HomeMy WebLinkAbout0112 CANTERBURY CIRCLE ll� C'ANr�eBuzy G�r�
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel ��9 Application # O?dlso /C200/
Health Division Date Issued
Conservation Division Application Feed
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project St re t AddressZ. c4olyorf /-IV
V
Village1 �
Owner i L �� Address
Telephone �0 — o®
/� 0.1 9�
Permit Request u'
V it IF
v ra e
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain �,/Groundwater Overlay
Project Valuation �U�• Construction Type &I W
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family 2( 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)
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 woor84,coal stove:;❑Yes ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: 0 e�cisting Q_new b size_
Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: i
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes O,Pao If yes, site plan review #
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name �6 Telephone Number
Address License #
�W&o kHome Improvement Contractor# r�D
Worker's Compensation # [fiCAA-0ib ZL?
ALL CONSTRUCTION DEBRIS RESULT G FROM THIS PROJECT WILL TAKEN TO
SIGNATURE DATE ,L
FOR OFFICIAL USE ONLY
a APPLICATION#
DATE ISSUED
t
MAP/PARCEL NO.
Y
' ADDRESS VILLAGE
c
s
OWNER
A f
V
DATE OF INSPECTION:
FRAME
t FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
`r
FINAL BUILDING
7`
DATE CLOSED OUT
ASSOCIATION PLAN NO.
t ,
RISE
ENGINEERING
5 Dupont Avenue
Yarmouth, MA 02664
OWNER AUTHORIZATION FORM
(Owner's Name)
owner of the property located at
(Property Address)
�60
(Property Address)
hereby authorize Cox
d
,
(Subcontra r)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
Owner' gnature
Date
Massachusetts - D6partment.of Public Safety
,.:Board of Building Regulations and 5tandarcls
Construction Seiperviscir
License: CS-100988' _
HENRY E CASSIIJ'Y
8 SHED ROW r�
WEST YARMOLFrH 0
Expiration
Commissioner 11/11/2015
a Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Co`nitractor Registration
Registration: 153567
Type: Private Corporation
Expiration: 12/15/2016 TrN 259188
CAPE COD INSULATION,.INC
HENRY CASSIDY --- - -
18 REARDON CIRCLE -- -- -
SO. YARMOUTH, MA 02664
d. Update Address and return card, Mark reason for change,
:CA1 45 20M•05711 Address Renewal Employment Lost Card
. .-de ar�y�zarzcuer��C✓n�C�/�/l%wdac�uueG�i
\ Office of Consumer Affairs& Business Regulation License or registration valid forindividul use only
i OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to:
egistratlon: 1.53567 Type: Office of Consumer Affairs and Business Regulation
xplratlon;,;;.12115¢201,6 Privale Corporation 10 Park Plaza -Suite 5170
:= w, Boston,MA 02116
3APE COD INSULATI;Q:N;;INC'.<':`.`.
HENRY CASSIDY
18 REARDON CIRCLE':•:'' `. � �
50, YARMOUTH.MA 02684 Undersecretar ——
Y T,vallid tit sign e
The Commonwealth of Massachusetts
Department of IndustrialAccidents
W Office of Investigations
a
d 1 Congress Street, Suite 100
Boston, MA 02114-2017
y`y
www,mass,gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A licant Information / Please Print Le ibl
Name (Business/Or7EV
' n/Individual);
tt _
Address; d0 UVt, V �I
City/State/Zip; ��,Gt� `` n Phone #;
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 I
employees (full and/or part-time),* have hired the sub-contractors 6. ❑ New construction j
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
working for me in any capacity, employees and have workers'
o workers' comp, comp, insurance,t 9, ❑ Building addition
[N p, insurance p�
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 1 1.❑ Plumbing repairs or additions
myself, (No workers' comp, right of exemption per MGL
l2.[] 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#1must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this'ifffidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities leave
employees. If the sub-contractors have employees,they must provide 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: &.�(, 4jamK,�L
Policy# or Self-ins, Lic,
Expiation Da*er
Job Site Address: City/State/Zip: ,Attach a copy of the workers' compensatio policy declaration page(showing the policy nexpiration date),
Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of crimuial 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 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 insurance coverage verification.
I do hereby cerllfy n r pains and penalties of perjury that the Informatlon pro videedd,r ova ds tree and correct.
