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Home My WebLink About0011 MARYALICE LANE / / �Vho�.0 �(,ctv .G� . Cape Save Inc. T0111 All AR STAi sf p 7-D Huntington Avenue South Yarmouth, MA 026 ; j -6 AN, $ , 6 Tel: 508-398-0398 Fax: 508-398-0399 . D t tills I�atrsa 444°� . 9/29/14 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 11 Maryalice Rd,Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-32 cellulose Basement: R-19 fiberglass blanket on box sill All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map - - V'.� Parcel l0 Application #,Z)O 3063v Health Division + ' Date Issued ,� l Conservation Division Application Fee g �i� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 6 P c Village Q"i f Owner a, y✓1 d ��G� Address New Telephone �� 1 t� GQa� r � (1,2� `Permit Request tea cL �C �Q�� QSC'dj'i�i J'l' ` ltJ e rdi �vOC `� a i� G i d7c aSC° lN� : S'�a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District ,�Tr Flood Plain Groundwater Overlay Project Valuation 300 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U / 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 Boom Cou ! Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: U7Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: existing„❑ rre�iv size_ ra, 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 --_ _ ___ _Pr._oposed Use APPLICANT INFORMATION ', l (BUILDER OR HOMEOWNER) p� 03 Name w° � kP 160eSaw,];�_ Telephone Number L 0)�O ^ ` Address J 14Q (0 `i License # So Q t/i'l�ly� Mtf Home Improvement Contractor# �` 3 Worker's Compensation #rW C ?3� 3 q6 9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ✓h SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ,7 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. 4 C The Commonwealth of Massachusetts rP ' Department of Industrial Accidents Office of Investigations ~, I Congress Street, Suite 100 Boston, MA 02114-2017 r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El please Print Le bl Applicant Information Cape Save,Inc. Name (Business/Organization/Individual): 7D Huntington Avenue Address: ' City/State/Zip: South Yarmouth, MA 02664 phone#: 508-398-0398 Are you an employer? Check the appropriate box: 'Type of project(required]ion 17 4. [] I am a general contractor and I 6 New construction 1.[� I am a employer with__ have hired the sub-contractors employees(full and/or part-time).* 7. Remodeling listed on the attached sheet. . ❑ 2.❑ I am a sole proprietor or partner- These sub-contractors have g. (]Demolition ship and have no employees employees and have workers' 9. (�Building addition working for mein any capacity. comp.insurance.t [No workers' comp.insurance 5 ❑ We are a corporation and its 10.❑ Electrical repairs o required.] officers have exercised their I I.❑Plumbing repairs o 3.❑ 1 am a homeowner doing all work right of exemption per MGL 12.❑Roof repairs myself. [No workers' comp. c. 152, §1(4),and we have no 13 a Other Insulation insurance required.]t employees. [No workers' comp.insurance required.] *Any applicant that checks box It must also fill out the section doing wort:and then hire ow showing their outside contractors must subs'compensation policy mit information.new affidavit indicating such.. t Homeowners who submit this affidavit indicating they g the name of the tContractots that check this box must attached an thtet onal sheet must pro ide their workers'compspolynnumber. and state whether or not those entities have employees. If the sub-contractors have employees, . Y employees. Below is the policy and job site I am an employer that is providing workers'compensation insurance for my information. Technology Insurance Company Insurance Company Name: 04/09/2014 TWC 3353968 Expiration Date: Policy#or Self-ii_::� ic.