HomeMy WebLinkAbout0131 BAXTER ROAD
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
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Map �� Parcel, Y3 7 Application #
Health Division (�n/(� — 03w �qr '' Date Issued 'I
Conservation Division F;Application Fee
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Planning Dept. Permit Fee
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Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address I34X_r67L R0621)
Village ,4NN!S
Owner Wew" 3)c P&T9,4 Address Y5-Y l-Shl ST' W b l L i vu-tovT; G
Telephone 'R b b $ ?1 cP 3'7/ C'i
Permit Request bc=lvt.oLc 7-i0 0 E_ A U_)) 4L LE.L►1v 5 FLo c d
W S v LA-110 eJ 31 U 6 T13 Ft 2.E fin,d S cA Q
Square feet: 1 st floor: existing 536 proposed N A 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation ' 7S. OdC� Construction Type (�eya 'Z �
Lot Size a utO Y S( Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family �, Two Family ❑ Multi-Family (# units)
Age of Existing Structure SDYRS Historic House: ❑Yes XNo On Old King's Highway: ❑Yes ❑ No
Basement Type: *A Full ❑ Crawl ❑ Walkout ❑ Other
Basement Finished Area(sq.ft.) 93 sQ Basement Unfinished Areal( ft) -
Number of Baths: Full: existing new Half: existing rew w
Number of Bedrooms: 3 existing _new ®,
Total Room Count (not including baths): existing new First Floor Rbom Count f
i
Heat Type and Fuel: 'X Gas _ ❑ Oil ❑ Electric ❑ Other C
c�,
Central Air: ❑Yes No Fireplaces: Existing _,New _ Existing wood/coal stbve: ❑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 O Proposed Use S 4 vvkE-
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name �'� �� �` W�tV4 �rV Telephone Number
Address Ia'a P-4\ d CT— License # eS — 07Y 9P'P -
Home Improvement Contractor# 113 9 01 `f y
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
fi uj(,j a# '1 40mvtou%-A
SIGNATURE l_kj DATE
FOR OFFICIAL USE ONLY
APPLICATION#
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DATE ISSUED
t` MAP/PARCEL NO.
4
J
s ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
"FOUNDATION
,i
FRAME
INSULATION;
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH -. FINAL ,
FINA
I tYsY^,f
- L BUILDINGa: -
DATE CLOSED OUT
ASSOCIATION'PLAN NO.
�L\ The Coninion►veahh of Massac•hitsetts
Department of Industrial Accidents
Office of In vemt L•:tions
60..0 i3 ashin ton
Boston, 41A 0_t 11
►vW1v.nrass.goVA1h,
Workers' Compensation Insurance Affidavit: Builders/C,-ntritefors/Electricians/Plumbers
Applicant Information Please Print LegibIy
\tattle'{Rusinr� "t)rgai tz,tion?I,:Jividu:tl}: Qalen Restoration Services
:-a\cldt-ess-99 Ampri can W
ay
Lit}iStatc; ip: MA_o2660 __ Phone r: 508 760 1911
Are you an employer?Check the appropriate box: Type of project (required):
I.® l ant a emplover.with_ 25 a. f am a _cncral contractor and I
employees(full and/or part time).
have hired the sub contractors fit. ❑ Ncw construction
2.❑ I ant a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no emplovees These sub-contractors have g: El Demolition
woe-in�u for nfe in any capacity. employees and h:nc workers' q E�uildin addition
(No workers' conip. insurance comp, insurance.-
required.] We are a corporation and its I0.❑ Electrical repairs or additions
i .❑' I ant a honteoWner`doing.;all work officers have exercised their I i.❑ plumbing repairs or addition.,
f myself. [No workers' comp. riZht ofrxemption per M(;l._ 12.E] Roof repairs
I insurance required.] ' c. 152 §l(4). and we have no
employees J'No workers' I.i.❑ Other
comp. insurance required.I
'Am,applicant that checks box 01 must also till out the smion helow showing their workers'compensation rx,Ilcy Inlix nu lilt
tlonteoccners who submit this affidavit Indicating the%,are doing.all work and then hire outside contractors nwst subnut a ne%% alfidavituldiccn,nc such
;Contractors that check this bed must attached an additional sheet showing the name of the suh-contractors and state v,ltcthcr or nor awsc entities have
employees, if the sub-contractors have employees,they must provide their workers'comp.policy nunihcr
!am an entplgyer/ltat is providing worker'cotttpettsution itlsurtlnce for my entplwees. Below is ttte polil tr and job site
information.
