The URL can be used to link to this page

Home My WebLink About0091 KNOTTY PINE LANE o d � . .. — � o � _ � � � - a �. C u � .. ., � 'b � � 9 �� - .. 6 '.. � n .. _ - _ _ � o .. .� .. n -. n u .. � .. .. o � .. a �_ :� � - w_ .. ,. c ., .. d .' _ � - - � .: a ^' a o y5, � '_ ,. L .. n , �. ,. •' - 0 a a �- �. p ... � .: _��.. � o - -. �� rt� ., e� ., b y �. .. � _. ,: c - n ' :,�- � � � �. .., o .. - " .. � c, - a _. _ _ ` ' .r �,�_ �. 1 - G � .. .. T.. .M � o 0 n .. �. r� _ _ r. T` .. ,� �., , p .. u - k P ,. ,. ,. Rio 1a =ig TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q. M A; ed Map Parcel V -i Application # O Health Division z cm � Date Issued Conservation Division o � 0 AppricaS Fee 00 Z Planning Dept. > G) Permit z Date Definitive Plan Approved by Planning Board ' o m Historic - OKH _ Preservation/ Hyannis M Project Atreet Addressu'l URI- Village I Owner2m MOM19v 4Address 1 LLf - Telephone 2 - Permit Request � I,Q/Y�7 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ,yroject Valuation 00 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 Telephone Number. �W S U] Z�U Address 2 L06J I ► License # MY 17 Home Improvement Contractor# I 1Sty� Email Worker's Compensation #(I l909 Z-9 ALL CONSTRUGTION DEBRISISULTING FROM THIS PROJECT WILL BE TAKEN TO _ SIGNATU DATE FOR OFFICIAL USE ONLY k 'APPLICATION# 1 DATE ISSUED MAP/PARCEL NO. k ADDRESS VILLAGE OWNER r. r DATE OF INSPECTION: FOUNDATION FRAME P INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL L {: FI,NAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r t t t rFown of Barnstable R-egalatory 'eri v1Ces x A4M ` Richard"V'.Scab,Director' Building Division Tom Perry,Building Commissioner: 204 Main Street,Ayanais,MA.0..2601: www.towmbarnstablema.us Office: 508-862-4038 pax: 508-790-6230 Property Owner Must Complete and.Sign'This Section If Ustne_=ABuilder Ben Thompson I, ,,as 0mo of the subject property hereby authorize , co act on my bebA in aII matters relative to va4rk:authorized by this biulding per=application for. 91 Knotty.Pine Lane,Centerville MA>.02632. (Address of bb) .,'-.-Pool fences and alarms are the responsibility.of the applicant. Po& are not to be€filled or utilized before fence is installed and all.final inspections are performed and accepted. N E-SIGNE•D'by Ben Thompson E SGNI=p by Ben Thompson Signature of Owner Signature of Applicant } Ben Thompson Ben Thompson Prim Nam _ -- Print Na> October 04, 2016 Datm Q:F0RMS--0W9 "ERM1SS10W-W.)iS ` 7 Y . t The Commonwealth of Massachusetts Department of Industrial Accidents r 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia NNorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. A licant Information Please.Print Legibly Name(Bus iness/Organization/Indrvidual):ALTERNATIVE WEATHERIZATION, INC. Address:2 LARK ST City/State/Zip: FALL RIVER, MA 02721 Phone#:508-567-4240 Are you an employer?Check the appropriate box: Type of project.(required): 1.E✓ J am a employer with 16 employees(full and/or part-time).* 7. .0 New construction am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. M Demolition 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10.C]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.0 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 12. Plumbing repairs.or.additions 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t❑ INSULATION 14.[ Other 6. We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out She section below showing their workers compensation policy information. t Homeowners who submit this affidavit indicating they are doing all woik 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.po cyli number. i I am.an employer that isproviNng workers'compensation insurance for my employees. Below is thepolicy:and jnb site information. Insurance Company Name:STAR INSURANCE COMPANY 0849257 00 Expiration Date:02/26/2017 Policy#or Self-ins.Lic.#: Job Site Address: GI f LU City/State/Zip: Attach a copy of the workers'co pensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation.punishable by a fine.up to S1,500:,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.A copy of this statement may be forwarded to the Office of Investigations of the DIA:for insurance coverage verification. I do hereby certzfy u r,..:pains a "o erjury that the information provided above is true.andcorrect Si tore: Date: Phone.#:508-567 40 Offiieial mse 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 j 6.Other 4 Phone#: Contact Person: { a f i t ALTEWEA-01 CCOSTAWY) DATE(MWODN �.,.....- CERTIFICATE,OF LIABILITY INSURANCE' Fs�81za1s ON ONLY AND CONFERS NO RI ' THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORIIAATiGHTS UPON THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFOROED 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(iss)must be endorsed. If SUBROGATION lS 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 endomement(s). PRODUCER pCT Mason 8,Mason Insurance Agency,Inc. Phi¢ _...__ _ _ 458 South Ave. Na :(?81)447-5531 - WX c No):1 ?-723a -71 Whitman,MA 02362 ADDRESS-info@masonandmasoninsurance.com INSURER(S)AFFORDING COVERAGE — NAIL ___-------_ .__._._ _---.__.. INSURER A:Evanston Insurance Co. ?a0(�g INSURED - INSURER B:Saf Insurance Com -___�__._. -- �y Deny_ -... 39,,M Alternative Weatherization,Inc. INSURER c:Star Insurance Company W 00006 2 Lark Street INSURER D: } Fail River,MA 02721 _.......-_..----_-_._------ �_ 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, TERRA 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. L R 1 TYPE OF INSURANCE -_.._._.-NN IN I POLICY NUMBER i Mw ( LIMITS A i X coMMERCIaL GENERAL WLBILItt EACH OCCURRENCE $ 1,000,00 �- CLAIMS-MADE ' X ;OCCUR 3C41663 O6l07/2016`06107l2017 j�R '� T6REI D-y�_..3.____._ ��isEs{Eaac�n�e} ,s � 100,00 "Ell EXR(Any-9 person}Y $ �5,00 GEN'L AGGREGATE LIMIT APPLIES PER, s PERSONAL&ADV INJURY I g 1,OOt3,00 •_—� i j I �G( ENERAL AGGREGATE E $y.....-- 2,000,000 I POLICY JE LOC j PRODUCTS-CCMPIOPAGG j$ 2,000;Iw OTHER: —:S AUTOMOBILE LIAMUTY i { ! Eaasx�d�„ 1,000,000 ANY AUTO t237702 0410812016 j 04/0812017 i BODILY INJURY(Per person) I g ALL OWNED SCHEDULED AUTOS 'AUTOS _ _.� X j .BOD{LY INJURY iPer acode" $ X HIRED AUTOS I AUTOSNON-0�NN£fl { i AE jeer accacternl ...___ _ $ _ i ? n X UMBREL.LA LULB I.X i OCCUR ' - g A -- > EACH OCCURRENCE g . 1,000,000 ExCEss uAB wCLAIMS-MADE' i TBD --- = _ 06/0712015€0610712017 AGGREGATE g DEO j j RETENTION 5 j WORKERS COMPENSATION s._ 1,000,00 AND EMPLOYERS'LIABILITY YIN 3 ' j STA UTE ? 'Ts-- �---.- C ANY PROPR{£TOR PARTNERtEXECIJTiVE ,WC 0848257 00 0410412016 i 0410412017 I E L EACH ACC3OENT - I S 60 I OFFICERMEMSER EXCLUDED? N i A I(Mandawry in wH) ? LDIsEASE-EA EMPLOYEE;s 500;60o i n Vas,daecrioe ux>er r- DESCRIPTION OF OPERATIONS Dhow j E.L.DISEASE-POLICY OMIT I S 500,00 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addional Remarks SchedWe,,nay Iw ffilached If mo""see Is required) Nat'l Grid Corp.Services LLC,d1bla National Grid;d/b/a MA Electric,d/b/a Boston Gas and Action Incas additional insured with respect to the GL anc contracted with Certificate Molder.Kathy Tobin�BCO,Tremont St Boston;Nstar Gas 8 ElectricJames Care @ New England Gas,45 North Main St,Fall RiverflAA 02720-AI Mickee,GLCAC,305 Eases St,Lawrence,MA;Columbia Gas of CIA are Included insured with respects to GL.Only for the following projcect,Weatherizakon installation for Law income Housing are Additional Insured with respects to Auto Liability per terms and conditions of form SCA 005 (02 16).Form Available Upon Request. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE National Grid THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 40 Washington St ACCORDANCE WITH THE POLICY PROVISIONS, Westborough,MA 01681 AUTHORIZED REPRESENTATIVF 0 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD -s.� :✓ � Office`of Consumer Affairs and Busiriess.Regulation 10 P.ark Plaza Suite..5170 Boston,:Massachusetts 021T6 Home Improvement Contractor Registration Registration: 1756,83 Tvpe: ;Corporation Expiration: 5/29/2017 Tr# 265489 ALTERNATIVE WEATHERIZ-IJION; IN.0 TIMOTHY CABRAL - ------------ _^ __ 2 LARK ST FALL RIVER, MA'02721: r update Address and return card.Mark reason for change. Address i4 Renewal j�1 Employment { Lost Card Office of Consumer Affairs&Business Regulation' License or registration valid for individuI use only �: IOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to-.. --v •: � 4R�-;i2egistration: 175683 Type::= Office of Consumer Affairs and Business Regulation Expiration: .5/29/2 17 Co�poratron 10 Park Plaza-Suite 5170 Boston,MA 02116 ALTERNATIVE WEATHERiZATION INC ` l TiMOTHYCABRAL � 2 LARK S i_ FALL RIVER,MA 02721 -i Undersecretary i I o validiwit ut Signatu `w1�Fass separtrrxt of fu`bl�c Saf x 0baid of ftit lutg Regulations ar,at " .. .. .. ... J Lfcet CS 105454 �kFafl]River MA'0021' �jy Jt t41 . EIC[JI ration . Corrvii6ssioner 0 10812017,,