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HomeMy WebLinkAbout0139 BISHOPS TERRACE /3q (�jlsho�ic i�,e-!� 71> CAPE C offillOF BARNSTAB E INS U L A T I (J. s :, — 11\SROUSS SlAMlCSS SPPAT IOASI SYSP..... - \AIIi YYlllgi INSYSAIION CSYINOS - , 1-800-696-6611Djv jS ,-- '['own of Barnstable Regulatory Services Building Division 200 Main St Hyannis, NIA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. perforined & completed the insulation and weatherization work at the property listed below. Cape Cod 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 P44niliA, 6IM-0,K. - f 3°I Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ( � ) ( ) oe') ! Slopes ( ) ( ) ( ) ( ) ( ) Floors Walls ( ) ( ) ( ) ( ) ) Sincerely He ry E C sidy J , President Cape Cod nsulation, Inc. - i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _ Parcel Application ©� Health Division Date Issued Conservation Division Application Fee' U ` Planning Dept. Permit Fee 3S Date Definitive Plan Approved by Planning Board I -Zq —� Historic - OKH _ Preservation/ Hyannis Project Street ddress C;J aU, Village Owner qUldAddress Telephone !d � r��a12) Permit Request n nuk UA re; 4,r juic CellIkId4 Ai 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: ❑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'sff hway: UYes�] No l aJ Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other �-- w � o Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.Rl -" 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 2A No If yes, site plan review# Current Use _ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name' Telephone Number p Address d ense# /D/> 9909 Home Improvement Contractor# A--5-Y� Worker's Compensation # ®D✓��y`��Ca� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �U SIGNATURE DATE 27, t FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED '_. MAP/PARCEL NO. ,1 ADDRESS VILLAGE s OWNER DATE OF INSPECTION: FOUNDATION FRAME j INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 4 PLUMBING: ROUGH FINAL ti GAS: ROUGH FINAL FINAL BUILDING -- -- -- --- r DATE CLOSED OUT ASSOCIATION PLAN NO. ' • ' r i iMxssachusetts- Department of Public ti;rfcty Board of Ruilthri- Regulations and Standards'. Qonstruption Supervisor License s 6' Licenl CS 100988 HENRY CASSIDY 8 SHED ROW r WEST.1>ARMOUTH, MA 02673 3., Expiration: 11/11/2013 t l uunis�iuuer Trt#: 7620 Office of Consumer Affairs and Business Regulation -- - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement.Contractor Registration Registration: 153567 Type:, Private Corporation Expiration: 12/15/2tl4 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card.Murk reason for change. Address 0 Renewal F� SCA 1 20M-05,1I' Employment � � Lost Card �:i A ���[' l(OJ7t JYCC4LG[K%CE(Cfd-CJ`�%%��70JCF012[4dG'�J +v\ 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: e istration: Office of Consumer Affairs and Business Regulation 9 15356T Type: g r xpiration 12/1`5/2014 Private Corporation 10 Park Plaza-Suite 5170 Ut `' Boston,MA 02116 CAPE COD INSULATION INC HENRY CASSIDY 18 REARDON CIRCLES SO.YARMOUTH, MA 02664 —�— — f val• nat re --- No, GllentiF:4597 CCINSUL CERTIFICATE OF LABILITY INSURANCE F. ,t(M 110N1Y1'Y y, THIS CERTIrICATk 15 IStiUEO AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS, CERTIFICATE DOES NOl'AFFIRMATIVELY OR NEGATIVELY AIVIk.N0,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES kSEI,OI/V,THI5 CER1lFICATC OF INSURANCE DOES NOT CONS I IY a rk A CONTRACT BETWEEN THE I$$UING INSUI IL`R(5),AU-1 tIQRILLu REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE liOLoCR. IMPORTANT:If tho carliflcatu huldur 16 an ADDITIONAL INSIJRI l7l inr pollcy(ies}must be en(Icu e(l.II`SUdRUGATION 1 lNA1VED,subju a w T ulv Icnnu uncl cundltlunx of the policy,cnrtaln pollclus may ru;l„L wl andurl tArnanl.A 64110nlenl on(M5 certific;Uie(loka 1101 curll'er oulliy to(tic COlIlIl4dly I,gICIa(111 IILU(1I'SUGh Vndaraenlelll(9}, JFltlUll�ilt �' .—_ &Gray IITs. -So. Oarints NAME: Marpalet YouN(U PtIUNE 4.14I•(011te 134 (NC No,E>i1:5O9-7t)U-4002 rqX__._..,_...._._-.__-........� .- - ;iuuti,Dullnls, MA U2660.100'I -- 5083`)8_79fIO WSURfIl(U)AFFORDANIA COVI`I'iA(i4 NAIC9 wsuRERA Peerless eeress InSUrance Ir:aueL.0 103J3 Cape Cod Insulation [no INSUREFU:Evanston hleuranco L'arnlaarly 455 Yarinoull, huad .sujERc:Atlantic Charter InSL118iicL- 1 IVzuinia, MA 02G0 1 INJURMp, ommerca In6urance C 0111pany 3475,1 I1,15URFR e.; - (:ERriFICA'TE NUMBER: _ REVISION NUMLjC-rt: THI;1 N TO CERTIFY I HAT '(HE. IaOL.ICIriS Or INSURANCE LI$'I'EO 11cl!: 'i'HAVE BEEN ISSUED TO 1 HE INSURED NAMED ABOVE 1=OR'I'RE POLIO'PERIOD tlV01 IIFIGA. MAY GC STANDING ANY RE]UIREMIENT TIERNI OR CONr?iTI0P10F ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WI IICII Ilus aatrlFli.;ATEi MAY kiL: ISSLIE:D OR MAY PERTAIN. THE INSURANCE eWfOROED BY ThE POLICIES DESCRIBED HEREIN IS SUDJECr TO ALL TI1E ltIIii, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES, LIMITS SHOWN IrI,nY HAV9 MEN RGDVCED BY PAID CLAIMS. twsk i TR _ I"YFE OF INSURANCE AODL SUOR --_- __ FOLI,=Y rl:Nlgpuely (MM700l1'YYYV� MM1011/YY1'Yt LIMI A uErILRAL LIAgIL11 Y CBP8263063 4101I2012 04/0'11201'• EACHQCCURRENCE $1,000000 X i Qh1M tNC AL GENERAL LIABILITY c Epl Mo Rffk11s T L LIU0 000 „o . .�CLAIMti-MADE [�OCCUR "'----`-- PERC,GNAt.a AOV INJURY I'I OUO Ul)B --I OENERALA(lORIA OAI — $2,000,000 _ i.�rtl AgiiHLt3A I'k L.IMI,'APF'.GtI PER: PRODUCTS• OMPUP AGG s2,000 000 NULICy I 'F'krl- C I -- - U AUTUMLINILkuAbiul'Y 12MMBCKVmIf, '- 4101(2012 041011201, COI INE091NGLCl.ICT Ea IyUUU.IUUO--— ANY AlJ I'O BODILY INJURN,(Pcr _._._ AL1,OWNI u X AUTOS BOOILV'INJURY(Pa,auciacnl) F NON•QVVNEO aREU AUTOS X AUTO i _.--- tl UMtJRkLLA LIAR x gccuR XONJ453512TG 04)011201' r-AcrloccumuzNcc 1 000 000 t Ml;ty G LIAM 1 ClA1MS-MADE _...... XLlr.NrloN 'ip00(h .. WUHKt:Kti L 011 ENnAI ION ----- C AND ehIPLOYER.TLIABILI rY WCA00525y U<' 06130120'1' X we sl�1'U;I—ANY PRQNRIL�t1jLF�yya2'r+Ly k 'x�^�C�- 4ACLIl/ul&M I2�.C,Up6!❑�kCuTIVk Y�l N C.L,EaCrI ACCIOr,N'1' �l;1 UOU UUU L!J NIA (hlundutury m NrI) C.L.DI M $') UUU UUU If/va,duncf1110,Inds; ' SGA;E.�Ga 6 PLOYEk — L.—._...._.__.— __,.,6L SCRIPTION OF QPLFiATIONS Ucluw G.L.DISEASE-POOL;1'EIMIT I I 1100II•IION OF OPERATIONS 1 LOCATIONS 1 VENICL6S(AUaub ACORIJ 101,Addhl,n I nun�wkc 6Phpquly,It IAPN @pgPB I@ fdpultd(1) "Workers Cornp Infol ITIIYlloll Int.,100W Offlcer6 or Proprietors CortltlCate hlaldal is lIIGILlded r13 an additional insurad undur i.;anaral Liability wholl roqulred by written Contract or agreement, CERTIFICATE HOt UEFt --- T!_ CANCELLATION Capo God Imiulatioil,inc . SHOULD ANY OF THE ABOVE DESCRRSE.O PQL.ICIkS FJt CANCFI,LI_,0lTl:FORL THE EXPIRATION DATE THEREOF, NOTICE WILL BE UEuvtkEU IN ACCORDANCE WITH THE r'OLICY PROVISIONCI. . AUMURIZEO REPRESEN I ATIVE (D 1fl0 -2010 ACORD CORFIOIRAFION,All rlyhla Ta�nrYucl. ACtJKU.z�(�U'IUIUy) 1 ()f'I Fhe ACORV I'dirl)11"Id 1000:lro rn0k torlld marks of ACORD 11Sti3t34U1M838!!tj MEY The Commonwealth of Massachusetts rint Forrn ,. r Department of.Industrial Accidents �. "i ° Office of Investigations 1 Congress Street, Suite 100 9V Boston, MA 02114-2017 ` w ww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): 6fi Ix iml Address: ZAVA& 04rdp) City/State/Zip: V✓� 1A, MA' Phone #: 1JD� Are you an employer? Check t e appropriate box: Type of project(required): I. I am a employer with 20 4. ❑ 1 am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors �' ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors,have g• ❑ Demolition working for me in any capacity. employees and have workers' 9. 