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HomeMy WebLinkAbout0052 RUDDER ROAD 5d 'Rkddsr�d, ( - - _ _ _ J � . CAPECOD INSULATION � � • Q ;. � CIP 11YIY U Stue,t[SS fplAT fpAN lYSP[Np[p dim i TARS YYRfYi INl YLAfIpN C{IlINOf �� � ' 1-800-696-6611 41 Town of Barnstable CD Regulatory Services ' Building Division 200 Main St llyannis, MA 0260I /y Dear Building Inspector - Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. perfornied completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance,to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BRI) inspector. All woik' `reformed meet r p � or exceeds Federa),�. State Requirements. Pro ert 0\ner" Property Address, Villag e 111SLILItlon Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( �) ( I7) Slopes I Moors l ) Wally r pI't Sincerely Ile ry L Cas y Jr, President C. ' e Cod .I , ulation, Inc.. i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel� Application 1 ��'1 �� O Health Division Date Issued 7_ — to IC Conservation Division Application Fe �? Planning Dept. Permit Fee 401 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address e7,4�2Z Village ,��,�1✓�(//.S Owner Address T_ >w� Telephone ' 77 Z Permit Request G ��xe /d kJ <'e/411D Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new? Zoning District Flood Plain Groundwater Overlay Project Valuation ?17J Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family J�', Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ;4No On Old King's Highway: ❑Yes 2f 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 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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Nameer,w C"P ftily�% Telephone Number s �7,6 /Z` 41-- Address �/_ %�� i �'��� License #�/� 9 �-� Home Improvement Contractor# Email Worker's Compensation #Al zig d6.S ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE�% j�// i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP--/PARCEL NO. ADDRESS, VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 1 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL B.UILDING,- DATELOSE;D OUT ASc§OEIATION.PLAN NO. Massachusetts -Depal"tr4nt of Ppblic Safety 6Da, rd of Building Regula;ions.?n8 Standards. ` Construction Supervisor License: CS-100988 HENRY E CASSII3 ' 8 SHED.ROW WEST YARMOLF171 02 10 J.•�..� ,� �;;\ Expiration Commissioner .11/11/2015 Office of Consumer Affairs and Business Regulation �r.s ` 10 Park Plaza - Suite 5170 w, >r i Boston, Massachusetts 02116 I Home Improvement Coq-tragtor Registration Registration: 153567 I s Type:. Private Corporation ' Expiration:- 12/15/2014 Tr# 233831 I CAPE COD INSULATION, INC ' HENRY CASSIDY _ _ -----' ---' --- 18 REARDON CIRCLE_ SO. YARMOUTH, MA 02664 -- ------ - --- - -- ' ---- `Update Address and return curd. Mark reason for change. _iCA(I2i 2pM-05/I I - Address 0 Renewal ,U Etnployment II Lost Card :. . a Office of Cuasumer Affairs& Business Regulatiou License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: E _ _ gistration: 1�53.567 Type: Office of Consumer Affairs and Business Regulation xpiration.: • 12/1'5/20.14 Private Corporatia� 10 Park Piaza-Suite 5170, ryx�yv,' r\ Boston,MA 02116 CAPE.,I COD INSULATIQN,r,l4*1C, HENRY CASSIDY 18 R'ARDON CIRCLE SO. Y RMOUTH', MA 02664 " — -• Undersecretary of val' witho t �tr e The Commonwealth of Massachusetts t Department of Industrial Accidents Office,of Investigations 1 Congress Street, Suite 100 ,r Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AvOicant.Information Please Print Legibly ibl Name (Business/Organization/Individual): 6mi, C_A_ . `* hNA/ ' Address: &v,6 iq ` `7��' (2 ICity/State/Zip:_ Are on an employer? Check the a propriate box: Type of project(required): I. I am a employer with __'2r7 4. ❑ 1 am a general contractor and I * have hired the sub-contractors 6. ❑ New construction employees (full'and/or part-time): ' 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have { ship and have no employees 8. ❑ Demolition° , working for me in any capacity., employees and have workers' [No workers' comp. insttrance comp. insurance.t 9. Building addition ❑ We are a corpo ration oration and its 10.❑ Electrical repairs or additions � 5. 3.❑ I am a homeowner-doing.all work officers have exercised their , I I.❑ Plumbing repairs'or additions myself. [No workers; comp. _ right of exemption per MGL Roof repairs 12 ❑ insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13YOther M1l/1 comp. insurance required.] 'Any applicant that checks box#I must also till out the section below showing their workers'compensation policy information. t l lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContracturs that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have ' 1 employees it the sub-contractors have employees,they must provide their workers'comp.policy number. . I am an employer float is providing workers'compensation insurance for my employees. Below is the policyand job site information. Insurance Company Narne`. "l Policy#or Self ins. Lic. yj 2 0 I Expiration Date:. . Job Site Address: t _�li�������✓ ,�'`�'` /� l/ S City/State/Zip:'. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration bate). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine 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$250.00 a day against the violator: Be advised that a copy of this statement may be forwarded to the Office,of Investigations of the DIA for insurance coverage verification. ' I do hereby cer fy r the pains and penalties of perjury that the information provided above is true and,correct. Signature: Date:.