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HomeMy WebLinkAbout0700 MAIN STREET (HYANNIS) (3) CCS rrne /h�S rMt'_1-C--tI r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel �/ I �d Application #C;2� 6 f S d s Health Division Ze_ ^ Date Issued -10 S Conservation Division g B Application Fee l�Q Planning Dept. Permit Fee yy �• �� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address j r� Village ci Owner Address / Telephone 9 PL j A►\/ Permit Request � ✓ � K,-IcW 0 e?/V y :h_ayt ' ,G 110"X, �1« 424L !� Square feet: 1 st floor: existing proposed —e nd floor: existing proposed ?ice tal new C7 Zoning District Flood Plain Groundwater Overlay Project Valuation S0.00 Construction Type (�+-��� /e'IMA4 i' 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 Ar"No On Old King's Highway: ❑Yes -EVNo Basement Type: ❑ Full ❑ Crawl ❑Walkout 'Other J(43. Basement Finished Area (sq.ft.) < Basement Unfinished Area (sq_fit) °r Number of Laths: Full: eAting. 'Alh- new Half: existing i] ' -new- Number of Bedrooms: A Al existing —new ,a Total Room Count (not including baths): existing new First Floor Roorp Count Heat Type and Fuel: C91�'as ❑ Oil ❑ Electric ❑ Other lam` Central Air: des ❑ No Fireplaces: Existing New Existing wood/coal stove' YrT ❑ No Detached garage: existin ❑ new •ze_Pool: existing ❑ ew size Barn ❑ existing new size_ At tached garage: ❑ e fisting new siz Shed: existing ❑ w size _ Othe Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial,,K'es ❑ No If yes, site plan review # Current Use �f'�Cv Q/�/�-w% Proposed Use n A`'i z c APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �c'>L►4� �i����� . cat �c � Telephone NumberL— Address /U-O License # Z 2 'Cv l /01 cFlll 2941A)41?_,,1Z1 �l Home Improvement Contractor# �l� Email I 'Rc)AP-- 2-2,0 rnt v Worker's Compensation # 2 D/V/ 0,5 5� ALL CONSTRUCTION DEBRIS RESULTI G FRO THIS PROJECT WILL BE TAKEN TO ui'd'I� /i SIGNATURE DATE_912,011i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r MAP/PARCEL NO. M` ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f POLAR DESIGN e BUILD Inc. 8/28/2015 Hyannis Building Department Hyannis, MA To Whom it May Concern, I authorize Dan Parrazzo—an employee of Polar Design Building to apply for a Building Permit in the Town of Barnstable, MA. He is an employee of our company. Tha OLY. Y, Do �ld F O'N ' I President Don O'Neill, President doneill@polardesignbuild.com 100 Grandview Road, Suite 312, Braintree, MA 02184 I 0 (781) 552-4203 I www.polardesignbuild.corn Mass. Corporations, external master page Page 1 of 2 f CI y �r Corporations Division Business Entity Summary ID Number: 001162431 Request certificate FYew search Summary for: POLAR DESIGN BUILD INC. The exact name of the Domestic Profit Corporation: POLAR DESIGN BUILD INC. Entity type: Domestic Profit Corporation Identification Number: 001162431 Date of Organization in Massachusetts: 02-26-2015 Last date certain: Current Fiscal Month/Day: 12/31 The location of the Principal Office: Address: 100 GRANDVIEW ROAD SUITE 312 City or town, State; Zip code, BRAINTREE, MA 02184 USA Country: The name and address of the Registered Agent: Name: JEFFREY O'NEILL Address: 100 GRANDVIEW ROAD SUITE 312 City or town, State, Zip code, BRAINTREE, MA 02184 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT DONALD F O'NEILL 100 GRANDVIEW ROAD, STE 312 BRAINTREE, MA 02184 USA TREASURER JOHN P DACEY 302 WEYMOUTH ST, STE 203 ROCKLAND, MA 02370 USA SECRETARY JEFFREY C O'NEILL 100 GRANDVIEW ROAD, STE 312 BRAINTREE, MA 02184 USA DIRECTOR DONALD F O'NEILL 100 GRANDVIEW ROAD, STE 312 BRAINTREE, MA 02184 USA DIRECTOR JEFFREY C O'NEILL 100 GRANDVIEW ROAD, STE 312 BRAINTREE, MA 02184 USA DIRECTOR JOHN P DACEY 302 WEYMOUTH ST, STE 203 ROCKLAND, MA 02370 USA http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001162431&... 8/28/2015 Mass. Corporations, external master page Page 2 of 2 Business entity stock is publicly traded: ❑ The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: Total Authorized Total issued and outstanding Class of Stock Par value per share No. of shares Total par. No.of shares value CWP $ 1.00 100 $ 100.00 100 ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Administrative Dissolution Annual Report Application For Revival Articles of Amendment v' View filings Comments or notes associated with this business entity: l New search http://corp.sec.state.ma.us/Cor'pWeb/CorpSearch/CorpSummary.aspx?FEIN=001162431&... 8/28/2015 r 37ie Commornrealth o,f_M ssadruse& Deparament a,f rndustrial Accidents - Office o,f n gaiiom. 