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Home My WebLink About0317 MAIN ST./RTE 6A(W.BARN.) S M E A No. 53LOR UPC 12543 smead.eom • Made In USA 4400 SFIMsrs9ncsaso+oaeas J � �rwMl.fnl� wwRTMD wrw iA!OWSRPOGRM&OW TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 3 o i 5 TOWN OF BARNSTABLE Map Parcel Application it Health Division 21+6 1,rR 13 Pi� 4: 07 Date Issued Conservation Division Application Fee Planning Dept. Permit Fee U�•00 Date Definitive Plan Approved by Planning Board D VIS110N Historic - OKH _ Preservation / Hyannis # G�' Project Street Address 3 st'kn St�ee�- Village Owner a S Address S a.rwC - Telephone Permit Request P41 R,19 ceIII&Inte 4-a -f4,el 1-v -f-h e ��amn� �.,r s�-g( -E'�►e a �� o L an 8A+ WA - �X aid In Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation S 0 0 0 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 ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes titNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V.Ngfi► U*56 /C-%Df� SVLV� Telephone Number SOS 3 031 Address I-D H44A 1�ct�A ✓e, License # a C ( 0 aT4 6 9f-A 1:jndw,�� . 0 Abli Home Improvement Contractor# 38 D Email Worker's Compensation # W G 0$ SN 0 ::�0 0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Yarrned��'� SIGNATURE DATE y 1 5 1 6 �? FOR OFFICIAL USE ONLY APPLICATION # -. DATE ISSUED 'I'IAP/ PARCEL NO. ADDRESS VILLAGE r OWNER DATE OF INSPECTION: K7 t tv FOUNDATION FRAME M 1 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL rr FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. .c ,. Piz, HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property. located at: M e [� (lJ eST ��J ('n S4a.�J I i i 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; air sealing; attic& basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 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 I have read the provisions of this agreement and give my consent. i . Home Owner(signature) f Home Owner email: Date: ' Agent:(signature) Date: q/7 A('-p Weatherization Contractors: Adam T Inc �hnie All Cape Energy Solutions i Alternative Weatherization Lohr Home Improvement Building Science Construction Tupper.Construction Cape Cod Insulation 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. Aaalicant 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): 1.Q I am a employer with 15 employees(full and/or part-time).* 7. ❑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 ❑ comp. required.] 4.❑1 am 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.❑Plumbing repairs or additions 5.[]I am a general contractor and I have hired the subcontractors listed on the attached sheet. 13.❑ROOf repairs These subcontractors 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.❑✓ 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. t 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Star Insurance Co. Policy#or Self-ins.Lic.#: WC085540700 Expiration Date: 4/9/2017 Job Site Address: 317 Main Street 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sip-nature: Date: 4 5 6 Phone#:508-398-0398 i 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 I � Contact Person: Phone#: COR� DATE(MMIDDIYYYY) A CCO CERTIFICATE OF LIABILITY INSURANCE 4/12/2016 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 NAME:CONTACTRisk Strategies Company Risk Strategies Company PHO E , (781)986-4400 1 FAC No:(781)963-4420 15 Pacella Park Drive EMAILss:randolphcld®risk-strategies.com Suite 240 _ INSURER(S)AFFORDING COVERAGE NAIC! Randolph MA 02368 INSURERA:Selective Ins. of America INSURED INSURER B Allmerica Financial Alliance Ins Cc 10212 Cape Save, Inc INSURERC:Star Insurance Co 7 D Huntington Ave INSURER D INSURER E: South Yarmouth MA 02664 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1641211375 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. rA TYPE OF WSURANCE POLICY NUMBER MPOLICY CYEFF PM�CYEXP - LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE'CLAIMS-MADE X�OCCUR PREMISES Ea occurrence $ 100,000 X 91994480 10/16/2015 10/16/2016 MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 RPOLICY a LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LMIT Ee accident I $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ AUTOSS VMED X SCHEDULED AWNA46796600 11/6/2015 11/6/2016 BODILY INJURY(Per accident) $ NON-X HIRED AUTOS X AUTOS ED P ardent AGE $ $ X UMBRELLA LIAB N OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MAIX , AGGREGATE $ 1,000,000 DED I X I RETENTION$ OIL 81994480 10/.16/2015 10/16/2016 $ WORKERS COMPENSATION -( officers Included for I X STATUTE ERH- AND EMPLOYERS'LIABILITY ANY PROPRIETORJPARTNER/F�CUTIVE YIN NIA C Coverage E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBFR EXCLUDED? (MandetorylnNH) t :, , NCOSS540700 4/9/2016 4/912017. E.L.DISEASE-EA EMPLOYE $ 500 000 If yes,describe Under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 I . DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,.Additional Remarks Schedule;maybe attached if more epace 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 Cape Light Ccompact ACCORDANCE WITH THE POLICY PROVISIONS. Barnstable County 460 West Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 Michael Christian/CLC O 1888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) Office of Consumer Affairs and Business Regulation 1-0 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2018 Try 419291 CAPE SAVE INC. i WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH'YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. ❑ Address ❑ Renewal ❑ Employment Lost Card SCA 1 0 20M-05111 ,,��--,�,, �Q �/(C �4'077Emont calill Q/(0//2KClJ9CCC/1(6.;Cf Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration:,::'1713gp Type: Office of Consumer Affairs and Business Regulation Explration__3(14/2018 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE;-- :N SOUTH YARMOUTH,MA 02664- Undersecretary Not valid i signature [� Massachusetts -Department of Public Safety �J Board of Building Regulations and Standards ''Paso uc'Urpro si ncl v iSoi -Sn2Ciniiv License: CSSL402776 WELLIAM J MC allSIQEX. 37 NAUSET ROAD I WM IF West Yarmouth NIA Expiration Commissioner 06128f2017 I Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 4/23/16 G Town of Barnstable 6 Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permit#B-16-948 TO: Building Inspector(s), This affidavit is to certify that all work completed for 317 Main Street,West 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 McCloskey Y'