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HomeMy WebLinkAbout800 BEARSE'S WAY (25) W A i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel O Application # p Health Division " Date Issued 2. Conservation Division Application Fe w/ Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Addressed I,-eq SeS Gm ti/9N��S Village Owner U, r 9 M 1�/�' Address— Telephone 7 g — 7` 7�/ o Permit Request ✓VS , Ace_ ®a,k.S � �M Square feet: 1 st floor: existing proposed 2nd floor:'existing proposed i Total.new Zoning District _ Flood Plain Groundwater Overlay ' s Project Valuation � 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: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: _ Zoning Board of Appeals- AA orization ❑ Appeal # Recorded ❑ Commercial ❑Y 7N If i plan omm e rc a es , o yew, site p anr e # _ Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ©Se �J U���� Telephone Number. -')U� Address/ License # 70077 C/).S-21 _ Home Improvement Contractor# Worker's Compensation # P-) u //C)2 5 (� ALL CONSTRUCTION DEBRIS ESU T G FROM THIS ROJECT WILL BE T N TO SIGNATURE 1 DATE L /� FOR OFFICIAL USE ONLY , s APPLICATION# DATE ISSUED -._•JL1 .MAP/PARCEL N0: ADDRESS VILLAGE t OWNER :a '. DATE OF INSPECTION: 5 ,,--,FOUNDATION.r FRAME INSULATION j' +' N r .x FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: +> ROUGH -,r - FINAL r FINAL BUILDING5L DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts Department of Industrial Accidents' ®ffie of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegjbLv Name (Business/Organizadon/Individual): Address: �� ' City/State/Zip: a c' ,•�, 'G �/ . C� � � Phone #: AYlam employer?Check the a propriate box: 'Type of projec (required): 1. employer with 4. I am a general contractor and I PI (full and/or part-time).* have hired the sub-contractors 6. ❑New onstruction 2. sole proprietor or partner- listed on the attached sheet. 7. emodeling ship and have no employees These sub-contractors have g. [] Demolition working for me in any capacity. employees and have workers' - [No workers' comp. insurance comp. insurance.$ g ❑Building addition 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 employees. [No workers' 13.[l 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. 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 am an employer that is providing workers'compensation insur nce for my employees. Below is the policy and job site _ information. Insurance Company Name: Policy#or Self-ins. Lie. #: 1_� /V, .(, Expiration Date: Job Site Address:_ OD�. i�� rs s (/v✓1- a vi/ City/State/Zip: ✓✓N/�5 Attach a copy of the workers'compensation policy declaration page(showing the policy number and c piration 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 •4e inforn n provided abome is true and correct Signature: ` Date: fkas,_ 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): r 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: y �ltiz €_.phi monive llh Ul t StJ3tI:�t 1?s S 3 feparirnen of Indzrs=ria'���ide�a�s Office of Investigations ton Street kZ_ :r"4 �. �_, 600 Washing Boston MA 02111 www.trcass.gov/dfet . nsIPlumbers Workers' Compensation Insurance Affidavit: Builders/Contractor �Please Print Le MY ,ARplicant Information Name (Business/Organization)€ndividual): 10 Address: J C; - 5"f Pone City/State/zip: Type of project(required): Are you an employer? Check the appropriate box: eneral contractor and I 4. Q I am a g 6. a7emodeling truction i.M I am a employer with have hired the sub-contractors employees(full and/or part-time).* listed on the attached sheet. �. 2.❑ I am a sole proprietor or partner- These sub-contractors have 8. 'Q Demolition ship and have no employees employees and have workers' q• Q Building addition working for me in any capacity comp, insurance•t [No workers' comp. insurance oration and its 1�•Q Electrical repairs or additions 5• Q We are a core required.] officer have exercised their I l.Q Plumbing repairs or additions 3.