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Home My WebLink About0565 MARY DUNN ROAD ��s ��-� ��rn t�� #' adijo �j�7.� �� J i PROJECT r NAME:' �l � r�-ems UC�Z ADDRESS: PERMIT# Ly PERART DATE: 'a LARGE, ROLLED. PLANS ARE IN: BoX 1 SLOT Data entered in MAPS program on:. � BY: 1 - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map.. �O Parcel Application # Health Division Date Issued Conservation Division Application Fe A. Planning Dept. Permit Fee ' Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address ^n ZIA D S1 sTb"r, zo q b Village n f� f1 Owner ��TA-(Z Ek ,� X_-_ Address IC-, 6or ��`7 Woe-w C ,.22 z_ Telephone Wei Permit Request:OL sib&i Ne.0 T�� dNr5L Sin �'v% w►S DC ss oz, � G$ lcrjl an o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed;`� Total"newer Zoning District Flood Plain Groundwater Overlay, r )-) Project Valuation -0 Construction Type 17ej4ria.-r"►.3 04 CS) Lot Size Grandfathered: ❑Yes ❑ No Jf yes, attach supporting documentation. • L y'7. Dwelling Type: Single Family ❑, Two Family ❑ Multi-Family (# units) , Age of Existing Structure Historic House: ❑Yes *No On Old King's Highway: ❑Yes �(�lo 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 Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name g.G f Gene- A;Z Telephone Number SO S$" 14 5D a.kOI,-.A ®0Wvk,aJ E Address Q�jo License # Cs— Home Improvement Contractor# Email P �_ GG reenw— .cam.. Worker's Compensation # SoL Arre ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO AI A SIGNATURE DATE e,AT /`� f^� t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. i ADDRESS ' VILLAGE OWNER { 4 ' DATE OF INSPECTION: ' FOUNDATION FRAME - ti INSULATION FIREPLACE , ELECTRICAL: ROUGH FINAL' } PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING . DATE CLOSED OUT '4. ASSOCIATION PLAN NO. 3 1 ne uommonweaun of massucnuseirs - Department of Industrial Accidents Office of Investigations= = I Congress Street, Suite 100 r Boston, MA 02114-2017 r ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleciricians/Plumbers Applicant Information Please Print Ledbly Name (Business/Organization/Individual): G.Greene Construction Co.,Inc. Address: 250 Lincoln Street, P.O. Box 160 City/State/Zip: Allston, MA 02134 phone #: 617-782=1100 Are you an employer? Check the appropriate box:, Type of project(required): . 1.❑✓ I am a employer with 100 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors: 6. ❑ New.construction, 2.❑ 1 am a sole proprietor or,partner- listed on the attached sheet. T ❑ Remodeling ''These sub-contractors have ° ship and have no employees t y 8. ,❑ Demolition working for me in any capacity:` employees and have workers'' 9. Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 40.[ Electrical repairs ofadditions 3.❑ I am a homeowner doing all work officers have exercised their f 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption,per MGLp 12.❑ Roof repairs insurance required.] t: i c. 152, §1(4), and we have no Foundations employees. [No workers' 13.21 Other - comp. insurance required.] F > } *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. $Contractors 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: I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 7 ; Insurance Company Name: Insurance Company State of PA(an AIG company) - Policy#or Self-ins. Lic. #: WC 4990647` R " Expiration.Date: 09/01/14 565 Mary Dunn Road Hyannis"Ma 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. - I do hereby certify under the pains and enalties of er'u that the in ormation provided above is true and correct - 6/19/14 � Signature: 4— — ----- Date: Phone#: 617-782-1100 ,. Official use only. Do not wriie'in this area, to be completed by city_or town official City or Town: Permit/License# - Issuing Authority(circle one):= r 1.Board of Health 2.Building Department 3.-City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other Contact Person: Phone#: • M ILI 6VINA 01 • . • . � 4 THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA 0001905-00 WC 004-99-0647 13889 082-02-0913-50 • G GREENE CONSTRUCTION COMPANY, INC. A I G } 240 LINCOLN STREEET ALLSTON, MA 02134-0000 - � ' An AIG company EXECUTIVE OFFICES:' SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE- WC990610 175 Water Street New York, NY 10038 I.D# 918074627 .. . ... WORKERS COMPENSATION AND EMPLOYERS THE LONGWAOLL AGENCY, INC. 93 ONGWATER CIRCLE - LIABILITY POLICY INFORMATION PAGE PO BOX 9120 NORWELL MA 02061- 806 INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL. 00499064 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE- WC990610 ITEM 2 POLICY PERIOD 12*01 A.M.standard time at the Insured's - mailing address FROM 09/01/13 ' TO 09/01/14 ITEM 3 A. Workers Compensation Insurance: Part One of the policyapplles to the Workers Compensation:Law of the states listed here: MA