The URL can be used to link to this page

Home My WebLink About0161 FOURTH AVENUE (HYANNIS) � cp t -��-r�, Fie._ -- - . : ,_ f CAPE C mlkim of BARNSTABLE INSULATION C J 2013 FIR 15 P14 2: 4 Z IIyLR OIALL Stq MlLS3 SPpAI SOALI SUSpLNPLP yAILL OYITSyS INSYLAIION CNUNOS. 1-800-696-6611 - DIVISION Town of Barnstable Regulatory Services ! Building Division 200 Main St Hyannis, MA 02601- Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. perfonned & completed the insulation anon 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 Propert , Address Village �-wh n1C NYtG,IeX� l .Insulation Installed: Fiberglass 'Cellulose R-Value Restricted Unrestricted Ceilings Slopes Floors ) ) ( ) ( ) ( ) Sincerely r He y E C� sidy J , President Cape Cod nsulation, Inca TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #0?0�oZ Health Division bate Issued 1 Z Z Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address j b � qq-L Village (/( �� ( V Owner k" �/ V��& Address Telephone Permit Request I vul oavt �ny div tvalwl, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation o6` ®l Construction Type i sg ld rd-L, ' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 2 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 N Total Room Count not including baths): existing new First Floor RoomCount .�. ( 9 ) g Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other , Cent,*al Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:.Ull Yes�O No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ i'w size_ Yd7 Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes Ur/No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameC �� /� �l��1�"�D eTelephone Number AddressT License #�/DD 9�� LJ Home Improvement Contractor# Worker's Compensation 6e"- ,S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE Dom. 7, 20f�. ' FOR OFFICIAL USE ONLY l . APPLICATION# z DATE.ISSUED r MAP/PARCEL NO. ti ADDRESS VILLAGE OWNER Y DATE OF INSPECTION: F ' f FOUNDATION i FRAME [,F INSULATION i FIREPLACE `r 11 ELECTRICAL: ROUGH FINAL !� PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING - DATE CLOSED OUT ` ASSOCIATION PLAN NO. - F The Commonwealth of Massachusetts :Pant Form f Department of Industrial Accidents Office of Investigations ' I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individual): Qj l a Address: {�dOlit, C tV�it City/State/Zip: Phone #: �D�- 7 ' - !Z Are you an employer? Check We appropriate box: Type of project(required): 1. I am a employer with 2� 4. ❑ I am a general contractor and I 6. ❑New construction employees (full an�or part-time). * have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand have no employees These sub-contractors have g ❑:Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their l I.El Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof rep a'rs insurance required.] t. c. 152, §1(4), and we have no j �e��(N employees. [No workers' 13Y Othcomp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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 this box 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. I am an employer that is providing workers'.compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: WGA OD 2� ,91 f' Expiration Date: Job Site Address: 1 V i 446, City/State/Zip: foa�hAA41'5POV+,_ 'r4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and piration 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 ce 'ten er the ains it enalties ofeed ry that the in ormation provided above is true and correct. Signature: Date / Phone#: 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#: Massachusetts' Department of Public Safet% Board-of BuilUing Regulations and Standards, Qonstruption Supervisor License .46 Licene'�CS 100988 HENRY CASSIDY 8 SHED ROUT/ WEST.IARMOUTH; MA 02673 " ^ Expiration: 1 1 11 1/201 3 <'umiuissiuner Tr#: 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: 12/15/2�b14 Tr# 233831 __, CAPE COD INSULATION, INC . HENRY CASSIDY _: — - ---- ---___-- 18 REARDON CIRCLE --- SO. YARMOUTH, MA 02664 — -----------------. Update Address and return card.Mark reason for change. SCA 1 Co 20M-05;11 Address Ej Renewal 0 Employment ❑ Lost Card C,/�n: l(O�I7l Y/LO%Z.ILK;(Y(IlL.OyCJ/!