HomeMy WebLinkAbout0038 LANTERN LANE La V,4e-e-.00cl L cra
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
MapS�lace pp
Parcel I Application? d 00
Health Division Date Issued
Conservation Division Application Fee /I
Planning Dept. Permit Fee a
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address
Village14�4AYXAc.
Owner 6 re'sC 10 Address ��-
Telephone I01- --7o 9,1 At of I J,
,Permit Request V� /i -f'�����,�a/� / S��U ,�� 1Zpack
ac k f_e(A 1LoS,X_.
c r C W, VoL4 2, a S
Square feet: 1 s floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 2 Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family 3/ Two Family ❑ Multi-Family (# units)
Age of Existing Structure t 1.6 Historic House: ❑Yes La No On Old King's Highway: ❑Yes d No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other IL7 4 -�
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq )
Number of Baths: Full: existing new Half: existing new,
Number of Bedrooms: �' existing _new
Total Room Count (not including baths): existing new First Floor Roo Count,..
Ln
Heat Type and Fuel: ®'Gas ❑Oil ❑ Electric ❑Other M
Central Air: ❑Yes 2'N0 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 Ahorization ❑ Appeal # Recorded ❑
Commercial ❑Yes �40_ If es site Ian review#�� yes, p i
Current Use "IAA�'t�'� Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name t a L - -
d.n c. Telephone Number -71 q "103 . 64(0
T
Address ��d'Vv't� 1� License#
(_ c :WSkQ- A 6 Home Improvement Contractor#
Email S D � .� e-! ' 1 \ Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE �' 4
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
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.
r
T The Commonwealth esalth of aassachuse is
Department of Industrital Accidents
Office:ofInvestiga# ns
600 axShii8 oh aSM et
Bruto*MA 02111
www.wassgov1dia
Workers'Compensation Insurance Affidavit:%Uders/Contractors/ElectrickusiPlumben
A2gUcjLthf6EMatioj PIta hCbjt Lbl
Name{Bsius/ iza�ivntfv�stvai}: ` 'l f 1.
V.
Address: o l le, fzoaj .�
CatylState/Zi . r Phone##. 0
Are r r you an employer?Check the appopiate lox° of pr�aj t(r )
�...7 y
1. .am a employer with 4. I arts a general contractor and 1
_ 6: New cot4t3ruction
employe"(fun and/or part time)_ have.hired the
2.Q 1 am a sole proprietor or parimer- listed on,the shy:..., 1. Q Remodeling 4
ship and bave no=ployees These. leave.. . . g. In Demolition
r
workingfor me ur an capacity. employ :and have worms'
Y c�P t3' Building addition.
t
4 B
o worker 'camp,insurance coanp, iastuance.
P
i
5:( We ate a corporation and its 10 Electncal repairs of additions t
3..0 I am a homeowner<3om9 all.Wcak o#&eis have exercised their 1 i .l?luml?irtg repairs.Ofadditions
myself:(No workers'comp. ngltt of ax on gee i L iZ oof
t' c,ISM, i 4N axtd we have ace.
:msurauce r . § ;.(.
3a:O T am a homeowner acting,as a emptWee&f No i1iot�ers' t 3 t tbf r � c"
g�esat rat�si(ie£er tc>R4} comp:,:uisiizasscc regt�rt:si.}
-Any appiir.=t that cheehs.boa#1 lust also.RU out.the section below showing the wotkeW co 3o f Wfa ftm
Hoaseawncrzs wtia submit this a zc�v t imicatin$.the are d6mg all wait-nd then b=outside=ntmctaea:must submit s uety anew t indicatin.t mxI.:
�., :Conttactoru that sheelG 6i3 bax iaiust a`tti}chxd ss adi3itianal WIM shdAriag the nun of she sa6-cnaCract�ta argil state whather or saotses have..: ? -
emptoyees Ifthc ntsaety have crapacycM.dwy amst Pmvide their:ww trw c
t:.
