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HomeMy WebLinkAbout0008 HOMEPORT DRIVE J .ram ILG �o �F l�2 �0 ��' �O rr — e , ��` 6' n r �-�� �o�o �� Energy, Inc 9� l� Permit Cancellation Request HomeWorks Energy is requesting the cancellation of the following building permit: Permit Number: B-20-302 Address: 8 Homeport Drive Barnstable Massachusetts 02601 Reason:The customer has declined to move forward with the insulation and weatherization work. We will no longer be planning to perform any of the originally contracted work at the associated address above at this time.Please cancel out this permit that is attached to this notice. Please reach out to the specified number below if you have any futher questions regarding this. Thank you. Sincerely, Scott Veggeberg HomeWorks Energy Inc. CSL#103832 HERS Certification#3081658 HomeWorks Energy 101 Station Landing,Suite 110 Medford,MA 02155 wxpermitting@homeworksenergy.com (508) 216-6497 �"E Town of Barnstable Building_ - _ g Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted `�S Until Final Inspection Has Been Made. Permit 6 (Where a Certificate of Occupancy is Required,such Building shall Not be,Occupied until a Final Inspection has been made. Permit No. B-20-302 Applicant Name: HOME WORKS ENERGY INC. Approvals Date Issued: 01/31/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 07/31/2020 Foundation: Location: 8 HOMEPORT DRIVE,HYANNIS - Map/Lot: 268-104- Zoning District: RB Sheathing: Owner on Record: VANKLEEF,JANICE Contractor Name:';HOME WORKS ENERGY INC. Framing: 1 Address: 8 HOMEPORT DR Contractor License: 181138 2 HYANNIS, MA 02601 `' N Est. Project Cost: $4,773.00 Chimney: Description: Weatherization a } Permit Fee: $85.00 Insulation: Project Review Req: 1 Fee Paid: $85.00 i Date: 1/31/2020 Final: Plumbing/Gas Rough Plumbing: \Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All.work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of Final Gas: the work until the completion of the same. ( �' �- --— Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing ,-' Rough: 2.Sheathing Inspection -` 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A)`. Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of Barnstable Building So°Post This Card That it�s Visible-From the Street Approved Plans Must be Retained on Job and;th�s Card Must.be Kept w ro A� Posted Unt�I F nal Inspection Has Been Made ti LPermit ar ° Where a Certificateof Occupancy.is Required,such Bwldmg,shallrNot be Occupiedyunt�)a Final Inspection has been made 3= ,..�h, ..z`6k ,'` Permit NO. B-20-302 Applicant Name: HOME WORKS ENERGY INC. Approvals. Date Issued: 01/31/2020 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 07/31/2020 Foundation: Location: 8 HOMEPORT DRIVE, HYANNIS Map/Lot: 268-104 Zoning District: RB Sheathing: Owner on Record: VANKLEEF,JANICE - Contractor Name:- , WORKS ENERGY INC. Framing: 1 Address: 8 HOMEPORT DR Contractor License' 181138 2 35. HYANN'IS, MA 02601 - Est' Project Cost: $4,773.00 Chimney: Description: Weatherization Permit*ee: $85.00 Insulation: Project Review Req: " Fee Paid:; $85.00 Date 1/31/2020 Final: y!' � t Plumbing/Gas Plumbing: F , Rough 1 u, x ;F 5 ,Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within siz months after1Jssuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for whichths permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street,or road and shall be maintained open for pub Final Gas: inspection for the entire duration of the . work until the completion of the same. Electrical 1 r The Certificate of Occupancy will not be issued until all applicable signatures by the Bwlding an Fire Officials e�pro;ided on this permit. Minimum of Five Call Inspections Required for All Construction Work: ; Service: 1.Foundation or Footing 2.Sheathing Inspection .