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HomeMy WebLinkAbout0144 CAP'N LIJAH'S ROAD ,, .. o . �6, ,. . .. .. s E�,.,._. ,ti �,. .. :, d ;: .> c ,.a a a e ., .. _ _, - '. c s n _ ,. �y - . . � c .. ,. y.,. a ,. W e ,� , , � - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel I TOWN OF BARNSTABLE Application # P Health Division 2, =a Is 5 Date Issued /d-Z7' 1 Conservation Division Application Fee Planning Dept. 17,�1 1 Permit Fee V 71 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address L ,a 14 0 - �t�V''1��. 0,2 �?Z �a r Village Owner/�r� /4,4�I C L Address/ l( .C .�' '� Lz'�`4 (r PJ Telephone Permit Request 6) A/yc a Yz k1 1 x r 0 �.�J✓a�(�l•.(' Square feet: 1 st floor: existing—proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �9 ( -konstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ver' 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) - - ._ Jul S Name ����� (�. Ci�1..�C" Telephone Number Y2 Address License # V\A44 0 ( Home Improvement Contractor# Email Vy%, Worker's Compensation # ALL O&STRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO C: SIGNATURE 1 DATE C C e FOR OFFICIAL USE ONLY APPLICATION# } -"DATE ISSUED t MAP%PARCEL NO. ADDRESS VILLAGE OWNER s DATE OF INSPECTION: FOUNDATION FRAME h . INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING e f" DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Barnstable 0 Reg datory Services MAS2 Richird V.SOA:Iyirector -BUild:2n -iv' i{�Il Tom l?eriy,Iiui2ding C:bmrcnssioier 20U Maims Street,IIyssn. .:MA 02601 m mtawn.barnstablaxxms Off=, 508-862-4038 Fax 508-790-62aO Co fete arc -$gq'Thi,s Sectioln ABuilder 9C ; „ as Cr s?f.tbe'sibjecr primpcty hereb a�zthorize to act:on;m�behalf,. in all maueis-zclatzv rA workauthorized byeais buflding.pernoit application.for: •4't'y4 {•Ai3c�ess r�.f�ob} "Pool fraccs;aid a rms air t ie z sports ility of�elappl c at :I o6'S `` aze> ot to be find t�riid before ibspeMons are,pufor=4 and accente(i, �el r.. n s o Appricaut . t1ame rL — P Nanne . Date �p Q;FoxMS,:OW &t?)Ss;ONP00 s The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITMG AUTHORITY. Aimlicaut Information Please Print Legibly Name(Business/Organization/Individual): 'Z Address: 0 S� City/State/Zip: S 0 'le OA-A-C-' Phone#: C-Z f ) `9 �2 `( — l o 0 Are you an a ployer?Check the appropriate box: Type of project(required): 1 Ca employer with employees(full and/or part-time).' 7. ❑New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.(No workers'comp.insurance required.) 3. I am a homeowner doing all work r 9. Demolition ❑ g myself[No workers comp.insurance requirtd.] ❑ 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contra=and I have hired the sub-contractors listed on the attached sheet U.❑Roof repairs These sub-contractors have employees and have workers'comp.insurances 14. er W L" I{R • L 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. -l 152,§](4).and we have no employees.[No workers'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 hint 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_ t'Z �nJ( 66 Policy#or Self-ins.Lic.#:_(,t� (� S tea. 0 0 C-) Expiration Date: C� 2 Job Site Address: y 17�+ i^- S" City/State/Zip: i /� Attach a copy of the workers'compensation policy d aration page(showing the policy number and expiratio date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.0.0 a day against the violator.A copy of this statement may'be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th p and penalties of perjury that the information provided above is true and correct Si ature: JDate: I D �l Phone#: Official use only. Do not w)Je in this area,to be completed by city or town offuiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health-.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b.Other Contact Person: .- Phone#: Office of Consumer Affairs R�s and B 8ulafiO 10 Park Plaza-Suite 5170 Boston,Nw 02116 Home improvement , Registrat�on Registration: 16048� 1 Type: P&M Cotpondo 201e4 bcpltawn: 7=018 ! . RETROFIT INSULATION, = '=�� JOSEPH REILLY N� INC.lNC. i ' P.O. BOX 105 SEEKONK, MA 02771 '�,�``�,.,+,—r•�_�� ��•f y •,y Yam.��y Renewal ❑ympm9aant ❑Loft Card WA 1 0 MWMI �/� , xo.urnsald off!' Lugs"or r`Sl,tnton valid for imdiividw wu Only one dC =a Affairs&NDimm WSolation yd=do aph-00 d2b' If omd rob=to: M�COW A1rT0, Rom; . ora of ca== �m and Sabt�matron Priyale Tyw.atlon 10 ParkPbsa-$dt9=" Et�hafi Noun,MA 02116 JMEM FaBuLy s a FAUJVVEK MA 0277 'c r U Not valid w itaoat ftogum Masamhuaada-Dopwbnwt of Publla Sa}aty Board of BWkttng Regulation and Standsrds C.onatructu►n SLpen9zr-S;.eciatty y Lkann:c93L-1 n1 Jogirm JKc ii f Pont 108 j Siubmk MA 2MI wov. Zu.•d' „,w Expiration i Cmt*ni Ow OVOW17 RETRINS-01 RBLACK1 ACORO DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7/27/2016 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 License#1780862 NAME: HUB International New England PHONE 508 676-1971 ac No):(508)678-2750 222 Milliken Boulevard AMC IL Ext:( ) EMAIL Fall River,MA 02722-9946 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Star Insurance Company 18023 INSURED INSURER B: RetroFit Insulation,Inca INSURERC: PO Box 105 INSURER D: Seekonk,MA 02771 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 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 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER MMIUDD YY MM/DD IJCY EXP LIMITS LTR INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CWMS-MADE OCCUR X PREMISES Eaocwrrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECTT LOC PRODUCTS-COMP/OP AGG $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea aoddent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per..'dent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ PER H- WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIABILITY 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN NIA A C0845201 0810212016 08/02/2017 E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? E.L DISEASE-EA MPLOYEE $ 1,000,000 (Mandatory In NH) If yes,desuibe under E.L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER _` CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN National Grid ACCORDANCE WITH THE POLICY PROVISIONS. 50 Washington Street f, Westborough,MA 01581 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD f As4or_s,map; and 'lot number ..... r :.--..:.1.. ............... SEPTIC SYSTEM MUST BE ALLED IN. COMPLIANCE ST Se"`wa e'cPermit number ~' .............................. < 9 i : ::... WITH, ARTICLE II STATE c cy a SANITARY. CODE AN n Py�f.TNEropy TOWN OF BARNST*HVIE BAHBSTADUE, i v C; 9 kb 9.a,�� i �BUKDING INSPECTOR ` APPLICATION; FOR PERMIT TO ......... QK .....QY1Ji?...... ae.. y . . TYPE OF CONSTRUCTION 04. .......... c�n-an Q.............:.......................................................... M ...............:.......a..:. A......19.. .G 1 c0 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ( Q Location ...U.r�.c>z5...... rY1:.....�-.1,.��C�.,.:,..... 5...�.► )�.!?�1!.U.t..�.�,rQ..,...M:tom?`.:...................... Proposed Use �W,JC.:{...�..L)'� q............. ................................................... ....... .... ....................................................................... Zoning District ..............: . .M............:...................................Fire District ... -R.Y.Y1'. .V,...�...5.�. .�Xl�.�.�C�C�.�. .......... Name of Owner �rt.-.... .:4 Y..! A.YI¢ ... ....n _ o ... . ... .O�cldress ..s-r�ca�... l�.!!.�?AY'L�1.A.1.:��1'.� ��.Y.IY..t 1.5 Name of Builder .......... Qtla(. ...............................:.....Address ......................61 ......................................... Name of Architect ........ YY>- .e.......................................Address ......... Number of Rooms ................{a................................................Foundation ... P6-e�.a/_e d... ..... ..... Exierior ......- -Is.......l.J!._ ...... 11.J+.Lap..bJQaAA...Roofing .... t......... . Floors ...........f............p /1'>R.. Interior .....I/,2........... .................:..... Heating ....... .FLOA. qQ.6......................................Plumbing ........L.'�o2...`!.J. `7........................................ I Fireplace ......Approximate Cost (�. I��c - .�, �. ....... 9.,�.R c�.. ......... ................ . ,. . . ....... ...... Definitive Plan Approved by Planning Board ________________________ - -------t 9--------. Area .................../..-.................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL-OF BOARD OF HEALTH ✓t hereby agree to conform to all the Rules and Regulations of the Town of Barn'-able regarding the above construction. ................................. ... ................ r - - Tellegen-Ferrone Associates • 18490 - 1 1/2 story, 54 ................. Permit for :................................... L i single family_'dwelling ] ..,y.........a �.�ICapt'n.'Lijah Road................ Location — -w .. .................. Centerville ................................................................ .......... �: r Owne �-1r Tellegen-Ferrone Associates - Y ................................................................ � � •,, . frame Type of Construction -� -- _ Plot ....v .............. . Lot .......#25..................... .. 1 Permit Granted ..........June..29.....,.......::,19 76 Date.of Inspection . 1 /' Date Completed ..(.d .J�l..� .... :.......19 PERMIT REFUSED -» ., •- _. .� • l ..................................... 19 ............. ..................................................... w c f ............................................................ ................. .......................... ........................t{.�....•............. �3 Approved ....................................:....... 19 F .......................................................... .................` .................... ................................... _ .............. r, Assessor's map and lot number �.. ................ ........... Sewage,'Permit number �7S r m 7 c TOWN OF BARNSTABLE Bpi THE tOY, •c', i BABHSTdDLi 0 1639. Yp\e�0 ; BUILDING INSPECTOR APPLICATION FOR PERMIT TO .........4.t:f r:!.f. ...... . .......... :t :..:fi ? t .. ,e,� t o. ,r.!.ti.. .. t ( r � ,n .... ...., TYPE OF CONSTRUCTION .............. ... ..1f)r' ...........................,a..... .. .......:.. .. .. . ......... .......................... .r ........................... ?..... .) ...19.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 1 (�1 �,.....��� r4'ir1..... t i✓� G,--f rl .o n�- ►� t c (i~ . Location ...:.: ......... ... ............ ..................:.....:.. .......... ...... ...4.................:.......... ;111 .) Qx �. Y1(3 Proposed Use `....................................................................................................................................... Zoning District Fire District ...... . . ... ..: ,........... ................. ?:................... . Name of Owner ..1�5,!Aciclress .,: .......... t n i r .. ....' Name of Builder ........... )(?.!r�.R.::......................................Address .................... ............................................. Name of Architect ......... p .................................Address . -�" '- Number of Rooms ................ ...................................................Foundation .......... rfQ ...... ..... h ) _l 1 (/ p/➢ h ................ Exterior ......r���'...... Crin.h j ( I?� I'? /l/2 /� ...Roofing ................. 0 - ....................................... Floors I r r).i, Lt'.:... ..........................Interior .....�.:� '?..�� ��,�,` 4..r. Ur; , ........... .t. r ..... .... Heating F(., I t.i.... ...� ` . .t�/)- k ..................... . Plumbing � f Fireplace U - . ..--..... . , !.... °::...................Approximate Cost ................ .���;.. ?..: .:............................. ' .Definitive Plan Approved by Planning Board _______________________________19________. Area ..... .............................. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �I� \ e, a V1 •� 1 W I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above � construction. �Tellegen-Ferrone Associat A=92-173 No 18490. ..... Permit for .....1...1 .2...star.y . . ...... . .. . . ........ .. single le ,f a m. il.y-dwel lii �I "**"** ... ..S10I.N....L-t2. oadLocation44........ .................................................... Centerville ...................................................................e........... Owner ...............UX.XW.....Te.1.1.egen-Ferrone Assoc. ...... ........ .... . . .......... .. frame Type of Construction .......................................... ........... ...... ................................................... ..I......... Plot ............................ Lot .......�t25 ......... ...... Permit Granted ........June 9 ...................19 76 - Date.of Inspection ....................................19 Date Completed ..............................:........19 PERMIT REFUSED ................................................................ 19 ........................................................... ................... �/�/'.r ................ .................... ..................... ............................................................................... Approved .................. ....... 19....................... ................................ .............................................. .................... .......................................................... 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