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Home My WebLink About0064 PATRIOT WAY ,, �: �' e c r ,, r .. c TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 195, Parcel `3 DI Application # Health Division Date Issued 7 ly/ Conservation Division Application Fee _ Planning Dept. Permit Fee J Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis E�H�iL S Ems?` Project Street Address 6� Pa��;0-1�' lNo�y Village CQ4+ery uQ, Owner e.55 C a MXM r.. Address s oune/ Telephone 50 a Permit Request �_-35 'cfdttJase an a�' IWAlokan :6 4L 4 N i t W�f Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuationj 3 VD 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:=p Y4 ❑ No Basement Type: ❑ Full 0 Crawl ❑Walkout ❑ Other ° Basement Finished Area (sq.ft.) Basement Unfinished Area (sq Number of Baths: Full: existing new Half: existing -new.- Number of Bedrooms: - existing —new - 03 Total Room Count (not including baths): existing new First Floor Room�Count rn 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 kNo If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 1 -ci Telephone Number 1�Q8 4 0 Address • I flAQ+'i46e License# C S ILh-v Home Improvement Contractor# Email Worker's Compensation # W C 0 8,554OU0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �,�v�►0 rG SIGNATURE DATE l9 a 3 ` FOR OFFICIAL USE ONLY z APPLICATION # ' DATE ISSUED MAP/ PARCEL NO. ' r ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: FOUNDATION FRAME INSULATION '3 :7 FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. M �r�'. I:�."�/ 9 '" 'r �• •- - .l`' � rare ` OQQ�CCO� . .The Commonwealth of Massachusetts Department of In.dustrial Accidents t ' I Congress Street,.Saite I00 Boston,MA:02114-2017 www mass gov1. is S N orkers'Compensation.Insurance Affidavit:Builders/Contractors/Electricians/Plumbees:. M TO BE FILED WITH THE PERMITTING AUTHORITY. T Avylicant Information Please Print Legibly" a ' Name(Business%Organizaton/Individual);Cape,Save Inc�' Address:7-D Huntington Avenue ;. City/State/Zip:South Yarmouth, MA 02664 Phone#1508 398-0398 Are you an employer?Check the appropriate bo%c ' - Type:of project(requ>tred);, , Y 1':E]I am a employer with 1.5 • • em to ee: full and/or art-time ° '� r - p y �( _P ) 7..0 New construction .r- 2.Q I am asole proprietor or partnership and have no employees working for me in: g Remodeling_r any capacity.[No workers'comp.insurance required], r 9. Demolition 3: I am a homeowner loin all work m self:g y [No workers'comp•.,msurance'requrred.]? - • 4.❑ 10 0 Building oddition I am a homeowner and will be hiring contractors to conduct all work on my properly:Lwilt •. ...... . ensure.that all contractors either.have workers'compensation:itisurance:or are sole 11.0 Electrical repairs or additions proprietors with no employees. , 12.❑Plumbing repairs or additions 5.❑'I am a general contractor and I have hired the sub-contractors listed on the attached sheet. I . These.sub-contractors have employeesand'haveworkers'comp..msurance.t 13 []Roof repairs ` 14.�Other Insulation 6.❑We area corporation.and its officers have exercised their right of exemption per MGL'c. , 152,§1(4),and we have no 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 altwork and then hire outside contractors must submit anew affidavit indicating such. . -Contractors that check this box.must attached an additional sheet showing the name of the sub-contractors and state whether or notthose:entities have. , employees. If the sub-contractors have employees,they must provide their workers'comp.policynumber: i I am an employer that.is providing-workers'compensation insurance for my employees. Below is the policy and job site information. Inslrance Company Name: Star Insurance Co. .' Policy#or Self-iris.Lic.#i WC085540700 Expiration_Date: .4/9/2017. Job Site Address: 64 Patriot Way City/State/Zip'Centerville Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). . . Failure to secure coverage as required under MOL c. 152.