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HomeMy WebLinkAbout0500 OCEAN STREET (15) - �j 1oQ GLno ;; -1 C)°-I ® (Pr N lip TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 6 019A Application # 026 6 l Health Division Q Issued CA c.-SA Conservation Division A` hcation Fee Planning Dept. .,v F, triit Fee Date Definitive Plan Approved by Planning Board a Historic - OKH _Preservation/ Hyannis ' Project Street Address VIC dn±10W 10 T�d!nml n I U e Village Own c 'All Address.5no Ocean 4/annIS Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Mconstrktion Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# _:nits) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: 0 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 bat[-,-,,): 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) Nai %9 f f4 jE� Telephone Number _ _ oc--� � J 7 Address J I n (te r � Rn a d _ License # d,1 4/L�� irk', . V 1 I Home Improvement Contractor# Worker's Compensation # CSC ''T 11-4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ��� C r i, FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. f a ADDRESS VILLAGE r ti OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE . ELECTRICAL: ROUGH FINAL { PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - r DATE CLOSED OUT ASSOCIATION PLAN NO. Emergency Contractors LLC HOME IMPROVEMENT/RENOVATION AGREEMENT This agreement made and entered into this 12th day of August,2014,by and between Emergency Contractors LLC,Fed ID#270657972, Home Improvement Contractor Registration#164370,362 Yarmouth Road, Hyannis, MA 02601 hereinafter referred to as"Contractor",and Yachtsman Condominium Association,hereinafter referred to as"Owner"for work to be performed on the property at:500 Ocean Street— Unit#35,Hyannis,MA 02601. This agreement is drafted pursuant to Massachusetts General Laws Chapter 142A§2 and the provisions contained herein are intended to comply with the requirements of said statute. 1. In consideration of the mutual covenants contained herein,Contractor agrees to perform said work for Owner,according to the following Specifications and the Scope of Work attached hereto as"Schedule A"together with any other documents incorporated herein by reference. 2. In consideration of Contractor's Services and Materials to be provided Owner shall pay to Contractor a Contract sum of$4,753.86 as set forth in the Payment Schedule Attachedhereto as"Schedule B"subject to any Change Orders. In the event that any.Change Order to this agreement shall reference a cost based upon"Time and Materials",the owner shall pay the contractor,with respect to said change order the rate of fifty-five ($55.00)dollars per man hour plus a fee for overhead and profit of-fifteen(15)percent of the cost of all materials related to said change order. 3. Any changes must be subject to the order and direction of said Contractor and must be in writing in substantially similar form to the change order attached hereto. 4. Allowances. If there are allowances which are set forth in this agreement or its schedules,all items covered by such allowances shall be supplied for such amounts and by such persons or entities as Owner may direct, but the contractor shall not be required to employ or supervise persons or entities to whom the contractor has reasonable objection. Unless otherwise provided in the contract documents: a) Allowances shall cover the cost to Contractor of materials and,equipment delivered at the site and all required taxes; b) Contractor's costs for loading and handling at the site,labor,installation cost,overhead, profit and other expenses contemplated for any stated allowance amounts shall be included in the contract sum and not in the allowances; c) Whenever costs are more than or less than the stated allowances,the contract sum shall be adjusted accordingly by change order. In the event that said costs are more than the stated allowances,contractor shall be entitled to a 15%fee for overhead and profit on the increase of said allowances. d) Materials and equipment under an allowance shall be selected by the owner in sufficient time to avoid delay in the work.Any such delay resulting from Owner's failure to select said materials and equipment shall not be the responsibility of the Contractor and the completion date set forth hereunder shall be adjusted accordingly to reflect any such delay on the part of Owner. 