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HomeMy WebLinkAbout0019 SUNNY-WOOD DRIVE /9 S'ynnywesa� �l �' U tr ,;fig�p�f• (} .. i F��'E#g•{g1+ f5. t.F W BYO/ 'TV�i l 0 L*`iRVI INSULATION " /IYE0.OEp9i S[p MLLSS fP0.pFCpM fYSPENOELI MRS 3YRf0.i WSYlpL10N CGlIN03 1-800-696-6611 L -� 1V1 ; I 'Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 . 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 (BP-I) inspector. All work preformed meets or exceeds Federal & State Requirements. PropertyOwner Property Address Village �/l.c✓1.,r TltuON,a�. I9 $�/NN� —�✓vr•D PQ. �y'4'��lf Insulation Installed: Fiberglass Cellulose . R-Value Restricted Unrestricted Ceilings Slopes ( ) ( ) ( ) ( ) ( ) Floors Walls ( ) ( ) ( ) ( ) ( ) Sl� . Sincerely He ry E Cas y Jr, President C e Cod I , ulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map v Parcel (� Applicationov Health Division Date Issued 5�,9� Y ALI Conservation Division Application Fee Planning Dept. - Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address If 12,e Village 1/ann ►S Owner, ✓z AW Tea g/ Address :S Telephone Z /Z ,l Permit Request _5 e%, 64_ o/-e 7.!Y Square feet 1 st floor: existing proposed 2nd floor: existing proposed Total new :Zoning District Flood Plain Groundwater Overlay, Project Valuation J -D D , dConstruction Type ;Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 4d"- Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Flo On Old King's Highway: ❑Yes ®Ko Basement Type: 0 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 i Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: 'D Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing, ❑ new size_Pool: ❑ existing 0 new size _ Barn: q 'sting nevQsize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other.t-4 . Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ u► Commercial ❑Yes ❑ No If yes, site plan review# . e Current Use Proposed Use n APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name _ Gi ,` w �Tlo.C� Telephone Number Address f�, ,g,�c✓6.E/ C/� License # 6�eOO-d!J 7k Home Improvement Contractor# /3�3.�G ;7 Email // ,, Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY 't APPLICATION# DATE ISSUED MAP/PARCEL NO. s ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION LM. FRAME INSULATION t 4 FIREPLACE a _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 'F GAS: ROUGH FINAL 9NAL BUILDING DAr 7&,CLOSED OUT AS OW-W ION PLAN NO. OWNER AUTHORIZATION FORM k- (Owners Name) owner of the property located at (Property Address) - (Property Address) hereby authorize o(Subcontractor an authorized subcontractor for RISE Engineering, to.act on my behalf to obtain a building permit and to perform work on my property. Owner's Si t re 1 x Date' : D JUN 1 8, 2012 i Massachusetts -Depaf`tmo'nt of Ppblic Safety :' ard of Buiidir'g Regulations�d Standards f. Construction Supervisor License: CS-100988 fif HENRY E CASSIDY'` - •� 8 SHED ROW WEST YARMOU41I 2 Expiration Commissioner 11/11/2015 A Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation rnrs_ r Expiration: 12/15/2014 Tr# 233831 CAPE COD INSULATION, INC , .ry, HENRY CASSIDY 18 REARDON CIRCLE '; . i = SO. YARMOUTH, MA 02664 `'Update Address and return card.Mark reason for change. 20M-05/11 SCA 1 i� Address Renewal Employment Lost Card . - . ��T e Cprii�oircr�ruuecz�`i a�'G%l2iradac�ulet�" 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: gistration 1U567 Type: Office of Consumer Affairs and Business Regulation xpiration 12/y"5/20..14 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION, IN � 1s HENRY CASSIDY 18 REARDON CIRCLE S0,YARMOUTH, MA 02664 Undersecretar y Aorwitho t�natre - aK< I CAPECOD-27 CVANGELDER .a►coea®� CERTIFICATE OF LIABILITY INSURANCE DATEYYYY) 4111201112014 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 _ CONTACT Cape Cod Commercial 434 ers Gray Insurance Agency,Inc. PHONE134 r EXt: FAX No:(877)816-2156 South Dennis,MA 02660 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC p INSURER A:Peerless Insurance Company INSURED INSURER B:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER C:Evanston Insurance Company 18 Reardon Circle INSURERD:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 EXP L R TR TYPE OF INSURANCE POLICY NUMBER MMIL DY/YYYY MMIDD EFF Y LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR CBP8263063 04/01/2014 04/01/2015 PREMISES Ea occurrence $ 100,00 MED EXP(Any one person) $ 5,00 ' - PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY❑ JECT LOC PRO- ❑ PRODUCTS-COMP/OPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident B ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person) '$ ALL OWNED X SCHEDULED AUTOS AUTOS - BODILY INJURY(Per accident) $ 1,000,000 X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 C EXCESS LIAB CLAIMS-MADE R/O XONJ453512 04/0112014 04/01/2015 AGGREGATE. $ DIED I X I RETENTION$ 10,000 Aggregate $ 1,000,000 WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WCA00525904 06/30/2013 06/30/2014 E.L.EACH ACCIDENT . $ .1,000,00 OFFICER/MEMBER EXCLUDED? N❑ N/A - -- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under the General Liability and Auto Liability when required by written contractor 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. ACORD 25(2014.101) ` The ACORD name and logo are registered marks of ACORD i ! The Commonwealth of Massachusetts i Department of Industrial Accidents W Office of Investigations 1 Congress Stree t,et, Suite 100 Boston,MA 02114-2017 v www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �rt Address: [(k 12 City/State/Zip: '�56 GV& Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 2G7 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling . ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers 9. ❑ Building addition [No workers' comp. insurance comp: insurance.x a required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions` 3.❑ 1 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 13 Other 71 'wi JA ( (�� employees. [No workers' .� comp. insurance required.] *Any applicant that checks box#I 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. 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: _ ' Policy#or Self-ins. Lic. #: IBC ool;2-7 ri 0 I Expiration.Dater 6 �b Job Site Address:/9 _%,i/fV,!/ /0& ,�L� City/State/Zip:4444 1 Z`,r2 Attach a copy oi 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. 1.52 can lead to the imposition of criminal penalties of a I 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 I do hereby cer rY the pains and penalties of perjury that the information provided above is true and correct Si nature: -Date: "'.6 tPhone#: - t Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/lLicense# - 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#: a INSULATION \ L =` [I IIYSR O(A35 S(Am[53 SMPAf IOAA( SYSptnP(q SA113 4gI13Y3 INSYIAiION G11411Ygf 1-800-696-6611 �`a Yd 'Fown o1 Barnstable 0{z 312G/13 k'egulatory Services Building Division 200 Main St Hyar ls, M;.A 02601 yr 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 Property Address Village Md,5&* &k&04,)16k /IF insulation Installed: Fiberglass Cellulose((,"R-Value Restricted Uruestricted } Ceilings ( ) ( ) ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors K'ntt (�O ( ) ( l0 ) Wails ( ) ( ) ( ) ( ) ( ) Sincerely lie ry E C, sidy J , President Cape Cod nsulation, Inc. 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ;J MapAJ,5Parcel Application #JC0 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Jc Z�2I/3,k-4 Historic - OKH _ Preservation/ Hyannis Project Street Ndress Village �-� P YArY 1I� Owner Address &/a e_-� Telephone -77� —212-IGI7 Permit Request / � - I It r5l 56&i' rt td .t'b 65 A06eu) Ve. b Z5" g; ��C #5 h 70Z Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ®" �� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting doc. mei.4ta tion. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) r Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's_.H ghway: Ll Yes-0 No Z33 Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other _.4; F� Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft); Number of Baths: Full: existing new Half: existing new; rn 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 I f No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Names �7 g:::;2 / Telephone Number �— Address Ze License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. 1: ADDRESS VILLAGE OWNER DATE OF INSPECTION: r FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ASSOCIATION PLAN NO. R "' f r -_.. N'lassachusetts- Department of Public Safety Board"of Buildin�- Regulations and Standards, Constriction Supervisor License Licen CSC 100988 HENRY CASSIDY 8 SHED ROW WEEV)EARMOUTH, MA 02673 —�` Expiration: 11/11/2013 ('unuui,xiuuer Tr#i: 7620 Office of Consumer Affairs and Business Regulation - -- 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2t14 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY - 18 REARDON CIRCLE S0. YARMOUTH, MA 02664 ......-............ Update Address and return card.Mark reason for change. (�SCA 1 ti 20M-05;7 1 Address ❑ Renewal O Employment 1 j Lost Card �.:'���r t('o-rirrrrnr��ctecrlC�o`CillrJdr7c�uJca((J Office of Consumer Affairs& Business Regulation License or registration valid for indivi[lul use only s OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 153567 Type: Office of Consumer Affairs and Business Regulation xpiration: 12/1`5/2014 Private Corporation 10 Park Plaza-.Suite 5170 ' ,� llY Boston,MA 02116 CAPE COD INSULATION INC HENRY CASSIDY 18 REARDON CIRCLE �� �' SO.YARMOUTH, MA 02664 Undersecretary Aotvalfiwitho tWatr The Commonwealth o Massachusetts II Print Form.:. Department of Industrial Accidents ,. Office of Investigations 9, 1 Congress Street, Suite 100 ' ,nr Boston, MA 02114-2017 � = www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Narne (Business/Organization/Individual): &An el W74 a Address: IrG(OGl �1V�i1 — City/State/Zip: V✓4L MA' Phone #: r,700- 1 " - IZ Are you an employer? Check t e appropriate box: Type of project(required):' I. I am a employer with 20 4. ❑ I am a general contractor and 1 employees (full and/fir part-time). * have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. ❑ Remodeling 2.❑ l am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' ❑ Building addition [No workers' comp. insurance comp. insurance.t 9. 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 11.0 Plumbing repairs or additions myself'. [No workers' comp. right of exemption per MGL / 12.