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Home My WebLink About0229 LINCOLN ROAD L7 �� V �DUG��j � �C: ALTERNATIVE WEATHERIZATION < Date: o A o • Town of Barnstable o 200 Main St Hyannis,M,A 02601 Re:Permit# dJr ! ' . .,.A Village^: .;. ,.-•�.T•he ins u anon weathelci-zdtio.�'::ii►y' - 02±i_"x ork at laas.l?.een ART completed';i '.�ccodance with';7;$O:C'MR:>:;, Timothy Cabral, President CSL-1.05454 58 DICKINSON STREET FALL RIVER,MA 02721 (508)567-4240 ALTERNATIVEWEATHERIZATION@GMAIL.COM h Town of Barnstable Building x rNw�rAi Post This Card So That it is Visible=Froth the Street-Approved_Plans,Must be Retained on,,Job and this Card Must be Kept. �- loo Posted Until*inal Inspect ion,Ha s Been Made. ' ,` • Where a Certificate of Occupancy is Required;such Building shall Not be Occupied until aTinal Inspection has been made.,' Permit Permit No. B-19-3822 Applicant Name: ALTERNATIVE WEATHERIZATION INC. Approvals Date Issued: 11/13/2019 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 05/13/2020 Foundation: Location: 229 LINCOLN ROAD, HYANNIS Map/Lot: 270-038 Zoning District: RB Sheathing: Owner on Record: DELAZARI,CARLOS D&CLEONICE F Contractor Name `--,,ALTERNATIVE WEATHERIZATION Framing: 1 INC. Address: 229 LINCOLN RD 2 R - Contractor License`,",' 175683 HYANNIS, MA 02601Chimney : I Est Project Cost: $4,378.00 Description: Weatherization 4 i Insulation: Permit Fee: $85.00 Project Review Req: Fee Paid: $85.00 Final: Date: j 11/13/2019 Plumbing/Gas Rough Plumbing: Final Plumbing: Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after�issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the'approved construction docume #o ntsr which permit granted.this h been Final Gas: All construction,alterations and changes of use of any building and str�uctures.shalLbe in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or'road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on;this permit. Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site -< Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT _ Apo ication numb ...........Date Issued .... 1i_ .. ..................... s Building Inspectors Initials........®....:............... r BUILDINGposb ..... ;, - E�, .. ............ D T g10 . . ,Map/Rarcel NOV 13 2019 TO'" 0 0 BTLTABLE: EXPEDITED'PERMIT APPLICATION: ROOT/SIDING/WINDO-WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of-Project: nn NUMB _RN STREET VILIAGE Owner's Name:(mar, (l 5 I�)��?��'/ Phone Number'2d_ 6 s- Email Address: Cell Phone Number Project cost$ ,3�'g Check one. Residential Commercial OWNER'S AUTHORIZATION' `. ., dAs owner of the above property I hereby authorize to make application for a building.permit in accordance with 78 MR _ 1 - _. _ 1 , z.. Owner Signature: Date: TYPE OF WORK E Siding - Windows(naheader.-change)_# - 'Insulation/Weatherization r El Doors (no header change)# Commercial Doors-:requhi'an inspector's=Peview 0 Roof(not applying more than l:layer of shingles) z Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name - Th � '1n'� &6 Home Improvement Contractors Registration(if applicable)# dw - Construction Supervisor's License# / yJ (attach copy) Email of Contractor a l 'err�a; i-ye �.z i x. Phone number 0,?-567 WY PP' ALL PROPERTIES THAT HAVESTRUCTURES OVER,75 YEARS OLD OR IF THE SUBJECT-PROPERTY IS IN A:HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. , APPLICATION NUMBER................................................... ..�.... *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES-* Manufacturer# Model/I.D. Fuel Type Testing Lab a Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APINICOT'S SIGNATURE Signature (/ Date All permit applications are subject to a building official's approval prior to issuance. Permit Authorization ass save Form Site ID: 3886931 Customer: Carlos Delazari — , I, C�`r I Q S v t i ( ,,owner of the property located at,' (owner's Name,printed) 229 Lincoln Road Hyannis, MA 02601 (Property StreefA,,ddress) (City) hereby authorize the Mass Save:Horne Energy;Services Program assigned Participating Contractor listed below to act on my behalf and obt ,_ a building permit to perform insulation and/or weatherization work on my property. Owner's:Signature;; Date .. FOR OFFICE'USE.ONLY We have assigned the following Mass'S.ave Home Energy Services Participating Contractor to the ,above referenced project. Participating Contraettrr Dfite= f Name: RISE Engineering Phone: 401-784-3700 Email: Page 1 of 1 For Off ire use only I I 4. The Commonwealth of Massachusetts Department of Industrial Accidents a 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY. Applicant Information Please Print Leeibly Name (Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC.' Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project(required): 1.[D I am a employer with 16 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]} 9. ❑Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[D Other INSULATION 152,§1(4),and we have no employees.