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HomeMy WebLinkAbout0040 ALDER BROOK LANE o uu UPC 12543 No. 53LOR NASTIM 0%RAN TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION :3 Tp��1?d OF �ARNs�ABLE Map 1 3 3 Parcel 0 5 A aplication # Health Divisionftt6 Date Issued a-1115 Conservation Division Application Fee 500 0y Planning Dept. Permit Fee d� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 4 0 A det` a�mo�r (�anG Village W es+ 3 g 1-05 t4 �G Owner �a�rt,� N Q to lh i�w Address Sr.,rn C Telephone S 6 8 S 6 169 5 Permit Request f��d �'�9 �16e (&58 'F o 4 ke, a rc an a 6aSeM eA eA Ae -,x4ic Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3),0D Construction Type Lot Size Grandfathered: ❑.Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Ages 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) I 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 ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes dNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name r 1,0,01 .e �C,_&­C, Telephone Number 298 G 3 4 Address J -D l� A ji' t-vn PVC, License #� Y ar-m@ u,.-}-h ME a6 6 Home Improvement Contractor# Email Worker's Compensation # 6JUJC 313 ,6 lY ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Ywr^o u&,- b SIGNATURE DATE 0 l FOR OFFICIAL USE ONLY APPLICATION # ' DATE ISSUED `MAP/PARCEL NO. r f ADDRESS - VILLAGE OWNER , DATE OF INSPECTION: , FOUNDATION . FRAME INSULATION FIREPLACE f f ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN.NO. , i The Commonwealth of Massachusetts Department of Industrial Accidents ` 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Avalicant Information Please Print Legibly Name(Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): I. am a employer with 2D employees(full and/or part-time).*❑I 7. F]New construction 2.[]I am a sole proprietor or partnership and have no employees working for me in 8• Remodeling + any capacity.[No workers'comp.insurance required.] 3.�I am a homeowner doing all work myself.[No workers'co insurance ]t 9. Demolition rap. required. 4.❑I aat a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp,insurance.- 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[E]Other Insulation 152,§1(4),and we have no 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. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors 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 andjok site information. Insurance Company Name:Wesco Insurance Company Policy#or Self-ins.Lic.#:WWC3136274 Expiration Date:04/09/2016 Job Site Address: 40 Alder Brook Lane City/State/Zip: West Barnstable Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under th pains andpenalties of perjury that the information provided above is true and correct Signature: Date: 1/20/16 Phone#:508-398-0398 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 Contact Person: Phone#: ^c DATE(MMIDDIYYYY) am�® CERTIFICATE OF LIABILITY INSURANCE 10/14/2015 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 pollcy(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 endorsements. PRODUCER CONTACT NAME: Colleen Crowley Risk Strategies Company PHCtN E (781)986-4400 FAX,No: (781)963-4420 15 Pacella Park Drive ao1�SS:ccrowley@risk-strategies.com Suite 240 INSURER(S)AFFORDING COVERAGE NAICi Randolph MA 02368 iNsuRERA:Selective Ins. of America INSURED INSURERB Allmerica Financial Alliance Ins Co 10212 Cape Save, Inc INSURERc Wesco Insurance Company 7 D Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL15101402127 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. INSR ADDLSUBR TYPE OF INSURANCE POLICY NUMBER MMIDD EFF MPMIICY EXP LTR LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OCCUR PREMISDAMES(Es occurrence) $ 100,000 S1994480 10/16/2015 10/16/2016 MED EXP(Any oneperson) $ 10,000. PERSONAL 8 ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY�PE LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILRY Ea COMBINEnt $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED VED X SCHEDULED AWMA46796600 11/6/2015 11/6/2016 BODILY INJURY(Per accident) $AUTOS . AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Par accident) ccident $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000, 000 DED RETENTION Nil il994480 10/16/2015 10/16/2016 $ WORKERS COMPENSATION Officers Included for X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE NIA Coverage E.L.EACH ACCIDENT $ 500 000 C OFFICERIMEMBER EXCLUDED? 1;1 (Mandatory In NH) WC3136274 4/9/2015 4/9/2016 E.L.DISEASE-EA EMPLOYEE $ 500,000 If Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included as Additional Insureds with respects to the General Liability coverage of Named Insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 460 West Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Michael Christian/CLC �s O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) i f I - �. Town of Barnstable ,egnibtory Se ces • ar►su RicbaidV Scaii,:Direttor Rading Division Tom Perry,D.Wi fUrcommdssioner 200 Main Sow Hyannis,•.A-61601 WWW.t6Svu ba nstable ma ns Office: 50.8.