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Home My WebLink About0500 OCEAN STREET (61) ,5-60 oc-'ea-gin S- 1.. t t BUILDING DEPT. Application number..... i MAY 112020 Fee.............1.4 ...................................................... &WNSMA$i IMAM �, LE Building Inspectors Initials..... ........................ Yb re�r� TOWN OF BARNSTAB nr, ri . V... V lJ ANNED Date.Issued.... .. .. �.�..... .............. Map/Parcel.......................... .7.4 �. . .......... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: -54'9 oC e&Q Isi-, 14 k �( (�' �,� , D * NUMBER STREET VILLA E Owner's Name: Phone Number Email Address: Id N M (cLN(ft1'.j `$'Cell Phone Number Project cost$�"�`�68 �� Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize N 4!e L Cl 0,4 G 0 to make application for a b i lding permit in ac rdance with 780 CMR 9 r� BUILDING D E PT. Owner Signature: Date: S" U 20 TYPE OF WORK TOWN OF TABU, --� Siding Windows (no header change)# J Insulation/Weatherization �� >LJ Doors(no header change),# Commercial Doors require an inspector's review Roof(not applying more than I layer of shingles) Construction Debris will be going to ±� 15'� p.�►�c3 � � 1 � U� CONTRACTOR'S INFORMATION Contractor's name q-/we -Jdac Home Improvement Contractors Registration(if applicable)# r�O (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor 6 tiA �I I v bIlIC r Phone number 174'(— >"2 ALL PROPERTIES THAT HAWSAUCtURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. �} APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date +PPLJCANT9S SIGNATURE ''4 S Signature Date y �' All permit applications-are sub'erttoa building official's approval prior to issuance. QN The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizadon/Individual): Address: PO 0� I / 7 City/State/Zip: 1 Tfi Phone#: 7�� Are you an employer?C eck the appropriate box: Type of project(required): 1.N I am a em to er with 1 4. I am a general contractor and I p y employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These 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 10.0 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' 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 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C e M P(IC CA T 1 C y Policy#or Self-ins.Lie.#: y 9 —� 6 t 0 f ^ Expiration Date: 0 _10 Job Site Address: 50y y c e vA if �� City/State/Zip: a!ZgAA J M4 D a 60( 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 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 insurance coverage verification. I do hereby fy under the p ins and penalties of perjury that the information provided above is true and correct Signature: Date: s-^ 5 ;)U Phone#: '7 7 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#: i 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 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-contractor(s)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 permit/license 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 (i.e. a dog license or permit to burn 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-NIASSAFE Revised 4-24-07 Fax##61.7-727-7749 www.mass.gov/dia odd ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D17119 ) T 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 and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: ATLANTIC INS GROUP AGCY PHONE FAX 530 ADAMS ST (AIC,No,Ext): (A/C,No): E-MAIL MILTON,MA 02186 ADDRESS: 795XJ INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY JOYCE,DANIEL DBA DANIEL JOYCE CONSTRUCTION INSURER B: INSURER C: INSURER D: PO BOX 117 INSURER E: WEST HYANNISPORT,MA 02672 INSURER F: COVERAGES - CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR kDDLIUBR POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDMYYYY) (MMIDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE D OCCUR. DREMISES(Ea occurrence) WED EXP(Any one person) Is ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY PROJECT ❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-4N611001-19 