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HomeMy WebLinkAbout0007 VANDERMINT LANE MCA ��- M � Cape Save Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 2-7-13 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for 7 Vandermint Lane,Hyannis has been inspected by a certified Building Performance Institute(BPI)Inspector. Ceiling: R-30 cellulose open blow & R-19 cellulose under decking Walls: R-13 dense pack cellulose Knee walls: R-7.2 Thermax All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey o TOWN OF BARNSTABLE BUILDING PER-MIT APPLICATION Map_, �� Parcel 051 Application # Health Division Date Issued Conservation Division ,'; Application Fee S,V Planning Dept. PPermit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address V Q�l�e�►h� �.an Village Owner cm or, Address SDA0 Telephone �J -4- 5 ( __ Permit Request _ R` 3 b a,n� �� e-e NA(6& �g2 l t b l ncrer e G1E o r v od',14 4 io,rl -t. ca A w& s cR-� sr&-Ass. Square feet: 1 st floor: existing proposed _2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Flo Construction Type Lot Size _ _ Grandfathered: ❑Yes ❑ No If yes, attachssu portinoocurntntation. 1-4 Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) _ w' ") Age of Existing Structure Historic House: ❑Yes ❑ No On Old King'`"s�Highwayr"❑Y6g ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other ? Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.f ' V 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: 14 Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes bd 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 6 No If yes, site plan review # _ Current Use — _. Proposed Use APPLICANT INFORMATION 4j (BUILDER OR HOMEOWNER) T -CM o — Telephone Number Name _U �0� 8 �` Address -� tt 4 ?, License # 1-C �0 kq-j- Home Improvement Contractor# Worker's Compensation #7—WC33 M 0- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO YVM6A SIGNATURE DATE ` lf` 03 i FOR OFFICIAL USE ONLY APPLICATION# 4 t _,DATE.ISSUED _.,_.'14MAP/PARCEL NO. . ADDRESS VILLAGE r OWNER DATE OF INSPECTION: _:_{FOUNDATION,Dt` " 0 FRAME —.,INSULATION,.!' � FIREPLACE F », ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: _ ROUGH e, r= FINAL 7 b• =?`FINAL BUILDING' i r DATE CLOSED OUT r ' ` ASSOCIATION PLAN NO. "`'" `— "• • �— f - Housing. 4-6D West Ragan.Stieft Hp=: s,--KA 026 01-369 8 i s5 s [ e. ... .. T (50 ?71-540 F_(5QS}T -7 rE} r o ati on -fTY on aIl lines _ v��vbe�oxrea�ecad mA i HOME OWNER WEATHERIZATiON WORK PER? FM FUEL REUSE: PLYASE FLU OUT-AND SIGN TMS.FORM IF YOU ARE THE APHICANT HOME OWNER" ti" � 1 hereby consent to and agree that weathexzzation-work may be done by e therization.Program of Housing Assistance Corporation ( herein after zefeaed as "Agency) on the property,located at The weatheaizationwork done wall be based on proUammaticpiaorities and availability of frmding and it may include all or some of the following measures: weather-stzipp" tr&cant of windows and� g doors insulation of attics�'s-dew • cells basem ents,enzents attic.tnc and other ventrlation measures and.poss31ly replacement of badly detedoraied windows-In consideration of the weatherization work to be done at my home I agree to the following: - I We pelssion to the "Agency its agents and employees to travel onto or across said property with such equipment and materials as maybe necessary to performweatherization work on said property. 2_ The Housing Assistance Corpoiation reserves the 3[i&to Inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5)yeaxs after the weatheri:a on work is completed_ I have read the provisions of this agreement as Iisted and freely give my consent Home OWA- r- (Signature) Date: 4 / -' 72c3 Agent- (6ga2±0Xe) Dates I-'�-AC aP.proved Weatherization Company Ca]i-ber Building&Remodeling Cape Cod IDmAzdo3j Save . Creswell CMIStruction FrontiezE erZy,Solutions Iahc&Sorsss e ez zith Resoltnionrne Rock Solid Coip # ctzon. All Cape iusulation The Cotntnonivealth of hassaclzitsetts - - Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,AM 02111 ►vwiv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): Cape S 0�yf_ -In C. Address: '� - fl �tAd►ting'�o(1 �ve0vt,.e City/State/Zip:5eu4 Yarmout�, MR Oa-664 Phone#: 508-- 3 q $ ' 0 3 9 g Are you an employer?Check the appropriate box: Type of project(required): 1.0 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. ❑New construction 2.❑ lam a sole proprietor or partner- listed on the attached sheet. 7.. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in:any capacity. employees and have workers 9_ ❑Building addition [No workers'comp.insurance comp.insurance 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 I l.