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HomeMy WebLinkAbout0465 SEA STREET f�GS SSA S7" ACTIVE �` • �'' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3'b Parcel q: I Application Health Division Date Issued' /0 Conservation Division Application - Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 4( S S EA S17 t=C� Village :r c r l e� Address,� �as � � � a e Owner I ocAs �, v`sah Telephone Ld Permit Request � ��b Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 000 Construction Type Lot Size in 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 C`Crawl ❑Walkout ❑Other hiIN Basement Finished Area(sq.ft.) 41 A, Basement Unfinished Area(sq.ft) 44 Number of Baths: F�I:existing new Half:existing -.?-- new Number of Bedrooms: ' e�iiting new Total Room Count(not including baths):existing new First Floor Room ount a' Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes J"No Fireplaces: Existing a New Existing wood/cow tove:k CYes No Detached garage:❑e. isting ❑new size Pool:❑ex' ing ❑new size Barn:❑exis ng ❑n* si Attached garage:❑exi Ming ❑new size Shed:❑e sting ❑new size Other: rn Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION AMA YLF} Telephone Number tl • (y Address 2 ( 9/ZC In I License# I D-C) :5��Z Y` A/)toi 5 4MA 0-u ao I Home Improvement Contractor# _ ___.—Worker:s-Compensation# ..eu.:...,.,ati.,.�..:�s,...�.•..z_„#e:-. ALL QQNSTRUCTION'DEBRITRESULTING FROM. THIS PROJECT WILL BE TAKEN TO SIGNATU DATE I { r �► FOR OFFICIAL USE ONLY t ' APPLICATION# DATE ISSUED MAP/PARCEL N0. - - ADDRESS VILLAGE - OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _ DATE CLOSED OUT s' ASSOCIATION PLAN NO. - O a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street S �< Boston,MA 02111' ' www.mass.gov/dia ' Workers"Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individuat): ��k!3a ALAARA-Address: Pt lC tr(fJ�C t.J � City/State/Zip: l''�A(�nl ,MA r�2(sA 1 Phone.#: ��y� O ((1_232-0 Are ou an employer?Check the appropriate box: .Type of project(required):. 1.�I am a employer with_ 4. [] I am a general contractor and I 6 �]New construction . 'employees(full and/or part-time),* � have hired the sub contractors listed on the sheet. 7. ❑Remodeling 2.❑ I am a'sole proprietor or partner- These sub-contractors have ' ship and have no employees S. ❑Demolition employee$and have workers' working for mein any capacity. 9. ❑Building addition [No workers'comp.insurance comp.insurance.$' required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions '3.❑ I am a homeowner doing all•work . officers have exercised their 11.❑P umbing repairs or additions ' myself,[No workers'comp. right of exemption per MGL 12. ./ Roof repairs y c. 152, §1(4),and we have no insurance,required.]t • 13.❑Other employees. [No workers' comp,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. tContractors that check this box must attached an additional sheet showing the name of the Sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: lob Site Address: City/State/Zip: 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 DIA for insurance coverage verification. I do hereby certify unde the pains•and penalties of per that the information provided above is true acid correct. — Si afore: Date: • Phone#: Official use only. Do no write in this area, to be completed by.city or town official. City or Town: PermitfLicense#' Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,Plumbing Inspector 6. Other Phone Contact Person: #: Client#: 1442 2TOB O ATM CERTIFICATE OF LIABILITY INSURANCE 07/28/08°""�' PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAT40N Dowling & O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 973 lyannough Rd., PO Box 1990 Hyannis, MA 026dl INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Argonaut Insurance Company Town of Barnstable •Mr. David W.Anthony, Chief Procurement INSURER B: INSURER C: 230 South Street Hyannis, MA 02601 . INSURER D: 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 DD' POLICY EFFECT/YIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER' DATE MM/DDY DATE MM/DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea occurrence) $ CLAIMS MADE D OCCUR - MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ JECT POLICY PRO- 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/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION AND BINDER266407 07/01/08 07/01/09 X WC LIMIT ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT $1 .000,OOO ' OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under. - SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER f ;ca i f 3 4. DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS _ Insurance coverage is limited to the terms,conditions, exclusions, other , ` = limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived, or extended the coverage provided by the policy provisions. j y (See Attached Descriptions) C=J 7rt' CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1_ DAYS WRITTEN Attn: Building Inspector NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 200 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis, MA 02601 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE f V-� � t.i.K►a� ACORD 25(2001108) 1 of 3 #52928 LS1 © ACORD CORPORATION 1988 Sep 30 2008 1 : 04PM HP LASERJET FAX p. l MR oFIHE ram, Town of Bairx;i..stable Regulatory Sejr,vaices ILA xnsrA Thomas F.Geiler,Director Suildin* Division Tom Perry,Building Commissioner ' 200 Main Street, Hyannis, MA 02601 www.town.barnstable_ma,us Office- 508462-4038 . Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder r , as Ownet of the subject pxoperty . hereby autho ems'`+IQM` s /' to act on my behalf, in atmattets relative to work authorized by this building permit application for: (Address of Job) Signa e o waer Date Print Name I If Property Owner is applying for permit please complete the Homeovmcrs Licros'c Exemption Form on the reverse side. i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.. Map to Parcel Application`# , 071 Health Division' Date Issued n I n 0`1 Conservation Division Application Fee / C> Tax Collector Permit Fee Treasurer. Planning Dept. / Date Definitive Plan Approved by Planning Board �IN Historic-OKH Preservation/Hyannis Project Street Address q S SeG�- c5 Village Owner ��,, a� ��� � � �C� Address r Telephone Permit Request Z;n'fe(I c) /' Tenn uc�t O 1h Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 117�0r5 —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 Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑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:14existing ZJ new`..size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: F' Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ � Commercial ❑Yes ❑No _ If yes, site plan review# Current Use Proposed Use Lei BUILDER INFORMATIONco � II Name A/1 -3� C:/rvs��h Telephone Number. R+p r Address d4 ( License# Z 3 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Q DATE `� 2 t FOR OFFICIAL USE ONLY r APPLICATION# • `DATE ISSUED - MAP/PARCEL NO. ADDRESS VILLAGE OWNER ~ DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE Y ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. c s The Commonwealth of Massachusetts Deparfinent of Industrial accidents Office of Investigations d 600 Washington Street Boston,MA 02111 , www.m ass.gov/dia Workers"Compensation Insurance_Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeLyibly Name (Business/OrganizatiomUdividual):. Address: 6 .�� -r` 6 3 Z O City/State/Zip: Phone.#: Q Are you an employer? theck the appropriate box: 'Type of project(required)-. 1.❑ I am a employer with 4. [] I am a general contractor and I employees(full and/orpart.time).* have hired the stab-contractors 6. ❑New construction . 2.❑ I am asole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, Demolition . working for me in any capacity. employees and have workers' $• 9. []Building addition [No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. [] We are a corporation and its ❑ P ' '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 MG 12•❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees• [No workers' ..13.❑Other comp. insurance required.] , ''Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowner;who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tL6ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or notthose entities have employees. If the sub-contractors have employees,they must providb their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins,Lic.