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HomeMy WebLinkAbout0031 SCREECHAM WAY �i cS'���, cv - _ ir TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 11Zxkp4 Map Parcel d•• Application # 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 A Vv, `,,�A1.., C 070 V n Village Owner .SkA 4r o.J Address S Cr«-C-V Ace w, , Telephone Permit Request r Ste` ; .mac ��or „Ir- S�-•�e�G� 4,quare IP/2a (1 �' J,4-r 'fv Cv^^NdtiLl /-�rC C fee 1st floor: existin propos 2ndoor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio CQ Construction Type Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family C7 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 i' o z Total Room Count (not including baths): existing new First FloorMioom Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other : Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woo %coal stav,9: ❑`Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing F�p net size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ' Zoning Board of Appeals Authorization 0 Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION - - - - - - (BUILDER OR HOMEOWNER) Name �j SpIJk ` �(•-, �ry � Telephone Number) Address y s License # -7 7 t Home Improvement Contractor# Email vLCt.,ll�, �') ��,✓��h _ [ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY I APPLICATION# DATE ISSUED f j MAP/PARCEL NO. . ..E ADDRESS $ VILLAGE OWNER i • DATE OF INSPECTION: FOUNDATION FRAME INSULATION ; FIREPLACE ELECTRICAL: ROUGH '•FINAL ' PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL . FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t ieg,u a Pry Sir ces l o rrt W�,t tee 4ift" i n�rsmi�siii # 4vu b'gain strta�it ai*tible ei% '-'I a 'Pr9 ear must, . 0�0is aa�d 5 a hi ion, f Us n ,A ' Jharon tSarnes s Orrs$lei aats t r 3 e �o Ketrotit - su,a ion can rry h f, Matte .r as 'to, *`A ut oan�'a ,teas=l r '�. z ut a apls ra fir l diiis Q fl ' iilrleiis aar� sre,ti spat t C,,aaxi are n)Dt t fly or i sore I c4 .c Sw'.' tale ,, speidrl�rss are �t�rrtz� arac$:�v���t�z3 Y, . �� '� R�N 134�N�S • • � r, .fir T/7/Z��� f..:! t � � F The Commonwealth of Massachusetts Department oflndustrialAccidents 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 PERMITTING AUTHORITY. Analicant Information Please Print Legibly Name (Business/organizadonMdividual):_ ,Z � {n -r �N SJ A�1 6-1) Address: 6- City/State/Zip: P Phone#: Are you an a ployer?Check the appropriate box: vJ.71 Type of project(required): i s employer with_employees(full and/or part-time).* 7. ❑New construction 2.E]1 am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity-(No workers'comp.insurance required.) 3.0 I am a homeowner doing all work myself[No workers'comp.insurance required.)t 9. 0 Demolition 4.Q I am a homeowner and will be hiring contractors to conduct all work on ray property. I well 10 Building addition ensure that all contractors either have workers`compeasati inssurartce or are sole 11.❑Electrical repairs or additions proprietors with no employees, 12.C]Plumbing repairs or additions 5.Q I am a general contractor and I have hired the subcontractors listed on the attached sheet 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.; I4. er L✓�1 � , L O� 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c, 152,§l(41 and we have no employes.[No workers'comp.in_sim=regr Td.] *Any applic ant that checks boot#1 must also fill out the section below showing their workers'compensation policy information ,;Any who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tContractors that check this box must attached an additional sheet showing the name of the sub-connectors and state whether or not those enntities have employees. If the subcontractors 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:_ ))—)Of2 TnJr Policy#or Self-ins.Lie.#:-,J d Y S oZ. C- D C) Expiration Date: C -2 Job Site Address: 3/ SC re ecAN A r— Lt>4 City/State/Zip: 60 i Ul �- { ' 624 — Attach a copy of the workers'compensation policy declaration page(showing the policy number and exp6ation date Failure to secure coverage as required under MGL c. 152,E§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. , 1 do hereby cvtyy under thi p and penalties of perjury that the information provided above is true and correct Signature: Jate: 5_13 / Phone#: I la Z4, 1's — (., (I l to Official use only. Do not w)jle in this area,to be completed by city or town officiaL City or Town: PermittLicense# 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#: i Office of Consumer Affairs and Business Regulation 10 Parr Plaza- Suite 5170 Boston, Massachusetts 021.16 Home Improvement tor Registration - Registration:_= w=s Registration' 160461 - ' ;i'��=,� -�-�,�_-_:�•� r- Type: Private Corporation Expiration; 7/29/2018 Trd 289184 RETROFIT INSULATION, INC. `�«µYE:.:?, -w .IOSEPH REILIY Y} ',��` -- P.O. BOX 105 SEEKONK MA 02771 'T • =-r:' Update Address and return card.Mark reason for cb=ge. $CA 1 0 2OM-05111 Address Q Renewal [] Employment a Lost Card V/LA (PQv9aHLA9!-U/�GK✓�a�(+di12fLQ1Cac�d6G6B�• - omet of consumer A tWrs&Busb"6 Reguiation License or registration valid for indivtdnal use only HOME IMPROt/I=MENT CONTRACTOR before the expiration date. If found re#ttl'u to: Reg1btration;3::`jgp4B1 Typo. Office of Consumer Affairs and Business Regulation '" lO lPark Plaza-Smite 5170 Expirations 7/39/Zf11$ Private Co"ration "- Boston NA 02116 --...'. RETROFIT INSULAIf_IN,t`y �.. .,.' JOSEPH REILLY .-�-; - `' 644 RODMAN S"f �•`•`," FALLRNER,MA 02721 Undersecretary N&t valid without sipature r N Massachusetts-Department of Public Safety Board of Building Regulations and Standards r y i. CtsnstsuetlnrtSunCrrisor,Sneaislt License: CSSL-102771 jOSEP11 J REET PO Box 105 Seekonk MA 02771 44 �fl�` ExpirationN E " l Iy n }e r • 6 RETRINS-01 RBLACK1 aC - CERTIFICATE OF DATE(MMMMYYYY) �..� LIABILITY INSURAN CE 8/1112016 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 License A 1780862 CONTACT HUB Internat gional New En land NAME` 222 Milliken Boulevard PHONE Et:(500)670.1971 a No; 508 678.2750 Fall River,MA 02722-9946 E-MAIL ADDRESS: ENSURER($}AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company Of South Carolina 19259 ii�siiRED INSURER B:Star hisuranceCompany 10023 RetroFiit Insulation,Inc. INSURER C: PO Box 1 05. INSURER D: Seekonk;MA 02771 INSURER E INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE E 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 RESPECTTO 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 L Y EFF POUCY EXP LTR _ TYPEOFiNSURANGE I D VW POUCYNUMBER MMIDDIYYW) (MMDaNYM LIMITS A X I COMMERCIAL GENERAL LLABIL TY EACH OCCURRENCE 5 1,000,000 CLAIMS-MADE 0 OCCUR X S21876.53 0811512016 08/15/2017 D DAMAGE rence'i $ 100,000 MED ExP(Anyone person) s 5,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'LAGGREGATEUMITAPPLIESPER GENERAL AGGREGATE $ Z,000,000 POLICY.7 J O- LOC PRODUCTS-COMPIOPAGO $ 2,QOO,000 OTHER 1 $ AUTOMOBILE LIABILITY COMBINED SINGLE UWT A Ea aaident " $ 1,000,000 ANYAUTO 910018200 08/1112016 0811112017 BODILY INJURY(Oar person) 5 )( SCHEDULED W AUTOS ii BODILY INJURY(PeraccJdent) $. X HIREDAUTOS X NON-OWNED I PROPERTY DAMAGE AUITOS Peracciden $ $ X UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS I" CLAIMS-MADE S2187653 OSM512016 0811512017 AGGREGATE $. DED I X j RETENTION$. 0 $ 1.000,00 Yi(ORKERSCOMpENSATION ! P.ER. O.TH- AND EMPLOYERS'LIABILITY YIN STATUTE ER OOFFICCEERW12MiBEREXCWDE�DiEC�V UTA C0845201 08/0212016 0810212017 �L EACH ACCIDENT $ 1,000,000 (MandaWrry.nNH) EL DISEASE-EA EMPLOYE 5 1,0 If yyeess00,000 . DESCdesorbe under RIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 J RESCRIPTION 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 National Grid THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN 50 Washington Street ACCORDANCE WITH THE POLICY PROVISIONS. Westborough,MA 01581 AUTHORIZED REPRESENTATIVE 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Bk 29671 P9 303 025653 05-24-•-•2416 a'1 U$ = 36a AMENDED ABSTRACT OF TRUST s Name of Trust: THE SHARON,MAHER TRUST Dated: September 14,2006 I, SHARON BARNES, VWa SHARON MAHER of Cotuit, Massachusetts the original Trustee under a Declaration of Trust dated September 14, 2006, for whit the Abstract of Trust was recorded on September 25, 2006 in Barnstable Registry o Deeds in Book 21374 at Page 222, certify as follows: (a) I am the current trustee of the Trust. 1 have remarried and changed my name, but retain the authority to act as the sole Trustee; d '(b) The Trustees of the Trust have authority to act with respect to real estate owned by the Trust, and have full and absolute power under said Trust to convey any interest in real estate and improvements thereon held in said.Trust and no purchaser or third party shall be bound to inquire whether the trustee has said power or is properly rr exercising said po'wer'or to see to the application of any trust asset paid to the trustee M for a conveyance thereof; and, (c) There are no facts which constitute conditions precedent to°acts`by the trustees or which are in any,other manner germane to affairs of the Trust. All Individuals Interested In title may rely on the contlnuing' existence of o the Trust until a further certificate Is recorded or registered establishing w the expiration or termination of the Trust. l✓xecuted�as a sealed instrument under the pains and penalties of perjury on May , 2016. SHARON BARNES, Uk/a SHARON MAHER, Trustee i COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. Maya,32016 Then personally appeared the above-named SHARON BARNES, fWa SHARON MAYBE proved to me through satisfactory identification,( Pc x&,u .e* I Vvv,...., c .to be the persons whose name is signed on the proceeding or attached document, and acknoowkdged the foregoing Iinstrument to be her free act,before me, �v C. C 'ght otary.Public My Commission Expires: 06/06/19 IGNla - f M v BARNSTABLE REGISTRY OF DEEDS John F. Meade, Register ��•`"". TOWN OF BARNSTABLE - ____ Permit No. ---------------- s�n� Building InspectorIIA" cash �Od ,619 Robb OCCUPANCY PERMIT Bond --w 7 Issued to McShane LOnst: Address Wiring Inspector I �, Inspection date Plumbing Inspector 'f� l ¢. _ Inspection date � d Gas Inspector Inspection date Engineering Department .. Inspection date Board of Health 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. i .............. ::.................. Building Inspector ' FROM. - TOWN OF 13ARN81TABLE Mr. Francis Lahteine BUILDiNG DEPARTMENT Tan ,. w ,.� w;r :' ' 367 MAIN STREET HYANNIS, Mtn OM1 Phone: 775-112a. SUBJECT: • FOLD HERE DATE - _ - MESSAGE Work I tas j.co let- d;wrP�+nt► , 293 4Ac;ShaneCostu�t � o Please release Bond. . +pcte r.47r•ss.rh.»:grm�a^!R•x�*r�x.sr##+sfiewa,4lyrrou ' SIGNED 1 DATE j F REPLY. } r , ' - SIGNED Ne7-RMf - - RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY 5 ` •' - • ` - - PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. I ` i C\ ACV ♦ T � ` I \ � Y ram,+t`♦�,. � � �7 J GRE.a.,�REO FOR T-yF_ ?"ti'/S ��:h�N /.S .qS /7" E",X"/S I.S' f�iV,Q !"may 7" /T •. C01V U�'/1'1S TO 20^1,11Vc�;7 RE��"��'� 1 a'.'cJ:Vv. �� L�.9TE.'✓G__:��19�5"_' SCF7LE•' / = � �c..�_f...-�_= �.�.�sr:_.._ -•� ,s_._ 'G _ - '�c',t'E T .M�4S.�^ t N ' • I Assessors map and lot number .................................... ... .' / eCSYSTEM MIUSIT e Sewage Permit number 3 0 ' ` !rC. LED IN Y tom. }� wini TIT` t SAUSeTa LE, • 2 House number .................. ...�1.. ........................................... 1639 `c Nt 9 �0 MPY p" TOWN OF BARASTABLE BUILDING I,HSPECTOR APPLICATION FOR PERMIT TO ...:. ... �e � R.....: t�-dinlst...... .................. ....................... TYPE OF CONSTRUCTION ...........:.IvCkf�?�? ..:.... ...:. ........................................................:............................ 6A."I...........................19.. . TO THE 'INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit acc rding to the following information: ^ -� b...?�....l.Z.............. . C�£ eA�I.......... .�Location ............ ff. ...........C�.. . Proposed Use .....S...4f....�'e........ c?`u.........:.. ..................`. ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner .... .C. .!'.�f� e..... o.�. ......Address ...� .. �. ........../.v� Nameof Builder .....................:..............................................Address ................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...........7.................................................Foundation ..........f� "e-<Q CA-W ............. ............ Exterior ............ /. ........................:..........:................Roofing ...............1.09Y... .................................... Floors Q vv ........Interior ........... 1.. '�, ........................................... .......... .. ------d .................................................. 9 J Heating .w........ —.................Plumbing ................ ........ ............... .............................. Fireplace ............... .. .. . .... . ..........................Approximate. Cost ............... �/.. �.'........... ......... . Definitive Plan Approved by Planning Board -----------_------_-----------19________. Area ...................... .......... ........ Diagram of Lot and Building with Dimensions Sd 9 Fee ........./�.�f.... .......:............ 9 . SUBJECT TO APPROVAL OF BOARD OF HEALTH ' �0,% OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ........ ........ .......►:. .. ................................ Construction Supervisor's License ..1.14�.1!�Q.�... McSTWANE CONSTRUCTION 25393' One Story No ................. Permit for .................................... Single Family Dwelling . ............................................................................... Location JAt...12........3.1...5.r-r.eP-Cb=..W.ay ............... C t14 i....t.............................................. Owner ...Aqt!A!19... ......... Type of Construction, Zr=e............................ ................................................ ............................... Plot ............................ Lot ................................ -Granted ..........Aug...u..s...t....5..................19 83 Permit Date,46f'inspection ..............................19 Di3te Completed .... .. .19 C IPA Assessor's map and lot number ...............%.... THE Sp-wage Permit number ( {, I Z BAflH3TADLE. i rasa House Plumber .................`.... .. ........................................... 90�,0,i639 00� •FO HAY a\ TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO a .�M TYPE OF CONSTRUCTION ............. r,;t!� .................................................................. 1 ...........................19.. .'' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location . / ? - t .... xt" :...........( ....!��:. ........... ....... ..................... .............. A.........................................:........ ProposedUse ......`.'... ?.!�...(-F.........?-d?-U.�.........fir reel a" ....................................................................... ZoningDistrict ...............................................,...�..�.....................Fire District ......... ..................................................................... Name of Owner .....i..✓. �?........... :'....Address .................................... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms r�.................................................Foundation �°'�' - `-' ....................... Exterior ............ ..............................................:.....Roofing ................. .. .: ...................................... Floors ............ ?. ..... Interior .......... /1 - ..!'' ........................................... ........................................................ Heating .. �..............� A...r! :.................Plumbing ...............:. ........ ............................. Fireplace ...............�`. ,., 9 { .......... ................ Approximate Cost ................. :..©.��........y................... .. -Definitive Plan Approved by Planning Board -------------------_-----------1 9--------. Area � ../ .`5.:....... . r Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH h '1 U Y) �4/I t OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. r/ Name ......... `�� t ..+. :. ................................. ' ✓ 02Ca /e` /)� ' Construction Supervisor's License .......:............�'.��..�...... McSHANE, CONSTRUCTION A=22-129 25 3 One Story NO ...........1�.... Permit for .................................... A Singlta Family Dwelling ............................................................................... Location „Lot...1.2........3.1...S.c.re.e.c h,.an..Wqy Cotuit ............................................................................... ,.,,McShane Constr ci. � Owner .......M t ................................... on .................... Type of Construction ....Fr.ame......................... ..... ....... ................................................................................ Plot ............................ Lot ................................ August 5, 83 Permit Granted ........................................19 Date of Inspection ....................................19 Date Completed ......................................19