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Home My WebLink About0109 BACON ROAD l � Iq-13 -H' I I � a A � 2 r z Efficient Buildings, LLC October 31, 2011 Town of Barnstable Attn: Thomas Perry, CBO 200 Main Street ' Hyannis, MA 02601 re: 109 Bacon Road, Hyannis, MA 02601 Dear Mr. Perry: This affidavit is to certify'that all work completed at 109 Bacon Road, Hyannis, MA 02601, has been inspected by a certified Building Performance Institute (BPI) inspector. Work included air sealing, door insulation, and installation of 518 sq. ft. R-49 cellulose and 390 sq. ft. R-19 cellulose in,attic, 80 sq. ft. R-30 unfaced FB in attic as dams, 48 sq. ft. of Polyiso in skylight shaft, 157 sq. ft. of Polyiso to crawlspace perimeter, and 86 ft. R-19 FB blockers to sills. All work performed meets or exceeds Federal and State requirements. Sincerely, �— Steve C. White - Owner/Managing Member Efficient Buildings, LLC 7�-r 8 Jan Sebastian Drive, Unit 10, Sandwich, MA 02563 Tel: 508-888-1110 Fax: 508-888-1109 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 Parcel .Application # 6� Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 1 o Ci AC o Village t�y ��yN) Owner N01ZJU►,, :G oQ_ Address �� U iJ Telephone C� -�"1'S - (�l O on- Permit Request -L NS QL�Yi i'o r+) �y flt-r 1\)&- y ot)Sc",p"F-1J2- fq & LLA-)L_q.Sr 7�, r E c v S+ r r I b-T Ca S bf T. die : "i , s6 Qr-2-Se -�0 acl Ict ` �> Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay -� Project Valuation Construction Type Lot Size Grandfathered: 0 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 D existing--'d new_ size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: - ? Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w:y Commercial ❑Yes ❑ No If yes, site plan review# 03 Current Use - - - - .___ _ Frop_osed Use rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name #-1L11� �2. 1�3iri_ Telephone Number - Address S t gA ,, I License # 9 U 5€9 h11 i N1 0 e2)-S Home Improvement Contractor# Worker's Compensation # �g�W`-j ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1 t t: 1 FOR OFFICIAL USE ONLY `APPLICATION# DATE ISSUED MAP./PARCEL NO., a ' ADDRESS VILLAGE OWNER i S DATE OF INSPECTION: ` FOUNDATION' -; t !, FRAME 1 INSULATION-kt FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL G-AS �_,,) ROUGH FINAL { � PINAL BUILDING �-C '= 1 •DATE CLOSED OUT s - F X. ASSOCIATION PLAN NO. { The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ti www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly v;]tl C (Business/Organization/Individual): g-y- ��LJl ✓t LLC- AddresS: GQt/1 D Vrtve- l -V� I V City/State/7_.ip:_�X JWi1 kn fiMA OZ`J�3Phone#: �dS-S Are u an employer'' Check th appropriate box: Type of project(required): l.V( am a employer with� 4. ❑ I am a general contractor and I _ 6 � New construction employers(full and/or part-ante)."� - have hired the sub contractors '.❑ listed on the attached sheet. 7. ❑ Remodeling 1 am a sole proprietor or partner- , ship and have no employees These sub-contractors have employees a g- ❑ Dcmolirion empind have workers' working for me in any capacity. comp. Building addition i [No workers' comp. insurance comp. insurance. required.] 5. We arc a corporation and its l0.❑ Electrical repairs or addition, f oficers have exercised their I I.❑ Plumbing repairs or additions �.❑ ( am a homeowner doing all work � myself. JNo workers' comp; right of exemption per MGL 12.❑ of repairs 1 in;arant:c raluircd.] ' c. 152,§1(4),and we have no i - 13. Other SJ' No workers` � ��- employees. f � comp. insurance required.] .:Ppl;cwnt that checks box#1 must also fill out the section below showing their workers'compensation policy information. funtcuw ncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ::.,ctors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have nr,w—,�cs if the sub-contractors have employees,they mast provide their workers'comp.policy number. .gym an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. nsur nce Company Name: ,,)I'cv i or Self-ins. Lic. .=14 Sil - 1- Expiration Date: Job Site Address:_ _. 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 luvc;ti rations of the DIA for insurance coverage verification. i do hereby certif er the pains and penalties eperjury that the information provided above is true and correct. 4ianzture: Date: ,a .�s;. Du not -rite in :his area,to be completed h►'city or torn official. Permit/License# -xath±arit- icircle one): ? t).8 fie-alth Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector Person _ Phone# ACORIZ CERTIFICATE OF LIABILITY INSURANCE °"TE(MMPDDNY"I) 03/04/2011 PRODUCER 508.94S.0393 FAX 508.94S.4048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eldredge & Unwkin Ins. Agency ONLY AND CONFERS NO ROM UPON THE CERTIFICATE 697 Main Street �TMCM.OVVERAG�E AFFORDED NOT THEPOPOLICIEEXTEND SE LOW. Chatham, MA 02633 Alan Long --- ---—AlNSURERS AFFORDING COVERAGE NAIL t INU_1 B6 Caliber 8ui'�ding and Remodeling Wf. Steven whalsuRERA National Grange Mutual Ins Co !14788 DBA: INSURER 01 GDaaerce Group I CIG001 8 Lan Sebastian Drive #10 wAmRc: Ace American Ins. Co. - gk_ 22667 Sandwich, MA 026S3 INSURER0: !_ -- ---- - INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NL13�R TYPE OF SOUR"" POLICY WimoER PATE —Ulm ---- ---- - GENF.tALUMIILnY MP027360 09/1S/2010 09/1S/2011 EACNoccURRENCE f _ 1,000, rX I COMMERCIAL GENERAL LIABILITY SOO I WIN CLAIMS MADE a OCCUR MED EXP(Any one pwwn) f 10 .004 /1 i —_.._-- --- PERSONAL&ADVINJURY s 1,000.0 - - — " GENERAL GATE s 2 000,ffid j GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-C01P10P AGG s 2,000, POLICY FITMT _17 LOC AUTOMOBILE LIABILITY BBNVCS 02/16/2011 02/16/2012 COMBINED SINGLE LIMB ANY AUTO - Me ) Ir ALL OWNED AUTOS BODILY NAM X SCHEDULEO AUTOS (per Ow�orl) 3 HIRED AUTOS BODILY DLIURY NON-0NMEO AUTOS (per (PrrPROPEM MDAILAGE s i GARAGE UABLLRY AUTO ONLY-EA ACCIDENT s ANY AUTO OTHER THAN EA ACC s -J AUTO ONLY: AM i ExCESS I UYfRE LA LASILM I 0JO27360 10/01/2010 09/1S/2011 EACH OCCURRENCE i f 1,000,- --I—--- .._ OCCUR 1 I CLAMS MADE I AGGREGATE A - t3— DEDUCTIBLE X RETENTION 3. 10. _ --- $ -- -- -- .. WORKERS COMPENSATION 4494P844 03/02/2011 03/02/2012I ER t AND 89PLOYEW UASILM Y I N ! wY PR E-L.EACH ACCIDENT f S00 C OFFICER#ABASER EXCLUDED? u w4st EL.DISEASE-EA EMPLOYE f 500 i 1rye py In NN)gCAPROOVISIONS' E.L.DISEASE-POLICY LW s S00100( OTHER . - j I +3E_scmPTIDN OF OPERATIONS I L.00A710N4I VEHICLES I•EXCLUSION 1 ADDED BY ENDORSEMENT I SPECIAL PROVISIONS II Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ASKW DESCRbfD POLICIES OE CANCELLED BEFORE THE EXPIRATION DATE TTIEr1EOF,THE WIMIMi INSURER INLL ENORAVGR TONAL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HDdEIR NAYED TO THE LEFT,BUT FAILURE TO DO BO-SMALL Town of Barnstable WPM NO OBUpATION OR LI ABLRY OF ANY MBID UPON THE NBYRER.ITS AGENTS OR Building Department 'mP" *A 200 Main Street A1i�1i01111M HyaInnis. MA 02601 ACORD 25(2009101) m 1— CORPORATION. AB riphb rsaerved. The ACORD nano and logo are r+ogi*wW mules of Massachusetts- Deliartmcnt.��f'P(ihlic Safch 9 Buarg�mt' Building Re�,tulations and standards Construction Supervisor License License: CS 95038 Restricted to: 00 I i STEVEN WHITE t 147 RIDGEWOOD AVENUE i HYANNIS, MA 02601 i I Expiration: 2l2&M12 . I i ( nmii.