❑ I am a homeowner doing all work right of exemption per N4GL 12.Q Roof repairs myself. [No workers' comp• c. 152, §1(4),and we have no 13.[]Other insurance required.}t employees.[No workers' ' comp, insurance required.] • ant that checks box#1 must also fill out the section below showing their workers'compen�t►on Policy information. *Any applicant are doing all work and then hire outside contractors must submit anew affidavit indicating such. t Homeowners who submit this affidavit indicating they the name hire subcontractors and state whether or not those entities have ,contractors that check this box must attached an additional throt showing vide their workers'comp.policy number. employees. If the sub-contractors have employees,they P ees. Below is the policy and joh Stye I am an employer that is providing workers,compensation insurance for Y e� y information. 5 ,-�- S - Co ` Insurance Company Name: l 1 3 � � Expiration Date: Policy#or Self-ins.Lie.#; I f� _ w �,�,`�3 Gti4 City/State/Lip: 1��YseS Job Site Address: the he number and expiration date). compensation oiicy dec arahon page(showing Policy imposition of criminal penalties of a Attach a copy of the workers'comp P Failure to secure coverage as required tinder Section 25 A of MGL c. 152 can lead to the Fa risontnent,as well as civil penalties in the form of forwarded ORDER of d a fine fine up to$1,500.00 and/or one-year imp of this statement may be of up to S250.00 a day against the violator. Be advised that a copy Investigations of the DIA for insurance coverage verification• the in onttation p►°ovaded shove is a and correct hereby certify under the ens and penalties of perjury thatf v J I do he y fy Date• / Si ature: p Phone i#: official use only, Do not write in this area, to be completed 6y city or town Offtciat ®ff PerinitlLicer►se## City or Town; I��ctor S.plumbing Inspector Issuing Authority(circle one): Electrical 1.Board of Health 2. Building Department 3.City ovrri Clerk �. -:)1,;7 cc-nslancr and lusin�- Regulaitioa 02 � C rnV �� r��..:n�Tit l„�3... Reoiw. 132349 Pip s� -= _ tittt2Qt:s. tF6t r27�2 4seph Duarte 5 Fa+f Si - - _ - Nareham, ma Q257 -------- I;p",m Addrm Od reQ 0`4 a b4 dam. itbond HOUF tMpROVE. FfIT GCWTRACTO" Otnes®f CeA&umr Albin red pMR*vWieati*n: , t32.344 ype' tp?,,R Hate owtv ExplP7etlott: 'f.'�`i2f1f3 7a;snersh� gaatao,�A 02I15 wet�oat swaaftre as� 'E�.`�e.t3.jtM-�(ft Dc-isas� �Rt c� �it{)Itti�:1ftf� a ,Wi�tHsi►e @ :a;ers�tPf Bull ism } (;,,s t Gs SUS JC35 `4 DOT Fib-yL..�ST MA �5g4 MA . . Yt 7049 Office of Consumer Affairs& Business Regulation OME IMPROVEMENT CONTRACTOR Registration: ,126$93 Type: ' Expiration{ $�3f2012 Supplement C. The Home Depot,At t ofie B:ervcces H k. DARREN DEMERS w"� ; 26.90 CUMBERLAND,MRKWAY S — A'I'D TA, GA 30339 Undersecretary License or registration valid for indiv.idul use only before the expiration date. If found return to: Office of Consumer Affairs'and Business Regulation 10 Park Plaza—Suite 5170 ;ard _ Boston,MA 02116 Not valid without signature DATE nNiit,Glff;a '. -�� D2/21/2011 CERTIFICATE OF UABILITY INSURANCE i THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 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 4 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 1-404-995-3000 CONTACT - --- FAX Marsh USA, Inc. - PHONE AX No: A/C NO.Ext)___----------- ------ E-MAIL homedepot.certrequest@marsh.com ADDRESS --------- Two Alliance Center, 3560 Lenox Road, Suite 2400 INSURER(S)AFFORDING COVERAGE _ NAtCR_ Atlanta, GA 30326 Fax (212) 948-0902 INSURER A: Steadfast Ins Co 26387 INSURED INSURERS: Zurich American Ins Co 16535 The Home Depot, Inc. shire Ins Co 23841 Home Depot U.S.A., Inc. INSURER C: New HAP 2455 Paces Ferry Road NW INSURER D: Illinois Watl Ins Co ,23817 Building C-20 INSURERS: NATIONAL UNION FIRE INS CO OF PZTTS I9945 Atlanta,--GA 30339 INSURER FI Illinois Union Ins Co 27960 COVERAGES CERTIFICATE NUMBER: 19834682 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 ADDL SUER POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR,wvn POLICY NUMBER MMIDDIYYY MMID A GENERAL LIABILITY GL04887714-01 03/01/1 03/01/12 EACH OCCURRENCE $9,000,000 DAMA ETO RENTED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISE E X aoccurrence) $—____--__._._ X MED EXP(Any one person) $EXCLUDED CLAIMS-MADE OCCUR ,000 ---- X LIMITS OF POLICY XS PERSONAL BADVINJURY $9.00000 X OF SIR: $1M PER OCC GENERAL AGGREGATE $9.000,000- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP)OPAGG $9,000,000 —_ --il POLICY PRO- LOC $ g BAP 2938863-08 03 1 03 1 1 COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY Ea accident _ __.-__.._ ._ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE — $ -- -- NON-OWNED Peracci ent _.._.-- HIRED AUTOS- AUTOS $ X SIR AUTO P UMBRELLA LIAR OCCUR EACH OCCURRENCE. $ EXCESS LIAS CLAIMS-MADE- AGGREGATE $ DEC) I J RETENTIONS $ C WORKERS COMPENSATION WC061967352 (ADS) 03/01/1 03/01/12 X WCSTATUloco �— AND EMPLOYERS'LIABILITY D ANY PROPRIETORIPARTNERIEXECUTIVE YIN NIA WC061967354 (FL) 03/01/1 03/01/12 El.EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED? N WC061967353 (CA) 03/Ol/1 03/01/12 E.L.DISEASE-EAEMPLO $1,000,000 E (Mandatory in NH) - — Hyes, D ESC RIPTION OF OPERATIONS below describe under E.L.DISEASE-PDUCY LIMIT $1,000,000 C Workers Compensation WC061967355(XY,MO,NY,WI, )D3/01/1 03/01/12 F TX Employers XS Indemnity TNSC46244151 (TX) 03/01/1 03/01/12 Occurrence/SIR 30M/lM E Workers Compensation NC1192378 (QSI) 03101/1 03/01/12 SIR im DESCRIPTION OF OPERATIONS I LOCATIONS i VEMCLES(Attach ACORD 101,AddWanal Remarks Schedute,if more space is required) RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOME DEPOT U.S.A., INC. ACCORDANCE WITH THE POLICY PROVISIONS. 2455 PACES PERRY ROAD NW AUTHORIZED REPRESENTATIVE BIIILDING GA3 ATLANTA, GA 30339 USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACIDRD 25(2010/05) The ACORD name and logo are registered marks of ACORD jfiero_hd 19834682 7-4 0-, < �3 a CFO � Cl Av A w QT .y rGG7�{ <m M m o w�a c m rov m u) �. ASr A N®� to N O S�a i ri ' Cp x r Vro » o O 3 3 W"s �y(O n m rn fA m 7 O Y pSY S! A _ � r_ mvrD .�. N in v9 S c -�� n t� n7;iZT" A n n W �; '�n w y L) �D ..........._.................._-._. M V 00 yy N .� C07 n v�i wa. u� Q �' od Cc c rtl V' -w� C+ 4 Isrn ow A in i co X. � cl N � fora r _ o ° 8.~ O C: m u 70 Xm>O 'an ° ............ (n ` %4 2 A !mow Cy U 04 drn IM � 1A � � � �9 �� � � to ' v_' n !2gjf Ar iM Ph w �yC m fi b 1+9 RI G1 . IMO s4 � � M M ew M am PCI oyf 4 S' f Jan 03 12 02: 45p Michael Bedard 1 -401-246-2868 p. 11 SEC-13��011 11 :32 AM CAPECRO5SROADS 0H9f�0HH£a P.01 N 'To Whom it May Concern: Job# J*- 1T -7 f h/1/b 17 70 ;,311 } Coricarning th.0 SbMm location, we give Install Moyne Depot approval to #of wjnd o", patio doara and entry dqors iColor �` -�` `� d�a r2 Manufacturer ( ,�,�,r �, ,�4 Grid oontigumb-f6- `�� r' ' r�+nc.�. r Grids between glace_ 1 J As atobdo thsee windows and or doors Meet With Condo m approval. "111 TJde �i Phone 11 ��t8 r PIQ-4--s .r -.k 40 ?5 - '..r—1 L/L d 4 LUOPM « 'LZV56906 3XOHd'VladX3ZL98 60:20 CL•ZL-40Z LA d SHV jodaa awOH << � LI*L5690S 3NOHd'410d)(9U9Z Z� :20 EL-ZL-LLOZ f Jan 03 12 02: 43p Michael Bedard 1-401-246-2868 p, 8 ROME IMPROVEMENT CONTRACT PLEASE READ'IMS Sold, hc.' \ Branch Name, Boston Date: ll -. `L L THurniit an Sexn=lledby! ) --1—1 d Ws The Hoar Depot At-Home Services. J 345A Greenwood SU=L Unit 2,Wonestcr.MA.01607 foil Ftee(8W)657-5182;Fax(508)756-8823 Branch Number:31 Pederul Tr)#7S-2693460;MF T e#C 024;t9;91 C:unt.Lien i6427 CT Uc 41 HTC.0545522;MA Home Toiproveruent Contraacct�tr-,Re-#126893 Installation Address: bt7 `���5 e --i1.1 C4 IState 'Lip Putchaser(s): Work Phone; _ Home Phone. _ _ Ca Phnoo: ]_ IL o b [ J [ �I [ 1 Home Address: (If.different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updatcs): _ ❑t DO NOT wish to receive any marketing email%from The Homo Depot Pra'ect Inforov9eioa: Undersigned("Custamer"),the owners of the property located at the above installation addre%s,agrees to buy. an At- pine Services,Inc.(The Home Depot")agrees to furnish deliver and arrange for the installation("Irrtitallatiun )of ad materials described on the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this refcrt arc,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: a--a teen—) oduds: S s:Street s #; Froject Amount C ORooSng ❑Siding windows ❑Insulation JI Cl U b C3Gtmcrs/Covers Entry 17oon ❑ 01 6 s• T5. Roofing Siding❑Windows lns ti- // �✓ t ❑Gaiters/Covers�ntry Doors ❑ tt�,J $ �� ❑Roofing ClSidinx Windows El Im.d won $ i]Gutters/Covers ❑Entry Doors ❑Roofing idin.- Wuuiovn Iiuolation ❑Gutters/Covers []Entry Doors ❑ $ Miumpro25%fmpor&or Contract Amouatdue upon exeadlnnofthawatrwL Total Contract Amount $ Maine Purietaw ;may not depodt inure than oov-adrd orthc Contract Amwmt Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certitwte (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,eacli Customer-under taus Contract agrees to be jointly and severally obligated and liable hereunder. The Horne Depot reserves the right to Issue a Change Order or tcrrmuala this Contractor any indivicittdl Products)included hereia,at its discretion,if The Home Depot or its authorized service provider detcrmines that it-cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbastcrs or it-srl point.other safety concerns,pricing errors or tx cause work required to complete the job was not included innthe Contract. Payrttent Sumroary: The Payment Summary* ���y� ,included as part of this Contract,sets forth the total. Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely tilled-in copy of the Contract At the time you sign Do not sign a Completion Certificate(note: there is one Completion Certificate for each IbAsd Prodnct as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pap The Home Depot the costs of materials,labor,exttcuses and services provided by The Home DeRpt or Authorized Service Provider through the date of termination,plus arty other amounts set forth in this Agreement or allowed under applicable law. THE ROME DEPOT MAY WIT HFFOLD AMOLtNTS O[VF.D TO THr, HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTMEP PAYA2ENTS MADE, WIfH0UT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Aece)fGvnee and aulitorization: Customer agrees and understands that this Agreement is cite colter a?,rezment httweett'C:rs[atncr and The Home Depot with regard to the Products and Installation services and supers odes all prior discussions and agrucuictim,either oral or written,relating to said Products and Trtstailation.This Agreement cannot be amignul or amended except by a writing signed by Customer and The Home Depot.Customer ackaowledgcs and agnuens that Customer bas read,undcntardq valawarily accepts the terms of and has reed ved a copy of this AgreemenL AC tkd Submi ed by; Customer's Signature Date Date Y Telephone N'o. 70 Cnstomer'S Signature Date Sales Consultant License No_ CANCELLATION; CUSTOMER MAY CANCEL THIS te'ap�lscshl°l AGREEMENT WITHOUT PENALTY OR OBLIGATION By DELIVERING WRITTEN NO'eICE TO THE HOME DEPOT 13Y MIDNIGHT ON THIS THIRD BUSINESS 13AY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE l5 - SPECIFICALLY PRESCRIBED BY LAW IN " CUSTOMER'S STATE. } YOTItd':.1,DV1TJ()NALTERh15ANDCOND171M)3ARF.0TATlLaONTUF,"VEINESIDE AND A-VAtfART(>F'rr1ISCONTRACT White-Branch Fie`Yellow-CUSIOrtler %-11 C-50 'i Td Wd60:£ 1300E £'6 'un.0 TLEL29£80S; 'ON Xdu TreEw2(: WOcld