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Home My WebLink About800 BEARSE'S WAY (14) �� s way _ _ _ _ _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4. ez) Map ' Parcel �3�/'®� j �Ap'plication�#�� I Health Division Date Issued C M 1W Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address / & �- Village t,I 1A 10 WO? S Owner f fLwm-t> /Ad6Lo 9629 lap�ddress cif Telephone --� ��- Permit Request _ c ►' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �S OD Construction Type E- Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) -G Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout 0-Otl`ier -eqLr, 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: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number ��OP- Address License # to 0-----T Home Improvement Contractor#A9 J 6Sh (d�ti Worker's Compensation # old � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE L DATE �� "l.r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOC IATION,PLAN NO. �TME T Town of Barnstable Regulatory Services y MASS. g Thomas F.Geiler,Director �p 16g9. 10 rFn M,r A Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder :;2 'M , as Owner of the subject property hereby authorize 1�,s�f/ ��i �i s I c A-d e- to act on my behalf, in all matters relative to work authorized by this building permit. Adf� WV (Address of J b) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. -A7o ` GI0 Sature o wner ature of Applicant �e A Heo Ai Print Name Print Name Date /. Q:FORM&OWNERPERMISSIONPOOLS 6/2012 i 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 q -� Please Print Legibly f Name(Business/Organization/Individual):' Lbw t��m _D/ /-� Address: P 0, &Y 41So(/g7zron `SG:bf2a� 2),r i ve City/State/Zip; ew/^ Phone#: rg 8 Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 10 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑�Wemodeling -construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.❑ Other 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. lContractors 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 ant an employer that is providing workers'coinpensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Z v Policy#or Self-ins.Lic.#: ^/ l Q a P 760 Expiration Date: i Job Site Address: /JJli1/ City/State/Zip: & Attach a copy of the workers' compensat on poli declaration page(showing the policy n ber 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 if tin a the pains and penalties of perjury that the information provided above is true and correct. aimafore: 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: c. J RightFax N1-1 12/22/2011 7:19:42 AM PAGE 3/003 Fax Server DATE .t_.x,._ `._, z � z�� .�� `��. �.,,,. i., �it s,�r „T"r.r or;s=x,.;�'.•.i l?J22l2011 THI3 CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON IM CERTIFICA HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTENT)OR ALTER THE COVERAGE AFFORDED THE POLICIES BELOW,THIS CERTMCATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS)�UTHCRUZO REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT;If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.if SUBROGfi,TION IS WANED,subject to the Comm and conditions Of the policy,certain policies may require an endorsement.A statement on this certificate d as not confer rights to the certificate holder In Neu of such andarsament s. PRODUCER CONTACT OCEANSIDE INS GROUP NAME: PHONE 52 WEST MAIN STREET A/C,No,Ext; HYANNIS,MA 02601 E-MAIL ADDRESS: PRODUCER CUSTOMER ID t INSURED INS S AFFORDING COVF.RAOIi NAIC# BENABBY INC DBA INSURER A ZURICH DISASTER SPECIALISTS INSURER B P 0 BOX 480 INSURER C SANDWICH,MA 02563 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY TEAT TBB POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO 7 BE INSURED NAND ABOVE F DR THE POLICY PERIOD INDICATED. N07WITHSTANDRJO ANY 1EQUIRl?dIE`7T,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPEC.rTO WINICKTHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HFREPI 18 SUBJECT TO ALL THE TERMS,I XCLUSIONS AND CONDITIONS OF SUCH POLICIES,LBUTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY E LIMITS LTR INSR WVD I GENERAL LIABILITY F-ACROCCURRENCE 3 DAMAG0 COIdNMCIALOENERALLTABQ<R'Y PRESSES TORENTED S (Each ' occurrence � MM.EXPENSEGnym,e S Q CLALMS MADE 0 OCCUR. Perim 0 _ PER80NAL,&AD'I S lNJORY U 1 OENERALAGOREGATE S GENL AOGRECATE LUSr APPLIES PER PRODUCTS-CO10101? I ' 0 POLICY 0 PROJECT 0 LOC AOG AUTOMORME LIABILITY CO'anI ED SINOLE S ffaLIMTI' i ch seciden i 0 ANY AUTO BODILYINJURY S w<Psrso BODILYINJURY S 0 ALL OWNLO AUTOS er Acciderd) Q SCF{DULED AUTOS PROPERTY DAMAGE S er ue,dent i 0 HIRED AUTOS 1 0 11024.OWNFD AUTOS S 0 Q UMBRELLALIAB 0 OCCUR EACH OCCURRENCE S U EXCESS LLAD 0 CLALMS-M4DE AOOREOATE 0 DEDUCTIBLE S 0 RUM4M.ONS S WORKERS'COMPF,NSATTON WC A AND EMPLOYERS LIABILITY NIA STATUTORY YIN ! L¢,ff[S ANYPROPRIETORIPARTNEW I EXECUTIVE OFFILRRI)Z2,BER N N/A 6ZZUH-4102P700 OV01/12 01/01/13III, AcxaccIDElrr 5500,000 EXCLUDED'! ]SEASL•-F.1CH IN NH) wYi;E 3500,000(ryes,describelndm DLSCRIPITONOFrMASE-POLICY S500,000 OPERATIONSbelow DESCRIPTTONOFOPZRAnDlgS1LOCArtON31VFMCLE3(Abeh ACORD101,Addilionsl Remsrks ScheMe,itm.ac:Psceurequiteto _ THE.TITSUREDS HA WORKERS COWENSA71ON POLICY AND ITS 1247M OTHER STATES INSURANCE EITDCASEI.IFHP AU HORIZES THE PAYMENTrOF BE41EFI iS FOR CLAIMS MADE By TM NSL'RED' E!\(PLOYEHS IN STATES OTHER THAN MA NO AUTHORIZATTO)l IS GIVEN TO PAY CLAIMS FOR BUJUM IN ANY STATE Or'MIZ THAN MA IF THE DIMZM HUM,OR HAS HIRED,EbOLOYEES OUTSIDE MA THIS POLICY DOES NOT PROVIDE COVERAGE FOR ANY SMTE OTHER THAW MA THIS REPLACES ANY PRIOR CERTIFICATE IBSIJED 701nM CERTIFICATE HOLDER AFFECHNG WORKERS C MP LrOVERTGE `�EIfT,>i�,kC},Ik ��A��§;,.'a�,.��a� e�Fr,.,:�.;Y ,.� _.`.:.x, l•:. _rM's�C�ItIAv�E,`,4'I"It): �� - _wrT'�' - SHOULD ANY OF THE A80VE DESC E:D POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,N TICE PALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PR VISIONS. _ -... AUnWRM RFPREWITATIVE 8rlawMacL.eaw ...A<.caiz��:€ no9in.:�.��;„art :�.,,�i•.: .,..� .,.�..�,_ s. "` - s: 7�4J, lIiS9&t1�Qb 40 C�JIiAi�?1Yr718b isceYnd '. r. • Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen-uor License: CS-071402 3OSHIIA L CO&N 1082 OLD S7XG, CENTERVIF LE 7 ~ J,•s:: f t 1� om', Expiration Commissioner 12/31/2013 1921�poo�a��wiicaealC/z _ n Mee of Consumer Affairs&Business Regulation v ~ — -- ME IMPROVEMENT CONT License or registration valid for individul use only RACTOR before the expiration date. If found return to: egistration 108642 Office of Consumer Affairs and Business Regulation Expiration 8/20/2014 r Type' 10 Park Plaza-Suite 5170 SENABBY INC/DISASTER-,SPECIALIST Supplement�,`:ard Boston,MA 02116 E` ? _ JOSHUA COHEN 4 'F Box 480 � Sandwich, MA 02563 Undersecretary • Not valid without signature