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HomeMy WebLinkAbout0161 MEGAN ROAD 1 (v 1 M e Q n 7d. Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 10/28/15Va Town of Barnstable CV =� Thomas Perry CBO Building Commissioner 200 Main St.Hyannis,MA 02601 RE: Building Permit#201506636 TO: Building Inspector(s), This affidavit is to certify that all work completed for 161 Megan Road,Hyannis has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATI.ON ra @.B "" •�ti LE Map a� Parcel �.3 S i_a � T Application # Health Division n, r 1: Date Issued Conservation Division Application Fee 50'0® Planning Dept. _� .�,� � . e@ Permit Fee 0" Date Definitive Plan Approved by Planning Board`' Historic - OKH _ Preservation / Hyannis Project Street Address L 61 me, aq Village r Owner L ose C s- "k Address SA-m:G. Telephone S a 8 3-3 4- '4g 10 Permit Request NJ k, 38 Ce 11 A 103 f mac +kc C&I C� rt}� o� 12- � � . 1'Dc£J -Ir t1 Pm e r>4: Lb o x s I ,r iA,,(, xew I 4—�2 1 �r —T(A,A e off,�►1. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation .3900 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ 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: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )! No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 511 �hc, 'Telephone Number 002 318 0 3 Q P Address -� w A+tl "jr License # �:LC I (� 6 G Home Improvement Contractor# 1 8 p C 7� D Email Worker's Compensation # W Wc313 lh1�T ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO fraxmoL4 � SIGNATURE DATE d G I S J f FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION f, FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING s DATE CLOSED OUT 7 ` J ASSOCIATION PLAN NO. f The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 "Ja www massgov/dia Workers'Compensation.Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth,MA 02664 Phone#:508-398 0398 Are you an employer?Check the appropriate boar Type of project(required): 1,[0 I am a employer with 20 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.F1I am a homeowner doing all work myself.[No workers'comp..insurance required.]t 9. ❑Demolition 10.0 Building addition 4. I am a homeowner and will be hiring contractors to conduct all work on my property..I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 2bing repairs or additions 5.❑I am a general contractor and I.have hired the sub 1 . Plum contractors'listed on the attached sheet. 12.❑Roof Plumbing repairs These sub-contractors have employees and have workers'comp.insurance.; 6.❑We are a corporation and its officers have exercised their right of.exemption per MGL c. 14. 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 contractorsmust submit anew 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:Wesco Insurance Company Policy'#or Self-ins.Lie:#:WWC31.36274 Expiration Date:04/09/2016 Job Site Address: 161 Megan Road City/State/Zip: Hyannis Attach a copy oft.he.workers'compensation policy declaration page(showing the'policy number and expiration 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 staternent maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under,th pains and penalties of perjury that the information provided above is true and correct Si ature: Date: 10/6/2015 Phone#:508-398 039.8 Official use only. Do not write:in this area,to be completed by city or town official City or Town; PermiflLicense# 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#: ,�cc Rc...-� > : DATE(MM/ DrAYCERTIFICAT OF LI U Y NSVkANCE 3/24/2015 THIS CERTIFICATE IS ISSUED.As,A MATTER OF INFORMATION ONLY,AND;CONFER-8 NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE.DOES NOT:AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND'OR ALTER THE COVERAGE AFFORDED: FFORQED BY THE POLICIES BELOW. THIS CERTIFICATE OF:INSURANCE DOES.NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURMS),.':AUTHORIZED REPRESENTATIVE OR.PRODUCER,:AND'THE CERTlFICATE:HOLt)ER4° . IMPORTANT.* If the certt&cate-holder Is an ADDITIONAL-INSURED,the#eolicy(les}msast be emlorsed. It SU13ROGATIOIN'IS WAILED,seebjecf to the tetms,and conditions of the policy,certaln,p.olicies may requlre an;endorsern0, A. A_statement on this certificate does not.confer rights to the certificate holder.in lieu ot;such widorsernen s PRoouceR NAME: Colleen Crowley Risk strategies 16 r. ny PHor>E (781y986-440a FA C a':t W963-4026 15 Patella Park Drive ..CCrowle ,@risk-strateg es.com Suite 240. _ INSURE s}AFFORDING COVERAGE' P1AIC# i 3ado3Esl> 3tA '02368 INSURERA.-Se'lective 4-OVERAGE— of America INSURED INsuRERs A7.3aa ance U212 Cape Save, xnc INSURERC,-Wesco :Insurance .: 7 D Huntinw tba Aire t .......:..... rt: INSURERO. INSURER E Muth YAM6,11th WK' 02664 /NSUR... COVERAGES CERTIFICATE NUMBER:CL1532491501 REVISION NUMBER:' A lS iS TO:�CERT1fY T AT TiHE POLie EB Qf iNSiJRANCE'L(STED BELOW HAVE i3EE1J IS�iJED:TO THE'INS(3RE0:`NAidIEO'ABOVE FOR'THE POL(CY'PEAiOD itSIEiICATEi7. fQ�fWfPFtSTANDING ANY REQUIREMENT,TERM OR CONDM NN OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH tii(5 CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED.HEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONSAND.CONDITIMS OF'SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN.REDUCED BY PAID CLAIMS, ` LTR TYPE OF:INSURANCE POLICY NUMBER DILICYEFF .PMO�JCYEXP < LIMITS GENERAL LIABILITY EACH OCCURRENCE.g 1 y000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oRence $ 100,000 CL4IMSMADE a OCCUR A 1994490 0/16/2014 0/16%2015 MED EXP(A.Y one Person) ,g 10,000 .. PERSONAL.'&;ADV INttL?Y $ 1,00a,Ia00 GENERAL AGGREGATE $ P,000,000 GEN'LAGGREGATELIMITAPPLIESPER: DU PROCTS,COMP/OPAGG $ 2,000,000 POLICY X PRO X LOC $ AUTOMOBILE LIABILITY <,_, ,._{ 'Ea accident l 1,000,00 B ANY AUTO , BODILY WJURY(Per person} $ ALL OYMED SCHEDULED 4679fi600, 1/6/20I9 1f6/2015 -'AUTOS :.. -AUTOS -r BODILY IN.RJRY(Per accident) $ ..,..X HIREDAUrOS. AUTO$ $ ` X UMBRELLA LIAR` X 66CUR EACH OCCURRENCE $ 1,o00,000 EXGESSUA6- .CLAIMSMADE AGGREGATE $ 1,0001000' DM RETENTION 9I. 1994450 4/1Gj2024 4/7 6f2(#l5 C wORKERSQ9MPENSAl14N _ AND EMP,LOYERSIL1.u*eaITY. . fliers Ynludkcl.for vcsrAru o H- ANY PROPRIETORIPAI TtlrJ2/IXEa17IVE Y7N OVBr3ge Y OFFICEPJMEMBER E?CL LLU]ECR E.L.EACH ACCIDENT , $ JOO Oaa (Mandatory;in NH} 1 S['14 /9/ Ol'5 f 9{ Ol b :E:L DIS£A.V EA EMPLOYE $ 4 •QD0 fyyes,desaihewider ., ,2't.. _ DESGRI II OF OPERATIONShe,ow E:LDISEASIE-POLICY LIMIT $ 500 000 DESCEBPT oN OF OPERAISONSf 10CATIONSI VEHICLES jAttaih ACORD 104;Additlonal Remarks Schedule,it moro apace is requl-d) Issued as evi,den a ofs:.insuranee. Thielsch Engineering,. Inc. is listed as additional insUred:as respects :Genera] yaal3slity,-as reguired;by writ co xtracf - . CERTIFICATE HOLDER CANCELLATION arsoa sxhtn"nm.+an cZPeli�--�--®s t,O�df. SHOUL7D Any l iF TN15,WVE`DESGRYBED�QLtC(ES"8E CANCELLED`BE7�ORE THE `EXPIRATION DATE THEREOF, NOTpae wiLL i DELIVERED IN Cape L ght CO]IapaCt ACCORDANCEWITH THE POLICY PROVISIONS. _ Attn: Margaret..Song . VO box 427/SCK AUTHORR®REPRESENrATIvE 3185 Main. stre6t 8arnstable.,' Pgt : 02S30- ; chael Christian/CLC '�"� ACQi31725 TI3/fJSj: :. Cad�888,Za7Q�9CORDCORKMATI0A3 �411regtrtsTesanred. INIS025(zotoos)_ot The ACORD riarne snit logo are regisfer®d marks,of ACORf) HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. I !✓t CZ . (_fq hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: i Weather stripping; air sealing; attic& basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. 1 give_permission to Housing Assistance Corporation the_property with such equipment and materials as may be necessary to perform weatherization. I 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement and give my consent. j Home Owner(signature) Home Owner email:'— l 'J� l.�•�/ Date: i f- Agent:(signature) A Date: t Weatherization Contractors: Adam T Inc Save i All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement Building Science Construction Resolution Energy Cape Cod Insulation Tupper Construction ��e Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 _. Home Improvement Contractor Registration Registration: 171380 1-2 Type: Corporation To M 0 t° { Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. w WILLIAM McCLUSKEY TI 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 rR g , ' F14` Update Address and return card.Mark reason for change. SCA 1 Co 20M-05l11 Address E] Renewal a Employment E] Lost Card • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only QAxpiration 3J14/2(3�6 Corporation OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: A171380 Type: Office of Consumer Affairs and Business Regulation ' 10 Park Plaza-Suite 5170 ,�,E . Boston,MA 02116 CAPE SAVE INC. ;ram; ".-g WILLIAM McCLUSKEY�'.�l � 7-D HUNTINGTON AVENI�E g SOUTH YARMOUTH,MA 02664 Undersecretary Not vali rthout signature Massachusetts -Department of Public Safety .Board of Building;Regulations and.Standards Surtei—iSor'arsieci-aiiv License: CSSL 102776 Z W �tit f t ti �. �.. WILLIAMJ MC LU 37 NAUSET RO) I , G West Yarmouth NIA '"Wit t `L Expiration Connrnissioner 06128/2017 } IKE Town of Barnstable = e � g Expires 6 months from issue date Regulatory Services Fee 4 '* BAMSTABt.e. • MA-S& $ Thomas F.Geiler,Director ibg9. �0 fD MA'l Building Division Tom Perry,CBO, Building Commissioner 1 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY of acid without Red X-Press Imprint Map/parcel Number U Property,Address 161 �7��yf S Residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address [. /I�dGL ZrGc / o �e u'� /"� R��l� - Contractor's Name GLt,��'�i �''��' � /,-7 4&0/ elephone Number Home Improvement Contractor License#(if applicable) / -? Construction Supervisor's License.#(ifapplicable) �S -PRESS 2 Workman's Compensation Insurance JAN 0 2013. Check one: ❑ I am a sole proprietor ❑�am the Homeowner TOWN OF BARNSTABL.E C'I have Worker's Compensation Insurance Insurance Company Name 1�a f.,C/Cis f1)Sly)44_-_ 61-?Pem" Workman's Comp.Policy# /�O/� �S }/> '5' A //_7 Copy of Insurance Compliance Certificate must accompany each.permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side fy`�LY100, of doors Replacement Windows/doors/sliders.U-Value a. aximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and.inspections required.` Separate Electrical&Fire Permits required. - *Where required: Issuance of this permit does not exempt compliance with other town department.regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. P A copy of the Home Improvement Contractors License&Construction Supervisors License is,'. eeed SIGNATURE: 1Gt O:IWPFILES_MORMS\building permit formsTYPRESS.doc The Commonwealth o,f Massachusetts Departinent o Industria;?Accidents Office cr,f'Investigr ions 690 Wwhington&Wet" Boston,MA 02111 . wnw.grass.gt vldia Workers' Compemafiou Insurance Affidavit:.$BudersfContractorslE�ecfric ans/Ph mb�ers" Applicant Information Please.Print L.egibi3_ Name(B„siner, b4urluc3ividual): Address. 711"Mir/ cirytsta rz p_ �/1� � /`W p;6olPhone Are you an employer?Check the appropriate boy: 'type:of project(required): 1.LJ 1 4. ❑ I am a general contractor and I am a emplflyer with�, 5_ ❑New construction employees(full and/or part-#ime)-* "hired the sub--contrackas I❑ I am a sole proprietor cry partner- listed on the attached sheep 7: ❑Remodeling listed.and have no employees These crib-contractors have g_ ❑Demolition working for me in any capacity- - employees and have Wks' 9 ❑Building addition ess [No wodo ' comp.insuzz=e: com7p_iasurau+�e l required.]. 5, ❑ We area corporation,and its 10. Electrical repairs or additions I❑ I ate.a homeowner doing all work officers have exercised their 11_❑Plumbing repairs or additions myself. [No workers'comp- right of exemption per IwYGL 12:0 Roof repairs insurance required-] c. 152,§1�(4),and we have no o wormers' 13•❑{3tlrer employees. commp.insurance nxluired.j. ;Any appkcsut that checks box Al:must also fill ow The a section below shawiag their workers'campensatisrn policy infaeumstian: HomeoAtners who submit this d&bmrit indicating they are doing aR weak sad then hire outside contractoes must submit a new affidavit indicating such Icon=cmis that check this box am=attached-additional sheet showing the name of the sub-ew=Ktocs seal stale whether Of not those entities have. employees. If the sub-contractats hwe emPloyees,fheYmvst.pmvide their xiorkm'comp.policy number_ Iam all srnplr�'er that is prmti&ng workL,,m'compenssa ion insurance for rriy smploy�eeL Below is 7tta pour} and job site information. Imurance Company Name Policy 9 er.Self-ins_Lic_ 4W 2 61 Expiration}hate: / Job Site.Addrew: / �G'�lt City/Statel7ap:/i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure too secure coverage as required under Section.25A of br GL c 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andfor one-yeas imprisonment,as well as civil penalties m the form of a STOP WORK ORDER and a foe of up to$250_QO a tray against the violator.. Be advised that a copy of this statement may be forwarded to the Office.of Investigations,of the,DIA for insurance coverage verifytic a I do hereby cerhi thepains andponalfi n o fpejjW 'that the information prat>ided a fS7 and correct. Date: Phone:# fos bd O �f2 6 official use ofrty. Do not write in this area,16 be completed by cio or totwi official City ar Town: PermiVUcense ig Issuing Antirarity(circle one): 1..Board.of Health y.Building Department 3.C ityll'o`itn Clerk d.Electrical Inspector :5.Plumbing luspectoe 6."C}tlrer 01/10/2013 10:27 FAX f 0001/0001 A � ® DATE(MMIDDNYYY) a s CERTIFICATE OF LIABILITY INSURANCE 1/10/2013 �4i(S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: CHARLES H GAHILL INSURANCE :AGENCY cN FAX, 1 -2800o IC (78 )83a )8 No PO Box 321 AooREss:gisela@cahillinsurance.com Duxbury, MA 02331 INSURER($) AFFORDING COVERAGE NAICX INSURER A:Nautilus Insurance Company INSURED PAUL & PADRAIG GALVIN INSURER B:Guard Insurance Company DBA GALHOMES LLC, GALVIN BROTHERS INSURER C: THORNTON 139, LLC INSURER D: 16 STEVENS STREET INSURER E: HYANNIS, MA 02601 1 INSURERF: 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 L suBR LIMITS LSR INSR yyyp POLICY NUMBER MMIDD MMIDD/YYW GENERAL LIABILITY EACH OCCURRENCE $ 1 00,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea oocurmnoe S $300 000 `CLAIMS-MADE C�OCCUR MED EXP(Any one person) $ 5 000 A NNO56105 09/24/2012 09/24/2013 PERSONAL&ADV INJURY $$1,000,000 GENERAL AGGREGATE $$2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $$2,000,000 POLICY LOC $i o COMBINED SINGLE IT AUTOMOBILE LIABILITY Ea accident $ ANYAUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PRPUTSWNED R t AMA $ HIRED AUTOS AO Per add $ UMBRELLA LIAR OCCUR EACH OCCURRENCE S LIAB CLAIMS-MADE AGGREGATE Is DECOD RETENTION$ $ WORKERS COMPENSATION I G X OTH• TWORY L LIMIT1Mrr S ER AND EMPLOYERS'LIABILITY YIN 06/01/2012 06/01/2013 ANY PROPRIETORIPARTNERIEXECUTIVE C-AWC327111 E.L.EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L DISEASE-EA EMPLOYE $ 1,000,000 If yes describe under E.L.DISEASE-POLICY LIMIT,$ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) PAUL AND PADRAIG GALVIN ARE EXCLUDED FROM WORKERS COMPENSATION COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FAX 508-862-4784 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION. All rights reserved., ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD r oFs�rqy • IARNSrABLE + 9� 6 SS, � Town of Barnstable plED MA't a - Regulatory Services Thomas F.Geiler,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. I, 6-035�a ;as Owner of the subject property hereby authorize ( GC VJIK Brn-Aefs to act on my behalf, in all matters relative to work authorized by this building permit application for: 1llcr avi' r z (Address of Job) i Signature of Owner D .te Prin Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on,the reverse side. Q:IWPFILES\FORMS\building permit forms\EXPRESS.doc °Ftra,� Town of Barnstable P Regulatory Services IARNSTABLE, ' Thomas F. GeiV02 P Mass. g 1639. 'n a Build>< lfD Mp�i g Tom Perry,Buildin 200 Main Street, Hywww.town.bar Office:. 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENS XEMPTION Pleas7PH DATE: /O k<J JOB LOCATION: number / street �s— p village v� "HOMEOWNER": name home pho # work phone# CURRENT MAILING ADDRESS: �� city/town state zip code The current exemption for"homeowners"was extende to include owner-occupied dwellings of six units or less and,to allow homeowners to engage an individual for hire who doe not possess a license,provided that the owner acts as supervisor. DIEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/sh 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 homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she sha11 be responsible for all such work performed under the building permit. (Section 109.1.1') . The undersigned"homeowner"assumes respo sibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned "homeowner"certifies th he/she understands the Town of Barnstable Building Department minimum inspection proc dures and.rnequirements and that he/s e will comply with said procedures and requirements. . L Signalure of Homeowner Approval of Building Official° Note: Three-family dwellin s containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 12.7.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any hom owner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.I.1 -Licensing of construction Supery ors);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. . .. ��. �V[�tss<tchusetts- Delfarrtment'of Public S.tfet� Board of Built im, Regulations and Standards IS Construction Supervisor License License CS 73839 PADRAIG J. GALVIN 16 STEVENS ST HYANNIS, MA 02601n�' ��— Expiration: 1/12/2013 Conmii.siuner Tr#: 10329 ' am�na�uue .o�✓�aaa J.0 P Office of Consumer Affairs&B smes9 Regulation y HOME IMPROVEMENT CONTRACTOR i r Registration 51301.84 Type ",. Expiration 1/2512014 Individual ' xRQ PA AIG GALVIN 3 1 PADRAIG GALVIN 102°'GOODRICH I HYANNIS,MA 02601`'; r, Undersecretary` K `� Assessor's map and lot number .. � ................................. SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE —� Sewage Permit number ............. ... 5............................... WITH ARTICLE II STATE ......... SANITARY CODE ANDOVd� Qy��THEtp� TOWN OF BARNS LE1� SS • i BAWSTUL$ i 0 p��.e�� BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..C - . ���� .... ............................................................................... .. ....................... TYPE OF CONSTRUCTION ...fC ...��......................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hler by applies for a permit according to thee following information: LocationG ......................... .................................. J ProposedUse . .... ....... //Alt,......................... . .........3t....................................................... ZoningDistrict ..J.4/..19, . ..................................................Fire District ............. ........................................ Name of Owner .. .................... ....Address G`.. e� ............................ . Nameof Builder ............... .....................................Address .................................................................................... v f / Nameof Architect ....................................... .......................Address .................................................................................... Number of Rooms ........... .....................................................Foundation ............ �. . . . ......... Exierior A . ........... . . .......................Roofing .... ..........: .......... Floors ....:..............Interior ....t �' J.....�.. ...... .......... .. .... ...... ..... ...................................... Heating . .....1 9'1..... .-.q ..."......Plumbing ........ ........................................................................ i Fireplace ...........I......................................................................Approximate Cost ...... .. ,...4..v.Lf..... . ...... ..........r. f Definitive Plan Approved by Planning Board 6EL t--------19 Area ..............0 •�P....... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH y 0 � © 'r I hereby agree to conform to all the Rules and Regulations of the Town of Ba nstable regarding the above construction. d Namer. ........................ Dacey, William E. Jr. No ....16768. . Permit for ...one sto . rL,,l ...... .... ...:........ ..................... single family. dwelling ...... `^.� ....1�egan Road..........::...........:..:... .... Loca�ion ........................... ........... .. .. . . f` Hf yannzs .A. William E. Dacey, Jr. Owner .................................... 3 frame Type of Construction - Plot ............................ Lot ................................ t � bec ember`3 e-' !..19 73 ► f Permit Granted .........I"10 .... -- - e'Date of Inspection ...... Date Completed .. 1. 1 I1 9 " PERMIT REFUSED l ...................................................c.................... Jy/f��" L / J - f, ,� • /�i ' .....:................................................. . - ............ ......................................................... .................... .r ,� o4 y ... - - '�� ! ................................. J f............. 100 J Approved ..,.................................:........... 19 ° ...............................................................................