600 Washington Street Iiaston, M4 02111 k ro-:niassgovIdia Warkers' Campensat:ion Insurance Affidavit-Bmlder-dCuntracturs)Elecfricians/Piumhers ApplicantInftarmatian Please Print Legibly Address: / Co it, Z+� ©2-1f V Citylstatelzsgp- Z�f�/�U�/Ztz= dlllI Mond r _ Edll- 5 912 15ZJ-Z— Are you an employer?Check the appropriate box: Type of project(required.: I.L� 1 am a employer uvi& 4 ❑I am a general contractor and I 6. ❑New construction employees(fu11 anzdfor part-timed* have]xired:the sub-contmctoas 2.❑ I am a sole proprietor or partner- listed on the attached sheet:. I ❑Remodeling slt>:p and have no employees. Mese sub-contractors have g_ ❑Demolition wod-ing forme in any capacity employees and have workers' [No wadmrs'comp.insurance corny.insurance.l 9. ❑Building addition required-] $- ❑ We area corporation and its 111 ❑Electrical repairs or additions 3_❑ I am a homeoumer doing all work officez s have exercised their 1 L❑Plumbing repairs or additions nV set€[No workers' �t of exemption per MGL �F- 17.0 Rs7ofrepaiis insurance reed]i c.152,§1(4)�and we have no employees.[No workers' 13.❑Other comp_insurance required.) •Any W ic—A tcbeckss'box g1 umst also fMoutthe section belowshuning ibeirwo$seie cammpensatinapolicyiaFornfiCM_ T Ho.TM+emmers Who submit ihis afddn ft M&Czting they ate domg MU Waal sad then hire autside coutoactors nmst submit anew affidavit indicating sudi FConntn tors tbzt check this boat must attsdiea an addirinma sheet showing the mute of the sub-cantracton and state Whether or not tbnse entities ham employees.Ifthesub-contactmshave employees;theymusrpinade their urorkers'comp.policynumber- I ant an evipZger that is prmadirrg warkets'cangwisrrieian hwirance for mf ampfapees Refory it ffre ptrTicy erred jobs site it formaliom InsurmcecbmpanyName: C 2G/' Z14 U Policy#or Self-ins-Lic. , ,� C� / C� `� F.xpirationDate: / z--� Jots Site Address: A) CitylStawzip: Attach a copy of the workers"compensation policy declaration page(showing the policy numlVer and expiration date). Failum to secure coverages as required.under Section 25A o€MGL tw I5"7 can lead to the imposition of criminal penalties of a fine up to$OOD.OU andvor one-year imgriso we.11 as civil penalties m the form of a STOP WORK ORDER and a tine of up to$250-00 a day against the-violator. Be a: zas that a copy of this statement may be forwarded to the Office of ItrrvesEfgations.of the DIA€ itmsurance covers " cstieaa Zrla kereby c fj�nisei tit ins id pen s a erjrarp tfiatf�lre informs vaprat�dabm c is true and correct Signature: Date: � Z S AU/ Phone 0- o 9�/L� Z J�Z-�' (lf�&d�art£}• �Da aot averts ra tfris area;ter be arrrrpTete�d bJ�taty rprfatrtr o;�reiat . City or Town.: PerimtUcense# Issuing Anfltarity(circle one): L Board of H&dth r.Building Department 3.Citytrown Clem d:Electrical Fnspertor 5.Plumbing Inspector 6.Other Contact Person: Phone it: - nformation and Tnst-nctions hja&SaWcffS Ge°eaal Laws chapter 152 requires all en players to provide w0lil='compensation far ffit , mpIoyees. rr}i F=Mlant to this she,au m pkYee is defined as°`_.evmy person in tie service of another under any contract of bil� express or implied,oral or " An VnpToyer is defined as'an indrvidoal,partnership,association,corporation or other legal ent iiy,or any two or more of the for ing engaged is alomt eatr.rprrse,and including the legal representatives of a deceased employer,or the ee of an in ,association or other legal entity,employing employees. However the or trust drvidnal, rP recer�er P _ d owner of a,dwelling house having not more thaw three apartments and who restes there m,ar the o_ coupant ofthe - dwelling house of another who employs persons to do mafi tmmce,construction or repair work.on such dwelling house or oa the grounds or building appurbmaot,`hcmto 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 p or'cease permit too operate a business or to construct bwidmgs in the commonwealth for any renewal of a h , p . �„ Ce the insurance.covexa a reguzr- a Iicantwho has not produced acceptable evidence of compIian with !; PP Additionally,MCrL chapter 152,§25C(7)states-N ther the co*m anwealth nor any of its political subdivisions shall enter into any cont-ad for the performance ofpublic woilc untl acceptable evidence of compliance with the in m-a ce._ con antho.. " r -cuts of this chapter have been presented to thecontacting �h'- �m Applican-b Please fill obf the workers'compensation affidavit completely,by che&zi g th-e boxes inat apply to your sitnafion and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their certificat*)of hin -ance. Limited Liability Companies(LLC)or Limited LiabrZity Partnerships.