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Home My WebLink About0168 MAIN ST./RTE 6A(W.BARN.) /per` S M EADR No. 53LOR UPC 12543 smead.com • Made in USA m mm=N M9 PROw w* TSFI ��PPOGRAM CERTIRED SD URaNG WWNESRPROORANIARG c TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3 5 Map Parcel Application # 1 . Health Division Date Issued o Conservation Division Application Fee ` Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board0J7� Historic - OKH _ Preservation / Hyannis Project Street Address '�/ �P GA /772' Village AliZ2r2L/SL� �B Owner Yk-je7frB Address TelephoneJ7,? 5 G Z j!�: J!: 5 r Permit Request Z/ -Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ®A o Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach4supporting-documentation. coo Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) , ? -� cn Age of Existing Structure Historic House: ❑Yes ❑-No On Old Kings,Highwayb❑Yes UNo m Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ;�; M Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of 134ths: 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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number.J 7,7370 Address �� i�o'df� �/� License # a :5 f e J1 4�w , U Home Improvement Contractor# Email Worker's Compensation #l2e,4ez1,S�.��G� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 71,2 z� FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAPV PARCEL NO. 4 ADDRESS VILLAGE OWNER ' t DATE OF INSPECTION: FOUNDATION '. FRAME INq LATION Y FIREPLACE ELECTRICAL: ROUGH FINAL k� PLUMBING: ROUGH FINAL GAS: ROUGH: FINAL FINA,LDUILD4NG' _. DATE<LCLOSED.OUT _ ' ASSOCIATION PLAN NO. r t w The Commonwealth of Massachusetts 2. Department of Industrial Accidents H. Office of Investigations UT 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aimlicant Information �j� a Please Print Le ibl Name (Business/Organization/Individual): CC/t t �Ul { �d Address: 14V*n C4 V G City/State/Zip: �b UaV&&Uffk106 Phone#: I.�Ye ou an employer? Check the appropriate box: Type of project(required): l am a employer with 2r2 4. ❑ I am a general contractor and I employees (fulland/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ l am a homeowner doing all work officers have exercised their 1 LE) Plumbing repairs or additions myself. No workers' com right of exemption per MGL Y [ p• 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.�Other I(i171 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. iContractors 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 Ili policy and job site information. I'q Insurance Company Name: AWh(/NA4& Policy#or Self-ins. Lic. #: WCA Qo1;2-2 Ci 1 0 ' Expiration Date: t//` ?76 Iq Job Site Address:me? � T�,� f� � 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 may be forwarded to the Office of I Investigations of the DIA for insurance coverage verification. I do hereby ce the pains and penalties of perjury that the information provided above is true and correct. ! Si nature: Date: i I Phone# or 7, / 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 Contact Person: Phone#: Massachusetts -DepaP`tmant of P'blic Safety ard of Building Regulations Rnd Standards F Construction Supenisora;:a License: CS-100988 HENRY E CASS113 ' 8 SHED ROW WEST YARMOINH 2 E x p i ration Commissioner 11/11/2015 - Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C4rj.�ragtor Registration =:.`..; ;" : '_-';: Registration: 153567 Type:YP Private Corporation CAPE C OD INSULATION Expiration: 12/15/2014 Tr# 233831 , INC ° _. - i`i,;'--= '`i HENRY CASSIDY :'• --------- 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card. Mark reason for change. SCA I ii 20M-05/1 I Address Renewal ❑ Employment Lost Card � (172.