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Home My WebLink About0800 BEARSE'S WAY (22) Cl oir"a-WS-1. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map c7--t Parcel pplicatioin #� � Health Division Date Issued oZt Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address Village !S r, Owner SG V-� e'b Address & ��_- �LJ4. 0/--d ax3'X- 17 Telephone Permit Request 1 - Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /S oo - Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) 01'�D Age of Existing Structure Historic House: ❑Yes ��❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout U Otther !a ;� 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 Te5AS_FFd2 fN!9a1AL15/ Telephone Number Address t �W &�)qul License#__("S- �A , I,DI CC . I/1/� Home Improvement Contractor# /� `J 6.3� Co/�.2 XJ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE l�D FOR OFFICIAL USE ONLY APPLICATION# � l Y 't t. DATE ISSUED MAP/PARCEL NO. • i ADDRESS VILLAGE "z OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL w FINAL BUILDING x , 1 DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,NIA 02111 wwrv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizalioit/Individual): ,_ en L A Dse5� r" od fs+�s Address:_ P U oy q � � ']�!Sri ue City/State/Zip: tom/.. Phone#: 8 Are you an employer?Check the appropriate box: Type of project(required): 1.M I am a employer with to _ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. Elw construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ffRemodeling ship and have no employees These sub-contractors have g• ❑ Demolition, working for me in any capacity. employees and have workers' com insurance.t 9. ❑Building addition [No workers comp, insurance p 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 I LE] 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 91 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. lam an employer that is providing workers'compensation insurance for ney employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: r Q 760 0 Expiration Date: Job Site Address S City/State/Zip: &- Attach a copy of the workers' compeasat on policy/declaration page(showing the policy nu&er 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. Ido hereby cer if un e thepains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Phone#: SIRE- 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#: I �RightF'ax 141-1 12/22/2011 7:19:42 AM PAGE 3/003 Fax Server :1T14 fFvZ� 'o ",,nRq. V n s tr> ' a. .a.� 7^? S>.•.yt sSgS mod,�''� >ar,r;rHf ISSUED ATE 12/2212011 i > THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CYRTIFICAIX HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTTrUTE A CONTRACT BETWEEN THE ISSUING INSURU48N j UTI10RIl,F,D REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT;If the cert8lcate holder Is an ADDITIONAL INSURED,the policy0es)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 certificated as not confer rights to the certillcate holder In Neu of such endorsements. PRODUCER CONTACT OCEANSIDE INS GROUP NAME: 52 WEST MAIN STREET A;CNNt:o,Ex AJC, HYANNIS,MA 02601 E40JL ADDRESS: PRODUCER CUSTOMER ID V. INSURED INSURE S AFFORDING COV5iTGE NAIC A 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 18 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEM ISSUED TO TIT MSURED NAMED ABOVE F R THE POLICY PERIOD LNDICATED. NOTWIT USTANDR70 ANY REQU1RF.t IIO1T,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMW WITH RESPECT TO CH THIS CnTTICATE MAYBE ISSUED OR MAY PERTAIN,IM INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN)JAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER POLICY NMIBER POLICY EFF POLICY E LIMITS LTR INSR WVD DIYYYYI i GENERAL LIABILITY , EACROCCURRENCE S MAMACIETORENTED $ 000MMERCW,OEMERALLIABILITY PREMISES occurrence ` MID,EXPENSE(Any mte S p CLANS MADE 0 OCCUR perim O PERSONALatADV S i INJURY 0 I GENERALAGORFOATE $ GEN'L AGGREGATE L25r APPLIES PER PRODUCTS-COMPIOP S D POLICY 0 PROJECT 0 LOC pO0 AUTODIO)ID,E LIABILITY COW, 2ZED SINGLE S LIAB'I' i i ch scclden I O A,n AUTD i SODILYINJURY S ar Persm BODB,YINJURY S 0 ALL owxEDAUTOS { xpccidadl a PROPERTY DAMAGE S 0 SCHEDULED AUTOS enm,dmt i 0 RMAUTOS , r O ITON•OWNfD AUTOS $ 0 0 UMBRELLALIPB 0 OCCUR i EAMi OCCURJt?NCE S 0 EXCESS LM O C'LAD4-MADE AGOAEGA'M S 0 DEDUCTIBLE S O R£IEMP.OII$ s WORKERS'COMPENSATION ( WC A AND EMPLOYERS LIABILITY NIA STATUTORY YIN LI4[S ANY PROPRIETORIPARIMER/ L EACH a OcmEN s500,000 EJECUTIVE OFncv— rENMER NIA 6ZZUR4102P700 01/01/12 01/01/13 EXCLUO I (NANATORYINNH) L DISFE-EACH S500,000 OA L i IT yes,descnbe trader OMCRUMO14 OF LDT;'eASr-POLICY $500.000 OPERATIONS below r DESCRIPTI0N0FOPZRATIDTPSR.00AT70NSNAFHCLES(ACach ACORDIOI,AdditiomIRemfrks Schtme•irmnrespueurequired) ' THF.INSUREDS MA WORrSM COMPENSATION POLICY AND ITS LDdRED O'DwR STAT--S D*7SURANCE EtMORSF.MENT AUMOR1ZfS nM PAYKDI OF BENEFr7S FOR CIA"MADE BY 7I1 NSUFM' EMPLOYEES IN STATES OTHER THAN MA NO AUTHORIF.AMON IS OTM TO PAY CLAIMS FOR BENEFITS IN ANY STATE OTHER THAN MAN TM WMtED HIRES,OR HAS TIDIED,EMPLOYEES OUTSIDE j MA rfUS POLICY DOTS NG7 PROVIDE COVERAGE POR NIY LTATE OTHEP THAN 2,fA THIS REPLACES ANY PRIOR CER'TIFICATe ISSUED TO ME CERTIFICATE HOLDER AFFECTING WORKERSC MP doVERAGR a:GERT�`,kCT.1,. n3R,::,`s�{,aa..,, aySxe ...,,�;:,i " �,.. �'I�i,.�S y.H a.Cx11117..4IliE.-,�k :10: . u -, ,:rrz.�..;;tu ,.,�_._•:_'�,�r g 'bT,'rweY;'' ;Q;y�": SHOULD ANY OF THE ABOVE DESC ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,N LICE HALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PR VISIONS. - ...... AlffH0R14D RI�RIDTXTATIVC ' 13Y(tii.W I�IGt.C1.eGt'W L;cccaRb:s i • i �e �P��ir�waacaea�G�o� Mee of consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR License or registration vali&for individul use only ?_ before the expiration date. If found return to: ® egi i ration 108642 Office of Consumer Affairs and Business Regulation Expiration 8/20/2014y 4 Type: 10 Park Plaza-Suite 5170 BENABBY INC/DISASTER_SPECIALIST Supplement�?.ard Boston,MA 02116 JOSHUA COHEN4 Box 480 Sandwich,MA 02563 � � — Undersecr etary Not valid without signature Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen isor License: CS-071402 . r.rS JOSHIIA L CO3E�N r 1082 OLD STAG R r--. NTE CE H A Expiration Commissioner 12131/2013 .i , THE l°y� Town of Barnstable Regulatory Services snxx cs Thomas F.Geiler,Director A i639• ♦0 - rFn�r°' 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, d��'�C 'tJ l�`t/L7Z� �BJ �/'rY► , as Owner of the subject property hereby authorize �isG.� - �� S�c � c- 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. 19 G�0 Suture o wner azure of Applicant akty Print Name Print Name Date QTORM&OWNERPERMISSIONPOOLS 6/2012