The URL can be used to link to this page

Home My WebLink About0800 BEARSE'S WAY (14) ��4vinei- w TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6�1'l Parcel ll n# App atibn # Health Division Date Issued Conservation Division Application Fee :,VS�Q Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address _ Village 10 lob C� Owners / Address Telephone Permit Request s -1 4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuations - Construction Type C 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 her -�5Laz 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 Addresses � Aib/� GC, License # es �� 6 Z 6 Home Improvement Contractor# Jb_S OL Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE q Ct I DATE } ^ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' FOUNDATION FRAME INSULATION FIREPLACE s ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL :t FINAL BUILDING r i DATE CLOSED OUT ASSOCIATION PLAN NO. The Con2ntonwealth of Massachusetts .f Department o De art Industrial Accidents P a Office of Investigations '- 600 Washington Street Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):j--�enakbW,y:]S -� A �, DI WA 1' _1 I Address: Pot r 0 X i4 sr 1 q ��Yl `5_�__IbgaLan A r i ye City/State/Zip: (., /^ Phone Are you an employer? Check the appropriate box: Type of project(required): 1.X 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. ag6modeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.1 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.❑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 worlccrs'coitrpetrsation ittsttrance for nay employees. Below is the policy and job site information. Insurance Company Name: a Policy#or Self-ins.Lic.#: Q 7600 Expiration Date: Job Site Address: . ZIA44�2 City/State/Zip: AMS Attach a copy of the workers' compensation policy clarat%on p e(showing the policy num er and expiration date).tl 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 ran a the pains and penalties of pet jury that the inforinati6n provided above is true and correct. Signature: Date: Phone#: — Official use only, Do not write in this area, to be completed by city or tows: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#: Town of Barnstable Regulatory Services 9 IE�, Thomas F.Geiler,Director s63q. �0 ATfDMA'l& 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 as Owner of the subject property hereby authorize /SGf /' �,ecf lr S rc J 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. A7o ` Sig,natuxe o wner ature of Applicant Print Name Print Name Date . :FORM&OWNERPERMISSIONPOOL 2 Q S 6/ 012 i RightF'ax N1-1 12/22/2011 7:19:42 AM PAGE 3/003 Fax Server ss THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONGERS NO RIGHTS UPON THE CERTIFECA HOLDER.THUS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED THE POLICIES DELow.TICS CERTIFICATE OF INSURAJdCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSVRER(S1,KUTHORIZCD REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:Ifthe certificate holder Is an ADDITIONAL INSURED,the pollcy(las)must be endorsed,if SUBR0 TION IS WANED,subject to the terms and condltlons of the policy,certain policies may require an endorsement.A statement on this cartMlcate d as not confer rights to the certMcate holder In Hsu of such endorsements. PRODUCER CONTACT OCEANSIDE INS GROUP NAME: E FAX 52 WEST MAIN STREET acNNo,Ext: (A/C No: ' HYANNIS,MA 02601 EAWL ADDRESS: PRODUCER CUSTOMER 10 Y. INSURED INS S AFFORDING COV57(Z6 WC ak BENABBY INC DBA INSURER A ZURICH DISASTER SPECIALISTS INSURER S P O BOX 480 INSURER C SANDWICH,MA 02561 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY TRAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TiM INSURED NAND ABOVE F R TIM POLICY PERIOD INDICATED. NOTWTIMSTADWINO ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W118 RESPECTTOJWHICHTIIIS CMTIPICATB MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED IIFREW IS SUBJECT TO ALL THE TERMS,IJXCLUSIONS AND CONDITIONS OF SUCH POLICIES,L AITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY LIMITS LTR INSK WV0 GENERAL LIABILITY EACROCCURRENCE 1 MAMAgETORENTED s 0 COMMURCIALOENERAL UTABU= PREMSES Och oecurrenoa I MED.WENSE(Any mae S p CLAIMS MADE 0-OCCUR persan 0 PERSONAL&ADY $ INJURY 0 I OENERALAaORWATE S GENL AGGREGATE LUATr APPIM PER - PRODUCTS-COtvNlOP S D POLICY 0 PROJECT U LOC AGG AUTOMOHI,E LIABILITY COMBATED SINGLE S LIWT Mach accident ANY AVMBODILYINAIRY S i M Person) i BODILYRTJURY S 0 ALL OWNED AUTOS er Accident) 0 SCHEDULED AUTOS PROPERTY DAMAOE S er accident i 0 HIRED AUTOS S ' 0 IION•OWNED AUTOS I 0 0 UMBREIA ALIAB 0 OCCUR EACH OCCURRENCE S 0 EXCESS LIAR 0 CLAIMS-MADE AGOREGATE S _ 0 DEDUCMLE S 0 REf6 rncN s S WORKERS'COMPENSATION WC A AND EMPLOYERS LIABI ITY NIA FIATUTORY YIN ANYPROPRMTOR/PARTNER/ - I EXECUTNEOFFICEPJME ER N NIA 6ZZUA-4102P700 01101/12 01/01/13 L EACHAccroFxl' S504,000 DCCLVDEM -EACH (MANDATORY WNH) G DMU DISRATL• 5500,000 EWLOYErr yes,desulbe kinder OBSCRWRONOF tl.DISEASE.POLICY $500,000 OPERATTONSbelow KA4rr I)MC"TtONOPOPMT)OrQNLOCAtIONAlVFMCLES(ACaoh ACORDIOI,Additionsl Remarks Schedu)e•irm=spaceurequireeD THE WSURED'S MA WORKFRS COMPENSA71ON POLICY AND ITS L2&M OTHER STATES DMMANCB ENDORUTAWI AtnHORIZESTHE PAYMEIT?OF BENEI'M FOR CL.ANIS MADE BY THF.INSURED' DOLAYEES IN STATES O RER THAN MA NO AUTHORIZATION IS GIVEN TO PAY CLAMS FOR BFNEFM IN ANY STATE UMR THAN MA T THE INSURED MES,OR HAS FIRED,EMPLOYEES OUTSIDE ) MA TINS POUdCY DOM NOT PROVIDE COVBRAOE FOR ANY GRATE OTHERTHAN MA - I THIS REPLACES ANY PRIOR CEYMCAT6 ISSUED 70 MEE CERTIFICATE HOLDER AFFEC77NG WOR]MRS C bIF COVERAGE SHOULD ANY OF THEP ABOVE DESC ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,N TICE HALL BE DELIVERED IN ACCORDANCE VATH THE POLICY PR VISIONS. _... AUIHOXM RJTREWITAT1VL' 8rGawMacLeaw _ �`.tCCOR`D'rtf� i0924 ��F;:�'>�%Y�£i° ;+�.,'.R•:� �,�� .X'��.. y.: 'c�,�•�, .r:�.,�pi_ r�;."� :t9 0 trll'd>±�'1'�GA1:�'#� "'redt;l: i i Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Super bwr License:CS-071402 A L COORN y JO SI3IT 1082 OLD STAG. CLNTLRVIIRLE r v 'r i �-- � Expiration commissioner 12/31/2013 Via, C��e�pdi��ia�iscaeall�e. ffice of Consumer Affairs& ---- Business Regulation - t — ME IMPROVEMENT CONTRACTOR License or registration valid for individul use only .before the expiration date. If found return to: egistration 108642 , Office of Consumer Affairs and Business Regulation Expiration g%2p/2014 r:rr Type'. 10 Park Plaza_Suite 5170 BENABB LIST Y INC/DISASTER. " Supplement a:;ard Boston,MA 02116 $PECIA' JOSHUA COHEN Box 480 Sandwich, MA 02563 Undersecretary Not valid without signature