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"� A t`APE COD INSULATION '#' ,as ; F-b N® , PIBGA DIASS SGAMILS3 SPBATPOAM SDSPENDED BARS DNTTEBS INSYIATION Z"NDS 1-800-696.-6611 D Town of Barnstable r o ' 'q�13 Regulatory Services pcl Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building 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 (BP-I) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village C Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( } ( ) ( ) ( ) ( ) Slopes Floors Walls m. irfowLln9 T Sincerely I hECasJr, Presidenton, Inc. .. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #C;L V Z5 0 37 Health Division Date Issued ti a r i 3 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation/ Hyannis Project Street Address Village bo ;!4o�A!�, Owner -Address Address Telephone - Z Z A' cat � > Permit Request 44e, 14�1GiiIJI—_ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay o Project Valuation &B4. D Z9Construction Type / Wsoj Lot Size Grandfathered: ❑Yes ❑ No If yes, attach�su)porting.documentation. Dwelling Type: Single Family 6` Two Family ❑ Multi-Family (# units) 7XI Age of Existing Structure Historic House: ❑Yes Flo On Old King's Lighway4,9Q 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 Typ(Nnd 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 /'gam � i����� 5112� Telephone Number �-- Address / � /�1�d/�vo e-emo, License # G 9 " Home Improvement Contractor# Worker's Compensation 4�a. D��✓`90� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ;e FOR OFFICIAL USE ONLY ' ARPLICATION# DATE ISSUED " . MAP PARCEL NO. L s ADDRESS VILLAGE OWNER i1 DATE OF INSPECTION: - 4 'r ,Y�FO,UNDATI.ONE_• �•-:���;•--,�. w�,�.- t, FRAME INSULATION..,-. xF�N,,•.,_., P r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING' =.a` DATE CLOSED OUT ASSOCIATION PLAN NO. r OWNER AUTHORIZATION FORMy (Owner's Name) owner of the property located at (Property Address) Ce— �-t e Fy I f� 4 � (Property A dress) hereby authorize CGj (Subcontr tor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Own 's Signature Date ( - E C. E D OCT T,0 2613 1 �flr.,sar'lultirtts l)t'11:u'tnnul ul Pulllli �;Ilct( ' k:sl� it t fiu;rrtl ul la4tilllin, I.r,ul.tuun� :Ind ,Ulnrl:u'tk ' Qonstru-ptiort Supervisor License n ik' . � Lli l.11�4;r, C.•�.w 1.uC)J�1� ! .. - - , N. �I �s��'' hIC.IVRY CASSIDY , d SHED ROW WEST JARMOUTH, MA 02673 Expiration: 11/11/2013 ( nnuul�hl,rl�li - TrF,: 7620 1.1 �' l(�CLkl. /L-C�"llll'E't l LC�l., CZ`. '6 L.C1 JJW ff.- 1 1(.' J 4 j U t-t-ace. cil'C.onsurner Affairs and Business Regulatioll 10 Park Ptaza - Suite 5170 Boston) Massachusetts U211 b 1--1.ome lrnprovern1 nt Contractor Registration Registration: 153567 Typo: Private Gorporatiort Expiration: 12/15/: '14 TO nool. CiVI -7 COD INSULATION, INC _ ..... ....... HENRY CASSIDY 18 RFA1,-\,DON CIRCLE S1). YARMOUTH, MA 02664 _ Update Address and return Card. Mark reason for chinige:' C� Address Renewal I:ulfrloyntcut I Last turd L-.I l.a - ,Ifh, rid t on,umer nlliti,s O: 1.lu.,uless.Regulation License or registration valid.for iudiv.i}lul rise only L 1,10Mh IMPROVEMENT CONTRACTOR hefurkc the expiration slate. If found rcturn to: �eyistratlow 153567 Type: Oflitc of Consumer Affairs and Business Regulation .iLx[manow 12/15/20141 Private Corpofalion 10 Park Ph2a-Suite 5170 ' Boston,MA 02116 i`' i''O'NRAJ111_MA 0-)664 O[Y:d tY1tIt0 t Ilal re " 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: Builders/Contractors/Electricians/Plrumbers A licant Information / Please Print Le ibl Name (Business/Organization/Individual): Address: City/State/zi : Phone 6F z / Are you an employer/?employef/i Check the appropriate box: [2.E] am a employer with. 4. ❑ I am a general contractor and I Typeof project(required): employees(full ancYgr'part-time).