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HomeMy WebLinkAbout0142 CHESTNUT STREET S71-V V .s 7- --------- ----- ------------- --- - CA E C INSULATION IIBSR GLASS SiAMLLS5 SPRATWAM SUSP[NOBO - - BATTS .GUTTERS INSULATION CNLIN05 _ 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St - Hyannis, MA 02601 A: Date: II�Zfp� Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. per f rmed& completed the insulation and weatherization work at the property listed below. C pe Cod M' 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 C"" /129 /16LAA IVA Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) ( ) ( ) Fes- S.& Uaw oe Walls Sincerely \ He y E C sidy ;President ` Cape Cod nsulation, Inc. t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION n 4 6� Map Parcel Application # e( cj� Health Division Date Issued 40 //-a 0,o, Conservation Division Application Fee Planning Dept. Permit Fee m Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/ Hyannis Project Street Address Village Owner� Address _-5*' Telephone 1-7 dE 7 Permit Request �41a z s;/4Zr Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation f FG0, b Construction Type'/�iw�� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0' Two-Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes 2- o On Old King's Highway: ❑Yes 4A-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 =gin w 2 Number of Bedrooms: existing _newNO 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: 0 Yes Lvgo f� rn 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 �'%�� Cad v %�!/ Telephone Number Address AA Ca License # /d l 9 444&d/i7GL Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE _";41A 4 /Z- a: ` FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. s } ADDRESS VILLAGE F OWNER — s DATE OF INSPECTION: FOUNDATION 'i FRAME INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL y '? GAS: ROUGH FINAL f FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 4 1 OWNER AUTHORIZATION 'FORM (Own s Name) , owner of the property located at I (Property Address) ' (IJ(Property Address) hereby authorize cod o (SE'u c ntractor) _ an authorized su�contractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owners Signat re ' Date cCIEaVc BEP' - 7 ,:2012 ' d -__�r-.� .+ �.. t(�./J/// 1�I��Q����6 L['�•Il{)���L�Cl�i11'.l�l'l'f f'a141A �y/l��lf/j�[,J��daN.������"'�'.�"��n�LtLk1�GIl�����/'r/V W 10 Park Plaza - Suite 5170 Boston; Massachusetts 02116 Home Improvement Contractor Registration Registration: .153567 Type: Private Corporation Expiration:, 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. -" --- - _ HYANNIS, MA 02601 Update Address and return card. Mark reason for change. L_I Address I _I Renew, 1 `I Employment I Lust Card 5-CAt ii 50M-U4N4-G7tll�lti f . Ofricej ut sumcr r gu1160 1 • - 1 icense or registration valid for individu!:ae cn!y �� lffair� B/u1s�-ue_ Rc •• HOME INfPWdit � TP2A W hclure the expiration date. if found return to: Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170 � t:f Boston,MA 02116 D INSULATION; INC HENRY CASSIDY 455 YARMOUTH RD. HYANNIS,MA 02601 -- Undersecretary t alid ith t si tune ' Ala„achusetts-Departnrenl of Public Safetj Board of Bdilding, Rc;,ulations and tiruul:u(Ix Construction Supervisor License ' Licrns�: cS 100988 - HENRY CASSIDY 8 SHED ROW ` WEST�-ARMOUTH, MA 02673 Expiration: 11/11/2013 <. LV I Z j rlvl No. 1605 P. 1 i _ Client4:4597 CCINSUC CORD,., CERTIFICATE OF UABILITY INSURANCE UATE(MMI°..... , THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER?THIISZ 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:It the Cerllfleat.hold.,i.an AbDITIONAL INSURED.the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and condltlons of the policy,certaln policies may reyulre an endoraamant.A statement on this certificate doer not Confer rights to the Certificate holder in lieu of such endorsemenl(s). PRODUCER Rogers&Gray Ins.-So.Dennis NAME: Mar aret Youn PHONE 434 Route 134 Arc No Exl:508-760-4602C Na 877-816.2'15B E-MAIL -- South Dennis, MA 02600-1601 508 396-7980 INBURE'RO)AFFORDING COVERAGE NAIC N -- iNSURrRA:Peerless Insurance 18333 INSURED ---_-- Cape Cod Insulation Inc wsuRERB:Evanston Insuranc©Company 455 Yarmouth Roac1 INSURERC:Atlantic Charter Insurance — Hyannis, MA 02601 INJURER D.Commerce Insurance Company 34754 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: T REVISION NUMBER: IS TO CERTIFY THAT THE POLICIES OF INSURANCE (I$TE0 bCLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY C014TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFOroED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS. gE�XCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EX POLIcYNUn+eEn MMIDDIYYYY) IMM/onffyyyj LIMITS ' A GENERAL LIABILITY COP8263063 0410112012 04/01/201 ppEACMIHgqOCCURRENCE $1 QQU UUU ` X COMMERCIAL GENERAL