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HomeMy WebLinkAbout0023 BREZNER LANE .;L(^A j"'`"4B.5"e'_�F"7y.c ) 1 C G 7S',.), F�S A, .y.� t+x. :� 3 ,..:.i.: ,. -,.,, 31 . LS_.,.; .,..:. .iy 'y �. - �, b�`k i� }r A�q -a A � .f Q`F �_xi .�� A A-} „l.�' w,-::^=' ,, .,,�, ;.� a -d. .�. n .�+%.4 t 4' t � i' 'Y+ aL f5a`rn .q: 4 =, ?k. sLl }.c. cp , ,:. t 3, 4�fi �.? ,4 F -S > 42„`,;+ a Yyy'e.r; 4:+. , .. u l ;! rh C, ,(x r` . ' 4 .;. n , , 4 f ,. , ;t ,. t -. -- t .0 ,. ,d`, i ,. , v; • s , - �,� ":l :;I d 4 { l✓!k h 1 1,; , l M1L t;. •' ' V J T \x 3 d G l�{ 2 35 5} ` ]t `/ T X i k, C E 4 A 1 i '� .� ! r e5 { t 4 4 _ ). h �S� tY { y 1 .K+ Y 7q t i' S\ 14t 2 Z �.. 1 i �,, Y3 s '1 ` yt tq * r < 1 y y 'b Y{ V 1 t 1 i - - � } L P P. r 3 � `" t t t s i Y. 7 p .q > ,,N..7 a t 7 r a r., 3 Y [ 4/ _ d !1 F f .4, F t 4 9 f } _ 1 , t - h� ..:- �, , ,. ,, w �. ,. - - - i d 4 7 )� :_• ,..: A - fC �Jl l t..'k ,t ,T. , 4 ,. r .. , n. _ :. _. .. : . , . „ , .;. ,. CAPE C 00N OF INSULATIV. ON „gip f .1 Vil 2 2110 IISIR GLASS. SEAM L155 SPRAT FOAM SUSPIHTIEO 5 ATTI OUTTIRS INSULATION. CEILINOS saw, '+1 veFcr 1-800-696-6611;g € s Town of Barnstable Regulatory Services Building Division g 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 '(BPI) inspector. All work preformed meets or exceeds Federal& State Requirements. Property Owner PropertyAddress Village Insulation Installed: .Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( )- ( - ( ZF) ( ) Slopes ( ) ( ) ( ( ) ) Floors ( ) ( ) ( ) f ) ) Walls T n. e r y (VO r k her ro r, e0l Sincerely H ry E ssi r, President pe C Ins ation, Inc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map� Parcel Application � lz�L/ r tg �� Health Division Date Issued ® :,V15 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH . _ Preservation/ Hyannis Project Street Address cU Village Owner� ,�f� Crr1�D � Address Telephone _50d JZ,�2,/zga/ Permit Request AV Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation o:1 G dD, D Construction Type,i4j_(0 j/d 4,0 Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family A-' Two Family ❑ Multi-Family (# units) " 1 Age of Existing Structure Historic House: ❑Yes 0No On Old King's. way: ❑;Yes:ti '�lo Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.). Basement Unfinished Area (sq.ft) :f Number of Baths: Full: existing new Half: existing new; a 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 &g2k /"' O Telephone Number cJ �7Y7�/9 Address le License # L/ w Home Improvement Contractor# t✓ .g 5 oz Email Worker's Compensation # /l /,D 4�j ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO AD SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION III F FIREPLACE A' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL M GAS: ROUGH FINAL A FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. / Masrncaruswtit 17a partri�cnt of F'r,ub11c Safety � ..:Board Of BUIldiny.,[30 gulatiant; siiid Standards' ' Cun.ih'uc'tion Super�'isur ,•;i:• License, CS•100988 .r - Ora HENRY E CASSTI) 8`SI-iED ROW WEST YARMOUfiH r ' ✓. . J> ; ,� nr ` Expiration Commissioner 11/11/2015 j"o a e Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite-S 170 Boston, Massachusetts 02116 Home Improvement Cbr>tractor Registration Registration; 153567 Type: Private Corporation rn� Explration: 12/15/2016 Tr# 259188 CAPE COD'INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE I SO, YARMOU.TH, MA 02664 Update Address And return card, Mark reason for changa s0A r 0 20M•05i11 Address Renewal Employment Lost Card �e cPanhrtaruue«lG/a�C�/l/l�Warro/ttwetGi � •• . : ..... .. . C_ Office of Consu mer Afrnlrs&Business Regulation License or registration valid for Individul.'use only OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: egistratlon: '153567 Type: Office of,Consumer Affairs•and Business Regulation xpiratlon; 1.2115/2016 Private Corporation 10 Pnrk.Plaza•Suite 5170 .„A Boston,MA 02116 CAPE COD INSULATIbN;:,INC HENRY CASSIDY ,. 18 REARDON CIRCLE 50. YARMOUTH, MA 02664• ' " Undersecretary N. vapid wi lit sign e The Conlmo/tfvealth of Massachusetts Department of Industrial Accidents Office`of Investigations " 600 Washington Street. Boston, MA:02111 .J www,mass.g ov/dia Compensation Insurance•Affidavit; Builders/Contractors/Electricians/Plumbers ,Information Please Print Le ibl isiness/Organization./Individual): J y/State/Zi. p: /� L ;b p' Phone #: r., ire you an employer? Check th- appropriate box; I. ,l am a employer with 4. ❑ I am a general contractor an&l y Type of project(required): 4 ' employees full and/or part-time).* have hired the 6, N w( p e). sub-contractors Q, e construction 2.