HomeMy WebLinkAbout0096 LINCOLN ROAD i
u
NOR—
L ter* "•s'�� .--�.. - _ -i
Date: l t 7 `I
Thomas Perry, CBO
Building Division
200 Main Street
Hyannis, MA 02601
RE: Insulation,Permits
R
Dear Mr. Perry,
This
affidavit is to certi that all work completed at:
t� C
has been inspected by a certified B ilding Performance_Institute (BPI) Inspector. All work-
performed meet&or exceeds federal and state requirements.
Permit application number: Z.0 0 �-(
Issue date: I.023 i 3
Sincere
Francis ehan
President
Frontier Energy Solutions, Inc_.
Office- 774-237-0410
Email: fssfrontierenrgy@gmail.com -
4.
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel `� Application #
Health Division Date Issued
Conservation Division Application Fee -J
Planning Dept. Permit Fee 1W
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/ Hyannis
Project Street Address 6 L, ,sol n
Village (e-D►.)I S
Owner kmf
� Address�,n LlY1,C��7� oC.t YCnp1111S. O1Ge(''
Telephone - J q
0
Permit Request NS O 11_3Ed o
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 000 .'DO Construction Type
Lot Size 9 Ac mc-1 Grandfathered: ❑Yes ❑ No If yes, attach s pporting iocu entation.
Dwelling Type: Single Family ;R Two Family ❑ Multi-Family (# units) c
Age of Existing Structure lqqo Historic House: ❑Yes J&No On Old Kings. Highway ❑W �00
Basement Type: ❑ Full ,UVCrawl ❑Walkout ❑ Other '
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq ft) ml
Number of Baths: Full: existing new Half: existing neyv
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing new First Floor Room Count
Heat Type and Fuel: ❑ Gas _V 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 Yl G\S SC�: v1 Telephone Number
Address V-,/► License # 10 59 q 1
hCZ-4(1,e MA Q-.(o3l Home Improvement Contractor# ) (7 O�SL4
Worker's Compensation # IQ 0-(0 15 3L5_-6123A
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
VM ()v&&vy AY\Y\r<, -A G R&rvviC, 10aw5
SIGNATURE DATE 10 17 ���3
r
I
FOR OFFICIAL USE ONLY
d APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
3
ADDRESS VILLAGE
OWNER
:r
DATE OF INSPECTION:
LFOl1N.DATIQ%j it !,wws,
i
FRAME
is INSULATION
} FIREPLACE
I
-
�* ELECTRICAL: —ROUGH FINAL
PLUMBING: ROUGH — FINAL
r
{+; GAS: ROUGH FINAL
off,
FINAL BUILDING', —
i
II DATE CLOSED OUT
ASSOCIATION'PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial 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/Organizationtindividual):
Address: Say. &rk-JA G �'•
City/State/Zip: Phone#: '� ) �-d.3 04
Are you an employer?Check the appropriate box: Type of project(required):
I A I am a employer with, C6 , 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. ❑ Remodeling
shipand have no employees These sub-contractors have
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 I LEJ 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.K Other ��� `2�A�1
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 am an employer that is providing workers'compensation insurance for my employees: Below is thepolicy and job site
information.
Insurance Company Name: Com
n M\
Policy#or Self-ins. Lic.#: V Expiration Date: 3 ty aO 1'4
Job Site Address: GI hC,C�'Y\ City/State/Zip: (,YYA1 DUOO ]
Attach a copy of the workers'compensation policy declaration page(showing the policy number 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Officeof
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and'correct.
Sif re: Date:' ]o 17 �.-o1-3
Phone#: i 7 LA - a 3 _ U11 1
Official use only. Do not write in this area,to-be completed by city or town ofjiciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other i
Contact Person: Phone#•
-rE OF UABUff INSURANCE
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16 � ➢fRlli7[�po®tLY .99B1. BE LfH1VA IN
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OWNER AUTHORIZATION FORM
l LiScn A. r>�
(Owner%s Name)
owner of the property located at
�U liI,,CoI ki
oa�
(Property.Address)
Uaw iS I MA 6 0w
(Property Address)
hereby authorize
(Subcontractor) .
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property.
