Loading...
HomeMy WebLinkAbout0255 COMPASS CIRCLE 0�5� Ca r»�4-s s C ;�-, fi TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 41 Map Parcel Application # of 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 R . �4 efts A-- Village fl Owner 5 AeAb-21,< Address Z-,!5-r S CCIL e�J Telephone - o Permit RequestJ& 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 -3 M Historic House: ❑Yes to On Old King's Highway: ❑Yes to Basement Type: Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) "T®o C1C-- Basement Unfinished Area (sq.ft) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: existing vnew Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: O Gas Oil ❑ Electric ❑ Other Central Air: ❑Yes KNo Fireplaces: Existing New Existing wood/coal stoye:. ❑Yqs ❑ No o Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: existing d nevi size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:: Wes' Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# C-0 r7l Current Use Proposed Use - w- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name A��� � -��C_ Telephone Number �� 7 2 3f'/,o Address Z-1 ? 1 4 a/Lo- , n License #124 /4�f- Home Improvement Contractor# Worker's Compensation # i ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOd_.�� SIGNATURE DATE12, FOR OFFICIAL USE ONLY APPLICATION# " DATE'ISSUED t MAP/PARCEL NO._•_ ADDRESS VILLAGE r OWNER_ DATE OF INSPECTION: FOUNDATION FRAME J , INSULATION' ' FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL R GAS: =1 - ROUGH FINAL x , FINAL BUILDIN00- t i i DATE CLOSED OUT F ASSOCIATION PLAN NO. ry -415 •fi dill, The Commonwealth:of Massachusetts, - A Department ofindust;ial,4cc deizts Of cce of Investigations o ns mo, 600 Washington Street •�`'�� Boston,MA 02111 t ; www.massgov1dia Workers' Compensation lasurance.Affidavit: Builders/Contra.ctors/EIectricians/Plumbers Applicant Information Please Print Lel=ibly Name (Business/Organization/Individual): G� wJ / D i Address: 1.8 City/State/Zip: Phone # � (p f 311 o Are you an employer?-Check.the appropriate box: ? 1, am a employer with, lZ? Type of project(required): 4. ❑ I am a general contractor and I employees(full"and/or part-time).* have hired the-sub contractors 6• ❑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 1 8. ❑ Demolition working for me'in any capacity.. workers' comp, insurance [No workers'comp. insurance' 5.'❑-We are a corporation andats'; 9• ❑ Building addition required,] officers have exercised their" 10.❑ Electrical repairs or additions 3.❑;I am a homeowner doing,all_work = right of exemption per MGL " I L[I Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t. "employees.(No workers' comp. insurance required] 13.❑'Other ;Any applicant that checks box 91 must also fill out the section below showing their workers'compensation Policy P p cy information. l �t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractorsthat check this box must.attachcd an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. l I am an employer that is providing workers'compensation insurance for nzy information. errzployees. Below is the policy and job site Insurance Company,Name:_ ve,- f, Policy#or Self ins. Lic.#:• `` 7 ( L)e Expiration Date: / / 13 M Job Site Address: 3.6 � �, /" 1/�i �i City/State/Zip: �&Nr er Attach a copy of the workers' corn pensatioa-policydeclaration age(showing the policy number and expiration date). Failure to secure coverage:as required undter 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 STOP WORK ORDER and a fine of up to$250:00 a day against-the violator.. Be advised that a copy of this stateme_nt maybe forwarded to the Office of Investigations of the DIA for insurance.coverage verification. 1 • I do hereby cert�under' pain d penalties of perjury that the information provided abovej is trueland correct I 5i afore: -2 Date: Phone //j -- Official use only. Do not write in this area,to be completed by city or town official City, or Town: Permit/License Issuing A uth ority.(circle one): i 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electncaffnsp ector S. Plumbing Inspector 6. Other 1 Contact Person: . Phone#. i ; e Client#-.241369 OCEANSIDEIN ACORDr CERTIFICATE-.b LIABILITY INSURANCE DATE(MWDDNYYY) 1/18/2012 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 SETWEENITHE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,•AND THE CERTIFICATE HOLDER. . IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies).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 endorsement(s). PRODUCER - - CONT PHONEACT Christopher Hedetniemi . ` HUB International New England 265 Orleans Road Alc Ne E t:508 946-0446 _ ac,Ne, 508-945-9136 - - E-MAIL North Chatham,MA 02650 ADDRESS: 508 945-0446 ,. .. INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Everest National Ins Co. 10120 INSURED -, Oceanside Inc; -INSURER B: S Clark Inc. INSURER C: ,. 217 Thornton Drive INSURER o: Hyannis,MA 02601 + ', ' INSURER E:" :.-...• .• d ?� .INSURER F i COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE:INSURED NAMED ABOVE FOR THE POLICYL 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.- INSR - ADDL UBR - _ .. .. ,: LTR TYPE OF INSURANCE INSR WVD " POLICY NUMBER POLICY MMILDIDTYEYYY LIMITS GENERAL LIABILITY - I ,. •' . EACH OCCURRENCE COMMERCIAL GENERAL LIABILITYDAMAGE TO RENTED _ PREMISES Ea occurrence $ CLAIMS-MADE .00CUR MED EXP(Any one person $ . , PERSONAL 8 ADV INJURY. $ ' y, GENERAL AGGREGATE $ GEN'LAGGREGATE LIMIT APPLIES PER: '' ` . • - ' - ,e F "`. PRODUCTS•COMP/OPAGG. $ - . POLICY PRO- LOC ^',:.' AUTOMOBILE LIABILITY ^' COMBINED SINGLE LIMIT - ^ r r Ea accident ' ANY AUTO BODILY INJURY(Per person) $ALL OWNED SCHEDULED ,� _ AUTOS AUTOS r BODILY INJURY(Per accident) $ r. NON-OWNED PROPERTY DAMAGE $ - HIRED AUTOS AUTOS ..- "' r a r;' - - - Per accident x. a UMBRELLA LIAROCCUR.,Q EXCESS LI _ .•_ .. . . `c - t EACH OCCURRENCE " § - �- . AB ,.• ' ` ,.`. • .CLAIMS-MADE - , AGGREGATE I $. . - .. '. •. DED I." I RETENTION$ _.' • ;'.� - ' .,., : .. _ ._ . . -'A WORKERS COMPENSATION CF4WC00045121 'F 1l01/2012 01lOV201 �• WcsTATU- "X oT1'I. § z AND EMPLOYERS'.LIABILrrY , A ANY PROPRIETORIPARTNER/EXECUTIVE Y/N - _ OFFICERIMEMBER EXCLUDED? N/A E.L.EACH ACCIDENT $1 000;000. (Mandatory in NH) •. .,.. N- If yes,describe under -+.- , , _ - El.DISEASE EA EMPLOYEE $1 000 000 - .DESCRIPTIONOFOPERATIONSbelow - ,`... t ' E.L.DISEASE-POLICY LIMIT E1,000000. DESCRIPTION OF OPERATIONS 7 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) , o , - i CERTIFICATE HOLDER ° CANCELLATION' Town of:Barnstable `' '* 4+ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I r a _ f THE EXPIRATION DATE .THEREOF,;, NOTICE WILL BE.DELIVERED,IN 200`Main Street ACCORDANCE WITH THE,POLICY PROVISIONS: I Hyannis,MA 02601 _ ` • -' .z'.a AUTHORIZED REPRESENTATIVE ot ©1988-2010 ACORD CORPORATION.All rights reserved ACORD'25 2010/05 ( ) 1 of 1 ...The ACORD name and logo are registered marks of ACORD #S645521/M645518 ` TC• • 002 e t F r Town of.Barxi-stable Regulatory Services Thomas F.Geiler,Director Building Division Tom.Perry,Building Convidssioner t 200 Main Street,Hyannis,MA 02601 wsww.town.b arnstable.ma.us Of ce: 508-862403 8 Fax: 508=790-6230 Property bier Must Complete and Sign,This Section u If Us ing A B udder. h as.Owner of the-subject property hereby authorize -.C_ to act on m7 behalf ' , in all matters relative,to work authorized by this buadingpermit application for. . . . r (Address of Job) 5 tore of Owner Date U Priat,Name If Property Owner is applYing forpennitplease:co.rnplete the Homeowners'License Exemption Form on the reverse side. Q:FORMS:OWN RFERMISSION is it ;r • j of Tree ram, . Town of Barnstable ' Regulatory Services y � s.�xxsrAsr.E Thomas F. Geiler,Director KA.E �P i6s� Building Division TFo �k Tom Perry,Building Comrrugsioner 200 Main-Street,_Hyannis,MA 02601 www.t o wn.b arnstab l e-Leta-us Office: 508-862-403 8 Fax: 509-790-6230 HO1v OViyNER LICENSE EXEMMON Please Print DATE: JOB LOCATION: number strcat village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/tnwn state zip code The current exemption for"homeowners"was extended to include ovrner-occupied dwellings of six units or Iess and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFxITION OF aondEOWNER Parson(s)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, attachcd or detached structures accessory to such use and/or farm structares. A person who constructs more than One home in a two-year period shall not be considered a homeowner. Such "horneowner"shall submit to the Building Official on a form acceptable to the.Building Official, that he/she shall be responsible for all such work performed under the building permit (Section I09.1.1) The undersigned"homeowner"asstunes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/sho understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Of c;W Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control, HOMEOWNER'S EXEMPTION .The Code states that "Any bomeowncr performing work for which a building pernvt is required shall be exempt from the provisions of this scction(Scetion 1D9.1.1 -Licensing of construction Supcnzsors);provided that if the homeowner