HomeMy WebLinkAbout0145 STEVENS STREET j .
��� _ �
����.�
r-----_____ � _ _ �_ _ _
r �
,/K7Eis�irieering Dept. (3rd floor) Map Parcel Z",5 4 Permit# "./ J
House# !� j ' Date Issued
- 1.00-4:30) Fee
. 0-2:00)
ann oFTNE rp;
19
BARNSTABLE,
MASS.
F BARNSTABLE IFDMPya F
Building Permit Application
P o ct treet Address
lage 1e
Owner Z-2,511 C Address
Telephone
Permit Request
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $
Zoning,District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes ❑No
Dwelling Type: Single Family Tr Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes 5NO On Old King's Highway ❑Yes QO
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
Builder Information
Name Telephone Number
Address License#
Home Improvement Contractor# I
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 DEBR SULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE ✓ DATE
BUILDING PE MIT DENIED FOR THE FOLLOWING REASON(S)
5�7�5
P FOR OFFICIAL USE ONLY
PERMIT•N_O.
DATE ISSUED
MAP/PARCEL NO.
Y a
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION-
FOUNDATION
FRAME
s
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL l
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
T hli`Cunlnrura�f'�ultli;aaf:1 Paascu�•Il rasctt s-
t
a' Department,of Iladu trial Accal eats
�_ 1 8MCCVf1fiY9S Ogatl,0,7S
•� iew _
•�,•: .,' Bo 12111
` Workers' Compcnsntion lnsurancc Affidavit
.�+nniirtnt inftirnintinn• _ — ^Please PR11VT•le i ilv ��~ '�V�—
jotc�n �� G�PGLGI✓cJ�l �' 6eWl t
cin ���� �.5 ��/l�/J /"//7" nhtmr" �� �Z�
Q I am a homeowner performin all work myself.
I am a sole proprietor and have no one working in any capaciry
1 am an eniplover providing workers compensation for my empiovees working on this joo.
cmmnom• n•tmr• `
cit�•� �Cj'�j�'/ �'6jy /��/!jam flftnnc�. ��jCf•�"�! z�U
insnrincc cn. 4-J�5GI/�Q�C� Lam- d7L� �iv1 � nniicti �G 1 �11( 32Z
I am a sole proprietor. general contractor. or homeowner(crrcic one) and have hired the contractors listed beiow wnc
the ;ollowinn workers' compensation poiices:
CmmC:tnP 11:-tnr•
�tltiresr
cin nhr,ne jj.
ingurnnrc rn nniie�
cmmnnev name-
adr'resa-
t its nhnne 0-
Attach additio'n2l sheet if necessary .=a..~'yR ^*_-•_ -,a."^.:.,...�- -..• :__....:�i._.,..r. •.......,:... ,.�,.v ,e�. ,.: .: _ �,. _..•.. ..-
F:ttiurr to scrure ctivernze as required ndcr section-15A of 51GL 152 can iczd to the imposition of criminal penalties of a fine t 51.500.UU anti
unc v cars' imprisonment:is wen as civii penaftics in the form of a STOP WORK ORDER and a fine of S100.00 a dap•against me. 1 understand tha
cop} of thi.,�tatetttent ma%-be fonrardcd to the voice of Investigations of the DIA for coverage i•erification.
I uo hereht•ccrni 'wil r the pain 3 tf enndtfes of perjurt•that the infoPr melon provided abode is true and correct.
Si_..^.attsre ✓ Date
Print namc Phonte'
NX,41*6 V,
ti
*• s'r` v.4 4 �t` 'k�'eV'4 �+sr'x'€''c�'u"t ^.tt`'Fp'�. �M x.'� �est r� ^,+'•-1 t .l •-�S.
ot�lClal U5C Gn11 da gat rertteys t)flt�aeraaato•lie t®anpdt cii � or aQ t of�tc�al
�p
}at��,+��`�-' ��' r`i.' M82nt2�fiCkPtSt'.I�- * ..t"-St3�lltjltl d„�, 9rifi�nY 4_
�'�r�i r[ -uup� rvpwY .' 3 �.o��t�j�„�;r. �,f^ r .� aY.� ,h•- g:..p k x9'�'' -ie�1,;.� '§'M ��b
,�i ; 3, .: ... * � F�
. x 3nt4tt6�7�"ret1Glre ' t'R =l,o.�ti v?�.;i t c,�' ✓ l•'C��a �`s�`, mot?� ,y= .
Infdrtnation�land Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide worlcers'compensation
employees. As quoted from the"'1a��". all e»rpinree is defined as every person in the service of another under
contract of hire, express or implied. orni or wrindn.
