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HomeMy WebLinkAbout0500 OCEAN STREET t ; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 32!1 Parcel D Application # 5 63'�)7 Health Division Date Issued /—/ Conservation Division Application F /6c) Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address s !'ee k Village ' Owner a _Dd ke44 Address 1061 oee_&1 Sf Uvt t'j Y Telephone Permit Request PY eue of A ec/C /�_Y Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay. Project Valuation o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach porting'docurntation. Dwelling Type: Single Family 1 Two Family ❑ Multi-Family (# units) M CDP Age of Existing Structure G�� Historic House: ❑Yes ,f l No On Old King Highways❑Y; 04 No Basement Type: Full ❑ Crawl ❑Walkout ❑ OtherLn Basement Finished Area (sq.ft.) .S";2Z Basement Unfinished Area,(sq. ) `' a Number of Baths: Full: existing_ new Half: existing 1 now Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil 4 Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing i 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(_ i 1®�c r Telephone Number Address 766 License # Home Improvement Contractor# Email J t �, � 4 s'{ Ale Worker's Compensation #/22 6/G J:2 e 7157 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN SIGNATU E DATE I f FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER I3 DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL I "4 > PLUMBING: ROUGH FINAL GAS: ROUGH FINAL F1.NAL BUILDING DATE CLOSED OUT ASS,%IATION PLAN NO. t Hie t omtrrr nsve�of Hassat:huseffs Depurhuent of laadms1iial Accidents 01TWe Of Imlestigations 600 l3'r ykington Mreet Boston,MA 02MI T4?nw.massS.go v1da[a Workets' Campensaticon Insurance Affidavit:BuildersfContractors/UectriciauslPlumbers Applicant Infarmation Please Print Legibly Dame(Susinessr6rganizationI0h?idna0- CiWStatzlZip: e Are you an employer?Check the appropriate box: Type project. ant s contractor and �of�'o] (required): 1_K I am a employer with� 4 _ ❑ I tt I 6- ❑New construction, employees(fall andlorpatit-time).* have hired the sub-contMCc D s. 2._❑ I am a sole propritztor or partner- listed on the attached sheet; y- ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolitioa working for me in any capacity- employees and have workers' g_ ❑Building addition [No workers' comp:insurance comp.insurance) req ;Ted-Ij 5..❑ We area corporation and its 10.1�kRectrical repairs or additions 3_❑ I am a homeowner doing all wod-- officers haves exercised their I LEI Plumbing repairs or additions myself [No workers'comp- right of exemption per MGL 12_.0 hoof repairs insurance I c_152, §1(4),and we haven, required] employ-[No worker' comp-insurance,required.-f *may appbomt that checks boa#1 most also ii11 out the section below showing ffidr wakes'coarpensation poling iufbrmation_ T Homeowners wbo submit ibis afbdsvit indkXCMg they art tiring Ra c D&and then hire outside Conhactnrs most Sdbmit a meat sfdnit mdicstM such tCQntmctnrs VW check this box mast attached as additinnsl sheet showiag the name of the web-oomkactoxs zmd state arhether or not those eiwitjes have eutplayees. Ifthe sttTo-contmctats base empIogees,the}nmLq pmuide their workers'comp.policy nunbez_ I am an employer that isprm id ag ti orkers'e-amperu Lion insrlrance for my*employees. Belau fs die poifcy raid job site irtforigzalfon. Insurance CompauyName: If 52Cea -1 Policy 4 or Self-Ms.Lim ExpiiatiouDate: Job Site Addtess:--5'0k::�) Cityr'State/zip:f14el- -e k1 f f Attach a copy of the workers'compensation policy de-darktion page(showing the policy nuffiber and expiation date). Failure to secure coverage as required under Section,25A of MGL c. 152 can lead to the imposition of criminal penallies of a fine up to S 1,500.0a and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator_ Be advised that a copy of this statement may be forwarded to the Office of Im estigations of the DIA far insurance coverage veriticatton_ I do herr-eby c fymi t- n r penalties ofpefury that the in jorrraafron prasrzded ahrwe iss hire and correct Siena Bate: Phone#: Olichil use only. Do not write in this area,to be completed by Gffy or town of jiciaL City or Town: PermitUcense# Issuing Authority(circle one): L Board of Health. 2.Building Ileparhneut 3.Cit rlromu Cleric 4.Electrical Inspector 5.Plumbing Inspector 6,Other 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 legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,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, §25C(6)also stales 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 airy applicant who has not produced acceptable evidence of compliance with the insurance.coverage mqu.ired." 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 compliance with the insurance requirements of this chapter have been presented to the contracting authority." 1 Applicants — Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,d necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their c:errificatc-(s) of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with 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 of Industrial Accidents for confirmation of insurarnce coverage. Also be sure to sign and date the affida-,;it '17he 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-insuranm 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 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. In addition,an applicant that must submit multiple permit/license 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 i!z (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 NOT required to complete this affidavit_ The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: ` ThLze Commonwealth of Ma.ssachus-�tts Degaltment of Industrial Accidents Office Qt 7uvesldpfious 640 Washington Strut Bostons MA 02111 T4.A 617-727-49LQO W 406 or 1-977-MASSAFE Revised 4-24 07 Fax 9 617-727-�49 �uww_Fnas�gnv�ciia 7 ® DATE(MMIDD/YYYY) ACID" CERTIFICATE OF LIABILITY INSURANCE 1/2/2015 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 i NAME: The Oceanside Insurance Group PHONE (508)775-0500 FAX No: (508)790-7955 E-MAIL ADDRESS: 52 West Main Street INSURERS AFFORDING COVERAGE NAIC# Hyannis MA 02601 INSURERA:Nautilus Ins Co INSURED INSURER B Am uard Insurance Company, RS Jones & Associates, Inc; INSURER C: 206 Cedric Road INSURER D: INSURER E: Centerville MA 02632 INSURERF: ` COVERAGES CERTIFICATE NUMBER:CL151203603 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. INSR TYPE OF INSURANCE ADDL S BR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 AMAIE X COMMERCIAL GENERAL LIABILITY PREM SESOEa occurr0ence $ 50,000 A CLAIMS-MADE Fx]OCCUR NN508088 12/18/2014 2/18/2015 MED EXP(Anyone person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER:, I PRODUCTS-COMP/OP AGG $ Included X POLICY JECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED RETENTION $ B WORKERS COMPENSATION WC STATU• I OTH- AND EMPLOYERS'LIABILITYOR, Y/N FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER NIA "2WC526715"� 12/17/201412/17/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 50O 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,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 "For Insured Purposes Only" ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE C Murray CIC/MC ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS095 t9ninnst ni Tha Arnon nama and Inn^ara raniafnrarl morlrc of A(non The Yachtsman 500 Ocean Street, Hyannis, MA 02601 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 f 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 performed as is delineated in the request we received from the Unit Owners. Contractor, 4 S,(6t i)-TkAas be 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. Signe Under the ns and Penalties of Perjury this�day off s�, , 20 fY r S etary Board of Trustees Yachtsman Condominium Trust 500 Ocean Street(c/o Manager's Office) Hyannis, MA 02601 Enc./File i i - A ME skIre - is BARINSTABLEJ.- MASS, bj Town of Barnstable Regulatory Services Richard V.Scali,Interim Director Btfilding Division Thomas Perry,CHO Building Commissioner 200 N4airi Street, Hyannis,INIA 02601 www.town.barnstable.ma.ui 01"fice- M-862-4038 Fix: 508-790-6230 Property Owner Must Complete and.Sign This Section If Using A Builder as -)Pem Owi,er of the subject prt. .................... -W herebv authorize tzAz—9- A to act on niv behalf, in all niavers relative u)work authorized bytbi building permit application for: 41� (Address of jog?) t4— 0 S gn,tw,e of -ncr V .P Nz ane If Property Owner is applying for permit,please Complete the liome.owners t,icense Exemption Form ou the reverse side. Revised 061313 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Cdnstruction Supervisor License: CS-103622 �3 ROSERT.S JONES�` ,•. > 206 CEDRIC RD � CENTERVILLE MA.02'6k32 `✓-'�,-. Expiration Commissioner 03119/2 0 1 5