�(.lX4dCLC./b%l�C'-� S-'X 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: :.1'53567 Type: Office of Consumer Affairs and Business Regulation xpiration:, .1211`5/2014 Private Corporation 10 Park Plaza-.Suite 5170 Boston,MA 02116 CAPE COD INSULATIONINC .. M HENRY CASSIDY 18 REARDON CIRCLE`` SO.YARMOUTH, MA 02664 Undersecretary hValitho t Wat _ No, 1601) N. I Cllent#:4597 CCINSUL ACORD,,, CERTIFICATE OF UABILITY INSURANCE DATE(MMIDDJYl)'y, - TNIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIUN ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDC/R`T HIS2 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AfVJ-ND,EXTEND OR ALTER THE COVLRAGE AFFORDED BY THE POLICIES BELOW,THIS CERTIFICATE OF INSURANCE DOES NOT CON5111 uTE A CONTRAC T BETWEEN THE ISSUING IN5URL ,AU7rIQRIZLLREPkC3LNTA"IVE OR PRODUCER,AND THE CERTIFICATE HGLi);t, IMPORTANT:If tho c.erllflcate holder Is an ADDITIONAL INSURL:U I Ors ---- (tIC t1:11119 alld CUIllllllolls Uf the NOIICy,Ctll•t5If1 I)UIICIE8 May lwi-w lu an unldortiunIunL.A stBW Neer t oh this adQ,GN t!Odoea null lllt:r righl9rtu(he C6rllflcaltl ltoldur in IieU of such endulsement(S). - PROIJUCEN Roger--.*&Gray Ins. -So. ❑tlrinis NAME: Mar aret YOU11. PHONE 434 Route'134 Arc Na ExI:508 760 4602 FAk AJC Ny..OI( t}I6•r150 E•h1AIL --- - ruuttl UDnnis, MA 0261i0-160'I SQfl 398•7980 INfJURKAW)AFFORVINGCOVEHA(w: NAIC0 INSUR6RA:Peerless Insurance '- 10333 Cape Cod Insulatlon Inc INSURERD:Evanston Insw•ance Col rtparly _ -----' 455 Yarmouth Road msuRLR c:Atlantic Charter Insurance -- --- 1-IyruDti3, MA 0260-I wyuRERB .Cornmerce Insurance Company 34T5'! INSURER E C('JVLftA(;E5 CERTIFICATE NUMBER;' REVISION NUIV E E R: TfIIy 14 rtl C Ef211FY THAT THE I�pL ICIES OF INtiURANGE LISTED nu__141�HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR RIE POLICY PERIOD INDICAI L-D. INO1WITt-ISTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICI-I rfus CER1lFIC:ATL- 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. INNtik — ADOLWEIR OF INSURANCE - ld-mPOLICY POLICY EFF pOLICV eIf ---- RUO'uen IMMIDDIYYYYI MMIOD/YYYY LIM1Yt: A 4ENENAL L1A ILITY CBP921i3 LIC 410112012 04/01/20ij EACH OCCURRENCE x1,000,000 X COMMkRWL GENERAL LIABILITY pA�q� 7 eNrl o PIt�MISS ,_�,e�oL �1Do,IwD CLAIMS-MADE DNOCCUR MED EXP(A1Y ono Patti $5,000 - K116QNAI.a ADV INJURY 11 000 000 OENERALA(313REoAlk _ $2,000 000 (.dN L A40Nt,t)gl k LIMIT AP_NLIEkI PER: PRODUCTS-GOMPIOP AGG x-2,000,9l1D _ I NULICY L Nkf} -- 8 Q AUTOMOeILkuAFflurY 12MMBCKVIW - 410112012 04101/201• COhIBINEpSINGL'CLIMIT -- Eaaccuicn( LI,U00 000-- ALL(qY AIIIU BODILY INJURY P' ALLUWNED X SCHEDUI.LiD _ ( <,P""<,I. _... AUIOS AUT03 -. BODILY INJURY(Paraociaanl) S --- -- ..X HIRED AV IOS X NON-OWNED . PROPERTY DANIACat --- -. ..-.— AUT�5 lNer Ucclgmul t H X uMeRkLLAUAd _ occur. XONJ453512 41U1/412 04/01/201 E,4+cHoccurr(ENca - EXCESb LIAR - -� x1_100o,oao --- -- _ LAIMS-MADk — --- AGGREGATE ro�_X ReleNnoN-11000U -- G D AN EMPLOYERS'LIADILITY WGA00525JU< 613U12012 06130/201 ) � - . ANY PROPRIE1'O P,y�7Mk /'',�GVTIVR YIN -—- --- OFEICEWMFMBER LX(I-UD �') F NIA G.L.EACH ACCIOKNTO(1U- (Mnnaalury is NH) - M $I U00 - If gnu, nO Udacn,InUcv E.L.DISEASE-EA C PLOYEE 0U0 DESCRIPTION OF OPL-_rdN,l'IONS l)niuw DISEASE-POLICY LIMIT 11,000,0U0 Utt$011'I ION OF OPEC(A'I IONS I LOCATIONS I V11HICLES(Atlaah ACORD 10I,Addldu-I Rumm ks 69hliaald,If rn9N epd9616 r0gUlydU) I. Workers Comp InfOrIT►ation*d llrclUdud OfflCers or Proprietors Gertlflcate Holder i3 InCIUded'as an additional insurad undut-Gonoral LiaOility when roqulred by written contract or agreement. CERTIFICATE HOLDER _ CANCELLATION CaPtl GUd InitiUlatiofT,hric SHOULD ANY OF THEABOVE DESCRIBED POLICIES 13E CANCkt.LhD OffORL THE EXPIRATION DATE THEREOF, NOTICE WILL BE ,DELIVLkED IN ACCORDANCE WITH THE POLICY PROVIaloNs, AUTHORIZED REPRESENTATIVE -^�-�-- 190 -2010 ACORD CORPORATION,All rights re arv(Jd. ACURu zp(2010105) i of 1 The ACORA name and logo tfni ra;lsh)red marks of ACORD liSt1384411M83tl40 MkY OWNER AUTHORIZATION FORM i, 3oS&P k Al L (Owner's Name) owner or the property located at ve,4� (Property Address) 0 A . 0 tXG 7 (Property Address) hereby authorize La cod, (Subcony actor) ' an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. 0wne Date