Loading...
HomeMy WebLinkAbout0100 NYES NECK ROAD 0 06 t,*J N� k, 6 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3 � ' Map- Parcel b(o� Application# aU) Sy_O0) Health Division Date Issued '— Conservation Division Application Fee Planning Dept. Permit Fee' �S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Sir Address Village ( ,&44 Owner 1100a �✓ Address Telephone 7 �'�- Z Perini Request 1"I1 ,j� t ,�t 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 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: 0 Yes_:❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑`existing ❑ r`ew :'�jze_ ,.,-; Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ' y CoMmercial ❑Yes o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - - - (BUILDER OR HOMEOWNER) Name U Telephone Number 7 - 17 Address Ju License # U 4 AtHomeImprovement Contractor# �7� Email Worker's Compensation # 6 6 4,11 aU D ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJ 9T WI L BE TAKEN TO *Ivnn SIGNATURE DATE ��� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION A ' ti FRAME V INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ` DATE CLOSED OUT ASSOCIATION PLAN NO. ,A! Massachusetts - Department of public Safety Board of Building Regulations and Standards Construction Superviscir License: CS-100988.• \\ } \ 1q HENRY E CASSII)�Y 8 SHED ROW a WEST YARMOU'rH t) {t / `�,•�•.� " �" Expiration Commissioner 11/11/2015 a .b Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C&n,tra'ctol• Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2016 Trfl 259188 CAPE COD INSULATION, INC HENRY CASSIDY --- 18 REARDON CIRCLE ----- -- -. SO, YARMOUTH, MA 02664 Update Adclress and return carol, Mark reason for ch,am e. :CA 1 2oM•osn 1 Address Renewal Employment ❑ Lost Cud �:'+ . .. ...... ..... ..... .. GFXe tpai�r��za�ttuea.�C✓r�'Co/�/CrtJJac�eraeC l a\ Office of Consumer Affairs& Business Reg ulatlon License or.registration valid for inoividul use only OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: eglstratlon: 1.53567 Type; Office of Consumer Affairs and Business Regulation xplratlon:,;;,12f1.5/201:6 Private Corporation 10 Park Plaza -Suite 5170 ::•::-. , BoS'ton,MA 02116 CAPE COD INSULAT.I:bN;;;INC'.::' iENRY CASSIDY m 18 REARDON CIRCLE 30. YARMOUTH, MA 02664 Undersecretary N. tit sign e The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Bull ders/Contractors/Electricians/PluInbers Applicant Information PIease Print Le ibly Name (Business/Organizadon/Individual): CIVOI& Address: � V6am, - City/State/Zi :� ` 1h Phone #: Are you an employer?Ch ck he appropriate box: 1. I am a employer with ! i� 4• ❑ I am a general contractor and I Type of project(required); r employees (full and/or part-time).* have hired the sub-contractors . 6 El 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' [No workers' comp, insurance comp. insurance.: 9• ❑ Building addition required:] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL repairs 12. Roof insurance required.] t c. 152, §1(4), and we have no 3a.❑ I am a homeowner acting as a employees. [No workers' 13. Other general contractor(refer to#4) comp, insurance required,] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compcnsaticr6policy information. J t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContracton that check this boz must attached an additional sheet showing the name of the sub-coutractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy olic number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job,site information +� rUA�a4 'Insurance Company Name: A t�� Policy#or Self-ins. Lic.#: � � ! �I ' G!(� �}�( Expiration Date: Job Site Address: iU City/St P Attach a copy of the workerst 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 un the pains and penalties of perjury that the information provided above is trued correct Si a ^� Phone#: O,QScial use only. Do not write in this area, to be completed by city or town offjciaL City or Town: Permit/License# Issuing Authority(circle one): -'- L Board of Health 2. BuildingDepartment p artment 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#• From:Rogers&Gray InsuraFax: To: +15087786736 Fax: +15087785735 Page 2 of 2 4 03/3012015 10:04 AM CAPECOD-27 BDELAWRENCE CERTIFICATE OF LIABILITY INSURANCE DATE 3/(MM/DD/YYYY) 3012015 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 CON CT NAME: Rogers&Gray Insurance Agency,Inc, PHONE Ext: Arc No: 877 816-2156 434 Rte 134 ( ) South Dennis, MA 02660 E-MAADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Peerless Insurance Company-see LIBERTY MUTUAL INSURED INSURER B:SAFETY INSURANCE COMPANY 39454 _ Cape Cod Insulation,Inc. INSURER C:Endurance American Specialty Ins.Co. 18 Reardon Circle INSURER D:ATLANTIC CHARTER INSURANCE GROUP South Yarmouth, MA 02664 INSURER E: • INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE 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. 11 SR AUDLISUBRI TYPE OF INSURANCE POL C E F PO E -- LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE T OCCUR CBP8263063 04/01/2015 04/01/2016 PREMISES Ewaoocccunence $ 100,O001 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00OI GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,0001 X POLICY jECT LOC PRODUCTS-COMP/OPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED tSINGLELIMIT $ 1,000,00 B ANY AUTO TBD 04/01/2015 04/01/2016 BODILY INJURY(Perpeison) $ ALL AUTOS OWNED X SCHEAUTOS BODILY BODILY INJURY(Per accident) $ NON-OW,IED OPERTY DAMAGE X HIRED AUTOS X PR AUTOS (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,00 C EXCESS LIAB CLAIMS-MADE EXCl0006635000 04/01/2015 04/01/2016 AGGREGATE $ DED X RETENTION$ 10,000 Aggregate $ 2,000,00 WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS'LIABILITY Y/N I STATUTE I ER D ANY PROPRIETOR/PARTNER/EXECUTIVE WCE00431900 06/30/2014 06/30/2015 E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED 7 N/A _ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 _T DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Workers Compensation includes Officers or Proprietors. Additional Insured status is provided under thi General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 18 Reardon Circle ACCORDANCE WTH THE POLICY PROVISIONS. South Yarmouth,MA 02664 AUTHORIZED REPRESENTATIVE 7 __- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD HOME OWNER WEATHERIZATION WORK (PERMIT: ..PLEASE COMPLETE ANDYSIGN THIS FORM AS THE APPLICANT HOMEOWNER: { VLm cat If t v� 2 r ,. r� �r hereby consent_to and agree that Weatherization work may be done by the Weatherization Program of�Housing Assistance Corporation on the property located at: y i � ' ._.....- ._...-- - The Weatherization work done will be based on programriatic priorities and availability of funding and it may,include all or some of the following measures: Weather stripping; air sealing;-attic&basement insulation;exterior wall insulation; ventilation measures In consideration'of the Weatherization Work to be done at my home l agree to the followings- 1 1 give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to`perform weatherization. 2. The Housing Assistance Corporation-reserves the right to inspect the fuel or utility bill for the weatherized unit on an.ongoing basis for no more than five (5) years after the weathenzation work is completed. I have read the provisions of this`agreement and give,my consent. Home Owner(signacure) f: Home Owner email:.6, rEfi iJ Q, e 0TY1 Date: +, ry Agent:(Signature) Date: j.- Weatherization Contractors:, Cif -�-- Adam T Inc Cape Save All Cape Energy .,Frontier Energy Solutions Alternative.Weatherization Lohr.Home Improvement Building Science Construction Resolution Energy Ca e Cod {—ns�7i fation Tupper Construction p CAPE CO® INSULATION 0 p USSR OtA55 SfPS11E53 St14r/0AR1 SUS01N0I0 . MiT1 6U11[45 1"Mu"OM QIi s P •q 1-800-696-6611 Town of Nnw')-4�G_ Regulatory Services Building Division Address - Address 2 - r _. Date: /� Dear uilding Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector, All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Villa l/U ON pee Cw4 �00 "P-S J - C -e�-'JI l� Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ( ) ( ( 3 ) ( ) oO Slopes Floors ( ) ( ) ( ) ( ) ( ) Walls ( } ( ) ( ) ( ) ( ) Sincerely _ E Cassidy Jr, President r<. ape Cod Insulation, Inc. WOOD STOVE PERMITO ��'yoFTNaroo`o� DATE 1/1771 TOWN OF BARNSTABLE FEE Z DAHHSTAn i 3 'oo ,6;9• �� r1 j 3 MASSACHUSE'I I S am c71 Solid Fuel Stove Permit �T70 ` . DATE OF APPLICATION ! � �` .::... FIRE DEPT. ISSUING PERMIT �,,,,, NAME (owner) .. .:.,7,, Q111/V ....M,.,, 4s1�� NAME (Installer) ��i .............................. r ADDRESS ..... - .....:...........R......................... ADDRESS ......�..................`...........©... ........... � ........<. .... ................ ......`.................................................. STOVE TYPE .CMJ.'... ................................. CHIMNEY: NEW ........................ EXISTING ........................ Manufacturer ...Il. �f��Q ...�..AS .//V,�a..'.�.. CHIMNEY:. Masonry ................................................... ...................................... Q Massa Approval ...:..........ti�J U .:.a .. .1. :..:.............:......:.... CHIMNEY: Metal .✓.....�........................................ This is to certify that the above installer has permission to install a solid fuel burning appliance at the listed address in accordance with an application on file with the ...................................,............................................................... Fire Department, and subject to the provisions of the Commonwealth of Massachusetts State Building Code and regulations made under the authority thereof. Issued By: ................ .........Title ..................... . Date .......................................... Permit to install expires .60 days after issue date GIs Stove ..GIs t.<1, . .. - `� (/ ..... !..N. ..... ....:.... .. ........................: ............................................................................... .......... ��p AA h. .:....SA. ....: ................ .... :. Q ....:..rStove Clearance .... . Floor .........l ..........� .. .� p' ........ . ............ ...... . QQ/. ....�C. ' ....(1 SmokePipe o� ................ ............... ................................................................................ SmokePipe Clearance ............ .......... .....4rJ ....... ,/ ............................................................ .......................................................... Chimney .....................Q� . k.Y1 ............�},.. L.C1C� ........ .............................................................. ................................................... ....... ... Smoke Detector ......................./.............................................................................................................................. ......................... ... ....... .... The undersigned hereby.certifies that the installation of solid fuel burning stove and equipment made under au- thority of permit dated ......:............................................... has been made in accordance with provisions of the Commonwealth of Massachusetts State Building Code now currently in effect and pertaining thereto ........................................................................ . Installer INSTALLATION APPROVED .....� 1..V..y By: ......... i..�,9.�....:.:....:......................... Title: A�)' date WHITE: FIRE DEPARTMENT CANARY: BUILDING .INSPECTOR - PINK: APPLICANT