#: ,(,� c City/State/Zip:/_4 .&*P1 S V Job Site Address: ration Attach a copy of the workers' compensation policy declaration page(showing thepoc not criminal penalties of a Failure to secure coverage as required under Section 25A of MGL c. 152 can leimposition fine up to$1,500.00 and/or one-year imprisonment,as well.as acivil of penalties i in the a f STOP th office and a fine of up to$250.00 a day against the violator. Be advised that copy Investigations of the DIA for insurance coverage verification. I do hereby certify under the airs and penalties of perjury t at the information provided abov is ue and correct. -- Si ature: -- -_--- - - - Phone#: 508-398-0398 official use only. Do not write in this area,to be completed by city or town official City or Town: y 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 • Phone#: Contact Person: CERTIFICATE OF LIABILITY INSURANCE D mDrrrYY) 4/9/29/2013 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 endorsement(s). PRODUCER co Acr Colleen Crowley y Risk Strategies Company PHONEE _ ('781)986-4400 FA(PiC.No:(181)963-4420 15 Pacella Park Drive E-MAIL ADDRESS- Suite 240 INs S AFFORDING COVERAGE NAIC-9 Randolph H& 02368 INSURER A Selective Insurance INSURED iNsuReRs:Safety Insurance CcmManV 33618 Cape Save, Inc INSURER C:TechnoloME Insurance coppany 7 D Huntington Ave INSURERD: INSURERE: South Yarmouth M 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL134960509 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. INSR TYPE OF INSURANCE OOl SLISR POLICY NUMBER MMOIDD EFF POLICY EXP LTR LINTS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 DAMAX COMMERCIAL GENERAL LIABILITY PREM TO N D PREMISES Ea occurrence) $ 100,000 A CLAIMS44ADE a OCCUR 199448001 0/16/2012 0/16/2013 MED EXP(Any one person) $ 10,000 PERSONAL 8 ADV INJURY IS 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LMIT APPLIES PER- PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY ACT El LOC AUTOMOBILE LIABILITY (Es MBINDitSINGLE LIMIT $ 1 000 000 ANY AUTO BODILY INJURY(Per person) $ 8 ALL OWNED SCHEDULED 5208200 1/6/2012 1/6/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIREDAUTOS `Y AUT S � WeO� DMAAGE $ X Underinsured motorist 81 split $ 100,000 A X UMBRELLA LIAB XJ OCCUR S199448001- 0/16/2012 O/16/2013 EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ C WORKERS COMPENSATION Officers Excluded from X 4 RSTAMnUs oT�- AND EMPLOYERS'LIABILITY YIN - ANY PROPRIErORIPARTNc-R1E)(ECUTIVE NIA overage E.L.EACH ACCIDENT $ 500,000 OFFICEPJMEMBER EXCLUDED? 353968 /9/2013 /9/2014 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under - DESCRIPTION OF OPERATIONS be,ow E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Att.eh ACORD 109,Additional Remark.Schedule,if mere space is required} Issued as evidence of insurance. Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a/ National Grid, Action Inc., Colonial Gas Company and NStar Electric are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION 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. PO Box 427/SCH 3195 Main Street AUTHORIZEDREPRESEMATVE Barnstable, MA 02630 Michael Christian/CLC �� ACORD 25(2010105) Q 1988-2010 ACORD CORPORATION. All rights reserved. INS025(20)005).0) The ACORD name and logo are registered marks of ACORD 1 Massachusetts-Department of Public Safety Board of Suildina Reaulations and Seandards Construction Supervixur Specials`- _icense: CSSL-102776 \•--- WII.LIAM J MC C-LUSKEY_. , 37 NAUSET ROAD ° West Yarmouth MA 02673 �0mm:Si0nei 06/2i3/2015 ( Office of Consumer Affairs and eusness Regulation �t 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM McCLUSKEY - 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 - Update Address and return card.Mark reason for change. DPS-CA1'ca 50t64•04/04-G101216, Address i Renewal J Employment. Lost Card ✓te Larri»zaoacuea� aO�•l�am..