I am an employertleat is prv�t'Bding worker'eomperrss d�n insu rice for. ¢ v3'em Below is. e,po&y ja#,sWe e
t ,
t ietfQawsatiora:. _ . :.
insnce Company Nam: `. - 6
Policy#or geld Lip.#: 1 Exr3uation.Date.: j
Job Site Address-��J Lab. 2 ✓` i, .la',�" it rlStatel e G-40
Attach a Copy.ot the*Aere.compensation policy declaratiompage.(showlog_the potty num r�and expiration date).. .
Failure to secant;coverage as required under Section 25A of MGL c:152.can lead�the.in4pmtion_.€rf sal pe nes cif a
'fm uP to S 1,500.40 andlor one=year i risotifiienl,as well as civil penalties in the forrR of a'STOP WORK ORDER,and a fine
of up to$250.00 a day against the violator,.:B4k advised that a.copy o f this statement ma: be forwarded to thei ce of
Investigations.of the.DIA.for'uasaarattce coverage verification.
.
I dig laeby.Cato un s€nd pgrral s 0 peV27 t the infoma n aAow Bird cryrrea
} Date: ,2.
Ph 6416
Offal art only. Igo nat write in t arese,to be rampleted by,;itp or town off3caat.
City or Town: l'ermitll icase# .
Issuing Authority(Circle one),
2.Board-of Health 2.l' dlug�Departtsmeut 3.Cityl'I`own Cleric. 4..0 rical Inspector S.Plumbing Inspector
Other
ber
Contact Persoat.Y Phone M
3/1.8/2014 1 : 10 : 10 Pm 874t} 03/06
tC�"a►� CERTIFICATE OF LIABILITY INSURANCE oA4W
THIS CERT#FICATE IS ISSUED AS A MATTER OF.INFORMATION ONLY AND CONFERS NO RIGNTS UPON THE CERTIFICATE HOLDER. THIS �
CERTIFICATE DOES NOT AFFIRMATMS Y OR NEGATWELY AMEND,EXTEP3W OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETIIitEEN THE ISSUING INSURERM AUTIMIMD
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:N Um'cedWwde hoWa Is an ADD[M)NAL INSURED,the Policy(ies)mush be endoirsed. If SUBROGATION IS WAIVED,subject to
the-hms and cons of the pofty,certain policies:may require an er►dorsement. A.statement an this cerlfCate does not cmdu rlgtbs to the
certilkater holder in lieu of such orwdorsmsrrtls)~
PRODUCER 005m-Dot 7 Jo"Fsrd
RflgersbGraylasucanceAgency . :.I84D)5&3184t RAC::Na (6a8)398dI2d6
4S4 Route 934
South Dennis.,MA 02M
A.IX Mental Insurance Cimtlsany 337§8
MUD -
Fmiler Energy Soluams Ina
5.02:Harwich Rood
Brews�,r,It&AB2635
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS To cF-RTiFY THAT Ttm POLICIES OF INSUT?ANCE LIS7ED BELOW 14AVE BEEN ISSUED TO THE INSURED NWM ABOVE FOR THE POLICY PERIOD
INDICATED. NDTWITHSTANDIXCG ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCWENT WITH RESPECT TO WHICH THIS
CERTIFICATE:MAY BE ISSUED OR WAY PERTAIN,THE.INSURANCE AFFORDED BY THE POLICIES'D6SC FJSED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOM MAY HAVE BEEN REDUC€a BYPAID CLAIMS.
