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HomeMy WebLinkAbout0186 PATRIOT WAY l 4 Cr1 T7a s o a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel --Application 0 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 6Pa IWI 0 W 0. Village t /Ce A f f If Owner F C f U►-- u dz iv a r-- Address ►i/ r�s�e �` Telephone So V o�® Permit Request /1 d 10,f ®[ C e 44 .Calf R.#yt J 4cyeceS 10 r( too Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District —Flood Plain Groundwater Overlay Project Valuation y/� Construction Type_ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. U;� Two Family ❑ - Multi-Family(# units) - Age of Existing Structure /79 Cl Historic House: ❑Yes ❑ No On Old ng's Highiu�ray:�a'Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other - Basement Finished Area(sq.ft.) Basement Unfinished Areas q.ft) Number of Baths: Full: existing_ new Half: existing nev�- Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor boom Colt ' Heat Type and Fuel: ❑ Gas ❑ Oil A Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing U 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 2fNo If yes, site plan review # _ Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name eT Telephone Number Address 7- D ' 4 _ License # _ ��_ � ?776 6a,rz 4-h _.r wiod t� Home Improvement Contractor# Worker's Compensation # J ux 3 3�gQ07 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO '4Lr.%w w SIGNATURE DATE i FOR OFFICIAL USE ONLY I APPLICATION# `• _—DATE ISSUED ;r . MAP/PARCEL N0._ y ft -I f r ADDRESS' — VILLAGE OWNER ". DATE OF INSPECTION: i FOUNDATION'-% #.. FRAME 'INSULATIONI' . ' FIREPLACE �+ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: , ;,— .. ROUGH ;_;_•��t, FINAL r� ,FINAL BUILDING'=' `a ,"__` V !r ' DATE CLOSED OUT ASSOCIATION PLAN NO. 10 . ousin � � 460 West Ty�st�� ; &oz6o1-ems$ Assistance T �506)7 71-5400 F�W T/5-713 HOME OWNER WEATHER1ZAMN woRK PEPmrr8 FUEL RELEASE: PLF.ASR Fff L OUT AND SIGN TES TORMI SOU ARE THE APPI-ICANT HOME OWNER- _ j tm A hereb consent to and agree that weatheii-zation work maybe y done by the`Weatherization Program of Housing assistance Corporation (hetCi a$er refered 2s 'Agency') on the pro L located at; 01 - �(%�P- V� Tb-e weatheni zation work done wM be based on programma k priorities and availabdity of funding and it may include all or some of the following measures_ Weather-st zppwg 8c canBiag of windows and doors,insulation of attics,-sidewalk&basements,attic, and otherventilation measures and-possibly replacement of badly detmiorated windows_In consideration of the weaIlLerizafion Work to be done at my home I agree to the following_ 1_ 1 give permission to the "Agency"its.agents and employees to travel onto or across said property with such etjaipment.and materials as may be necessary to pmfozm weather.z tio-u Wailc on said Pro— Percy-2- The Rousing Assistance Corporation reserves the right to inspect the fuel or ut dity bM for the -weathezzzed unit on an ongoing basis for no more-dz five(5)years after the weatherization work is completed I have read the provisions of this agreement as listed and freely give my consent- Home O-w . (Signature) Date_ g j l —1 Date_ HA-C approved Weatherization Cozlpan-y �ac e 4 e Caliber Building&Remodeling Cane Cod Innsulafl-on Cape S ave CzesWCH Cons'r acti-ou Frontier Energy somons I;ohr Sons -Peter sr.bi-th Resolution Er=U Rock Solid Co on- All Cape 13a adore i The Cotnrnonivealth of Afassachusetts Department of Industrial_Accidents Office oflnvesti;ations 600 Washington Street Boston,AM 0-7111 1 v3vitk tauzrs.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizabon/Individual): C oa 5 d,ve, 7,n C. Address: 7 — 4 H"*,'ng4-on NVCAV C, City/State/Zip:soo,4 YasmovAl mA OAb 4 Phone#: 508-- 3 9 8 - 0 3 g 8 Are you an employer?Check the appropriate box: �` 4. I am a general contractor and,I Type of project(required): 1.10 I am a employer with .20 ❑ g 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ lam a sole proprietor or partner- listed on the attached sheet 7..❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition , working for me in:any capacity, employees and have workers' 9. []Buildincy addition [No workers'comp.insurance comp.insurance required.] 5. ❑ We are a corporation and its 10.E]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]f c. 152,§1(4),and we have no employees.[No workers' 13.0 Other T n &. l S th, on comp.insurance required.] *Any applicant that checks box�I must also fill out the section below showing their workers'compensation policy information. t Homeommers who submit this affidavit indicating they are doing all work and Then hue outside contractors must submit a new affidairit indicating such. ,Contractors that check this box must attached an additional sheet shoeing 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 mz employer that is providing workers'compensadoq insurance for my employees. Below is the policy and job site information. Insurance Company Name: TeOh n o t 0 4 To 5 vvr an ot: C Policy r or Self-ins.L'ic.r: C 3 3 $ Expiration Date: y I ( 3 Job Site Address: G V41 �1f, `I/ City/State/Zip:1� t�vv`l 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 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. Be advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Signature: Date: IZ3 1 3 Phone:": S ' 3 7 3 Official use only. Do not write in.this area,to be completed by city or tower 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 E: i ACoO V CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 11/9/2012 THIS-CTIRTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS (itRTIFICATE 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 NAME CT Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 ac No):(781)963-4420 15 Pacella Park Drive E-MAIE _ssperrazza@risk-strategies.com Suite 240 ADDRINSURER(S)AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURERB:SafetV Insurance Company 3618 Cape Save, Inc # tNsuRER c-.Technology Insurance Company 7 D Huntington Ave INSURER D: INSURER E South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER-CL1211954576 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 ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY) IMMfDDIYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES SES(Ea occurrence $ 100,000 A CLAIMS-MADE GE To REWTED— F OCCUR 199448001 0/16/2012 0/16/2013 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG 5 2,000,000 X POLICY PRO LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMrr a cadent 1,000,000 B ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED 6208200 1/6/2012 1/6/2013 BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE X AUTOS Per cadent $ X UMBRELLA LIA�—HCLAIMSAIADE Underinsured motorist BI split $ 100,000 OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB AGGREGATE $ 1,000,000 DED I I S199448001 0/16/2012 0/16/2013 $ C WORKERS COMPENSATION Officers excluded WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN' X ANY PROPRIETORIPARTNER(EXECUTIVE r0 a coverage E.L.EACH ACCIDENT S 500,000 OF EXCLUDED? N/A (Mandatory In NH) C3318007 /9/2012 /9/2013 E.L DISEASE-FJ4 EMPLOYE $ 500,000 If yes,describe under IDESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Issued as evidence of insurance. Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a/ National Grid, Action Inc. , Colonial Gas Company and NStar Electric are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 427/SCH 3195 Main Street AUTHOR¢EDREPRESENTATIVE Barnstable, MA 02630 Michael Christian/SMS �� - ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 roninnsi m The Arnon nd Inn..Oro�enic4ered mer4c eCADn f a -- tMassachusetts- Department of Public Safety. Board of Building- Re�-ulations and Standards Construction Supervisor Specialty License License: CS SL 102776 Restricted to: IC WILLIAM MC CLUSKY 37 NAUSET ROAD WEST YARMOUTH, MA 02673 f: t Expiration: 602/2013 (.'ununi_. ncr 776 - � �. �A40ac keoea Office of Consumer Affairs andusiness Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation - Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC: WILLIAM MCCLUSKEY _ 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 026.64 Update Address and return card.Mark reason for change. Address Renewal Employment € Lost Card PS-CAI Ca SONI-04/04-G101210 e L�a�rL»ea�iaseald• c��:.11a.sacluselt� registration License or valid for individul use only Office of Consumer Affairs&Business Regulation -'HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ' Office of Consumer Affairs and Business Regulation F Registration: .::171380 Type- g , � '� =' Expiration: 3/14/2014 Corporation 10 Park Plaza-Suite 5170 •- Boston,MA 02116 CAPE SAVE INC.: WILLIAM MCCLUSKEY - 7-1)HUNTINGTON AVENUE SOUTH YARMOUTH MA'02664 Undersecretary Not valid wit o signs Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 06/12/12 Town of Barnstable Thomas Perry CBO Building Commissioners 200 Main St. Hyannis,MA 02601ZE RE: Building Permits 4 Dear Mr. Perry, This affidavit is to certify that all work completed for 186 Patriot Way,Centerville has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: Basement- Floor.- All work performed meets or exceeds Federal and State Requirements. , Sincerely; William McCluskey I , - TOWN OF BARNSTABLE Permit No. ----------_--------- i �� Building Inspector ■... Cash -------------- OCCUPANCY PERMIT Bond -------------- No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Su46oik Rwttty TAurt Address Wiring Inspector -- Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department: Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ...................................................... 19..._._ ................................................................................._.........._.............. Building Inspector t4sessor's map and lot numoer *THE WITH TITLE 5 39. 0DE AN TOWN `� ~.. BA�~^=� . =.��=,�°=�===�"~O"°S~ .. � . ^ ' BUILDING . � N 0 � N ��� � ���� �� �� N0N0-0� N ���� . �� ��Nm 0 NN �� ' , ~ ' ^ So�d�ol}c Realty Trust ^` APPLICATION FOR PERMIT TO .,----.--------.��—��—.—.—.—.------.---------..---. TYPE OF CONSTRUCTION _______..�jnnl Q..f.alnily... j.dtXl.t ij;itl............................................. � ' June 21 70 ................................................ ........ TO THE INSPECTOR OF BUILDINGS: ~ � ' The undersigned hereby applies for o permit according to the following information: Location .........................I�Qt...#.. iot..VV�I�_. ����...��`__.L�!�33_____________ | e �ami � �e�ideutial | Proposed Use -----------.�.����-----.��--------------------------,------.-- Zoning District ........ 8..�� ' ]��..r.ej�j alive District ---. ll�—�— !�— Nom* of Owner S Il��lt�%� ![�g�[t A6J,ex F. D ]�c�� ��� /����j��r3c����� | «", --'.��`:.::::' ' ---' �" -- ° "— '' '' ----' | Nome of Builder --��a.m.e.----------------'A66resx --------/samE ................................................ Name of Architect ---------.---------.--'AdJres ----------------_------.____.. aev�az ed Number of Rooms ----------------------Foun6o�iun ----.1����--..�����/�����---___.,_ Exterior --(�e����r'��]�i��l!�!�-------------�RooGng ---'�� .. .............................. Floors !� '�����..00derI�l�P����-------|n�e,io, — .��������r................................... Heating ---.1�Iectic------------------Plumbing .........1![C................................................................. �ri SUBJECT TO APPROVAL F BOARD OF HEALTH OAO, ---ZV90 . OT I hereby agree to conform to all the Rules and Regulations of the! Town a BarnstcLble regardin the above Name _--.— ....... � � ^ s - . Suffolk Realty Trust A=193-198'' No 2.U92.....:. Permit for ..1...story..dw&J.1irig ................:.............................................................. Location ....lo;t-47.6.....1.86.- a,tr•iGA.•Way......• .......................CenteLvine................................ Owner .....Stlf f-Q1k.:Realt. .Trus.t................ R Type of Construction yp ............Wood..................... J. • , ' i . ............................................................................... I Plot ............................ Lot ................................ ` Permit Granted June..21.19 79 } Date of Inspection .........19 `U 2 Date Completed .... ..���.„ ......19 1 RMIT REFUSED ref N > t d" ... .M...��CC................................. 19 ........ .�.®. .m. ............................................. r 46 . � -� ......... ............................................. ,.......... .......� .2.......................................... t rn ♦V - Approved.....`. .................................... 19 ,. :...., .. .......................... 4 s r- Fs # z LoT 7S 9Z,Z D ' O�, l LO M SUB So/L �' :� ' 97•Q - ---------- ..zoo_----�-9 ' �, •`` ��°N 1� MED. + c Q BG • Z 6 ' � S � G FINE l � / 0, d 0 SAND 76 . 4 9 /9 c . 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