5. Work Schedule. The parties hereby agree that the date of commencement of the Work shall be on or around September 2,2014. However,the parties further agree that Contractor's failure to commence work precisely on said date shall not be a material breach of this agreement provided that Contractor begins work within ten days of said commencement date. In addition, Owner hereby acknowledges that the commencement date is contingent upon appropriate weather conditions and if weather conditions are not appropriate to commence said work,the commencement date shall be delayed until appropriate weather conditions exist.'Contractor agrees to achieve substantial completion of the work within 30 Calendar days of the actual commencement of the work subject to any contingencies listed herein. Contractor shall not be held responsible for any delays or termination of work which is caused by any discovery of environmental conditions not caused by Contractors actions, including but not limited due the discovery of any conditions implicating any wetlands or hazardous material laws. 6. Owner hereby warrants and represents that prior to the commencement date Owner is the lawful owner of the land and buildings thereon upon which Contractor shall be commencing the work. 7. Contractor shall not be liable for any delay or nonperformance caused by Act of God,or any other contingency beyond its control. s 8. Owner is hereby notified that all contractors and subcontractors must be registered by the Administrator of the Board of Building Regulations; unless exempted therefrom, and that any inquiries about a contractor or subcontractor relating to a registration should be directed to the Administrator. 9. Owner is hereby notified of owner's three-day cancellation rights under Massachusetts General Laws section forty-eight of chapter ninety-three, C section fourteen of chapter two hundred and fifty-five D,or section ten of chapter one hundred and forty D as may be applicable. 10. Warranly. Contractor warrants to the owner that materials furnished under this agreement will be of good quality and new unless otherwise required or permitted by this agreement,and that the work will conform to the requirements of this agreement. If required by Owner,Contractor shall furnish satisfactory evidence as to the kind in quality of materials and equipment. Contractor warrants that his work will be performed,in a workmanlike manner and that he warranties said work for a period of 1 year from the date of substantial completion of this contract or from the date of the final inspection by the building inspector,whichever is earlier. With respect to any equipment installed by Contractor, Contractor agrees to deliver any manufacturer's warranties to Owner and Owner agrees to rely solely upon those warranties. Said warranty notwithstanding,Owner hereby acknowledges that with respect to any concrete structures, including foundations,small cracks normally appear after said material has cured and that said cracks are normal and are not a result of defective workmanship or materials. Therefore,with respect to any such concrete structures, including but not limited to foundations,Contractor warrants for a period of one year, commencing on the date of substantial completion or from the date of the final inspection by the building inspector,whichever is earlier,that said concrete structures shall be free from groundwater leaks. Leaks which result from floods are specifically excluded from said warranty. With respect to any shingled roof provided by Contractor to Owner,Contractor hereby warrants for a period of one year that said roof shall be watertight for a period of one year commencing on the date which an occupancy permit is issued for the property or from the date of the final inspection by the building inspector,whichever is earlier. Contractor's warranty excludes remedy for damage or defect caused by abuse,neglect,modifications not executed by the contractor,improper or insufficient maintenance,improper operation,or normal wear and tear and normal usage. 11. Permits. Unless otherwise provided in the contract documents,the contractor shall secure and pay for the building permit and other permits and governmental fees, licenses and inspections necessary for proper execution and completion of the work which are customarily secured after execution of the contract. In the event that Owner secures any permits in Owner's name, Owner shall be excluded by the guaranty fund provisions of Massachusetts General Laws Chapter 142A. 12. Release of Liens. Contractor can provide a Release of Lien from all major subcontractors and suppliers, upon completion of the project. Bank type release form, if required,should be furnished to contractor by owner prior to beginning of contract work,which will be properly filled out and be presented to him upon receipt of final payment in full. Unless otherwise noted in this document,the contract shall not imply that any lien or other security interest has been placed on your residence. 13. Utilities. Owners telephone,electric,toilet,water and heat to be made available for contractors and workmen's use during the progress of the .work. Owner is responsible for any new service utility hookup fees required by local electrical utility company. 