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HomeMy WebLinkAbout0142 WAYLAND ROAD I y- ,2 Ok Assessor's map and lot number ................... .................. %TrHE to t-'!'Sej"e Permit numbe'r ......... ........................ 11 33AUSTl1DLE, MAO& House number ... ...... i...............................;.............. 1639- mit TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION ..... Xp!!j..Tramp, ............................................................................................................. ...........................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Lo��..#...kl.tj..... ..................................................: ..P1 A Location ..... .... .. Hn ....MA.................................... ProposedUse ............................................................................................................................................................................. Zoning District ................................................................Fire District ......................................................... Name of Owner C.a.,pri.qp......................................................rn ReaMq, Address ..265..D70-nionth..ROAAL�:...H Y,?,n n ............ . .. ....... .... Name of Builder-F.ranco....Rea.1...E.s.ta.t.e...Dev,....9�Adclress ...7.65...Fa.lmo.u.th...Ro.a.d.....Hyanni.s............ .. ....... .... .... .. .. .. .. .... .. .. ......... .. .... ..... ....... .. .... ..... .. .. . ..... .......... .. Inc. Nameof Architect ............................ ...............................Address .................................................................................... Number of Rooms .........S.i:: .................................................Foundation -P.!%P it...................................................... Exterior 9laRbq.a.rd...and./o.r....s.hinal.e.s..................Roofing Asnbalt Shingles .. ..... ....... .... .. . .. .......I... . .. ..................................................................................... Floors ....................................................................Interior ........She ........14o.ck.................................................... Hea* ting-G.a.c;........ .....................................................Plumbing ....... ..............er............................................ Fireplace ......None .......................Approximate Cost ......................................... Definitive Plan Approved by Planning Board --------------------------------1'9�L-- Area : ..:... .......... Diagram of Lot and Building with Dimensions 5-0 Fee .... ................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH . AJ OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. No me CAPRICORN REA TY TRUST A=271-205 71 -- �05. 2-4137 One Story No .... ...........z Permit fo .................................... Single Family Dwelling ............................................................................... Location ;At...444......1AZ..Wayland...RQad Hyannis ............................................................................... Owner ,Capricorn RealtX Trust , Type of Construction Frame ................................................................................ Plot ............................ Lot ................................. Permit Granted June 16, Date of Inspection ....................................19 Date Completed ......................................19 .�F3 ssesdor's map,and lot number ....................��:.... 5....... _ 0� j 'C 7 E Sev �ige Permit number .......... ..................1.......................... d SEPTIC SYSTEM MUST" t: . INSTALLED DAMS T!►DLE, i House number .....1......... ........ S A LED ifs COMPLIANT *O MAea ...................... ,,. WITH ?'ITLE VLAg',0DE 5 AND TOWN O F BAR ' � ,� BUILDING I.NS'PECTOR � APPLICATION FOR PERMIT TO ......................................s gle,,,Family .... A .TYPE OF CONSTRUCTION ........ ood..Frame................................................ .............................................. 1.. . .....................9` TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit 'cording to the following information: LocationLot..#... .c ....."..1. ..............................................Hyannis. ... .................................... ProposedUse ............................................................................................................................................................................. Zoning District R.B• H annis Fire District ....y....................................................................... Name of Owner Capricorn Realty„ ;Trust Address ...76Jr..ka. .I11A.1�.��?..�Qa,d,,,, yaX1I� ,U,,,,,,,,,,,, Name of Builder-Franco Real Estate Dev. C9ddress ...765 Falmouth Road,.. H yannis ..................... .... Inc. Nameof Architect ..........................:.......................................Address .................................................................................... Numberof Rooms ......... iX.................................................Foundation .. ..C...............................:................................... Exierior Clapboard and/or„shingles..................Roofing Asphalt Shingles r Floors Car .et..................................................................., Sheetrock ........ Interior .......... .................................................................... Heating-G.a.s -.-._F....W.......A........................................................... . Plumbing ......T..wo....-......c.o Per.............................................. ... .. .Fireplace None ..................................Approximate Cost g00.00 ................................................ ............ ................... . ............ . Definitive Plan Approved b Planning Board ___________________-__________19________. Area .. 9y .......... Diagram of Lot and Building with Dimensions Fee .. 7 ............................. .. SUBJECT TO APPROVAL OF BOARD OF HEALTH /J r ►V OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... .... .. . ................ . ................. ... i CAPRICORN,REALTY TRUST 2,4l37 , One Story No .... ...... One for .................................... Single Family Dwelling ............................................................................... Location .....Lo.t...#.4 4.......1.4.2....Way.land...R.d. ..... .. .. .... . . .. . ....... .. .... .. Hyannis k. .............................................................. ................... Owner ....Capricorn Realty Trust ............................................................. Type of Con"Eiru'ction ..... :4�<-Ame......................... ........... .................................................................... Plot .:.Z........................ Lot ................................ June 16, 82 Permit Gra ted ........................................19 Date oflhl's$Weior.7—. 5�5��gt......................10 Date Completed,, .............19 ! 6 s { �NAY�Air (4o'WAY) �oAD 9' jj to 4-7+ ITT 44 �Il o y� • i294-� r � � N q f(1 - ©,U -s . HCF CERTIFIED PLOT PLAN WADI EW CONSTRUCTION ONLY Ida nV4 TOP OF FOUNDATION IS 3S FEE �o�lm"well IN BOVE LOW POINT OF ADJACENT Su ���'���� ','�� 1 AASS'a OAD. SCALE: I "= SO! DATE : G/ 15 /8-L LDREDGE ENGINEERING COIN �� I CERTIFY THAT THE F�wbA-net-J -� CLIENT EOISTERE REGISTERED ei/LoS SHOWN ON THIS PLAN 1S LOCATED E D CIVIL LAND JOB NO. _ ON THE GROUND AS INDICATED AND ENGINEER SURVEYOR DR.BY, J-= CONFORMS TO THE ZONING LAWS OF BARNSTABLE M SS. 712 MAIN STREET CH°®Y` H YA N R I S, MASS. SHEET OF I DATE E LAND SURVEYOR ,, t TOWN,OF BARN ABLE. permit' No 2413 4 Buil_ding Inspector : 4 Cash , ,! X— \� ''+etlPr OCCUP/�iVCY P.,ERMIT Bond _ "No building nor 'structure shall be',erected; `and no land;building'or structure shall be' used for a new, different, changed, or.enlarged 'use',without a Building,,Permit• .therefor' first having been obtained from the Building Inspector. No,building shall,.be'occupied until a- certificate of occupancy has been, issued by the Building Inspector" Issued to Capricorn Realty Trust Address Lot #441 142 Wayland, Road Bjannis Wiring Inspector' _ ri i"�f -� r 'P.,Inspection date I, rF n' '' Plumbing mspectoi Inspection date ; Gas Inspector L`�} �Y " Inspection date S i'b l FnxA .Y (k �Z X Engineering Department `' Inspection date THIS .PER11M WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE{B. UILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. „ _. :Building 3n peetor `✓. v. t. Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee ®PReSS Thomas F.Geller,Director P Building Division AFC ,CBO, Building Commissioner TOWJV 28 2006 200 a Street,Hyannis,MA 02601 op Bq www.town.barnstable.ma.us )ffice: 508-862-4038 R�ST,q� Fax: 508-790-6230 EXPRESS PE APPLICATION - RESIDENTIAL ONLY Not Valid without Red X Press Imprint /parcel Number 17 2-cl erty Address �{ 2 LA'A (. 1 t� �, VI t41� residential Value of Work ,t5"t). 00 Minimum fee of$25.00 for work under$6000.00 ier's Name&Address ��'�.\ \ v V i y tractor's Marne_w wy-- �A eS Telephone Number_ g,5 b In ae Improvement Contractor License#(if applicable) (� izense-#(�f-app eabl-• a Vorkman's Compensation Insurance Check one: ❑ I an a sole proprietor ❑ I=the Homeowner I have Worker's Compensation Insurance once Company Name rkman's Comp.Policy# � � ���� O( � ✓ )y of Insurance Compliance Certificate must be on file. nit Request(check box) t 1 Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property wn st si operty Owner Letter of Permission. A copy e o7 e ment Contractors License is required. NATURE: �- )rms:expmtrg ise061306 1e84206216 T0:17e14551510 P.1 MARK HERBST 15 Peep Toad Rd. Centerville MA 02632 Cell phone 774-23816 - r PROPOSAL SUB 293g Dean Kahr MITTED TO: 142 Wayland Road WORK PERFORMED AT: h'yannisMA SAA& Cell Phone: 617-974-12S5 We herby propose to furnish the Completion of the following; materials and o : Perform the labor necessary for the 4W-AO Remove 1 ,�,or o f'existin shin I les Install 8"dri ed�e Install ice 8c water shield at edge Instal1151b e!t Darpr Install certainteed woodsc Storm nail all shin les e 3 r al ae resistant shin tes Re lace lumhin hoots Counter lash chimne bent rid e with cobra Ve t b ht with ice &water shield All debris cleaned Bail Price includes material labor&dum ees All material is guaranteed to b accordance with specificationse as specified, and above work to performed in workmanlike manner for the um of�ivd for above Dollars S and completed in a substantial ($ ,250.00)with payments as follow•ousand Two Hundred&Fifty fz+ll amount due upon complerion *Any alterat;on(s) from abov �ovolvi agreement; and beco an a ra g extra costs will be added under written RESPECTFp ge over and above signed etimteagreemenSignature t 2-14- ACCEP The above r' ACCEPTANCE OF PROPOSAL A s ecification & conditions are satisfactory, we herb You are autho d to do the Signatures) ��� 0 y accept nd yments will be as specified above. Date: .. a * This proposal maybe withdrawn by said com a P ny if not.accepted within 30 days I i �jze-�a;,�,,,,00uaea�/t o�✓vu�ac�cuae�d , Board of'Building Regulations and Standards License or registration valid for individu)ute only HOME IMI�,QVEMENT CONTRACTOR before the expiration date. If found return to: �� �� Board of Building Regulations and Standards Registrb tr 6480 One Ashburton Place Rm 1301 lugf 08 Boston,Ma.02108 dual o MARK HERBST _ MARK HERBST 35 PEEP TOAD RD.c`"4 °~ Not valid with t nature CENTERVILLE,MA 02632 lyeputy Administrator CERTIFICATE OF INSURANCE 1SSUE DATE(MM/DD/YY) `PRODUCER THIS CERTIFICA EIS I39I ED AS A MATTER OF INFORMATION ONLY AND Leonard Insurance Agency Inc CONFERS NO RIGHTS UPON THE CERTIFICATE HOLb$R, THIS CERTIFICATE I DOES NOT AMEND,EXTEND OR REFER THE COVERAGE AFFORDED bX THE . P 0 Box 494 II POI.ICIEs BELovv. Osterville, MA 02655 COMPANIES AFFORDING COVERAGE INSURED Mark Herbst 35 Peep Toad Road II LETT R COMPANY A A.I.M. Mutual Insurance Co Centerville, MA 02632 I� i :OVERAGES TIi151S TO CERTIFY 7'HIAT T111;POLICIES OF INSURANCE LISTED HELOW HAVE BEEN ISSUED TO THE INSUREb NAMED ABOVE FOR THE POLICY INDICATED,NOTWITHk rANDING ANY REQtJJREMENT,TERM OR CONDITION OP ANY CONTRACT OR OTHER DOCUMENT ROVEWITH RgsPECTTO wlii-PERIOD THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS sUB7ECr TO ALL THE TERMS, EXCLUSIONS AND cONDrrloNs Of SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ,O TV1%f!!±!i- POLICY EFFECTIVE POLICY rwMATIO 1'H I'OLiCYNUTIDL•'A DATE(MM/DD/YY) DATE(MM/DD/YY) LvdITS GENERAL LIAD I I, GENERAL AGGREGATE 3 COMPILRCIAL OFNF,I(AL LIARILITY LAIMS MAU°� CUR PRODUCTS-COMP/OP AGG, S C _3C PERSONAL&ADV,INJURY S OW NL•R'S&CONIRA4TOR I$I'll i BACH OC:CURRI3NCG 3 �— PIPE DAMAGE(Any I AUTOAIOUILR LIABILITYMIED.EXPENSE(Any om persull) 3 , ANY A VI'0 MBINED SINGLE I LIMIT _ All OWNED A(n'0S f CHFUULEDAUTQS BODILYINJURY (Pet parson) S Hll=AUTOS NON-U\VNCD AUTOS BODILY INJURY (Pet=ddem) S GARACU LIABILITY i PROPERTY DAMAGE 3 •XCESS LIABILITY ACItOCCURRENCG M S BRG A FOKN _ _ ASGA UOI¢ - - - - - - - 111111211(TILANUMIll FORM _- - - - - - - - - - - - - - - - - - - - - - - - - - - WURRIiR S C'OMITNSATION LIABILITY ND x wC STATU- OTH- CMPI,OYIiI(S' � tTU- L TM PxUI`ftIITORr 7016215012006 01/10/2006 01/10/2007 $ PAKTNL INCL RS/FXrkVTIVG ; X L DISEASE.-POLICY LIMIT 3 500,000 01I,CERS Al(b: ; •X 1 UTHEt1 BL Dt Srs--EA EMPLOYEE 3 100,00 i I I u.a(IIYION 01'0(!EKATIONS/1,giCATION$/VryIIICLL•-$/SITICIAL IThMS i i :RTI(;ICATL HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED$EPORE THE EXPIRATION DATE THRBOF;.' HE ISSUING COMPANY WILL ENDEAVOR TO i MAIL 15 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LE1 'BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR ['Own Of Barnstable Bldg Dept. LIABILITY OF ANY KIND UPON THE COMPANY. ITS AGENTS OR 4-1in St REPRESENTATrVES. I i3lf1l)Oi,, MA 02601i AUTHORIZED REPUSENTA71VX ' The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations A + 600 Washington Street Boston,MA 02111' 5 www.mass.gov/dia ' Workers'Compensation Insurance Affidiivit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organizatiovmdividual): VY\f\S \L— �-e• 5 Address: City/State/Zip: + C� Phone.#: `J 'a ` Are you an employer?Check the appropriate bog: :Type of project(required):. 1.('� I am a employer with 'J 4. ❑ I am a general contractor and I 6. ❑New construction . employees(full and/or part-time).* . have hired the sub contractors 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 vorkin for me in an capacity. employees and have workers' g Y P ty t• 9. ❑Building addition [No workers' comp.insurance . comp. insurance. 5. ❑ We are a corporation and its 10.❑Blectrical repairs or additions required.] 3.❑ I 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. ' oof repairs insurance_required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other_ comp,insurance regtiired.] *Any 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 anew affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees, if the sub-contractors have employees,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. Insurance Company Name:_ Policy#or Self-ins.Lic.#: Expiration Date: l I ` 1 t Job Site Address: i y � � \�NA) City/State/Zip: Attach a copy of the workers' compensation policy declaration page'(showing the policy numb r 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 maybe forwarded to the Office of Investigations of the DIA for insurance c era a verification• I do hereby certify under the p n enalti of rjury that the information provided above is true and correct. Signature: Date: Phone#• � u 0 5((- V — Official use only. Do not write in this area, to be completed by.city or town official City or Town: ' Termit/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#: IR10F1d1UL1011 A.1111 1115t,1 UULIV113 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 vyith tkie 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-conti•actor(s)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 carry 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 Accidents. Should you have any questions regarding the law or if you are required to obtain a workers.' 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 Towp 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 permivUcense 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 infomiation if necessary)and under"Job Site Address"the applicant should write"all-locations in - (city�or P Y ( Y) . 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 fo any business or commercial venture (i.e.a dog license or permit to bum 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:. e COMMODWWth of Mas rhusetts Department of IndustdalAccidents Office of In.vest gatlons 600 Wasbington Street B6stom,MA 0.2111 TeL ##617-727-4900 ext 406 or 14 7-MASSAFE Fax 4 617-727-7749 Revised 11-22-06 W.mamgov/dia