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HomeMy WebLinkAbout0034 SHEEP MEADOW ROAD 0 P7lf!(16C'O -J< cps UPC 12543 No. 53LOR Epp ® 57.CONS HASTINGS, MN _ ,_---- •- MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston, Massachusetts 02108-1904 (617)723-3800 Ma Only(800)392-6108,FAX(800)851-8424 8/6/2016 Form of Notice of Casualty Loss to Building Under Mass. Gen.Laws,Ch.139,Sec.36 1owK o� VJOS P�arnS+i61 f Net. (��Gtnn.�si M�- ozd of Re: Insured: SARAH LENTZ Property Address: 34 SHEEP MEADOW RD,WEST BARNSTABLE, MA 02668 Policy Number: 1356485 Type Loss: Water Damage: Plumbing Systems Date of Loss: 08/04/2016 Claim Number: 408249 Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General Laws,Chapter 139,Section 3B is appropriate,please direct it to the attention of the writer and include a reference to the captioned insured,location,policy number,date of loss and claim or file number. MPIUA Claims Division CMA00021 i Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 3/9/16 d Thomas Perry CBO ��' � Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 RE: Insulation Permit 16-60 Dear Mr. Perry This affidavit is to certify that all work completed for 34 Sheepmeadow Road,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 Q N" OWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 10 1 Parcel O Application Health Division Date Issued Conservation Division Application Fee �0 CID Planning Dept. Permit Fee J-57,L)0 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 3 LJ c5 Q M ewe-w Village B Ott n5` A b(el Owner Z r Address Telephone 1 35 33 Permit Request Gnu R' �6 ce«wlos� fi�e (C. I Jr, CM Mr e a_ic I0.Me Wl exParkJ) n.0 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed TotdEnew, Zoning District Flood Plain Groundwater Overlay I '`' 03 Project Valuation S 16 0 Construction Type Ln Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docume tation. 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 gNo If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name MNrLIUL, L C„ r, Telephone Number S`0 Address +IAA�(4, jam Hvo License # C L 0 ok (, S• 'tr euA} ` I h OM 6� Home Improvement Contractor# 1 ?' 3 Email Worker's Compensation # Ww C 313 b�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Z DATE FOR OFFICIAL USE ONLY ' APPLICATION # ' DATE ISSUED t YAP/ PARCEL NO. &, ADDRESS VILLAGE OWNER - - 7 ' DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION x FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL :p - ''t GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED OUT ASSOCIATION PLAN NO: „ r li i 1 The Commonwealth of Massachusetts Department of Industrial Accidents _ I Congress Street, Suite 100 Boston,MA 02114-2017 www massgov/dia Rrorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant 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.�✓ I am a employer with 20 employees(full and/or part-time).' 7. []New construction r 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.] 9. El Demolition 3.[:]1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition . 4.O I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 501 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. 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,theymust provide their workers'comp.policy number. t I am an employer that is providing workers'compensation insurance for my employees Below is thepolicy andjob site information. ` Insurance Company Name:Wesco Insurance Company Policy#or Self-ins.Lic.#:WWC3136274 Expiration Date:04/09/2016 Job Site Address: 34 Sheep Meadow Road 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 th pains and penalties of perjury that the information provided above is true and correct Signature: Date: 121/16 Phone#:508-398-0398 Official use only. Do not write in this area,to be completed by city or town official City or Town; f Permitlicense# 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#: AC" CERTIFICATE OF LIABILITY INSURANCE r� Y DATE(MMIDDIYYYY) 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 terns 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 PHCIN E (781)986-4400 FAX No: (781)963-4420 15 Pacella Park Drive EMAIL ccrowle @risk-strate ies.com ADOREss: Y g Suite 240 INSURER(S)AFFORDING COVERAGE NAIC� Randolph MA 02368 INSURERA:Selective Ins. of America INSURED INsuRERs 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. �TTRR TYPE OF INSURANCE POLICY NUMBER SMILE EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A 7 CLAIMS-MADE a OCCUR PREMISES Ea occurrence $ 100,000 91994480 10/16/2015 10/16/2016 MEDEXP one person $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY a JECT FX]LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: BIN ffTRn7rV= $ AUTOMOBILE LIABILITY Ea accident $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ AALLOWNED X