4 ` I
I
Owner's"Signat r
Date
1
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map ,7oO,Go Parcel Permit#
o��C"r'�p,���' �', fSaBLE
Health Divisio 1� �ti Date Issued e l 7/ 6, .7
Conservation Division j +' 3 Application Fee*0. 19-�
Tax Collector d AC& / f. Permit Fee �r,o O
� v
Treasurer Di��'iS;t7�� JA8E�'�0SY$��
Planning Dept. sr&LD IN OO l isr m
Date Definitive Plan Approved by Planning Board ENWRO 1; -"TE!6
C
Historic-OKH Preservation/Hyannis TO RC.(;UU®O At E AIVI
olya
Project Street Address 710
Village
Owner _ZnA� Address
Telephone's6 g - 7 7 5 — -5a 7 9
Permit Request
Ly X 14,1
Square feet: 1 st floor: existing�p� proposed _ 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuatiolk o 0 d-0 Construction Type
Lot Size Grandfathered: Cl Yes ❑No If yes, attach supporting documentation.
Dwelling Type: Single Family d Two Family ❑ Multi-Family(#units)
Age of Existing Structure vP > - 19 4 Historic House: ❑Yes allo On Old King's Highway: ❑Yes 9NoNJ
'
Basement Type: *Full Q.Crawl ❑Walkout ❑Other
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:hexisting ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size
Attached garage:Cl 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
BUILDER INFORMATION
Name Co. Telephone Number
Address z f �( 0. �� License# 13 (o 7Z L
�S .b�2rnr f 1�cL Home Improvement Contractor# I a 9
Worker's Compensation# n
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE _ DATE Cn ^ 17 O 3
FOR OFFICIAL USE ONLY
PERMIT NO.
Y
1
DATE ISSUED --
MAP/PARCEL NO.
ADDRESS' , VILLAGE
OWNER {
DATE OF INSPECTION:
FOUNDATION blrdo
FRAME - ��ir! 7��0ZO 3 AI A A/� 7//(0 XO 3 O A
INSULATION
4
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH'; FINAL
GAS: ROUGH FINAL
FINAL BUILDING t�5 /n/= '� �� / 3 •(/��h - . 1
S
DATE CLOSED OUT
ASSOCIATION PLAN NO. �'
0-®cACTUC3 N ®F PRC)PERYY LANES 1M^Y NCYT BE ^CCUR^-T9 STANDARDLEGEND
NOTE:not all symbols will appear on a map
0 7 - 4 \./ � GOLF COURSE FAIRWAY
LA �� EDGE OF DECIDUOUS TREES
1 j 1,150 2
---- -- __ _
� EDGE OF BRUSH
----- -------- ----- - ORCHARD OR NURSERY
V-V-7-V EDGE OF CONIFEROUS TREES
1l �� MARSH AREA
/ — • •— EDGE OF WATER
X I O 2 70 - _ _ = DIRT ROAD.
DRIVEWAY
- _ PARKING LOT
__ r I��.--- PAVED ROAD
Map 270 ____ _____ - _ r — - - —
1 02 DRAINAGE DITCH
2 - - - - - PATH/TRAIL
/ / I Ma
PARCEL LINE**
mil^ FT T MaPno E---MAP#
I 1 21
860�HOUSE NUMBER
___ \ ap
� 8y 1 FOOT CONTOUR LINE
o l
/ . 4 — l� 10 FOOT CONTOUR LINE
_ Elevation based on NGV029
b X4.9 SPOT ELEVATION
00o STONE WALL
-X—X- FENCE
Map 2 w RETAINING WALL
-I F+ RAIL ROAD TRACK
6 STONE JETTY
9\ / _ SWIMMING POOL
\ �J 2 ❑ 1 j PORCH/DECK
❑ BUILDING/STRUCTURE
H+fA- DOCK/PIER
M p 270 HYDRANT
Map 6 VALVE ® MANHOLE
61 o POST 0" FLAG POLE
T O W N O F B A R N S T A B L E O E O O R A .;P, H 1 C I N F O R M A T .1 O N S Y S T E M S U N I T a SIGN ® STORM DRAIN
N PRINTED S01tE:IN FEET *NOTE:This map is an enlargement of a **NOTE:The parcel lines are only graphic representations DATA SOURCES: Plonimetrics(man-made features)were interpreted from 1995 aerial photographs by The James
1"=100'scale map and may NOT meet 'of property boundaries.They are not true locations,and W.Sewall Company.Topography and vegetation were interpreted from 1989 aerial photographs by GEOD W UTILITY POLE n TOWER
" t ` Q 20 40 National Map Accuracy Standards at this do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet Notional Map Accuracy Standards
t INCH=40 FEET* enlarged scale. on the map. at a scale of 1"=10D'. Parcel lines were digitized from FY2003 Town of Barnstable Assessor's tax maps. -0- LIGHT POLE O ELECTRIC BOX
The Commonwealth of Massachusetts
- Department of Industrial Accidents
,� -- =Uoffice 0/INIV85 0a oas
600 Washington Street
-= Boston,Mass. 02111
— Workers' Com ensation Insurance Affidavit
i
name:
location:
CitV a yhone
❑ I am a hongowner performing L work myself.
am a sole rietor and have no one workin in ca achy
I am an em 1 roviding workers' compensation for my employees working on this job.
co a X.