❑ 1 am a sole proprietor or partner listed on the attached sheet, 7, [] Remodeling ship and have no employees These sub-contractors have working for me in any capacity, employees and--have workers' $` 0 Demolition '[No workers' comp, insurance comp, insurance.# 9. ❑ Building addition required;) 5. 0 We are a corporation and its "10,❑ Electrical repairs or additions ' 3.❑ I am a homeowner doing all work officers have exercised their . l LEI Plumbing repairs or additions myself, [No workers' comp, right of exemption per MGL insurance required,] t c..152, §1(4), and we have no: 12.0 Roof repair's employees.�[No workers' 13, Other - 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. 'Contractors that check this box must attapred 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 �,nformatlon. Insurance Company Name; � ` . ' � A , , i Policy # or Self-ins, Lie,#: x,E':' 00 4 Expiration Date: Job Site Address: 5 �� .���JVr�f/� Cit /State/Zi Attach a copy of the workers' Compensation policy declaration page(showingthe p,��� policy number and expiration date),. Failure to secure coverage as required under Section 25A of 110L c, 152.can lead to the imposition of criminal penalties of a fine up to $1,50,00 and/or one-year igprisonment;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 insura coves e verification; . I do hereby certify daWhe pa an penalties of perjury that the Information provided above is true and------correct, Si 'nature: a Date Phone#; 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, Buildingbepartment 3. City/Town Clerk 4, Electrical Inspector 5. Plumbing Inspector 6. Other P Contact Person; ,, r 'CAPECOD•27 BOELAWRENCE A COP R0" CERTIFICATE OF LIABILITY INSURANCES DATDIYYYY, 6/3 30/2 012 015 THIS CERTIFICATE IY 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(les)must be endorsed, If.SUBROGATION IS WAIVED,subject to the terms and condltlons of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the certificate holder In lleu of such endorsements ( PRODUCER CONTACT Rogers&Gray Insurance Agency, Inc. NAMf;PHONE FAx 434 Rle 134 E : A/c No:(877) 8.16.2156. South Dennis,MA 02660 EMAIL • - — ADDRESS: INSURERS AFFORDING COVERAGE NAIC INSURER A,Peerless Insurance Company•see LIBERTY.MUTUAL wsuREo INSURERS:ATLANTIC CHARTER INSURANCE GROUP Cape Cod Insulation, Inc., INSURER C; 18 Reardon Circle INSURERD;. South Yarmouth,MA 02664 INSURER E INSURER F u. COVERAGES CERTIFICATE NUMBER;: .. REVISION NUMBER, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 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 _ LTR TYPE OF INSURANCE POLICY NUMBER, MMIOD EF r04/0112016 IDDLIOm P LIMITS - A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE%> $ 1,000,000 CLAIM$•MADE I A j OCCUR CBP8263063 04101/2015 DAMAGE TOI�U�� PREMISES(E0 occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ - 1,000,000 GEN'L AGGREGATE LIMIT APPLIE&:PER: PRO• GENERAL AGGREGATE $ 2;000,000 X POLCY JECT ❑"lOC PRODUCTS•COMPIOPAGO $ 2,000,000 OTHER: AUTOMOBILE LIABILITY �, COMBINED- Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NO(OWNED PROPERTY DOS AMAGE. $ P r e Idenl UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR H-CLAIMS-MAOE AGGREGATE $ CEO RETENTION$ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STAT TE �RH YINB ANY PROPRIETORIPARTNERIEXECUTIVE WCE00431901 06/30/2016 06/30/2016 E.L.-EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) II yes,describe under E,L.DISEASE•EA EMPLOYEE $• 1,000,000 DESCRIPTION OF OPERATIONS..below E.L DISEASE•POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES�( CORD 101,Addltlonal Remarks Schedule,may be atlached if More space Is required) Workers Compensation Includes Officers or Proprietors, Additional Insured status Is provided under the General Liability and Auto Llabllity when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation, Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WITH THE POLICY PROVISIONS, South Yarmouth, MA 02664 AUTHORIZED REPRESENTATIVE . ©1988.2014 ACORD CORPORATION, All rights reserved,--- ACORD 25(2014/01) The ACORD name and logo are registered marks.of ACORD , Town of Ba mstable Regulatory Services • Richard V.scab,Director Building Division Tom Perry.Building ComtdWoner 200 Main Sheet,Hyannk MAI 02601. www town,barnstablexa.ns Officer 508-8624038 Fax: 508. -6230 'ropexty Owner Must- Complete and Sign this Section r if I s ng.ABu deer :..._^_... _.. P ,, p L 1n r1 lrs Owner of tlxe sobject properly hereby-authorize rev b U ka 0 K1 act,on n'V.b , in Z mmm relative to wl authorized by tbis building pe=k'application for. le AMdress ofjobJ Foal feuoes and'Alb s are the r+esponsibiiiipof the:applicant.Pools mf installed and ail final CII 75 az+e norto be fille lr{�]27e �bef0 ce inspections are performed and accepted:` " igflature o f Over Sigaaaue of Applicant cYl ^ LL S / �'D�J io o� �� Pratt Name .' P&i-Nance