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HomeMy WebLinkAbout0078 SEABOARD LANE 7' Sea lhoa L�.�e j Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee - V Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY n(�Not Valid without Red X-Press Imprint Map/parcel Number Property Address ® bf � _} , r-VClk ' Q O�- Residential Value of Work (0, Minimum fee of$25.00 for work under$60.00.00 Owner's Name&Address Contractor's NameI�C1Ch Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) aworkman's Compensation Insurance X-PRESS PERMIT Check one: ❑ I am a sole proprietor J U N _ 7 2007 ❑ I am the Homeowner 4I have Worker's Compensation Insurance TOWN OF BARNSTABLE 's/ Insurance Company Name l�� A"V, SIB fit, Workman's Comp.Policy# Y T1� 3 q 1-1 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) [ Re-roof(stripping old shingles) All construction debris will be taken to A_A_ ❑Re-roof(not stripping. Going over existing layers of roof) P ❑ Re-side 4 ❑ Replacement Windows/doors/sliders. U-Value (maximumm..44) *Where required: Issuance of this permit does not exempt compliance with other town department regu—fa�ns� Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License is v?gi?hr@. SIGNATURE: , Q:Fo=:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents I Office of Investigations 600 Washington Street W= Boston,MA 02111 . www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): �• nosk CV0 "Cl-tom E-L,il I- Address: �) p k. 1 c3 l City/State/Zip: MIA 61loroo PhoneA �'-o J . 3O�_(Sst� Are you an employer? Check the appropriate box: Type of project(required):. 1. I am a employer 4. I am a general contractor and I with� ❑ 6. ❑New construction . employees(full and/or part-time).* have hired 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 hiP , employees and have workers P working forme in any capacity. 9. Buildingaddition [No workers' comp.insurance comp. insurance, ❑ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. 3.❑ I am a homeowner doing all work ❑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. I am an employer that is providing workers'compensation insurance formy employees. Below is.the policy and job site information. Insurance Company Name: ( w,E Policy#or Self-ins.Lic.#: y 0 �Fy 5� C, Expiration Date: Job Site Address: 2ef Se ,;-y d 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 Investieations of the DIA for insurance coverage verification. I do hereby ce under the pains and penalties of perjury that the information provided above is true and correct Sisnature: Date: Y U Phone#: Official use only. Igo not write in this area,to be completed by city or town of eclal. 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#: Information and Ins' tructions W . Massachusetts General Laws chapter 152 requires all employees 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-conti•actor(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 elate 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, ILIA 02111 Tel. #617-72.7-4900 ext 4.0.6 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia A t D. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 04/30/2007 PRODUCER. (508.) 790-1919 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Sandpiper Ins. Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 12 Enterprise Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601— INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:Penn-America Insurance B.L. Mosher Construction, Inc. INSURER B:Granite State Insurance Po BOX 1131 INSURER C: INSURER D: S. Dennis MA 02660- INSURER COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADUL POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DDIYY) DATE(MM/DD LIMITS A GENERAL LIABILITY SUB1015606 11/29/2006 11/29/2007 EACHOCCURRENCE S 1,000,000 DAM AGE ToRENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence 50000 S ,_ CLAIMS MADE a OCCUR / / / / MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,OOO,OOO GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY JJEECT LOC. AUTOMOBILE LIABILITY / / / / COMBINED SINGLE LIMIT ANY AUTO (Ea accident) S ALL OWNED AUTOS / / /. / BODILY INJURY SCHEDULED AUTOS (Per'person) S HIRED AUTOS / / / / BODILY INJURY NON-OWNED AUTOS (Per accident) S PROPERTY DAMAGE S (Pe(accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO / / / / OTHER THAN EA ACC S _ AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY / / / ./ EACH OCCURRENCE S OCCUR EICLAIMS MADE. AGGREGATE S S DEDUCTIBLE / / / / S RETENTION S S B WORKERS COMPENSATION AND NC8859394 11/30/2006 11/30/2007 TORYLIMITs X OER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE S 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L"DISEASE•POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONSILOCATIONSfVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING_ INSURER WILL_-ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FOR INSURANCE PURPOSES ONLY FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHOR ACORD 25(2001/08) ©ACORD CORPORATION 1881 INS025(0108)"05 ELECTRONIC LASER FORMS,INC.