#: Expiration Date: Job Site Address: City/State/Zip: 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 tip 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 insurance coverage verification. I do hereby certify:ender the pains•and penalties of perjury that the information provided above is true and correct Sienature: Date: S C i Phone #: �� 3 2� R (? Official use only. Do not write in this area,'tb be completed by city or town o 1claz City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2,Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other. Contact Person: Phone#: Town of Barnstable, Regulatory Services Thomas F.Geiler,Director c16 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 508-862-4038 Fax: 508-790-62.30 Property Owner Must Complete and Sign. This Section If Using A.Builder I,��T� �U ✓ s��,yDFt tJ , as Owner of the subject property hereby authorize ,L",+1 < to act on my behalf, in all matters relative to work authorized by this building permit application for , E�SS Se' (Address of Job) Sign Owner Date Print Name QFu MS:OwNERPERMISSION S+ C o�m.g'R` aNi o � Board of wldmg Regulatio s an tandards Construction Supervisor License License: CS 52139 i xk i E pion %1yp09 Trg 15608 ' Restriction OO�r - ; t � 5t t FRANK ZIBUTISi - i ,{ 130 RASPBERRY�� NEE MARSTONS MILLS,M74 02648 Commissioner f A PURCHASE ORDER AND WORK ORDER REQUEST FORM PURCHASE ORDER REQUEST ALL FORMS MUST BE SUBMITTED AT LEAST 48 HOURS IN ADVANCE. REQUISITION WILL BE SUBMITTED TO STEVE SUNDELIN FOR APPROVAL. DATE: PERSON MAKING REQUEST: ITEM (S)OR SERVICE: Ut �Q ` TO BE PURCHASED: Cal LOCATION OF THE WORK: O� ESTIMATED COST OF PURCHASE: Q ACCOUNT NUMBER TO BE CHARGED: v / y u S �� VENDOR NAME: l n c,J n **' IF REQUEST IS OVER$5,000.00,3 QUOTES MUST BE ATTACHED. ***IF THIS IS A NEW VENDOR YOU NEED TO GET NAME,REMITTANCE ADDRESS AND FEDERAL TAX ID FORM.FINANCE WILL NOT ACCEPT A NUMBER ONLY. P.O.MUST BE ISSUED BEFORE PURCHASE IS MADE and PO#NEEDS TO BE ON THE WORK ORDER. APPROVED BY PO NUMBER yy YOURFORMAN APPROVED BY DIVISION SUPERVISOR o/dpwstructures/blankforms/poworkrequest TOWN OF.BARNSTABLE°BUILDING PERMIT APPLICAjTION Map 3 Parcel I c! 0 Permit# Health Division Date Issued ADO Conservation Division (/zs-�zo®� Fee Tax Collector Treasurer r , Planning Dept. 1 , Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �- E!21= L, Village 14 YAti r► / s � M ft SS t ; Owner --ro UJ to ` a f;pgR ry STA f3 LE_ Address CWZE o F T6M!ES SMEu)i42T Telephone �d8 EM 61-4 ri FIER Permit Request r: T i S &F—AC tf I-I . C . 12ta Wl� 5�E_ PL Ary Sy Tows of QANS7WL_F_ 'ya-mb r(A L-f 3/ zC00 Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Valuation U '5o Zoning District Flood Plain Groundwater Overlay 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 Total Room Count(not including baths): existing new. First Floor Room Count Heat Type and Fuel: ❑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 ❑hew -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 BUILDER INFORMATION Name GRASS'F—TTI 13 Q0T14PQS :ZyC?. Telephone Number ��--2 F' 7 7.3.E Address LF--,oX ! S s O License# 0 3 Q O 3;L CoT U I—F , MA Home Improvement Contractor# Worker's Compensation# SWAAMV 8 PA L4_0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7EMW 07--24 ZNSIVELF r SIGNATURE �� DATE c}ONt 26, 2( 3nJ . FOR OFFICIAL USE ONLY u PERMIT NO. {+ DATE ISSUED MAP/PARCEL NO. _ ADDRESS F VILLAGE f OWNER, t" DATE OF INSPECTION: - 3 -FOUNDATION 4 FRAME a INSULATION FIREPLACE ELECTRICAL: ROUGH =FINAL PLUMBING: ROUGH FINAL GAS: s ROUGH ' FINAL FINAL BUILDING f DATE CLOSED OUT A 17V ASSOCIATION PLAN NO. = The Commonwealth of Massachusetts Department of Industrial Accidents r office oflnsestigations _ 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name: location: $0K 15 So citV IAc,T wad G 2 6 —5 Dhone# ❑ I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one workin in arty capacity %%/�%%%%%%%//%//%%%////%%%%/%%%%%%%/%%%%%/%%%%%%%%%%%%%%%%%�/��%%%%��%O�/�%�%/%%%/, er rovidin workers' compensation for my employees working on this job. Xx ❑ I am an employ P g coin any name: ,.. :address ;: <: "hone `insurance co: /. am a sole proprietor, general contractor,or homeowner(circle oneIry and have hired the contractors listed below who have workers' co ensatioii polices: the following mp P . comvanv name � 1.;��+�' �t�# ►�� �' �#�' 31, address .. ;....:.:;. ......... t � nsnranceco:,; •� c�tm�i iaay name: '� - address. . . ela ro ire t.c `'" .... : - one#. :: ci : _.. h :: `' .. ....... .. :... 