The URL can be used to link to this page

Home My WebLink About0115 DONEGAL CIRCLE ASTOR -,:�,., ti t'(�,::'4 r. ..."^''4 +:�.w ,. c._f i. - , iJ+'..... `+. .r..t_ a .. �.:. __'<,:µ: ,. -. �+"T._,<,,,'''��Aask�ll..;a�u+,u G'�r..r,.;'r•y.'.>s%_�!x f,?,Pt,�':'.C::"r ri v'k�ln a•.r h.}.»,a..A�;x>:1 4, �,Cr",h. nrr� '�:'�.h �@ �','< ! `�F.c�::�,.r<e rn,7 'y.' L<"hw. d a•' "'f �' . ..,�';•�,�+:�sa'c•w,,,.a.-.t..":,.�•i«c .+l wJ o4 6s. At qE, a ti'f,Fr:,'Y�y'y .7y:td. pf��a',5:� k ��EA;�,��! �d,�l"�� •R .nz.4� "�' `"eg �iiY. AT NSA Out 1; of chi IF VS MY TIN e - t t _ i : } t , ?t 5. A e4 k k': A S ?OMA holy f i NATO IS MO y t 5 t `1 - - t R a } rSIR � T.&MOSQ001 slot am t!t4ath mat { t F K _ STUT WOO MA OMANt r Y / 9 , 5. ��'�Axjqsv van n ; ,•' � t e f t , h c uss Awn a ; f s S i ! ztR`'s ZAPE COD 'INS ULATION ' BARNSTABLE •NYCA QI V$ S(AMllll lPAAV IGAM lU$P(.o.o -AM L oulll(t IN(U(AfIQN CN1INUl .. 1,'600-696=6611 ti ), � `['own of Barnstable Regulatory Services Building Division 200 Main St t-lyarr.ai.s, MA 0260.1 - L Date: Dear Building Inspector Please Accept this Affidavit as.documentation that Cape Cod Ins, lotion, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod lrrsulation did this in accordance to the specifications listed on the building perzzrit application. All work has been-inspected by a certified Building Performance institute (BP-1) inspector. All work preformed meeis or exceeds Federal & State Requirements. Proms Owner property Address Suseva 13not,,,n Il5 , 1.bn146,4L 09c4e 1 06,"1l� lasulation Installed:. Fiberglass :Cellulose R=,Value;. 2.R.estricted Uru•estricted J. Ceilings Slopes Floors - ( ) ( ). " ( )` ( ) :( ) Walls 43 ; Sincerely Fle ry L S. y Jr, President (_'. e Codaz , ulation, Inc, I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i Map Parcel_o? Application # �U Health Division Date Issued 241. �IS Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Str t Address ' Vof P/ Village Owner Address Telephone Permit Reque �� Loll q66 T & JjAjkm�4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 170d' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family U/ Two Family ❑ Multi-Family (# units) AgeV Existing Stru ure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No cc BasEMent T-ype: ❑ ull ❑ Crawl ❑ Walkout ❑ Other Basement Fipished Alga (sq.ft.) I Basement Unfinished Area (sq.ft) Numt,r of Baths: F l xisting new Half: existing new Number of Bedroom existing _new Total *om`Couht (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 ❑�/o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION BUILDER OR HOMEOWNER) lutName t . .mover ' Telephone Number ✓" �� 7�'7 Address 6l , License # "� Home Improvement Contractor# 16�� Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJE WI�L BE TAKEN TO SIGNATURE °� DATE �1 FOR OFFICIAL USE ONLY APPLICATION# tt DATE ISSUED r MAP-1 PARCEL NO. ADDRESS VILLAGE OWNER E DATE OF INSPECTION: i t FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i FINAL BUILDING, p. DATE CLOSED OUT N 4 _ ASSOCIATION PLAN NO. y ' I I Massachusetts - 06partment.of Public Safety R ..Board of BuildingRegulations g and Standards Construction Super)iscir License: CS-100988., HENRY E CASSD)V ',.. 8 SHED ROW WEST YARMOLFrH fl �I 1� .- `.%2 tip Expiration Commissioner 11/11/2015 i i s . Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Co:ntra•ctor Registration Registration: 153567 Type: Private Corporation Expiration; 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE --- SO, YARMOUTH, MA 02664 _. Update Address and return card. Mark reason for change. 3CA 1 db 20M•05/11 Address Renewal Employment Lost Card V/ze�oai�r��zaruuecr.�C/c,`'C�/T/l�curJac�crJeG7�l a\ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only UVOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistratlon; 1b3567 Type: Office of Consumer Affairs and Business Regulation xpiration; .:121:95/20;1:6 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 CAPE COD INSULATION;,INC";` HENRY CASSIDY 18 REARDON CIRCLE'-..''; .:= g � SO.YARMOUTH, MA 02664 Undersecretary Tva tit sign e The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations W d 1 Congress Street, Suite 100 a W W Boston,MA 02114-2017 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El ectricians/Plumbers Applicant Information Please Print Lellibly Name (Business/Or ' n/Individua!Zvbv l): Address: City/State/Zip: Phone #: 17( '•�� q �� Are you an employer? Check the appropriate box: Type of project(required): 1.$;'I am a employer with ' 4. ❑ I am a general contractor and 1 employees(full and/or part-time), * have hired the sub-contractors 6; ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity, employees and have workers' 9. Building addition [No workers' comp, insurance comp, insurance.t g required.] 5. ❑ We are a corporation and its 10,❑ Electrical repairs or additions officers have exercised their 3,❑ I am a homeowner doing all work �" 11;""❑ Plumbing repairs or additions right of exemption MGL- myself, [No workers tion per comp, p p 12.7 Roof repairs insurance required,] t C. 152, §1(4),and we have no employees. [No workers' 13.[ Other[ 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°dffidavit 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'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; 1'1`C✓ `�.wV g [4,:t(aK ._ Policy#or Self-ins, Lic, #: 1I'�� )". 0 Expiration Da : �v i r. e Job Site Address. k City/State/zip:: ri Attach a copy of the workers' compe cation 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 certify n r pains and penalties of perjury that the information provided a ove ' true correct, Si nature: Date: L �� 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. Building Department 3. City/Town Clerk 4. Electrical Inspector 5,Plumbing Inspector 6,Other Contact Person: Phone#: r ` 1 CAPECOD-27 KLIGETT CERTIFICATE OF LIABILITY. INSURANCE DATE(MMIDDIYYYY) 6113/2014 'HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS :ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES IELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE.A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED ;EPRESENTA.TIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, JIPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the.policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to 1e terms and conditions of the policy, certain policies may require an endorsement, A statement on this certificate does not confer rights to the ertificate holder In lieu of such endorsements . DUCER CONTACT lers&Gray Insurance Agency,Inc. NAME: Barbara DeLawrencePHONE Fite 134 A/c. o.Ezt1 (a Ne); (877) 816-2156 th Dennis,MA 02660 ADDRESS: bdelawrence ro ers ra .com INSURERS AFFORDING COVERAGE NAIC N INSURER A:Peerless Insurance Company IREo INSURERS:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER C t Evanston Insurance Company 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth,MA 02664 INSURER E; INSURER F: ' ERAGES CERTIFICATE NUMBER: REVISION NUMBER: IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS _RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, {CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE _ADDL SUB POLICY NUMBER MMLDD�FF MMIDDI E YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR CBP8263063 64/01/2014 04/01/2015 PREMISES Ea occurrence) $ 100,000 MEO EXP(Any one person) $ 5,000 PERSONAL E ADV INJURY $ ' 1,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: P GENERAL AGGREGATE $ 2,000,00 X POLICY a JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ .AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 11000,000 ANY AUTO 14MMBCKVMK 04/01/2014 04/01/2015 BODILY INJURY(Per person) $ . ALL OWNED �( SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ rx HIRED AUTOS X NON-OWNED ' PROPERTY DAMAGE $ Per accident r .X UMBRELLA LIAR X OCCUR - EACH OCCURRENCE $ 1,000,000 EXCESS LIAR CLAIMS-MADE XONJ453514 04101/2014 04/01/2015 ( AGGREGATE $ DED X RETENTION 0,000 ORKERSCOMPENSATION Aggregate $ 1,000,000 PER OTH- ND