engages a person(s)for bin to do such work,that such Homeowner shall act as supm-vism Many homeowner:who use this exarnptioa are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Rcgblations for Licensing Construction Supervisors,Section 2.15) This lack of awareness bft=Tesults in serious problems,particularly er when the homeown hires unlicensed persons. In.this case,our Board cannot procccd against the unlicensed person as it wrould with i Iicenscd Supervisar. The homeowner acting as Supervisor is ultimately responsible. To ensure that the bomeowner is fully awwr of his/her responsibilities,many communities Tr-quim as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fm7n1catificatian for use in your community. Q:forins:homeexcmpt ely 1 _ J � ! Office of Consume- Affairs & Bu ness Regulation 'HOME IMPROVEMENT CONTRACTOR W Registration: :A,00121 TYPe� f Expiration. 14 Private Corporatioi O SIDE, INCH Richard Clark 217Thornton Dry r � Y H annis, MA 02601 ;1 _ A d f Y �' r L_Jndersccretary ti _...._ .,_.__.._. _._. .-.._..... F2(0`i� d N N e .. „... nxa:ew��unmev.+..na.+n�r+r-xe•�+. - O n Y . N Massachusetts Department of Public Safety a , 4 P I N d J A'� 1 Board of Building Regulation s and Standards `. Construction Suner`•isor °' '� °' 3 N r U m .J . License: CS-000043 @ ° S .� o �` • l��A m t RICHA" W L 3�ARK ._ � f; 65 ACRE �iI BARI1TSTA� �E Expiration TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 to Parcel.. � / � - Application # Z (� Health Division Date Issued l�i Conservation Division Application FeAA Planning Dept. ` Permit Fee Date Definitive Plan.Approved by Planning Board a Historic - OKH _ Preservation/ Hyannis Project Street Address 5 5 o S C i�c`o e Village #�,n f11 S Owner 06 Z' �� Address Telephone tr1 ! Permit Requestr W—& s4-64 1 S L-. e e 0 Jae Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay --� Project Valuation % 9 0 b 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 17 4- q Historic House: ❑Yes ❑ No On Old King's Highway: 0_'es 0 No no Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other °,•'.; M. 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 �No If yes, site plan review# Current Use . Proposed Use- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name $VIE` CTelephone Number 50$ " 3 9? Address 7-C k-Lu\+Ii n _ License# C aim Q LI Home Improvement Contractor# 6 4 LI 3 Worker's Compensation # W ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO rrc^R 0-kA SIGNATURE DATE J/_,,92 — h FOR OFFICIAL USE ONLY APPLICATION# E v ::DATE ISSUED ,-,MAR./PARCEL NO. k 4 = r v ADDRESS VILLAGE i OWNER i t DATE OF INSPECTION: Fr FOUN_DATION, A '; # FRAME ` A INSULATION [ s,{; .: FIREPLACE ` ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS:.t , ,-­� ROUGH ,t FINAL FINAL BUILDING ' + !DATE CLOSED-OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts w Department of IndusbW Accidents Office of Investigations 600 Washit"n Street Boston,MA 02111 www,mas&gov1dia or ers' Compensation Insurance AMdavit: Builders/Contractors/Electricians/Plumbers Annilcant Information Please Print Lem Name(Business/Orgamizat awbdividual): M t€'a AeA, & .b,s y&,t blidk C &A Address: 1A u ro Rl ni;on,�1_Aa. City/State/Zip: ` �y ( #40l 67,agone t Are you as employer?Check the appropriate box: Type of project(required): 1.211 am a employer with�_ 4. 0 I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition workingfor me in an capacity. employees and have workers' y � �'• 9. �] Building addition (No workers'comp. insurance comp.insurance.* required] + 5. 0 We arc a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 IQ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL ' 12.0 Roof repairs insurance required.]+ c. 152,§1(4),and we have no employees.(No workers' 13.E]OthcrTllalA Q, G'n comp.insurance required.] *Any applicant that checks box M1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they me doing all work and then hire outside contractors must submit a new affidavit indicating such. tContracwn that check this boat 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. l ale an employer that ispoviding workers'compensation insurance for my empl"ees. Below is the policy and job site inforQn. II Insurance Company Name: P.G h n e I o u V -'1n S UL alqCe C OM p a,Off( Policy#or Self-ins.Lic.#: _r W C•, 3 0 9 '9 7 0% " ExpiraT lion Date:..._1 01 a 1 01 a 1 I Job Site Address: BLS S Coto b AS C.`c•c'e City/State/Zip: VILA41si, Attach a copy of the workers'compensation policy declaration page(showing the policy anmber 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 D1A for insurance coverage verification. I do hereby certify under she pains aaies erjury that the information provided above is true and eoerrecL Si f Date: �1 _ p_ ►:� _ _ Phone#: � r1391&. Offceial use only. Do not nirite 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#: AC40REWCERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/20/2011 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 policy(ies)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 endorsement(s). PRODUCER NEACT Shannon sperrazza Risk Strategies Company PHONE (781)986-4400 FAX N .(791)963-4420 15 Paeella Park Drive -Maes:ssperrazza@risk-strategies.com Suite INSURERS AFFORDING COVERAGE NAIC# Randolpphh MA 02368 INSURERA:Selective Insurance INSURED INSURERB:Safety Insurance Company 33618 Michael McCluskey, DBA: Cape Save INSURER C:Technol0 Insurance Company 7 C Huntington Ave INSURER D: INSURER E South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBERCL11102041451 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. INSR SUMPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMSavIADE ❑X OCCUR PP81994480 0/16/2011 0/16/2012 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea IINEIoc .itSINGLE LIMIT 1 000 000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 6208200 1/6/2011 1/6/2012 BODILY INJURY(Per $ AUTOS AUTOS ( ) X HIRED AUTOS NON-OWNED PROPERTY DAMAGE N X AUTOS (Per accident $ Underinsured motorist BI lit $100000 300000 XUMBRELLA B X OCCUR PPS1994480 0/16/2011 0/16/2012 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ C WORKERS COMPENSATION Executive excluded X WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/Nfrom coverage E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ® N/A 500 O00 (Mandatory in NH) TWC3297972. 0/21/2011 0/21/2012 If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,i/more space Is required) Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc. , and Housing Assistance Corporation are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. 484 Main Street Hyannis, MA 02601-3698 AUTHORIZED REPRESENTATIVE Michael Christian/SM3 �TG�'�1�- = ACORD 25(2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. INS02.5 oninns)ni The Annon name and innn a►c ronie+nnorl mnr4a of Anr1Rr1 1 Massachusetts- Depart►nent r►f Public Safet} Boars!of Building Rch!ulations and Standard. Construction Supervisor specialty License License: CS SL 102776 x Restricted to: IC WILLIAM MC CLUSKY 37 NAUSET ROAD a WEST YARMOUTH, MA 02673 Expiration: 6128=13 t i,nunissioaer Tr#: 102776 i _ — Office of Consumer Affairs and usiness Regulation - 10 Park Plaza - Suite 5170 Boston,Massachusetts 021.16 Home Improvement Contractor Registration Registration; 164432 Type: -DBA Expiration: 10/s/2013 - CAPE SAVE -� rr# 217656 MICHAEL MCCLUSKEY k 7C HUNTING AVE. p _. S. YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. _ DP8-CAI 0 5OM-oaro4-0101216 Address F�.Renewal Employment (" Lost Card f ✓!LP f/w4sLYyivapcz o ' `�a�ai�ea ' .� Office of COusumer Affairs&B mess Regulation License or registration valid for individul`use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: ` - Registration:. 164432 Type: Office of Consumer Affairs and Business Regulation Expiration: 10/6/2013 �u, DBA .. 10 Park Plaza-Suite 5170 C,4a " AVE Boston,MA 021.16 MICHAEL MCCLUSKEY - . . 8201 S.HOURD CT � ✓J CHAPEL HILL,NC 27516 Undersecretary 0 f valid without signature 1 SAVE Weatherization August 22, 2010 To Whom It May Concern: William J. McCluskey is an employee of Cape Save. He is authorized to negotiate contracts and building permits for our.company. Michael McCluskey Cape Save—Owner 919-593-5939 cell X Huntington Avenue,South Yarmouth,MA 02664 460 West Fain Street • HOUS G Hyannis, MA 02601-3698 HOME&ENERGY E REPAIR ASSISTANCE , ; r T (508) 771-5400 F (508) 790-- ,. CORPORATION 2425 HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: a Gnu--P L N[ I F YOU .A�I�rE THEAPPLICANT HOMEOWNER. fi.3tip, RNO L.�I� hereby consent to and agree that weatherimAion work may be done by the Weatherizati on ogF'r ram of H ousing Assistance Corporation (herein after referred as "A cy") on the property located at: (101 PA T h e w eat heri zati on work d one wiII be based on p rogram m ati c p ri ori ti es.and availability of funding and it may include all or some of thefollowing measures:. Weather-stripping& caulking of windows and doors,insulation of attics, sidewalls& basernents; attic and other ventilation measures and possibly replacement of badly deteriorated windows In consideration of theweatherization work to bedone at my home I agreeto thefollowing: 1. 