�� ;kM T Rough: 3.All Fireplaces must be inspected atthe throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT a m Applicati®n,number..... .. : ••••••• Fee............................& ...................................... ....... $ Building Inspectors Initials.. .............................. 13�1 � Date Issued.'....]............... .......... ................ ... Map/Parcel..02 ... .... /. ... . TOWN OF BA STABLE "" `- s EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATIIERIZATION PROPERTY INFORMATION -IAN 3 O;� Address of Project: O no(YiLpo rf Ci n y e-- 2ornS&ba-- NUMBER STREET VILLAGE Owner's Name: a i Cam. l n�F a Phone Number 5 0�-3 0 ti 0 Email Address: i _C_c9 mcod. � Cell Phone Number Project cost$ C-/ . 2 Check one Residential 4inerciaP OWNER'S AUTHORIZATION As owner of the above property I hereby authorize S t5 A' A c JJ M L rJ_T to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding ❑ Windows(no header change)# (Z Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to 1510 G(ar)be r 4 W i,W►4 y CONTRACTOR'S INFORMATION Contractor's name LOff AC �e Home Improvement Contractors Registration(if applicable)# :., 1136 (attach copy) Construction Supervisor's License# /03 53 L • '=w (attach copy) Email of Contractor n e,j.Jt h!A wn Wo_nar c!4,(n M Phone number 1 g) -30S- 33 ) 9 APPLICATION.NUMBER *For Tents Only* Date Tent(s)will be erected Removed on number of tents-total Does the tent have sides? Yes,No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event �- .,r�Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent Fuel source being used LP tank 20 lbs. or>Yes No ,if yes, a gas permit is required. Natural_Gas Yes No , if yes,a gas permit is required. If food is being served at-your event please obtain a health Department approval between the hours of 8:00am-9:30 am or 3:30 pm-4.30pm. Commercial events may require fire Department approval, *WOO]D/COAL/PELI.,ET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S 1LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CM R the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATiJRE Signature - Date -3C7 -202a All permit applications are subject to a building official's approval prior to issuance. t SCANNED JAN 3 0 2020 PLAN VIEW Name: f� � 8 �� —r1GV-J'r"T� Site 10: Finished Sq. Ft: Phone: Year of House: Electric Acct#: Address:$ r #of Floors: Gas Acct#: • unit 9: #Occupants:;?z Housing Type? DUCTWORK INSPECTION Ducts Insulated❑ Duct Linear Ft. Duct Square Ft. ' Duct Air Sealing Hours Duct Insulation _ 1 /U �— I d 1 - Duct Insulation Removal �b BASEMENT INSPECTION - Existing Spec'ing Ln/Sq.Ft. ` Bsmt Wall AG Crawl Ceiling _ r .._••,. . i-{o f Crawl Rim Joist Bsmt RJ wl Sill Bsmt RI NO Sill — -- — Vapor Barrierl sgft. Bsmt Door ` - Y N Blower Door? WALLS&GARAGE Drill Location? Siding Ce11 Hei ht Existing Spec'ing S .Ft. Framing ; Exterior Wail 1 0 x x Ballo Platform Exter-ier-Wafl-2— x x Balloon/P atform Overhang- x x Garage Wall x x Balloon/Platform Garage-6eiliag__� x x • j 1. 2 f — 7 Insulation Removal Sqft. Sweeps: WX Stripping:_ WORK SPEC'D BUT NOT CONTRACTED -,ROAD BLOCKS PRE SEN (MANDATORY i ttic Basement Crawls ace Other: K&T Y Moisture Y ombustion Sft Yneewall Overhang/Garage Asbestos Y/ Mold>100 sq.ft Y/N 0 Detector Missing Y N Ductwork jExteriorMlls; - Vermiculite Y/(NJ Structl Concerns Y N they:- Notes for Lead Vendor/Work Not Contra Red: 4 � i I KW WALL AND KW FLOOR Blind Spec? G F OR. « KW SLOPE AND GABLE END Blind Spec? ❑ Why? - - - Why?FRAMING EXISTING' SPEONG 46.FT. FRAMING EXISTING SPEC'ING S .FT. WALL X X SLOPE X X _ FLOOR X x GABLE X" X ACCESS x TRANS x x + RAN S x x ATTIC ATTIC x X _ SLOPE X X SLOPE EXISTING VENTING? EXISTING VENTING? EXISTING PIPES? Y/N• • KW Vendng I Vent OF OF Ho Damming sheathing Access Tern Access KW Vent( Vert OF: Temp A¢eu t C4. insulated Wall X X Feed Light�O i�ns.Hone BF Vend 6F BFV chim.