The URL can be used to link to this page

Home My WebLink About0006 STANLEY PLACE G S%7n/vim {�Gflc6 J . _ - - - � — J -- - -- F. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel pplicatio3 n0'4 v Health Division I Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street AddressAf � Village Owner -el Address Telephone 77,t;�0 2 73 Permit Request 1211z d�eeA�5* '01 5k-z elkss Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay, Project Valuation �oo, o Construction Type_ 0 %o� 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 ANo On Old King's':Highway: L*Yes.'::�(No `== ' Q-A CD Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other i `11 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft), Number of Baths: Full: existing new Half: existing neo 5 CD Number of Bedrooms: existing —new r 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 Telephone Number J,4= Address _1�r_4�e i��p �j;r2 License # Home Improvement Contractor# Email Worker's Compensation #f�vL,L¢Dds'"2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I L ,.r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. A j ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING D'ATT&CLOSED OUT ARS4,7 ION PLAN NO. 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 AoAlicant Information Please Print Legibly Naive (Business/Organizadon/Individual): z•��4� G, J��,�� e --------- Address:City/State/Zi oZ 4hone #: �,� ' Z /4- Are you an employer? Check the appropriate box: q employer � 4. .❑ I am a general contractor and I Type of.project(required): 1. I am a em 10 er with '� employees (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 8. ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp. insuranceJ 9• ❑ Building addition required:] 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doingall work officers have exercised their . 11.❑ 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 3a.❑ I am a homeowner acting as a employees. [No workers' 13.0 Other/,�/'�,� general contractor(refer to#4) comp. insurance required.]. Any applicant that checks box#1 must also fill out the section below showing their workers'co t mpensatiot#policy infotma4lon. Homeow Homeowners who submit this affidavit indicating they are doing ail work and then hire outside contractors must submit a new affidavit indicating such, I tContmctors 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 employ=,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. w Insurance Company Name: 4� �,f/?j Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: 'Z�"/jCity/State/Zip: ,G} 6 Z 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 cernfy u ,n�W the pains and penalties ofperjury that the information provided above is true and correct r St a Date. ,g Phone #: 4 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#: r «� / . F l l�r �T CAPECOD-27 KLI CERTIFICATE OF LIABILITY INSURANCE cETT _ DATE(MMIDO/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION.ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS id 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 INSURERS ,AUTHOR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ) AUTHORIZED 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 Rogers&Gray Insurance Agency, Inc. CAMenCT Barbara DeLawrence 134 Rte 134 PHONE _' iouth Dennis,MA 02660 ra/c.No Xt F Ne; 877 816-2156 EMAIL J 1 ADDRESS'bdelawrence@rogers2ray.com INSURERS AFFORDING COVERAGE — INSURERA:Peerless Insurance Company _ NAIC# LRI _ INSURERS:COMMERCE INSURANCE COMPANY pe Cod Insulation Inc INSURERC:Evanston Insurance Company Reardon Circle INSURERo;ATLANTIC CHARTER INSU AR N EC GRQUP th Yarmouth, MA 02664 . . .. INSURER E; :OVERAGES INsuRERF: • . — CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NIA O D ABOnVEE 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,. E CL USIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS. 'R TYPE OF INSURANCE So �B POLIC POLICY EFF POLICY EXp X COMMERCIAL GENERAL LIABILITY Y NUMBER MMIDD/YYYY MMIp /Y LIMITS _4- l CLAIMS-MADE CX)OCCUR CBP8263063 EACH OCCURRENCE 04/01/2014 04/01/2015 c10 RE_NY -- $ 1,000,000 PREMISES(Ea occurrence) _ $_'_ 100,000 MED EXP(Any one person) $ 5,000 G N'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY r $ 1,000,000 POLICY I l PRO- (� -JECT LOC GENERAL AGGREGATE $ 2,00.0,000 l� OTHER PRODUCTS-COMP/OP AGG $ _ 2,000,000 AUTOMOBILE LIABILITY — $ Y r COMBINED SING E LIMIT t! ANY AUTO 14MMBCKVMK Ea accident _ $ 1_1000,000 !.. AUTOSALL NED X SCHEDULEp ` , 04/01/2014 U4/01/2015 BODILY INJURY(Perperson) $ AUTOS �_ HIRED AUTOS X NON-OWNED' . BODILY INJURY(Par accident) $ AUTOS PROPERTY DAMAGE -- Per accident $ X UMBRELLA LIAR X OCCUR $ EXCESS LIAR CLAIMS-MADE XONJ453514 EACH OCCURRENCE $ 1,000,000 04/01/2014 04/01/2015 DED X RETENTION 10,000 AGGREGATE $ WORKERS COMPENSATION Aggregate AND EMPLOYERS'LIABILITY $OR 11000,000 EC H ANY PROPRIETOR/PARTNERIEXUTIVE YIN/—N^� WCA00525904 STATUTE OFFICERIMEMBER EXCLUDED? 1 I N/A O6I3O/ZO14 06130/2015 ---(Mandatory In NH) t—_l E.L.EL.EACH ACCIDENT $_ 1,000,000 It es,CRIPTION OF OPERATIONS below describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,00 ' DES E.L.DISEASE.-POLICY LIMIT $ 11000,000 j �RIPTION OF OPERATIONS?LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may ba attached if more space Is requlred)a Sere Compensation Includes Officers or Proprietors, tlo ai Insured status Is I provided under the General Liability and Auto Liability when required by written contract or agreemenCwith the Certificate Holder.k ITIFICATE HOLDER CANCFI I ATinN Massachusetts -Depattme'nt of Public Safety ".;860rd of Building Regula;eons Intl Standards .� Cunstnrction Supenisor License: CS-100988 1.C1�,lVItY.F CASSLI)i( 8 SILED.ROW r1. WEST YAWYLU VILL 2` r ,... Expiration Commissioner 11/11/2015 �4 ,", � CL�YI/y12c� z�r�eczi/�L �iG��acl�GGJfI`� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massach>:lsetts 02116 Home Improvement Coy, ragtor Registration Registration: 153567 Type: Private Corporation - i•y6= Expiration; 12/15/2014 TIC' 233831 CAPE COD INSULATION INCH.: r � HENRY CASSIDY 18 REARDON CIRCLE" SO. YARMOUTH, MA 02664 ' Update Address and return curd. Mark mason for change, .,uRl u;✓i i 0 Address E] Renewal L ncployment [-� Lost Cnrd ?.`�e��ac'6udet UtFive of Consumer Aftair•s Sr.Business Regul„6011 License or registration valid for individul use only before the expiration �. S-- OME IMPROVEMENT CONTRACTOR data. If found return to; V euilstration: 153. 67 Type; office of Consumer Affairs and Business Itebullition s xpiration: 12/1-5/201 Private Corporation 10 Parlc Plaza-Suite 5170 Boston,MA 02116 �t(c)N INSULATIQN,i;IMCr _ CyICASSIDY SEA"DON CIRCLE YA MOUI f-i, MA 02664 'Undersecretary of Val' witho t nat ro ' r, �^ OWNER AUTHORIZATION FORM A q%N� ' (Owner's Name) owner of the property located at (Property Addr ss) (Propedy Address) n- 1 , hereby authorize �—o S �a�l eNj (Subc=foeR an authorized subcontractoEngineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature 7A 6/,/4- Date ' Town of Barnstable *Permit# 9 Expires 6 months rr.Issue to Regulatory Services Fee ` Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 ®�REsS SIT www.town.bamstable.ma.us PEW Office: 508-862-4038 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint "rO Or B��NS��L lap/parcel Number Toperty Addresshz /4 idential Value of WoS 8D®, o Minimum fee of$25.00 for work under$6000.00 )wner's Name&Address S' ;ontractor's Name Telephone Number O lome Improvement Contractor License#(if applicable)_ C �6� li ;onstruction Supervisor's License#(if applicable) Korkman's Compensation Insurance Chec ne: 2-1 am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance isurance Company Name Vorkman's Comp.Policy# A3 T? tr -7 6l a r" o,_ ;opy of Insurance Compliance Certificate must be on file. ermit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) O Re-side ❑ Replacement Windows: U-Value (maximum.44) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. IGNATURE: :Foans:expmtrg evise071405 r(.e Board of Building Regulat ons an Standards One Ashburton Place - Room 1301 Boston. Masj%tr setts 02108 Home Improvemenactor Registration Reqistration: 142994 Type: DBA � r Expiration. 6/8/2006 WAYNE DOWNEY GENERAL CCu WAYNE DOWNEY h 99 NORTH DENNIS RD. S.YARMOUTH, MA 02664 W Update Address and return card.Mark reason for ckang Fj Address [] Renewal Employment Lost Card Co 50M-04l04 G101216 . oFtHE Town of Barnstable Regulatory Services - BAMSTnat.E.. . y� Mnss. g, Thomas F. Geiler,Director prE 639.a 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 I, -)W 'J )o , as Owner of the subject property hereby authorize OA`8t �0��_E`l to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) 74 Signature of Owner Date Print Name Q:FORM&OWNERPERNESSION