Loading...
HomeMy WebLinkAbout0408 MAIN STREET (HYANNIS) (16) a S7 'Al S7 I� f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map7� Parcel Application #_ Dr Health Division Date Issued Conservation Division Application Fee L Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 196 g ry 5T 3114 3-7-0 70,- Village YR.v�•J Owner_ 11b0 M4,.,j je,016 LL.0 _Address bl3we Xs7��T nz� Telephone-77S'dy ac, Permit Request Nlma)rcl/�9 of T" V l�Ria�#R 71&_S Square feet: 1 st floor: existing proposed _2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0�-o0®, Construction Type �yy- Lot Size Grandfathered: ❑Yes ❑ No If yes, attachfsupporting docu�entation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) t0-13 Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highwdy: L 4Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ~� DIY 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 ❑ 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 _Steed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # _ Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# _ Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name C Telephone Number Y-7 37 Yd,0 Address _ �b 7394,,r License # b y4(►-r�is; M6. 601 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE A DATE FOR OFFICIAL USE ONLY APPLICATION# i{ DATE ISSUED MAP/PARCEL NO. "o ADDRESS VILLAGE 'k OWNER DATE OF INSPECTION: '_—FOUNDATION 'try FRAME INSULATION f FIREPLACE t ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL GAS: s ROUGH ._, % FINAL FINAL BUILDING - — DATE CLOSED OUT ASSOCIATION PLAN NO. S f he ommonwealth of Massachusetts epartinent of lndestrid Accidents 0jTwe of Invesfigations 600 Washington Street Bostor;MA 021ll www.Mass gov/dia Alicant.Information Workers' Compensation Insurance Affidavit: Builders/Conti-actorsXlectricians/Plumbers Please Print Le 'b Name (Business/orgy =taon bdmdueI): 60 mALq Address: �. RD a6. City/State/Zip: t3i-vw41MA 0,;z6o I Phone#: A9'1 ,an employer? Check the appropriate — c5 `73 S " Gov bar, 1. am a employer with 0 4. [] I an a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner_ listed on the attached sheet. 7. [] ship and have no employees These sub-contractors have working for me in any capacity, employees and have workers' g Demolition ow ' [N orkers comp.insurance comp.>asurance.$: 9. B❑ ui7ding addition required] 5. ❑ We are s corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing ail work officers have exercised their . myself [No workers' comp. right of exemption per MCrL 1 I.❑Plumbing repairs or additions insurance required.]t c. 152, §1(4),and we have no 12•❑Roof repairs employees. [No workers' 13.[]Other comp.insurance required] *Any aPPIiceat that checks box#1 must also fA out the section below showing their workers'compensation policy information t homeowners who submit this affidavit indicating they ace doing all work and then hire outside contractors must submit a new affidavit indicating ntractor that check this box must attached an additional sheet showing the name of the sub-conhactors and state whether or not those entities suckL have employees. If the sub-contractors havc employees,they must provide their workers co Policy mP•P cy number. I am an employer that is providing workers'compensation insurance or information. f my employees. Below is the policy and job site Insurance Company Name: ' A !' Policy#or Self-ins. Lic. Expiration Date: Sob Site Address:_ �a g vn/yrr� ST l 320 g City/State/zip: " 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.crimiaal fine up to$1,500.00 and/or one year imprison