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HomeMy WebLinkAbout0005 JUNIPER ROAD r-. ;,. :, ate,. `.a, r ,. .. .. ,, n . . , : .. f a s� a ,� ...;� b�. v -' .. �', ' '� k. � ..: �'. .. ` � ,. F _ _ .. :. .. .. �� I .a I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o2 O Parcel O `� Application # In s Health Division Date Issued �Z° /C4 IL Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis JEMPTL S J I Project Street Address _,j- ucOii�G�/2� Village Owner J�o�/f l� n'J©,?I Address ;,9 Telephone J-Z? 4 Z / 2 F 3 7- Permit Request a ��r�y �'�i >'C.� , 294ez Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 7o d, D Construction Type_/4,/ y_�A�d 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 ANo On Old King's Highway: ❑Yes 2(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: 0 existing 0 new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 3 " CN Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# '?? c� Current Use Proposed Use APPLICANT INFORMATION a (BUILDER OR HOMEOWNER) Name A6e1:P Zi/1J r-i:o Telephone Number Address 4,F: AgwlIJ �/ License # /d 4 f Oc-- c1„T Y4 Home Improvement Contractor# /& ,517 Email yy 4&Ael<?44/,-Cpd l yYd/4 i;fAl, Worker's Compensation #klze �2,0/ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. 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. Town of Barnstable ° Regulatory Services Richard V.Scab,Director ieJP ,,,a► Building Division Tom Perry,Building Commissioner zoo Hsin, Stmet IInmLis.MA 02601 % vw.towc.barnsiable.ma.os Office: 508-8624038 Fax:_508-790-6230 Pmpetty Owner Must Complete-and Sign This Section Yf Using A Builder I, cv P 1�,� �/�,�1�_ ,as Owner ofshe.suNectpropenY v . hcrebyaurhorize to ace 4n rnybehmf, in all maws relative to work authorized by thu binding pe mu application for. Y1 V�'I� jutk J 1 (Address of Job) "`Pool fences and alarms are the responsibility of the applicant Pools are not to.be.filled or a Ized before fence is installed and all final inspections are performed and accepted o Owner Signature of Applicant Print Name Punt Name 1 i5aia 0MRMSAWNWERMISSI0NMLS 6? �'. Massachusetts Department of Public Safety;, Board of Building Regulations and Standards y License: CS-100988 Construction Supervisor HENRY E CASSIDY ? 8 SHED ROW Y .. , ��7�,.. WEST YARMOUJ'H Expiration: Commissioner 11/11/2017 Office of Consumer Affairs and Business Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement Ce:ntractor Registration Registration: 153567 Type: Private Corporation Expiratlon: 12/15/2016 Tr# 259188 CAPE COD INSULATION, INC HENRY CASSIDY -- 18 REARDON CIRCLE -- 30. YARMOUTH, MA 02664 _.. Update,Address and return card, Mark reason for change. $CA 1 2OM-05ni 0 Address Renewal Employment Lost Card &X e�ponr�aaaruuea.�G�o�C�/�laJJac/uaeG�J \ Office of Consumer Affairs&Business Regulation License or,registration valid for individul use only 90ME IMPROVEMEN7'CONTRACTOR before the expiration date, If found return to: egistration: <1.63567 Type: Office of Consumer Affairs and Business Regulation xpiration;;:1:27.15120.1.6 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116' CAPE COD INS ULATI'ON;;:INC''. HENRY CASSIDY 18 REARDON CIRCLE` g� S0. YARMOUTH, MA 02664 Undersecretary 9.N, valWd The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations l = Jf :i 600'Washington Street Boston, MA 02111 www;muss,gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectriciansiPlumbers Applicant.Information Please Print Legibly Name (Business/Organization/Individual): � r QJ�-' Address: �� � lr��� � � ✓ City/State/Zip: � � b 'l Phone Are you an employer? Check th appropriate box,' Type of project (required); l. .l am a employer with 4, ❑ I am a general contractor and I T employees(full and/or part-time),* have hired the sub-contractors 6, El New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7, [] Remodeling have sub-contractors ship and have no employees These 8, Demolition working for me in any capacity, ,employees and have workers' (No workers comp. insuranc e p� com insurance.t 9, ❑ Building addition - 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 o 11,❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL l 2,❑ Roof repairs insurance required,) t c,,152, §t(4), and we have no i _ . employees. [No workers'. 3. Other p/ � comp, insurance required,] "Any applicant that checks box NI must also fill out the section below showing their workers'compensation policy information, t Homeowners who submit this affiMit 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 subcontractors and state whether or not those entities have employees. If the subcontractors 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; Policy 9 or Self-ins, Lic. 9: Expiration Date. i i _Job Site Address; r�//''r9�2✓LAle City/State/Zip;_WP,) af- e, e. �— 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 Investi ations of the D1A for insurand. coverage verification, I do hereby certify d the pal an penalties of perjury that the information provided above is true and correct, �, Signature: L' Date: Phone 9: i _Z 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 Phone#! /'� `�• CAPECOD-27 TQUIRt ACORO° DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE , 4/27/2016 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 hotder In lieu of such endorsement(s), PRODUCER - CONTACT - - - NAME: Rogers&Gray Insurance Agency,Inc. PHONE. FA 43 Rte 134 A/c No E t: A/c No): (877) 816.2156 South Dennis MA 02660 E-MAIL mall ro ers ra ADOREss: @ 9 g Ycom• INSURERS AFFORDING COVERAGE NAIC N INSURER A:Peerless Insurance Company INSURED INSURERB:Safety Insurance Company 39454 Cape Cod Insulation,In.c.. INSURER C:Endurance American Specialty Ins. Co, 18 Reardon Circle INSURER D-:Atlantic Charter Insurance Group South Yarmouth,MA 02664 INSURER E INSURER F; COVERAGES CERTIFICATE NUMBER: 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. INSR ADDLSUBR TYPE OF INSURANCE PO C E F PO IC EXP - LTR INSD D POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ 1,000,00 CLAIMS-MADE OCCUR CBP8263063 04/01/2016 04/01/2017 DAMAGE TO RENTED' PREMISES Ea occurrence $ 100,0G MED EXP(Any one person) $ 5,OC PERSONAL&ADV INJURY $ 1,000,0C GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,OC X POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,0C MOTHER: $ AUTOMOBILE LIABILITY n COMBINED BINEDaccidenISINGLE LIMIT $ 1,000,0C B ANY AUTO n 6232707 COM 01 04/0112016 04/01/2017 BODILY INJURY(Per person) $- ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED HIREDAUTOS X X AUTOS PROPERTY DAMAG $ per, er accident $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 2,000,0C C EXCESS LIAB F CLAIMS-MADE RIO EXC10006635000 04/0112016 -04/01/2017 AGGREGATE $ DED I X I RETENTION$ 10,000 Aggregate $ 2,000,0C WORKERS COMPENSATION PE R 124 H• AND EMPLOYERS'LIABILITY Y/N STATUTE D ANY PROPRIETOR/PARTNER/EXECUTIVE WCE00431901 0613012016 06/30/2016 E.L.EACH ACCIDENT $ 1,000,0C OFFICER/MEMBER EXCLUDED? F NIA (Mandatory In NH) If E.L.DISEASE-EA EMPLOYE $ 1,000,0C Yes,describe under " DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,OC DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES (ACORO 101,Addltlonal Remarks Schedule,may be attached If more space is required) Workers Compensation Includes Officers or Proprietors, - Additional Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Bill Swanson Builder THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 50 Camelot Lane ACCORDANCE WITH THE POLICY PROVISIONS, Brewster,MA 02631 AUTHORIZED REPRESENTATIVE @ 1988-2014ACORD CORPORATION, All rights reserved. ACORD 25(2014l01) The ACORD name and logo-are registered marks of ACORD