EMPLOYERS'LIABILITY STATUTE ER FFlP 0MEM8 ERIEXCLUDEDY ECUTIVE Y� NIA WCAO0525904' O6/3OI2O14 06/30I2015 E.L.EACH ACCIDENT $ 1,000,000 Mandatory In NH) f yyes describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 ESGRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ' 1,000,000 RIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addlflonal Remarks Schedule,may be attached If more apace Is requlred)` �' s ers Compensation Includes Officers or Proprietors. " aonal Insured status is provided under the General_Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, 'r IFICATE HOLDER CANCELLATION — - wns 1 . PAfRT WAANG mass saveCONMCMIR PERMIT AUTHORIZATION FORM I, SUSAN BROWN ,owner of the property located at: (owner's Name,printed) 115 Donegal Cir CENTERVILLE (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. nees Signature Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: C(A PE- CO C3 —L—�IS�f L lto� 1 Z k, Li Participating Contractor Date C]ff C■] 01 �° For Office use Only Rev.12132011 F7NE'?��y� TOWN OF BARNSTABLE BARNSTABLE, i p pYAr`e�. BUILDING INSPECTOR 000 APPLICATION FOR PERMIT TO ................ .. .. .. ..... ... op TYPE OF CONSTRUCTION .. ... . . .... ,..... . ...... . ................. ................ .. +e. .19. .. .. TO THE INSPECTOR OF BUILDINGS: The undersigned hereb applies for a permit accordin to the following information: Location .. .�.7 .e. ........ :::. .. . .. .. Proposed Use0.4 ........................... Zoning District A-L....... ................................................Fire District R ............... .........:............. ....... Name of Owner "'"'... � �::: .:. ........ . ......... ...........Address ... ... .. .�, 'v... ....... - Name of Builder Address Nameof Architect ..................................................................Address .................................................................................... //� k Number of Rooms ....... ..........................................Foundation .:/!. ........ ........... ... .... . . ........................................... Exterior ....... . ...........Roofing Floors .Interior ...4 ...... ... .................... .................... ..................... Heating ...........................................................Plumbing ......I..................................... .................................... Fireplace ...... ..................................................Approximate Cost 6 Difinitive Plan Approved by Planning Board ________________________________19________. G I Diagram of Lot and Building with Dimensions _. THE PROPOSED METHOD OF PROVIDING FOk SANITARY WATER S.;PPLY, SEWAGE DISPOSAL,__ AND INAGE IS HEREBY A ',';`RCS'd ED oil— TOWN OF BARNSTABLE- , BOARD OF HEALTH "�- A LICE'L ED INSTALLER MUST OB T gird SEWAGE PERMIT, kND !Ns,rALL 5YSTEI , ho I N �- '13 1-®vL�t �17 I Hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Dacey, William E. DEC 31 1971 No .... Permit for .......one.As rY........ .............aing:l..e..fam4.7.y.. wa'allp........ ..... Location '1.`5 Domgal..gixcle........................ ..........................QP-zte 3ndlla............................. Owner ............. ................. Type of Construction .............fmarme................. ................................................................................ Plot .. Lot ......#Z14................... ' Permit Granted M ... March 26. ..............19 As""t........ . .. Date of Inspection 'A .... 4!............19 7/ Date Completed 19 �~ i PERMIT REFUSED { 1 ................................................................ 19 ............................................................................... 4 ................................................................................ ............................................................................... Approved .,............................................... 19 ............................................................................... A