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HomeMy WebLinkAbout0408 MAIN STREET (HYANNIS) (5) r i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s Map Parcel �`� Application # QZ ®V Health,Division Date Issued Conservation Division Application Fe 01 Planning Dept. ` Permit Fee d 15 Date Definitive Plan A roved b Planning Board pP Y 9 Historic'- OKH _ Preservation/ Hyannis C w Project Street Address 909 m A l�v ST Village &Aivw,S Owner_ yDo rnA,w Qf:_A� Address P. 0. 8-ox 'Telephone ry - 7-7 5- -,�Ll o o Permit Request"`- `DUB \0 o—T VA,%JA1A -RD)e 1 r" -13A5Ctri%i�PM� JbrL P(+ QL)-1Q n�� G` j f r-� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new -. Zoning District Flood Plain Groundwater Overlay ' r-Project�Valuation_'?3 0, 0100 Construction Type 5'ra l , It uop, S Nevi Qock.. 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 ❑ No On Old King's Hi hway: 0 Yes i❑ No Basement Type: Urfull ❑ 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: fB Gas ❑Oil ❑ Electric ❑ Other Central Air: O 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 id/Yes ❑ No If yes, site plan review# Current Use Proposed Use P-E7 A" APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 1 C�( 11��w- Telephone Number Address 6 � °"r � License # y Idq �6 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO n y vv`n s7- SIGNATURE DATE k FOR OFFICIAL USE ONLY APPLICATION# I ` • r `DATE ISSUED f MAP/PARCEL NO. ADDRESS VILLAGE - 4 'a OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING = g , DATE CLOSED OUT ASSOCIATION PLAN NO. ' e 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 Legibly Name(Business/Organization/Individual): Address: a City/State/Zip: iYis o Phone.#: , o -`7) Nrry Are employer? Check the appropriate bog: Type of project(required): 1. 1 am a employer with jV 0 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. �'J odeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' P 9. ❑Building addition [No workers'comp.insurance comp•incrn-anceJ red. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infoTrnation. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. YContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have en ployees. If the subcontractors have employees,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: A m�2i GA r ��flowR w�Aovi ES ' — Policy#or Self-ins.Lic.#: (�J(�y C)S Jr/. — Expiration Date: ) �D Job Site Address: LID 9 n,A N City/State/Zip: 4mt;,'t lb a Od 6 a 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 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$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 Si ature: Date: Sy.6 0 Phone#- -2 5' - y C V 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/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees:, Pursuant to this statute,an employee is defined as"...every person in the service of another under 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 more of the foregoing engaged in a joint enterprise, and including the legal representative's 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 employs persons 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 be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate 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,MGL chapter 152, §25C(7)states`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 out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies*(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have , employees,a policy is required. Be advised that this affidavit 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 law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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. In addition,an applicant that must submit multiple permit/license applications in any given year,need only.sub mit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e. a dog license or permit to born leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone-and fax number: The Commonwealth of Massachusetts Department of ladustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 t W. #617-727-4900 ext 4-06 or 1-977-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia r OFIKE Tp� Town of Barnstable Regulatory Services BAIMSTABLE` ' ` Thomas F. Geiler,Director 9$'°rFo39. �` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject 1 property hereby authorize 19 ' to act on my behalf, in all matters relative to work authorized by this building permit application for: ♦ f�l q(D Cq[O fl 1/1 5 e l7 MA (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. fl•F�1R MC•(1WUFR PFR Tu1CCCIf1N , Town of Barnstable �Op VE 1p�� Regulatory Services Thomas F.Geiler,Director saxxsTeate, � , v MASS. $ i639• �� Building Division PjFO �A 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 or 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 he/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..1—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 Hrith 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 form/certification for use in your community. 