. -LTRR- - TYPE OFDISURANCE PoucyNUASM _ Liv LINITS
GENERALiL'lt UTY EACE;CCCURRMCE ." S
..CXlWERCIALGENR27 LIABILITY DAMAGE - $
ClkIA9tR1R3E' L-1 hhEII: (Anyane�evccn} $ ._.._
I {{
_PERSONAL&.ADVINJURY $_
_ GE`ERALAGGRMATE $
AGGREGA'iEUWTAPpLIFSPER PROBUGTS-00900PAGG $
o-
I 'ICY �EarT
[ AtITfldI3WL£iUl[;iL17Y � $
! ANYAUTO EC)C1LY{NriIRY(Per'persun} '$
ALL ONMM- qSCHMULMHOOILY Ni.VIRY(Par aced $AUTOS AUTOS
HIREDAUn3SAUTOSN 4M ii PROPfRTY
DA
19ABRMLA LIAR O=R jt EACH 0=RFdNM $
EXCESSLIAS CLAMf,'1A71E AGGRIr.ATE $ -
DID_ RETB you S $
A. SIARM EEMIRL NIA vuuc-91ta aio Is�lsaovtA snar��aa srtarxnas �� Accros t' a �,otls pan
_ IhlandataYtarail L.L.'3ISLAC�-C1CI741PLOYfC $ 1.tI@0,4813.IRI
' i Sh' RATICaNSbetaer E.L..DISEASE-POUOY LINT. $ lJMXaOAD
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DZ�tIFr1�iOF4➢>�IAIHHdS1LOC�TiONStV6�L>s�{&ttaehACAR61&4.Ad�crslRt�arks3chedr�Hmores��ler�u"vedl -
CERTIFICATE HOLDER CANCELLATION
Town oTsandwich
130 main S'tmet SFIDULD ANYOF THE ABM 13ESCMBM POLICIES BE CANCELLED BEFORE
Sendwkb,MA 02583 TM EXPIRATKM AAT.E THMEOF, NOTICE Witt BE DELMMED, IN
ACCORDANCE WITHTHE POLICY'I`ROWSIDNS
AhiTHOFM REFRESENFATRM
a 71188 Ot0 ACCORD CORPORATION.AH rights resmed.
ACORD 25(2II'IDJII6) The ACt3RO na ne a d logo are rgfste to *s of A0ORD
3201
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Housing .
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HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE:
PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE
THE APPLICANT HOME OWNER.
I hereby consent to and agree that
A4
weatherization work may be done by the Weatherization Program of Housing
'Assistance,,Corporat.ion ( herein after referred as "Agency" ) on-the
property located at:
The weatherization work done will be based on programmatic ,priorities and
availability of fundixig and it mayinclude -all or some of the following
measures:
Weather-stripping & caulking of windows and doors, insulation of attics,
_ sidewalls & basements, attic and other ventilation measures and possibly
replacement of badly deteriorated windows. Inconsideration of the
weatherization work to be done at my home I agree ,to the following:
1. I give permission to the "Agency" its agents and employees to
travel onto or across said property with such equipment and
materials as may be necessary to perform' weatherization work on
said property.
2. The Housing Assistance Corporation 'reserves the right to inspect
the fuel or utility bill�foi the weatherized unit on an ongoing
basis for no more than five '(5) years after the Weatherization work
is completed.
I have read the provisions' of this agreement as listed and freely give my
consent. _
Home Owner(signature) `�,
4
7a,4
Home,Owner email: Date:
Agent: (Signature) ' Date: t i
HAC approved Weatherization Company:
Adam T. ,Inc Ca e S e
All Cape Energy Frontier Energy Solutions
Alternative Weatherization TOr Home mprovemen�•'—
Building Science Construction Resolution Energy
Cape Cod Insulation Tupper Construction
/z �{`s�intarr�sttR fun f=.yerrzuacfilrre l3 tHln vSl`t{�for indwidul Un tt�
OffimofCwmmerAffairs �n jAceaftairregmm
�IIE IMFROVEgtMU COMMACM before the mpration dew If found regm Q:
160854 type: t�t'ice ofConsumer iixs and Business Regslation
on_- 918T�EXl6 .._ 10 Park Pia -Suite 517A
Bosten.MA02116
FF2OMMIE R ENk t(aY SflLEl7it5t�S
FRANNGSSMK{�t''�pIyNSHEEE�W �
CHRD
BREWSTER MAWM1
- DdCP3eCTRaaTy - w signatum .
I
Restricted To:Lei:tC-insulation ConErat im
PAassachu4ett---D-epaunerri of PabRc Safety
Board of SUIWIng Regulations-nd Standards
fits -CSSL 1t11 .
Brewster ffi - y
Fai tw e#a possess a amet*ecFation cfthe Mas ausetts
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