HomeMy WebLinkAbout0015 WACHUSETT AVENUE LA
Engineering Dept. (3rd floor) Map n1/r Parcel Permit# �V�J
House# - Date Issued 0-3 —19
Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) e Fee p2Sl
Conservation Office(4th floor)(8:30-9:30/1:00:2:00)
Planning Dept.(1st floor/School Admin. Bldg.) DIME
D initiv P an Approved by Planning Board 19
BARNSTABLE.
MASS p
UT rFO MAC IN
TOWN OYBARNSTABLE
Building Permit Application
Project Street Address A5
Village
Owner L11 Address
.Telephone
Permit Request k
e z A/ �a kl ./ CL
4
First Floor v 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 ❑ Two Family ❑ Multi-Family(#units)
Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑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
Builder Information
Name Telephone Number �)
Address License#
{�3 Home Improvement Contractor#_ IZ6 1-7 I
Worker's Compensation# �2 0
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
�4&�
SIGNATURE DATE /9F
BUILDING PERMIT DENIED FOR FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
-f, r
,PERMIT NO.
DATE ISSUED
MAP/PARCEL NO:
ADDRESS VILLAGE
A
OWNER
DATE OF INSPECTION: -
FOUNDATION _
FRAME
INSULATION v w
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL , 2
GAS: ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT. '
ASSOCIATION PLAN NO.
The Towne of Barnstable
KAM P Department of Health Safety and Environmental Services
Building Division
367 Main Stress,Hyannis MA 02601
Ralph Crosson
Office: 508-790-6227
Building Commission
Fa)c 508 775-3344
For office use only
Permit no. ,
Date a
AFFMAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"n=nstruction,alterations,'renovation,rtpair,modernization,conversion,
improvement,,removal, demolition, or construction of an addition to any.pm-casting owner 00cupied
building containing at least one but not more than four dwelling units or to sUacttues which are adjacent
to such residence or building be done by registered contractors,with cm1ain c=eptions, along with.other
requirements.
oo
Type of Worst: PW Est Cast-422�—, ,[
Address of Work: S �1 S�0 ✓
O%mer.Name- n
z�Date of Permit Application: Q
I hereby certify that: .
Registration is not required for the following rrason(s):
Work excluded by law
Job under S1,000
Building not owner-occupied
Owner'Piing own permit
Notice is herebv green that: CONTRACTORS
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH TINREGISTERED
FOR APPLICABLE HOME McROVEMENT WORK DO NOT HAVE .ACCESS TO 1H
ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner.
Date Con or naz# Registration No.
OR • ,
f
The Conrtnoti lrcalth of:l fassac h usctL1
De pa ojlrrdustrial Accidents
1- Office OflnyeV19=189S
600 !f'aslrinf'to►t Street
Boctotr. Ma.u. 02111
_ Workers' Compensation Insurance Affidavit
6 "
li •in inf rni_ion. Pi- —p I -�.
m r -
locati n
c'tv
ho #
CD I am a homeowner performing all woe myself.
❑ I am a sole proprietor and have no one work-in-- in anv cap
acity I
❑ I am an emplover providing workers' compensation for my employees working on this-job.
contnanv mime: ate- Qa7g@'t}I t PARS Reef
address: P C) Row QIn
Marston Mills MA 02648 Phone# 428 1177
insurance cn. C'rerii t- CAnerZlInG:_._. SWC 17005900
I am a sole proprietor, general contractor, or homeowner(circle arc) and have hired the contractors listed below who have
the following workers' compensation polices: n _
company name:
address
city nhonc#-
insurance r_o-. Solid sY
I 'a.�.. _ Y"' _ ..�'..Yy. ��.-_ __ _�r'^'•�.:�.-',L iT"f'•�•'-'•:S- '-T�•t•-_ _ ....-_v•...t...._..-
_..__.- ... ..- ...�.-._...-. _I_♦ J. .,- _ W-...r-:i •.wr.Jr - -w_- -I-1_!1__-_ __ - -_ - 1•- _ � L'.�i.Y• V_-�
company name:
address-
phone#-
insurance,co policy#
Attach additional sheet if necessary
�V�..r.-�._-..__!�__r,•J../..l�..��._.�_��-_.�__�_.__..r�.•�__-w.r-._..r.IG 4�Y«....t.1-__�•i.1K"iwL��LL•.1KSc'wrlL
Failure to secure coveracc as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a tine up 10 51.500.00 andior
une%cars' imprisonment as%%ell as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. .1 understand that a
cope of this statement ma% be forr%arded to the Office of Investigations of the DIA for co%•erage%verification.•.
1 do hereht•certifl•tinder t pains and penalties of pert iy that the information provided above is true and co reef.
Si^naturc
Print name ,,,.., „_ - L- — Phonc# G2a—11-17
official use onI% do not write in this area to be completed by city or.toe•n official
city or tn%vn: permit/license# rIBuifding Department
[3Licensing Board,
O.chcck if immediate response is required OSelectmen's Office 1
[3I1calth Department
contact person: phone#: r'tOther .
I
AcoRD CERTIFIC±AI"E OF LIAEI .IT' NURAfU(. Av1 z DATE
2/98
PRODUCER
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Drake,3wan & Crocker Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
lAgency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
14 Lo t's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Orleans MA 02653-0429 COMPANIES AFFORDING COVERAGE
i David D Rust COMPANY
I PhoneA Assurance No. 508-255-3212 Fax No. Co. of America
INSURED —
COMPANY
B Credit General Insurance Co.
