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HomeMy WebLinkAbout0270 NORTH STREET (3) ago �ti st PROJECT NAME: o �V10 AAJ )ln ' ✓a ,/S ADDRESS: 5 GkvtVA�S PERMIT# PERMIT DATE: I Z 3 U `?) - O LARGE ROLLED PLANS ARE IN: BOX SLOT Data entered in MAPS program on: 1 Z 15 BY: a r q/wpfiles/forms/archive ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 3 (P Application #o Health Division Date Issued 1Z- 0 "I l T Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address a 70 N OE41h S+-Ee-et &1anklm' M o Village ��n Owner �J UJO-rd L Q.s a01 I 1 P��2 Address (P U u�c: t n &. Ga .( L(0, Tom- Nosh 6f-Pef 1199(D �QaQJ�1 T Permit Request MSS Qa Hcy-1 04 01 I2x3 a .C► � fix L4 4 4-e n4pc aaN 0 44k fYa.L Lao 4 r a ctu,ra-I .drn (� I+ M,mAs Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1 1 -35 0 Construction Type 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 ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing =new---s < Number of Bedrooms: existing _new -; Total Room Count (not including baths): existing new First Flood om Copot ' Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other - � -� cn Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woo /coal stye: V JYes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: L3 existing'❑ r� 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 '7 7-i ✓ (BUILDER OR HOMEOWNER) Name JTelephone Number g!�o L4 11 - (D Address V l . License #_ CS l© , )0:7 Vanh,&' Home Improvement Contractor# Email Ac_ PtlQ o = I�Q DEBR��oS�RESpc� C'�, Cn�M Worker's Compensation # L CONSTRUCTI N ULTING FROM THIS PROJECT WILL BE TAKEN TO bEis r IGGNOURE DATE FOR OFFICIAL USE ONLY APPLICATION# F DATE ISSUED MAP/PARCEL NO. R � K4 ADDRESS VILLAGE OWNER M I: DATE OF INSPECTION: FOUNDATION FRAME 4} INSULATION ;f FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL f FINAL BUILDING DATE CLOSED OUT r I. ASSOCIATION PLAN NO. r P c c: S f ( address a 2(4. G'-tat in - Gr't:�1 f n Permit Request �_�'.1�S 0� S 'L� G�1 (l 1 f�-�C 3 a �l � ,�X Lf �- � e N p �,2ary 411 ! i�`�lr� l (CI L LOV3 r Ck Gas" L C CL:h rX \ b'y"i o tJl1S u Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 7 35 Construction Type Lot Size Grandfathered: Q Yes J No If yes, attach supporting documentation. Dwelling Type: Single Family J Two Family J Multi-Family(#t units) Age of Existing Structure Historic House: J Yes, J No On Old King's Highway: J Yes J No Basement Type: J Full J Crawl J Walkout J 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 J Oil J Electric J Other " Central Air: J Yes J No Fireplaces: Existing New Existing wood/coal stove: J Yes J No Detached garage: J existing J new size_Pool: J existing J new size _ Barn: J existing J new size_ Attached garage: J existing J new size _Shed J existing J new size — Other: Zoning Board of Appeals Authorization J Appeal # Recorded+J Commercial J Yes J No If yes, site plan review# Current Use Proposed Use APPLICANT INNTFORNIATION (.BUILDER OR HOMEOWNER) Name MO q r Telephone Number "C D - 19 Address License# C .- 10c)(Y79 Home Improvement Contractor# Email :��PUk , In o AAcA51 i ro, e ni:1 Worker's Compensation #' L CONSTRUCTI N DEBR S RESULTING FROM THIS PROJECT WILL BE TAKEN TO I OGNATURE DATA a . The Commonwealth ofMassaclzusetts �p Department of Industrial Accidents Office of lnves Ugations 600 Washington Street Boston,MA 02111 lvww mass gov/dia Workers' Compensation Insurance Affidavit: BuilderslContractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/organization/Individual): Address: Irib 1 L CitylStatelZi :On "J�C!It_o3 phone#: L�you an employer?Check appropriate box: I am a employer with (p G.._ 4. ❑ I am a geaeral contractor and I Type of project(required): employees(full and/or part-time).+ have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- Iisted on the attached sheet. 7. ❑Remodeling slip and have no employees These sub-contractors have working forme in any capacity. employees and have workers' 8. (]Demolition [No workers'comp.insurance comp.insurance.; 9• ❑Building addition 3.❑ required.] 5. ❑ We are a corporation and its 10.11 Electrical repairs or additions 1 am a homeowner doing all work officers have exercised their nryself.