�Damming IY'Roof�C2RY) l �' X,Handler AM Temp Acceu t• i Pull Down DS Hatch J Wall Hatch"/ Door o/ 8"Roof Vent�RV) —� ^�.•' ' Vol: - X .0058 X 19(1 story) X x -ATTIC 1 Blind Spec? ❑ - x X_ ATTIC 2 ;✓Blind Spec? 7 1 �i5.412 story) _ •• Existing Spec'ing Sgft Existing {Soec'ing 5gft 136(3at°ry) fl0 e / Trusses Cross Batting Floored Floored / Mixed Insulation Duct Work Lath S �6"Loose None lo -------''"" Cath Sloe f _ , - Walls- Walls Access —1 1 Access i Venting Propavents Vent BF I BF Hose I Damming_ enttng; Pro averts Vent BF BF Hose I Damming co oCn �' WHF Box:_ � Temp Access: _ v c Sheathing Access:CL _ sn - — `^ R.L.Covers: - _sq.Ft)300= - (Ulst NFA Venting) (Needed Sq.Fill 300=_,(Exist-NFA Venting)= (Needed q NFA Venting) # --- NFA Venting)- Roof Type:. Existing Venting? 2" Q" hi e+ dt.i Existing Venting? �Pec LY 1 fir- Qt o 4r ,4� r Sayl Z i s irrrr n Energy, Inc -- - Hom� To whom it may concern, Scott Veggeberg is a current employee of Homeworks Energy Inc.and operates under our insurance policy. Policy numbers that Scott is covered by are as follows: Commercial General Liability:79300606S002 Automobile Liability:6244378 Umbrella Liability: 7930060660002 Workers Compensation and Employers' Liability: ECC-600-4001017-2020A All HomeWorks Energy permits are pulled under his CSL license. The insurance provider is AIM Mutual Insurance Company. If you have any questions or concerns please contact Director of Weatherization Adam David Glenn at 774-36S-2446 or adam.glenn@homeworksenerw.com. Thank You, Adam David Glenn - Director of Weatherization HomeWorks Energy. Insulation/Air Sealing Permit Authorization Specialist: Christopher Boc Company: HomeWorks Energy `�t Email: christopher.boc@homeworksenergy.com Address: 101 Station Landing Cell: (617)827-8218 Medford,Ma 02155 HOrneWO& Phone: 781-305-3319 Customer: Plouffe Address: 8 Homeport Dr Email: 0 Barnstable Site ID: 3847058 Phone: - I,the owner of the property identified above hereby authorize HomeWorks Energy Inc.,or their Partner to act on my behalf-in obtaining any building permit that maybe required to perform insulation and/or Weatherization work on my property and all matters related to the work authorized by said permit if one is obtained. Any related permit application cost will come at no additional charge provided that the agreed Weatherization work is completed. Customer Signature: Date: 8/6/2019 Plo e s - V 0 HomeWorks mass save Energy, Inc PARTNER 101 Station Landing Ste 1!0,Med;ord,,VA 02155 (78.:1!305-331 g rrr.120 Customer Name:Janice Plouffe L Email:Not provided Phone:508-778-0479 Premise Address:8 Homeport Dr,Barnstable,MA 02601 Mailing Address:8 Homeport Dr,Barnstable,MA 02601 Project ID:3868739 Date:Aug.6,2019 Job Description Measure Description Location Quantity Unit Total Cost Customer Cost AIR SEALING 10 hr $800.00 $0.00 WEATHERSTRIP DOOR&ADD SWEEP 3 each $240.00 $0.00 ATTIC FLAT-8"OPEN R-30 CELLULOSE Other 897 SF $1,291.68 $322.92 ATTIC DAMMING- R-38 FIBERGLASS Other 125 SF $307.50 $76.87 12" MUSHROOM ROOF VENT Other 2 each $241.50 $60.37 VENTILATION CHUTES Other 52 each $181.48 $45.37 VENT BATH FAN THRU ROOF Other 1 each $118.75 $29.69 WALLS:VINYL SIDED 4"CELLULOSE Other 749 SF $1,460.55 $365.15 BASEMENT SILLS: R19 FG BATT Other 60 SF $131.40 $32.85 Project Total $4,772.86 Weatherization incentive ($2,799.64) Air sealing incentive ($1,040.00) Total Program Incentive $3,839.64 Customer Total $933.22 Total Contractor Price and Payment Schedule HomeWorks Energy, Inc.agrees to peiform the above described work,furnishing the material and labor,specified for the listed total price. Payment of the balance ofthe customer contribution is expected up.on completion of the work. Customer Signature: t __Date: Customer Phone: _ nagn t Of?