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Home My WebLink About0004 SYDNEY DRIVE TOWN OF BA T� Lr CAPE COD INSULATION it'`E ? a ® i FIB"YMSS SLAMLSSS SPRATSOAM SYSPSNRSR _ - SATTi 4YTTSRS NSYIAifON CSILINOS 1-800-696-6611 DIV!Sj i Town of Barnstable Regulatory Services Building Division 200 Main St $� Hyannis, N.lA 02601 /=` z�-�`�' Date: ��'`�� . • Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & V completed the insulation and_weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the buildingipermit application. All work has been inspected by a certified Building Performance Institute (BP•I) inspector. All work preformed meets or exceeds Federal & State Requirements. Propert Owner Property Address Village', �vny yv rv��/-1a yl) A Y Sydze7 41- Insulation,Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings i Slopes Floors ( ) ( ) { ) ( ) ( ( ) 4 Walls (AA' Sincerely He ry E Cas y Jr, President - C e Cod I ulation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Ppplicatio # `. Health Division Date Issued /2--31 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project fll Stre t Address Village Owner I AA 11A Address Telephone Permit Request o 0au Ac Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation v 4� °� Construction Type, ®pp Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docum�tation. f� i _ Dwelling Type: Single Family �dl Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway:"0 Ye80 ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other W A=� 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 d �P ,��/�� !�� Telephone Number L: fVf Addressf i �� u/�� /� License # Home Improvement Contractor# ��3✓� Worker's Compensation X9�9� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT ILL BE TAKEN TO SIGNATURE DATE J FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED If MAP/PARCEL NO. 14 ADDRESS VILLAGE OWNER DATE OF INSPECTION: amFO.UNDATION .UnO_,• 'FRAME ..� .. r,-.I - �i INSULATION Is I FIREPLACE ELECTRICAL: ROUGH FINAL 'r. PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING j' DATE CLOSED OUT ASSOCIATION PLAN NO OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) l/ r/tinhi 5, 4 Gl (Property Address) r hereby authorize S 0?J-1 (Subcontracto ) an authorized subcontractor for RIS ngineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Sig ature ?/1712®l zj Date - Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-100988 HENRY E CASSIIW' 8 SHED ROW WEST YARMOUTH;1�1* Expiration Commissioner 11/11/2015 F i ! • ... -. is c��J)Y41)?01r-0(—) r.lC�l r.� , C�-!"�(�J J c .�r.l� ' x Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston Klass >cliusetts 02116 nic Improverileni Cot>tractcr Registration Registration: '153567 vpc: Private Corowation Expiration., 12/-15/A)-1 t Trk 2DOJ1 CI AP COD INSULATION, INC : 11I-ARY CA35IDY ............. . .__ 16 F\'F*ARDON CIRCLE At_? YARMOUI-H MA 02664 --. .. . .. ........ UptliltcAtldress mid rehrru cnt'tt. 11'lartc reason tin ehauge. Address L^I Re.ucwsll I t!:mt.tloytile I I Lull bard l t uu,uur(, [tfui(s t t.tusuless Replatitlu Liccnu or registratiuu valid for indiviltill use Only I�r��l ylltuMr.:IwROVEMENT CON I-RAC.TQR tw utc the expiration(late. If'fouud rclui u'tti;. ��IpY+J qLyl,trauvl,: 153567 Type, Office of(unsumer Alfairti and Liusiucss t2c6ulul'iun ' -X,plrzrllun. 1:'/lh/2U1 Pnvale Corporatloll 1U Park plaza-Suite 5170 tiostuu,NIA 02116 IION IN( Uu(Icrscrrct,lry of l•al wi flo t oat '1'e The Commonwealth of lllassachusa?tts Department of Industrial Accidents Office of Investigations 600 Washington Street { .Boston, IVMA '02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers pplicant Information Please Print IJegrbl� Name (Business/Organizabon/ladividual): �p/�� Address:1� city/state/zip. Phone #: 5�G ��'1 2-Ire Youaa.eurploy r? Check the appropriate box: < Type of project(required): l..�I am a employer with. 4. ❑ I am a general contractor and l employees (full anc�tor part-time).* have hired the sub-contractors ' 6• ❑ New construction listed on the attached sheet. 7. 2.❑ 1 am a sole proprietor or partner- _ ❑ Remodeling 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.t 5. ❑ Building addition required:] 5. ❑ We are a corporation and its 10,❑ Electrical repairs or additions .❑ 1 am a homeowner doingall 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 3a.❑ I am a homeowner acting as a employees. [No workers' 13. 