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HomeMy WebLinkAbout0135 WEST MAIN STREET (2) co -- i i S M EAD KEEPING YOU ORGANIZED \o. 10230 H163 TWO'' MIN.RECYCLED INITIATIVE CONTENT 10% Ce0eaMerseprcmp POST-CONSUMER wmjfiDropronurtj' ssoisoo MADE IN USA GET ORGANIZED AT WEAD.COM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION as Off: B RNSTABLE + Map Parcel Application ���ry Health Division n� �P 37 ril 12: 02 Date Issued �D 6 ..P;1. Conservation Division Application Fee Planning Dept. Permit Fee 10V • V� r11 1, T Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis fro �rnw�(_ Project Street Address • Village �V ,�41.�.1%y! Owner_,�/' &_S?% r° ��u� Address Telephone. Permit Request � , C e Z Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4. Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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 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 0 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) Name �1- /�/� z�� Telephone Number Address A:51 S er ,G, -.6 License # C'' 2—d ] Home Improvement Contractor# Email J ���' h ^ ��/!i l 4Norker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �� I. FOR OFFICIAL USE ONLY '} APPLICATION # DATE ISSUED ' MAP/PARCEL NO. r; j ADDRESS VILLAGE OWNER L, DATE OF INSPECTION: 's FOUNDATION FRAME INSULATION FIREPLACE r' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING DATE'CLOSED OUT ASSOCIATION PLAN NO. Y t - .Tlie Car�irizorr.��errlth�,f��tssr�rrTiu�etts _ _ I� rtrr�er2:t a,�.�r.�dsrstriat AccideFr�t.� - --- Oj�fILe o,f�Tt1.wsdgQeFff7rS {A : _ 600 Washington Street Baston;,_-M4 02111 "Workers' CampensafionInsurance Affidavit:Bml:derslContractors/Flectricians/Plmmbers Applicant Infarmaf un Please Print Ledb Name LI/ !&,fi _0 _G= z a AddFess: L.LIW Cityf:3tatef�i: Phone n Are you T Ioy er? e.ckthe appropriate boa; ra am a eneral contractor and I �e of project 1 ( ��.- I. am a employes with ❑I g 6_ ❑New constructiart employees(full sndlor part-time)-* hav e luredthe sub-contractors 2.❑ I am a sole prqpzietor:or . listed on the attached sheet: 7. ❑Rf modeEng b�� nesesu -contractors have ship and have no employees. 8_ ❑l7etnolition w kc 1 e ia an ci• employees aand.hive wofcers' ar1�ba y� � 9. ❑Building addition [N°worsoers'camp.insurance comp.insurance-1 - " required-1 5. ❑ We are a-corporation and its 10:❑Elecfdcal repairs or additions h d i ha ve ave a ercse their 1 L❑Plumbin airs or additions re 3.❑ I am.a fiamaou*ner doing all work g P myself[No w 'camp- right of exemption per MGL 12.❑Roofrgmirs iwu ce requited j i c.152,§1(4h andwe have no employees.[Nd wo&ers' 1.I_0 Other comp_insurance required.] ;Any appEiaatffiatctet1aboxRtmustalso511 out the sectionbelowsharndngfheirwo&er compeasat; npoRcyin5nnzdao_ Som mamm vrho submit dus affid2ni indicating they are doing ZU WoA m4 ffiea like 0Utdde contradars nmtt submit a new affidavit indicating Mcb fC'antractorstbafcbeticihazboxm attached ay.sdditiunal sheet shouing the name of the sub-contsdDa.aadstafewhethecor not rInseeafdtiesbavP employees.Irthesub-contacforshive employeasi fE1ey=stpzc1idethe1r markers'-comp.policy number- Iacre art eurplol�r flercf isgratzdrizg nrorkers'eortipertsrrfrart insriratee,for m}*enrpiay�ees BeToav is i7ta pvticy�rurd jo7a she inf ornzarian. Insurance Company Name- 61-A C Z( 30 [� Policyi'tor elf-ins_Tic_ r�f1.C49,92 MxpitationDate= Iob A ddres Jt�1 f - r L�.�9f��1� t,S ,�City/SW&Ze .tP. 1. , Attach a copy of the workers'compensaiionpolicy declaration page(shaving the policy num er and expiration date). Failure to secure coverage as requireduuder Section 2.5A of MGL c 152 can lead to the imposition of cArninal penahies of a fine up to$L50D UQ and'ar one year imprisaun:eut,as wen as civil penalties in the fern of a STOP WORK ORDER-and a fuse of up to$250-00 a day abainst the violator. Be a hisetl that a copy of this statement maybe forwarded fa the Office of Immstraatim of the DIAL for insurance coy erage verification- I do lier-ctiy cRrtrfj�a.Rrdrer tMR prurzs aced periafiixs ofperjzut ,fleatf7te irtfonTLatw7iproiuTed aboi .is bare mid carrect S olature: X/tis�L� Date: Phone ik 0 t3fjfcicrL usg areT�+. Dv rest errita in tFti�.frrefr,�+be crrr�rpTeted b}'rift'artnn�n o; a£ City or Tan n.: Permiff iceinse: Issuing Anthori ty(circle one): 1.Board of HeaIth 2.Building Department 3.City{Fmen Cleric 4.Electrical Inspector 5.Plumbing Impector ti.Giber Contact Person: Phone-P: --- -- — 6 • armatZan and ins cans � � •- TVMassachmetfs General Laws chapter 152 regoaes all empIoyers to provide worker'compensation fur their employees. r p� u this fin,an.�&5ye is defined as.°`every person m.the service of another under any co�ract of hire, ;'R express or implied,Aral or written" arEa association,corporation or oflaer legal eUiy,or any two or more An Moyer is defined as"an mcfivicb3A p =ham, of the foregoing engaged ina Joint eni�erpIIse,andinclu Eng the Iegal Fepresenfa&cs of a deceased employer,or the receiver or trustee of an mdividnal,parfneas1:4.association or other legal entity,employing employees. However the owner of a dwelling house baving not more than three aparb neots and who resides therein,or the occupant of 1he - &Welliog house of another who employs persons to do mafitmm e,con*ac tion or repair work on such dwelling honsc or on the grounds or bmldmg appur�thmmto sb Unotbecanse of sash employmmtbe deemed to be an employM-" MQ ob. apter 152,§25C(6)also states that"everySfat` or local licence agency shallwithhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicantwho has notprodnced acceptable evidence of cdmpfiance:with the fncnrance coverageregnired"" Additionally,MGM chapter 152,§25C(7)states-Neither the cormamw d&nor nay of its political subdivisions shall enter inib any contract for the pPrFrrrm an ce ofpublio wollc untl acceptable evidence of compliance with the Tn e=a;,ecd. of tb.is chapter have lbeenres pemmd to flat contracting�laozity_" req�enien fs Applicants Please f II oi:t the workers'compensation affidavit completely,by cheaki g flLe boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), aridress(es)and phone;mimber(s) along with their cmrfifcate(s)of ins�nr-ance. yid Liability Comp ames(LLC)or LimitedLiabilityPartnerships(LLI? wit�ino employees other than the ' members or parfne are not regn a ed to carry wolkers'compensation mmirmc a Yan LLC'or LLP does hate eiployees,apolicyisrequired. Bearlvisedtlfat this a$dayitmaybesobmitti-,dtothtDepa-finentofIndusirial Accidents for confirmation of limn nce coverage. Also he sure to sign and date the affidavit The affidavit should be refired to Le city or town that the application fur the permit or license is being regnested,not the D epartment of j�n ti l Accid� Should you have any gnestions regatdmg the lawn or ifyou are regmred to obtain a workers' compensationpolicy,PleasecalltheDepadme tatthen.=berlistEdbeIow: Self-insEu comparesshoulderfl--rtheir self-mS7Hnce license gybes on the appropIIafn lme. City or Town Officials t Please be sm e flaat the affidavit is complete and prided legibly. The Deparfmmt has provided a space at tile:bottom of the affidavit for you to fIl out in the event the Office of Invesiigafions has to contact you regarding the applicant Pleas e b e sure to f 0l.in the pennitllice r,mtnber wbich vill be used as a reference number. In addition,an applicant that must submit multiple permWHcense applications in.army givm year,need only submit one affidavit I adirafiag cTT Trot ifnecis s-aTY)and under"Job Site A4jress"the applicant ghotld with "aIl locations n (c?tY or pohcym���afroa( town)_"A copy of"the-affidavitthathas beta officially stamped orma&ed bythe city or town may be provided to ae applicant as proof that a valid affidavit is on file for fatal putts or licenses. A new affidavitmust be fIled out dash or citizen is o a license or pemitnot related to any business or commm—id venture e owner blaming year..There a hum _ (ie.a dog license orpennittn bum leaves do-)saidpmsm is NOT requedto completm this affidavit The Office of kvesligafions would like to fink you in adVMCO for your cooperafion and should you have any ques on. please do not hesitate to give us a call. The Departmenfa address,telephone and fax number: ' L�,CammmW an of MassaGhmstt-, Departaem-t cif 1�dustialAccUenfa fits of Ixt. gatiaQaI% ��4�as�m�tan S`ix�t Boston.MA QI 11 e,-L . 6617- -49W cxt 4-06 or I-9 MASSA� Fax#617` 27774 Kevised4-24-07 , mas!--gPgIdia. THE� Town of Barnstable , Regulatory Services M Richard V.Scali,Director 1639. Me. Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must E Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (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. Signature of Owner Signature of Applicant Print Name Print Name i . Date QYORMS:OWNERPERMISSIONPOOLS CD�® DATE(MMIDDIY A WY) CC . CERTIFICATE OF LIABILITY INSURANCE 09/27/2016 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). PRODUCER NAME:CONTACT Martha Findlay OLDE CAPE COD INSURANCE AGENCY INC. A�No.E,d, (508)771-3300 1 FAc No: D ADDREDRE SS: marthaf@occia.com A 296 MINTER ST. INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: VILLANI CONSTRUCTION INC INSURERC: INSURER D: PO BOX 692 INSURER E:' WEST HYANNISPORT MA 02672 INSURER F: COVERAGES CERTIFICATE NUMBER: 88474 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 SUER POLICY NUMBER MMIDDIYYW MMIPOLICY EFFL DY/YYYY LIMITS EXP LTRvivo COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR - —PREMISES Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL BADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: - GENERAL AGGREGATE $ POLICY❑PECOT- F]LOC PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY - EOa BINEDiSINGLELIMIT $ ANY AUTO - BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLALIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ 1$ WORKERS COMPENSATION X PER OTH- .STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED7 NIA NIA NIA 6HUB9982A27315 10/02/2015 10/02/2016 (Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool At www.mass.gov/lwd/workers-compensation/investigations/. 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. Town of Barnstable 230 South Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Daniel M.Cron ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-074360 Construction Supervisor RICHARD VILLANI PO BOX 692 I WEST HYANNISPORT- W 02672 = CA Expiration: Commissioner 06/23/2 018 Construction Supervisor Restricted to: s of any use group which contain Unrestricted-Building less than 35.00 0 cubic feet(991 cubic meters)of enclosed spa - Massachusetts urrent edition of the Failure to possess a15 cause for revocation of this license State Building codeMASS.GOVIDPS pPS Licensing information visit:W j' ain;eu2ls;noy;[es.PIIUA;ox _ k1upiaasl3pufl l,09Z0 b N'SINNVAH �j 3N`dl P•'.OJdM 60L INtfl�ln aHdH01b 1"__ -=-'=f,: INEfIIIA(MVI-10Rf . 9iiZ0 dT�i`uo;sog — uol;elldx IenplAlpul G:C.OZ`--./ - OLiS a;ms-Ezeld�I1ed Of :adl(1 09S8Z1 y :uol;ej;sl6a i uol;el'nffag sseu►sng pue s11e;;V.iaumsuoD jo 9ag3U 2iOlOVb1NO01N3W3AObdWI 3W :o;uan}3i puno33l 'a;ep uol;elldxa ay;aao;aq uoiluln2ag ssaulsnfi p s.il?zJJV Ja�unsuOD J0 aay3O Sluo asn Inpitipul-10;pgeA uo.;sl;sl�al io asuaalD `� r - - s HASTINGS Meadow Condominium Board of Trustees 135 West Main Street Hyannis, Massachusetts 02601 (508)420-0047 September 91h, 2016 Brad St. Coeur 17534 Bristol Bay Lane Lake Worth, FL 33467 Dear Brad, The board of trustees is in receipt of your request to replace work within your unit at Unit 3, Hastings Meadow Condominium in accordance with the rules and regulations or by-laws of the condominium association. After reviewing the work requested,the following was provided: WORK TO BE COMPLETED: • Replacement six(6) (all)windows with Double Hung with the configuration to match the current existing configuration. All windows to have dividers. DOCUMENTATION: 1. A copy of the BUILDING PERMIT HAS NOT been received. 2. A copy of the PROFESSIONAL license HAS NOT been received. `7_1`l"t 3. A copy of the certificate insurance and/or workman's compensation, i urance naming HASTINGS MEADOW CONDOMINIUM as an additional insured HAS NOT been received. v, q CONDITIONS 1. The licensed carpenter for whom the license has been provided must be present during all work. The identification of the carpenter performing the work must be verified by the grounds manager at the time of installation. 2. All materials to be taken off the property and not placed in dumpsters on the property STATUS: APPROVED (subject to #3 under documentation) Should the work completed and/or item installed not conform to this submission,the board of trustees will require removal/correction to comply with this approval. If you have any questions please contact Shawn Horan at 508.775.6880 or John Pupa at 508.420.0047. Cordially John J. Pupa Financial/ Business Manager Hastings Meadow Condominium VILLANI CONSTRUCTION INC. Roofing& Siding Specialists . PO Box 692 West Hyannisport,MA 02672 508-778-2495 1-888-766-3043 Member of the Better Business Bureau—Insured—Licensed—Free Estimate . ��xa�6o6aL Brad St. Cocur August 3, 2016 Unit 3 Hasting Meadows. 1-954-260-1725 Hyannis Ma. 02601 bradbbc@comcast.net 'DESCRIPTION Furnish and install the following, labor and materials to install replacment windows at Hasting Meadows.condiminum Hyannis.As follows: Remove 5 windows. Install 5 Harveys all vinly low E half screens replacment windows. 3 over3 We propose hereby to furnish labor&materials complete in accordance with above specification for the sum of: ONE THOUSAND NINE HUNDRED DOLLARS: $1,900.00 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ( � Parcel U Q�. Application # Health Division Date Issued�,9 (-1-r S l Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village In l� l Owner e �f � � Address Telephone 9.: �V' o `� l�- �, ,al W0; 17 Permit Request 's Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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 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;T❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ex sting ❑new maize_ 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) Name �Kf l�' 'fit?"� > ���fir,r Telephone Number ® "34o - Address �� (i�1�' 'TiQb, 'e"1 . License # C , � ,��C� Home Improvement Contractor# l �O Email 0 401'%Pell- % 60 Y)­, Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE 45 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH r FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. Y ��zrrt�r� #Q�?�r�sr�eFtrrs �e� t n��t�sfiaa��Sccrder� — - ue tr,��rsa:est�a�iorrs 600 Wm*i€*tm&reef B'owfva t 02 �' wH.�ty.rr�uss.gr�dut Work-are Campensalwrt Insurance Affidavit EmldersfCa-ntra:cfurs/ElectcicianMumbers Applicant Infermat on Please Priest Lefihly Name t s� gani i i �r}_ // �i/ C, 0,,f� Address. 40!C1e foil /A C.ty,rSta - -- Phony 47- 0 Llreyo employer:`Cbecl�txpl[ssriat3 bow: T of ect r 4. I ama. cmtmatcr and I - I I am a employer lager with ❑ 1 6- ❑New const L,i,,.. employees{full anrVorgart-time}* have biredtlie s1lb-contraciDrs. 2_❑ I am a sole proprietor or partner- Iiste-d on the at mched sheet y- ❑R=odeltag ship anc1 have no employees These sub-contractors have g- ❑Demolitiou- womi£i ng for mein any capaca- employees and have wolkers' 9_ ❑Builcrmg addition [Ng vmrkers' comp:insure a Comp.MsuraT �'r�J 5-El Are are a corporaiionand its 1(1�Electrical repairs or additions 3_❑ I am a homeowner&Ding all IWoti;_ officers hn-e exercised fheir I I❑Plumbing repairs or additions myself LN6 wo -ms'comp- ri&-}of e�mpfioaper MGL I�Rwfrepaim lft�hanrg 1f c.152,§1(4) and we Rave no employees [No Wig• 1 _❑€]thee comp-insurance rEquied.1 . "Any aaplbotnt that dhedss box rI unlit alsa i410�tt�seciiflabeTaca ch�;�r 3�eir�odc�T eoameasatiaa p� vttr�submit ties af�dmif imcstig they a�tiamg�IItr sad 6iea} tide coahactc;cs must smhmita adroit Tyr�a sar&_ -£�nLsctos thgt c7�k this 6ax mgst stteclsed sa addilimisI zt<eet shvcEmg ti�name of file ukt-oohs emd s�vrheti�[ nut amass 5�-� empiayees_ ime snlr-contactmhwe mmpIc*yees,they must pwvide t:it wmk-e&comp policy aumbez I am arz.einpZoyer that ispm4ffffg workers"congwnsa6an itmirim-ce for my empinyem HeL?ty is fits paUcy and}ob site irt�fntmmti�� Insurance CompagyName: OIA # or S e1€lees Ur :g rah Ste AgdiesrZ:3 ll�.e�� �, Citylstaterzip: Each a copy of the markers'compensation polio:ff declaration gage(shwwing the policy=Tuber and e3:p�h7atian date). Failure to semre coverage as reTCiredunrkx Seckca 25A o€MGL c. 152 can lead to the imposition ofcrimmal penalfi,es of a fine up to S1,5UD©D an&or one-year imprivonment,as well as civil penalties in the form of it STOP WORK ORDE1t and a fine o€up to�250-DO a,day against the violator_ Be advised brat a cam*of this stdaneat maybe fxwarded to the OT=of Iur,estipdom of 11e DIA for insara ce carerage 4ffic2tion_ I,&hereby under d wms� d" ai#ess o; 'For utp tfsetA tiff fbnriaiianprasa&£abar¢is trace mrrl cvrrsct 5i�atare: _ Date- Phone iv a id usa ant}. Ike not sprits is this area,to ba compfeted by city or town offieiaF City or Town- PermitUcense# Issuing Autharky(tdreIe one): L E;aard of$ealtht 2.Bud'Tng IIepmi tment 3.Cltyrrw r Clerk 4.IIechical Fnspec or S.PlgmUmg Fn pmtor .6.Othfx, Contact gersan: 6 i Roofing& Siding Specialists PO.Box 692 West Hyannis Port,MA 02672 508-778-2495 1-888-766-3043 Member of the Better Business Bureau—Insured—Licensed—Free,Estimate June 5 201.5 V%AAt St N \ 5 a2 6 \ slsul.ly67@comcast.net DESCRIPTION Furnish and install the following, labor and materials to re-place 2 sliders Remove 2 existing slider. Install 2 Harveys 60x 80:Replacment sliding glass doors. ,Install new exterior and interoir trim. We propose hereby to furnish labor&materials complete in accordance with above specification for the sum of: THREE THOUSAND'SIX HUNDRED DOLLARS: $3,600.00 sy - Z�G 1 -7 p e HASTINGS Meadow Condominium Board of Trustees 135 West Main Street Hyannis, Massachusetts 02601 (508) 420-0047 July 20`h, 2015 Brad St. Coeur 17534 Bristol Bay Lane .Lake Worth, FL 33467 Dear Brad, The board of trustees is in receipt of your request to replace work within your unit at UnitX,, Hastings Meadow Condominium in accordance with the rules and regulations or by-laws of the condominium association. After reviewing the work requested,the following was provided: WORK TO BE COMPLETED: • Replacement sliding glass door . DOCUMENTATION: 1. A copy of the BUILDING PERMIT HAS NOT been received. 2. A copy of the PROFESSIONAL license HAS been received. 3. A copy of the certificate insurance and/or workman's compensation insurance naming HASTINGS MEADOW CONDOMINIUM as an additional insured HAS NOT been received. Upper Cape Tech-Adult Classes: Invoice Page 2 of 2 Copyright©2012 Upper Cape Tech.Hosted By e-Business Express&Web Design by Morditech.com&GlendaleDesigns.com h"s://www.uppercaDetech.cc/mm5/merchant.mvc?Session ID=54dcc8eeed069c9lf4a8d... 10/13/2015 � U Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-074360 r S RICHARD M L01 ' PO BOX 692 West HyannisporF Expiration Commissioner 06/23/2016 w1v°� 5Of �yUse(991�)of is feet vnre5trictea 35,0f cub cones less ; enclosed space • the Ma�achu5etts nt diti�on°c2,°n of this license. a rrev° pP5 Corr ilureto posses�e is causefo N1ass•�O State Building C ation V1sit: W`►�'N For OPS UcensInBtnform i T^ � (�//Z��e Wpntaac tocaNkZ°19&mdaolucj I License or registration valid for individul use only anv Office of consumer «Business Regulation before the expiration date: If found return to: ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Type UVegistration: 12; 0 10 Park Plaza-Suite 5170 Individual piration:="4�21201n7 Boston,MA 02116 l a 441 RICHARD VILLANI � , G�RICHARD VILLANI •,y\ 109 WAGON LANE j Not valid without signature HYANNIS,WA 02601 Undersecretary f - ------------ - ACOO" CERTIFICATE DATE(MMIDDMYYY) RT I F I C ATE OF LIABILITY INSURANCE 10/13/2015 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). PRODUCER - CONTACT NAME: Erica Barrett OLDE CAPE COD INSURANCE AGENCY INC. PHONE E 1 i (508)771-3300 FAX No): E-MAIL ADDRESS: .erlcabO@occia.com 296 WINTER ST. INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA 25666 INSURED INSURER B: VILLANI CONSTRUCTION INC INSURERC: INSURER D: PO BOX 692 INSURERE: WEST HYANNISPORT MA 02672 INSURERF: COVERAGES CERTIFICATE NUMBER: 4926 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. IN RI - ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE IN D WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER ANYPROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A NIA 6HUB9982A27315 10/02/2015 10/02/2016 (Mandatory in NH)If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 - ' DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 230 South Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 Daniel M.CrD ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD United Service Adjustment, Inc. P.O.Box 269 t Framingham,MA 01704-0269 Phone: 1-888-633-4855 Fax: 1-508-879-7385 Building Commissioner/Inspector of Buildings Board of Health/Board of Selectmen 367 Main Street Hyannis,MA 02601 RE: tnsured(s): St Coeur,Bradford/St Coeur,Deborah DBA: Property Address: 135 West Main St.;Unit 3,Bldg A Hyannis,MA 02601 Company Policy Number: HO17055384 Date of Loss: 9/l/2017 Company Claim Number: H0002224 USA File Number: USA25709 Claim has been made involving loss,damage,or destruction of the above-captioned property,which may either exceed$1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Sec 3B is appropriate, please direct it to the attention of the writer and include reference to the captioned insured, location,policy number,date of loss,and claim number. On this date,I caused copies of this notice to be sent by first class mail to the municipal officials named above at the address shown. Adjuster: Jack Durant Date: 9/5/2017 TOWN OF BARNSTABLE 22950 `w� a Permit No. ---------------------- sw�r.m Building Inspector Cash tlt� OCCUPANCY PERMIT Bond N/A 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 JarneS J, Tz=ilpr' Address Centerville Unit #3 135�West Ml ain Street, N�jaraiis Wiring Inspector � s' `� :Yt! ' s"i Inspection date Plumbing Inspector ' Inspection date Gas Inspector Inspection date Engineering Department Inspection date 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. 1 Building Inspector