HomeMy WebLinkAbout0255 STEVENS STREET aT
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 0 Parcel Permit#
Health Division0Qa
Conservation Division - k / �/�,(J /�'
6q
Tax Collector ,
Treasurer , l
Planning Dept. �i �w 'Checked in By
Date Definitive Plan Approved by Planning Board 'Approved By
Historic-OKH Preservation/Hyannis
Project Street Address 255 Stevens Street
Village Hyannis
Owner One Village Market Place L.P. Address 297 North St . , Hyannis
Telephone ( 508 ) 775-9316
Permit Request Building; - Tenant fitout
Square feet: 1st floor: existing 4500 proposed 2ndfloor: existing proposed Total new —0
Valuation J4 467_?, Zoning District FHB Flood Plain Groundwater Ovdrlay ;
Construction Type }
Lot Size Grandfathered: ❑Yes W No If yes, attach supporting d cument�pn. U7
cl:'
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House: ❑Yes UNo On Old King's Hig way: L&,Yes %No
Basement Type: ❑Full ❑Crawl O Walkout . O Other N/A
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: Il Yes Cl No Fireplaces: Existing New Existing wood/coal stove: ❑Yes OKNo
Detached garage:❑existing 0 new size Pool: ❑'existing ❑new size Barn: 0 existing Cl new size
Attached garage:❑existing ❑new size Shed:Cl existing ❑new' size Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial Mes ❑ No If yes,site plan review#
Current Use vacant office space Proposed Use commercial
'BUILDER INFORMATION
Name Michael Roberts Telephone Number (508 ) 775-9316
Address 297 North St . , Hyannis License# CS053861
Home Improvement Contractor#
Worker's Compensation# 5000549012006
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO2/_1��� /fir
SIGNATURE DATE 6/6/07
4 is ae Roberts
FOR OFFICIAL USE ONLY
'S
e ,
PERMIT NO. .�
DATE ISSUED `
MAP/PARCEL NO. ,
ADDRESS VILLAGE
{
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION r
FIREPLACE -:
ELECTRICAL: ROUGH A FINAL
PLUMBING: ROUGH FINAL
I R -
GAS: ROUGH FINAL
FINALBUILDING
DATE CLOSED"OUT
! 4
ASSOCIATION PLAN NO. -`"
.The Commonwealth of Massachusetts
Department of 1ridustt'ial Accidents
Office of Investigations
600 Washington Street`
Boston,MA( 02J11
wtyw,mas&gov/dia
Workers' ompenisation Insurance Affidavit: $uiiderslContractorsl ]erid p ease qi t Le ans/PluMbQfs
ARID-HeRnt Infox�ooiatio
RP
Name(S0sh=g0r'S tion/.b4ividual) S I
Address:
297 :NORTH ST.
City/SUte/Zip. H Y A N N I S 'M A 02601 phone#; ( 5 0 8) 7 7 5—9 316 _
Are appropriate box:
Type of project(required):
e you an employer?Check th
4. � I am a gerzeraT contractor and I 6- �New construction
I am a employer with have fired the sub-contractors
ernployces(full and/or part-time)_* 7, ❑Remodeling
lasted on the attached sheet
2.❑ 1 am a sole proprietor or partner- These sub;contractors have $. Demolition
ship and havc no employees employee' and have workers' 9• Building addition
working for me in any capacity. comp insirranec:+
[No workers'comp.insurance 5 We are a corporation and its !0 Q Electrical repairs or additions
required.] officers hflve exercised their ... 11.[]Plumbing repairs or. additions
3,❑ i am a homeowner doing al l work right of exemption per MGL 12.[]hoof repairs
myself.[No workers'comp- c. 152,§1(4),and we have no
insurance required.]t 13:�Qther
employees.•[Ivowurkers'
comp.insurance required-)
"A"y applicant that checks box N roust also fs71 out the sectionbeiow sbowing their workers'compcnsatm polity tLemstion.
+1,omcowncts who submit obis affidavit mdiegft they me doing all wwk acid then hire outside conttactots most'tsubmit a rot not affidavit t in Beres g such.
sheet showing the name of the sutrconttaetois an. .uatc w}u�}ecr of not those entities have
t4Contractass that check this box souse attached an additioriat thou h�n-,1ers'comp.policy number.
employoes If the pub-conrractas have employees,they sue'• provideand
fob Fite
that is rrrridir+g,rorkers coarperfsation insurance for n:y loPem Below is the po ey'
lam aR p
injbrmadom
Trisuganee Company Name: ASSOC A T E D £
#: W C C 5000549012006. EXpiration Date:
12/07/07
Policy or Self-ins,Lic.
Job3iMAddrass: 255 Stevens St . . i "
Clt�,/StatelZip Hyannis , MA 0 2 6 01
and fratlozl d$te).
Attach a copy of,the workers't:oloalieuusationpulicy dcclaratlon gage(Showing the policy numb.er Pao P
aired under Section 25A of kCTL c. 152 can lead to the imposition of criminal penalties of a
Failure to secure coverage as required
fine up to$1,500.00 and/or one-year;mprisomm,e:ot,as well as civil penalties in the form of.a STOP WORK ORDER and a e
t fhe violator. 3e advised that W copy of this statement may be forwarded to the Office of
of up to$250.00 a day again
Investi ations of t.e IA for insurance c vera a verificatio. ? rovided above is true and correct. .
do hereby certrfy under the pains and penalties of perjury t t the itrfornsalion.p
ha
' . Date: 6 6 0 7 —
1
Michael JJ. Roberts
Ph one# ( 508 ) 775—i9316 x
official use only. Do nor write in this area,to be camptt'red by city or town offciaL
i Permit[License#
City on Town.
issuing Authority(circle'prle):
1.Board of health 2.Budding Department 3-CitylT ►vn Clerk 4.Electrical)Inspector 5.plirnibing lnspector
6.Other
Phone#:
Contact Person:
03/20/2007 12:21 5087756526 HOLLY MNGT PAGE 021'03
Dstot VL3/2007 Times $442 AM TO; 0 7,13057756536 DOWling E O'Nail Pape: 002-003
Cligniii 10170 _;SJP_PEWISSETTCO
ACORC„ CERTIFICATE OF LIABILITY INSURANCE oATE(MNVOarrrYr,
02/13/07
PaoDUCER THIS CERTIFICATE IS II;SUED AS A MATTER OF INFORMATION
-wling&O'Neil Insurance ONLYAND CONFEF S t'O RIGHTS UPON THE CERTIFICATE
'pncy HOLDER.THIS CERTIF CATS DOES NOTAtMEND,EXTEND OR
222 West Main St PQ Box 1990
ALTER THE COVER ii AFFORDED BY THE POLICIES BELOW,
--
Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC e
INSURED
INSURER A: Associated 5 t� iooyers Insurance Compa
5ippewiseett Construction Corp.&Hard Nat Construction INswRERa:
297 North Street r ' ERcI
Hyannis, MA 02601 INSUR D:
COVERALLS INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TWF INSURED NAMED]ABOVE FOR THE:Pt UCY PERICD INDICATED.NOTWITHSTANDING
ANY REQUIREMENT,TPJW OR CONDITION OF ANY CONTRACT OR OTWER DOCUMENT WITH K9SK(.'T 70 WHIG I THIS CERTIFICATE MAYBE ISSUED OR
MAY PERTAIN.TIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE 7111 EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES.AGGREGATL EMITS SHOWN MAY HAVE$FEN REDUCED BY PAID CLAIMS.
T'R TYPE OF INSURANCE PQUC1f 11UN 6ER P LY EFFECTIVE PO 6Y i tQe SON
DATE INWI/Da DATI:IAaMIto LiMirt
GENLqU UA9nlT'Y EAGHOCCURRENCE i
CO141411 AL GENERAL UABI1,T'Y DAMAGE RENTED S
CIAIM,a11 0 OCCUR MED EXP(Anyorw a
PERSONAL&ADV INJURY S
GENERAL A061i E i
GEFH 6130fiE04TELUAITAPPLICS PER PRODUCTS-WUP)OPAGG I
POLICY MR- LOC
AUTOMMLF UILBILRY
COMBIN6Dsrrel>:uMiT
ANYAUT'0 (Ea10di S
ALL OWNED ADIOS
BODILY iNURY S
SCHEpW.E0AUT45 (Pw pi
HIRED AUTOS
URY
NON-OWNEDAUIOS (parudQ eA 6it) S
(Pu acaOu+lOPERTY CAAfA6E S
GARA'W L021:11 V � AUTO ONLY-FBI AMDENr 5 �
MAY ALTO OTHER TNAN EA ACC is
AUTO CN'Y' AGO 5
Exc6SSAIMERI'LIALii Try EACH OCCILFACI 6 S
OCCUR EI CLAIMS MADE AGGi G;AASE $
S
RETENT
OEDUGnULE
S
ION S
A wamim com"ISATIoN Am WCC5000.549012006 12107106 121o7l07 X s
IIMIi%Qyf B'LIAeaTTY WCsrA'1'r OTH-
ANYPROPRIETDFVPARTNEWEXEGUTNE E•LEACHACCIOM is"01040
OPPIGTiRMEMSER EXCLUDED?. 'IAI.PRAV E,L DISEASE- EMPLOYEEiSOG
OTHER�ER �IRr� -L-O1W=AeF-PD ICY L:MIT fiW0.000
O1H
DESCRIPTION OF OPERIIi I LOCATIi vOW11 E57 ENVA_U51i ADDED BY ENpOiigVENTI SPECIALPROYWMNS
Insurance coverage is limited to the terms,conditions,exclusions,other
limitations and endomenients. Nothing contained in the certificate of
Insurance shall be deemed to have altered,waived,or extendad the
coverage provided by the policy provision&
CERTIFICATE HOLDER CANCELLATION _
SHOULD ANY o0 THE ABOVE M:Wl 2901'911 BE CANCELLED UEFDRE Ti ExPIRRTION
Suffield MgmCCcrp,dtAl• DATE THEREOF,Ti1551,111%WSW'ERIMLL ENDEAVOR TOMAIL 1Q_ DAYSWRn'T'EN
297 North Street 111 TO 711E CERTIFICATE►u h i R NAMED TV THE LEFT,BUT FAILU Rr TO p0 SO SMALL
Hyannis,MA 02601 IMPME NO ORUaA71ON OR LIAMU Y OF ANY IUNO UPON THE INSURER nS AGENTS Ire
REP1111iii An .
AU7vOR4ED R�PRf56111`
ii
e -
ACORO 25(2001t08)1 of 2 #46415 LS1 co ACORD CORPORATION 1988
�'I
M.
I BOARD OF BUILDING REGULATIONS
;License: CONSTRUCTION SUPERVISOR
' Number: CS 053861
' = Birthdate: 02/13/1955
Expires: 02/13/2008 Tr. no: 18454
-Restricted: 00
MICHAEL J ROBERTS
1815 FALMOUTH RD#C6 G—
CENTERVILLE, MA 02632
Commissioner
- 4
Town.of Barnstable
R.egulatory Services
Thomas F.Geiler,Director
Building Division
RFD i TomTerry, Building Commissioner
200 Main Street, Hyannis,NIA 02601
www.town.ba-f table;ma.us t
' Fax: 508-790-6230
office. 508-562-$038
Property Owner Must
Complete and Sign TMs Section
If Using ABuilder
d
by Stuart Bornstein ,as owner of the subject property
' a ♦; Mierael. J . Roberts to-actonmybehalf;
• - 'hereby
in all
niaxters relative to work authorized bythis building pemut application for,
255 . Stevens St- ,Hyannis (VMP )
. .�. aiJob j
6/6/07
Date
Signitur of
Stuart Bornstein
print N=e
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