0 Buildng addition [No workers' comp. insurance comp. insurance.$ i p required.] S. We are a corporation and its 10.❑ Electrical repairs or additions ❑ 3.❑ 1 am a homeowner doing all work officers have exercised their 11-El Plumbing repairs or additions No workers myself. ' comp, right of exemption per MGL Y [ P• 12.❑ Roof re a•rs insurance required.] T c. 152, §1(4), and we have no employees. [No workers' 13. Other z4 h comp. insurance required.] *Any applicant that checks box d#1 must also till out the section below showing their workers'compensation policy information_ r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check(his box must attached an additional sheet showing the name of the sub-contractors acid 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 infi�rmatian. ,f,� r,� n Insurance Company Name: tk� r c' ��� I YI V a(/I ''II rn� Policy #or Self-ins. Lic. #: WGA 00 219 Expiration Date: Job Site Address: 66kop-2 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 Investigations of the DIA for insurance coverage verification. I do hereby cer f n#er the aims r ._,d penalties of er'ury that the information provided abf ve is true and correct. Signature Date: I?Bone 1#: � /'' 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#: I . J 1 m e mass c a ass save PQdti CIPATING - Savings through;energy efficiency CONMCTR PERMIT AUTHORIZATION FORM 1, David Webb ,owner of the property located at: (Owner's Name,printed) 139 Bishops Ter Hyannis (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X Own ignature 01/03/13 Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project:. Participating Contractor Date Rev. 12132011 _ -_ t �r Town of Barnstable '�::ePermit# .o Expires 6 mo om' e Regulatory Services. Fee * ELARNbrwa[.s. • awes. Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 50&790-6230 EX PRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address `I 3� t3%sips /Crr`w (residential Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: X-P R ES S PERMIT ❑ I am a sole proprietor VI am the Homeowner ❑ I have Worker's Compensation Insurance J U L 12 2012 Insurance Company Name TOWN OF.BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ' [Replacement Windows/doors/sliders.U-Value 29 (maximum.35)#of windows ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: s' • Q:\WPFILES\FORMS\b Pingg,permnit forms\EXPRESS.doc Revised'05N I2 The Commanweah*o,f Massuchusei s Department o,f Industrial Accidei s fl, ce of Imstiations ' 600 Washington Street Boston,MA 0211I w mnm&mkovfdiu Workers' olupensation Insurance Affidavit Budders/Coaftuctor&Tlectric ans/P u nber-s A��._ pphcant Information Please Print I emb3y Name David ljzw i Address: 3 '1 City tabe p;. n%s ;N-- o C61 Phone## Are you an employer?Qteck the appropriate box: Type of project r 4. I am a contractor and I 31 P_ ] ( = 1.❑ I am a employer with ❑ � employees{full andfar part-time) have hired 6. D New constructioned the sub-cxmtracta 2-❑ 1 am a sole proprietor or pan hxT- listed on the attached sheet. 7- ❑Remodeling ship and have no employees 'These:sab-contracturs have 8. Demolition wod:ing for me in any capacity. employees and have walkers" [No workers'comp.insurance comp.Msurance.I 9. ❑Budding addition ] 5. ❑ We area corporation and its 10-❑Electrical repairs or additions 3- I am a homeowner doing all work officers have tmrcised their 11-❑Plumbing repairs or additions njw1f[No workers.'camp- right of exemption per IsrIGL 12.❑Roof repairs insurance rewired.]I c.152, §1(41 and we have no employees.