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Home My WebLink About0020 CROCKER STREET e• �,, F` e a � . r �� '�� ':*:�. .tom ::r:.. ia. :r: i � :,. .. �.�'. .r - - N', � '+ h Ji:' ��b i+'cJ , . A � (F,. " b y �f i CM f 5, l Y `i� 11 l� �. .. �. -h. s;:+t�, K.� °i ,' `:.c _,,. � a� .,� `p� .,i'. ,� x ti „r t '!'�, s r �zi 'i�' ..�Yf. v " } s .. .� � i � ,. :.... ... .. � .. ... s .. .. .. �.� ..,. ... �. 1 t t r T ii ,. ` .. - .. i � .. - .. ' 4 a � �� .. .. �' a 1' .i ... ,. .. � ,' � ` � _ r .� _ � IC 143014 Cape'Save Inc. �rz-7-D Huntington Avenue �"`� a. o South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 10-25-14 8Z:Z T Wd V"I� Town of Barnstable Thomas Perry CBO ' Building Commissioner 200 Main St. Hyannis,MA 02601 f ,^• '�;ro RE: Building Permit x TO: Building Inspector(s), This affidavit is to certify that.all work completed for 20 Crocker Street,Centerville has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. Ceiling: R-38 cellulose; R-22 cellulose under deck in knee wall attic Walls: R-13 dense pack cellulose Knee wall: R-7 FSK Crawlspace: R-10 Thermax on foundation All work performed meets or exceeds Federal and State Requirements. Sincerely, t • William McCluskey TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o� ` O Parcel / Application # g I i j�D Health Division Date Issued 2126 Jl Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address Oq 0 r0 C �ef/ At Village Ceo, 'e_pe v sr- G `P Owner f d ll a (', Address S Qvn ,c qt-(0 Telephone /r) `` `! Permit Request Ai-%e Sect/ w ggdiept aaw A 7a u defo or 71 C fva )ttiee-'Wet ;'Md if 3,) 1 A� C cL Etc)U �t1G c ✓`i i f 0 G'Yd u/ �C e k/d MAW 1 �hf�/l� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District �1 Flood Plain Groundwater Overlay Project Valuatio� V 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family '❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: 0`?'es U No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other > ' C) Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)- f Number of Baths: Full: existing new Half: existing 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) �•l Y fName'^'°�'� �c � '` ✓� Telephone Number 11 / v ®� p � T Address C / i "� � y� License S �o wt d` A AV Oa y Home Improvement Contractor# l, . Email Worker's Compensation #VC 2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE �`� sr r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED t' MAP/PARCEL NO. i ADDRESS VILLAGE S OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 6, GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Building Permit Authorization I, Delaney, William; as owner hereby give my permission to - Cape Save, Inc. 7-D Huntington Avenue South Yarmouth, MA 02664 Office: 508-398-0398 -to take all necessary steps to obtain a building permit to perform work at my property located at 20 Crocker St Centerville, MA 02632 Signed Date C . The Commonweatth of Massachusetts Department of Industrial Accidents OffIce of Investigations 1 Congress Street, Suite 100 Boston, MA'02114-2017 www.mass-gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Print Legibly Auplicant Information Name (Business/Organization/Individual): Cape Save,Inc. Address: 7D Huntington Avenue City/State/Zip: South Yarmouth, MA 02664 Phone#: 508-398-0398 Are you an employer? Check the appropriate box: Type of project(required): 1. ✓0 I am a employer with 17 4. E] I am a general contractor and I 6 New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have g. [] Demolition ship and have no employees working for me in any capacity. employees and have workers'comp.insurance 9 Building addition .+ [No workers' comp. insurance 10.❑Electrical repairs or additions required.] 5. We are a corporation and its re 3.❑ I qu a homeowner doing all work officers have exercised their 11.(]Plumbing repairs or additions right of exemption per MGL myself. [No workers comp. I2.