HomeMy WebLinkAbout0153 SPRING STREET SA-
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CAPE COD
INSULATION
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mse Ot4ss Sf I'M INSULSPRAT ON sck.e Su
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1-800-696-6611
Town of /3"-"
Regulatory Services
Building Division
Address -
Address 2 -
Date;—
Dear Building Inspector
Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed &
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
(BPI) inspector. All work preformed meets or exceeds Federal & State Requirements.
Property Owner t PropertyAddress Village
/4", 7'f
1�73 t �/
Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted
Ceilings ( ) ( ) ( ) ( ) )
Slopes ( ) ( ) ( 9
Floors ( ) ( ) ( ) ( ) ( )
Walls
Sincerely
ry E Cassidy Jr,Tresident '
Cape Cod Insulation, Inc. x=
cz
rn -
t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel Application #
Health Division Date Issued/
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project St r et Address L
Village
Owner,'^ Address
Telephone `2 o
Permit Request �&v 6�11 D
Square feet: 1 st floor: existing ' proposed 2nd floor: existing - proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation �9i l a Construction Type
Lot Size Grandfathered: ElYes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family a/ 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 s;
Total Room Count (not including baths): existing new First Floor Rom Count �zD
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/cc I stove:=fl Y�❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ exiting ❑. ew Pze_
rn
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
Zoning Board of AppealYo
orization ❑ Appeal # Recorded ❑
Commercial ❑Yes If yes, site plan review
#
Current Use Proposed Use
APPLICANT INFORMATION
�,Q (vkki
/IhDER OR HOMEOWNER)
Name Telephone Number
Address License #
�1 uUl � Home Improvement Contractor#
Email Worker's Compensation # W—k sa�
ALL CONSTRUCTION DEBRIS RESULTING F OM THIS PROJT WILL BE TAKEN TO
SIGNATURE DATE ( r�
r
FOR OFFICIAL USE ONLY
APPLICATION#
DATEISSUED
MAP/PARCEL NO.
r '
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
r FOUNDATION
FRAME
i'
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
kci
' FINAL BUILD.ING.,
h DATE.:CLOSED OUT
A$„POCIATION PLAN NO.
r
Massachusetts - Department of Public Safety
..:Board of Building
• uilding Regulations and Standards
Construction Supervisor
License: CS-100988..
HENRY E CASSE) '
8 SHED ROW
WEST YARMOU'rH ic
Expiration
Commissioner 11/11/2015
' z Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Co*htractor Registration
Registration: 153567
Type: Private Corporation
Expiration: 12/15/2016 Tr# 259188
CAPE COD INSULATION, INC
HENRY CASSIDY
18 REARDON CIRCLE ---
SO. YARMOUTH, MA 02664
Update Address and return card. Mark reason for change.
'CA1 +5 20M•05n1 Address Renewal .0 Employment Lost Card
— -------- ...... . .....
V/ae (pai���za�uuecc�C�a�n/�/l�cwdcee>!er�teG�1
C\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
egistratlon: 153567 Type: Office of Consumer Affairs and Business Regulation
xpiration:,.-....1.21:1.1201.6 Private Corporation 10 Park Plaza-Suite 5170
Boston,MA 02116
CAPE COD INSULA7I;QkjNc° _-.
HENRY CASSIDY
18 REARDON CIRCLE- g
SO.YARMOUTH, MA 02664 Undersecretary N valid wi tit sign e
The Commonwealth of-Massachusetts
Department of IndustrialAccidents
w W Office of Investigations
a
d I Congress Street, Suite 100
W Boston, ALL 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le ibl
Name (Business/Orn/Individual): e
Address: !Z;Vhk V
City/State/Zip: % & Phone#:
Are you an employer? Check he appropriate box: Type of project(required):
1.$ 'I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. Now construction
2,❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling v
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. 0 Building addition
required.] 5. ❑ We are a corporation and its 10,0 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
employees. [No workers' 13.(� Other �(
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 this1ffidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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: 1'�� aU. � �� �(� ` _
,nn 1 O 1 ,-
Policy#or Self-ins, Lic. #; f��d2
Expiration Date:
Job Site Address; 1-)n City/State/Zip:
Attach a copy of the workers' com pens ati n policy declaration page(showing the policy numb 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 n r pains and penalties of perjury that the information provided above is true and correct.