[No workers' 13_❑Other comp:instumm required.] piny a�plir�Est clied¢s bins#1 mast also fill out the section belaw showing their vmdexe ca mp�y am Hameoaners who saba=this dEd-ff indmating they are doing all wink and the¢hoe outside contractors lst sabow a new afdaeit indicating such_ lCouttactals that check t dr,but mast attached as additional sheet showing the nmne of the smb<onfsacbocs and:state whedw oraot those entities have employees..If the mg)-canttactorshave etoglo3eeN they n=provide their wodcew comp.policy number. I am an emphyer that is providing workers conpen anon.insul=ce for troy ding7h win Below is the poficy and fob site infot�ttrtion.. Insurance Company Name:. Policy#or Self iris.Tic.#: Expiration Dale: Job Site Address: CitylState,+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 andlor one-yearimpusonme4 as well as civil penalties in the form of s STOP WORK ORDER and a fine of up to$250-00 a.day against the violator. Be.advised that a copy of this stab.=end may be fi nwarded to the Office of Investigations of the DIA far imivance coverage verification. I do hereby cm fj,under tha pains andpenabYes ofpeduty thatthe information proved above fs tnue and correct Sie�ature: Date: Phone#: 76E- 3G6- sba 3 Ojg ai use only. Do not write in this area,to be completed by city or town offLciat City ar Town: PerumtlLicense# Issuing Authority(circle one): 1.Board of Healthy 2.Building Department 3.awrotiwn Cleric tElectrical Inspector S.Plumbing Inspector 6.Other. Contact Person: Phone#: 6 ' z Town of Barnstable Regulatory Services s nsrE, " Thomas F.Geiler,Director 1659. Building Division Tom Perry,Building Commissioner 200 Main Street, .Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION 7 �/� 2 Please Print DATE: /I/ - JOB LOCATION: 31 6161og _Alrxe number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: �! J7• �U"/�c� ci /town state zip code, The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow } homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor: DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person wbo constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form t acceptable to the Building Official,that he/she shall be-responsible for all such work performed under the building permit (Section`'.,i 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, )ylaws,rules and regulations. I'he undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection .)rocedures and re . ' ements and -he/she will comply with said procedures and requirements. signature H eowner 1pproval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State BuildingCode` ;ection 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt rom the provisions of this section(Section 109.1.1-Licensing of construction.Supervisors); provided that if the homeowner ugages a person(s)for hire to do such work,that such Homeowner shall act as-supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor .see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often esults in serious problems,particularly when the homeowner hires unlicensed persons.In this case,our Board cannot �iroceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is .ltimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require;as part.of the ermit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page f this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in our community: 4 \WPFILES\FORMS\building permit forms\EXPRESS.doC .evised 051811 BARN.STABLE, i ' ,� Town of Barnstable lfD MA'l� Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject ro e' P P rty hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date - Print Name If Property Owner is applying for permit;please complete the Homeowners License Exemption Form on the reverse side. QMPFILES\FORWbuilding permit formsTYPRESS.doc Revised 051811