§25A is a criminal violation punishable by a,fine up to$1,500.00 _ s 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_A copy of this statement may be forwarded to the Office of Investigations of'the DIA for insurance z'. coverage verification. - T do hereby certify under th :pains and.penaides ofperjury.that the information provided above is true and correct , - ,. . Si attire: Date: 231 Phone#:508-398 0398 Official use only. Doww write:in this area,'t6 be completed by city or town official City or Town; `' ` 4 Permit/License# 1 Issuing Authority(circle one): f 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector ' 6.Other I Contact Person: Phone:#• . PATE ImMmomvY) , .A RDA CERTIFICATE OF LIABILITY INSURANCE 4/12/2016 THIS CERTIFICATE 1S 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 )NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(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.conferrights to the certificate holder In.lieu of such endorsements.. PRODUCER NAME Risk Strategies .Company Risk Strategies Company _PHONEN AICo E C No: (781)986-4400 FAX (181)963-4420 15 Pacella Park Drive Ar==S:randolphcldgrisk-strategies.com Suite 240 - INSURER(S)AFFORDING COVERAGE .. NAIC# Randolph MA 02368 -INSURER A:Selective Ins., OF America INSURED INSURER AllMerica Financial Alliance Ins Cc 10212 CaPe Save, Inc IreuRERc:Star Insurance Co 7 D Huntington Ave INSURERD: INSURER E: South Yarmouth MA 02664 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1641211375 . 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 MICH 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.. MMI ICY EFF MPMMI ICY EXP LTR LIMITS:.. .. X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED A CLAIMS-MADE F-x1 OCCUR PREMISES Ea ooaurence $ 100,000 X 91994480 10/16/2615 10/16/2016 MEDEXP wy oneperson) $ 10,000 PERSONAL.&ADV INJURY $ 1,000,000. GEN'L AGGREGATE LIMIT APPLIES PER:. GENERAL AGGREGATE $ 2,000,000 POLICY�.JECT El LOC PRODUCTS-COMP/OP:AGG $ _ 2,000,000.. OTHER:. $ AUTOMOBILE LIABILITY Ea accident SINGLE LJ $ 1,000,:000 B ANY AUTO BODILY INJURY(Per person) $ AUTOSN� �' SCHAUTOSEDULEDAla8A46196600 11/6/2015 11/6/2016 BODILY INJURY(Per iceldent) $ NON-OVMIED PROPERTY.DAMAGE $ X HIREDAUTOS X AUTOS Peraccident X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A7 EXCESSLIAB. CLAIMS-MADE AGGREGATE $ 1,000,000 DED X RETENTION:$ _ HIL 01994480 - 10/16/2015 10/1612016 $ - WORKERSCOMPENSATION Officers Included for , X ANDEMPLOYERS'LIABO_ITY STATUTE ER H _ ANY PROFRIL I VW/ A]NERIC-� I IVE YIN NIA Coverage E.L.EACH ACCIDENT $ 500,000 OFFICER(MEMBER EXCLUDED? C (Mandatory In NH) WCOS5540700 4/9/2016 4/9/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 It yyees,desaibe under R DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500 0:00 DESCRIPTION OF OPERATIONS I:LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included as Additional Insureds with respects to the General Liability coverage of named insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF 711E ABOVE DESCRIBED'POLICIES BE CANCELLED BEFORE. Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Coact ACCORDANCE WITH THE.POLICY PROVISIONS. Barnstable County 460 West Main Street AUTHORIZED REPRESENTATIVE Hyannis, Ma 02601 _ Michael Christian/CLC (�1999-2014 ACORD CORPORATION. All rights roaaryod. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD )NS025(201401) I Town of Barnstable ° Regulatory Services 3 w ivc wd V.ScIX-O Ted" • EtA83 BOdiiag Divisioit Tom Perry,Bwkwg Commissioner :.. 200Nbk Sues%Hyannis;MA02601 w"towo barwtnble *us Offices 508-862-4038 Fax:. 508 790-6230 Property Qwner Must Complete and Sip This Secdon x€U,.in A.Dui der Je551ca �1nlrhah ,as 0=0. if.the.sub*t pro" hembyoiize �� j�Yc� wct:on:t�pbeba3 , ins rttattw mhdn to.work aphorized by this budding pe rok application for: Uc cok (.CVkc.r V,1 UV IL (�s of join r�-= "'Pool fences and ajaims are thie r+esponksiy of the applicau Pools .am not to be Med or=T=d before fence Is_:k .I-dW and A final., inspections are perfom3ed and accepted. of Owner S*natme.of Applica,as F=t Name Print Naafi 3 to /6 QT-ORb%V NPQOIS . Ns Offiq. It ce of C=iialrg and,Business Regulation 10 Park Plaa Suite 5170 Boston; Massachusetts 02116 a �, , Home Improvement;Contractor Registratlor .o Registration 1;71380: Type ..Corporation . � � �""=! F�cpiratron 23/14/2018 TO A1.929 CAPE SAVE INC. WILLIAM McCLUSKEY =tea ms ice; 7-D HUNTINGTON.AVENUE` � L. SOUTW=YARMOUTH, MA 02664. � ..��, �'1` 1 f,Update Address and return card Mark reason for change: �'¢� Address >Renewal Employment Lost Gard. SCA 1 d'e AM-05111 �r J/red��a��zancueu�l/oP/1la�ruc�iCseft q`\ Office of.