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Home My WebLink About0016 HAMPSHIRE AVENUE /� �-�cxv� p S � i `c—C T�Vim, _ --- - _..1-,...__ � _ 1 Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 7/22/15 , Thomas Perry CBO Town of Barnstable Building Division ; 200 Main St. Hyannis,MA 02601 :F • RE: Insulation Permit 201503268 Dear Mr. Perry , This affidavit is to certify that all work completed for 16 Hampshire Ave,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,' William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 U Parcel �a Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee .5 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address -MA S U re AVe11 v e Village � Owner��►��^e� . (hv��@^ g( �iC�aC Quns r Address (i 6 G�cw RYe, Qos�on MR �a13 Telephone 13 a 91 S 6 Permit Request 4 an R' �1 �►be�s�0.SS, A V19 cedl%k1ese +0 +hE ecf'�ic. 9 Alpt IKSJ &AJ - 0 rl�6111 `n L ( - . -he 4, y fyr, cL. b 41j -(3 ce(lNI a Nkr Sea tLe A)c 0. 64.semealwi4 id14)- PA. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation$5 0 0 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 (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 r_ Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: J.Yes:iO No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ ex sting ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: _ Un • i Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )lo If yes, site plan review# -` Current Use Proposed Use APPLICANT INFORMATION a (BUILDER OR HOMEOWNER) ---- _ r - Name . -nC, W III0) C-C45 Telephone Number 508 3f9a Address -D License # -c- �• Y�,flrl p��1�1 Qr �� 6 L� Home Improvement Contractor# I il3et Email Worker's Compensation # WIMC 313 LaIn 'l ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE VV DATE P s �I FOR OFFICIAL USE ONLY Y: ' APPLICATION# is DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f G� The Commonwealth of Massachusetts , Department of Industrial Accidents r I Congress Street,Suite 100 Boston,MA 02I14-2017 - wwri.mass gov/dia LL NVorkers'Compensation:Insurance Affidavit Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual) Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:5.08-398'-0398 Are you an employer?Check the.appropriate box: Type of project(required):- i:❑✓ I am a employer with.20 employees.(full and/or part-time).* 7. New.construction . 2.❑I am a sole;proprietor or partnership acid have no employees working forme in: 8:_ Remodeling any capacity.[No workers'comp.insurance.required:] 3.�I am a homeowner doing all workmyself.[No workers comp.insurance required.]t ' , 9. 0 Demolition Q 4❑I am.a homeowner and will be hiring contractors to conduct atl Work on my property: I will Building addition . 10 ensure that all contractors either.haveworkers'compensation:insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions ❑5. I am a general contractor and I have hired the sub-contractors:listed on the attached:sheet. 13:�ROOf repairs These sub-contractors have employees and have workers'comp.insurance 14. Other Insulation 6.❑We are a corporation and its officers have exercised their right of exemption per MGL cs 152,§1(4),and we have no:employees.[No workers'comp.insurance required:] *Any applicant that checks,box#1 must also fill out the section below showing:their workers'compensaton•polrcy information:. t Homeowners who submit this affidavit indicating.,they are:doing all work and then hue outside contractors mususubmit anew Affidavit indicating:such. tContractors that check this box must attached an additional sheet showing the name.of the sub-contractors and state whether orsnot 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:Wesco Insurance Company Policy#or Self4ns.Lic.#:WWC3136274 Expiration Date:, 04/09/2016 Job Site Address: 16 Hampshire Avenue City./State/Zip; Hyannis Attach a copy of the workers'compensation policy declarationP ge o cY number and expiration date).(showing theP Failure to>secure.coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations:of.the DIA f6t irlsuraiice coverage verification. I do hereby certify ander th pains and:penalties of Perjury that the information provided above is true and:correct Signature: _ Date:- 6/1/2015 Phone#:508-398 4898 Official.use only. Do=notwrite in this area,to be completed by city or town official.' City ofTownc Permifticense# ; Issuia g Authority(circle.one); _ L.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5,.Plumb><ng1tispgetor 6.Other Contact Persons• Phone:#: ACt/R DATE(MMfDD)YVKY); �.,,.. CERTIFICATE OF LIAB.ILIW INSURANCE S/24/2015 THIS,CERTIFICATE IS ISSUED AS A.MATTER OF INF.ORMATION.ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS , CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY:THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE, DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS) AUTHORIZED' REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER;' IMPORTANT: !#the sertit#cate isaldar is an Al3DITIONAL INSURED,tyre pollcy(tes)must be endorsed, I€SUBROGA*n0k is wAIVm'sutr]ect to the terms and conditions of the policy,certain;;policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In Usti of...such;endorsement(s). PRODUCER ME: Colleen Crowley NA Risk strategies° Comapanlr PHONE. {?81)986.-440t) Fft ITe11963-QQzo rc o 15 Patella Park Drive LAn . .carowley@xisk-strategies.com Suite 244 -. . "IMURER(SJCAFFORDINGCOVERAGE NAICO €indolph PEA 0235$ muRER A:Selective ins. of Anerica INSURED _. _ INSURERS A 1=Xica rinancial Alliance 0212 Cape Save, Inc 7 D.Huntiagt on lNsuRERc Wesco Insurance as Ave. INSURER D. ' INSUREt2E $flufih YUMA.: 4�A 02664 INSURER F: . COVERAGES CERTIFICATE NUMBER:CL]532491501 REVISION NUMBER: ThIiS iS TO CE4TdFY T#iAT i#if POLICIES OF iPiSifiiAiVCE tf5TEt3'$EtOW HAVVE BEEN ISSUED TO THE 1NSURED'iVAMED'ABOVE"Fi7R'fiHE POLICY"P£R'IOD INDICATED. NOTWITHSTAN00G ANY REQUIREMENT,TERM OR C040thbN OF ANY CONTRACT OR OTHER DOCUMENT WRH;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, INSRBY PAID:CLAIMS. LTR- S t ICY:EFf PO EXP LIMITS TYPE OF INSURANCE. POLICY'NU[ABER GENERAL LIABILITY EACH OCCURRENCE $' 1,Door,000 X COMMERCIAL GENERAL'LM'ILITY RGE N �+ CLAIMSMADE.�0CCUR 199Q480 D/16/201II O/I6/2013 MEN 500,000 lSES Ea oxurrence $ 1' D EXP(Any one person) $ tses .&ADutNJURL ' s ` 1 0.Q0t) GENERAL AGGREGATE $ 2,000,000 GEN'L AGGR€GATE LIM)T APPLIES'PER`. PRODUCTS-COMPlOP PG.G-'$ 2,000,000 POLICY X PRO X :LOG $ AuromOSLE;CMBILRY Ea accident 1 000 000 B ANY AUTO BODILY IN JURY(Per.person) $ AIL OWNED SCHEDULED 6396500. 1/6/20I4 1/6/2ols AUTOS AUT)S.: BODILY INJURY(Per acddent).$ X HIRED AUTOS L 10A1 QpZD i AGE. $AUTOS X X UMBRELLA LIAB }� OCCUR EACH OCCURRENCE $ 1,.000,000' A EXCESS UAB CLAIMSMADE DED RETENTION Qb' AGGREGATE $ 1,0 00,000 1994480 o/aa/2aa o/��Y2(ti5 $ C "RKERBCOMPEN6A114N ffi,aer fadludetl for vicsTaria orH AND EMPLAYERS' IAPLITY g Im ANY PROPRIETORlPAJ�TNERIEXECU7IVE v r N overage s OFFiCEPJMEMBE3?ECCLLOEM Q N to. EL.EACH ACCIDENT $ rJ00 000 (MandaforyinNH) fi'[�$ /5/2O7"5` E.L DISEASE-EA EMPLOYE $ �}(} IP yyees,describe wider DESCRIFTIONOFOPERAT10NSbetdw lm l.,DISEASE-POUGYLIMIT $ 500 000 DESCRlPTiONOF4FERATIONS!LOCATIONS/VEHICLES(Aflach'ACORDift Add(IlonalRemarksSchedWo,ifmarespaceisrogwred) '.Issued as widence of,insurance..; •, Thielsch Engineering, Inc. i;s listed as. additional in red.:as respects Genera] Uabi1 t .as -requir ci,bar wsitt ra c4Mtract,_ _ .. .. CERTIFICATE HOLDER CANCELLATION a+sCAgG�Cape13 ght .0�3 s Gt3i1i"A9VYi1F THE iABOVE DESCIF(8ED POLICIES 6E CAI CELLED BEFORE THI: 'EXPIRATION DATE THEREOF, NOTICE WILL GE DELNERED IN Cape Ligbt Conpact ACCORDANCE WITH THE POLICY BROVIsIONe. Attnc Margaret song. .. AUTHORIZED REPRESENTATIVE..... ... ..: �O BQX 927/"BCFi 319.5 Main stree Barnstable,; Chael Christian/CLC �CC1Ri7 Z (ZtIY�/$5 Ca}1988,24IQ/4COrTD COf3li?RAT4#?a} Ali rpgtrie rs>ser�red. INS 025(zotoas).oT, The ACORD name and Ingo are registered marks of.ACORD. t Building Permit Authorization F it Tom Mullen & Michael Younger , as owner hereby give my permission to ` Cape Save, Inc. 7-D Huntington Avenue Lr South Yarmouth, MA 02664 Office:508-398-0398 to take all necessary steps to obtain a building permit to perform work at my property located at 16 Hampshire Ave Hyannis, MA 02601 Signed Date t r T 1 I Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 'Home'Improvement Contractor Registration r Registration: 171380 Type: Corporation Expiration: 3/14/2016 Tr# 249649 CAPE SAVE INC. y _ WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 7 - ---- -- s Update Address and return card.Mark reason for change. SCA 1 C. 20M-05/7 7 E] Address LJ Renewal Employment Lost Card - ��<< `lrarivrru cuuecclt�r��4r'l/�tit:;ae�iete//' . 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: WEpiration:g5g3/ egistration: �:171380 Type: Office of Consumer Affairs and Business Regulation 4/2016. Corporation 10 Park Plaza-Suite 5170 � � 7 Boston,MA 02116 CAPE SAVE INC. WILLIAM McCLUSKEY __ 7-D HUNTINGTON AVENUE-W 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 s WILLIAM J MC C-LU KE;Y r 37 NAUSET ROA1) West Yarmouth RA 02 3 754— JJ�I 7",. Expiration Commissioner 06/28/2015 t . i