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HomeMy WebLinkAbout0047 SECOND AVENUE ,h-.-+iil'�'ti^�. +T- A'.Y"!i""`^r°''� w,?,n _ .+�.A,- ..e"�.w� _ __ n. ie. '.f�4f��k-_e...nP�9 w!�rw.�a�w.!IT! :c.-.H^e�rw.J4.+r+�i� 8/ �� = C� tell 7— _�;Vf Barnstable l it# �3 Town o.� Expires 6 months from issue date Regulatory Services Fee — BARMAeL& � MAM Thomas F.Geiler,Director 1639. °�Fp MKI Building Division -PRESS PERMIT Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 N�� 5 2��2 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERWr APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imp `rint O F BARNSTABLE Map/parcel Number jp Li Property Address Z4-I �c an(A e 0 s 1 v' )1 y V 1 D ca� 5 S ql esidential Value of Work O O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address�T-'enn, �I- D u ►`1 q y7 �rrrl�� >S ry�llP, Wl� �S" Contractor's Name o d I (a Telephone Number � C [r,0 Home Improvement Contractor License#(if applicable) I-1 i/ 4 Construction Supervisor's License#(if applicable) e-yg �kman's Compensation Insurance F Check one: ❑ I am a sole proprietor ❑.I am the Homeowner Mr,have Worker's Compensation Insurance Insurance Company Name A SIA!-a AAC,e Workman's Comp.Policy ,ACopy of Insurance Compliance Certificate must accompany each permit. Permit Reque (check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to VMS j F.l1— ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: ) roperty Owner must sign Property Owner Letter of Permission. /A copy of the home Improvement Contractors License&Construction Supervisors License is rpluired. SIGNATURE: C:\Users\decollik\Ap ta\Local crosoft\ dows\Temporary Internet Files\Content.Outlook\QRE6ZUBMEXPRESS.doc Revised 05301 `\ 71ee Contmonivealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 wivinniass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electiicians/Plumbers Applicant Information Please Print Legibly Name(Busmess/Organizationibdividual): Ln'Rin rnoo T tna n eP ri nn + Address: t�23-7 Mai V) (a I�rx i of Y U City/Statelzip: ► A- Phone#: `��i(- 4 3,Q) - k 3 G n Are yog.an employer?Check the appropriate box: Type of project(required): 1. I am a employer urith 4• ❑ I any a general contractor and I 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 workingfor me in capacity. employees and have workers' �' � t3`- I 9. ❑Building.addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]1 c. 152,§1(4),and we.have no employees.[No workers' 13.0 Other comp.insurance required.] :Any applicant that checks box ftl mast"511 out the sectionbebra•showing eheit workers'compensation policy information. 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 addict nal sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-cantractors have employees,they must provide their workers'comp.policy number. I am are etrtpioyer that is prot,idir;g workers'couipensatiarr irrsuratrce for rtt_v employees. Beioro is the policy,a►rd job site inforuratiorr. Insurance Company Name: C 1'Gl S�11�1:r M C'P_ I M-Q',Ul&A i Policy'or Self-ins.Lie.g:��-[�Q (e)'W S 16— L L4 Expiration Date: Job Site Address: yoa &P . City/State/Zip: Q 5+ff V I��P. MA 0,2(055 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 S1.,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$250.00 a day against the violator. Be advised that a copy of this statement may be for%wded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains aced penatlies of perjnry that the irrforntation provided above is into and correct Si ture.: Date: o"l. Phone M �;i­ " O,(]icial rise only. Do not write in this area,to be completed by city or town official City or Town: Permit/Ucense A Issuing Authority(circle one): 1.Board of Health ?Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone M 6 r t 0 k lffl� 4J 64 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 00 01 A 07 11 Issuing Company: Acadia Insurance Company 290 Donald J. Lynch Blvd, P.O. Box 9168 1 Marlborough, MA 01752-9168 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY RENEWAL INFORMATION PAGE NCCI Carrier Code No.: 33391 Policy No.: WCA 0268516 - 14 Previous Policy No.: 0268516-13 ✓ 1. Name Insured and Address Agency Name and Address 07401 LaBarge Engineering and Contracting, Inc. (508) 791-2241 231 Main Street Sullivan Insurance Group, Inc. Route 28 Ten Chestnut Street, Suite 1010 West Harwich, MA 02671 Worcester, MA 01608-2804 Other workplaces not shown above: Refer to Name and Location Schedule FEIN: 043552990 Risk ID No.: 0262586 Bureau File No.: Entity of Insured: Corporation POLICY PERIOD 2. ;The Policy Period is from 09/26/2012 to 09/26/2013 12:01 AM Standard Time at the insured's mailing address. COVERAGE 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part two are: M Bodily Injury by Accident$ 500.000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee I C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: ALL STATES EXCEPT ND, OH, WA, WY AND STATES DESIGNATED IN ITEM 3A OF THE INFORMATION PAGE. D. This policy includes these endorsements and schedules: See "Schedule Of Endorsements" I WC 00 00 01 A 07 11 Includes copyrighted material of The National Council on Compensation Page 1 of 4 4. Insurance, with their permission. 1 • I ✓. -C ze. ea / aV/�crvoac�u aelta License or registration Office o onsumer'AF�rs Business Regulation g Stration valid for individul use only -- HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ,,*149496 Type: Office of Consumer Affairs and Business Regulation --: Expiration: �1L:1.312014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 RGE ENGINEERING;;$=E:ON;T,•RACTING INC cam—="� TODD LABARGE 237 MAIN ST-RT 28 W HARWICH,MA Undersecretary of alid without signature 1 Massachusetts -Department of Public Safety �--° Board of Building Regulations and Standards construction Super�'isur License: CS-068313 TODD A I ABARGE 237 MAIN S iCFRT.28 W HARWICfI MA' 02671:`e Commissioner Expiration 02/07/2014 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 m) of enclosed space: Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS r Y • RAMnABL Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Te hin i ie'v" M , IA ass ,as Owner of the subject property hereby authorize TnCIA A• Lod arQP_ to act on my behalf, in all matters relative to work authorized by this building permit application for: y�SPClMA AUP, QS�6rU►LIP, 6ti (Address of Job) Li'/�Jj Signatur f Owner Date n Ai toao* M • Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\QRE6ZUBMEXPRESS.doc Revised 053012 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION `Map ,' Parcel Permit# 9 / `7 Health Division I2/z61a5 D.S• f� 0OS`G20 Date Issued -2 — U �� Conservation Division 7/ 7,0 OS Fee f�� Tax Collector_�� _ �"/� �5 Application Fee Treasurer Planning Dept.t. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address S'wyd . Village lStcsl"Jull ao— ` _Owner �7L'notFf b' M • tw% Address A1/75�_ Telephone ,rp- (a, I Permit Request f,,E11 o r2 is---L Fzx1 T GJr lts�N) ND 2,429 CNN Square feet: 1st floor: existing �propo�sed .'� 2nd floor: existing proposed _� Total newer% Valuation 3 S d q,P)D Zoning District Flood Plain Groundwater Overlay Construction Type 000D f R f% m� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. l Dwelling Type: 9 Y T e: Single Family 0 Two Family El Multi-Family(#units) JIN Age of Existing Structure L'.T`''i�S Historic House: ❑Yes b/No On Old King's High ay: ❑` 4No Basement Type: Full Crawl ❑Walkout ❑Others q �• Basement Finished Areas .ft. Basement Unfinished Area(sq.ft) _ � `r ( q ) ® .. Number of Baths: Full: existing f new Half:existing G9 Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Roo Count Heat Type and Fuel: �Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 1 o Fireplaces: Existing d New Existing wood/coal stove:�❑Yes No Detached garage:/existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing Cl new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes If yes,site plan review# Current Use AC, AJI, Proposed Use S::s mg-- _ BUILDER INFORMATION Name ©S s Telephone Number Address �L��� 1 (�l �f a '� License# o lr'L Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO &ui-yt &-4' Sfahfi�r AND � L SIGNATURE DATE /n=> /0�— FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE _ OWNER DATE OF INSPECTION: " rs FOUNDATION FRAME INSULATION FIREPLACE _ a ELECTRICAL: ROUGH FINAL ' ;+ PLUMBING: ROUGH FINAL z..I GAS: ROUGH FIN L FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. RESIDENTIAL BUILDING-PERMIT FEES APPLICATION FEE New Bindings $100.00 Residential Addition $50.00 Altmitions/Renovations $50.00 Change of Contractor/Builder $25.0.0 s FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq,foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING square feet x$64/sq.foot= f 3$ x:0041= plus from below(if applicable); GARAGES-(attached&detached) square feet x$32/sq.ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf- 1500 of 100.00 >1500 sf-Same as new building permit: square feet x$96/sq,foot= x.0041= STAND ALONE PERMITS Open Porch x$30.00= . (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Sw1mnWg Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee ,�Ej .Dee 13 05 09:43a (5081428-3399 p. 1 Town of Barnstable r Regulatory Services • 0 Themaa 1►.f eiler;Director Building-Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.mims Office: 508-8624038 Fax: 508-79066230 Property Owner Must -Complete and Sign This Section If Using A Builder I; ,ju fC�f� �C77 ,as Owner of the subject ptuperty hereby authorize `� S l e:(5 to act on my behalf in all matters relative to work authorized by this building peanit application for: 5W,,,A 4e er i(tei PA c)6ss� (Ad&cee of Jou) IZ-13—Z.DD Sigua o Owner Date ro Friat Name Q:FVRMS:OwNIItPERNIIS S10N I 'd OSSt+-OZb-BOS- T uuaC es2aBO so cl oaa °T Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date2 If found return to: Registration: 131378 Board of Building Regulations and Standards Expiration: 711 312 00 6 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 PEACOCK&CROSBY BUILDERS,INC. SCOTT CROSBY 1112 MAIN STREET UNIT 7, C:�2 OSTERVILLE,MA 02655 Administrator Not valid without signature it ---•�____��_7-7_.--_.--pO--.._._...:.--•--------...---.�_...._-..._.._..-_�,._ j � ✓�ie •rObvnim�uuea� a�./I��aaa¢c`e[caetla I BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR NumberC-CS 043556 !` Bi —te=1?.f13/179�62 i plr�e :iti 11t/ 006 Tr.no: 5008.0 �_ tl Rt Cc c!: n0 1 SCOTT E CROS 62 CROSBY CIRG— OSTERVILLE, MA 02655 Commissioner P; Town of Barnstable ° Regulatory Services Thomas F.Geiler,Director °rFQ ►`0 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862.4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied. building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Gee e—L=—l'��b Estimated Cos$ Ok Address of Work: Sea � Au4_ Nfew U t e ( kk aa(-5s Owner's Name: -eu�i�ft' Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH.UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby ap ly for a permit as the agent of the owner: )3 � Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeafdav NOV-11-2005 FRI .01 47 PM P. 02 kk 1112 t �_�..._41.... .._..... 1--•--...39 3/8.,....... I 1.1836R .� W •W33241LB". . .24:24 36 iB27ppT B16RHD 26 314 � • WMGD3636 EF196 24 •DW . S636TOS . � 39 1/2 66 36 ---centerof sink 69.75��.off.left .- 60 ILI well PMSINKDB 166 BFH12RHDS 0 3/4. �--F.B.3 .15 ..BD415 AGD24 _ n� 4. HeatShields.applied to12 W1236L l Interior-edges on-both bd321 T CR36L H — .._......__._._ - r .BEt •BST.. BWT18 24. 24 WC2436L. B36DDT " - 16enter of window 79.5"from f6R of W2136Ak L 41/2 corner .21 .30--=---21._... .: 41 I F--36 1/4...._.. I 60TELL0 HOME CENTER 508-477-3132 Client: Mrs Judy Wass __. -.•. MFG: Marillat Classic June 2005 9otello Nome Canter P:o. Box V: Cush pheae.M.42A.6147 _ Square.. r Door Style: Wbitaba ll Square DUC• «Osterville ._ _ __ ._ Design; final pricing 1 t'8 W.M.katChen View:-Plan__....... _....._.. _................_ .Me _ 02655. pssi4ner.. —_ -....— —..__.._..... Scale; Scale-to-fit ,.—---........._...—._.._....:_ Pew:1. :builder _—__ ;Dats�_�;�./11/05 ------..:........_.. _. ..... ......_......._ ._..._ -.—