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Home My WebLink About0664 YARMOUTH ROAD (pro �'l ya--�rr��a�.�-�, �G�� _ 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -Q-_ M 1't I�� BUILDING Map A a Parcel I Application # Health Division AUG 30 2016 Date Issued Conservation Division TOWN Oi- SAP%TAB Application Fee . Planning Dept. LE Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Y,,4/Zkn v v i�a Village_ )✓/�d/X,/, 3 Owner ,�O�/j� �'� /� Address Telephone r,ZZ 5_",7 Permit Request /2,4P_)2 77'ig Tleal //.e-'/a,Se le—,- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation f 9G®d e Construction Type w d� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �K Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ANo On Old King's Highway: ❑Yes 4No 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 I 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 4 !z,-0 Telephone Number �OF72L 4/� Address �/ ' /� �ci� V t' License # � .4-1G Lif Home Improvement Contractor# AI sf S 7 Email&// dW N,� M Z/iZjlb�; 1'6,�4 Worker's Compensation # /_;-0a ti ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 2�j4oe SIGNATURE ZI 4 Y DATEv��1/l� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION .FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. -\ The Cornrnonwealth of Massachusetts Department of Industrial Accidents i I Congress Street, Suite 100 Boston, MA 02114.2017 }v>•vw,mass,go v/(lira 1-Y.Qvkers' Compensation Insurance Affidavit; Builders/Contractors/Electrictans/Plumbers, TO BE FILED WITH THE PERMITTING AUTHORITY, Aoalicant Information Please Print Legibly Name(Business/Organization/Individual)' 6�I-& Add I-ess.�_rL'-- �✓'G.��,� ice' �Ciz — Clty/State/Zip: /- Phone Are you an employer? C eck the appropriate box; Type of project (required) I. am a employer with employees(full and/or part-time).' 7. ❑ New construction 2.�l am a sole proprietor or partnership and have no employees working for me in $, Remodeling any capacity, fNo workers' comp. insurance required.) 9. Demolition 3C 1 am a homeowner doing all work myself.Mo workers`comp. insurance required.)t ❑ 10 Building addition a ❑1 am a homeowner and will be hiring contractors to conduct all work on my property I will ensure that all contractors cither have workers'compensation insurance or are sole 1 l.(_] Eleotrical repairs or addict proprietors with no employees 12.E]Plumbing repairs or add it S.Q I am a general contractor and I have hired the subcontractors listed on the atached sheet. 13.❑ oo repairs airs These subcontractors have employees and have workers'Comp. insurance I 6❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14,[ Other L G/ -1/_ 152,§1(4),and we have no employees (No workers'comp, insurance required] 'Any applicant that checkA box N 1 must also fill out the section below showing their workers'compensation policy information. r Homeowners who submif2hrs affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such IConuactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not(hose entities have . emplcyees If the subcontractors have employees,they must provide their workers'comp.policy number. I ant rin employer that is prov1dilig workers' compensation insurance for my employees, Below Is the policy and job scr- information. Insurance Company Name' �� /,/ 77� 2 Policy 9 or Self•ins. Lic. H. �� T l�f Expiration Date. '~ Ci�d es Job Site Address: City/State/Zip; Attach a copy of the work rs' co ipensation policy declaration page (showing the policy number and expiration da Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,S00 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 day against the violator. A copy 4this statement may be forwarded to the Office of Investigations of the DIA for insuran _ coverage verification. I rdo hereby certify under the pains Hurt persaltles of penury that the lnfortn ation provided above !s true anrd correct. e Signature. Date; Im Phone M q—!�f`� Offecint use only. Do:iior write in this area, to be completed by city or town offlclah City or Town; Permit/License h 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; Pbone #t _ CAPECOD-27 CLEDDUI, A Ro CERTIFICATE OF DATE(MMIDD,YYYY) LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTI_F FICATE 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 IORDED BY 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 pollCles may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), PRODUCER CONTA ba CT Rogers&Gray Insurance Agency,Inc. NAME: Barra DeLawrence 434 Rte 134 PHONE South Dennis,MA 02660 EMAIL E t A/C No): ADDRESS: bdelawronce@rogersgray.com INSURERS AFFORDING COVERAGE NAIC r! •INSURED INSURER A:Peerless Insurance Company INSURER B:Safety Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Insurance Corlpany 41718 South Yarmouth Reardon Circle,MA.02664 INSURER D:Atlantic Charter Insurance Company 44326 S INSURER E: INSURER F: COVERAGES CERTIFICA... :NUMBER; REVISION NUMBER: THIS IS 70 CERTIFY THAT THE POLICIES OF IN -LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWTHSTANDING ANY REQUIREMENT, TERM:.pR.