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HomeMy WebLinkAbout0415 MAIN STREET (HYANNIS) (8) �► t ,. �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map 3;?(o Parcel 0 `� Application # Health Division Date Issued 6 Conservation Division -, Application Fee J� Planning Dept. Permit Fee ` Date Definitive Plan'Approved by Planning Board" Historic - OKH _ Preservation/,Hyannis -� UP Project Street,Address q1 /'74ig Village_ 14fAh�S Owner rJ Cgive Address 7/ /oche P—Afz /yl Adeevj,; �o a�7S� Telephone SD 7 v 6 - i 9 9 Permit Request Zo, Ad d au window fm d a �� ';of�� d ez.L' ,Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoniriq District Flood Plain Groundwater Overlay Project Valuation d O®p Construction Type Lot.Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. DwellirkType: ble Family ❑ Two Family ❑ Multi-Family(# units) 4. ge QPLExisting!§iructure Historic House: Sul Yes ❑ No On Old King's Highway: ❑Yes ❑ No `Basam_ent Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Fished 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_Poo 1: ❑ 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 IfYes ❑ No If yes, site plan review# Current Use A-4-601411 Proposed Use. At Vr 4���. APPLICANT INFORMATION / (BUILDER OR HOMEOWNER) Name �/)� /' /�« p Tele hone Number Address y3 /7`� �/ License # _ 0!)X9 5 b Home Improvement Contractor# I tri eta. ' Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Id4 L DuM,� SIGNATURE �S/7�- ZZ, DATE S' P FOR OFFICIAL USE ONLY APPLICATION# DA E ISSUED l MA /PARCEL NO. l ADDRESS VILLAGE A OWNER 3 DATE OF INSPECTION: FOUNDATION f i a 1p" , J FRAME A&M or- o RPll INSULATION NS 6,V- CQ at lloe ltot-" FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING l DATE CLOSED OUT ASSOCIATION.PLAN NO. of Town.of Barnstable Regulatory Services SARNPHAS& E Thomas F.Geller,Director `rEo► � Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street,-Hyannis, MA 02601 www.town.barnsta b le.ma.us 'Office: 508-862-4038 Fax-: 508-790-6230 PLAN REVIEW i - Owner: f S C L U rc � .Map/Parcel:- Project Address L-f I $wilder: The-following items were noted on reviewing: 4 J Reviewed by: o .}' , Date: �o -� Q:Forms:Plnrvw 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/Organizarionandividud): ac cu Address: /q3 WS dOd - City/State/Zip: �.en-�c�✓i I(e Phone.#: 3 D Are you an employer?Check the appropriate bog: Type of project(required): 4. I am a general contractor and I 1.❑ I am a employer with � 6. El New construction loyees(full and/or part-time):* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet 7. El Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'comp.insurance comp.msuranceJ 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 I LE]Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs JJ �insurance required.]t c. 152, 1(4),and we have no 13.['Other Q2e Q�4 employees. [No workers' comp.insurance required.] 0"p W°h� *Any applicant that cheeks box#1 rnust also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subrnit a new affidavit indicating such. tContractors that check this box rmrst attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have anployem. If the sub_contractors 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: Policy#or Self-ins.Lie.M Expiration Date: Job Site Address: 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 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 of perjury that the information provided above is true and correct Si ature: h �V. Date 4//z) f, _ Phone 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 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 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 submit 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 to any business or commercial venture (i.e.a dog license or permit to bum 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 TO. #617-727-490.0 ext 4.06 or 1-977-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia oFjHErq,�, Town of Barnstable Regulatory Services San MASS. E$ Thomas F.Geiler,Director �A i63q. ♦� TF019 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 Using A Builder I, hrS� C.Oi InAurt L L C , as Owner of the subject property hereby authorize g�c �ac�neco to act on my behalf, in all matters relative to work authorized by this building permit application for: HIS mm , S-i ll a ni (Address of job) Signature of Owner Date C404 venture L LC Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&OWNERPERMISSION - SHE Town of Barnstable Epp y�P, Regulatory Services + BARNSfABLE, Thomas F.Geiler,Director 9 MASS. Building Division lFn � 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 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 fonn/certi fi cation for use in your community. Q:forrns:homeexempt �W. ndo la=Yn i�►5 '07 1169t ,LS KIM �o• myj4 x zx ��d .N 0 2�3gE 166y0 - � S12 5T ow Z N IOW J W I n m f/t �a0 qa �/� in �1 O U �r '1 c oa S a zbl ca% o d Z R< �33 w, f5 Z bD �-' O 4 �• n �9.15-DYE 120.69 S-TREF, 1 ' •pecK 5�'=xd d0 1ti�S Tr�Ple:dX8 " r�c►•n� aX fro O � 4 dam'e h0 YMvre .}'�4 ► Y /v (e axsCie e p �r�P k Jill Y G R I L L 415 MAIN STREET HYANNIS •MA 02601 508.775.9600 FAX 508.775.9698 ASAGRILL.COM w �T� o Hyannis Main Street;Waterfront � H><storzc D><str><ct Comm>Ess><M swuvs`rABt6. � ; - �, 200 Main Street � ' �''�n�"'�0�' - Hyartnts Massachusetts 0260.1 � '�'� F' TEL.508 862=4665/:FAX 508 862 4725` # ` -�` Aw rx Application to Hyannis Main Street Waterfront Htsfonc Distract Commission ;in the Town ofBamstable for a CERTIFICATE OF APPROPRIATENESS, Application is hereby made in;tnp{icate,for he issuance of a CertEfcate of Appropnateness under M.C. l_. Chapter 40G, The Hisfonc Distracts A'ct for proposed work as descnbed°b`elow and on,:plans, drawings or photographs aecompanring this appliifion for PLEASE CHECK ALL CATEGORIES THAT APPLY 1 Eztenor Butldmg�Constrticrion [] New$utldtng ❑ Addition [�Alteratton � .'�--� Indtcate. e of btutdtn H.guse typ g ❑ ❑ Garage [`]'Commerctal ❑ Others_ w �� 2 Eztenor Pamttng` ❑ ` ' 3 Signs or Btttboards ❑ New sign [� Existtng stgn; ❑ Repamhng exis#mg stg�n 4 Structure:` ❑ Fence ❑ Wall ❑ Flagpole ❑ Other .ec� %J>r� t,l k ` 5 P..arktn Lot New Buildtn Addittori' Alteration '''� g ❑ g ❑ ❑_ (Please see the gu�deImes for<explanation and requtrements) TYPE OR PRINT LEGIBLY =DATE � � ©� ' ASSESSOR'S MAPNO ��� >.. ASSESSOR'S PARCEL NQ l3/tI APPLICANT' y`�- APPLICANT MAIIrING ADDRESS ��� �yC@fi `+ t' �e�t�r�rf 1� 4 �J 9 ADDRESS OFPROPOSEDWORIC �/� ��i�` _S�; � �'�ilr.j PROPERTYOWNER � � CCG, � r� TEL NO ��' 9vo ENO OWNER MAILING ADDRESS /?/ . �(,cGr/✓ f rf�a t vE 1mph 2 too al NAME- FULL NAMES AND MAILING ApDRES5ES OF ABUTTING OWNERS:Include name of ad�acgnt property owners across any public street or way This mfonnatton is best obtatned at the Town Assessor's =. Office (Attach addittonal sheet ifnecessary) AGENT OR CONTRACTOR � ryrti +�(t"�c�a TEL NO ADDRESS �73 �.} �� ��t''✓��� �. Dv�3�� Novo ljw� Asa Grill Daily sales summary 11/15/07 8:42pm From 07/14/07 to 07/14/07 Page 1 Date Items Discounts subtotal Tax TOTAL Tip+Grat 07/14/07 17440.14 -340.70 17099.44 863.09 17962. 53 1445.26 Total All 17440.14 -340.70 17099.44 863.09 17962. 53 1445.26 Less Paid-out/(-In) 365. 75 NET 17596.78 MOMIRWAVRWM an � L 4k 4 DETAILED DESCRIPTFON OF PROPOSED WORK Give all particulars of work to be done, mcludirig detailed data on such architectttral features as foundation,chimney;sidmg,roofing,roof pitch,sash and doors,window and door frames,trim gutters ' leaders,roofing and-.paint coaor,including rratenalsto be us...ed, if speccficatons clo;not accompany plans got ON ARM psi '; In the case-`of signs, give locations of existing signs and proposed locations of new signs (Attach 'i additional sheet,if necessary) tlPjltel : l.ra�+ � (Uri 1;:►tnc�c�i,•s: e � aTCh ' Signed �"' r� C.