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HomeMy WebLinkAbout0024 LONGVIEW DRIVE ve 1 C �?�f °� 0/ �t �'wn.of Barnstable *Permit# P� Expires6months" m ' SEP 29 2014 Regulatory Services Fee * swxtvsrns MASS. OF BARNSTA fird V.Scali,Director 9� 16; jDTED MA Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.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 Property Address , L-oN (T V t6 04 EoT i residential Value of Work$ o ' Minimum fee of$35.00 for work under$6000.00 ........... ---.._. .................. ------ _........ .. Owner's Name&Address (/�/� l �(�n1 6Ai Contractor's Name ���- V -��2 t?�� 2A Telephone Number ©�-- Home Improvement Contractor License#.(if applicable) '79 LlG Email: ,v - Construction Supervisor's License#(if applicable) �S — /G ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor. ❑ I am the Homeowner .0 I have Worker's Compensation Insurance Insurance Company Name M Workman's Comp.Policy# yl/ — ��� 561 - If - -01 VA Copy of Insurance Compliance.Certificate must accompany each permit (Q Permit Request(check box) 69-Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to9161�wE Ey&ltY a4,y ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum 35)#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 Im rovement Contractors License&Construction Supervisors License is re uired. SIGNATURE— QAWPFH,ES\F0RMS\buildA-permit forms=RESS.doc Revised 061313 Office of Consumer Affairs and Bu iness Regulation 10 Park Plaza - Suite 5170 Boston Massachusetts 02116 Home Improvement r di tractor Registration ��-.tom-'�• - .- i Registration: 174461 f Type: Individual , Expiration: 2/13/2015 Tr# 236148 LVADOR ZAMORA � w_ SA SALAVADOR ZAMORA 105 ORCHARD ST 'f WATERTOWN, MA 02472 -!Update Address and return card.Mark reason for change. N;t . ❑ Address 0 Renewal Employment ❑ Lost Card SCA 1 %.20M-05/11 - - ins erAfraa�acaeal a�csRe Regulation /!: License or registration valid for individul use only Office of Consumer Affairs&Business Regulation g y ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: — a egistration: ,174461 Type: Office of Consumer Affairs and Business Regulation _ xpiration 2/13/2015� Individual 10 Park P za-Suite 5170 �. Bosto ,MA 2116 SALVADOR t. ; k SALAVADOR ZAMORA` - z 105 ORCHARD ST WATERTOWN, MA 02472`{' Undersecretary Not valid without signature Massachusetts - Department of Public Safety Board of Building Regulations and Standards i Construction Supervisor License: CS-096416 SALVADOR U Z., MORA- 105 ORCHARD STR0MV' WATERTOWN IRA 02�2 Expiration Commissioner 09/06/2016 Aco' CERTIFICATE OF LIABILITY INSURANCE r ATE(MMIOD/YYYY) `.,� 09/090 4 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 pollcy(les)must be endorsed. If SUBROGATION IS WANED,subject to the terns 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 NCONT ONE: Amanita Bose 182 M Inc.Insurance Agency, PHONEZlg .(617)612-6503 FAX 61 926 0912 EMAIL (AIC,No): Watertown,MA 02472 AD : abo�t�anstrance.com INSURERS)AFFORDING COVERAGE NAIC A INSURER A. Vermont Mutual 26018 INSURED Zamora Group LLC INSURER B: SaW lndemnity 33618 105 Orchard Street INSURERC: AIM 000000 Watertown,MA 02472 INSURER D 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. ILT R TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DCYYYYY IMMMOIr"yj LIMITS A GENERAL LIABILITY Y BP18012131 07/11/2014 /11/2015 EACH OCCURRENCE $ 1,0001000 COMMERCIAL GENERAL LIABILITY DAMAGETORENIED n e $ 50,000 CLAIMS-MADE ©OCCLR MED EXP oneperson) S 5,000 PERSONAL&ADV RMY $ 1,000.000 GENERALAGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO LOC $ B AUTOMOBILE UABIuTY Y 6229M 07/14 M14 07/14/2015 COMBII COMBINED SINGLE UW ANY ALTO BODILY INILRY(Per person) $ 100,000 ALL AUTOS AUTOS D BODILY IhULRY(Per acddenQ S 300,000 HREDAUTOS AUTOS PROPERTY DAMAGE S 100,000 $ UMBRELLALLA13 OCCUR EACH OCCURRENCE $ EXCESS LIAB CUUMS-MADE AGGREGATE S DED RETENTION S S C WORKERS COMPENSATION WCC 500 501340A-2U14A 05/16/2014 05/16J2015 we STATLL OTI+ AND EINPLOYERS LIABILITY Y I N ANY OFFICERWEMB�P�UDED? CUTIVE ❑ NIA EL EACHACCIDENT $ 100,000 to(Mandaryln NH) EL DISEASE-EA EMPLOYEE S 100,000 If yes,describe under DESCRIPTIONOFOPERATIONSbelow EL.DISEASE-POLICY LIMIT s SM.000 -TI -T DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddRlonal Renrrks Schedule,B more space Is required) SC Property Management LLC shall be named as additional insured as required by contract. CERTIFICATE HOLDER CANCELLATION ` 1 o w/.I F)p SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD } 1e CttrnIMt YMA-- i of Vassacbmsets Deparhuent qfh s&i4TI Acdderrts - - - Office of-,f s ians 600 WashingtanStree.f Boston,MA 02M wtt:�tvanass.gavIdia ,orkers'Campensafian Iusugauce Affidavit Builders/ContractorsMecfricianMumbers tra>mt Informafian Please Priat Lej ib Name(11nslonllntiitndnalj_ ��-�►!" � Gt/t/�-8 � Address-_( City/stattIaip: �2- AMC 9 D Are you an employer?Oheckfhe appropriafe bow: of . o'ect r _: ---- - -T Pr-_3 .. (�I-nd). -- -----.. $. I am a employer with 4. nri a geral confracfor an I 6- []New sfctsction employees(full andlor gait-#ime)* C�/ have hired the sub-contractors. 