❑ 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.X Other _n S th., Vi on comp.insurance required.] *Any applicant that checks box 41 must also fill outthe section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and Then hire outside contractors must submit a new affida%it indicating such. ,Contractors that check this box must attached an additional sheet shoeing 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: _TCGh n 01 0 tj V Tn 0.r GC Ge,th an Policy Nor Self-ins.Lic.r: 3 3[ g Expiration Date: (4 R ' 13 " \ r i 1 Job Site Address: �- V all cl ec�`111 T L- A e l. City/State/Zip: 1 1111 ' Attach a copy of the workers'compensation policy declaration page(showing the policy numb r and expiration date). Failure to-secure coverage as required under Section?5A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investieations of the DIA for insurance coverage verification. I do hereby certol under the pains and penalties of perjury that the information provided above is true and correct Sienature: Date: '' of Phone 4!; 3 9 B - 0 3qg Official use only. Do not write in this area,to be completed by city or town official ..City or Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone:`: A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYM 11/9/2012 aMft 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 WANED,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 NAME CT Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400AIC,No):(781)963-4420 15 Pacella Park Drive Eo/UE •ssperrazza@risk-strategies.com S'lllte 240 INSURERS AFFORDING COVERAGE NAIC# Randolph MA 02368 INSURERA:Selective Insurance INSURED INSURERB:Safety Insurance Company 3618 Cape Save, Inc INSURER C.Technology Insurance Company 7 D Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBERCL1211954576 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 ADDLSUBR LTR TYPE OF INSURANCE POLICY NUMBER MM/uDD EFF MPOMILIICp EXP UNITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES RENT occurrence) $ 100,000 A CLAIMS-MADE a OCCUR 199448001 0/16/2012 0/16/2013 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY S 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOCI $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a a ident) S 1 000 000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 6208200 1/6/2012 1/6/2013 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOSE NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ X Underinsured motoristBI s lit $ 100,000 X UM13RELLAlJA6 JCLAJMLM,�aE CCU EACH OCCURRENCE $ 1,000,000 A EXCESS CIAB AGGREGATE $ 1,000,000 DED RETENTION 199448001 0/16/2012 0/16/2013 $ C WORKERS COMPENSATION Officers excluded X WCSTATU OTH AND EMPLOYERS'LIABILITY Y 1 NOR"I ANY PROPRIETOR/PARTNER/EXECUTIVE from coverage E.L.EACH ACCIDENT s 500,000 OFFICER/MEMBER EXCLUDED? a N 1 A (Mandatory In NH) C3318007 /9/2012 /9/2013 E.L.DISEASE-EA EMPLOYE $ 500,000 If es,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT S 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES A( ttach ACORD 101,Additional Remarks Schedule,N more spas is required) Issued as evidence of insurance. Issued as evidence of insurance. National Grid Corporate Services LLC d/b/a/ National Grid, Action Inc. , Colonial Gas Company and NStar Electric are listed as additional insureds as respects .General Liability as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS, PO Box 427/SCH 3195 Main Street AUTHORIZED REPRESENTATIVE Barnstable, MA 02630 Michael Christian/SMS ACORD 25(2010/05) ©1988 2010 ACORD CORPORATION. All rights reserved. INS02;mn+nnai ni The arnRr1 r—atarvel meelrc o f Af`nrifl f Nlassachusetts- Department of Public Safety Board of Building Retnilations and Standards Construction Supervisor Specialty License k License: CS SL 102776 Restricted to: IC WILLIAM MC CLUSKY 37 NAUSET ROAD WEST YARMOUTH, MA 02673 Expiration: 6/28/2013 (`ununisi„„f.,. Tr#: 102776 - � -12Ate �/�� 'r Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 171380 Type: Corporation - - - - Expiration: 3/14/2014 Tr# 222184 CAPE SAVE INC. WILLIAM McCLUSKEY -_ -- = _=-. 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 Update Address and return card.Mark reason for change. , ;_; Address Renewal ; Employment Lost Card PS-CA1 0 SOM-04/04-G101210 Jl:e �a„�„zaouaealll c��° lla;aclzuaet ion valid for individul use only `, ` Office of Consumer Affairs&BJsiness Regulation License or registration y -,� --'HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ram; Registration::—' Office oonsume f Cr Affairs and Business Regulation Type: �' ,- 10 Park Plaza-Suite 5170 Expiration: -3/1412014 Corporation Boston,MA 02116 CAPE SAVE WILLIAM McCWSKEI!_:: 7-D RUNTINGTON AVENUE.z7 SOUTH YARMOUTH.'MA 62664 Undersecretary Not valid wit o signa