� Owner Contractor Agent (CFRCLE ONE) SPACE BELOW LINE FOR COMMISSION USE Recewed by HMSWHDC II ,This Ceitificate;is hereli � III Time Date a By Signe IMPORTANT If this Certificate is approved,approval is subject to the 20 day appeal period provided in the Ordinance C NDITIONS OFAPPROVAL � e �� f �, Asa Grill Daily sales summary 11/15/07 8:41pm From 07/11/07 to 07/11/07 Page 1 Date Items Discounts subtotal Tax TOTAL Tip+Grat 07/11/07 5944.70 -168.98 5775.72 289.69 6065.41 558.45 Total All 5944.70 -168.98 5775.72 289.69 6065.41 558.45 Less Paid-Out/(-In) 72.75 NET 5992.66 •i t`^ L ri f' i IIYA.NNIS MAIN STREET WATERFRONT HISTORIC DISTRICT C;OIVIMISSION *�*SPECIFICATION SHEET*** ADDRESS OF PROPOSED WORK` <�"t��' ��f� �' FOUNDATION STDNG TYPE COLOR CHIMNEY TYPE COLOR ROOF MATERIAL= COLOR, PITCH WINDOW �Y?�$Qn : COLOR W�xTe AMA 1900 ON ma TRIM COLOR DOORS . COLOR - SHUTTERS'..' GUTTERS 0-1 GARAGE DOORS ` ' COLOR NOTES Fill out completely mcludmg measurements and matenats/colors to be used Three cop�esof this form arerequ�red for subm�ttat.of an application;along unth three copies Yam pa eachof the plot planaandscape plan;;and elevahonplans,when appl?cab}e The.Plot plan need natb.:e'.'Certified",but should show all structures on the lotto scale. ; a I i Asa Grill Daily Sales Summary 11/15/07 8:40pm From 07/07/07 to 07/07/07 Page 1 Date Items Discounts Subtotal Tax TOTAL Tip+Grat 07/07/07 15507. 55 -283.03 15224. 52 768.64 15993.16 1282.67 Total All 15507. 55 -283.03 15224. 52 768.64 15993.16 1282.67 Less Paid-Out/(-In) 1124.85 NET 14868.31 miwer ►r� 1 226 DR fND ` / N6gk9 AND HELD 3 49 69 69 w NO O - 3 z FERNANDO SOUSA TR. r C ASSEPA�R S MA 326 "' C0o w 14,450*S.f. N Y O � N 3 � O 1 1S.6' WlO�4� G CJO'Ate? �f. O C a 44 . C IOU4p o O£cl, RY HYANNIS PUBLIC LIBRARY ASSOC. IPA ®' 1rDOD T�RAHE ASSESSORS MAP 326 q PARCEL 13 Q� HUM415 G Yp X 4 � o co o µPSG m g£4Rt' co T Co oy z.s' rn T09 OVERHANC 0.6' OVER ayS�n� n `N sau.0a 22 w 93.8fi 3.2' :b O I'V DAVID L COLOMBO SRELDON STEWART TRUST. ASSESSORS MAP 326 PARCEL 1S a 415 t AIN STREET HYANNIS •MA 02601 508.775.9600 FAX 508.775.9698 ASAGRILL.COM i s •i M1 i i .. .�F►aMyit .. y did a _ ^t Ar Y E 'Sa a11t A �. i .41 CD a U. CL kii o �iU •� �� �`" ��N d�i�i4 �-,W'JV{� 40.1 6 eDEP: Print Receipt Page 1 of 1 Submittal Summary & Receipt Your submission is complete. Thank you for using DEP's online reporting system. You can select"My Homepage"to review your status, DEP Transaction ID: 173988 Date and Time Submitted: 4/2/2008 11:09:06 AM Other Email : Form Name: BWP- Demolition Form for AQ-06 Payment Information DEP code: 30275 Date: 4/2/2008 11:08:11 AM Amount($): 85 Payment Detail: shane m Pacheco--Card —0641 Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab https://edep.dep.mass.gov/Restricted/webpages/printreceipt.aspx 4/2/2008 x a Qo@ MAIN STREET HYANNIS ROX-0 02601 o508.775.96000 FAX 508.775.9698 0ASAGRILLGOM Massachusetts Department of Environmental Protection Bureau of Waste Prevention .Air Quality 1100070105 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition ImporWhen filling 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. 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 ASA GRILL Environmental Protection a.Name notification 1415 MAIN ST requirements of b.Address 310 CMR 7.09 Barnstable MA 1 02601 c.Citvrrown d.State e.Zip Code (508)364-2456 1 Ishane@smpcapecod.com f.Telephone Number area code and extension .E-mail Address(optional) 6,600 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: RESTAURANT I. Is the facility a residential facility? ❑ Yes ❑✓ No o_ M. If yes, how many units? _ Number of Units -0 3. Facility Owner: =N FIRST CAPE VENTURE �o a.Name -0 171 LOCKE DRIVE, b.Address _ MARLBOROUGH MA 01752 �(o a Citvrro n T d St. e� e.Zip Code �0 (508)786-1899 I f.Telephone Number Qrea code and extension) o E_mail Address_(national O IMARCELLO �Q h.Onsite Manager Name ag06.doc-10/02 BWP AQ 06•Page 1 of 3 1 .A ;an ti �n G R ' l 1 L L i i 415 MA1N STREET HYANNIS •MA 02601 • 508.775.9600 FAX 508.775.9698 ASAGRILL.COM f i • �3 ��� _- � fie �ianvnzoouuecr�l� a�✓f�ac�uc�eC� e j BOARD OF BUILDING REGULATIONS . r,I r License CONSTRUCTION SUPERVISOR Number CS 092958 , I t _,J Birthdate0/�7_gj_972 1 � t ExpiroS 10/i712009 Tr.no: `92958 I' " SHANE PACMECfJ j 74 GREAT HILL SANDWICH, Commissioner 77 j. i I COMMERCIAL ADDITION/ALTERATION ❑ Letter of Approval from Site Plan Review(if necessary) If locat�n OKH or Hyannis Historic District- Certificate of Appropriateness ppropnateness required P Plan Map & Parcel number ❑ Full Description of project (U-value of replacement windows if applicable) ❑ If sprinkler or fire alarm system is required, do not accept application package without prior approval from Fire Department in writing. ❑ DEP letter attesting notification, hazardous materials results , if necessary Sign-Offs fro Healt� ❑ Tax Collector ;__ Conservation Treasurer ❑ If ZBA relief(Special Permit or Variance is required for project: ❑ C�,y. of Decision ocumentation proving that the decision was recorded at the Registry of Deeds w/in one year-of ZBA decision date. Lop Street address of project orrect square footage Estimated Cost Own 's name & address Contractor%s name,e, address &telephone number El __--�Contractor's signature ❑ Full sized plans, stamped plans (1 full size and 1 reduced) Wo - an's Comp. form. Copy of Insurance Compliance Certificate must be on file. [ZVC@ntruction Super's License OR ❑ Controlled Construction Documents f C e& expiration date on license i 00 next to restrictions ❑ Application Fee ❑ Permit Fee ❑ Property O, caner rnustsign Property--Owner Letter of Permission. .-�-- -- - q-forms/bld gpermi is/permi tchecklists rev.071007 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION . Map (. Parcel 014 Application# dZ�" ' 07 Health Division Date Issued Conservation Division_ Application Fee ` G Tax Collector Permit Fee Treasurer Planning Dept. yt Sq� se 4P Date Definitive Plan Approved by Planning Board .`►, �? j�E "rE IW BUREAU„ lr?, .a'IENT Historic-OKH Preservation/Hyannis =e,r �, .. t Project Street Address ^11,9 .1` sa_ Village /!✓I� GGff Owner rS Co e ufe1A,4114 P'Yes 149/ VC a &"i Telephone i arCsz l f® I Sod -1 '80-79 Permit Request RcMjVf #9//'JQV da-l-A (`esndye, on-L ®V a r.0 a-{ tvef.2 Li Y G? 85 re a n i'I L 6f'C,,e 4in4- eeylac& sA:5irs o EX-1-A n;a u+n ,niS�2� WQ 11 . o?Xq ecc xsL , 'c1t,�ic1 1(0 01C Square feet: 1 st floor:existing proposed O 2nd floor:existing proposed D Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 6�4000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) �i Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes O`No r� Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other w' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) # N) :~ Number of Baths: Full:existing new o Half:existing = new =o Number of Bedrooms: existing 0 new 0 ' =: (JI t Total Room Count(not including baths):existing new ® First Floor Roo Count' Heat Type and Fuel: dGas YOil ❑ Electric ❑Other Central Air: C(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 dyes LJ�Io If yes, site plan review# Trent (� �'� 4 i`4 Cu Use Proposed Use BUILDER INFORMATION ��� .�o� S&C/-d V '� Name�� �u Telephone Number S Address veS AV License# CS 69_1�959 // // o ►t�,�i/'�Cr✓��[.� � �� Home Improvement Contractor# /V�4?633 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ar)2514 l fir SIGNATURE ! DATE d 00 FOR OFFICIAL US,E ONLY e t APPLICATION# [?ATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME Y INSULATION FIREPLACE ` ELECTRICAL: ROUGH FINAL 7 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO. ` The Commonwealth of Massachusetts . i Department of Industrial Accidents Office of Investigations ' a 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumber__`s Applicant Information Please Print Le ibl Name(Business/Organization/Individual): fi Address: l S c City/State/Zip: ( 11-k(V4 C/la Phone. #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor,and I mployees(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. ❑Remodeling ship and have no employees These sub-contractors have g: ❑Demolition workingfor me in an capacity. employees and have workers' ' . Y p tY• $ ing 9. Build addition [No workers'comp.insurance comp. insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 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 + r comp. insurance required.] *Any 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 are doing all work and then hire outside contractors must submit 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 employees,they must provide their workers'comp.policy number. lam 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. M Expiration Date: Job Site Address: 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 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 penalties of perjury that the information provided above is true and correct. Signafore: C ✓��' Date: 0 Phone#: S®8 .3 fO 4 — �IS Official use only. Do not write in this area, to be completed by city or town offcciaL City or Town: Permit/License# Issuing Authority(circle one): . L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I� Information and Instructions r ' 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 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 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-contractor(s)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 submit 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 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 to any business or commercial venture (i.e.a dog license or permit to burn 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 Industrial Accidents Office of Investigations s 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7744 www.mass.gov/dia `` oTMET�ti Town of Barn-stable Regulatory Services 9MAS&iE$ Thomas F.Geiler,Director 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 property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (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. Q:FORMS:O WNERPERMISSION Town of Barnstable �OFSHE fp�� Regulatory Services BASTAB Thomas F.Geiler,Director MASS. 163¢. .0� Building Division rFD �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 supervise . 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 j 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 personas 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 form/certification for use in your community. Q:forms:homeexempt Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air.Quality100068240 r • BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Important: A. Applicability When filling out pp .Y 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. B. General Project Description 1. a. Is this facility fee exempt=city, t wn, 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 2 Facilit Information: • to comply with the y Department of Environmental 4 Protection a.Name notification [� requirements of b.Address 310 CMR 7.09 W 3 09gi VJ ��b :3�MA I �` (:;h4trvilt� YYJ� d zi o Code V 0.1 f.Telephone Number area code and extension E-mail Address(optional) 00 h.Size of Facility in Square Feet i.Number of Floors e �o j. Was the facility built prior to 1980? [(Yes ❑ No k. Describe the current or prior useof the facility: f U, . I. Is the facility a residential facility? 