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HomeMy WebLinkAbout0408 MAIN STREET (HYANNIS) (15) � � i� s7 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map._ Parcel Application oalL Health Division &06 Date Issued Ok3 Conservation Division Application FOO U Planning Dept. Permit Fee -7 � Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address �®� Y►')(��w �► Village I A+NYLAS Owner *d mA i- P-eA!ry Address I� ��3C c�65� ,i9N,y'�-yam Telephone yo Permit Request — 'r(us -0 0-Fi0oQ IV 5ed2oCr', luwifL livi i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation UV U Construction Type re e( Si�C�Ta°eka Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes QKo On Old King's Highway: ❑Yes ❑ No Basement Type: Sf`ull ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) � /U U 56 F7- 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: 0Gas ❑Oil ❑ Electric ❑Other Central Air: EY'Yes ❑ No Fireplaces: Existing New Existing woot�'bal stove: ❑Yes ❑ No r. Detached garage: ❑ existing ❑ new size Pool: ❑existing ❑ new size _ Barn: ❑ ting U�new;.size _ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: -- Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial dYYes ❑ No If yes, site plan review # Current Use REIA _- - Proposed Use 22 gi APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 6a,4A& -- Telephone Number -o 7- 6q,) p � � 7� Address G a License V 1►4 C)a Go 1 Home Improvement Contractor# l-2.3 431 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Utti-nSTCGZ SIGNATURE C. DATE �e Y s t FOR OFFICIAL USE ONLY 9 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 t ASSOCIATION PLAN NO. f - cy The Commonwealth of Massachusetts Department of Industrial Accidents, Office of Investigations 600 Washington Street' Boston,MA:02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/OrganizatiordIndividual). q()a IbA,N d 17 Address: O J1 S a City/State/Zip: ,vis 4111 Phone.#: J VA '7)5�"�t/0V Ar-e,�y".an employer? Check the appropriate box: Type of project(required): 1.L1 I am a employer with /y G 4. ❑ 1 am a general contractor and I employees(full and/or part- ne). * have hired the sub-contractors 6. ❑New construction tu 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. C]Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp.insurance t required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their. I L]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[]Roof repairs insurance required.]t C. 152, §I(4),and we have no. employees. [No workers' 13.❑ other comp.insurance required] *Amy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they am doing all work and them hire outside contractors must subnut 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 have employees. If the sub-contractors have crnployces,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: �/►"tk kjCj)ty' a Policy#or Self-ins.Lic.#: 1,y d y Doi-�/�— Expiration Date: 1 /! Job Site Address: 1409 ►1-,,6 City/State/Zip: J�y i4� IM u 4 G c I Attach a copy of the workers' compensation policy declaration.page(showing the policy number 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 tip 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 certify under the pains and penalties ofperjury that the information provided above is true and correct. v Signature /Jl .�� Y 4S ~i�_/'�- , Date Phone# �} 7 7 S' _ a L/U 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 2.Building Department 3.City/Toym Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other - Contact Person: Phone#: ri (HE r Town of Barnstable ti Regulatory Services • r • BARN6TABLE, • y MAM $, Thomas F.Geiler,Director 4''�Fn;�►r'�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us ,Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Us ing A Builder I, R`ILiAFZ� �tinlw , as Owner of the subject property hereby authorize �jg _ � to act on my behalf, in all matters relative to work.authorized by this building permit application for: 0 14vw (Address of Job Signature of Owner Date PFAJAI Print Name If-Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS:OWNERPERMISSION l SHe Town of Barnstable �oF r�� .. Regulatory Services snaxsrABLE, ; Thomas F.Geiler,Director MASS. 0.19. A�°� Building Division lFD MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units of less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that be/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.I -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fomr/certification for use in your community. Q:fonns:homeexempt 4' 8/21/2008 09: 13 Bryden & Sullivan Insurance Donna ,Seviour-*Robert Gilkie 2/3 ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DS DATE(MM/OD/YYYY) PURIT-1 1 08/21/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: AIG INSURER B: Puritan Clothing Company INSURER C: Drawer 730 INSURER.D: Hyannis MA 02601 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. NSR DD POLICY EFFECTIVE POLICY EXPIRATION LT., NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/OD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL UABIUTY PREMISES(Ea 1-N I LD ce) $ CLAIMS MADE ❑OCCUR MED DIP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPUES PER: PRODUCTS-COMPIOP AGG $ POLICY JEO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO - (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EAACCIDENT $ ANY AUTO • OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA UABIUTY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE RETENTION $ $ WC STATU- OTH- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE WC9408512 01/01/08 01/01/09 E.L.EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1000000 It yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POUCY LIMIT - $1000000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Named insureds on policy are Puritan Clothing Company of Cape Cod Inc. & Four Hundred Main Realty Trust i CERTIFICATE HOLDER CANCELLATION BARNS03 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 BARNSTABLE TOWN HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 397 MAIN STREET REPRESENTATIVES. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE [Kelley A.Sullivan ACORD 25(2001/08) ©ACORD CORPORATION 1988 I Four Hundred Main Realty P.O. Box"2652, Hyannis; MA 02601 • 775-2400 May 6, 2008 Town of Barnstable Building Department This is to certify that Gary C. Graham who is an employee of Puritan Clothing Co. of Cape Cod, Inc. is covered for Worker's Compensation per the attached insurance certificate while performing work for 400 Main Realty. Very truly yours, Robert J. Gi re Controller J . Alf7 ...._'ice _ 1#o d o �uit Ong Regul It �d�tanlar7s Construction Supervisor License License: CS . 42246 Expiration: 3/20/2010 Tr# 18950 Restriction: 00 GARY C GRAHAM .. 66 BRANT WAYi`> HYANNIS,MA 02601 Commissioner (� Q� �_ oM�o�� o nRD i O z tit o D -9 Z r m - zx W D �yc ADO m D a� fU Z �y El O NC z S 113g(� td X (� � w sz0z M oF--i � k--� Z r— r 1D �0 bd _ 0 (mil D 0V) � � 0 kD y C� O CC) ca -1Rv tj V) CY= IN F0 x bd -0 (-- -0 W —I t7'j o C-) m c� z ►- o M r z Z X � D � 0' Z \ (� I Gl� bd m n - F- G1 31 1 V) x m F-� D D � �--� td D O = r D - � GZ-) () 3 � � 3 F D F m -i M a bd F- C Z \ tj 0 O r D m 0p d = v tj :E-- fTl p D D (� D p �1 bd mm o MV) 7 ,u 1 j -9 r� z D70d 70 70 D �C7 r ELEVATOR SHAFT PLAN , SOLSTICE DAY SPA 408 MAIN ST. , H YAN N I S, MA, LOWER LEVEL DATE: SCALE: DRAWN BY: AUGUST 5, 2008 Y4"=1'-0" L. GRICE