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HomeMy WebLinkAbout0168 MARINER CIRCLE 1� a, Assgsso�'s map and lot number ?....`�...1. q.ia s.�)�. O�, /`�� �/-��,yoFTHETo� Sewage Permit numberSEPTIC SYSTEM MUS INSTALLED IN COMPL 9TAILE, i fM House number ................ ..b..b................................................ WITH TITLE 5 'op M6& 00� ENVIRONMENTAL CODE TOWN -OF B,'A�R N S 1'' � LATlolus BUILDING -=INSPECTOR APPLICATION FOR PERMIT TO .............: ...................................................... TYPE OF CONSTRUCTION .......: .... . . ........... .. ............. ............................ ... `..........19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acc_ording.tq the following information: / C�? .......................�4 .... ............................................................ ...... Location ... . ... ..... ... .... �:........... ProposedUse ...... . .................... .� .......................................................................... ......................................... _� Eire District Zoning District ............................... .............. ........... .. %......... .................................................. Name of Owner ... .......` .................. Z...:":.:..:......Address ............ ................ Nameof Builder ...... ...:..:..:::..... ...........................................Address .................................................................................... Name of Architect ....:........................................................:.... ........................ ....................... Number of Rooms ................IG............................................Foundation ....� v. .. 6 ........................ ... Exterior ... .�"" ...... . ................Roofing Y��.............................. ........................................ Floors �°`....���.....�-��..............................................Interior ......�.. ........ .....:................................................. 4 • .........................Plumbin ( L$.. Heating ,/ . . ! v"........ g ................................... Fireplace � . ..... ................................,.........Approximate Cost ....... ...P..:�J ......................... ... . .......... ............ / / ` Definitive Plan Approved by Planning Board _ ___ ------19_�_`-'. Area .........(. . ?....J.�. ...... Diagram of Lot and Building with Dimensions Fee ............ S SUBJECT TO APPROVAL OF BOARD OF HEALTH 1%/27 r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regurcling the above construction. Name ......:. ......... ...................................................... � � � . . - ^ � Theo Const','— ' r Date Completed 19 PERMIT REFUSED 00 ^ � ~ ~� ^ . . . ..' . . . . . � / lA ' . ^ ' .--.—.-----.—.—' - '----'---~~'—~'^' ' ^ Assessor's map and lot number .^. ...:....Z.,.�: Sewage Permit number d�Q Z BAWSTABLE, i Housenumber .........�.L(3.............................................. r Mae6 Gp i639. \e00 �0 MAI a• TOWN OF BARNSTABLE 4 BUILDING INSPECTOR APPLICATION FOR PERMIT T.O .............:.......... .. ............ ......... ........................................... TYPE OF CONSTRUCTION ...IY� ! •��"—'� �-" r. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ?�,/ .... „��, L ....... ,: �� ................o ProposedUse / ..................... ....................... . ......................................... ...............I......................... Zoning District ............P.� ................:................................Fire District ...........!�...�� _ ........................................ Nameof Owner ................ .............................Address ............. ....... !rr..:.......,..... .�., / 7.1 • ......Address Name of Builder .... ............................... ., Name of Architect """�Addr-ess—.....,..._..._..._.............. — I Numberof Rooms ................. ...........................................Foundation ........ ......................................................... Exterior G/� Xa ...�sc-f, ZV7� �� ..................Roofing � �C.%�!�..,,�� �r'�............................. ........... . ..)...... Floors .....���... .....�..................................................Interior ...... Heating %" �N �!/..... r���........................Plumbin ........./„�-�` .�L .................................... . g � ............... Fireplace .................. 41 .a.........................................Approximate Cost (o ... ... .:................................................ Definitive Plan Approved by Planning Board __-__W=!______L_-------19__�__`_'. Area ..: f �. ...:°. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH _ f NV I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...�.............. ..................................................... , - . � / - . . . � ^ - ' ' ^ � � . . -. ' ' . � . , � ~ ' - . / � , � . � . . ' . - '. .. ' .-' / Theo Const. Type of Construction ........f..r.7a)e........................ Date of In IPERM14REFUSED lA � --~^--'—'----' ---'--^''^'--^—' ' ' s .40 7- 0 <0 0 f l 4 0to ;I V if 1 F yj i, 1 N I ' I i I g I i PLAN SHOWING To FOUNDATION LOCATION C OT UI T, MASSACHUSE T T S I OWNED BY ?"i`'��j COf✓��'�".�C? !%Q ? x ;' w a v:3) w.• SCALE : / "= DArE: /yQv. -5 /9�9 oW P a � Q :iQ I NORMAN GROSSMAN---- - — REGISTERED LAND SURVEYOR `�a I HEREBY CERTIFY THAT' THIS FOUNDATION IS LOCATED �� ass ON THE LOT AS SHOWN AND CONFORMS TO THE TOWN � noRMay OF BARNSTABLE ZONING REGULATIONS REGARDING a GRCSSYdJi 'n SETBACKS FROM STREET LINES AND LOT LINES . " 12775 4 F D SU ' j NORMAN GROSSMAN R. L. S. DATE TOWN OF BARNSTABLE Permit No. Building Inspector "1 s" TAU Cash ` �'r0■PY�'\� / /� V 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 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 a $ Town of Barnstable OFTHE ro1y� Building Department Services Brian Florence,CBO • zxxsTlR^,R Building Commissioner 200 Main Street, Hyannis,MA 02601 prEO www.town.barnstable.ma us Office: 508-862-403 8 Fax: 508-790-6230 PERNncT# 1 - 7 7 FEE: $35.00 SHED REGISTRATION RESIDENTIA-L ONLY a 200 square feet or Iess ` C3 -t•v Mat441U eIttcf- 6r,L4* f v Location of shed(address) Village Property owner's name Telephone number v: �sxI? Size of Shed Map/Parcel# 201 e J:)&7!VY5 � a0'• eU vh ate 9 Hyannis Main Street Waterfront Historic District? Old Ki g's Highway Historic District Commission jurisdiction? You must file with Old King's Highway Conservation Commission(signature is required) . Sign off hours for Conservation 8:00-9:30&3:304:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOARANIED BY A PLOT PLAN Q-forms-shrdreg REV:08/6/17 r�� � t •. w a � r $:3 � t �. '"°`, r;. �` _+. � #'�, n .«;W .'•a � ���=. ga 3� �, 1'' ="p ;,4 ,, y." —a`• -- t--•r + ,�„t e ri=.' `.aw. $`_ ✓ .. a •�'' R^:. 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I tt ^�_ �' ;a• _ .a , + Q Q _:t p a y NORMAN,GRQSSMAN- REGISTEAtO LANDv SURVEYOR,# 'z' a .fir q ..,} �-. �•:�.. � �.ry Sa-. «.J wr rj i k)�,,.,•fw�a�2•-:} +�' Ewa t� �,�; _4'" �} sN �z Zh � st��' Iyi HEREBY,fOERTIF, Y tNAT T HIS FOUNDATION IS�LO;CATED �ZH �� /� 0N•TNE L0-7 AS ,;.SHOWN AND'CONFFORMS-,TO;oTN,E'TOWN � r a OF�BARNSTABLE 'Z NORMAN ONIIdG��REG ULArT 10NS.REGARDING 4: .R rA T t ES : ,r SFTBACKS" fROM 'STREE•T INES NO LO 'lN i2»s, a « rF: ..d'it " ,.r. "+'en..: da -§ "- •((� '►fa y Y y a,.�•t� 7� x .�:.GfZ.% a �,s a T3;` s" "'a-'# �,w '=r",�,s..c a,..rt • �w Yf"'� �. �{r��`TU�� *t� 'y"#� .� {.Iw:... �'s' l+a+y. [� N R L- S .r ,,..,II V-R�Af• FO RLO-5 SNM .,K.d -�+'t^�`2i._.a.,.},3• ,'sti'• v'`X"".f ` . �"..1 {��' R -"s � �,"3 . t•, ct M A f F TT S f L a T t` ' t wr.' 1l r @. ms_.t..v �.� +r + -:'- t ,ti .a.. �.,g# S:ya F ,«r �. p�•": .-1'"x '3: €._.� � n;�sy y++,. ttt }#� t ,,xt Application number.. // /^/ 1 ...`a........ ' .�V Fee ........................... ...... .�............ DAINSUBU. ` `; Building Inspectors Initials...... .. DateIssued........ ......... ........................................... Map/Parcel..... .. / +� q.. .1....( ..... ................. TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION, PROPERTY INFORMATION �i Address of Project: �,�s L� � � �► cc �� `�1 ©o �� NUMBER. STREET VILLAGE Owner's Name: f � Phone Number ��- L 5? — 4� a t Email Address: _Z�twe k!A�'J Q ek:CQell Phone Number Project cost$ \-9�©,co Check one Residential V Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize ' \�tL NCA ..o to make application f r a building tin accordance with 780 CMR ` Owner Signature: �`'-� Date: TYPE OF WORK ` Q Siding ❑ Windows (no header change)# F-1 Insulation/Weatherization 0 Doors (no header change)# Commercial Doors require an inspector's review MRoof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION , Contractor's name Home Improvement Contractors Registration(if applicable)# attach copy) Construction Supervisor's License# (attach copy) ; Email of Contractor `'°;L"3�? Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTYES IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER ' Y *For Tents Only* Date Tent(s) will be erected Removed on number of tents total i 3 hfl r Does the tent have sides?Yes No (If yes please attar floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs.'or> Yes No ,if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES * ' Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature /` Date /G--q- ? All permit applications are subject to a building official's approval prior to issuance. r J The Commonwealth of Massachusetts 4 = Department of Industrial Accidents Office of Investigations , 600 Washington Street Boston,MA 02111 1 ' 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: 1E , �, � *-A 6aS3(/ Phone#: Sc�r-�f 6/co Are you an employer?Check the appropriate box: i Type of project(required): 1.L7 1 am a employer with `* 4. I am a general contractor and I have hired the,sub-contractors 6. ❑New construction employees(full and/or part-time).*, 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 working for me in any capacity.• employees and have workers' 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.F1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E�<oof 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#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. $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 thepolicy and job site information. Insurance Company Name: ,a.��� Policy#or Self-ins.Lic.#: t.,13CUO kyCG1560 Expiration Date: >—a� Job Site Address: 6 ��C3.� rb`�c' CSC e� City/State/Zip: �.�1" 6a63s 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 certify under=* d of perjury that the information provided above is true and correct Si ature: Date: !� f Phone#: �G� ' y 5 7- ON S 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#: a Information and Instructions 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 numbers)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 Department 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.,In 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 burn 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: The Commonwealth of Massachusetts Department of Industrial Accidents' Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.govfdia CERTIFICATE F I DATE(MWDD/YYYY) O LABILITY INSURANCE 10104118 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 have ADDITIONAL INSURED provisions or 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 _GNAmNEAu' MBIISSe Flakier Robert E Bouchle Jr.Insurance Agency,Inc. AICN o Ext: 508-564.5560 Alc No: 508-564-5531 1352 Route 28A PO Box 400 Cataumet,MA 02634 -ADDRESS: info@Bouchlelnsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: S&H Underwriters(Acceptance Indemnity) INSURED INSURER B: MWCARP(Atlantic Charter Ins Co) Stuart&Co.,LLC INSURER C: 175 Teaticket Highway,Unit 13 INSURER D: Teaticket,MA 02636 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. LTR TYPE OF INSURANCE INSD WVO POLICY NUMBER MM/DD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE a OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any oneperson) $ 5,000 A CL00263842 05/22/18 06/22119 pERSONALBADVINJURY $ 1,000,000 GEMLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per acceded) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS UAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X ST TUTE" ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 B OFFICERIMEMBER EXCLUDED? � NIA WCV01406600 05/23/18 05123119 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 1011,Addltional Remarks Schedule,may be attached B more space Is required) Brian Stuart Is not Included In the workers compensation coverage. ' I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF NOTICE WILL BE DELIVERED IN Jane Raymond ACCORDANCE WITH THE POLICY PROVISIONS. 168 Mariner Circle Cotult,MA 02635 AUTHORIZED REPRESENTATIVE Robert E Bouchle Jr ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD CommonWeatth of Massachusetts Division of Professional Licensure -,f Board of Building Regulations and•'Staridards, C o n st r-patio n'SDperu i sor CS-023320 r Expires:0611812020 KENNETH I STUART `t 63 HANDY RD POCASSET MA 0255CL Commissioner �:7fe�rt�i,.szar�rareil/�._ry:--i��irl�ir�itse(l 1 ., „ Office of consumer Affairs.&Business Regulation T HOME IMPROVEMENT CONTRACTOR TYPE:LLC R�gistratlon _ 'on rs �153684 01/02/2019 STUART&CO LLC8. r KENNETH STUARTi ra _ 63 Handy fs Pocasset,MA 02559 f Undersecretary:ti r