that the information provide�17yl7ll bin e and correct Date: Phone#: 0,01dal use only. Do not write in this area,to be completed by city or town o ficiat City or Town. Permit/Lkense Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ® DATE A CERTIFICATE OF LIABILITY INSURANCE 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 The John M.Sullivan Insurance Agen NAME: PHONE 781-449-9330 FAX GFS/CRAFT P.O.Box 920047 INC.No Ext: A/C No): E-MAIL Sullivan.insa V venzon.ne Needham,MA 02492 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: Penn America RISURED ►RSURER B:Associated:Employers 1tMitual 40959 G. F. Sprague&Company, Inc INSURERC: Craftmasters, Inc INSURER D 45 Kearney Road INSURER E: Needham, MA 02494 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 RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY P 6792057-01 2/23/2011 2/23/2012 2,000,000 EACH OCCURRENCE $ TO RENTED COMMERCIAL GENERAL LIABILITY REEMISES Ea occurrence $ 100,000 A CLAIMS-MADE Fx_1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 21-000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COEaMBINE ccidentD SINGLE LIMIT a ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acddeM UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- I JOTH- ANDEMPLOYERS'LU1BILnY Y/N WCC500031501200 11/11/201 11/11/201 ANY PROPRIETOR/PARTNER/EXECUTIVE E E.L.EACH ACCIDENT $ OFFICER1MEMBER EXCLUDED? F-1 N t A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS i LOCATIONS It VEHICLES(Attach ACORD 1t",Addittonal Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION G. F. Sprague&Company Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 45 Keamey Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Needham,MA 02492 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEN E ©1988-20ft ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Assessor's offioe (1st floor): Assessor's map and lot number ...... �7 1-7 s a T E o Board of Health (3rd floor): Sewage Permit number ............... PAIRUNSTAIL Engineering Depart enf (3rd floor): o 1b 9• e� House number lck.i,.................................:....................... '°�F a` 0 ypY APPLICATIONS PROCESSED 8:30-9:30 AM, and 1:00•2:00 P,M. only TOWN .OF BARNSTABLE BUILDING -I-NSPECTOR APPLICATION FOR PERMIT TO .... ti:f........ ............................................................................ TYPEOF CONSTRUCTION ...................................................................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location $ .4?r.......iY)A...►... .�.xv C c... ...... AYW�ST �'e ProposedUse ..... ......:................................................................................................................................ Zoning -District ..............I........................................................Fire District SAY",&T. 0k.................. 1-CeY�Ue ` .....Address 1 a C�(.�Y�SS„IC�?l. WE:��� � .�/.... .I , Name of Owner ................Y..........1�......�.`S t]a.�.......... ..... Name of Builder `c *Ae NC.X.... ............Address�7Y..ALA?1��1. Nameof Architect .................................:................................Address ..............•..'................................................................... Number of Rooms .....~�.........................................................Foundation NO...............................................'...................... Exterior ,s.1►..... Roofing ?...W.�7.O.0............ �...SXy..l1S!1 .. Floors No .........Interior Heating0.......:....................................................................Plumbing Ma........:........ Fireplace YES...-....mC'.i...j..C!! .rnNCy. .J7.i' „f ftAr,.t.....Approximate Cost . .Q�.0-00...:7....................................... Definitive Plan Approved by Planning Board ________________________________19-------- . Area ............. 7,., ............ Diagram of Lot and Building'with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree io conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name F�.ecA Pl-.`TI.G)G...�t.:... A .7r............................. Construction Supervisor's License O© I„3,g„ HERBERT H. 30290 Alter -House No ................. Permit for .................................... lag......... ...... ..... ...D..........wel.....i. • Location 2895 Mao n S-reet ................................................................1 . .......................B.ar.n.q.t.abl.e.............................. Owner ........Herbert H. Bross .......................................... Frame Type of Construction ...............:.......................... .......................... .................................................... Plot ............................ Lot ................................ December 15 , 86 Permit Granted ......................................19 Date of Inspection sn��.77?7........19. 'Date Completed .......... ..............19