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HomeMy WebLinkAbout0500 OCEAN STREET (13) .5'D� CDc�-r 5�--� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ��rr��ll f ; c3_Q STABLE Map Parcel Otmnr,' '' Application #C-_� Health Division "' t '`} Date Issued Conservation Division Application Fee Planning Dept. E Permit Fee (®-0 0 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address y,,A- Village �.�'toe Owner ��,�� /A,c/ `rl Address ��f�r c� Telephone f;Y/L 51- Permit Request 7 �� ,A2 ZD lr t��� �`�•//�/dSB �/a ,f� , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z 7 do, D Construction Type �,lO 7jp,C/ 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 P No On Old King's Highway: ❑Yes ANo 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 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: ❑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 /ili4z,14 gl Al Telephone Number lja�f 77 f'/f Address /if Ay/_G�'O,f1 e:�;,e License # /e ep lefj, � /fihlD Ul�� Home Improvement Contractor# Email / Worker's Compensation #A1:/eee4 V- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO f 1�f�16 22 SIGNATURE DATE b , .e FOR OFFICIAL USE ONLY 'APPLICATION# DATE ISSUED MAP/PARCEL NO. t ADDRESS VILLAGE `j OWNER DATE OF INSPECTION: , FOUNDATION FRAME t F, INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. s Yachtsman Condominium Trust Board of Trustees 500 Ocean Street Hyannis,ALL 02601 DATE v s'�1►� k 5 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 perLonned`as i,4elineated`iH the request we received from the Unit Owners. Contractor, CA Pe. Co rn PA CT U t e— 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 Unde a?P ` and Penalties of Perjury this O day of 20 � c Secre Board f Truste Yac man Con ominium Trust Ocean Stree, (c/o Manager's Office) Hyannis, MA 02601 Enc./File 01/01/2010 00:26 9786833980 EJ GANEM PACE 03/04 VP OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at a (Pro a Ad . p rty dress) • G ril ( roperty Ad ress) hereby authorize p� �AS L/ ICL (Sub co ctor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building Permit and to perform work on my property, , .r -r�•4s>i�di� �i®ed' Owner's Signature Date Masshusrat:a ••.l') pat{nicnt.of 13.ublic.Saf� y. ..Beard of F3u1161ng R0gulations ai d Standards Cu list ru('fion Sul)ery isur License: CS-100988 a. HENRY E CASSEO 8 SHED ROW 14 .p WEST YARMOU?I'H 1 Expiration Commissioner 11/11/2015 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 - Boston, Massachusetts 02116 { Home Improvement Coi ,tractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY - 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card, Mark reason for change, sCA 1 0.5 2OM•05/11 [] Address Renewal ❑ Employment Lost Card V/te cpanr��ta�t�uea.�C�a1'dAk,,jdncX,ejeM- Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT'CONTRACTOR before the expiration date. If found return to: eglstration: :153567 Type: Office of Consumer Affairs and Business Regulation ;j xpiratlon;c;:1:2h9:512Q:16 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATI.PN.;-Ac HENRY CASSIDY 18 REARDON CIRCLE g � SO. YARMOUTH, MA 02664. Undersecretary Aid 5signe The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www,mass.gov/dia �r orb kers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansiPlumbers l icant Information Please Print Legibly yI Name (Business/Organization/Individual): (_,f Address: ' City/State/Zip:!�MVA, WIVMMIAM, PAR' Phone #: ice' Are you an employer? Check th appropriate box;` 4. I am a general contractor and 1 Type of project (required); I am a employer with � ❑ , g 6, ❑ New construction employees(full and/or part-time).` have hired the sub-contractors1. 2,❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7, ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp, insurance. $ 9. Building addition required.] 5, ❑ We are a corporation and its 10.0 Electrical repairs or additions q ] 3,❑ I am a homeowner doing all work officers have exercised their 1 1,❑ Plumbing repairs or additions myself o workers' com right of exemption per MGL Y � p 12,❑'Roof repairs insurance required.] t c, .152, §1(4), and we have no employees. [No workers'. 13.� Other P ' d. comp. insurance required,] f *Any applicant that checks box 41 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. . $Contractors 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 the policy and job site !hformation, Insurance Company Name: ✓'� i V� i � p Y Policy # or Self-ins, Lie,#; Ciel0J Expiration Date: Job Site Address:c�D YOG'i/a A. it /��y�T/S City/State/Zip�1 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 iAprisonmerit, 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 Office of lnvesti ations of the DIA for insurarw.%coverage verification. I do hereby certi7/ � the pai an penalties of perjury that the information provided above is true and correct, Si ,nature: Date: 6V z I V %._oo� / Phone#: oe 7, 25, 121Y- Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circleone): . 1, Board of Health 2, Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other ' CAPECOD-27 BDELAWRENCE CERTIFICATE OF LIABILITY INSURANCE 76130/2015 (MM/DDIYYYY) TE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS cc" NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 'AlS CERTIFICATE OF INSURANCE DOES` NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED `iI TIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, ANT; If the certificate holder Is an ADDITIONAL INSURED,the poliCy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to f�arms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the x ficate holder In lieu of such endorsement(s), ADUCER CONTACT �gers&Gray Insurance Agency,Inc. PHONE 434 Rte 134 c E FAx South Dennis, MA 02660 e.MAll (877)816.2156 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURERB,ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation,Inc, INSURER C: 18 Reardon Circle INSURER 0: South Yarmouth,MA 02664 INSURER E: 1 INSURER F: COVERAGES CERTIFICATE NUMBER; ILI] 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 LTR TYPE OF INSURANCE POLICY NUMBER MMIDDY MM/DDIYY P A X COMMERCIAL GENERAL LIABILITY LIMITS EACH OCCURRENCE $ 1,000,000 . CLAIMS-MADE OCCUR CBP8263063 04101I2015 04I01I2016 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO• JECT LOC,^� PRODUCTS-COMPIOPAGG $OTHER: 2,000,000 AUTOMOBILE LIABILITY ro - C $ OMB ED SINGLE LIMIT ANY AUTO Ea accident $ ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS HIRED AUTO 'NON-OWNED BODILY INJURY(Per accident) $ S AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAI $ OCCUR EXCESS LIAB EACH OCCURRENCE $ HC—LAIMS-MAOE DED AGGREGATE $RETENTION$ - WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY PER OTH B ANY PROPRIETORIPARTNERIEXECUTIVE YIN WCEOO431901 STATUTE ER OFFICER/MEMBER EXCLUDED? NIA 06/3012015 06/3012016 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) If Yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (CORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprlbtors, Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, f , CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION, Ali rights reserved, ACORD 25(2014101) T The ACORD name and logo are registered marks of ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel D �. placation # U Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Stre t Address a'CE��U ��� U OV Y Village Owner Address Telephone 15 co O M-CT*(cn) Al A 0 /91 , Permit Request Z W 1.�� 5 5 � '7 'Z*✓ Square feet 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 41000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting,docur>8ntation. S� Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) - Age of Existing Structure Historic House: ❑Yes ❑ No On Old King�saHighway:"�Lll Yeses❑ No `ry Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing neWJ' 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: ❑ 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 �7' A617'e__L_ Telephone.Number Address iPl el c COY?4 License #il W. Y/ LMM-04 M V Q2 Home Improvement Contractor# Email 5t--KOZ(2- !-�- MA* • CO'Yn Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �Y i FOR OFFICIAL USE ONLY AOPLICATION# t `DATE.ISSUED MAP/PARCEL NO. t t ADDRESS VILLAGE t OWNER DATE OF INSPECTION: FOUNDATION w FRAME I INSULATION f FIREPLACE t t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL c GAS: ROUGH FINAL FINAL BUILDING L OATE,CLOSED OUT s. AS-SO TATION PLAN NO. s The Commonwealth of Massachusetts Department of IndusitialAccidents 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/Organization/Individual):Address: Al'/Z ��Al E e'19Y?e V City/State/Zip: KOKOArl, � Phone#: Are you an employer?C eck the approp ate box: Type of project(required): 1.❑ I am a Y emp to er with 4. ❑ I am a general contractor and I 6. ❑New construction mployees(full and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or parer- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an act employees and have workers' Y capacity. �• incrrrance# 9. ❑Building addition [No workers'Comp.insurance comp. 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 11.❑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 dW employees.[No workers' 13.[ Other L(J/11 n comp.insurance required.] a��11 Ifi *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. 1'am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip- 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 Office of Investigations of the DIA for insurance coverage verification. I do hereby ce n the d p alties of perjury that the information provided abov is uLe and correct Si afore: Date: //2 �7 Phone#: _6d-2_S 1— � Z Official use only. Do not write in this area,to be completed by city or town official 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 Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract ofhire, 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 also states that eve state or local licensing agency shall withhold the issuance or �P § (� "every g g Y 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 perfounance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants PIease 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 certificate(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 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. 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 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 in (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 (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Ike 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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of lnvestigations 600 Washington StrQet Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749. VeNW.mass.gov/dia OFTMElaY'6 Town of Barnstable Regulatory Services • sARNSTAE.E, , MASS $, Richard V.Scali,Interim Director Building Division 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 as Owner of the subject property hereby authorize ` � �'l�i r �- to act on my behalf, in all matters relative to work authorized by this building permit dy (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 of Owner &at6ie of Applicant Print Name Print Name Date The Yachtsman 500 Ocean Street, Hyannis, MA 02601 Yachtsman Condominium Trust P.O. Box 1283 Hyannis, MA02601-1283 (508)775-1515 y a DATE 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 This letter serves as notice of that 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 /I/ day of� 'i'L , 20 ecreta dry,of es Yachtsman Condominium Trust 500 Ocean Street (c/o Manager's Office) Hyannis, MA 02601 Enc./File L Massachusetts - Department of Public Safety Board of BuildingRegulations g ns and Standards Construction Supervisor License: CS-104384 STEVEN L IIETZEY. 'r 72 PINE CONE DR WEST YARMOUTH R - I �26 Expiration Commissioner 0 712 7/2 0 1 5 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Aw Map _ Parcel 7, ® vC J Application # C�o Health Division Date Issued I CA J_ t Conservation Division Z,� �t Application Fee Planning Dept. Permit Fee 'f P Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 5v® ' S�azt c 1- e Village Owner Address S =3 � Telephone 97 f,, 7 4, Y " 03 Permit Request er 515-a 9v e.T -5 'r -k �-+-r i /di1►� l,r7L' �rrY/ ' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation d �D`� 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, -I f3 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Counte Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stover Yes;❑ No 00 Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑'mow 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) V SvJ -2726 lec< s'_ Name �- ,� Telephone Number 5/3 0 y 3 S�e- Address License # i,Y `►�� lLy�f L4, we 6 2 ��� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE &L.1- '2Y Ar, pppp, t FOR OFFICIAL USE ONLY1. 'F f APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER ` DATE OF INSPECTION: r x FOUNDATION 'FRAME K ' INSULATION: {. t _ FIREPLACE n s ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH . FINAL i -FINAL BUILDING 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/Organization/Individual): e'+ Elz�r�i t �o>1 Address: City/State/Zip: +9�iWid, �2�qr PhoneM 5-'0V V30 V? - Are you an employer?Check the appropriate box: Type of project(required): 1.2r I am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7 modeling ship and have no employees Thesesub-contractors have g. Demolition working'for me in any capacity: employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. F1 We are a corporation and its 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their l l.[j3'Pltimbing 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.❑ Otber 1 LO comp.insurance required,] *Any applicant that checks box#1 must also fill out the section below showing their workcrs'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. #Contractors 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. 1f.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 the policy and job site information. Insurance Company Name: 1 N S v�ILM a LA_ igavp Policy#or Self-ins.Lie.#: C M `�15 Z..S-)J Expiration Date: 17- - Zo t Z�, Job Site Address: City/State/Zip: 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$2510.