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HomeMy WebLinkAbout0500 OCEAN STREET (55) 3,aLf oy © 7k^ Il T TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 V ,Map.:� Parcel Applicatio Health Division Date Issued ✓r-��!CP ~ Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by,Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address -�_00 Oc eo,, <S-,�- Li,1,;fit_ Village 14V Cl hn is Owner ( a u c" o �cyie sz� Address Telephone �-O$ ' 66 q - 6,O i Permit Request /a ce-- �k��S ji G��r�a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood 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 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 Number of Bedrooms: existing —new O ,� Q Total Room Count (not including baths): existing new First` )or%om C$ nt Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other 0� Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wod/aV.. hstove `❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: LIT-xisting ❑ 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 e-2�) Telephone Number Address y� K�y/t�c�l JC�r� , License # C' S `- 7 Y S l yn P, xa, 1114 0,)1 YZ) Home Improvement Contractor# 33 OS Email & k eA'sp Q V z.,-r Zah, Ab--r Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU y DATE r 't FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ISAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - ----- - --- The Ctantmom€eal&Qf?Musachms - �e�rtz �o�'�' strarrl�Scc�ear#s --- - Office Ofl invest iga iarr-s 600 Wm, *u asr��`fi-eet Bastorj,•MA fi11H wnaw.musygai-Mia Wormers' Cctmpensat minsm-anceAffidavit:Bi:EiIders/Contra:c#7orsMectricians]Mumbers Applicant Infar cation Please Print Lef�ibly Addre-ss- v 60 A--i.�t C;ify/stat,-Z : sh/,CL q q Phone g-- -? Z& 6 9 9 Are you an employer?Check the appropriate bay:4 T. I a$ . ct�ntractor and I 3�of�iect(required): L❑ I am a employer faith � 6- ❑Near employees{full and/or part-time)-* have himathe MZ contractors - I am a sole proprietor or partner- listed on the attached sheet; y- Remodeling ship and h;n c no employees Thesesib-contractors have g- ❑Dem.alifiou working far me is any capacity? employees and have workers' a_ ❑Ruilding addition Wo vrorker8 acrap_rnYmrranre comp_fncarame J reT.ired-] 5-❑ We are a corporation and its 10-❑Electrical repairs cr addifians 3_❑ I am a hammer doing all work officers haNTe egeTased heir I L0 Plambing rep si rc or additions• myself- [No worb='comp- right of en=ption per MGL 12-0 RDof rep=, e.15Z §1(4kandwefrancno ans ax»�ar requized_I 1 13_0 Other employees [No wo6m& comp-msmanm requiresi. *Any apgfie�at that ehedcs bar'-I must also M ad the sectiva belDw ch�di&wale T rnmpensslim paHLy infnumicm gg��Hnmeua�nes wbn submit idm afhdsvit nwffr trtg diet'are daing sR ifcak anal diem Ike autade canh'.actocs— subffiit a uew aftidn'it T�l�5:urh K..tTII7L8C[a6 thst riseck this box nXW amrhEd:=7rMifi ms7 5'IZEet sl=hag the nmne a#iffm Quk-oomftx bx-S sad st s vrhether Dr=t t m&E�s 5 b3Ye employees Ifthe sub=coutmctms have emglosee-%they nmst pnzvide theme-wu&es'comp palficy atmmbes lam un inmrance for my emptoyear. Below is thepoEcl rucdiob site itifotmstiati_ ' Iam=ce CoumpanyName: Policy#or Self-ins-Its;� Expiration Date: Job Sites Address: Cifig/Stawzip: Attach a copy of the'workers'compensation policy declaration page(showing the policy namber and expiration date). Failure to semme cavm age as regairedutzder Section 25A o€MGL c. 152 can lead to the impositim ofciimit al pffna1>ies of a fine up to$I,5DD-Da and/or onegear impEi as wen as civil penalties in the form of a STOP WORK ORDER and a En e ofup to$250-00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office-of IIIresfigatiosss a€�DIA for rnetrxrtc�ca�erage veri�r�lion_ I&hereby cr-ltfy/uu-nder dcs pa ns andponaWas ofpedzuy tJtstthe inf brmuWangravidid abave&,hue and correct Phone (7fjzciat use ally. I?a rrat write in th&area,to be cr mp&ted by ait3 or town officiuL Cite'or Town- PermitUcense# Issuing An-thority(drde:one): 1.Saard of$ealth 2.Building I tpn-hnmt 3.Cityffawu Clerk 4_EIectrical Inspector 5.Plumbh g Inspector 6.O4her