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HomeMy WebLinkAbout3655 MAIN ST./RTE 6A(BARN.) amss m�,� s� �/ � oNE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 0�0 Application # Y Health Division Date Issued IZ--� Conservation Division - �)t° Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved,by Planning Board Historic - OKH _Preservation / Hyannis Project Street ddress to G A Village 4e4y1 i Owner 64A J Address 3 ��� 1P� G/9 ��✓ +�.� / � Telephone 3; - Permit Request e-h)MIs-ey seom. Aza ��A LV_S r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation # 00 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: X,/Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other eve C-ow-, `- C,rr Basement Finished Area (sq.ft.) Basement Unfinished Area(sq..:) Number of Baths: Full: existing new Half: existing µ ''s new_ Number of Bedrooms: existing _new rpra Total Room Count (not including baths): existing new First Floor Room";Count "..o Heat Type and Fuel: ❑ Gas XOil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/,coal stove: ❑Yes WNo 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameVe:.2 40elf Telephone Number �-2 Address /:2 License r 0.2 Home Improvement Contractor# Worker's Compensation # t-t�G ,q`��� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL )TAKEN TO iR SIGNATURE "r -' DATE r ' •7�' , _ FOR OFFICIAL USE ONLY ArPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: ` FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL - - t PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /✓.fir A����yC Address: , / Z ��i'�iv �•�iv� City/State/Zip: 91=2n=a= � 4,' fr.2«�Phone#: 5­0F ' 16 2- I L de/ Are you an employer?Check the appropriate box: Type of project(required); 1.XI am a employer with 4. 0 I am a general contractor and I employees(full and/or art-time have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor o r- listed on the attached sheet 7. ❑Remodeling shipand have no employees These sub-contractors have 8. []Demolition working for me in any capacity. employees and have workers' comp. insurance.$ 9. ❑Building addition [No workers' comp.insurance P• required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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 , employees. [No workers', 13.0 Other el 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. lContractors that 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-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 1,6r t C-eVS!f t 4#L000 . 1 ev„C-� �o23v Policy#or Self-ins.Lie.#: Expiration Date: i Z fL Job Site Address:_�� /� LL 'J/ ),Ltd City/State/Zip T � , < - : 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 insurance coverage verification. I do hereby certify u er the p ' and pe es of perjury that the information provided above is true and correct. Si ature: Date: Phone#: � '314 2 F/ Official use only. Do not write in this area, to be completed by city or town official 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 Cent#ct Person: Phone#: eug. 28. 2012 11 : 19AM No. 6120 P. 1/3 AVKUTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 08/29/2012 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(les)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: Joanne Bretton Southeastern Insurance Agency, Inc. PH NuE : 508.997.6061 FAX N,: 508.990,2731 439 State Rd. E-MAIL ADDRESS: P.O. Box 79398 PRODUCER CUSTOMER ID/: North Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIC III INSURED INSURER A: Central Insurance Companies 20230 Steven Cappelucci INSURERS: 12 Gordon Lane INSURERC: Yarmouthport, MA 02675 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2012 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 CONTRACTOR 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. LTR TYPE OF INSURANCE INSR WVD POLICYNUMBER MMID MMfDD LIMITS GENERAL LIABILITY CLP7944623 11/3012011 11/30/2012 EACH OCCURRENCE $ 1.000,00 11 TO X COMMERCIAL GENERAL LIABILITY PREM SES Ea occu�ence $ 100,00( CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,00( A PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 3,000,00( POLICY 7 jE7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 ANY AUTO BODILY INJURY{Per person} $ ALL OWNED AUTOS BAP8458349 1012812011 10/2812012 BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC862499C 12/08/2011 12/08/2012 ORS LIMITS OER AND EMPLOYERS'LIABILRY Y I N A ANY PRO/MEMBERPEXCLUDEO ECUTIVE ❑ NIA E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 yes, be under D ST EN CAPPELUCCI IS INC E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable AUTHORIZED REPRESENTATIVE 200 Main St Hy nnis, MA Joanne Bretton O 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD �W r° Town of Barnstable Regulatory Services MASS. g Thomas F.Geiler,Director 9� 039. �0 'OrFn wu•�" Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 4 ' as Owner of the subject property hereby authorize vim j�� / � �z-r����, i to act on my behalf, � in all matters relative to work authorized by this building permit: (Address of Jodi) y **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 o ner Signature of Applicant �� C BSc' • ` S,/e�e6v 11', C�/� G/�G� , Print Names Print Name ate Q:FORM&OWNERPERMISSIONPOOLS 6/2012 Town of Barnstable Regulatory Services swatvsrasLE, Thomas F.Geiler,Director MASS. i659 •0� Building Division rfD MA'I A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEM IO N �,� ,/ Please Print DATE: r1 �//�/ z JOB LOCATION: number' street �G C village HOMEOWNER": 11 k — - -7G- �.�G name home phon # hone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended t include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire w does not possess a license,provided that the owner acts as supervisor. DEFINITI0 F HOMEOWNER Person(s)who owns a parcel of land on which he/she si es or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detache stru tares accessory to such use and/or farm structures. A person who constructs more than one home in a two- ear peg d shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official a forma ceptable to the Building Official,that he/she shall be responsible for all such work performed under the ildin e 't. (Section 109,1.1) The undersigned"homeowner"assumes responsib' ity for compli e with the State Building Code and other. applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/s e understands the To of Barnstable Building Department minimum inspection procedures and requiremen and that he/she will co ply with said procedures and require Signature of Ho e er Approval of Building