HomeMy WebLinkAbout0015 WATSON STREET I f �..
Application number................................................
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KAM Building Inspectors Initials........,..... �..
DateIssued.....................o........................................
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Ma p/Parcel.... .................................................
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address,of Project:-`-> /5- Ala �In _;_jCl�ll G�'Ir71 S
NUMBER . TREET VILLAGE
Own s Name: �-� �Gn Ca�J l Phone-Nurnber
11 cl
cEinail-Address: 5Ph iD.-5 Od (din C611-Phone Number
Wojectcost$ ua Check one ;Residential: V.- Commercial
J _
_ OWNER'S S AUTHORIZATION i
As owner of the above property I hereby authorize
to make application for a building permit in acco ance with 780 CMR
G
Owner Signature: Date: �I(�l'1 �,
(TYPE OF WORK-
❑ Siding 12 Windows (no header change)# `7 ❑ Insulation/Weatherization
❑ Doors(no header change)# Commercial Doors require an inspector's review
Roof(not applying more than I layer of shingles)
Construction Debris will be going to
CONTRACTOR'S INFORMATION
Contractor's name
Home Impro r' ent Contractors Registration(if applicable)# (attach copy)
Co ction Supervisor's License# (attach copy)
Email of Contractor Phone number
ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
r �
APPLICATION.NUMBER............................................................
*For Tents Only*
4 Date Tent(s)will be erected Removed on number of tents total
Does the tent have sides?Yes No (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No `
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required.
Natural Gas Yes No ,if yes, a gas permit is required.
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval,
*WOOD/COAL/PELLET STOVES
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side right side
HOMEOWNER'S LICENSE EXEMPTION .
Homeowner's Name: fy) )c a p
Telephone Number �� b�/�� I ��� Cell or Work number 'j��-OW� 7 V
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures,specific inspections and documentation required by 780
CMR and a Town of Bt le.
Signature L61,Az77- Date.
APPLICANT'S SI NATURE
Signature ,� '"Date
All permit applications are subject to a building official's approval prior to issuance.
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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
Applicant Information Please Print Legibly
Name(Business/Organization/Individual):
'Address:
Cify/State/Zip: el/U / Phone#: ��7',y5�`Y
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
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 g, ❑Demolition
workingfor me in an capacity. employees and have workers'
Y P h'• $ 9. ❑Building addition
[No orkers' comp.insurance comp.insurance.
uired] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
C3. 1 am a homeowner doing all 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
employees. [No workers' 13.[__1 Other
comp. insurance required.]
*My applicant that checks box#1 must also fill out the.section below showing their workers'compensation policy information.
t Homeowners who submit.this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entitiei have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
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 here tify under he pains nd I ' of perjury at the information provided above is true and correct.
._ _ _ 1
Si afore: ' FDate:—
Ph /� 7 ��7
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#:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if
necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to cant'workers'compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Aceidet s. Should you hay a airy q.testi6ics regarding the law-&it you are;required to obtain a worke—rs'
compensation policy,please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington.Street
Boston,MA 02111
Tel.#617-727-4900 ext 406 or 1-877-MASSAFE
Revised 4-24-07 Fax#617-727-7749
WWW.Mass.gov/dia
Bk 32116 Pg57 #29788
06-26-2019 @ 11: 04a
'QUITCLAIMDEED
I,Scott L.Rolfe,Successor Trustee of the GEORGE P.NEWTON TRUST,under declaration of
Trust dated September 21,2012 and as evidenced by a Trust Abstract dated February 24,2014 and
recorded with the Barnstable County Registry of Deeds in Book 28161,Page 83
in consideration of THREE HUNDRED THOUSAND and 00/100($300,000.00)DOLLARS
grant to Michael P. Gould, Sr. and Diane H. Gould,husband and wife,as Tenants by the
Entirety,of 317 Mount Hope Street,North Attleborough,MA 02760
with QUITCLAIM COVENANTS
That certain parcel of land situated on the Southerly side of Watson Street,so-called,in that part of
g the Town and County of Barnstable,Massachusetts,known as Hyannis,with the buildings thereon
and comprising LOTS 136& 137 as shown and delineated o n a plan entitled"Map of Villa Sites,
South Hyannis Shore Co.,Hyannis,Mass.,Capt.J.D.Whidden,Gen Mgr.,January 1903"which said
V7
Plan is duly filed in the Barnstable County Registry of Deeds in Plan Book 8, Page 119 and said
parcel is more particularly described as follows:
NORTHERLY: by Watson Street, so-called,there measuring ninety(90)feet;
2 EASTERLY and by Lots 124, 125,and 126,there measuring one hundred twenty and
3 NORTHEASTERLY: 68/100(120.68)feet;
SOUTHERLY: by Lots 127 and 128, there measuring seventy and 68/100
(70.68)feet;
-b
Q WESTERLY: by Lot 135,there measuring one hundred forty(140)feet.
S Being the same premises conveyed to this grantor by deed of George P.Newton,individually and as
a Trustee of the GEORGE P.NEWTON NOMINEE TRUST which deed is dated September 21,2012
and recorded with the Barnstable County Registry of Deeds in Book 26703,Page 5.
MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY EXCISE TAX
BARNSTABLE COUNTY REGISTRY OF DEEDS BARNSTABLE COUNTY REGISTRY OF DEEDS
Date: 06-26-2019 @ 11:04am Date: 06-26-2019 @ 11:04am
Ctl#: 345 Doc#: 29788 Ctl#: 345 Doc#: 29788
Fee: $1,026.00 Cons: $300,000.00 Fee: $918.00 Cons: $300,000.00.
Bk 32116 Pg58 #29788
Executed as a sealed instrument this 26'"day of June,2019.
In the presence of
7X
Witness to Signature Scott L.Rolfe,Successor Trustee of George P.
Romw
E::� 0 jii Newton Trust
THE COMMONWEALTH OF MASSACHUSETTS
Bristol,ss.
On this 26 h day of June,2019,before me,the undersigned notary public,personally appeared
Scott L. Rolfe, Successor Trustee as aforesaid and proved to me through satisfactory evidence of
identification, which was his driver's license, to be the person whose name is signed on the
preceding or attached document and acknowledged to me that he signed it voluntarily for its stated
purpose on behalf of George P.Newton Trust.
Roxanne E.Richard,Notary Pub
My Commission Expires: 3/13/26
RICy
Q.0
=�
d/deed.TrustNewtonRolfe
NOtAR`� ����`
JOHN F. MEADE, REGISTER
BARNSTABLE COUNTY REGISTRY:OF'DEEDS•
RECEIVED 6 RECORDED ELECTRONICALLY
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The Town of Barnstable
Department of Health Safety Pnd Environmental Services
Nua _ Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Grossen
Fax: 508-790-6230 _ Building Commissioner-
SHED REGISTRATION
/S `t/,477SOAl 97 2-EF7 A1Y#A1A11Y /!I�
Location of shed(address) v 0\nF\e_
Property owner's name Telephone number
32`4
Size of Sheri Mapmarcel#
Signature Date
Hyannis Main Street Waterfront Historic District?
Old King's Highway Historic District Commission jurisdiction? Al h
Conservation Commission(signature required)
THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN
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PETITIONER. ., . ,. REG. PROFESSIONAL LAND SURVEYOR