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 SHOWwMA INSR Y HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSO WVDPOLICY NUMBER P LICY EFF P L Y E P A X COMMERCIAL GENERAL LIABILITY MMIDD/YYl Y MMIDDIYYYY LIMITS CLAIMS-MADE Pq OCCUR CBP8263063 EACH OCCURRENCE $ 1,000,01 04/01/2016 04l01/2017 PREMISES Ea occurrence 5 100,0( MED EXP(Any one person) $ 5,0( PERSONAL&ADVINJURY $ 1,000,0( GEN'L AGGREGATE LIMIT•APPl:l6S PER: GENERAL AGGREGATE $ 2,000,0( X POLICY❑PRO• •JECP LOC OTHER: PRODUCTS-COMP/OPAGG $ 2,000,0( AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT B ANY AUTO 6232707 COM 01 Eaacc!deno 5 1,000,0( ALL OWNED" X SCHEDULED 04/0172016 �04/01/2017 BODILY INJURY(per person) $ AUTOS AUTOS BODILY INJURY Perscelden; $ X HIRED AUTOS X .NO"OWNED AUTOS PR P R DAMAGE $ Por accident X UMBRELLA LIAB X OCCUR $ r-- C EXCESS LIAB CLAIMS-MADE EXC10006635001 r BACHO.000RRENCE $ 2,000,OC 04/01/2016 04/01/261 AGGRactiTE $ DED X RETENTION$ 10,000 -- WORKERSCOMPENSATION Aggregate. $ 2,000,00 I AND EMPLOYERS'LIABILITY OTH- D ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N CEOO4319OZ STATUTE' ER OFFICER/MEMBER EXCLUDED? NIA 06/30/2016 0.6/30/2017 E;L;.EACH ACCIDENT $ 1,000.00 (Mandatory In NH) II Yes,describe under E.L.DISEASE-,Eq•Q D MPlOYE' $ 1,000,00 ESCRIPTION OF OPERATIONS below E.L.CIS EA .E.••POLICYLIMIT. $ 1,000,00 i DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLE'$ (ACORD 101,Addition aI Remarks Schedut0,may t-atteohld'i(more aPace Is required) Workers Compensation includes Officers or Proprietors. (Additional Insured status is provided under the General Liability and Auto.Llability4hen required by written contract or agtedment wlih the Certificate Holder. I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE "��`Hi9gZ13@'BUJ d@rS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 94A Co erce Parktogth ACCORDANCE WITH THE POLICY PROVISIONS. Sou T atham,MA 02669`•,. AUTHORIZED REPRESENTATIVE ACORD 25(2014/01) The ACORD name and logo are registered marks 2of ACORD D CORPORATION. All rights reserved. i. Massachusetts Department of Public Safety Board of Building Regulations and Standards license; C5.100988 C on8trUCtlOn Supervisor HENRY E CASSIDY. s J 8 SHED ROW \> WEST YARMOUTH ^^� Expiration; Commissioner 1 1/1 112 0 1 7 &=7 Xlel Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Co:ltractor Registration Registration; 153567 Type; Private Corporation " Expiration; 12/15/2016 Trb 259188 CAPE COD INSULATION, INC HENRY CASSIDY -- ---- 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update.Address and return card, Mark reason for change. scA I [] Address Renewal Employment (� Lost Cant ...... ........................ ......_ ... /ee omc��aaozcvec��G/t o�'C%�lcwacr.c%c�deCtd ' as \ Ofnl v of.Consumer Affnirs& Rusincss Regulntion License or registration valid for Individul use only OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to; egistratlon; 1.:53557 Type, Office of Consumer Affairs and Business Regulation j xpIratIon; :;1.2115/20.1.6 Private Corporation 10 Park Plaza •Suite 5170 Boston, MA 02116 CAPE COD INSULAT OQf,*...INC HENRY CASSIDY 18 REARDON CIRCLE` . SO. YARMOUTH,MA 02664 Undersecretary valid wi tit sign e HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. 1 1-0(1/k l9eJA hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: �y�il/J /hA tUy6a� The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic& basement insulation; exterior wail insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit oh an ongoing basis for no more than five (5) years after the weatherization work is completed. I I have read.the provisions of this agreement and give my consent. Home Owner(signature) , Home Owner email: Date: Agent:(Signature) Date: �4( wl& Weatherization Contractors: CA Adam T Inc Cape Save All Cape Energy Frontier Energy-Solutions Alternati •therization Lohr Home Improvement Building Science Cons r Tupper Construction Cape Co nsu