Si nature; Date:' 1 11 1
Phone#:
Official use only. Do not write in this area, to be.completed by city or town offlclal.
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#:
i
CAPECOD•27 KLIGETT
CERTIFICATE OF L DATE(MMl00lYYYY)
.� (ABILITY INSURANCE 611312014
i CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
.TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
,OW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
RESENTA.TIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
'k.0RTANT; If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed, If SUBROGATION IS WAIVED,subject to
terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the.
ficate holder In lieu of such endorsement(s).
°:ER NAME: Barbara DeLawrence
&Gray Insurance Agency,Inc. - PHONE
a 134 Ate.No.END: (a/c Not; (877) 816.2156
Dennis,MA 02680 EA DREss; bdelawrence ro ers ray,COm
INSVRERI81 AFFORDING COVERAGE NAIL A
INSURER A:Peerless Insurance Company
INSURERB:COMMERCE INSURANCE COMPANY
Cape Cod Insulation Inc INSURER C;Evanston Insurance Company
18 Reardon Circle South Yarmouth,MA 02664 INSURER 0:ATLANTIC CHARTER INSURANCE GROUP
INSURER E;
INSURER F
'RAGES CERTIFICATE NUMBER; REVISION NUMBER;
.+
IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
,ATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
•.IFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE.TERMS,,
',USIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP —
' MM/DO/YY Y MMIDD YY LIMITS
s COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
CLAIMS-MADE AI OCCUR CBP8263063 04101/2014 04/01/2015 D
PREMISES Ea occurrence $ 100,000
MED EXP(Any one person) $ 51000
- PERSONAL&ADV INJURY $ 1)000,000
N'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO. GENERAL AGGREGATE $ 2,000,00
JECT LOC PRODUCTS•COMP/OP AGG $ 2,000,000
OTHER:
TOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea accident $ 1,000,
X000
ANY AUTO 14MMBCKVMK 04/01/2014 04/01.12015 BODILYINJURY(Perperson) $
t All OWNED SCHEDULED - '
AUTOS AUTOS BODILY INJURY(Per accident) $
HIRED AUTOS X NON-OWNED
AUTOS PROPERTY DAMAGE $"
Per accident
UMBRELLA LIAR X OCCUR $
EACH OCCURRENCE $ 11000,000
EXCESS UA9 CLAIMS-MADE XONJ453514 04101/2014 0410112015
• DED X RETENTION 10,000 e AGGREGATE $
RKERS COMPENSATION
Aggregate $ 11000,000
EMPLOYERS'LIABILITY Y/N STATUTE �RH
ci ICER/MEM ERIEXCLUDED?ECUTIVE NIA WCA00525904 06/30/2014 06/30/2015 E.L.EACH ACCIDENT ,$ 1,000,000
i,ndatory In NH) • _ _
It t," describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000
iCRIPTION OF OPERATIONS below
E.L.DISEASE-POLICY LIMIT $ 1,000,000
'.tION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
1;.Compensatlon includes Officers or Proprietors, '
dial Insured status Is provided under the General Liability and Auto Llablllty when required by written contract`or agreement with the Certificate Holder,
•
t=1CATEHOLDER` f�AAlr%CI I A+1 LI
¢ 460 West Main Street
Housing Hyannis, MA 02601-3698
Assistance �Kfi' Tel: (508)771-5400 Fax(508)775-7434)
Corporation
TTY on all lines
Cape Cod
Wo%ath --- rizo%tk-,- n1
-,% o%
Fruv. ti U el
Your tenant has requested and is eligible for weatherization of your rental home
through government funding. This wN be ,provided at no cost to you. Program
regulations permit us to spend' around $2,500- $7,500 in materials and labor per
dwelling unit.