_ Specialist Signature: _Date: LIMITED 71ME OFFER: The prices and Incentives in this contract are subject to change in accordance with the sponsoring utility MassSave Home Services Program oVers. Proposals can be sent to:tnboxCd)HometVorksfnergy.com ./!//� {C�('/f//!!i'i/(i'f'r/l�fi /�f ,�!,r1ri•iff:/i/!if`'/.!�i Office of Consumer Affairs and Business Regulation 1000 W ashingtoilt Street-Suite 710 Boston,Massachusetts 02118 Home Improvement Contractor Registration Type Crirpdradcn R��tslrAtiani 1 t11$A _ HOME WORKS ENERGY,INC:. a�.plrEit3¢n. 6�QcT24?i - '101 STATION LANDING STE*t0 MEDF©RD,f:1A 02155 Updnte Addre..and PA.-Lard. _ Qirice cr C.—nat AIIA s 8 Bu4ingcs Rcaisbett� ' Rlaal5'nn HOAE1APAOJEIAEN7t tACD Reg istration valid fcrinadvdual use ordp TYPf:Caznrakw 4fae th.expiration dtdi If roUndw n a - - office at Cansurncr Atia7rs end Buslrwao Rpgu6ation - 181 tS2 J3rrGr2029 - tOpp'Nash[r a Strnst•Sedte 710 AOWIE':.'L'RKGrfir"CY.I.4C Q9Lt0 n�,:t"o uZti - . G� r,0XVEiq'EQERfi �''r 101 ST aTION'LANDING Sl'E 110 p valid withoeit signatura 2.1COFORD..rw•+ ?1S5 �tJtttet 5r_t<Fi�ry= Cornntonwe31lh ('A ivfassArnuselts: Construction sup"visor Specialty Division of prol4.sst6t?al Licensure Board of Building Regulations and Standards Pestricted to: ttr CSSL4C-Insulation Contractor Gortstrctwan=sgetrSssr specialty r CSSI..103832 '- 1 E`xpir es: 1011312021 SCOTT VEGGEBERG 8 COVINGTON ST#1 , BOSTON MA 02127 Failure to possess a cuf liiion of the Massachusetts State Building Code is r• or revocation of this license. Commissioner yz-6 For inforrnattcnr about this license t yye J Call(617)727.3200 or visit www_mass.govldpl i Construction Supervisor Re:Address .'��r-� �� (or)application# Name Scott Veggeberg Telephone Number 508-273-7593 Address 101 Station Landing City Medford State MA Zip 02155 License Number 103832 License Type Expiration Date 10/13/19 Contractors Email N/A Cell# 508-273-7593 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable,Attach a copy of your license. Signature Date ----1 HOMEENE-01 LLARIVIERE . 6%. R CERTIFICATE OF LIABILITY INSURANCE DATE 12119/20/ YY) `—� 12/19/2019 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 have ADDITIONAL INSURED provisions or 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 CONTACT Lisa Lariviere NAME: Foster Sullivan Insurance Group,LLC PHONE ,Ext):(978)686-2266 301 jA X 163 Main Street No);(978)686-6410 North Andover,MA 01845 E-MAIL ,certificates@fostersuilivangroup.com INSURERS AFFORDING COVERAGE NAIC# INSURER A:Homeland Insurance Company NY 34452 INSURED - INSURER B:Safety Indemnity.Insurance Company - 33618 Homeworks Energy Inc. INSURERC:NH Employers Insurance Company 13083 Homeworks IIC LLC 101 Station Landing Suite 110 INSURER D: Medford,MA 02155 INSURER E: INSURER F: 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 POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR 7930060650002 4l1/2019 4l1/2020 DAMAGE TO RENTED 500,000 PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ipef LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO 6244378 4/1/2019 4/1/2020 BODILY INJURY Perperson) $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY BODILY INJURY Per accident $ X AUTOS ONLY X N&rN0J ED PeOr accitlentDAMAGE $ A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 X EXCESS LIAB CLAIMS-MADE 7930060660002 4/1/2019 4/1/2020 AGGREGATE $ 2,000,000 DED I X IRETENTION$ 0 $ C WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY T YIN ECC-600-4001017-2020A 1/1/2020 1/1/2021 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE a NIA E.L.EACH ACCIDENT $ FMandaR/M NH)EXCLUDED? 