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Home My WebLink About0212 MEGAN ROAD ara mern "Rd. oF�r� Town of Barnstable *Permit#ti ' � �4iRe ulatofres 6 months u Issue date g ry Services Fe —� MAN i639. �e Thomas F. Geiler,Director tl Building Division Torn Per ry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.to wn.b arnstab l e.ma.us Office: 508-862-4038 EXPRESS PERMIT APPLICATION'_ RESIDENTIAL ONLY Fax: 508-790-6230 Not Valid without Red X-Press Imprint Map/parcel Number ZI(7. J, Cb Property Address 2. 2 i [Residential Value of Work f Minimum fee of$3 .00 for wor k under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable)_ ?3 Construction Supervisor's License#(if applicable) g Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# . :�opy of Insurance Compliance Certificate must accompany each permit. 'ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side replacement Windows/doors/sliders. U-Value #of doors 2i (maxirnum .44)#of windows q *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,C—onslervrvation',etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improve actors License& Construction Supervisors License is equired. YNATURE: VPFIL ORMSlbuilding permit formslEXPRESS.doc ,ised 070110 OFFICE: (508) 997-1111 ;; MA. Builders Lic. #021330 FAX: (508) 997-1297 Home Improvement TOLL FREE: 1-800-407-1111 AWCARE FREE Contractor's License WEBSITE: men Inc. #100503 MA. www.carefreeho^mesccompany.com239 HUTTLESTON AVE. (FIT 6) • FAIRHAVEN, MA 02719 #15179 R.I. DATE 9 f��j�/ C1// ADDRESS S"Z 43 ZIP CODE ADDRESS OF JOB S' L TEL JOB DESCRIPTION Ad 9 Z-1125 72wl Al "exl 447 ;X� 1o., ffAO�W GM5 :—L4:�V erg /4le-61 16. 4&_ 10 rV-_lid Scheduled Start U4fy Scheduled Completion A. Replacement of missing or rotted lumber is not included unless specified. B.All start&completion dates are approximate and could change due to weather conditions. C.Stripping of roof includes removal of up to two(2)layers of Ileseach aliti I yer to be charged Q ft2. D. Replacement of rotted roof boards/plywood to be charged �w E. Exisiting chimnet flashings will be reused; replacement, if nec ssary, is not included. F.Care Free Homes, Inc. is not responsible for.mold/mildew conditions that are pre-existing.or result from leaks not brought to the attention of C.F.H., Inc. promptly. The Company hereby proposes to furnish labor and material to complete the above work for the amount herein. Fulfillment of this "'order is contingent, however, upon the want of strikes,fires,arid-any natural disasters;the ability to obtain materials,or any other T conditions beyond the control of th ompany. Cost of Project$ - PAYMENT TERMS 0A1 04 W, Date 1. You,the Owner may cancel transaction at any time prior to midnight of the third business day after the date of this transaction. 2. You,the Owners agree to pay any and all expenses incurred by Care Free Homes, Inc. in collecting money due under this contract and enforcing the terms of this contract, including but not limited to, reasonable attorney's fees, interest and court costs. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CARE FRE HOMES, INC. ACCEPTED: Buyer L Buyer acknowledges Owner: By: f receipt of fully completed copy of this Areement Owner. l All contractors and subcontractors shall be registered by the director and any inquiries about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration One Ashburton Place, Room 1301 Boston, MA 02108 Tel. (617)727-8598 Client#:33723 CAREF "'ACORD.. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDfiY"_ THIS CER2011 TIFICATE 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 Herlihy Insurance Agency,Inc. NAME: a/c°Na E.t:508 756-5159 508 751-5747 51 Pullman Street A/c No: E-MAIL Worcester, MA 01606 ADDRESS: 508 756-5159 CUSTOMER ID#: INSURED INSURERS)AFFORDING COVERAGE NAIC ft Care Free Homes Inc INSURER A:Interguard Insurance Company 239 Huttleston Avenue INSURERS:Safety Indemnity Insurance Comp Fairhaven,MA 02719 INSURERC: 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'A13OVE 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 I DDL UBR L R TYPE OF INSURANCE NSR D POLICY NUMBER MM/DD EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY A PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- PRODUCTS-COMP/OP AGG $ POLICY LOC $ B AUTOMOBILE LIABILITY 6213850 07/01/2011 07/01/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY(Per person) $ X SCHEDULED AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS PROPERTY DAMAGE $ (Per accident) X NON-OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS E LIAB CLAIMS-MADE JDEDUCTIBLE AGGREGATE $ RETENTION A ORKERS COMPENSATION CAWC244O43 09/01/2011 09/01/201 X Wo STATU- OTH- $ ND EMPLOYERS'LIABILITYFFLIMIT ANY ICER/MEMBER EXCLUDED?ECUTIVEY® N/A E.L.EACH ACCIDENT $1,000,000 andatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 ii yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 367 Main Street AUTHORIZED REPRESENTATIVE Barnstable, MA 02601 )1@199UG09 AORO CORKORATION.All rights reserved. ACORD 25(2009/09) 1 of.1 The ACORD name and logo are registered ma of ACORD #S48858/M48747 P62 ti tssacnusctts vepartment oT runitc Jaiety Board of Building Regulations and Standards 6'dnstructioFl�Supervisor License License: CS '95228 Restricted to: 00. DANA PICKUP 19 HAMLET STREET FAIRHAVEN MA 02719 Expiration: 3/22/2012 Commissioner. Tri#: 1M.80 J � ✓�ie �o�rvnw,iuueczllli o��/�aaaacfucvi,/,26 -- — __ --y Office of Eausulner=Affairs S�3us'newRegulat c,r.. License or.registration valid for►nd v;dul use orl j? 3 HJM,E IMPROVEMENT CONTRACTOR before the expiration date If found return to 1 Registration �00503 [ Office of Consumer Affair,and Busines§'Regulation.;' Ekl?rataorn=6f�9----- TYp it 1.0 Park Plaza=Suite k7 Supple men yard. Boston,'iVIA 02116 CARE%FREE HOMES tNCF ti_- i i. DANA PICKUP [ 239 Huttleston ave� f Fairhaven, MA02i19 '= 1 lJndersec:retar� „�, Not valid wi out signa f j The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigadons 600 Washington Street Boston, MA 021.11 www.mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name (Business/Orgaaization/Individual): f! Address: Cl23 4k 5 City/State/Zip: ` q Phone#: 7- F2.0 ry, an employer? Check the appropriate bog: m a employer with Z.C� 4• ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction am a sole proprietor or partner- listed on the attached sheet. 7. [-Modeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp,insurance.# 9. ❑Building addition 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.[1 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 al]work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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'compensado insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: (� Expiration Date: Z _ Job Site Address: c City/State/Zip: Attach a copy of the workers' co9pensation 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 up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations f the DIA for insurance coverage verification. I do hereby ce under t ns and naltie ry that the information provided above ' true and correct Si afore: Date: �� /} Phone#: 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#: Assessor's map and lot number 2 P ...... � ) 7 SNISTEM MUST BE jj ; 4 Co"', !�I�CE Sewage Permit number €ga ri *f1 Y p R, 41 S 1 Alt E ................. ....................................... @ yij+Y'9 �i;:i�'-,r j'- ± xilTA Y CODE AND TO�E1P}: yofTNETp�� TOWN OF BARNS I .. __.... 89HBSTSHLE, i "6 9 .•� BUILDING INSPECTOR c M a APPLICATION FOR PERMIT TO ...0. �� .............................................................................................................. TYPE OF CONSTRUCTION.®..... .... ... ... :. .......... ..............,®,......................................... �.. . . : .,9. /... TO THE INSPECTOR OF BUILDINGS: a. The undersigned herreby applies for a permit according to the f Ilowing information: t Location `./............//.... .......� y........�4.1 1............ .... .......... .... ............... ... .: .................. Proposed Use J. .. . .. ... ... j/ Zoning District ...4.9.............................. ..........................Fire District ......../ . . ..... ...... X / �° Name of Owner G�idJ � Address ...!/ ...(IS,C.//�. ..................i��o... . .. .. .. .. . ..... .. .. . �f - Name of Builder .. . ...... �........ .. ,............Address .................................................................................... Name of Architect �'............................................................. .. ..................................................................Address ..........................................................,................... .... Number of Rooms .......6......................................................Foundation ..... (1.... ........ ................... Exterior .. . . . .... ...........................Roofing .:.. . ........... ............................................. Floors ...�........................Interior .. .... Heating .... .......... ....... ................,..................::.Plumbing ...................................................: Fireplace ............../.................................................................Approximate Cost ...... .,.dr. .....r� Definitive Plan Approved by Planning Board �_____ _________________19.7 Area ....f. . ? KJ....... ............... /�� 00 Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �G I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ............... .. ............. ... ..... .....................•... W. E.. .D. 8oaItxr Trust� =~ | | ' . 1°""v one No ................. Permit for ----- --. L~~- | ) a��o1e - _'._' - ' . _��..��.....-------.. ` | Road ` Location ................................................................ / ° | �---.-.--...�--.----.----------- ~� Owner ---W._]8��D°. Trust ___. Type of Construction frameframe-------------.. '—..�, ^.--------------------. Pk �� Plot ---------. Lot ---./cq----- February -Permit 8 ��' ' lV �� Perm ----' ^.��-'-. Dote Inspection ................z........lV r Date Completed v'�� ' -�.. ' � ^ c ` PERMIT REFUSEN/ ----'`_-----..--------- lg ..-----------.-----.... -------.' ^--^--~^'-^-----------------' '.~.---.--.-... . .. --.----~.-.-..--- .-------~-.-----..----.----.~ Approved ... lg -----_--------.~-----.---.... ~ -----------.-----------.....- ' . ' ^ � '