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HomeMy WebLinkAbout0020 GLEASON STREET - -- ao C�',Ce�isan� -S'T i �� YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1s` FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE 1-7 Fill in please: APPLICANT'S YOUR NAME/CORPORATE NAME �r �nOnti 12, h��ZZt . D, `1�C BUSINESS YOUR HOME ADDRESS: 354 u-O k e Raab TELEPHONE # Home Telephone Number 5D�774 Z8'-,57a�1 NAME OF NEW BUSINESS A0 Cao�e. Uco�oay OR EIN: o14 - Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS ZO e VVIfv ZUQ 1 MAP/PARCEL NUMBER 3 L� When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMM R'S OFFICE This in( ividu h b n.info e o any permit requirements that pertain to this type of business. Au rized Si re COMMENTS: 2. BOARD OF HEALTH This individual has been i or ed of the en-n equi I h t pertain to this type of business. horized Signature" COMMENTS: 3. CONSUMER AFFAIRS (LICENSIN 3AUTHORITY) This individual has b in ormed o licensing uirements that pertain to this type of business. Auth4r,11zed Signature' COMMENTS: J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION L Map- v Parcel. A Iiicati on pp Health:Division 'Date Issued Conservation Divi ion Applicatioh Fee Planning4Dept; Permit Fee Date Definitive.Plan Approved by Planning Board Historic - OKH1 Preservation Hyannis Project Street Address a 44 80 )c Village lvlo� Owner Address C Arr Telephone 5V e 86.2 - SYS? Permit Reques.t OFIF IKO 0 e rX Square feet: 1 st floor: existing—proposed 2nd floor: existing—proposed _TbtqI pew--i Zoning District Flood Plain Groundwater Overlay Project Valuate Construction Type r..0 f 7711 -,-;3 (D i. Lot Size Grandfathered: Ll Yes LJ No If yes, attach supporting documenfa ion. Dwelling Type: Single Family Q Two Family Ll Multi-Family(# units) co Age of Existing Structure Historic House: L3 Yes LJ No On Old King's HigHway: LIYes LPNo Basement Type: Ll Full Ll Crawl Ll Walkout Ll Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: LJ Gas _LJ Oil LJ Electric U Other Central Air: Ll Yes Ll No Fireplaces: Existing New Existing wood/coal stove: LJ Yes Q No Detached garage: Ll existing LJ new size—Pool: Q existing Ll new size Barn: Ll existing Q new size Attached garage: Ll existing LJ new size —Shed: Ll existing L3 new size Other: Zoning Board of Appeals Authorization U Appeal # Recorded U Commercial LJ Yes L] No If yes, site plan review # Current Use Proposed Use A6APPLICANT INFORMATION It.C.,(BUILDER OR HOMEOWNER) Name � �� jTelephone Number 5DS- 7v24;-J_-9,r01. -799 Address O?s 1 soA" "L4_1 License # 776 /a Home Improvement Contractor# 01-5!Otl Worker's Compensation # A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7a9 . 07 FOR,OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ` ADDRESS VILLAGE OWNER `= DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL } -GAS: ROUGH FINAL FINAL BUILDING i i f DATE CLOSED OUT r ASSOCIATION PLAN NO. i - 41 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information . Please Print Legibly Name(B �(]Business/Organization/Individual): e to( Sr A# zee Address: 4/0S .GVEv)� 9/weg 04 ots ypA*6 Gil City/State/Zip: Oo2 37 9 Phone.#: 5-0,0 S3 �y9� AVI u an employer?Check the appropriate box: Type of project(required): 1. am a employer with ��( 4. ❑ I am a general contractor and I �=d—* have hired the sub-contractors 6. ❑New construction employees(full and/or part-tim.e). 2.❑ I am a soleproprietor or partner-' listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'-comp.insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp_ right of exemption per MGL 12.❑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 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. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: CiGCn � !✓Q/�(�7�r/--�5>�,C�. Policy#or Self-ins.Lic.#: `��1�/'1`7'ZZ�yf d� Expiration Date: 2 "28"Z 0/6 Job Site Address: 24Q (;ICAW464 49 City/StatdZip: -&*A- 1-S, Af,Da60/ 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 tip 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 Investi ations of the DIA for i8surance,coverage verification. I do hereby certify pains a pe s of perjury that the information providldove i true and correct. Si attue: Date: B Phone}#: s -7K.G Y/91 Official use.only. Do not write in this area,to be completed by city or town official .