12/01/2019 12/01/2020 X LIMITS ANY PROPEMTOR/PARTNERIEXECUTIVE NIA E.L.EACH ACCIDENT Is 100,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000 D DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. THE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR JOYCE,DANIEL. CERTIFICATE HOLDER CANCELLATION r"TOWI` OF'13,R STABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 200 MAIN STREET, BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B DE D IN ACCORDANCE WITH THE POLICY PROV AUTHORIZED REPRESENTATIVE HYANNIS,MA 02601 ;;Pe y- ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORP ng is reserved. Commonwealth of Massachusetts Division of Professional Licensure Board or Building Regulations and Standards Construction Supervisor CS-102512 Expires: 12/13/2020 h DANIEL J JOYCE,JR : PO BOX 117 WEST HYANNISPORT MA 02672= - Commissioner Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 158158 12/16/2021 1000 Washington Street -Suite 710 DANIELJOYCE = Boston,MA 02118 DANIEL JOYCE 14 DOLPHIN LN / HYANNIS,MA 02601 Undersecretary Not valid vI}ith�sign tuff k ' F pFt ,pw Town of Barnstable *Permit# �6 0 Expires 6 months from issue date d Regulatory Services Fee �� jAjuj$rA9r,Er, , MAS& �� Thomas F.Geller,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601IT Office: 508-862-4038 X-P ;,7 Fax: 508 790-6230 APR 1 4 2004 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red%Press Imprint TOWN OF BA R N S TA B i_E Map/parcel Number �a y dy C)Qtj Property Address_?60 OCeA 0 U A; Residential Value of Work �hn Owner's Name&Address n>1 ag Y`(14t,I e ocQ -. (11a1 c�e�, rn A 61) Contractor's Name �O<i r\�2 Orvuem e ram' Telephone Number S0S - 7 7_S-1 7-1 k Home Improvement Contractor License#(if applicable) 10 3 7 Construction Supervisor's License#(if applicable) 06 Vo 13 1919orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 0-Have Worker's Compensation Insurance Insurance Company Name f'l'� ��"� =`ems. (nb, Workmen's Comp.Policy# Permit 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. U-Value •a (maximum.44) *where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Own must sign Property Owner Letter of Permission. o ement Contractors License is required. Signature Q:Forms:expmtrg Revise053003 r °per rti Town of Barnstable Regulatory Services 3 e,►utsrNLL Thomas F.Geller,Director Building Division _ rfD Mp' Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-862 4038 Fax: 508 790-6230 Property Owner Must Complete and Sign,This Section If Using A Builder j ni5 nn��C:�.. . ._- _.;as.Oaznet.ofthe.subject prop etty ....�...__ .: .hereby authorize S - r e .. : to:act tin tny..behalf,. in all mattets relative to work authoEzed-by.this building.pe=oit-applicationtfor. JUO Cleo-n J. b"J 0), (Address of Job) Set �� Signature of Owner Date Priat Name a n a I 28 Maple W'bda'S Malden, MA 02148 RE: 500 Ocean St .Unit 41429 Hyannis March 11, 2004 i CONTRACT WINDOWS ■ Remove and Dispose of two metal picture window units with sliding flankers. ■` Furnish and install new Anderson TerraTone Picture Window units with casement flankers. ■ New windows to have Low E glass, Argon gas and full screens. i for trim. • I necessary exterior shingles and inter I Quote includes al ry g ■ Does not include any painting, plumbing or electrical. SLIDERS ■ Remove and dispose of existing metal sliding door unit between living room & patio. ■ Furnish and install Anderson TerraTone 6'0" x 6'8" Patio Door with screen & hardware. ■ Includes interior & exterior trim as necessary. Depo Start Upon Dennis Donnelly ` Date Brad Sprinkle Date t Ce e• fi t' = P. ;IS AT, 11 3 t kN i J dl bob Re VIA 140 CON, x, �wY ' \ h i A J � i ^i. r .; i NT �[ pal le .......... E t ,.a ble Rd. oto Ins} .� Ad�� _ . r � CIA �q. AU I '1 1 +& td'10, F filt t s rr � : cift?edn �f tie c1d, �r { 1jp DIG SAF GALL CEO �. � •r's, . L M t tics seWtLice-n a d fur W.i rdu oni h be-fore the ex i pa Un dam. if fm, nd , to.. ;rth Board of td I`ve -aand it Stand One AsMuftw Place , : Bostau, Ma,, 0. r