penalties of a Of up to$250.00 a daywell civil penalties in the form of a STOP WORK ORDER and a fine against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for mi suz e„ce coverage verification. I do hereby certify under/the pains and penalties of perjury that the information provided above is true and correct Si Date:. i G Dffzcial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/Ucense# Issuing Authority(crircle one): 1. Board of Health 2.Building Department .1 City/Town Clerk 4.Electrical Inspector 5.Plumbing,Inspector 6. Other g P Contact Persons.. Phone#: • 'Town of B arn-stable Regulatory services 8.0 iron-a nr Tr • L Thoma F. Geiler,Direr-for Eat BLII. dhig Dl;Yisfoa Tam Perry,$¢ilding Cam js!&i&aet 200 Main Stcct,Hyaais,MA 02601 . �w�.fnwn.barnstable.ma.IIs . Office: 505-862-403 S Fax: 508-790-6230 Property C�Wncr-Mus t Complete acid Sign This. Section If Using ABuilder I, 121G A20 Pi%rlyd✓ , as Owner of the subjcct.groPexty hereby authorize [j,g2y ('. 1i9 f fi¢ to air on my 6ehf, is 2R his relatige to work aithorired by this binding permit aPPRatioa for. 3 o 30/Y ha�,� tiN; (-AddTr-ss off ) Signature of Owner ) Dam Prrat Na= IfPmp��e is applyiag forpermit plcase core lete.the Homeowners License Excraptior, Form on die reVerpe side. Y Nlassachusetts- Department of Public SafetviLl Board of Building Reulutions and Standards Construction Supervisor License License: CS 42246 Restricted to: 00 GARY C GRAHAM 66 BRANT WAY ' HYANNIS, MA 02601 "aa Expiration: 3/20/2012 ('onunissinrr Tr#: 18292 I Restricted to: 00 00- Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 100142686 e` Decal Number BWP AQ 06 Notification Prior to Construction or Demolition Important:Wh n fing out A. Applicability - forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-donot use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09(2)ten (10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. B. General Project Description 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied Instructions residence of four units or less? ❑Yes []✓ No 1.All sections of b. Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in order to comply with the 2. Facility Information: Department of 400 MAIN REALTY LLC Environmental Protection a.Name notification IP O BOX 2652 requirements of b.Address 310 CMR 7.09 H annis J M CA 02601 c.Ci /Town d.State e.Zip Code 5087752400 f.Tele hone Number area code and extension E-mail Address(optional) 12000 2 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ✓� _Yes No k. Describe the current or prior use of the facility: MERCANTILE I. Is the facility a residential facility? ❑ Yes No _o m. If yes, how many units? Number of units 3. Facility Owner: . �N 400 MAIN REALTY LLC -o a.Name o P O BOX 2652 b.Address HYANNIS IMA co c.Ci /Town d.State e.Zip Code 0 15087752400 f.Telephone Number area code and ex a sin .E-mail Addre o Tonal d GARY C. GRAHAM �Q h.Onsite Manager Name 0'ag06.doc•10/02 BWP AQ 06•Page 1 of 3 11111, Massachusetts Department of Environmental Protection Ll Bureau of Waste Prevention . Air Quality 100142686 BWP AQ 0 w Decal Number Notification Prior to Construction or Demolition General Statement:If � p B. General Project Description (cont. asbestos is found during a 4. General Contractor: Construction or Demolition IGARYC. GRAHAM operation,all responsible parties a.Name must comply with 166 BRANT WAY 310 CMR 7.00, b.Address 7.09,7.15,and HYANNIS MA 02601 Chapter 21 E of the General Laws of c.City/Town d.State e.Zip Code the Commonwealth. 15087376420 This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an IGARYC. GRAHAM asbestos removal' h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. IGARYC. GRAHAM a.Name 66 BRANT WAY b.Address HYANNIS MA 02601 c.Cit /Town d.State e.Zip Code 5087376420 f.Telephone Number area code and extension) g.E-mail Address(optional) GARY C. GRAHAM h.On-site Manager Name 2. On-Site Supervisor: GARY C. GRAHAM On-Site Supervisor Name r 3. Is the entire facility to be demolished? ® Yes ✓® No N -° 4. Describe the area(s)to be demolished: ° INTERIOR NON-BEARING PARTITIONS �N -O �O 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: INSTALL NEW INTERIOR PARTITIONS cc i_° C7 �Q n ag06.doc•10/02 BVVP AQ 06-Page 2 of 3 Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention • Air Quality 1 Decal Number BW P AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project, were the structure(s)surveyed for the presence of asbestos containing material (ACM)? [] Yes ❑✓ No If yes, who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 2/27/2012 - -- -( 4130/2012 a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving ❑ wetting ❑ shrouding b. If other, please specify: ❑Q covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver Number D. Certification co I certify that I have examined the GARY C. GRAHAM -o above and that to the best of my a.Print Name -o knowledge it is true and complete. The signature below subjects the b.Authorized Signature -N signer to the general statutes 1CONSTRUCTION SUPERVISOR _o regarding a false and misleading c.Positionrritle -o statement(s). 1400 MAIN REALTY LLC d.Representing �c0 e.Date(mm/dd/yyyy) d ■ ag06.doc•10/02 BWP AQ 06•Page 3 of 3■ eDEP - MassDEP's OnlineFiling System Page 1 of 2 MassDEP Home i Contact I Feedback MassDEP's Online Filing System Usemame:GARY Nickname M eDEP 1 Forms M Profile Hel Y � Y P Receipt Forms Signature Summary/Receipt print rec Your submission is complete. Thank you for using DEP's online reporting system. You can select "My eDEP" to see a list of your transactions. DEP Transaction ID: 451773 Date and Time Submitted: 2/16/2012 9:40:51 AM Other Email : Form Name: AQ 06 - Construction/Demolition Notification Payment Information DEP code: 62945 Date: 2/16/2012 9:40:05 AM Amount ($): 85 Payment Detail: GRAHAM GARY - AccountType -- AccountNumber ****7532 Confirmation Number: Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab MassDEP Home I Contact I Feedback https://edep.dep.mass.gov/Pages/PrintReceipt.aspx 2/16/2012 0 0 0 TO NORTH ST. - PARKING DN D=57M��S>t + uc� .. r II JL f 394 MAIN 390 MAIN 388 MAIN . a a UP FIA1 3-L MAIN STREET -T CIW01.Nft?WAI DEMOLITION PLAN 390) 394 MAN ST. , HYANN S, MA . DATE: SCALE: DRAWN BY: FEB. 16, 2012 NO SCALE L. GRICE 02-17-'12 10:20 FRW-SO DENNIS 5083942267 T-383 P0011001 F-230 Br yden&SY11iVan Since 1963 urance Agencies February 17, 2012 Toxin of Barnstable Main Street Hyannis, MA 02601 RE: " Workers Compensation Policy 1 Policy .#WC2020003223 Effective Dates: 02/01/12 to 02/01/1$ - To Whom It May Concern: Please be advised Puritan Clothing and 400 Main Realty are Named Insureds on the above Workers Compensation policy as common ownership. Gary C..Graham is an employee of Puritan Clothing and 400 Main Realty. His actual payroll will be charged at the year end audit.` Sincerely yours, Kelley A. Sullivan, CIC President 88 Falmouth Rd, Hyannis MA 02601 •(508)775-6060 Fax(508)190-1414 485 Route 134•P.O.Box 1497•So.Dennis.MA 02660•(508)398-6060•'Fax(508)394-2267 www.brydenandsullivah.com 1 Four Hundred Main Realty P.O. Box 2652, Hyannis, MA 02601 • 775-2400 February 17,2012 Town of Barnstable C 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; Richa rd Penn President Parcel Lookup Page 2 of 4 327-089 338 MAIN STREET(HYANNIS) KUHN, CHRISTOPHER P & HY 327-006- 001 342 MAIN STREET(HYANNIS) MANGELO, MICHEL G TR HY 327-112 345 MAIN STREET(HYANNIS) HIBEL REALTY LLC HY 327-113 347 MAIN STREET(HYANNIS) YETMAN, KENNETH & LOUISE HY 327-114 349 MAIN STREET.(HYANNIS) MANGALO, MICHEL C HY 327-005 354 MAIN STREET(HYANNIS) CAPE COD LODGE 226 IOOF HY 327-004 BARREIRO, FELISBERTO, G HY TRS 356 MAIN STREET(HYANNIS)- Multiple Address BARREIRO, FELISBERTO, G 327-004 (360 MAIN STREET(HYANNIS)-ALBERTO'S REST.) TRS HY 327-115 357 MAIN STREET(HYANNIS) NEWMAN INVESTMENT LTD HY PTN RS HP 327-003 FIELD, MELVIN D HY 327-002 GEORGE, THOMAS N &ALICE HY TR 327-002 GEORGE, THOMAS N &ALICE HY TR 327 002 GEORGE, THOMAS N &ALICE HY TR 367 MAIN STREET(HYANNIS) - Multiple Address BARNSTABLE, TOWN OF 326-021 (230 SOUTH STREET-SCHOOL ADMIN BUILDING) (MUN) HY 327-001 GAROUFES, KALLIOPE G TR& HY 327-001 GAROUFES, KALLIOPE G TR& HY 327-001 GAROUFES, KALLIOPE G TR& HY 327-116 385 MAIN STREET(HYANNIS) UNITED STATES OF AMERICA HY 397 MAIN STREET(HYANNIS) - Multiple Address BARNSTABLE, TOWN OF 326-138 (250 SOUTH STREET-GUYER BARN) (MUN) HY. 326-013 401 MAIN STREET(HYANNIS) AHYANNIS PUBLIC LIBRARY HY SOC 408_MAIN_S_T_REET(H-Y-ANNIS).-.Multiple_Address 327-262 (39-0 MAIN"STRE ET-(HYANNIS)--=SaIon-Concepti(Fml PENN, MILTON L & HY National-Wholesale)) 408TMAIN-STREET(HYANNIS)=Multiple Address 327-262 (388.MAIN.STREET(H1CAN.N.IS_).m-C.olorful-Creations PENN, MILTON L & HY (FmlyCOLONIAL CANDLE)) 4084MINTSTREET-(HYANNIS)-Multipple—"-Addre--1-- 327-262 (394 MAINTSTREET(HYANNI JEWELERS) S):G.U_ERTIN-BROTHE--RS PENN, MILTON L & HY 4O8 M INA STREET(.H_Y_ANN'S)�Multiple Address PENN, MILTON L &327-262 HY (396-_MAINTSTREET(HYANNIS)—THE 400-BtNLDING) C408'MAINTSTREET(HYANNIS)=Multiple Address-� 327-262 PENN, MILTON L & HY (408TMAIN S_T_REET(H-Y-ANNIS)--PURITAN-CLOTHING) 8TMAIN STREET`(HYANNIS)- Multiple Address�0 a 327-262 (45 NORT_H-STREET---For-merl:y-National-Wholesale) PENN, MILTON L & HY 309-221 412 MAIN STREET(HYANNIS) PENN, MILTON & HY 326-014 415 MAIN STREET (HYANNIS) SOUSA, FERNANDO TR HY 309-218 420 MAIN STREET(HYANNIS) - Multiple Address DUMONT, DAVID S TR HY (422 MAIN STREET(HYANNIS)-JEWELERS) http://issgl/intranet/propdata/lookup.aspx 5/8/2006 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4J o r� Map �d�7 Parc I �bd� i is; ;y Lit pP�s �,• , /� {� Permit# ''1f it ] p Health Division �6 d A ,� d Date Issued qkc A 4 wfU� �j�n„ Conservation Division 16 x 8; 4 7 Application Fee Q Tax Collector Permit Fee 7 6 Treasurer s� fl 'iSfU, Planning Dept. CONNOM SEWER ACCOUNT Date Definitive Plan Approved by Planning Board D� Historic-OKH Preservation/Hyannis Project Street Address �og IYIgiN l�(je�� f�2� "� Llo77L"q� Village 1`�V gNti�S Owner �{Oy /h19 f�`7 Address Telephone 509 ^77 --0�y0� Permit Request kefud vg7�,: fat OAQCe Wi9CE. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 7) 00-0 Construction Type Lot Size v0 a" Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) ' Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑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 ❑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 (� �CE:_ t S' f Proposed Use Di C BUILDER INFORMATION Name GiVq C (X-A h%, Telephone Number 50$,: 732 yan Address l ,wT License# ©�f y� l�laNti13 , vy\A— Home Improvement Contractor# I D3 b,5 5 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO . I�Ur►„n5%?�2 SIGNATURE DATE w_ FOR OFFICIAL USE ONLY PERMIT NO. y DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME iC INSULATION FIREPLACE ELECTRICAL: ROUGH FINALdo PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING " DATE CLOSED OUT, ASSOCIATION PLAN NO. ,�.. Results Page 1 of 1 Licensed Contractor Look Up Select the search method: I License�g Maximum number of matches: Enter Search terms separated by spaces.142246 Select Search type: r> AND OR Search Search Results City/Town Name Type Street Lic. # Restriction Expiration State Zip GRAHAM, 66 BRANT HYANNIS GARS, C CS 42246 00' 03/20/2006 WAY MA 02601 Total of 1 ` Records ' matched. Back to Home Page BBRS Privac Statement http://db.state.ma.us/bbrs/contract.pl 9/16/2004 The Commonwealth of Massachusetts Department of Industrial Accidents - Mef BlAML~M V 600 Washington Street Boston,Mass. 02111 Workers' Co m ensation.•Insurance Affidavit-General Businesses nMEL address: A A/, A/ T' city ol�A N/✓/ J' state: A zip: 2 b e / • phone#(� � Jam- Z o o . work site location(full address): 410$ D Aj4 , 51 ❑ I am a sole proprietor and have no one Business Type: El Retail ElRestaurant/Bar/Eating Establishment working in any capacity. ❑ Office❑ Sales(including Real Estate,Autos etc.) ❑ I am an em to er with em to ees(full& art time. Other Z tf 1 L A./n/G Df✓�✓E I am an employer providing viorkers' compensation for my employees working on this job. com"any•iiaiiie• `O��' '/����.,. ��►�:7�'►:l '�T-.�t!2-%T� Tfi�iti< °' -.. ,��.�'�'j:iF.�o'a sd"dress•• .. :�''::''�?A�'•.f►::f' ;:�✓-`'�' •1' S •e a hop #•�./ t�,5 C.ANC, ...irrr;��~.. ✓�'• '',vra:yt✓ .Ca .insurance.cars•: +���'���! _,•'�•' I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: COMMiiV name: address: J. p oa e.. .. eity # : �is•: .;s . _ insurance co. ------------ Sri ' company address. ' - • 7:U r .. .. .{...�.. , y Rho insurance co: Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the foim of a STOP WORK ORDER and a fine of$100.00 a day against me, I understand that a . copy of this statement may be forwarded to the Office of Investigations of the'DIA for coverage verification. I do hereby certify r the pa s penalties of perjury that the information provided above is true and correct Signature �' Date /.�I�t/ Print name O E C/- Phone# �s0 0/ —�T official use only do not write in this area to be completed by city or town official city or town: permittlicense# ❑Building Depar tment ❑Licensing Board ❑'check if immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; ❑Other (revised Sept 2003) V 7 Information and Instructions Massachusetts General Laws chapter 152 section 25.requires all employers to provide workers' compensation for their. employees. As quoted from the i'law", an employee is defined as every person in the.service of anothenunder any contract of hire, express or implied; oral or written An employer is defined as an individual,partnership, association, corporation or other legal,entity, or any two or mgre of the foregoing engaged in ajoint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However 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 employspersons to do.maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment.be deemed to bean employer. MGL chapter..152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit toIoperate 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. Additionally,neither the commonwealth nor any.of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with'the insurance requirements of this chapter have been presented to the contracting . authority .Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation.:Please supply company name, address and phone numbers along with a certificate of insurance as all affidavits 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 returned to the city or town that the application for the permit or,license is being. requested, not the Department of Industrial Accidents. Should you have any questions regarding the"lave'or if you are required to obtain a workers' compensation policy,please call the Department at the number listed.below. . q . City or Towns , 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 permit/license number,which will be used as a reference number. The.affidavits may be.returned to the Department by mail or FAX unless other arrangements have.been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. . j j The Department's address,telephone and fax number: . The Commonwealth Of Massachusetts Department of Industrial Accidents emm of lmlesngafts 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext.406 COMMERCIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $150.00 Alterations/Renovations $100.00 le O • 0 Building Permit Amendment $50.00 FEE VALUE WORKSHEET NEW BUILDINGS square feet x$140.00/sq.foot= x.0081= ALTERATIONS/RENOVATIONS-OF EXISTING SPACE . . square feet X$96/sq.foot 70 = O O O X.0081= 7 STORAGE BUILDINGS ONLY square feet X$32.00/sq.foot= X.0081 Commprojcost Rev:063004 o�IME, , Town of Barnstable Regulatory Services , ABI,E, x Thomas F.Geller,Director BA 11ass. 9 s639• Building Division �prfD MAC A Tom Perry,.Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 Property Owner Must Complete and Sign This Section If Using A Builder ?z' ' ,as Owner of the subject property I, 6� •�}(a to act on my behalf, hereby authorize in all matters relative to work authorized by this building permit application for: (Address of job) /OL Date Signature of Owner Print Name Q:FORMS:OWNEUERMIS SION TOW. OF BARNSTABLE - -- i BUILDING PERMIT PARCEL ID 327 262 GEOBASE ID 24374 ADDRESS 408 MAIN STREET (HYANNIS PHONE HYANNIS ZIP - LOT BLACK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 79297 DESCRIPTION RENOVATE OFFICE SPACE PERMIT TYPE BREMODC TITLE COMMERCIAL ALT/CONV CONTRACTORS: GARY C GRAHAM Department of ARCHITECTS: Regulatory Services TOTAL FEES: $642.70 BOND $.OU pf CONSTRUCTION COSTS $67,000.00 437 NONRES./NONHSKP ADD/CONY 1. PRIVATE °*`0 ._. . * BARNSTABLE, MASS. 03g9- A BUILDINO DIVISION���..' BY ✓(/ . DATE 'ISSUED 09/16/2004 EXPIRATION DATE " TOWN OF BARNSTABLE T r' .- �- BUILDING PERMIT .PARCEL ID 327 262 GEOBASE ID 24374 r ADDRESS 408 'MAIN STREET (HYANNIS PHONE HYANNIS ZIP LOT - BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 79297 DESCRIPTION REROVATE 'OFFICE SPACE PERMIT TYPE BREMODC TITLE COMMERCIAL ALT/CONV CONTRACTORS: GARY C GRAHAM � Department of ARCHITECTS: - Regulatory Services TOTAL FEES: $642.70 BOND $.00 pf CONSTRUCTION COSTS $67,000.00 437 NONRES./NONHSKP ADD/CONV 1 PRIVATE :f 0 ."_..R, * BARNSTABLE, MASS, 039. • t � ��FD MA'S A BUILDI D 1SION BY ✓ ��_ G � �if� DATE ISSUED 09/16/2004 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR%ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. I iml 0 1;I RUMMM I I layj['-i 1:1 IN g;Lfjj m 11-:1ZI N-.1 BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 0� 2 2 2 3 , O 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT A/i y/6 S 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. e I I ' I Ivt: HMIT i 4- 4— ir — — (j 275 s E �e. i I q aoc auawng 'X�5%/N�� I i ` DN - n -� _. M in �. 2,547 sq. n \ i 11A\ i ; EXISTING L SE i 65' K E Y ; existing WoM demising walk k 7(2kSS = 7 9 FROM r,r.n. .rr.ir •iwur