[No workers'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. 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 policy and job site information. Insurance Company Name:LIBERTY MUTUAL INSURANCE Policy#or Self-ins.Lic.#:XW0/5'8�867158 Expiration Date:06/07/2020 Job Site Address/ C.-J _ n I� City/State/Zip: J- /,!/{ Attach a copy of the workers' compensation policy declaration page(showing the policy nu er and expi ation date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.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 e s and alti s of a ury that the information provided a/+bovf is tr a and correct Signature: Date: Phone#:508-567-4240 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#: f 1 � =0'151M24/1 /DDIYYYY) '`C"RE)` CERTIFICATE OF LIABILITY INSURANCE9 THIS CERTIFICATE IS ISSiJED 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 have ADDITIONAL INSURED provisions or 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 NAME: Anthony F.Cordeiro Insurance Agency AICON o Ext: 508-677-0407 AIC No): 508-677-0409 171 Pleasant Street E-MAIL ADDRESS:Fall River,MA 02721 HSouza@Cordeiroinsurance.com Fall INSURER(S)AFFORDING COVERAGE '-NAIC# INSURER A: Liberty Mutual INSURED INSURER B: Ohio Security Alternative Weatherization INSURER C: Ohio Casualty 2 Lark St INSURER D: Fall River,MA 02721, 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 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDDNYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR PREMISES(Ea occurrence) $ 300,000 MED EXP(Any oneperson) $ 15,000 A Y Y BKS68867158 06/07/19 06/07/20 PERSONAL a ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accidenti $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B OWNED Ix SCHEDULED Y BAS58867158 06/07/19 06/07/20 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOSXHIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accideni $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE Y Y US058867158 06/07/19 06/07/20 AGGREGATE $ 1,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE I I ER ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? � NIA XW058867158 06/07/19 06107/20 (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 I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Action Inc and NGRID,USA,its direct and indirect parents,subsidiaries and affiliatesshall be named as Additional Insured on commercial General Liability and Automobile Liability polcies. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN NGRID USA ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road Waltham,MA 02451 AUTHORIZED REPRESENT ? s S ©198#-2015 ACORD CORPORATION. All rights reserved.j ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD -' commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards ConstruEtibn'Sdpervisor CS-105454 ` * "' 1% , Expires: 05/08/2021 TIMOTHY CASRALt f 58 DICKINSON STREET. 0 FALL:RIVER MA 0272t Commissioner 1 bFil G�f�2/�zG�f2GC�eCl Z G� _/ r CGS CGC' ZCL% � Office of Consumer Affairs and Business Regulation - -- - 1000 Washington Street - Suite 710 " Boston. Massachusetts 02118 • Hoare Improvement Contractor Registration Type: Corporation Regi tr fly,: i 7--683 ALTERNATIVE WEA.THER!ZAT!ON. !NC: Exp moon: 05128/2021.. 2 LARK ST E",!L RIVER, 1 02721: Update Address and Return Card. - Office of Consumer.Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:CorQora ion before the expiration date. !f found return to: Registration Expiration. Office of Consumer Affairs and Business Regulation 175683 05128, 21 1000 Washin ton Sire�'� g 4t. -Suite 710 ALTERNArIV WEATHERIZAT!ON.INC. Boston;,MA 02118 „ _ . TIMOTHY CABRAL 2 Is,RK S FALL R!V_R.N.A. 02721 , lot val9,id N� ithoui signature Undersecretary. 11 Town of Barnstable pF1HE Tp1i_ Regulatory Services c Thomas F.Geiler,Director * MhNSTOLE, Building Division M' Tom Perry,Building Commissioner '0>Ep Mp`i A 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ffice: 508-862-4038 508-790-6230 Approved: 9F Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: �� ✓� � t'1 �� 1 Phone#: SOO �J�� bK12 Address•n; -� 1 N I Village• V I�l�1I 1 T Dame of Business: P R \ A N \N Type of Business: Map/Loa ( �s 4 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carved on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. the undersigned,have read and agree with the above restrictions for my home occupation I am registering. applicant nib. I�� "6 (� n(� �1 Date: iomeoc.doc Rev.5/30/03 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates.(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission tor operate.) Business Certificates are available at the Town Clerk's Office, 1" FL.,.367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: Id � � �Q � Fill.in please: 40 ,' ra APPLICANT'S YOUR NAME: x BUSINESS YOUR HOME ADDRESS: [A ~� Y�- - TELEPHONE # Home Telephone Number rj0 3 C�tit uE -- �O NAME OF NEW BUSINESS 1 W I 5e 1 p� TYPE OF BUSINESS • N IS THIS A HOME OCCUPATION? ^YES N Hated-beep-glme L , ADDRESS OF BUSINESS�.a-�I "�G� t-)YA NOV JJ_ MAP/PARCEL NUMBER - 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 Y g Y Y Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFIC This individual has informe any permit requirements that pertain to this type of business. Authorized natur COMMENTS: '0 .J 2. BOARD OF HEALTH This individual has qLinformed f:the ermit r t pertain to this type of business. rized Signatur COMMENTS: 3. CONSUMER AFFAIRS(L ENSING AUTHORITY) /11Y This individual has n inform of the licensing requirements that pertain to this type of business. uthorize ignature`* COMMENTS: L r /� e t ✓ Y, Town of Barnstable *Permit# Z6 116 Fxpires 6 months from issue date Regulatory Services Fee _ snxrrs°rnaieMAS 39. 0 � Richard V.Scali,Director i679 A�� p Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 SEp www.town.bamstable.ma.us TOWN O 1 72015 Office: 508-862-4038 ,Y F 8,4 ft790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLAB�� 0 2Q Not Valid without Red X-Press Imprint Map/parcel Number 2`�0 Property Address ZZQ 4 1 h G.o 1 Ai [Residential Value of Work$ 2Sa Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address l_C k V 'OCi �D cA ZIOLI—/ Contractor's Name ! 16L� � --C—Cj(j tl Telephone Number Home Improvement Contractor License#(if applicable) 76 Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I m the Homeowner have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# R L� S^ ( Lr f LI Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ st(check box) LY Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to I ''l -( ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\Decollik\A pData\Local\Microsoft\Windows\Temporary Internet Files\Content.0utlook\21`I01DHR\EXPRESS.doc Revised 040215 4 � y y a Wlass.achusetts - Department of Public Safety Board of`$yi!d,,n� R.egu;ati ns and Standards; r; CorrsCrir_ri;': ` )upenisor Speci�lh_ Licerise:.CSSL-106031 Aw-71 SEUS DESOUZA 20 COOK CIRCLE _ Hyannis MA 02601 ;, J Expiration .i Commissioner` 10/05/2018. wi - ._..- (�/'L2�p/7T/1%2N/2LL/BCLGC�L�C,/(�LLL�SCLC�LUJBCGI Office of Consumer Affairs&Business Regulation IMPROVEMENT CONTRACTOR. Type1. egistration: .'1_81774 r,,,OME I Corporation _--4 21 xp"ation: 2017.; p STRONG CASTLE BUIL_"p"I;N.G SILAS DESOLIZA 20 COOK CIR HYANNIS,MA 02601 '• ` v Undersecretary r -- �--- .Restricted To aCSSL RF�Roofing If Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mjss.Gov/ PSDPSi oFTME k BAB MBLE,MAM • Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO 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 o If Using A Builder I, C 2..�,_Q� L�Y�`t�Q� ,as Owner of the subject property hereby authorize /�Qt-� �X"e 6 ®��I to act on my behalf, in all matters relativ o w a y this building permit application for: 1 ^ (A dress of Job) © 2' ®1 Sign e of Owner bate Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 Town of Barnstable Regulatory Services of Richard V.Scali,Director Building Division BARIMaeM ` Tom Perry,Building Commissioner MASS. �16ia- 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occuied 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. DEFINITION 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 he/she understands the Town of Barnstable Building Department minimum 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 permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are 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 he/she understands the responsibilities 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 form/certification for use in your community. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDIIR\EXPRESS.doc Revised 040215 Aco'o® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDLYYYYY) 9/17/15 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: PAUL SCHLEGEL Schlegel & Schlegel Ins Broker PHONE FAX 34 Main Street EMC.AIL m (508) 771-8381 A/ No: (508) 771-0663 ADDRESS: schleqelinsurance@qmail.com West Yarmouth, MA 02673 INSURERS AFFORDING COVERAGE NAIC# I NSURER A:NGM INSURANCE COMPANY 14788 INSURED INSURER B:TRAVELERS STRONG CASTLE BUILDING INC -INSURER C: 20 COOK CIRCLE INSURER D HYANNIS, MA 02601 1NSURERE: 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 ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR __ —---- -- —AEDLSUBR-- -- -- - POLICY EFF____P0ffiCY_EXP1 — ---- - - - LTR TYPE OF INSURANCE INSR I WVD I POLICY NUMBER MM/DD/Y MM/DD/YYYY LIMITS A GENERALLIABILITY MPT1035P 6/20/15 6/20/16 EACH OCCURRENCE $ 1,000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 500 000 CLAIMS-MADE a OCCUR ME EXP(Arty one Person) $ 10 000 PERSONAL&ADV INJURY $ 1,000,000 _ GENERAL AGGREGATE $ 2 000 000 GEN'LAGGREGATELIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY PRO- LOC $ JECTAUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acc,,. $ _ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTYDAMAGE $ AUTOS Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 6HUB5B71497714 11/20/14 11/20/15 WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N FIR ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCIDENT $ 100,000 000 OFFICE P/ME MBER EXCLUDED? N/A -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEI $ 100,000 _ If yes,describe under -- DESCRIPTION OF OPE RATION S below E.L.DISEASE-POLICYLIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is regui red) , CORPORATE OFFICERS HAVE ELECTED TO BE COVERED UNDER THEIR CURRENT WORKERS COMP POLICY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN I CARLOS DELAZARI ACCORDANCE WITH THE POLICY PROVISIONS. 