Official Note: Three-family dwellings conta g 35,000 cubic feet or larger will b required to comply with the State Building Code Section 127.0 Construc on Control. OMEOWNER'S EXEMPTION The Code states that: "Any homeowner pe orming work for which a building permit is required all be exempt from the provisions of this section(Section 109.1.1 -Licensing of constru 'on Supervisors);provided that if the homeowner enga-es a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exempti n are unaware that they are assuming the responsibilities o supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results n serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed P son 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:forms:homeexempt {z a �dti"�o° a Massachusetts - Department of Public Safety Office of ConsumerAffairs&Bu messRR -MWeg Board of Building Regulations and Standards ME NT CONTRACTO VE is or RO Construction Su pen �r P e: � str M G n HOME T P OM p H Y Registration 432610 381, 13 Individual License: CS-074635 1, Expiration*a STEVEN D CAPPY L ;. ST N D.CAPPELLiJ j'<G 12 GORDON LN; YARMOUTHPORT MA 1 I STEVEN CAPPELLUCCa- 12 GORDON LN T P]IP,=Q�675 " Undersecretary c� Expiration POR JJ YA RMOUTH J.•�.-� ~ 07/16/2014 Commissioner 1 _ E.: License or registration valid for individul use only before the expiration date. If found return to: i Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 { Not.valid witho Sig ure Woo � | ' � INSTALLED IN COMPLIANCE ENVIRONMENTAL CODE AND mARISTABLE, TOWN OF BARNSTABLE BUILDING INSPECTOR TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordin the following information: Proposed Use ............Rr6u.i.r... Name of Owner .......PTA..k.4VX.........M...L473...................Address ....��fi7v�vv PrvL "tAxttv.� Mrc. SUBJECT TO APPROVAL OF BOARD OF HEALTH � OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' � | hereby agree to conform to all the Rules and Regulations of the Town mfBarnstable regarding the above construction. Nome —. -.-.��.v—..��_�—.�-`°_.�_-^��.--. . " � . Construction Supervisor's License .................................... � FIELDS,-A-LLYN No ,28163 Permit for Remove Section of Bldg. .............................................. ... �,,Dwelling .. .................... 6.......................— ................... 466afi. Main Street Location ................................................................. Barnstable .............. ................................................................ . 4' Allyn Field Owner .......................................................... Type of C6nstruction .......Fr ......ame.............................. ..................... ............................................ Plot ........................ Lot ................................ y , Permit -Granted ........Jul 8 85 ...................... .........19 Date of Inspection ....................................19 Date Completed .............. ..........19 M M a: ri M �7 Assessor's map and lot number ...1..1..! =- s, SEPTIC SYSTEM MUST BE F INSTA Sewage; " Permit number ....... "......... ... .. LLED IN COMPLIANCE WITH ARTICLE 11 STATE SANITA`d Co TO ND Tow 7M E roe o : TOWN OF BARN 5 .�TBjLE 868BSTeI1LS, i t• 9� Mb qC% L7 BUILDING " INSPECTOR O MAY a APPLICATION FOR PERMIT TO-..`AA9k7.::... r y TYPE OF CONSTRUCTION .........4-1*,PA4P........................................ .................................................................... ................................................19........ TO THE INSPECTOR OF -BUILDINGS: ' The undersized hereby applies for a permit according to the following information: Locatl6�°f .... ....../1 nl....S. ........! ! �-!/.� !L ...../!1!f'................................ Proposed Use AM/.a../.......�........���..l.T..�J�...............:............................:...............:......................:...... ZoningDistrict ........................................................................Fire District ................................................................................ Name of Owner Tf10I,�. '.... /..lT !QV L .Address �. R....�'1!fl��. Name of Builder 4n 9a..CF.. AC.4...Address .. ✓ :.. ,7rI.......���� C....l.!'!.�!......... Name of Architect ..................................................................Address r l Number of Rooms .........../.............CiX.:l....................Foundation .49Nw 1 20!ff ee�G �cRA(;lc S/'!lsG � Exterior ...jW..h.d.7....lCeO &......r*/*'U f 4.C ................Roofiing R,=jM,q..�.i . Floors ......................................................................................Interior .......... LL................................................. Heating ..........lrflH 'M.... (,R...........................................Plumbing ...............:.................................................................. Fireplace ................ ..............................................................Approximate Cost . BQO......0.10................... ............ Definitive Plan Approved by Planning Board ---------------_---------------19--------. Area .... 9............................... Diagram of Lot and Building with Dimensions Fee �'............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH .......... New jVtV days OAV.s 5'3 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Kalijarvi, Thorsten V. J 19267 add to frame No ................. Permit. for .................................... dwelling ` Loc6tion ......c./. ..Main-.Street................... t r 1 Barnstable ....... .............................................................. Thorsten V. Kalijarvi - Owner .................................................................. w - frame _ Type of Construction r .................................................... ...... .......... i Plot ......................... .. Lot ........... ................. { Me .June 3 Permit Granted ........................................19 77 Date of Inspection .. l.��. ......... j�.....19 ' Date Completed ........ �.... .� :.19 PERMIT REFUSED .................................... 19 -.... ............................................................ ..... ............ •�...................... ...................................................... ............... .....•..� ....... _ .......................... .......................... .................. -. t'Approved .......................................I......... 19 ; ............................................................................... .................. ......................................................