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HomeMy WebLinkAbout0034 FRANBILL ROAD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel D'73 Application# c � 41T Health Division Conservation Division Permit# Tax Collector Date Issued Ila Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board f Historic-OKH Preservation/Hyannis PF___ Project Street Address 2) fNr-\ Village 62(vQl J Owner I)QA1 e. G`(_n.ARA Address r-,VA Telephone ,��� ` �' 00 Permit Request ) @w Gqt 1 lIC66 _"Rwon n uW 6 W S�G,,a� umq 4W nu-i \1" - sfzrM6 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay i Project Valuation 60 O Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting•documentation. C Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway:c.❑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 U 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 BUILDER INFORMATION Names --3q -'�2, ��'X.�LC.�s �7j� •• Telephone Number 7 Address \� k License Home Improvement Contractor# /f-3�Lb Worker's Compensation# &rC ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �} FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED i MAP/PARCEL NO. ADDRESS r VILLAG'E OWNER DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE --_ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 6 -s r �\ r•-� Vv••-..-v•-I�v.w-•- V AIrwYYrAv-rw•✓W�Y• • • Department'of hidasfriai Accidents r Office of Investigations, 600 Washington Street Boston,ham! 02111 : www.mas&gov/din ®Yorkers' Compensation Insurance Affidavit:Bu:Uders/Contractors/Electriclans/Plumbaers AplDlicant Information Please Print Leeibly Name (Business/Orp=ationdn&vidual)• Address• ~7-D Vr� iA,ls, a 07 City/State/Zip: c/A4 VA�� 'M&A( Phone#• �'Ok-�3q/'_-22'4-7 Are you an employer? Check the-appropriate box:. , = Type of project(required):- �am a lover with /I 4. ❑.I am a general contractor and I ' 1. crap 6. ❑Naw construction employees (full'and/or part-time).* have hired the sub-contractors 2.[] I am a sole proprietor or partner= r listed on the attsched sheet 1 7. [T Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition o workers' comp.insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or.additions required.f officers have exercised their 3.❑ tam a homeowner dom-g all work ° right of exemption per MGL 11.❑ Phmibmg repairs•or additions myself;[No workers' comp c, 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees.[No workers1' 13.❑ Other ' comp.insurance required.] ► *Any applicant that checks box#1 must also 511 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 :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy imforrnation. I am an employer that is providing workers compensation insurance for my employees.'Below is the policy and job site information. Insurance.Company Name: �rvL�'�L!tG4-tea ' { vL Policy#or Self-ins.Lic.#: Expiration Date: " y^ 7 Job Site Address It- �d City/State/Zip: V4,'"r, Attach a copy of the workers' compensation policy declaration page(showing the policy number andexpiration date). Failure to.secure coverage as required under Section 25A of MGL c. 152 cari lead to the imposition of criminal penalties of a fine u' to$.1,500,.00 and/or one-year imprisonment, as well as.civil penalties in le form of a 8TOP•WORK ORDER and a fine of u to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ' andpendddes of perjury that the information provided above is true and correct - i:• tore: Date:' ����""'®•� • f Phone#: �Q�i���- �Z�`� • , , Official use only. Do not.write in this area,to be completed by city.or town official, City or Town; Permit/License# Issuing Authority(circle one); : 1.Board of Health L•Building Department 3.City/Town Clerk 4.,Electrical Inspector 5.Plumbing Inspector 6,Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 tequires all employers to provide workers' compensation for their employees. ' Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." - « , association,Farporation or other legal entity,or any two or more An employ artner$bjp.; r er is defined aS::a�indivi��,:P . of the foregoing engaged in a joint enterprise, and inci6nj the legal representatives of a deceased employer,or the ' an individual,partnership, association or other legal entity,employing employees. However•; receiver or trustee of 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 woi•Yon such dwelling house the grounds or appurtenant thereto shall not because of such employment be deemed to bean employer. on " or gr 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." ter 152, 25 C 7 states"Neither the commonwealth nor any of its-political subdivisions shall Additionally,MGL chap .. § ( ) enter into any contract for the perfor nape of public work.untl.acceptable.'evidence of compliance with the insurance 1egmements 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 snb-contractor(s)name(s), address(es)and phone mimber(s)along with their certificate(s) of C or Limited Liability Partnerships with no employees other than the insurance. Limited Liability Companies(LL ) YP ) 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 raturued to the dty or town that the application for the permit or license is being requested, not the Depar6neat of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensationpolicy,please call the Department at the number listed below.. S'e1f-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 perrnit(license number which will be used as a reference number. In addition, an applicant that must submit multiple p ermitlicens a applications in any given year,need only submit one affidavit indicating current policy infoanation(if necessary)and under"Job Site Address"'tlie applicant should write"all locations in (city or "A co of the•�affidavit that has been officially stamped or marked by the city or town may be provided to the town)• PY applicant as proof that a valid affidavit is on file for;future permits•or lioeaases..Anew 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 burn leaves etc.)said person is NOT required to complete this affidavit like to thank you in advance for your cogperation and should you have any questions, The Office of Investigations would please do not hesitate t0 give us a call. The Department's address,telephone and.fax number: The Commonwealth of Massachusetts . .. ' Department of Industrial.Accidents .. office 9f Invest11ga#0ns 600•Vdashingfon:Street, . Boston,MA 02111. Tel.#617-727-4900 ext 406 or-1-877-MASSAFE . Fax#617-727MO Revised 5-26-05 www.mass.gov/dia J ' Town of Barnstable Regulatory Services Thomas F.Geller;Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us 508-862-4038 Fax: 508-790-'6230 Permit no. Data . AFFIDAVIT HOME IlVIPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c.142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or constructign of an addition to any pre-existing owner-occupied building containing at least one but notmore th=four dwelling units or to structures which are_adjacent to such residence or building be done by registered contractors,with certain exceptions,along with othei requirements. '�'ype•of Work: �? 11 ` "') O Estimated Cost ' Address of Work: Owner's Name: Date ofApplication: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law []lob Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITKUNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMTROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Cofactor Nam gistration No. OR Date Owner's Name RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE _ New Buildings $100.0.0 Residential Addition $50.00 Alterationsamovations $50.00 Ch=p of Contractor/Builder $25.0.0 FEE VALUE WORKSBEET -NEW LIMG SPACE R square feet x$961sq.foot= x.0041= plus frombelow(if applicable) ALTERATIONSMINOVATIONS OF EMSTING SPACE square feet x$64/sq,foot x,0041= 6 plus frombelow(if applicable). GARAGES'(attached&detached) square feet $321sq,ft. x.0041= ACCESSORY STRUCTURE>120 sq.ft.. >120 sf-500 sf $35.00 r >500 sf-750 sf 50.00 . >750 sf-1000 sf 75.00 >1000 sf- 1500 of 100.00 >1500 sf-Same as newbuilding permit —_square feetx$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) Ingronnd Swimming Pool $60.00 • ti Above Ground Swimming Pool $25.00 Relocation/Moving $150,00 (plus above if applicable) Permit Fee Town ®frnstable Regulatory Services r . Thomas F.Geiler,Director z6 aon � ���� wilding Divis �fD HRA� Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us _ Fax: 508-790-6230 office: 508-862-403$ property ®'caner Must Complete and Sign This Section If Using A Builder as Owner of the subject property to act•on my beh hereby authorize alf in all mafEers relative to work authorized by this building permit application for: lP .® d�s d2a 7 (Address of Job) Signatare of Owner Date 45 �64,eA Print Name Q:FORMS:OWt�'RPERMiSSION q T ­V t. �z "7' r r4 Pis nftQ 4"k $ i-\At j Prc VI-4, "25) "tt, 17- % 2- rift ON-AVOM SOUTH YAMOU*AIA 02MW DATE(MM/DD/YYYY) TM. CERTIFICATE OF LIABILITY INSURANCE 104/122006 PRODUCER Phone: (781)986.4400 Fax: 781-9634420 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION GATELY MORGAN&GILFOYLE INS.,AGCY.,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE RISK STRATEGIES COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 400 NORTH MAPN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. RANDOLPH MA 02368 INSURERS AFFORDING COVERAGE NAIC# I INSURED 1INSURER A: American Home Assurance THERMCO INC. INSURER B: i 7 D HUNTINGTON AVENUE INSURER C: I SOUTH YARMOUTH MA 02664 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 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR'ADD'4 TYPE OF INSURANCE POLICY NUMBER 1 POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSRO I DATE MM/DD/YY DATE MM/DDlYY) iGENERAL LIABILITY 1 EACH OCCURRENCE js COMMERCIAL GENERAL LIABILITY I I !DAMAGE TO RENTED I g - PREMISES(Ea occurence) CLAIMS MADE OCCUR I I MED.EXP(Any one person) is PERSONAL&ADV INJURY is GENERAL AGGREGATE Is . j GEN'L AGGREGATE LIMIT APPLIES PER: — --- PRO- IPRODUCTS-COMP/OP AGG. is I POLICY E JECT I LOCI 1 ' j I AUTOMOBILE LIABILITY I I I I COMBINED SINGLE LIMIT j ANY AUTO I (Ea accident) i$ -� ALL OWNED AUTOS BODILY INJURY ;(Per person) is SCHEDULED AUTOS j HIRED AUTOS j BODILY INJURY NON-OWNED AUTOS (Per accident) g I PROPERTY DAMAGE g (Per accident) I i GARAGE LIABILITY I I AUTO ONLY-EA ACCIDENT I$ ANY AUTO OTHER THAN EA ACC $ _ j I AUTO ONLY: AGG I S EXCESS/UMBRELLA LIABILITY I EACH OCCURRENCE I s I OCCUR CLAIMS MADE 1 AGGREGATE Is is DEDUCTIBLE RETENTION s I I Is - WORKERS C58966 .02/04106 62/04/07 N/C STATU OMPENSATION AND WC89 TORY LIMITS I I OTHER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT IS 500,000 A ANY PROPRIETORlPARTNER/EXECUTIVE I _ OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE Is 500,000 11 yes,describe under -- SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT IS 500,000 JOTHER: I I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS ISSUED AS EVIDENCE OF INSURANCE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE J. 94G/ately, Jr., President ACORD 25(2001/08) Certificate# 11906 ©ACORD CORPORATION 1988 I Board of Bu�inggula ons and tandar s _ One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 103926 Type: Private Corporation Expiration: 7/10/2008 THERMCO, INC. _ WILLIAM MCCLUSKEY 7D Huntington Ave. ----S. Yarmouth, MA 02664 -- — ---------- - Update Address and return card.Mark reason for change. Address Renewal L Employment Lost Card 0 50M-04/05-PC8698 ��C -V/071L�ISQ�IZLUCCGGCIG 6�/!/GCLdJClC/2(I,6CC�1 Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT.CONTRACTOR before the expiration date. If found return to: Registration: 103926 Board of Building Regulations and Standards Expiration: 7/10/2008 One Ashburton Place Rm 1301 — Boston,Ma.02108 Type: Private`Co rpo ration FHERMCO, INC. NILLIAM MCCLUSKEY j 7D Huntington Ave. S. Yarmouth, MA 02664 Deputy Administrator Not valid Without signat x - - ME '( ��fLCL 4)7Ljl2dI1U/CCZCt� G ✓!/GQ�3CZC/tCCdP.�6 ! ;��, BOARD OF BUILDING REGULATIONS' }; License: CONSTRUCTION SUPERVISOR ` Number: CS 000671 Birthdate: 03/09/1955 Expires:03/09/2008 Tr.no: 17920 Restricted: 00 THOMAS E DOWNEY r.. 17 SPARROW WAY S YARMOUTH, MA 02664 — Commissioner t FROM :THERMCO FAX NO. :5083987866 Sep. 29 2006 08:OOAM P2 THER MCO HOME IIVMPROVE E'. -z T' 2t� 7-D Huntington Avenue South Yarmouth, MA 02664 (508) 398-7277 FAX (508) 398-7866 Sally Shea Town.of Barnstable Regulatory Services Building Division September 29,2006 Ms. Shea: Mr. Thomas E.Downey is the head man in our remodeling division and has authority to act as an agent for Thermco in any and all matters. Sincerer I.J.McCluskey(President Thermco Inc.)