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HomeMy WebLinkAbout0500 OCEAN STREET (41) S c>c) S4-, 11/08/2007 15:27 5087786448 HYANNIS FIRE PAGE 01 :F IiYAlq -S FlOR DEPARTMENT • �s 95.HIGH.SCHOOL RD. EXT, HYANNIS, MA.62601 HAROLI; S. BAUNELLE, CHIEF Swoi rruorYY'dl!!Gr ortl!lOvu.noM ,. FIRE PREVVENTION BUREAU '6L►SINESS PHONE:(50$)775.1300 FACSIMILE PHONt:(508)778-8448 I.T..DON,.ALD 7i. CHASE;JR.;CF1 LT. FRIC F.FIUBLF.R,CFI FI.ItE .PREVEN-RONV'OFFICER FII!M PREVFN HON OFFICER BUILDING.: COa:E COMPLIANCE FORM THIS FIRE PREVENTION BUREAU.HAS REVItEWED71JE PLANS D4TJ D. , FOR THE PROPERTY. LOCATEQ AT i' ALaO IC�1QV'JI4 '-A 7-74 THE CHART 13ELOW INDICATES THE STATUS OF OUR REVIEW; RECEIVED REVIEWED COMPLIES 1'-NAR'RATIVIE. FiIh A .. 3 Hl!DAAN LO.C'ATIpN 1:: A71 5(1 !F?LY. r 4=SPRINKLER SY6T.1w` 5`SRRINKLER CONTfh EQUIPMENT' • r _ . 6=5TAfNQpI'IE`SYSTE:NIS: 7- TAfi1OP(pis V,.A( ,LOGA�'IU1�1 ;DE f AF TM NT-dOIifPVEGTl 0.1`ECTIV sYPT- i ;.;. 1 U-F:P. .a^. 8. ANNUNIA�fOR LOCATION`. �- 11-5MQKE GONTR /EXHAUST, 12-SMOKI= CONTROL EQI.�I?.:LOCATION .. ;13=LICE:SAFET.Y,SYSTEif ( ATURE. ' -14! 'o 'E)tTINtUUISHING SY TEMS' OL.EQUtI? LOCATII;SN fd-*�iF#E.pR( T C1'Ib1V RC10MS:`'-' 17-FIRE f�E 6Tt~OTIO�JFUIRI. A: E.. . 14-ALAAM"T.RANSMI8s10P1`METHC - UEI�CE f1F Of'Et�ATIO[ pl~PORT '2b-AGCEF'TA(VCE.TESl`I(NC . �iI;-X' . r,.'. bW�BELeVE; :H, 'DdOUN1ENTS T PL ND COMPLIANT FOR THE ISSUAHOE OE A BUILDING PERMIT: WE HAVE COMPLt`TD THE'ACC PTANCE TES O FOR THE OCCUPANCY PERMIT AND BELIEVE THAT WITHIN THE SCOPE'OF THE BUILDING PERMIT,THE„"ABO' IN COMPLIANCE_ F TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION.. Ma .�� G PD "� p ,�Par(c�elQ Application# " Health Division t•/"7 U Date Issued Conservation Division r Application Fe 00 Tax Collector Permit Fee -F 7 ► S� Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street AAre � ) �2G h C� eel Village H%4 0" VA�S Owner 7:�0.Vy1Pt k-"a o0aA \AJ Aker Address �00 Ocean , J I I Lf Telephone CS/?) (_7�3- -- ermit Request �L. -, w e o \�v� (6�0 C ` 1 V e 'ace a� ��e- �d ev�,;eve W o c��� V 6(k�s 0-ew �Oakh �ub leVe\ l 7.'S k J� yf_al 00 3 \10600avd o uy\\,d YIP (' ue yi'C,tyuk �,,, Cei, 1 r\-q l 4 J Square feet: 1 st floor:existing proposed 2nd floor:existing proposed ( Total new Zoning District Flood Plain Groundwater Overlay PTMSCt Valuati Construction Type RQV,�,o T f r Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting;documentation. �n Dwelling Type: Single Family ❑ Two Family ❑ MUItitFamily(#units) `Io Age of Existing Structure t Historic House: ❑Yes 4[No On Old King's Highway: ❑Yes No Basement Type: ❑Full Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 1\O Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new / Half:existing / new - Number of Bedrooms: existing 3 new— O - Total Room Count(not including baths):existing new -O First Floor Room Count Heat Type and Fuel: A 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 XYes ❑No. If yes,.site plan review# Current Use Gti�low,w\tuV^ Vlyi�`�s Proposed Use BUILDER INFORMATION • Name Oh vt c Telephone Number��Ott 73 1 Address co-fL, Rcm8 License# 4'aY) Home Improvement Contractor# D0 51 Y 0 Worker's Compensation# a g 3-r7 6-91 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Y e feel ow-, cc�se_qc�-s t ' SIGNATURE DATE A 2 4 - FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER , f DATE OF INSPECTION: FOUNDATION s FRAME © K- a-- -7 P INSULATION ��- FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH 'FINAL GAS: ROUGH FINAL t FINAL BUILDING �r DATE CLOSED OUT ,t ASSOCIATION•PLAN NO. JI HoF,�' ti Town of Barnstable. Regulatory Services WSM Thomas F.Geiler,Director `bArE �b�` Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 5 08-862-403 8 fax: 5 08-790-62 3 0 Property Owner Must Complete,and Sign This Section If Using A Builder as Owner of the ro e subject . ) P P riY hereby authorize of e Ns�u pin Zto act on my behalf, in all matters relative to work authorized by this building permit application for; OceakO . (Address of Job) ' ,�% C� a Signal Owner j�a • ®w►es q er � Print Name QF0P MS:0WNERPERMIS S I0N GRANITE -T'�TIE INSURANCE COMPANY 34135-0000 WC 823-75-96 13192 . ------------------o� -- 3-66-0207-00 .•-.•• . PENNSYLVAN I A CCONSTRUCTION INC 38 CARLA RD �� Member Companies of HYANN I S, MA 026o 1-0000 American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 OLDE CAPE COD INS AGCY INC WORKERS COMPENSATION AND EMPLOYERS 296 WINTER STREET LIABILITY POLICY INFORMATION PAGE HYANN I S, MA 026o 1-0000 INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 008735933 OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - wc9go610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 02/1 1/07 TO 02/1 1/o8 ITEM 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 the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ SOO.000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Remuneration Premium Classifications Code Number mluneOrat on ❑X Annual ❑3 Year 0 Annual ❑3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $141 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $284 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $3,667 If indicated below, interim adjustments of premium shall be made: ❑ Semi-Annually ❑ Quarterly ❑ Monthly DEPOSIT PREMIUM ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 02/20/07 ASSIGNED RISK 66 Issue Date Issuing Office Authorized Representlaive WC 00 00 01 3N67 INSURED'S COPY Y i f fMOM- VI , 4a m5 t _ r h `r v +,, ✓ -V0�97/IJZowaAeqGGIL 6'. i 1t L166��6 ! �' •° ? Board of Building Regulations and Standards Construction Supervisor License { ar �, License: CS 5140 l Birthdate 7,/25/1938 i r ' Expirali no 7/25/2009 Tr# 506 Restrwtion 00, +r y, WALTER J LACEY ` 38 CARLA RD HYANNIS,MA 02601 "' Commissioner k t( 9 2 j i iLy I a, i I , FTA 4 m_i M L �,s;' r, a,i•: M44 e r ar N rs �n °Flag Town of Barnstable Regulatory Services MUWSTMLF. Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. AA / / l Type of Work: CfM OGt Pi( Q�Gt'O( / b vl Estimated Cost Address of Work: o L7 OCe g o S &,4 PI yl l S Owner's Name: d r7dl e. Wa/l/cr Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under s 1,000 ❑Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: Date Contra or Name Registration No. OR Date Owner's Name Q:fomns:homeaffidav I 11-02-2007 11:52 From-DUFFY ASSOCIATES 781-883-6623 T-062 P.002/002 F-138 Yachtsman Condominium Trust 50 Ocean Street Hyannis,MA 02601 November 2,2007 To Whom It May Concern: The Board of Trustees for the yachtsman Condominiums hereby grants permission to Lacey Construction,Inc.,to remodel unit#114. It; is our understanding that a bathroom will be added on the top level. Sincerely, Robert L.Duffy Board of Trustee 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 A licant Information {. .Please Print Legibly Name(Business/Organization/Individual): . 0.c e w S lr G OVA �Rc Address .3R l Cf a oCe� City/State/Zip: 14 n to s kI L�6�1 Phone.#: (G Ua Are you an employer? Check the appropriate bog: :Type of project(required):. r--+ 4. I am a general contractor and I 1.� I am a employer with_ 6. ❑New construction . employees(full azld/ozport-time) * • have hired the sub contractors listed on the'attached sheet. 7. Remodeling 2:❑ I am a'sole proprietor or partner- These sub-contractors have Demolition ' ship and have no employees S. ❑ employee$and have workers' 'working for me in any capacity. $ 9, ❑Building addition [No workers comp.insurance, comp.insurance 10.❑Electrical repairs or additions required.] 5. [] We are a corporation and its 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 insuranm required.]t c. 152, §1(4),and we have no 13.❑ Other _ employees. [No workers' cornp,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. . lContractors 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. compensation insurance for my employees. Below is.the policy and job site' I am an employer that is providing workers' information. 1 Insurance Company Name: '1 Y(lV�\� �LO�2 hi' UIrG c t? 001,0A 0 eV1 —per Policy#or Self-ins.Lic.#: (��3 ` - �' Expiration Date: ceoa` 1 e���S.� City/State/Zip: 0 0 (1 1 Job Site Address:�0� O � �' 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 maybe forwarded to the Office of Investigations of the WA for insurance covera a verification. I do hereby certify under the pains•and penalties of per that the information provided above is true and correct. Simafore: t/U Date; — Phone# Cow 08� �13 9 3 I `7 O fficialonly. Do not write in this area, to be completed by.city or town official. Town:' Permit/License# a�. hority(circle one Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: I ACORD CERTIFICATE OF LIABILITY INSURANCkuD JL DATE(MM/DD/YY) STY-1 04/06/00 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE'POLICIES BELOW. Hyannis MA 02601 Phone: 508-775-6060 Fax:508-790-1414 INSURERS AFFORDING COVERAGE INSURED INSURER A: Eastern Casualty Insurance Co INSURER B: Rustys,Inc. INSURER C: 55 Mary Dunn Rd INSURERD: _ Hyannis MA 02601 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE MM/DD/YY DATE MM/DD/YY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ J POLICY PECTRC LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER A EMPLOYERS'LIABILITY WC00493004 01/06/00 01/06/01 E.L.EACH ACCIDENT $ 1000000 E.L.DISEASE-EA EMPLOYEE $1000000 E.L.DISEASE-POLICY LIMIT $1000000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS YV CERTIFICATE HOLDER N ADDITIONAL INSURED;INSURER LETTER: CANCELLATION LACEYCO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL LACEY CONSTRUCTION IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 38 CARLA RD. REPRESENTATIVES. HYANNIS MA 02601 Richard A. Sullivan ACORD 25-S(7/97) ©ACORD CORPORATION 1988 AA/�•.gy�pp DATE(MM/DD/YY) ..LLV YLl�,.:...;. .,�A I N �.I F A I`l E 0 4/0 4/0 2 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION OLDE CAPE COD INS AGENCY, INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 435 .MAIN STREET COMPANIES AFFORDING COVERAGE HYANN I S MA 02601 COMPANY ----- ---------------- — A THE HARTFORD INSURED COMPANY GREER ELECTRIC INC B COMPANY 275: OCEAN STREET REAR C HYANN I S MA 02601 COMPANY D : ....:....................... :::::::::::::::::::::: :.:::::._:.::::::::::::.:::.:::,.:::::::::.:::::::::::::.:::.::...::.::::,:::;::.:::::::::::::.:::::::::::::.::::::::;::::::::.::::::::::,:::::.::::::::::::.:::::..::;.-..:::::.::::::::::::::,::: ERAG THIS T CERTIFY THAT THE:POLICIEF INSURANCE LISTED BELOW L W HAVE :::::...........................................::. S S O C POLICIES S OS E O A E 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. CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTA DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE $ COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG $ CLAIMS MADE -1 OCCUR PERSONAL&ADV INJURY $ ' OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ FIRE DAMAGE(Any one lire) $ MED EXP(Any one person) $ AUTOMOBILE LIABILITY ANY AUTO. COMBINED SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY ,NON-OWNED AUTOS (Per accidenl) $ PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE__ $ _ UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND 0 8 WE C I B 6 9 8 3 3/0 5/01 3/0 5/0 2 X TORY LIMITS ER EMPLOYERS'LIABILITY EL EACH ACCIDENT _ $ y 100, 000 THE PROPRIETOR/ INCL PARTNERS/EXECUTIVE EL DISEASE-POLICY LIMIT $ _500, 000 — -- OFFICERS ARE: EXCL EL DISEASE-EA EMPLOYEE $ 100, 000 OTHER DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/SPECIAL ITEMS ,1 - S 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE LACEY CONSTRUCTION EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 0 r 1 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 38 CARLA ROAD BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY HYANN I S MA 02601 of ANY KIND UPO THE COMPANY, ITS AGENTS OR REPRESENTATIVES. AUTH 1 P E3 N TI ` , V Mart a indla ' MF A :.............. ......I ....... ... . X.......................... ................................. .. ......... .............................................................................................................................................................................DA.4. C..flWUFtA1'lON;:19se (o Gily --.___ of /01 • ,p i ✓ r�(� - -� 33 L o 13 R� DN --'� a � o rd Q z rn AiV m e� S 3 �166r SIP 33 _ i s \� DN --