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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel 03'Z Application # 6
Health Division Date Issued Z �7
Conservation Division Application Fee Sd
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board I
s/l3
Historic - OKH _ Preservation / HyannisoK Jzf
Project Street Address zlk4 g Z.o��
Village a
Owner Address -z_,yi y_.�v c-_ 10 nL!�, Cry zc iv.�.c.E
Telephone %dam- -3 A-
Permit Request
Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 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 k C'. Historic House: ❑Yes p No On Old King's Highway: ❑Yes fd No
Basement Type: C2(Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft)
Number of Baths: Full: existing z new Half: existing new
Number of Bedrooms: a existing _new C
Total Room Count (not including baths): existing new First Floor Room Comet
Heat Type and Fuel: CKGas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal st ve: gYes ❑ No
--�
Detached garage: ❑ existing: ❑ new size_Pool: ❑ existing ❑ new size _ Barn:I❑ existin ❑ e v size_
{jl
Attached garage: Yexisting ❑ 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 V Telephone Number aols- '% 33 - 1%3 %a
Address '��ce ���.� �-�d License #
ra-3 I, q0vx. w..A d L5 c.'3 Home,Improvement Contractor# -
Worker's Compensation # we Aqs ces 3C
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
`moo�a'Z%.3C - ON, % `.L
SIGNATURE DATE
it
i
FOR OFFICIAL USE ONLY ,
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
j1 DATE OF INSPECTION:
FRAME - - -- - -
n,-,INSULATION.- iv, k ;_
} FIREPLACE
ELECTRICAL: ROUGH FINAL ....
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
I. FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
d
Pnnf Form : ".TheCommonweahh ofMassachusetts
Department of Industrial Accidents
Offce of Lnvestigations.
l Congress Street,Suite 1.00
Boston,MA.02114-2017
www mass-gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contrgetors/.E ectriicians/Plumbers
Applicant Information _ Please Print Legibly
Name(easiness/oigan;zac on/tndividuo) Con=Serve Energy;Inc .dba ConserVlslon Energy
Addrcss:376 Route 1'30'
City/State/Zip:Sandwich, Ma 02563 Phone#
Are,you any employer?Check the appropriate box: Type;of project(required):
L❑✓ .1 am a,employer wilt►8 4. ❑ 1 ain a general contractor and f
.employees(full and/or part-time).* have hirttithe 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 8. ❑Demolition
working for me in any capacity. employees and have:workers' 9,. ❑Btiild ng:add[on.
[No workers'comp.insurance' comp.insurance
required] 5'. ❑ We area coiporation,and its 10.❑Electrical repairs or additions.
officers have exercised their
3.:❑ I am a homeowner doing all work 11'.❑Plumbing repairs or additions
myself.[No workers'comp: right of exemption,per MGL
1'2.❑Roof repairs
insurance required.:]t c. 1:52,§1(.4),and we have no
employees..[No workers' 13. ✓❑Other,Weatherization 2013
comp.insurance required.]
•Anyapplicant 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 mususubmit'anew affidavit indicating such.
tContractors that check this'box•mustattached.anladditional sheet:showing[he name;of.the sub-contractors and:state'Whether or not those entities have
employees. if the sub-contractors have employees,they must provide thcir workers'comp.policy number.
1 am,411 employer Oat is providing workers'compensation insurance for my employee& Below is the,policy and job,site
;information.
Insurance.Company Name:S61ective lnsurance Co.cif the SouthEast
Policy#or.Self--ins.Lic #WC7956539 Expiration Date:3/14/2014:
Job Site Addre§s: City/State/Zip:
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►mpostion of criminal penalt►es:of,a
fine up to$I,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. Re'advised that a copy of th statement may be.forwarded to the Office of
Investigations of the DIA for insurance coverage verification..
I do hereby cerd 'under the ains.and naldes o. er'u. lhat.the in ormation provided above rs true and correct
Si nature: ,` Date 3 2i' 2 8
Phone#t 508-833-8384
Offcial use only, Do not-write in this.area,.to be completed by city or.town official
City or Town: Permit%l,icense ff
Issuing Authority(cirele.-one):;
1 Board of-Health 2i Building Department 3:City/Town Clerk 4.:Electricallaspector 5.Plumbing Inspector
6.Other
Contact'Person:? Phone.M
�1 CONSENE-01' MVAUGHAN
ACORZX I ATE COOK DIr"
CERTIFICATE OF LIABILITY INSURANCE31261201s
7HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON JIVE 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: H the certificate holder Is,an ADDITIONAL INSURED,the poilcy(los)moat be endorsed. H SUBROGATION`IS WAIVED,subject to
the terms and conditlone of the policy.oerteinpollclesmay_require an endorsement A Statement on this certificate does not confer rights to the
certificate holder In lleu of such endorsement a
PRODUCER 'CQNTACNAME- Strata iC,f3asiness Unit`
4 Fg&GGray Ina.-Dennis Branch PHONE IALC 608 398-7880 ; 877 816.2166
4 ADDRESS.
South Dennis,AAA 02880 `
INSURER AFFORDING COVERAGE _ NALCD: ,
INsuRERAa.SelectIVG Ins.CM of Ute Southeast
INSURED INSURERei'
Con-Serve Energy,Ina.. INsuRERc:.
dbe ConserVklon,EneNy
507 Main St. INSURERD: _.
Hyannis,MA 02601. INSURER E
.. INSURER F, ..
COVERAGES _. CERTIFICATENUMBER REVISIONNUMBER:
THIS IS.TO INDICATED.CERTIFY THAT THE POLICIES NO7WMISTANDING ANY REQUIREM
ENT.NT. TERMRANCE ISTED OR CONDITION OF BEEN IS-SUED TO THE INSURED A-NY CONTRACT OR OTHER DOCUMEENT VNTH RESPECT TO 1IVMIC PERIOD ABOVE FORTkE POLICY THIS
CERTIFICATE MAY ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED SY THE POLICIES DESCRIBED HEREIN I.S. -SUBJECT TO ALL THE TERMS,
EXCLUSIONSAND CONDITIONS.OF-SUCH POLICIES.:LIMITS SHOWN MAY HAVE BEEN REDUCEDBY PAID CLAIMS,.
L7R TYPE OF INSURANCE .. POLICYNIMSER.._... . POLIC.EFFIMMIDDITYM _..__.U611TS. ..-_.
.'OENEAALtgeam ' EACHOCOURRENCE. 3 1,000,000--
A -X commERCRiGEbeA&Ltuam 2011298 AR412013 3114/2014 "PRFIAISES Ee S 1
00,0
1.
CLAWS411ADE QX occyii' . IeEDI]tRtAn arPerarq s 10,00
PERSONAL&ANIMJURY s i,000,0
- 1'GENERALAGGREGATE- S. ... ._ 3,000,000
GENLAGGREOATEL0/117:APPLES0EFL'- PROIXC.CCMPIDPADG $ 3,000,000
-
xi POLICY F1.
AUIOIIDalE lL18a11Y acI SINGLE
QdeN E.
ANYAUTO SOXLY INJURY OWPnon)
ALLCANED SCHEOULED UODILYiNJURY .
AUTOS AUTOS (Per aodtlenll 8
HIRED .. .AUTOS P R` S -
r111e+o?1A.11AB OCCUR
EACHOCCURRENCE= 3
CLAW AGGREGATE S
WORKERSGOMP.ENSAT10rl onI• ..
ANDEMPLIO!rMNAsrrY YIN - - - 1 -E
A fun E❑ CT868639 311412013• -3114120
O 14 "E L EACH ACCIDENF $ 600,
FFMER1Al�.E7�WOEDT ._. NIA - I.
"hNN) 1E.L.IrSEASE=FA EMPLOYEE
3. 600,00
II QlatotlEsOF .. ."_..,..._.. " `E:LOISEASE-PO=.UM1T i. ..... �.
_ OF:CPERAr10NSbWw� �_..._.. __.-. ...,._... ..
' DFSGtOPiION�OP aPERAtaYIafLOT:A7NINS/VEIaCtBS(Mu4A&MAI 1._M�tlooH Renrltt.9d�ub.IImot�apne�B, d). -
--EXCLUDED,OFFICERS UDDER WORKERS COMPENSATION:CONOR 8 COURTNEY MCATERNEY-NOTE THAT BLANKET ADDITIONAL.INSURED'
OVERAGE APPLIES TO THE COMMERCIAL GENERAL'LIABILITY(IFA WRITTEN CONTRACT IS IN PLACE).;
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE C11NCELLED BEFORE.
gineedng THE EXPIRATION, DATE. THEREOF; NOTICE dNiLl BE'DELIVERED. IN
WBA ER '
4341 Elm AVAe ACCORDANCE UNTHTHE POLICY PROVISIONS:
Crarmton,'Rl02910 _.... ..__..:
AU7H0RI2EDREPRESEWATI4E -.._.- .. -
0
0.19884010 ACORD CORPORATt0DL AH rigtife reserved:
ACOR0:26(2010105) The;ACORD.name and togo:are registered mark*of ACORD
r:
e
OWNER AUTHORIZATION FORM
(Owner's N me)
owner of the property located at
LF Alve- A/-4 z1
(Property Address)
(Property Address)
hereby authorize Se`t 3 1
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behaff to obtain a building
permit and to perform work on my property.
Owner's Signature
� I
Date
RISE ENGINEERING Federal tq#05-0405629
Rl Contracctor Registration No 8186
A division of Thielsch tugineer ug MA Contractor Registration No 120979
CT Contractor Registration No 620120
1341 Elmwood'Avenue,Cranston;R102910
(401)784-3706 FAX(401)784-3716 CONTRACT
Page 1
PROGRAM. THIS CONTRACT IS ENTERED INTO BETIA(EEN.RISE:.
CLC=RCs ENOWEERINGJUMPIE.CUSTOMER FOR WORK AS
ENGINEERING DESCRIBED BELOW
CUSTOMER ._ - - PNONE.. -.. - DATE' -. ;Cph to .
Mary Biliouris (508)737=9789 10/18/201.3 151156
SERVICE STREET BICpNG'.STREET.
298 Nye Road. 298 Nye Road
W
SERVICE CITY.STATE,ziP - -8111.1N0 6MSTAT'E•iw
Centerville,MA 02632 Centerville,MA;02632
JOB DESCRIPTION
Provide labor andmaterials to seal areas of your home againstwasteful,excess ail leakage. This work will be performed in concert
`with the use of special tools and diagnostic:tests to assure thatyour home will be'left w7th a healthfillaevel of airexchange and;
indoor air quality.Materials to.be used to seal yourhome can;include:cauiks foams weatherstripping and other products .Primary:
areas for seal in elude.air leakage to attics,basements,attachedgarages and other unheated areas(windows are not.generally
addressed.) 06)working hours.
At the completion of the weatherization work,and At;no additional costto the homeowner,:a;final blower door and/or'combustion
safety analysis will be conducted the sub-contractor to ensure the safety of the indoor air'qualiN.
$i;232.00`
Homeowner is responsible for the removalrof the stored items blockingithe installation of weatherization work in the attic.:
Removal must:occur,prior to the:scheduled:work starL.
$000
Provide labor and materials to.install a 6"layer of R-22 Class 1 Cellulose added'to:(240)square feet,of floored.an space:.
$307.20
Provide labor and materials.to install an 8"lAycr,of R-28 Class I Cellulose added to(532)square III fopen attic sP ace.,
$670;32
Provide labor and materials to insulate the back of the attic door with 2"rigid Them' ax board and seal the door's`edge with`:
weatherstripping to;restrict airleakage,.
$72 22
Providelabor and materials.to.install(I)insulatedexhaust.hose with roof mounted flapper yent to exhaust existing bathroom fans):.
$11610
Provide Tabor and materials_to install ventilation=ehutes i.n(72)rafter bays to roaintam air:,Agw.
$251=.28
Provide labor and materials to install C.6y.4."X 16"rectangular alumimum soffit vents to increase ventilation in attic areas:specify
color.White
$173.46
Provide labor and materials to install (2f39)square;feet of R-.(0 rigid Thermax insulation to the crawlspace perimeter wall,up to the.
sifl and'against the:bandtoist:
$1101-2a
Provide:;labor.and materials to install!."FSK faced semi-rigid;fberglass,board insulation to;(370)square feet of Common wall area.
$1,224.70
Remove(5,70)-square.feet of balt;style insulation.fTom.the crawlspace area.:
$552.90
CSSL-102778
CONOR;D MCllYERNEY -
39 SIASCONSET-DRIVE
SAGAM6RE BEACH MA 02.i62:
`y
0811.912014
Oltice oftoasume A'(fairs&'Busincss Rigulanom
HOME IMPROVEMENT CONTRACTOR
Registration;: 171251 Type
;Expiration:_ 3/1/2014' Partnership
COU-SERVE ENERGY
CONOR mONERNEY
376 ROUTE 130 SUITE G
SANDWICH.UA 02563 a
L odersErretan•
License or:regi.siration vaiiid for individuI use:only
befoee.tbe expiration date.If found return to:
Office of consumer'.Affairscanil,Business Regulation.
16 Park Plaza-Suite 5170:
Boston,MA 611.16
A`
Not valid without.signature
z? V
r.
IN
f
COP
:. � k
11/14/14
Thomas Perry, CBO
Town of Barnstable
BuildMgg Division
200 Main St
Hyannis, MA 02601
RE: Insulation Permits
Hear Mr.Perry,
This affidavit is to certify that all work completed for insulation work at 298 Nye Road (application
#201308624) has been inspected by a certified Building Performance Institute (BPI) Inspector.
Afl work performed meets or exceeds federal and State requirements.
Sincerely,
Conor McInerney `
ConserVision Energyzz
0
Ln
i
376 ROUTE 130,SUITE C
SANDWICH,MA 02563
508-833-8384 W W W.CONSERVfODAY.COM
1
�„��'" ►o,� TOWN OF BARNSTABLE Permit No. _ __--------
-----
Building Inspector
� �aun.n, Cash --
°" OCCUPANCY PERMIT Bond ---___---------- -
Issued to Address
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
Engineering Department Inspection date
Board of Health Inspection date
THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL
SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN
REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE
BUILDING CODE.
Building Inspector
Assessor's map and lot number ... ...... s .`
Sewage Permit number �..��1... ?1 /V. ..
� 7 k fST 0i; Z BAHHgSeTADLE,
U . t
House number, .... ..... ...C� sr-PA1C S ' s J
i q*f �A,it _ ° tea `0
i am
TOWN O E� B��� I1]�ryry�� �,�,A B*L E f,
-BUILDI S INSPE TOR
. .J� ...1h ..... . .
APPLICATION FOR PERMIT TO '........... .. ........ ..
.....
. . ...............................TYPE OF'CONSTRUCTION,,...'...:......:. � ..... ... ....... ..
3 Y ,
............. . A
TO THE INSPECTOR OF BUILDINGS: °
The undersigne he eby a lies for a permi ac ordi g to .t a followin information:
Location ....... .. .. ... .. ..... ............................... ...................................
Proposed. Use ....... �(.J�l'Ss .. ............. .v ��n ry........................... ..... ... .............
re District ".. •• /1A. ......
Name of Owner . Q(�-!..0 //l• 5......Address .:. l i(.. .� . ..P�......�. f�/�l�Z��
..... �. ..f .
IL _ -, �. l
Name of Builder
..( ....................Address .............................. .... ....
'Name of Architect ................................................*..Address
Number of Roo s Foundation .. ... V�"� ......
... .•�..5..:. •. .y.. ... ..... .•4...•••••• • M•
_ ` f
Vl� .�... ........C..1/ ...�� � ..... /........... g /lu/
..Roofin ..... ..........................P�
Exterior ...... .... .. ....... .. ....... . .:...........
., . Le
Floors Interior ....... ...Cf......... ...........................................................
Y... .. ..
. . A.0 .. '.... . .Plumbin .......... .........................
Heating pjQ
...� , c.c. .. �fo� ,� . .............. . . . G
Fireplace. �% ..................:. .........Approximate. Cost .............. .. ./..................................... .
l Q//
Definitive Plan Approved by Planning Board ________________°_____________19________. Area .......a..0 .�P.�!... : ....r...
Diagram of Lot and Building with Dimensions Fee ..... . ............................
SUBJECT TO APPROVAL OF BOARD OF HEALTH
`•i as t� r ' • - _ k _ '.. .... .. • ,
q4� r
OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS , M
I hereby agree to conform to all the Rules and. Regulations of the Tow Barnstabl regarding the above
construction.
Name ......... ... .. ....(... ........................................
d
Construction Supervisor's License ..............
7
COOLIDGE HOMES
26390 e story
No .....:........::. Permit for .. . ..:............................ '
} .Sin Family..1 gjj1>1J........................
*') Location ....4Q.t...2,.....2..9.8.JNy.p-..IMd.................
2 ..................... q n,UwLriue....................................
Owner ..
Type of Construction ...... 'ram..... .............
t3 Plot .............. ......... Lot`.................................
84 f
x Permit Granted .. : 4r. - - , 19
r
Date.of In .... . ........ .....19
Date Completed .... ......1' :...`-.. •
. ° .19��,
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