The URL can be used to link to this page

Home My WebLink About0800 BEARSE'S WAY (15)rc TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map li q Parcel /D Application # Health Division Date Issued "rJ Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic stor c - O KH _ Preservation / Hyannis Project Street Address - -e-- % �y s Village ,� p�I �J 0 wl a Owner 1 0,fl>�4��TG��J&a Address Telephone Permit Request A&& �69`72p i3 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1S'0 D. r Construction Type op 64"00. 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 tether -5�!gtz 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 :2 - Address - / A) License # 65 A,l W I�JJ a�I fr--A Home Improvement Contractor# J�5� CJ AJ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �4 DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER f DATE OF INSPECTION: i. FOUNDATION t' FRAME r INSULATION t� FIREPLACE ELECTRICAL: ROUGH FINAL i' PLUMBING: ROUGH FINAL P Y GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT, ASSOCIATION PLAN NO. ( The Commonwealth of Massachusetts r Department of Induitrial Accidents ' 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): Benabbu / A -_skr _l-WC 0(f5+S Address: P ), ��( � City/State/Zip: W1^ Phone 8 Are you an employer?Check the appropriate box: Type of project(required): I.X I am a employer with to 4. ❑ I am a general contractor and I employees(full and/or part-time).*• have lured the sub-contractors 6. ❑Ne construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. emodeling ❑ v p p These sub-contractors have ship and have no employees 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 t 1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 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. 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 isproviding workers'compensation insurance for nay employees. Below is the policy and job site information. Insurance Company Name: Z 1 in-Ano ,0� - Policy#or Self-ins.Lic.#: '7 O a P 7,00 Expiration Date: � I Job Site Address: / o? ity/State/Zip:�A /S Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required tinder 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 inforinati6n provided above is true and correct. Si gnat Date: w � 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 1 RightF'ax N1-1 12/22/2011 7:19:42 AM PAGE 3/003 Fax Server J" • s Q 1t r i vjR1 +.€31 t� ;F r lfii' ISSUE DATE 12/222/2011 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTR'ICA HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED THE POLICIES BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INBURER(eh)AUTIIOR=U REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the poticy(les)must be endorsed.if SUSROG TION IS WANED,subject to the - terms and conditions of the policy,certain policies may require an endorsement,A statement on this certificated as not confer rights to the certhIcate holder In Ilau of such endorsements, PRODUCER CONTACT OCEANSIDE INS GROUP P14ON 52 WEST MAIN STREET AtCNNo,Eat); (iuC,No): ' HYANNIS,MA 02601 64ML ADDRESS: PRODUCER CUSTOMER ID t. INSURED INS AFFORDING COVERAGE NAIC# BENABBY INC DBA INSURER A ZURICH DISASTER SPECIALISTS INSURER B P 0 BOX 480 INSURER C SANDWICH,IAA 02563 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS 19 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE F At THE POLICY PERIOD INDICATED. NMVITHSTANDINO ANY REQUEIF.MENT,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 J X EUI 18 SUBJECT TO ALL THE TERMS,E XCLUSIONS AND CONDITIONS OF SUCH POLICES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY E LIMITS LTR INSR WVD I GENERAL LIABILITY , EACROCCURRENCE 1 MALWETO RENTED S 0 c%evma-i o SIERAL uABed (Each PPM&SES(Ea ' occurrence)1 . • MED.EXPENSEf�,ny one S a CLADAS MADE 0 OCCUR Perim 0 PERSONAL&ADV S INJURY 0 I OENERALAOOAEOATE S j GERL AGGREOA781.I47r APPLIES PER ' PRODUCTS-001�II'IOP i j D Poucy 0 PROJECT 0 LOC I AGO i AUTOMOBILE LIABILITY COMBAffDSINGLY S L1NOT i ch secldenl � ANY AVTt BODILYINTURY I ; M Pert 0 ALL OWNED AUTOS j BODB YRIJURY S I ' { erPccidenl) ' 0 SCFCDULED AUTOS PROPERTY DAh1AGE S er aatdmt O KREDAUTOH S 0 IION•OWMI)AUTOS T 0 0 UNSRELLALIPB 0 OCCUR 1 EACH OCCURR NCE S 0 EXCESS LU+B 0 CLAIDdS-MODE AOGAEOALI S 0 DEDUCTIBLE _ 0 Rrmrr10N T WORKERS'COMPENSATION WC 1 TUTORY A AND EhTPLOYERS LIABILITYt NIA STA L� YIN ANY PROPRDSTORIPAIIIII-RI I LEACH ACC mENf ISOO,000 E)MCLgMOFFICERAMIBER N NIA 6ZWB-4102P700 01101/12 01/01/11 IXCLUIJFD7 L DiSEh7E-EACH (NLANDATORY IN NID IOYEE $500,000 i rryes,dcscrFe tridw DL•SCR711014 OF L.TAMASE-POLICY TS00,000 OPERATIONSbelov f - URSCWTIONOFOPERATlOrl82OCAttONRNMCLHS(AFsch ACORDIOI,Addilioui Remvks Schedole,irmoreepueurequlreeD THE INSURER'S MAWOPYSM COMPENSATION PDLICY AND rIS I.B-A7HD OTHER STATS INSURANCE RMOR6FMEM AUTHORIZES THE PAYgUrfOF BENEFM FOR CLAD&MADE BY 771Z INSURED' EMPLOYEES IN STATES OMER THAN MA NO AUTHORIZATION IS GIVW W PAT CLAIMS FOR BENEFn3IN ANY SrATE OTHER THAN MA 1F TIM INMt D H=,OR HIR HAS ED,EMPLOYEES OUTSIDE j MA AUSPOLICYDOL5N0TPROVIDECOVERAGEFORANYMATEOTFIBPTHANMA THIS REPLACES ANY PRIOR CERITFICATE I85TIED TO THE CERTIFICATE HOLDER AFFECTING WORKERS C MP EOVERAGE ,�.: a 4> 5 r SHOULD ANY OF THE ABOVE DESC 91D POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,N TICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PR VISIONS. ..... AUMORIM)RtPR23T,7ltATIVC E. 13rGa+vMacLeaw x.,:r:':. . h T* i0btk5i61v*IU1:1" "'`iFaci�f i i Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Super kor License: CS-071402 JOSHUA L CO&N 1082 OLD STXG CENTERVEPLE � is"'` Expiration commissioner 12/31/2013 Fr P ��eor»nsoi7cueaCC/o — _ ffice of Consumer Affairs&Busine,ss Regulation ME IMPROVEMENT CONTRACTOR License or registration valid for individul use only <, before the expiration date. If found return to: egi on 108642 Office of Consumer Affairs and Business Regulation ' ®..• Expiratiration gj20/201.4 Type:, 10 Park Plaza-Suite 5170 . BENABBY INC/DIS,4STER SPECIALIST Supplement�`ard Boston,MA 02116 JOSHUA COHEN Box 480 Sandwich, MA 02563 Undersecretary Not valid without signature THE T Town of Barnstable Regulatory Services ye ssBts ag Thomas F.Geiler,Director �p 1639.Tfo�na.+1% 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 -72/'M , as Owner of the subject property hereby authorize (i A..4 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. S*ature o caner ature of Applicant r Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012