X.
v
a lion
fF
frisurance co
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
the following workers' compensation polices;.................................::.,::::::.:::::.:: :.::.:.......::::::::.:::.:::::::::::::::.:::.:::.::.;:.::.::.;:.::;.;;;;;:.:•;::::;.;;::r;.,:.,:.:.::.:.«:::;::
XXXV.
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......................................... :..:.:.
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as
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Fa[hu a to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine to S1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is truce and correct
Si gnature a_VU� Date (o — I — .6 3
Print name r_ Phone#Sd Z-3 q y
official use only do not write in this area to be completed by city or town official
city or town: permdtllicense# ❑Building Department
❑Licensing Board
❑checkff immediate response is required ❑Selectmen's Office
❑Health Department
contact person phone#; ❑other.
(devised 9/95 PJA)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as every person in the service of another,under any contract
of hire, express or implied, oral or written. r,
An,em to er is defined as an individual, partnership, association, corporation or other'legal:entity, or any two or more of
P, Y s .
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or
trustee of an individual,partnership, association or other legal entity, employing employees.'hwkever the owner of a
dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of
another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or
building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal
of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has
not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the
commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until
acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting
authority.
Applicants
Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and
1 company names, address and hone numbers along with a certificate of insurance as all affidavits may be
�•, supplying P Y P
submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and
date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is
being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you
are required to obtain a workers' compensation policy,please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the
affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be retained to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please do not°he'sitate,to,give,us a call.
c
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Imlestlgatlons
600 Washington Street
Boston, Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
�oFtHE, ti Town of Barnstable
Regulatory Services _
BAMS LA ' Thomas F.Geiler,Director
NAM
019. ��� g
Buildin Division
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-962-4038 Fax: 508-790-6230
Permit no,
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion,
improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions, along with other
requirements. {�
Estimated Co# I Q
Type.of Work:►
Address of Work: -I
Owner's Name: V C70�t`c`
Date of Application: (o
I hereby certify that:
Registration is not required for the following reason(s):
❑Work excluded by law
❑Job Under$1,000
[]Building not owner-occupied
❑owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date ontractor Name Registration No.
OR
V03
Date Owner's Name
RESIDENTIAL BUILDING PERNUT FEES
APPLICATION FEE
New Buildings,Additions $50.00
Alterations/Renovations $25.00
Building permit Amendment $25.00
FEE VALUE WORKSBEET �
NEW LIVING SPACE � �� ,I • � � .
9_-7a•_square feet x$96/sq.foot= x.0031=
plus from below(if applicable)
ALTERATIONS/RENOVATIONS OF EXISTING SPACE
square feet x$64/sq.foot= x.0031=
plus from below(if applicable)
GARAGES(attached&detached)
square feet x$32/sq.ft.= x.0031=
ACCESSORY STRUCTURE>120 sq.ft.
>120 sf-500 sf $35.00
>500 sf-750 sf 50.00
>750 sf-1000 sf 75.00
>1000 sf-1500 sf 100.00
>1500 sf-Same as new building permit:
square feet x$96/sq.foot= x.0031=
STAND ALONE PERMITS
Open Porch x$30.00=
(number)
Deck x$30.00=
(number)
Fireplace/Chimney x$25.00=
(number)
Inground Swimming Pool $60.00
Above Ground Swimming'Pool $25.00
RelocationlMoving $150.00
(plus above if applicable) d— C- 00 0
Permit Fee
�F1HE ip�, Town of Barnstable
Regulatory Services
r •
► Sn S LE,KAS �
� Thomas F.Geiler,Director
9 DiAS $
`bprE163[g. Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must.Complete and Sign This Section If Using A
Builder
I, Ooxvc . 1 1 , as Owner of the subject property
hereby authorize J .0 — to act on my behalf,
in all matters relative to work authoged by this building permit application for(address of
job)
mac.
4ature of Owner Date
3o�ty� '� �. �,� aNE
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HOME IMPROVEMENT CONTRACTOR
Registra' i \428249
Exptra Iron 23115/2005
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404 MAIN ST
SO. DENNIS,MA 02660 Administrator
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Numbers-=\ 073676
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