HomeMy WebLinkAbout0316 SEA STREET (4) 0
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Engin. rin'g Dept. (3rd floor) Map !I 4 O
House# 1 (6 Date Issued
Boith( rco (8:159�30/.1:00-4 30) 2(0C_ S Fee.
Conservation Office (4th floor)(8:30 9:30/1:00 '2:00) (� L e�M
Planning Dept. (19t floor/School Admin.Bldg.) D `oFtHE►o,;ti �� a.�t
0.4ayl DO F
Definitive Plan Approved by Planning Board 19
MA9S � <Q V
TOWN N OYBARNSTABLAJ rfDMA�A l� Q0
Building Permit Application
Project Street Address 3 I S en �� t
Village I'd IRA w in i
Owner CA. �De C,,N1)r; `l�S S 6 C i Address 3 16a L S'T
Telephone r i pco�<; i
Permit Request �e I�ic �nlS n4Scf'v-ne_ ti1`�i�' f.-Cect Din
First Floor square feet Second Floor' square feet
Construction Type '
Estimated Project Cost $ 104o.00
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
- units
Multi Famil #
Dwelling Type: Single Family ❑ Two Family ❑ y( ) l•
Age of Existing Structure - Historic House ❑Yes tS No On Old King's Highway p Yes `&No
Basement Type: 'Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths:' Full: Existing New Half: Existing New
No.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
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size)
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial ❑Yes ❑No If yes,site plan review#
Current Use Proposed Use
�gg— Buildeeinfo-_ afion _
Name Ke'C,r t.�V 0.YACL f Telephone Number 44
Address �] �V in i��nn v.Y �- . License# 10 d0 .4
D I(MI Home Improvement Contractor#
r Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �gGO`y3rt �-�
SIGNATURE DATE
BUILDING PERMIT D NIED FOR THE FOLLOWING SON(S)
1' P 1 ��/ ►�
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DEPARTMENT OF PUBLIC SAFETY .
CONSTRUCTION;SUPERVISOR LICENSE j.
Nu�ber Expires:
Restneted To. IG
KERR1'-N'�NCNANARA
two BOX 1144
OSTERVILLE, NA 02555
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:. One 'Ashburton Place Room 1301 ate ' �e ate"
Boston Massachusetts 02108 a �t ;u ��
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HOME IMPROVEMENT CONTRACTOR a "
Registration 118118 Expiration 02/01/99
a t �
TYPE:. PRIVATE CORPORATION # rt y 4r� a;
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OE ll TOR
F, Y r HOME NPROVENEN W RAC
'Al
t� Registration f18118 ��t
:CAPE COD & ISLANDS PROP MNGMNT e N � r
KERRY ..M . :MCNAMARA N z r� � � Type PRIVATE CORPORATION
37 WHITMAR RD F sRam
rzpiration 02/01%9�
�kC� cIN
she
S MA 02648 4 £
MARSONS MILL CAPE CUD 6 ISLANDS PROP MN61
E
KERRY ,`MCNAMARA �,
NITM R RD
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fps 'r4 noMINISTRnTOR ARSONS HILLS MA 02648
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ariastable
TheTownofB
g� Department.of Iffe-alth Safety and Environmental Service..
y„eI Building Di isloII
367 Main Strom Hy=is MA =501
Uph C
Office: 508-7 90-6Z7 Building C.:
Fax: 508-;90-6Z30
For afftce use only
Permit no.
Date AFFMAVIT
VF.� .
ROME IlYIP RO 'ViENT CONTRACTOR LAW
SUP13LEMF,-4T TO PERMIT APPLICATION
L c. 14ZA rc uires that the arcconstructton, alterations, renovation, repair, moderni=lien.
MC 4 rc-ezisrin�
conversion, improvement, removal, demolition, or constracdon of as addition to any
p
owner occupied building containing at least one but not mare than fou ie cloy�ct0 ,®wit
structures which arc adjacent to such resideencce or building be done by regis
her re utre
I
with of 4
certain exceptions. g
Est. Cast oo
Type of
Address of Worst: a`
�SSc�G -
Owner's Name
Date of Permit Application:
I hereby certify that:
Registration is not rer;uircd for the following re::san(s):
_ Work excluded by taw
Job under Si,000.
building not owner-occupied
iIlng Own o
permit
Owner puffing
'Notice is hereby given that: UI�IREGISiF.RErJ
OWNERS PULL G THEM O«N PERMIT OR DEALING WiTA
OVEIVIENT WORK
CONTRACTORS. FOR APPLIC.�BLE RAM OR GUDO- NOT HA ECOME ARANTY FUND UNDER MGL 4ZA �
ACCESS TO THE.�iTRATION PROG
SIGN FM UNDER PENALIZES OF PE1'
I hereby
for ermit the agent of the owner.
Conirnerar Name
R�tranoa-No.
Date
The Commonwealth of Alassachuseffs
121 ; Dt:partnunt of Industrial Accidents
Of 19MV92AMS
•VI
600 Sire
Boston. A1asv. 0 111
Workers' Compensation Insurance Affidavit
li :tot information:
name: h e- C� YY( NV Leta,ev-!a
Incition: BOX 1144 (� S�l'/ri1 ��,1� �at () 2rP,56
gftL
nfitmc)y
CD I am a homeowner performing all work myself.
1 am a sole proprietor and have no one working in any capacity
• .. _-.s. ...•wy-..�—.s-•..._.......-..n.+.�.+-....er.r•�++f�a.^+...m+/.%7>^:.:I•r.'..^+,.!.!,�.!.+�a�.w.�.,�.....�•�....�..r+ .t.++�•..•....�...•...q,-..._....�_.. ...w.a
"T am an emplover providing workers' compensation for my employees working on this job.
.cn►nnanv name:
address,
city: nhonc#•
insurance co. noiicv#
[j I am a sole proprietor. general contractor, or homeowner(circle wte) and have hired the contractors listed below who have
the.following workers' compensation polices:
comnanv nnmc: 1' Vl�'-i• 0 VVt2,1
addre55: �Z2.. ;�. •'�`11�1� C 1
cio,: Phone#• "t Z.g oSo
insurancr ro. naiics
cnnir7anV nntne: - -
address
city: phnne#•
insurance co. noiici•M
Attach additional sheet f necessary. ..• _ I't`...%.•...,�,r`".".' _'"' '_._'_'�.�
Failure to secure coverage as required under Section=5A of 111GL 152 can lead to the impositiony of criminal penalties oi'a line up to S1.500.00 ndiur
unc years'imprisonment as well as civil penalties in the form 0172 STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a
cope of this statement ttta% be funvardrd to the Office of Investigations of the DIA for coverage verification.
1 do herehr ccrti u/cr tilt pairs d prnaitics njperjun•that.the information provided above is true and cor�eyc{1.
SiEmature Date �52 rU
AU
V q vY1Q�` Phone['tint name
�r
official Ilse univ do not write in this area to be compacted by tiny or town official
tin or town: permit/license# rIBuilding Department
Licensing Board
I] check if immediate response is required (]Selectmen's Uffice ►_
C]ticalth Department
contact person• phone#: rjOther
rx a • • • •
GRANITE STATE INSURANCE COMPANY 13102 36818 WC 354-14-6"9
SEND CORRESPONDENCE TO:
AMERICAN INTERNATIONAL.CO.
PENNSYLVAN I A P.O.BOX409
'' '� • • • •' :• • •• • • • .. s PARSIPPANY, NJ 07054-0409
PHONE: 1-800-645-2259.
CAPE COD & ISLANDS PROPERTY MANAGEMENT, Member Companies of
°0 BOX 1144 American International Group
DSTERVI LLE MA 02655-0000 EXECUTIVE OFFICES:
70 PINE STREET, NEW YORK,N.Y. 10270
1.D# •• ••
WORKERS COMPENSATION AND DOWL I NG & O I NE I L INSURANCE AGE
EMPLOYERS LIABILITY POLICY 222 WEST MAIN . STREET
INFORMATION PAGEP 0 BOX 1990
HYANNIS MA 02601
1SURED IS CORPORAT ION PREVIOUS POLICY NUMBER WC 3355303 (RENEWAL)
)THER WORKPLACES NOT SHOWN ABOVE
e`Po1 2 POLICY PERIOD 12:01 A.M.standard time at the insured's -
mailing address FROM 0 1/1 5/98 TO 01/15/99
EM3 A. Workers Compensation Insurance: Part.One of the policy applies to the Workers Compensation Law of the _
states listed hero:
MA
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 $ 100,000 each accident
BodilyInjury b Disease $ 500,000 J Y Y policy limit
0,
Bodily Injury by Disease $ 10000each employee
C. Other States Insurance: Part Three of the.policy applies to the states, if any, listed here:
SEE ENDORSEMENT WC 20 03 06A
=M a The premium for this"policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans.
All information required below is subject to verification and change by audit.
Estimated Total Rate Per Estimated
Classifications Code Number Remuneration $100 OF Re- Premium
® Annual ❑ 3 Year muneration ® Annual ❑3 Year
SEE ATTACHED SCHEDULES
TAXES/ASSESSMENTS/SURCHARGES $98
DENSE CONSTANT(EXCEPT WHERI:APPLICABLE BY STATE) $1 90 MA
JUVIUM PREMIUM$ t,00 MA TOTAL ESTIMATED PREMIUM
- $2,645
ndicated below, interim adjustmer"ts of premium shall be made: /
❑Semi-Annually ❑ Quarterly ❑ Monthly DEPOSIT PREMIUM$ 2,645
ENDORSEMENTS(FORM NUMBER) .
SEE ATTACHED SCHEDULE
01/29/98 ASSIGNED RISK 66 y6
Issue Date Print Date: 01/29/98 Issuing Office
967 Authoriz Representative WC 00 00 01
INSURED,S'ropy
DECKS
If located in OKH or Hyannis Historic District-Certificate of Appropriateness is needed
Map/parceliumber
Sign-offs fr7th
:
He
_ Conservation
Tax C lector
Owner's nam &,dddress
Deck D' nsions
Estimate Cos
Complet dwelling info 'ion for the Assessor's dept.
Applicant's telepho a number
Plot an
Two sets of plawith cross section
Workman's Comp. form
AiomP vemen e^ artnr'S Affid va it
c ' per s se AND Home Improvement Spe ' se
OR
o caner i~ xe do
c exp' eon license s
, `Ch xpiration da
e
q-forms-PERMITS 1
Rev 6/2/98