❑ Roof re airs Q n,insurance required.] t C. 152, §1(4), and we have no �j y�� �GY�Z( /� employees. [No workers' 13.� Other W Tl comp. insurance required.] // "Any applicant that checks box#I must also till out the section below showing their workers'compensation policy information. r I folneowners who submit this affidavit indicating they are doinglall work and then hire outside contractors must submit a new affidavit indicating such. ICuntractors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those entities have employees. Ifthe 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. 6�vhv Insurance.Company Name: dvl ►f,,cl Policy # or Self-ins. Lic. #: WcAoo�z-�Z&5 01 Expiration Date: � V Job Site Address: City/State/Zip: 6e (7�/t.� � Attach a copy of the workers' com ensation 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 tine Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby cer f nver the pains-md enalties of er'ury that the in ormation provided above is true and correct. Si �ar�re: Date. Phone#: YN ' ®}ficial use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: No, I UU') Client#:4597 CCINSUL AGORD,., CERTIFICATE OF LABILITY INSURANCE I)AIt(NIhI,Dj,IY,Yy,TH ISCEkTIFICATE IS IS$UED AS A MATTER OF INFORMA110N ONLY AND CONFERS NO RIGhT8 UPON THE CERTIFICATE HOLUC�rt�11QS' TIFICATE DOES NOl'AFFIRMATIVE!_Y OR NEGATIVELY ANIVAD,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 1111S CERTIFICATE OF INSURANCE DOES NOT CONS I I I UIE.A GONTRACT BEI-WEEN1'HEISyUINGINSURE-;IlI(S),AUltiQRILLLI N rA 1*1 VE OR F'r1pDL10ER, ANp THE CERTIFICATE I IOLL1f R. IMPORTANT:If the cerllflcat�l huldr�r ib an AbDITIONAI INSUhi'.`i].thn Oohcy(ies)I)lust b'endured.IY SUBRUGATIQN 1:;WAIVED sut,)wc io " 1115 W1 nls and culTdlUn us of the policy,cnrtaln pollClet;may ruy�.,i��w,andDranmanL A stelBrnent pn this certifilaula(14ea nul calmer ri0hhl kI the f-0(llllcdlu hgldar if" ll(;(d Cll SU4h d1141pr9@ITICnt(5). _._---` k I.-----------.._�. di(l,Ulli LR ,— .— NAM : M 12ot(t:r:: Gray Ins. E al n . -So. Lltlnnts �— PNDN@ 4,i4 ROLIte I34 AIC No,ExIL 508460-4.602 A1C Nr� Q// QIU 2156 , .11L1 Uullmt;, MA U2hG0•9GU'I _^--- bud 3.)6 19110 NF URI HID)AFFOnI)ING COVE"HACiI NAIL d INSiUOFRA;Peerless InsufanDa 18333 INaIII<I.0 Cape Cocl Insulation {nc Wsul,ERa:Evans;ton InSuranca L'nrryaany - 'I55 YJI mouth R000 INsuRERC:Atlarntia Charter InsUl'4mCv- flytunlla, MA 0260.1 r IN9URERD� 0(nlTlefC01n6Uf711Ce C�Utill]lny 34]jl IN5URFR C �N64fi4ft 1'; c.tiirlriciKrLNumdER. - M R __ REVISION NUUL lu5 1, C'I0 -RI II Y I HA t' 1 Ht IaOL IL It S Ur wg1,RANGE uS1'CD Iul;1Y NAPE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I IE POLICY PL.wOD uvUl ILLI. 1`10IWII1--1,81ANUING ANY N01-JINEM NT, TEI3Pol OR CONDITION OFANY CONTRACTOR OTHER DOCUMENT WI-1-1-1 RESPECT 1.0 wiDoi-I Huts CRI&IGAIL.. MAY L1E. ISSUED OR MAY PERTAIN, THE INSURANCE AI' ROEO BY THE POLICIES DESCRIBED HEREIN IS SUOJEC,r TO ALL. THE TEHMS. i-XCLl1510NS AND CONDI FIONS OF SUCH POLICIES. LIMITS SHOWN Ila.ati'N,iyF oE6N RGQUCED BY PAID CLAIMS. ---- — 'N'R ADOLSl14R — i TR I"Yr+r,OF IN9UNANGE POLICY EFF HiILICY eliW ---_..__�__._____,_.... __......_.._..`_—,_ __ _ro Llcr m n���(l IMMIDDIYYI'YI MMI(,—,_�D/YYYYL- q uENLRAL LlAwlu,Y T CBR026063 4/0112012 04/0,1/2011 EAcFloccuRrterlcE T1 000000 X COMNIFRCIAL GENERAL LIABILITY a T erttfen 1s f 1:wu 0f00 ncoL_ . .. CLAIMS-MADE X OCCVR BP�k� .._ 01E0 Exr(AIIY ona PONG11) y 5,000 ------_.._..._-.-_ -- 09R9GNAl a ADV IN)UHY ri-1 000 000 OENERAL.He+OR OAll 1�,000,UUU —N L I.AC Clk�UATL:LIMIT'APPLI PRODUCT' Pkf} -GOMP100 AGG s 2 Ut—U0 ODD 1 .. D AUTOMOWILk LIA1310T-Y -- 1210105CONIK 41U1/2012 0410'112U1, e°h -14-Cb SINGOE-EKIIT I�UUO—e__.DUU J _ I __- AU rD5 Ala nU fU DODILY INJUL`h' P<r,G.�„ $ At I- SCFef)UL6U AVTOS X AUTOS BODILY INJURY(Par a.:caaenl) E-- x rIIHkD AU COLi }( NON OWNCD li X UMbRkI LA LIA[I gcL;ur, XONJ453512 410112012 041011201' cAcrlDCCURRCNctla .F1 000 QOU 61(t Eh� LIA(1 I.LAINIS-NIADL: AGGRt;C:A I'!= $1 UUU UUU ui-u X nciltlNrlur, ,li u00p, C WOnKL 0 G,0Nlt'ENUA110N T WG S'I'ATIL I 011'h AND tMNLOYFR3`S LIADIL.IIY VIfCAOQ525JU� 6/3012012 U613U/.1.Q1 X 1aLLlfYIL1 ,L„ kJi_..AN1 PRQP121L1(1}�PA 'NL- / I;CUTIVK YIN _..._-.. ._ _.._ tICEWMFM8kl2�X(�_U4 (/ �� NIA C.L,EA01I ACCIOkN1' UUO UU0 @1wWulnry a NMI Ir vu�,aoccnua inua, E.L.DISEASE..CA GMPLov(;t: .1"I QUG UOII rH:SCNIPTION OF OPLihATION,`i Uoluw G.L.DI^'LASE-POLICY LIMIT y'I 000 UUU 1 I U[�i:ryll•IION Oh OPt1WlJONS I LOCA I'IONS 1 VEHICLES(AUaah AC ORU tq 1,AJdhlon.,I�i•�nrikc ti�hpqultl,111AGN 8pq�d lu rdf),IIItlU) Workers Comp InfonTlaNOrl III(-I(ldud Ofticerti cu-Piroprletors . C"llitcaW I IOldlsr is InL;IudefA TIs do additional insurad unLlur Gunuial Woility whon required by Written contract or Rgreemellt. cEr:TIFIc Al e:HOLDER CANCELLATION -........... c apo GUO 14IGUIrltiol l,Ine SHOULD ANY OF THE A130VL Of-SCRIDED POLIGIE$VIE GANGf I,LGP RL'rURI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVEkED IN AGGORDANCE WITH THE POLICY FROVIaIONtr. AU RiURIZ[D REFRVSENTATIVE i ^4 w tO 1811 -2010 ACORO CORPOIRATION,All 1'IJI1tJ ra arvuLl. a(cLntu zh(2U1UIUy) 1 of'I The ACORD name and IDOD(arn roUl4iirad marks ofACORD 1ISta3844?IM83t)<1Q MkY OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) Ce.n tecv- i t t'C, (Property Address) hereby authorize C of T n (Subcontractor an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building. permit and to perform work on my property. Owner's Si t re Date IE G IF. OMC JUN 1 8 r 2012 CAPE COEF�'uF"�"�ARNSTAgl 12 NOV 6H IIBBB GLASS SSAMl555 SPBATSOAM SUSpSNDSB BATSS 4UTT5B5 INSUTAfION CBUINOS u 1-800-696-6611 Town of Barnstable Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: a- 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 Property Address Village. f&delrOa j k d w j(,k 1 q 3[xAA u)ooj 44y " Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ) (X ) (3�) ( ) (X). Slopes ( ) ( ) ( } ( ) ( ) Floors ( ) ( ) ( ) " ( ) ( ) Walls r ( ) ( ) ( ) ( ) ( ) Sincerely He y E C sidy , President Cape Cod nsulation, Inc. - 1 A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel lj J Application #A V / ,ZCJ-512-8 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 /l" _lr� 777.� Village Owner Zzg_l ,L�22 � Address .-Z,�Aef Telephone 7�7 i` Z/Z Permit Request /,o �,���2 �:� CZZ,r� `x s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed : Totaknew' Zoning District Flood Plain Groundwater Overlay Project Valuation dGDOd D Construction Type �2J Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting do'dumentation. Dwelling Type: Single Family Or"' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 2,f�o On Old King's Highway: ❑Yes _QWo 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) Name Gid� �'�� ,/v✓�L1/d,�Ti6/� Telephone Number Address License # liegeal' U,�� Home Improvement Contractor# Worker's Compensation #mil' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE a/�j FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. f ' ADDRESS VILLAGE OWNER 'j DATE OF INSPECTION: ~ FOUNDATION t FRAME c INSULATION y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i ! GAS: ROUGH FINAL ti FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - Y OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) . (Property Address) hereby authorize C 01 lot Tr C (Subcontractor, an authorized subcontractor for RISE Engineering, to.act on my behalf to obtain a building permit and to perform work on my property. Owner's Si t re x Date fFM-OVF AN t 8` 2012 f i c&MMWWWW did �i - 10 Park Plaza - Suite 5170 i Boston, Massachusetts 02116 Home Improvement Contractor Registration ti Registration: 153567 Type: Private Corporation Expiration: 12/15/2012 Tr# 206433 CAPE COD INSULATION, INC HENRY CASSIDY 455 YARMOUTH RD. - - - HYANNIS, MA 02601 _. . -.•:Update Address and return card. Mark reason for change. L_I Address I__I Renewal I. ..I Employment l_ I Lost Card S-CAI 0 DOM-N/04-GIU1216 (Office t :u��nnsumer Affairs L3us ne�'//'��Re ul�tion License or registration valid for individu! -se en!, HOW c11 PR6� f�` C71V1` at�TC7W" tea before the expiration date. 1f found return to: Registration: 153567 Type: Office of Consumer Affairs and Business Regulation Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170 ;) Boston,MA 02116 OD INSULATION; INC HENRY CASSIDY 455 YARMOUTH RD. HYANNIS,MA 02601 Undersecretary t alid ith t si ture }- V8»;SIIiIIJI'ttS-.*partmellt of Public Safm Board of B(ildin�- Rowlarions and ruular(ls' ;;construction Supervisor License License: CS 10098a HENRY CASSIDY 8 SHED ROW WEST 1 ARMOUTH, MA 02673 Expiration: 11/11/2013 ('uuwii.•i,ncr Tr#: 7620 1 zv 12 3 No. 1605 P, 1 Client#:4597 CCINSUL ACORD,,. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDLI YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER?7 IIS2 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 ceruftcate holder is an AbDITIDNAL INSURED,the policy(ies)must be endorsed.It SUBROGATION 13 WAIVED,Subject to the terms and conditions of the policy,certain policies may require an andor6emant.A statement on this certificate does not confer right$to the certificate holder in IieU of such endorsemen((s). PRODUCER Rogers&Gray Ins. -So.Dennis NAME: Margaret Youn ON E 434 Route 134 AIc No Exl:508-760-4602 uc No 677-816.2156 E-MAIL - South Dennis, MA 026UO-16U1 508 398-7980 _INBURF;ft(B)AFFORDINQ COVERAGE NAIC N INSURBRA:Peerless Insurance 1_0333 INSURED^ '-"-- - Cape Cod Insulation Inc INSURERS:Evanston Insurance Company 455 Yarmouth Road INSURERC:Atlantic Charter Insurance Hyannis,MA 02601 INsuRERU:Commerce Insurance Company 34754 INSURER E: - ____ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE �OLICIES OF INSURANCE I.I$TfFD 0CLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY C014TRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY TI1E POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS sHOwN MAY HAVE BEEN REDUCED BY PAID CLAIMS. SR ADDL SUER POLICY EFF POLICY EXP R TYPE OF INSURANCE' POLICY NLI preER MMIDD/YYYY MMIDn1YYYV LIMITS A GENERAL LIABILITY COP8263063 4101/2012 04/011201 EACH OCCURRENCE 81 ODU UUO X COMMERCIAL GENERAL LIABILITY p �q� 'r ELATED PaEMIS S .,.—rence $100 000 CLAIMS-MADE rX OCCUR MEO EXP(Any one pamon) $5 000 PER80NAI.