Paul J. Cazeault etal DBA Paul COMPANY
J. Cazeault & Sons Roofing C
1 P O Box 2781
I Orleans MA 02653 COMPANY
D
COVE>Rag
THIS IS TO CERTIFY THAT THE POLICIES 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 SUBJE[;T TO ALL THE TERMS,
4 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO
L R TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION
DATE(MM/DD/YY) DATE(MWDDNY) LIMITS
GENERAL LIABILITY GENERALk.;GREGATE $ 1000000
' A ftCOMMERCIAL GENERAL LIABILITY CFP25552812 05/01/98 05/01/99 PRODUCTS COMP/OPAGG $ 1000000
CLAIMS MADE a OCCUR PERSONAL-ADV INJURY $ 500000
OWNER'S&CONTRACTOR'S PROT EA H OCCL ZRENCE $ 50 o 000
j
-- FIRE DAMAC'_(Anyone fire) $ 300000
MEDEXP(A.;.y one person) $ 10060
AUTOMOBILE LIABILITY
ANY AUTO COMBINED,INGLE LIMIT $
ALL OWNED AUTOS j- -
SCHEDULED AUTOS BO person
DILY INJU 2Y $
(Per )
HIRED AUTOS
i BGDILY I""tY
PION-OWNED AUTOS (Pe $
accident
IPROPERTYE. MAGE $
i —
Y'GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $
,NY AUTO I OTFIER THAN AUTO ONLY:
E\CH ACCIDENT $
I
AGGREGATE $
EXCESS LIABILITY
EACH OCCUf.RENCE $
UMBRELLA FORM AGGREGATE $
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND k
!ORY LP.TS EREMPLOYERS'LIABILITYEACH AC(IDENT $ 1000 00
THE PROPRIETOR/ INCL SWC17005902
PARTNERS/EXECUTIVE 08/09/98 •08/09/99 EL DISEASE POLICY LIMIT $ 500000
OFFICERS ARE.
EXCL t—
-
)OTHER EL DISEASE-•EA EMPLOYEE I$ 1000 J 0
)
j II
. t
DESCRIPTION OF OPERATION
S/LOCATIONSIVEHICLES/SPECIAL ITEMS —
Roofing
t
ERTIFICATE HOLDER —
.......
40*577777
r a I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE.LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHF,LL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND ON T E COMPANY,ITS AGENTS OR PRESENTATIVE&
+' AUTHORIZE EP ATIVE
�COkD 254(U95)>
;`UACORD COFtFORATION 1988._
g `� .,.��,n- ��' /��"�f�''-�`',-s��i�.y���"�`S`� 1...� „✓. k�r h��41. i���"%�'j�f, �� -`va� 'tY+? �, w+ fr"a �+• ift��ad,'.s v^ n•X'f` _
�HO`ME IMPR0VEMENT CONTRAGTORS. R GI TRA IONS
4 n r �,s•
� �. .•�•� � � � and fSta;nda�`ds
Boa'xd of�Bu��ldi�ng`��f2egul�ations.
"' '.> �' ...t� q�;.,., .,,�w.�.ary,rt ' .J'A'�t thus •y'"`.�'CA�:._yt�} �"'m`�' I ... i� r a, a
-� �, ,� BostcDn �Mass=achusett's ,�OZ���fl'S §� �
} � i a. n..�$ r2k �'-°r'#✓s .a x�Si r>-'';� �� I to , .. `
} O E I:MPRO.VEMENrTW00NTRtaCfiOR -
eg}� tY"atlan -1f60T `, - E�xp-rray.ron�,< ?sk
� H
INPROVEN EN- GONTRADJOR
t �a
x PAU GAZE A�ULT�& SONS 204FING fi ^` Type- �ARTNERSH
r �' -bL'9�`vl -+` t.tc a`•r���.3: t'r7 �,. ,f'" �
.4� � P`a�r J G�azeaul�t e �"� � gi � ,� Ezpirtat�on gO�� 0'
22fjGX,ddia.lt�Rd�
.� � .:Orel e'�aais MA026�58��}' '� � ��. �. � �. � I�' r •� , �' PAUI. 7 CAZEAULTn�•SONS ROOFI
677-7
�s::1'r112"I'M►.;rIT OF PIJ13t_IC SAFETY 1.36726
ONE ASI' BURTON PL(WE, R11 1.301.
8US7 CJN< 11A 021-08-'_:16:18
CONSTRUCTION SUP[HRV:C`:3OR L:[('ErISi
Number: L:xp.i.res:
CS 026325 1-012 011. 99
mr --
Restricted To: 091
3
PAUL J CAHAOL`I`
,
1585 r1A11\1 S T
,.. _..._... _.........
U S T-E R V:C L L L= r1 A (h»�i
Keep tap for receipt- and change
` t. address notification.
'" ,�'1ie �o9,v�no�uoea� o�°✓�aaoac�uaella�j '.
DEPARTMENT OF PUBLIC SAFETY ,4
C0NSTRUkI0' SUPERVISOR LICENSE F i
Nu Expires:
J
J` 11?AU1T
1585 MAIM_ T
�; OSTERVILI.E� MA 02655
RE-ROOFING
If located in OKH or Hyannis Historic District-Certificate of Appropriateness
required unless same color/same materials specified on application
Map/parcel number
Sign-offs fr in:
Tax Collector
( Treasurer
❑#'of squares of shingles or square footage of roof to be shingled
❑specify stripping old shingles or going over old roof.
If going over
❑how many roof layers existing now
❑what size are rafters? What is span?
Complete dwelling information for the Assessor's Dept. - if known
❑ Workman's Comp. form
Home Improvement Contractor Affidavit(RESIDENTIAL ONLY
Home Improvement Contractor's License
OR
0 Homeowner's License Exemption(RESIDENTIAL ONLY
Check expiration date on license
COMMERCIAL WORK-No License is required.
Fee --� ,
q-forms-PERMITS 1
Rev 6/2/98