Si nature: Date: "'✓
, Phone#:
Offlclal 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 1 City/Town Clerk 4, Electrical Inspector• 5. Plumbing Inspector
6, Other
Contact Person: Phone#:
f/ CAPECOD-27 KLIGETT
-�� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
611312014
THIS CERTIFICATE 15 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 pollcy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT
Rogers&Gray Insurance Agency, Inc. PHONE Barbara DeLawrence
434 Rte 134 c o FA C No; (877) 816-2156 _
South Dennis,MA 02660 A DRESS:bdelawrence@rogersgray.com
1 INSURERS AFFORDING COVERAGE NAIC k__
---If---- INSURER A:Peerless Insurance Company
INSURED
INSURERB:COMMERC8 INSURANCE COMPANY _
Cape Cod Insulation Inc INSURER c:Evanston Insurance Company
18 Reardon Circle INSURER D;ATLANTIC CHARTER INSURANCE GROUP
South Yarmouth,MA 02664
INSURER EIk : -- --I
INSURER F: 1
CO ERAGES CERTIFICATE NUMBER: REVISION NUMBER:
T IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
IN ICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
C RTIFICATE 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 SR
LTR TYPE OF INSURANCE INSD POLICY NUMBER MMIDD YY —POLICY
EXP YY LIMITS
A X COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE a OCCUR CBP8263063 EACH OCCURRENCE $ 1,000,000
04/01I2014 04/0112015 PREMISES(Ea occurrence) $ 100,000
MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
X POLICY❑ PRO- a GENERAL AGGREGATE $ 2,000,000
I JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: -----
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $
B Eaaccidenl $ _ 1,000,000
ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person) $
ALL OWNED X SCHEDULED _
AUTOS AUTOS BODILY INJURY(Per accident) $
X HIRED AUTOS X NON-OWNED
AUTOS PROPERTY DAMAGE $
Per accident
X UMBRELLA LIAR X OCCUR
C EXCESS LIAR CLAIMS-MADE XONJ453514 EACH OCCURRENCE $ 1,000,000
04/01/2014 04/01/2015 AGGREGATE $
DED X RETENTION ��,�0� Aggregate $ 1,000,000
ORKERS COMPENSATION PER OTH•ND EMPLOYERS'LIABILITY _
D NY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCA00525904 06/30/2014 06/30/2015 STATUTE ER
FFICER/MEMBER EXCLUDED? a NIA E.L.EACH ACCIDENT $ 1,000,000
Mandatory In NH) _
f gs,describe under E.L.DISEASE•EA EMPLOYEE $ 1,000,000
CRIPTION OF OPERATIONS below
E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
Workers Compensation Includes Officers or Proprietors.
Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificato Holder.
CER IFICATE HOLDER _._ CANCELLATION
n1
' Town of BarnstablePermit:
�FIHE Tpy, Regulatory Services ate:
v ti
Thomas F.Geiler,Director _
* BARNSTABLE, ► ee6 Q�
MASS. Building Division
� i639• ��� Tom Perry, Building Commissioner U �
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
TOWN OF BARNSTABLE
SOLID FUEL STOVE PERMIT
Owner: Phone:
Install at: //Zrepf ���Ui" �K/
Village:
Map/Parcel: Date:
Stove
A. Ne Use
B. Type: CR:adiant
C. Manufacturer: ��-�4,Z Z jam_Lab. No.
D. Model No.:
Chimney
A. New/ xisting If existing,please note date of last cleaning)
B. Flue Size
C. Are other appliances attached to Flue? M
D Pre-fab Type and Manufacturer
E. Masonry: Lined/Unlined
Hearth
A:.Materials:
B. Sub Floor Construction:
Installer
11
Name: t'S/i//� /�C1 Address: Z GI;;7
Phone: S!O T 7S 6-e—K/
Location of Installation:
APPROVED BY: f D 67
Please make checks payable to the Town of Barnstable
*This constitutes an official stove permit after inspection,photographed, and approved by the
Building Inspector
Q:forms:stove
Rev 122801
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Asp map and lot 'number ... ."!.¢..0--`... .. .q C 7`'77
} SEPTIC SYSTEM MUST'BE
`' oSe.' a e Permit number ....:... ........ INSTALLED IN COMPLIANCE
r' g a ,ti...... 6 WITH ARTICLE IL STATE
f I SANITARY: CODE¢AND-TQWN
TO1WN: OF BARN1O •LE
Z E STATIC;, i A cr,
M 4'
y AS 'ca
p�}639 BUILDING: ' INSPECTOR
'E?p,ypY M1. x
APPLICATION' FOR PERMIT TO l. �r 'ct2
r: Ts r`-
r+ TYPE OF CONSTRUCTION ....... I? t���.................................................................. ..... ......................
r ...... � !�'�'�..2 7..................19..7 7
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according, to the following information: .
Location ......��. ..... ...........:414.6 ' :..... ..............................................................