�cc•�uselia Office of Consumer Affairs&Bins' lation License or registration valid for individu[use only r ?HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ?? Registration::.-171380 Type: Office of Consumer Affairs and Business Regulation NEEDS =SEW, Expiration 3/14/2014 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE=SAVE WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH MA 02664' Undcrsecretarp Not valid wit d signa P Building Permit Authorization I, Raymond Cadrin : =, as owner hereby give my permission to Cape Save, Inc. 7-D Huntington Avenue 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 11 Maryalice Rd Hyannis, MA 02601 : , Signed Date - Town of Barnstable *Permit# go ~ 'yp Rvpires 6 months from issue dote BAMMM , : Regulatory Services Fee 9 NAM Thomas F.Geller Director "TEa►��" Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 X-PRIT Office: 508-862-4038 Fax: 508-790-6230 �e 2 6 2004 EXPRESS PERNIIT APPLICATION - RESIDENT%U��R�STgSLE Not Valid without Red%Press Imprint Map/parcel Number o?q. ( e d7 5— Property Address .l.l�(YI&d AA Z« �v�� MA- 6Q[bol esidential Value of Work 2,006 Owner's Name&Address ass j ��a�d st. 411 into oa13� Contractor's Name.-� r i n Ll2 �t7 Di�,�te mQ Telephone Number �� 7 S'i Home Improvement Contractor License#(if applicable) V 3-7 S� Construction Supervisor's License#(if applicable)S [PWo'rkman,s Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner &�-nave Worker's Compensation Insurance Insurance Company Name 1�11 T-iM MLd, _XAL. . Work,n n's Comp.Policy# 3CO g9 ` In ( a OO4 Permit Request(check box) ❑'Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) e-side ❑ Replacement \Windows. 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. Ho Improvement Contractors License is required. Signature Q:Forms:expmtrg Revise053003 o act on my behalf in all matters relative to the rinkle Home Improvement t if necessary. I authorize Sp 1 e ermits, applications etc.) work to be performed on this job ('• • P HOMEOWNER: ARE ANY BLANK SPACES DO NOT SIGN THIS CONTRACT IF THERE Contractor Signature Owner signature _ 2, .0 y Date Date F C -I� r CERTIFICATE OF INSURANCE ISSUBDATB(MWDDIYY) PRODMER TI S CERTLEICATZ 'IS D UA TTER OF INFORM INFORMION ONLY AND CONFERS NO RICHT$UPON THE CERTIFICATE HOI )". 'PHIS CERTIFICATE Dryden&Sullivan Ins Agency DOES NOT WD,EXTEND OR ALTER THE COVERAGE An'OUED BY THE Inc 88 Falmouth Road COMFANIFS AFFORDING COVERAGE Hyannis,MA 02601 INSURED Sprinkle Home Improvement Inc COMPANY A.I.b2, Mutual Insurance Co 199 Barnstable Road (LETTER A Hyannis, MA 02601 j COVERjkGES _ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE S ENOURD TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CQNTRACP OR OTHER DOCUMENT WITII RBSPECTTO WHICH THIS CERTIFICATE MAY BLS ISSUED OR MAY PERTAIN,THE INSURAN=AFFORDED by TM POLI(IES DESCRIBED HEREIN IS SUBJECT TO ALL THE TIrwS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN IWUCED BY PAID CLAIMS. Co TYPE 00INSUJ(ANCE POLICY INIZWsu POLICY T6zP.CTIV6 YOLICY exImATIO. L?NtIT5 L DATE(MM/OUnY) AATE 4M1DDfYY) GENERAL LL#zzu ERALLIADIISTY RNBRALAGGRFAAT6 S COMMERCIAL GENERAL LIABILITY • ODUCTS-COMP/OP AGO. S tM3 MADE CCU ERBONAL&ADV.INJURY o"BwS A gNTltAOTOR'S PRAT. I I CH OCCURRENCE S i ' IREDAMAG¢(Arrywxfire) f 6D.EXPENSE(AAV 6W pmroN I AUT01401I EUANUAft MIiINDDS1NGL£ ANY AUTO LIMIT f ALL OWNDD AUTOS BOOILY!W URY CIMDULDD AUTOS i (Pa p pram 8 AUTOS NON AWNED AUTOS ODB.Y BV) F Pc.ac�iQenU GARAGE LIABILITY PROPERTY DAMAGE S Excim AMITY DAcn OCCURRENCE t R4LLA FORM AGOREOATE f THER THAN UMBRELLA FORM WORKIIR'SCOMPPNYATIONAND X WC ATU- CEN• EMPLOYERS�LQ"111L 'Y � Y �Z 7OC4943012034 OSl13=4 05/13!2003 f A TI[E PROPRIETOIir 500.000 FARTNDRSAIX,CUTIVE X 1PICL OISCA3P L f OpFI ARE EL DISEASB-•6A R P E ! IK000 OT!