(LLP)with no employees other than the members or partners,are not required to carry workers' compensation i s raa,ce If an LLC or LLP does have employees,a policy isregnir d P e advised that this affida-vit may ba mbmittr-dto the Dapartment:of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be retrmmed to$re city or town that the application for the permit or license is being requester not the Department of Tn ran SFr;al Accidents. Should you have any question regar-ding the law or if you are required to obtain a workers' compensationpolicy,Please call the Department at the nnmberlis e:d below. Self-insured companies should enter their e umber on the line. self-instrauce Iicens n �Pe City or Town Officials Please be sure that fire 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 Iavesti.gations has to contact you regarding the applicant. Please be sure to fill in the PeViLWHcense number which will be used as a reference number. In.addition, an.applicant that must submit mubipIa pm itllicens5 applications in arty gives year,need only submit one affidavit mdicatiag current policy iufom.ation Crf necessary)and under"Job Site Address"the applicant should wute"all locations i (city or_ PO "A copy of the-affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proofthat a valid affidavit is on fo7e for fat= pennits or Iicenses- Anew affidavit must be,filled OiA each ining a license or permit not related to any business or commercial venfrire year.Where a home owner or citizen is obta (ie. a dog license or permit to bum leaves etc.)said person is NOT regc±md to complete tbis affidavit The Of$oe of Invest gations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Departments address,telephone and fax number. The Cammmwwltb�of MaRachus- Depattment of 1-idusitiat Agents Oface Qf utve atimi ��4an Stream Basto-u�MA Cal II Tf,14' 617 727-49W'=t406 or 1-&77-MA SSAF Fax:9 617` 27-77D Revised 4-24--07 masgQgfciia �-n"ET°�z Town of Barnstable ` Regulatory Services f { v �'$ Ok Richard V.Scali,Director ArE10) a Building Division Tom Perry,Budding Commissioner 200 Main Street.,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder Z- ��!, /� , as Owner of the subject property hereby authorize �� ��1'7 �9��1��-�zj: to act on my behalf, in all matters relative to work authorized byythis building permit application for. (Addzess of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final ections e performed and accepted.. ,1,6Y eo SiKxtur( - A print Name Print Name � J Da Q:FO RMS:O WNERPF-RMISSIONPOOIS A� CERTIFICATE OF LIABILITY INSURANCE OVDAT015MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Gail Cregg Fred C.Church,Inc. NAME: 41 Wellman Street PHONE 978 3227266 FAX (978)454-1865 AIC o Ext: A/C No: Lowell,MA 01851 i, (800)225-1865 E-MAIL gcregg@fredcchurch.com fredcchurch.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Liberty Mutual Insurance Company 23043 INSURED INSURER B; Liberty Insurance Corporation 21814 Polar Design Build,Inc. - 1150 West Chestnut Street.Ste 3 INSURER C: Brockton,MA 02301 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:32648 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER I POLICY LTR TYPE OF INSURANCE POLICY NUMBER MM DD/YYYY MM POLICY LIMITS GENERAL LIABILITY I I EACH OCCURRENCE S 1,000,000 X I DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence `$ 300,000 CLAIMS-MADE 171 OCCUR MED EXP(Any one person) S 5,000 B 260141014 12/31/2014 12/31/2015 PERSONAL&ADV INJURY S 1.000,000 GENERAL AGGREGATE $ 2.000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PR0.JECT LOC S AUTOMOBILE LIABILITY I (Ea e accident)SINGLE LIMIT S ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) S AUTOS AUTOS ( )I NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Peraccident s 5 UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE (S DIED I I RETENTIONS $ WORKERS COMPENSATION - X WC AND EMPLOYERS'LIABILITY YIN STATU- X OTH- A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S 1,000,000 OFFICEWMEMBER EXCLUDED? NIA 260141054 7/20/2014 12/31/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE S 1,000,000 If yes,describe under 7,000,000 DESCRIPTION OF OPERATIONS below- E.L.DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE:Flagship Estates,320 Stevens Street Hyannis,MA 02601 CERTIFICATE HOLDER CANCELLATION Town of Barnstable 367 Main Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Hyannis,MA 02601 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE P I Client# Mst# 32648 Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD