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HomeMy WebLinkAbout0059 PINENEEDLE LANE k i ��� Town of Barnstable *Permit Ex�uer 6 months from issue date o� Regulatory Services Fee • MABEL Richard V.Scali,Director 4y �. ► ` Building Division J Paul Roma,Building Commissio r2Q 200 Main Street,Hyannis,MA 02� I�Al �j — ----- www.town.barnstable.ma.us ��� / Office: 508-862-4038 ��� $ 790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint 2 Map/parcel Number_9 y®3 S Property Address �Q NPP& In VResidential Value of Work$ 900 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Mwr* "Names mes cr, 999 -1 y owr4c oo k r a ANN IS MP, oz4a 1 Contractor's Name Zvpr j Pkm 1N C. `'1 ar"jo SCn Telephone Number Home Improvement Contractor License#(if applicable) 9 793 f 5- Email:be&h d.�rT'/I'L1fF • C O ram_ Construction Supervisor's License#(if applicable) ca 0 VS9 RtTorkman's Compensation Insurance Check one: ❑ I am a sole proprietor 0101, am the Homeowner have Worker's S ati'nA3OAQa am p i N S u r l4N cQ CO M p Mry y Insurance Company Name Workman's Comp.Policy# Wcc 5005 OtI-��9 70 17 A Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Yoke-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Yarn oug d o rn Q. ❑1 Re-roof(hurricane nailed)(not stripping. Going over existing,layers of roof) e-side RI eplacement Windows/doors/sliders.U-Value (maximum.32)#of windows �s #of doors:_3 "where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisor's License is required. SIGNATURE: Q:\wPFIL ES\FORM.S\building permit forms\EXPRESS.doc 01/25/17 r , ter qfrud=&dAcrJan ` e gf� $8t7 F3rg�oR street - mPmmmmgflv1V7a WaximTs' CanVensaffimlnsmranceAffi*��+'Bm1deIS Qmtracftm-J TeGEIZriancJRlnrrrhers Hipp Inft rnatm' n Please Print xmm '6�'` �S�►� Gft roen v T N C v Addr 4)99 ZV*O N g�1 A A ,gro�is M Pr O•Z&4>1 -- Socs- 366 a3y7 Are nm an employer?fherkthe appropriate bay ' Type of project L I ama employ A'Stli y 4. ❑I am a O nerd conirsc r andI 6. ❑New employees cfallaedforpart-timed* flarehimdthe sun-coahaCtco 2.D I am a sale dos orpartaw- Tined oa the attacixed I. 0 Remodeling sbip and have so employees Thwe smb-conftad s base U❑Demolifioa wcddag for.M ia any capacity emFloyew andbave worms' 9. ❑Building action lldo ems' Camp.his;MZWO Camp.iMMM# resmie�-� 5. ❑ We are a cmpwdi=;md ifs 1Q❑Ele cal repairs adtfz�azrs 3.❑ I ama bomwvmw doing all sic officers hmm exffined da!ir 1L❑Plumbsagrepaus or a bets. r,wokkcefs' of exemlxtion per] 4M �n c,f52,�l{�and we have no l-'P'Hof 13-,K O pool's co=p-msxae require&] •dapapg&o?2�sccheftbminmastOmMomtfleswfimb9ow9wrmgSie'awa&=e a=12MSRSeupaficgn� ML wboSQh�ffZi tea` t5epKM8am.Wsg mi&mhimGumdecvmma =s#Fahmitamwsf&da india WCTi fCa�ac(na$�st�ida,trmcmast a�acl�9aaddifioaal siaeet shnmasgtbea�eof the �d st�eadeetbec araotifmse eotitiesha� employees.Iftbemrr=bEd=bave=pIofa fiLep pm-AE* a anrke&-mp.130HUm-bet lain ari efrfp1*w Siat fspraviff xg warkers'componsiien in=rancefor ray empkwes BeTaty is flfe pa&Gy ara:i job site €nformattna,Ta eComgaay.-Lb=: MAiN gkwel�" Am n—c er ASsar"ce COMP-11-IVY -Pahcy�or Self ir$s_tie_ iMfFT COY7 2 F abate: Z 24-i Job�feAaar� 59 P�n�Ne od� lh c�yfstaf� t�'y�rvnr t S Vhp- OZ�.�e Arch a cogf of the workere compensatioapolicydeciaratimi page(showing the poficy number and expiration bate). Fa.&=to sew cauerage as requiredunder SwEan 25A of MM c�157-can had to the irapa,Ytiorr of criminal pe-19 of a ime up to$l 50a.00 an&or one-geacimp ist as well as civfl penalties ra ihe fa=of a STOP WORK ORDERand afsne of up to$25a0a a dip agaiast the violadar. Be advised that a cagey of this zbderned.maybe f vwnded to the Office of IsvwHgataaas o€fm DIA foF coverage cam- , 'Fora hMg y certify tzudsr d w pains and penaffirs afFedkg fimtflm ih oraaaf'rara pr -hW abatis is trans and correct Date: 7 112 17 Piaorfe Sir - 3 40- Sr 3 A/7 O B&id aog a mjF% Da aut mite in ffsh area,to be-can Pkesd by city ditan-t City or To% Ferzn ilLicesse� Issxdn Anfhority(ctrcTe one): L Board.of .g Department 3.CAYfroi.Clerk 4.Electrical rkspeCtoE• S.Pb m mg Inspector &Mer Contract Person: Phone 9: — -- 6 ormafian aiid lastrae-donsIfissaca= • `p� ets GetemI Laws car M req=m an euaployeas to lie Wa±me MSRtIM:E3r their=PIOY=r- P �flis sue,an.easglo�is$wed SM: cReaYP�s°n m$is saYicc of a��ceder any aflmr; =g3l=ar implied,Dial or wft=a" Aa Ioy,is&:,. d as_an indzQidaal,paxtDessl�,assAcsaiiDm,.carpa�fraa at gibes Iegal es�fy,az two or mo¢� o€�fioregoazg��m aJ� ��g�� �of a d�ased�plape�,or fire or tL,�of an individnaL per,assoriafnn or offimlegd entity,employing mnpmye--- However fie owner of a d�elIm ht�nschavmgnofmCefbaO.iin�e-BPMb �s MdWhorMUdesi3ieae 3,orb o�off=- dWelTmg bonse Df anodes w�mopinps pm=M to do mom,caas action or repair wink am.samEL&9m mg b=m or am.fie gm=a& Or bmWIMg shaIlnntbecaztsc of surds e�iDymratbe deemedin be ea�I�A MGL dmpte r 152,§ZC(6)also siaiPs that¢evmy sfdm or local Hc`'J•`!dn agency shall withhold ffie a=aucg or renewal of a$cersse or pdrsssit to op e a°bsisiness or to'cot'b m za ffie��oaefI$i for any apgIica ntwTio has aDtprndnced acceptable evideura of compliance with tIve assurance coverage reganred Ad.ffiinnalbl.MCrL chaptm I52.§25dM states-NeEffita ibe - nor ay ofifs.poIiti nbdivisiDns shBn ve e min any cmxiiart fcrtfhc p ofpnblio odc mmI accxpfs3Zble ev1dmcc of compllap ce�+ith fie . regm =fs oft=chapis�haveheenprese edin fie cDrMactin9.a3ffaoiLy w; - App�caats - Please fa ovt fie woskeas'�=_sz nn affidavit comipleb-4.by g fo boars�apply to your and,if n Y.empty name(s),addresses)mid pho m=mb=Cs)aIongw&'ffi it c (s)of o$les thane msm-Emm. I,�ii�dLia1?iIiiy Companies(IZG�o2I sited Liab�ityP®rfneashigs(!LP) nn �pIoyecs membtas or p�tues arenotr ed to cauy ''c�enmlion msmaace_ If an LLC or 112 does have c=pIoyees,apolicy is=4aiE i Be advisedib ffiis a�daYiEmaYbG s tD f'e DeFadm�of lndnstxial Accidems for co lon of mscrrance coves�ge: Alm be score to siga and daf�thL-xffgzvif: The+affidavit should ber ftm3rd to,$e city artD-Ymt hatihe applic a im fo=fiepeanit or Hcense is bemgrequesfEd,noffheDe partme:of of Badhstad.A cm tc,tg gOddyon have any questions regm-dmg the Lm or ifyon are regcm ed in obt�awo�cras' COmP=SationpoTcY;*=Maf2dDCPMfMentatfie:rnzmbes]is�dbeJnw: �edf-ias�aedcx�panicssbnnldeninrtheir self-lasaranceIicMsDmnmbersomfie line. City ar Town.Officials - t Please:be sore flat fie dHavit is comrple#,emdpria±tdIegrfiIy. The Deparimenthas pmvided a spacx at fie bc)tb= ofthe:affidavit for youto fR outiathe eves the Office ofj vcsffgair'oss has to conin tyonrega d'nsgfc;aFPh�nfi Pleasebesm too fllinilepeu iL � c==rmmb=whichvMbeusedasareffirmcemzmbcz In add inn,anappHce t that=MA sobnzit=LUMple pesrnTN.fir�cP appllr�ions in aaY given year;need-only salmi one affidavit indicate ctrn=t afiaa ifnc )and und=`.TOb Mtm..A�"fhe's pant shoii]dv'ri�"sII local ns m (may policy mfor+-+ - [ be vided to me " .town)"A copy of affidavittlat has bey officially atmcped ar nim5md byte city or to may pro spplicmn as proof that a valid affidavit is m film fnr ftdnres'p— - or Ticemm Anew affidavitmum t ba bIled oil e�i year 7hes6'a home owner or cai=a is obtak: g EL Hmmsc or pemit not xelatcd fQ any bmimcss or c=M=W vim$ - (ie.a dog licease orpc=ittobmnlmvm etc.)said penon is NOT rcqahedto cDi3pIeiei3ns affidavit The Office ofInver Vaaulz�to thankyonimadvance forym=coopeinn and sbovldyonhave auy gues-tlrms, plesse'do not hesifsfm to gcve ns a c M The I3epazfiae s address,trdephone and fm=mnber Tha commomqedtk Of&&Machu - , 60Q Sty i Ell Ted.4,P 617- -4- tit -96 cat I-9'7-1' :� Fax#617-727-7749 Rzvised4-24•-07 �� Town of Barnstable Regulatory Services dF Richard V.Scab,Director Building Division t . t Paul Roma,Building Commissioner