1 h^ m—m r aim ep 3 D l�0 3 pn, 33 N� O Qfl- O O O O O UP TO MAIN ST. m r m m A m D Z m r O WO O O U1 O O O m x O 5 O a O 408 MAIM ST. , HYANNIS , MA, LOWER LEVEL DATE: E: DRAWN BY: T May 5, 2008 %6"=1'0" L. GRICE g-. { —i SSS000�Jaaiir A rl� m Constr�ctior; egu ad IS an jr Li r d Upervisor Licensean ar s j � z 42246 �_ I r EXP►rat ion; 93126 �2016 Try 18950 JJ l GARY C GRAHAM ss g M .,t 'fi i HYANNIs '' MA p260 �- ` Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1100071628 Ll BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Imp 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-do not 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. I 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:this form must be Blanket Decal Number completed in order to comply with the 2. Facility Information: Department of Environmental puritan cape cod Protection a.Name notification 1408 main st. requirements of b.Address 310 CMR 7.09 h annis MA 02601 c.Ci /Town d.State e.ZiD Code (508)775-2400 1 lcgraham@puritancapecod.com f.Tele hone Number area code and extension .E-mail Address(optional) 3,100 1 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: retail I. Is the facility a residential facility? ❑ Yes p No O m. If yes, how many units? Number of Units —0 3. Facility Owner: N 400 main realty �o a.Name o p.o. box 2652 b.Address h annis ma — 02601 �(D c.C'ItvtTown state .Zipde _o (508)775-2400 cgraham@puritancapecod.com f.Telephone Number area code and extension .E-mail Address(optional) a gary c.graham Q h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06•Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality 1100071628 ` BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General Statement:If B. General Project Description (cont. asbestos is found during a 4. General Contractor: Construction or Demolition gary c.graham operation,all responsible parties a.Name must comply with 66 brant way 310 CMR 7.00, b.Address and Chapter h annis ma � 02601 Chapterer 21 E of the General Laws of c.Ci /Town d.State e.Zip Code the Commonwealth. (508) 737-6420 1 lcgraham@puritancapecod.com This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an gary c.graham asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. gary c.graham a.Name 66 brant way b.Address _ h annis ma � 02601 c.Ci /Town d.State e.Zip Code (508)737-6420 1 lcgraham@puritancapecod.com 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 3. .Is the entire facility to be demolished? ® Yes ✓® No �N -0 4. Describe the area(s)to be demolished: 0 3100 sq.ft. basement walls and ceiling N -0 0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: retro-fit existing vanilla box only m G_o �d �Q ag06.doc•10/02 BWP AQ 06•Page 2 of 3 Massachusetts Department of Environmental Protection _ ■ r Bureau of Waste Prevention • Air Quality 1000�1628 BWP 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: 05/20/2008 08/01/2008 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 b. If other, please specify: ❑ wetting ❑✓ shrouding ❑ 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 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 manager o regarding a false and misleading c.Positionffitle =o statement(s). 1400 main realty d.Representing �(D e.Date(mm/dd/yyyy) �O C ag06.doc•10102 BWP AQ 06•Page 3 of 3 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, s� Robert J. Gi ie Controller z 4/2/2008 09:38 Bryden & Sullivan Insurance Donna Seviour-*Robert Gilkie 1/2 AGGRO CERTIFICATE OF LIABILITY INSURANCE , OP IDPUR DS DATEfMM,'02/0 PURIT-1 09/02/0'^0' ' PRODUCER „ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 8ryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND;EXTEND OR 88 Falmouth Road — _ ALTER THE-COVERAGE AFFORDED BY THE POLICIES BELOW. . 1 Hyannis MA 02601 Phone: "508-775--6060 Fax: 508-7907141:4 INSURERS AFFORDING COVERAGE NAIL# ". .'.INSURER A'. AIG INSURED - ., ... _ .. 'INSURER E - "'Puritan'Clothing Company INSUPE 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. R D - POLICY EFFECTIVE POLICY EXPIRATION, LTR NSRD TYPE OF INSURANCE - POLICY NUMBER DATE(MMIDD/YY) DATE(MM/DD/YY) LIMITS - GENERAL LIABILITY - EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY - PREMISES(Ea occurence) CLAIMS MADE •❑OCCUR 1 - MED EXP(Any one person) $ PERSONAL E ADV INJURY $ , GENERAL AGGREGATE $ - GEN'L AGGREGATE LIMIT.APPLIES PEP,: .- PRODUCTS-COMP/OP AGO $ - POLICY. PRo-JET LOC C AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT $ ANY AUTO - (Ea accident) ALL OWNED AUTOS ` BODILY tWURY $ SCHEDULED AUTOS (Per person) HIREDAUTOS - .. - - - BODILY INJURY- $ NON-OWNED AUTOS (Per accident). PROPERTY DAMAGE $ (Peraccident) GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT ANY AUTO _ _ .. . - OTHER THAN - EAACC $ - AUTO ONLY AGO $ EXCESSIUMBRELLA LIABILITY _ ... EACH OCCURRENCE $. OCCUR ❑CLAIMS MADE - _ AGGREGATE $ .. DEDUCTIBLE ._ _ .: $ .. RETENTION - $ - WC STATU- OTH- - WORKERSCOMPENSATIONAND .. TORYLIMITS -ER EMPLOYERS'LIABILITY WC9408512 01/01/08 01/01/09 E.L.EACH ACCIDENT $1000000 A ANY PROPRIETOR/PARTNER/EXECUTIVE - OFFICER/MEMBER EXCLUDED? - - E.L.DISEASE-EA EMPLOYEE $1000000. It YES.describe under : .. .. . .SPECIAL PROVISIONS below �- ,... - E.L.DISEASE-POLICY LIMIT R 1 OO OO.O-O, OTHER --. ..._.....-. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS _ - Note: The named insured on-the workers compensation policy is: Puritan Clothing Company.of Cape Cod`Inc.end/or'Four Hundred Main Realty, Milton Penn;Howard Penn and Richard Penn, Trustees: 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$0 SHALL BARNSTABLE, TOWN HALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 397 MAIN STREET REPRESENTATIVES. - - HY IS MA 0260iI AUTHORIZED REPRESENTATIVE GV Kelle A.Sullivan ACORD 25(2001108) ©ACORD CORPORATION 1988 i W W w U W n W l� J ELEVATOR �--------- i9-io��---- r (fina( dimensions -- -- _ Ci O L to be determined)I ? O N O O Y z a 0 F-- O O O O 3 ) 105 SQ ' o o O O O ELECTRIC PANEL UP (not a ZCHUTE u z W Q 0 0 N L 0