SCHEDULED AWBA46796600 11/6/2015 11/6/2016 BODILY INJURY(Per aocident) $ AUT X HIRED AUTOS X NON-OVNVED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION Nil B1994480 10/16/2015 10/16/2016 $ WORKERS COMPENSATION Officers Included for X I 87ATUTE ERH AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE Coverage E.L.EACH ACCIDENT $ 500,000 C OFFICERIMEMInBER EXCLUDED? ry NIA 6VC3136274 4/9/2015 4/9/2016(Mandatory NH) E.L.DISEASE-EA EMPLOYEE $ 500 000 Ile 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 O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) i o� t ti Town, of Barnstable ttejulatoiy Services suWWAMA, Rich rii'V.ScaTi;I)Freetor. Wm Dudldbi Di Tom Perry,U*Iding'.Cbmmisstoner 200 Main Street,H*mis,Uk 02601 iv%-w.toWn.barnstable.aia.as Office: 508-862-4038 Fax:. 508=90-6230 Propezfy Owner Must Compkte:and.$Ibis Section. If Usinn ..A .udder I, �,.r, �, ,�,f Z ,as(?w:i-' of the subject propeny heitbywth-prize e- s to act on:mybelzalf,. in alI•mattm relative to-Work.a orized by this building permit application for. 34SL, Micioui W2' -,n to 6L MA o2 6 6 e ""Pool•fences and alarms-aiae t ie respo s �lii r o the ap Iican�:Pools .are motto be fiRCA or uiaized bef'ob femoe-is:%ns Al and all fibai'. inspections are perfonned and accOted- 7 Signature of owner Signawie.of.:A.pphca.at 2rint Name Nnt`Name 1 A5 / Date Q:FoMS:o%vrlF.ztPE9MjSSI0NP001S . �. � �!f� ��o n•z-gin a��r.�ea��� o% C>r����s�r��u�e��• Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 171380 Type: Corporation A 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. sCA 1 C. 20M-05111 Address ❑ Renewal ❑ Employment Lost Card • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 171380 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 UVExpiration::.-3/14120{.6 Corporation I Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY . 7-D HUNTINGTON AVENUE SOUTH YARMOUTH,MA 02664 Undersecretary Not vali rthout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards n._-._ - o-_-c_l-t.. a.Jwu iiCtiiii�JniinEi�iiiir ountia�n_• License: CSSL-102776 WILLIAM J MC('tU 37 NAUSET ROAD I Jl West Yarmouth IRA (V VX. 921.-� Expiration Commissioner 06/28/2017 © / �• Assessor's map and lot number .......M..A +..�>!......... Sewage Permit number ....... ....................?......................... 2. �FTNET TOWN OF 'BARNSTABLE Q i BARNSTABLE, i ° G MPY a BUI,LDING : INSPECTOR APPLICATION FOR PERMIT TO .::-*it .:....... /:,. '+........ ....................... ........ TYPEOF CONSTRUCTION ^-�' .'. '.....,... .....................................................................................:............. r' ......... ...................19. TO THE INSPECTOR OF BUILDINGS: ^,..."�. The undersigned hereby applies for a per/mit according to the following information: /p♦.. Location ............................i .i.r�.. Aw�✓i��;.i' ram...............................i..r . � w��I/l;y� .................................{ �.... .......................... ........... Proposed Use ........ ................ .... a..........................................................................................I......................... ........ .... . Zoning District ..........................Fire District t��� / � ca.�..M. . !.�!. ............ �O J T �/� ;1�✓1 �sc,�r iS4/.,.�4. .......Name of Owner � ! i11wiA,,. .........Address Name of Builder ....' ...............Address 'l? fm/. 4 � � Nameof Architect ..................................................................Address ...............:..................................................................... Number of Rooms ......................... ..........................................Foundation ........can .... ...................... •r.....,�... .... ................../...��..!. .. .../rf! '.............................................................. Exterior f.. ,/ .11 Roofing /`A/J yf � r _ Floors ....... ...'? '...................................................................Interior .................................................................................... y. /I " Heatingt! �t <. �� .,. ��!..................Plumbing .................................................................................. ...................................... s Fireplace ......../r�.c n...............................................................Approximate Cost ......... :. C]C7... ............................... Definitive Plan Approved by Planning Board -------------------_-----------19_______. Area ':5........r ...!............. Diagram of Lot and Building with Dimensions Fee . SUBJECT TO APPROVAL OF BOARD OF HEALTH D • 1 � I hereby agree to conform to all the. Rules and Regulations of the Town of Barnstable regarding the above . construction. Name ... �'.. ............(`........`...��...... ...L?.................... . ' � ° 18823 l 1/2 story, � ^ No ................. 