Insurance Company Name: ,,_Ace American Insurance Company
Policy ::or Self-ins. l�c 5B894542 4/1/14
Expiration l:)ate:
Job Site Address: � �`� �o�cL City°/State!L,ip:_, `�_�7_NJIU[S,_--- ---
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. 0. an,lead to the imposition ofcriminal penalties ofa
fine.up to S1.500.00 and/or one-year imprisonment. as well as civil Pena!=ies in the form ofa STOP WORK ORDER and a tine
of up to S250.00 a day against the, violator. Be advised that a copy cif to:s statement may be forwarded to the Office of
Investigations of the DIA for insurance covera�_e verification.
!do hereby certify tinder the pains and penalties of perju?v Ihut the inforntativi.,nrotvtted above is true and correct
Si-n.iture: Date: 4jbi/
Phone 508 760 1911
Official use on1r. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License ii _
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4..flectrical Inspector i. Plumbing Inspector
6.Other`
Contact Person: Phone#:
' Rightfax C1-2 5/14/2013 11 :44 :48 AM PAGE 2/002 Fax Server
.J
CERTIFICATE OF LIABILITY INSURANCE I 07ATE(MMIDDJYYYY) .
T IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
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 and endorsement. A statement on this certificate does not confer rights to
the certificate holder in lieu of such endorsements).
PRODUCER CONTACT .
NAME:
HUB INTERNATIONAL NEW EN PHONE FAX
265 ORLEANS RD (AIC,No,Ext): (AIC,No):
E-MAIL
NORTH CHATHAM,MA 02650 ADDRESS:
77GKF INSURER(S)AFFORDING COVERAGE NAIC III
INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY
WHALEN RESTORATION SERVICES,INC.WHAEL SERVICES, INSURERB:
INC DBA CHEMDRY BY WHALEN SERVICES INSURER C:
INSURER 0:
22 AMERICAN WAY
INSURER E:
SOUTH DENNIS,MA 02660 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY TM1771711 E 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 ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MKDD%YYYY) (MMMDIYYYY) - LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
DAMAGE TO RENTED $
CLAIMS MADE M OCCUR. DREMISES(Ea occurrence)
ED EXP(Any one person) $
ERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $
POLICY PROJECT LOC RODUCTS-COMPIOP 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 LIAR CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
A WORKER'S COMPENSATION AND X WC STATUTORY OTHER
EMPLOYER'S LIABILITY Y/N UB-5B894542-13 04/01/2013 04/01/2014 LIMITS
ANY PROPER ITORlPARTNERIEXECUTIVE N❑ NIA E.L.EACH ACCIDENT $ 1;000,000
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESIRESTRICTIONSISPECIAL ITEMS
THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE.
THE INSURED'S MA WORKERS COMPENSATION POLICY AND ITS LIMITED OTHER STATES ENDORSEMENT AUTHORIZES THE PAYMENT OF BENEFITS FOR CLAIMS
MADE BY THE INSURED'S MA EMPLOYEES IN STATES OTHER THAN MA NO AUTHORIZATION IS GIVEN TO PAY CLAIMS FOR BENEFITS IN STATES OTHER
THAN MA IF THE INSURED HIRES,OR HAS HIRED EMPLOYEES OUTSIDE OF MA THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY STATE OTHER THAN MA.
