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Home My WebLink About0059 GEMINI DRIVE S M EAD No. 53LOR UPC 12543 smead.com • Made in USA OjFI raa�ua®an�snoounue WNWA-mmCMAKOW � c�� Lam- 31�a1 � TOWNOF BAUSUB`L" 'BUILDING PERMIT APPCICAITON ulinllVO lAbLE Map I Parcel Application # Z0 V Health Division Date Issued Conservation Division Application Fee O" Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Boardi Historic - OKH _ Preservation/ Hyannis Project Street Address ✓'`��_��2jlU/ ��2 Village.y, � � / Owner Address Telephone 2�9 3 4 O Z F J>� Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing .proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 'lid Dj G Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ M,ulti-Family (# units) Age of Existing Structure Historic House,/�Yes allo On Old King's Highway: ❑Yes ANo 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 I 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 ❑ No If yes, site plan review # Current Use - Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name l'�� L �/�y 1A Telephone Number .J 7, tf- Address �/ ,G2,/�i/1/dam C'r� License# io o Y" Home Improvement Contractor# ��.��,�'!_ 'Z Email Worker's Compensation #f► 4 D "l' /�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO f SIGNATURE DATE ,{ FOR OFFICIAL USE ONLY it :3 APPLICATION# r y, DATEIISSUED MAP/PARCEL NO. N ADDRESS VILLAGE OWNER r; DATE OF INSPECTION_: FOUNDATION ' a FRAME `r INSULATION s>, FIREPLACE '4 ELECTRICAL: ROUGH FINAL C., r PLUMBING: ROUGH FINAL s GAS: ROUGH FINAL j FINAL BUILDING. DATE:CLOSED OUT ASSOCIATION,PLAN NO p Town.of Barnstable Regulatory Services • �" " Richard V.sc4 Director Building Division Tom PeM,Buil4ing Commissioner 200 Main Street,Hy=iis,.MA 02601 www.towa.barnstabte aia.as Office: 508-8624038 Fax: 508-790.-6230 Property Owner Must Complete Nand Sign This Section Xf YJsin .' Budder b I; ,as.OwneT of the.si 1`ect P roP�y Cherrbyauthorize _0".on mybehalf, in all matters relative to vi authorized by this buMmg permit application for. {Adth�es's'o��nb), n"Pool fences and alarms are the respons ikyof the-applicant Pools are not to be.filled or utilized before fence is installed and all final inspections are.performed and accepted. 4, WtM o Owner -Signatm of Applicant 2 I jr L - FW)L� Prust.Naime Print Name 171 LI/I Z:�_ Date Q:FORbMOWNERPfiRMlSS1ONMLs Massachusetts-Department of Public Safety Board of Building Regulations and Standards License; OS•100988 Construct'lon S uperv,Isor. HENRY E CASSIDY' ,V�-41 8 SHEO ROW WEST YARMOUfH i t Expiration; Commissioner 11/11/2017 Commissloner 11l11/2015 t Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Kome Improvement Co.nt,rarctor Registration ' Reglstralion; 153567 Type; Prlvale Corporation Expirailon; 12115/2016 TrY 259188 CAPE 000 INSULATION, INC HENRY CASSIDY I ` ' •• —_._. 18 REARDON CIRCLE t I SO, YARMOUTH, MA 02664 Updale Address Rnd return card, MRrlc reason for chnngc. $QA, +', zoM•o5/Ir ❑ Address [� ReneWRl ❑ I✓mploymenl Lost C'�• /ce omrraa�uvaralt/c v�!'e/l/l�warr•o/cweGto ..... ........ ...... .. Offlcc of Consumer Affairs& Ruslncss Rqulatlon Lleense or registration vRlld for Indlvldul use only OME IMPROV,8, ENT CONTRACTOR before the expiration dRts, If found return to egistratlon; 1*33557 Type; Office of Consumer•AffRlrs Rnd Business ReguiRtion xplralPon;- 1; h45120.:i6 Prlvate Corporalon 10 Park PMR .Suite 5170 CAPE COD INSULA?:ik7:N:;:;I1C' '"'i Boston, MA 02116 HENRY CASSIDY 18 REAROON CIRCI.F.', ' '•;,,;' �� S0. YARMOUTH,MA 0268Q Undersecretary N. ut sign e Ilse Uommoinvea.lth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street ;:,• ;: Boston, NIA 02111 ' wrvrv,mass,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers . Applicant Information Please Print Le ibl Name (Business/Organization/Individual); �/rt ' t r ^ � Address; City/State/Zip; •"� VA., ff 1114 t fhp' Phone #; Are you an employer? Check th• appropriate box; Type of project (required): I. I am a employer with 4. ❑ 1 am a general contractor and I employees full and/or part-time),* have hired the sub-contractors 6. New construction 2.