•i ncr :Tr#: 19311 Office of Consumer Affairs&RdAiess Regulation . HOME IMPROVEMENT CONTRACTOR .ff Registration 154359 Type: i Expiration: 2F2013 Ltd Liability Corpo CALIBER BUILDING:'A -.4. t FLING,LLC. f; STEVEN WHITE t 8 JAN SEBASTIANt ,R1iTVO SANDWICH,MA 02563 Undersecretary i r i License or registration valid for individul use only before the expiration date. If-found return to: Office of Consumer Aff>tirs and Business Regulation ati 10 Park Plaza-Suite 5170 Boston„MA 02116 [. Not valid without siguature -y y� q ..Xls hk yk�,tr,�nP re � •... a I I, M heI o N -TAY W IL 'f' SA M E S -b E S M o N b , as owners) of the subject property at: l 0 a A b aC�bl hereby authorize Steve White of Caliber Building And Remodeling, LLC (contractor) to act on my behalf in all matters relative to the building permit application. signature of o er Ate signature of owner date Engineering Dept. (3rd floor) Map p f7 Parcel ; j/ Permit# _ g House# r Date Issued Board of Health(3rd floor)(8:15 _`9:30/4:00-4 36)- Fee Conservation Office(4th floor)(8:30-9:30/1:00.=2:00) Planning Dept.(1st floor/School Admin. Bldg.) d�NE Definiti Ian 4 proved by Planning Board 19 _ BARNSTARLE. MASS.1639. p � TOWN OF BARNSTABLE Building Permit Application t _, ; Project Street Address p L"3 .co tJ QD Village '-.l`H.d%,A n is Owner MRS TA V I D12 Address 1 ►89 '�ACOW-R� . Telephone '7 7S Permit Request ST'Qt t� 'r 1?P_Rao 1r Z 661c. S a n^-Q 2 e S�►'_ U P4 rB Pco R o v e IZeoF Sl~► -e 'Aro-b 1 r S� First Floor square feet Second Floor square feet Construction Type k Estimated Project Cost $ �. Try) a' Zoning District ", Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Sal Two Family ❑ Multi-Family(#units) Age of Existing Structure 30 y"c 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 No.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 Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Dame Z V A 1J ohTelephone Number 7 7 1;—0 IR 95; Address 171r, r a u�T'� oS� 7 R. License# ► Ay�,a � OS 7 q 21Y A462=kJ . n rr f k A4_ Home Improvement Contractor# i Q FAu L m A-zzo L A- Z R,c�; U i It 4-tu r Worker's Compensation# Q C•3J`I Sa'a NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION D IS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) . 1►'- r FOR OFFICIAL USE ONLY PERMIT NO. 3329 — _ DATE ISSUED s T « s " '} MAP/PARCEL NO. ADDRESS * `_ VILLAGE' 4w, OWNER DATE OF.INSPECTION: t'r ^ -, '. V FOUNDATION « FRAME - r v INSULATION FIREPLACE - ELECTRICAL: ROUGH '' FINAL PLUMBING: ROUGH FINAL, t , tFINAL GAS: ROUGH r :- ��.��• �� -t=; �( t = - � .. � f; r• M,�� Jam• FINAL'BUILDING DATE CLOSED OUT ~ASSOCIATION PLAN NO. J 7 r • the - _ - . . The Town of Barnstable NAM �$ Department of Health Safety and Environmental Services Building Division 367 Main Stress►Hyannis MA 02601 Office MS-790-6=7 mph uuaissic::. Building Fax: 508-790-6Z30 For otnce use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT'CONTRACI'OR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, =ovation* repair, modernization. conversion. improvement, removal, demolition, or construction of an addition to any pre-existing Omer occupied building containing at least one but not more than fbur dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions.along with other requirements. oo Est.Coster ' Type of Work: r - Address of Work: t D 9 1 AX O Owner's Name ZS Date of Permit Appilcotion• ja 42 6 I hereby certify that: Registration is not required for the following renson(s): —Work excluded by taw _Job under S1.000. Building ttot owner-occupied —Owner pulling own permit Notice is hereby given than OWNERS .PULLING THEIROWN PERMIT OR DEALING WITS ONREGSSTTERRED CONTRACTORS FOR APPLICABLE HOME ITAPROVEMENT WORK DO NOT HAVE ACCESS TO THE,ARBITRATION PROGRAM OR GUARAMT FUND UNDER MGL c. 142A SIG1T ALTZS OF PERJMY [ awiy for a p rmit as the agent of the owner. _ //*/J I �ONS 1 ay 3.2�d Dace Contractor Name Registration No. OR Date Owners Nome The Commonwealth of Massachusetts Department of Industrihl Accidents - 600 Washington Street Boston,Mass 02111 Workers' Com ensation Insurance davit name: location: city phone# [] I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers* compensation for my employees working on this job. comnanv name: yi fr n'N( address: 6- �X C�9� GJ l I�ann,t Pa2� '' tt city t� 2GZ&Z phone#: PC, insurance ca. nlicv# 641(1,6 ^ (A O 3 L O p '�i///a�ai,��'��'�i/,�//i. ��,�/�� t✓ir,�///� ��////.anion/i/aa//.