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Home My WebLink About0302 BEARSE'S WAY 3p� �eQ�-ses �a� J , � - - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel'' b 1 ( Application #CD6 , 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 W P4!1 Village Owner 'f �S _ Address �I D g FA l?S W Telephone Permit Request AM 9-3o ce-Lwl. t,b ff" Im onni 4=L �l R.. SQL �J't'LG� g PtS i!SM�IUT" Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation tf>ip 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(sgftt 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,_ ZE 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 C.bND_R /ICI IVt<,N _ Telephone Number 3341• 832 - 2*Z3 Address 95 1'3U a Su rM C License# 0 02,7719 6PftoDVJ1 CM Mc� OZ'Sb1"6 Home Improvement Contractor# Worker's Compensation # (odl 7AS 14 b 1 2-0 t7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE (mm( /VLSI DATE Z { • '$ = Ica FOR OFFICIAL USE ONLY APPLICATION# ' it .DATE ISSUED ,MAP/PARCEL N0. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' . _FOUNDATIOW, , M1 FRAME ,INSULATION J' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS ,n, T';E: -= ROUGH FINAL ` :iFINAL.BUILDIN.G b_:DATE CLOSED OUT ASSOCIATION PLAN NO. i � Print Form The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation,Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please.Print Legibly Name(Business/Organization/Individual): FRONTIER ENERGY SOLUTIONS Address:376 ROUTE 1301 SUITE C City/State/Zip:SANDWICH, MA 02563 Phone#:339-832-2823 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓❑ I am a employer with 8 4. ❑ I am a general contractor and I employees(full;and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑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.❑ 1 am a homeowner doing all work officers have exercised their 1 l.❑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' 13.0 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. tContractors 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 the policy and job site information. Insurance Company Name.AIM MUTUAL INSURANCE Policy#or Selfins.Lic.#:6012954012012 Expiration Date:7/25/2012 Job Site Address:310 BEARS ES WAY City/State/Zip: HYANNIS MA 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 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 hereb certi. under the airs and Zenaldes of er'u that the in formation provided above'is true and correct Si r : I Date: 12/2/11 Phone M. Official use only. Do not write in this area,to be completed by city or town officiaL Citypr 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#: CERTIFICATE OF LIABILITY INSURANCE y DATE(N&1/DD1YYY) 10/18/2011 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 CONTACT Rogers & Gray Insurance Agency NAME: PMOHE FAX Inc (A/C. No. Eaq: (A/C. Nol: - - E-MAIL PO Box 1601 ADDRESS: PRODUCER South Dennis, MA 02660 CUSTOMER IDS. INSURED(S) AFFORDING COVERAGE NAIC P INS1!1XI INSURER A: A.I.M. Mutual Insurance Co - 33758 Frontier Energy Solutions LLC INSURER B: 39 Siasconset Drive INSURER C: Sagamore Beach, MA. 02562 1FISURER D: ' 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, TERN 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. Au` POLICY NUMBER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE DY/DD/YYW) ien,m/YrrYI GENEVAL LIABILITY EACH occuRANce 6 ❑CGIRO:I:;IAL GEIJ-eF:AL LIALILIT'i DAMAGE TO RENTED 6 PRFNISES(Ea.occurrence) ❑❑;L:.I ML 1•IAI•E ❑<;•;CM1: MED EIP (Any one.person) 5 PERSONAL 4 ADV INJURY $ GENERAL AGGREGATE GEW L A;•iF'EGATE LIMIT APPLIES Eli: $ ❑F:'LI'`Y ❑E'F.:JE•;T❑4•; PRODUCTS-COMP/OP ADD $ AUTOMOBILE LIABILITY COMBINED SIHf E LIMIT ❑Atli AVT� (ea accident) $ ALL iWNEL AUTO:: - BODILY INJURY (per person) $ �S'•'MBCVLEL AVT:3 BODILY INJURY(per-dent) $ ❑HTFJ;C 4V'ISJ3 PROPERTY DAMAGE - (pex aceldent) 6 ONild-iWIJEC AUTi.'• - . $ 6 aUI•II.NELIA LLA6 ❑ .,'�`CfR EACH OCCURRENCE 6 ❑EZ-= LIAR ❑ •_L.AIm 1EADE AGGRFAATE- 6 . ❑F;ETEIJTIidJ WORKERS COMPENSATION k ItaTD- pTE_ AND EMPLOYEES LIABILITY THE 6R,ARIETOF✓PAF.TIJEkS/ E.L. EACH ACCIDENT A E`ECUTIVE OFFICERS ARE •T $ 1,000,000 ❑ irl•:1 ® :=1 6012954012011 07/25/2011 07/25/2012 E L. DISEASE -POLICY LIMIT $ 1,000,000 E.L. DISEASE-EA ENPLOYSE $ 1,000,000 COMMENTS/DESCRIPTION OF OPERATIONS OR LOCATIONS: ALL MEMBERS ARE EXCLUDED FROM THE WORKERS'COMPENSATION POLICY. ) CERTIFICATE HOLDER CANCELLATION CONSERVATION SERVICES GROUP SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 50 WA3HINGTON STREET POLICY PROVISIONS. WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVE OWNER AUTHORIZATION FORM 3------------- b .1 (Owner's Name owner of the property located at (Property Address) o6u5/ (Property Address) hereby authorize' FCOP4 I (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. 5wneg Signature 614- Bate e a"a€ as a r- = d Ui to CO 04 fi N. C }.> �v0 °f Q � Q U �u 0- 0 o � Z. U. - F- >c - i0` " a 0.VV) C Y m � rn W Uj V ur ,� L° w t w CO d p+� ci� w z a ww ? N. � UO _ tea w aa5 y = Q. r tGG U A L Z Q(n 0 ,� n\ a V Q '. 0 q Derr u N r . License or registration valid for individul use only. before the expiration date: If found return to: Office'of Consumer Affairs and Business Regulation 10 Park Plaia Suite 5170 1 Boston,MA 02116 Not- slid witho�Siggnatu - Assessor's map and lot number ....... MUST BE INSTALLED IN COMPLIANCE ViTH AFRTICLE II STATE Sewage Permit number .....�.Z.2— ............................... SANITARY CODE AND TOWN REGULATIONS ?NEr��y TOWN OF BARNSTABLE 33nNSTAIILB, i .6 9 �� BUILDING INSPECTOR E war a. . . APPLICATION FOR PERMIT TO ........... 0�.1 .........!�tv 111.!?. ......................................................... TYPEOF CONSTRUCTION ........................aa a........+.. .a. .......................................................................... ........... D.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............�/�e�; �> (s�/t��/ /`+ aJ�Ali ProposedUse ............ /AP 411.,GIelvr.r. ............................................................................................................................... ..........................Fire District ............. .. Zoning District ...................... .......... /`�"�',c�i7.�?..1..:5........................................... Name of.Owner a ? ..�`.�... ."!1.�? r!!!Y..f�....Address �S,S-kal1.!'?�...:.:`.'^". .... .. 1. ` .`........ Name of Builder jaV71.�—.............................Address .........................�� c2vs� ........................................ c .. Name of Architect ..................Sa�??.�...............................Address ........................✓"c?ene......................................... Numberof Rooms .......................... ...................................Foundation ......'......1... ...e4L................................................ Exterior ...............�/'o-�........ �` ��t/........................Roofing ............... � .cr��. .............................................. Floors �j Interior �. �. �// ........................451! '.....1.................................. ............... ... ?�. ............................................. Heating J..................... le r............�1. .......................Plumbing ,.......1:�Og'..��'1....�.....11. .�........!.F................... Fireplace ...............o. ...................................................Approximate Cost .. .x.�®�.�.................................... Definitive Plan Approved by Planning Board ---------------___ -----------19________. Area �.......................... ......... ... ..... ....... � Diagram of Lot and Building with Dimensions Fee �O � SUBJECT TO APPROVAL OF BOARD OF HEALTH N N Ate. I hereby agree to conform to all the Rules and Regulations of the Town f Barnstable regarding the above construction. l Name ... ..... .p�..... ..c... ...... . ,�......... _ %ittemore, Robert L. 7 ' ^, ~m� C ~ one story No Permit for ...............�/ 1 p�!�.�amily dwelling Ev Robert L. V&ittemore Owner ^ � | . � ' � . ` ' | � , [ � . — PERMIT REFUSED \ ` ' | ` ' ' X } / ' ' ^ ' -----'------------------- ~-----------.—^.~--.—~—.---. � x./ � --------.. � —..---.—..—.—.------~. � " Approved ................................................. lA ` -------.---------.------.---. ^ � - -------------------------... � _~'