Contact Person. Phone€€r 6 Information and Instructions Massachusetts General Laws chapter 152 requires all.employers to provide workers'compensation for their employees. Pursuantto this statate,an m ployee is defined as"...every person in the service of another under any contract ofbire, 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 as employer." MGL chapter 152, §25C(6)also stags that"every state or Iocal 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(7)states"Neither the commonwealth nor any of its political subdiv-isions shall enter into any contract for the performance of public work until acceptable evidence of compliance v,-rith 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(L LP)with no employees other than the members or partners,are not required to'carry workers' compensation insurance- If as LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Depa lmeat of industrial Accidents for corifirmalion of insurance coverage. AIso be sure to sign and date the affidavit. 'lfie 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 obtma a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-in curanoe 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 RH 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 viU be used as a reference ntnnber. In addition,an applicant that must submit multiple permitlliumse 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 aiidav1 ` 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. 'fro Commo iwWth of M=aeliusrftts Department of Ind al Acaideats Off 1 m of kvestigatims, 1500 Washington St=t _ B.o�oa 4�1Ii `I`ei.t 6I 7 727-49-GG�4Q6 or l4 MAS F Revised 4-24-07 F�x#617-727-7I49 www runs gov1d a • s�vsres[.s. • Town of Barnstable Regulatory SeMees Richard V.Scali,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 I ( Lod as Owner of the subject l property hereby authorize C� 1 1 CS� to act on my behalf, in all matters relative to work authorized by this building permit application for:5(0 c) I , (oc emq U 41 s (Address of Job) � 9 Signature of Owner Date Laiaa= Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on'the reverse side. � a . QA*FiLESIFORMS\building permit formsEXPRESS.doc Revised 061313 , L { Yachtsman Condominium Trust Board of Trustees 500 Ocean Street Hyannis,MA 02601 r4 DATE RE: Unit 3 ( , 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 erformed as is delineated in the request we received from the Unit Owners. Contractor, p'Ra)1 -f� jl� 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 Under the Pains and Penalties of Perjury this aS day of F j-�,jruAra- , 201 p Ah CBoard retary of trees Condomini Trust O an Street(c%o ager's Office) _ Hyannis,MA 02601 Encffile IN _ .. w r_:1s263:E74. 0 °.23-2015' 2=52 NST BAR AELE LAND 'COURT ;:REGISTIRY YACHTSMAN CONDOMINIUM"TRUST' CERTIFICATE OF TRUSTEES We,the undersigned being a majority of the Trustees of the Yachtsman Condominium Trust under Declaration of Trust dated January 1, 1989 and recorded with the Barnstable County Registry District of the Land Court as Document#475622 and noted on Certificate of'Fide #C-2I,hereby certify pursuant to Article III of said Trust that the following persons are the current members of the Board of Trustees and hereby confirm the acceptance of the same: Name Term Expires Robert Am s June,2017 mond Do erty June,2015 ' C Joyc avin June,2016 Richard Gagne June,2017 Stev n Patalano June,2016 Executed under seal as of the day of -< t_,2011 y, DOtI t S R.GR.ABTREE �: fioi�;q�ublle Mailing Address: � COiMONk::+o:Mki;WHUSM My COMH33ion Expires Yachtsman Condominium Trust aaroiri t1,2010 c/o Crabtree CPA&Associates 426 North Street Hyannis,MA 02601-5132 Massachusetts Department of Public Safety Board of Building Regulations and Sta,ndards License: CS-077664 7- „ Construction Supervisor BRANDON M BALIESTIERO tx 45 BONAD ROAD . ' STONEHAM MA 02180 f4 J Expiration: Commissioner O6/14/2016 A . ,►,E, Town of Barnstable *Permit# - 0 2� KExpires 6 honthsftom issue date k Regulatory Services Fee 1639.. R 2 5 2015 Richard V.Scali,Director �I O� BNHN I BLE Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY G Map/parcel Number Not Valid without Red X-Press Imprint o � 1 Property Address 2 W4 llo i-'T T \C= J-1 A-f4 NJ ('S P v�Trc.,A(,, J Residential Value of Work$ 2OZD. 0-0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 0/17"01� 6 R�N� Contractor's Name �A Telephone Number d 0 g e 3(n q—4 y9 y Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor . I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: Z ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pro erty Owner must sign Property Owner Letter of Permission. A y of the Home Improvement Contractors License&Construction Supervisors License is e ui SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 r a 2lae Comwomveah*of-Vanadumettv Department qfIndustrid Acdderrts 600 Washbigion Street Baston,MA 92M +yvn:mmmgarldia WGrimrs' Campensatian.Insurance Affidavit: B.tamer-JCContx-actar&Mectdcians/Plumbers ApplicamtIII @rya al! Please Print f eel'tiiy aaa��: Co I I-(-�M�sr�� . �-�•l city M 6P-`T P 508 -3 &4� �oLt74 Are YalII an employer?Check the appropriate bar; Type of project(required): I.❑ I am a employer with 4_ ❑I am a general contractor and I * lmvehimdthe sub-conkactars 6. ❑I�ie oonsfrunEion employees(full anof part time. ' 2.❑ I am a sole proprietor orpmtnT- listed on the attached sheet. 7. ❑Remodeling ship and have no employees . These sasb-con ract=have g- ❑Demolition working forme inkcapacity- employees and have workers' [No corkers'camp.fimura ce comp_imuram# 9..❑Building addition nr d 5. We are a toiporatinn and its 10-❑Electrical repairs Cr Additions 3. I am a hameowner doing all work officers have esercised thtiir 1 L Q Plumbsngrepairs or additions rraysel€[NO wofkM'rnmg- Tight,of a =ptiau per MGL 17—YI Rflofrepairs innza=e reed.]a c.152,§1{4k andwe have no employees.[No workers' ❑f?ther S i�i N C7 comp.insurance regi ired.] 'Any appficsvttffiat cbeclabas#1 amp else ia�auf the secBoaheLawshnmag ifieiriaatkers'eampeassatiaaporacyia�aemaaauL &nmeQa rswbasnbm�tskisafiiidaruin caiiugtieeyaxedais.-Ruwadesnot&MbiteoutsideCantractommnst submit anew affidavftiodir.aaegsac'it iCaunacctm thzt rbea ibis boat mast siterhed soz additional sioeei sbocriag the aaame of the s con cuo-a sad state Wheffiet arnat these entitlesba� emp'.'7ees.Ifthe mB-caaftactarshwe employers,1he}'mascpmu-de their umrke&romp.pGhcy ttamben I arra an eutplOycrr flicrtisPrauidirtg workers'caaperrsatiort irtsriraraas f nr err}*elrrlvtay�eeR Mow is tltepaticp and job site infor madam Insurance CompanyNTame: 'Policy 4 of Self ins.Iic_4: ExpimfibaDate: Job&te Addressz Cif3rlStafe�2sp: Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and respiration date). Fat&m to secm-e coverage as required under SmEon 2 5A of MGL m 157—can lead to the imposition of criminal penalties of a fine up to$U.00.00 anWar one-year imprisomnerd as wen as cif peaalties,in the forts of a STOP WORK ORDER and a fine of up to 0-0-0 a day against the violator. Be advised Ent a copy of this statement way' be forwarded to the Of of Investigations of the DIA for insurance coverage verification- Ida hem6y ramify a tat ' s andpenaltres o.fperjusy thatthe infornuM oupnauided abmv it bars and carrect Si�ature: Date: 4'25— l Phone k So �3 r (o`� Co`�4`f Ojo al use only. Do rtat write in dib ua'ea,fa be crrrrrgteteri by�ortoarn otjiciaL City or,Torn: Permiff&ense 9 Issuinig-Axtharity€circle one): L Board of E[e21 i Budtg Department 3.City1rown Clerk d.Electrical Inspector S.Plumbing hmpector " 6.Other Contact Person: Phone#- laforn�a an end lns�tctions M ccar_�+T•setis Geb=al Laws d ajY=152 requires BE emgloyYas in provide 'compensation for their employees. Pmsaaatto this st gnte,an,.MMPlnyMff is defraed as:.every person in the service of another under any contract of hire, express or smpliect oral or writes" Am mmpkyer is defined as"an mdiridnaI,patth�,asso�fron,corparrzon or other Legal eutcy,or any two or more of the foregoing engaged ina joint e�erp� ,and including the legal seprese�ves of a deceased employer, the receiver• tr or trustee of an individual,per,association or oiherlegal eotty,employmg e�l°9 - $oweverthe