�(nire•rrecrr/,caetalll u�F>/Gl e�a�cc`eufeCC office or Consumer Affairs& Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: gistration: 1'53567 Type: Office of Consumer Affairs and Business Regulation -' xpiration: 1.2/17S/201.4 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATI;©N I ..... `( HENRY CASSIDY 18 REARDON CIRCLE SO.YARMOUTH,MA 02664 Undcrsecretar Y of Val witho t nat re I ' 1 CAPECOD-27 CVANGELDER CERTIFICATE OF LIABILITY INSURANCE FDATE DIYYYY) 411/2014 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to tiro terins and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not contor rights to the certificate holdar In lieu of such endorsement(s). PRODUCtR CONTACT NAME: Cape Cod Commercial RoyvJlers&Gray Insurance Agency, Inc. PHONE ($77)816-2156 434 Rle 134 (AIC.No.Eztl: —_�AIC,Not; — South Dennis,MA 02660 EMAIL ADDRESS: INSURER(S)AFFORDING COVERAGE _ _ _ _ _NAICN .. ....-.__.—._—_._. _ INSURER A:Peerless Insurance COmpa_n!�__--__.__ ^— Ia uR-" INSURERe:COMMERCE INSURANCE COMPANY _— Cape Cod Insulation Inc INSURER C:Evanston Insurance Compaliy__— 1B Roardon Circle INSURERD:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 INSURER E: INSURER F: COVERAGES _ CERTIFICATE NUMBER: REVISION NUMBER: I HIS IS TU 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-1.0 WHICH THIS CtR I IFICArE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 1.0 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Iran, _.._._____-_-- _ t TR rYPk OF INSURANCE" lZooc SUER POLICY EFF POLICY EXP _ — — POLICY NUMBER MMIDDIYYYYI IMM)DDIYYYYI LIMITS A l X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE y 1.000,00 AM51GE-To ENTED--_ - CtAIMa-MAUE X OCCUR CBP8263063 04/01/2014 04/01/2015 PREMISES Eaoccurt•ence 5 100,000 I._._...a �----- _ MED EXP(Any one person) y 5,00 PERSONAL&ADV INJURY _ $ 1,000,00 ANI,;CCHi:GAIE LIMIT APPLIES PER, GENERAL AGGREGATE $ 2,000,000 PROX vol It,-, jECI l LOC PRODUCT'S--COMPIOP AGG b •--_---2,000,000 I I UIIIL-H 3 AUTOMOBILE LIABILITY COMBINED SINCLE LIMIT $ Ea accident .—_----_---..__— B "INYAU10 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person) S _ ALL 01AVE0 SCHEDULED n111ilS AUTOS X BODILY INJURY(Per accident) b - - 1,000,00 _- X X NON-OWNED PROPERTY,OAMAGE ___ _ ^b ruktUnU'll.S AUTOS Peraccidenl X UMUHCLIA LIAU X OCCUR EACH OCCURRENCE S 1,000,000 C txl;r»LIAR CLAIMS-MADE R/O XONJ453512 04/0112014 04101/2015 AGGREGATE _ $ nr:u I X I REI'ENI'IONS _ 10,000 Aggregate y 1,000.00 WORKtRS COMPENsA(ION IOTFI- (ANUtMPLOYtRS'LIABILITY YIN D .AN,t ROPHIL FORIPARTNERIEXECUTIVE CA00525904 06130/2013 06/30/2014 E.L.EACH ACCIDENT $ 1,000,00 •V(I•ICERWEMbER EACLUDED9 FIN NIA 1,000,00 (Mandatory In Nil) E.L.DISEASE-EA EMPLOYEE $_ I II r��o-c me wwor — — 1,000,000 :�WSCHIPi ION Or OPERATIONS below E.L.DISEASE-POLICY LIMIT f UEZAXI'I ION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more spa co Is required) -- Wulkers 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 EVIDENCE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DC-LIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved.' ACORD 25(2014101) -The ACORD natne and logo are registered(narks of ACORD t r Y ; Housing Assistance 4 kin Corporation Cape Cod HOME.OWNER 1 RESIDENT WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. l YVETTE CRANE hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation (herein after referred as "Agency") on the property located at: 168 Rt. 6 A WEST BARNSTABLE The weatherization work done will be,based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping &caulking of windows and doors, insulation of attics, sidewalls& basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the"Agency"its agents.and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent. Home Owner: (Signature) Al, f � Date: 4/10/2014 Agent: (signature) Date: 4/10/2014 HAC approved Weatherization Company :` .g cX ,vi Adam T Incorporated All Cape Energy Alternative Weatherization Building Performance Contracting LLC Cape Cod Insulation Cape Save Frontier Energy Solutions Lohr Home Improvement Resolution Energy