Program regulations require us to weather-strip and caulk doors and windows; insulate
attics, sidewalls and floors. All work is professionally done by established private
contractors. We will conduct a final inspection to make sure that all work is completed
to specifications.
If you request, you will be informed of the estimated measures before they are done
and provided with a list of the actual measures and costs following the completion of
the work.
We also need proof that you own the property. A copy of a CURRENT TAX BILL OR
DEED listing you as the owner will satisfy this requirement.
Please fill in all blank areas of the enclosed agreement and return with the proof of
ownership as soon as possible.
If we do not receive the enclosed form within two weeks, we will do a basic
energy audit of the home, but no weatherization work can be recommended or
done.
If you have any questipri.s lease call Suzanne Smith at 508-771-5400, ext. `123 or email her @
a r"cavecodAZF
e
LANDLORD: ✓ ".. �° TENANT:
email: email:
PHONE: (home) PHONE: (home)
(cell) (cell)
TENANT/PROPERTY OWNER/AGENCY WEATHERIZATION AGREEMENT
1. The Parties to this Agreement are the following:
(hereafter known as Tenant),
(print your tenant's name)
(hereafter known as Property Owner)
(print your name)
and Housing Assistance Corporation (hereafter known as Agency). In consideration of the mutual promises
hereafter stated,the Parties agree as follows:
2. The date of Agency's signature will be the effective date of this Agreement.
3. Property Owner and Tenant consent and agree that the Agency may do the following with respect to the property
located at (street,town)
unit# and currently leased or rented to the
Tenant:
a) Enter the premises for the purpose of performing a Weatherization inspection.
b) Enter the premises to perform Weatherization work which the Agency determines in its discretion is
necessary and appropriate as a result of the Agency's inspection of the property and in accordance with
the appropriate priority list for the type of dwelling. The Agency and the Agency's contractors may also
enter the appropriate common areas of the building for the purpose of accomplishing the Weatherization
work. The Agency and representatives of the Commonwealth of Massachusetts, Department of Housing
& Community Development (DHCD) may further enter the property to inspect any and all work
hereunder. The Agency will provide reasonable notice of the timing of the Weatherization work and
inspections. The Weatherization work will be performed in accordance with the Property Owner's
consent as further specified below:
*** INITIAL ONLY ONE OF THE FOLLOWING
I consent to performance by the Agency and its contractors of any Weatherization work determined
necessary and appropriate by the Agency as a result of its inspection of the property. I understand that
the Agency will provide a detailed statement of the actual work performed and the associated value at
the completion of work.
I will provide a separate consent to performance by the Agency and its contractors of Weatherization
work following my receipt of the Agency's inspection report and a statement of the estimated work and
associated value. This additional consent will be sent under separate cover as Attachment A. I
understand that the Agency will provide a detailed statement of the actual work performed and the
associated value at the completion of the work.
4. The Property Owner understands and agrees that any and all work, including related repairs for which the
Property may also be eligible, will be performed at the Agency's discretion. The Agency estimated completion of
the Weatherization work by the end of 2013.
5. If the Property Owner is required to make repairs to the property prior to the commencement of Weatherization
work by the Agency,the Property Owner will be notified by the Agency and will be required to make the repairs as
soon as possible. Except where the Property Owner receives a written extension from the Agency, time is of the
essence in the performance of repairs by the Property Owner,
6. The Property Owner and Tenant authorize the Agency to receive a statement from the fuel supplier/utility supplier
as to the quantity of fuel/utilities used at the above address in each of the past three years and the future three
years. The information is to be/,used only to determine the cost effectiveness of the Weatherization
improvements.