1,000,000 E.L.DISEASE-EA EMPLOYEE $ If es,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence Only CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Homeworks Energy Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9Y ACCORDANCE WITH THE POLICY PROVISIONS. 101 Station Landing Ste 110 Medford,MA 02155 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth ofMassaghusetts Department of Industrial Accidents Office of Investigations 600 Washington Street a Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): HomeWorks Energy Address: 101 Station Landing Ste 110 City/State/Zip: Medford MA 02155 Phone#: (781)305-3319 x5007 Are you an employer?Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 200 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 g. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp.insurance.: 9. ❑ Building addition 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 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.❑■ Other Weatherization employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors 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: NH Employers Insurance Company Policy#or Self-ins.Lic.#:4001017 Expiration Date:1/1/2021 . Job Site Address: (Z hotm PA(4 'Ort ye- City/State/Zip:900 02-60, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expirati n date). Failure to secure coverage as required under Section 25N of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.0.0 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 certify under the pai enald of perjury that the information provided above is true and correct. Signature: ="` '! Date: ) -3 o- 20 2 o Phone#:(781)305-3319 x5007 / wxpermitting@homeworksenergy.com 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#: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years), A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it.does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that is required by law. DATE:6-07-2017 Fill in please: '' i '. DBA Sno 3F�'"= APPLICANT'S YOUR NAME/S: John R r n � w Construction _ Hyannis,n i s ^ •,.. BUSINESS YOUR HOME ADDRESS: 8 HomeP�rt' nr Hv MA F i^ki:;.� ti ;:• ,rr��V 508 •i��;;�,,s�-ii,,,r�r;,. :c.> =7 71—9 3 6 6 `a�.ys' -;;.r TELEPHONE # Home Telephone Number 508-776-2907 - 4' ,i`!%lis istwe kl EIN #: E-MAIL: snowconst .,,��;,�,,, ..,,� 45-4587519 _ NAME OF CORPORATION:- - NAME OF-NEW BUSINESS 5110W c onr17 TYPE OF BUSINESS IS THIS A HOME OCCUPATIO ? YES NO / h ' ADDRESS OF BUSINESS. . . � MAP/PARCEL NUMBER [Assessing} When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable.. This form is intended to assist you in obtaining the information you may need: You MUST GO TO 200 Main St. (corner of Yarmouth ' Rd. & Main Street) to make sure you have the appropriate permits and licenses_required to legally operate your business in this town;: 1. BUILDING COMMISSIONER' FICE This individual has been ' d of any p t re uiremerits that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION RULES AND REGULATIONS. FAILURE TO Authorzed Si u e COMPLY MAY RESULT IN FINES. CO S: 11-717 2. BOAR HEALTH This individual has been informed of.the permit'requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: . r - °�TMf rti The Town of Barnstable Department of Health, Safety and Environmental Services 1MEMABUE. ' Building Division KAM 059. 10�` 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: 3 Name: 1► Q1m I? L G19'eZ �2-/14 2 5;04s Phone#: 771 _ 7 7 G C Address: /*,4x /t) Village: A- Type of Business: 1///4-j/G /,o 14,6 Co• Map/Lot: --;26 / ZZ INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be , included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersign ,have read and agree with the above restrictions for my home occupation I am registering. i /�vVt a Date: —� 9q Applicant• / Homeoc.doc 4�- /l:0SA