= DEaL-KMON OS OMaUTIONSA OCAZIONSftMCLEtifSML*4IT XS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED EMU TAB Proof of Imurauce WatATION DATIi THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MARL 10 DAYP wwrTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILUItg TO MAIL SUCH NOTICE SHALL.IMPOSE NO O"ATION OR LIABILITY OP ANY FIND UPON TILE COMPANY, ITS AGENTS OR REPRESBNTATLVES. ___ AU'TFIOA=D REPR SENTATIVB v ce -- __ The Common wealth o tts = l Massachuse Department of Industrial Accidents Ofl/CB 0///II�ESll�81/0/!S 600 Washington Street . y3 Boston,Mass. 02111 Workers'Compensation Insurance Affidavit name: location: C— phone a 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job. cotnoan�same:: �� i(1 f Vvl dit�f.P 1iY)P�l ttttth�ss:>:� l{?: �ltr �rtrnn I S-- �Yl o a CoDI phone#• .7 75 — I_?71 O 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who hu,: the following workers'•compensation polices: s. eomt►anvnam� OEM comoinvstame: : . s3tx: phone#: iiiapett'eee�eoz of fY p�Y Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 andior one years'imprisonment as well as civil penalties In the form of a STOP WORK ORDER and a line of S100.00 a day against me. I understand that a COPY of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cerllfy under the p ins and penal!/es of erJury that the Information provided above Is true a d comet[ Signature t' Date Print name hone# rcheck ly do not write in this area to be completed by city or town official permitAicense If nBuilding Department []Licensing Board - mediate response is required []Selectmen's Office []Health Department n: phone N, nOther (Mind 3I9S PJAI Information and Instructions Massachusetts General Laws chapter.152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual., partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three.apactments and who resides therein,or the occupant of the dwelling house of-another who employs persons: o do maintenance construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable.evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should-you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space atthe bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance-for you cooperation and should you have any questions, please do not hesitate to give us a call. r The Department's address,telephone and fax nuin?-f.r., The �:otu:t ;:uv;.;aitl� i iras5:.c14:t:►� :.: Denarttrent oa'T:tdusft-.,* : dfffce of Investigations 600 Washington Street Boston,Ma. 02111 fax#:.(617) 727-7749 nhnne (617) 727-4900 ext. 406. 409 nr 375 f 1 / - „ BOARD OF BUILDING REGULATIONS rqy License: CONSTRUCTION SUPERVISOR Sk..,p F. '� Y• I Number: CS 006643 Birthdate 10/08/1955 Expires:.40/08/2005 Tr.no: 5711 4 ; Restricted: 00; BRAD K SPRINKLE 190 LOTHROPS LANE i W BARNSTABLE, MA 02668 Administrator A U.r �J�e l�'Cl'll2Yi20�YtdlJP,2G/.�'G 0��/l�L.(X*k1(LCYZllJP�6 Board of Building Regulations and Standards s - HOME IMPROVEMENT CONTRACTOR — Registration: 103757 Expiration.: .719/2006 Type: Private Corporation SPRINKLE HOME IMPROVEMENT,INC. Brad Sprinkle 199 Barnstable Rd. ,, Hyannis,MA 02601 Administrator i 00-35,000 cf enclosed space (MGL C.112 S.60L) I-Masonry only } 1G-1&2 Family Homes { Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. _.., i DIG SAFE CALL CENTER: (888)344-7233 License or registration valid for individul use only „ before the expiration date. 1f found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02108 Not valid without signat re