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0600 CRAIGVILLE BEACH ROAD
, I rL aV � r r :L . , af. !• ". •q ; rlt !.i.` U. � • :. rf1 J ar' an,y. : y , • { :: f S ,. Tif r ::1=xt ":: `. �" x'.. t' fy. !1 y' P. IF.y. ry.. d n .. u '+ : .n'r • + r r � ^. r r .rt .. .9 A' �1G• 9M t - '� ...;1 d n .. �I� � � �I a fi',,J _ "li 'x i L•'.. � 1 4_ •�y' .5, r, f-' !fA`�' � ,i tl � C _:1 1 1f1 e r r'. a'h k �.5; .,i>t ,�..; 4""" a:. � e •.t .:: eta<«,, a . Ir � � I 5 5 �•1. . H q i, i'it�. �;..Y '!< d n. „yt'•. +� }'„.. MN. � ' r ., ;, .•: iu qP t t;. s by (! :4 '1 - :,� :a v �. 9fr. lu.� `� ir. i t-� � �, t 'i�� tM1 it �`� '�• e any:..` t - ,, x .�.:,:• .,,:. _._. .,.n :... ,_ _.._...: !�.,':- n _' ,a -'C Gr :b' 1 .ao , : Ir r Y _ '.li 1��1. ( - rr •, ,ir�t' - J 4Ag�� P .�39-. Q .4 1 d , , +r r ,y. , ' " n .,. ,.yl �, a .�,��.d�'' •.,i' ° - �. � + :., .. ;T• ,.. n - r4 • a 4 : r r r � r } llfi,OF V3 8W_ CAPE SAVE Weatherization, 508-398-0398 December 14,2011 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, CII This affidavit is to certify that all work completed for permit application#201100877, Status A, Parcel 246224 at 600 Craigville Beach Road, Centerville, Permit type: RADD, and issued on 2/24/2011 has been inspected by a certified Building Performance Institute(BPI) Inspector. R-30 Cellulose insulation was added to the attic. Walls were dense packed with R-13 cellulose insulation.All work performed meets.or exceeds Federal and State Requirements. Sincerely, William McCluskey Coe) ,1311 Cape Save 7 Huntington Avenue Suite C, South Yarmouth;MA 02664 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Z Parcel ZZ� Application # 2011 X8-7-1 Health Division Date Issued alQY111 Conservation Division Application Fee A50. Planning Dept.t. Permit Fee V`� Date Definitive Plan Approved by Planning Board ? � Historic.- OKH _ Preservation / Hyannis Project Street Address \/1 ca C '? Village _,.. 6 Owner Address Si Telephone Permit Request S '�� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio� Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0' Two Family ❑ Multi-Family(# units) Age of Existing Structure I q L`"I 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 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 rAk, J Telephone Number Address 7(2, - yt, 4 66 k�e License # C- '(A0,/ya.u, VAR, 62,(e 6Y Home Improvement Contractor# 16 q `13 �- Worker's Compensation # W ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE \� DATE FOR OFFICIAL USE ONLY I I " APPLICATION# s � DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER -3 DATE OF INSPECTION: ' 1 t i • FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t_ PLUMBING: ROUGH I FINAL i GAS: ROUGH FINAL FINAL BUILDING s `1 s r DATE CLOSED,OUT ASSOCIATION PLAN NO. _ !f c' U,J,flee©f investigations '= 600 Washington Street Boston,MA 02111 WWW.mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aunlicant Information Please Print Legibly._ Name(Business/OrgaaizadonftdividW): (TT, �', u r l • 1 j-4 \O U_ iA/h ( SAVE Address ASEP .S" < o1-t� Ci /State/Zi : is, YVk 0= Phone#: ���- 3 C( - 0?A r Are you an employer?Check the appropriate box: 1. y I am a employer with �? " 4. 0 I am a general contractor and I T�of project(required): _.,� employees(full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees Thy sub-contractors have g.. 0 Demolition working for me in any capacity. employees and have workers' [No workers'comp. insurance comp.insurance) 9• ❑ Building addition ram;) 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I 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' 13.2�Aer p Sur Zr41an j . general contractor(refer to#4) comp.insurance required,) 'Any applicant that checks box#1 must also fill out the section below showing their workers' compensatiod{tolicy inf oration. 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 attached an additional sheet showing the name of the and stare whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'co mp.Policy number. Ian an employer that is providing workers'compensation insurance for my employees. Below is the informadom policy andlob site Insurance Company Name:_r14A 0-1-1 5 W S lt Policy#or Self-ins. Lic.#: 1 -q 3--n 9 51 Expiration Dater - Sob Site Address: L City/StateiZip:���� Z Attach a copy of the workers'compensation policy declaration page(sbowing 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 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. /der hereby cerdjy ander the paimand pe ojperfury that the informadon provNed above is&we and eorreeL SignaturevL 1 tr 16C.,000tact eiat use only. Do not write in this area,to be completed by city or town offlClaL or,Town: Permit/License# ing Authority(circle one): I. oard of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector ther Person: Phone#: ACOROCERTIFICATE OF LIABILITY INSURANCE DATE(MMlY). �1:1/1y2oio010. ." 