��///��uiai,�ia�/i//,i.�:�✓/�c�/////,�/aioiiii/,aaiiiii //ia�ioi�: ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: .... .. com anv name: address- phone phone#: insurance cm comiyanv name: address: city phone#: Insurance co. lim# 40 FaOure to seeurs coverage as required under section 25A of 1iGL 152 can lead to the Imposition o[criminal penalties of a Me up to si soo.00 and/or one years'imprisonment as well vil penalties in the form of a STOP WORK ORDER and a tine of 3100.00 a day against me. I understand that a copy of this statement ma forward the OMce of Investigations of the DIA for coverage vetincatiom I do hereby // certify der the p d penalder of perjury that the information provided above is true and correct Date 5 /� b/9 E - - Print name �.Q�JL Phone# ol11da1 use only do not write in this area to be completed by city or town ofIIdal dtv or town• peemitNeense# Mudding Department ❑Licensing Board ❑cheep if mu—nediate response is required Q Selee hl a Office Departrumma contact person. phone#• QOther (mnsea 9195 P1AI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their ", an employee is defined as every person in the service of another under any cc " employees. As quoted from the "law c of hire, express or implied, oral or written. An employer is defined as an individual, partnership,7association. corporation or other legal entity, or any two or more of die foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receive. . rustee of an individual , partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of .�.e_..4—A....,t...n„P.r.,TMe to do maintenance , construction or repair work on such dwelling house or on the grounds o: building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor anv of its polit(cal-subdivisions shall enter,into any.contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have-been presented to the comracting authority., Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to yaw vits may be nd supplying company names, address and phone numbers along with a certificate of insurance submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out is the event the Office of Investigations has to number which will be used as a reference numbect r. regarding affidavits mahe y Please retnrned t" be sure to fill in the peraut/licease nun the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please io not hesitate to give us a call. The Depamteat's address,telephone and fax number: , The Commonwealth Of Massachusetts Department of Industrial Accidents Oluce of Investigations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 7274900 eat 406, 409 or 375 N i V, A a P Vf T o' �o r►� �o C r• N ,.... rya � r4 N O_ F••� `T AO \ f1e• �O ~ O ►+ N r N P N co O G rn 00 Clo v Oo �O A 1 i RE-ROOFING ❑ If located in OKH or Hyannis Historic District-Certificate of Appropriateness required unless same color/same materials specified on application Map/parcel number Sign-offs from: --� ❑ Tax Collector ❑ Treasurer Er"of squares of shingles or square footage of roof to be shingled 0"Pecify stripping old shingles or going over old roof. If going over ❑how many roof layers existing now ❑what size are rafters? What is span? ❑ Complete dwelling information for the Assessor's Dept. - if known Workman's Comp. form [.� Home Improvement Contractor Affidavit(RESIDENTIAL ONLY) Home Improvement Contractor's License OR ❑ Homeowner's License Exemption (RESIDENTIAL ONLY) Check expiration date on license COMMERCIAL WORK-No License is required. Fee i I I q-forms-PERMITS 1 Rev 6/2/98