229 LINCOLN RD HYANNIS, MA 02601 AUTHORIZED REPRESEN TIVE I 4 ©198 -2010 4C0_IRUORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACOkb Phone: Fax: E-Mail: I Client#:760861 2TOPQU1 DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 911712015 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). CONTACT PRODUCER NAME: Dowling&O'Neil Insurance Ag A/C PHONE No,Ext 508 775-1620 FAIJc,No: 5087781218 973 lyannough Rd,PO Box 1990 E-MAIL ADDRESS: Hyannis,MA 02601 INSURERS)AFFORDING COVERAGE NAIC# 508 775-1620 INSURER A:National Grange Mutual Insuranc INSURED INSURER B:Associated Employers Insurance Fernando Rodrigues DBA INSURERC: Top Quality Carpentry INSURERD: 33 Harbor Hills Road INSURERE: Centerville,MA 02632 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 CONTRACTOR 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 RED CE Y EFD B PAID CLAIMS. ADDL SUBR LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DDIYYYY MM/DDIYYYY GENERAL LIABILITY MPT0427P 6/13/2015 09/09/201 EACH OCCURRENCE $1 OOO OOO A DAMAGE TO RENTED s500,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence MED EXP(Any one person) $1 O,000 CLAIMS-MADE 51 OCCUR PERSONAL BADVINJLRY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS-COMP/OP AGG $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ POLICY jR� LOC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS $ NON-OWNED PROPERTY DAMAGE Per accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAB OCCUR AGGREGATE $ EXCESS LIAB CLAIMS-MADE DED RETENTION$ WC STATU- OTH- B WORKERS COMPENSATION WCC50050138412015A 9/08/2015 09/08/201 X AND EMPLOYERS'LIABILITY Y I N E.L.EACH ACCIDENT s500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? [ NIA E.L.DISEASE-EA EMPLOYEE $5OO OOO (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Strong'Castle Building,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20 Cook Circle ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD JM1 #S1577401M157674 The Cart morrfvealth of Massachuseta Degarment of Industrial Accid'erris Office of Investigations 600 Waderngtorr Street Boston,Ml 02111 wmv mas&gov/dTaa Workers' Compensation Insurance Affidavit:Builders/Contractors/Electticians/Plumbers Applicant Information Please Print f egibll� Name ghzinesE� tion&.diuidual): Address: lO city/State/zip: 6 a Phone#f 6i ,1 Are you an employer?aeck the appropriate b Type of project{required): 1.El am a employer with 4. lam a general contractor and I employees(full and/or part-time).* have hired the sub-contmdors 6. ❑New constructing 2.❑ I am a sole proprietor or patter- listed on the attached sheet 7. ❑Remodeling slip and have no employees * These sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have wogs' 9. ❑Building addition. J[No workers'comp.insurance comp.insurance mpired-] 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 MOL 12_❑Roof repairs insurance required.]g c. 152,§1(4],and we have no employees-[No workers' 13.❑Other comp.insurance required.] *Any app6caart that checks box#1:mnsd also fill out the section below showing their wozkers'compensadompolicy information- I Homeowners who submit this affidavit indicating they are doing all wait and then hire outside contractors nmst submit a new affidavit indicating such =Contractors that theca this box must attached an additional sheet showing the name of the sub-coattmctom and state whether or ant those entities have employees. If the sub-conttsctars have employees,they must pammrride their workers'rip.policy number. lam an employer tltatis prmi&ug workers'mmperisa on insurance for my ettyAsyyees. Below is thepoficy and job site informadon. Insurance Company Name: :iL Gl lJ L( k- Policy It or Self-ins.Lic.4: 6 F2 S 3 _� l"1 q 7 7 Expiration Date:5 se , L 2D15 Job Site Address: City[StatelZip: Attach a copy of the workers'compensation polies declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL 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$250M a day against the violator. Be ad-vised that a copy of this statement may be forwarded to the Office of Investigations of a DIA for insurance coverage verification. Ida hereby ce ,�y under the ns and penalties of per uty that the inforaidion pt oWded as€cove is trim and correct Si tore --�� j Date: -e - 2 Phone M L Offlciai we only. Do not write in this.area,to be completed.by city or town official City,or Town: Per.mit/Ucense 9 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#: