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Home My WebLink About0800 BEARSE'S WAY (17) �� s t�� _. d Ld TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map jl Parcel 0 61D 67T9 Application # 07c� 0 y Health Division Date Issued 1 Conservation Division Application Fee Sze Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis --� Project Street Address �O -�- [� L✓ "' Village t Owner :11Lkm 600 o•I "' Address l � 16�r Telephone Permit Request `� /V 11 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type LOOS' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) c-9S Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ _ �/_//Walkout Udther 6 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 "_D>S43 4�� lKci /57" Telephone Number C� o ��13 Address 9 �10 546 License # eS 42I 7�61J �1Zz�)/<Z=h ; M0 Home Improvement Contractor# I J sk co ke-Aj Worker's Compensation # ��'��✓� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. t ADDRESS VILLAGE L t OWNER DATE OF INSPECTION: t FOUNDATION FRAME INSULATION s FIREPLACE t ELECTRICAL: ROUGH FINAL c PLUMBING: ROUGH FINAL ' s i GAS: ROUGH FINAL t FINAL BUILDING f A DATE CLOSED OUT r ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations ' 600 Washington Street Boston,MA 02111 r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information '_ A -� Please Print Letzibly Name(Business/Organization/Individual):_!3o-n Ak)b.�IyT�, -D/ A !24erspeca (s-ts Address: P U SX 4 �� S'�,�- a5�lc�� .I,l'l ue City/State/Zip; e. /~ Phone 899- 1/6 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. ❑N construction 2.El am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling 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.t 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 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. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors 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 my employees. Below is the policy and job site information. Insurance Company Name: 1,Cb-Ame-ri, 0� t- Policy#or Self-ins.Lic.#: y A P /6 Expiration Date: P Job Site Address a2 City/State/Zip: Attach a copy of the workers'compeasa on poli dec aration page(showing the policy n ber 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 trn a the pains and penalties of perjury that the informati6n provided above is true and correct. Sianature: Date: 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: j IF"" ffice of Consumer Affairs&Business usiness Regulation - - 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 8j20/2014 Type: 10 Park Plaza-Suite 5170 BENABBY INC/DISASTER_SPECIALIST Supplement(:ard Boston,MA 02116 JOSHUA COHENr; Box 480 Sandwich, MA 02563 Undersecretary Not valid without signature I - RightFax N1-1 12/22/2011 7:19:42 AM PAGE 3/003 Fax Server x., a: .. ..ld! it ,is•- ar-si 12/22/201 l THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON DIE CERTUICA HOLDER THIS CERTIFICATE DOES NOT AFFDtALATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED THE POLICIES BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING DVSURER(Sh�UTHORIYICD REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT;B the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 d as not confer rights to the certMeate holder In Aou of such endorsements. PRODUCER I CONTACT OCEANSIDE INS GROUP NAME` 52 WEST'MAIN STREET A/cNNo,Ext: AJC,No): HYANNIS,MA 02601 E-MAIL ADDRESS: PRODUCER CUSTOMER ID V INSURED INS AFFORDING COVERA(YH NAIC II BENABBY INC DBA INSURER A ZURICH DISASTER SPECIALISTS INSURER B P 0 BOX 480 INSURER C SANDWICH,MA 02563 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER; THIS IS TO CERTIPY TEAT THE POLICLE9 OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THR TNSURBD NAMED ABOVE F R THB POLICY PERIOD INDICATED. NOTWITUSTANDIIIO ANY REQUI U DrIE:`Tf,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICHTMS CERTIPICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DPSCRMED IMREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SBOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY E LIMITS LTR INSR WV11 DlYYYYI I GENERAL LIABILITY EACROCCUMNCE I 0 COISMCLU.OENERALLTABILM PREMISES(Each T occurrence MID.WEN"SE(My mse S p CLAIMS MADE O OCCUR. parsm 0 PERBONALBADY T i INIURY 0 1 OENERAL AOORWATE S OEN'L AGOREOATE L251'APPLIES PER PRODUCTS-Cotel0P T ' D POLICY (I PROJECT 0 LOC A00 AUTOMOBILE LIABDATY COMBINED SINGLE T LihITT i ch actldent � . 0 ANY AM BODLYDTMY I er Pers i O ALL OWED D ALTOS I BODILY INIURY S n Accidcd) O SCH�UL.ED AUTOS PROPERTY DAMAGE S (Per aa,dmt O RM AUTOS S 0 ITON•OWNED AUTOS S 0 O UMBRELLALTAB 0 OCCUR EACH OCCURRZYCE S 0 EXCESS UAB 0 CLAIMS-MADE AOOREGAn S 0 DEDUCMLE S 0 RETENTION S S WORHERS'COMPENSATION I WC A AND EMPLOYERS LIABILITY NIA I STATUTORY YIN ! LASTS ANY PROPRIETOR/PARTI.I7®.R/ EXECVfNEOFFIC/-R/MEI� ER N NIA 6ZZU84102P700 01101/12 01/01/13 L EACH AacmEtrr 1500,000 EXCLUDEM (MANDATORY IN NH) LDISEASD•-E1CR LOYEE T500,000 ! if yes,dcacnbc tndar DL•SCAIPIION OF LDhnASE-POLICY 000,000 OPERATIONS below 1' UENCRIPTION OF OPERATIONB/LOCALTONRIYMCLEI(Attach ACORD 101,Additional Remarks Schedule.irmerc spree Is required) THE WGUREDS MAWOREERS COMPENSATION POLICY AND TIS LTMTTED OrtI?R STATES INSURANCE ENDORSFM2TT AUMORIZES TAE PAYMENT`OF BENEFTIS FOR CLANS MADE BY TIM TNSURED' INPLOrM IN STATES OiR•DR THAN MA NO AUTHORIT.ATLON IS OIVFN TO PAY CLAIMS FOR BFNEFTI9 IN ANY STATE OrrAER THAN MAD'TAE INSURED 11RES,OR HAS HtEtED,EMPLOYEES OUTSME MA 1HISPOIICYDOCSNOTPROVWECOVERAGE°ORNTYCTATEOTHERTHANAtA TEAS REPLACES ANY PRIOR CERTIFICATE ISSUED TOTIIE CERTIFICATE HOLDER AFFECMG WOR7i=C MP dOVERLOE t:, f 4 s . r- (•t,i4111!4xJb k1!10: .....:"rr3, .�:::- r ,�:�� ':.sr4,1.1;"Sy'�:&;/x`n-:`• SHOULD ANY OF THE ABOVE DEBC ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,N TICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PR VIEtONS. ..... AUTHORNFD RERIMIKATIVE B rCa+u Mac3l.eaw ;I.�:,7 s�s1fhT"?J,. 5 $ �0IFR'1'it5}Ir It{T':' i Massachusetts-Department of Public Safety Board of Building Regulations and Standards .Construction Super kor License:CS-071402 ``ti�:r r5 ors }c;fi; JOSHUA L COl&N 1082 OLD STAG. CENTERVM LE r•. Y Expiration Commissioner 12/31/2013 �1HE Tq,i, Town of Barnstable tiO Regulatory Services • anxiv r E Thomas F.Geiler,Director 039. 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 I, o`1)Zl"7?,4V Ilavle- -r rs�/�M , as Owner of the subject property hereby authorize A..d 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. Gt'0Ir Sjp"ature o wrier ature of Applicant Print Name Print Name Date QTORM&OWNERPERMISSIONPOOLS 6/2012