• Phone#: t r gfficial use only. Do not write,in this area,to be completed by city or town official. . City or Town: Perinit/License# A- Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other IContact Person: Phone#: •` '` "� - CAPECOD-27 CVANGELDER CERTIFICATE OF LIABILITY INSURANCE 7411/21014 IMM/DDIYYYY) 'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.- IMPOR•rANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to dw loans and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not center rights to the corTificatu hold6r in lieu of such endorsement(s).- PROuucER - .. CT CONTA NAME: Cape Cod Commercial Rooars&Gray Insurance Agency, Inc. PHONE --- TAX---- --- 434 Rto 134 Alc No E9L - —- �_LA�c No (877)816 2151i South Dennis,MA 02660 E-MAIL �— ADORESS:. INSURER(S)AFFORDING COVERAGE _ NAIC0 --------_�-_-__ __ INSURER A:Peerless Insurance Compan�r _ INSURERS:COMMERCE INSURANCE COMPANY — Cape Cod Insulation Inc —INSURER c:Evanston Insurance Com—panY •I8 Reardon Circle IN SURERD:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 , wsuReRE; ` --... ----- ------ -7 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I HIS 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'r0 WHICH THIS 4 CER-11HCATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, irk! k TYPE OF INSURANCE ---—.- AD15L.SUl3R — POLICY NUMBER — MM OIDmYY MMIDD YYYY ^--_�_--_ LIMITS ---- -------- ICI A I X OMMkRCIAL GENERAL LIAETILITY - 1,000,00 EACH OCCURRENCE $ - — DAMAGE TENTED-- _�CL4IM9 MAUL X OCCUR. r GBP8263063 0410112014 04l01l2015 pREMI`,ES Eoocdu,,mcoL- _$ 100,000 x _ IVIED EXP(Any ono person) $ —, 5,000 . ,PERSONAL&ADV INJURY $ _1,000,000, �FN(A('(:1 I(;A I E LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO. X i t'UUi1'r I I JEC1 � LOC PRODUCTS:CUMI/OPAGU 2,000,000-y - __- I AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ B ANYAUIO 14MMBCKVMK 04101/2014 04101/2015 BODILY INJURY(Pei person) $ --�— ----- ----- ALI O'.A'NED X. SCHEDULED . BODILY INJURY(Per accident) $ 1,000,000 �.-Wi0S AUTOS _ —_ 1 X I NNE X NON OWNED H D AUTOS AUTOS - Par accident -_ i $ I X UMBRELLA UAF! X I�OCCUR EACH OCCURRENCE $ 1,000,000 C I I excess LIAB CLAIMS-MADE R/O XONJ453512 041UI12014 04/0112015 AGGREGATE $ 'lieu I X Rt:IE.NfION$ 10,000 Aggregate $ 1,000,000 WI WQKKER5 COMPENSATION - - PER OTFI - - 'ANUeMPLOYkRS LIADILtTY @ - STATUTE _ YI D , N vl 01 RILIURIPARTNER/EXECU-IVE `;;;N---����I WCA00525904 06/30/2013 06/30/2014 E L.EACH ACCIDENT 11 1,000,000 �y AHCERrMEMBER EKCLUDEC? L� NIA 1JM111dat0(y In Nil) - . E.L.DISEASE-EA EM PLOY E--E= i I(roo dtl 54I Irl.unudr ---------� - 1,000,00 ME5CRIPIIONOFOPERAIIONS.be1o, `E.L.'DISEASE-POLICY LIMIr $ ULSCRIP I ION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) - - yy��orker5 Compensation includes Officers or Proprietors. AI diuonal Insured status is,provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EVIDENCE OF INSURANCE THE EXPIRATION DATE THEREOF, - NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved." (CORD 25(2014101) The ACORD name.and logo are registered marks of ACORD �WON r'4,6 AAA, PARMA= mass save o Semin9a thmao am w oftlancy PERMIT AUTHORIZATION FORM 1, 5 aC /0/� I Q n ) , owner of the property located at: ( ner's Name, printed) ' (Property Street Address) ( yfrown hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. O ers Signature Date ` FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: CAPE- ^fAS ELL X-T,DA Ila Participating Contractor Date Rev. 12132011 Assessor's map and lot=number ...... . .../-.i........... ........... SEPTIC S " Q � YSTEM MUST BEN of Sewage Permit number, ...�„� ���.r¢..... d .�l�tt.. � ' /�f INSTALLED IN COMPLIANCE WITH ARTICLE I TATE i BARNSTABLE es � H_use number ........................................................... �..r ...... . SANITARY CODE O DE AND TOWN 1 6 9, !oL�! 4' — � Y. aP \e� c ± TOWN 'OF' ' BARNSTABLE DURDING{` INSPECTOR 11) 6 APPLICATION FOR PERMIT TO ........; '.... .................✓.............: .........................` l'��'.."...��� ..���°G.. ........ TYPE OF CONSTRUCTION ......►! rd......................r.........................................:............................................ ...................................... TO THE INSPECTOR OF BUILDINGS: t. The undersigned hereby applies for a permit according to the following information: Location .........�� ��.?�J.C'. .... U. .��...:.:..:. L.U % ++ �/ ' �4,� ....... ..... ....................... ....................................................... Proposed Use .... ................................................... ...........................................................................................................-...... Zoning District ......RJ....................:................:...:...............Fire District /A1Va✓! Name of Owner .✓.. fit�� .....< ....11.MC.XA/#!�&".Address .4 ...J���!44.04 (�. ..... ............................................. Name of Builder r � ti �✓� � :. l�' `ap�' �L �1-. ....................... ...................Address Aw..../........ :.................. Nameof Architect ............ ..J...........................................Address ................................................:................................... -Number of Rooms ........� �'! .v...........................................Foundation l;e-, 'n,( 13/ evDC l . 