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HomeMy WebLinkAbout0102 CLIFTON LANE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION _ Map 2L�� Parcel U Application #,,l- Health Division Date Issued f^1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address (� la( ,F-� C Ay-c.rs . L CY\A 6o) (0 3 Z-- Village Owner V�(Ae.(k Address 0 at= Telephone q qz2: a `/ 7-0 Permit Requestl Ai = ;.� S , e c t d C) T ArT6 e­ o �o (1 r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio S 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: U existing �0 net size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other:r) Zoning Board of Appeals Authorization U Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name T(lik►{'��� � `��l Telephone Numberc��'/ .Address �� `off License# Qd- 7 7 ) Home Improvement Contractor# d `� / Email 4)e-r�t. C 9 (—Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Af DATE SIGNATURE - / 7 FOR OFFICIAL USE ONLY A,kPPLICATION # DATE ISSUED MAP/ PARCEL NO. . ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION t FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. �4 The Commonwealth of Massachusetts Department of Industrial Accidents- 1 Congress Street,Suite 100 Boston, MA 02114-2017 www mass.gov/dia ' iVorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. l TO BE FILED WITH THE PERMITTING AUTHORITY. ; Applicant Information Please Print Leeibly ( t g ) RetroFit Insulation Name Business/Or anization/Individual Address:PO Box 105 City/State/Zip:Seekonk, MA 02771 Phone#:508-989-6436 Are you an employer?Check the appropriate box: Type Of project(required): I.E✓ I am a employer with 10 employees(full and/or part-time).* 7. New construction 2.M I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] . - ' 9. ❑Demolition 3,M I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition, ensure that all contractors either have workers'compensation insurance or are sole 1 L❑Electrical repairs or additions proprietors with no employees. • 12.E]Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof re airs These sub-contractors have employees and have workers'comp.insurance) p 6.�We are a corporation and its officers have exercised their right of exemption per MGL c. OtherWeatherization 14.�✓ 152,§1(4),and we have no employees.[No workers'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 or m employees. Below is the olio and job site f Ypolicy 1 information. Insurance Company Name:STAR Ins. Policy#or Self-ins.Lic.#:V9WC802160 Expiration Date:8-2-18 Job Site Address:102 Clifton.Lane City/State/Zip:Centerville, MA 02632 Attach a copy of the workers' compensation 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$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.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 the airs andpenalties ofperjury that the information provided above is true and correct. Si nature:` Date: 11/13/17 Phone#:508-989-6436 . Official use only. Do no - ':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#: DocuSign Envelope ID:6B5D6881-B4A1=412E-89CO-16595BF89EOD s Town of Barnstable- . - Re ulatory Services g . S V.•Ri hard calf Director c BuildingDivision Paul Roma, ` Building Commissioner 200 Main Street,;Hyannis,-MA"02601 www.town.barnstable.ma.us 4 ; Office: 508-862-4038 Fax: 508-790-6230 P'rbperty-'Owner Must Complete. and Sign This Section .. I, Robert F Goodale �_- a_ as Owner of the subject property hereby authorize Retrofit Insulation to act on my behalf, in all matters relative to work authorized,by this•building permit application for: 102.Clifton Lane t Centerville,°MA 02632 , (Address of Job) 0 Signed by' ocu I�bkvf �b6hk 11/10/2017 M1 -10:48 AM EST —.. 70523s5CIB8548e ' Signature of Owner y a: Date Robert Goodale Print Name r If Property Owner is applyingfor permit,please completethe Homeowners License Exemption Form.. C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.butlook\L7U69LF2\EXPRESS(2).doc 01/25/17r _ . 1 � CJ�'G� Q • office of Consumer Affairs and Buss ess Regulation 10 Park Plaza 'Suite 5170 Boston,Massa 02l 16 Home emeut .f Registration a. • �--=�-' Registration: ISM, Type: Prwate Corporation �;;��,.— , •• ,? b�plral3on: 7128MS Tti► 264K64 RETROFIT INSULATION, INC. JOSEPH REILLY • P.O. BOX 106 SEEKONK, MA 02771 Update Ad6ras ad terra nrd.Mirk swop for ehttage. Address ❑Rguewal ❑ftpipaat 0 Lost Card 6CA 1 w ZWA4W11 �/Ie oawmo.ucea o ' ae�weaslA Limm or rya valid for individual Olt Duly oSa atCM=er Aftin do Bnaonl - yam ffie ez arattoa dabs. if fond rdnrtl to: Wo wPRO�mwff CONTRACTOR -off"dConsumer Affairs and Badmu 8egulatiou R ►i. `1�0461 TYpa% 10 Park Pfasa-Satbe 9170 S P=0 ceeporabn Bases4 MA 02116 - :- ;:p RETROFIT I JOSEM REILLY v ' • . FALLRMA MA 0272� '` Undasaorv&W Not valid wiffiout shmAvire r 1 t .. • r - " Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constructi0t01S'lpe �/ipr Specialty CSSL-102771 Expires:06105/2019 } PO 10 JOSEPH REILLY SEEKONK MA 02, t ref-�"�5'4i•tL�'�`� Commissioner • . x } RETRINS-01 DCARVALHO AC+C7RD� DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 07/27/2017 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 I this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). I PRODUCER License#1780862 .- - CONTACT Diane Carvalho - NAME: HUB International New England PHONE FAX 222 Milliken Boulevard (A/C,No,Ext): (A/C,No): Fall River,MA 02721 E-MAIL diane.carvalho@hubinternational.com ADDREss: - INSURERS AFFORDING COVERAGE .NAIC# ` - INSURER A:Selective Insurance Company of South Carolina 19259 INSURED INSURER B:National Liability&Fire Insurance Company 20052 RetroFit Insulation,Inc. INSURER C: PO BOX 105 - INSURER D: Seekonk,MA 02771 - INSURER E: INSURER F: - s 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. I INSR - ADDL SUBR POLICY EFF POLICY EXP -i LTR TYPE OF INSURANCE p I p POLICY NUMBER IC DDIYYYY ;LIMITS A IX COMMERCIAL GENERAL LIABILITY 1,000,000 L� ( EACH OCCURRENCE $ CLAIMS-MADE ®OCCUR S 2187663 08/15/2017 08/15/2016 DAMAGE To RENTED 100,000 PREMISES Ea occurrence $ _ MED EXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ( - GENERAL AGGREGATE $ 2,000,000i . POLICY❑JEST (�LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: I _ - $ -A AUTOMOBILE LIABILITY ( CO aBINEDitSINGLE LIMIT $ 1,000,000 ANY AUTO IA 9100182 0811112017 08/11/2018 BODILY INJURY Perperson) $ ' OWNED X SCHEDULED rxAUTOS ONLY AUTOS BODILY INJURY Per accident $ HIRED �( NON-OWNED - PROPERTY DAMAGEAUTOS ONLY AUTOS ONLY Peraccident - $ A X UMBRELLA LIAB X OCCUR - - ` EACH OCCURRENCE $ 1,000,0001 EXCESS LIAB CLAIMS-MADE S 2187653 - .08/15/2017 08/15/2018 AGGREGATE ,$ 1,000'0001 I DED RETENTION$ $ B WORKERS COMPENSATION - , • STATUTE OERH _ AND EMPLOYERS'LIABILITYYIN 9WC802160 08/02/2017 08/02/2018 1,000,000' ANY PROPRIETOR/PARTNER/EXECUTIVE —, E.L.EACH ACCIDENT $ OFFICER/MWBER EXCLUDED? NIA 1 _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I 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 40 Sylvan Road ACCORDANCE WITH THE POLICY PROVISIONS. ' 02451 AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD YOU WISH TO OPEN A BUSINESS? For Your Information) Business certificates (cost$ .00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission tb operate.) You must first obtain the necessary signatures on this form at 200 Main St.,.Hyannis. Take the completed form to the Town Clerk's Office, 1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. � DATE: Fill in please: APPLICANT'S YOUR NAME/S: noodo I e TT, BUSINESS YOUR HOME ADDRESS: I GZ I i f roF La vl C j TELEPHONE # Home Telephone Number 7 1� 1 4 Z - 2_ ( 2 NAME OF CORPORATION: NAME OF NEW BUSINESS , . TYPE OF BUSINESS V I C1('(Y 17 K I uc;r an -IS THIS A HOME OCCUPATION? NO , ADDRESS OF BUSINESS MAP/PARCEL NUMBER Q 14'7 b)o (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO JO-2-OD Mai St. - [corner.of Yarmouth Rd. & Main Street) to make.sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. .BUILDING COrj, ISSI NER'SAOFIdC�� / This individh en il-ify permitr9quirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION Au iz d Sign re** RULES AND REGULATIONS. FAIEURE TO MM I s _ COMPLY MAY RESULT IN FINES. v 2: BOARD OF HEALTH This individual has been me of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual-has b en informed of the licensing requirements that pertain to this type of business. Authorized Signature** �— COMMENTS: Town of Barnstable 0fIHE rok Regulatory-Services Thomas F. Geiler,Director • Building Division w BARNSTABLE, y MASS. Tom Perry, Building Commissioner °tfoMpca 200 Main Street, Hyannis, MA02601 www.town,b a rnstab l e.ma.us Office: 508-862-4038 F, 508-790-6230 Approve Fee: 5. — Permit#: . HOME OCCUPATION REGISTRATION Date: /Naiiic: /LU L�(L% &1,r_b 10'W XY 1'hnne #: 7��� �Iq7 —2q2o Address: �� �L/F%UN �f�Ml Village: �EN2V/CGS Name of 'l'ype of Business:- 1106V pg&bDJCi ibW Map/Lot: L L17 c))G INTENT: It is the intet)t of this section to a11ow the resicleuts of•the"1'orwt)of B3 ir-nstable to opertte a home occ•upaticiu ciritlrin single family dwellings,subject to the provisions of Sec•tiorr 4,-1.,4 of the Zoning orcliriance,provicled that the actiirity shall not be clisceniible fr-oni outsicle tlie.drirelIing: tliere shall he no increase in noise or odor; uo crisual alterttion to the premises w[rich Woulcl suggest Mything other thaui a residential use; no increase in traffic above,normal residential volumes; and no increase in air or ground titer pollution. After registration csritlr the Building Inspector,a customary home oc•c•upation shall be permitted as of right subject to the following Conditions: • The actierity is carried on by(lie permanent resicent of a single frilly residential chvelling unit, located rvitlriir that dwelling unit.. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the chvelling which are not customary in residential buildings,<urd there is no outside evidence of such use. • No traffic mill be genemted in excess of rromial residential volumes. • The use(foes not-involve the production of offensive noise, rribmtion,smoke, dust or other pau•ticular matter, odors, electrical disturbance,heat,glare, humidity or other objectionable effects. e There is no storage or use of toxic or hazardous materials, or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot corrtairiit)g the Customary Home Occupation,aril not mthin the required Front yard. • ` here is no exterior storage oi•display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation, other than one ian or one pick-up truck not to exceed one tot) capacity, and one trailer not to exceed 20 feet in length and not to exceed it tires,parked on the same lot containing the Customary Home Oce•upatiou. • No sign shall be displayed.inclicating the Customary biome Occupation. • If the Customary Home Occupation is listed or advertised;is a business,the street address shall not be included. • No person shall be employed in the Customary Horne Occupation rrho is not a pennaucnt resident of the dwelling unit. I, the undersigned, have read and agree nitdr the above restric•tions.lor my borne occ•upatiou I am registering, Applieant: /% �`7 ✓`C L bate: / �/ Town of Barnstable *Permit OF THE lOtyy Expires 6 months from issue date Q�' O • �- = Regulatory Services Fee ' �G ■UMSfAOLL b v� ME& $ Thomas F. Geiler,Director 1639• Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street, Hyannis,MA 02601 w X- PRESS PERMIT Office: 508-862-4038 Fax: 508-790-6230 J U N 6 2 0 01 EXPRESS PERMIT APPLICATION Not Valid without Red X--Press Imprint TOWN OF BARNSTABLF Map/parcel Number Z`� _ —7 2 z"A . Property Address [Residential OR ❑Commercial Value of Work ����=� Owner's Name&Address Contractor's Name C0tS ;2 t �,,�,� ,! �raj�tP•ei Telephone Number �f�'� Home Improvement Contractor License#(if apTicable) Construction.Supervisor's License#(if applicable) 0 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I AM the Homeowner Elf have Worker's Compensation Insurance Insurance Company Name va F2 S 7 C{ �d 7� ���� Workman's Comp.Policy# 7:2' 73 y'R tab k 7J-F -7 -o Permit Request(check box) . ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) 2-Ce-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *Where required: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic..Conservation.etc. Signature ' expmttg