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Home My WebLink About0100 DUMONT DRIVE d �� Dv i Cape Save Inc. 7-D Huntington Avenue' South Yarmouth, MA 02664 Tel: 508-398-0398 Fag: 508-398-0399 1/19/15 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permit#201409079 TO: Building Inspector(s), This affidavit is to certify that all work completed for 100 Dumont Drive,Hyannis has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. } Sincerely, r William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 304 Parcel o /aL Application Health Division Date Issued I S Conservation Division Application Fee v Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address _ imn o A�` �r+ye. Village A A I'S Owner_ k�►EI A I �,�f Q,p�,y�.r Address SgML Telephone H 4 Permit Request NJ R9 A-Ad 9- 28cel1 se, =E0 le cri4i,Tr, ftJJ R-g � r t �� er�cl-.Ss -{-r B a i �n�A e f�� -F-�►e «I�s �► i'�'►1 �-ICI cal��..44�� +6 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0 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's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sc -=� Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Roo Count-o Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other v, 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 C. W,11141% cC� k Telephone Number Address it n Ave. License # ZC l OAS gL a,M6C ,. f'l oat 6� Home Improvement Contractor# J 13 8 Email Worker's Compensation # 19WC 3QR�5 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE a' I r w, i FOR OFFICIAL USE ONLY ' APPLICATION# DATE ISSUED MAP/PARCEL NO. t ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - r ij The Commonwealth of Massachusetts Departrnent of In4ustrcal Accidents:' ^ � 1" Office of Investigations =" ut r 1 Congress Street,State 1 Q0' ' Boston,MA 02-14-201� ; www:mass.gov/dttt Workers' Compensation.Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print'Legibly N1n1e(Business/Orgonization/indivtdual).. Cape Save lnc Address: 7D:Huntingtori Ave - City/State/Zip: South Yarmouth. MA 02664 Fhone'#: 508-398-0398 Are you an employer?Check the appropriate;box: Type of project(required) L(✓ 4. [ 1 am:a general contractor and 1 - 1 am a eitiployer with� 6. New-constntct on employees(full andlor part-time); have hired the sub-contractors 2. 1 am a sole proprietor or partner- listed:on the;attached sheet.. 7. n.Remodeling' , ' These sub-eontractot have g,,[�Deinolitton ship and have no employees -' } ,, � ,. �• "� workingfor the in any capacity.' employees and have'ivorkers = Y p ty+: . a 9. ❑ Building addition [No`workers'comp..insurance comp:insurance.+ 5.. We are a corporation;an required.) its; 1�.[�°Electrical repairs,or addtttons 3.; 1 am a homeowner doing all work; _ officers have exercised then 11.E";1'htmbng repairs or addrtton5 myself.(No;urorkers'comp, right of exemption perlvlGL 12.�Roof repairs insurance zequired.j`t c. 15?, §1(4),and we Irtsulafion have;no 1 - mployees.IN workers' 3.�:Other e , comp.insurance.required.], r "Any appl icanf that checks box#`I must also'fitl ottt(he section below shQ rng their x.orkers'eoritpensation-policyipformation.. t Homeowners who submit this affidavit indicating they are doing all yvtk andth'en hire qutside ccntractnrs must submit a new af'fidavtl'indicattng.such, , =Contractors that check this box nust attached an additional sheet shoe°inA the name oFiheaub con`tmetors and state whether or not those entities Have: i tnployees. If the sub-ontraetors have employees,they riiust`provide their workers'comp:policy number: I am-an etployerthat is proividhig workers'cortrpensat nn insurance for my employees. Belo i�the polrcy:and joJhsife information. Insurance Company We Insurance Company Policy#or Self-ins.Lic.#; WWC3085633.. . . Eaptration.-Date~ .04/U9/2015 Job Site Address.: r Ci. /State/Zi Attach a copy of the workers'compensation policy,declaration page,(showing thepoli.4 number nd expiration date): Failure to secure.coverage as;required under Section 25A of MOL c. 152 can lead to the impositiori'of cnminali.pcnait es•of a fine up toS1,500.00 and/or one=year impnsonment,as,well as civil penalties in the.form of STOP WORK.ORDIrR atrda fine -. of up to$250.00 a day,against the violator. Be advised that a:copy of this statement may be forwarded xo the Offxce of Investigations of the D1A for insurance coverage.veriticatton, I do hereb certi sander the airs and "enulties o er' that the.in'onnation provided above as tpue and`cnrrec } l Stmidt re: Date L Phone#: 509-ass-839$; , Uffrrial irse only: Do notiurite rn this urea,'fa be completed by}city nr town official.. , '' a Cfty or'Town Permit/Ltcen"se;# g ty( '. } issu►n :Authori circle one l 1.Board of.H.ealth 2':Budding Department-3 CityFTown Cierk,, 4.Electr>Ical Inspector 5.Plumbing-Inspector 6.Otler ., . .•; Contact Person: '' ''' " Phone';#: r' '4 CERTIFICATE 4F LIABILITY INSURANCE iiii DATE ) 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 INS RED,the pollcy(les)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 endorsements. PRODUCER• TN*A:VcT Colleen Crowley Risk Strategies Company PHONE . (78l)986-4400 A'X. CNo:(7S1)963-4420 15 Pacella Park-IDr'ive ecrowley@risk-strateg.es.com .." Suite 240 INSURER(S)-AFFORDING,COvERAGE NAIL! Randolph MA. 02368 INSURERk:Selective Ins. OE' America INsuRED irsU'REas=Allnmerica Financial Alliance 10212 Cape Save;, Inc INSURi c'iwesco Insurance Company 7 D Xuntingtomv,4ve INSUREW3: INSURER E: South"_Yarmouth Mh :09664 INSURERF: COVERAGES . CERTIFICATE NUMBER:CL14111085532 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. IL7R TYPE OF INSURANCE POLICY EFF POL CYBXP POLICY NUMBER, i MMIDD I LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000.,000 X. COMMERCIAL GENERAL LIABILITY REMIS E en e $ 100,000 A CLAIMS-MADE Q OCCUR 91994480 0/16/2014 0/16/2015 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X, PRO-jECT X`. LOC $ AUrOMOBILELIABILOY _fE,,ccid.nt 1,000,000 ANY AUTO BODILY INJURY(Per.person) $ $ ALLOWNED SCHEDULED 6196600 1/6/2014 1/6/2015 AUTOS x AUTOS 80gILY1NJURY'(Peraxident} $ % x Ups ED A A PROPERTY OAMAG�' $ Perecdtle t x UMBRELLA LIAR $ OCCUR I EACH OCCURRENCE $ 1,000,000 A EXCESS LIAS CLAIMS-MADE AGGREGATE $ 1,600,000 ND -: RETENTION 0/16/2015 $ Hil 1994480 0/16/2014 C WORKERS COMPENSATION bffiders Included for R STATU- YLIMTS OTH- AND EMPLOYERS'LIABILITYTOR ER ANY PROPRIETORIPARTNER/EXECUTIVE YIN -overage. E.L.EACHAGCIDENT $ 5OO' OOO (MandatoryInIBER EXCLUDED? NtA 3085633 /9/2014 /9/2015 (MendatoryJn NHp E.L.DISEASE-:EA EMPLOYEIE$ _500,060 ges desaibe under CRIFTX)NOF OPERATIONS below t E.L.DISEASE-POLICY.LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks'Schedule,if more space Is required) Issued as evidence of insurance. Issued as evidence of insurance. , , Thielsch Engineering, Inc, is listed as additional insured as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION msong@capelightcoompact.org SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS.. Attn: Margaret song PO 'BOX 427/SCK ALmi0R1ZEbREPRESENI'ATIVE 3195 Main Street - Barnstable, MA 02630 chael Christian/CLC " ACORD 25(20.10/05) O 1"888-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD HOME OWNER WEATHERIZATION WORK PERMIT: . PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. I Wea0etA= hereby:consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: ` v 6 The weatherization work done will be based on programmatic priorities and availability of ' funding and it may include all or some of the following measures: Weather stripping; air sealing; attic&basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. have read the provisions of•this agreement and give my consent. Home Owner(si9natur®) L Home Owner email: . ""Date: A ent: si nature Date' Weatherization Contractors: ' Adam T Inc C e Save All Cape Energy Frontier Energy Solutions Alternative Weatherization Lohr Home Improvement Building Science Construction Resolution Energy Cape Cod Insulation Tupper Construction x �' � , ��re• �t2?%2�?2-f,�?2-C��Cr��- � �i��a��c��c�c��e Office of Consumer Affairs and Business Regulation ive 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 _ r Type: Corporation „t Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. WILLIAM McCLUSKEY n ' 7-D HUNTINGTON AVENUES SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. scn i 2oM-osii i Address Renewal Employment (� Lost Card %1e�rriunu raurcttlC�tr�*�l��rucro�tt�e//' 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 Expiration �3%4/301.6; Corporation 10 Park Plaza-Suite 5170 ,. Boston,MA 02116 CAPE SAVE INC. IRA i 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 Construction Supervisor Specialty License: CSSL-102776 WILLIAM J MC C-LUSKE 37 NAUSET ROAD West Yarmouth 1VIA OZ 73 Expiration Commissioner 06/28/2015