1� ev go nsnrance co�:<: :: Fafiwe to secure rnverage ss required ender Section 25A of MGL 152 can lead to the imposition of criminal penalttes of a tine up to S1,500.00 and/or o�y�,�imprisomnmt a,weII a,dvti penalties in the form of a STOP WORK ORDER and a tine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DU for coverage verification. I do hereby certify p • an p es o perjury that the information provided above is true and correct Signature Date Print name / Phone# official use only do not write in this area to be completed by city or town official permit/license# ❑Building Departrnmt city or town: Licensing Board is required ❑Selectmen's Office ❑checkif immediate response ❑Health Department contact person: phone#; Other WNRCIIN Oevind 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, 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 an employer. MGL chapter 152 section 25 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,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please'fill in,the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of i mwmce as all affidavits 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. City'or Towns ,� ; ' ' ,r , _, � • 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 fill out in the event the Office of Investigations has.to contact you regarding the applicant. Please .. o t may be return t_ be sure to fill in the pernntllrcense number which will be used as a reference rumber. The affidavits y the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call.. • The Department's address,telephone and fax number: j.�,, '� ._ The Commonwealth Of Massachusetts Department of Industrial Accidents Office of levesilgallons 600 Washington Street i Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 FEE VALUE WORKSHEET LIVING SPACE (2000 sq ft or greater) square feet x$115/sq.foot= (less than 2000 sq ft) square feet x$96/sq. foot= (affordable housing) square feet x$57/sq.foot= (40B or low income) GARAGE(UNFINISHED) square feet x$25/sq. foot= PORCH square feet x$20/sq. foot= DECK OtT f C 310 square feet x$15/sq.foot= "� ALTERATIONS/RENOVATIONS t 'vex 3 (� 1 AR , 3 OF EXISTING SPACE . . . . . . . cost=. . . . . . . . . . . . . . . Total Project Fee Value Office Use Only Permit Fee I projcost d► I i i 1 i I Ii 1 • < 1 •/4 (�'697L7J10'I7.(!/CQGLIL QL i (i(,pd�p,�tlL6Q� BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 039032 Expires: 1 1/2001 r.no: 11078 Restricted To: 00 r- CARL A GRASSETTI 1611 MAIN ST POBX 1310 COTUIT, MA 02635 Administrator • p If 'E D C i a a i x C e i. ' E i 1 � 9 ,J L.. F rr: 310 CMR 10.99 > Form 2 Fti•No. DA-92073 4& CF TH f t0� Hyannis 1 Commonwealth { 4 C+N,Town i DARTSTABL1, S . of Massachusetts ,00 Mb v `�� ApDncant Town of Barnstable '°�o 39 k'e Structures & Grounds Dept. Date Ftectu"Filed- Nov. 24, 1 g92 Determination of Applicability Massachusetts Wetlands Protection Act, G.L. c. 131 , §40 TOWN OP BARNSTABLE ORDINANCES, ARTICLE XXVII From Barnstable Conservation Commission Issuing Authority Town of Barnstable To Structures & Grounds Dept. Town. of Barnstable (Name of person making request) (Name of property owner) 800 Pitcher' s Way Address Hyannis, MA 02601 Address This determination is issued and delivered as follows: 0 by hand delivery to person making request on (date) U by certified mail,return receipt requested on December 22, 1992 . (date) Pursuant to the authority of G.L. c. 131 , §40. the Barnstable Conservation Ceimni 88i has considered your request for a Determination of Applicability and its supporting documentation, and has made the following determination(check whichever is applicable): Location: Street Address Lot #191 Ocean Ave. , Hyannis Map Number. 