owner of a dwelling house having not mate than three apartments and who resides therein,or the occgxmt ofthe - dw Uia house of ano8rer who employs persons to do mair�e,construction or repair wo=k on such dwelling house or oa the grounds or building ap FLt=m3tthemto shOnotbecause of such employmentbe deemedto be as employer" MOL chapter 152,§25C(S)also states that"every state or local li id?g agency sh2_U Withhold ffie issaance ar renewal of a license or permit to operate a business or fn construct buffdiugs in the commonwealth for any applicantwho has aotprodnced accepfable-evidence of compliance e) the insurance coverage required Additionally.MM chapter 152, §25C(7)states=Neither the comm®-wmn nor jay ofits poIitical subdivisions shall enter into any contract for the perf=an-ce ofpoblic wowu ntiq acceptable evidence of comPliancewith the orancs ins ._ requirements of dais chapter have been presented in the r nnfr� a authoty_" APPIi� Please fill o--t the Wotheas'compensation affidavit completely,by checlong the boxes that apply to your situation and,if necessary,supply sob-conhactor(s)mmne(s), addx�ss(es)and gh°ne n�ber(s) along with tbes certiftc te(s) of insurance. Limited Liability Companies(LLC)or Limited LiabHity-Per nerabips CLEF)with no en:EPIoyees other than the members or pmtaers,are not requited to carry wmke& compensation insmmce. If m LLC or LLP does have employees,a policy is req¢hed.•Be advised that this affida-vrt maybe submitted to the Department of Industrial Accidents for conffimation of ice coverage. Also be sure to sign and datelre affidavit The affidavit should be retnxaed to the city or town that the application fur the permit or license is being regnesbA not the Department of ' Tr rT r� aI�l tents Shnnld you have aay questions regarrling the law or if you are required to obtain a workers' couipensati-onpolicy,Please caHtim'Depmtmentattben=berlistadbelow: Self-inarredcompanies should entertiieir self-insurance license nmuber on the appropriate line. City or Town Officials f Please be sui-e that the affidavit is complete and prod legibly. The Department has provided a space at the bottom of the affidavit for you to fM Ott in the event the Office ofluvesti gatiom has to contact you regarding the applicant_ Please be sure to fill is the pe it/Iiceuose number which will be used as a reference number.-In addition,an applicant that moist submit multiple peimiftllicense applir ations in any given year,need.only submit one affidavit indicating career policor y information.(if necessary)and under`Job She Address"the applicant r]o otrl d wdt�"atI locations n ( Y town)--A copy of the-affidavit that has been officially stmnped or mzked by the city or town may be provided to the ' applicantt as prooftbat a valid affidavit is on fle for Bore pmmifs or licenses_ Anew afEi avitmurst be fiaed oiut each year.Where a home owner or citizen is obfiainmg a license or peo-it not related in any business or commercial ventme Cie. a dog license or permit to b=leaves etc.)said person is NOT regithed to complete this affidavit The Office of Investigations would him to thank you in advance for your cooperation and should your have any questions, please do not hesitate to give us a call- The.Departmenfs address,telephone and fax number.' ` 'I3�e f on�rzt�anwesi�Qf M�chusseM - t ss Depa:dmmt caf l ust zal Aocidenta ice of I-vegtigatio= WQn.Stmd ' o I&o�111 T(�_L 617 -49OG Qit 4-06 or 14M-M SSAFF, Fax 617'27-77D Revised 4-24-07Tnas.- �f�a r - t s t nA EWSMARM s Town of Barnstable QED MA't Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038• -• Fax: 508-796-6230 Property Owner Must Complete and Sign This Section. If Using A Builder as Owner of the subject property hereby authorize to act on my behal� in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPHLESTORMS\building permit formAEXPRESS.doc Revised 04=15 Town of Barnstable Regulatory Services �tIHGE Tok, Richard V.Scali,Director ~°* Building Division IIAMsrns= * Tom.Perry,Building Commissioner MASS i63F9. � � 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION �2S "' 1�• Please