HomeMy WebLinkAbout0500 OCEAN STREET (5) CA "7
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.` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel fJ lJ Application #
Health Division Date Issued
Conservation Division Application Fe ,,l
Planning Dept. Permit Fee Z
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation/Hyannis
Project Street Address _S'0a ucea4,, A u 7
Village / van
Owner Ain V le cr-e Address.?cZ aast(10ae Cf #Ohi (awadn C44,—
Telephone 262 IiWx
Permit Request A,7`G�t y "'�®ve ` ��h5 cai�_c
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District _Mood Plain Groundwater Overlay
Project Valuation . 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 ff Historic House: ❑Yes Pd-No On Old King's Highway: ❑Yes �"o
Basement Type: Wull ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sgnft)
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existingo new
Total Room Count (not including bathe): existing new First Floor Room Count , �'
Heat Type and Fuel: ❑ Gas ❑ Oil I Electric ❑ Other fir;
Central Air: ❑Yes gNo Fireplaces: Existing New �_ Existing wood/coal stove: ❑YesANo
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_
Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 4(9 W oeE'
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use -2 Z9 w 18 Proposed Use
T APPLICANT INFORMATION
'� (BUILDER OR HOMEOWNER)
U Name _ � v�° r?I 4' Telephone Number
Address �� ems&r- P� License # 6 `f Sr
t14 dsj�-4, Cc& Home Improvement Contractor# 436r2,,10
6
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM TTHI PROJECT WILL BE TAKEN TO
SIGNATURE DATE /
F FOR OFFICIAL USE ONLY
-¢APPLICATION#
DATE ISSUED
MAP%PARCEL NO.
E '
ADDRESS VILLAGE
r
' OWNER
D4TE OF INSPECTION:
- a
7
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
5
GAS: ROUGH FINAL
FINAL BUILDING
r
DATE CLOSED OUT
ASSOCIATION PLAN NO.
r - Office of Iizvestigatioris.'
600 kPrrshingfox Sfreet
i'w.mass:gav/dia
Workers' Compensafion Insurance Affidavit: Builders/ContractorsTlecfricians/Plumbers
o '` Please Pisnt Legibly
A ficant W rmation
Name(Business/Organizaiion/lndividnai): �f
•Address• � P,cs` dCG�
City/StatdZip:. // Phone.# d 1 'cJ�oZGC
Are you an employ ?Check.the appropriate bow ' _ :Type of project(required);.
1.® I am a . to with`. C 4. [� I am a general contractor and I -
* have hired the sub contractors 6. Q New construction .
employees(fnIl a Noi part lime). -.
2:❑ I am a•sole propriefm or parb=-
listed-on the'attached sheet 7. ���
ship and have no employees These sub-cont<a:ctars have •8. ❑Demolitioh
Working for me.m aq c ac employees and have workers' 9. 0 Building addition
Y $p. �5'• .. '
[NO Workers' comp.m=an�r comp.insurance, -_
10. Electrical airs or additions
5. � We area' corporation and its ' ❑' �. .
requn ed] officers have.ex=' ed their : 11.0 Phnnbmg repass or additions
3.0'I am i homeowner-doing all Work' ,
right of exemption per MGL
myself [No Workers' comp. 12.❑Roof repairs :
insurance required.]t c. 152, §1(4),and We have no '
to ees, o Workers' 13:0 Other -
Comp.Msorance requred_]
*Any applicant that checks box#1 most also fM out the section below showing their workers'compcosation policy information
t Homeowners who submit this affidavit mdicafmg mey are doing all work and then him outside contractors must submit a new affidavit indicating such.
$Contractors that check this box.must atianccd an additional sheet showing the name of the sub-contiactacs and state whether or not those entities have
employees. if the sub-coat=tma have employes,they must providb their workers'comp.policy number.
I airs an employer that is providing workers'compensadon insurance for.my employees. Below is the policy and job site
information
Insurance Company Name:
Policy#or Self-ins.Lic.#. -5 0a� � �`` �N -`c<ExpsationDatr,: 6
/� vC ,K,h c`t :City/State/Zip: / -
Job Site;4ddres �� VCQ��, Id" t/7 x,�.c '
Attach a copy of the workers' compensation policy declaration page•(showing the policy number and expiration date). .