0.4......... ......................................... .. .......... Exterior .. 9��,1 �t?' � r'' �:� .Pj'. `vO Roofing ...../aS� "L.`.................................................... ............................................................ ......... ... . ...............................Floors .. , .................... Interior .....� C: ..Heating ... .. r4 ............................Plumbing ......(R4 ell. Fireplace ...... ..0...............................................................Approximate Cost ................ Definitive Plan Approved by Planning Board _______________________________19--------. Area .....y/.�. ...46................... Diagram of Lot and Building with Dimensions Fee /Qom SUBJECT TO APPROVAL OF BOARD OF HEALTH • S • s 0-V _ Lor Old r I hereby agree to conform to all the Rules and Regulations of the Town of Ba nstable regarding the above construction. Name .... ... .. � ,- :....................................... . ....... . i MacLachlan, James F 206 -, No ................. Permit for .........add..to..dWQ.1,l ing rt. .. ........ Location 1udder Road................................. f 41. ...... f .......H2Onnis.... Owner ........James..F. MacLB.Chl;,j'�................ .................. 1 Type of Construction ...................frame............ - .r ." . a Plot ^.. ................... Lot ...........It. ................O t Oermifi Granted .........: ctober 14 19 78 Date.o ection r ` Date ,Completed ................................ Y 3 PERMIT REFUSED F ............................................................... 19 +r�L.......................................... .................. ...... I ................................................................................ i ............................................ 44 �- .............................................................................. 1 Approved ................................................ 1 , ............................................................................... ......................................................... 4 ............ • a_ t; ` 'Assessor's map and lot number :.r..�........ / .. �............... v I . Sewage Permit number ...I% ' !L ri, :...:.. ..................,. n... ........ Q Z SAMSTABLE, i Hous number ............... 'o "'B& p 1639. e00 TOWN OF BARNSTABLE F' BUILDING INSPECTOR APPLICATION FOR PERMIT TO ........ ..L> '� 0 �✓ ..} r • f .... s ............................................................................:............................. TYPE OF CONSTRUCTION ......'. ...".°.....�..........................`.`......................................................... :.- - ..........................:...................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...........I.......................................`...!................................-"►tr...%.......................'..`.r ......!,........ ........................... Proposed Use ` f Zoning District ........................................... Fire District .... ........... ............................................................... ' Name of Owner ... ........ ........... �....�:%:!�r......f��.(ri.�/.Address .-�Z�....... ..".`: ........lfG:'...:.�................................ . ,« f< i` Name of Builder ......i.:.` ! !'a...............r�.�.....................Address ''.::.....!f��..�'r`,................................. ............................6r-�. _ "` Nameof Architect ............ ....:'............................................Address .................................................................................... Number of Rooms ......... ............................................Foundation .rc��6 -+rr i ................./..s....t...I....�.....�....I.�...r..i.�..,..../.....tf........ Exterior �:.., ..........���.�� '. ..Roofing .....::k.'....� .'{. ..!........................................................ . ................................................... .......... r� �rA +/� '.�•I '� !Jt Floors '' Interior ....................... ..................................................................................... ............................................................. Heating .....'. .........e................e...'..`.......................................Plumbing .......' ..........!. .................................................... Fireplace ........................Approximate Cost - /. ....w............................. Definitive Plan Approved by Planning Board --------------------------------19--------. Area .......................................... Diagram of Lot and Building with Dimensions ee ........../`5F ........~.....w...................... SUBJECT TO APPROVAL OF BOARD OF HEALTH i I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ` .... .................................................................. ' MauLaoblan, James FI.v jA=247~I72 . - ' No ---2Od72.—.— Parm� for �«« �p = g ( ! ----.---------. ` -------���� ) / Location ---.—^5.2-:�.AggkK�.JjQ ' . .............................................. YA. I.$__ . ) J��eo � Ovvner --------.t.. ----- Typa of Construction --..]�����-----�-- --------------------------' a Plot Lot r� Permit Granted -- Date Completed � � ^ ' PE�RMn REFUSED ' ' .................................................. / ' —^' ................... --' ^—'` ' ' - ................... Approve g ______—._--.&—_—......---..L.--.. ' / --------------.------............... ` |