0 'Yes 2'*N0 =O m. If yes, how many units? Number of units 1 -° 3. Facility Owner: �o a.Name o b.Address c. [Town d S ate e.Zip Code 0 fb f.Tele h ne Number(area code and extension) g.E-mail ddress optional) -� 08 -"1 -+-r is 49 F m �Q h.Onsite Manager Name E ag06.doc•16/02 - BWP AQ 06 Page 1 of 3 Massachusetts Department of Environmental Protection L7�1 Bureau of Waste Prevention • Air Quality 100068240 Decal Number BWP AQ 06 Notification Prior to Construction or Demolition General Statement:If B. General Project Descri p (cont.) cont.) ' asbestos is found during a 4. General Contractor: Construction or Demolition operation,all responsible parties a.Name must comply with 310 CMR 7.00, b.Address and Chapter Chapterer 21 E of the I q3 tAI General Laws of c.Cit /Town d.State e.Zip Code the Commonwealth. Cei4glvd 4 a This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an So v 3 '( - 2gSG F �' 2 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. a.Name Gsu, Jul. ; b.Address c.Cit /Town d.State e.Zip Code f.Telephone Number(area code and extension) g.E-mail Address(optional) 5o (414 - )q5(" 56& CD SM C4 Co� h.On-site Manager Name 2. On-Site Supervis r: On-Site Supervisor Name 3. Is the entire facility#o be demolished? ® Yes ER/No �N =0 4. Describe the area(s)to be demolished: o Size-i��r K InIc�Se-I ) mole ). -0 -0 5. If this is a construction project, describe the building(s) or addition(s)to be constructed: (2 bw- fe-rncc6 Lcl agO6.doc•10/02 y BWP AQ 06•Page 2 of 3 y t, Massachusetts Department of Environmental ProtectionL7 _ Bureau of Waste Prevention Air Quality 1100068240 Decal Number BWP AQ 06 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 Q(No If yes, who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. 'Construction or Demolition: Week Cvr+ 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 Y ❑ wetting ❑ shrouding b. If other, please specify: [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 yXV, cc lvo =o - above and that to the best of my a.Print Name _o knowledge it is uw Au_ true and'complete. uo The signature,below subjects the b.Authorized Signature �N signer to the general statutes . 0W;11i,r regarding a false and misleading c.Position/Title �o statement(s). C& U; v e. E� nx� - eu .4 a-. d.Re res ntin a vv e.Date( /dd ) �o �d 1 ag06.doc•10/02 BWP AQ 06•Page 3 of 3 F IKE rqk, Hyannis Main Street Waterfront o Historic District Commission B A RJoh,,S T ,7!E Growth Management TOWN * a'R`,`AW. � 200 Main Street 9� 1639. 10g °Teo Hyannis, Massachusetts 0260f Phone: 508-862-4665 /Fax: 508-862-4784 .0 FEB 21 A10 .31 CERTIFICATE OF NON APPLICABILITY Application is hereby made, in triplicate, for the issuance of a certificate of non applicability under M.G.L. Chapter 40C, The Historic Districts Act, for proposed work as described below and on.plans, drawings, or photographs accompanying this application. TYPE OR PRINT LEGIBLY DATE Lo d ADDRESS OR PROPOSED WORK �i�s �4/n #Y4n411 ASSESSORS MAP NO. OWNER r/ Cool)-e Ve,7T✓re ASSESSORS LOT NO. G HOME ADDRESS (0) �Ve /r 1661U Cl TEL. NO. c56 rU' -1 35 80 74 AGENT OR CONTRACTOR �d- ADDRESS 7 3 A lef /& �1?✓j ✓1 Ile TEL. NO. S-�`b 364- �1S6 This application is for exemption of proposed exterior construction on the ground that: (1)It will not be visible from any way or public place. (2) It is within a category declared entitled to exemption by The Hyannis Main Street Waterfront Historic District Commission. (Check applicable box) PROPOSED WORK: Describe and furnish plan of proposed work, showing location on lot, and if an addition is involved, showing location of existing building. ? LJi dog `, S be_in re�0VeJ �f��• +'kA Y-eeG'r c-� �-4 j T IGG r* q/)4 6.t�nee�� rep)4cecI +k ClaN , a J lexks �lnq C(Cpba4rct inaat'j tS -hez v IS)bkc -(c-ar-n graj,Iot I eve � . SIGNED Owner-Contractor-Agent Space below line for Committee use. Received by H.D.C. The Certificate is hereby Wo yeloy ao A Date Time - By Date Approved Disapproved ❑ BOARD OF BUILDING REGULATIONS I License CONSTRUCTION SUPERVISOR i a I Number CS 092958 is 8irt�hdatea0/17/1972 " pires 1 011 7/2 0 0 9 Ex Tr, no: 92958 Restticted r00.jr SHANE PACHECQ 74 GREAT HILL I ` SANDWICH, MA 02563 '' Commissioner g ly i� 83 CP- ryupy„y Adel W Z d •C N r r� ,` •y� y c �