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HomeMy WebLinkAbout1295 MAIN ST./RTE 6A(W.BARN.) Sm"pad e s asr'�En�Oy� UPC 12543 No. 53LOR Np C* unp YM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ` Parcel �`�/ © � Application # �" `� I Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address J :7-9 J'7 Village Owner �I'G��" �,5�'.� ,��' ��7' Address Telephone Permit Request Square feet: 1 st floor: existing I°�ropos 2nd floor: existing proposed Total new--c-r Zoning District Flood Plain Groundwater Overlay Project Valuation Shoo, Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s&pportingt cur ntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) ` Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings Highway.,:o Yr-P ❑ 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 n�jgr rn 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 ❑ 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 �� �o�� Telephone Number d`oC;P Address `r` ' �"� License Home Improvement Contractor# .2 9 99 Worker's Compensation # v'gr ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��/ SIGNATURE CjC DATE c �� n } R.. FOR OFFICIAL USE ONLY APPLICATION# DATE-ISSUED MAP/PARCEL NO. y. FE 4 ADDRESS - ' VILLAGE •, .' '' t OWNER. DATE OF INSPECTION: y FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL � PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ` ASSOCIATION PLAN NO. 10 - , t "The Commonwealth of Massachusetts Department of Industrial Accidents i, �� i Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): lJ��� Address: City/State/Zip: /1y/��"' �l/�� Phone #: Are an employer? Check,the appropriate box: Type of project(required): 1. 1 am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(frill and/or part-time).* have hired the subcontractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in.any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 1 L❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.0 Roof repairs insurance required.) t employees. [No workers' 13.0 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: y��~ f'vLIIG��' Policy#or Self-ins. Lic. #: //45' o /� � Expiration Date: Job Site Address: 9 �7�a�fT City/State/Zip: /,0' &)Co" J 'O"'A• 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 fue of up to 3250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. jr do hereby ce fy under the pains and penalties of perjury that the information provided above is true and correct- Sienature: Date: Phone#: 7 7 Jr' c«,> 1�7, Official use only. Do not write in this area, to be completed by city or town official City or Town: Perm itfLicense# Issuing Authority (circle one): . 1. Board of Health 2. Building Department 3. bty/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: .., ofI Town of Barnstable N� Regulatory Services • snarrsrAsr.e, . r ��. �, Thomas F. Geiler,Director �p s6f9• � e rE1619-� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62: Property Owner Must Complete and Sign This Section If Using A Builder I, .S Mill ill L A—A/ , as Owner of the subject I property hereby authorize OD-S (} to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of r Date Print Name If Property Owner is applying forpermit please complete the Homeowners License Exemption Form on the reverse side. .Q:F0RMS:0 WNERPERMISSION the Town of Barnstable - of ram, ,. y�P "0 Regulatory Services • siwJsi.Asc.t=, Thomas F. Geiler, Director MAIM y q, 1659. Building Division �1FD 'Y a Tom Perry,Building Commissioner 200 Main Street; Hyannis,MA 02601 ww*v.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DA TE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellin>rs 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 Persoa(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, 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 all such work performed under the building permit. (Section 109.1.1) The undersigned "homebwner"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: Three-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 Mork 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 2.15) This lack of awareness often results in serious problems,particularly when the homcowncr hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would wiith 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 of this issue is a form currently used by several towns. You may caret amend and adopt such a form/certification for use in your community,. RightFax N2-1 2/29/2012 6:04 :53 AM PAGE 2/002 Fax Server ACORD. CERTIFICATE OF LIABILITY INSURANCE 02/29/2012 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(es)must be endorsed. H SUBROGATION IS WAIVED,subjectto the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemerd(s). PRODUCER CONTACT NAME: PHONE FAX BRYDEN&SULLIVAN INS (A/C,No,Ext): FAX (A/C,No): 88 FALMOUTH ROAD E-MAIL ADDRESS: PRODUCER HYANNIS,MA 02601 CUSTOMER ID# 232MY INSURER(S)AFFORDING COVERAGE NAIC ff INSURED INSURER A: TRAVELERS MENNITY COMPANY INSURER B:. LEBOEUF JAMES DBA BARNSTABLE COUNTY INSURER C: CONSTRUCTION AND DBA INSURER D: 71 BETH LANE INSURER E: HYANNIS,MA 02601 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FORTHE 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 ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF DATE POLICY EXP DATE LTR TYPEOFINSURANCE INSR WVD POLICY NUMBER (MMMDD\YYYY) (MM\DD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY + DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PROJECT LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ W WORKER'S COMPENSATION AND C STATUTORY LIMITS OTHER EMPLOYER'S LIABILITY Y/N UB-0498NI49.11 05/14/2011 05/14/2012 E.L.EACH ACCIDENT $ 100,000 ANY PROPERITOR/PARTNER/EXECUTIVE Y E.L.DISEASE-EA EMPLOYEE $ 100,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-POLICY LIMIT $ 500,000 Ii yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE, THE WORIOERS'COMPENSATION POLJCY DOES NOT PROVIDE COVERAGE FOR LEBOEUF JAMES. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE HYANNIS,MA 02601 Charles J-Clark ACORD 25(2009/09) 1988-2009 ACORD CORPORATION. All rights reserved. e ' Town of Barnstable ^' Old King's Highway Historic District Committeem ` ; 200 Main Street, Hyannis, Massachusetts 02601MASM °D ,•� (508) 862-4787 Fax (508) 862-4784 APPLICATION, CERTIFICATE OF APPROPRIATENESS FOa ,`�,� DEMOLITION OR RELOCATION OF A BUILDING OR STRICTURE (including partial demolitions of buildings,structures; outbuildings, stonewalls,etc.) Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of,Chapter 470, Acts and Resolves of Massachusetts, 1973,for proposed work as described below and on plans,drawings,or photographs accompanying this application: Date: �/}ti /17 d4l/l a—Address of Proposed work: Assessors Map and lot# 17 F 0 02,661,D� House 41�1�Street RAM S/r --village: V, Demolition of: ❑house. ❑part of house ❑Garage ❑ barn ❑stable ❑commercial ❑stone wall Mother Description of Proposed Work: A5811-2 7-- 9NTAy14 P//U 9 f S /AJ 7a 2:a.= Please complete the following information: d Square footage of footprint of building(s)to be demolished: Building 1: 1119 2: Square footage of total floor area ofbuilding(s)to be demolished: Building 1:,yL _ 2: Owner(please print): &1z% (/5 71-96 .� 44w T615 T Tel#: _ Owner's mailing address: Signature of Owner Note: All applicu o s must be signed Fy the owner,A evidence of authority to ael for III owner submitted Agent/Contractor(please print): ! /d G /BEGS Tel M —� Address: G��✓'" Signature of Contractor/Agent: If application is for removal to a different location,sta where: Note: A separate Certificate of Appropriateness is required for a relocation of a building or structure within the Barns Old Icings Highway Historic District. Check list e - 012 � �- Application for Certificate of Appropriateness for Demolition or Removal,4 copies FEB p 8.2 r,- Site plan,4 copies, i,-_ Photographs of all elevations of building(s),outbuilding(s).or stone walls being demolished. Town of 8,nst bI6 I,'- Fee according to schedule. Old Kmmittee I-- List of abutters,see staff co For Committee Use Only This Certificate is hereby r Date: ommittee Members Signatures: RECEIVED _ JAN 18 2012 Conditions of Approval,if any a jNT Q;IGMD-Groups101d Kings HishwaylOK11 New ApplOKH Demolition 07.doc Town of Barnstable Geographic Information System January 19,2012 17901s 01220 171i00400t 117901soo1 so 'Qa� 60 e9 179020 179001 so so t78021001 176019 loom 179W • *0 $1247 to i0 1247 179031 $1310 17700B 01344 Alt 197046 41ps137tj 178021002 • 177001 01295 so 177004 $1340 — moon 01375 177002 so 197011 so 0 127 Feet 197001O02 ( s 126 DISCLAIMERS'.This map is for planning purposes only. It la not adequate for legal Map:176 Parcel:021002 Selected Parcel boundary deternanat on or regulatory rdwprew,on. Enlarge b Enlargements beyond a scale of Owner:BARNSTABLE LAND TRUST Total Assessed Value:12115100 1'=1IX1'may not meet established map accuracy standards. The parcel lines on this map w"! ,.E are only grapirk representatiors of Assessors tax parcels. They a,e not true property Co-Owner: Acreage:9.65 acres Abutters S boundanes and do not represent accurate relationships to physical features on the map Location:1295 MAIN ST./RTE 6A(W.BARN.) such ea building locations. Buffer R` as i « ..Y4.8 setl�. �°' - d 3•KaYM Ir.�W l;Ly� { p0.... - f �y 1 r 11-95 ,AiN * 1 J .o. 4 M ve y v i tfa+r �. •ri`<. �-+��" i � "`�Yam. ACb .yY n a. ...ter ..f...+�MP•3w'•'�� __. - •"t .: «_ .«y n ak a Kt _ ' ,.. r �a a z 1 o wow IWI x i e. n rc ""...naxi{z �h �' •µ3..ye X � wf "i _.., �. � , .., _ --.�, m,, �. �. _ �� _. 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