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Home My WebLink About0028 LANTERN LANE ads /.�toTei� ,GAI. �. . __ _ _ _ CAPE SAVEzz Weatherization 508-398-0398- December 14,2011 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application #201102804, Status A, Parcel 307202 at 28 Lantern Lane,Hyannis,.Permit type: RADD, and issued on 5/31/2011 has been inspected by a certified Building Performance Institute (BPI) Inspector. R-10 Cellulose insulation was added to the attic. Basement perimeter was wrapped with R-5 reinforced foil or vinyl faced ductwrap.All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluske Y 14 Cape Save 7 Huntington Avenue Suite C, South Yarmouth, MA 02664 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel moll, Application # 2,0 ,1Z 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 o�,g Lkoc Village 4 g 0,(10 i Owner bona --N v�o,ne5 Address S am Telephone Permit Request Il c e�)vS O S 'li-Vic, -oc ,,VA L'+"e(-(b5 D '�' `�^ ') P /J I'1( �C..�2.1 Ltj'L° mill e- at d ► 1O'v9G L.� 1"� 1��L 1/G Q Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3 000 t Do Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family W 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 fi Basement Finished Area(sq.ft.) Basement Unfinished Area (sq':;ft) c? I II) Number of Baths: Full: existing new Half: existing =' new t Number of Bedrooms: 3 existing _new � � Total Room Count (not including baths): existing new First Floor Room sCount ' o Heat Type and Fuel: 20 Gas ❑ Oil ❑ Electric ❑ Other_ Central Air: ❑Yes No Fireplaces: Existing I 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 l Proposed Use e,s Vie►+i� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) r i�,'� I CL1054 cName wll is e Save 50 g - 28 - 03Telephone Number Address �� 4061� 100 License # 2 C 4-7 6 '�7_n�+1� 1 OLMN4 I m� U�`�6`�I Home Improvement Contractor# 1 0 l Worker's Compensation # 99 h / 5 I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO a-rftluJtk SIGNATURE DATE 5 (t3 / l FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ti ADDRESS VILLAGE OWNER t DATE OF INSPECTION: ' i FOUNDATION FRAME INSULATION " FIREPLACE �F r ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING F DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business(organization/Individual): M i c ei .mac iC b�13�.4 T ' Address: -C. (AU 0 a NQw�l t%l _1�� City/State/Zip: S • ,YA cign - tAft &LU Rone#: - 3 9- Are you an employer? Check the appropriate box: 1.CK 1 am a employer with 4. I am a general contractor and I Type of project(required): 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. Remodeling ship and have no employees These sub-contractors have S. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'coihp. 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 1 IQ Plumbing repairs or additions .No workers myself. ' com right of exemption per MGL Y [ p 12.[] Roof repairs insurance required.] c. 152, §1(4),and we have no ' employees. [No workers' 13.E] Other-�nstj i�ltH1 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 axe 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 an an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: t"maT i s S�,1 (Z t�(Z-C Policy#or Self-ins.Lic.#: G�G 0!505!2� t 1 Expiration Date: Z1 6 ( l! Job Site Address: "�� L C t1+c f n L a n to City/State/Zip: katlni Attach a copy of the workers'compensation policy declaration page(showing the policy number 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 DIA for insurance coverage verification. I do hereby certify under the pains n=enakLes that the infor►nadon provided above is true and correct. Si afore: P Date: 5-- d.�� _ Phone#: 1& 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#: CERTIFICATE OF LIABILITY INSURANCE DATE 1/1/"°D"" 1I1/2a10 Q 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 endorsements). PRODUCER !_NAME: Shannon Sperrazza Risk Strategies Company !PHONE (781)986-4400 FACIN— t?su 963-e420_^ 15 Pacella Park Drive ADDRESS;ssperrazza@risk-strat.egies.com —' Suite 240 los�_=ODUCER p0018476 R andol h NA02368 INSURERt3)AFFORDING COVERAGE i NAlC# INSURED [INSURER A:Seneca Specialty Insurance Cc INSURERS Aeatin Group Ins Services _ MichaelbscCluskey, D13A: Cape Save INSURER c Chartis Insurance 7 C Huntington Ave INSURER o INSURER E: South Yarmouth bdA 02644 INSURER F COVERAGES CERTIFICATE NUMBER:CL1011132675 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 tt INDICATED. NOTIMTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS i CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 1 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L jR.'• TYPE OF INSURANCE — - POLICY EPF ! pppLICY EXP — POLICY NUMBER Motu ! NNMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE :$ 1,000,000 X COMMERCIAL GENERAL LIABILITY ,PREMISES(Es occcsrencet $ 50,000 A 'CLAIMS-MADE OCCUR AhG1002606 10/16/2010:10/16/2011!MEDEXP(Any one persony +$ 10,000 PERSONAL&ADV INJURY s 1,000,000 ---- 1 i GEC NERAL AGGREGATE is 1,000,000 G£N'L AGGREGATE LIMIT APPLIES PER: 1 !_PRODUCTS-COMPiOP AGG�T$ 1,000,000 X `POLICY�^ PRO-JECT LOC g _ -- AUTOMOBILE LIABILITY i COMBINED SINGLE LIMIT $ 1 t)00 000 `ANY AUTO 6208200 :11/6/2010 '11/6/2011 I —al) ' ' _ y ALL OWNED AUTOS it BODILY INJURY(Per person) ?$ ? I I BODILY INJURY(Per eccident)I S X ;SCHEDULED AUTOS 1 (PROPERTY DAMAGE X !HIRED AUTOS ! (Per accident) $ s�X ;NON-OVMED AUTOS g 1 X'UMBRELLA LiA$ OCCUR EACH OCCURRENCE �$ 11000,000 - EXCESSUAB i I 1,OOO r 000 - AGGREGATE 1,000,000 DEDUCTIBLE j ! y— B RETENTION $ i 023578601 P/16/2010:10/16/2011! $ C WORKERS COMPENSATION ! *chael MaCluskey I MIC STATU- ; OTH-i AND EMPLOYERS'LIABILITY YIN '` I X 'TDRY LIMITS ER ? _ ANY PROPRIETORIPARTNER/EXECUTIVE I I .s excluded from coverage{ OFFICERIMEMSER EXCLUDED? ly I j N I A I 1 E.L.EACH ACCIDENT $ 540�000 Myaes in NNE} ' ;9930951 10/21/?OS010/21/2011:E L DISEASE_EA EMPLOYEE$ b00,000 DE3GIRIPTIDN OF OPERATIONS below I i E.L.DISEASE-POLICY LIMIT I$ 500 000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (A#aeh ACORD 101,Additional Remarks Schedule,it more space Is required) Issued as evidence of insurance. Contractors-Executive Supervisors or Executive Superintendents. 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. Attn: Ruth 460 West Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 'chael Christian/SMS �a,�� ,'�"� ...- .: .-•r. ACORD 26(2001") 01988-2009 ACORD CORPORATION: All rights reserved. INS025(2tatW9) The ACORD name and logo are registered marks of ACORD 9.4e -Crol��d 6 k'k�F,_ Office of Consumer Affai s and Business Regulation Ih! 's � t 10 Park Plaza - Suite 5170 `` Nr , Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164432 Type: Supplement Card CAPE SAVE Expiration: 10/6/2011 WILLIAM MUCCLUSLEY 8201 S. HOURD CT CHAPEL HILL, NC 27516 „`.' ___.�_ ..__ Update Address and return card.Mark reason for change. 0PS-CA1 0 s0a,-04/04-G10121e ( i Address `:.— Renewal _—'I Employment (- Lost Card "� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only � 3HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation v� Registration ;164432 Type, 10 Park Plaza-Suite 5170 Expiration 10/6/2D11•. Supplement Card Boston,MA 02116 CAPE SAVE Y. WILLIAM MUCCLUSLEY 7C HUNTING AVE S.YARMOUTH,MA 02664 Undersecretary Not valid wit ou signature NI-i sachuscits Department eft'Publi tiafet� Board of Buildint, Re, ul-a6011s trail Mann aril �. Constru than SOpervis€:r Specialty License License: GS SL 102716 Restricted to...IG 3 ' 1IVIL=LIAM MC CLUSKY 37 NAUSET ROAD WEST YARMOUTH;:MA 02673 E.xpiratiaw 6/28/2013 t'!•ntrn i�tii„Firs' T r#: 102776 88-12512010 09:23 9193M 2955 PAGE 01 i 01 COE 'SAVE 1 Weatherization 508-398-0398 August 22, 2O10 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 IMeCluskey Cape Save—Owner 919-593-5939 cell X Huntington_Avenue,South Yarmouth,NIA 02664 460 -West Main Street UTTG Hyannis, KR 02601-3698 ASSISTANCE ENERGY & HOME REPAIR T (508) 7 90-7106 r (508) 7 90- ORPORATION 2425 HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASEFILL OUT AND SIGN THISFORM IFYOU ARE THEAPPLICANT HOM EOWNER. 