14. Miscellaneous. Owner further agrees and understands that the following items are included as part of the Agreement; (a)it is Owner's responsibility for identifying to Contractor the correct property lines or survey; (b)Owner must provide Contractor usable facilities to conduct business such as,storage for materials,parking for workers,keys-and access to premises for deliveries and any other reasonable requirements of Contractor; (c)Contractor will match work to existing colors as closely as possible unless otherwise detailed in these documents;(d)Owner agrees to clear the work area of non related items such as furniture,furnishings, household items,etc. Failure to do so will necessitate Contractor to make the work area accessible and will result in an extra charge at the rate of$25.00 per hour, plus equipment if applicable; (.e) Owner agrees to allow Contractor to erect a project sign on the job site,to photograph the job and use Owner's name for advertising and promotion purposes. 15. All home improvement contractors and subcontractors shall be registered and any inquiries about a contractor or subcontractor relating to registration should be directed to:Director,Home Improvement Contractor Registration,One Ashburton Place,Room 1301,Boston,MA 02108. 617-727-8598. In Witness Whereof,the parties have hereunto set their hands the day and date first above written. DO NOT SIGN IF THERE ARE ANY NY BANK SPACES L, [ ustomer] Date Emergency C ractors, LLC Date By Robert Lomba,Operations Manager You may cancel this agreement if it has been signed by a party thereto at a place other than an address of Contractor,which may be its main office or branch thereof, provided you notify Contractor in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. Signature of Owner acknowledges receipt of attached right of cancellation. r SCHEDULE A SCOPE OF WORK/ SPECIFICATIONS See attached scope (Yachtsman_35_RFG) SCHEDULE B CONTRACT SUM / PAYMENT SCHEDULE Due upon Acceptance $ 1,500.00 Due upon completion of Scope of Work $ 1,500.00 Balance due Net 30 upon Substantial Completion $ 1,753.86 Total $ 4,753.86 NOTICE OF CANCELLATION (Date of Original Agreement) (Name of"Owner" in the Agreement) You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the Contractor of your cancellation notice, and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the Contractor at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement; or you may if you wish, comply with the instructions of the Contractor regarding the return shipment of the goods at the Contractor's expense and risk. If you do make the goods available to the Contractor and the Contractor does not pick them up within twenty days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Contractor, or if you agree to return the goods to the Contractor and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Emergency Contractors, LLC 362 Yarmouth Road, Hyannis, MA 02601 not later than midnight of (Date) I hereby cancel this transaction. YI(Da ) ( ner s si ture) Emergency Contractors 362 Yarmouth Road Hyannis,MA 02601 508-775-1120 Phone 774-470-1575 Fax i Client: Yachtsman#35 Property: 500 Ocean Street Hyannis,MA 02601 Operator Info: Operator: JOHNG Estimator: John Greenwood E-mail: John@emergencycontractors. Position: Estimator com Company: Emergency Contractors Business: 362 Yarmouth Road Hyannis,MA 02601 Type of Estimate: Other r Date Entered: 8/10/2014 Date Assigned: 8/10/2014 i Price List: MABO7X JUL14 Labor Efficiency: Restoration/Service/Remodel Estimate: YACHTSMAN_35_RFG This estimate includes only the items covered. Tax Id#27-0657972 t i F f if i Emergency Contractors 362 Yarmouth Road Hyannis,MA 02601 508-775-1120 Phone 774-470-1575 Fax YACHTSMAN 35 RFG Main Level Deckl Height:3' DESCRIPTION QNTY 1. R&R Siding-hardboard panel-paint grade 128.00 SF -----Allowance for 4 sheets of siding. 2. R&R 6"wood polymer decking-Labor only(per SF) 206.50 SF 3. Additional charge to attach decking w/screws 206.50 SF 4. R&R Rubber roofing-Fully adhered system-75 mil 2.37 SQ 5. R&R Sleepers/underlay 2"x 4"sleepers 206.50 SF 6. R&R Deck flashing-galvanized-6"wide-L shape 15.00 LF i General DESCRIPTION QNTY 7. Haul debris-per pickup truck load-including dump fees 1.00 EA Grand Total 4,753.86 John Greenwood Estimator i i i YACHTSMAN_35_RFG 8/12/2014 Page:2 Department of Industrial Accidents Office of Investigations r 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 1 ) Naive(Business/Organization/Individual): vy-�K.ACALA C-A A 1AjaM LJO - Address: . \d (\, A� YY) o- (11 City/State/Zip: I Phone#: - Are you an employer?theck the appro rate box: Type of project(required): employer I am a er with 4. ❑ I am a general contractor and I \ P Y 6. ❑New construction employees(full and or part-time).* have hued the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp.insurrance.t required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 131-1 Other comp.insurance required.] *Any.applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hive outside contactors 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: cz 1 ` y Policy#or Self-ins.Lic.#: [ Expiration Dater Job Site Address, �`.J City/State/Zip. Attach a copy of the workers' compensation policy declaration page(showing the policy num er 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 tine 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 of the DU or insurance coverage verification. I do hereby c Jy under Mize pains and pent It of perju th ' rmation provided ab ve is true and co ecr .,A L Signature: te: ' 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.EIectricaI Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: f: r' �THE,gy, Town of Barnstable Regulatory Services 9BMWSTABM� Richard V.Scali,Director i639' ♦0 Building Division Tom Perry,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 ,or .��� � re�rp° to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of ob) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. S e of Owner = ignature eApplicant y % �) c Print Name Print Name Date Q:FORM&O WNERPERMISSIONPOOLS Town of Barnstable • . Regulatory Services P�°Fme ray Richard V.Scali,Director Building Division sxaxS'"M ` Tom Perry,Building Commissioner MASS. 1639- ��� 200 Main Street, Hyannis,MA.02601 QED"a�a www.town.barnstablema.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 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 &ReguIations 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. Q:\WPFILES\FORMS\building permit forms\EXPRESS,doc Revised 061313 S c W CS 103622 ROBERT S JO ES 206 CEDRIC:RD CENTERVILL..E NLA OA5 !-�' 03/19/2015 r 1 i r i i i i r I { r i I I i t 4 r t { e The Yachtsman 500 Ocean Street, Hyannis. MA 02601 Yachtsman Condominium Trust PC Boy 1283 (5 ' -1515, RATE.. ICI-.: Unit ",,acac : _:. � ht�ni.ia C.�i>nd((r:,.. �?i (urti l�r �t, ;r)(1 Ocean Str;ct, l lvan.nis Io dw Town of Barnstable Buiidlii�_) .Ile 11vird {,I..l..rmes Wr the Achtsrnan t;cindorninimn Frtl t voted and approvt' d the 1ttachtxi prt)pos} II to he fvrIl)rmad as is Minc':'iti,`d in the request.-we rcc{ivied frorn the Unit ()1\ncrs. 1llis lc wr sury es as notWe of Q We R) iWprovc laic.' proposal. vdilch has been not al in the Minutes t,,..the BOUrc3 't1cY�tiri�. s -')ign d (Jpder [lie lAgns and hMnAties Of POIJUTY this Zl it E)l ' GQ (i ... ............... Jams, At'I Nnt%td Condom mitt Trust 500 Ocean Street (c () Manager's I li annis, `,4A 02(ii)I llt1P C j"dff'{'f%l Offi ce of Consumer Affairs nd Business Regulation 1.0 Park Plaza - Suite 170 Boston, Massachusetts 0211.6 Home Ini prove nn.ent Contractor Registration Registration: 164370 Type: Supplement Card EMERGENCYCONTRACTORS LLC Expiration: 101112015 R. SCOTT JONES 73 IYANNOUGH RD - - - ----- HYANNIS, MA 02601 Update Address and return card,Nlark reason for change. Address Renewal Employment Lost Card _t .0flice of Consumer Affairs& Business Rej,,ulation License or rehistration valid for individul use only . TOME IMPROVEMENT CONTRACTOR before the expiration date. If tonnti return to: Office of Consumer Affairs and Business Regulation Registration: 164370 Type• 10 Park Plaza-Suite 5)71) Expiration: 10i112015 Supplement.ard Boston,NIA 021)6 EMERGENCY CONTRACTORS LLC R. SCOTT JONES / IYANNO UGH RC3 iYA.NNIS,MA 026v1 t ndersecretary 'dot v out Sionaturc l 29.07.2014 15:48:23 Guard Insurance Guard Insurance Group 4/5 .� -DATE Acoio CERTIFICATE OF LIABILITY INSURANCE 07/29/2014 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 INS AGY PHONE FAX (A1C,No,EXI): (AlC,No): 973 Iyannough Road E-MAIL P.O. Box 1990 ADDRESS Hyannis, MA 02601 NSURER(S)AFFOROING COVERAGE NAICD INSURER A: INSURED INSURERS AmGUARD Insurance Company 42390 Emergency Contractors LLC INSURER C: 362 Yarmouth Road INSURERD: Hyannis,MA 02601 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 NAMFD 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, ADDL SUB POLICY E- POLICY EXP ILS I TYPE OF INSURANCE POLICY NUMBER MMlDDIYYYY MWDD,YYYY LIMITS GENERAL LIABILITY DAMAOE TCCURRE O RENNEO S COMMERCIAL GENERAL LIABILITY PREMISES IF, oaurroncel S MED EXP(Any one person) 5 CLAIMS-MADE OGCU^• PERSONAL 8 ADV INJURY S , L- j GENERAL AGGREGATE S GEN'L AGGREGATE LIMI T APPLIES PER: PRODUCTS-COMPIOP AGG S POLICY PRE --LOC S COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) S ANY AUTO BODILY INJURY(Per person) S ALL OWNED I SCHEDULED BODILY INJURY Per awdenl) S AUTOS AUTOS - PRGPERTY DAMAGE--- --------- --- NON-0VJNED - S HIREOAUTOS I AUTOS ;Perawdcnti UMBRELLA LIAR ,OCCUp I EACH OCCURRENCE S '. EXCESS LAB CLAIMS MADE AGGREGATE S DED —T— I RETENTIONS S WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY T R IMIT•C X R ANY PROPRIET.WPARTNEWEXECUTIVE ILiNIA I R2WC59414 t3 03l03I2014 03/03/ZOfS E.L.EACH ACCIDENT s B OF FICER'1.1EtdBER EXCLUDE01 E L DISEASE-EA EMPLOYEE S (Mandatory m NH) If Ves de°dbe under i DESCRIPTION OF OPERATIONS twlow E.L.DISEASE-POLICY LIMIT S - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Romarks Schodula,if mono sp—is roquirsd) Exclusions: Scott Gladish CERTIFICATE HOLDER CANCELLATION 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 -S TOWN OF BARNSTABLE BUILDIN4 PERMIT APPLICATION Map -1 Parcel () 1 Application # Health Division Date Issued Conservation Division Application Fee _ Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 10, MOO S7RAF[ i) y IT 3! VillageYl Owner � � Z- Address 1p1 q M<L�- kph Telephone_ Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type o Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting do�umERation. CD Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: -U Yesr�❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other l� N� 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 ❑ Appea; # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �c;W 14t5T �- Telephone Number- --wag-25q- �262 - Address �7i / � �d'(U a� N 4 y a.: License # f 0 q3 e?q w We;-r yam , 01�?T!�. Home Improvement Contractor# Email SC ���m �'C � Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# a DATE ISSUED MAP/PARCEL NO. ADDRESS - VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING a Di4Tr=:CLOSED OUT l ASSO .W- ION PLAN NO. The.Commonwealth of Massachusetts -• Department of IndustrialAccidents Office of Investigations 400 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgaaization/Individual): Address: �:Z Z_ P/4V 6�C�M V City/State/Zip: (1" K 024 73 Phone#: 5-0 4 2-6 "2- Are you an employer'Itheck the appro rate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.VI am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees T`aese sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'Comp.insurance Comp,insurance.# required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P 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 �/U7 V� Ova 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: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine 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 of the DIA for insuranc cove We verification. I do hereby tern r the pains pen o perjury that the information provided above is true and correct Signature: Date: 14 hL4 Phone#: Z6 / .52"6 Z 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.PIumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in*a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house 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 local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance 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. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pemutllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or 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 filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749. www.mass.gov/dia �IMNETti Town of Barnstable r ' Regulatory Services BARNST"i$$ Richard V.5cal4 Interim Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 t Property Owner Must Complete.and Sign This Section If Using A Builder I, -F ,as Owner of the subject property hereby authorize �� — to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or.utilized before fence is installed and all final inspections are performed and accepted. Signatate of Owner tare of Applicant �0 - 6T2 �- P:dnt Name Print Name Date The Yachtsman 500 Ocean Street, Hyannis, MA 02601 Yachtsman Condominium Trust P.O. Box 1283 Hyannis, MA02601-1283 (508)775-1515 v.ATE RE: Unit ' , Yachtsman Condominium Trust, 500 Ocean Street; Hyaruiis To the Town of Barnstable Building Commissioner, The Board of Trustees for the Yachtsman Condominium Trust voted and approved the attached proposal to be performed as is delineated in the request we received from the Unit Owners. This letter serves as notice of that vote to approve the proposal, which has been noted. in the Minutes of the Board Meeting. Signed er the Pains and Penalties of Perjury this day of�9 , 20 S Cr tary, Bo d of Trustees Yachtsman Condominium Trust 500 Ocean Street (c/o Manager's Office) Hyannis, MA 02601 Enc./File r 1 Massachusetts -.Department of Public Safety Board of Building Regulations and Standards Construction Superi isor t License: CS-104384 � STEVEN L HETZFY, 72 PINE CONE DR WEST YARMOL11H 1 �26 Expiration Commissioner 07/27/2015 0