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HomeMy WebLinkAbout3329 MAIN ST./RTE 6A(BARN.) 33, w , t9� rr ` h r i a a., a A w k , ry f e Y .rre r'. J '- � YtlR'^ . r ae. ;,' iF ,,;v � t. ..�}. » .�• d` g� r 3, �� k:A ��'a. N ��;,'. �'� �� ,y:� e• r sy :�r 8..:y., ,5'; .,, apt t ... �•.� �� -� ,�. e. -�' k�. �.,. r.. J 8. L y r A Ain, ;.W ... ,. 'i>J a ,,, «s"' ',rvf>.,, 1 4° a t' 'A�;n,. ► x'. .. q'A x.. •,'-,,dd.,...:d'- .,� 't _ � A. N.f,..,.._ ci. .;`.. `.A" ^i. .a •etv^5 „ ra w. .: .ryA�'.. ,. k ,L.: k - 8,...'..:k. A. :: VON . ..by ... .y Y� , t<a. t '.�t #. +' .!F>. kr .✓n Mgt,, A` <. � a<' �,,° vas.. ,��, ,� '�,��' ,,.,,. �p ��.,, ,,. aF �r aF,.*.. «,.;....t. :. '..: �r�., �r r �° .e§ •.e �. ,4 So- .r,' •.. i,. 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Application "; 0 Health Division Date Issued Conservation Division Application Fee 3 3 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH _Preservation /Hyannis Project Street Street Address 33.A Village- - Owner� - � CZca�i��r-� Address. /0 2 S_ - L�ermit_Request - 7 v� UT . 4e 4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District _ Flood Plain Groundwater Overlay Projje�ation'"'_650C/, 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) 1 Number of Baths: Full: existing new Half: existing new Z" Number of Bedrooms: existing _new .1 Total Room Count (not including baths): existing new First Floor Ra`�o CouriP Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other ZZ o _U: Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woo /coal stove: J4 Yes ❑ No � t- Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: existing ❑ R6w 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 HOMEOWNErQ"> Name �'_ Telephone;Nu Address-w 2 R �U� S License# 6 d Home Improvement Contractor# Worker's Compensation # ALL,C_O_NSTRUCTION,DEBRIS-RESULTING-FROM THIS PROJECT WILL-BE TAKEN TO` `'----7 SIGNATURE ky -DATE__ l� t_- i� -' FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED MAP/PARCEL NO. , ADDRESS VILLAGE OWNER DATE OF INSPECTION: I i FOUNDATION FRAME INSULATION FIREPLACE r I ELECTRICAL: ROUGH 1 FINAL r , r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 3 , ' DATE CLOSED OUT ASSOCIATIQN PLAN NO. ti. r ' The Commonwealth of Massachusetts Department of Industrial Accidents 137 Office of Investigations 600 Washington Street ti Boston, MA 02111 ,1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly /e r Name(Business/Organization/Individuan:VC,C (G(!�2-y ` U P- n '� Address: 4 ' S� t 6 e GL�' l�/ City/State/Zip: Phone.#: Are you an employer? Check the'appropriate box: Type of project(required): 1.❑ I am a employer with 1 4. ❑ I am a general contractor and I ployees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction listed on the attached sheet 7. ❑Remodeling 2. am a sole proprietor or partner` ship and have no employees ` These ces a ntraet , have g. Demolition � to ees and have workers' working for me in any capacity. y 9. ❑Building addition [No workers' comp.-insurance ° COS' $ 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 l l.❑Plumbing repairs or additions myself-[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance regmred.]1' employees. 152, §1(4),and we have no • emiployees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'comparsation 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. tContraetors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have eemployces,they must pm-vidt;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. r-- Insurance Company Name: V,0C TC.-G" Uric 6-1::;. — Policy#or Self-ins.Lic.#: a/irlo g 3 Expiration Date: ! ZA,? G Job Site Address: 3 A d, City/State/Zip:&/""i,�� 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 e. 152 can lead to the imposition of crimirial penalties of a fine tip 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 WA for insurance coverage verification. I do hereby certify under the pains-andpenalties ofperjury that the information provided above is true and correct Si atur Date: O 0 — a Phone#- -50Y 3'3a'4'26V 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#: 4., 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 e,tity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representative's of a dec ased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing loyees. However the owner of a dXelling house having not more than three apartments and who resides therein, the occupant of the dwelling house another who employs persons to do maintenance,construction or repair ork on such dwelling house or on the grounds building appurtenant thereto shall not because of such employment b deemed to be an employer." MGL chapter 152, §2 t7 also states that"every state or local licensing agency shall thhold the issuance or renewal of a license or rmit to operate a business or to construct buildings in the ommonwealth for any applicant who has not pr uced-acceptable evidence of compliance With the insur nce coverage required." Additionally,MGL chapter 1 , §25C(7)states"Neither the commonwealth nor any , its political subdivisions shall enter into any contract for.the p ormancc of public work until acceptable evidence f compliance with the insurance requirements of this chapter have een presented to the contracting authority." Applicants Please fill out the workers' compensation idavit completely,by checkin/anr xes that apply to your situation and,if necessary,supply sub-contractors)name(s), ddress(cs)and phone number(s) g with their certificate(s)of insurance. Limited Liability Companies(LL r Limited Liability PartneLP)with no employees other than the members or partners, are not required to carry wo ers'compensation insuf an LLC or LLP does have employees, a policy is required Bp advised that this davit maybe subm the Department of Industrial Accidents for confirmation of insurance coverage- Ale be sure to sign a theaffidavit. The affidavit should be returned to the city or town that the application for the t or license requested,not the Department of Industrial Accidents. Should you have any questions regard' the law or ie required to obtain a workers' compensation policy,please call the Department at the number ed belownsured companies should enter their self-insurance license number on the a ro riate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. TheNda ent has provided a space at the bottom of the affidavit for.you to fill out in the event the Office of Investigacontact you regarding the applicant Please be sure to fill in the perxnit/license number which will be usedere a number. In addition,an applicant that must submit multiple permit/license applications in any given ye only bmit one affidavit indicating current policy information(if necessary)and under`Job Site Address" the ashould ite"all locations in (city or town)."A copy of the affidavit that has been officially stamped or m the city o town may be provided to the applicant as proof that a valid affidavit is on file for future permits ors. A new davit must be filled out each year.Where a home owner or citizen is obtaining a license or permitted to any bus ess or commercial venture (ie.a dog license or permit to bum leaves etc.)said person is NOT ro complete this davit The Office ofInvestigations would hke to thank you in advance for yperation and shoul ou have any questions, please do not hesitate to give us a call The Department's address,telephone-and fax number. The Ummonwealth of assachusetts Department of Ind � Accidonts Office of Imes ' flans 600 WashinglQ Street Boston,MA 111 TO.#617-727-4900 ext 4-06 1-977-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia BUILMAI-01 MENA AWRD,M CERTIFICATE OF LIABILITY INSURANCE °A1/1 i2008' PRODUCER (508)852-8500 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Protector Group Ins.Agency;Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 100 Front Street,Suite 800 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester, MA 01608-1435 INSURERS AFFORDING COVERAGE NAIC# INSURED Building Maintenance Corp dba US Roofing INSURER A:Acadia Insurance BMC Realty Trust INSURER B:Insurance Company of the State of PA 58 R Pulaski Street INSURER C: Peabody, MA 01961 INSURER D: INSURER E: 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 DD' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION' LIMITS LT DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 DAMAGE TO RENTED A X COMMERCIAL GENERAL LIABILITY CPA0085685 12123/2007 12/23/2008 PREMISES Ea occurence $ 250,00 CLAIMS MADE a OCCUR MED EXP(Anyone person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 A ANY AUTO MAA0085652 12/23/2007 12/23/2008 (Ea accident) ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X. NON-OWNED AUTOS (Per aocidenl) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,00 A X OCCUR CLAIMS MADE CUA0085698 12/23/2007 12123/2008 gGGREGATE. $ 59000,00 DEDUCTIBLE $ RETENTION $ Is TH- WORKERS COMPENSATION AND �( WC STA TU TORY LIMITS ER ER B EMPLOYERS'LIABILITY 9408398 12/23/2007 12/23/2008 E.L.EACH ACCIDENT Is 500,00 OFFICERIMEM ER EXCLUDED? CUTIVE 500,00 E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 500 00 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ r OTHER If A Installation Floater CPA0085685 12/23/2007 12/23/2008 Job Site Limit $100,000 A Equipment Floater CPA0085685 12/23/2007 12/23/2008 Rented/Leased Equipment $75,006 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE:Shaws Supermarket,625 West Main St,Hyannis,MA and other possible jobs r CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable MA DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Town Hall 200 Main St NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601- IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATNES. ED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 U.S. Roofing a division of Building Maintenance Corp. ®. � P O. Box 3118 (ROOFING Peabody, MA 01961-3118 Telephone: (978)532-6300 Fax: (978) 977-0803 6. Payment Terns: The total cost of the contract is $ 8,500.00 Payment shall,be rendered in the following manner: Balance (100% of the total project cost) shall be paid upon successful completion of all roof work 7. Attorney's Fees: In the event of default,the Owner shall pay costs for collecting amounts owing including, without limitation, court costs, expenses and reasonable attorney's fees, in addition to any sum that the member may be called on to pay. S. Entire Agreement: This contract constitutes the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. The Owner agrees that Contractor has made no statements, promises, commitments or representations not contained herein. 9. Modification: Other than that required as a result of paragraph 4 above, any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if evidenced in writing signed by each party or an authorized representative of each party. 10. Unfomeen Circumstances: Contractor is not liable for delays due to weather, strikes, accidents, acts of God or other circumstances arising out of causes beyond its reasonable control and without its fault or negligence. 11. Governina Law: It is agreed that this agreement shall be governed by, construed, and enforced in accordance with the laws of the Commonwealth of Massachusetts. IN WITNESS WHEREOF, the parties have signed their names hereto: Date: 8-6-2008 Date: .S. Roofing, by its agent, Property Owner: Willard H. Murray