❑ 1 am a sole 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' �i (No workers' comp, insurance comp, insurance.# 9. ❑ Building addition required,) 5. ❑ We are a corporation and its 10-0 Electrical repairs or additions 3 D 1 ahomeowner doing all work officers have exercised their 11,0 Plumbing repairs or additions myself. (No workers' comp, right of exemption per MGL insurance required,) t C. 152, §1(4), and we have no 12,E] Roof repairs employees. (No workers' 13,1� Other. ' comp, insurance required.) Any applicant that checks box N I must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this aMdavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check phis box must avaphed an additional sheet showing the name of the sub•conb,actors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers' comp, policy number. I am an employer that is providing workers' compensatlon insurance for my employees. Below is the policy and job site Mfo.rmalion, Insurance Company Name; ,, Policy # or Self ins, Lic, #; lr�Ci el�l 0 � ✓� Expiration Date;_ Job Site , __ _ _��/, // ity/State/Zip; Attach a copy of the w6ihkers' compensation policy declaration page (showing the Policy � p y 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 i.prisonment, as well as civil penalties in the font 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 lnvesti rations of the DIA for insura covera e verification, 1 do hereby certify d the pal an penalties of perjury that the information provided above is true and correct. Si nature; ` Date- Address:— Phone#: z Official use only, Do not write in this area, to be comp eted by city or town offclal, 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; CAPECOO-27 BDELAWRENCE ACORO`" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 6/30/2015 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: Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 c AIc No): (877)816.2156 South Dennis,MA 02660 EMAIL ADDRESS: INSURER 5 AFFORDING COVERAGE NAIC 0 INSURER A:Peerless Insurance Company•see LIBERTY MUTUAL INSURED INSURER B:ATLANTIC CHARTER INSURANCE GROUP . Cape Cod Insulation,Inc. INSURERC: 18 Reardon Circle INSURERD: South Yarmouth,MA 02664 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR•OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I�TR TYPE OF INSURANCE POLICY NUMBER MMIDDY EFF MM/DD LICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR CBP8263063 04/01/2016 04101/2016 PREMISES(Ea occurrence) $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES RER: GENERAL AGGREGATE $ 2,000,000 X POLICY a PRO• LOC PRODUCTS•COMP/OP AGG $ 2,000,000 JECT OTHER: $ AUTOMOBILE LIABILITY a COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS t NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ , $ UMBRELLA LIAR O CCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS•MADE AGGREGATE $ DED I RETENTION$ $ WORKERS COMPENSATION PER OTH• AND EMPLOYERS'LIABILITY Y/N STATUTE I iER B ANY PROPRIETORIPARTNERIEXECUTIVE WCE00431901 06/30/2015 06/3012016 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L.DISEASE•EA EMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additlonal Remarks Schedule,may be attached 11 more apace Is required) Workers Compensation includes Officers or Proprietors, Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CAFE COD INSULATION 7qb/),. Iq N P4 /Ip IAlff 71AA11117 '"MAY V'A"Op 3USYIHO3O IAIf! OUillpl IHIUl Al10H f11lIHOf 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: 2123116, Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, completed the insulation and weatherization work at the property listed below. Cape 1Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance .Institute '(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village C A0-q 5 �4W11V1 �2 GJ � Insulation Installed: .Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( (x) ( y�) ( ) (K) Slopes ( K� Floors ( ) ( ( ( ) Walls ( ) ( ) ( ) (VOr r)ror,"e l in .cam Sincerely 2rHE ssi r, President Ins ation, Inc,