1 give permission to the"Agency" its agents and employeesto travel onto or acrosssaid property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. .TheHousing Assistance Corporation reserves theright to inspect thefuel or utility bill for the weatherized unit on an ongoing basisfor no morethan five(5)yearsafter theweatherization work is completed. I have read the provisions of t "reement al eel d freely give my consent. Home Owner: (Signature) EIS �-- D ate: Agent: (signature) ' Date HAC approved Weathenzation Company Caliber Building &Remodeling Cape Cod Insulation e Save Creswell Construction Frontier Energy Solutions Lobx&Sons . Peter Smith Resolution Energy Rock Solid Construction Sprinkle Home Improvement C:�T?iwumerr�42nd Se�� &�'t'a�"t:s:Pi-�l.;�w.: sh�e3'.�F��fiP�ij..or�pertiiit rcl�a�ci<w.dtc Pos'assor's ma and lot number p *THE T ErPTIC SYSTEM Irl€151 Sewage Permit number` ......:.. ° �- �1t?STA°s_L ) li'9 CCi�fr11'' �S WIT i A RT 1 �� 11 S!fJ = BAPSTADLE. Housenumber ........................................................................ ;VAea 5ANITS,RY• CODE AND 2639. EGU LAT10NSo n war a TOWN. OF �B -,-ftNS ABLE BUILDING I'l-S-PECTOR APPLICATION FOR PERMIT TO ...... ......................................................:............................... TYPE OF CONSTRUCTION ...... ............. .... s ............................................................................................. ,/� .....................19, TO THE INSPECTOR OF-BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ... 7`... c�. .......? . . ors..... ................................................. ProposedUse ............................................................................................................................................... Zoning District ..., .....................................................Fire District .... ... ... . ell—K .................................... Name of Owner .......................................Address .... .. 0....... Nameof Builder :.. ... ...................Address .....,,. . . ................,........................................ 10 Nameof Architect .....%.. ......��......................................Address .................................................................................... Number of Rooms ...........6..................................................Foundation ................................................ Exlerior . �kK�...... .......................................Roofing .......z6 ...14:4.Xa`................................................. Floors .... !. .tcQ�E..... ......� tX......................................Interior ..... P✓Ir.....��� ........................................... Lam:. ............... 9 p Q, .Fireplace .............. ..........................................................p '�..�, Approximate Cost ..........127 . Definitive Plan Approved by Planning Board ---------------_---------------19________. Area Diagram of Lot and Building with Dimensions Fee ......................... SUBJECT TO APPROVAL OF BOARD OF HEALTH �S a4 4 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name4.. l'. .. ........................ Cedar Acres A=310-429 �1 21126 v Build sin le « � P ................. permit for .....................g............. , f1Y..dwelling....................................... t+ ZS� - Location -- ..Cgmpass„Circle ................ y.31?JCI . ................................................ Owner .QQdAr.. RAalty..Trust............ i 4. . Type of Construction .WAOd..FrAMq................... . ........................................................................... ! r � I Plot lot ...42A....................... Permit Granted ........Mar..Gh..?.. ............1979 Date of Inspection ......... ......... .................19 t Date Completed .. ... . ......19 P. PERMIT REFUSED t ............................................................... 19 ............................................................................... , ................................................................................ ............................................................................... [ . f . f Approved.................................................. 19.............. : .............................................................................:. ............................................................................... Assessor's map and lot number ...........�.........~..........�.....�' ' G.;" J(` _ /� ` l� - �F®FTHEro (7d- Sewage Permit number ........ ............................................... Z BARNSTAME, i House number . M �Q M I TOWN OF BARNSTABLE _ BUILDING INSPECTOR APPLICATION FOR PERMIT TO '.........:S!:............................................................................................ .... TYPE OF CONSTRUCTION ....... /: ,/ ` ....................................................................... �. ............................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Locations.,f ../. y/..............................................; /......le........................................................................................................ ProposedUse .... 2:a ' ,.-s� ................................................................................................... ........................................................ Zoning District 'T 'ri'� ...Fire District ...... .............................................. N Name of Owner ..................... '.,.^'......................................Address w �.... � .-................................................... ./ i Name of Builder�,.,--1,1,.`.!/'.'.! -*;-.'^" '?''.-s!' ................Address /'r '�i', Name of Architect fj �......................................Address .................................................................................... ........................... Number of Rooms i ^..................................................Foundation ... ...:::::............................................... Exierior t, 2 f� ......................................Roofing � Floors i �1L.......................................Interior .....P1 .::z ! ' ........................................ '... ......................................... Heating ................................Plumbing �' n) O "1 Y ...................t............................ ............... .... ............................................... Fireplace ......:...........�............................................................Approximate Cost ......... .! ................................... Definitive Plan Approved by Planning Board --------------------------------19-------- . Area ..�0-. ...................... ' ?00 Diagram of Lot and Building with Dimensions Feel .` 4� SUBJECT TO APPROVAL OF BOARD OF HEALTH - r goo r' - r 4 } . l V I 1 lr I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �` ...........t. ............................................. Cedar Acres A_310=429 No ...2-1.1,26....Yermit for ....Build„single,,,,, Xami ly..dweJ.1.ilig........ . Location ........ ... .irQ1.(P....... ...................Hyannis............................................. Owner ....Cedar:..Acr.es..Realty...Tru�t......... Type of Construction ....Wb7Qd..FX1.ZL 0................ t d" Plot ............................ Lot .. .....3A...... .......... /tMar.cb-2.6 Permit Granted ..... ........19 79 Date of Inspection..................................19 Date Comp le ed ......................................19 PERMIT REFUSED .................................. .................. 19 ...... ......... .. .. ..J 1/........ ..... .. .................................... ......... . ............................................................. .................................................................... Approved ................................................ 19 y'"" • TOWN OF BARNSTABLE 21126 Permit No. ______--- - I ��� Building Inspector N .STA Cash OCCUPANCY PERMIT Bond No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit- therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Cedar Acres Realty Tr, Address South Yarmouth 1n1- 441 Ai 95S Cmmnapg Circle. Hyannis Wiring Inspector r Inspection date.' Plumbing Ihspkector �- Inspection date Gas Inspector ,' Inspection date Engineering Department Et�G2 Inspection date �� �� ` 7;,l THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TORN REQUIREMENTS. 7 19 f i�/Building Inspector ,►P � t• 4 .0 e 7-- 'QD a a 0 V` o a Z A f' Y .5H !/V f JV 6 z W �� �� �` �Gtf��;,� °"•` G'�'.7,.4.�? %GQ�`.Sy .tPEAG T..� TA2t.�S T 7 OF Sw HORMAY cP� g o GROSSMAN ,A 12775 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 r � � 3 _ 0.7 12-22-11 r Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 a tn RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 255 Compass Circle,Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-30 cellulose All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey 1 i U 9 Z_N U1+rrpw C OCEANSIDE, INC. 217 Thornton Drive Hyannis, Massachusetts 02601 — C — (508) 771-3110/800-464-3318 i i 4r.. f i . I � I • i i i i f I ' t ( I v I i