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HomeMy WebLinkAbout0363 BARNSTABLE ROAD - �� `�J r _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. C Maps: Parcel, Application Health Division ` Date Issued Conservation Division '.Application i Planning Dept Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH t _ Preservation/Hyannis Project Street Address &f Wi "pArl , X M3V5) 14 1'P4 Village 7 AA- Owner Address Telephone Permit Request 601 a V Gind fwhmqkki�? 1--U _aca CkLro a b , Z Square feet 1 st floor: existing proposed 2nd floor: existing proposd Total:new = Zoning District Flood Plain - Groundwater Overlay ' ( Project Valuation:54 Construction Type Lot Size Grandfathered: �' Yes ❑ No If es, attaTy tirig documentation. Dwelling Type: Single FamilyV ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 50 Historic House: ❑Yes 4 No On Old King's Highway: ❑Yes ANo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other.AV06 e Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) NOY)e 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 ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: 0 existing ❑ new size.—Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization. ❑ Appeal # Recorded ❑ Commercial 0 Yes ❑ No If yes, site plan review# Current Use Proposed Use Q i I� _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name CJCn A0�� �, Telephone NumberO�- %',s��/. �� Address s-l471 License# is- 4 ze Home Improvement Contractor# -Y Worker's Compensation # �(000 / ALL CONSTRUCTION DEBRIS RESULTING 4 /SU NG FROM THIS PROJECT WILL BE TO s� SIGNATURE DATE /Z- 16re FOR OFFICIAL USE ONLY I - .APPLICATION# DATEISSUED MAP/PARCEL N0. ADDRESS VILLAGE � 3 t OWNER ' DATE OF INSPECTION: ' FOUNDATION FRAME , x INSULATION , FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH -'FINAL GAS:. ROUGH FINAL 'Z FINAL BUILDING DATE CLOSED OUT �r ASSOCIAT ION'PLAN'NO. } x ' The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, BMA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orkanization/Lndividual): 1 �'Y [� ! ��U� Address: (p 3 CJ���✓1 � ��° �� City/State/Zip: r) IS Phone.#: 5 OS -7 7"5�1- 1 Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the stab-contractors 2.ElI am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp.-insurance comp.insurance.t required] 5. F1 We are a corporation and its 10.❑"Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself:[No workers' comp. right bf exemption per MGL 12 [A 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'conVensation poky information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contactors must submit anew affidavit indicating such. IContraetors 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 employees,they must providt 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. Insurance Company Name: (Y) fi*(e n- m r a C S rJ Policy#or Self-ins.Lic.#: o O (O(M S 1 ;L Expiration Date- ID • ! •y Job Site Address: S �����1 M)�2le City/State/Zip: t f Attach a copy of the workers'compensation policy declaration page(showing the policy n er and expiration date). Failure to socure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal 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 DIA for ms urance coverage verification. I do hereby certify under �the'cnformation provided above is a an correct. Signature: Date: ®� _ Phone# 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. r 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 ehapter.'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-contractors)name(s),address(es)and phone number(s) along with their certificates)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 date 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 bum 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 Dgwtnent of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 ar 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mamgov/dia tot 10/29/2008 Time: 11s97 AM To: 9,1John 508 775.93:35 Rogers & Gray Ins. Pages 00:1 Client#:49133 TBIGROU ACORM CERTIFICATE OF LIABILITY INSURANCE DATE 10,29/08D1YYYY, PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers 8L Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR .,., ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. P.O.Box 1601 ' South Dennis,MA 02660-1601 sp;' INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURER.&. American International Group . TBI Group,Inc INSURER 8: dibla Rotary Collision Ctr.of Hyannis INSURER G: 345 Barnstable Road Hyannis,NIA 02801 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 DOCUNENT 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 CLfJMS. LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION I A E t LIMITS GENERAL LIABILTY EACH'OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CUrr. _ CLAIMS MADE a OCCUR MED EXP(Any one persin; $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COVPIOP AGG $ POLICY 7 PRO- LOC IECT _ AUTOMOBILE LIABIL17Y CC•MBINED SINGLE LIMIT ANY AUTO iEa accident) $ ALLOWNED ALTOS BODILY INJURY $ SCHEDULED AUTOS IPer pemon) HIRED AUTOS ' BODILY INJURY $ NON-OWNED AUTOS Moracc dent) PROPERTY DAMAGE $ (Per accdent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ .ANY AUTO OTHER THAN EA ACC $ . - - AUTO ONLY: .AGG $ EXCESSIUMSRELLA LIABILITY° _ I EACH OCCURRENCE $ OCCUR ®CLAIMS MADE AGGREGATE $ $ I DFDUCTIELE $ RETENTION $ - _ $ A WORKERS COMPENSATION AND WC0050134.20 10/01/08 10/01/09 �( ORY I A bTuS e7H- EMPLOYERS'LIABILITY MY PROPRIETORIPARTNERIEXECUTIVE - E.L.EACH ACCIDENT $10O,000 - OFFICERJMEMBER EY.CLUDED7 - E.L.DISEASE-EA EMPLOYEE $5DO,000 If yea desdr be under - - SPECLAL PROVISIONS becw - E.L.DISEASE-POLICY LIMIT $100 000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS , 'Workers Comp Information** Included Officers or Proprietors--Jonathan-Porkl<a Project at 345 Bamstable Road,.Hyannis,-Roofing-class-5545-added:to policy effective 10/28/2008 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1n DAYSWRITTEN 200 Main Street _ N0710E 70 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 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/06)1.'of 2 -t #39800 WOB ©ACORD CORPORATION 1988 x Roma, Paul From: Broadrick, Tom Sent: Wednesday, January 24,2007 11:52 AM ,D To: Daley, Patty; Swiniarski, Ellen g fi4D2 f� s` 6 Cc: Perry, Tom; Kennen, Kate; Weil, Ruth; Roma, Paul (o Subject: "RE: Rotary Collision Patty, I sent you an Ipswitch IM message about this guy. . .here's the latest: Paul Roma put a stop work order on him since he had no building permits. Porkka wants to change an overhead door to a customer service entrance; he wants to start renovating a portion of the interior space for office use; he wants to put on some sort of exterior shingle that is not wood; he wasn't aware he needed a building permit to do any of that. So we left it like this: He will come back with a sample of the shingle for our approval, I told him the DIP encourages natural materials; he will .take photos of the building and draw on paper prints where he intends to put the new service door; he will also show how he will frame up the old overhead door; and he will apply for building permits. . .so he will need a DIP sign-off which I can do to get him moving in the right direction. He needs SPR whether formal or informal and he needs a demo permit to knock down that section where he wants to put his travel lane. He might be back today. Tom B -----Original message----- From: Daley, Patty Sent: Monday, January 22, 2007 3 :30 PM To: Swiniarski, Ellen Cc: Broadrick, Tom; Perry, Tom; Kennen, Kate; Weil, Ruth Subject: Rotary Collision Hi Ellen, I met with John Porkka today at the rotary collission site. His plans seem to be very much in the spirit of the DIP. I'll be sending him a memo this week on the points we discussed. Let's keep each other in the loop, Patty Patty Daley Director of Comprehensive Planning Growth Management Department 508-862-4768 1 yoFTNETo�y TOWN OF BARNST ALE BARNSTABLE, 039. DULDING INSPECTOR APPLICATION FOR PERMIT TO ............ .........................:....................................................................................... TYPE OF CONSTRUCTION ° ..............................1...............19. . TO THE INSPECTOR•OF BUILDINGS: _ The undersigned h�reby applies for a permit according to the following information: Location ... ....... .................... ...................... .:........................... .... ProposedUse ......... r.I........G. - .................................................................................................... Zoning District ............. ...................................................Fire District .... ..................................... ................................ Name of Owners ..Address /(�O�r Name of Builder L D....W�... C?O C `L�......Address ?.!ll....5..7 .. !�. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ,, !!C r .L`!.. �.......................................foundation .... ..................,................. Exierior ....4l?l.Y..��.!� T.... !.ti/.LUG .......................Roofing ..?!9 ..4l!�"LT ...............:...............................:..... Floors ...... �...L'.. � Interior .. ... .................................................... ........................................................................ Heating :.G. ..C7 /:G................................................Plumbing ........... ..--......... .. ................................:........:.... l Fireplace~.......'...` ......... ...........................Approximate Cost .. �.�� ........... Definitive Plan Approved by Planning Board -------------------____-_______19 Diagram of tot. and Building with Dimensions -� SUBJECT TO APPROVAL OF BOARD OF HEALTH f. s SEPTIC SYSTE IW INSTALLED I MUST WITH A N COMPLIANCE RTICLE I- STATE 1.4 SANITARY COD ATE ; REGULATION E NO 7'oWf1j .: )��(6 �� voGIJ�� f } I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ! ....... ...... D v v � � --� p '. ►- Z O 'b o _ m m N Q co r CD ci m m O O :p HD C o O ( N m ;W °° Q. 10 �o ,o 10 ,o MA P 310 p)-0 f l� d.+.-...+rV�....+-•�'..,,,--.r..r°r'x:.*--_`�'.r — - - =-+.--� -�-..�-?�isa...:-.�.,w.,......«,.�v'. -. ... r�'"'.'ia".'°"� ^...,.m...o�.r....n...r,_. sr, W' wsr M 13L5 ROAQ TOWN OF BARNSTABLE SIGN PERMIT i PARCEL ID 310 120 GEOBASE ID 22689 ADDRESS 363 BARNSTABLE ROAD PHONE HYANNIS ZIP i LOT BLOCK LOT SIZE i DBA DEVELOPMENT DISTRICT HY i PERMIT 71590 DESCRIPTION 4X12 ROTARY COLLISION CENTER PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: ARCHITECTS: Department of Regulatory Services TOTAL FEES: $50.00 BOND $.00 CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE pz I wtxsrnBLE, ass. t639. I BBUILDI G D71SION DATE ISSUED 09/17/2003 EXPIRATION DATE // zi