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HomeMy WebLinkAbout0165 YARMOUTH ROAD (8) old SI-o <-es -+"Fenn; +s - 149� +- 1 Eck FILE BACK IN ATTIC BANKERS BOX FILE ALPHABETICALY BY STREET PLEASE D0 NOT FILE IN STREET FILE 1�:s" ����-ma��� .� 4 r � a��5 � ! ' � � r i `�J { �� ��i i i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel �8 Permit 7 ? �S �2 g rZ Health C'ision `��� Date Issued y .- c Conservation Division v i/ by 'mac Application Fee SO. Tax Collector : Feef -3 (J _ r �n Permit Treasurer Planning Dept. -APPLICANT MUST OBTAIN ASEM - CONNECTION PMUT FROM THE Date Definitive Plan Approved by Planning Board ENGINEERING DIVISION PRIOR TO CONSTRUCTION. Historic-OKH Preservation/Hyannis Project Street Address 145 f memou 3 kotd Village /1 yamy,C5 Owner AVI.S '/►.&r cigo /w. 1uc. Address 9.23 ouT is/q &.1VIr y Telephone 6000- 375—00,5" j�AR�►oal�h joo�rT; m,� oz G 7S -Permit Request EYr"JQX LydA AV . �o),nr Ra1Td d min, .�o�eds' I�erp�i,e6' /?ox'� � ' �ow,CdS Fa��►/,�14 A �'Ai.�J�" s9�/ 7rrum sy*eFiic,,%r Square feet: 1st floor: existing 7375 proposed 2nd floor: existing .2,-�S proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0,251 000.X Construction Type �5 B Lot Size 1. 1 70 d. Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes XNo On Old King's Highway: ❑Yes )(No Basement Type:AFull ❑Crawl ❑Walkout ❑Other ` Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 73 yS _ 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: XGas ❑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:0 existing ❑new size Attached garage:❑existing ❑new size a Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization 'LI'Appeal# Recorded❑ Commercial XYes ❑ No If yes, site plan review# - Current Use AQ r,;/ Proposed Use BUILDER INFORMATION Name Telephone Number Address m0 1,3oS�� �2aJ,Pr�� License# 0/ !; ik6vs�WeLw Home Improvement Contractor# 01,6,E Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO a SIGNATURE DATE YIP 6W ion AV.c FOR OFFICIAL USE ONLY PERMIT•NO. • i i DATE ISSUED MAP/PARCEL NO. ADDRESS ! . VILLAGE OWNER DATE OF INSPECTION: ,L FOUNDATION - FRAME , INSULATION - FIREPLACE r ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH ` - FINAL ` GAS: ROUGH s FINAL' cr FINAL BUILDING y DATE CLOSED OUT ` ASSOCIATION PLAN NO. " AT CTI 014164" Tr.no: 24817 GA RY O BE 147 LINDEN ST C BERLIN, MA 01503 Commissioner c r a } Architects&Engineers 0 o man r r r Design-Build Contractors ■ ■ ■ Construction Managers A S S O C I A T E S June 8, 2004 Mr. Robert P. Goodman Goodman Associates 1000 Boston Turnpike Shrewsbury, Mass 01545 RE: Authorization to obtain building permit Dear Mr. Goodman, I hereby authorize Goodman Construction,Inc. to apply and obtain all licenses,permits and approvals necessary for renovations at 655 Route 132,Hyannis, MA. If anyone should have any questions or require any additional authorization,please have them contact me at their convenience: Sincerely, j Mr. Charles G. Bilezikian c/o Mill Lane Management, Inc. 923 Route 6A,Unit Y Yarmouthport, MA 02675 1000 Boston Turnpike•Shrewsbury,MA 01545•Tel: 508-842-8453 •Fax: 508-842-9031 www.goodmandbc.com COMMERCIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $100.00 99 Alterations/Renovations $50.00 S0 .O 0 Building Permit Amendment $50.00 FEE VALUE WORKSHEET NEW BUILDINGS square feet x$140.00/sq.foot= x.0061= ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet X$96/sq.foots, L X.0061= STORAGE BUILDINGS ONLY square feet X$32.00/sq.foot= X.0061 j f Commprojeost 771e Commonwealth of Massachaaseft — — _ Department of Itsd OtHal Acrislerat$ _ ��� _ . 600 Warshin��n sae&, Boston,Dues. 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Dwelling Type: Single Family Q Two Family LJ Multi-Family(# units) Age of Existing Structure Historic House: LJ Yes LJ No On Old King's Highway: LJ Yes El No Basement Type: Q Full L3 Crawl LJ Walkout LJ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sqq) -n Number of Baths: Full: existing new Half: existing new I" Number of Bedrooms: existing new 1 Total Room Count (not including baths): existing new First Floor Roo Count N 5- Heat Type and Fuel: U Gas L3 Oil L3 Electric Ll Other Central Air: Ll Yes L] No Fireplaces: Existing New Existing wood/coal stove: LJ Yes D No Detached garage: LJ existing Unew size—Pool: LJ existing Unew size Barn: LJexisting Dnew size Attached garage: Ll existing Unew size —Shed: Q existing Q new size Other: Zoning Board of Appeals Authorization LJ Appeal # Recorded LJ --_Commercial, ig Yes - -D No If-yes,,site-plan-review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address License # Home Improvement Contractor# Worker's Compensation #&1C.1 2,4>Z A)q-CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO .4 SIIGNATUU��� DATE Y „? FOR OFFICIAL USE ONLY APPLICATION# x 4 . DATE ISSUED F MAP/PARCEL NO. x ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION t I . FIREPLACE ELECTRICAL: ROUGH FINAL k PLUMBING: ROUGH FINAL k GAS: ROUGH FINAL 5 FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 s• °� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address:- City/State/Zip: d4 Phone.#: � Are you an employer? Check the appropriate box: Type of project(required): 1.al 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 tS'• # 9. ❑Building addition [No workers'-comp.-insurance comp. insurance. -10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12j0?lRoof repairs insurance required.] t c. 152, §l(4),and we have no employees. [No workers' 13.❑ Other 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. tContractors 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: Policy#or Self-ins.Lic.# J Expiration Date: Job Site Address P City/State/Zip: Attach a copy of the GKrkersI compensation policy declaration page(showing the policy raber and expir lion 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 hereby certi under e p ns d p nalties of perjury that the information provided above is tr a and correct Si afar . Date: Phone#: 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 ,r 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 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 Town Officials Please be sure that the affidavit is complete'and printed legibly. The Departent 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. hi 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 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: . i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston,MA 02111 Tel. #617--727-4400 ext 406 or 1-877-NlASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia �► r Town of.Barn-stable 0 Regulatory Services H"�'MAS& Thomas F Geiler,Director Building Division Tom Perry,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 l ,4.r,i► �25 , as Owner of the subject property hereby authorizeNor�;o ., c.H to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) g 3t 0S -Signature of Own Date Print Name If Property Owner is applying. for pen-nit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNER.PERMISSION z r � Town of Barnstable o Regulatory Services r _ - awtuvsrware, ' = Thomas F. Geiler,Director 1659. A $ Building Division lED htAy Tom Perry,Building Commissioner 200 Main,Straet, Hyannis,NIA.02601 . % w.town.barnstable.mams Office: 508-862-403 8 Fax: 508-790-6230 HOrKEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village ___140MEOWNER'- l name home phone# workRbane# CURRENT MAILING ADDRESS: city/town state zip code . The current exemption for"homeowners"was extended to imclude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor: DEFINTITON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for ali.such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that_he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements: Signature of Homeowner' Approval of Building Official . Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control: HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner pcifbnning work for which a building permit is required shall be exempt from the provisions of this section,(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly When the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would ould with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible;. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently.used by several towns: You may caret amend and adopt such a forrnkartifi cation for use in your community. Q:forms:homeexempt. ✓�ie �a..v.�am�ecueall� crP✓tLraasaclure�Gi .\ Board of Building Regulations and Standards License or registration valid for indmdul use only - "- . before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR -= Board of Building Regnlations and Standards -- Registration: 110649 One Ashburton Place RID 1301 Expiration: 11/3/2010 Tr# 276541 Boston,Ma.02108 Type: Individual THOMAS A.HILCHEY THOMAS HILCHEY 82 Old Chatham Road. �°"`�"'� Not valid without signature HARWICH,MA 02645 Administrator Boa�ofuifi 'nouan Construction Supervisor License " License: CS 34718 Birthdate ,.9119/1953 a ExpiraUon 9/19/2009 Tr# 6391 Restriction THOMAS A HILCHEY 82 OLD CHATHAM RD HARWICH,MA 02645 Commissioner AR WCIP Liberty LSSUIlVG OFFICE 181 Mutual Workers Compet;,sanon and INFORMATION PAGE Errrployets Li?"Hty Policy ACCOUNT NO, SUB"ACCT NO.--] Liberty Mutual Lxura ce Group/Boston 1.329413 0000 LIBERTY A1IITUAL FIRE INSURANCE CO 16586 POLICY NO. TD/CD SALES OFFICB CODE SALES CODE N/R IS WC2-31S-329413-029 XX X WESTON" 102 REPRESENTATIVE 30M 2 YEAR ASSIGNED 2001 Item 1.Name of THOMAS 11KCHEY Insured FINK 03-1449294 Address 82 OLD CHATHAM RD RISK ID 049214 HARWICg,MA 02645 Status 01 .INDIVIDVAL, Other workplaces not shown above: SEE ITEM 4 A7o.Dey Yeer o.Day Year Item 2.Policy Period:From 03-13,2009 to 03-13.2010 12:01 AM standard time at the address of the insured as stated herein. Item 3,Coverage A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: Ma B. .Employers Liability-Insurance:"Part Two of the.policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident 100,000 each accident BodilyInjury b Disease 500 000 policy limit Y � �T P Bodily Injury by Diseast 100,000 each employee C. Other States Insurance:Part Three of the policy applies to the states,if any,listed bore; SEE END WC.20 03 06A. D, This policy includes these endorsements and schedules SEE EXTENSION"OF INFoFwAnON PAGE Item 4.Premium -The premium for this policy will be determined by our Manuals of Rules ClasslficaUoins Rates and Raring Plans. All information required below is subject to verification and change by audit, Promiumgssis Races LINE110 Per 5100 Estimated Code Estimated otRE- Annual C�aSSiffC2t10nS No.* TVA Annual Plemiums muaeratioo premiums SEE EXTENSION O>±INFORMATION PAGE Minimum Premium 5 500 (MA ) Total Estimated Annual Prennium $ 9,944 Interim adjustment of premium shall be made: ANNUAL This policy,including all endorsements issued therewith,is hereby countersigned by �iahorl�d Reta'eeenretlye Dale 03-n3-n9 LOG.Code Term, oper.".. Audit Basis. PeriodloPayrnept Raiiognastis Poi.9L. $omastele Dividend RENEWAL.OP. 03.03.09 NR h WC2-31S-329413.028 CCPo 4030 Rt Copyright 1987 NatloPW Counal on Compenmbon Imurance WC 00 00 01 A Broker Copy i i norm •nei .(niin9u nn111) inQ11T 01131aA0-1 wilr , 7 rnn7 •ir -9nu _®®