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Home My WebLink About0500 OCEAN STREET (4) �� a s CIL"' �— ►� ' l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 'l40Map Parcel V - o Application # Health Division Date Issued Conservation Division Application Fe r, Planning Dept. Permit Fee ' 0 0 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address ,To® n C C--an nT 7 v an n i s ZJ A Village �� ' 7 /2- Owner t TO,0)0 1-, l p A-4 cG; Address Telephone7_7/- c;? J o'o' 1 Permit Request e-rnn 0 v e- QLn DA C P j2 I a C e- InQ4� n to r 0,n d( O si e r _S 1, d1 e S A n cd C r Si n 2-O O S r �' I E'�S fe r nn 0% 'S I ►e 1 o/t Square feet: 1 st floor: existing ZZ,�proposed 2nd floor: existing /O proposed Total new 2-35✓ Zoning District Flood Plain Groundwater Overlay Project Valuation OOC Construction Type C;J O C 0A !�""' e_ r D Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s pporting,docur entation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) C do C> .. Age of Existing Structure Historic House: ❑Yes XNo On Old King'' Highways ❑Los XNo Basement Type: ❑ Full ;Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) O Basement Unfinished Area (sq.ft) 6no s a Number of Baths: Full: existing Z new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing anew First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil 'Electric ❑Other Central Air: ❑Yes XNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes XNo 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 � /-r>'`/lLAC-C►' Telephone Number 77 y- 2 I Y- Address n 4 k f-Cn '_S 4 License # Cs` O 7 V 7 del-, oho e4l /-1 /-i 027 Home Improvement Contractor# G lobes\ Pcope'_4;y Email Worker's Compensation # 1✓WC I oC)Cola 4/G4;- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNA DATE 3 e FOR OFFICIAL USE ONLY APPLICATION# J DATE ISSUED MAP/PARCEL NO. . 1 ADDRESS VILLAGE ` OWNER DATE OF INSPECTION: ' FOUNDATION FRAME A, 1 INSULATION FIREPLACE y ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASS PLAN NO. * The Yachtsman 500 Ocean Street, Hyannis, MA 02601 t Yachtsman Condominium Trust P.O. Box 1283 Hyannis, MA02601-1283 (508)775-1515 Yachtsman Condominium Trust Board of Trustees 500 Ocean Street Hyannis,MA 02601 DATE 3/C;� j/J 1 RE: Unit Yachtsman Condominium Trust, 500 Ocean Street, Hyannis To the Town of Barnstable Building Commissioner, - The Board of Trustees for.the Yachtsman Condominium Trust voted and approved the attached proposal to be erfo ed is delineated in the request we received from the Unit Owners: Contractor, �h / !fv i � has been contracted by the Unit .Owner to perform the work as defined in the proposal. This letter serves as notice of the Board's vote to approve the proposal, which has been noted in the Minutes of the Board Meeting. Signed Under the Pains and Penalties.of Perjury this day of'l� 520 c U5cean Trustees an Condominium Trust Street(c/o Manager's Office) Hyannis,MA 02601 Enc./File k Taw Con2manfmakh of-VlassachmsdO Deparhnent qfhdas&ia1 Accidents - - OiWe Of_&vex Uivrrs 600 Washingtom,reet Boston,MA 0211I wn-m.7no=goildia orkets' CampensatianInsuranceAffidavit:Buildersl'Contra:ctnrsMectricianMumbers Applicant Infarmation ) Please Print Legibly Name(Rtrsinrs816rganizadioulludiiridttal�: / c.i � Address: , , Li S J City/Scat&zip: f , e_�,O to c- -> 1-m �one� -7 7 y - Z I Are you an employer:`Check the appropriate boy: T of. -t r � 4. I areta contractor and I Fl3e Pr'oJ f��- L R am a employer with�_ ❑ � 6- ❑New a nsfructiaa employees{full and/orpart-time)* have hired the sub cavtrwtors. 2.-❑ I am a sole proprietor or partner dsted on the attached sheet 7- ❑Refnodeling strip and haze no employees These sub-contractors have g_ ❑Demolitioa worbng forme in any capacity_ a Vlmy,,and have workers' _ ❑Building addition [No'workers' comp: suranc insurance comp-msurar�1 asgnired_I 5..❑ 'We art;a corporation and its 10.0 Electrical repairs m additions 3111 am a homemm r doing all WO& officers h 7tim exercised their. I I..❑Plumbing repairs or additions myself. [No workers'comp- right.of exemption per MGL I2 El RDofrTairs insurance required.]f c-1.52, §1(4),and weh;n-enu employees-[No works' 13O.ther comp-insurance required-], �- 'Any sapHc3nt that checks box"1=s t also ffil oni the section below shawing rhea tvauicers'Compessatiou goiicg infimn6m._ T Homeowners olio submit this afhd:vit inmcsting they ate doing aII unac=4&ea lure pae &contracmes nmsi submit a new affidsrit mriicstm satli contractors&Ft cbecic this box must sttads as additional sheet sbnvemg the name off ffie WbF-- Sand steiP orhetire[aunt tl sg Des 5avg employees- If the soli-contractors have employees,they must provide their worker'comp.palicp ntMber_ .tam an empZayer that is prmiding tt�orkers'congwnsation irw4r ance for my e-rapLayees. Below is thap.0cy artd}ob site infor mint&— // l Insm-ance Company Polity or Self ins Lim `�j,y G 1 (�i n 17-�-I O.S� ZO/Sr_ Expiration Fats: Job Site Address: �—LOQ 0 rP Gn S Z Cib,/State/Zip- O Z(C Mach a ropy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A o€MGL c. 152 can lead to the imposition of criminal periaIties of a fine up to$I,5D0.00 and/or one-year imprivormed,as well as civil penalties in the fb m of a STOP WORK ORDER-and a fine. of up.to$250.0 0 a.day against the violator- Be advised that a copy of this statement may tie forwarded to.the Office of Investigations of gie DIA for instrancg coverage verificatitm_ I do here rider the par tinrT penalties of pedaty that in,f brmatian pral�idRdr ahFt�¢is bu$arrrf carrsct sitms Bate: Z P -7 -7 Y - Z- -9 11 Official use only. Da not write in this area,to be completed by city:or town of'ciaL City or Town: Pm-mitUcense# Issuing Antharity{tsrcle one}; 1.Board of Health 2.Building Department I Citytrawn Cleric 4.Electrical Inspector 5.Plumbing Euspector .6.Ot:her Contact Person. Phone#" — 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"_..every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the Iegal representatives of a deceased employer;or the receiver or trustee of an individual,partnershilp,association or other legal entity,employing employees. However 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, 625C(6)also states that"every state or Iocal licensing agency shall witbhold 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, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compli.Ence vrith the insurance requirements of this chapter have been presented to the contracting authority Applicants — Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their ceriricatc-(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(L LP) %✓Yin no employees other than the members or partners, are not required to carry workers' compensation insurance_ If an LLC or LLP does have employees, a policy is required_ Be advised that this affidavit may be submitted to the Department ent of industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affM2vit 'lire 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. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials 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 eventlhe Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permitllicease number which will be used as a reference number, In add i don,an.applicant that must submit multiple perm.iitllicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations ilz (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is N TOT required to complete this affidavit. The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, to t e please do not hesitate o v us a call. P � The Department's address,telephone and fax number: Tho flo�rmonwealth of IVMassachusctts Degartmeut of h dustW Accide., s Offlce Qz lavesligatims 600 WasWRgon St=t Boston_MA 02111 Tel.A 617-727-4900 w 406 or 1-9 MASSAFE Revised 4-24-07 Fax 9 617-727-7149 7Rrw.mas&9QV/dia DATE(MMIDD/Y`(YY) CERTIFICATE OF LIABILITY INSURANCE 11/03/2014 THIS CEETIFICATE 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. IMPORTAVT: If the certificate holder is an ADDITIONAL INSURED, the policy()es) must be endorsed. If SUBROGATION 1S 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 certificateholder in lieu of such endorsement(s). PRODUCER 0 1291 -001 CONTACT NAME: J K Olivier!Ins Agency Inc �cNN.Ext: (508)947-1818 Farc.No.: (508)946-1162 64 East Grove Street EMAIL Middleboro,MA 02346-0000 ADDRESS: INSURERS AFFORDING COVERAGE NAIC s wsuteED INSURERA: A.I.M.Mutual Insurance Company 33758 Global Property Services Inc INSURERB: 55 Winthrop St Ste 1 INSURER C: - Rehoboth, MA 02769 INSURERD: INSURER E: 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. I�'TR TYPE OF INSURANCE A DDL SUB POLICY NUMBER POLICY EIpT POLICY EXP LIMITS. IN SR WVD (MM/DD/YYYY) (MM/DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIALGENERALLIABILITY DAMAGET-RENTED $ CLAIMS MADE ❑OCCUR PREMISES Ea occurrence MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY RO- OC ECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ! ANY AUTO Ea accident ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMSMADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION X WC S TU- AND EMPLOYERS'LIABILITY q ANY PROPRIETOR/PARTNER/EXECUTIVE Y IN TORY PMITS ER A OFFICER/MEMBER EXCLUDED? N/A VWC-100-6012405-2014A 8/5/2014 8/5/2015 E.L.EACH ACCIDENT $ 100,000.00 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000.00 D9CRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE {� ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 5971 Massachusetts Department of Public Safety: Board of Building Regulations and Standards' Corsfruction Supervisor � License: C&074872 JOSEPH M POILIS-tc� 55 WINTHROP ST " L7rZ1� REHOBOTH MAY 0219' 1 Expiration Commissioner 08/23/2016 > I . �fe (oa��vinarecuea��¢��aa:rac�cc�eCl`s ` Office of Consumer Affairs&Business Regulation 'NOME IMPROVEMENT CONTRACTOR egistration 1.52036 Type: g 712512616:• Individual JOSEPH POILLUCCI i } iK _I JOSEPH POILLUCCI r ! - 2115 CHESTNUT St. - N.DIGHTON,MA 02764 Undersecretary o s t * WMNsr"LF, MASS. ,� Town of Barnstable Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO 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, 53S e-j2 C-e-k ,as Owner of the subject property hereby authorize a�� }'c c� �i S e��i c e S, to act on my behalf, in all matters relative to work authorized by this building permit application for: SCC CCe.' 'S-�L / z (Address of Job) Sign e of Owner Date as �.�1'� �O i l ' C-e-- Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPHLESTORMS\building permit forms\EXPRESS.doc Revised 061313