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above is true and correct Signature: Date: 61Z r i° Phone#• 5-v F- V I a Y7 0 L- Official use only. Do not write in this area, to be completed by city or town officiaL 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 Contact Person: Phone#: ACOPQ CERTIFICATE OF LIABILITY INSURANCEDATE( `') 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 poi(cy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the berm 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 endorsemen s. PRODUCER Southeastern Insurance A �nne Bretton gency, Inc. 997.606i 439 State Rd. L No:508.990.2731 P.O. Box 79398 North Dartmouth, MA 02747 INSURED INSURER(8 AFRORDING OOVEM09 NAIC� Mehan Group B & H Service Company LLC INSURER A: rc ts Insurancetea: INS DBA: William Heath Jr DBA 265 Great Western Rd INSURERMc: : Ha r�lli ch, MA 02645 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:2011-1 REVISION NUMBER: LIMSER HIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, XCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE9MR WVD9POLIYNUAEt LmsrsSAL LIABILITY C � OW915251 "1212011 04/12/2012 EACH OCCURRENCE $ 1,000,0001 X COMMERCIAL GENERAL UABIUTY EST;QR $ 100, CLAIMS�AADE a OCCUR A MED EXP(Any one person) $ S,0O PERSONAL&ADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 2 ��, GEM L AGGREGATEPUM♦IT APPLIES PER: PRODUCTS-CCMPIOP AGG $ 2,000,0 POLfCY JECT IOC auro NY ILIE AUTUABlLJTY NKA7015S W2512011 08/25/2012 COMB11ED SINGLE UMIT ANrauro (Eaaadderd) $ 1,�0, ALL OVVIED AUTO$ BODILY INJURY(Per prson) $ A X SCHEDULED AUTOS BODILY INJURY(Pr acckWd) $ X HIREDAUTOS PROPERTY DAMAGE $ (PeraccMe� X NONOMED AUTOS S UMBR A L,A9 OCCUR CUP914371 04/1212011 0411=012 EACH OCCURRENCE $ 1.000 D EXCESS SLAB A ClA1MS-AdADE AGGREGATE $ DEDUCTIBLE X RETENTION $ 10,000 $ VIORKM COMPENSATION $ a"fb LIABILITY r/a WCA909792 04/19/2011 04119/2012 X ANY A OFFICER NBEREXCLARIlmED7 CUTIVEa NIA E.L.EACH ACCIDENT $ 1,000,00 (MWVfttafy In NH) NO EXCUSIM E.L. DES DISEASE-EA EMPLOYEE $ 1 000, ff yye s OCRIPTID, ft under N OF OPERATIONS below E.L.DISEASE-POUCY LMNT $ 11000, DFSCWPnON OFOPEIATIONS I LOCATIONS I VEImCLES(AUnh ACORD 101,AdMmW RamarM BMeduk N more space is r"Wmd) CERTIFICATE HOLDER CANCELLATION FAX: 508.790.6230 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable AUTHORGMDREPRESENTATIVE 200 Main St Hy nnis, MA 02601 Joanne Bretton ©1988.2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD ACOAQ AGENCY CUSTOMER ID: LOC* ADDITIONAL. REMARKS SCHEDULE Page of AGEWY NANO)BRED Southeastern Insurance Agency, Inc. B & H Service Company LLC POLICY aUMBI R 26S Great Western Rd Harwich, MA 0264S CARRIER NAIC CODE EPPECTnrE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25_ FORM TITLE: ACORD Certificate of Liability Insurance Garage Liability ADM LTTRR INSRO POLICY MASER ( '1 ORAL(WOW LIAM AUTO ONLY-EAACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTOONLY: AGO $ Automobile Liability SR� EFMCTIVE POLICYEXPIRATIONLTR I POLICY N p( A Excess/Umbrella Liability 11R PSIICYNUNB�tMR ADM POLICY EFFECTIVE ODATEUC IXf�PikLIMITS A $ Other Liability Dot POLICY EFFECTIVE POLICY EXPIRATION LTR POLICY N JMBER DATE PB9WDD M DATE(MWDWM LINM • i ACORD 101(2008101) ®2008 ACORD CORPORAnON. All rights reserved. The ACORD name and logo are registered marks of ACORD r v ` COMMONWEALTH CE MASSACHUSETT'S AS A MAMETAL TER UNRESTR WORKERS ISSUES THE ABOVE LICENSE TO: WILLIA'M O' HEATH JR m . yam , 265 -GREAT WESTERN RD N HARWICH MA 02645-2428 13413 04/28/13 14956 COMMONWEALTH OF MASSACHUSETTS p. SH M TA ORKIS AS J.OURNEYPERSON-UNr�ESTRiCTED ISSUES THE ABOVE LICENSE TO; WILLIAM 0 HEATH JR 265 GREAT WESTERN RD '« .HARWI CH MA 02645-2428 ' 1215.1 04/28/13 1,4955 m D � 3 a 1 HE r T t•., � r ..., ax Ed Ganen �°"�►'� 'i 4 ' r 3 Hill Top Rd. Methuen,MA 01844 �` fi �'� .F February 4,2011 >l` We hereby propose to furnish all the materials and all the labor necessary for the completion of the following: Installation of a gas heating and cooling system using Trane equipment. All work will be performed in a professional manner and shall be tested and inspected to meet all state and local codes. All work will carry a one year warranty. RGr 500 OUIJA/ S? The following is included: _ I Trane(4)ton Condenser 14 SEER/1 Condenser pad A Trane 4 ton cased coil i Trane 80%- 100,000 BTU Gas Furnace 01. , . , v� r Supply and return plenums All main ducts to be metal with R=8 foil faced insulation All joints to be taped and sealed All duct legs to be flexible with R-8 foil faced insulation I Digital thermostat 1 Sensor for the 2d floor area to turn on the blower, only to circulate the air B-Vent chimney Condenser to be set on cement for sound dampening All electrical wiring Door sensor for the slider to shut off the A/C Keep the job-site clean/Removal of all trash generated Box all exposed ducts in the units, mud, sand,and prime the boxes Mud, sand,and prime all access holes Supplies into each room/Central return in the upper shaft All refrigeration lines to be copper with 3/8"insulation All drain lines to be PVC Gas piping for all gas fixtures: drier,outside grill, furnace and future stove and fireplace All supply grills to be aluminum or nylon to prevent rusting 1 -4"filter rack and filter Total price is $13,700.00 Terms: 33%of the total price upon accep 33°/u when ro gh is completed and 34%of the total price upon completion and all inspections are d Acceptance Signature Date Submitted By Date 3 � Aw��