306 PArrAliimhAr: 191 N 1. C The area described below, which includes all/part of the area described in your request, is an Area Subject to Protection Under the Act.Therefore, any removing, filling, dredging or altering of that area requires the filing of a Notice of Intent, 2. G The work described below,which includes all/part of the work described in your request, is within an Area Subject to Protection Under the Act and will remove, fill, dredge or alter that area.There• fore, said work requires the filing of a Notice of Intent. Effective 11/10/89 2.1 .3. O The work described below, which includes all/part of the work described in your request, is within the Butter Zone as defined in the regulations, and will alter an Area Subject to Protection Under the Act.Therefore, said work requires the filing of a Notice of Intent. This Determination is negative: I1. O The area described in your request is not an Area Subject to Protection Under the Act. 2. . The work described in your request is within an Area Subject to Protection Under the Act, but will not remove, fill,dredge,or alter that area.Therefore,said work does not require the filing of a Notice of Intent. 3. O The work described in your request is within the Buffer Zone,as defined in the regulations, but will not aller.an Area Subject to Protection Under the Act.Therefore, said work does not require the Ifiling of a Notice of Intent. 4. O The area described in your request is Subject to Protection Under the Act, but since the work described therein meets the requirements for the following exemption,as specified in the Act and the regulations, no Notice of Intent is required: Issued by Barnstable Conservation Commission ISignature(s) This Determination must be signed by a majority of the Conservation Commission. i this_ 22nd December 9_2dayo, bebre me personally appeared Eric Strauss to me known to be the person described in, and who executed, the foregoing instrument,and acknowledged that he!she executed th�saas /her fie act an deed. INovember 6, 1998 tary P l My commission expires This Determination does not relieve the applicant from cOmDiying with an other aDDlicable leoeral.state or local statutes.ordinances, by-laws or regulations.This Determination shall be vatic for three years form the dale of issuance The aPDlicanl,the owner,any person aggrieved by this Delerrninaoon,any Owner of land abutting the land UDOn which the prOoosed work is 10 be none,or any ten residents of Ins city or town in which such land is located.are nersoy noliflso 0•Ineir tight to reouest the DeDanmem of Environmental Protection to issue a Suoerseomg Determthation of Apolicabilily orowding the reouest is made by cenitieo mail or hand delivery to the Department,with the appropriate filing fee and Fee Transmittal Form as provided in 310 CMA 10.03(7i within ten days from the date of issuance of this Determination,A copy of ins request shall at Ina same lime be sent by oertif ied man or nand delivery 10 the Conservation Commission and the applicant. 2.2A I' l ` r r COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY —Q• OF 1010 COMMONWEALTH AVE. 9111111116 MASSACHUSETTS BOSTON,MA 02215 EXPIRATION DATE —INS i h. '1[ IF'ER J i:S'!=!ice RESTRICTIONS EFFECTIVE DATE LIC—NO. 00 05_;:_:c_17 o 5/1- ?: DR GAGED IN THIS OCCUPATION. O ROV. AIITH. Assessor's office(1st Floor): Assessor's map and lot number 3 D 49/ >GJ�ti '• twc Conservation PROPERTY ba,,,at' Board of Health(3rd floor): _ TO TOWN SEWER 1'RIO I'O AVN {Sewage Permit number 9J, /� C. �JC N• DARIsTLELc rua Engineering Department(3rd floor): �o�oe39.`\�d° House number Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN. OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �E� 5TePeT '3C,�Aa S ST/LC�-7 �Iy�3titiiJ Proposed Use ��/l /`�4 USt�- Zoning District Fire District Name of Owner ,O VJltl 6 8--o G lklk Address —Tc/,7 /W/V Sf Name of Builder � �a lc/J APOO Address (F0 0 • Name of Architect 173 V'• �. `� o4�c'�N Address 000 Number of Rooms Foundation Exterior Roofing ®!AI Floors Interior Heating AlC N e Plumbing I'Vewl•C'���- 00 Fireplace W0 C Approximate Cost 14 ©DO. Area Diagram of Lot and Building with Dimensions Fee sC i 1 OCCUPANCY PERMITS REOUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License 05?3d 't TM N OF BARNSTABLE e 4 F No 35581 Permit For REMODEL/BUILD HANDICAP RAMP Bath/House ` Location 465 Sea Street Hyannis Owner `Town of Barnstable Type of Construction Frame s Plot Lot Y e IiE Permi.V!�;0,51',e ted December 29 , 19 `2 d - . Datection 19 w 7/9� 19 Date Cted j rz i f � r i TOWN OF BAR,NSTABLE ' BUILDING PERMIT PARCEL ID 306 191 GEOBASE IP,-.21596 ADDRESS 465 SEA STREET PHONE HYANNIS ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY I PERMIT 54516 DESCRIPTION KEYS BEACH H-CAP RAMP I PERMIT TYPE BADDD TITLE BUILDING PERMIT ADD DECK CONTRACTORS: C_A_GRASSETT I Department of Health, Safety ARCHITECTS: and Environmental Services c-TQTAL FEES: $50.00 BOND $.00 pxT 'CONSTRUCTION COSTS $4,650:00 i 434 'RESID ADD/ALT/CONY 3 PIC. PR 'P"" .; * BARNSI'ABLE, • MA83. .., 059. A�O� I FD MO'I► BUILDING DIVISION BY DATE ISSUED 07/13/2001 EXPIRATION DATE �- TOWN OF, BARNiSTABLE BUILD��NG FARCE �L ID (�b 101 r' . GEOBASE ID, 21596 ADDRESS 465 SEA STREET-. : . PHONE .LOT h"F BLOCK LOT SIZE 'DBA "�; ' ' DEVELOPMEN ' DISTRICT HY PERMIT 54515 DESCRIPtia! ,KEYS 'BEACH H--C;AP E,AKP PERMIT ,TYPE BADDD TITLE BUILDING PERMIT ADD, DECK CONT CTO s: C_ RASSE� Department of Health, Safety 'ARCHITECTS--- and Environmental Services TQTAL FEES: $ U_00, BOND $.00 ,,CONSTRUCTION COSTS $4,656.0 4$4 AESID ADD/ALT/CORk1 S PIJB SIC PR:Ti"_ l + BARNSTABLE, 0,39. .BUILDING DIVISION i F. BY DATE ISSTJED. 07/13/2001 EXPIRATION DATE . ' _ . THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,.ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER.THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY.APPLICABLE SUBDIVISION RESTRICTIONS. ' MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL'INSPECTION PERMITS ARE- REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS. HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION, OCCUPIED UNTIL FINAL INSPECTION HAS BEEN.MADE. . 4.FINAL INSPECTION BEFORE OCCUPANCY. 2 A i C BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 I 2 2 2 ' 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I 2 BOARD OF HEALTH i OTHER: SITE PLAN REVIEW APPROVAL j WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVEDTHE: STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY, .VARIOUS STAGES OF CONSTRUC- MONTHS OF.DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION.- NOTED ABOVE. TION. r II rn — ao r v � _ z � . TO ALL W USINESS OWNERS DATE: f r, . Fill in please: APPLICANT'S YOUR NAME:_L C( In I �ZR JPP,!5�S BUSINESS o® YOUR HOME ADDRESS: 90 9 qzCu//CC ' - TELEPHONE,�DFS- Telephone Number Home 0&= 0 NAME OF NEW BUSINESS f TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES I NO r_� Have you been given approval from the buildin division? YES NO 10 ADDRESS OF BUSINESS - s MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONE 'S OFFICE This individual has be infor d of any permit requirements that pertain to this type of business. u orized Signature* COMMENTS: e Rr-ul 'yfat( D 2. BOARD OF HEALTH This individual has b informed of Mor r quirenIgnts Pat pertain to this type of business. Off- Aut orized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** I COMMENTS: Business certificates (cost $20.00 for 4-years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. 8 a ogo $a' bP. l iff6 is - r-0'7'1- � o a s s 12• 1 . I S �P N bP• a . N F Sea Street - Keyes Beach TOWN OF BARNSTABLE b D ADA Requirements Department of Public Works ---� n Sea Street Structures&Grounds BARNSTABM ft m Hyannis, MA 02601 800 Pitchers Way, Hyannis, MA 02061 9�a :a3� �•� 1 z � t I ; Jai I I \ �\ cajAirek �-X 15 T I N G rARK-� Q G I IV IV 4;E T U E. E.X►S T �!64 Pk-7t4 W d`t'a `� cr Izti c 5 5t-1nw ID. > 4 l 1 � S { T f- / i�t••\,�_-p��'__ COUTrurnus 2hG, j r / / , 3j4 x 6 pr pCG�rcic., Q-, �I rr 2x IoA� rip 3 / HT � T W ', r ' y�E L , `r rt -- �� _ t ' - rr Z T-f 1._ ' ! I ti rL x �! R 4 Y 4 ZT-- C ti l pal K. C t zW A '� �►�?2t fr t�A.LS C' 1 y �I A y ":c STRI U,%,Kt 7 t}. T f'4..� NG = GOM FACT bENhE r X - - — - -- I t C.r P «( v G C+IZ&p E a h L 0 G RAUIV- f ta 1 L 5 T/,1 L5 TO lam! H Or t N c.TA,...b.LE { P F 17 - - --- - Y/ 5 C. F', t-IF r . - 1 ^ � ( M � '� ri b � .t i t (, � 1 � � ."�� EX l�j- � ✓ ti �I-',� i �.1 �—� I '` � �i �( ( �_7 1 �..� -- r, afO ----- - - �. ; _► Lot - --_--