-(a00)327-0545 Page 1 of: L92. TDomvnzo�zeuea a�`/ Oac«ucoPCta Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration ,;.145504 Eidpirat1, 7yy2009 Tr# 130121 Pn�ate Corporation B.L.MOSHER CONST INC BERT MOSHER ,���, ,ro;r,• 74 SEARSVILLE RD _�- z� •`° �. S.DENNIS,MA 02660 Administrator ��� f-W, . f - ' ' I I As - . o�'s map and:lot numbers A3 d�X OFT ETA ,Sewage Permit number ................. .... ...G. E SEPTIC SYSTEM MUST AHHSTaDLE, � '-louse number ...... ........:. ..�.................................. ....... ;..F. INSTALLED IN C®MIPLIAN M" 1639 WITH TITLE 5 ''°�aMix.��0 TOWN 'O F BARN �' � . ��QE �I BUILDING . 'INSPECTOR APPLICATION FOR PERMIT TO .....� ./.................... .................... ................... TYPE OF CONSTRUCTION .............. /1/ ®:(..�' �J/(.... .. ...............,/JD�.�j.......................... .........z ` .................. . .....19 TO THE INSPECTOR OF BUILDINGS: i The undersigned hereby applies for a permit according t the following information:, Location .. O:S�'...... o .. 1/pv/ .. .....: /�.!4!.`�.. .. �L��� ^ �-� .:... Proposed Use ....... J..� �/ �:. ...... ........�/..J ./C ' .......................... i Zoning District .... ......W— ...................... ..................Fire District .......�� Name of Owner llLm) ��. ... . ..... Address ...... j ..... .......................... Name of Builder zl./.-LAIrrYl ..................Address .......... Name of Architect ...Address ........:..::..................................................................... .............. Number of Rooms .................................................. ................Foundation . ..t✓ .... Exterior .... `!....... ................. ......... .....................Roofing ...... .................................. Floors ....... G1�.....f...I..........:.........Interior ......... ....................................................... GG Heating ......... .. /Y. ................................Plumbing �Z%` �t� ................................ Fireplace .............-e.vb......:..................................................Approximate Cost . 0, Definitive Plan Approved by Planning Board ------------------1i9L. Area ..... .................. Diagram of Lot and Building with Dimensions Fee l !.. .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTHO/�jl� To I I hereby agree to conform to all the Rules-and Regulations of the Town of Barnstable regarding the above construction. Name ............................. ................ .. ..................... . ' . . . 'GREENBRIER CORP. El � ........~1^ ^`°.e... °°°i l�...Dwelling............. Locohnn _Iot_#35_7O.. .�Laoe ^ . Hyannis '------'=^^~r--'—^-----'-----'' . . {�re�nbziez �oz �4vnar ------.�----.!����T��------. � Type of Construction ..... ---:..—.----------------.,---.. ^ ' . Plot ------.--- Lot ----------' ' + , . . '^ January 13^ ' 81 Permit-Granted ----------..f--]g . / . ^ Doha of Inspection — —~~��u............!��lA «� . `~� Dote Completed —.�l—.�..�—��'�--.]q � � . _^ ^ ���&&0[ ����$�� � . ----.~�.---..----�-----. 19 _ ' ' .---'�.—.--.--.�~.--.-------'—�--- , / �~ � ^ . —'--''r-—`------'—^—~'^`------'^ ~ ' ' ' - . . �—_—.��.� . .--....-----..—_—..--.. ---''.--'—'--~^^—^^^^'`^^'^^—'—^^'—'r` . . . ' ' ---------------'. lA Approved ' ` ---''r--`^-----''-----'^--,---' . . ' . ----- ...... . ' | ' [^ . ` Assessor's map and lot number !.r.'�: .......................... l��i " , Ppfr E Sewage Permit number Z BARNSTODLE, i Muse number ................��................................................. 93 9�G M6 9 0� �0 TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..... .`.......... .. ...✓�..: : :........................................... TYPE OF CONSTRUCTION .... ....:' `{ :f ::. .......................�...........fd�^........r..` ............................. ................................................ 9 �. I TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a(�ppe�ejrmit according to the following information: \,, Location ...n-� .1..............'........................................................�� ? f/. :.. .. :. .. ':...f✓^'... ..:... ProposedUse ................ ....'F. ...................:......................:.... .. ..: ...........................................................I.......................... Zoning District ..........:. :.:.................................................Fire District ....... .... ........... Name of Owner J1..........................1�f .. .`-.: /1 !-:..:.......Address ! !j . ........ .�...............! .. .........::...'!`:............ i Name of Builder 1.....1 / _' =- ...............Address I Nameof Architect .................................................................Address ............:.:..-...—:............................................................ Number of Rooms ................I'. ................Foundation �'�r%�,f` ..::..`...................................................... Exterior ��.......'.''�IC. / (�<! � '' / / �!.. ..:............. ........ ................................ ..............................................:..::.................................Roofing ......,...:...:.......... .. ',... Floors Interior ..�.:.,.............;:........................../�.................... ............ .................................................................. Heating_".........:.........�:1'- ... ............................................Plumbing ...............j............. ........c.................................... Fireplace .............Az.<. l.........................................................Approximate Cost ................... '........... ............................. Definitive Plan Approved by Planning Board _f `i ______ 19__ _. Area ..... a Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..................................................� '. ............ ............... GREENBRIER CORP. — No . 14... Permit for ....One,,,Story........ Sngle,,,Family Dwelling,,,,,,,,,,,,, Location L! ;.0.425 . N...&Qia,boa d...Lame ; ................Hyaxiai a............................................. Greenbrier Corp.. Owner ..........................................::...................... a Frame Type of Construction .......................................... ................................................................................ Plot ............................ Lot ................................ January 13, 81 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19 PERMIT REFUSED ........................................... .............. 19 ............................................................................... avl�o ............/..-/...-- ............ Approved ................................................ 19 ............................................................................... ............................................................................... �{` w fl I ' +� 1 iil �•�Y #k t - - - �• V"(..� .a°^fry - r { }v t;t 5" pUvArictv � `+r•t s i. rah �+.� ,� ri 2 `V FouniAA7-rCn/ -. _.� i ' 'y .x "�{y. �'�.' '?.: SANS" � 9*��� •`M•x'h' � .�� _,.�.,. _ �-+ `�-- "'-�,M°r- -a'�--'_ �-�-f^^--_-�.a...f.. -t-.,.}r �'.+_=.,#..� --�-:�,tu.�n.Tr°>�`'/` `�".` Jp. -•�,r3'-"�"` .�'"`-�� '' _x. f ^t.7f�r.f 4 Z r� ( i. 5 :# I #•:�Af i ;y�; `� ���yy tY r�f� 3't��35 rfi°�,r -i'tK t 4. .''�' .S •� i � e is �./ - t c TTT 1 { °'31.f 1' �°}Y �'- S.G�,•{ 44) Ck` A�'x,R4'y_. 5r �g'%S,CC sthk 1 t.So.icy pg Y•s-`i---- 4•-- _5sl'=-ti 1;.,�-_ ?..- it N .54 CERTIFIED PLOT PLC . ,. . COHSTROCTION ONLY jy�,,, '-ti1s 'SOP,. OF FOUNDATION IS FEET ABOVE LOW POINT OF ADJACENT IBAINIIA S V Tl q ROAD. SCALE : DATr°E: �z�z3 �(} ' t� £x �/ /3e ER • LDff GE ENG1NEE RING CO.INC) CLIENT I CERTIF'Y THAT THE��u��a .: .{ SHOWN ON THIS PLAN 15 LOCATED EGISTERE® LSUORVEYOR TERED 8oc CIVIL N® JOB NO. ON THE GROUND AS INDICATED AND t CONFORMS TO THE ZONING LAV8 . . EN®1�9EER DR. ®v OF BARNST ®LE , SASS. . -- - 712 MAIN ST. - ? HYANNIS, .MASS. � O . SNEE'T_.LOF / � RE®. IAIb® 3 Rv� TOWN OF BARNSTABLE Permit No. ______22914 t . Building Inspector Cash � �YL Bond `mod OCCUPANCY PERMIT --- x "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged`use without a Building Permit therefor first having been obtained from the Building Inspector..No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Greenbrier Corp.. Address 1 nt- A95 ,7R ;qp l-wnnrd T-nno_ T:hrnnn•i a Wiring Inspector y�, Inspection date Plumbing Inspector ��• � .__./� , f' .s Inspection date Gas Inspector S f' '„ a t z�/il Inspection date 6 dEngineering Department �,n - Inspection date I a r c i THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. { . .. J... .... ..._ Is... _` ...................... Building Inspector r,