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant,of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house of 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 i;rith 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 contiacto s names address es and hone number(s)s along with their certificates of necessary,supply sub r( ) ( ),-address(es) p r( ) g ( ) insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided.a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. hi 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 " of the affidavit that has been officially stamped or marked b the city or town may provided to the town). .A copy Y �P Y tY Y 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 fo any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston, MA 02111 Tel. #617--727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-774.9 Revised 11-22-06 www.mass.govldia z rows Town of Barnstable Regulatory Services BAR' ". . Thomas R Geiler,Director fn ''�� Building Division Toni Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Properly Owner Must Complete and Sign This Section If Using_A Builder h ITV L L( A'Ikt ( � � ; as Owner of the subject property hereby authorize ��L��4 /�' oo�i�� to act on my behalf, in all matters relative to work authorized by this building permit application for. go (Address of Job) o Signature of Owner Date T— Print Name 7;7y If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the-reverse side. Q:FORMS:O WNERPERM ISS ION ire Town. of Barnstable- Regulatory Services swsxsrxsLF- Thomas F. Geiler,Director MASS Building I}ftision • prFn Ma's" Tom Perry,Building'Commissioner . 200 Maid.Street, Hyannis,MA 02601 Rrwv.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village name home phone# work.phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached-structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit: (Section 109.1.1) - The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that.e./she understands the Town of Barnstable Building Department mm=um inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the- State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner performing work for which a building perrrit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner cngages a pmson(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that helshe understands the respoTmbilitics of a Supervisor. On the last page of this issue is a_form currently used by several towns. You may care t amend and adopt such a fomr/certification for use in your corrununity. Q:forms:homccxcmpt '102009 FRI 11 21 AM CCHC PURCHASING; FAX No. 1 508 790 4657 P. 002/004 ATEc 4ftA%M1Efe1r.A► CC1WVR^MT%r, I.I.oE CommerciaOndustrial 405 West Street West Brldgewater,MA 02379 T 508-583-9499 F 508-583-7500 June 23,2009 Bill Hafferty Director of Engineering Cape Cod Hospital Re:New Roof Installation We propose to furnish all labor,materials and equipment necessary to complete "roofing on referenced project per.our proposal only,for the sum of: $322750.00 Thirty Two Thousand Sewn Hundred Fifty Dollars Qgua cation4: 1. Secure building permit. 2. Remove and legally dispose of existing roof system down to deck 3. Remove and replace up to 1200 square feet of plywood roof deck.New plywood sheathing to be secured with 8D ring shank nails 4. Furnish and install 2" Polyisocyanurate insulation over existing deck and mechanically attach per xnembzane manufacturer's specifications. 5. Furnish 8 foot square tapered drain sumps at four existing drain locations. 6. Furnish and install a.045 Reinforced Mechanically Fastened EPDM roofing system to include all flashings and incidentals,installed in accordance with the mapufacturer's current specifications and details. 7. Furnish and install new membrane flashings to only,two (2) exhaust duct curbs,four(4) roof drains,two (2) chimneys,four(4) plumbing vents and four(4) pitch pockets. S. Furnish and install new pitch pockets at existing pitch pocket locations 9. Furnish and install new rubber pads at existing condenser units. 