2 0 I am a sole proprietor orpartner- listed on the atwhed sheet y- e�Prmodeliug ship and have no employees These sub-contractors have g- ❑Demnlifina w for me in an ci r- employees and have wosicers' offing y capa � _ p_ ❑Building addition jl is worlrers'comp.is�mrra„rE comp.iris ancve l 5-❑ We are a corporation and its 10.0 Electrical repairs or additions ICT-ire&] I e h ff ❑Plumbing ave exrcisde e thir li_ umn ditions 3_❑ 1 am.a homeowner doing all watt �repairs or ad myself.[No workers'comp- right of exemption per MGM 12_0 Roof repaiis Dance requimd]$ c-154 §1(4} and we have no employees_LN'a warkers I3_0 Other comp-insurance,required]. *Amy appBoml that checks boa#1 tans t slso fa out the section below showing ihea vuikea'compensaion policy irffihimafic� #Hvmeawnets aho submit this si�idav d inr%rrvr rg they are riving all tcorSc aid ihea hae outside contractors sffis stabmit a nesfi a d3rit mkhcst mrh tCanincturs lost efsecic this bolt mast attached as addifioosl sheet shoring the tie of the�and slat$u}ietLef oennt�usis tartities T>� amplayees Ifti a offi-contaMrs hxM employees,they must pmvide their workers'comp.palicp ntunbes X am are empLayer#Flat is ptvvid lag ttrorkers'cortrperrsalian LrLv4raac-a f ar ray e-mpluyem Belau is thepatic}acid job sits rn,forn�atiarL Insurance GompanyNatne: iratlQIIDat£: ram- ,� ) Job Sim Add�rsss: `{ Lo�� V/L`- Giiy4sta6e1Zig:(X.N A tack a copy of the workers'compensation Policy de-daration page(shoving the policy number and ration date). Failure to secure coverage as required-under Sectica 25A of ISML c. 152 can head to the imposition ofcriminaI peaafEies of a fine up to$1,500.00 andlor one-year impri'sonnEent,as well as civil peualfi es in the fozm of a STOP WORK ORDER-and a fins ofup to$250.00 a.day against the violator_ Be advised that a copy of this statement smybe forwarded to the Office of Itn es6gations of fh,e DIA for Tna m=,n c0-trage verification- 1 do hereby cm-lify rt. the prrirts to p-e Ff-es ofperjury thatfhe irtforrrzuhan prat2ded abzn a is beta mid carrsct S.it=_na Date: C/ 33 0#zC&I us--an y. Da not write in th&inert,to be campi`eted by city or town offieraL Cite'or Town Perridt icense ff Iasuin Authority(circle one): 1.Board 4f health 2.Building Department 3.OitW wm Clerk 4.EIectrical Inspector S_P1umbiu Inspector 6:�htr u Information and Instructions- Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuautto 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 defoaed 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 or 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 Iocal 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 with 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 necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of 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. TLe affidavit shoal-d 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 lme. 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. In addition,an applicant that must submit multiple permit/licease applications in any given year,need only submit one affidavit indicating curreut policy information(if necessary)and under"Job Site Address"the applicant should write"all locations m. (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses_ A new affidavit must be tilled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn Ieaves etc.)said person is NOT required to complete this affidaNdt The Office of Investigations would IRce 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 M ssachusetts DepartmeD:t Gf Industial Accidents office of luyesfigatims 600 Waslirtan&xeet BostQzt,IAA 02111 Tel.4 617 727--4.9GO.W4QG or 1-a MASWE devised 4 24 07. Fax## 617-727-�49 www_mass-go-Odin OFF Toly * * anxxsrwsLFE f 9� � Town of Barnstable jDlfo rnw't a 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 If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the i reverse side. Q:\WPHL.ESTORIvIS\building permit fbnns\EXPRESS.doC Revised 061313 Town of Barnstable Regulatory Services P�0*IKE r, Richard V.ScaIi,Director ° Building Division * aaaxsrrasr.E. Tom Perry,Building Commissioner hMss_ 9Q� s619- � 200 Main Street, Hyannis,MA 02601 jOTEo nMI° 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-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. 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 persou(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 personas 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 Iast 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. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 Zamor' roup, LLG General Construction 105 Orchard St.Water]own,ALA,02472 Cell. 617-334-3307 Fax. 61 -744-0335 DATE: SEPTEMBER 8,2014 BILL TO: Mr. Kevin knippenberg Cape Cod,MA ESTIMATE Strip roof shingles of entire roof Replace damage wood Ice water shield to entire roof Drip edge and Ridge vent Install new roof shingles (Certenteed 25 years) New lead flashing around chimney Replace any damage trim, check all around have ready to paint(next spring) Remove all trash Building Permit Labor/Materials Total$8,500.00 Uhses Zamora 617-334-3307 Thank you for your business! All 2��