'Permitƒor ------------ | ^ single family dwelling i ---'---'-----------'-------- �� �u dow Road Location -----------.-.--.-.----. � � West Barnstable ---------------------'---- � � Jane B. Lagamann Owner --______________._____.. � ' Type of Construction.............-�ram a---------. ` x* ~ � . ' ---------------.----------.. . � Plot � � Permit Granted -_~ of Inspection. ' � ""'= Completed ` � - � ` . � PERMIT REFUSEDl --------�------------ lV ' . . --------------------------. � . � � � '��� � 5w,^~r~°~ ��^rv~ � � . ' . � - -----. --.. ' . � --- ........ ............................ y , Assessor's map and lot number ......./10.9.....Al....... �' �. SEPTIC SYS - a TEM MUST B� , / _/J7, 74 INSTALLED I•N COMPLIANCE WITH ARTICLE II STATE Sewage•Permit number ................................. .............: ........ E AND TOWfV �. _. SANITARY COD L RECU TI �� _ TOWN.' OF :BARNSTAB Bpi THE TO _ �: .. PAS a i 6 3 9• _ Y BUILD�IM. -INSPECTOR pO .`e� tr'•' ' ti �^ APPLICATION FOR PERMIT,tiTO .:... ........................... rs� cTYPE OF CONSTRUCTION .....�..... ...............: ............................................................................... %C .................. .1...................19.? TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ....... 1.kf—........ ...o ... ................................. Location .. ,v.. ........ � .... � ` ProposedUse .......... .......... .... ........... ............................................................................. ...................................... Zoning District j� Fire District .......we. W 1........6q.1r.1n.S. 4. .1e�............... j� /J Name of Owner (.7,•... �e/ ru 6.........Address �Q. .V1.... . ...•. ....� ... . .. . . Name of Builder .............Address ..70....%� ''''s! !GRI— �2L..... .... ..... ............... Nameof Architect ..................................................................Address ................:................................................................... er Numberof Rooms ................... ..............:....:................:..Foundation ..�......... ........... ........... ...................... Exterior '... ........ ... .......... . ...Roofing ...... Floors Interior ............... ......a... .................... Heating ,�ti`'�l. �%!/. .................Plumbing .......................�..... ' /J 0 Fireplace .........�7!.. .............................................................Approximate Cost ..........:(..../..............��0if/.................�...... .. ....... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area .../l.. O...� !: .....'....... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH V 100 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name •11001/11. ....`!,.1za................... .. .. Lagemann, June B. No 18823 3 . ...... Permit for ......1....11.2 story; ...................... g.l.e..family...dwe.l.l.ing........ . . . .. . .. ............. ...... . . ...... Location ........Sh pmead.ow..Ro.a.d............................. .... .... . .. West Barnstable ............................................................................... Owner ..........J.une...B.....L ann .aRem .................... ............ Type of Construction .......... r gae....................... . ................................................................................ Plot . #6 ................................ ranted Noypmb 18 19 76 Permit Gi .....i Date of Inspection A r..7.a. �9 Date Completed ..................19 PERMIT REFUSED . ................................................................ 19 ................................................................................ ................................................................................ ............................................................................... . .......................... .................................................... Approved ........................................... ..... 19 ............................................................................... .......... ........................................................... SH -EF-P MF-Aoow ROAD ' 4 s 36.7?- 00 LOT 5A i► 7a , o L o r —�•� Lo-r bA �t +4000t t � 5 q. FT. as fu ;u , tn , tP PROPOSED SE.PTlc SYSFE&..- Q Z AREA u1 0 10 s t ``- ul cV Lu ► �.+ 230 " ± `n/ALCOTT o -_� .z�. .r �..-�. ..r..,.-_, -..= •Lam:.. o C -.- .. p= _^ -... A mES LOT '5OA U C - .r.{ c � PLOT P L At Zr,1trl � �N4' .1 �s B A R N S T A B L E M 45510 Z Ca r`}` 1 +f" aA- +hc �our)dcL°kor) For- PAV L B-o-rELLa tHown yh(2 r¢or,. 1 g 0,c4-Ual i�/ „ _ o ca `� e d on 4--1',Q r o i...t r-I j ,�C,1 �CCz. ci;: - O N o V. 8 1 7 Ga con-�orr-n5 +o cLiI - owQ of RA RNsra13i dun )n ci1�ln re.yj -m � �'5bony Jury `�1 C�+� �1:n C� r�C.�b^" ���'"� '`�. � C'' � Imo��.!'�'� ro- �► f 1319