1c� �1 hereby consent to and agree that weatherization work may be done by the Weatherizat on Program of Housing Assistance Corporation (herein after referred as Agency")on theproperty located at: Theweatherization work donewill be based on programmatic priorities and availability of funding and it may include all or someof thefollowing measures 1, Weather-stripping& caulking of windows and doors, insulation of attics, sidewalls& basements, attic and other ventilation measures and possibly replacement,of badly deteriorated windows. In consideration of theweatherization work to bedone at my home l agree to the following: 1 1 give permission to the"Agency° its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property, 2. The Housing Assistance Corporation reserves the right 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 Tsted and freely give my consent. HomeOwner: (Signature) Date Agent: (signature) Date 7 HAC approved.Weatherization Company J e� All Cape Energy, Caliber Building&Remodeling, Cape Cod Insulation, Cape Sav , Creswell Construction, Frontier Energy Solutions, Lohr&Sons, Peter Smith, Resolution Energy, Rock Solid Construction Ft { Town of Barnstable *Permit# a 71��o� Expires 6 months m issue date Xn� �� Regulatory Services Fee -� SEP - 4 2007 Thomas F.Geiler,Director �t Building Division TOWN OF BARNSTABLE Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number C Property Address b L Ai j r 9-A L 1 I, f T Y ANI J 6 D z,/,o f [Residential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address Me—CA4 Y— yc/l.�WA Contractor's Name Telephone Number_ Home Improvement Contractor License#(if applicable) Gj,) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: /1;;L I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) t /Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note:_ Property Owner must sign Property Owner Letter of Permission. A copy of the.Ho m Improvement Contractors License is required. SIGNATURE: Q:Fomis:expmtrg Revise061306 Board of Building Regulations and License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registration �52773 g g f One.Ashburton Place Rm 1301 ExpfiraOon r9/28/2008 ;, Boston Ma.02108 Type ;DBA,. iv J GROUP DANIEL WOOD 38 EVELYN CIRCLE Y" �- o 6, C.�--CENTERVILLE,MA 02632 Deputy Administratorid without signature ! r h The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 , www.mass.gov/dia Workers"Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatiomgndividual): , Address: City/State/Zip: Phone.#: Are you an employer? Check the appropriate box: -Type of project(required):. 1.❑ I am a employer with 4. I am a general contractor and I mployees(full and/or part-time).'" have hired the stub-contractors 6. ❑New construction . 2. 1 am a•sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑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 11.❑Plumbing repairs or additions myself [No workers' camp. right of exemption per MGL 12 Roof repairs insurance required.]t c. 152, §1(4),and we have no . employees, [No workers' . •13.❑ Other comp.insurance required.] "Any applicant that checks box M 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. xContractors 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 providb their workers'comp.policy number. Iam 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:#: Expiration Date: Job Site Address: CAA!M, 4Lh.1 ,1V , City/State/Zip: � ` �ANN tS rXNA. Attach a copy of the workers' compensation policy declaration page(showing the policy number 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 DIA for insurance coverage verification, Ido hereby certi 'nder the pains•and penalties ofperjury that the information providedabove is true and correct. Signature; - o�s'� Date: �/ ' 4) Phone#: ' S t S 3 r- X O — Official use only. Do not write in this area,'tb be completed by city or town acial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i I °F JHE)°may Town of Barnstable. • Regulatory Services sniwsrASLE, • mss. $ Thomas F.Geller,Director 16�ATfD H9. A,� ]Budding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,-MA 02601 "V-town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject 7 property . hereby authorize � i �, to act on my behalf, in all matters relative to.work authorized by this building permit application for: 2 LAB pm k-i LN , ANN i s V1&6k- O !) (. 0 (Address of Job) Signature of Owner `\�" _ Date Print Name Q TO RM&O W NERD ERM IS S 10N