KAM 3 �� 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE ERENUMON Please Print DATE: JOB LOCATION: number street village— -- "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: cityhown 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 lie,'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 at 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: Tbree-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&Regulations for Licensing Construction Supervisors,Section 3.15) 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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXVRESS.doc 0620/16 ToWn of Barnstable Regulatory Services Richard V.Sca14 Director Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maus Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the sub)ect property hereby authorize C U*0A9 C f megr ty TKc• to act on my behalf 01 in zU matters relative to work authorized by this building permit application for: S9 fri He NeeJ4 . In (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. 0-01 r_ Signature of Owner -of Applicant pip-OAK � odd �Ff1 Aw+iN E. Th2L% Soh Print Name Print garne '7 I-L 17 Date QF0xIVM.0W iERPERMISsIODI W S BTCUSTO-01 WAILIGHAN ACORU® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/2/2017 i 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 have ADDITIONAL INSURED provisions or 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 endorsements.. PRODUCER N29PCT Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 (A/C,No,Ext)_ _ (Arc,Ne):(877)816-2166 South Dennis,MA 02660 oREss:mail@rogersgray.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Main Street America Assurance Company 29939 INSURED INSURER B:Associated Employers Insurance Company 11104 B T Custom Carpentry,Inc. INSURERC: 999 Route 132 INSURER D: 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 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX]OCCUR MPT6472F 08/29/2016 08/2912017 DAMAGE TO RENTED 500,000 PRE ISES(Ea occurrence) - $ _ MED EXP(Anyone e' ' $ 10,000 PERSONAL&ADV INJURY' $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JECT 0 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILYBODILY INJURY(Per accident $ HI TOS ONLY ARU ONLDY ROPER tDAMAGE $ UMBRELLA LIAR H OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER WCC50050117392017A 02/0112017 02/01/2018 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE /N E.L.EACH ACCIDENT $ _ (M.. R/MEMBER EXCLUDED? ❑N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 5OO'000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Dennis THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 485 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. South Dennis,MA 02660 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety 3 - Board of Building Regulations and Standards License: CS406046 Construction Supervisor - BENJAMIN E THOMPSON 999 fYANOUGH ROAf); =� �:,. HYANNIS MA 02601 Expiration: Commissiotier 02/09/2019 _ -- Office of Consumer;Affairs and Business Regulation 10 Park Plaza-Sure 5170 Boston;:Massachusetts 02116 Home Improvement C Registration Registration:._'179345 Type: .Corporation Expiration: 7/23/2018 Tr#'419291 BT CUSTOM CARPENTRY INC. = BENJAMIN THOMPSON i ^� 999 IYANNOUGH RD HYANNIS, MA 02601 - 77, Update Address and return card.Mark reason for change. scA 0 2onn osm l Address Renewal Employment Lost Cary L'l/re�+fir�ua�rracall�o�'��astac/%tuelll Office of Consumer Affairs&Business Regulation License or regbire ion valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return.to: Registration: '179345 Type: Office of Consumer Affairs and Business Regulation ' - Expiration:_::'.;7f23J2818 Corporation 10 Park Plaza-Suite 5170 _..__ Boston, 11 STT CUSTOM CARPENTRY INC BENJAMIN THOMPSOtJ 999 IYANNOUGH RD HYANNIS;MA 02601 Undersecretary of valid without ' ature