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Home My WebLink About0180 LEWIS POND ROAD IUD Le�;� s ALTERNATIVE WEATHERIZATIQN . TOWN OF BARNSTABLE ��, � ✓ � r'�� 2018 FEB -6 AM 6: 47 o f ,3 DIVISION Date C�UYI( d Town of Barnstable 200,Main St. Hyannis, MA 02601 '6-d Re: Permit#The insulation work at has been completed in accordance witii.780C1 i�! ,.„` Agency work perforated forJew dw— Timothy Cabral; :`-' President CSL-105454 TIVEWEATHERIZATION®GMAIL.COM 58 DICKINSON sTREET ( FALL RIVER,MA 02721 i (508) 567-4240 1 ALTERNA R l— i --I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION BUILDING DEPT �?Jo UY Map__0 _ Parcel * o � � Application # Health Division JAN 10 2018 Date Issued Conservation Division TOWN OF BARNSTABLFApplication Fee xx Planning Dept. Permit Fee V Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address %�y ewl S Village �,fff p Owner �aviU e, Address / �6#�r i Telephone DO d a �O - Permit Request oi 6 Ws Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 21/Y 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 Telephone Number A-M-J,,lo7-�i �U Address �Ce. �c.(� ,��'�/ License # �A e,_2 i Home Improvement Contractor V Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO S-- cCL SIGNATUR DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE 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. Town of Barnstable Regulatory Services BAINSTAULE, Richard V. Scali,Director MASS. Q; °0 1639. ,,�� Building Division A� DMP, A Paul Roma Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section I, DAVID F DOYLE , as Owner of the subject property hereby authorize , � to act on my behalf, in all matters relative to work authorized by this building permit application for: 180 Lewis Pond Road Cotuit, MA 02635 (Address of Job) Signature d1fowner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. F C:\Users\decollik\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 t i The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):ALTERNATIVE WEATHERIZATION, INC. Address:2 LARK STREET City/State/Zip:FALL RIVER, MA 02721 Phone#:508-567-4240 y Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a�mployer with 16 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees'working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.a I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition ❑4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑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. ❑ 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.�✓ Other INSULATION 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 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'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:STAR INSURANCE COMPANY Policy#or Self-ins.Lic.#:0849257 00 Expiration Date:4/4/18 Job Site Address: ! 0y Z&,Uis Alad 4 • 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 MGL 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 fine of up to$250.00 a day against the violator.A copy of this statement may.be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify unde th ins an a 'es p rjury that the information provided above is true and correct Si mature: Date:N. ! 6 Phone#:508-567-42 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: k y � jffli ` -- ` v Yw «-� wY� ter, S °z Rom£ fe ej r } a ;4e Office of Consumer Affairs and Business Regulation r 10 Park Plaza Suite 5170 Boston, usetts 02115 Horne Improverna tractor Registration Type: Corporation } " Registration: 175M ALTERNATIVE 1NEATHERIZATION,ING Fratien: 0512812019 2 LARK ST ' FALL RIVER,MA 02721 ? ' r r Update Address and return turd. Mark reason for change. SCAI 4'a �., ..,/>f':� .Jt IYGC:.rI Jf�%fLlrfit.!i�.;•?�fl,J,::.LlfiJ,lL'f,'��' Office of Cammer Affairs&Sadness Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Cowation before the expiration date. If found return to: f } atlon >att Office of Consumer Affairs and Business Regulation x'a +?• 7i_. 05l28J2019 10 Park Plaza-$Oita 6174 k ALTERNATIVE W A•E#iERl AT1,ON,INC. n,MA 02116 TIMOTHY CASRAL, 2 LARK ST (_) FALL RIVER,MA 02721 Undemecretaly Vd4AO .. � ALTEWEA-01 SNERONHA DATE(MWOONM) CERTIFICATE OF LIABILITY INSURANCE 05126l2017 THIS CERTIFICATE IS ISSUED AS A. (BATTER OF INFORMATION :ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY DR 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. i IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 1S WAIVED, subject to the terns 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 endorsemen s. I PRODUCER CT Christine Costa Mason&Mason Insurance Agency,Inc. €t�CCTI ,E,t):(781)523-M7 Laic No): 468 South Ave. A Whitman,MA 02382 ccosta@,masoninsure.com i INSURE S AFFORDING COVERAGE NAIC# INSURER A:Evanston Insurance Co. `35378 INSURED INSURER 13:Safe Insurance Company `38454 Alternative Weatherization,Inc. i INSURER Insurance Company 18023 2 Lark Street INSURER D Fall River,MA 02721 INSURER e €INSURERF: OVERAGES CERTIFICATE NUMBER: __ REVISION NUMBER: j I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE-FOR THE POLICY PERIOD I j INDICATED. NOTWITHSTANDING ANY REQUIREMENT; TERRA 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. I1,NT i ADOL SUBR3 POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER I 1,0{IO,fl00 A 1 X 1 COMMERCIAL GENERAL LIABILITY 1 i EACH OCCURRENCE S 115 .° TO iCLAIMS-MADEHALE XOCCUR I 3C42088 0610712017 0610712018� w S 100,tI00 € 5,000 j # i I :MED EXP An one oersor �5 i PERSONAL&ADV INJURY 5 1,000,0( IO kg 'L AGGREGATE LIMIT APPLIES PER: j € GENERAL RA AL GAL GGREGATE S 2,000,000 4E 2,000,000 I POLICY y%J ?LOC i i PRODUCTS COMPIOP AGG €S i i i5 OTHER' CC)4161NED.sINGLE LIMIT 1,000,000 g AUTOMOBILE LIABILITY i i' `S i1.J�,fACG�tri 1 ANY aura 6237702 04l0$12017 0410812018 BODILY INJURY JPar erssn� s_ OWNED - I SCHEDU'EC i AU?OS OtiLY AUTOS j 3 80D?L' Y INJURY Per acrdank) S I p l tO�TY DAMAGE I I 'X +AU t7S ONLY AUTO ONLY I aractident S I I ' 1,000,000 A UMBRELLA LIAS i X OCCUR i €EACH OCCURRENCE 15 ] 16107208 AGREGATCLAIMS-MDE XOBW6619616 0610712010 f 1,Ofl0,OflXEXCESS tIAB' DED I RETENTIONS I I -S i ? Ia _ . ? X 1 T H SA AND EMPLOYERS*NI C WORKERS COMPENSATION YIN fl84�27 flfl 042017 i0410412018 RT. i - $00,000 E .EACH ACCIDENT S ANY PROPRIETORrPARTNER/EXECUTIV= " NAi FC =VBR EXCLUDED? 600,000 I N DISEASE-EAEMPLOYEE S it yyes,describe under j 500,000 OESCRIPTiON OF OPERATIONS below i E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(ACORD 101,AddiYiomil Remarks Schedule,may be attached If more space Is required) 3Action Inc.and National Grid USA,its direct and Indirect parents,subsidiaries and affiliates shall be named as additional insureds on-Commercial General :'.Liability policy per terms and conditions of forms CG2010 and CO2037 and Commercial Auto Liability policy per terms and conditions of form SCA 006(02. 16).Forms Available Upon Request. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CA14CELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN € National Grid I ACCORDANCE WITH THE POLICY PROVISIONS. 40 Sylvan Road ! Waltham,MA 02451 - 1 AUTHORI2E0 REPRESENTATIVE I ACORD 25(2016103) O 108-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD