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HomeMy WebLinkAbout0855 WEST MAIN STREET 855 r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z� Parcel _d0/ Application # V) D Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address at &Aii& Village 1AUcj_� nn ►S Owner �-Acx���-� , 1�,�-r, Address Sam-�n Telephone rl' 14 - !�,1 �)-ci Permit Request I_qS w a o L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �Gi000,°O Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. 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 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: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION .,� (BUILDER OR HOMEOWNER) —Name EIL Telephone N - �- ,� p umber ��t7g g � -O ( i Address /i Z - nZA License # C S -1 0q 31&9 MAHome Improvement Contractor# 1 3 t I_(0 Email /o r1l 'v 9 �C o w C),19 , c Y✓) Worker's Compensation # WC. .T� V ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO —7owr\ o SIGNATURE DATE �� S FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Massachusetts-Department-of Public Safety Board of Building Regulations and'Standards t Construction Supervisor License: CS-093893: ' J- ROBW J GEND$O PO BOX 195 � i Sagamoce Beach NIA 5G2 Expiration oe ConniisMoner 0��3120�6 ` 4 i ' Client#:209669 GENDRCONST ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/18/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Marsh 8r McLennan Agency LLC PHONE 888 850-9400 FAx 866-795-8016 A/C,No,Ext: A/C,No 100 Front Street,Suite 800 E-MAIL Worcester,MA 01608 ADDRESS: 888 SSO-9400 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Hanover Insurance 22292 INSURED INSURER B:CNA Insurance Gendron Construction, LLC INSURER c: 323 Manley Street INSURER D: West Bridgewater,MA 02379 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 CONTRACTOR 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMBS LTR INSR WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY ZBNA79549000 12/07/2015 12/07/2016 EACH OCCURRENCE $11000 000 CLAIMS-MADE 1 OCCUR PREMISESOEa occuence $300 000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY J O � [XI LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY AWNA79563900 12/07/2015 12/0712016 COa accidentS MBINED INGLE LIMIT $1> >000 000 E ANY AUTO - BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR UHN79549100 12/07/2015 12107/2016 EACH OCCURRENCE $10 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1 O 000 000 DED I X RETENTION$ $ A WORKERS COMPENSATION WHNA79561700 12/07/2015 12/07/201 6X PER OTH- AND EMPLOYERS'LIABILITY U IER ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT $1 OOO 000 OFFICER/MEMBER EXCLUDED? � N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Installation ZBNA79549000 12/07/2015 12/07/201 500,000 job site A Equipment ZBNA79549000 12/07/201512/071201 25,000leased DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Maureen Niemi SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 855 West Main Street,Unit 15 ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE �rTtQy t'T,DE�2w��( i ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S2011104/M 1989892 BXSXK The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Gendron Construction, LLC Address:323 Manley Street City/State/Zip:'W. Bridgewater, MA 02379 Phone#:(508)580-4626 Are you an employer?Check the appropriate box: Type of project(required): 1.X I am a employer with 35 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 working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp. insurance. � required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]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.X Other Repairs comp.insurance required.] *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 a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not 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:Hanover Insurance Policy#or Self-ins. Lic. #:WHNA79561700 Expiration Date: 12/7/2016 Job site Address: 855 West Main Street, Unit 1 City/State/Zip:Hyannis, MA 02601 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 frte 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 hereby certify der t e pains and penalties of perjury that the information provided above is true and correct Si ature: Date:12/18/2015 Phone#: 5085804626 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#: ti MARSH&MCLENNAN WORLD CLASS LOCAL TOUCH. AGENCY Formerly known as Protector Group -Insurer's Affidavit as to Workmen's Compensation Insurance I, Karen E Angel, CLCS, 100 Front Street, Worcester MA 61608, Account Manager(Name, Address, Title), authorized representative of Hanover Insurance, do hereby affirm that effective 12/07/2015, Gendron Construction, LLC is insured by said insurance company with Policy Number WHNA79561700 for workers' compensation in accordance with the Massachusetts General Law, Chapter 152, and Subsection 7.05A of the Standard Specifications for Highways, Bridges, and Waterways of the Massachusetts Department of Public Works. (Signed) Subscribed.and.Sworn to before me the __. ._../_ 7�'�.l_...___......._.day of_ at 100 Front Street, Worcester MA 01608. Notary Public My commission expires LAME cor�oM►+jyw cEa�tvonAra�yoPf�w N7 rd Spmbr15. vvww .. AMA -NewEngSand.c®m Marsh&McLennan Agency LLC 1 100 Front Street,Suite 800 1 Worcester,MA 01608 I T 888-850-94001 F:508-852-8600 r ReRNf�LRi.F. • �a Town of Barnstable Regulatory Semees Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder t�.l ,as Owner of the subject property hereby authorize o 1/1 to act on ray behalf,' in all matters relative to work authorized by this building permit application for: 855. \ J e-s� Nc r, a}, L�Lti t5, N�cx�r�.t 5 (Address of Job) tgnat ire of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License,Exemption Form on the reverse side. Q:IWPFII.B T0PJvIS\building permit formslE�RESSA)c Revised 061313 f FISHERMAN'S VILLAGE CONDOMINIUMS 855 West Main Street Hyannis, MA 02601 October 28, 2015 To Whom It May Concern Re: Authorization Please be advised that Board of Trustees have given permission to Maureen Niemi, Unit 15, to replace windows and slider doors in her unit located at 855 West Main Street, Hyannis. Should you have any questions or require additional information, please contact our management company at 508-385-9499. Thank you for your-attention in this matter. Sincerely, =�Ul Linda Stevens Treasurer—Trustee Fisherman's Village Condo Assoc. . Doc'_ I F 1 56P227 12-21.-2010 1 er-ers BARNSTA1_?LE LANE1 ' COURT REGISTRY FISHERMAN'S VILLAGE CONDOMINIUMS CERTIFICATE OF BOARD MEMBERS AND ADDRESSES PURSUANT TO MASSACHUSETTS GENERAL LAWS—CHAPTER 183A I, ereby certify that I am the Secretary of the Fisherman's Village Co ominium Trust (Declaration of Trust recorded in the Barnstable County Registry of Deeds, Document No. 163081,Master Deed recorded in the Barnstable County Registry of Deeds, Document No. 168536, as amended on 7/26/72). I hereby acknowledge and attest that the following individuals have been duly elected and presently serve as Trustees of Fisherman's Village Condominium Trust: Linda Stevens,855 W. Main St. Unit#19, Hyannis,MA Dennis Marchant,PO Box 442,Barnstable,MA 02630 Marianna Pappas, PO Box 16387, High Point,NC 27261 I hereby attest that our legal mailing address is: Fisherman Village'Condominiums P. O. Box 1682 East Dennis,MA 02641 I hereby attest that Fisherman's Village Condominium Trust, having duly contracted with Paul A. Baron,Baron Property Management, its Managing Agent,is authorized to execute Certificates of Lien (61)) and to both receive and send notices of a legal nature, regarding Fisherman's Village Condominium Trust.;Any current Trustee has also been empowered to execute Certificates of Lien (61)). Witness my hand and sealthis_ day of e der 92010. Secretary and Trustee COMMONWEALTH OF MASSACHUSETTS . Barnstable s.s cle,� 6e r /3 2010 Then personally appeared before the above named, Acknowledged the foregoing instrument, by her hand subscribed, to be her'free act and' ' deed as Secretary, before me. ne 25 2011 X e"f�-_v My commission expires Notary Publi,, SARNSTABLE COUNTY � REEGISTRY GP DEEDS f MICHAEL J SHOEMAKER �'�'P 1t CCP`r`,ATTEST I Notary Public i } Davidson County jtm A DE, Rx G North Carolina - My Commission Expires Jun 25, 2011 oADRICTA01 C cGf:ICTPV of nFFf)S RE-ROOFING/RESIDINGIWINDOWS COM MRCIAL Fj If located in OKH or Hyannis Historic Disttict- Certificate of Appropriateness required unless same color/same materials specified on application © Map/parcel number a4 G - 0 3 1-CO P Approval Sign-offs from: ❑ Tak Collector ❑ Treasurer ❑ # of squares of shingles or square footage of roof or sidewall to be shingled/sided ❑ 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?' ❑ Owner's name & address ❑ Project valuation must be entered ' ❑ Builders Information ❑ Signature ❑ Workman's Compensation Insurance Affidavit State form must be completed and.a copy of Insurance Compliance Certificate must be submitted. ❑ A copy of the Construction Supervisor license is required. Effective March 1, 2009 ❑ Check expiration s date,no restrictions ❑ Permit fee$160.00 ❑ Property Owner must sign Property Owner Letter of Permission. Projects requiring the use of a crane must complete the forms issued by the Aeronautics Commission q-forms/bidgpermits/prrmitcheckiists rev.070610 L/ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration , r Registration: 183116 Type: Individual P Expiration: 8✓28/2017 Tr# 270027 ROBERT GENDRON ,«� ROBERT GENDRON ; a 3 47 DIANDY ROADWe ~ 4 , SAGAMORE BEACH, MA 02562 — ; Update Address and return card.Mark reason for change. SCA 1 Co 20M-06/11 Address 0 Renewal Employment Lost Card • C,:=I�P.�tJ/R09LL1A2LL/P,CL���0����ld1CLCJ1.LLdC� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:.4> `q:g3116 Type: Office of Consumer Affairs and Business Regulation Expiration 8/28/24;1] Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 ROBERTGENDRONi"d go ROBERT GENDRON 47 DIANDY ROAD SAGAMORE BEACH, MA 02562 Undersecretary Not valid without signature