RI _ • c B. Employers Liability Insurance: Part Two of the policy'applies to the work In each state listed In Item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1 ,000,000 each accident ' Bodily Injury by Disease $ 1 ,000,000 policy limit ` Bodily Injury by Disease $ 1 ,000,000 each employee- j C. Other States Insurance: Part Three of the policy applies to the states, If any, listed here: AK AL AR AZ CO CT DC DE FL GA HI IA .ID IV IN KS.KY LA MD ME MI._MN MO MS MT NC NE NH NJ NM NV NY OK OR PA SC SD TN TX UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE-'WC990612 ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. k All Information required below Is subject to verification and change by audit. Remium Basis Rate Per. Estimated aassifications z Code Number Total Remuneration $100 OF Re. Premium 0"Annual❑3 Year muneration Annual ❑3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE- WC7754 TAXES/ASSESSMENTS/SURCHARGES. $7,725 'EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $338 MA MINIMUM PREMIUM $500. MA TOTAL ESTIMATED ANNUAL PREMIUM $223.760 If indicated below,interim adjustments of premium shall be made: ❑ Semi-Annually - ❑ cluaRerly ❑ Monthly A DEPOSITPREMIUM -$223,760+ 09/05/13 CHICAGO 02 Issue Date ° o '• • ,` _ Iseuing Office° z Authorized Representative WC 00 00 01A 39967,(f31Jd OM08) � Archive Cpy. - . Mass. Corporations, external master page Page 1 of 1 1a rWilliam Francis Galvin Secretary of the Commonwealth of Massachusetts r d� Corporations Division Business Entity Summary ID Number: 743061483 Request certificate New search Summary for: G. GREENE FOUNDATION, INC. The exact name of the Nonprofit Corporation: G. GREENE FOUNDATION, INC. The name was changed from: G. GREENE CONSTRUCTION COMPANY FOUNDATION, INC. THE on 02-18-2004 Entity type: Nonprofit Corporation Identification Number: 743061483 Old ID Number: 000823621 Date of Organization in Massachusetts: 08-15-2002 Last date certain: Current Fiscal Month/Day: / Previous Fiscal Month/Day: 12/31 The location of the Principal Office in Massachusetts: Address: 250 LINCOLN STREET P.O. BOX 160 r City or town, State, Zip code, BOSTON, MA 02134 USA Country: The name and address of the Resident Agent: Name: ROBERT L. GREENE Address: 240 LINCOLN STREET P.O. BOX 160 City or town, State, Zip code, ALLSTON, MA 02134 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address Term expires PRESIDENT ROBERT L. GREENE 48 PEAKHAM ROAD SUDBURY, MA NA 01776 USA TREASURER THOMAS BETTLE 216 EDGEWATER DRIVE PEMBROKE, NA MA 02359 USA CLERK. RENE L. GREENE 48 PEAKHAM ROAD SUDBURY, MA NA 01776 USA DIRECTOR ROBERT L. GREENE 48 PEAKHAM ROAD SUDBURY, MA NA 01776 USA http://corp.sec.state.ma.us/CorpWeb/Corp Search/Corp Summary.aspx?FEIN=743 061483&... 6/19/2014 I Fe ty h,ui wtm nt of u s Re u 'a'a"t n-i", n 0 W I d a, a d Standard's +.c os * cs 4, 3 3, ` �aH J- 01IN UOV NEY 7 a. 11 Ri� k } - £ l y g ` � e'3. 6(" Hw Wal toMA 02*51 g on, � f �� pi, ra 1 X mi s on O15 EaxxsTnBLE ' ,mg Town of Barnstable, prED MA'S A Regulatory. Services Richard V..Scali,Director Building Division Thomas Perry,CB0 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 1 v Y I; cal gg, Pt,4 P . 4PAr';as Owner of the subject property hereby authorize cr Gr-ePn P �� (_ Ca to act on my behalf, in all matters relative to work authorized by this building permit application for: s (Address of Job)' Signature of Owfier Date . Dod (/e reZ X/�4v a Print Name .. If Property Owner is applying for`permit,,.please complete the Homeowners License Exemption Form on the reverse side.: F QAWFILES\FORMS\building permit forms\EXPRESS.doC Revised 061313 I:E T"404'b G. GREENE CONSTRUCTION COMPANY, INC.: t June 19, 2014 Town of Barnstable Building Department . 200 Main.Street r b. , Hyannis, Massachusetts 02601 - To Whom It May Concern: Please be advised that John'Downey our'Director,of Safety and Operations, is.-authorized to pull, building permits for G: Greene Construction,on any project We'undertake. Should you have.any questions, please don't hesitate to contact me directly at (617) 560-1800. ` Sincerely; Robert L. Greene President 240 Lincoln'Street, P.U. Bow 398, Boston, VIA 021344318, 617.782.1100 Fay G17.782.d857 e�NSTAR one NSTAR Way �} EL EC TR/C Westwood,.Massachusetts 02090 rovJ'Al or GAS t 25 4 June 24,2014 Barnstable Building Department 200 Main Street, Hyannis,MA. 02601 To Whom It May Concern: Please be advised that David Velez,Project Manager,is an NSTAR employee,and is responsible for the project at the Company's property on Mary Dunn Road in Hyannis,Mass. G.Greene Construction Co.has been hired by NSTAR as a contractor. David Velez is authorized to represent the Company's interest as it pertains to construction on this property and management of this contractor. BY: Doug as .Foley Vice President Electric Field Operations