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HomeMy WebLinkAbout1220 IYANNOUGH ROAD/RTE132 (4) C:;� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,_ Map Parcel �bD Application # ®�a/o� Health Division Date Issued < (A < Conservation Division _ Application Fee 06 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis. "�— Project'Street Address .-e-0 14 Owner,,,Yju1 bd Address T�� bs !�✓�/ T Telephone 77­15-, Permit Request.- 6M 3 Ara,­' T Square feet: 1 st floor: existing ✓ proposed 2nd floor: existing proposed Total new Zoning District Flood Plain v Groundwater Overlay v (Project Va� tuation / Construction Type dY.? Lot Size AJ'X0- Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes LA No On Old King's Highway: ❑Yes 10 No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other (� Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) 4,Z1V Number of Baths: Full: existing new Half: existing _ J11- -new Number of Bedrooms: existing ©new Total Room Count (not including baths): existing 1 new First Floor kt m CourZ Heat Type and Fuel: CJCGas ,❑ Oil ❑ Electric ❑ Other _ -71 Central Air: Yes - ❑ No Fireplaces: Existing rs New O Existing woodcoal stove: ❑ s ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing Z- ] new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Mal Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial"®Yes ❑ No If yes, site plan review # Current Use k Cad l�- Proposed Use a.,z-- APPLICANT INFORMATION (BUILDER OR HOMEOWNER)- ---- -- - - — Nam I F. VISA. ( Telephone Numbers 2S- -4 - Address es LOh �J e v lm6,1-4 DZI Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE- 4T,4KEN'`TO� SIGNATURE C DATE 2 �-� ` FOR OFFICIAL USE ONLY h 4i APPLICATION# DATE ISSUED + t y MAP/PARCEL NO.... F ADDRESS VILLAGE OWNER .a DATE OF INSPECTION: :._-FOUNDATION { FRAME ,4 INSULATION) FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS:--,,.-, ROUGH -µ-, =- FINAL :FINAL BUILDING+?_ f E - f DATE CLOSED OUT } ASSOCIATION PLAN NO. The Commonwealth o Massachuseft Department oflndus&W Accidents Office of Investc'gatdons 600 Washmgton Street Boston,MA 02111 wwtw mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIecfricians/Plumbers Applicant Information Please Print Legibly Name(Bnsinesslo nip onitndividuat): l/1✓1 �71YLI` 1�l/ S -Address: ,- '. . W tY P �YL 14 CI /St3te/ZI Are you an employer?Check the appropriate bog: a of ro'ect r U. 4. I am a -TyP P ] (required):: 1.❑ I am a employer with ❑ general contractor and I 6. New construction . . employees(full and/or part time).*. have hired the sub-contractors ❑ 2XI am a'sole proprietor or partner- listed on ihe'attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me irr any capacity. employees-and have workers' [No workers'comp.insurance Comp.insurance.$• 9. ❑Budding addition required.] 5. ❑.We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their M❑Phimbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.]t c.152, §1(4),and we have no I2.❑Roof repass employees.[No workers' 13.❑ Other con3p.insurance required.] *Any applicant that rhwlm box#1 nzw also M out the section below showing their w'M1 rs'compensation policy information. t Homeowners who submit this afdevit indicating they are doing all work and ihrar hire outside contracto must submit a new affidavit indicating such. TConhactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub•cont®ctors have employees,they must pnmde their worlans'comp.policy oli 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: Policy#or Self-ins.Lic.#: C3 Fj S 4 Expiration Date: Job Site Address: Attach a copy of the workers'compensation policy declarafion page'(showing the policy number and expiration date). Fail=-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 f me of up to MOM a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of InvestizatLons of the DIA for insurance co a verification. I do hereby certify under the ai w-and penalties of perjury that the information provided above is true and correct Si tore: Date: Q Phone Official use only. Do not write in this area, tb be completed by city or town official City or Town: PermitiUcense# -Issuing Authority(circle one): .Board of Health 2.Building Department 3.Cit 6.Other y/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Contact Person: Phone#: i ,4e R CERTIFICATE"OF LIABILITY I °"'�'�"'°/27/INSURANCE 3 27i12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERrIFICA HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED T THE POLICIES BELOW. THS CERTIFCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER( ), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. , IMPORTANT: ff the certificate holder is an ADDITIONAL INSURED,the polies) must be endorsed. If SUBROGATION IS W VED,subject to the terms and conditions of the policy,certain Policies may require an endorsement A statement on this certificate does not for rights to the certificate holder in lieu of such endorsement(s). PRODUCER i NAIVE: Tobman, Molignano 6 Weiner Ins PHONE FAX 21 McGrath Highway, Suite 303 E 6 7 471-1 23 (Ar Nqd; 617) 773-2474 Quincy, MA 02169 A INSURE s AFFORDING COVERAGE NAICs INSURER A:Travelers Insurance Co INSURED INSURER B-Associated Em to ers Insuran Ultimate Doors 6 Windows Inc NSURE2 C: 55 Whipple Street INSUREt0: I S Weymouth, MA 02190 . , 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 TH POLICY PERIOD INDICATED. NOTIMTHSTANDIING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEC TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ,LL THE TERMS, EXCLUSIONS AND CONDITIONS OFSUCH POLICIES.LMTTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE TW BR INSR POLICY NUMBER PMND F I MTS ! A UPS 6802471N378 2/23/12 2/23/23 EAGHOCCURRENCE 1 OOO 00O IC CCh9dERCIALGENERALLIABILITY DAAMGETORENtr D 300,000 CL WS—MADE a[ OCCUR i MEDE7�(Any are aeon) 5 000 _ PERSONAL&PDVINJURY i 1,000,000 GENERALAGGRECATE 2,000,000 GEN•LAGGREGATELIMITAPPLIESPER PRODLICfS•ODMPA�PAGG 2 OOO OOO POLICY PRO LOC A AUTOMOBILE LIABILITY BA2605NO09 2/23/12 2/23/13 aaocldent M 1,0 00 0 00 - AL ANY W I BODILY INJURY(Per person) AUTOS IVE X SCHEDULED.AUTOS BODILY INJURY(Per accident) NON-OWNED HIREDAUTOS AUTOS, PROPE Q rt AMAGE UMBRELLALIAe OCCUR EACHOCCURRENCE 8 EXCESS LIAR CLAIMS-MADE. AGGREGATE $ DED R TION S B ANDoWORX�o N 0—WENS WCC5008974012012 3/4/12 3/4/13 g WCFATU arl+- s ANY PROPRIER)RIPARTNER/EXECUTiVE OFFICERMEMBEREXCLIDEW Y7 NIA E.L.EACHAcacgyr S 1.. 560 000 (Mandabry In NH) HYe�s daeaiDeunder E.L.DISEASE-EA EMP E S 500.000 DESG�RIPnIONCFOPERATIONsbelow o-. L.DISEASE-POLICY LIMIT a 500,000 - i I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Alfadl ACORD 1(1,AddWond Remit Schadde,B mwe spew b nqU led) i • i i CERTIFICATE HOLDER CANCELLATION , MATHEW WEIDER SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANI IELLEO BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1220 IYANNOUGH ROAD ACCORDANCE W17H THE POLICY PROVISIONS. SUITE 7 HYANNIS, MASS AUTHOAMREPRESENTATNE GARY D HEBSCH 01988-2010 ACORD CORPORATION. All ,ights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: I T00 XV3 9Z:6T. ZTOZ/RZ/£0 ' Town of Barnstable Regulatory Services BAMMANXASS M+es. Th omas F.Geiler,Director � 039. ' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: ,508-790-6230 - y' Property,Owner Must ' Complete and Sign This Section If Using A Builder I, iP-MoaK -++ ,as Owner of the subject p>operty hereby authorize to act on my behalf, , in an matters relative'to work authorized by this building permit (Address of job) fences and alarms are the responsibility of the applicant. Pools are not.to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. s4rKtrire of Owner S6ature of Applicant Print Name Print Name 7-1 �— Date QTORM&O WNERPERMISSIONPOOLS V Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction-Supervisor License: CS-055318 ®� MICHAEL P CSAFULLI. °'a .wk 86 WHIrPLTTRFfTS +�,` J $O WEYMOOJTHIVYA;0210:, CommissionerExpiration 01/16/2014 ,p�, �e •�orrvyno�uuea�'o�,./�aaaac�ivaet7a � .... ,., • -\ Office of Consumer Affairs&Business Re u�ntion g ! License or registration valid for individul use only • ` OME IMPROVEMENT CONTRACTOR ( before the expiration date. If found return to: r:,!6 Registration:, �I!6 6 Office of Consumer Affairs'and Business Regulation s` 18 Type: 10 Park Plaza—Suite 5170 Expira Wh'i-M°0l 812'013 Supplement Card Boston,MA 02116 ULTIMATE pOC= ;rB; ;fIDt7V)S�INC. 1 MICHAEL CRISi4pl It 55 WHIPPLE ST ;. S.WEYMOUTH,MA 0210 ' Undersecretary Not valid without signature The Commonwealth of Massachusetts.William Francis Galvin -... Page 1 of 3 The. Commonwealth of asp Massachusetts William Francis Galvin Secretary of the Commonwealth, Corporations s Division ' One Ashburton Place, o ace 1 7th floor Boston, MA 02108-1512 Telephone: (617) 727-9640 P & L L, INC. Summary Screen Help with this form bequest a Certificates, The exact name of the Domestic Profit Corporation: P & L L, INC. Entity Type: Domestic Profit Corporation Identification Number: 042973164 Old Federal Employer Identification Number (Old FEIN): 000259015 Date of Organization in Massachusetts: 07/17/1987 Current Fiscal Month / Day: 12 / 31 Previous Fiscal Month I Day: 00 / 00 The location of its principal office: No. and Street: P. O. BOX 1776 .255 BREEDS HILL ROAD City or Town: HYANNIS State: MA Zip: 02601 Country: USA If the business entity is organized wholly to do business outside Massachusetts,- the location of that office: No. and Street: City or Town: State: Zip: Country: Name and address,of the Registered Agent: Name: MARK W. THOMPSON .No. and Street: P.O. BOX 1776 255 BREEDS HILL ROAD City or Town: HYANNIS State: MA Zip: 02601 Country: USA The officers and all of the directors of the corporation: Title Individual Name Address (no Po Box) Expiration http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.a... 4/5/2012 The Commonwealth of Massachusetts William Francis Galvin -... Page 2 of 3 First, Middle, Last, Address, City or Town, State, zip of Term Suffix Code PRESIDENT L. PAUL LORUSSO 15380 S.W. 72 AVE., MIAMI, FLA 15380 S.W.72 AVE., MIAMI, FLA TREASURER L. PAUL LORUSSO 15380 S.W. 72 AVE., MIAMI, FLA 15380 S.W. 72 AVE., MIAMI, FLA SECRETARY MARK THOMPSON 999 RET 132 HYANNIS, MA USA 999 RET 132 HYANNIS, MA USA business entity stock is publicly traded: _ The total number of shares and par value, if any, of each class of stock which the business entity is authorized to issue: Par Value PerTotal Authorized by Articles Total Issued Class of Stock Share of Organization or and Outstanding Enter 0 if no Par ' Amendments Num of Shares Num of Shares Total Par Value No Stock Information available online. Prior to August 27, 2001, records can be obtained on microfilm. Consent Manufacturer Confidential Does Not Require Data Annual Report _ Resident For Profit Merger Allowed. Partnership Agent Note: There is additional information located in the cardfile that is not available on the system. Select a type of filing from below to view this business entity filings: http://corp.sec.state.ma.us/corp/corpsearch/CorpS earchSummary.a... 4/5/2012 The Commonwealth of Massachusetts William Francis Galvin -... Page 3 of 3 ALL FILINGS Administrative Dissolution Annual Report * Application For Revival °- Articles of Amendment Comments ©2001 -2012 Commonwealth of Massachusetts- All Rights Reserved Help i http://corp.sec.state.ma.us/core/corpsearch/CorpSearchSummary.a... 4/5/2012 t 1510, - 36'5"— --6'1". . ... y dy- ,.J36" _10'3" 10'q".. ............ --10,11"----ra 127 4x12 rock 68 — 4x8 ock �-/P -^......... 30 — 12' etal track ` ' 14 8` - 2x - N 120 8- — 2x Metal 18 12' 2x Metal a Stud screws Drywall scre s Mud x2 ....w.. Tape J 10'T, ' 1510, 36'5"— ' 6!V J j N 0 12 -.4x12 rock 68 - 4x8 ock =/ I 30 — 12' etal track - 14 8' - 2x ' 120 8' 2x Metal 18 12' - 2x Metal R Stud screws ; Drywall scre s Mud x2 Tape J �-