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no 13:0 Other Insulation employees. [No workers' comp. insurance required.] •Any applicant that checks box#1 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 attached 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'camp.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: Technology Insurance Company Policy#or Self-ins.Lic.#: TWC 3353968 Expiration Date- 04/09/2014 / fate/Zi ��-t P Q 80, Job Site Address: �"t�e �� City S p Attach a copy of the workers' compensation policy declaration page(showing 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. I do hereby certi under the pains and enalties of er'u, tl at the information provided above is rue and correct. Si ature: - - =. Date2 -_ _.__ ___.__ _-___---_ Phone#: 508-398-0398 rFOfficial use only. Do not write in this area,to be completed by city or town official ' Permit/License# City or Town: 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: Phone#: ACCP CERTIFICATE OF LIABILITY INSURANCE DATE 2 20"3�.. , -. .,. 10i i 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(les) 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 endorsements. PRODUCER NAME colleen crowley Risk Strategies Company PHONE E (781)986-4400 FAC No:(781)963-4420 No 15 Pacella Park Drive rFAMMSS, Suite 240 INSURERS AFFORDING COVERAGE NAIC# Randolph M 02368 INSURERA:Selective Ins. of America INSURED INSURERB:Safety Insurance Company 3618 Cape Save, Inc iNsuRERc:Technology Insurance Company 7 D Huntington Ave INSURERD: INSURER E: South Yarmouth MK 02664 INSURER F: COVERAGES CERTIFICATE NUMBER:CL13102268490 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 MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MPM�ICY EXP LIMrrs LTR GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN X COMMERCIAL GENERAL LIABILITY PREMISES a occurrence $ 100,000 A CLAIMS-MADE Q OCCUR 1994480 0/16/2013 0/16/2014 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO ECT X LOC $ AUTOMOBILE LIABILITY COBIND Ea accident SINGLELim I 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 208200 1/6/2013 1/6/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per acrid nt X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION >3Z 1994480 0/16/2013 0/16/2014 $ C WORKERS COMPENSATION Officers Included for X F YSTATU- OTH- ER AND EMPLOYERS'LIABILITY ANY PROPRIETORiPARTNERIDECUTIVE Y/N overage E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? TO NIA 3353968 /9/2.013 /9/2014 (Mandatory In NH) E.L.DISEASE-EA EMPLOY $ 500 000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Weatherization Specialists GL: Blnkt AI, Blnkt PNC, Blnkt WOS, Per Proj Agg, Per Loc Agg / GL Exclusions: Snow & Ice Removal/OCIP/Wrap Ups CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRE§ENTATIVE chael Christian/CLC `� ACORD 25(2010105) 01988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD .. L� ,. C"Insir uciiivn Slide viNur specinliv ice W LLIAM J MC(C-LUSX EY 37 NAUSET ROA19 .West Yarmouth NA OZ67 sio 06128i2015! t. .?W� c'�i Office of Consumer affairs and Business Regulation 10 Park Plaza- Suite 5170 =f Boston, Massachusetts 02116 Home Improvement Contractor Registration' Registration: 171380 Type: Corporation Expiration: 3/14/2014 Tr# M184 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH YARMOUTH, MA 02664 - Update Address and return card.Mark reason for change. Address M Renewal "— Employment 7, Lost Card DPSCAI'0 50i,-04104-G101216 ;�-.- ✓fie v�a�:t�n�n:aealf� c<�•l�.ar.�icrsac�' . %, Office of Consumer Affairs&Rdsiness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ter=: Registration:_ 171380 Type: office of Consumer Affairs and Business Regulation. `_ '' Ex iration• =3114/2014 Corporation 10 Park Plaza-Suite 5170 p rp , y .' -Boston,MA 02116 CAPE SAVE INC WILLIAM MCCLUSKEr \ 7-D HUNTINGTON AVENUE _ , SOUTH YARMOUTH,MA 02664 Undersecretary Not valid w Ao signauac_�'