--862-4038 Fax •508 790.-623A Property Owner Must Complete,aft&S*uThb: Ser- -tion IfUsingy.-ABider heiebyauthorize G rA 0— 2 IA L- _ t o acc ot;,my behalf, in all matters.rd iv a zm workmthmized'.byrhis building permi-application for �O M&, {Addm � MA- �2 6 `PWl fa ices and alarms are.rtie rmpoi itgof:�die:appfi t. Pools are mtta.be"fill A.a uvhzed beloi ;fence is inst and all(final uupectiq az pexfo cl•aad:acceptecl. S• -,o ownrw S4aamrer6f.Ap;&c= �o�re� C1e/W►� mint Name Peat Name • � i Z z� r� Dom•• u QiFORIKScOWNE�EJtM1SS10NP0UtJ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. _ WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. scn, C. zoMvsn, Ej Address Renewal ❑ Employment Lost Card �l/tv frt,iicrict•rctt�eul/�ts/�!�(.ttJ::nr�ttJ�//5 ._.. .. _ • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only 'WE OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 171380 Type: Office of Consumer Affairs and Business Regulation xpiration:;—3/14L20a6. Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE:' SOUTH YARMOUTH,MA 02664 Undersecretary Not vali tthout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards LOirStrilCiuirr `DiirrOi�iafir�ncCinii�' -.:tea " License: CSSL402776 WILLIAM J MC OUS19 37 NAUSET ROAD tIIf West Yarmouth NIA Expiration Commissioner 06/28/2017 Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 2/3/16 Thomas Perry CBO ' Town of Barnstable Building Division o 200 Main St. Hyannis,MA 02601 QU RE: Insulation Permit B-16-37 CO Dear Mr. Perry This affidavit is to certify that all work completed for 40 Alder Brook Lane,W. Barnstable has been inspected by a third party Certified Building Performance Institute(BPI) Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey Assessor's map and lot number ......`� 3 �� ' /`' / / ✓r c _ - -7 C%THE TO Sewage Permit number ( :yc� A MUNOTALUD OR ���� / CoMli TdDLE, i House number I.......:....... ,,�i63 ♦� . WITH TITLE 5 ENVIRONMENTAL CODE o , °ypYa\ TOWN OF BARNSTAO LATIO -<<, BUILDING "I,NSPECTOR APPLICATION FOR PERMIT TO ...... Y..........q .. ................................................ ' TYPEOF CONSTRUCTION ............................................. ................................................................................. .. ....A...........................10 . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ermit according to the following information: Location .....1...1......`.,a . .. ...... ......................................................................................................................... Proposed Use .............. ..... ........G �1 .... ................................ Zoning District .......��X-%. ( ~� ............................................Fire District ...�!"..........:..............�........... ........................... Name of Owner . A-,A`4.:... ......................Address � Y ..' Name of Builder.... ................................ ..................Address ..jq< VCR A... `� . .. . Nameof Architect ........:...... ....................Address `............................... .................................................................................... Number of Rooms ..................................................................Foundation 7774m.c�..(:O.,'1Cv.p. ........................ Exierior ....................................................................................Roofing ...... � Floors ....�� 4�!tr .i...�0!1�Y. 1C` ..........................Interior ............. Heating ..................................................................................Plumbing .................................................................... Fireplace ..:......................................................:........................Approximate Cost ...........!K�,Q.Canw................................... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ...L1.L1 zP...................... Diagram of Lot and Building with Dimensions Fee .` ��....... ................................ SUBJECT TO APPROVAL OF BOARD OF HEALTH 00 /G Ry �V- I hereby agree to conform to all the Rules and Regulations of the n of We above construction. Name ...................... 21427 Russell, William No ..�1427.... Permit for .....gaxage.....aCr,.•t© dwelli Location ........Alder-brook Rd........................... �. . .......................... � WeS}r..J3jarns.tablP- William Russell,, } Owner .......................................... ...................... u Type of Construction .......Fr; ....................... ............................................................................... y Plot ............................ Lot ................................ o � Permit'Granted July..... .......19 79 Date o_f Inspection • .......19 Date Completed .............. ............19 t PERMIT REFUSED ....... ..... .................................... 19 .:>............................................... 3. .. . ....................... ...... �46 . <.................................................. !, 3e.Cr. .. ................................................. ApproWcS... ........................................... 19 M 0 M. .................... ...................................................... i • 4 s 40 7- 4-or s W � i R24 r • f S/L[. EL.E 1✓-- --fE.ET 400✓E PO,QD GvE-S T L OCA T/O/\/ BA'eNST<16Le--4 14A—Q 55• SCALE �- 4O -D,1 TE= PLAN 2E ocL-V e A/Cf-- �C- AJ LO7- S A 5 5/N O C4J N /^j 2.-2 3 PA S/ !R , GEORQE, G J' LOW, J ,'`C�i ✓ 41 of H I NEQEBy CEQTiFy' T</ATTA/E EXIST- OfSSEa yp� /NG FOU.VDATiON LOCLIT/QN /SQVZP.E 0 E ,4s 6WOWV A�vo---DO-ES_CoAvFo,eM WlTN Ts-/E 81-1/LD/1vG SE743ACe,06 JUi2EM6V OF T.,/E TON/N Of40/Z VIE C3�4 n!S 774�3 L 717 /ov — - -1 - - G�Ou�EGL={ T,v'YG02 Co�7? E L L / _ .�S - - 6 GtiiGGO�t/.ST yA2tilO uTs/vo 8T MA-: / el . �G6hc - 7-2/—7- Assessor's map and lot number JJaa,m� h f �,• SEPTIC SYSTEM MUST p� � INSTALLED ,IN COMPLIANGS c Sew-age;Permit number ................................. ........................ �IVI7H ARTICLE II STATi �lUNITARY Com g4j) � ,Qyo�THEr,� :N TOWN OF BA S YABLE " a � BUtL0.1NG INSPECTOR , 9�p 639• �`'\00 MP D Y . � L i -i `a �t r'-� 0: Q -9 CC, CA • y � � r APPLICATION-FOR PERMIT TO ........... / R. ......................... ....... .... oTYPE OF CONSTRUCTION .............. ....L.- ... .�'I.�=.......................................................................... }'1 • tom. .......................................... � ' s.. 9..21-7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....t?.V.�.��` ...L, `�. -�/...... . .L;.�........................................... ProposedUse c��` � .�-/..�!!.. >- .................................................................................................. Zoning District ..... ........................ .......Fire Districtlw A? il?'j, LF PW Name of Owner ........ ..............................Address ........................... Name of Builde714 ��/ �M1V6?L) ....Address ls1�L�s% �l�i // � ................ ....................... Nameof Architect .........�.......4..........................................Address .........................................................................°.�......... Number of Rooms :_ ........................................................Foundation ......C-�.......�.........../� Exterior PJ40 dT�/��LG--.. .............................Roofing A:�Vx.I, � Floors ?'1U � fl .Interior . 5llgF/ !►®���... ...... .. ...... .......... ........ Heating // �f�' /... -......................Plumbing ..... ? J .. lf /`�/Z( U� .51 Fireplace ....................................................Approximate Cos ..... ......................................... Definitive Plan Approved by Planning Board -------------------_-----------19___------ Area ......�....f UP Diagram of Lot and Building with Dimensions Fee U SUBJECT TO APPROVAL OF BOARD OF HEALTH ®rx •i• I hereby agree to 'conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Narr . ......... Russell, William H. P462 " 1 1/2 story No ......... Permit•for .................................... le 'famili dwelling ..... ing. ................................................................. -d� Locatiod. .D.Al.d.er.Arook...Lane.............. .. ....... .... ...... .. ........ ........ L West Barnstable ........................................................... ..................... Owner William H. Russell ................................................................. ame ype'of Construction .................... ...................... T fr ............ .............................................................. I #5 Plot ... ..................... Lot ................�7 ............ August 2 Prmit Granted .......... ..............��i 9 Date of Inspec ion. ....K19 6 Date Completed ........19 PERMIT REFUSED Cam- 51 de r 1;7/...... ................................... ............ .... 19 ..................... k;;:� JAI ............... ..................... . ................................. ..........V;............... V .......................... ................... ....... • 46' J "v Approved .................................... ..�r . .......... 19 ...................... ....................................................... -A,....................... V col