Failure•to secure coverage as required tmder Section 25A of MGL c. 152 can lead to the imposition of crirmmal penalties ofa
foe 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 thaf a copy of this statement may be forward d to the Office of
Inyestii�ons of the WA for inerrrance coverage verifiratiom
I do hereby cerli the airs�• jpenalties of perjury that the information provided abo is true /it correct
DatE: a G
Si afore:• —
Phone
Official use only. Do.not write in this area, tb be completed by.L*..or town offrciaL
City or Town: PermitlLicense# '
Issuing Authority.(circle one): -
'I,Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6. Other
Contact Person: Phase#:
�.•� GREEWDA1 4P tD:JP
�.,. DATA JMMMDNYVV)
CERTIFICATE OF LIABILITY INSURANCE F0311S113
THIS CERTIFICATE IS"UEO AS A NATTEn OF INFORMATION ONLY AND CONFERS NA RIGHTS UPON THE CERTIFICATE MOLDER.THIS
CERTIFICATE DOHS NOT AFFIRMATIVELY OR NEt3ATWELY AMEND. EXTEND OR ALTER THE COVERAGE AFFORDED RY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT AETwEsN THE Is5UIF30 INfiURrm(s), AUTHCRIZ-0
REPRESENTATM OR PRODUCM- AND THE CERTIFICATE HOLDER.
IMPORTANT: If the 00ftfioate 114109r is an ADDITIONAL INSURED,the polisy(ies)must be endorsed. It SUBROGATION ISWAIVED,subject to
the terms Arid colwitions of the Policy,certain policies may require an endanemant. A statement an this eortitleAta does not confer rights to the
oCRificate holder in lieu of such endom2TS!lt{a?•
s°' T
PRDDUCER Phone:608-5874640 No _
(3ammons•Adams Ins.Ag.,Inc.
F
234 West Center Street slx:303-S87-S36
West 8rigge"tar,MA 02379-
Charles E.Adams
WSUR,ERI!{)AFFOk31NC G�AEI! I NA16 N. ...
mAMAIMA, iartfOrd C;A5UIQlKV IMSUITIK-E Co �f10�456 —
INSI)RED David A,Grew �. wlluwcn a: -
438 Weir Rd
Yarmouthport,MA026TS-2525 .._--..-
I"URML: ...
Itaavaye 4
C V RSGE& _ CERTIFICATE NUMBER: MY 2N NYM RIP:
THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED SELOW RAVE BEEN ISSUED To THE INSURED NAMED AI}QVE FOR THE POLICY PERIOO
INDICATED, N01WITIISTANDING ANY REOU'REMENT, T1ERh1 CR CONOITION Q=ANY CONTRACT OR OTH=R DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS Sui5jECT TO ALL THE:YFRMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAIL)CLAIM$.
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PER60NAL AADV INJURY E
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AUTOS -- NLCNaWNEa I j I P�5r4RrfnAkW:4-' 5
HIRED AUTOS I ALITOG i Per dmis
I I UMIMeLLA uke -I Y - - EACH C.'CURR�NCC S
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A ANY PRORAEMe�XOLI1DEa+hCVTI �I N I A� i:S18(5U 11 P76.6-11 10114/12 10114/13. E.L.eL cAr'H Acc!oFRT s 100,00
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RIPTION Ou OtPERr1TICN5{wtyg i 1 I Ell OI£F4G,POLICY LUA!T I L �BQ.on
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MtIq KDON OF 4PiRATIONS 1 LOCAY04 i VEWICLAS(Attach ACM 101,Addiftful RM&RO 3dlydt s,IT more spa*Is MQdfW
SOB-394-6230
CERTIFICATE K()L0gFt LLATIQN
SHOLLLD ANY OF THE ABOVE CESCRIVW pol lCM0 Be CANCELLED WORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town Of Eamstable ACCORDANCE WITH THE POLICY PROVISIONS,
AL1TN0rtKEp RQpRE3rfITATIVP,
Cnarles"a 4
5�019 •2010 ACORD GO T N. AP rights rtsorvsd.