0therzP / general contractor(refer to#4) comp.insurance required.] '�y applicant that checks box#1 must also fill out the section below showing their workers'cotnpensatioapoGcy inforooaidon: Flomeownets who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new.afficdavit indicating such. tCoutnu:tors that chock this box must attached an additional sheet showing the nano of the sub-conaactots and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their woiken'comp.policy number. 1 am an employer that is providing workers'compensation insurance for my employees. $elow is the policy and job site information. Insurance Company Name: /,r/ G Policy#or Self-ins: Lic:#: IzG^ / Expiration Daterj� y��r� Job Site Address:-.- ..q City/State/Zip: 'a.i� VVt. Attach a copy of the vworkerV compensation policy declaration page(showing the policy number and expiration date). i Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 cernfy nder the nd penalties of perjury that the information provided above is ti rye and corretx Da 1 q �� i Phone 'Official use only. Do not write in this area, to be completed by city or town official City orTown: Permit/License# Issuing Authority(circle one): L Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Ins ector 5. Plumbing I ector 6 Other P gna P Contact Penon: '^ Phone#: CAPECOD-27 MYOUNG �.._. CERTIFICATE OF LIABILITY_INSURANCE DATE(MMIDDnYYY) 71812013 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 B TH E HE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERIS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the p0licy0es)must be endorsed. If SUBROGATION IS WAIVED,subjectto the terms and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does,Hot confer rights to thD ce(tihcatu holder in lieu of such endorsement), CONTACT r<ul)uceR License#PC-514062 -- RogcrS tt,Gray Insurance Agency,Inc. NAME: _ Margaret Young — PHONE I - ----..-- --� 434 Rte 134 IAIC, 1 FAIc No �Sukilll Dennis,NIA 02660 t MAIL E I ---— --- __ --- �. _..ls.._._-.__.. ADORE myoung_.rrogersgray.conn - INSURERS AFFORDING COVERAGE NAIC It -- ............. --� wsURERA:PEERLESS INSURANCE COMPANY INSURER 13:COMMERCE INSURANCE COMPANY Cape Cod Insulation, Inc. INSURER C:Eva nston Insurance Company I8 Reardon Circle • INSURER o:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 ----- --.—.-.-- ----- INSURER E: INSURERF: - -- VERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ iI'rf1S IS 10 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 VVITH RESPECT TO WHICH TI11S CERIIFICAI E MAY BE IS,S',UED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 1.0 ALL THE TERMS, kXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ......._.__..____.____._._.. TYPE OF INSURANCE 'A015C SUER I_fR ' laaiL POLICY NUMBER - ,IMMIDDNYYY A,(MMIODIYYY - - - LIMI'15 ULNERALLIABILITY EACH OCCURRENCE $ 1,000,000 A X" 't:UMMERCALGENEPALLIABILIrY CBP8263063 41l/2013 4114614 -DAMAGE-TORENTED--_ " ----- '��' ' PREMISES Ea ocalrrortcol $ 100,000 - ---- CLAIMS-MADE I J q(:CIJR MED EXP(Any anaT,af�n) $ 5,000 l� --- - -----,- PERSONAL eL ADV INJURY $ 1,000,000 GENERAL.AGGREGATE _ $ -2,000,000 GrN l Al>uREGA'I'E L.IMI r APIPL IES PER: PRODUCTS-COMPIOP AGG $- -2,000,000 PRO- J POLICY.t — AUiOMUBILE LIABILITY CZIMB)NtD�NiMLELILIMIT- ! Ea acddan� -$!_. 1,000,000 B AN i AUT'U _ 13MMBCKVMK 4/1/2013 4/1/2014 BOOILY INJURY(Per parson) $ AUTOS OWNED y SCHEDULED BODILY INJURY(Par acGdanO $AUTOS X tIIRED AUTOS AUTOSVVNEO PROPER�YbAMAG — ' ' PER ACCIDENT X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 C I XCESS LIAFJ CLAIMS-MADE XONJ453512... 4/1/2013 4/1J2014 AGGREGATEl'JEU X RETENTION$ 10000 —L_1 - — _ WORKERS COMPENSATION �- v4 STQTU AND EMPLOYERS'LIABILnY t _ D ANY PROPRIETOR/PARTNER/EXECUTIVE Y!—N' WCA00525904 6130/2013 6/3012014 E.L.EACH ACCIDENT $T^T 1,000,000 OFF, EXCLUDED? (� N!A _._—_ — (htartdalury in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Ir Yet,dosenue undaf - _�._...-_ OESCRIP'I'ION QF OI'ERAT'IOIVS t alaw-- - E.L.DISEASE-POLICY LIMIT $- - 1,000,000 I I UcS,:RIPI'ION OF OPERATIONS I LOCATIONS/VEHICLES (AltaWl ACORD 101,Additional Remarks Schedule,If more space Is required) —^ _ Workers Compensation includes Officers or Proprietors. Addlional Insured status is provided under the General Liability when required by written contract or agreement with the Certificate Holder. I CERTIFICATE.HOLDFR CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE i Cape Cod Insulation,Jnc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. LACORD AUTHORIZED REPRESENTATIVE 1988-2010 ACORD CORPORATION. -AIL rights reserved, 25(201O/05) The ACORD name and logo are registered marks of ACORD