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HomeMy WebLinkAbout0306 OAKLAND ROAD CA THEINIORFOLK DEDHAMGROUN August 15, 2015 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B Building Commissioner, or Inspector of Buildings c/o City or Town Hall 367 Main St. Hyannis, MA 02601 Board of Health or Board of Selectmen c/o City or Town Hall 367 Main'St. Hyannis, MA 02601 Fire Department or Arson Squad c/o City or Town Hall 367 Main St. Hyannis, MA 02601 RE: Our File No.: P1599253 Insured: ROSE NATHAN Address: 306 O^AKLAND`ROAD',HYANN[&,-MA_ Policy No.: H1200905A Loss Date: 08/14/2015 Loss Type: Building or Other Structure Damage A claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Ch. 143, Sec. 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 3B is appropriate, please direct it to my attention and include a reference.to the captioned insured, location, policy number, loss date and claim or file number. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property, and the claim will be paid in our customary manner. Sincerely, Lorraine A. Peirce Sr. Property Claims Examiner 1-800-688-1825 x1139 NORFOLK&DEDHAM MUTUAL FIRE INSURANCE CO. 222 Ames Street,P.O.Box 9109,Dedham,MA 02027-9109 DORCHESTER MUTUAL INSURANCE CO. Telephone:(800)688-1825 FITCHBURG MUTUAL INSURANCE CO. ® Fax:(781)329-1818 ,> TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel $S Application 00.1.✓lJd i ©v Health Division Date Issued A '7—�3. Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address Village t em l Owner $e 0.��wo Address s rz(A e Telephone 508 aa- I 3 k o l .Permit Request �n_ —3� - 30 ��llalo;p -t-o *k �Zloet. R- 19 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 6 0 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, att supporf±.ng doc4imentation. co o Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) mz Age of Existing Structure Historic House: ❑Yes ❑ No On Old K� g's Highway: Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area sq.ft)_ .� c� t Number of Baths: Full: existing new Half: existing � news, 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 Central Air: ❑Yes ❑ No Fireplaces: Existing 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 X No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION ' (BUILDER OR HOMEOWNER) Name WI 1 rOkArkt C.6 e aswe SSG-. Telephone Number 501 03 q Address �� �nt�en License # _C 0 a SQ .+ 1 afmpK-�� 6 �6 b�I Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO�a.cm SIGNATURE DATE LU - C% - �3 4 ti FOR OFFICIAL USE ONLY APPLICATION# 4DATE ISSUED MAP/PARCEL NO. `r ' t ADDRESS VILLAGE OWNER :r Ft k• ' F` DATE OF INSPECTION: t -FOUNDATION, r FRAME F; INSULATION t FIREPLACE a ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT F ASSOCIATION PLAN NO. t t-iousin Assistance Corporation Cape Cod HOME OWNER WEATHERIZATION WORK PERMIT & FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE �/�,' THE APPLICANT HOME OWNER. I hereby consent to and agree that weatherization wok may be done by the Weatherization Program of Housing Assistance Corporation (herein after referred as"Agency") on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: 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 the weatherization work to be done at my home I agree to the following: ' 1. I 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 P weatherization work on said property. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5)years after the weatherization work is completed. I have read the provisions of this agreement as listed an ,freely give my consent. l ' Home Owner. (Signature) Date:' a Agent: (signature) d Date: t HAC approved Weatherization Company All Cape Energy. Cape Cod Insulate n Cape Save fficient Buildings,LLC Frontier Energy Solutions. Loh:r-&aons,-.. - .Resofutipn Energy e Ak The`Commonwealth of Massachusetts Department of Industrial Accidents [� i:r Office of Investigations I Congress Street, Suite 100 e �'t Boston,MA 02114-2017 -,, www.mass.gov/dia Lr Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Auplicant Information Please Print Legibly Name (Business/Organization/Individual): Cape Save Inc. Address: 7D Huntington Ave City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-398-0398 Are you an employer? Check the appropriate box: Type of project(required): 1.0 l am a employer with 6 4• ❑ I am a general contractor and 1 6 ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole.proprietor or partner- - listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8, ❑ Demolition and have workers' working for me in any capacity. employees t 9. ❑Building addition [No workers comp. insurance.comp. insurance 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.El I am a homeowner doing all work officers have exercised their I l.