ACORID?.6(2010106) Tho ACORD nsn*and logo are rlegistemd Ma o of AGORD
Tn(!n;T0,60 fA YVd l4d�Q.Z1 CTO�,dG!�;
Massachusetts - Department of Public.Safety -
Board of Building Regulations and Standao s
Construction Supervisor Licewse
'License: CS 76458
• DAWID k,,GREW
.438 WEIO ROAD �
YARMOUTHPORT,"MA 02675
..........
y �- Expiration., 611/201, d°
0 mum issigener. Tr#: 18509„
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6
Yachtsman Condominium Trust
Acceptance of Trust Approval
The undersigned Owner[s] of Unit#7 of the Yachtsman Condominium Trust, 500 Ocean
Street,Hyannis, Massachusetts,acknowledge[s] that the Trustees of the Yachtsman
Condominium Trust have approved the following proposal:
Installation of a in-wall air conditioner to be installed by the third bedroom.
All outside materials shall matching existing conditions..
By acknowledging the Trustees'vote approving the proposal for Unit#7,the undersigned
Owner[s] agree that:
1. The specifications provided to the Trustees for approval (copies of which are
attached and incorporated hereto) are the final drawings and specifications of the
improvements. There shall be no additions or variations to the said drawings
and/or specifications without the Trustees' prior written consent.
2. Approval by the Board in no way constitutes a waiver by the Board of the Trust's
rights. Moreover, approval by the Board does not indicate that the Board accepts
liability or responsibility for the actions of the owners.
3. Any contractors (and sub-contractors) hired to work on the proposal shall obtain
the necessary approval and permits from the appropriate local authority or
statutory body required under any law (including any statute, ordinance,by-law
and/or regulation). Any and all Contractors and/or sub-contractors shall not
commence, continue or complete any work without having the appropriate permits
and approvals secured. Contractors and/or sub-contractors shall provide the
Manager of the Yachtsman with copies of all approvals and permits, contact
information, including emergency contact numbers.
4. Any work undertaken shall comply with all relevant local, county and state codes,
by-laws,regulations and statutes.
5. Any contractors (and sub-contractors) hired to work on the proposal shall maintain
the appropriate liability insurance. Contractors and/or sub-contractors shall
provide the Manager of the Yachtsman with copies of the relevant insurance binders.
6. Any�work undertaken shall be completed by Memorial Day and no work shall be
undertaken again until Labor Day, unless approval is sought from and received from
the Trustees.
7. I/We assume(s) responsibility for any future costs associated with loss or damage
related to the work.
8. Other:
As stated above, the materials must match existing exterior materials.
=1-
. t .F
Acceptance of Trust Approval
Page 2 of 2
The undersigned`Owner[s] of Unit#7 therefore accept the approval of the Trustees of the
Yachtsman Condominium Trust subject to the above-noted conditions.
Signed thi 5 y of f�F��i-- 2013
f �
Si a e - nit Ow er
Print a p
t Owner
Signat e - nit wrier
Print- ame -Unit Owper
Witness / Manager Yachtsm/Lari Condominium Trust
Documents Attached:
Permits Received (Title and Date Received):
v
Town'-6f.Barnstable.
guia ox _S rvrces
Thomas F.>Geiler;Director_
Building Division . . . .
Tom Perry,Building Commissioner.
200 Main Street;Hyannis,MA 02601
www:town.bamstable.ma.us
Office:. 508-862-403 8 Fax: 508-790-623 0
Property Owner Must
Complete and Sign This Section
If Using A Builder
as Owner,of the subjectp
l -property
.
hereby authorize�Cj�y' 67:r4J641to act on my behalf
in all?natters relative to work authorized by this building pettait
(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 - Signature of Applicant:
Print Name Ptint Name
�P .`3
Date
QT0R1&:0wNB.xPERMMs10riPoors.6/2012 : • : =
•