Print DATE. . JOB LOCATION: �n 7 V S Ay i` A /V o 5 GKT nu`mAer surd vivage MAR `�� W e ()® -210 If—6 C19/ name home phone# work phone# . CURRENT MAILING ADDRESS: 1 Tn'�' �S'J ✓ v Pj t&A city/town spate zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year ear period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The unde igned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedur,, an r ements and that he/she will comply with said procedures and requirements. Si of ITonieowner Approval ofBudding Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction ControL HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFlLES\FORIJSbmlding permit forms\=RESS.doc Revised 040215 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q� Vo kO Map �2-� Parcel ( zt&6�P ic a�ion Health Division Date Issued Conservation Division Application Fee TP, �. U Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Ou a, n &4 ci U nTT 1 Village Owner AddressRa [�C) X I a�,� Telephone — -7 Permit Request l Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati ncnsq 4 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.f ZJ Number of Baths: Full: existing new Half: existing Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Roo Co nt �' Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other i 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 r a APPLICANT INFORMATION -: (BUILDER OR HOMEOWNER) Name Rom, Sc . o n< S Telephone Number���)1c 5 Address License # Home Improvement Contractor# RWorker's Compensation # l. 2 4 I (5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO k SIGNATURE DATE ,f FOR OFFICIAL USE ONLY 'r APPLICATION# j DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 1� r GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED OUT I ASSOCIATION PLAN NO. r Depar0nent of Industrial Accidents f` g --- -- - - -- O o Invesdz ations-- 600 WashhWtoiz Street Bosto. MA 02111 - - www.massgov/dia Workers' Compere' sation hsm ance Affidavit: Bnflders/Contractors/Electdcians/Plumb'ers A.pplicant Laformation Please,Print Le " l Name(BnsinessbrganizationadividaaD-- L+d(���L Address: C /state/Zi : Are you an employer? Check the appropriate bog: Type of project(required); 1.141 am a employer with 4. ❑I am i general contractor and I employees(full and/or part tune). * have hired the mib-contmztors S. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling and have no Io ees These sub-conf act have �P � y S. []Demolition working for me m any capacity. employees and have worlmrs' [No workers'comp.-inci nan 9. ce comp.msuraace.# ❑Building addition required.] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1I. Plumbing repairs or additions myseLf [No workers' camp, right of exenoption per MGL mtn an sce required.]t c. .152,§1(4), and we,have no 12. of repairs employees. No workers' 13.❑ ther comp.insurance required.] `Any applicant that ehecla box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they=doing all work and then hire outside contractors must submit a new affidavit indicating such, #Contr?rinrs that cbeckthis box mnst aftaehed an additional sheet showing the name of the sub-contractors and state whether or not those entities have enmloyea. If the subcontractors bave employees,they mast provide their wDrkM'comp.policy munber. I on an empLayer that is providin workers'compensation insurance for my employees BeL6w is the policy and job site information. Insurance Company Name: Q rr ,, ll Policy#or Seif--ins.Lic. Expiration Dare: Job Site Address Orr �{ I3 � City/State/Zig ' Attach a copy of the workers compensation policy declaration page(showing the policy n umer and egp ahon 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 miprisrn,n;Pnt,as well as civil.penalties in the form of a STOP WORK ORDER and a tine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded t0 the Office of Investigations of the DIA for msurance'coveiage verification. I do hereby c under the airs' enawas of perjury That the information provided above is tare and en ert Phone# 1� official use only. Do not write in this area to be completed by city or fawn offzeia( City or Town: Permitucense# i Issuing Authorify(circle one): 1.Board of Health 2.BadmgDepartment 3. City/Town Clerk 4.Llectriml Inspector. 