PROJECT ADDRESS:135 BAXTER ROAD,HYANNIS,MA 02601
CERTIFICATE HOLDER CANCELLATION
HENRY DEPATHY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
459 ASH STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B DELP&JIED
IN ACCORDANCE WITH THE POLICY PRO y -'
WILLIMANTIC,CT 06226
AUTHORIZED REPRESENTATIVE —
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPO ngh s reserved.
Massachusetts Department of Public Safety
' Board of Building Regulations and Standards
Construction Supenisor
License: CS-0749281 ,
W ILLIAM WHALEN
122 POND STREET
BREWSTER MA770263
J s rxpiratron .
C orrrnirs stoner 08/10/2014
mil! Y`!.I/////Itli//+rvll�l�•1. �' X _
� License or registration valid for individul use only
as Office of Consumer Affairs S Business Regulation before the expiration date. If found return to:
SOME IMPROVEMENT CONTRACTOR Office of Consumer,Affairs and Business Regulation
4> egistration: 129244 Type:
10 Park Plaza-Suite 5170
;Expiration: 7/30/2013 Private Corporatio. Boston,MA 02116
Whalen Restoration Services Inc:'
William Whalen
22 American Way .,
South Dennis,MA 02660 Undersecretary Not valid without signature
f
$16' . 6,' „'
14'6"
KE D ECTORS REVIEWED
'BARNSTABLE BUILDING DEFT. . DATE
FIRE DEPARTMENT' DATE,
BOTH SIGNATURES ARE REQUIRED FOR PERMITING
yv.`r:d t�clL_
CARBON MONOXIDE,ALARMS 3' 1,�
MUST BE INSTALLED PER s -
MASSACHUSETT_S'BUILDING CODE
3' 3" —� 11' �,,� 3, 6"7„
~ 117toumfKildren - .. QPSSl •(� In_' -
co
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101
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DEPATHY_BRD 5/24/20 3 age:
04i22i13 12:46 PEOPLES UNITED BANK TECW DEPT 508 760 9995 NO.850 P002/002
_
,a4122113 09:12 508 760 9095
Apr"22 2013 8:45RM Whalen Restorations 508-760-9SSS pace 2
Restoration Services Inc.
Fire,Smoke,Soot'Wota&Mold Rdoedielion Scrvices
Clcaning . Deodorization . RecormMetion
°$peclallsing In Furs Restoration - Ail Work Guaranteed
Access, AWtborizstion And,Dlireet Payment Request Form
I (we) authorize WHALEN®RESTORATION SERVICES to perform work as per estimate
at properly located at Qaxter,Road, Myarinis;MA 02601 to repair damage caused by
fire on 4120/13.
In accepting responsibility for the damage that;has occurred at this property, I (we)
understand that I (we) must authorize this work, I (we) hereby authorize WHALEN
RESTORATION SERVICES to perform this work and scoept responsibility for payment
upon completion.
I (we) authorize"and direct my Insurance Company, Norfolk&Dedham, Policy
#N0420365, to make,payments directly.to WHALEN RESTORATION SERVICES,
Insurance Claim Specialists,for doing this woric and to that extent I(we)as.aign the
benefits applicable to this loss to WHALEN RESTORATION SERVICES. I(we)
acknowledge receipt of' copyfiereof Y,
�alaoi� _
DATED Owrl:;t
slo
UWNEtt
WHALEN RESTORATION REP. SIGNED
22 American Way,South Dennis,MA 02"0
Phone:(508)760-191 1 . Fax'(S08)760A995 1-NO.244.2509
E-Mail:k"IM-naNyhol
Web Page:httP;/tw-w:whal&u=orations,com
.e
`. TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please-print. ;
DAZE
JOB LOCATION 137z)X7e r
Number
Street Address
Section Of Town
H9MEOWNER11.
2e h �'� 7`✓i�
�.
Nam
Home Phone PRESENT MAILLNG Work P one
.ADDRESS„.. �1
City Town Stateo� _`
Zip Code
The current exemption for` "homeowners"occunie dwellinas of six units or lesswandas ettended to include .engage an an individual for hir e who s homeowners to s the does .owner not
acts as su possess a lic
e ens rvisor. e, provided that
DEFINITION OF HOMEOWNER:
Person(s) who owns a parcel of land on which he/she
reside, -on which there is, or is intended to be, a one
resides or intends to
dwellin to six family
qr attached or detached structures accessory to such use and/or farm
structures. A person who constructs more than one home in a
period shall not be considered a homeowner.
to the Building Official on a form acceptable to the B tshall wo-year
that he she shall be responsible form
for all Such of Official,submit
Building Official,
buiY'dina oe*-mit. (Section 1p9,1,1) such work erformed under the .
The undersigned "homeowner" assumes responsibility
State Building Code and other applicable codes. '
regulations, for compliance with the
by-laws, rules and
The undersi ned " "
g homeowner" certifies that he/she understands the Town
Barnstable Building Department minimum inspection roc
requirements procedures and of
HOMEOWNER'S SIGNATURE,
APPROVAL OF BUILDING OFFICIAL
Note:„ Three familY d
required to com 1 wellings 35,000 cubi feet
Control. p y with State Building C,Ode Section larger
or q , will, be
M Construction
HOME OWNER'S EXEMPTION
The. code states that: "Any Home Owner performing work for which a building
permit is required shall `be exempt from the provisions of this section}(Section ,169.1.1 - Licensing �of` Construction Supervisors) ;
Home Owner engages a provided that', if
person(s) for hire to do such work, that such.. Hoare
Owner shall act as supervisor: "
Many Home Owners who use this exemption are unaware that they are assuming
th® .responsibilities of a `supervisor (see Appendix Q
for Licensing Construction Supervisors, Section 2.15) .Rules Thisa lack goflations
awareness of results in serious problems,Owfier particularly when the 'Home hires unlicensed persons. . In this case our Board against cannot proceed the unlicensed person as it would. with licensed-. supery sor. The
Home Owner act as supervi"sor is ultimately responsible.
To ensure "that the Home Owner is fully aware of his/her responsibilities,:
many, 'communities'.requi re, as part of the permit application,, that..,the Home
Owner 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 care to amend and adopt such a form/cer
community. tification for use in :your
I II .
Assessor's office(1st Floor):
Assessor's map and lot number _ 3 P`o6 THE>o``
Conservation 1 7
Board of Health(3rd f or): _ MUST CONNECT TO TOWN SEWER 2 sesasr�ncc
Sewage Permit number
�o rua
Engineering Department(3rd floor): o s630. \�d°
House number �o rw►•
Definitive Plan Approved by Planning Board 19
APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2.00 P.M.only
TOWN OF BARNSTABLE
BUILDING I INSPECTOR
APPLICATION FOR PERMIT TO
TYPE OF CONSTRUCTION _A41-49
e / 19J
TO THE INSPECTOR OF BUILDINGS: �—
The undersigned hereby applies for a permit according to the foil win information:
Location 1 3 I I J
Proposed Use
Zoning District Fire District
Name of Owner Address ,
Name of Builder 24a Address
Name of Architect Address Number of Rooms c 29 1 �ll Foundation c/�
rk41W-1*
g s .
Exterior T'��� /� ��'/ Roofing
Floors C' InteriorGi'� ✓
Heating Plumbing
�✓ < aps
Fireplace Approximate Cost f,-
Area Cy��
Diagram of Lot and Building with Dimensions Feemi—
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction.
Name - .P
F
Construction Supervisor's License
k
DEPATHY, HENRY L.
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i
No 34947 Permit For REMODEL
—Single Family Dwelling
Location Baxter Road
e Hyannis
E° Owner r Henry L. Depathy
r Type.of Construction Frame '
Plot Lot i
Permit Granted April 7 , 19 92
��
Date of Inspection � 19
Date Com feted Z� 19
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