❑Plumbing repairs or additions myself. [No workers comp. right of exemption per MGL 12.❑ Roof repairs � c. 152, §1(4),and we have no Insulation insurance required.] 13.❑✓ Other Insula 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Technology Insurance Company Policy#or Self-ins.Lic. #: TWC3353968 Expiration-Date: 04/09/2014 2 ` C Job Site Address: 3b � �a�' t 4'�� � City/State/Zip: 0A Attach a copy of the workers'compensation policy declaration page(showing the policy numb r 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 S1,500.00 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 Leib under the gains and penalties ofperi ,that the im ormatio Date `. to m provided above is true and correct. Signature: Phone#: 508-398-0398 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 4A 9(201D3 Y) 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(les)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: Colleen Crowley Risk Strategies Company PHONE (781)986-4400 FAC No:(781)963-4420 15 Pacella Park Drive Suite 240 INSURE S AFFORDING COVERAGE NAIL 0 Randolph MA 02368 INSURERA:Selective Insurance INSURED iNsuRERs:Safety Insurance CcmpanV 33618 Cape save, Inc INSURERC:Technology Insurance Company 7 D Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02644 INSURER F: 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. L�TR TYPE OF INSURANCE SUB POLICY NUMBER MMI ICY EFF POLICY MMIDD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE Ex—J OCCUR S199448001 0/16/2012 0/16/2013 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 IECT X POLICY PRO LOC COMBINED SINGLE $ AUTOMOBILE LIABILITY Ea accident LIMIT1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 208200 ' 1/6/2012 1/6/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS ON OVWED PROPERTY DAMAGE $ X HIRED AUTOS E AUTOS Per accident X Undednsured motorist BI s 6t $ 100 000 A X UMBRELLA LIAR X OCCUR 199448001 O/16/2012 0/16/2013 EACH OCCURRENCE $ 1,000,00D EXCESS LIAB CLAIMS MADE AGGREGATE $ 1,000,000 DED I I RETENTION $ C WORKERS COMPENSATION officers Excluded from X I WC STATE OTH- AND EMPLOYERS'LIABILITY ER ANY PROPRIETORIPARTNERIDECUTIVE YIN overage E-L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ® NIA 33 /9/2013 /9/2019 (Mandatory in NH) 5968 E.L.DISEASE-EA EMPLOYEA$ 00,000 if yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a National Grid, d/b/a Boston Gas Company, d/b/a Essex Gas Company, Action Inc., and Housing Assistance Corporation are listed as additional insureds as respects General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION (508)7 90—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. 484 Main Street Hyannis, MA 02601-3698 AUTHORIZED REPRESENTATIVE chael Christian/CLC ACORD 25(2010105) .©1988-2010 ACORD CORPORATION. All rights reserved." 9 °~ Massachusetts -Department of Public Safety Board of Building,Regulations and Standards Construction Supervisor Specialty License: CSSL-102776 WILLIAM J MC C-LUSKEY 37 NAUSET ROAD West Yarmouth NIA 0267a3��- r 06/28/2015 Commissioner Office of Consumer Affairs and usiness Regulation 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. 7 Address 17 Renewal Employment 71 Lost Card DPS-CAI ca 50M-04/04-G101216 Consumer r Affairs&I ss Regulation a License or registration valid for individul use only �� Office of Gossamer Affairs&B sines Regulation � Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 171380 Type- Office of Consumer Affairs and Business Regulation — ) Expiration: =3l14/2014 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAP€SAVE INC:.. ..- _. WILLIAM McCLUSKEY. 7-D HUNTINGTON AVENUE- „� SOUTH YARMOUTH-,-M.k.02664 Undersecretary - Not valid wit o signs Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 10/16/13 Town of Barnstable ` Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 a a • Y o � --s RE: Building Permits -� CO Dear Mr. Perry, NO This affidavit is to certify that all work completed for 306 Oakland Rd,Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-30 cellulose Walls: R-13 cellulose dense pack Basement: R-19 fiberglass in box sill All work performed meets or exceeds Federal and State Requirements. y Sincerely, William McCluskey