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Home My WebLink About0800 BEARSE'S WAY (12) 1 _ d't(A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0&10 l4 Ap ication # Health Division Date Issued �< Conservation Division Application Fee Planning Dept. Permit Fee S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address o , ,r_J Z�),Pr ej AIA Village � d Owner ��r _ i L I 5j;N �0Ll.)_< Address Telephone Permit Request 96,R C,!F_ -TI-Dio Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /,j OD - " Construction Type t� v�ai 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 goherstdn 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# l�Current Use - -- - Proposed Us, APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name i Telephone Number i � '� %Z// Address0 5 License # 05 s_ �fT� t r_, 1 iC `A 6.3�5 I Home Improvement Contractor# /d Worker's Compensation # Z/l0sZ f26r-> ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE is IF 'i. FOR OFFICIAL USE ONLY APPLICATION# i DATE ISSUED MAP/PARCEL NO. ADDRESS - "' VILLAGE OWNER .. E IF . t j. DATE OF INSPECTION: Ic FOUNDATION E I. FRAME INSULATION r r FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL " GAS: ROUGH FINAL FINAL BUILDING s DATE CLOSED*OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents V' Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):.'-BPPAk W :Lc T/ A lis5s r _q j Address: P�) )Y 4ROZ5 To `sebg�- an .I),ri vex City/State/Zip: w/~ Phone#: _ 8 Are you an employer?Check the appropriate box: Type of project(required): 11 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. ❑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 8. ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp.insurance. 9. ❑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 1111 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. 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 ant an employer that is providing workers'compensation insurance for any employees. Below is the policy and job site information. Insurance Company Name: Zuricb-Aw)eldcf� Policy#or Self-ins.Lic.#:_ Q P Expiration Date: Job Site Address: t/ City/State/Zip: Attach a copy of the workers'compens tion pohey declaration page(showing the policy nuz4er 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 un a the pains and penalties of perjury that the information provided above is true and correct. Si afire: Date: Phone#: Official use only, Do not write in this area, to be completed by city or town official. i 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#; Right) ax N1-1 12/22/2011 7:19:42 AM PAGE 3/003 Fax Server - ,��hP s1,.C> yr��rEv. r�'ak��`Y+{(?� L r u�r� 1 1..,�ti3��r.i�+E�"i <?�>• THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TILE CERTIFICA HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED XX THE POLICIES ` BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSDRER(SN�UTHORIY,IED REPRESENTATYVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the pollcWos)must be endorsed,If SUBROG TION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement,A statement on this certificate It as not confer rights to the certltleale holder In Aau of such andorsament s. PRODUCER CONTACT OCEANSIDE INS GROUP NAME: 52 WEST MAIN STREET PHONE Ext: (AA/CC,NO); '. HYANNIS,MA 02601 G-ML ADDRESS: PRODUCER CUSTOMER ID V. INSURED INS S AFFORDING COVERAM NAIC tF BENABBY INC DBA INSURER A ZURICH DISASTER SPECIALISTS INSURER B P 0 BOX 480 INSURER SANDWICH,MA 02563 INSURER D INSURER E INSURER F' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CER I INY THAT ME POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TBE INSURED NAMED ABOVE F R THE FOUCY PERIOD INDICATED. NOTw17BSTANDING ANY REQUMEMW7,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITS RESPECT TO CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED BEREIN IS SUBJECT TO ALL THE TERMS,EIXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BE W REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY E LIMITS LTR INSR wvu GENERAL LIABILITY EACIIOCCURRENCE I MAMAGETORENTED I 0=0MCLALOENERALIIABI TCY PREM MS(FAch ' occurreaea I n - MID,EXPENSE(Any one I u CLAIMS MADE 0 OCCUR perian 0 PERSONAL&AD'/ I INJURY 0 1 OENERALACOREOATE S GERI,AGGREGATE LI4Ir APPLIES PER PRODUCT'S-COMPIOP I j 0 POUCY 0 PROJECT 0 LOC A00 AUTOMORn,E cdABD,ITY COMBINED SINOLE S i chsccident) i 0 ANY AUTO i BODI,YINAMY I M Pers i 0 ALL OWNED AUTOS BODI,YIKMRY I � i (Per Aeciderd) 0 SC}CDULED AUTOS PROFEBTY DAI,LAGE S er seidmt i 0 HIREDAU'TOS - I 0 NON•OWNFDAVTOS I 0 0 UMBREALIPB 0OCCUR i EACH OCCVRR:I�CE M, S 0 EYCESSLIAB 0CLAL4-MADE AGOREOATS S 0 DEDUCIBLE _ 0 RETIE mall S I WORKERS'COMPENSATION 1 1VC A AND EMPLOYERS LIABILITY NlA STATUTORY L WN ! lam AIIY PROPRIET'OWARTKER! I ExECUTInOFFICEE�IZER N NIA 6ZZUEIA102P700 01/01/12 01/01/13 L.EACH ACCIDENT $500,000 IXCLUDEJYI _ (MANDATORY IN NH) 'L DMYEEEE-EACH 550000 tryes,dcsenbemderDISCIUMONOF LDI;eASE-POLICY! 1500,000 OPERATIONS below + UESr-"TtOT40YOPERATIONBR.00AttONSNMCLES(APach ACORD 101,Addilioml Remuks Schedule,itmore spice is require( THF.DISUREO'S),AA'NORYERS COMPENSATION POLICY AND ITS I2,=OTM'R STAIFS DISUAANCB ENDORSFMENI AUIHORIZE3 TIM PAY`KDT1tF BENEFITS FOR CIA"MADE BY TIM MSLAED' F-\IPLOYEES IN STATES OTHER THAN MA NO AUTHORMATION IS OTVFS•I TO PAY CLAIMS FOR BFNEFTTS IN ANY STATE OTHER THAN MA IF TIM INSURED H Mi OR HAS HIRED,EMPLOYEES OUTSIDE MA=POLICY DOM- NOT PROVIDE COVERAGE"OR ANY LTATE OTHER THAN MA THIS REPLACER ANY PRIOR CERTIFICATE ISSUEDTOWE CM=ICATE HOLDER AFFECITNG WORIMRS C MP COVERAGE I r �+a r c.r .yn 3.SXlu)fib 4f0: �:' N- �:xa �:tou t ti_z�= ....,,�.. -,.. SHOULD ANY OF THE ABOVE DESC ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,N TICE VALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PR VISIONS. ..... AURIOM=REPRELMATIVE - 8rlaw MdTc(.ecuv ;'.itt CbTtll2;'1 6D97,4 �$, Y..r : ,+�, � � r.{shl�"�5 r f4tt&3Ud CO t1Ii7�PL>711r :1RaeaYrd i 1 i Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen-kor License: CS-071402 T.S JOSHUA L CUHLN - �r 1082 OLD ST_X CENTERV�LE r �,•�:- 51 i `� Expiration Commissioner 12/3112013 s c Mee of Consumer Affairs&Busiuess Regulationu�e - -- ME IMPROVEMENT CONT License or registration valid for individul use only RACTOR before the expiration date. If found return to: e p ration 8/20/108642 Office of Consumer Affairs and Business Regulation . 9" Exxpiration 2 1-4 Type' 10 Park Plaza-Suite 5170 BENABBY INC/DISASTER SPECIALIST Supplement(,.ard Boston,MA 02116 JOSHUA COHEN Box 480 Sandwich, MA 02563 Undersecretary Not valid without signature BIKE rqy, Town of Barnstable Regulatory Services • snxtvsrna[s. Thomas F.Geiler,Director �ArFOMAIp`�� 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 f41y1',,"`Li. /;/Y► , as Owner of the subject property hereby authorize '0/SGf fG,/' --�Vqeci A..00 e- to act on my behalf, in all matters relative to work authorized by this building permit. (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. Signature o wrier ature of Applicant Hjo.Af A) Print Name Print Name Date QTORM&OWNERPERMISSIONPOOLS 6/2012