LIABILITY PREMIS a oNccurr0enae�EEs� $100I 000 CLAIMS-MADE aOCCUR - .MEOEXP(Anyonepareu) $5000 PER80NAL&AOV INJURY 21,000,000 ' GENERALAOQREOATF s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP(OP AGG s2,000,000 POLICY PRO- LOC -Q AUTOMgHILEUA6W $ TY 12MM11CKVMK 4101f2012 041011201' COMBINED SINGLE LIMIT Eaarcidrm 1 UUU UUU ANY AUTO BODILY INJURY(P-Peron) $ ALL OWNED X SCHEDULED �- AUTOS AUTOS BODILY INJURY(Pat sc4denl) S X HIRED AUTOS X NON-OWNED PROPERTY pM AUTOS - (ParecrJdenN �- B X UM.RkLLALIAe OCCUR XONJ453512 - 4101/2012 04/01/201 EACH OCCURRENCE, $1 o0O 000 EXCEg6 LIAe CLAIMS-MAOE AGGREGATE $1 000 UUU DEC) X RErENnoN 10000 C WORKERS COMPENSATION $ AND EMPLOYERSp'�LIgA�BIlL�ITY WCA00525902 6/30/2012 06/30/201 X WGSTATU• OTH. OFFICERJMEMBER ES(C�u6 / kCUTIVE Y I N r E.L.EACH ACCIOkNT .t1,000 000 a NIA )MendaWry in NH) it yea,daecfta,fnd& - E.L.DISFASE-EA ENiPLOYEE $1 00U 000 DESCRIPTION OF OPERATIONS Delaw _ E.L:DISEASE,POLICY LIMIT $1 000 000 r r DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(AUaah ACORb lb 1,AddllID—i R'.m ks 6ghodUig,I(MQre epgCe 18 rogUlrOCU "Workers Comp Information Included Officers or Proprletors Certificate Holder is included as an additional insured under Goneral Liability when required by written contract or agreement. i CERTIFICATE HOLDER CANCELLATION Cape Cod lnsulation,inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES RE CANCELLED 9EFORC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROV1510NS. - - AUTHORIZED REPRHSENTATIVE ®198 -2016 ACORD CORPORATION,All rlghtta reserved, ACORD 25(2010/05) 1 of 1 The ACORD name and logo aru ragistored marks of ACORD #583849/M83848 MEYt. r 4 . . The Common I j ;. ;Ilih bf Massachusetts .Department 0 iiiclustrial Accidents Offict' ,:i Ijlvestigations w, 600 41 rlI ton Street Boat., . . AIA 02111 Worker's c.on peiisatlon Insurance. Aftici.,::;: Builders/Conti•actors/L.lectricians/.4'lurlil)ers 11;ltliraut lnft.►rinati<in plems'e 1 HIA Legibly t V;urn• I,I;tlsitt�.tis/Org;aniz�ttictn/Incliviilclall: �� ;, '1 C� ____ Pho 7' Z/ - ne#: :�C��'' � 6 ��.�/_. . arc you an ctuployerY (.'heck (lie appropriate box: Type of project(rctluire(l): I I .uu at ntpluyer wiflt_ �1. El 1 am it u,..`J contractor and 1 have 6. ❑ ,NewncunSlruclion cutployrrs (mull and/or prat-tirlle).* hired thk .ui, ,0H1I`act0rS listed on 7. Remode.liuo theaat,ii,rd It ct.$ ant a soli: ptoprietor at'partnership 'These,ni , uc[ors have 8. ❑ Demolition and have:no citrployt;es work-in";for employ'.:' ::::.1 have workers' comp. 9. '❑ Building addition ulc ut an} rapacity. [No workers'. iitsutanr. j 10, ❑ Electrical mpairsm additions ruuyr unurancC rrquirad.] 5. We arc i 1i )oi Micin and its 11. PlUmbing repairs or aciclitions oftit.er� Ira' xrrcised their right of ❑ :un a htuueowuer doing; all word, exempnoti I•,i NIGL c. 152§(4),and 12, Roof repairs my>xaf INii workcls' comp. wehavc.•w„Hiployees. [No workers' 13. Otktcr��C���"�!f'�l7�rr t utsut:ux c rcyuirrd. .r comp. tn,i,1:111,c required.] .yiphcant that checks box ill moist also fill out the section below show u,_,ik,it workers'compansatim policy information. --� t lh-mcu•wiwls"vh„sulnnit this aftiduvit indicating they are doing ull woil•, ;,i lien hire outside contractors must submit a new affidavit indicating such. ,+ �uia,tdois that chcck this box must attach an additional sheet showing ih, :;,i-t' nt the sub-contractors and state whether or not those entities have employees.ii :i:,>uh<unuacturs have entpluyocs, they roust provide their workers'cou:l, , cumber. t tun an employer that is pro vidirig workers'eoutpensation insorance for my employees. Below is the.yoliey aril job site nt/imIllation. 1 Ineuaru:r Courp:uly Name: A I Ott-,t-, �����- - - /D )�+•• t- -r ter- . lull„°lint .\ell-ilts. l.it: lt: �(!1 o .`) �__: ExpirationD,tta. Job>ttr Addic,ss .� - City/State/Zip: — attach a copy of the wurlcers' compensation policy declaration pat;,-i,:i... ing the policy number and expiration date). Vailae to,ecurc ctrvcretge as reguifed tindcr Section 25A of MGL c. IJ',.:n Iced to the itnposilion of criminal penalties of a fiuc up tv$1,500-00 amUoa Ana•-yc;u nnlrrtsournr.nt, as well as civil penalties in the:foini of a STOP u i fl'' IK ORDER and a fine of up to$250.00 a day against die violator. be..advised ul dtis statcutcu( trtet e fco warded to the Office of Ltve5ti ,-w, n:; it the DIA for insurance coveruge verification. 1 do here c i•/ uruler the ins and penalties of'pr ifu;y that the information provided above is true acid correct, Si Ufricial use only. I)o rcor write iri this area, to be completed lii,,i v or town official Ciryor'fowu: I'erinit/License# ` lssuiug;Authority (circle one): I. Board oFliealllt 2. Building.Departmeul I Gt)/'ii„eu (;Ierk 4.ElectricialInspector 'S.111moibutb Inspector 6. l,)ther Contact Person: _.-..^� Phone#: