HomeMy WebLinkAbout0500 OCEAN STREET (8) -- - -- - - -- add
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map /�' '— Parcel "Lv bft; Wplication ;
Health Division Date Issued 3
Conservation Division ,/ ` Application Fee
Planning Dept. Permit Fee �JLJ
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address c�00 � '-a�, I ? �2
Village i 3
Owner O Address-? 66ea� Ale- r c (V T
Telephone )7.71
Permit Request o Ir. 61 `tCA
ep—
S
(2 lc�
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 kNo On Old King's Highway: ❑Yes 43�'No
Basement Type: ❑ Full ALCrawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft,) 0 Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing CZ new 0 Half: existing 0 new<
Number of Bedrooms: existing 0new --t
�' w o
Total Room Count (not including baths): existing new 6 First Floor RoomlGount
Heat Type and Fuel: ❑ Gas ❑ Oil .Electric ❑ Other
Central Air: ❑Yes ONO Fireplaces: Existing New 0 Existing wood/coa'stove: Y,YesNo
I L10
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ riev siRb_
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial 0 Yes ❑ No If yes, site plan review#
Current Use d-7 C0 Proposed Use to' ,(�,`a,
APPLICANT INFORMATION _
_ (BUILDER OR HOMEOWNER)
Name / //e d 6;-e y Telephone Number 6Z2r C2V 3-;17 C&O
Address 4K? ���� r License #
li'�W S Home Improvement Contractor#
Worker's Compensation # 5-6
�d/l
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE tQ
I'
{ FOR OFFICIAL USE ONLY
t
APPLICATION#
DATE ISSUED
•y
MAP/PARCELNO.
r
C
ADDRESS VILLAGE
OWNER
7
DATE OF INSPECTION:
FOUNDATION
!!y F
FRAME
y INSULATION
Y FIREPLACE
I ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING
{
DATE CLOSED OUT
ASSOCIATION PLAN NO.
Departmerst oflndustriad accidents:..
• ' ; Off ce of Iravestigafiozis.• - . - : : -
600 Wizskingfan Street
stox;MA OZXII . .. ..
w wrvtv.mass govIdia
Workers' Compensation-1-a rance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Les?iblY
Name(Business/organizationllndividual):
' •Address•- � lL t��!`r- - • .. . - .. . . -
City/State/Zip:. h2d cl l C�` Phone:
Are you an employer. Check.the appropriate bow :Type of project(required):.
1.�'I am a e to er wiih`. C . 4. ❑ I am a general contractor and I
mp y 6. ❑New construction .
employees (full and/or part time).*. have hired the sub-contractors
2:❑ I am a'sole proprietor or partner- liag
listed on the.-attached sheet 7. ��
ship and have no employees These sub-contractors have -8. ❑Demolition .
working for me.in any capacity employees and have workers' 9. ❑Building addition
comp.insurance,
[No workers comp,insurance -
required-.] . :
5. ❑ We are a corporation and its � 10.❑Electrical repairs or additions
3,❑ I am a homeowner-doing all work' officers have.exercised then 11.❑Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.]t c. 152, §1(4),and we have no lin Other
Cmployees.-[N6 workers'
. comp,insurance required-]
*Any applicant that checks box#1 must also fill out the section below showing thcu•workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such.
#Contractors Heat 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-contactors have employees,they must provide their worlmrs'comp:policy number.
I am an employer that isproviding workers'compensation insurance for.my employees. Below is thepolicy andjob site
information
Insurance Company Name:
Policy#or Self-ins.Lic.# �<�069. W)o '6` Ex
Psalion Date:
Job Site Address: & 1.1 �� City/State/Zip: C��Yi c�Lal �S ` �0
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 insurmpe'coverage verification
I do hereby certi r the and of perjury that the information provided above is true and correct
Si alure: Date:
Phone#• �� rifD d ��oC
Official use only. Do not write in this area, tb be completed by tiV..or town official
City or Town: Permit/License#
Issuing Authority,(circle one): .
A.Board of Health 2,Building Deparbnent 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#
I�f®rma on., an
Massachusetts General Laws chapter 152 requires:all employers to provide workers' rompensation.for their employees. `
Pursuant to.this.statnfe,an employee is defined as"...every.person inlhe service of.another under any contract of hire;
express or implied,oi:al or written".
,.
An emplayer.is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
_of the,foregoing engaged in a joint enkrpnse,and including the legal representatives of adeceased employer, or-the...
receiver or trustee•of anindividual,partnership, association or other legal.entity,1employing emp oy=. However e
owner of a dwelling house having not more than three apartments and who resides therein, th or e oc cup ant of the .
dwelling house of another who employs persons to do maintenance,.construction-or repair work m sash+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()s.fates"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for.the performance of public work until-acceptable-evidence of compli�ce with the ins�nce
requirements of this chapter have been presentrd'to the contracting authority."
Applicants
'on an if
b checking the boxes that apply.to our situation d,
e workers' c ensation affidavit completely, . y
Please fill out the w r comp Y g
necessary, 1 sub-mntiacto s name(s),address(es)and phone number(s) along with their certificate(s) of
supply r( )
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 size that the affidavit ii complete'aad printed.legrbly. The;Department has.provided a-space'at the bottom
of the affidavit for you to f311 out in the event the Office of Investigations has to.contact you regarding the applicant
Please be sure�to;fill in the pe mit/licen' number which will be used as a reference nrnnber.,In.addition,au applicant-
that must submit multiple permit/license 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 fo any business or commercial venfum
(Le. 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 givens a call,
The Department's address,telepho= nd fax number: y "'�..•
The CQMM%.LWQe1th OfMa&.s h ttSt
DQpa�(=t of kcal MM&Sts
Office,Of luye!��tioas -
6�Waintn Store
Stan, ILIA 02111
'1`a.# G17-727-490.0 exii 406(�.r 1- -MASSAFE i
Revised I I-22-06 Fax#�C17'27-7749,
WWWM sQd
®RE"WDAt OP tD.JP
•`� ���• CERTIFICATE OF LIABILITY INSURANCE �07JISr
THIS CERTIFICATE IS ISSIM AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGMTS UPON THE CEItTIMATE MOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NIGATrdELv AMEND. ExTEND OR ALTER THE COVERAGE AFFORDED By THE POLICIES
9ELOw. 'THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE: A CONTRACT BETV11mw Twe ISSUING INSUR ER(S), AUTH0012120
REPPMENTATI'VE OR PRODUCER,AND TWE CERTIFICATE HOLDER.
IMPORTANT: I9 the Cevti Mtb 1101091 is an ADDITIONAL INSURED,the pottty(let)must be endorsed. If SUSPOGATiON IS WANED,subject to
the tetras and Conditions of the¢'►olicy,certain pelicies may require an endwsement A aftte +ent on thin motifiealts does not=Ibr rights to the
cerdifiom holder in lieu of such endomemerWal.
PRODMR Phono:608-687-56Q Norstcv;qTnc, _
Gammon-Adaim Ins.Ag.,Inc.
234 West Center Street Fox,308-S87-S36
VUtLyt Orlop"*r,MA A"a379-
Charles E.Adana _J__ ivsuR�—{a1 AFFORMHc eevwtmas NAC n
mAUACRA:hlaPdOrd Cd$U8Ity Irl3u="CO }�4565
INSUArD David A,Grow
438 Weir Rd Iltguf4@s:c.;. i
Yarmouttlpotl,MA 026TS-2525
INSURER F
IOUs�raoK e: I
COVERAGES CERTIFICATE NUMBER: N ER'
THIS IS TO CERTIFY rKAT THE POLICIES OF INSURANCE LISTED 6FLOW KAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
lmd=ATED, NOT'V47. H$TANDING ANY REQUIREMENT, TERA1 OR-cQNDITION 0=ANY GONIR4CT OR OTH R GCtiUvzw M111 RESRECT TO WHICH THIS
CERTIFICATE MAY BE ISSL1E0 OR MAY PERTAIN. THE INSURANCE AEFORCED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HNVE BEEN RE.OUC:£D BY PAID CLAIMS.
I" TYPE of INaURAXCE ratl rtVM6CN M 0CIC1rc'EYCYF ' MPOLICV -' UAl1T8
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OESCRIPTION OF OPERitT ens;styr QIEF4EE.POLICY LgA1T
oEBCfaPt00N OF OPat1AMNS r LCX'ATatB i VgMIC=(Attach ACOM tot;Addift ml RwaAro 3the IHs,IT MOI9 SWO Is 0"w"
SOO-394-6230
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NO=ANY OF THE ASObE OESCRISW POUCIES ae CANOt3LLL0 GCOORE
TILE EXPIRATION DATE THEREOF, NOTICE YYILL BE OELIVEREO IN
Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHCRUP RRMPSE4TATNP.
cnar►es Eva
-2056 RCORD CO T N. An rights rtserved.
ACORD 7.-6(2010105) The ACORD ream and logo art:registered ma ts of AGORD
TA00/ 1160 ffh, I'bt3 RdtQ Zt CTOZ%�Z!i!'
I
Town,o�Barnstable
Regulatory Seirvaces
9 MAn . Thomas F.Geiler,Director.
47 i630.
�Eo Building.Division
Tom Perry,Building Commissioner.
200 Main Street,Hyannis,MA 02601
wwwaown.barnstable.ma.ns
Office . 508-862-4038 Fax 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
le a-Z as Owner of the subject property
rl
hereby authorize to act on ray behalf,
in all matters relative to work authorized by this building permit
.(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 Signatute of Applicant
Print Name Print Name
Die
QTOWS.-OWNEUMUMMONPOOLS.62012 =
4�THE
Town of Barnstable : ..
Regulatory Services
Thomas F.Geiler,Director.
. . ..
s639 ,�� Bandin Division
ArED MAC�` -
Tom Perry,Building Commissioner
200 Main Street, Hyannis,MA 02601 .
www.town.barnstableana.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: -
number street. . " . village
"HOMEOWNER':
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
.. A
The current exemption for"homeowners"was extended to include owner-occupied'dwelings of six uniis,or less,ands
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor. J.Q11
DEFINTTION 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 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/slie shall be
responsible for all such work performed under the building p rmit';.(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 undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official "'' ` ..7°
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 foT 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 Y f
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 fomdcertification for use in your community.
Q:forms:hofi,=xempt .
n LV. i7 ZAVI 1 t%UF, G/VVJ rtvbiQunziai Home rundl
Yachfisman Condominium Trust
Acceptance of Trust Approval
The undersigned Owner[s] of Unit#17 of the Yachtsman Condominium Trust,500 Ocean
Street,Hyannis,Massachusetts,acknowfedge[s] that the Trustees of the Yachtsman
Condominium Trust have approved the following proposal:
• Installation of a replacement window for the kitchen window
(Andersen brand,color to match existing)and interior kitchen
renovations. Any shingles that are replaced on the exterior shall
match existing.
By acknowledging the Trustees'vote approving the proposal for Unit#17,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), The Owner(s)specifiy that 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.
S. 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 assumes) 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- ..
n
--- ------ -- ��• �� �_� rlfVl.: J� VVJ nGb1UG11Lldl nome runai
Acceptance of Trust Approval
Page 2 of 2
The undersigned Owner[s] of Unit#17 therefore accept the approval of the Trustees of the
Yachtsman Condominium Trust subject to the above-noted conditions.
Signed this 4 d�rof t� O>�i1Z�,
2013
Signature-Unit Owner
---------------
Print Name-Ui ' er
Signature- Un t 0 ner
Print Name-Unit Owner
Y• t an Condominium Trust
Documents Attached:
Permits Received (Title and Date Received):
--------------
.4 I
' ' 4
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention a Air Quality Please Enter Decal#
BWP AQ 06
Notification Prior to Construction or Demolition
A. Applicability
Important:When
filling out forms A Construction or Demolition operation of an industrial, commercial,or institutional building, or
on the computer, residential building with 20 or more units is regulated by the Department of Environmental Protection
use only the tab (DEP), Bureau of Waste Prevention-Air Quality Division, under Regulations 310 CMR 7.09,
cursor do o move tter Notification of Construction or Demolition operations is required under 310 CMR 7.09(2)ten(10)
use tt,e return days prior to any work being performed.The following information is required pursuant to 310 CMR
key 7.09.
V It�l
yma-x
B. General Project Description
1. Facility Information:
Name
Address --
Awl PL
s AIX
Instructions c
CrtylTown Stw Zip Code
1.All sections of
this form must be TeWhone Number E-mail Address(optional)
completed in order
to comply with the Size:
Department of
Environmental jQ 31
Protection Square Felit Number of Floors
notification
requirements of 310 CMR 7.09 was the facility built prior to 1980? M_Yes ❑ No
2.Submit Original Describe the current or prior use of the facility:
Form To:
Commonwealth of �r �-U Cd �y
Massachusetts
Asbestos Program
P.O.Box 120087 Is the facility a residential facility? NLYes ❑ No
Boston,MA
02112-00117 If yes, how many units? l
2. Facility Owner:
Name ell
n n P �r� C'
Address
S&CCa i' yIna . Q?�?�
Cityrrown State Zip Code
Telephone Number(incline area code and extension) E-mail Address(optional)
Z)el l;(It �� �CDo oZ cG
On-site Manager
ag06app(1).doc-6104 BWP AO 06-Page 1 of 3
Massachusetts Department of Environmental Protection l®D y
LlBureau of Waste Prevention .Air Quality Please Enter Decal#
BWP AQ 06
Notification Prior to Construction or Demolition
B. General Project Description (cont.)
3. General Contractor:
�37�>auc �rre�1
Name Z O "6`' %oU
Address f� �,Q � /,�/ •�y���
City/Town f state Zip Code
�� �GY7 Y r,vs i/erczaLc- -z e,�-
TelephiTne Number(include area code and extension) E-mail Address(optional)
On-site Manager
C. General Construction or Demolition Description
General
statement:If 1. Construction or demolition contractor
asbestos is found ��
during a �(d
Construction or Name
Demolition 2-
responsible
operation,all Address
responsible
parties must
comply with 310 Telephone Number(include area code and extension) E-mail Address(optional)
CMR 7.00,7.09,
7.15,and Chapter On-site Ma r
21 E of the
General Laws of
the 2. On-Site Supervisor:
Commonwealth.
This would
include,but would Name
not be limited to,
filing an asbestos 3. Is the entire facility to be demolished? O Yes C do
removal
the�10eth
rim 4. D ribe the area(s)to be demolished:
and/or a notice of t t (� C
release/threat of G
release of ahazardous
041 substance to the tt t <� Q`n �tV L
Department,if
applicable. 5. If this is a construction project,describe the building(s)or addition(s)to be constructed:
ag06app(1).doc•6104 BWP AQ 06•Page 2 of 3
Massachusetts Department of Environmental Protection
Bureau of Waste Prevention .Air Quality Please enter Decal#�
BWP AQ 06
Notification Prior to Construction or Demolition
C. General Construction or Demolition Description (cunt.)
6. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing
material(ACM)?
❑ Yes &0
If yes,who conducted the survey?
Name
Division of Occupational Safety Certification Number
7. Construction or Demolition 3 3 l 3
Start 9we t End Bate
8. For demolition and construction projects,indicate dust suppression techniques to be used:
❑ seeding ❑ paving If other, pleases c�'
❑ wetting O shrouding
)Zcovering0 other
9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency?
Name of DEP of er
Title
Date of Authorization
DEP Waiver#
D. Certification f
I certify that I have examined the , d"
above and that to the best of my Prin
knowledge it is true and complete.
The signature below subjects the Autho d Src nature �
signer to the general statutes ,) ��rew /./emu
regarding a false and misleading Position rtle
statement(s).
Representing
7 C '
Date
P.E.#
ago6app(1).doc•6104 BWP AQ 06 Page 3 of 3
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