* have hired the sub-contractors 6• ❑ New constriction 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 mein any capacity. employees and have workers' [No workers' comp. insurance comp. insurances 9. ❑ Building addition . I required:] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their ' 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.] t C. 152, §1(4),and we have no 12•❑ Roof repairs 3a.❑ amI a a homeowner acting as a employees. [No workers` 13• Other general contractor(refer to#4) comp.'insurance required.] tAnY aPPLicane that checks box#1 muse also fill out the section below showing their workers'compensatiodi olicy information. Homeowners who submit this affidavit 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 sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'co mp,policy number. lam an employer that is providing workers'compensation insurance for my employee& Below is the policy and job site information, Insurance Company Name; Policy#or Self-ins. Lic.#: �-2 Expiration Dater lr��a f j3G Job Site Address: S' � --� i �J 1/ �;o �2 lorL' City/State/Zip: 6'z J' Z Attack 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 e. 152 can lead to the imposition'of criminal penalties of a fine up to S1,500.00 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. 1 do here certi nder the by fy nd penalties of perjury that the information provided above is true and correct Da d phone# 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): L Board of Health 2, Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: CAPECOD-27 _ MYOUNG _ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) ATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS U 7/8/2013 c DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES fHIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED -SENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. JRTANT:-If tho certificate holder is an ADDITIONAL INSURED,the policy(tes)must be endorsed. If SUBROGATION IS WAI .,Ie terms and conditions of the policy,certain policies may require an endorsement. Asia tement on this certificate does not confer rights VEp,subject t t to o certiticate holder in Ileu of such endorsernent(s). PRODUCER License#PC-514062 - - .CONTACT Rogers&Gray Insurance Agency,Inc. NAME: Margaret Young 434 Rte.134 PHONE -Fnx - South Demlis,MA 02660 Alc o AIC No EMAIL _ -.-�.__I_ I ADDRESS:m�/OUng,rogersgray.COrn II INSURER(SI AFFORDING COVERAGE --i ' —NAICq INSU8EU �-- -- --- ------ - - INSURERA-PEERLESS INSURANCE COMPANY T SURERS:COMMERCE INSURANCE COMPANY. Cape Cod Insulation,lnc. SURERc.:Evanston Insurance Com3any18 Reardon Circle South Yarmouth MA,02664 SURERD:ATLANTIC CHARTER INSURANCE GROUPURER E:COVI=RAGtS —_ URERF: 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 CONTRACTOR OTHER DOCUMENT WITH I RESPECT 10 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. . IN SR`-.-----.-..�_-_...- AUtiL 7CSP8263( LTRTYPE OF INSURANCE INSRPOLICY EFF POLICY EXP GENERAL LIABILITY - MMIDDIYYYY MMIDD/YYYY LIMITS �EACHOCCURRENCE $ 1,000,000 A X t 0MMERCAI.GENERAL LIABILITY' 63 4/112013 4/'I/2014 pD G1REMI E1SO o1Cn,Emence) $ 100,000 .CLAIMS-MADE (_X J OCCUR --- MED EXP(Any one person) $ 5,000 — PERSONAL&ADV INJURY $ 1,000,000 L�--�. GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: _.._.—._ 1PULICYLRO- (� PRODUC'f5•COMP/OPAGG $ 2,000,000 ECT I LOC _ $ -- AUTOMOBILE LIABILITY - C MBINED SIN L LIMT B Ea accident 1,000,000 _ ANY AUTO 13MMBCKVMK 4/1/2013 4/1/2014 BODILY INJURY(Per poison) $ - ALL OWNED SCHEDULED _ AUTOS -- AUTOS BODILY (Per accident) $ —— X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE _'$ AUTOS ER ACCIDENT x UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 C Excess uAe - CLAIMSJ�IN XONJ453512 4/112013 4/112014 -' AGGREGATE $ 1,000,000 _ DED X. RE ENTIQN .