&AOVINJURY $1 000000 GENERALAGQRE(3ATE s2,000,000 GEN'L AGGREGATE LIMITAPPLIEB PRR: PRODUCTS•COMPIOP AGG $Z 000 000 POLICY PRO- LOC p auroMOIVILE UA131uri 12MMBCKVMK 4/0112012 04/011201 EpMBI�E INGLE LIMIT ml 1 OOO OOO ANY AUTO BODILY INJURY(P.,Pcron) $ 4AUTosx CHEDULED UTOS BODILY INJURY(Per Auddnl) S XTQSWNEDPROPERTY �( S e XoccuRXONJ453512 4/01/2012 04/01/201 EACH OCCURRENCE $1 000 OOO CLAIMS-MADE AGGREGATE $1 OOO OLIO OEU X RETENTION 10000 C WORKER80OMPENBATION WCA00529902 WCSTATU. OTN AND EMPLOYEERSS''FLIIA�BTINLITY YIN 6J30/2012 06/30/201 X OFRCNY ER/MEMBOER WOTUD����OVTIVB I N/A E.L.EACH ACCIDENT" 11,000,000 nder (MendeaDe in It yap,deecrioe d und E.L.DISEASE-EA EMPLOYEE $'1,000,000 DESCRIPTION OF OPERATIONS bola. _ E.L.DISEASE.POLICY LIMIT $1 ODO OOO DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AUaah ACORD 101,Addlila,w Romwks Sphodulp,I(more apace le regw1m) "Workers Comp Information 11 Included Officers or Proprietors Certificate Holder is included as an additional insured under General Liability when required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION Cape Cod InSulatioa,inc SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCFLLEO PEFORE THE EXPIRATION DATE THEREOF, NOTICIE WILL )3E DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIDNs. AUTHORIZED REPRESENTATIVE 4 ®i9ah 2010 ACORD CORPORATION,All fights reserved. ACORD 25(2010/05) 1 Qf 1 The ACORD name and logo err,roglstered marks of ACORD #S83849/M83848 MEY The Common wc,dth of Massachusetts V Department of Industrial Accidents 4 Office Investigations 0i 600 Wo,Oli'ngton Street CC 4 Bosvot.1, IIIA 02111 W41 1 .Lilt ISS.govldla �Vorker's colf"Pe"sation Insurance Afficj..,'J't: Builders/Contractors/E lectricians/ritin.1bet-s applicant 1.11 formation Please Print Legibly ie, Pd Phone#: QZ :are YOtt an et ploy"'? Check, the appropriate box- Type of project(required): employer with 4, 0 larn and I have 6. "'HiPlOYCC.'s (full and/or part.-tirne).* 1:1 New CUBStRiCti011 hire()tllc ­b contractors listed on 7. Remodeling a.�olc pro the attai:hc;,l�;heet, am f prictor or partnership These SUb--jilractors have 8 c' i, and have: nu employees work-in, for emplo),ces tllld have workers' comp, 9. file if any capacity, [No workers' insurance:.1 13 lidding addition C01111)illSILItallCe ruqLlifeCl.] 5. We are:l COIJQiation and its 10. ❑ Electrical repairs of additions officers 11ai,c cxercised their right of 11. Plumbing repairs or additions a ho'lleowner doing all work eXeMplit.11.1 pet MGL c. 152 § (4),and 12. Roof repairs myself. tNo workers' comp. we have iw ruiployees. [No workers'nsurant:e13. Other rt(ILlile-d.I conip. 111"Ill�lilce required] e P !\"y z'PPIIcd'l1 that checks box #1 rrILISt MSO fill Out the section below sho r llwir workers'compensation policy information. who'Subillit this affidavit'indicating they are doing all work 'illd dion hire outside contractors must submit a new affidavit indicating such..Nllhl,:Lors that Check this box must attach in additional sheet showing IIILwoiie of the sub-contractors and state whether or not those entities have eillplo-yees,11 the pub-�x>rnractucs 01"PlOYces, they must proyidt:their workers'collip poh,:),number. 'It"(it,employer that is providing workers'compensation inset-ante formy employees.Below is the policy and job site hI.SLHiAllCt'('0111paay Narne: r Q rQ2 A C_e Policy it of .sell-ills. Lic. It: Expiration Date: Job Jtcc-Address: ._ City/State/Zip: Attach a copy of the worllersl compensation policy declaration page(siiol,vijig the policy number and expiration date). to sec`,"'Quvr'49r- as requirod Lindcr Section 25A of MGL c. 15 :;m load to the imposition of criminal penalties of a fine Up to$1,500,00"llXVI uilv-yea"Illil)"Su"MeW,as well as civil penalties in the form of a STOP VOM�ORDER and a fine Of Lip to$250,00 a day against the violator.Be advised Aflaial� oz that Ll cupy of di"�;ial.ejnellt Irld e forwl:Lrded to the Office Of lnvesti�,,iikms of the DIA for insurance coverage verification. .... .... 'ded f"'�""Lc'ne I do,here c ins al, under the ins and penalties 0j'pqjur_v that the information provided above is true and correct. Date: '7 Ojjicitil use only. D(.)rtut write in this area, to be completed bl-eit),or town official City Or Town: # Issuing Authority (circle one): '1.Board of Health 2. Building Department 3.CitY/Tomi Clerk 4.Electrical Inspector 5.I'lunlibing Inspector Hoard 6.()the,- :olttact Person: u,-LIt I Itt V Phone#: Engineering Dept.(3rd floor) Map13 Parcel � �o 3 " Permit# CL � House# Date Issued (Board of Health(3r9floor)(8:15 -9:30/1:00-4:30) C� ee f �-n r/Conservation Office(4th floor)(8:30- 9:30/ 1:00-2:00) Z L � Planning1st floor/School Admin.Bldg.)Dept.p ( g•) SEPTIC SY$TE E Definitive;Plan Approved by Planning Board 19 INSTALLED IN E ' WITH TI ABLE. I NtVIENTAL q• �� ND TOWN OF BARNSTA ° VN REGULATIONS �n Building Permit Applic 'on Project Street Address Village Owner�(Q,�,� _ ala Z/G o vr���G� Address Telephone Z22 / l i Permit Request✓ ���1� � COY Y a 3 First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ i Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family 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 No. of Bedrooms: Existing 3' New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other r Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use eC — Proposed Use Builder Information r� Name - Telephone Number 775 Address 7t 691 License# Q i/a �iS3Z Home Improvement Contractor# /G/7e�F" . Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FR IS PROJECT WILL BE TAKEN TO o SIGNATURE A � BUILDING PERMIT D OLLOWING REASONS) FOR OFFICIAL USE ONLY _ PERMIT NO. y DATE ISSUED, MAP%PARCEL NO. • '` - t t - ' _ t L j ADDRESS VILLAGE } , OWNER ' r DATE OF INSPECTION:' FOUNDATION F ' FRAME INSULATION FIREPLACE ELECTRICAL: TROUGH" FINAL rr PLUMBING: R&GHC FINAL 05 GAS: ;f' !- FINAL FINAL BUILDING-m A DATE CLOSED OUST, ASSOCIATION PLAN NO. • _ ..l i The Town of Barnstable eg Department of Health Safety and Environmental services Building.Division 367 Main Street,Hyannis MA 02601 Office: 508.790.4=7 mph Crosscn Fax: 508-790-6230 Building commission.- For office use only Permit no. Date AFFIDAVIT ' HOME IMPROVEMENT'CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization. conversion. improvement, removal, demolition, or construction of as addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. e�Type of Work: h� ��. . f A Est.cost ZAddress of Work: �Owncr's Name Date of Permit Application:_ 1 - I hereby certify that: Registration is not required for the following rensonlsj: Work excluded by law Job under S1,000. Building not owner-occupied _Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR' DEALING WrM UNREGISTERED CCCERAC?OHS FOR APPLICABLE R RAM OR GUARANTY FUND UNDER MGLPROVEMEPIT WORK DO O 142A � ACCESS TO THE ARBITRATION SIGYED UNDER PENALTIES OF PERJURY I hereby apply for a.permit as the agent of he o ractor Name - Registration No. Date OR Da:e Owners i e The Commonwealth of Massachusetts y _ Department of Industrial Accidents ' Office olloresmootioos Imo' 600 Washington Street v�J Boston,Mass. 02111 Workers' Compensation Insurance Affidavit �ame: ion: / /�oca ty C�i4o VA `(/ e— ohone# ❑ I a homeowner performing all work myself am a sole r netor and have no one working in any ca acity ❑ I am an employer providing workers' compensation for my employees working on this job. companv name: address: city: phone#: insurance co. 2011cv# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers'' compensation polices: �_ companv name: ::.;......:.... address: city phone#: insurance co olicv# : campanv name: address: city: phone#: Imurance co. <;:. olicv# Failure to secure coverage as required under Section 25A of tifGL 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP♦VORK ORDER and a flne of 3100.00 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 certify ide and penaki tf peri tat the i ormation provided above is tru.-and correct q Signature Date L- Print name Phone# E do not write in this area to be completed by city or town official permit/license t! Mudding Department ❑Licensing Board ediate response is required ❑Selectmen's OfIIce❑Health Departruent phone#; ❑Other 0evow 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their "law", an employee' is defined as eve person in the service of another under any coin employees. As quoted from the laevery ;P 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 rec.—wer trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds c: 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 renew of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who ha 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 along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of incnrar+ce coverage. Also be sure to sign and application for the permit or license is ' should be returned to the city or town that the a 1 p date the affidavit. The affidavits tS' PP 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 at the 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 io the Department by mail or FAX unless other arrangemeuts 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. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Olilce of Investigations 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 eat. 406, 409 or 375 - � ✓lie i�anvmooziaea�t a�✓l�raoaclucae� DEPARTMENT OF PUBLIC SAFETY CONSTRUCTION SUPERVISOR LICENSE r Nalber ;rEKpires: Birthdate x GCS ;04�5040 . 08123/1998 08/23/1951 � Restricted Ta. 00n z THOMRS C PAPPAS 8"9UINSIGAMOND AVE5. FALMOUTH, MA 02540 A 41 -.�.s... •e.l"'�'�.. .�-•'eT}�w�l�?I�iR AtIPR.6�;.''�.�4nz4T.1E�4��1`.r�3;'!1"�.`;•. HOME IMPROVEMEN?.;;CONTRACTORf,9;h k Re9istrat�iQn' 08989 �[ype �INDIVIDUAC , �1 " A Expiration 'tA8%28/98 `pA, -TNONAS C PAPPAS q� f ti VQ � �o 6�OUth� ILA 02540 ADNNISTRATOR� a k �,�jo �SfiS 16 r oC c161 .�x8P;3e n 0A, I �vl�tbGI°►�y Deck�n� t��oG� S-fo<<nT��s S-F� I IA r'f ge4weelJ v?6 SP�n��eS �GS� �o ConcRe-+c rcz�;rJG RI i CNc- Co-oSu It-DEp-S f /9 (A 23.5 k W N Deck 54.2 �® N N � 4 6 House l9 N 9.2 M 2a Qo , ? 7 y � RES. ZONE: ..kc_ FLOOD-ZONE: THIS MORTGAGE I NSPECT I ON PLAN IS FOR BANK *USE ONLY TOWN:- CENTERVILLE • REGISTRY OWNER: CHARLES RO AND RUTH RO DEED REF:CTF. 106879 BUYER: MADELYN WALKOWICH DATE:- 8/7/88 PLAN REF: L.C. 32849-B SCALE: 10= 3c� ' e re by certi y-.t at t e ui ing 8round on his plan as showniandoitted on � X� OF Mq� Y CONSULtion does conform to the PAULA. M 70 RASPBERRY .LANE zoning law setback requirement of MEARHEW C., MARSTONS MILLS BARNSTA LE No.32M MASS 02648 and does riot lie flood hazard area wash shown epecial o� th .u.d. ' flood m p dated qN0 SO—TREy is plan made from an instrument Paul A. Merithew, RPLS survey, not to be used for fences etc 4�58 _ w Q�pFt '°wti Town of Barnstable *Permit# y p� Expires 6 months from issue date ,,, AB Regulatory Services Fee i639• 0� Thomas F.Geiler,Director p 'EO1A°` Building Division Tom Perry, Building Commissioner X-PRESS PE 6T 200 Main Street, Hyannis,MA 02601 1'' ��77 6 Office: 508-862-4038 JUN 3 U 2003 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTM10191J NSTADLE - ? Not Valid without Red X-Press Imprint Map/parcel Number 2 ! 13 " �1 Property Address ,Residential Value of Work'[ Owner's Name&Addressf g w�.nr� r, G'�.+•�e..r y�Ira u �o Contractor's Name UL VJA, D On ��elephone Number Ca Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 9.9brkman's Compensation Insurance Check one: , ❑ I am a sole proprietor I am the Homeowner have Worker's Compensation Insurance Insurance Company Name WD 0C Workman's Comp.Policy# Permit Request(check box) ARe-roof(stripping old shingles) All construction debris will be taken to z G uz0_.5 ❑Re-roof(not stripping. Going over existing layers of roof) w.,` ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) *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. Signature Q:Forms:expmtrg Revisedl21901 y f w oFtHE r�,, Town of Barnstable Regulatory Services B^ AsS. 'M * Thomas F.Geiler,Director y Hcnss. $ `bArFo;9;.�A`� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property ` hereby authorize tilt c-e—r-a,�s1 Pre,, uexrip.nt to act on my behalf, in all matters relative to work authorized by this building permit application for(address of job) Signa f Owner Date ... i rG k �" Piin"t Name r • dtvl8ai use OQIY e stratioa Ya{id tou d rura#o: ,� f ir:.63crc'3ttid���: Orr date. Standards oxptratton luldono and G:O11J)IICY/i{lle;r! s begOreth ldl "' 1301 -Jp. Standard Board o4 B'd etolationsN"C�►O-cOR gulldfnS� �obbur� ;, poard of 00 00 one Ma,�2108 , IMpvtovs $ostoa, 1401463365' Roe lOOn: slo3 POP, _ r --�..-• jYPO w pout stv*tore NICKED SRt,ON for I' RKDCNKOR�EANg RO• pdmin�t+ra �R�pNSe MA 02863 i' yr Y ,- i. K -r,.La .:.�:.:ac -•m .�,.. .. • �> TOWN OF BARNSTABLE permit No. 28150 Building Inspector s.■.n.0 Cash ----- ------ — " O,CCU.PANCY PERMIT Bond ------__�__�� Issued to `-,,Capricorn Realty Truab. Address r Lot 446, 19 Sunny Wood 'Drive, Ryaniiis Wiring Inspector �i° ``/ �G� Inspection date Plumbing Inspector. Inspection date Gas Inspector,< ^ Inspection date ct Engineering De Inspection dateartmnt �f- 7 Board of Health vJttr°�^�- ^Inspection date '(�P!+3/,qCl THIS PERMIT WILL '1VOT E VALID, AND THE,BUILDING SHALL NOT BE OCCUPIED UNTILN ^ SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ;r �,b ,C -. ....,_� .. �:�—. '. ................................................. 19..._._._ /Building,Inspector _. F S � TOWN OF BARNSTABLE BUILDING DEPARTMENT s �s8i°rut _ TOWN OFFICE BUILDING � HYANNIS, MASS. 02601 �OIUY►. MEMO TO: Town Clerk FROM: Building Department//O----� DATE: An Occupancy Permit has been,issued for the building authorized by BuildingPermit $ ......... .�..J�.( ....................._........................................................................................................................... ... issued to r..Co/ ... .......... /�✓.. .. ............ ..........�1���............................ Please release the performance bond. �,�ONT 30 4' Z_c T�, m 5 . , 6 .� U.vo 9 5 g4FV 9 N ills,/za VvT `' PLOT PLAN THE S TRUC'TURE S SHOWN WERE LOCATED ON THE GROUND �P`VA OF ,yAV IN ON lag C. //moo ti� MASS FRANK WS7A S WHITING y 1 • THIS SKETCH IS FOR PLOT PLAN ��o No. 29869 0 PURPOSES ONLY AND SHOULD �Fsr�,9�°ICTER�`S�Q��/ :_ NO T BE USED FOR ANY —`-A�� O THER PU O SE. �. �-z-8� CAPE COD SURVEY ROFESS/ONAL LAND SURVEYOR CONS U'LTANTS- - - 3261 MAIN ST/ROUTE 6A PROJECT No 03 - / { -�7 BARNSTABLE VILLAGE, MA 02630 (611)`362-8133 -7-� 7 Y5 Assess4r's' map, and lot number .... _~ 1, a �FTNETD Sewage Prit nu1017 mber• , s B9H3 TABLE, i House number '� .... . `y .... d F a a y MABa } 3 4 T r.:{ s9. ' TOWN'. :OF -BARNSTABLE B.U. I�L°D I HAG :A H SP E C T 0 R onstruct Si le Fami j Dwe].3.i APPLICATION 'FOR PERMIT T ..... ......... ...........? ......................x.................. g. ...... ..:.... .............. ... } Woad Frame TYPE OF CONSTRUCTION ...................................................................:...................................... ..... ._ ,.... TO THE INSPECTOR'OF BUILDINGS:. i The undersigned hereby applies for a permit according to"the following information: �6 Sunn Wood I, e " H annis LocationLOt... ........ ..............Y.......................... ...r......Y.......... ... . ... ......... ......... ......... .. ............................................. i ProposedUse .... ............................................................................. i Zoning Distr.ici".:. 8.'. Fire District ... 1,y.4X3X j.6.....:.......... ....,................................. Name of Own 'lc-.o m..keal Trust . ...: Addr`esa66..F.ai=uth...Road H axua3. Ma, Name of BuCO R23 , Ear. . �'.Y.e.CrQ...�:ZX1CR.."Add.ress S2tr1@...... ................................................... _ }{ Name of Architect ..:............ .:......Address ......... Number of Rooms .Sa?X.:...................... .........................:..Foundation ...P..C................................................... ExleriorQ!Papboard..a2a43,/.or..rS.bdTlglen.............. ....Roofing ....:. A,sph�alt••ShInglea....•.............. FloorsCa.rPAt.:............................................ .....................Interior .........Sheeltr.GG-k................................................... Heatin Ag.....� F+WeA.r........................... .............. Plumbing :... gG g Two..... upper................................. G Fire IacvOrie................. >�0 p ......................................:....................Approximate. Cost .��kO.tQOQ... ......................................... Definitive Plan Approved by Planning Board _____________________--------19________. Area �. Diagram of Lot and Building with. Dimensions Fee � ..1.. . . . . . ' SUBJECT TO APPROVAL OF BOARD OF HEALTH f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' I hereby agree to conform to all the Rules and,,. Regulations of the. Town of Barnstable regardin the above construction. Name ...... ...... ....... ....... .. .. .... /"'t'�'�8'i' y ConstructioA Supervisor's License0 CAPRICORN REALTY TRUST ' '�' S •� 28150 1z Story -._ T • _' _ _ Sw - • k!i -NO. ................. Permit for .................................... _ Single Family Dwelling Lot 4-6 19 Sunny..Wood'Drive Locatio ....................... . ..... .......... E 7 - . �. ; ... � ..� ........ - . Hyannis x p; Capricorn Realty Trust Owner ...... ................................................ .. W Type of.Consfructiorr: Frame........................ ...... y... ...................... ....... ; Plot Lot"... ........................:.... Permit Granted .... July 3,' J ............. 1................ ...... '9 85 Y Date of Inspection .. te • Date Completed ....�.�1 ' 3.• ` r •et. -r!ii- Assessor's map and lot number ....� ...,:.:.�� "'.... THE Sewage Perri 'umber ....... ( � h '1, % Z BAWSTADLE.i House number `......_...................f........... ............... ::...... 90 "639 0� TOWN OF BARNSTABLE� BUILDING INSPECTOR Construct Single Family Dwelling i APPLICATION FOR PERMIT TO ................................................ ......::...........:::.. Wood Frame TYPE OF CONSTRUCTION ; �. v. 011.f 9:. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit rding to the following information: r' Lot --- rLocation ..... ....#t4�h... .. mm-lir ..ffj�?Q.d...��s ........Bygmiq........................................................ ................................... ProposedUse ......... .. ............ ................................................... Zoning District R. ...8�.............................................................Fire District ...............................................a21X1 _ .... ­ .................. Capricorn Realty Trust 6 Falmouth Road, Hyyaniiis Mass Nameof Owner ......................................................................Addres '�..............................................................................! �< Franco Real 'Est.Dev.Co. pInc. Same Nameof Builder .................................................................. Address ............................................................ Nameof Architect ..................................................................Address ...........................................................<........................ Six .Number of Rooms Foundation P'C' .................................................................. .............................................................................. Clapboard and/or Shin Les Exterior g Roofing Asphalt Shingles Carpet Floors Interior Sheetrock n Gas' F.W.A. Two — Copper Heating ...... ..:........................... .....................................Plumbing ............. ................ None, , 4 $40 000'.00 Fireplace Approximate Cost ..........r .�.:.... ...................................................A 1......................................... ............ Definitive Plan Approved by Planning Board ________________________________19________. Area io56... ft.+.............. Diagram of Lot.and Building with Dimensions Fee i SUBJECT TO APPROVAL OF BOARD OF HEALTH ♦♦ -OCCUPANCY PERMITS REQUIRED FOR'NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regard the above construction. Name .....................................1. / �! . r 'r rr+t(,e,4C6rnstrructiorirS4.e rvisor's License0.00�8.9 .... ............... CAPRICORN REALTY TRUST A=273-235 28150 ................. Permit for ...1.LA�,�u................ Single Family Dwelling.................. ........................................................... Lot 46, Location ...................... ..... Hyannis . ............ .......................................................... Owner ......Capricorn Realty Trust ................................. .......................... Type of Construction ....Frame. .......... .................................................................... Plot ............................ Lot ................................ Permit Granted ....July 3, .........19 85 ...................... Date of.Inspection ....................................19 Date Completed ............................. ........19 fir i P'