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HomeMy WebLinkAbout0021 PHEASANT WAY WEST ems ,-F- �sl• is � II TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division `�i1 '? t 12 Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic -'OKH _ Preservation/Hyannis Project Street Address �Pheg%;g j4 IJ&q eC4)Le_r-u Village (?cuL'tcy u r` G1P. Owner LZ 0A0 n 0 Ua 11 Address Uec il, Telephone 50 O Permit Request _ w � (.�2 6 �-p} � cj,,,6 .tom a('s,r�(��/s ��na�l r�� j R-)I gal a va(E+ '16ft"...11�opt� -11�- af(vl. 6 cgc a4+L, I celk(ou 6 Sl.S' (�roa.rf-. ,ks✓lt.I�L+� rOy�Gyv''✓(s (.s✓tB�� bv(lc(..l-sct davr fez er f�+,�'L (�07'" Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuan 3 L -34 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: ❑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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Alaltol 4Telephone Number �0 F- 6 -2 —61 o Address L® C tie Ue S -• License# Lo��LO f 0 ©a 7 a-D Home Improvement Contractor# � Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Q oecl A0 R0 44",ae,r Y- &• r4 Il gt(i1 ew Me tg 6 SIGNATURE <'" 1 �� DATE 1W/7 FOR OFFICIAL USE ONLY _APPLICATION # ,y GATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE r 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. The Cotmnonlvealth ofMassachitsetts Department of Industrial Accidents 1 Coitgress'S'treet, Suite 100 Boston, MA 02114-2017 M s v fvx,minass.govIdia Wovke.rs' Compensation Insurance Affidavit::Builders/Contractors/Eleett-icians/Plumbers. 170 B 1'I"LED y111a'hl"I'h1.G PGI21b1[1'"I'I\`G AUTHORITY. Aimlicant Information Please Print Legibly. Name(BLISiness/Organization/lnclividua,l); Insulate2Saye.Inc. Address: 410 Grove Street City/State/Zip: Fall River MA 02720 Phone#: 508-567-6706 Are you an employer?Check the appropriate box: ' Type of project(required): 1.QX I am a employer wiih 20 employees(full and/or part-time).* 7. New construction 2.F-1 lain a sole proprietor or partnership and have no employees working for me in 3. ❑.Remodeling any capacity.(No workers'comp.insurance required.] a.[D a am a homeowner doing al l work myself,[No workers'comp.insurance required.]t 9. ❑.Demolition 10 Q Building addition a.❑t am a homeowner and will be hiring coiattactors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical.repairs or additions proprietors with no employees. 12.Q.Plumbing repairs or additions 5. t am a general contractor and I have hired the sub-contractors listed on the attached sheet:- ❑ 13.a Roof.repairs These sub-contractors have employees and.have workers'comp.insurance) 6.Q we are a corporation and its officers have exercised their right of exemption per MGL C. 14.MOther Insulation 152,§1(4),and we have no employees.[No workers'comp.insurance required] *Any applicant that chuck,,box_•I mast also fill oui,the section below showingaheir workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing till work and then hire outside contractors must submit a new affidavit indicatings,uch. Contractors that check this box must attached an additional sheet showing tine 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 nutiabcr. I ant an employer that is provliling workers compensation insurance'for my employees. Below is the policy antdjob site inforntation. Insurance Company Name: Liberty Mutual Insurance — Policy#or Self-i.ns:Lic. it: XWS 5641.8741 _ Expiration Date: 12/10/2017 t Job Site Address��lPCiI�/?9� Q/Q— - City/State/Zip 1ce� �// / Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure tosecure coverage as required under M.GL c. 152,§25A is a criminal violation punishable by 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 fins;of up to$250.00 a day against the violator. A.copy of this statement may be forwarded_to the Office of I:n.vestigations of the DIA for insurance coverage verification. I do herebii certify utt.rler the ra' s InjFeu ties of petjuiy that the btfibrntation provided above is true and correct. Signature: Date: 1111041 Phone#: 508-567-6706 Official use only. _Do not write in this area, to be coutpleted by city or town official, City or Town: Permit/License# 'Issuing Authority(circle one): l..Board of Health 2. Building Department 3.:City/Town Clerk a. Glcctrical;Cnspector. 4.Plumbing;[n-spee�or. 6.Other Comaet Person: Phone#: Office of Consumer Affairs and Business_Regulation 10 Park Plaza - Suite 5170 Boston; Massachusetts 02116 Home improvement Caratractor Registration Type: Corporation " ~ i - Registration: 180747 INSULATE 2 SAVE , INC. Expiration: 12/28/2018 410 Grove St Fallriver,. MA 02720 Update Address and return card: Mark reason for:change. 3CA 1 0 20M-05/11 O.Addre_s-s_Q_Renewal O Employment O Lost Gard Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual useonly TYPE:Corporation before the expiration date. It found return to: Aegt trs anon iration Office of Consumer Affairs and Business Regulation 1.80747 12/28/2018 10 Park Plaza-Suite 5170 it Boston,MA 02116 INSULATE 2 SA N, „ Roland Langevin ANN �- 410 Grove St Faliriver,MA 02720� ' Undersecretary Not valid without signature w Commonwealth"of Massachusetts Division of Professional Licensure Board of Buiiding.Regulatiotls and standards Constr» CtnSi1rvsat CS-103861 Ej ir es: 08/24/2019 ROLAND LANGEVIN 56 HIGHCREST—,ROtiD FALL RIVER MA02720 r Commissioner w r J A CERTIFICATE OF LIABILITY INSURANCE DATE(MM11D2YYYY)16 r r• 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 CONTACT NAME: Anthony F. Cordeiro Insurance PHONE FAX 171 Pleasant Street "C. ' (508) 677-0407 AI No: (508) 677-0409 E-MAADDRESS: hsouza@cordeiroinsurance.com Fall River, MA 02721 INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Liberty Mutual Insurance INSURED INSURER B: Insulate 2 Save, Inc. INSURERC: 410 Grove St. INSURERD: Fall River, MA 02720 INSURERE: 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPEOFINSURANCE INSR WVD POUCY NUMBER MM/DDIY MMIDD/YYYY LIMITS A GENERAL LIABILITY Y Y BKS 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES E occu a ce $ 300,000 CLAIMS-MADE �OCCUR ME EXP(Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2 000 000 X I POLICY JEC LOC $ de A AUTOMOBILE LIABILITY Y Y BAA 56418741 12/10/16 12/10/17 EOMBWEDISINGLELIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS $ A X UMBRELLALIAB X OCCUR Y Y USO 56418741 12/10/16 12/10/17 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000 DED RETENTION$ $ A WORKERS COMPENSATION XWS 56418741 12/10/16 12/10/17 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFF ICERMIEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) "For Insurance Purposes Only" CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. i AUTHORIZED REPRESENTATIVE I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: Page 1 of 1 CONTRACTOR WORK ORDER ENG1€dEERli�t Mass Save®Home Energy,Services. 5 Dupont Avenue South Yarmouth,MA 02664 Customer Name:Joanne Donovan Email:jdunnol2@gmail.com Phone:508-808-5506 Premise Address:21 Pheasant Way West,Centerville,MA 02632 Project ID:3316679 9 � AIR SEALING: $80 00 $96000 WEATHERSTRIP DOOR&ADD SWEEP 2 each $80.00 $160:00 WALCS::V1100D SIDED 4"CELLULOSE 1428 SF $1.95 $2,784.60 KNEEWALL:2"RIGID BOARD 312 SF $3.85 $1;20.1:.20. KW'SLOPE-FG R19,6 2"RIGID 216 SF $5.45 $1,177.20 ATTIC FLAT- 12"OPEN R 42..CELLULOSE 600 SF $1.68 $1,008.00 KNEEWALL FLOOR-8'DENSER-25 CELLULOSE 352 SF $2.00 $704:00. FINISHED KNEEWALL:ACCESS 2 each $135.00 270.00 $. _ .4 x 16'.SOFFIT VENTS 8 each $28.91 $231.28 SLOPE-6".DENSE R-19 CELLULOSE 110 SF $2.07 $227.70 REMOVE EXISTING INSULATION.INCENTIVIZED 216 SF $0.97 $20952. VENTILATION CHUTES .60 each $3.49 $209i40 INSULATE BULKHEAD DOOR 1 each $110.00 $110.00 TEMPORARY ATTICACCESS TH:RU ROOF 1 each $92.42 $92.42 Installed:Measures Total $9 9&82 tlti Ity lncentive. . Weatherization incentive $6,168.99 Air sealing incentive $1,120.00 Total Utility Incentive $7,288.99 Customer.Share Total CustomerShare. $2,056.33 Less Deposit,.Of $0 00 .11 Customer.Soitre Balance $2';056:33 DocuSign Envelop e�ID:7FB5C774-CF2A-4AB7 9EDC 598A3FE5D29B C� s cit f ! & �.. 'W ' . _ JAY,'- - e 4,_33166.79. Cun h Joanne Donovanh 21 Pheasant Way,West nterville MA 02632 amt tfie ,Save Horne Eefy 5s Prorm yatri r xisted 1 eiaw# a yin m�ttraff al t�f c� 8n a biuile#► rmrto rrm rnlaon a rrefieriea; y t Doe Signed by: 7.11/15/2017 6 14 PM EST . ......:.: :XYC'i a731� h Ki.V I Ili have F, Opatm akr�e iccefsetrd$ rc 7 Name: RISE Engineering Phone'.40177M-3700 Email: