HomeMy WebLinkAbout0942 FALMOUTH ROAD/RTE 28 �—__
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATIO14
_71
Map d' C7 Parcel L Application
Health Division Date Issued Z� Poo=-
Conservation Division Application Fee
Planning Dept. Permit Fee A05
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address O q Q
Village 4 oq 11 hi s
Owner .,tvvD v7k Address ! q Q v 1, E f r
Telephone
-,--Permit Request Q e 'ttC r,190 Cj r (� U-0 a.fl a A,i ws L)
Square feet: 1 st floor: existing��$roposeOnd floor: existing proposed Total new
Zoning District C�� d Flood Plain d Groundwater Overlay
Project Valuation 1 "� � l .t Construction Type
Lot Size C.y{ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family IU-' Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes O'N—o On Old King's Highway: ❑Yes Cho
Basement Type: ❑ Full CSC rawl ❑ Walkout ❑ Other
Basement Finished Area (sq.ft.) D Basement Unfinished Area (sq.ft) It(9 D
Number of Baths: Full: existing aq-1 new Half: existing new G
Number of Bedrooms: ?� existing a new
Total Room Count (not including baths): existing new ® First Floor Room Count
Heat Type and Fuel: [was ❑ Oil ❑ Electric ❑ Other
Central Air: U' es ❑ No Fireplaces: Existing L New Existing wood/coal stove: ❑Yes ❑ No
Detached garage: LJ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_
Attached garage: 11 existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:,—,
M
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ X.� '
L ;...J
Commercial ❑Yes ❑ No If yes, site plan review #
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Current Use P S t e h 1, C Proposed Use 're
- - APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Telephone Number SW l J
Addresses ��, PS License #
S ✓ b o /Home Improvement Contractor#
Email 0` D. (61 Al- Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTI G FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE
FOR OFFICIAL USE ONLY y
i APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
„y
i ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
r
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
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Worloers' Compensafion Insurance AfdaviL-Bnflders/ContracbrsMeetdcians/Plmmbars
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c�/Reap: m^� Ol O 2 6 u Phone#:
Arc you an emplager?C6xk the ap opriate bay
Type of Project(rcgtsaed);
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cmplDpocs(RE�dlor part ic)* have bard the sob-mcftucEos
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Insmm=Conpany Name:
Policy f or Solf ins Lic.#: Bg&ationDain
rob Mr.Adclmm: 1 411—��
Attach a copy of thm workrrs'compeasafiou policy dedumdon page(shotkg flic pD&T number and c pkxdan date).
Fail=to s==covm-ge as=pfirdmsder Socd=25A ofM(3L m M cmticadtD fho hnpi3sftiacL of csimiadpe ;;Igi- of a
frria to$1,500.00 and/ar onz-year miprisram M:;as well as civil pmzl'tI s in the fD=of a STOP WORK ORDER and a fine
Df up to$250.00 a day against the violator. Be advised f mt a copy of this std==tmay be forwarded to tho Ofim of
Fnymlga&m of fho DIA forfiomm ce covesege vesifrcaflom
711 da hereby arrsrofpm jray thatthe urforma arsprovsded ab a it fmz acid carted' Date: U 6
Phone#:
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License or registration valid for mdividul use only
before the e"spiration date. If found return to:
l] Office of Consumer Affairs and Business Regulation
10 Park Plaza-'Suite 5170
Boston,MA 02116
' i Not valid without signatur
��1 VlZL' iQ6%IUr1LOYGll1P,CLGGIL�C%//GGQdCLCt'LLLQPG�A �•
u4LOffice of Consumer Affairs&Business Regulation'
OME IMPROVEMENT CONTRACTOR #
�f a istration: << � T �
9 ..l77983 Type:
Expiration 31412016 Corporation
J JOHN L.FAVRELILJCLIST OODWORKING INC. t
JOHN FARRELL '5 --s
38 CAPTAIN ELLIS LANE~ g � voY i
I HYANNIS,MA 02601
I Undersecretary
max,
1 M.assachuseY,s -Departmentpi�P"L4bliC Sfety
Board of Building Regulations an&f Sn`crds
Construction Supen isor
License: CS-107456
JOHN L FARRELL '
38 CAPTAIN ELLIS E
Hyannis MA 02601 ° '
' f
;X.' Expiration
Commissioner 07/08/2017
- - -Buildings of any use group which
Unrestricted
contain less than 35,000 cubic feet(991m3)of
enclosed space.
f
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
www.Mass.Gov/DPS
For DPS Licensing information visit:
1
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CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD YYYY)
06/15/2015
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT
NAME: JIM HINDMAN
SCHLEGWEL INSURANCE BROKERS PHONE FAx
(A/C,No,Ext): 508-771-8381 (A/C Ne)508-771-0663
34 MAIN STREET E-MAIL
ADDRESS: SCHLEGELINSURANCE@GMAIL.COM
WEST YARMOUTH MA 02673 INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:TRAVELERS
INSURED INSURER B
David Bianco
INSURER C:
942 Falmouth Road
INSURER D:
INSURER E:
Hyannis, MA 02601 INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, 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 HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR INSR WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS
TYPE OF INSURANCE
(MM/DD/YYYY) (MM/DDlYVVV)
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY
PREMISES(Ea occurrence) $
CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE S
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $
POLICY PRO LOC $
JECT
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
(Ea accident) S
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS (Per accident)
F . $
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED RETENTION $ $
A WORKERS COMPENSATION 6HUB-2E66329-6-15 01/16/201501/16/2016 WC STATU- OTH-
AND EMPLOYERS'LIABILITY Y/N TOR Y LIMITS ER
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000
OFFICER/MEMBER EXCLUDED? FIT] N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required)
DAVID BIANCO HAS ELECTED TO BE COVERED UNDER HIS CURRENT WORKERS COMPENSATION POLICY
CERTIFICATE HOLDER CANCELLATION
FARRELL CUSTOM WOODWRKING INC
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
38 CAPTAIN ELLIS LANE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
HYANNIS MA 02601 ACCORDANCE WITH THE POLICY PROVISIONS.
MA
AUTHORIZED REPRESENTA VE
IN HAND
1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD name and logo are registered marks of CO D
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed.If SUBROGATION IS WANED,subject to
the terms and conditions of the policy,Certain policies may require an endorsement.A statement on this certificate does not confer rights to the,
certificate holder In lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
Dowling&O'Neil PHONE 508 775-1620.
Insurance Agency E-MMAIL
A/C No• 5087781218
973 lyannough Rd., PO Box 1990 ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIL S
Hyannis,MA 02601 INSURER A:Associated Employers Insurance
INSURED INSURER B
Andrew Craft
46 Blueberry Lane INSURER C:
East Falmouth,MA 02536 INSURER o
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF.ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LUTR TYPE OF INSURANCE WSR y VD POLICY NUMBER POLICY
YY MID YYP LIMITS
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY PREIMi5F1 S REDe $
CLAIMS MADE OCCUR MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GENERAL AGGREGATE $
GEN L AGGREGO- El rATE LIMIT APPLIES PER: , PRODUCTS-COMPIOP AGG $
POLICY JECTT LOC $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea ax,deM
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $
HIRED AUTOS NON-OWNED PROPERTY
accident)DAMAGE $
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE. AGGREGATE $
D . RETENTION$. $
A WORKERS COMPENSATION -AND EMPLOYERS'LIABILITY WCC50050126002014A 0/28/2014 10/28/201 "�X STaTu-
y/N oTH
ANY PROPRIETORIPARTNERIEXECUTIVE EL EACH ACCIDENT $500 000
OFFICER/MEMBER EXCLUDED? a N/A.
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500 000
It yes,describe under
DESCRIPTION OF OPERATIONS below. EL DISEASE-POLICY LIMIT $50O 000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space le
required)
Insurance coverage is limited to the terms;conditions,exclusions,other limitations and endorsements.
Nothing contained in the certificate of insurance shall be deemedto have altered,waived,or extended the
coverage provided by the policy provisions..
CERTIFICATE HOLDER CANCELLATION
John'L.Farrell Custom SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Woodworking,Inc. ACCORDANCE WITH THE POLICY PROVISIONS.
38 Captain Ellis Lane
Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE
J
I
•1•own ot•Barmtabie
Regalatory Services
Richard Y.Scali,Director
Building Division
Tom Perry,Building Commissioner
MASS.
16 200 Main Strom Hyannis,MA 02601
www town.barnstable.ma.us
Office: 508-862-4038 - Fax 509-790-6230
HOMEOWNER UCEDISE E7tE 2U0N
.rp DATE: '•� --- �- —'ple�scPtint -
(� ], t
JOB IACAlIOK- '1 a d J�J''�' Ca k(44�1 '
- number street. village
�. ✓�� 573?--�Bag
name hnznc phone 9 wo k phone r-
CURRENT 14AIIAdGADDRFSS: 3 0 .•L4)w <) /VA, d 1.
• aityhown zip code
The current exemption for"homeowners"was extended to include owner-occMied dwellings of six units or less sad to allow
homeowners to engage an individual far hire who does not possess a license,provided that the owner acts as snnervisor_
DEFTNLTION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,oa which there is,or is intended to be,a one or two-
family dwelling,attached or detached sttvctrrres accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such`homeowner"shall submit to the BuJdng Official on a form
a.eccptable to the Building Official,that he/she shall be responsible for all,such work performed under the building Permit (Section
109.1.1)
The undersigned`.`homeowner"assumes responslility for compliance withtho State Building Code and other applicable codes,
bylaws,rules and regulations. _
The undersigned"homeowner"certifies that he/she undr_rstmidc the Town ofBamstable Building DepartmentmfnhnTrm inspection
cedur ents and that he/she wlll comply with said procedures and requaemeuls.
ofHomcowncr
Approval of Bufl ding Official
Note: Three-family dwellings containing 35,000 cubic feet or larger wM be required to comply with the State Building Code
Section 127.0 Construction ControL
HOMEOWNER'S EI KKMON
The Code states that: "Any homeowner performing work for which a building permit is required shaI1 be exempt
from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner
engages a person(s)for hire to do such work,that such Homeowner shag act as supervisor."
many homeowners who are this exemption are unaware that they are assuming the responsibilities of a supervisor
(see Appendix Q,Rnles&Regulations for Licensing Construction Supervisors,Section Z15) This lack of awareness often
results hi serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot
proceed against the unlicensed person as it would with a licensed Supervisor_ The homeowner acting as Supervisor.is
Ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsrbr7r't les,many communities require,as part of the
permit application,that the homeowner certify that he/she understands fhe responsibilities of a Supervisor. On the Iasi page
of this issue is a form currently used by several towns. You may cam t amend and adopt such a form/certification for use is
your community.
QAWPFILEMRMSVnifidmg permitf mnsEXPRFSS_doe
Ravised 061313
ofT Town of Barnstable o � -
Regulatory Services
g Richard V.Scali,Director
Building Division
Tom Perry,Bolding Comaussioner ----- --
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Ownei Must
Complete and Sign.This Section
If Using A Builder
I, ,as Owner of the Subject property
berebyautborize to act on rnybehA
m all matters mlalive rib work authorized bythis wilding permit application for.
(Add= of Job)
'' `Pool
fences and alarms the responsibility off
the applicant. Pools
are not to be filled or d before fence is installed and all final
inspections are performed and accepted.
SigIla= of Owner S4 atare of Applic
Print Name Print Name
Date
Q:FORMS:OwNF EMMSMIW00IS
AFFIDAVIT
I, Nancy A. Klepser, of 942 Falmouth Road (Route 28), Hyannis, MA do hereby on oath depose
and say as follows:
1. 1 was born in 1934 on Cape Cod and raised at a home located at;-942 Falff6uth Road in
Hyannis.where I currently reside. The property now owned by my brother, John T. Carlson.
2. This property is separated from 954 Falmouth Road, Hyannis, by a road formerly known as
Strawberry Hill Road, which was a dirt road in my childhood and for some time thereafter.
There were ruts on either side of the road from the wagon wheels.
3. My grandfather, Joseph A. (Alonzo) Ellis, owned both 942 and 954 along with other land in
the area that he purchased in 1940. He was a farmer and ran "Ellis Farm" on 954 Falmouth Road
and abutting land.
5. When I was about 14 years old (1948), I sold strawberries with my grandfather at a shack
located at the edge of the road where 954 Falmouth Road is located.
6. In that same year, 1948, a pig pen was constructed toward the middle of 954 Falmouth Road—
there is now an apple tree in the same spot.
7. The farm at 954 Falmouth Road has been fenced off to keep animals inside the enclosed area
since the 1950's.
8. The Cape Cod Rough Riders was started on the Ellis Farm in 1956, specifically on 954
Falmouth Road. For a number of years there were horse shows on this property through the
Cape Cod Rough Riders. In fact, I am the only surviving founding member of the Rough Riders.
9. Since the mid-1950's, there have been always been significant structures on 954 Falmouth
Road including fences, pig pens, barns, stables and paddocks.
10. The property was used for the boarding of horses, donkeys and cows. My family operated a
pony ring on 954 Falmouth Road for a number of years charging fifty cents a ride. Horseback
riding lessons have been on-going at 9541 Falmouth Road for several decades.
11. With regard to the travelled way between 942 and 954 Falmouth Road,I was around when -
the United States army made regular used of this road for access to building behind it. Members
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of the army are the only people who have stopped me from using the road. This road currently
serves as a driveway to a home owned by the Barnstable Housing Authority which is located to
the rear of 954 Falmouth Road. I have personally witnessed the use of this way as a road for
over seventy years.
�r
SIGNED UNDER THE PAINS AND PENALTIES OF PERJURY THIS / DAY OF
AUGUST, 2013.
COMMONWEALTH OF MASSACHUSETTS'
Barnstable, ss:
On this day of August, 2013, then personally appeared the above named Nancy A.
Klepse, an individual known to me, and acknowledged the foregoing statements to be true to the
best of her knowledge and belief, before me
N
My commission expires:
NOTARY PUBLIC
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CARBON MONOXIDE ALARMS
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MASSACHUSETTS BUILDINI CORE
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BARNSTABLE BUI DING DEPT. DATE
FIRE DEPARTMENT DATE
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