10. Fabricate and install.040 mill finish.Aluminum roof edge at roof perimeter. 11. Furnish membrane manufacturer's fifteen(15) year roof system warranty. • 12. Assume owner to provide access to Delta Roofing equipment and personnel, 13. Excludes 5% NM sales tag. 14. Puce good.unti 07/31/2009, and then subject to review. .Note: Remove and replace additional deteriorated wood deck,if found. $3.25perSquare Foot North Billerica,MA 0 West Bridgewater,MA 0 Portland,ME 0 Jacksonville,FL Massachusetts - Department (it'Public Safet.N . " f Board i _ � Buildin Rc i 1xtions and Standards - Construction Supervisor License License: CS 77678 Restricted to: 00 JEFFREY A HOLLSTEIN ;. 23 INGHAM WAY `r PEMBROKE, MA�02359 Expiration: 8/8/2010 (' nunisi ncr Tr#: 8813 ACORD,M CERTIFICATE OF LIABILITY INSURANCE 2/28/2010 DA2/26/2009 PRODUCER LOCKTON COMPANIES,LLC THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 5847 SAN FELIPE,SUITE 320 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOUSTON TX 77057 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 866-260-3538 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED DELTA ROOFING OF SE MASSACHUSETTS, INSURER A: Arch Insurance Company 11150 1301728 A TECTA AMERICA COMPANY,LLC INSURER B: Illinois National Insurance Company 23817 405 WEST STREET,UNIT#3 WEST BRIDGEWATER MA 02324 INSURER C: INSURER D: INSURER E: COVERAGES DELRO02 AR THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER 3 U HO IZED REPRE ENT T VE OR PRODUCE AND THE CERTIFICA E HOLDER. 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 A X COMMERCIAL GENERAL LIABILITY 41PKG2244100 2/28/2009 2/28/2010 DAMAGE TO RENTED PREMISES Ea occurence $ 1,000,000 CLAIMS MADE �OCCUR MED EXP(Any one person) $ 10,000 X XCU INCLBRD FM PROP PERSONAL&ADV INJURY $ 1,000,000 X I POL.AGG.$20,000,000 GENERAL AGGREGATE $ 4,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 4,000.000 PRO- POLICY JECT X X ILOC A AUTOMOBILE LIABILITY 41PKG2244100(AOS) 2/28/2009 2/28/2010 COMBINED SINGLE LIMIT $ 2,000,000 A X ANY AUTO 41CAB2244200(MA) 2/28/2009 2/28/2010 (Ea accident) X ALL OWNED AUTOS BODILY INJURY $ XXXXXXX SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ XXXXXXX. X NON-OWNED AUTOS \ (Per accident) X dAUTO PHYSICAL DAMAGE PROPERTY DAMAGE $ XXXXXXX X DED/COLL$100,000 (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ XXXXXXX NOT APPLICABLE ANY AUTO OTHER THAN EA ACC $ XXXXXXX AUTO ONLY: AGG $ XXXXXXX EXCESS/UMBRELLABE 4891162 2/28/2009 2/28/2010 LIABILITY EACH OCCURRENCE $ 5,000,000 B X OCCUR CLAIMS MADE AGGREGATE $ 5 000 000 UMBRELLA $ XXXXXXX DEDUCTIBLE X FORM $ XXxxxXX X RETENTION $ 10,000 1 $ XXXXXXX A WORKERS COMPENSATION AND 41 WCI2244000 2/28/2009 2/28/2010 X WC SLTATUH- IMIT DER EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under NO SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS CANCELLATION: 30 DAYS AS NOTED BELOW EXCEPT 10 DAYS NOTICE FOR NON-PAYMENT. BLANKET WAIVER OF SUBROGATION IS GRANTED IN FAVOR OF CERTIFICATE HOLDER ON ALL POLICIES WHERE REQUIRED BY WRITTEN CONTRACT WHERE PERMISSIBLE BY LAW. CERTIFICATE HOLDER IS NAMED AS AN ADDITIONAL INSURED(EXCEPT FOR WORKERS'COMP/EL)WHERE REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CANCELLATION 3980185 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DELTA ROOFING OF SE MASSACHUSETTS DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 405 WEST STREET,UNIT#3 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL WEST BRIDGEWATER MA 02324 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATI ACORD 25(2001/08) For questions regarding this certificate,contact the number listed in the'Producer section above and specify the client cude'DELRO02'. ©ACCffD CORPORATION 1988 Jul • 31 , 2009 1 : 55AM delta No . 2161 P . 1 ATEC ER CArA COMPANY,L. i i Jeffrey Hollsteln Presidr.nt i (508.583.9499 Dirrct Cn,ineu 180"17328"13 506,726.448I f 508.583.7500 C jhojjscejnwdeltaroofIng.eom q05 West Sweet West Bridgewater,MA 02319.com www.$►e enrooLcom w,deltaroo8ng.com www.tecGiamerlca