ProposedUse ...................................................:................................................................................:.........................................
Zoning District ....1. .i. ..:......................................................Fire District
Name of .Owner ...�V.—ar.,�..... -C /....: ............Address �� D l�• c!lUot:.... ..... ./.. .................
Name of Builder .f r
....................-�' /................. Address ......:�.P.}�?.�'-.....................................:........................
Name of Architect /� Address ::....................Q,lsC�!(-�.�.f..............................................
....................Foundation ��r!Cf".� ...........
Number of Rooms ...:�� ............................ ........... ......................................
J
Exterior .....CE'.Gfeix...
...�`? y.&5..................................Roofing ...... •.5.f�.l?.'1. ........................................................
Floors ..... .liOAO.A...."-...C.K!p.e ..Interior ......tlVR.�o�/!4. r:�
................................ .............................................. ....
Heating ..... 1.1R. ...................................Plumbing .....wZ.... 4i' .. .......................................................
Fireplace ....Qrie.....................................................................Approximate Cost .....3. V 0..6�.�¢..........................................
Definitive Plan Approved by Planning Board -------------------_-----------19________. Area ....�l..g :�9....L.4......
Diagram of Lot and Building with Dimensions Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH
16
I hereby agree-to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction. �r
Name ......Lr. ,0- ..........Ileeel....*
......................
Lacey, Walter J.
19877 one story
................. Permit for ....................................
single family dwelling
.............................................................................
Location ..........112...Canterbury Circle............... ...... ... ........ .. ...... ......
Hyannis
...............................................................................
Owner .............Walter..J.. ....La.cey......................... . ...... .. . .... ......
Type of Construction ..................frame................
Plot ............................ Lot .............24...............
—Permit Granted ".....January 5 .19'--78
Date of Inspection ........... .......19
Date Completdcl ... ..... ..................19
PERMIT REFUSED
................................................................. 19
...................................................................
.......................................
.......................... .....................................................
........... .. ..... ........................................................
'-o
App 'd-,'�pve ............................................ 19
...............................................................................
...............................................................................
Ass"sor's map and lot number ... (A...' ..�. ....1 � 0
-.... . ; �/�. �/�� G'- 7 77
C7 1)' l
eaage Permit number .................(J.d.................................
TOWN OF BARNSTABLE
y0 f 7N E t0�
ss •
j BARNSTABLE. i
"6
am BUILDING INSPECTOR
� AY Or•
t. AP.PLICATION FOR PERMIT TO ..... .... ... . .. ...... . ..............................................................
TYPE OF CONSTRUCTION ...... h.rz.'I'n A� ...........................................
..........................................................................
........ ...�7.................19..77
TO THE INSPECTOR OF BUILDINGS:
The undersigned hereby applies for a permit according to the following information:
Location ............. Q..::.. .............:....................................................................................
ProposedUse ......................................................................................................................'......................................................
{
Zoning District .....I -1..........................................................Fire District ...............................::�............................................
1�l" .
Name of Owner ....... !?.................... / Address SO,�, r;�; :............7 ;l�..
� , �- / 5
Name of Builder .............:.............. ................. ..................Address
.
Name of Architect ...�{.W.,q ................Address ....................................................................................
................................
Number of Rooms ......................Foundation ..... on. �w.p�.e
...r'... ....... ..... ....................................................
Exterior .Ali Y G, IP S A,;ol, /�
................... h.� ..............I....................... Roofng ..r........ . ............. .......................................................
i� / — � t�_T l�RII!�AYJFloors ........ ...... ; .......................................................
Heating ..... '...:.s iv"I'v Plumbing ;2 ..s
3y s � .
Fireplace (t o Approximate Cost ..... 0Go
......,........................................................
Definitive Plan Approved by Planning Board ________________________________19________. Area .... ......
Diagram of Lot and Building with Dimensions Fee � .�
.............................................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
I
I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above
construction.
Name ...................:..��f �
t........................................................
U /
Lacey, Walter J. Ap249-129
2.0/7 permit for ....,one story
............ ........................
single family dwelling
...............................................................................
Location 112 Canterbur.. Circle
.................. .........................
................�Y.annis.........................................
Owner Walter . ..
J. Laey.......................
........................ .... .....c
Type of Construction frame
..........................................
...............................................................................
Plot ............................ Lot .. 24.......................
January 5 78
Permit Granted .......................................19
Date of Inspection ....................................19
Date Completed ......................................19
PERMIT REFUSED
................. ........... ............ ......... 19
................ � ...! V .................
..................................................:.............................
.........................
...............................................................................
Approved ................................................ 19
...............................................................................
...............................................................................