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 CONTANAME:CT Shannon Sperrazza Risk Strategies Company PHONE (781)986-4400 gAX No:(781)963-4420 15 Pacella Park Drive ADDRESS:ssperrazza@risk-strategies.com Suite 240 PRODUCERCUSTOMER ID D0018476 Randol h MA 02368 INSURER 5 AFFORDING COVERAGE NAIC# INSURED INSURERA:Seneca Specialty Insurance Co INSURER B:Keating Group Ins Services Michael McCluskey, DBA: Cape Save INSURERC:Chartis Insurance 7 C Huntington Ave INSURER D: f INSURER E South Yarmouth MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1011132675 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. ILTR TYPE OF INSURANCE ;N L SUBRI D POLICY NUMBER I MMlDDYIYYYV MMIDDNYYY LIMITS GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 X ;COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence) $ __ 50,000 I I 10/16/2010 10/16/2011 A � CLAIMSa1AADE C OCCUR I i �1002608 MED EXP(Any one person) $ 10,000 I PERSONAL 8 ADV INJURY $ 1,000,000 Ii `I i GENERAL AGGREGATE $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-COMP/OP AGG $ 1,000,000 X POLICY PRO JECT i I LOC i $ AUTOMOBILE LIABILITY ( COMBINED SINGLE LfM1T --) I (Ea accident $ 1,000,000 I 6208200 fll/6/2010 11/6/2011 �- ANY AUTO I I BODILY INJURY(Per person) j$ ALL OWNED AUTOS I I X ( BODILY INJURY(Per accident) $ SCHEDULED AUTOS j PROPERTY DAMAGE X HIRED AUTOS '� (Per accident) $ X I NON-OWNED AUTOS ( { $ $ X UMBRELLA LIAB j IOCCUR EACH OCCURRENCE $ 1,000,000 I EXCESS LIAB I CLAIMS-MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ B ! RETENTION $ 023578601 10/16/2020110/16/2011: $ C I WORKERS COMPENSATION t4ichael McCluskey I X T/C STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN �s excluded from coverage EL EACH ACCIDENT I$ 500,000 OFFICER/MEMBER EXCLUDED? � NIA (Mandatory in NH) 9930951 0/21/2010 j]0/21/2011(E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 r, DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Issued as evidence of insurance. Contractors-Executive Supervisors or Executive Superintendents. CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corp , ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ruth 460 West Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 Michael Christian/SMS ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS025(2ooso9) The ACORD name and logo are registered marks of,ACORD Ael Office of Consumer Affa/san-d Business Regulation 10 Park Plaza - Suite 5170 -5 Boston., Massachusetts 02116 IIome Improvement Contractor Registration Registration: 164432 Type: Supplement Card Expiration: 10/6l2011 CAPE SAVE WILLIAM MUCCLUSLEY 8201 S. HOURD CT CHAPEL HILL, NC 27516 Update Address and return card.Mark reason for change. )';3•CAt a SnPa_0:«'Yi4s f;2i5 _ Address -i Renewal - Employment i"i Lost Card ..�f?6 �!'G�fZ.yrrct"7YFl1Gs7.1��!�._l(lX 3+':{•�!t�C:i . ° ; ., Office of Consumer Affairs&Business Regulation License or registration valid for individui use only ON f< I before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR m, Office of Consumer Affairs and Business Regulation S t' Registration: 164432 Type: 10 Park:Plaza-Suite 5170 f `sy• Expiration 10/6/2011 Supplement Card Boston,MA 02116 CAPE SAVE WILLIAM MUCCLUSLEY: _7C HUNTING AVE. S.YARMOUTH,MA 02664 , Lndersecretary "' � ' Not valid wit ou signature �- �1.t .ii'iittectr.r Department of i'toiilic: �'.ticvaq " Brtt tl +it Building :tilts '�t•uitl trds License: CS SL 102776 WILLIAM MC CLUSKY 37 NAUSET ROAD nr WEST YARMOUTH, MA 02673 u �-��- --y Expiation: 6/28/2013 t; +::a�;•,;<,rF:: Te=: 102778 4 oFt��r `�or�Tn of Barnstable _ 1') Regulatory Services t sax2ns[e(` Thomas F. Geiler,Director �Ea,,,,Y& Building Division Tom Perry,Building Commissioner 100 Main Street,Hyamnis,M-A 02601 Nii",.town.barnstabte.ma.us Office: 508-862-4038 Fax: '508-790-6230 Property Ow- er Must Complete and Sign This Section If Using A Builder as OATner of the subject property h �' _ to act on m e ereby authonze � !� � Y behalf, m all matters relative to work authoriztd by this building permit application for: _ CRA (Address of Job) Sign ture of Owner to GA Print Name If Properly Owner is applying for pen iit please complete the Homeowners License Exemption Form on the reverse side. f , Q:FO?.1iS:01+�rRPERPaISSiC?'3 • z i