--- 1 —WORKERS COMPENSATION EMPLOYERS'LIABILITY STATU- OTHD ANY PROPRIETORIPARTNERIEXECUTIV WCA00525904 TORY I S 13q0TO OFFICERIMEMBEREXCLUDED? NlA 6130/2013 6l3012014 E.L.EACH ACCIDENT $� (Mandatary In NH)Ifes•doscrihe under E.L DISEASE-EA CMPLOYEE $DESCRIPTION OF OPERATIONS belowE.L,DISEASE-POLICY LIMIT $ i I - • DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Workers Compensation includes Officers or Proprietors. Addtional Insured status is provided under the General Liability when,required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER - CANCELLATION - -- -- -- I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cape Cod Insulation,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE - ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Py ,*THEtO�y TOWN OF BARNSTABLE I BAUSTIBLB, i Mb 9 BUILDING INSPECTOR 9 'FD MAX a APPLICATION`FOR PERMIT TO .. e� .....o!!e.:.7lil?1i.L ....(�.w ��lry. ............... ................................. TYPE OF CONSTRUCTION ...................... '',�.E., ..................19.. TO THE INSPECTOR OF BUILDINGS: / The undersigned hereby applies for a permit according to the following information: Location .....La ....�...,� !S.t& ....../Pe.- ............. /c ,,� >,,r�....................................................... ProposedUse ..........� .................................................................................................................................... Zoning District ..........R.4, ..':T...........................................Fire District ..�i �i l!�f�.:...�.� f:!1.���...... Name of Owner ......i> Q.hn!.GS.I......r�P.12).P 5..... J!!.�........Address5.!1.lP� ►.v.. ............�f�iL���.l�A��2 /p �............. Name of Builder ....kC1.r.1'Y1u3 ...R9.n:?C.S....... .........Address ...................................//........................."...: Nameof Architect ................Ald./.V.e ...................................Address .................................................................................... O Number of Rooms .............j?....1I.??.S.'.....................................Foundation !!6�r ......CG. ........................... Exterior ...............5! ljtt17....................................................Roofing ..... 1 s. ?.l.A.. ...................................................... Floors ?�f11�! ...................................................Interior ......... �y.l.!..'°. ............................................... Heating �JR.l�1.-.1'./. .............................................Plumbing .............. ... ............................................ Fireplace ............/. S.............................................................Approximate Cost .........� ��.. .:..° ............................... Difinitive Plan Approved by PlanningY Board ---------------_--------------19--------. /760 S$) FT Diagram of Lot and Building with Dimensions f /� ff ri 41r U� ii4 {i Ld CA a 0 Y^4 \ I:A I 0 � � � � ) � Fc.oaA3, 6 0' C U) LL; I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 1 ... Name .'6:�...Lox.e�4e,�,a.. . - Nornsaot Bonm»a~ . __-~Zmc- . 1-4987 - one story ' No ................. Permit for ....................................single family d-welling ! --_—.:.--.--..:.-----....------..— � | \ | ' I��nt�m I��`=" ----'— -------''-----'--'-----''' - . � ` - Centerville ..~--_----~-----.—,—.—.-----.. Noz�meat—Home o—° Z�c° Owner —~---'--- --- --------` � frame Typo of Construction .......................................... —''—'—'—'--^'^^----^—^-----^—'--'' U � Plot ��� . ------..—... Lot ---' ............... � � � Permit. Granted. � 72 Date of Inspection lily-r-*-i �x �& Date Completed .. .���~J���V'K~»�� � PERMIT REFUSED .----..---'.---.—..--.—.--- 19 ...'...,..--.,...-....~...~--..---~—.— ~_~...~....—..------.^--------. � -----------'^^^^'—`-'—''^'—^--'--'` ...-----,..........—......—....—~--.. � Approved ................................................. 19 . . � ' ^ -------.—.---.—.—...----.--..--. � . . � l ` ------------------.~.—.,.....— ` ^ �