An e nrplt trcr is defined as an individual. Partnership, association. corporation or other legal entity, or any two
the foregoing eng.1;_ed in a joint enterprise. and including the legal representatives of a deceased employer, or
receiver or tntstee of an individual , partnership. association or other legal entity, employing* employees. Hon
o\\Iner of a dwelling, house having not more than three apartments and who resides therein. or the occupant of
dwelling house of another who employs persons to do maintenance , construction or repair wort: on such dwe!
or on the ,rounds or building appurtenant thereto shall not because of such employment be deemed to be an er
�,/1GL chapter 152 section 25 also states that every state or local licensing ncrcncr• shall withhold the issuanc
renewal of a license or permit to operate a business or to construct buildings in the conimonivenith fora:
applicant ivho has not produced acceptable evidence of compliance with the insurance coverage requires.
AddMoraIly. neither the commonwealth nor any of its political subdivisions shall enter into any cot7trac: for tl:
nce of compliance with the insurance requirements of this c!
periorn7ai7ce of Public work until acc:pYab(e evide
been presented to the contracting authority.
.-kllillicants
Pi:rsc till in i}he �vorl:ers' compensatiot7 affidavit coinpieteiy, b} clhec kin_ the box that applies to your situ:.tio
suopiyin_u company names. address and phone numbers as all affidavits may be submitted to the Department o:
Industrial .-accidents for confirmation of insurance -overz_e. Also be sure to sign and date tiic atlaciavit< T
a>:tidavit Should be returned to the city or town that tine appiication for the permit or :ic -se :s being ;e«udsted-
not Phe Departm
ent of Industr lai ,Ac ciddems. Ellouid, `you have any -questions rding the , law- Or ':r `toll are
to obtain a workers' cothipeihsation polic_ . please Gail the Department at the number listed beiou.
Olt ter row n.
� •�
Please be sure that the at�davit is complete and printed legibly. t ne Department has provideda space at the be
the aff3dzvIt for you to fill out in the event the Office of Investiptions has to contact you re`arding the applical
be sure to fill in the Permit/license number which will be used as a reference number. The affidavits maybe pet
the Department by mail or FAX unless other arrangements have been made.
The Office of Irivestications would like to thane: you in advance for you cooperation and should y_ou have any a
please do not hesitate to give us a c-a 11.
The Department s address telephone and fat: number~
n. sC WP•t^"".�'1 fW u'ei- 1-Le "Its -� '-` '� ,± '4 n ., ... ,
1'agceiaaiaa®nW6IthOfassachusetts
k'T � w'td7a-`.tz $w..�#-x iSz}'r"• - {
< a y
Depart 6i ®f4,41.1i tra ccgeicnts
nk" E bed�so g
�����
h ka�"t'�j� ^` N ;�� �x et/e y"'.r�" k^ ="r5'+>s -..:�'�u` e '�.W,y ��', /T`./�3//��.•. ,'`ISO,
�� sr .V• "Y.'jx„TY"`,S{ *�,�c'.
DATE:. :.D o::::::::..w
:. :.
:........ :..................................... TER OF INFORMATION
cERCERTIFICATE IS ISSUED AS A MATT�PRoou THIS
Dowling & 0' Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Agency, Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
g Y, ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOWi
222 West Main St. PO BOX 1990 _COMPANIES AFFORDING COVERAGE
Hyannis, MA 02601 COMPANY
AAssur. Co. of America
INSURED COMPANY Y Y
Bortolotti Construction, Inca BMar land Casualty
PO Box 704
Marstons Mills, MA 02648 coMCPANY
COMPANY
'r17cEf �-a D
s ::: .'•::':::;::::: ':':':::;:;:;: ;r ':':i:` ';:?; ::;:;"': ';'' ::: :: ::?:2:::?:::::;;:2:::::: ':;:':%%Y:::%:::::%<:':::'` ::'::::: 2 :::''::`:::` ":' :::::'::::::::::::;:%:":':':: :�:'`:':: :::
THIS IS TO CERTIFY.THAT THE POUCIES 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.
CO TYPE OF INSURANCE POLICYNUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS
LTR DATE(MM/DD/YY) DATE(MM/DD/YY)
A GENERAL LIABILITY TDP28407519 03/07/96 03/07/97 GENERAL AGGREGATE $1 000 000
X COMMERCIALGENERAL LIABILITY PRODUCTS-COMP/OPAGG$1 OOO 000
CLAIMS MADEFX OCCUR PERSONAL&ADV INJURY $500 OOO
X OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $5 0 O O O O
FIREDAMAGE Anyonefire $5O OOO
M ED EXP(Any one person) $10 000
B AUTOMOBILE LIABILITY CA90521170 03 07 96 03 07 97 COMBINED SINGLE LIMIT $500, 000
ANY AUTO
ALL OWNED AUTOS BODILY INJURY
X SCHEDULED AUTOS
(Per person) $
X HIRED AUTOS BODILY INJURY $
X NON-OWNED AUTOS
(Peraccldent)
PROPERTY DAMAGE $
GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
ANY AUTO OTHER THAN AUTO ONLY:
EACH ACCIDENT $
AGGREGATE $
EXCESS LIABILITY EACH OCCURRENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM $
A WORKERS COMPENSATION AND TC 7 9 1 14 3 3 2 2 0 3 0 7 9 6 0 3 0 7 9 7 STATUTORY LIMITS
EMPLOYERS'LIABILITY EACH ACCIDENT $100 000'
THE PROPRIETOR/ INCL DISEASE-POLICY LIMIT js500, 000
PARTNERS/EXECUTIVE OFFICERS ARE: REXCL DISEASE-EACH EMPLOYEE $l0O 000
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS
Operations performed by the named insured as provided for by the terms
and conditions of the policies .
