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HomeMy WebLinkAbout0500 OCEAN STREET (57) k I k i h i k i i _ _ _ i C I �, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Lf Map Parcel Application #��� ,p Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation /Hyannis Project Street Address n ' Village OwnerG Address i?() ITOX Telephone Permit Request a" a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 1 Flood Plain Groundwater Overlay Project Valuati Construction Type o Lot Size Grandfathered: ❑Yes ❑ No If yes, attach orting Y`_ um mtatiorT C Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings 'g a 0 Ye s ❑ No` Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other T� YP CD Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) ' Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new a Total Room Count (not including baths): existing new First Floor Ro©M-; ount Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/c I stove:__]Yes?❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ w --sLe 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 af. Telephone Number Address 0<-a1c �' , License # 'C C�Z c)- M Home Improvement Contractor# Worker's Compensation # Q VlJ w "I4 ) 4 T ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR E�Z DATE C3 i E FOR OFFICIAL USE ONLY APPLICATION# G ' DATE ISSUED 3 � ' MAP/PARCEL NO. S N ADDRESS VILLAGE s s , OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL x. PLUMBING: ROUGH FINAL ¢ GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. — c Depmtnent of Industrial Accuients " f g — - O. o Investi aeons--. 600 Washingtoh Street Boson,'.MA 02111 www.massgov/rlia Workers' Compensation Insurance Affdavrt:Builders/Contractors/FIectricia.ns/Plumbers Applicant Information Please Print -Name(Bnsiness/Dtgdni�tion/Fndivit : •Address: . • • Ci /StatelZi Are y�o an employer?Heck the appropriate bog: Type of project(required), 1.E I am a employer with 4. I am a general contractor and I * have hied the sub-contractors 6. ❑NeW construction employees(full and/or part-time). • 2.❑ I im a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling These sub-contractors have ship and have no employees S. F-I Demolition - working for me in any capacity, employ= and have worlmrs' [No workers'comp.•mi F nce comp.men-,M=.t 9. QJBuildmg addition wed,] 5. We area corporation and its 10.0 Electrical repairs or additions officers have exercised their - 3.❑ I am a homeowner doing all work 11.❑Plumbing repairs or additions • myself [No workers' comp, right of exemption per MGL 12 Roof repairs m� ce,rimed,]t. c. 152, §1(4), and we have no 01 employees. [No workers' 13.q Other comp.insurance require&] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit ties affidavit indicating they are;doing all work and then hire outside contractors most submit a new affidavit indicating such. #Contractms that cherlc.tim box rant attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the n -contractors have employees,they—st provide their workrrs'comp,policy mnber. I am an employer that is providing workers'compensation insurance for my employees- Below is the policy and job site irzformadon d L-is.=mce Company Name: CV— . Policy#or Self-ins.Lic.# Expiration Date: 3 3 Job Site Address: 0 City/St�wzip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expir• ioa 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 imprisnnn;P„t,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against tine violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance'coverage verification - IF do hereby c - under dtpaizrs penalties of perjury that the irzformation provided above is ue aril rrW4 Signat Date: /o Phone Official use only. Do not write in this area,to be completed by city or town offzcid City or Town: Permit/License# Issuing Authority(circle one): f.Board of Health 2.BttildingDepartment 3. City/Town Clerk C'Electrical Inspector. 5.'Pltrmbing Inspector 6.Other C=4at Person: Phone#: 0 DATE(MMIDDNYYY) AC40R U CERTIFICATE OF LIABILITY INSURANCE 09/10/2014 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 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 C. o Ex A/C No 973 Iyannough Road E-MAIL P.O. Box 1990 ADDRESS: Hyannis, MA 02601 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: !INSURED INSURER B: AmGUARD Insurance Company 42390 i Emergency Contractors LLC INSURERC: i 362 Yarmouth Road INSURERD: Hyannis, MA 02601 INSURER E 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. ICY EXP I INSR TYPE OF INSURANCE AD SUER POLICY NUMBER MM/DD/YEYYY MMIDD/YYYY LIMITS ILTR GENERAL LIABILITY EACH OCCURRENCE $ 0 DAMA E TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 0 CLAIMS-MADE OCCUR IVIED EXP(Any one person) $ 0 j PERSONAL&ADV INJURY $ 0 I GENERAL AGGREGATE $ 0 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ O POLICY PRO LOC $' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ j ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ I HIRED AUTOS AUTOS Per accident i $ I UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WCTORY TATU-LIMIT X OiT AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 B OFFICERIMEMBER EXCLUDED? � N/A R2WC 594148 03/03/2014 03/03/2015 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 I L i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) I Exclusions: Scott Gladish 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. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD T Massachusetts -De artment rat Public Safety Board at Building Regulations and taresfards �,`sr�ktr'?.tt'itaxTl'�uj)CY"4 iSt3r' �".• .,� License CS 103622 ROBERT S JONE5 206 CEDRIC RD CEN'TERVILLE MA 0 16 w . ... .�"✓' . ,, :;",,i Expiration cata ntissiean�r 0311 9/20 1 5 J? y[t.,'t` 1tf7lCii? 1C1 "Fd � Office of Consumer affairs And. Business Regulation. 10 Park Plaza - Suite 51.70 _. Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164370 Type: Su PI Card EMERGENCY CONTRACTORS LLC Expiration'. 10/1/2t?15 R. SCOTT JONES 73 IYANNOUGN RD 4._._ _. __ . __ . ... HYANNIS, MA 02601 ...____ 3.. Update Address and return card. __.. _......_. Mark reason for chenbae. _ SCA; 0 20PA1 e5!,1 Address i Renewal [ ' Employment i Gast Card .f>rf; sue,, Office of Go6sume.r Affairs-tl Business Regulation License or registration valid for individni use only r ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 'Registration: 164370 Type' 10 Park Plaza—Suite 5170 Expiration: 1011f2615 Su dement:--aid pp Boston,,M.A i}ltlb EMERGENCY CONTRACTORS LLC R.SCOTT JONES 73 IYANNOUGH RD y s;� �� .._..._ ✓� �_� HYANNIS.MA 02601 t>ndcrsecrctary N al id without signature The Yachtsman 500 Ocean Street, Hyannis, MA 02601 achtsman Condominium Trust P.C. Box 1283 Hyannis, MA02601-1283 (508)775-1515 DATE RE: Unit/��'achtsman 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 de;ineated 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 r the Pains and Penalties of Perjury this 0 day of d�� , 20 ,icretary, Board of Truste Yachtsman Condominium Trust 500 Ocean Street (c/o Manager's Office) Hyannis, MA 02601 Enc./File - inc rqy — 1_v rr u vi A-# sau�.0 iviv Regulato4_$.er_v_wec _ ------: — — t Thomas F.Geiler,Director Building DivisioU. - Tom Pent',Budding commissioner 200 Mam street,Hyawds,MA 02601 - - • �w.town.barnstablema.us - . . Fax: 508-790-6230 office: 508-862-4038 Property Owner Must - Complete and Sign.This Section_ If Using A Builder as Owner of the subject psopetty hereby authorize a` Q C�4r c e`t om to act on my behalf, Ge in an matters relative to work authorized by this building permit (Address of Job) Pool fences:and alarms are the responsibility of the applicant. Tools are not to be EMed or utilized before fence is installed and all final inspections are performed and.accepted. e of of Applicant .. Ap �t V Pant Name Date Q-.FOR2Jl3:OW1QERPEIZMISSIONPOOL3 6f2012 -. - - -