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Home My WebLink About0500 OCEAN STREET (20) 7�3 I d6 3 tt y,);4- 5 v, 3a 4 oL1 o �, I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION of O 4T Map Parcel J11- Application # Health Division _ Date Issued Conservation Division Application Fee Planning Dept. Permit Feel 3� •� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address �� 0�1 D span\ C�A r Village 1�v GW\\-S Owner ai h a Address qgAca A- Qa, \N).sA- oh,�1A O�N9-3 Telephoner/ Permit Request \ ZM CA A �,\A 0 11) roovN s, M o Q on- Its eGu r GA\ ed'ibY` t�Yl r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay roject Valuation 3 00 (�0.0 0 Construction Type \�e 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 S[No On Old King's Highway: ❑Yes 4 No Basement Type: ❑ Full Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 3 new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: • ❑ Gas ❑ Oil A Electric ❑ Other Central Air: ,6 Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑.Yes , No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: C-existing ;f newer size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: _ Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ `r Commercial ❑Yes ❑ No If yes, site plan review 4 I � Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name t o Tele hone Number 0 - / rIJ a e c C p C� �� 3 � .� Address 00,c\ O, V` d License# CS - 0 �D W4w\,f\,\S Home Improvement Contractor# may I ® d G\ ac Z' Cj a bsos sA• h(N Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �IA�1 p h SIGNATURE DATE l//Jl11-3 �4 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 4 ' MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: _ =FOUNDATION; z i - . FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL E ` f PLUMBING: ROUGH FINAL 4 GAS: ROUGH FINAL .; FINAL BUILDING DATE CLOSED OUT ! ASSOCIATION PLAN NO. i f J P • 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 organizstion/Individuai): Qc 4 Address: City/State/Zip: 1-I - ) Phone#: (-,S_OR r13 V-31 '7 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. U I am a general contractor and I em P employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.L-J.I am a sole proprietor or partner- listed on the attached sheet. 7. R Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity.acitY employees and have workers' t 9. El Building addition [No workers' comp.insurance comp.insurance. required] 5. ❑ We are a corporation and its 10.El 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 employees. [No workers' 13.❑Other 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. $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-contractor;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 andjob site information. Insurance Company Name: ce r 1 0 0 Policy#or Self-ins.Lic. Expiration Date: / I/ h y Job Site Address: ?OD D r 1Pc��['. �"j w _ City/State/Zip: q c,%Nr\s di 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 certify under the pains and penalties of perjury that the information provided above is true and correct: Si e: Date: / Phone#: 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 M JLA urn Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this stattrte,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 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,MGL chapter 152, §25C( )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." 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 numbers)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 permittlicense 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 (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: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,-MA 02111 TO.#617-727-4900 ext 406 or 1-977-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.n1MgovMa .- �� ;, y . � i/ �' �7 1 ' 1 �' �1'7 ,- o � � �' 5 � ��(� //n� `V �� c s Massachusetts - Department of Public Safety Board of BuildingRegulations and 9 Standards _. Construction Supervisor _ License: CS-005140 WALTER J LACElr - 38 CARLA RD HYANNIS MA 02601 Expiration Commissioner 07/25/2015 • sWIvsrABM • 39. Town of Barnstable Regulatory Services Richard V.Scali,Interim 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 as Owner of the subject property hereby authorize A TUA X o .:Jto act on my behalf, in all matters relative to work authorized by this building permit application for: ,,Soo �.1V% 2�hL.S� C)D 60 t (Address of Job) Signature of Owner Date C aAc Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILESTORWbuilding permit forms\smokecarbondetectors.doc Revised 050412 LACEY CONSTRUCTION, INC. 38 CARLA ROAD HYANNIS, MASSACHUSETTS 02601 (508) 775-6811 (508) 737-3171 November 19,2013 Yachtsman Condominiums Board of Mangers 500 Ocean Street Hyannis, MA 02601 To Whom It May Concern: Per instructions from the Town of Barnstable building inspector, I am requesting for you to give them permission to issue Lacey Construction a permit to remodel the bathrooms in Unit# 52. Because it could affect the neighboring unit according to the building inspector,written permission is needed from the board to issue the permit. Thank you. Sincerely, tWalter J. Lacey � � I ' P r i' The Yachtsman 500 Ocean Street, Hyannis, MA 02601 Yachtsman Condominium Trust P.O. Box 1283 Hyannis, MA02601-1283 (508)775-1515 DATE� � r� l 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-4—day of , 20%,3. - L J 10 Sec etary, oard of Trus es achtsman Condominium Trust 500 Ocean Street (c/o Manager's Office) Hyannis, MA 02601 Enc./File ped ray 1.a 74— Pe R I F o' Em I ' �---- -' -TYA q 4�hY