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
Town of Barnstable EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVORTO MAIL
Engineering Deptment J_O_DAYS WRITTEN NOTICE TOTHE CERTIFICATE HOLDER NAMED TOTHELEFT.
367 Main Street BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
Hyannis, MA 02601 OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
.........................1......
............................................................ ...:....::::.: :.....:':•::•:::::::.. .. : '
:::::::::..::.::..:::.........:.:.......:........................................................i�13........................................................................
• 4
Barnstable
47 i Yarmouth Road
P.O.Box 326
C O M P A N Y Hyannis, Massachusetts 02601-0326 '775-0063
2/25/97
TOWN OF BARNSTABLE
BUILDING INSPECTOR
TOWN HALL
HYANNIS MA 02601
REGARDING: Water Service #1548 151 Stevens Street
Water Service # 959 145 Stevens Street
Water Service #2535 278 North Street
Water Service #4651 270 North Street
Water Service #3103 270 North Street Rear
Dear Sir,
At the request of the owner, the above water services
were shut off at the curb stop at the main on 1/8/97 and
terminated for the purpose of demolition of the buildings
thereon."
Sincerely,
B RNSTABLE WATER COMPANY
w
Commonwealth Electric Company
2421 Cranberry Highway
COMBO))CdcWareham, Massachusetts 02571
Telephone (508)291-0950
484 Willow Street
Hyannis, MA 02601
Bortolotti Construction Company
Re:Building demolition Stevens and North Streets
To whom it may concern;
This letter i -to inform that the 4 services requested for disconnect, have been
disconn ed.
i
e ruly ours,
ar B. French
Custome Service Supervisor
RBF/jgm
To:', edrLo].oti,1. collsl.j tid,lon From: BONNIE FIGUEROA 227 97 It 28arn 1). 2 of
%,0LONIAL
G A b C 0 M P A N V
A[A 02664
27, 199'.7
27()A, 270T3 & 278 North St'i I-eel;
5 V, 1.51 Stevens Street.; flvaalus, MA
Tlws 1'etteris to coill.imi I hal (here a.re 110 1111( -is 1-1 JeFgV(.)L111d 11(iltn".11 :;1cm ies to 11i,eabove
I-Aerenced property. I'lils was con'lirmed by our represQ-jlitafive oii Feblll:U-y 2( , 199T
Sincerely,
Eaaocee �eqc,(,maa
13 1',
Distributi(pri Deparlmept
(.)R1(j1N1A1, S,I.(..NI-,T-) 2/27/97
_301 � 2�3 �
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type) 457 5-05
Mass. Date 199_ Permit *
;�I Building Location 145 Owner's Name
%4"AAA Type of Occupancy
ckw
New Renovation Replacement ^ Plans Submitted. Yes` No
N
¢
N W n
Y 2 ¢0 ,
/1
N N U
W W ¢ O u m ►- = n
u N
cc
C u < ¢ ¢ O
6 m W A J W O A d C a
fA ¢ N W = < � W S ¢ O W W ¢ W W
(7 a 2 J 1- z W W G7 O > W F C. J 1- W
< W W 7 < S < < O O 64 O Si �-
¢ O 0 J u ¢ > O a 1� O
SUB—BSMT.
BASEMENT
1ST FLOOR
2NOFLOOR
31RD FLOOR I
4TM FLOOR
STlI FLOOR
eTM FLOOR
TTH FLOOR
BTN FLOOR
Installing Company Name SNnwl s PT.iTMRTNr & HRATTNr. Check One: Certificate
Address P.O. BOX 39 Corporation
W BARNSTABLE, MA 02668 Partnership
Business Telephone 362-9111 Firm/Co.
Name of Licensed Plumber or Gas Fitter CHRISTOPHRR SNnW
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes MC No ❑
If you have checked yg, please indicate the type coverage by checking the appropriate box.
A liability insurance policy Other type of indemnity❑ Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by
Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement._
Check one:
OwnerC Agent C
Signature of Owner or Owner s Agent,
hereby certify that all of the details and information I have submitted(or entered)in above plication are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the permit issu s applicatio will be in complian ith all
pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gen
By T of License: `��;
Of
gn r or ittw
Title Gastitter
Master License Number 10705
ON/Town Journeyman
I - 2 q 5
1