Loading...
HomeMy WebLinkAbout0062 HAMDEN CIRCLE �I Town of Barnstable *Permit# ��/a6 s Expires 6 months from issue date Regulatory Services Fees. * XPRESS 16;9. �0$ Thomas F.Geiler;Director PEIT iOjEb Mld" Building Division Tom Perry,CBO, Building Commissioner MAY 2 -2012 200 Main Street,Hyannis,MA 02601 666 www.town.barnstable.ma.us �o�N ®F RReem� Office: 508-862-4038 FdX' EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number, Property Address Gr-cJe- [94esidential Value of Work /Z; 000 00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address re-Y, Contractor's Name Telephone Number 1,47 3 Z/ Home Improvement Contractor License#(if applicable) 11137 2 Construction Supervisor's License#(if applicable) 9 3-7 1 lP 19 Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner, v[]",have Worker's Compensation Insurance Insurance Company Name. 1 er Workman's Comp.Policy# (N C C 50V Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 1:9Re7roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to *M60A VY�Iukr ❑Re-roof(hurricane nailed)(not stripping. Going overr existing layers of roof) [ 'Re-side #of doors [Replacement Windows/doors/sliders:U-Value • 84 (maximum.35)#of windows /Z *where required:Issuance of this.permit does not exempt compliance with other town department regulations,i:e.Historic,Conservation,etc. . ***Note: Property Owner must ign Property Owner Letter of Permission. A copy of the Hom mprovement Contractors License&Construction Supervisors License is quired. SIGNATUtE: C:\Users\decollik\AppDataU.ocal\Micr so$\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc - Revised 072110 r •b snatvsr . 639. Town of Barnstable Regulatory Services. Thomas F.Geiler,Director , Building.Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us. Office: 508-862-4038 1 Fax:. 508-790-6230 { Property Owner Must Complete and Sign This Section If Using A Builder. I, Afi-&K Eye S q t;, ,as Owner of the subject property hereby authorize Con to act on my behalf, in all matters relative to work authorized by this building permit application for: `. (Address of Job) gnature of r Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. E ,. 3dS5tvti,,, E�dR�` C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 h The Commonwealth ofMessachusetts Department of Industrial Accidents Office of Invesfigations 600 Washington Street Boston,MA 02111 www.mass goy/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciandPlumbers APPlicant Information Please Print Legibly Name(Business/Organizadon/Individual): Address: City/State/Zip: A(lenh 1'2S k d 4hone M —Z�Z�.337 A an employer?Check the appropriate box: Type of project(required): 1: I am a employer with Z .4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole propridtor or partner- listed on the attached sheet t 7. ❑Remodeling ship and have no employees These sub-contractors have 8: ❑Demolition working for me in any capacity. workers'comp.insurance. g• ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required] officers have exercised their 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myselt [No workers'comp. a 152,11(4),*and we have no 12.0 Roof repairs �—� insurance required.]t employees.[No wodm& comp.insurance required.] R - ::=j 13.0other *My applicant drat checks box d I must also na out the sxtion below showing dick vroiloecs'Mapensatiou policy inlanadon. t H=Wvvn=s who submit this affidavit indicating they am doing aff work and then hire outside coahactocs must submit a new affidavit Mmtmg suck. =Contractor that check this box must attached an additional sheet showing the name of the�sad their woriccre comp.policy m6orma61M. I am an employer that is providing workers'compensation lnarcrancefor my employees Below!s the policy and job site Fn,formalioR. / ' Insurance Company Name:_ fi , Policy#or Self-ins.Lic.#:L_WC_C_G /)q I Q I 7_Q J gxphation Date: Z /� �'W/L5 Job Site Addr'ess:1/ / Ce.I1�"�'( t`C�L CitylState/Zip: Attach a copy of-the.workers'compensation policy declaration page(showing the policy num er 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$1,500.00 and/or one-year imprisonment;as well as civil penalties,in the form of a STOP WORK ORDER and a fine of up to S250.00 a day againstAm violator. Be advised tat h a copy of this statement may be forwarded in the Office of Investigations of.the DIA for insurance coverage verification. I do lcereby er a penalties of pedury that the rnfamo ion provided above is true and correct .Si fur Date: 12 Phone 2 0TWIal use only. Do not write in this area,to be completed by city or town official City or Town: Permit/Ucense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4 Electrical Inspector 5.Plumbing Inspector 6.Othec Contact:Persons Phone#: 7mil -I�i!= t _ -} - Dll�leC a COmumer airs ��`sI�CSS K[gtitflbOU '. HOME MPROVEMENf CONTRACTOR }*csr.se: c S 93716 ; ': Ran: 163732 Type:. Restricted � : 00 EgArMow 7/17/2013 -Private Corps: RYAN CAMPBELL RA CAmpBEItaE rERPRI$ES INC. 126 BAYRIDGE:DR RYAN CAMPBEII' S DENNIS, MA 02660 , _ 126 BAYRIDGE DR Qom_ o ' SOUTH DEWS,MA:02660 Ullderstcrttiky:_ 21073' License or regis"tiOu valid for individat use only beforethe expiration date..jfifouud return to: , office of Consumer Affairs and Busine�gtron 14 YarkYlaza-Suite 5170 _ --Bose MA D2116 - e of V w rth gign8tnre I r .i r _ PERSOI`IAL f M.Bank€` 4k M EY ORDER x` ' - ly t ® r a t - •r - r r '' -t �i v,;x 7 /5 11293 l I r TO, 9,; JIli ,�S 4jf /l0 A✓•'. ; PAV TO THE 1 tk ORDER Of /?Ir2 0 )Er } L4f"iC�tt �\t b t ✓ i rvilDb y { i kI�O{N`r GOTIABLE I NOT TO�EXCEED $1,000 00 w 4 N E M, i J a r !r :i t" t 5 ;y .»f r ? °/� v P.URCHASER S SIGNATURE �: OZ. �r�+rSTAMER,aG - A {PURCHASER S ADDRESS , i RACAM-1 OP ID: MD DATE(MM/DDNYYY). �.� CERTIFICATE OF LIABILITY INSURANCE . 05/02/12 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(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 SOH2SS$000 NAME:CONTACT - - - - Kerry Insurance Agency, Inc. FAXScott Kerry 508-240-1860 PHONE A/c No,Ext: (A!C No): PO Box 1945 E-MAIL North Eastham, MA 02651 ADDRESS: W. Scott Kerry - INSURER(S)AFFORDING COVERAGE NAIC 3 INSURER A:Associated Employers Insurance INSURED R.A. Campbell Enterprises Inc. _ - INSURERB: Ryan A. Campbell INSURER C: 126 Bayridge Drive South Dennis, MA 02660 INSURERD`. INSURER E: _ INSURER F: - COVERAGES CERTIFICATE NUMBER: 'REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEAUULISUBR POLICY EFF POLICY EXP LTR INSR - POLICY NUMBER MM/00fr Y MM/DD/YYYY LIMITS GENERAL LIABILITY - - - EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY D7�MATci R ENTEIT PREMISES Ea occurrence $ _ a - CLAIMS-MADE El OCCUR MED EXP(An one person)-,,. $ PERSONAL44ADVINJURYI $ GENERREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCES-�OMP/OP AGG- $ PRO- POLICY $ ' JECT LOC .._+ I : AUTOMOBILE LIABILITY - ECOM aBI tlet3SINGLE LIMIT ANYAUTO - BODILY INJURW(Perperson):;Ij `. ALL OWNED SCHEDULED BODILY INJUR, Per accident AUTOS AUTOS ( J $ NON-OWNED PROPERTYD 'AGE c 3 HIREDAUTOS AUTOS - - - Peraccident - $ UMBRELLA LAB OCCUR - EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENT ION$ - $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N - TO ITS I I ER - - A ANY PROPRIETOR/PARTNER/EXECUTIVE 5009706012012 01/11/12 01/11/13 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? El N�A (Mandatory in NH) - _ - E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under - DESCRIPTION OFOPERAT IONS below E.L.DISEASE-POLICY LIMIT $ - 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS:/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) - Residential Carpentry Ryan A. Campbell elects coverage under this workers compensatin policy.. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of:Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. . Building Department 200 Main St AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 W.Scott Kerry ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are.registered marks of ACORD Assessors map and lot 'number Sewage Permit number ......................................................:... �10i?HErO�y. TOWN . OF BARNSTABLE S � i 89HB9TADLE, i 9� o pYae�� BUILDING , INSPECTOR ' r.. r t, APPLICATIONFOR PERMIT TO .................. .........`...........;;.. ,/,,.......................................................................... TYPE OF CONSTRUCTION ..........:f,' ./4- A,� 1=� ..kr ! )�...... .'.....�..:�� _ ` ...... E' .............. f .19. !. . .� r� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: / Location /��r % �/ A/ f-� /1% /) � /1�....../- / /-1? / f r- %fi v/ ►/A!+ '. Proposed Use .........................................` ? . '1=f'., .....: �..................................................................................I......I................... . .... Xo AZoning District ......: ..............................................................Fire District }!. ............................................................ Name of Owner ., ..� . /�; t. ... !- n %/1 !n�± 4 ,.r Address-' t� <r`.................:. �'' rF ✓a �` Name of Builder . ^� ? .... / ��!..lu>!i/3.-,i fiAddress .. ............................... Nameof Architect ...........-::-- '::.....................................Address .................................................................................... Number of ,Rooms . . f. ...........Foundation ..... �a 'ci i' 6Z.' T ........!:M--t-''��..:..... .1,/ ..... .. .�i� . G .r-• ..7 �, .. .::.!!�I•..Roofing ....... n rL 7s? P . r ��.r �rn... Exterior �......... ' Interior % '� �- Floors ......... . .. 'f'?: �:' ......... `t.................................... ........_...................... ,..................................... Heating f f+- -I-e-1` ► c r.... C� r^... .:..Plumbing ........... /J i�� :�................................................I.......... ..... ... Fireplace . ' ! , ...................Approximate Cost ............................................. ........`..... Definitive Plan Approved by Planning Board -------------------_-----------19________- Area ,'r//�.-� 1......... Diagram of Lot and Building with Dimensions ` 1 g 9 Fee .................�,.*.... .. SUBJECT TO APPROVAL OF BOARD OF HEALTH !3 + f 30 IN , n I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �. Name ............................................. Cedar Acres KXX Realty- Tr. A=291-182'/291-182 No ..... Permit for ............ sanle family dwelling .......... ....... .... Location ........62. Hamden Circle....... ............................. . .......... ............Hyannis........................................ Owner ..........Cedar...Acr s Realty Trust 11 .- ... . ...... ...... Type of Construction ......frame............................ . ..................................................................................... '000) Plot ............................ Lot ... ....9 ........................ ..........(June 19 78 Permit Granted ........................................19 Date of Inspection ...... .11..........................19 Date Completed ..........................:...........19 PERMIT .REFUSED ............................................................... 19 ................ .... 1........ .. .. .. ............ ................. .............. ............ ..................... . ........................... ................................................ ................................... Approved ................................................. 19 ............................................................................... ................... ........................................................... I , TOWN OF BARNSTABLE 20321 �� •ew Permit No. ------------------------------ Building Inspector 1 '6.anrAU Cash nn� Zp OCCUPANCY PERMIT Bond --------------------_---- "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Cedar Acres Realty Trubt Address Great Pond Drive, S.Yarmouth, MA lot #79 62 Hamden Circle, Hyannis Wiring Inspector R e Inspection date Plumbing Inspector , - Inspection date Gas Inspector Inspection date ✓Engineering Department J,ri "f * �� Inspection date A) THIS PERMIT WILL NOT BE VALID,_AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ` 1 ©�/�1 19.4� 1. t . r -G�t' d .......... ......f. ................., ..7 ........ Building Inspector............................_ r Assessor's ,map''and 'lot number ...........:.... « i:.�� - ,T 4 SEPTIC SYSTEM MUST BE INSTALLED IN COMPLIANCE Sewage Permit number ....................:...................... ........... WITH ARTICLE }} STATE "� " � � `� ;- � SANITARY CODE AND TOWN -yo�TKEro�. 1-7 , TOWN " OF BARNS Thr1 �Q - 1 86HB�ST 11L a. BUILDING/ INSPECTOR 0 pY APPLICATION FOR`PERMIT TO i G..P.� `.... .........:................:.................:..................... ..,. r w v TYPE OF -CONSTRUCTION?�....:,........ ......J0a f� -TO-THE-INSPECTOR OF-BUILDINGS:, The undersigned hereby applies for a permit according to the following information: Location .........../�. ...... .. ........... r� ..� �•G`rl ...... .�.:f ... .....� .�� ,�� �n J ProposedUse ........... .�,ldlJ . .. . ........... ................................................................................................. ZoningDistrict ...... .. .......................................................Fire District , ........................................................... Name of Owner i' -��:. C�L.Q�. Addv'ess'�:...........` .... .. Name of Builder ...... %?.�-�•.C1....Y .� . .2e_ 'P.:.cldress ...: �1� .............................. Nameof Architect ...........: `.................................Address .................................................................................... s Number of Rooms .... J .... ./V. . ' �:.TG ..... r .. .............Foundation ..... Exterior ...... rRoofing ....... .. . /1�� �^""f""'.... Floors "........L . .....................................Interior ........ .. ........ ................... H eating lit/G ...�. .',Z..... ....Plumbing ...........G /!1 �� :::.✓..Y?:��:���` ..................... Fireplace ............. ..,N.. ...............................................Approximate Cost ............. ................ Definitive Plan Approved by Planning Board _____-__________________________19________. Area / ! ®.Q... ......... . ............. .... . Diagram of Lot and. Building with Dimensions Fee �.?. ................ .. ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH 01 60 3 0 N, , r I hereby agree to conform to all the Rules and Regulations of the.Town of Barnstable regarding the above construction. Name . Cedar Acres Realty Trust ' Nol..... 0321..•Permit for .one s torY..... .... . €amilY`dwelling................... � y � •_ •� - -{+-. Location' 62 Hamden Circle ' " .... .....F1YSZMIA........................... .......... - a• l� s t ./ Owner .........Ced r.. Rea1tY..Trust.... V - _ t5 Type of Construction ............... .fr.gunp................... ................................................................................ Plot ............... . ..... Lot .........#7.9................. - Permif�Granted .........June..19.........:...'.19 78 t/ - Date of Inspection ....... ..................... ..19 Date Completed ./.aF `6 V.....^. .....19 PERMIT REFUSED t - .................................. ...f........... 19 ............... . ................................................... ........................ .......................................... . ......... er ..........................• ................................... ..!... ... 1 ?........................................................... t 'Approved ......................................... 19 / ...... ..... .. ...:........................................ , f ............................................................................... 101 G.NV Slur, _3 als "08A S);Ob8133 t)`;IOab'J?j Sti011vino32f 9,N:1P407 �9JdGiro2rNfJ AO WAOi 3Hl Ol. S.%do,' oo GNV NMOHS rb 10 1 3Hi P10 CI3!VOO I S, N011 01NOW S!Hl iVvil AJlla3J AU383H i l v p-Sg i `Q { o14 `V z t e�c 4 � �T '�+ � � Ql �� �34i dp� 'k q;� _ � a a a r,�t p�Owtvoa i a i . 1