[No workers'comp. right of exemption per MGL 11.Q Plumbing repairs or additions insurance required.)t C. 152,§1(4),and we have no 12.0 Roof repairs employees.(No workers' 13.0 Other , r• comp.insurance required.] 'Any%n4jeam dM checks box 91 must also fill out the section below stowing their workers'compeosadm polity information. t Hontcownets who submit this affidavit indicating they are doing all work and then kite outside eontraetots must submit a now affidavit indicating such s*GY,etara that sub-c�l�r have en hey ea will y mu sprat showing the nA=of the sub•coomwtors and state whedw or not those entities have anployees. If the employees,they moat provide their woskas G0MR Policy number. I am an employer than isproviding workers'compensailon insurance for my employees: Below is the policy and job silt lnforinar�on. Insaraace Company Name r •h 1 h Su,+ru.nCJ Ce Policy#or Self-ins.Lie.#: _ Expiration-] Wi� Job Site Address: r� CitylStatelZip: i-Vr_T � (►�a�„�1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). FMIum 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 imprisoarnent,as of up to$250.00 a day against the violator. Be advisedwell as civil penalties in the form of a STOP WORD ORDER and a fine that a copy of this statement may be ftnwarded to.the Office of Investigations of the DIA for insurance coverage verification. I do hereb3,certify under the p . and penahles of perjury that the information provided above is true and correct Date• l c. 'cc 1 t 11. FJ=aing ly. Do not write in this area,to be completed by city or town officiaC Town: PermitlLicense# rity(circle one): L Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspector b.Other Contact Person; Phone#: COMMERCIAL INSURANCE WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY-INFORMATION PAGE Insurance for this coverage part provided by: Servicin Offloe: ZURICH AMERICAN INSURANCE COWANY PHILADELPHIA 2000 MARKET STREET SUITE 1100 1. Policy Number WC 5747084-01 PHILADELPHIA PA 19103 Named Insured and Mailing Address Renewal of Number WC 5747084-00 Producer and Mailing Address MODULAR SPACE CORPORATION , (SEE NAMED INSURED ENDORSEMENT) WILLIS OF PENNSYLVANIA INC 1200 SWEDESFORD ROAD 100 MATSONFORD ROAD OFFICE #325 BUILDING 5, SUITE 200 BERWYN PA 19312 RADNOR PA 19087 Producer Code 10 3 81-8 21 Other workplaces not shown above: FEIN:54-1375284 NCCI Company No. 10863 0 New ❑x Renewal ❑ Rewrite of Prior Policy No. This information page,with policy provisions and endorsements, if any,completes this,policy. Insured is:CORPORATION 2. Policy Period: From:03-30-2014 to 03-30-2015 W 12:01 A. M. Standard Time at insured's mailing address. Insured's Identification numbw(s): 918123660 ' 3 A Workers Compensation Insurance: Part One of the policy applies to the Workers' Compensation Law of the states listed here:to B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The Limits of Liability under Part Two are: Bodily Injury by Accident: 1,000,000 each accident Bodily Injury by Disease: 11000,000 policy limit Bodily Injury by Disease: 1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: See Endorsement D. This Policy includes these endorsements and schedules: See Schedule of Fohms and Endorsements, 4. The prermurn for this 130 icy will a determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required on the following Classification Schedule is subject to verification and change by audit. See ClassM=00i n Schedule TOTAL ESTIMATED STANDARD PREMIUM $ PREMIUM DISCOUNT $ If indicated below,adjustments EXPENSE CONSTANT $ of premium shall be made: PREMIUM FOR ENDORSEMENT $ TAXES AND SURCHARGES x Annually ❑ �y TOTAL ESTIMATED ANNUAL PREMIUM $ Semf,Annually ❑ This is aTnree MINIMUM PREMIUM Quarterly Year Fixed sate DEPOSIT PREMIUM $ Agent or Producer Countersigned by Fiesident Uoerwd Agent Date WC 00 00 01A U WC-D,314A w-94) Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY COMMERCIAL INSURANCE INSURANCE POLICY-INFORMATION PAGE Servicing Office: Insumnce far this caverage part provided by: PHILADELPHIA ZURICH AMERICAN INSURANCE COMPANY 2000 MARKET STREET SUITE 1100 PHILADELPHIA PA 19103 1. Policy Number WC 5747084-01 Renewal of Number WC 5747084-00 Named Insured and Mailing Address Producer and Mailing Address MODULAR SPACE CORPORATION WILLIS OF PENNSYLVANIA INC (SEE NAMED INSURED ENDORSEMENT) 100 MATSONFORD ROAD 1200 SWEDESFORD ROAD BUILDING 5, SUITE 200 OFFICE #325 RADNOR PA 19087 BERWYN PA 19312 Producer Code 10381-821 Other workplaces not shown above: FEIN:54-1375284 NCCI Company No. 10863 ❑ New ❑x Renewal ❑ Rewrite of Prior Policy No. This information page,with policy provisions and endorsements, if any,completes this policy., Insured is:CORPORATION 2 Policy Period: From:03-30-2014 to 03-30-2015 at 12,01 A. M. Standard Time at insured's mailing address. Insured's Identification number(s): 918123660 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers' Compensation Law of the states listed here:mA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The Limits of Liability under Part Two are: Bodily Injury by Accident: 11000,000 each accident Bodily Injury by Disease: 1,000,000 policy limit Bodily Injury by Disease: 1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: See Endorsement D. This Policy includes these endorsements and schedules: See Schedule of Forms and Endorsements. 4. The premium for this policy will a determined by our.Manuals of Rules, Classifications, Rates and Rating Plans. All information required on the following Classification Schedule is subject to verification and change by audit. See ClamMoation Schedule TOTAL ESTIMATED STANDARD PREMIUM $ PREMIUM DISCOUNT $ If indicated below,adjustments EXPENSE CONSTANT of premium shall be made: PREMIUM FOR ENDORSEMENT $ x Annually ❑ Monthly TAXES AND SURCHARGES $ 5emi-Annually ❑ This is a Three TOTAL ESTIMATED ANNUAL PREMIUM $ Quarterly Year Fixed gate MINIMUM PREMIUM $ Policy DEPOSIT PREMIUM $ Agera or Producer Countersigned by Resident Licensed Agent Date WC 00 00 01 A U WC-D,314A(07.94) Page 1 of 1 Town of Barnstable Regulatory Services ��� g Richard V.Scali,Director 1639 Building Division QED MA'S� 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, Guar� E Lo c5 //e ,as'Owner of the subject property hereby authorize -', to act on my behalf, in all matters relative to work authorized by this building permit application for. 0 / 0�7 /U0�-�1 �G�P-eat l GC�II�IIf' (Address of Job) " -*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. Signature qFbAer a of Applicant i J6 b Print Name Print Name ` Date Q:FORM&O WNERPERMISSIONPOOLS Town of Barnstable Regulatory Services ���TttE Tpy Richard V.Scali,Director Building Division * EARxsz'ABM Tom Perry,Building Commissioner nrnss. 1639• 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phont¥r CURRENT MAII.ING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two- family dwelling, attached or detached structures 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 Building Official on a form acceptable 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 responsibility for compliance with the State Building Coce and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspectica procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building erode Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall 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 shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in 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 responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a formlcertification for use in Pyour community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 Mod act' December 29, 2014 ............... .....:... . ...._........ . . ...... ... ... . To whom it may concern: 1 am writing to confirm that Tim Stellenwerf has been employed with ModSpace since 2010 and currently holds the position of Project Manager. Feel free to contact me at 860-348-9595 or contact our Human. Resources Dept.at 610-232-0964 for additional verification Regards, Steve Cline ModSpace Operations Manager—CT I MA T: 860.348.9595 C: 860.471.1864 F: 860.343.3748 E: steve.cline(o)modspace.com 85 Kenneth Dooley Dr. Middletown, CT 06457 Boston Serviat,Center-zt;nedlenniun)Diche Lakeville. NIA.034i www.modspace.com. 1 ` Connors, Allison I From: Cline, Steve Sent: Thursday, October 23, 2014 5:06 PM To: Connors, Allison Subject: Tim Lic i 3� Steve Cline ModSpace Operations Manager—CT /MA T: 860.348.9595 C: 860.471.1864 E: steve.clineCmodspace.corn 85 Kenneth Dooley Dr. Middletown, CT 06457 19 HJ PI i