Loading...
HomeMy WebLinkAbout0292 LONG BEACH ROAD O� a� LdD�� OEfi 6*79 r Town of Barnstable *Permit# p� Expires 6 months from issued e 'Regulatory Services -Fee. RARNSPABLE, * -; �D � Thomas F.Geiler,Director A d Building Division Tom Perry,CBO,:Budding Commissioner " 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION' - RESIDENTIAL ONLY . Not Valid without Red X-Press Imprint Map/parcel Number A 0_1 Property Address 9C;, 4�0 � Residential Value of Work�z)On Minimum fee of$35.00 for work under$6000.06 Owner's Name&Address AA OS&Z 3 y 444 1V r 6 . �, 06o ni Contractor's Name io?`L 11C> 5 `L 2 Telephone Number p f5,— 41X-&(y Home Improvement Contractor License#(if applicable noc:QQ PERRAIT Construction Supervisor's License#(if applicable) jV MAR 0:7 2012 Porkman's Compensation Insurance Check one: 3 " ❑ I am a sole proprietor" I am the Homeowner TOWN OF nISTPoBLE I have Worker's Compensation Insurance ° Insurance Company Name 'o Workman's Comp.Policy# t J G� ?, Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hur ailed)(stripping olTshingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping.'Going over existing layers of roof) ❑.Reside r " R #of doors u ❑ Replacement Windows/doors/sliders.�,U-Value (maximum .35)#of windows *Where required:`Issuance of this permit does.not exempt compliance with'other town department regulations,i.e.Historic,Conservation,etc.', ***Note: Property Owner must sign Property Owner Letter ofPermission,. ° A copy of the Home Improvement Contractors License&Construction Supervisors License is $`y required. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 The C'onrmbrr#veakh of Massachusetts ` _ - Department of lndrrstriral Accid ws - -- Office of Investigations 600 Washington Street Boston,JIM 02111 wa mkmass;gvv/atia Workers' Compensation Insurance Affidavit: Builders]Contractors/Electticians/Plumbers Applicaut Information // Please.Print Leidbly Name(Bu�e�lOrganzstianllndivitinal): / vL� �u 3 C����Z-S L . Address_ t l 1 cf;� M 4,k UAI iT 18 CitylstatefZip= 57i_2u(u PO sSPtone 4 s-ZSs -41X- 3Ao s Are you an employer?Check the appropriate box: Type of project(required): 1.I am a employer with� 4i Elb.I am a general contractor and I ❑ P � New construction employees(full and/or pant-time)_* have hired the sub-contractors I❑ I am a sole proprietor or partner- lasted on the attached sheet 7- ❑Remodeling Them sub-contractors have 8. De molition ship sand 1aat�e no employees _ or for me � ci employees and have weirs' working ]' �'- I 9. �Building addition. [No workers'comp.insurance comp.inswanco _ . required-] 5.. ❑ We are a corporation and its 10.❑Electrical repairs or addititms 3.❑ 1 am a homeowner doing all work officers have exercised fir 1 I Plumbing repairs or additions myself[No workers'comp- right of exemption per MGL - 12>?LRpofrepass insurance required.]1 c. 152, §1(4),and we have no employees [No workers' IIEIOther.. comp.insurance required_] ;Any appfic that checks box#1 mmst also fill out the section below sboWi rg tales workers'coxepensation policy infaenene� Ilomeeowners who submit this,af5datdt imdi;cating they are doing all wort and&en hire outside contractors trust%*n3 t a new affdwit'imdicating such. ' g on=ctars that chests this box must attached an addiaiand sheet show the name of the sob-oon=ctors and stele whe u or not tbase enthses have e®phyyees.Iffthe mb-contractors have emrplayees,they r®rst provide their workers'comp.policy number. I awn an employ"that is proWdinag,workers'compensation insaarance fo.r nzy empLayees. Below is the policy and ob site irafo!rrriahon. nn _ Insurance Company dame: /yFYT7 Orib� 2A Nor : 5��2�9�1 — Policy ACE Self-ins.Lic-#: [,��e.S to F..xgisation Date. Bob Site Address: ;)L � aIA -City/State/Zip: a ' Attach a copy of the workers'compens Lion 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 fine up to$1,500.00 andlor arse-year imprisonsnent,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office:of Investigations of the DIA for insurance coverage verification. I do hereby cerd(y ynder thepains randppenrahies of pedury th_atthe information groaridedarbmw is trans and correct ]?ate- /v2— Phone#- S� ,��O 316 S� Official sass only. Do nut write in this area,to be completed by do or tower oficiaF City or Town: P'ermitMkense# Issuing Authority(gels one): 1.Boatel of Health I Building Department 3.CitylTowrn Clerk 4.Electrical Inspector S.Plumbing Infector 5.Other Contact Person: Phone.#: Oct 13 10 05:36p Beaoon Woods 8604302607 p.1 MA of ueavgrAMAHAM = - Town of Barnstable Regulatory Sen,,ices -Thomas F.feiler,Director Building [division Thomas Perry,C130 Building Commissioner 200 Main Strut. Hyannis.NIA 02601 . ww•w•.toKa.barrrstbhluns3.os . office: 503-3624035 Fmx: 708-7111-623 0 Property Owner Must Complete and Sign TWs Sectio n If Using A Builder as()vn ct-of the subject pro-perty hcmby authoiixc Lj► LLc w1. S e_.k,dit_,r W ner oe my behalf, V in all tztancrs relative to work nudiotized by ibis building permit application for. - (Address of job) 97 04AZ . 5i;,*rtatntre of(Xvaex Date. Print game If Property 0%ner is apph ing for permit please complete the Homeowners License Exemption Form on the reverse side. C': l w�s�CGlllik'Ap;fG?xiaa,crwh:�titrt.,.t3 ii4 ir.Jv++s`-Temp+ran tntem�t t il.s C ontCn:.C)arrx�k'.7�b K;r1 AZ`•E XPKztiti.doC Revis,ed 0121 10 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEIVIENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration. 69461 Type: 10 Park Plaza-Suite 5170 Expiration , 2NV2'13,; Supplement(;ard Boston,MA 02116 E, / THE HOUSE CARRENTlrIS iIC} // WILLIAM SCHMIIL� 1112 MAIN ST UNIT 1$ s � � -- OSTERVILLE,MA 02655 Undersecretary Not vali thout signatu"re Massachusetts- Departnunt of Public Safct� Board of.Buildhw Red ulations and Standards Construction Supervisor License License:;cs 76571 WILLIAM L SCHMITZ 66 CARAVEL DR ' HATCHVILLES;MA 02536 �" •r Expiration: 9/9/2013 ('ummissiuncr . Tr#: 3843 t • Client#:12032 21BISHOPRiCST ACOR& CERTIFICATE OF LIABILITY INSURANCE DAT /2912DIY 0229/2012 2 THIS'CE`RTIFICATE 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: Dowling&O'Neil PHONE o Ext:508 775-1620 FAX a/c,No: 5087781218 Insurance Agency E-MAIL 973 lyannough Rd., PO Box 1990 ADDRESS,„ INSURER(S)AFFORDING COVERAGE NAIL# Hyannis, MA 02601 INSURERA:National Grange Mutual Insuranc INSURED The House Carpenters,Inc. INSURER B: 1112 Main Street, Unit 18 wsuRER c Osterville, MA 02655 INSURER D 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD LIMITS A GENERAL LIABILITY MPJ3361M 3/09/2012 03/09/2013 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $50O 000 CLAIMS-MADE FX OCCUR MED EXP(Any one person) $1 O OOO PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-UCT COMP POLICY PRO - roPAcc $2,000,000 JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ AUTOS OWNED PROPERTY DAMAGE $ HIRED AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ S EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WCJ3369M 3/09/2012 03/09/201 )( WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500 000 OFFICER/MEMBER EXCLUDED? FN N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $5OO OOO If yes,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE, EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 20O Main Street 5 ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S92900/M92899 LS1 Town of Barnstable *Permit# a® Expires 6 months front issue date . Regulatory Services Fee OCT: _ 7 Thomas F.Geiler,Director TpW/V QF z009 Building Division �f����7 Tom Perry, CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Q -- - -- --------------------- R 2 c(� .". Property Address--------- [residential Value of Work T O) MO Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address 4,►du�ii 1, f AJ151 �051:1?__ Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Q0 3 E2 lorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ['I have Worker's Compensation Insurance Insurance Company Name PUT IFi C 71 0I L S Workman's Comp.Policy# O' I o / d 10 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ' "-roof(stripping old shingles) All construction debris will be taken to l►V J �9/N!11��5 f -/ ❑Re-roof(not stripping. Going over existing layers of roof) 2-IRe-side [�JXeplacement endows/ ors/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 Owner must sign Property Owner Letter of Permission. o y o e ome Improvement Contractors License is required. SIGNATURE: Al Q:Forms:expmtrg Revise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information !! _-// Please Print Legibly r Name (Business/Organizatiort/Individual): °J. a u Address: c5'Q,l2J City/State/Zip: /v'S M6 02&0 l Phone#: ND rl1 2 9( � Are you an eulployer?"UAeck the„appropriate box: Type of project(-required): 1. I am a employer with 4. El I am a general contractor and I * have hired the sub-contractors 6. ❑New construction. employees(full and/or-part-time). ed sheet. 7� Remodeh;i 2.❑ I am a sole proprietor or partner- , ^listed on the-attached 0 g 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.,0 We are a corporation and its 10.❑ Electrical repairs.or additions 3..❑ I am a homeowner doing all work officers have exercised their I I.Q Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E:] Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other -comp. insurance required.] Any applicant that checks box#I 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: 41-1-7-661,4A P47WRQRr I AI E C Q , Policy#or Self-ins.Lic.#: 91! 1 O/ V I U / Expiration Date: Job Site Address: Leffla U446 t 04 City/State/Zip: QSkr.O• if MA. 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 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' nder pains and penalties of perjury that the information provided above' true and correct: Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1:Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: MAR, 13. 2009 10:24AM HART INSURANCE NO. 635 F, 2 A ORD CERTIFICATE OF LIABILITY INSURfrM ANCE D0311alDD109 „, 03r13I2oa9 PRODDCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION HART INSURANCE AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES. NOT AMEND, EXTEND OR 243 MAIN STREET ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX 700 BUZZARDS BAY, MA 02532-0700 INSURERS AFFORDING COVERAGE NAIC# INsua�O EJ Jaxdmer Builder,InC INSURER a ARBELLA PROTECTION INS CO 41360 48 Rosary Lane INSURER s: ARBELLA PROTECTION INS CO 41360 Hyannis,MA 02601 INSURER e: ARBELLA PROTECTION INS CO 41360 INSURER D: ARBELLA PROTECTION INS CO 41360 INSURER E: COVERAGES THE"POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POL-IGIES,AGGREGATE-L-IMrr$SHOWN.MAY.HAVE_BEEN REDUCED_BY PAID.CLAIMS._ INSR DIL POLICY HUM9ER POLICY EFFECTIVE POLL'&XPIRATION LIMITS A GENERAL LIABILITY 8500042039 01/01/09 01/01110 EACH OCCURRENCE S QOOODO COMMERCIALGENERAL LIABILITY rjEnnISES iEa miAranca 5 300 000 OLAIMS MADE ❑OCCUR MED EXP(Any ono Breen) 5 5.00 PERSONAL S AOV INJURY S 1'0OD"DD0- GENERAL AGGREGATE S 2,000 000 GEN1 AGGREGATE LIMIT APPLIES PER; PRODUCTS•COMP/OP AGG $ 2,000,000 POLICY PRO LOC S AWMMOGILEUABiLITY 87083400003 01/01/09 01/01/10 CONIBINEO SINGLE UMrr $acgtlonly 1.000,000 (Ea ANYAUTO X ALL QWNED AUT06 BODILY INJURY $ (Per person)I SCHEDULED AUTOS HIREDAUTOS BODILY INJURY S (Per awmnI) NON-0WNED AUTOS PROPERTY DAMAGE $ (Pat awmgl) GARAGE LIABILITY A Y-EA ACCIDENT 5 ANY AUTO OTHER THAN I EA ACC S AUTO ONLY, AGO S C EXCEL UMBRELLA LIABILITY a1/01/09 01/01/10 eACH OCCURRENCE $ 2 000 000 OCCUR ❑CLAIMS MADE AGGREGATE S 8 5 DEDUCTIBLE RETENTION S $ D WORI(FRS COMPENSATION AND 9111010109 01101/09 01/01110 '"C sTATu- oTH. EMPIAYEWLLASILITY E.L.EACH ACCIDENT $ 500,000 ANY PROPRIfiTORrFARTNER/ExECL+TIVE OFFICERrMEM9FR Ex4LL E L DISEASE-EA EMPLOYEE S 500,000 !f yaa deal'ba trntler E L DISEASE-POLICY LIMIT 5 500.000 SPECIAL PROVISIONS--- OTHER DESCRIPTIgN OF OPERATIONS I LOCATIONS!VEHICLES IEXCWBIONS ADDED BY ENDOR$SMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OC YHE AaoVE DESORm1=o po=FS BE CANCELLED BEFORE THE EXPIRATION DATE THE HE REOF,T ISSuNG INSURER WILL ENDEAVOR TO MAIL 3V DAYS WRITTEN Town Of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 367 Main Street IMPOSE No OBLIGATION OR LIABILITY OF ANY KIND UPON TIRE INSURER.ITS AGENTS OR Hyannis, MA 02601 RPRESENTATNEs_ AUTHOMM REPRESENT ACORD 25(2001/06) 0 ACORD CORPORATION 1988 p -Effo ui m g #egulaqionq--s- Fan tan ar s One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home ImprovementTb:ntractor Registration - `' - Registration: 110609 •---� Type: Private Corporation Expiration:. 11/3/2010 Tr# 276582 E J JAXTIMER, BUILDER, INC. ERNEST JAXTIMER ^' w � 48 ROSARY LN 1 HYANNIS; MA 02601 Update Address and return card. Mark reason for change. � r Address : Renewal i Employment i i Lost Card DPS-CA1 io SOM-05/06-PC8490 �/Le-U0✓/y7�rrtO7ll.I�eQUl2 o�✓l�Gaddl2�t6e�,b Board of B6ildiogRegulati6ns and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration: 110609 One Ashburton Place Rm 1301 Exa Lora 1/3/2010 Tr# 276582 .w Boston,Ma.02108 } Type Pnvate Corporation ## t E J JAXTIMER BV&F-0ER C j ERNEST JAXTI 1 �E 0 48 ROSARY LN l\ ! •� HYANNIS,MA 02601` "' Administrator Atalid wit out signature Bo" a'id of Building Regulation§and Standards r N Construction Supervisor L t icense r';' ,_ Licen a CS` 325i` Sll; i 1 12010 Tr#.13629 �1� I I� - - - ,I, F'�es�trreactio Qf� 1 ;� , ERPIEST J JAXTIA7fE> e•r 48 ROSARY LANE 1 Ivi I M HYANNIS, A 02601 —' I � Commrsswner y� Sep 30 09 12: 18p p. 1 Vy/JU/�VU 1 I I 'QY 6VL It$ r.VV l/VV I Town'of Barnstable Regulatory Services j%W=W F',G,mfr,nlrector Building Divfidon Tom Pman BuMus Comv&liana 200 Main Sweet, Himmis,MA 02601 aim. 508-862 4039 Fax: �8-���i0 .�-yas-y9og Property Owner Mint Complete and Sign This Section If Using A Builder YMIC,,14CL ,+zs Qasnaer of the subject Property,. h,=Cby'2.U*0tize J -A'f T(A�MM��1.�4� _ /1tLG to act oA=7 behalf, in all=jLttetE relative to work LU&0x;zed by this bwumg pexrait application for- ?-�Z �. 5 'v I Ie dda�zrw of Job) sigWtuxe of Ownax Date r - p�atN>zme - •- .ps.o�ntrsxaass�ox . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map l ` ' Parcel A`0 Permit# `{ 3� Health Division Date Issued p Conservation.Division Fee �Q �•� Tax Collector ' ri / SEPTIC SYSTEM MUST EE Treasurer a, U 4k � 0 C� INSTALLED IN COMPLIANCE WITH TITLE 5 Planning Dept. VIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board I� 4E7TOWN REGULAT IONS Historic-OKH Preservation/Hyannis Ill �1 t Project Street Address d• U N 6- �4C1�1- 7 Village CEPT EZV)hlL, A Pr Owner )Au&Xk!S A I Cilii. L A- Address UJ -r kE06-DAD 6�,& "(3QAV C I` Telephone Permit Request Lo)�� �t S ITS[UAW, REPOCIul EVIL S k S-E D W lkDOWS Square feet: 1 st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost,61000 Zoning District Flood Plain Groundwater Overlay Construction Type W 0G1) >aqm Lot Size b 3 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ ' Multi-Family(#units) . Age of Existing Structure 7J Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other CV2 CGO C EL [- Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 3 new Half:existing new Number of Bedrooms: existing l- _ new Total Room Count(not including baths):existing I new First Floor Room Count Heat Type and Fuel: ❑Gas ®'Oil ❑ Electric ❑Other Central Air: ❑Yes Wo Fireplaces: Existing aL New Existing wood/coal stove: ❑Yes LMo Detached garage:existing ❑new sized Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:L9'existing ❑new size 94M Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes V1 o If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name t3L�{O(� �, rkx_ Telephone Number Address )by li�7 License# Home Improvement Contractor# taU Worker's Compensation# AM —cyq4,i5-_of�f ALL CONSTRUCTI N DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I SIGNATURE ) DATE FOR OFFICIAL USE ONLY PEkWT NO. DATE ISSUED •- - MAP/PARCEL•NO. ► ADDRESS y53i- ' VILLAGE - OWNER' ' t 1 1 DATE OF INSPECTION: - - FOUNDATION FRAME INSULATION �• - FIREPLACE t ELECTRICAL: ROUGH-i '` FINAL' �- PLUMBING: . ROUGH^j " FINAL j- F GAS: ROUGH. sr FINAL. - FINAL BUILDING, , 7 DATE CLOSED'OUT r _ ASSOCIATION PLAN NO. i , • The Town of Barnstable �• RnR�ST'nR1E. ' N^S-1_ Uellar-tment of health `,ifety and I:rtvir-onrrlental Services drat" ' Building Divlston 367 Main Street,Hyannis MA 02601 Office: 508 79"227 Ralph Crossen Fax: 508-715-3344 Building Commissioner For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four d%;r-Uing units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work:&p -*-S119EW/}LL.LUIjhJaW Est. Cost Svpoo Address of Work: 27 d�OfV6.44ACl4 I�G CQA�Tfe 1111•l-ct rJu • Owner Name: ) tts S Date of Permit Application:9V&UST- I hereby certifv that: Registration is not required for the folloAing reason(s): Work excluded by law Job under S 1,000 Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING NkTTH UNREGISTERED CONMr ACTORS FOR APPLICABLE HOME IMPROVEN EI`T WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the oN% ,cr. otGcv SAM ate ontractor name Registration No. OR Date Owmer's name I✓fe Om/IJLIYIKI/P.QGL/y Qf�,/�'.`w•wf.Gf,JNA.(!(.LI.a +; i BOARD OF BUILDING REGULATIONS (License: CONSTRUCTION SUPERVISOR r F ,• Number: CS O47928 Birthdate: 09/29/1948 Expires:09/29/2001 Tr.no: 5792 Restricted To: 00 , STEVEN J BISHOPRIC 1018 RACE LANE MARSTONS MILLS MA 02648 Administrator r ' ✓fie �ar�vrrea�iicueall� a�✓�la:kt�zc�ivavlla, Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR ' Registration: 106141 Expiration: 07/22/2002 Type: PRIVATE CORPORATION STEVEN J. BISHOPRIC INC. Steven Bishopric PO BOX 687/11.12 MAIN ST UNIT OSTERVILLE,MA 02655 Administrator COMMONWEALTH OF MASSACI-��TSET T �� •� .,. �^ R DEI'A '1 ?SIT'OF L'TDUSI'RiAL A,CCCIDENTS 600 WASWNGTON S 1 k Janes: Garaaoee BOSTON. MASSACHUS=S 02111 ::c.-uss*ne• WORHERS,COMPENSATION INSURANCE AFFIDAVIT Steven J. Bishopric) Inc: / HR Logic 1, p;ccnscclpermittcc) With a principal play of business/residence ac P 0 Box 687 Osterville, MA 02655 (Ci ylStatclzip) do hcrcby certifj; under the pains and penalties of perjury; that: [)(I am an cmploycr providing the following workus' compcnsation coverage for my employees working on this job. Liberty Mutual - - WA2-63D-004155-017 Insurance Company Policy Number j) I am a sole proprietor and havc no onc working for mc. I am a sole proprietor,genera]contraaor or homeowner(circle onc) and havc hired the contrzaors listed below Who havc the following workus'compensation uuunsscc.polidcs: f I Dame of Contractor. Iusur=cc Company/Poliq Numbcr A'amc ofContraaor - Insurance Company/Policy Dumber I,hmc ofConazaor Insurancc Company/Policy Number i 0 1 am a homeowner performing all the work myself i NOTE Plcuc be a•+ue that wbili boancowaers who esaploy persoos to do waiotcoaacc,eoastruciroo or rcpa;r wocic on a dwelling of not snore thaw three units is whi6 the homeowaer also resides or on the grouods appurteaamt cbcrcto arc not gcoerally considered to be eraployus under the "orbea Coropeosauoa/let(GL C 152,sees. 1(S)),appliutioa by s boracowocr for a licwsc or permit may evideoec the legal sutus of sa ert:ployer undcr the Workers'Co rapeosatioa Act i vadcrstand that a copy of this statement wX be forwarded to tint Dcpa:tr.cnt of Industrial Acddcnu'O(iicc of lnscranu(of-00vcratic wrificadon and that failure to secure eovuap u rtjuired undcr Section 25A of MCL 152.can kad to the imposition olttirnina)pcnalt;cs consisting of a franc of up to S1500.00 and/or imprisoemcat of up to onc year and civil pcnalucs in thc.form of a Stop C19rk Ordcr and a franc of S 100.00 a day against mc. Signcd this day of Uccnscc/Pcrmi cc Licensor/Pcrmiaor ow 7 0 Ccattm.IG�t �. 1 SAfil UCW twPttl.". J1 �' EKrdt . 11`�( �( �rsaT rs Aue. 1'.Nari-t i�l�cL1+► i,.vJCeb Yy 8+1= VA ciew GGirifS6e�If�i, y i�•�� �j„9�� nl A9 J. SL 4041 VI c.'.- I,y1-qS -°Y.%v �r•�T 0 Z. wry View JfibY AEht : 1 ;� �.-rta�.,•S�s:Go.-;c.c.s.: � �1N.OF:A!1 .JOIN SA'ot'�4a COY�:�n.reQrrr,.�sao r-uc.r.�i..w�., � t. • `Mica's, lC�v wlt6.r.rr .riom� pr,rnlltr,T,,fii. ) ' S6a prtVdl�pp, ,�b41.4 ft.t.. fkz &ZA19 LAB Go�er�J VV nr rr9... rN� °lore 6.1i I r i*go. C.A.—mim-a i M/r QT�� ZsA14 A+.i A +4.1�1C`nr F'F-dT►nor:1 aF •r;� (�-9.f '4 rtAa► tP.tN_ Iw•l 'C.)c1�T►Jr� ( ' '1'6't..AGL: L1bi6' .d:t- :�'r'rK�1.r� '��x�•p ; . �--r�•..�, �.•-��-�. �,T Aooro�eo b9r t�r�nent a l6arraul P�o�.tla� 1MJC7 lrleis.;T3 1f�16rr�s jtVc bF 'iIid�h i i MWWNER T � �N:aF�cCTM -� _ pM