5,•Plumbing Inspector 6. Other Cantct Person= Phone#: 1 DATE(MM/DDIYYYY) ACC MD CERTIFICATE OF LIABILITY INSURANCE 09/10/2014 THI�RTIFICATE 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 NAME: DOWLING &O'NEIL INS AGY PHONE FAx A/C No Ex (A/C No 973 Iyannough Road E-MAIL i P.O. Box 1990 ADDRESS: Hyannis, MA 02601 INSURER(S)AFFORDING COVERAGE NAIL0 INSURER A INSURED INSURER B: AmGUARD Insurance Company 42390 Emergency Contractors LLC INsuRERc: 362 Yarmouth Road INSURERD: Hyannis, MA 02601 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. I INSR AD L SUBR POLICY EFF POLICY EXP LIMITS I LTR TYPE OF INSURANCE INSRIM& POLICY NUMBER (MMIDDIYYYYI IMMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 0 DAMA E TO R NTED 0 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE DOCCUR MED EXP(Any one person) $ 0 PERSONAL&ADV INJURY $ 0 GENERAL AGGREGATE $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 0 POLICY $ PRO LOC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ i A.LLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION TOCY STA IMITS X OTH ER AND EMPLOYERS'LIABILITY Y I N i ANY PROPRIETOR/PARTNER/EXECUTIVE❑ NIA R2WC594148 03/03/2014 03/03/2015 E.L.EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBER EXCLUDED? Y (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below j DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,N more space is required) I Exclusions: Scott Gladish i I I CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. I AUTHORIZED REPRESENTATIVE i 01988.2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD = * The Yachtsman 500 Ocean Street, Hyannis, MA 02601 mow. achtsman Condominium Trust P.O. Box 1283 Hyannis, MA02601-1283 (508)775-1515 Dare RE: Unit,/ '31, 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. Signe nd the P and Penalties of Perjury this day of /®_ , 20 . �. retary, Board of'rr.0 tees Yachtsman Condominium Trust 500 Ocean Street (c/o Manager's Office) Hyannis, MA 02601 Enc./File Massachusetts d D partrnem af, Public Safety Board of Building Regulations and Standards i_icens�: CS-103622 ROBERT S JONES 206 CEDRtC RD %pe .f CENTERVILLE MA .cJExpiration � tom' C}ff xce of Consumer Affairs rid Bus i ness Regulation. 2a , 1.0 Park Plaza - Suite 51.70 Boston, Massachusetts 02116 Home l.mprovernent Contractor Registration Registration: 164370 Type: Supplement Card i Expiration: 10/1/2015 EMERGENCY CONTRACTORS LLC .' R. SCOTT JONES 73 IYANNOUGH RD :� `, �' _. ._ ............ HYANNIS, MA 02601 ......... Update:'Address and return card.Mark reason for change. s k t Gory ;j Address Renewal Employment I Lost Card ---_Offiee of Consumer:Affairs&Rusiness Regulation License or registration valid for individul use only �r ME IMPROVEMENT CONTRACTOR before the expiration date. [f found return to: lis -..,.i2e istration: office of Consumer Affairs and.Business Regulation 9 164370 Type: 10 park Plaza-Suite 5170 -: Expiration: 101 112 0 1 6 SUpplemeni'',ard Boston,MA 02116 EMERGENCY CONTRACTOPS LLC R.SCOTT JONES 73 IYANNOUGN RD HYANNiS;hrlA 02601 _ _._. �.._ __...... ---- .:.:__.. Undersecretary Not v id w tonature i v r rya v.a r«aa......+........�.. Regulatory_S.ez vices ---- ------ - —- "c'""`F� Thomas F.Geiler,Director `�� ► Building Division Tom Perry,Building Commissioner 200 Mal street,Hyannis,MA 02601 w w.town.barnstable.ma.us . Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must " Complete and Sign. This Section If Using A Builder �Gt � 7`��✓�0 as Owner of the subjectpzoperty hereby authorize' 1-4t�G rrae �e'yi 712L v e- to act oa my behalf, in all matters relative to work authorized by this building permit • ®�/ tom[C'. GiC.� (Address of Job) Pool fences:aihd alarms are the responsibility of the applicant. -Pools are not to be filled or utilized before fence is installed and all final inspec 'ors are rme'd and.accepted. st=ne o Signature o pplicant . Print Name Print Name Date Q:FORMS:OWNERFERMISSI0I,T00I S 6201i