`Consamer Affairs&Business Regularton License or registration valid for tndivtdul use only bef _ HOME;IMPROVEMENT CONTRACTOR ore the expiration date.'If f "liet d u rn to Registration 'i71380' Type: Office of Consumer Affairs;and Business..Regulation 10 Park-Eliza. Suite 5170`' Expiration 3/14/2018, Corporation Boston,MA:., .' CA VE INC. ' k WILLIAM McCLUSk' Y { k 7-D HUNTIN TON:AVENUE G SOUTH YARMOUT.H,MW66i 4 Undersecretary Not valid, .i ignature . Massachusetts -D:epartment of Public.Safety Board of Building Reguiations:ana.Standards cI- lLi11 r. rIt.U1auCl Visor-'rJ.IICl.1�.r'. , .License: CSSL 102776 WHAJAM J MC G' U 37 NAUSET ROAJD 11 , West1armout6113A >' `%�...�1/ec•�rri?` Expiration Commissioner 06t28/2017 i l Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 7/29/16 ; Thomas Perry CBO v, Town of Barnstable Building Division 200 Main St. Hyannis,MA 02601 . RE: Insulation Permit 16-1822 Dear Mr. Perry This affidavit is to certify that all work completed for 64 Patriot Way,Centerville has been inspected by a third party Certified Building Performance Institute (BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey 1 y - 1 .. COO 4h. 64 Sep, T14: l .41 #1 SAO5; e _ o is, f�• atc�la�q a • t BAXTER 24043 su ` _Ylr�li+iv MAif 1 C `t'►�- ! TF4A't- T1-+` Dt1NU. 5c-ac ahl �-� ,;Z�� cvn.��t�4�•j�, W#'r"ti Tt-1�. tT7�,�t..�ti.:�_ , '.�; r��•'ks��kw t—cr,4Y{,.)!I"�'M`=ti.�T rj Gt~ "1"Id�, . PL, Be (Q PA 4—c U''TE.CV. L L. AA4�'i, TO T ,, -,s:i.tt�.;c_ ... ' `� ��pPL.1 .►`1"r t.._ �Z. A.rZT14 O e.. Assesor swap:and lot °number ,1.7�.::... .. ...... •.. .. � � �7—: K"M SYSTJ.Em M4—S`T V.f Sewage,,Permit number .. ../••• �/ : ...... �h15Tq�LLEDJA fQM1 �lAi'� WITH ARTJQ, .4 $ ATE TOWN O F BA,RNSTAEjVft!v,_,'P RY BODE AiVDT 63 9 �•� BUILDING INSPECTOR u . APPLICATION"FOR PERMIT TO ....,..y .t�i,L�r'.............:...................................................................................... TYPE OF CONSTRUCTION ...... . ?:rP l.... ./xv.!; . ...... ............. ......................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: II, Location ..... ...... e .................... ..., ................................................ Proposed Use ...X4A .<..l-.. ., Fier '�/I ......jF/.cY..e" .(i..4 ................................................................................... Zoning District / ............ . ..... ..�............_...........................Fire District ..�L..�'�,rl/•cmfr�i�.e:....... . .5'�?�!1.1.�€s�........ Name of Owner .1 . .ttLt...lr`,�i<��s:!r��..!!Jc�;-..Address .....��!/4'r',[1.�:��-.............................................. Nameof Builder ...............X*.2.,f.—...............................Address ...............t7.................................................................. Nameof Architect .............. e ...............................Address ....:............................................................................... Number of Rooms ......... .........................................Foundation. ........ :.a.................. Exterior ........ .............................Roofing .. � ..�'S.4-'O-.fl................................ Floorsa.e- ...c?.y.........................................................Interior ........✓..``-�....., ... .e Heating ....... f Plumbing ......... �....................................................... Fireplace ....:....... :......................................Approximate Cost ........ + .. /................................... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area l%! ...,J.�...:..... Diagram of Lot and Building with Dimensions Fee .......apitQ.._ .....1. SUBJECT TO APPROVAL OF BOARD OF HEALTH yf 9 I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �� 1_ %f! �.• � t%✓ e .c ,�� itJ y .� .Name / �dl................ R. Ar liama° Inc. lowri � 18770 one story, °~�o -----.. Permit for .................................... , . - � ` ino� - - �� v (��m°^° Location --.- -----..--�.. / Centerville ` ---,-�---.-----------------.. _ ' Owner . &rthmr Williama° Ino. ---R.-----------_------- ' frame Type of Construction .......................................... _ ' . . " . ` --------------------------.. . ~ ' Plot ---------. Lot .��3� ( -~-------'' ` - . ' Permit Granted ......... ' . ' Data of | ,--._' -' ._ . . ~ -. � ~D6te Completed .......................................lg � .. . . . . . ~ PERMIT REFUSED , . ' --.-._..�---...-.------- lQ / . ( ' . ~ .--------.-.----------.-----.. . . ............................................ . ^ -.-.------�----.----....-...--- . ' ( ---./��.� 't. - - r —~^^^--^----'^----^' � . x ~ � _ MApproved' _ ' ^ _, .`=--------.^..�-.. 19 ` - � . -- .. �---------.------..---. . , ---.�.�'.�. --.-------~-.---~.` , ' - = ��