7. The Property Owner agrees that the rent for the dwelling unit will not be raised because of any increase-in the
value thereof due solely to the Weatherization work performed.
I
8. In consideration of the Weatherization work hereunder, the Property Owner further agrees that upon the effective
date of this Agreement and during a period extending through 201312014, approximately one
year from the time the work is completed,
a) The present rent $ per month will not be raised for any reason. (The rent amount must be
filled in). Heat included in rent? Yes_ No
However, this Paragraph (8a)will be waived by the Agency in writing if, and only if,the premises
are leased under a state or federal rent subsidy program, in which case the actual rent charged
by the Owner shall conform to the standards of the rent subsidy program.
Please state'which Housing Subsidy program your tenant is on and through which Agency:
b) The Property Owner will not institute any summary process action for possession except in the case of
non-payment of rent or other good cause related to the Tenant(or any successor Tenant).
c) In the event the Property Owner decides to sell the premises, Property Owner shall comply with one of
the two requirements below,
--The Property Owner shall not sell the premises unless the buyer agrees (with a copy forwarded to the
Agency) in writing prior to sale to assume all obligations of the Property Owner set out in this
Agreement; or
--The Property Owner shall pay the Agency an amount equal to the cost, as certified by the Agency, of
the Weatherization materials installed and labor performed in the premises as of the date of sale. Said
amount shall be paid to the Agency immediately upon sale.
9. (Applicable only if Tenant's heat is included in rental payment and blanks are filled in) At the end of the
period set forth in Paragraph 8 above, the rent shall not be raised more than % per for an
additional period of one year, and the provisions of 8b and 8c above shall continue in effect for such period.
However, the rent provisions of this Paragraph 9 may be waived by the Agency in writing if, and only if, the
premises are leased under a state or federal rent subsidy program, in which case the actual rent charged by the
Owner shall conform to the standards of the rent subsidy program.
10. The Parties agree that the terms of this Agreement are incorporated into any other lease or agreement between
the Property Owner and the Tenant, and between the Property Owner and any successor Tenant, and if there is
any conflict between the provisions of this Agreement and the provisions of such other lease or agreement, the
provisions of this Agreement shall govern. However, if such other lease or agreement, including without limitation
a lease or agreement under state or federal rent subsidy program, contains stronger protections for the Tenant,
such stronger protections shall apply.
11. For breach of this Agreement by the Property Owner, the Property Owner shall reimburse the Agency in an
amount equal to the cost, as certified by the Agency, of the Weatherization materials installed and labor
performed on the premises, as well as attorney's fee and court costs. The Property Owner may also be liable for
damages to the Tenant in accordance with applicable law; in such instance, the Property Owner shall reimburse
the Tenant for attorney's fees and court costs. Without limiting the foregoing, the Agency may at its option
terminate this Agreement, by providing written notice to the Property Owner and Tenant, in the event of breach by
the Property Owner or Tenant..
12. Performance of the Weatherization work hereunder by the Agency is contingent upon the availability of funds to
the Agency from the commonwealth of Massachusetts and the federal government, as well as the eligibility of the
Tenant under WAP program requirements. The Agency may terminate this Agreement, by providing written
notice to the Property Owner and Tenant, if the Agency determines that the unavailability of funds or ineligibility of
the Tenant warrants termination.
13. The Parties acknowledge that this Agreement i under so4l. It is intended by the Parties that the Tenant or any
successor Tenant is the intended beneficiar, the Agr�ement-and.shall have a right of enforcement.
Property Owners Signature: N— Date_
Phone:
Address:
i
' Tenant Signature n -- /:c_..-� —f<' i;-iDate /f✓ ^�� }ci'`
Agency ApprovedAYeatherization Company_ �0�Cter
All Cape Energy / Adam T. Incorporated/ Cape Cod Insulation / Save /
Frontier Energy Solutions / Lghr&_Son n.p. / Resolution Energy
Date
Agency Signature ;�i<, '' 'F .���- "�-'